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
The updated COVID-19 vaccines and RSV shot for kids are in short supply, and patients are having trouble getting themselves and their children vaccinated. AMA’s Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, breaks down why the shots are so hard to find and how the CDC is advising physicians to make the most of their RSV shot supply. Plus, the latest COVID-19 case numbers and how analyzing wastewater helps track respiratory virus infections. AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, AMA Chief Experience Officer Todd Unger hosts.
- Find the latest CDC Respiratory Virus Updates.
- Searching "COVID vaccine near me"? Use the COVID vaccine finder.
- Read CDC's recommendations to Protect Infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 Respiratory Virus Season.
- Access the CDC COVID Data Tracker to find your local wastewater surveillance map.
- The Centers for Disease Control and Prevention latest COVID forecasting is available via the COVID-19 Forecast Hub.
- Find where to get a flu shot in your area.
- The AMA is your powerful ally in patient care. Join now.
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 in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Welcome, Andrea.
Garcia: Thanks, Todd. It's great to be here.
Unger: So a headline earlier this week called what we're facing a, quote, "seasonal viral stew." Sounds delicious. Andrea, tell us more about what that means exactly.
Garcia: Yeah, well, that was a headline in an NPR article that we saw run over the weekend. And it's, of course, referring to this respiratory virus season, this period of time where we know we see more people getting sick as temperatures drop and we move indoors. As for the contents of this stew, I think there are, of course, the big three viruses that we talk about every week—flu, COVID and RSV.
We know that these are the three viruses that cause the most burden for our health care system and the most severe disease. There was a recent Kaiser Family Foundation survey that showed that last year, about 40% of households had at least one of these viruses. But these aren't the only viruses that we're going to need to contend with over the fall and winter.
There are, of course, rhinoviruses and non-COVID Coronaviruses, which we know can cause the common cold. There's parainfluenza, which can cause croup and pneumonia in children. There's enterovirus D68, which caused a national respiratory virus outbreak in 2014. And then there's that relatively new human metapneumovirus, which was first identified in 2001. That's in the same family as RSV and has similar symptoms.
Unger: Well, I guess we have moved far beyond the tripledemic and into seasonal stew territory. And with so much swirling and a good part of it going unreported, Andrea, how can we get a sense of what's really going on out there?
Garcia: Yeah, well, wastewater surveillance is really what is starting to give researchers more of a complete picture. A lot of these viruses have very similar cold and flulike symptoms. And people may just stay home and not even visit their doctor when they have them. And that's when analyzing that wastewater data, which is collected from community level sewage plants, can provide some clarity, even if people who are just mildly sick. These viruses will show up in wastewater.
I think knowing what's circulating locally can help inform physicians and hospital systems as they plan for surges. Right now, all the CDC expects those hospitalizations during the 2023-24 respiratory viruses and to be similar to last year, which we know was better than the height of the pandemic but was worse than the previous year or so. Hospitals could be overwhelmed if these viruses all peak at once. The CDC, of course, says vaccines as well as those common sense measures like hand washing and staying home when you're sick can help keep those levels down.
Unger: And I guess that wastewater analysis is something, I guess an unexpected outcome of the pandemic when that became so much more common. Andrea, we know that vaccines continue to be the best way to protect ourselves and everybody else. And as for—and for RSV, we also have a monoclonal antibody shot for babies. Last week, we talked about how it hasn't been easy for everybody to get these shots. Has that gotten any better?
Garcia: No, and in fact, on Friday, we saw Sanofi, who's the manufacturer of the drug, say they're seeing unprecedented levels of demand for nirsevimab, which is that monoclonal antibody therapy, which was co-developed with AstraZeneca. In light of those shortages and supply, we saw the CDC issue a health advisory for physicians to help guide them on how to use that limited supply.
FDA approved nirsevimab in July. CDC has recommended it for all infants younger than 8 months, born during or entering their first RSV season and for those infants and children 8 to 19 months who are at increased risk for severe disease. Nirsevimab comes in a 50-milligram and 100-milligram dose. And it's that 100-milligram dose for infants weighing more than 11 pounds where we're seeing those doses in short supply. We're starting to see those RSV cases increase in some areas, particularly the Southeast. So that could be also contributing to that demand.
Unger: So given the situation, what is the CDC advising?
Garcia: Yeah, so they're advising that doses be prioritized for those at highest risk of severe illness. So that's infants younger than six months and those with underlying conditions. The recommendations for that 50-milligram dose have not changed. And so we're seeing CDC advise against using two of those 50-milligram shots in infants weighing more than 11 pounds.
