CDC studies on Long COVID cognitive impairment and excessive alcohol use, plus ultra-processed foods

. 12 MIN READ

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.

How often should seniors get COVID boosters? Does brain fog decrease IQ? Latest ACIP meeting recap, brain fog and IQ, how alcohol affects your health, plus ultra processed food study.

Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.

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  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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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. I'm Todd Unger, AMA's chief experience officer. Andrea, welcome back.

Garcia: Thanks, Todd. It's great to be here.

Unger: So, let's start off with an announcement from the CDC'S Advisory Committee on Immunization Practices, or ACIP, which just wrapped up its latest meeting. And we're going to be talking to the AMA's ACIP liaison, Dr. Sandra Fryhofer, in a few days. But Andrea, in the meantime, can you share a quick few highlights from the meeting?

Garcia: Sure. So one of the things on the agenda was that updated '23-'24 COVID vaccine and whether or not some populations would benefit from an additional dose of the vaccine this spring. That committee looked at COVID data, including hospitalizations and vaccine coverage data. And they weighed the benefits and harms of an additional dose in determining what they would recommend and for whom.

I think keep in mind that people who are immunocompromised were already eligible for an additional dose based on previous recommendations. In the end, what we saw the committee do was recommend an additional dose for those who are 65 and older. We have seen the CDC director sign off on that recommendation the same day. So just to clarify, this is a second dose of that most recent iteration of Pfizer, Moderna or Novavax vaccine that were introduced in the fall.

Unger: So just to clarify, I heard you talk about two different populations-- number one, immunocompromised, and the second one, those that are 65 and older. Anybody else affected by the announcement?

Garcia: That's correct. So people who are moderately or severely immunocompromised have already had that option to receive an additional dose of the updated vaccine. And that was at least two months following the last recommended dose. At this meeting, it was concluded that older adults would benefit the most from a dose this spring. And that's in part because we're not seeing the same seasonality with COVID as we are with flu and RSV. We are likely to still have COVID cases this spring.

The additional dose is not recommended for other age groups who are at lower risk of severe illness and hospitalization. There was recent data supporting these recommendations. We're seeing adults age 65 and older account for 2/3 of all hospitalizations related to COVID. And that was between October of 2023 and January of 2024.

And those age 75 and older account for nearly half. So adults in this age group are going to be eligible, and they're also most likely to have received a vaccine in the fall. So there is a willingness among this population to get an additional dose. This recommendation does bring the U.S. in line with Canada and the UK.

Unger: Excellent. Andrea, speaking of hospitalizations, are we still seeing a significant number of hospitalizations from COVID? You don't really necessarily see that much in the headlines anymore?

Garcia: Well we're still seeing too many, especially, as we've talked about here many times, we have vaccines and treatment that can help reduce the risk of serious illness. The CDC staff did brief the committee at the meeting. And they mentioned that activity seems to have peaked over the Christmas period. But there are still roughly 20,000 people a week hospitalized for COVID and about 2,000 deaths per week. Over the past year, those new COVID hospitalizations have never fallen below 6,000 a week. So we definitely still have some work to do.

Unger: Good golly, those are some big numbers and appreciate the update on that. I know there was a lot more discussed at the meeting. And we'll be sure to get into the details with Dr. Fryhofer later this week.

But Andrea, staying on the topic of COVID for one more minute, last week, we talked about some new findings around brain fog that's associated with long COVID. This week, more research. Tell us about that.

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Garcia: Yeah, so last week, we talked about those findings that suggested that disruption in the blood-brain barrier, along with a hyperactive immune system, are likely those mechanisms behind brain fog. There was a new study published last Wednesday in The New England Journal, and that measured cognitive impairment in the months after a COVID infection. And it showed that COVID's impact can be measured in the equivalents of IQ points.

So according to a Stat article, researchers from Imperial College of London found that even when people recovered from their COVID symptoms in 4 to 12 weeks, they had the equivalent of an IQ score 3 points lower than an uninfected person. Among those with long COVID-- that's defined as those symptoms lasting more than 12 weeks after testing positive-- that drop was 6 IQ points. And for those people whose disease was severe enough to require hospitalization, the deficit deepened to 9 IQ points.

I think in better news, people whose persistent symptoms had resolved by the time they took the test performed about as well as people who had symptoms that didn't last very long.

Unger: Those are some pretty incredible numbers. Tell us a little bit more about what that means, exactly.

Garcia: Well, one of the lead authors noted that what the study shows is that brain fog can correlate with objectively measurable deficits in a person's actual memory and executive task performance. It raises questions about what these IQ declines mean, if they'll disappear. That'll require further research.

