Public Health

COVID pandemic turns 4, Paxlovid and measles outbreak news, plus MMR shot & RSV vaccine for babies


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.

When did COVID start in the U.S.? Should I take Paxlovid? What is the COVID death toll? Where is the measles outbreak? Is measles eliminated in the U.S.? What is the RSV vaccine recommendations for children?

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


  • 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, great to see you.

Garcia: Hi, Todd. Thanks for having me.

Unger: Well, Andrea it's hard to believe, but earlier this week, we marked the fourth anniversary of the WHO declaring COVID a pandemic. Some news outlets took the opportunity to examine the impact COVID's had on the U.S. over the last four years. Andrea, there are a lot of implications, but tell us about the key takeaways.

Garcia: Well, Todd, March 11, 2020, has certainly become synonymous with the beginning of the pandemic as that was the day the WHO declaration was officially made. We've seen news outlets including Axios put this in perspective by reminding us that that was also the day Tom Hanks and his wife Rita Wilson announced that they had contracted the virus.

They were really the first high profile people diagnosed with COVID-19. It was the day the NBA canceled the rest of its season, which then began a domino effect of event cancellations shortly after. I think it's moments like these that most of us won't forget as we think back about how little we knew of the horrific toll the next several years would take.

In fact, on that day back in 2020, due to the challenges we had with testing, we really only had recorded a little over 1,100 COVID cases in the U.S. and just 38 deaths. But if we put that into context now, we know that more than seven million people worldwide have died of COVID, and nearly of course, 1.2 million people in the U.S. alone.

Unger: Gosh. It's really strange to think back to that time, and of course, how little we knew in terms of what was to come, certainly. Andrea, how do our numbers today compare to the worst of the pandemic?

Garcia: Well, as we've talked about often, we've come to realize that COVID is likely never going to go away. But we're now at a point where we aren't seeing the same level of disease. And that's in part due to population level immunity from both vaccines and infections as well as two effective vaccines and treatments.

As ABC News looked at the numbers then and now, they really showed that beginning with hospitalizations, according to the CDC, if we look at the data from March 2, there were 15,141 new hospital admissions for COVID. That's about 10% the number we saw at the peak of the pandemic when we had more than 150,000 hospitalizations recorded. And that was for the week of January 22, 2022. Of course, that was during the worst of the Omicron wave.

For deaths for that same week ending March 2, we were seeing 576 deaths. It's the lowest number recorded since the summer of 2023, several times lower than that peak of nearly 26,000 deaths during the week ending January 9, 2021. These numbers could be lower right now if we had greater vaccine uptake and those who were eligible received available treatments early on in their illness.

We know based on that CDC data, just about 22.6% of adults and 13.5% of children have received the latest COVID vaccines. I think the better news is 42.4% of adults 65 and older, which we know is the group at highest risk of severe illness and death, have been vaccinated.

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Unger: Well, the miracle of vaccines and treatments that you really just outlined there. I do want to go back to something you mentioned earlier about accessing available treatments. We talked about this a few weeks ago and how Paxlovid was being underutilized. Andrea, has that situation gotten any better?

Garcia: Well, it's been a challenge, an ongoing one. One of the reasons we're seeing now is price. We know in late December, Paxlovid shifted to the commercial marketplace. And before that, the cost was being covered by the federal government. We're now hearing about how some people are heading into pharmacies and are in sticker shock when they're asked to pay $1,000 or more for the drug.

However, that shouldn't be the norm. People with private insurance should be paying less than $100 for the treatment. And the drug is still free for those who are uninsured or enrolled in Medicare or Medicaid or other federal health programs, including those for veterans.

KFF News recently looked into the phenomenon and found several other reasons for the lack of uptake, including low awareness of the benefits of Paxlovid. Of course, there are things to be careful of. Physicians need to watch out for a potentially dangerous drug interactions with other common medications for cholesterol or blood clots and for other conditions.

But a recent JAMA Network study also found that sick people 85 and older were less likely than younger Medicare patients to get COVID therapies like Paxlovid. And the physician who led that study noted that it seems to be proactive in health-literate people who are getting the drug. Those who are receiving information more passively really have no idea whether it's important or harmful.

Unger: As always, getting that information to the right people at the right time been a challenge for obviously four years. Andrea, it sounds like we still have a lot of work to do there. Now there is a treatment locator program that may help somewhat. Can you tell us more about that?

Garcia: Well, Asper, which is part of the U.S. Department of Health and Human Services is encouraging all health care partners that offer Paxlovid, Lagorio or Veklury for outpatient use to participate in a COVID-19 treatment locator program. And that's to improve physician and patient access to the medications.

