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


AMA Chief Experience Officer Todd Unger speaks with AMA Chief Health and Science Officer Mira Irons, MD, on the weekly look at the numbers and trends, including a record-breaking weekend with new cases and deaths across the country.

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 also in Chicago. Dr. Irons, let's start by reviewing this week's numbers. It's been a record breaking weekend, not in a good way. Talk to us about what's happening across the country with new cases and deaths.

Dr. Irons: Yeah, absolutely, Todd. It has been record breaking and not the way we want it to be. So the latest numbers from this morning are 2,549,069 individuals have been diagnosed with COVID and 125,853 have died of that. Dr. Redfield from the CDC last week came out and actually said that they estimate that for every one person diagnosed, 10 people actually have COVID that we don't know about. So that takes that 2.5 million and brings it up to 25 million people. But the thing to remember is that still more than 90% of people in the United States are susceptible because 25 million in a population of 330 million is five to seven percent or somewhere in there.

If you look at what's happening in the country, the south and the west continue to feel the burden of the increases in COVID. Texas, Florida, Arizona are the big states that people have been hearing a lot about. Significant increases in hospitalizations in Texas and Arizona. Florida doesn't report their hospitalizations, so we could only assume they're seeing the same thing. And the White House Task Force gave a press conference last week for the first time in several weeks. So all of those together, I think are good evidence that there are concerns in the country.

Unger: Are we just seeing basically the same wave that hit the coasts now just making its way through the south and the west?

Dr. Irons: You know, that's probably a part of the explanation. I think many of these states did not see a huge burden of COVID in that first wave that came through and so they were also interestingly the states that reopened in an accelerated manner. You know, if you look at the states that aren't showing significant upticks; New York, New Jersey, and Connecticut are actually decreasing. Illinois hasn't had a big spike. Michigan hasn't had a big spike. I think that those are the states that were hit the hardest and so they've really taken a slower path and a more measured path to reopening.

Unger: And we're really seeing, day after day now at this point, of record breaking cases, correct?

Dr. Irons: Oh, absolutely. And if you look at global numbers, it's even worse. 10 million people globally affected with COVID and 500,000 deaths from COVID. A quarter of those cases are in the United States. The other concerning thing, and you may have seen this figure out there, the original figure shows the COVID cases going up in the United States. And then we did flatten the curve and we started to see things coming down and now they're picking up. And the slope of that line is the same slope as the slope that we saw in March and April. Different parts of the country, obviously, but we're seeing increases in either 31 or 33 states, depending on whose data you look at.

Unger: This is very alarming data. Can we talk a little bit about the trends that are driving this? One about young people.

Dr. Irons: Yup.

Unger: Let's talk about that.

Dr. Irons: Well, we're seeing several of the governors in the states, I think Florida for one, maybe Texas, I'm not quite sure, have said that the largest number of new cases are in the younger age groups. And that could be because there is more testing available, but also because younger people are congregating. They're congregating in large areas. The governors in Florida and Texas have actually pushed back and they're starting to not allow bars to be open to try to keep the large congregating areas from leading to that spread. But I think that in terms of younger people, they are thankfully less severely affected. Although they don't get a complete pass. There are still younger people that are hospitalized. There are younger people that are dying in hospitals. Two teenagers died in Florida last week.

But the concern is that you see a lot of asymptomatic spread and it's estimated that about 20 to 40% of the spread occurs from people who are asymptomatic. So you may not see significant disease in people who are younger, but the concern is that they are going to serve as vectors and pass it on to older individuals, people with chronic disease, people who are vulnerable populations. So even though we're seeing the death rate decreasing now, when we look at the numbers in the United States, we know that the death rate follows the diagnostic rate by at least two to three weeks. So I think we should prepare ourselves.

Unger: Are there any specific populations that stand out in terms of the infection rate?

Dr. Irons: Oh, absolutely. We have to be concerned about minoritized and vulnerable populations. We see the disproportional impact on Black populations, the Latinx populations, but also on people who are older. The CDC actually changed their guidance last week and they're no longer focusing on an age. They're no longer saying 65 and above. What they're saying is that people in their 40s are at a higher risk for severe infection than people in the 30s, people in the 50... You know, it's gradual increase. So then as you get older, you are more likely to be severely impacted, but people with chronic disease, heart disease, renal disease, lung disease, sickle cell disease, children with complex medical issues. Those are really the populations—people in nursing homes—that you really want to protect.

Unger: Well, let's talk a little bit about the guidance and some of the conversations that have been occurring. One of the lines of response has been this is an issue about increase in testing, not increase in kind of cases. How do you respond to that?

