Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
Featured topic and speakers
In today’s COVID-19 Update, AMA's Chief Health and Science Officer Mira Irons, MD, reviews COVID-19 numbers and trending topics related to the pandemic over the past week. Dr. Irons also looks at the slowdown in vaccinations, the Johnson & Johnson/Janssen vaccine pause being lifted, as well as Michigan's COVID-19 outbreak and vaccine access in India.
Learn more at the AMA COVID-19 resource center.
Speaker
- Mira Irons, MD, chief health and science officer, AMA
Transcript
Unger: Hello. This is the American Medical Association's COVID-19 Update. Today we have our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Chief Health and Science Officer Dr. Mira Irons, in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago.
Dr. Irons, let's start with the news on the vaccine front, and specifically touch base on the lifting of the pause of the Johnson & Johnson vaccine. We did speak with Dr. Sandra Fryhofer, the AMA's liaison to the ACIP yesterday, and gave us some background on the thinking behind the decision to lift that pause. But can you comment in terms of what you think the overall impact on our vaccine efforts will be?
Dr. Irons: So, Todd, that's a great question. The ACIP committee met on Friday, and states across the country resumed administering the Johnson & Johnson vaccine on Saturday, a day after the ban was lifted, after the FDA lifted its temporary pause over concerns over the extremely rare blood clots. As you know, the vaccine now comes with a warning label about the disorder, which has been identified in 15 people out of the nearly 8 million doses given out. Measuring the impact of the pause is tricky, since there's no way of knowing what the trajectory of the vaccine uptake would have been in the absence of the pause, but what's really the good news about lifting the pause is that we know that it allows states to restart vaccination efforts among hard to reach populations, including rural Americans, migrants and elderly people who have difficulty leaving their homes. And some people just only want one shot, and so there was a large group of people who really preferred the vaccine because of that, so it'll allow us to reach more people.
Unger: Speaking of one shot, we are seeing a growing concern about people getting fully vaccinated, that is, getting that second shot with Pfizer or Moderna. Can you talk about that?
Dr. Irons: Oh, absolutely. And that, as you know, is a real problem. We've seen that people are failing to get their second doses. More than 5 million Americans or nearly 8% of those who got initial Pfizer or Moderna shots missed their second doses, according to the most recent data from the CDC. That's more than double the rate among people who got inoculated in the first several weeks of the nationwide campaign. The reasons cited for not coming back include fear of side effects, including flu-like symptoms, which are more common and stronger after the second dose, although a large number of people report that they don't get any symptoms after the second dose. Others said they felt they were sufficiently protected with a single shot.
Another hurdle have been the problems with shipments or scheduling that have prevented people from getting fully vaccinated. You know, these are two-dose vaccines developed for maximal efficacy and immune response. A single dose of the Pfizer and the Moderna vaccine does not trigger as robust an immune response as two doses do. Especially important when you want them to deal with the more problemsome variants. We also don't know how long any immunity is going to last with a single dose. So we really need to keep stressing the importance of getting that second shot, the full recommended dose, to achieve maximum protection.
Unger: Absolutely. Well, let's talk a little bit about progress with overall distribution efforts. I kind of see the counter moving up every day when I check that. We're now at about 140 million people getting at least one dose. Are we seeing a greater challenge at this point in terms of the pace of vaccinations?
Dr. Irons: Yeah, we absolutely are. For the first few months that we were doing this in the vaccination space, demand was much, much greater than supply and we are waiting for those supplies to come in. Well, now supply is greater than demand at many locations and vaccination rates are now falling across the United States. Last week, we began to hear how some county health departments that couldn't keep up with vaccine demand a month ago have started closing their mass vaccination sites for lack of customers, and some counties are also now declining vaccine shipments. As you said, the CDC said on Sunday about 140 million people have received at least one dose of a vaccine, but that includes about 94.8 million people who have been fully vaccinated. But as you said, vaccinations are decreasing. Providers are administering about 2.75 million doses per day on average, about a 19% decrease from the peak of 3.38 million on April 13.
Unger: We have a long way to go to get to those numbers that we need. What is driving that decrease, do you think?
Dr. Irons: You know, it's really difficult to say, and it's likely far more complicated than just the J&J pause. Many Americans who are eager and able to be vaccinated have now been inoculated, and among the unvaccinated, some are totally opposed, while others would get a vaccine if it was more accessible to them. This could mean we see a shift in tactics where physicians in small practices become part of the solution. This shift, however, would require the administration to distribute the vaccines in much smaller shipments to many more providers.
