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, reviews COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Also covering movement on FDA's Johnson & Johnson and Moderna booster EUA consideration, New York's vaccine mandate and Merck's antiviral COVID-19 treatment pill.
Learn more at the AMA COVID-19 resource center.
- Andrea Garcia, JD, MPH, director of science, medicine & public health, American Medical Association
Unger: Hello, this is the American Medical Association's COVID-19 Update video and podcast. 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, in Chicago as well. Continues to be good news this week about national rates of COVID-19 case numbers declining. Andrea, can you begin by sharing what's happening out there and what do we think is driving the decline?
Garcia: Yeah, Todd, well, thanks for having me back. We are seeing the number of daily new cases in the U.S. fall. They've fallen 35% since September 1 and the encouraging news is that the serious COVID illnesses are also declining. The number of people in the U.S. hospitalized with COVID has fallen about 25% since September 1, and like you said, the reasons are somewhat unclear and there's no guarantee that the decline in caseloads and hospitalizations will continue but the turnaround is now large enough and it's been going on long enough to deserve some attention.
Worldwide cases have also dropped more than 30% since late August, so that trend is consistent with that two-month cycle that we've talked about before. And since the virus began spreading in late 2019, cases have often surged for about two months, sometimes because of a variant like Delta and then declined for about two months.
Unger: We don't really know why this happens. I mean, I saw the graph. It's kind of startling when you look at these two-month cycles. At some point, hopefully someone will figure this out.
Garcia: Hopefully. Epidemiologists at this point don't really understand on why. Many of the explanations we hear, that it's seasonal or it ebbs and flows as social distancing mitigation measures are implemented more stringently, but that doesn't really fully explain it.
So the two-month cycle has occurred during different season and even when be human behavior was not changing in obvious ways. The most plausible explanation involves some combination of virus biology and social networks.
Perhaps each virus variant is especially likely to infect some people but not others and once many of the most vulnerable have been exposed, the virus recedes. So perhaps a variant needs about two months to circulate through an average community. We know that human behavior ... quickly also plays a role and as people hear about cases increasing, they become more careful.
Unger: It's interesting. I've seen a lot of the folks out there saying, "Is this the last large wave? Is this the last surge?" What do we think about that?
Garcia: Yeah, I think it's too soon to tell. I don't think we know for sure if these declines are going to persist, especially as we go into the winter months but there are definitely reasons to be optimistic.
The share of Americans who are 12 and over who received at least one vaccine has reached about 76% and there's a growing number of vaccine mandates that are likely to, as we know, increase vaccination. We're hearing about the potential authorization of the Pfizer vaccine for children age five to 11 and we know that will also increase vaccinations going into the fall.
Something like one-half of Americans have also probably had COVID already and that natural immunity helps, so it's still recommended that those individuals get vaccinated.
Unger: So those are some good pieces of news, finally, and it's interesting to start, hopefully thinking about a little bit about the end game here. What is the kind of current thinking on whether the virus will eventually disappear? How do we see this playing out?
Garcia: So COVID has not only been one of the worst pandemics in modern times. I think we all feel that it's been pretty unnecessarily bad. Of the more than 700,000 people in the U.S. who died from it, we know that nearly 200,000 people could have probably been saved, if they had chosen to take a vaccine.
The thinking is that COVID isn't going to disappear anytime soon and many scientists are starting to believe that'll continue to circulate for years but we know that the vaccine can transform COVID into a manageable disease, like cold or flu.
Unger: Well, speaking of vaccines, how are the numbers looking there?
Garcia: So 215.5 million Americans have received one dose. That's about 65% of the total population. Of those 185.5 million, are fully vaccinated or 56% of the population. So far, the CDCs indicating that 5.71 million people have received a booster dose.
Unger: There was also an escalated call from the CDC for pregnant and breastfeeding Americans to get vaccinated. The numbers are pretty incredibly compelling as to why. Can you tell us more about that?
Garcia: Yeah. So we saw an urgent plea from federal health officials. CDC issued a health alert. They're asking that anyone who's pregnant, planning to become pregnant or currently breastfeeding, get vaccinated against COVID as soon as possible.
We know that COVID poses severe risks during a pregnancy when a person's immune system is tamped down. This raises the risk of stillbirth or other poor outcomes, according to the CDC. Twenty-two pregnant people in the U.S. died of COVID in August. That's the highest number, in a single month, since the pandemic started and hospital data indicates that 97% of pregnant people who were infected with the virus when they were hospitalized, either for illness or for labor and delivery, were not vaccinated.
So vaccination rates among pregnant people are lower than the general population. Fewer than one-third were vaccinated before or during their pregnancy.
