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What does Ozempic do? What are the side effects of Ozempic? Is bird flu still around? Is there a vaccine for norovirus? Is red dye 3 banned in U.S.?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses high rates of COVID, RSV and seasonal flu, as well as the recent CDC alert regarding hospital testing and treatments for bird flu. Also covering the FDA ban on red dye no. 3, plus new research on how GLP-1 drugs could lower the risk of 42 health conditions like Alzheimer's, dementia, substance abuse disorders and more. AMA Chief Experience Officer Todd Unger hosts.
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- For bird flu news visit Centers for Disease Control and Prevention CDC H5N1 Bird Flu Current Situation Summary (CDC H5N1 technical report).
- CDC Health Advisory for Accelerated Subtyping of Influenza A in Hospitalized Patients.
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Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Garcia: Cases of flu, COVID and RSV remain high across the U.S. And they're likely going to stay that way for several more weeks. The CDC also reports that this is causing a lot of people to seek health care at a high level. So many hospitals and physicians are likely really feeling this right now.
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: Pretty chilly day here in Chicago. And lots to talk about, as usual. Andrea, last time we talked, we didn't get a chance to talk about bird flu. But there have been some developments, including a new CDC alert. Tell us more about that.
Garcia: Well, last Thursday, the CDC issued a HAN, or a health alert, to clinicians and laboratories in response to those human infections we've been seeing with avian influenza A, H5N1. And the agency is urging health-care professionals to accelerate subtyping of all influenza A specimens from hospitalized patients. Particularly those who are in the ICU, the agency is recommending a subtyping diagnostic test, ideally within 24 hours of admission, as well as increasing efforts at clinical labs to identify nonseasonal influenza.
The alert also emphasizes to clinicians starting antiviral treatments such as Tamiflu immediately, without waiting for those test results, and taking a thorough exposure history from a patient with suspected or confirmed influenza who is hospitalized. And as we talked about last week, this alert does come at a time when levels of seasonal flu activity are already very high.
Unger: Andrea, what's the thinking behind this change?
Garcia: Well, this approach can help prevent delays in identifying human infections with avian influenza A viruses. We know that those delays in diagnosing bird flu can complicate public-health investigations and delay treatment for exposed individuals and can also affect hospital-infection control.
Those patients who are not tested right away might struggle to remember where they've been exposed or the people they've been in contact with since becoming sick. Plus, with those seasonal cases so high right now, it's really essential to distinguish between seasonal flu and bird flu as quickly as possible.
Unger: Well, this theoretically seems like a pretty easy fix, testing people as they get, of course, admitted to the hospital. Is it that easy?
Garcia: It may sound like it, but most influenza tests ordered in clinical settings don't distinguish between avian influenza A H5 and seasonal influenza A viruses. So, a positive result simply confirms an influenza A virus infection. If hospitals don't have the capability to do that subtyping on site, they may need to send those specimens to either commercial labs or to public health labs that do.
And then it's also going to be important to notify the health department promptly if H5N1 virus infection is suspected, probable or confirmed in a hospitalized patient. A CDC spokesperson noted that by the time these test results often come back, the patient may already be discharged. Their household contacts may no longer be within the window for effective antiviral treatment, which we know works best when it's given early.
Unger: So, lots of challenges there. Andrea, given the circumstances, what are the numbers looking like right now for both seasonal flu and for bird flu?
Garcia: Yeah, looking at seasonal flu first, the CDC's estimating that there have been at least 12 million illnesses, 160,000 hospitalizations and 6,600 deaths from flu so far this season. As for bird flu, we recently learned about another human infection, a child in San Francisco who developed a fever and conjunctivitis but was not hospitalized, and thankfully, has since recovered. Including that case, 67 people have been infected by bird flu to date. And California has been hit the hardest, accounting for 38 of those cases based on the CDC data.
Unger: Now, Andrea, I know a few months ago there had been some discussion about a vaccine. Any movement on that front?
Garcia: Well, as we've discussed previously, there are several vaccines that target H5N1. And the federal government has been working to increase the number of doses in the national stockpile. Just last week, we did see the U.S. Department of Health and Human Services announce that it will be awarding $590 million to Moderna. And that is to accelerate the development of influenza vaccine, including those that protect against bird flu. We do know that since 2023 Moderna has been working to create pandemic influenza vaccine, which would help protect against certain viruses, including H5N1 bird flu.
This new funding builds on the $176 million that HHS awarded Moderna last July. On Friday, Moderna said that this additional funding is going to help pay for late-stage development, licensure of the vaccines and expanded clinical studies for additional subtypes of pandemic influenza to hopefully help prevent other potential public health emergencies. And as a reminder, last week we talked about how Moderna is currently enrolling participants in a stage III trial for a norovirus vaccine. There's definitely a lot going on in this space.