Either way, I think it's important for physicians to accurately frame risk for their patients. Dr. Francis Collins, director of the National Institutes of Health, compared the risk of a blood clot from the J&J vaccine, which is a bit less than one in 500,000, to the danger of aspirin causing significant bleeding in the intestines among people who regularly take aspirin. He said, "You know, we're talking about something about 1,000 times likely to happen, but we as Americans are not that good at this kind of risk calculation." The bottom line, whatever the reason for the slowdown in vaccinations, it could delay the arrival of herd immunity. The longer that takes, the more time there is for variants to arise.
Unger: Yes. And we've talked separately about ... We've kind of entered what I'll call the marketing challenge of this, where it really is about messaging, and distribution, and access, and new channels to reach more people. And I guess each one having to be kind of treated differently to get to where we need to go. Well, in terms of new cases and deaths, what are we seeing out there? Despite the significant progress that we're making on the vaccines front, we still have a significant number of cases out there.
Dr. Irons: Oh, absolutely. So the numbers for today, 32,077,935 confirmed cases of COVID-19 in the U.S., and 572,200 people have died of COVID-19 in the U.S. More than 50,000 new U.S. cases were reported on Saturday, and case rates are similar to those of the second peak last summer, though they have fallen significantly from the third peak over the winter. 50,000 new cases a day is just too much.
Case numbers have started to slowly decline as conditions have improved in Michigan, New York and New Jersey. We're starting to see this hopscotch around the country. Oregon is seeing a higher rate of case growth than any other state, though it continues to report fewer cases per capita than several Northeastern and Midwestern states. Though there's been some improvement, Michigan still has the worst coronavirus outbreak in the country. And hospitals, they are admitting about twice as many young adults with coronavirus now as they did during the fall peak. One Michigan doctor reported putting more patients in their twenties and thirties and forties on oxygen and on life support now than at any other time in the pandemic.
Unger: Yes, and as we know from one of our updates earlier this week, young folks, and particularly young women, seem to be susceptible to a lot of the post-COVID or long COVID symptoms, even with infections that don't seem as problematic at first. So it's so important for young people not to be complacent and to get vaccinated. In Michigan, you mentioned there we're seeing still the impact of variants on contagion.
Dr. Irons: Oh, absolutely. Most public health experts say that Michigan outbreak is being driven by the B.1.1.7 variant, which is more contagious and more severe. That's the so-called U.K. variant. And as pandemic restrictions have been loosened, younger people are out and about, socializing and in the workforce. And they are also among the last to be vaccinated. And I think that's why we've seen the shift in the age demographics of people being admitted to the hospital, because we've been fortunate that so many people over 65 were vaccinated, but that leaves the young people that really aren't lining up as much as they should for vaccines.
Unger: You know, one of the things, as we kind of see a surplus of vaccines here in the states, is kind of a growing sense of frustration and anger around the globe at a lack of access to vaccines, and the impact that that's having on the pandemic. This is a particularly critical issue right now in India. Do you want to comment on what you're seeing globally there?
Dr. Irons: Oh, it's just tragic. If you look at the global numbers, more than 147 million people have been diagnosed with COVID and there have been more than 3.1 million deaths. India is experiencing a tragic and really devastating second surge. On Sunday, the country reported more than 349,691 new infections and 2,767 deaths, marking the fourth consecutive day it set a world record in daily infections, though experts warn that the true numbers are probably much higher. The country now accounts for almost half of all new cases globally. A new variant, B.1.617, is thought to be at least partly the cause of the catastrophic rise in cases there. At the same time, hospitals are overwhelmed. They're scrambling to get more oxygen for patients. In New Delhi, the capital hospitals this weekend turned away patients after running out of oxygen and beds.
In response to this, the Biden administration said on Sunday that it had partially lifted a ban against the export of raw materials needed to make vaccines. The spokesperson for the National Security Council in a statement said the United States has identified sources of specific raw material urgently required for Indian manufacturer of the Covishield vaccine that will immediately be made available to India.
Unger: Well, Dr. Irons, thank you so much for the update this week. We've got a lot of work to do still, and just to continue to encourage people, get your vaccines. That's it for today's update. We'll be back with another segment shortly. In the meantime, for resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us. 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.
