Mira Irons, MD, discusses surge in U.S. cases as more counties emerge as hot spots

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger and AMA Chief Health and Science Officer Mira Irons, MD, review COVID-19 numbers and trending topics over the past week, including the worst week so far in surge of cases not just in the USA, but across the world.

Learn more at the AMA COVID-19 resource center.

Speakers

• Mira Irons, MD, chief health and science officer, AMA

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, also in Chicago. Dr. Irons, before we jump into this week's numbers, I wanted to address the ongoing attacks on physicians regarding treating COVID patients, including some accusations that they're somehow inflating the number of cases reported. The AMA responded to this last week. Can you talk about that?

Dr. Irons: Todd, thanks very much for asking this question. I'm going to answer. I'm just going to read the statement that the AMA issued on behalf of Dr. Susan Bailey, because it tells the whole story. "Throughout this pandemic physicians, nurses, and front line health care workers have risked their health, their safety in their lives to treat their patients and defeat a deadly virus. They did it because duty calls, and because of the sacred oath they took. The suggestion the doctors, in the midst of a public health crisis, are over-counting COVID 19 patients or lying to line their pockets is a malicious, outrageous, and completely misguided charge. COVID-19 cases are at record highs today." We'll talk about that in a minute. They're getting higher. "Rather than attacking us and lobbing baseless charges at physicians, our leaders should be following the science and urging adherence to the public health steps we know work, wearing a mask, washing hands and practicing physical distancing."

Unger: Well, thank you so much, Dr. Iron. And as the statement says, these accusations come at a particularly dangerous time in the pandemic, when we're seeing record numbers now popping up almost every day. Can you talk about this week's numbers and what's happening across the country with new cases and deaths?

Dr. Irons: Well, it's been the worst week yet for cases in the United States, and really in the world, I believe. The current numbers 9,208,956 people have been diagnosed in the United States with COVID. 231,003 people have died. Globally, the numbers are higher than 46 million cases diagnosed, and more than 1.2 million deaths. The country reported a record of more than half a million new COVID cases in just the past week. Over the past week, there's been an average of over 80,000 cases per day, an increase of 43% from the average two weeks ago. Just on Friday alone, we recorded over 99,000 COVID cases, and at least 848 new COVID deaths and 884,285 new cases were reported on Saturday.

As we talked last week, it's no longer one area that's driving the surge. It's really the entire country. On a private call with governors on Friday, Dr. Deborah Birx said that at least 1,200 counties, that's a whole third of the country, now qualify as a virus hotspot. Half of US counties saw new cases peak during the past month. Almost a third saw or record in the past week. In the Upper Midwest and Mountain West, records are being smashed almost daily. Hospitals are filling up. And it's moving around the country. I think that different states are in different parts of the pandemic in this surge. We were talking a lot about North Dakota and South Dakota last week. Now we're seeing these surges in Illinois, Ohio, and in the Western part of the country. New England, which was relatively safe with low numbers until recently, are starting to see an uptick in cases. And so, it's marching around the country.

Unger: So that does redefine the nature of "hotspot" in this case. Can you talk about, then, the deaths, because that's always been kind of a lagging indicator? How is that trending right now?

Dr. Irons: I think less than what we saw in the spring, but you have to understand the natural history of the disease. So COVID, first you develop the early symptoms of COVID and you get diagnosed. And then people who are going to have a moderate to severe case usually starts showing those symptoms six to seven days, a week after diagnosis. That's when you get admitted to the hospital. And then if you go down, begin to experience really severe complications, people get moved to the intensive care unit. And usually the deaths, when they do occur, are going to occur three, four, five weeks after that initial diagnosis. And so this is what we've experienced. We see the cases start to rise, then we see hospitalization start to rise, usually a week to two later, and the deaths seem to follow. Having said that, although the death rate is going up slowly, it still hasn't reached the high death rates that we saw in the spring.

Unger: And that's due to what?

Dr. Irons: I think it's a variety of factors. I think that we've learned a lot about how to treat severely ill patients with COVID. We have some medications that work, steroids, and we know how to provide respiratory support to patients. It's a combination of factors.

Unger: What we're seeing in response to the surge, some states are now implementing new control measures. Do you want to talk about those?

