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, about COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Including CDC's updated testing and masking guidance, as well as details from the recently released Morbidity and Mortality Weekly Report (MMWR).

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  • 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, a lot has happened over the past week. Big update from the CDC around mask guidance. Can you give us a quick recap of the change?

Garcia: Yeah, so thanks for having me Todd, and last week we were sort of anticipating what this change would be and we were expecting an update from CDC. And what we heard last week is they're shifting their guidance for vaccinated individuals to call on them to again wear masks in public indoor settings, especially in those areas of the county where we're seeing high or substantial levels of community transmission of COVID.

Unger: You know, Andrea, a lot of the headlines that you see out there say something to the effect of the CDC reversing their earlier decision but that's not really a fair take on this. I mean, there's a reason they changed the guidance, right?

Garcia: Right, and I think CDC had sent out when they announced their guidance a few months ago that as we get new information, we can expect the guidance will shift. And that is really what we are seeing here is the CDC has new information based on an outbreak in Massachusetts, and that new information is resulting in a shift in the guidance.

Unger: And so there was some pretty specific guidance on the masking part about who needs to start wearing a mask indoors. What's the way that that is determined at this point?

Garcia: Yeah, so the CDC website, specifically the CDC COVID Data Tracker has a county level map where people can see the transmission level in their area. So if you fall into one of those red or orange categories, those are areas of known concern and that is where CDC is recommending that individuals mask up in indoor public settings. We know that over two-thirds of the country are currently within those areas and we're seeing substantial transmission in all 50 states so people should continue to watch that map, which I understand is updated daily, and see if their area falls into one of those areas. And if it isn't now, it certainly could be soon given what we're seeing.

Unger: Wow. That statistic that you gave that over two-thirds of U.S. counties have high or substantial transmission. That's pretty startling given where we were just a short time ago. Are there any times when fully vaccinated people are advised to wear masks, even in areas where the transmission isn't high?

Garcia: Certainly, and I think it depends on your individual risk as well. We certainly ... you don't have to wait until your area is in one of those categories to mask up if you want to take extra steps to protect yourself. But what the CDC is saying is fully vaccinated people could wear a mask regardless of transmission, especially if you're immunocompromised, you're at increased risk for severe disease or if someone in your household is at increased risk for severe disease and, of course, if you have kids who are not yet eligible to be fully vaccinated. I think the other big piece of news that came out from CDC is they're recommending universal indoor masking for everyone in schools regardless of vaccination status and local transmission rates, and this really brings the CDC guidance in line with the recommendations of the American Academy of Pediatrics.

Unger: There's a lot of news. A lot of guidance in this latest announcement. One of the pieces that may not have gotten as much attention is in regard to testing. Can you talk about that change in guidance?

Garcia: Yeah, so the CDC is now recommending that fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID to be tested three to five days after their exposure and that you continue to wear a mask in public indoor settings for 14 days or until you receive a negative test result. And this is a change because before what the guidance said is that fully vaccinated people did not need to be tested in the case of known exposure unless they became symptomatic.

Unger: And so why would a vaccinated person have to get tested then?

Garcia: Yeah, now that we know vaccinated people have a high enough viral load to transmit the virus to others, that testing change makes sense because they can be a person who's transmitting the virus, so that's why we see that change in testing.

Unger: Another set of words that most average people thought they would never be talking about viral load but that leads us to the next question, which is about the data that led to these changes that was reported in a report by the CDC on Friday. Can you talk about some of the specifics from that report?

Garcia: Yeah, so they published in their MMWR about some of the information about the outbreak in Provincetown, Massachusetts, and the takeaways there were that the Delta variant is more transmissible than what we originally suspected it would be but that also that immunized people who have a breakthrough infection can spread that virus to others. So we heard Dr. Wilensky explain that these high viral loads suggest an increased risk of transmission among vaccinated people with the Delta variant and this is concerning and it's a pivotal discovery. And like we talked about earlier, that's what is leading to this new updated mask recommendation. If the vaccinated people can carry high enough virus to transmit it, they can contribute to increases in new infections, although we think this is probably to a far lesser extent than unvaccinated people are at this point.

Unger: Well, it's interesting because, obviously, breakthrough infections among vaccinated people were always expected with what the effectiveness of the vaccines are but I think the big change here is the Delta variant, right?

Garcia: That's right. I mean, with the Alpha variant, we weren't seeing this ability of vaccinated individuals to transmit the virus to others. And that is really what has changed and what has led to the up-to-date guidance.

Unger: As contagious as chickenpox, I think that was the words that came out about that, which is very contagious. It's really changed the game, and thus, the guidance change as well. Obviously, vaccines remain the key to getting this under control and what are the implications that you're seeing out there in terms of vaccines? Anything else?

Garcia: Yeah, I would just say the vaccines are our number one public health intervention here. That's our primary tool we have against the virus. We're still seeing 97% of those hospitalized with COVID-19 are those who are unvaccinated. And like we talked about that transmission is still occurring mostly among the unvaccinated and that is who remains most at risk. So really we need to pick up the pace of vaccinations to decrease the number of people who are susceptible to severe illness.