And that's to preserve that supply for those infants weighing less than 11 pounds. So it's possible, I think, and should also be kept in mind that insurers may not cover that cost of two 50-milligram doses for one infant. CDC is further recommending that clinicians suspend using nirsevimab for children aged 8 to 19 months who are eligible for palivizumab in the 2023/2024 RSV season.
The HAN does note that nirsevimab should continue to be offered to American Indian and Alaska native children who are aged 8 to 19 months who are not eligible for palivizumab, and those who live in remote regions where transporting those kids with severe RSV is challenging, and also in communities where there are high rates of RSV and older infants and toddlers.
I think the other thing to keep in mind is OB-GYNs should be discussing those potential nirsevimab supply concerns when counseling pregnant patients. We do know there's that maternal vaccine that is available to protect newborns. FDA-approved got RSV vaccine Abrysvo for use in pregnant people. And that provides protection to babies in the first six months of life.
Unger: Well, thank you for the update there on RSV. Unfortunately, it's not the only shot that's been challenging for some parents. Some have reported also finding difficulty with updated COVID vaccines for their kids. Andrea, what's going on there?
Garcia: Yeah, so there was a Kaiser Family Foundation news story that was done in partnership with NPR. And that showed that the pediatric version of those updated COVID vaccines for children 6 months to 11 years old are still challenging for some parents to find. And I think that could be due to a number of logistical obstacles.
And we've talked about before the fact that this is the first time since the start of the pandemic where the federal government isn't paying those manufacturers directly for the COVID shots. And that was a process that allowed doctors and pharmacists to receive those shipments for free. Now, we're seeing pharmacies and doctors have to pay up front for those vaccine doses from suppliers to stock them on site. And that can get complicated.
Unger: So complicated. How exactly does it work?
Garcia: Well, children with commercial health insurance get vaccines through the commercial marketplace. I think it's also important to keep in mind that there is a vaccine for children program that's a federally funded program that provides vaccine at no cost to children who might not otherwise be vaccinated under VFC. CDC buys that vaccine at a discounted rate for distribution to those registered VFC providers.
In the commercial marketplace, we know that those entities that purchase large quantities of vaccines like retail pharmacies tend to be prioritized for distribution. We're seeing smaller to medium-sized physician practices not being prioritized in the current distribution. That means that parents taking their kids to their physician for vaccines could run into access issues. And we also know that pharmacists can vaccinate children three years and older under a temporary federal law.
So some pediatricians are concerned that if we want to get these younger children vaccinated before gathering such as Thanksgiving and the winter holidays, the time is now. And so these physician practices need access to the vaccine.
Unger: Absolutely. And it's not just the kids that are having problems. There's some adults too that are having a hard time right now. What is happening with the situation there?
Garcia: Yeah, and that too is largely a result of the COVID vaccines entering the commercial marketplace. There was a recent article in USA Today that said pharmacies are also currently overwhelmed with demand. Their staff has dwindled.
So many of them have been limiting the number of appointments available for vaccines on a daily basis. Other people are turning to local hospitals, community health clinics, independent pharmacies. But many of those haven't received their supply yet and don't necessarily know when to expect it.
Some facilities have said they've just begun to receive their first shipments of the vaccine in the past few weeks. Others are still waiting for supply that they've ordered. And so they've been unable to offer the vaccine. So taken together, finding these COVID vaccines now that they're in the commercial marketplace may not be as easy as it was in the previous rollouts.
Unger: Well, given the context, which there seems to be some issues in there with getting the vaccines, what are the actual COVID numbers looking like? Are we beginning to see an uptick in cases?
Garcia: We've largely seen declines in recent weeks. If we look at those early indicators, test positivity and ED visits are still both declining. For those severity indicators, hospitalizations are declining. But deaths from COVID rose 4.2% compared to the previous week and that we know deaths are a lagging indicator.
So hopefully, that's going to go back down. Deaths were up in a number of states. They rose most sharply in Oregon. As we enter respiratory virus season, we need to stay focused on prevention, get vaccinated and take those common sense steps to really stop the spread of the virus.
Unger: Andrea, thank you so much for all of these updates. There's a lot to track here. Folks, we'll be back with another update next week with Andrea. In the meantime, if you enjoy discussions like this, you can support more programming by becoming an AMA member. Find out more at ama-assn.org/join. We'll be back soon with another update. In the meantime, you can 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 podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
