AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
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In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, covers the latest news physicians need to know, including: new updates from the FDA on Paxlovid, data from a recently released study on maternal mortality rates increasing in the U.S. and the CDC's warning on the spread of a deadly fungus, Candida auris. AMA Chief Experience Officer Todd Unger hosts.
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Unger: Hello and welcome to the AMA Update video and podcast. Today we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago. Welcome, Andrea.
Garcia: Thanks, Todd. It's good to be here.
Unger: Well, I couldn't tell when I was just first reading this first question whether this was from The Last of Us or actual headlines. You decide, but headlines talk about a deadly fungus that spread throughout the pandemic. What do we need to know here, Andrea?
Garcia: Yeah, so this is new research coming from the CDC that was published Monday in Annals of Internal Medicine and it looked at national surveillance data for Candida auris. And that's a drug-resistant fungus that health officials had hoped to contain, but it's now in more than half of states. It's just a handful of cases, but higher concentrations in California, Nevada, Texas and Florida. This fungus is considered an urgent threat by the CDC because it can cause serious illness and death, especially in people who are already sick or have longer, frequent stays at health care facilities or, of course, have weakened immune systems.
It's not a particular threat to healthy young people, but it can be transported on their skin or clothing. This fungus was first reported in the U.S. in 2016. At that time, there were cases in Illinois, Maryland, New Jersey and New York, and it was suggested that transmission might have occurred at that time in health care facilities.
Unger: So sadly, this is real and it is a danger. Andrea, how did this spread over the course of the pandemic?
Garcia: Yeah, so over the course of 2021, state and local health departments across the country reported 1,474 cases. That's about a 200% increase from the nearly 500 cases we saw in 2019. And it's likely because the pandemic, of course, shifted our attention with COVID, so less emphasis on screening for C. auris. But also the fungus tends to cling to nursing gowns, gloves and other PPE that normally is changed pretty frequently. But we know during the pandemic, that was often reused due to supply shortages.
Unger: Well, now that we are kind of where we are, what are we going to be able to do about that?
Garcia: Well, physicians should definitely keep an eye out for Candida auris, and health care facilities that suspect that they have a patient with this fungal infection should contact state or local public health authorities for guidance. We know contact precautions are used to manage patients with C. auris in acute care hospitals, and either contact or enhanced barrier precautions are recommended in skilled nursing facilities. Really intensive efforts need to be put in place to stop the spread of this, and we saw that previously in New York and Illinois, that seemed to be effective. So we can definitely learn from that previous experience and put those appropriate measures in place.
Unger: And we'll certainly keep an eye on that as news develops. Andrea, turning to COVID, we haven't talked much lately about the XBB 1.5 variant. What's the news there?
Garcia: So if we look at the CDC data, XBB 1.5 is now about 90% of COVID cases here in the U.S. And if you remember, just three months ago in mid-December, it was only about 7% of cases. So it's really remarkable how quickly it became the dominant strain. Currently, there doesn't seem to be another variant that's going to replace it any time soon and the WHO hasn't identified a new variant of concern worldwide. And XBB 1.5 was downgraded from a variant of concern to a variant of interest.
Unger: I guess that is a piece of good news, but what are the numbers looking like?
Garcia: Throughout the U.S., we're really seeing reported cases, hospitalizations and deaths all decreasing over the past two weeks. If we look at The New York Times data, there are about 22,300 new cases of COVID on average per day. That's a 34% decrease from two weeks ago. Hospitalizations are down about 14% from two weeks ago, so we're at about 22,500 people hospitalized with COVID per day.
There are still about 330 deaths per day on average, but that's a decrease of about 38% from two weeks ago. And then I think if we look at test positivity, which is another good indicator, it's around 7%. And that's also declined about 14% over the past two weeks. So I think promising signs all around that these declines that we're seeing are unlikely to change course, at least in the very immediate future.
Unger: And that is good news, then. On a separate note, the CDC released a report last week that captures another casualty of the pandemic, maternal health. What are the key takeaways from that report?
