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 the Delta variant, which states are seeing surges, mask mandates and how to reach the "movable middle" among Americans yet to be vaccinated.

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, last week we heard from Dr. Walensky, the CDC director, and her tone had changed noticeably. Can you tell us about her message and what feels like a worsening outlook for us right now?

Garcia: Yeah. Thanks Todd. It's good to be here with you again. The theme of her message was really consistent with what we've been saying and that is that the U.S. is not out of the woods yet with this pandemic. And we find ourselves again at a pivotal point with the highly infectious Delta variant, which is significantly impacting unvaccinated communities. If you remember back to July 4, you know we seem to be throwing a party declaring independence from the virus, but the tone now we're hearing Dr. Walensky call the Delta variant one of the most infectious respiratory viruses known to scientists. And that's really concerning because we still have tens of millions of Americans who are not yet vaccinated. I think there's a growing sense of concern, especially among parents with young kids who are not yet eligible for the vaccine and even among those persons who are immunocompromised who may be fully vaccinated, but not yet fully.

Unger: Yeah. This a ... it's very unsettling. And I think a lot of people out there thought this was kind of over, at least in this country are ... We're looking again at the pandemic among the unvaccinated and a big concern. When you look at the stats for the weekly cases and deaths, what are you seeing there in terms of the trajectory?

Garcia: Yeah. So this week we are at 34,536,402 reported cases of COVID-19 and 611,012 deaths. So the number of new cases has increased by almost 250% since the beginning of the month. We're averaging about 50,000 new infections reported each day and that's up from 12,800 per day on July 1. We're also seeing increased hospitalizations and deaths. We've seen an average of 269 daily deaths over the past week. That's far fewer than the highest levels earlier last year but it's 19% higher than just last week. You know, we're still seeing that 97% of those hospitalized are unvaccinated, which further supports what we've been saying, that vaccines are effective against the variants in preventing serious illness and hospitalizations.

Unger: And that's a critical point in the discussion. You know, now that we're seeing kind of that incredible trend and not a good one, is there a discussion that you're seeing on reinstating a universal mask mandate given all this news?

Garcia: Yeah. So for now the CDC guidance for vaccinated individuals remains the same and masking indoors is not required. But it's being widely reported at this point that the CDC is actively considering revising its guidance. So we may see them recommend fully vaccinated individuals wear masks in public settings.

We're expecting an announcement on this at any time but we don't yet have the details of what the new guidance is going to say. But what we do know is that local health officials can take those steps. They need to protect the public in their jurisdictions when they're seeing higher cases or lower vaccination rates.

So last week we talked about LA County and their move to reinstate mask mandates in indoor public spaces for the vaccinated and unvaccinated. And this week we're seeing other jurisdictions take those same steps. So Provincetown, Massachusetts, St. Louis, Missouri, they're moving in that direction as well. And I would just also know that in Washington state we've seen a number of counties, including Seattle, King County, who are recommending that the vaccinated individuals wear masks in indoor public places because this is an extra layer of protection and it will help us all stay safer.

Unger: Some words from Dr. Fauci as well about revising these guidelines. Any word on that?

Garcia: Yeah. So he indicated that CDC is actively considering revising that guidance. And so that's really what we're seeing in the news today, that those conversations are happening and we can expect an announcement on that soon.

Unger: All right. And we'll be back to you with more information on that announcement. In the meantime, we are seeing a continuing trend in a number of states where the vaccination rates are lower relative to other states. Can you talk about which states are being most effective right now?

Garcia: Yeah. So every state is reporting growth in COVID-19 cases but the latest surge is really being driven by severe outbreaks in a handful of states. At the White House COVID briefing last week, it was noted that 40% of all new cases the prior week were recorded in just three states, Florida, Texas and Missouri. Florida continues to lead the nation in new cases, recording more cases this week than California, Texas, New York and Illinois combined. And like elsewhere, it's the unvaccinated that account for nearly all of its hospitalizations and deaths.

What we're hearing from epidemiologists is that there are various factors at play in Florida. It's the large number of unvaccinated people. It's the relaxation of prevention measures like mask wearing and social distancing. It's the spread of the Delta variant and people congregating indoors during hot summer months.

Unger: We've seen some pretty sad stories come out of those states. A doctor telling stories about people that are asking for the vaccine at the point of being put on a respirator. At that point, as the doctor said, it's too late. So get vaccinated. And are we seeing any kinds of signs of other severe outbreaks in other states? You mentioned that the rate is basically up across the board. Any other kind of issues of note?

Garcia: Yeah. Yeah. So if we look at Alabama and Mississippi, which have some of the lowest vaccination rates in the country, they're at only about 34% of their population in Mississippi. The daily cases is now up more than 200% in the past two weeks. And that is driving hospitalizations and deaths almost exclusively among the unvaccinated. In Alabama, the average number of new daily cases has tripled in the last two weeks to more than 1,100 a day. And that's the highest rates since mid-February.