Unger: There is a lot. And that's good news. Andrea, we'll look forward to seeing what comes out of that research, obviously. Let's turn our attention to the myriad other viruses that are out there right now. What's the background there?
Garcia: An ABC News article published earlier this week gave a good overview of the situation, and according to the article and CDC data, cases of flu, COVID and RSV remain high across the U.S. And they're likely going to stay that way for several more weeks. The CDC also reports that this is causing a lot of people to seek health care at a high level. So many hospitals and physicians are really feeling this right now.
As of January 11, emergency room visits and hospitalizations were highest for flu, followed by COVID and RSV, which are similar levels. Death rates, however, are at the highest for COVID at 1.4%, followed by flu at 1.2 and RSV point 1.1%. The CDC also said that while some indicators may be suggesting that illness activity has decreased or remain stable, this could definitely be due to reporting delays from the winter holiday and changes in whether people decided to seek health care, rather than an indication that respiratory virus activity has actually peaked.
Unger: All right. Well, thank you for that update. And I know the advice continues to remain the same. If you feel sick, stay home and be sure to contact your physician if symptoms persist. Of course, it's also never too late to get vaccinated. Andrea, let's turn now to another topic that made headlines last week. The FDA has banned a controversial red dye. Tell us more about that and the evidence that prompted the decision.
Garcia: So we're talking about a dye that is known as red dye number 3. This dye gives items that cherry-red hue. It can be found in many candies, drinks and snacks, such as bubble gum, fruit cocktail. According to articles in the Washington Post and the New York Times, as well as other media outlets, this dye is already prohibited in the EU and elsewhere. And in the U.S., the coloring was removed from cosmetics decades ago.
So last Wednesday, we saw the FDA move to ban the dye after more than two years of pressure from advocates who argue that it's safer to use natural coloring that's derived from plants such as beets and red cabbage. This dye is not to be confused with red dye number 40, which is found in some popular breakfast cereals and has a different chemical composition than red number 3, which has been shown to cause cancer in rats when it's given at high doses.
While the FDA did decide to remove the artificial dye, the agency maintains that there is no evidence that ingesting the coloring causes cancer in humans. The agency said it based its decision on the Delaney Clause of the Federal Food, Drug, and Cosmetic Act, which prohibits additives found to cause cancer in humans or animals at any dose.
Unger: So, this big change, does that happen right away? Or what does the implementation look like?
Garcia: Well, it doesn't happen immediately. The dye must be removed from food by mid-January of 2027 and from ingested drugs the following year. Some prominent manufacturers have already removed the dye from popular items, such as Peep candy, which we see a lot around Easter. That's because this dye is already banned in other places. So many food and beverage makers do already have recipes without it that they can now use for U.S. consumers.
Advocates are also now urging the agency to take a look at its regulation of red dye number 40, as well as yellow dyes number 5 and 6, blue dyes numbers 1 and 2, and green dye number 3. So, my guess is that we likely haven't heard the last on this.
Unger: I'm sure a lot of people are eagerly awaiting the developments there. Before we end this week, Andrea, one more topic to cover, and that's Ozempic, which is once again in the news. What do we need to know about that?
Garcia: Well, although Ozempic and other GLP-1 drugs always seem to be in the news this week, the headlines were because of a large study on GLP-1 drugs that was conducted, that found that these drugs could potentially lower the risk of 42 health conditions. There was an article in Fortune that provided a good overview. This observational study was led by researchers at the Veterans Affairs Saint Louis Health Care System.
It found that the use of GLP-1 was associated with reduced risk of a number of surprising health problems, including substance-use disorders, suicidal ideation, schizophrenia and other psychotic disorders. Risk reduction was also found for neurocognitive disorders like Alzheimer's and dementia, along with infections, liver cancer, and even life-threatening clotting disorders, like blood clots in the lungs. And then confirming what we already knew. These drugs showed benefits like a reduction in the risk of stroke, heart attacks, major cardiac events and kidney disease.
Unger: Wow. That is just a huge number of possible benefits. Do we have any sense of how this works or why?
Garcia: Well, I think that's really the question. And there are definitely some theories out there. But the answers are definitely subject to further research. And how this study's results will be interpreted or acted upon also remains to be seen. I also want to note that the study did find that people who took these medications also had a higher risk for some health outcomes.
So there was an increased risk of nausea and vomiting, GERD, sleep disturbances, bone pain and abdominal pain. So, patients should be having a conversation with their physicians for an individualized risk-benefit analysis before they're starting these medications. And we know that GLP-1s could certainly find multiple uses over time. And this study helps suggest possible areas for future research.
Unger: Well, very interesting possibilities there. And we will certainly be diving into those more in the future episodes. Well, that wraps up today's episode. As always, Andrea, thanks so much for being here and keeping us informed. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. 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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