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


In today’s COVID-19 Update, a discussion with AMA's Director of Science, Medicine & Public Health, Andrea Garcia, JD, MPH, to review COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Also covering booster shots, end-of-summer case numbers and trends, as well as the growing shortage of ICU beds across the U.S.

Learn more at the AMA COVID-19 resource center.

Speaker

  • Andrea Garcia, JD, MPH, director of science, medicine & public health, American Medical Association

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 have our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Director of Science, Medicine and Public Health Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer also in Chicago.

Andrea, coming off a holiday weekend, I'm just going to guess and say, this is not where we thought we were going to end up this summer. What do you see in terms of the latest statistics and the outlook for us going into the fall season?

Garcia: Thanks for having me Todd. And that's right, we know summer began with a huge drop in COVID cases in the U.S. and the real hope that the worst of the pandemic was behind us. And we're now ending this season with increasing deaths, full hospitals and I think the realization that this virus is going to be with us for the foreseeable future.

And while vaccine rates are ticking upward, the reports of new infections are starting to fall in some of those really hard hit Southern states. Really, Labor Day weekend bears little resemblance to Memorial Day when the country was averaging fewer than 25,000 cases daily or even the Fourth of July when President Biden spoke about nearing independence from the virus.

So right now, we're seeing more than 160,000 new cases a day and about 100,000 COVID patients hospitalized nationwide and more than 1,500 Americans are dying most days. That's worse than when cases surged last summer but it's still far lower than the winter peak.

Unger: I'm going to assume that the fact that we are below the winter peak of last year is due to the power of the vaccines. Does that explain where we are right now?

Garcia: Yeah, vaccines are effective in preventing severe disease and death but we know that 47% of the U.S. population is not fully vaccinated. And that is really allowing the Delta variant more than enough opportunity to inflict suffering and disrupt our daily lives.

Health officials still say that most of the patients who are being hospitalized and who are dying are not vaccinated and that it's the unvaccinated population that is driving the current surge, which we know is overwhelming our health care system.

Unger: And I know that, I mean I guess it depends on how you look at it then but the surges in addition raise some questions about the waning immunity among the vaccinated. We did speak with our ACIP liaison, Dr. Sandra Fryhofer, last week about boosters and that September 20 date that the administration gave for offering them to the general public. At that time, she told us that the data was currently under review and we need to wait for FDA approval and an ACIP and CDC recommendation. Looks like that situation might be changing, where are we on booster situation?

Garcia: I think that's still the case. And in response to this, we know federal health officials have asked the White House to scale back their plan to offer booster vaccines to the general public on September 20. And they're saying that regulators really need more time to collect and review all the necessary data.

On Sunday, the White House chief of staff said it will only offer boosters once federal regulators have offered their support. His exact words were, "I want to be absolutely clear, no one's going to get boosters until the FDA says they're approved or until the CDC advisory committee makes a recommendation."

Prior to that, last Thursday, Dr. Woodcock, the acting commissioner of the FDA and Dr. Walensky, the head of the CDC, told the White House that their agencies may be able to determine in the coming weeks whether to recommend boosters but only for recipients of the Pfizer vaccine and possibly just some of the population to start.

With that being said, over the weekend, we heard Dr. Fauci say that any delay in clearing the Moderna booster would be only a few weeks later at most. Regulators are really just beginning to review critical data that will help them determine how to proceed on the issue of boosters so we're in a bit of a wait and see mode for now. We know that FDA's advisory committee is meeting on September 17 to discuss the Pfizer data and the ACIP meeting dates have yet to be posted.

Unger: And hopefully that will bring some more clarity to the situation. On top of that, we have some health experts that are still arguing that before we start trying to emphasize boosters for vaccinated people, we should still be putting in more effort to reach more of the unvaccinated population. As you mentioned, 47% of Americans are still not fully vaccinated. Where do we stand on vaccinations as of this week?

Garcia: So about 950,000 vaccine doses are being administered each day. That's up from a low point of about 500,000 doses per day in late July. 206.9 million people, or 62.3%, have received at least one dose of a COVID-19 vaccine. And that includes about 176 million people or 53% who've been fully vaccinated. The CDC is also reporting that more than 1.3 million fully vaccinated people have received an additional primary dose since August 13. That's the day after the FDA opened up eligibility for third doses for some people with weakened immune systems.