The study author did caution that causation can't be inferred directly from this observational study. And while the differences are clear, the reasons for the differences aren't clear. Having said that, I think we're beginning to see this body of research build that really does continue to validate the experiences we know physicians are hearing from their patients. And hopefully, this will help inform treatments.

Unger: Well, it's a good thing that we're hearing more and more about research on long COVID, so many people still affected by that. Another consequence of the pandemic was a surge in alcohol-related deaths. And we don't talk about this as much, but the CDC just came out with new data on that front. Andrea, tell us more about it.

Garcia: Yeah, there was a new study published by the CDC. It was covered by The New York Times. And it talked about alcohol-related deaths and how they surged in the U.S. by nearly 30% in recent years, with roughly 500 Americans dying each day in 2021. That translates to about 178,000 people dying in 2021 from excessive drinking compared to about 138,000 in 2016.

So the study chronicled a sustained spike in drinking during the COVID pandemic that continued to rise after we saw those stay-at-home orders in 2020. The incidence of alcohol-related deaths was higher in men. But among women, the death rate increased at a quicker pace. There are a number of theories as to what drove that increase, ranging from stress from the pandemic to increased home delivery services that were offered by the beverage industry during that time.

Unger: Now, Andrea, those are some very worrisome numbers, and understandable in terms of the causes that you outlined. But it doesn't sound like we have seen them taper off, necessarily. Is that right?

Garcia: Yeah, that's right. And separate and apart from that study, there was another recent survey which showed increases in binge drinking by middle-aged adults, so among people 35 to 50. That's a cohort that includes millennials and Gen X. And binge drinking was at its highest level recorded in decades. 29% reported consuming five or more drinks in a row in 2022. That was up from 23% in 2012.

That annual survey is called Monitoring the Future. It's sponsored by the NIH. It also found the same age group reported record-high use of cannabis and hallucinogens.

Unger: Well, that's a big challenge. What do we do to curb numbers like that?

Garcia: Well, the CDC study had a number of recommendations. They noted that states and counties can promote policies to increase alcohol prices, possibly through taxes, to make products harder to obtain. They also suggested a mass media campaign that could encourage people to drink less.

I think another suggestion directly relates to our physician audience. And that is encouraging doctors to ask patients about their alcohol use and make a plan with them to cut down since there is evidence of drinking's harmful effects on health. We know researchers have found that even a little bit of alcohol is bad for your health. Studies are now linking alcohol use to damage in a person's DNA and how it can break down cells and cause mutations that develop cancer. Even red wine, which has long believed to provide some health benefits, is coming into question.

Unger: And that was terrible news because, along with that, we're also starting to see other things that we're learning about that have health consequences. In addition to alcohol, one of the things that has been in the headlines this week is about the impact of ultra-processed foods in people's diets. We've known that these foods are bad for some time. But what's changed here in the outlook?

Garcia: Yeah so this was covered by several news outlets, including The Washington Post. And this study was published in BMJ. It was an umbrella review of 45 meta-analyses drawing on data from nearly 10 million people.

The review found an association between eating too many ultra-processed foods-- so breads, cereals, snacks, frozen meals that have been industrially manufactured with flavors and additives-- and more than 30 health conditions, including heart disease, anxiety and early death. As you mentioned, we've already seen dozens of studies that found that people who consume a lot of these ultra-processed foods have higher rates of weight gain, obesity, cardiovascular disease, cancer and diabetes, as well as other chronic illnesses.

I think what makes this study different is how comprehensive it is. This umbrella review examined 14 different review articles, all published over the last three years, none reportedly funded by companies who are in the business of making these ultra-processed foods.

Unger: You know, Andrea, it feels a little bit overwhelming as we learn more and more about the impact of different things in our diet. The question is, Where do we go from here on something like this?

Garcia: Yeah, there was an editorial that was published alongside of that study. A group of international academics argued that ultra-processed foods are not merely modified foods. Typically, they contain little, if any, whole food. They're made from cheap, chemically altered ingredients, including modified starches, sugars, oils and fats.

They wrote that no reason exists to believe that humans can fully adapt to these products. They added a calling for UN agencies and member states to develop a framework on ultra-processed foods. And that would be akin to the treaty that we saw on tobacco control.

In the U.S., we know that the Dietary Guidelines are currently under development. They could potentially warn against ultra-processed foods as that committee working on those guidelines examines the science on the possible health risks, including obesity-related diseases. And then an alternative could be to swap out those ultra-processed foods for healthy options to see if symptoms improve. So, we'll definitely continue to follow this.

Unger: Thank you so much for that update. I guess we'll take a pause right here and wrap up for today. Andrea, thanks so much for being here and keeping us informed as usual. If you value trusted public health information, you can support more programming like this by becoming an AMA member at ama-assn.org/join.

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.

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