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


AMA marks the 100th episode of the AMA COVID-19 Update videos, providing physicians with what they need to know about the COVID-19 pandemic. 

In today’s COVID-19 update, Todd Unger, AMA chief experience officer and Mira Irons, MD, AMA chief health and science officer, share details about new testing and a cautiously optimistic look at the latest numbers and trends.

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 marks our 100th episode of providing physicians with what they need to know about COVID-19. Today, we'll look again 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 in Chicago. Dr. Irons, let's start by reviewing this week's numbers. Let's talk about the trends with new cases.

Dr. Irons: Sure. So the new case count as of this morning was 5,404,115 cases still rising. And the deaths as of this morning are 170,052. We still see the cases rising. They may have slowed compared to two weeks ago. Two weeks ago, or three weeks ago, we were talking about 70,000 new cases a day. Last week, it was in the mid fifties and over the weekend, we were in the high 40,000 range. So maybe that is a slowing in some of the States that were having surges. But when you look across the country, it's pretty much the same map. A lot of the surge, the Sunbelt and the West coast, is still seeing a lot of cases. We're starting to see upticks in cases in States like Illinois and some of the other States that were holding their numbers. And New England; New York, New Jersey, Connecticut are still doing really well.

I mean, if you look at the positivity rate for New York and Connecticut, it's less than 1%. New Jersey is about 1.4%. Some of those other States in New England and the mid Atlantic are in the two to 4% positivity range, as opposed to several other States that are still over 10% where the surges were.

Unger: Well, we're still averaging more than a thousand deaths per day in August. Can you talk a little bit about what you're seeing and the trends there?

Dr. Irons: Yeah. Well, the trend is that we're starting to see a plateau, and when we think back to March and April, when the first surges started, we saw a steep rise and then we saw a decline that continued. What we're seeing now is we seem to be plateaued at over a thousand deaths a day for several weeks now. And so that just reaffirms the fact that the surges are real.

Unger: So at this rate of about a thousand deaths a day, we'll cross that 200,000 mark in a month.

Dr. Irons: Yeah, absolutely. And, I think that the CDC began to say that last week and the week before and I just think back to the discussions early in March and April were 200,000 was out there as a possibility. And we all hoped it wouldn't happen, but I think we are going to hit it.

Unger: That's bad news.

Dr. Irons: Yeah, it is.

Unger: Well, let's talk a little bit about some of those underlying trends that are leading to that. First off, let's talk about virus testing, what's happening with that?

Dr. Irons: Well, I think that the diagnostic testing, we're hearing from a lot of places that there are long delays in getting your results back. There are supply chain issues that we've known about. Early on it was viral transport media, PPE, nasal pharyngeal swabs. A lot of the laboratories are saying that the re-agents supplies are low, and so I think that there are delays in getting tested. But it seems to be in pockets of the country, where there's a large demand, there's a large time lag. Perhaps in areas where there is less demand, the results are coming back quicker, but over the last week, the number of tests done per day trended down. It seems like it's gone up again a little over the last few days.

Unger: So the delays in receiving results, to some extent, we were concerned that it was dissuading people from even getting tested. Do you see that as maybe hopefully turning around?

Dr. Irons: I hope so, but I think the important thing also is that once someone's tested, if they're tested because they have symptoms, or if they have had a known exposure, you really need to quarantine yourself until you get the test result back. And when you have long delays before getting the results back, you don't have the opportunity. If you find out you're positive seven days later, but you have not effectively quarantined yourself, then you have exposed a lot of people.

Unger: Can you give us some perspective on how many tests a day we should be doing relative to where we are?

Dr. Irons: I don't know that anybody really knows what that true number is. People have, have gone from anywhere from 750,000 a million a day, to tens of millions a day. I think that there are a lot of different opinions as to what that number should be, but I think the reality is that we're not anywhere near where we need to be.

I think people have congregated around that you'd like the positivity rate to be at 3% or less, and in order to get there, you have to test a lot of people just to see where you are and so that you can identify people and quarantine them, isolate them to get down to that number.

Unger: Well, in a very positive piece of news, big news coming out of the FDA about a test from Yale University. You want to talk about that new coronavirus test?

Dr. Irons: Yeah. And so it's a saliva based test. It is a genetic test, it's a different way of doing the diagnostic test. So that instead of taking 12 hours or even 24 hours, you can get your result much faster. And it is a saliva based test, which doesn't require the swabs and the media, and a lot of the reagents for running the test the way it has been run in the PCR based test. And so it allows labs to test larger numbers of people more effectively and more quickly.

Unger: That's very good news. According to our guests from last week on the show, Dr. Marcus Plescia, when we talk about contact tracing, that really is tied so closely in terms of our ability to be able to test larger numbers of people more regularly.

Dr. Irons: Absolutely. Yeah. You want to identify people quickly, identify their contacts, and then test, and this will certainly do that.

Unger: So let's talk a little bit about the latest research on children and their results for coronavirus.

