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

 

In today’s COVID-19 Update, AMA Chief Experience Officer Todd Unger reviews rising COVID-19 case numbers and trending topics related to the pandemic over the past week with AMA Director of Science, Medicine and Public Health Andrea Garcia, JD, MPH. Also covering the World Health Organization's (WHO) opinion on life post-Omicron, as well as newly published data from the CDC, JAMA and what that research means in the battle against the current U.S. COVID surge. Additionally, the FDA has revised authorizations for two monoclonal antibody treatments—a topic AMA's immediate past president, Susan Bailey, MD, will be discussing in an upcoming webinar with experts from the FDA.

The webinar: "COVID-19: What to know about therapeutics and other treatment options" is scheduled for Tuesday, Feb. 1, at 3 p.m. Central.

Register and submit questions for the webinar.

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 video and podcast. Today we have our weekly look at the numbers, latest news and trends 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, thanks for joining us again this week. Last week, we talked about just the surge in Omicron cases, just continuing to climb across the country, with some of the early hotspots showing signs that it may be peaking. Can you give us a picture of what it looks like this week?

Garcia: Well, thanks for having me, Todd, and yeah, the good news is that the progress that we talked about last week, mostly at that time in a handful of Eastern cities, has now spread to more of the country. So new COVID cases are finally starting to fall nationally and we've seen more and more states sort of past that peak in recent days. By the end of last week, the country was averaging around 720,000 new cases a day, that was down from 807,000 the week prior. And then as we look at Monday, we're averaging about 690,000 daily cases and that's lower than it has been but of course it's still far higher than any other point in the pandemic.

Unger: Well, it might be just too you early to ask this question then because we're obviously not in the clear yet but are we heading toward the clear at this point?

Garcia: I mean, it's definitely positive news and we're continuing to really identify more infections per day than any prior surge and some states in the West and the South and the Great Plains are still seeing really sharp increases. And even though hospital admissions are leveling off, many, many hospitals are still full. If you look at Mississippi, for example, they're reporting nearly all of their state's acute care hospitals are pushed to capacity. And then deaths are continuing to mount. We know that's a lagging indicator, so we could still see those go up and right now, we're seeing about 2,100 deaths per day. Still, the overall decline in cases is bringing this sense of relief that we are finally heading in the right direction with the surge.

Unger: We certainly hope so and our thoughts continue to be with all of those folks on the front lines out there. As you point out, still tremendous capacity issues at many hospitals and health systems across the country.

If you look at South Africa as an example of kind of a leading indicator of what might happen here with Omicron, what can we learn from that situation as far as where they are right now?

Garcia: Yeah, so states are seeing cases fall as quickly as they rose. And that is similar to what we saw in South Africa. New cases in South Africa have fallen 85% from their mid-December peak to about 3,500 cases per day, that's down from a high of 2,400 but they do remain above levels seen in South Africa the weeks before Omicron. So they haven't totally leveled off.

Unger: So again, looking at your crystal ball, what do we think a post-Omicron future looks like for the U.S.?

Garcia: So during an appearance this week, Dr. Fauci said what we would hope is that as we get into the next weeks or the months or so, that we'll see throughout the country, the level infections get below that area of control. And we talked about that last week. That doesn't mean that we're eradicating the virus, infections will continue but the goal and the hope really is that they don't disrupt society, that our health care systems aren't overwhelmed. And while he confirmed that we're heading in the right direction, many are still struggling, particularly those with large unvaccinated populations. And so I think while we're optimistic, the warning is not to get too overconfident. This virus has surprised us before and that could certainly happen again.

Unger: When you're looking at that crystal ball, is there an answer to whether I'll ever be able to go back to the gym again or not? That's the answer I'm looking for right now. I'm sitting it out still. Interestingly, the World Health Organization also weighed in. I think people are starting to look at this kind of possibility of a post-Omicron future and what that looks like. What did the health officials there have to say?

Garcia: So WHO officials are saying that Omicron spread could help end the emergency phase of the pandemic and that the variant really offers hope for stabilization and normalization. I think others are taking a more cautious approach, including the head of the WHO, he said, "It's dangerous to assume that Omicron will be the last variant or that we are currently in the end game." Either way, I think most scientists agree that Omicron will leave behind much higher levels of immunity in the population. I think the issue is that protection offered by previous infection could wane over time and it also might not apply to future variants.

Unger: And those are really kind of two separate issues. One of the emergence of another variant, I mean, this one kind of came out of nowhere pretty fast globally, but the issue about immunity once you've had Omicron, particularly if you've been vaccinated, you have a breakthrough infection. These are questions on everybody's minds. What do we know for a fact about immunity from an Omicron infection?

Garcia: So there's been a lot of talk about hybrid immunity and that's what results from a combination of preexisting vaccine antibodies and then natural antibodies from a breakthrough infection. In other words, a fully vaccinated person who gets infected, they are left with this hybrid immunity. And as we talked about earlier, scientists generally agree that people have an elevated level of protection after a breakthrough infection. And some have compared this immunity boost of a natural infection to getting a fourth dose of vaccine.

