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

COVID-19 July 7, 2020 update

In today’s COVID-19 update, Todd Unger, AMA Chief Experience Officer and AMA Chief Health and Science Officer Mira Irons, MD, discuss this week’s COVID numbers, trends and latest news.

Learn more at the AMA COVID-19 resource center.

Speakers

  • Mira Irons, MD, chief health and science officer, AMA

AMA COVID-19 Daily Video Update

AMA’s video collection features experts and physician leaders discussing the latest on the pandemic.


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. Before we get started, I just want to note that this week is Resident Recognition Week at the AMA, recognizing residents who are beginning their residency and also transitioning into practice post-residency. And we'll talk a little bit more about guidance from Dr. Irons. Dr. Irons, let's start with the numbers. Can you take us through what, again, has been sadly a record breaking week for the pandemic?

Dr. Irons: Absolutely Todd. The same things we've talked about last week are continuing to a greater degree in some states. So the current numbers are 2,888,730 people have been diagnosed with COVID disease, COVID in the United States. The deaths are about 129,947. The numbers continue when we look at what's happening around the country. Florida, Texas and South Carolina have had their single highest day numbers in the last few days. If you just look at Florida and Texas, it makes up about 43% of the increase we're seeing in the United States. Just to give some perspective, a few weeks ago, we were looking at 20,000 new cases in the United States. Now, we're in that 48,000, 49,000, 50,000 range on a daily basis.

Unger: How would you compare what you're seeing in Texas to the earlier days of the pandemic in New York?

Dr. Irons: So in fact, I can tell you that Florida's number yesterday was a little over 11,000. It is higher than any peak that New York hit in the pandemic, earlier on. Hospitals are starting to see it. We are hearing that hospitals in Texas, Arizona and Florida are starting to fill. I think in Houston and Austin, they're saying that hospitals will be at capacity within the next two weeks. This current trend continues. So we're, seeing in different parts of the country what we saw in Chicago, New York and the other major metropolitan areas a few months ago.

Unger: Now we obviously have surpassed 50,000 new cases in a day. Dr. Fauci warned that we could reach as many as a 100,000 new cases a day. What are the trends that are driving that?

Dr. Irons: So there's not one clear trend that's driving it. I think that over the last two or three weeks, four things have come together. We had the effect on Memorial Day, then we had the protests occurring. We had states that were opening to varying degrees and in various ways, and we had individual behavior. We have people who were tired of being at home, didn't want to wear masks and finally getting out. So it seems as though four things were coming together to create the increases that we're seeing. You've probably seen the pictures over the weekend. I mean we have concerns about the fact that we've just gone through another holiday weekend. There were beach parties, beaches were full. And so we're holding our breath to see what's going to happen from that.

Unger: What do you see as some of the responses at the state level to the spikes?

Dr. Irons: Well, a variety of responses. The Texas governor issued a mass mandate. I think that the Pennsylvania governor also increased the need to wear masks in public. We're seeing some governors pull back on—Or hit a pause, maybe hit a pause in advancing to the next step, or pulling back. Indiana was supposed to go to phase five today, I think, and they actually are going to phase four and a half so that they're not opening completely. Some governors are shutting down bars and large gatherings. And I think there's a concern about indoor, indoor events with large groups of people.

Unger: In Michigan, I think there was a rather large number of infections traced to a single bar.

Dr. Irons: Yes.

Unger: Is that right?

Dr. Irons: Yes. I don't know the details of it especially, but we're seeing that. You're seeing large infections to a single bar. I think last week I read about, and it might've been in University of Washington, there were a large number of students that had all been infected from being together and gathering. It just makes sense. It's a respiratory virus, it's spread from person to person. The more people you have in contact with each other for a greater period of time, you're just going to get that increased spread.

Unger: You may know that this week is our Resident Recognition Week where thousands of residents are beginning new residencies. In light of what we're seeing in terms of this week's numbers, do you have any advice or words of encouragement for residents right now, particularly for those that are completing their training and moving on to independent practice?

Dr. Irons: Yeah. So the first thing that I'd say, and I'm a former program director which has defined my life and will always define my life, thank you. Thank you for everything that you're doing. Thank you for choosing medicine as a career, and congratulations. And that applies to medical students that graduated, are entering residency, residents that are becoming fellowships or people that are finishing fellowships and going into practice. It's an extraordinary time. It's an unprecedented time and it's an extraordinary time. And there are certainly a lot of barriers that we have and a lot of problems that we have to deal with, but it's also an amazing time. It provides an amazing opportunity to really transform the health care system into a better health care system that's more equitable.

