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Is there a link between blood type and COVID? Does COVID cause cardiovascular complications? Can COVID affect your heart? Is the flu shot effective this year?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses when to get your flu shot, breakthrough COVID infections, as well as COVID-19 and cardiovascular health risks.AMA Chief Experience Officer Todd Unger hosts.
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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. I'm Todd Unger, AMA's chief experience officer. Andrea, welcome back.
Garcia: Hi, Todd. Thanks for having me.
Unger: Well, today, we're going to talk about the importance of getting flu and COVID vaccines and new research that makes this case even stronger. Let's start with the flu. Andrea, last week, the AMA launched its annual flu campaign in partnership with the Ad Council and the CDC. Tell us a little bit more about that.
Garcia: Well, Todd, this campaign is really about reminding people of the importance of getting that annual flu vaccine through new PSAs. This year's theme urges people to play defense against flu. In other words, get that vaccine to protect yourself and your community from the risk of flu and its potentially serious complications.
It highlights how antibodies that develop after getting the flu vaccination work hard to protect against the flu. And the idea that we're doing this as a team, not just for yourself, but for your loved ones, too. The new PSA will appear in TV, radio, social media, out-of-home and digital formats nationwide in time and space that is donated by the media.
Unger: I love "play defense against the flu." Flu stay away from me. Andrea, I know each year we try to determine just how bad the flu season is going to be. Looking at last year can help provide some context. What did the numbers look like last flu season?
Garcia: Well, the CDC preliminarily estimates that at least 41 million people got sick with the flu last season. Of those, 18 million people visited a health care professional and 490,000 people were hospitalized. 25,000 of those died due to flu illness or related complications.
And these are concerning numbers, especially when you look at the fact that less than half of all people in the U.S. received a flu vaccine. We also see long-standing health care inequities reflected in these numbers. Black and Hispanic populations are at higher risk of severe complications from flu due to disproportionately low vaccination coverage. This campaign is really looking to improve vaccination rates in these populations in particular.
Unger: Wow. 500,000 hospitalizations, that's a really stunning number. Andrea, we've heard it before but remind us again of just how significantly vaccination can help change a number like that.
Garcia: Yeah, so those who were vaccinated reduced their flu-related hospitalizations by about 40% in adults and 50% in children. You can imagine then how different those numbers would look if 90% or 95% of people had gotten vaccinated. That's why it's so important for physicians to continue that drumbeat and strongly encourage their patients to get vaccinated. Right now is the perfect time.
We know we're also likely to see RSV and COVID this respiratory virus season. So it's important to get up to date on other recommended vaccines as well. Only certain populations are recommended for the RSV vaccine. But like the flu shot, the CDC recommends everyone six months and older get the updated COVID vaccines with few exceptions.
Flu vaccines and COVID vaccines can be given at the same time. So most people aren't going to need a separate appointment. And a flu and COVID shot may seem like a small or unnecessary thing, but it really is the best thing people can do this season to protect themselves and their loved ones. It's the one thing that we can do to help stay healthy and be able to enjoy the holiday season.
Unger: Absolutely. And for you and your family, it's so important. And if people want to learn more about the campaign or the flu, they can visit the campaign website, getmyflushot.org. Once again, that's getmyflushot.org. Well, yet another reason to get vaccinated is reflected in what we continue to learn about COVID.
In this past week, a new study came out linking COVID to heart attacks and stroke. Andrea, that's pretty surprising. What can you tell us about that?
Garcia: Well, Todd, it was reported in the University of Minnesota's Center for Infectious Disease Research and Policy. And this new research does show that COVID infections increase the risk of heart attack, stroke and death. And in some cases, it doubled the likelihood of major cardiac events in the three years following infection.
These findings were published in the American Heart Association's Journal of Arteriosclerosis, Thrombosis, and Vascular Biology. In conducting the study, researchers at the Cleveland Clinic and the University of Southern California used the UK Biobank data for more than 10,000 people who had COVID and nearly 218,000 people who did not.
And those dates were between February and December of 2020. Then, they looked at major adverse cardiovascular events, including heart attacks, stroke and all-cause death through October 31 of 2022, approximately three years after COVID infection. And what they found is that the risk of major cardiac events was elevated in COVID patients at all levels of severity.
