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, a discussion with AMA's Chief Health and Science Officer Mira Irons, MD, to review COVID-19 numbers and trending topics related to the pandemic over the past week. Also covering the latest on vaccines in the U.S. and globally, a state-by-state look at trends, and updated mask-wearing guidance from the CDC.
Learn more at the AMA COVID-19 resource center.
Speakers
- Mira Irons, MD, chief health and science officer, AMA
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're taking 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 in Chicago. Dr. Irons, first topic on everybody's minds continues to be vaccines. Any news on the vaccine front?
Dr. Irons: Absolutely. This is going to be a busy month for vaccines. There are two vaccines. The FDA is reviewing applications for two vaccines. The External Advisory Committee is going to review the Pfizer BioNTech application this coming Thursday. Just for everyone to know those meetings are public. They are webcasts, so anyone wants to listen in to the discussion that the External Advisory Committee has, they can just register on the FDA website.
The data that the committee is going to be reviewing gets posted two days before. So, we expect to see some of the data that that committee will be reviewing as early as tomorrow potentially. The Moderna vaccine, the committee meets again the following Thursday, the 17th, to review the Moderna application for authorization. So, depending on what the committee says, we may have authorizations in the near future. The committee always has the opportunity to bounce questions back.
And so, we'll see. We should know at the end of each meeting pretty much what they think. The new meeting that actually got posted just earlier this morning is the ACIP committee, so the Advisory Committee on Immunization Practices, has scheduled an emergency meeting this coming Friday, December 11th, and also one on Sunday, the 13th. The agenda hasn't been posted for that, but a lot of the committees are gearing up for work this week.
Unger: Is that primarily related to vaccine priorities or other topics?
Dr. Irons: It's unclear with regards to the ACIP meeting. ACIP is the group that makes recommendations for use of a vaccine in the United States. So, it could be that they're meeting the day after the external advisory committee meets to discuss that vaccine, the Pfizer vaccine, but until we see an agenda, it's really unclear.
Unger: Well those discussions about vaccine priority are certainly heating up. Do you have any insight around that particular topic?
Dr. Irons: Well, the ACIP committee last week issued its recommendations for phase 1A and that's to prioritize health care workers and also individuals in long-term care facilities. They didn't talk about 1B or 1C yet. At this point, it's not that critical for them to talk about the later phases because we're going to be limited in the number of doses that we have for December and into January. But my guess is they will be meeting later to talk about the rest of the prioritization.
Unger: Well, of course the United States is not the only country on the brink of approving or either rolling out vaccinations. Can you talk about efforts across the globe on the COVID-19 vaccine front?
Dr. Irons: Sure. So, the UK, as everybody knows, authorized the Pfizer BioNTech vaccine last week. They have what's being reported as 40,000 doses. So, they are actually starting tomorrow. They're starting with health care workers and the elderly. And what was reported today is as they get more of the doses distributed, because remember, this is the vaccine that requires the really ultra-cold storage. They'll expand to physicians giving the vaccine out.
In the rest of the world, we are hearing that the Sputnik V vaccine, which is the Russian vaccine, they have started immunizing with that vaccine. From the reports, physicians, teachers, people at high risk. Their results haven't been reported yet in a scientific journal, but what's in the media is that there's a randomized control trial of 44,000 people and interim analysis showed an efficacy of above 90%. And there is an intent, in the media reports, it says that there is an intent to report in a scientific journal. So hopefully we'll be able to see that, but they have already started immunizing people at high risk.
The Chinese have already started immunizing with their vaccine and it seems as though their vaccine, China actually has several vaccines and trials, are also being used in the United Arab Emirates and potentially in Turkey. We haven't seen the results of any of those trials yet.
Unger: Well, certainly good news. Hopefully on the vaccine front—we need it because we are just on an unrelentingly bad trajectory as far as new cases and deaths are concerned. How about the overview of this week's numbers?
Dr. Irons: It's been one of the most devastating weeks since the pandemic began. The country topped 2,800 deaths for the first time Wednesday and did it again on Thursday. To put this in perspective, now that the pandemic is killing nearly 3,000 people in the United States every day, that's the equivalent of another 9/11 attack every 24 hours. The numbers are just staggering. Cases are rising too. The last seven-day average is about 200,000 new cases a day. Hospitalizations are over 100,000, which means that the new cases are not just asymptomatic cases that are due to increased testing, but real. And hospitals are filling up and where every day is a new high.
Unger: Certainly, the patterns that we're seeing across the states seem to be shifting a little bit. Can you give us a broad overview of what's happening at the state level?