Dr. Irons: Residents of El Paso are under a two-week stay at home order. Indoor dining was halted in Chicago beginning last Friday. Governor Cuomo of New York ordered incoming travelers from non-neighboring states to be tested before and after entry instead of requiring the 14-day quarantine. We know that some mayors are also instituting public mask orders. We're seeing different things around different parts of the country.

Unger: So across the seas there, we're seeing Europe doing similar measures. Can you talk about what we're seeing there?

Dr. Irons: Absolutely. Europe is seeing huge increases, as well as countries responding with stricter measures. The UK, the British prime minister announced expansive new restrictions on Saturday that effectively are a national lockdown. This follows Greece, Austria, France, Germany, Belgium, and Ireland are also shutting down large parts of the society. Some are doing it differently, but France instituted significant lockdowns last week. So, the European countries are really trying to get out ahead of this second wave. They tend to be a little earlier than what we see in the United States, but they also, I think, learned from their spring surge and they're instituting restrictions pretty quickly.

Unger: Pretty incredible, combined, the US and Europe exceeding 500,000 cases per day for the first time, and then upwards from there. What do you see as any other kind of trends and drivers that we're seeing this week?

Dr. Irons: Cold weather. I think one of the drivers that we know is cold weather, people aren't outside. They're congregating indoors where there's less ventilation. I think colleges, we're also seeing the surges in colleges. Rallies. It's a respiratory virus. We've said this before. Bring a lot of people together in close quarters without masks, and you're going to see spread. And also fatigue. I think that we're hearing this, that people are just tired of it. They're expanding their bubbles. They're expanding their bubbles and allowing other people in. And then there was a Gallup poll that came out, I think, within the last week or so, that showed that social distancing habits have also tapered since July. So I think people's behaviors are starting to go back to life as we knew it prior to COVID.

Unger: So, we just made it through Halloween weekend, of course. Thanksgiving's on the horizon. So, a lot of concerning context that we're going to have to deal with. Anything new on the vaccine or treatment front this week?

Dr. Irons: No, I think that things are moving along. I think that Moderna, the two Phase 3 trials, Moderna has completed its enrollment. I think Pfizer is close. If it hasn't completed enrollment, it's close to completing enrollment. And then the AstraZeneca vaccine and the J&J vaccine Phase 3 trials are still coming along. I think we probably are waiting on an application to the FDA for emergency use authorization from either Pfizer or Moderna or both within the next few weeks to months. And then the process calls for the external advisory committee to be called. Those are public meetings. Everybody can listen into those meetings. Once the FDA makes a decision, then it goes to the CDC ACEP committee, and that meeting will also be public.

Unger: Well, finally, let's address the subject of misinformation, and anything that you'd like to clarify this week, particularly as it relates to the COVID counts. What can you tell us about that?

Dr. Irons: I'd like to speak to the notion of excess deaths. Whenever there's a pandemic or an epidemic, public health experts know that the official death report is probably less than what is ... that it's under-counted to some extent. And so, what they do, and they do this routinely, is they actually look at a specific period of time, deaths in this case from January through October, and compare it with previous years. So the CDC did that and found that there was an excess of 300,000 deaths between January and October in the United States, compared with the years from 2015 to 2019.

Now, reasons for that could be that there were patients who actually died and had COVID, but were never tested. There could be individuals who died at home of COVID and were never tested. But then also another reason is people who died because their healthcare was interrupted because of the pandemic. Either they weren't getting their care for chronic disease, or they were afraid to come to the hospital or to physicians. And so it's important, anytime you see a large healthcare emergency, to not only look at the reported deaths, but the excess deaths that have occurred because of that.

Unger: Finally, any other key messages that the AMA would like people to hear this week?

Dr. Irons: Well, not a statement per se, but Dr. Bailey authored a viewpoint last Tuesday, October 27. And I think it's worth calling out. It's called The Assault on Physicians and Science Must End. And she called out the misinformation that has circulated since the beginning of the pandemic, how the AMA stands on the side of science, and also how trust in physicians is more important than ever, especially with an impending vaccine.

Unger: You can read Dr. Bailey's complete viewpoint on the AMA site, ama-assn.org. Thank you so much, Dr. Irons, for being here today and sharing your update. That's it for today's COVID segment. We'll see you tomorrow with another COVID-19 update. A quick reminder to vote if you haven't already. For resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us and 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.