Garcia: Yeah, so that report is titled "Maternal Mortality Rates in the United States," and it shows that not only is the number of women who died from maternal causes in the U.S. rising but that we saw a really sharp increase in 2021. In 2021, the number of women who died of maternal causes was 1,205. And if we look at previous years, there were about 658 maternal deaths in 2018, 754 in 2019, and 861 in 2020. So we're definitely seeing a clear upward trend in the data.
Unger: So it's very unusual. What is causing that? Is that related to the pandemic in any way?
Garcia: So I think the thinking is that perhaps that jump between '20 and '21 was due to the pandemic. But we know those numbers were rising before that and the U.S. had the highest maternal mortality rate of any industrialized nation. The new report doesn't specifically mention the pandemic, but maternal health experts have said it's natural to assume that the pandemic fueled that rise in maternal deaths. And if we look at a separate report from the GAO, it does set COVID as a contributing factor in at least 400 maternal deaths in 2021.
I think it's also important to point out that we continue to see these persistent racial and ethnic disparities in the rate of maternal deaths, and that's—that rate is significantly higher for Black women compared to white and Hispanic women. And of course, there are a number of factors that play into that from access to care to transportation, living environment, employment. So those definitely were exacerbated during the pandemic. And of course, health officials continue to stress that one of the best ways that pregnant people can protect themselves and their unborn babies is to get vaccinated against COVID-19.
Unger: Absolutely and thank you for highlighting those points, particularly around the disparities that we're seeing there. We're going to take a closer look at maternal deaths in a future AMA Update coming soon, so keep your eyes peeled for that. Now, let's get back to some other news. Paxlovid, it was endorsed as a treatment for COVID. What can you tell us about that?
Garcia: Yes, so last week the FDA's Antimicrobial Drugs Advisory Committee recommended Paxlovid as a treatment for adults with COVID who are at high risk of progressing to severe illness. That recommendation is likely to lead to full approval of the drug, which we know up until now has been available under an EUA since about December of 2021. And when FDA granted that EUA, it was based on data from a clinical trial that showed unvaccinated people who were at high risk of severe COVID saw an 88% reduction in their risk of hospitalization.
So this panel considered some new data that was released by the FDA that showed that Paxlovid reduced hospitalizations and death both in unvaccinated and vaccinated people. And the agency is estimating that based on the COVID rates in January, Paxlovid could lead to 1,500 lives saved and 13,000 hospitalizations averted each week in the United States.
Unger: Those are big numbers, really, really incredible. Do you think it's going to help with uptake on that—on Paxlovid? We have been hearing that some physicians are still hesitant to prescribe it.
Garcia: I hope that the data and the fact that this is very close to a full approval will help. There was also a study published last week in JAMA Health Forum that estimated that if Paxlovid uptake had been what it is now during that omicron wave in the winter of 2022, nearly 5,000 deaths would have been prevented, and that's huge. Currently, the only antiviral drug, remdesivir, that has full FDA approval as a COVID treatment is limited because patients have to visit a clinic three days a week or three days in a row for infusions.
And we know Paxlovid it is an oral antiviral pill. It can be taken at home. So hopefully, we'll see that use, that uptake improve.
Unger: Now, one of the reasons I think that might be an obstacle are the kind of stories that we've heard about a rebound effect after taking Paxlovid. Do you have any more information about that?
Garcia: Well, FDA did review the data around rebound cases, and based on that clinical trial data, they are saying that they did not identify a clear association between Paxlovid treatment and COVID-19 rebound. That FDA analysis did find evidence of rebound among patients, but that data showed those rebound rates range from about 10% to 16%. But there was no difference between people who took Paxlovid and people who received the placebo.
I think it's also worth noting that there were no major safety concerns identified in the clinical trial data, but they've flagged about 137 medications with Paxlovid drug-to-drug interactions that could lead to serious adverse reactions. So it's important to have a conversation with your physician if you're taking any medications and considering Paxlovid.
Unger: It absolutely is. That's great advice, and Andrea, that wraps up today's episode. Appreciate you being here today. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. 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.