Unger: And I'm going to guess that the states with kind of the lowest vaccination rates are probably the ones that are seeing the most significant surges. Is that what you're seeing out there?

Garcia: That's right. And Kentucky made news over the weekend as the governor there called the situation dire. The state recorded a seven-day average of 4,423 new daily cases on Saturday. Deaths and hospitalizations have been rising there too and we know that about a fifth of Kentucky school districts have had to close temporarily because of COVID infections since classes began last month.

Unger: And we were reading about Governor Beshear and a lot of the flexibility he had to make, decisions have been kind of hands tied, the legislature there. And it just points to the fact that politics have played a big role here. We'll actually be talking to Dr. Steven Stack, former AMA president and now the commissioner of the Kentucky Department of Public Health about what's going on in Kentucky, how they're handling that. And in addition to that, we are also continuing to hear about a shortage of ICU beds across the country. Any updates there?

Garcia: Yeah. Oregon and Idaho have joined the list of U.S. states that are running out of ICU beds as they confront a surge in new infections. The Oregon Health Authority reported on Saturday that only 50 of the states' 638 ICU beds were available. In a statement last week, Idaho's governor said that just four of the states nearly 400 beds were still open. When we look at the national picture, we know that the Delta variant has filled hospitals in many states. When we look at the HHS data, only a handful have more than 30% of their overall ICU beds still available. And many, like Oregon and Idaho, have less than that. And we know that this means hospitals are once again approaching really difficult scenarios and having to decide who can be treated and who cannot.

Unger: And that is really concerning because we're at a pretty vulnerable time with kids going back to school, colleges starting up as well. There are a couple of new studies that have been released by the CDC confirming that what we've been hearing, which is pediatric hospitalizations due to COVID, increased a bit over the summer. Can you tell us what we're seeing right now?

Garcia: Yeah. The new studies, as you said, have confirmed the upward trend of children being hospitalized for COVID. One of the studies looked at data from late June to mid August and the hospitalization rates in the U.S. for children and adolescents increased nearly five fold, although they remain slightly below that January peak. The study also showed the same thing we found in adults and that is vaccination does make a difference.

Unger: Can you talk a little bit more about the details of that? What are we seeing?

Garcia: Yeah. So during the summer wave, the hospitalization rate was 10 times as high in unvaccinated adolescents as in those who were vaccinated. According to a second study, pediatric hospital admissions were nearly four times as high in the states with the lowest vaccination rate as compared to those in the highest vaccination rates. The study also found that COVID related emergency room visits among children were more than three times as high in the states with the lowest vaccination coverage compared to the states with the highest vaccination rates. So I think these findings really underscore the importance of community-wide vaccination to protect children.

Unger: Are there any other kind of key takeaways? What does this mean?

Garcia: Yeah, so it's difficult to determine causality from the numbers. We still don't know if the increase in hospitalizations are because Delta is more severe or if it's because it's more transmissible. And we know that these increases could also be in part due to other factors, such as masking. We do know that the weekly rates of pediatric hospitalizations have been climbing since July. Those rates have increased the most sharply for children who are aged four and younger. With all that being said, based on the limited data available, it doesn't appear that the Delta variant is affecting the incidents of severe disease or death among children, which have been somewhat steady and relatively low throughout the pandemic.

Unger: And lastly, ivermectin continues to be a pretty hot topic. The AMA issued some pretty strong statements about ivermectin last week. Will you just give an example of what that looked like?

Garcia: Yeah. So last week, the AMA released a joint statement with the American Pharmacist Association and the American Society of Health System Pharmacists. That statement strongly opposes the ordering, prescribing and dispensing of ivermectin to treat COVID-19 or prevent COVID-19 outside of a clinical trial. We know that ivermectin has not been approved by the FDA for use in preventing or treating COVID-19 and the statement urges physicians, pharmacists and other prescribers to warn patients against the use of ivermectin outside of FDA approved indications and guidance. I would also add that we know the veterinary forms of this medication are highly concentrated for large animals and they pose a significant toxicity risks for humans.

Unger: And for those of you who are interested in hearing more about ivermectin, we're going to have Dr. John Farley, a physician from the FDA on tomorrow's COVID-19 Update.

In the meantime, Andrea, thanks for being with us here today and sharing your perspective and the latest trends. We'll be back soon with another COVID-19 Update. And for resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us. 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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