Unger: It's pretty shocking when you think about the head start that we had here in the U.S. in terms of the pace of vaccination to see that vaccination in the European Union has exceeded the U.S. for the first time. That's a big change. So when we think about all of this news that's coming out, have we seen any changes with vaccination efforts nationally?

Garcia: We are seeing some increases, so providers are now administering about 673,000 doses per day on average. That's an increase. We had been hovering around that 530,000 per day mark. Obviously, this is ... It's still well below the peak in April. CDC's reporting about 191.8 million people as having received at least one dose of the vaccine, so that's 57.8% of the population, and 164.9 million or 49.7% who are fully vaccinated. I think the good news is we finally reached that 70% mark on Monday of adults over 18 who have received at least one dose of the vaccine. It's about a month later than we'd hoped for but it's good to finally reach reach that goal.

Unger: A second about immunization managers and just I think our closing was 192 million people have gotten at least one dose and hitting that 70% mark about a month later than hoped, those are big numbers but still a long way to go given the Delta variant and the impact that it's having right now. You mentioned that last week, we were seeing a slight up tick in vaccination in some of the hardest hit areas. Florida, for instance. Big news there this week. Are we seeing that trend continuing?

Garcia: Yeah, so that trend is continuing. Vaccines are rising in those states that are experiencing those surges of the Delta variant, so for the third consecutive week, states with the highest number of COVID cases have had the highest vaccination rates. So Mississippi, that seven-day average of those who've received the first dose has more than tripled in a month. That same pattern can be seen in Louisiana where that seven-day average of the first dose has almost quadrupled. And in Missouri, that number of first doses has almost doubled over a month. So this gives us some hope but I think overall these jurisdictions are still lagging behind the rest of the country and their overall rates remain low but I think it is promising to see these numbers increasing.

Unger: How are we actually doing when you're looking at specific number of cases this week?

Garcia: Yeah, so this week we surpassed 35 million confirmed COVID cases. We're at 35,135,404 reported cases of COVID and there are 613,769 reported deaths. So we know that Delta variant is now responsible for almost all new COVID cases in the country, and the seven-day average of cases is up 64% compared to last week, so we're at 66,606 cases for the week that ended on Friday.

Unger: You know when we were talking a minute ago about kind of state by state, one thing I didn't hear from you is about Florida, and can you tell us what's happening there?

Garcia: Yeah, so Florida continues to be really a hotspot for COVID transmission. They reported 21,683 new cases on Friday alone. That is the highest one-day total since the start of the pandemic. And on Sunday, they broke the previous record for current hospitalizations, reporting about 10,000 people hospitalized with confirmed COVID cases and that previous record was for more than a year ago. So there, Florida's really leading the nation in per capita hospitalizations for COVID. Their health systems are reaching a point of being overwhelmed. We're hearing that the cases there are younger and younger, and they're starting to have to put emergency room visitors in hospital beds in hallways. And at the same time, we're seeing the governor resisting mask mandates there and we saw the executive order signed on Friday, which said parents have the power to decide for themselves whether or not their children wear masks in schools this fall. So obviously, that's counter to what the recommendations of the CDC and the AAP are at this point.

Unger: Hard to understand given again, another astounding number, almost 22,000 new cases on one day, the highest since the pandemic started. That is definitely not the direction where we're hoping to see here. In terms of kind of heading that off, one of the things we are seeing are more employers asking for proof of vaccination. Can you talk a little bit about that?

Garcia: Sure. Yeah, I think part of that is we saw the Department of Justice released a memo which said that there is no federal law that prohibits mandates for these vaccines while they're under an EUA and so we're starting to see more employers move in that direction. Certainly, it's notable that President Biden announced that there would be really a two-tier system for our federal employees, there are 4 million federal employees. So those who don't get vaccinated will have to social distance, they'll have to be tested regularly, they'll have to wear a face covering and they also will face limits on official travel. So that really felt short of a mandate because you have a choice between masking or taking these other public health preventive measures but we're seeing more move in this direction. And certainly, Google and Facebook, for example, recently announced that they would be mandating vaccinations for U.S. employees before they return to the office. So we're hoping that we'll see other employers move in this direction as well.

Unger: Of course, we saw last week a group of health care organizations, including the AMA, supporting mandates for health care workers. Seeing lots of activity among universities, colleges, Indiana University mandate just upheld as well, so lots developing there. In terms of other messages, anything else from the AMA that we should let folks know about this week?

Garcia: Yeah, I would just note that the AMA released a statement in support of the CDC's updated mask guidance, noting that with continued increasing spread of COVID in the U.S. the number of people who remain unvaccinated, that this updated guidance for vaccinated individuals is really needed to help curb the spread of COVID, particularly the Delta variant, and that wearing a mask is really a small but important measure that we can take to help us all stay safer. And then of course, we continue to strongly encourage everyone who is eligible for a COVID-19 vaccine to get vaccinated as soon as possible. If you have questions or concerns, speak with your physician and review trusted resources, including

Unger: Absolutely, and I think you hit on the important thing is we're hearing more and more talk to your physician and get vaccinated. And that wraps up today's COVID-19 Update. Thanks again, Andrea, for being here, keeping us informed on the latest numbers and trends. We'll be back soon with another COVID-19 Update. For resources on COVID-19, visit Thanks for joining us today. 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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