Of course, the more providers that opt in, the more it helps physicians and patients quickly find the closest location with the availability of these medications. Providers simply need to put in their location information, know which COVID outpatient treatments they have, and agree to be visible on the locator. And we're going to put more details about opting into that locator in the description of this episode.

Unger: That's great, and it sounds like that'll be very helpful. Andrea, shifting to another virus that we're hopefully on the tail end of the season, RSV. Been some promising new results for the new antibody that was developed to prevent severe RSV in babies. What can you tell us about that?

Garcia: Well, it's very good news. Research from the CDC shows that Nirsevimab, which as you mentioned, is the monoclonal antibody designed to protect babies from severe Respiratory Syncytial Virus or RSV reduce the risk for RSV-associated hospitalizations in babies by 90%. This data is the first real-world evidence of therapy effectiveness, so it's really exciting to see.

RSV continues to be the leading cause of infant hospitalizations here in the U.S. And this past year was really the first year that immunizations were available to protect babies from severe RSV. So both Nirsevimab and the maternal RSV vaccine, Pfizer's Abrysvo really have given us powerful tools in our fight to reduce RSV disease burden in those who are at highest risk for severe outcomes.

Unger: That's good news. And it's nice to hear that the formulations that you mentioned are working as intended. Can you remind us of who those vaccines are recommended for?

Garcia: Yeah. So Nirsevimab is recommended for all babies younger than eight months who are born during or entering into their first RSV season. And that is if their mother did not receive that maternal RSV vaccine. It's also recommended for some children who are at increased risk of severe RSV in their second RSV season.

Both Nirsevimab and the maternal RSV vaccine do have specific timelines for when they're administered. And this seasonal administration really is designed to maximize the benefit that immunizations provide by aligning to that RSV season. That's when we know babies are at highest risk for severe RSV.

And physicians can get more information on that seasonal administration of these immunizations on the CDC website. We'll put the direct link to that page in the description of this episode. It's also important that parents have the information that they need to make decisions about which immunizations work best for their families. The CDC is encouraging physicians to discuss these options with pregnant patients and parents.

Unger: Well, thank you for that. So good news on the RSV front. Unfortunately, we're not seeing the same good news with measles, which is still making headlines here in the U.S. Andrea, tell us more about the latest on that.

Garcia: Well, Todd, it's really coming down to more cases. As we've said, measles is highly contagious and it is spreading. On March 7, we saw the Chicago Department of Public Health confirm the first case of measles in Chicagoans since 2019. And we are now up to five cases here in Chicago. Four of those cases are in two young children and two in adults in a migrant center in the city.

People who are unvaccinated in that shelter are being screened for symptoms, and they are being offered the MMR vaccine. At the same time, we've seen three cases being reported in Michigan. And meanwhile, we've talked about the outbreak in Florida. Broward County School District has now said that that outbreak of measles cases, one of its elementary schools, is officially over.

If we do look at the numbers from CDC though, there have been 45 measles cases across 17 states. And that means that we're on track to surpass the 58 cases that we had in 2023. This rash of outbreaks has sparked concerns that we may lose our status as a country where the disease has been eliminated. And that's a distinction we've held since 2000.

Unger: Andrea, what's losing that distinction mean exactly?

Garcia: The WHO defines measles elimination as the absence of endemic measles virus transmission in a defined geographical area for at least 12 months. And that's in the presence of a surveillance system that has been verified to be performing well. In other words, if a measles outbreak continues here for a year or more, we could lose that measles elimination status.

Just note that eliminated does not mean the same thing as eradicated. We have seen first world countries lose their measles elimination status in recent years. The U.K. only regained its status in 2021 after losing it in 2018. We know that this is due to declining vaccination rates globally, and of course, that resumption of international travel.

Here, federal health authorities encourage maintaining that target of 95% MMR immunization coverage, but we know that rate has been on the decline since 2019. For example, in the 2022/2023 school year, we know that that rate dropped to 93.1% among kindergartners nationally, which the CDC estimates leaves 250,000 kindergartners at risk of infection.

Paul Offit, who is obviously a noted vaccine expert and a guest on AMA Update numerous times, said in an article on The Hill, "I think not only have we largely eliminated measles, but we've eliminated the memory of measles." I don't think people remember just how sick measles can make you. And unfortunately, I think that we're beginning to see how that is playing out with these increasing cases that we're seeing.

Unger: Well, I think Dr. Offit's quote there makes a lot of sense. And folks out there, time to get vaccinated. And if there's any question whether you're covered or not, make sure to check with your physician. That wraps up today's episode. Andrea, thanks so much for being here and keeping us up to date.

You can support more public health programming like this by becoming an AMA member at We'll be back soon with another segment. In the meantime, you can find all our videos and podcasts at 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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