Unger: Wow. And we're certain people more susceptible to this kind of outcome than others.
Garcia: Yeah, the authors found that hospitalization for COVID was a bigger risk factor for a cardiac event than having cardiovascular disease without COVID. So patients with COVID had a 21% greater risk of heart attack, stroke and death than people with cardiovascular disease without a COVID infection. There was also this interesting link to blood type. Overall, non-O blood type, so A, B and AB were more likely to suffer a major cardiac event after hospitalization.
And according to the study's authors, this potential interaction between the virus and the piece of our genetic code that determines blood type could give us a better understanding of what COVID does at the molecular level and help teach us about pathways linked to cardiovascular disease risk. Obviously, more research is going to be needed in that area. But it also means that physicians should consider history of prior COVID infection when formulating cardiovascular disease preventive plans and goals.
Unger: So interesting. I haven't heard talk about blood type since kind of early in the COVID pandemic. Obviously, so much more to learn there. But one thing we have learned, COVID is bad news. We also learned this week from news how past COVID infections in children can impact their long-term health as well. Andrea, what do we need to know there?
Garcia: Now, this study was actually just published on Monday in JAMA Network Open. It was an observational study of 614,000 U.S. patients aged 10 to 19 years old. And it suggested that there is a higher risk of new onset type 2 diabetes after COVID infection compared to other respiratory infections.
So for this study, researchers who were based at Case Western Reserve University used electronic medical records to retrospectively analyze rates of type 2 diabetes in hospitalized or non-hospitalized pediatric patients one, three and then six months after infection with either SARS-COV-2 or another respiratory pathogen. And that was between January of 2020 and December of 2022. So half of the patients had COVID. Half had another respiratory infection.
And what they found was that the risk of new onset type 2 diabetes was significantly higher from the day of infection to one, three and six months after a COVID diagnosis than with other infections. And that was true both for boys and girls. The risk was similar.
Unger: Wow. We've talked about heart attacks, stroke and now diabetes as possible outcomes of having COVID. Do we have any idea why this could be the case for diabetes?
Garcia: Well, the researchers said that several factors may be at play here. For one, they noted that additional metabolic stress imposed by COVID may have pushed rank disease in an already susceptible child. They're also looking at possible autoimmune components of type 2 diabetes that may be a contributing factor.
And while the excess risk for new onset type 2 diabetes after COVID-19 infection was modest overall, the authors said it represents many patients at a high cost. We know the estimate of diabetes in the U.S., their costs in 2022 was already $412.9 billion.
And those costs are even higher when we consider that these patients are diagnosed as children. And therefore, they could face higher disease-related costs over a lifetime. We know that people diagnosed with type 2 diabetes as children may have a more severe disease process, and complications from that disease may come sooner.
Unger: Well, if that wasn't enough to convince people to get vaccinated, we also now have a study that shows the importance of vaccine-induced immunity over natural immunity. Andrea, what did we learn there?
Garcia: Well, in a nutshell, what this study found is that, although the rates of infection were similar, COVID reinfections in people who weren't vaccinated resulted in far more hospitalizations and deaths than breakthrough infections in people who were vaccinated and never had a COVID infection. And that analysis was published last Tuesday in the Journal of infectious Diseases. It was conducted by researchers from the Veterans Affairs, Pittsburgh Health Care System and Weill Cornell Medical College.
Among nearly 14,000 vaccinated veterans, not previously infected with COVID, 11.2% had a breakthrough infection. Among them, 11.8% were hospitalized or died within 28 days. And of the nearly 14,000 unvaccinated, previously-infected veterans, 18.3% experienced a reinfection. And of them, 17.3% were hospitalized or died.
Researchers say this study provides strong direct evidence that vaccinated individuals who develop breakthrough infections are less likely to experience more severe disease outcomes compared to unvaccinated individuals who develop a reinfection. And there are a variety of possible explanations for this. And we don't have time to go through them all. But they really point to the same thing—that it is important to get your COVID vaccination.
Unger: I'm going to call that the theme of today's AMA Update. Lots of reasons to get your COVID shot. And again, going back to our early discussion, get that flu shot as well as we prepare for winter. Andrea, that wraps up today's episode. And again, thanks so much for being here today and for your perspective as usual.
If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. 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.
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