My only words of advice would be: really remember and internalize the privilege that people give us for caring for themselves and for their families, for their parents, for their kids, for their brothers and sisters. Take care of yourselves, take care of yourselves and your families. Never stop learning, and that's one thing that COVID really has taught us is never stop learning, but also never stop asking questions. Never stop questioning why we do things the way we do them, could we do them better? And those of us who are on the other side of our careers are always there to be helpful. So please, please call on us.

Unger: And thank you residents. Let's talk about broader guidance in terms of correcting or providing clarity around some that's been confusing. What do you see this past week?

Dr. Irons: So I think that one of the main things, and I wouldn't say it was correcting, I think it's more providing clarity, is the redefining of vulnerable people, populations of people that are vulnerable or at increased risk for the severe manifestations of COVID. The CDC did redefine those populations and that was actually based on information that we're getting from hospitalized cases in the United States. And so they did a few things that are interesting. One is that they took away that age limit. We were all so focused on 65 and above, but when you actually look at the hospitalized patients in the United States, you see increased risk as people get older. So it's a sliding scale and having people worry at one particular age doesn't provide the real picture.

They also added some more clarity about medical conditions, chronic renal disease, chronic heart disease, chronic lung disease, Type 2 diabetes, sickle cell disease, people who are immunosuppressed. And that includes people who are on chemotherapy for breast cancer or young children who are on chemotherapy for cancer. And then they added those are the people at the largest risk, but then there's a second level, moderate to severe asthma, Type 1 diabetes, hypertension. So I think that we're just getting more clarity in terms of who the high risk populations are.

Unger: There was some news out too about racial disparities quantifying the actual rate of that coming out of the "New York Times." Would you comment on that?

Dr. Irons: So I don't know the exact number to that, but I think you're absolutely right. When you look at racial disparities, it's a disproportionate impact on people in the African American and the Latinx communities. If you look at hospitalizations, if you look at mortality, if you look at diagnosis.

Unger: Yes. I think they quantified the contraction rate as being almost three times as high for black Americans and Latinos as white Americans.

Dr. Irons: Yeah. Yeah.

Unger: Any updates on vaccine development or trials timing?

Dr. Irons: So some promising encouraging results from the Pfizer vaccine that came out of their Phase 1 trials. So over the next two months, two to three months, we'll actually have four vaccines in Phase 3 trials. Now, Phase 3 are actually the trials that look at safety and efficacy. And so the Moderna vaccine, the Pfizer vaccine, the Oxford vaccine and the J&J vaccine are either starting trials in July, or it's July, August and September for all of those. There are large numbers of people that they're looking to enroll in those trials. They're also looking at different populations of people. So the elderly, the children, people who are in those vulnerable categories. But in order to determine efficacy, the vaccines have to be given at a time when there's an active disease in the community to look at whether or not you can become infected with COVID or not. So determining efficacy is really going to depend on the activity of COVID.

Unger: Finally, big announcement from the AMA, AHA and ANA about masks. Do you want to talk about that?

Dr. Irons: So just this morning I believe, the AMA with the American Hospital Association and the American Nursing Association issued a letter to the American people in terms of public health measures and how people should use simple public health measures, like wearing a mask, social distancing, hand hygiene, to help protect themselves but also to help protect others. One of the issues that we're seeing out there, and we've talked about this before, is even though younger people are thankfully usually less affected by COVID, they can actually transmit the disease to others who may not be; they may be in a more severe category. There's also a problem with asymptomatic spread. You can't just go by symptoms to try to stay away from people or to put a mask on. And because of that, really to protect yourself and protect others, we're encouraging people to wear masks, socially distance and wash their hands.

Unger: Yeah. So I think Dr. Harris, the immediate past president of the AMA, mentioned over the weekend, there's not a harmless case. You can either contract COVID, but you can also pass that on and we continue to make strong recommendations to please wear a mask, maintain physical distancing and wash your hands.

Dr. Irons: Yes, absolutely.

Unger: Well thank you so much, Dr. Irons. I want to thank you for your perspectives on this week's COVID-19 update, and whether you are entering a residency or transitioning to your post-residency position, we want to thank you and recognize the residents out there in America for all your contributions. We'll be back tomorrow with another COVID-19 update and for resources on COVID-19, go to ama-assn.org/COVID-19. Thanks for joining us and 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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