Dr. Irons: Yeah, I think that if you look at the Midwest still remains the worst hard hit area, but the good news is that seven of the states in the Midwest, I think it's Illinois, Iowa, Missouri, Kansas, Nebraska, North Dakota and South Dakota, we're starting to see declines in the numbers of cases and in their activity. So, the hope is that maybe some of the measures that we're put into place are starting to pan out, but we're still in that window when we might see the Thanksgiving surge. So, it's unclear, kind of good news, but we'll see what happens over the next few weeks. There's also some thought out there that so many people tested prior to Thanksgiving, that what we're seeing now may be lower than expected just because people aren't being tested. But the next few weeks will tell the story.
Unger: Unfortunately, it seems that some of those decreases in the Midwest are being offset by what we're seeing activity wise on the coast and New York and California. So not a good situation there, especially with California.
Dr. Irons: Yep. Absolutely. The Northeast are now reporting more cases than they did in the spring. I heard this morning that Boston opened a convention center to be ready for 200 COVID cases. In California, stay at home orders for the next three weeks have been issued for a large part of Southern California for about 30 million residents because their hospitals are topped out. And so, in order to prevent more people going to hospitals where there aren't beds or there may not be beds to care for them, the governor is enacting the stay at home orders.
Unger: So, we're seeing in the midst of these skyrocketing numbers, of course, fatigue for physicians who are responding on the front lines to these and increasingly capacity issues across the country. What are you seeing in terms of how physicians are responding to the numbers at this point?
Dr. Irons: Well, absolutely vocal, pretty much across the country. In Connecticut, Tennessee, Missouri, Mississippi physicians have issued unusually public police for stronger responses to the pandemic as hospitals and staff started breaking point. The largest organized effort thus far is a letter that dozens of doctors sent to Governor Lamont in Connecticut. A quote from the letter, I can't say it better, “We're prepared to do whatever we can to care for, comfort, and heal all those that we can, but we want everyone outside to know what we're up against and not to assume that our capacity is limitless.” Health care workers, physicians, nurses, respiratory therapists, they're begging people to really do the right thing, try to get the numbers down.
Unger: Well, let's talk in terms of key drivers and trends that we're seeing this week. You mentioned about Thanksgiving. We're not out of that window yet in terms of what we may see. We heard Dr. Fauci say we might see that really ramp up toward Christmas and beyond. Any other key drivers?
Dr. Irons: I think that if you look at the course of the condition, you start to see new cases up to 14 days afterwards. So, we're still in that window and usually you see hospitalizations about seven or eight days after that, and then deaths follow by two to three weeks. And that puts us right up against Christmas. And so, whatever's going to happen then in terms of people getting together with families indoors, in poorly ventilated areas. One, all of the modelers are doing forecasts and we learned a lot about modeling early in the pandemic that it's hard to know if the numbers are going to come out, but the University of Washington Institute for Health Metrics said that the death rate could reach over half a million by April, according to an estimate.
Unger: That is disastrous news.
Dr. Irons: Yeah. Just tragic.
Unger: In the meantime, we have seen some additional guidance coming out of the CDC on mask wearing. Can you give us some background on that?
Dr. Irons: Yeah. So last week, the CDC, and this is really in response to this significant surge that we're in right now, which is just predicted to get worse before it gets better. The CDC issued guidance that people should wear masks indoors when not at home. That's the first time that they've actually made universal mask recommendations for indoor use, but it just goes along with what we know about how this virus is spread and the fact that, especially indoors, the risk of transmission is so high that to protect yourselves and others, they're asking people to wear masks.
Unger: Any other key pieces of information or to confront misinformation or misconceptions that we need to clear up this week?
Dr. Irons: Yeah, not really. There is some discussion on whether the vaccine is more effective than making someone immune or getting the disease itself is more effective. We still don't know much about the durability of antibodies from the clinical infection. That answer's going to take some time to clear up. We do know that, for example, with pneumococcal vaccine bacteria, you get better immunity from the vaccine than from a natural infection.
So, the story for COVID is still being written, but to be clear, getting COVID-19 is a far more dangerous option. And so, to illustrate this there was a paper in the JAMA Internal Medicine a while back that looked at more than 3,000 people who were between 18 and 34 who were hospitalized for COVID. 20% required intensive care and 3% died. We still don't know everything we need to know about this disease. So, what's clear is that it's important to get vaccinated when the vaccine is available and it's important to protect yourself, masks, socially distance, washing hands until we get enough of the country vaccinated that we can all feel safe.
Unger: That's good advice. Thank you so much for being here and updating us on the latest with COVID-19. That's it for today's COVID-19 update. We'll be back with another update tomorrow. 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.
