AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
What is the new COVID variant? How many variants are there? How long does long COVID last? How long do COVID GI symptoms last? Which states have bird flu?
Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
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- Wondering how long are COVID tests are good for or do expired COVID tests work? Check #FDA COVID test expiration date extensions.
- COVID Wastewater data via CDC National Wastewater Surveillance System (NWSS).
- CDC current avian flu map.
- For bird flu news visit Centers for Disease Control and Prevention CDC H5N1 Bird Flu Current Situation Summary (CDC H5N1 technical report).
- If the CDC issues new health warning, get the latest CDC health alert 2024 via the Health Alert Network (HAN CDC website).
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Unger: Hello, and welcome to the AMA Update video and podcast. Today we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine, and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.
Garcia: Thanks, Todd. It's great to be here.
Unger: Well, a little bit of a surprise—but coming out of this past holiday, Fourth of July, weekend, the story seems to be about COVID. And as we talked about a couple of weeks ago, health officials are predicting a "drift upwards" after the Fourth of July. Andrea, are we seeing that?
Garcia: Well, as we've talked a little bit about before, Todd, our COVID surveillance systems certainly are not what they once were. So it's a little difficult to say if this is a bigger surge or that drift upwards. We're certainly seeing an increase in cases. We know that both test positivity and ED visits, which are early indicators, are increasing. And hospitalizations are also up by about 13%.
I think it is worth noting, though, that hospitalizations and deaths are low compared to the peaks that we saw in previous years. We did see CDC issue a bulletin last Wednesday, just prior to the holiday, which noted that there is no distinct COVID-19 season like there is for flu and RSV. That's because the emergence of new variants has been associated with COVID-19 surges. Over the past few weeks, some of those surveillance systems have shown small national increases in COVID. It was also noted in that bulletin that widespread surges, as well as local surges, are possible over the summer months.
Unger: Interesting pattern, or lack thereof. But to the point about geographic patterns, are we seeing certain parts of the country being hit harder than others right now?
Garcia: That recent data shows infections are rising or most likely rising in about 39 states, particularly in the west. We've seen a substantial rise in people being diagnosed in Hawaii and then, to a little bit of a lesser extent, Arizona, New Mexico and Washington. There was an article published over the weekend that reported that Florida is also seeing a surge in ED visits for COVID. And that's nearing what they experienced during the worst of last winter's peak. The most recent stats put Florida among the highest of states experiencing COVID right now. Key metrics from wastewater and nursing homes there have climbed steeply.
Overall, CDC says that nationwide, COVID activity remains low. And nationally, coronavirus activity in wastewater remains low but it is increasing. Experts do say that wastewater is best interpreted as a way of understanding which way the virus is trending. In this case, all indicators are pointing to up at this point.
Unger: Andrea, do we have any idea about what is driving the increase, say, in Florida and the other states that you mentioned?
Garcia: Well, in previous years, we've seen COVID activity pick up at least twice a year since the pandemic began, once during the summer or early fall after a lull during the spring and then again during the winter, driven by new variants of the virus. CDC data does show that COVID diagnoses have been ticking upwards since early May, when we were at an all-time low. I think that occurrence of extreme heat events may contribute to COVID outbreaks in the summer as people head indoors or head to cooling centers.
We also know that this uptick is tied to a handful of variants we've talked about before, known as KP.2 and KP.3 or the FLiRT variants. Those are now dominant nationwide. And they're driving nearly half of new cases in recent weeks. And behind them, there's a mix of other variants that have accelerated. So LB.1 is the next largest at about 10% of cases. And in the regions spanning New Mexico through Louisiana, CDC estimates that a new variant called KP.4.1 surged to about 17.9% of infections through June 22—so certainly something to watch there.
Unger: Absolutely. And Andrea, from what I understand, there's also an overlooked symptom that's hard to believe after all these years when it comes to COVID. Tell us more about that.
Garcia: Now, that's something that The New York Times reported on late last week. And according to that article, gastrointestinal issues are a common, but often unrecognized, sign of COVID infection. I think many of us don't think of COVID when we have stomach issues. But to be clear—that this is not a new symptom of COVID. In fact, as the article pointed out, it can be traced back to that first patient documented with COVID in the U.S. That patient experienced a cough and fever, but also had two days of nausea and vomiting. People can also experience GI issues in isolation without any of the telltale signs we've come to associate with COVID.
Unger: So Andrea, if this has been around since the very first case in the U.S., why are we just talking about it now?
