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AMA Update
New COVID variant JN.1 symptoms, latest studies on Paxlovid rebound and Hydroxychloroquine
Jan 10, 2024
Featured topic and speakers
An in-depth look at the latest wave of respiratory infections sweeping the country. AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses trends in COVID, flu and RSV infections, details of the latest COVID variant and the return of mask mandates. Plus, the low use of Paxlovid and deaths linked to the use of hydroxychloroquine to treat COVID during the first wave of the pandemic. AMA Chief Experience Officer Todd Unger hosts.
- Wastewater COVID dashboard via CDC National Wastewater Surveillance System (NWSS).
- Searching for "flu vaccine near me" or "cdc.gov vaccines"? Find vaccines in your area.
- CDC FluView Weekly US Map and Influenza Summary Update.
- Free at home COVID tests by mail still available.
- Check expired COVID test expiration date extensions.
- Learn more about the Home Test to Treat program.
- National Institutes of Health's "Paxlovid (nirmatrelvir/ritonavir) effectiveness against hospitalization and death in N3C: A target trial emulation study."
- Hydroxychloroquine study "Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate" in Biomedicine & Pharmacotherapy journal.
- Nature Communications study "Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials."
- The AMA is your powerful ally in patient care. Join now.
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. Welcome back, Andrea. This is our first discussion of the year for 2024.
Garcia: Happy new year. It's good to be here.
Unger: Well, we made it through the holidays, but now it seems like literally everyone we know is sick. Andrea, what's going on with that?
Garcia: Well, it certainly does feel that way. And if you're not sick, chances are that you know somebody who is. And as we've talked about before, there are disruptions in reporting over the holidays for respiratory viruses. There may be limited appointments for testing. People are traveling and they might not get tested. Or they might use an at-home test, which we know are not reported.
So even with these caveats, there's no doubt that we are seeing a lot of respiratory viruses swirling right now as we continue to see cases of RSV, COVID and flu across the country. According to the CDC, those respiratory illnesses are now elevated in 38 states. Of those, 21 are experiencing very high activity. So that helps explain why it feels like almost everyone is getting sick right now.
Part of this is seasonality. It's an annual trend. It's fueled in part by holiday gatherings, travel, colder weather. And that drives a lot of people indoors, so what we're seeing right now is not entirely unexpected.
Unger: Andrea, when we think about the kind of three illnesses that are going around right now, can you take us through how the numbers break down for each?
Garcia: Yeah, so based on some of the articles, it seems like flu seems to be increasing most dramatically. And CDC says it expects that those numbers are going to be continue to be elevated for several more weeks. We generally do see flu season peak between December and February.
CDC Director Mandy Cohen said she expects this flu season to peak by the end of this month. I think the good news is the flu shot this season is well matched to the strain that we're seeing circulating the most. So there is still time, and it's still worth it to get that vaccine if you haven't yet. Even though cases tend to taper off, we can still see flu circulate well into the spring.
Unger: And where do we stand on RSV?
Garcia: Well, RSV is certainly still prevalent. But for the most part, those cases rose in the fall, and they have plateaued or even decreasing in some places. If we look at that CDC data, cases appear to have peaked around Thanksgiving. I think complicating the situation right now is that some people, like particularly children, are getting sick with RSV and other viruses simultaneously. And that makes tracking, diagnosing and treating more difficult.
One pediatrician noted that in the past we would have one disease that we were tracking or monitoring at a time. But now babies and children have multiple diseases at once. It's not that they just have RSV, but they're getting RSV and COVID or influenza and RSV because all of these viruses are prevalent in our community.
Unger: And having any one of these would be bad. I can't imagine having more than one at the same time. And Andrea, as we talk about the three viruses out there, the third one, of course, is COVID. Tell us a little bit about how those numbers are looking.
Garcia: Yeah, so COVID cases are certainly increasing. And while CDC data indicates that COVID hospitalizations aren't increasing as much as they have in previous years, right now, we are seeing more people hospitalized with COVID than we are with flu. The CDC has reported that the wastewater viral activity level for COVID is the highest that it's been since the Omicron surge in 2022. And it is increasing in all regions.
And just as a reminder, we do increasingly rely on that wastewater data as people are taking at-home tests more or, in some cases, aren't testing at all. With that new highly infectious COVID variant, low uptake of the latest COVID vaccine, we're at about 19% of adults who have received that, and then, of course, few people taking precautions, like masking, we can really expect to see this spread continue.
Unger: Andrea, tell us a little bit more about the variant that is driving this particular wave.
Garcia: Yeah, Todd. So it's JN.1, and the CDC released an update on January 5 about the prevalence of that variant, explaining that it may be intensifying the spread of COVID-19 this winter. It's currently responsible for about 61% of cases in the U.S., and that's based on data ending the week of January 6. And that's a sharp rise from the 7% of cases in late November.