Dr. Irons: Oh, absolutely. And sadly, it's not what we had hoped it would be. I think that since the beginning of the pandemic, we've known that children seem to be infected less often and seem not to be as severely affected as adults. That seemed to be what we were learning. What we're seeing now is that the numbers are higher than we would have expected. So the American Academy of Pediatrics, I think it was last week or the week before, issued a study that over 338,000 children have been infected, have tested positive since the beginning of the pandemic. But the number that is really startling is that 97,000 children were tested positive the last two weeks in July. And if you look at the reports coming out of the CDC, the hospitalization rate has gone up steadily from March through the end of July for children.

And if you look at the severe cases, about one third of the kids that are hospitalized end up in intensive care units. Some of those kids are ventilated. The disparities are there also. If you're a Hispanic child, you are eight times more likely to be hospitalized with COVID. And if you're a black child, you're five times more likely to be hospitalized with COVID than your white peers. And so we are seeing that kids are being infected, they are being hospitalized, they are being severely affected. And then we have known about the multi-inflammatory system disease that comes afterwards in kids.

Unger: Well, let's talk about vaccines and treatments. Any news this week?

Dr. Irons: Nothing really new this week. I mean, the phase three trials are continuing. We hope that enough people will volunteer for those trials, that we can start seeing those results coming in soon. And there are still several thousand trials going on for therapies. So nothing new, but things are continuing in the right way.

Unger: Okay. A couple of confusing issues that have popped up over the last few weeks. Talk first about the switch in data collection during the pandemic and what impact that's having on reporting.

Dr. Irons: So you might remember that in July, the hospital data collection system had always run through the CDC. And then at some point in July, HHS wanted hospitals to report more data elements. And in an attempt to be more nimble and add more data elements to a reporting structure, they asked the hospitals to report directly to HHS so that they wouldn't be double reporting to the CDC and to the HHS at the same time. The positive news is that it seems as though twice as many hospitals are reporting through the HHS data reporting system than had reported through CDC. However, it's taking time to clean up the data and the data wasn't being updated. It was over a week had passed before the updates to the data. The key indicators were being put out there on the public website. And some of those key indicators like hospital bed availability, ICU bed availability are what products and resources are allocated by, and also what local health authorities, governors, mayors used to direct some of their policies. And so we're watching that very closely.

Unger: There's also a new study about masks. We know that wearing masks are important, but apparently some masks are better than others, particularly about gaitors would be the one that was labeled as being problematic. Can you talk about that?

Dr. Irons: It was an interesting study. It came out over the weekend or at the end of last week, and it came from Duke and it was done actually by their physics and chemistry departments. And the goal of the study was to actually measure the efficacy of certain masks in transmitting viral particles, respiratory particles. And so they looked at 14 different masks and it started from the N95 respirators, and it went through surgical masks and a variety of cloth masks that looked like surgical masks with the ear loops that come close to your face, but then also had bandanas and neck gaitors. And what they found was actually the most efficient mask was an N95 respirator, which we would have thought. The surgical mask came in second, but many cloth masks that were made with more than one layer of cloth actually were almost as effective as the surgical masks, which was really good news.

I think the news that was more concerning to some people, especially athletes who tend to wear bandanas and the neck gaitors was that it wasn't as efficient. And in fact, I think it was the fleece gaiter that was less efficient than the control, which was no mask at all. And I think it's just that it was both the material that the mask was made from, if you hold the material up to the light and you can see through it, then it's not going to be effective. And I think a lot of the neck gaitors and the bandanas tend to be like a really thin one layer polyester. But then also there was some issue with the fleece masks that they thought it was affecting droplet size. So I think the take home from that was that the effective masks are ones that actually cover your nose, cover your mouth, and come close to your face rather than having an open area in the bottom.

Unger: All right. Well finally, any key messages from AMA that we want people to hear this week?

Dr. Irons: Yeah. So the AMA wrote a letter to Secretary [of Health and Human Services] Azar asking for prioritization for doctors and the public to also prioritize the use of diagnostic testing for COVID. Given the increased demand for COVID testing because of the surges, the decrease in the concern with resources, our focus was that testing should be prioritized to those with a medical need. Either symptoms of COVID, known contacts, testing that was required before a procedure, before a medically indicated procedure, and so that letter went out last week.

Unger: Finally, also something from the Michigan State Medical Society around prior authorization. Can you comment on that?

Dr. Irons: So Michigan Medical Society and the AMA released a survey finding potentially harmful consequences of prior authorization processes improved by health insurers, and actually found that the burdensome red tape adversely affected patient outcomes. Just adding to the delays in getting care for people.

Unger: So that has been known for some time that patients are suffering when that occurs in certain circumstances. So I know the AMA's position on that is that it must stop. So thank you very much. I appreciate you being here for our hundredth episode. Thanks for sharing your perspective and these important updates. That's it for today's COVID-19 update. We'll see you tomorrow for episode 101. For updated resources on COVID-19, go to ama-assn.org/COVID-19. Thanks for joining us...

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