Garcia: Well, as the article points out, as COVID cases rise, it's important for us to be aware of those lesser known symptoms and how to spot and address them. According to a physician quoted in the article, those GI symptoms can hit during the first few days of an infection as a precursor to other symptoms or on their own. Diarrhea is common. People can also lose their appetite, experience nausea, abdominal pain and vomiting.
And I think it's also important for people to remember that COVID doesn't look the same every time. For example, you may have experienced respiratory symptoms one time and GI symptoms the next. And I think it's also important to remember that Paxlovid, which is the oral antiviral pill for treating COVID, can also cause some symptoms like diarrhea.
Unger: So Andrea, what should we take away from all of this information?
Garcia: Well, if you're experiencing GI symptoms or other symptoms of COVID, it's certainly important to stay hydrated. It's also really important to test so you know whether you're experiencing COVID or something else and that you can take proper precautions.
As we talked about back when we started to see the hints of a summer wave, anyone can get COVID. Most cases will be relatively mild. But older people, people who are immunocompromised, do remain at heightened risk for more severe outcomes from COVID-19. That's why we're seeing CDC recommend everyone six months and older receive that 2024-2025 COVID vaccine once it becomes available later this fall. And that's, of course, to both protect themselves and the people around them.
Unger: All great information. Andrea, one thing we haven't talked about in a while is long COVID. Any updates there?
Garcia: There was a recent article in the Washington Post. And it noted that with most people being spared from experiencing hospitalization and death from COVID at this point, long COVID has become one of the larger threats from the virus to the general public. As we know, long COVID encompasses symptoms that last weeks to years. They may include debilitating fatigue or brain fog, persistent cough and chest pain.
As the article notes, anyone who gets COVID can develop long COVID, even people who are otherwise healthy who have mild cases. But that risk does increase for people who experience severe illness, who've never been vaccinated, or who have underlying conditions or are 65 years of age and older. And I think while long COVID has become less—a less common outcome of infection than earlier in the pandemic, long COVID patients are calling for a more aggressive response to COVID to minimize transmission because of the lasting impacts of long COVID.
Unger: And I know that research is continuing in this area, as well, which is something we're going to continue to track as it progresses. Andrea, let's turn now to another virus that we've been talking about for the past few months. And that's bird flu. Any news there?
Garcia: So we did see a fourth person test positive for A(H5) bird flu, this time in Colorado. That case was reported on July 3. Like the previous three cases, one from Texas and two in Michigan, this person is also a dairy worker who had exposure to sick cows. That patient reported eye symptoms only. They received antiviral treatment and have since recovered.
I think based on that information, the CDC's current human health risk assessment for the general public does remain low. On the animal health side, the USDA is reporting 139 dairy cow herds, up from 132 herds the prior week, who have been infected. Those herds are still in the same 12 states. Of those 12 states, Colorado currently does have the worst outbreak of bird flu among dairy cattle in the country. I think that's somewhat surprising, given that Colorado's dairy production is lower than many of the other states involved in the outbreak. About a quarter of Colorado's herds are now infected, most of which were identified in the last month. Of course, that increase there could also be a reflection of increased monitoring and testing in that state.
Unger: Andrea, have there been any updates on a potential bird flu vaccine?
Garcia: We did hear last week that the U.S. government announced that it would be providing $176 million in funding to Moderna to accelerate development of a pandemic influenza vaccine that could be used to prevent bird flu in people. According to coverage by the Associated Press, Moderna already does have a bird flu vaccine that is in the early stages of testing. That vaccine would use the same mRNA technology that is used to create COVID vaccines.
The development of this vaccine would, of course, help bolster the nation's pandemic flu capacity, which currently relies on the older, more traditional vaccine platforms. The new funds from HHS include continued development of the vaccine as well as a late-stage trial next year if those early study results are positive. HHS stressed that the project could be quickly redirected to target another form of influenza if a different threat were to emerge.
Meanwhile, we know that the fill and finish activity does continue on vaccine from bulk stocks of that traditional vaccine. And those first 4.8 million doses will be available in the middle of July, with production continuing through August, which is faster than the government anticipated. But if, when, and how those doses will be distributed remains to be seen.
Unger: Well, that's something we'll obviously continue to track. And that's it for today's episode. Thanks so much, Andrea, for being here and sharing all this information and updates.
If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama.assn.org/join. You can always find all our videos and podcasts at ama.assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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