Unger: So I guess the question that goes along with that is for people that have been vaccinated, they've had a breakthrough infection, should I be envious of them because they can go back to a normal life now where I'm still taking precautions, at least in the kind of months to come? Is that a possibility?

Garcia: Well, I think there's just still a lot we don't know in terms of the strength and durability of that hybrid immunity and the variability that we see between individuals. And so what we're hearing experts say is proceed with caution. I think intentionally getting infected to gain hybrid immunity is not something that we would recommend because the virus is unpredictable and we know that even young, healthy people can end up in the hospital. And then there's the possibility of long COVID, even if you have a very mild infection. So it's important for the public to be aware of this and it's important for physicians to really stress this with their patients.

Unger: So don't let that guard down I think is what I'm hearing from you at this point. We continue to learn a lot about vaccine effectiveness and Omicron. New data was just published by the CDC on Friday. Tell us about that.

Garcia: Yeah, so there were three separate studies released late last week on booster doses and the findings really suggest that booster doses for Pfizer and Moderna are not just reducing the number of infections with Omicron but they're also keeping infected people out of the hospital. The extra doses are 90% effective at preventing hospitalization with the variant. And they are also reducing the likelihood of visits to the emergency department or to urgent care clinics. The data showed that extra doses are beneficial against infection and death, particularly among those age 50 and older. And we heard Dr. Walensky say on Friday that these reports add even more evidence to the importance of being up to date with COVID vaccinations, which obviously includes booster doses for those who are eligible.

Unger: This kind of story so to speak about the vaccines being so important to prevent infection and also just dramatically effective against severe effects, hospitalizations, death, is this new information that's coming up?

Garcia: So it is new information but we did have previous information. I mean, FDA and CDC looked at data when they were authorizing and recommending booster doses. So a lot of that data at that time was from Israel. So this is some of the first data we're seeing come out of the U.S. and some of the first data that we're seeing around effectiveness against the Omicron variant. So these studies are by far the most comprehensive and reliable assessments of the booster shots and the role they're playing in the U.S. pandemic.

Unger: Anything interesting about how these studies were put together? What did they look at?

Garcia: So they really looked at millions of cases and tens of thousands of hospitalizations and deaths. Like we said, two were from CDC, published in MMWR, the other published in JAMA. The first study looked at hospitalizations and emergency room and urgent care center visits in 10 states over a few month period. The second focused on COVID-19 cases and death rates in 25 states. And that was from April to December. And then a third study looked at people who tested positive for COVID from December to January at more than 4,600 testing sites across the country. So really when you look up these studies together, it's a really powerful case that boosters are a valuable defense against Omicron. And yet we know there's 40% of fully vaccinated Americans who are eligible for boosters who have not yet received one.

Unger: Well, those are the facts. And I'm curious, are they driving an increase in vaccinations or do we continue to see kind of plateau there?

Garcia: So I think we're seeing the number slowly inch up. According to the CDC this week, a total of 251 million Americans have received one dose, that's 75.6% of the total population and of those, 210.5 million are fully vaccinated. That's 63.4% of the population. And we are at about 84.3 million people who have received a booster dose.

Unger: Now in other news, Omicron has caused the FDA to look at the effectiveness of some of the COVID treatments, specifically monoclonal antibodies. What's the story there?

Garcia: Yeah, so recent data has shown that two of monoclonal antibody treatments that we've been using are highly unlikely to be effective against the Omicron variant. And based on this data, we are seeing the FDA revise its authorizations for these treatments. They're limiting their use to only when a patient is likely to have been infected with or exposed to a variant that is susceptible to these treatments. And because we know that Omicron is circulating at a very high frequency, about 99% according to the CDC, these treatments are not authorized for youth in the states, territories or any U.S. jurisdictions at this time. The FDA did say that if in the future patients in geographic regions are likely to be infected or exposed to a variant that is susceptible to these treatments, then the use may again be authorized in those regions.

Unger: AMA weighed in on that decision too, supportive of that move.

Garcia: Yeah, so the AMA released a statement in support of that decision, and I'll just quote, "Given the latest data showing the Omicron variant of SARS-CoV-2 is responsible for 99% of current COVID infections, we're pleased that the FDA is following the scientific evidence and limiting the use of monoclonal antibody treatments to those that are effective against the Omicron variant. Limiting the use of these treatments will help ensure patients receive the best available therapy." And of course, we recommend that physicians take a look at the NIH COVID treatment guidelines. They have the latest information about authorized therapies and recommendations for their use. And while treatment is great, prevention is better, so we strongly encourage everyone to make sure they're up to date on their COVID vaccines, including booster doses when eligible.

Unger: Lots of new information, things always changing. And for those who want to know more about therapeutics, the AMA is doing a webinar with experts from the FDA, coming up on February the first. And you can find a link to register for that webinar in the description of this episode. So take a look there or check out the AMA site.

Andrea, thanks again for joining us. That wraps up today's episode. We'll be back with more information shortly. For additional 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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