Unger: Those are startling and really sad. So everybody out there, I think you know those statistics and it's just even more compelling. Get that vaccine. Speaking of which, vaccine mandates have been all over the news this past week. The good news is they, overall seem to be working, to get more people vaccinated, especially the folks and those kind of holdouts. Can you tell us more about what we're seeing from whom and what the results are?
Garcia: Yeah. There's been a lot of focus on what's happening in New York in particular. That state has a mandate requiring more than 650,000 hospitals and nursing home workers to get vaccinated. That went into effect last week. This did prompt tens of thousands employees who had held out, to go and get their shots.
It's also, as you can imagine, prompted a flurry of lawsuits and judges across the state will be determining when and how to allow exemptions to those mandates.
While the number of people losing their jobs, as you see it in the news headlines seems large, so far the number of workers in New York who've actually walked away from their job is relatively small. And it's, we don't think likely to result in the staffing shortages that have hit other parts of the country.
Unger: That is good news. The AMA came out in support of these efforts. Can you just clarify for our audience out there, what the AMA stance is exactly on these mandates?
Garcia: Yeah. So the AMA issued a joint statement last week with the Medical Society of the State of New York in support of New York Governor Kathy Hochul's efforts to require health care workers to be vaccinated against COVID-19.
Part of the statement read, "The path to ending the pandemic must be based on science and vaccination is an indispensable part of the solution. The AMA, MSSNY and physicians we represent, understand that there are many who are confused and uncertain and we remind everyone with questions or concerns about COVID-19 vaccine, to turn to their trusted physicians to guide them."
Unger: Absolutely. Andrea, last week, we talked a lot about the Pfizer booster. There might be another booster on the way. Can you tell us about that?
Garcia: Yeah. So we've heard that Johnson and Johnson is planning to ask U.S. regulators this week, to authorize a booster shot for its COVID-19 vaccine and the FDA scheduled meetings of its expert advisory committee, on both October 14 and October 15, to discuss whether to grant an EUA for both Moderna and the J&J boosters.
The fact that the Advisory Committee meeting on J&J was scheduled before the company had filed an application to the FDA, I think reflects a particular sense of urgency, to provide guidance to the recipients of that vaccine.
Last month, J&J announced that a second dose given two months after the first, increased the vaccines effectiveness against symptomatic COVID by about 22 percentage points to 94%. And the company also said that two shots were a hundred percent effective at preventing severe disease, although that estimate was less conclusive.
Unger: Well, this week brought some other interesting news about a possible COVID treatment—an antiviral pill. What do we know about the pill? And do you think this is be a game-changer?
Garcia: Well, Merck announced last Friday in a press release, that its pill to treat COVID-19 was shown in a clinical trial to cut in half the risk of hospitalization or death when given to high-risk people early in their infection. The strong results are promising and they suggest that a new effective and easy-to-use treatment for COVID will become available in the U.S., though supply is likely to be limited at first.
Garcia: Merck said it's going to seek an EUA from the FDA for its drug and the medication could be available by later this year. Merck's drug would be the first oral antiviral pill to treat COVID-19 and it's likely to be followed by a number of other antiviral pills, that companies are racing to bring to the market. I think it is important because a pill has the potential to reach more people than the antibody treatments that are being widely used right now in the U.S.
Unger: It's kind of another tool in the armament, so to speak. I mean, I've had Tamiflu when I've ... Very early in the process of being diagnosed with a flu. Is that kind of how we see a pill like this kind of contributing to our overall efforts to fight the pandemic?
Garcia: Yeah, we do. I mean, I think it's another tool in our toolbox that will help protect people from the worst outcomes from COVID but it's not a substitute for vaccination. We know that that is the best tool. It can prevent you from getting COVID in the first place. We want to prevent infections, not just treat them when they happen.
Unger: Do we know how this pill actually works?
Garcia: The Merck drug is designed to stop the virus from replicating by inserting errors into the viruses genetic code. Physicians will prescribe the treatment to patients who will receive the pills from pharmacies and the drug is meant to be taken four capsules, twice a day, for five days. So, that's a total of 40 pills over the course of the treatment.
The federal government has already placed an advanced order for 1.7 million courses of the treatment, out of a price of about $700 per patient. That's about a third of the cost of the monoclonal antibody treatments, which are typically given to patients intravenously.
But again, the limited supply is going to mean that only a small number of people will receive it, at least initially but it's always good to have another tool to fight this virus.
Unger: Absolutely. 40 pills is ... That's a lot. But the other important point you brought in there in terms of, I guess, being more convenient and a lot less expensive than the monoclonal antibodies. It is another important tool in the chest, if that comes to pass.
Andrea, I see we have a battle of home renovations occurring on both ends of this conversation, so we'll call it a day for today's COVID-19 Update and be back with another segment with you next week. For more information 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.