I think, with that said, JN.1 doesn't seem to be causing more severe illness than previous variants. The symptoms you're going to see if you're infected with JN.1 is going to depend in part on your underlying health and the level of immunity you have. But generally speaking, those symptoms are similar to the viruses caused by other variants, so sore throat, congestion, runny nose, cough, fatigue, headache, among others.
So although overall COVID illnesses do seem to be less severe than in previous years, that CDC data does indicate that hospital admissions for COVID right now are up 20% and deaths are up 12.5% from the previous week. We're still losing about 1,500 people per week on average due to COVID.
Unger: So a lot. A lot. It continues to be. And because of this particular wave, I have been seeing some stories about the return of masks and mask mandates. Is that something that you think we're going to see again as a preventative measure?
Garcia: I don't think we're going to see widespread masking requirements return. But we're certainly seeing some hospital systems resume masking requirements in some states. So Reuters reported that we're seeing this in medical settings in New York, here in Illinois, Massachusetts and California. I think of greatest concern are those older adults, infants, people with compromised immune system or with chronic medical conditions and people who are pregnant.
Part of the problem is people may not be isolating if they have the virus because they either can't because they don't have access or don't want to test. So if someone assumes they have a cold, it could be COVID. The Federal Government has continued to make some free at-home tests available. But testing is certainly not as accessible as it was during the public health emergency.
And we are likely seeing employers who are less willing to accommodate those COVID-related absences. That's why, even if you're not required to wear a mask, experts say now is a good time to wear your N95 or your KN95, especially if you're going to be indoors in close quarters with others.
Unger: Right. And Andrea, as COVID cases rise, Paxlovid is once again in the news. What do we need to know about that?
Garcia: So there were some recent articles in The New York Times and Washington Post that were reporting on the results of a new study conducted by the NIH. And that looked at a million high-risk people with COVID and found that only about 15% of those who are eligible for Paxlovid actually took it.
And the authors of the study found that if even half of the eligible patients in the U.S. had gotten Paxlovid during the time of the research, 48,000 deaths and 135,000 hospitalizations could have been prevented. Paxlovid was found to cut the risk of death by 73% for high-risk patients in this NIH study.
Unger: Those are some pretty extraordinary numbers and a bit surprising. Did they talk about why?
Garcia: So we haven't seen a study that's focused on clarifying why so few people have used the medication. Anecdotally, we don't think it's because people don't know about the drug. Most people do. The New York Times suggests that some of the reluctance may come from doctors who are worried about interactions with other drugs. People worry about the rebound cases or the metallic aftertaste.
However, in a recent review of studies, the CDC did say that there is no consistent association with Paxlovid use and COVID rebound. And we know studies have also shown that that rebound can happen even without treatment.
Others claim they want to wait and see if things will get worse. But the problem is, if you wait to see, that treatment is no longer effective. You need to start it early. And some individuals may not recognize that they are themselves at risk of severe disease.
Of course, cost can also be a factor. It's priced now at about $1,400 per course, though private insurance are expected to cover some portion of that price. And Pfizer is also offering copayment assistance for the drug. I think, regardless of the reason, this is something we need to pay attention to right now. COVID deaths have been elevated since September at about 1,200 to 1,300 deaths per week. But as we just talked about, those numbers are inching up, and we're now at about 1,500 per week in December.
Unger: Right. Well, a word we haven't heard in a while—hydroxychloroquine. On the other end of the spectrum, so to speak, there is a new study out about the potential harm that hydroxychloroquine may have caused. Andrea, can you tell us more about that?
Garcia: Yeah, certainly. This was a study done by French researchers, and it suggested that nearly 17,000 people in six countries, so France, Belgium, Italy, Spain, Turkey and the U.S., may have died after taking hydroxychloroquine during that first wave of COVID. As a reminder, hydroxychloroquine is an antimalarial drug. It was prescribed off label to some patients hospitalized with COVID during that first wave of the pandemic.
And that was despite the fact that there was an absence of evidence documenting its clinical benefit. That study was published in Biomedicine and Pharmacotherapy. And that figure 17,000 stems from a study published in the journal Nature in 2021 that reported an 11% increase in the mortality rate linked to the drug's prescription against COVID-19 because of potential adverse effects, like heart rhythm disorders, and its use instead of other effective treatments. And this is a good reminder of the damage that misinformation can cause and the importance of using evidence-based treatments that we know work, like Paxlovid.
Unger: Well, that is excellent advice and conclusion coming out of this and, I guess, a good way to wrap up today's episode. Andrea, thanks so much for kicking us off for 2024. Everyone out there, if you enjoyed this discussion and you want to support more programming like it, I encourage you to join the AMA.
Become a member at ama-assn.org/join. We'll be back soon with another AMA Update. In the meantime, 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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