We know that ICUs are filled and filling quickly in Southern Missouri and Northern Arkansas. And Louisiana, which was averaging fewer than 400 cases a day at the start of July, is now at more than 2,400 cases a day. And when we compare that to Vermont, which has fully vaccinated two thirds of its residents, the numbers there really look a lot better.

Unger: Well, I know that in many of those states are down mostly in the kind of south, I've seen the governor, I think, of Alabama out there kind of stumping for the vaccine. Are we seeing any kind of movement in increasing vaccination efforts there?

Garcia: So we're seeing some. So in the five states with the most significant rise in infections—Arkansas, Louisiana, Florida, Nevada, Missouri—we're seeing vaccinations rates beat the national average for the second week in a row. We know that immunity from vaccination takes time though. So it may take a while before we see the benefits of that increase in vaccinations in those populations. And with the Delta variant spreading so rapidly, we know that we may need to take other preventative measures as well.

Unger: Yeah, that's real catch-up mode given, especially because people need two doses of the mRNA vaccines, Moderna and Pfizer. So a lot of time built in there, to reach kind of that level of immunity from the vaccines. Do we know anything about this group that's kind of finally getting vaccinated? Are they being driven to do so by these outbreaks? What is making the difference and moving them ahead?

Garcia: Yeah. Todd, it's difficult to say for sure, who is getting vaccinated right now. It seems, obviously, that these people were not the ones who were really eager early on and rushed to get vaccinated. They're not that highly vaccine confident group. But it also seems that they're not the ones who are firmly opposed to vaccinations. So the New York Times did dozens of interviews in eight states last week and in multiple vaccines settings. So clinics, drug stores, mobile sites—and they're really talking to people about why they were getting vaccinated and try and get a better picture of who this group is. And I think what they found is this is, this is the middle ground. This is what we call that movable middle or the uncommitted.

Unger: Such an important term and marketing from my world, is to understand that movable middle and kind of figure out what kind of messaging it's going to take to move them, versus hardcore resistors on the far end of that. You know, it's not just kind of one block of people. It takes a lot of different messages to really close that gap. Any kind of insights from that article or in other places on how we reach that movable middle?

Garcia: Yeah. So we know that they have either been unwilling or unable to receive a COVID-19 vaccine until now. So it's either taking someone or something. It's either a persistent family member, a work requirement or a growing sense of seeing the millions of people who've been vaccinated and this realization that they're safe, that may have convinced them to get vaccinated. So their answers suggest that it's either mandates or greater restrictions on the unvaccinated that could really help make a significant difference here.

We don't yet know like how many people are ultimately in this group and how many of them will get vaccinated and how quickly. And that's really what we need to know to understand the course of the virus in the U.S. But obviously we do know that there's great potential for physicians to help move this group. A physician strong recommendation for a vaccination really goes a long way here.

Unger: Yeah. I just read yet another story this morning about what it's really going to take to move people. And again, physician trust rises to the top of that list each and every time. You know, beyond the states that we're talking about right now, any other kind of overall observations about the vaccination rate nationally?

Garcia: Yeah. So providers are administering about 530 doses per day on average. And that figure has been holding pretty steady in recent weeks but it obviously remains well below our April peak. About 3.3 million people were getting vaccinated per day then. The CDC is reporting about 188 million people who have received at least one dose of a COVID-19 vaccine. That's 56.8% of the population, and that's 163 million people or 49.1% who have been fully vaccinated. The percentage of adults, so people 18 and older, who've received at least one dose of vaccine is at 69%. So we're just shy of that 70% mark that we hoped to reach by the Fourth of July. But I would note that when we look at that number on a state by state level, we've only, we're only at about 22 states that have met that 70% threshold.

Unger: Yeah, that really is the underlying story there, the difference between states. Especially with what we're seeing now with the Delta variant. And it's good to see. I mean, it's been, you know, two weeks past that quote, original deadline, but seeing where we are right now at 69% overall, that is good news. But still a lot more work to go.

You mentioned this issue about mandatory vaccines and, you know, there was some news yesterday with the AMA and a number of other groups. Can you talk about what that announcement was?

Garcia: Yeah. So in line with everything that we've been talking about today, the AMA joined 55 other health care organizations and societies in supporting vaccine mandates for all workers and health care and long-term care settings. That joint statement, which was released on Monday, said that mandating vaccines is the logical fulfillment of the ethical commitment of all health care workers to put patients and residents of long-term care facilities first.

Unger: We are going to have Dr. Susan Bailey, AMA's past president, on shortly to talk more about that announcement and what it means. So you can look forward to that later this week. That's it for today's COVID-19 Update. Andrea, thanks for being with us today and sharing your insights. We'll see you again next week for another update. In the meantime, for updated 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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