Dr. Irons: Oh, that's not the answer. And the reason we can say that it's not the answer, there are two answers to that. One is that we're seeing hospitalizations go up. So hospitals in Arizona and the large Texas metropolitan centers are packed. They're at capacity. They're seeing more and more cases coming. And so those people would have been identified, regardless of having more testing. But also when you see that test rates are running at more than 20% positive, that means there's community spread in those areas. So this isn't just that we've sort of opened up the testing pool. I think a huge part of it really is that there is community spread. Hospitals are getting impacted.

Unger: Well as a way to, of course, suppress or prevent that kind of spread, masks have been a hot topic over the past week. Can you talk a little bit about the guidance that's coming on mask wearing?

Dr. Irons: Yep. Well, we do know that masks are helpful in preventing the spread from someone who actually has COVID, either they're asymptomatic or they have symptoms. And we're also starting to see evidence that it actually prevents people from getting infected. So it serves as a barrier. If you think about it, the virus is spread by droplets from person to person, and it does create a barrier. I think there has been confusion about how protective masks are. Two to three months ago, we were worried about there not being enough masks for health care providers and first responders, but the data's clear and the message now is that people should be wearing masks, especially when they can't socially distance, especially when they have to be within six feet of people.

Unger: Well, with the growing number of cases, has there been any notable progress on developing treatments? Any updates on vaccine trials and timing?

Dr. Irons: So the clinical trials are still continuing. Hundreds and hundreds of clinical trials are continuing. Convalescent plasma, remdesivir has announced that they're going to start clinical trials with a nebulized version. Right now, the way remdesivir is given is intravenously, but they're starting some clinical trials to deliver the drug directly to the lung through a nebulizer. Monoclonal antibodies—many of us are very hopeful that those trials are working out fine. And then steroids, which are controversial in treatment, but the trials are continuing, which is the way to answer that question rather than with anecdotal or observational data. And the vaccine trials are continuing. The Moderna vaccine is going to start phase three in July. I believe the Oxford AstraZeneca will start phase three in August. And so the next three to six months should give us some data, both on treatments and therapies that may serve as a bridge to a vaccine and vaccines, but we're all going to have to hang in there for at least the next six months.

Unger: Well, on that topic, there've been a few statements that came from the AMA over the past week. Let's talk first about the one from Texas.

Dr. Irons: So Dr. Bailey, the AMA president, was down in Texas last week with the Texas Medical Association. And there was a joint statement that came out from the AMA and the Texas Medical Association urging all fellow Texans to protect each other. And that's the important statement to get out there. The individual responsibility is going to be huge in helping to mitigate the continued spread of the virus and we all really do have to protect each other.

Unger: Sadly, we're also seeing levels of intimidation against public health officials. Can you give us some more background on that?

Dr. Irons: Oh, absolutely. I think there were several news reports that came out over the last few weeks of public city, county, and state public health officials who are being intimidated, or  receiving threats of violence against them personally and their families, who are being intimidated because of rules that are being enacted within their cities, counties, and states for helping to mitigate the virus.

Unger: That is the last thing we need are fewer public health officials because of that kind of intimidation. Lastly, just a quick comment. There were some drugs that there was a lot of hope around them earlier, but now for hydroxychloroquine and chloroquine that statements to discourage that. Can you talk about that?

Dr. Irons: Yes. So, hydroxychloroquine and chloroquine, there was a lot of media attention and other attention on those drugs. The AMA, together with the two National Pharmacy Associations, going back two months ago, put out a statement indicating that testing of those drugs should be within the context of carefully monitored clinical trials. And two weeks ago, I believe, the FDA took back the emergency use authorizations for those two drugs for the treatment of COVID-19 because the clinical trials did not show that they were efficacious against COVID-19 and also raised some safety issues. So the AMA and the two pharmacy organizations last week issued a statement to make people aware of this change.

Unger: Well, if I could sum up based on what I've heard today, we're in this for the long haul and currently in a very record breaking, and not in a good way, period. So it's important for everyone to wear a mask, continue to maintain physical distancing, and wash your hands. Those are the tools we've got in our arsenal right now. Any additional comments before we close down today's segment?

Dr. Irons: No, the top three are the ones you've already said, but the pandemic's not over. It's not over. And we are in this for the long haul.

Unger: Well, thanks very much Dr. Irons for joining us today. That's it for today's COVID-19 update. We'll be back tomorrow with another segment. For updated resources on COVID-19, go to ama-assn.org/COVID-19. Thanks for joining us today 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.

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