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Featured topic and speakers
Featured topic and speakers
An update on the surge of COVID and other respiratory diseases in the U.S. and across the world. AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the JN.1 variant that’s driving this surge and explains how it compares to the Omicron surge. Plus, the latest prescription trends in weight-less drugs like Ozempic and whether or not Ozempic and Wegovy have a side effect of suicidal ideation. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- 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. I'm Todd Unger, AMA's chief experience officer here in chilly Chicago. Welcome back, Andrea.
Garcia: Yeah, Todd. It's great to be here.
Unger: Well, last week, we talked about how everyone seems to be getting sick right now. And this week, we have news to suggest it's not just happening in the U.S. Interestingly, Andrea, apparently a lot of people were asking that question because it was one of the most viewed AMA Udates in recent history. Tell us a little bit more about the situation we face this week.
Garcia: Well, last week, we saw the World Health Organization see about holiday gatherings, and the spread of JN.1 globally has led to significantly increased transmission of COVID worldwide. We saw the WHO director general say that nearly 10,000 deaths were reported in December alone, and hospital admissions during the month jumped 42% in nearly 50 countries. That's mostly in Europe and the Americas, including, of course, the U.S.
That number is also based on countries that shared their data. It's likely that cases are on the rise in other places as well, but they just haven't been reporting or tracking the data. 10,000 deaths is a far lower number than we experienced, of course, during the peak of the pandemic. As the WHO director pointed out, the real tragedy here is that most of these deaths are likely preventable, and that's just unacceptable for where we are right now.
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Unger: Absolutely. And you said that JN.1 variant is driving this global surge just like it is here?
Garcia: Yeah, it is the most prominent variant in the world right now. As a reminder, it is a descendant of the Omicron variant. So the latest vaccine should offer protection, and it's definitely not too late to get it.
Unger: Excellent. Are we also seeing a rise of other respiratory diseases at the global level?
Garcia: Yeah. The U.S. is not alone in that either. The technical lead at the WHO for COVID-19 also cited increases in flu, rhinovirus and pneumonia. She said that we should expect those increases to continue in the Northern hemisphere through the winter months.
She also said that while bouts of coughs, and sniffling, and fever in the winter months is not new, this year in particular we are seeing that cocirculation of many different types of pathogens. Given this, WHO officials do continue to strongly recommend that people get vaccinated, they wear masks and if you're going to be indoors, make sure that areas are well ventilated. Again, the vaccines for COVID, flu and RSV may not stop you from catching these diseases, but they significantly reduce your chance of being hospitalized and even dying.
Unger: So important. Andrea, turning back to the U.S., this COVID wave that we're in continues to make headlines. Is there anything new that we need to know?
Garcia: There was a New York Times article that came out late last week. And the headline was, "We Are in a Big COVID Wave, but Just How Big?" And I think that's what many people are wondering right now. Looking at the numbers, reported levels of the virus in wastewater data are higher than they've been since that first Omicron wave, though those severe outcomes are certainly less common than in earlier pandemic winters.
And if we dig a little deeper into those numbers, we're seeing COVID rates go up across the country. The CDC's national wastewater surveillance system is categorizing about 41 states with available data as high or very high viral activity. And that compares to about 38 states categorized at these levels last week.
Unger: Andrea, do we have any sense of when this wave is going to reach its peak?
Garcia: Modelers are saying that we should reach that peak soon, maybe even this week. However, high levels of transmission are expected for at least another month and beyond that. The data we have now suggests there are around 35,000 hospitalizations reported in that first week of January and 1,500 deaths in late December.
Those are still far lower than previous years. And if we look back and provide some context, at the same time in 2020, there were around 100,000 hospitalizations and 20,000 deaths.
Unger: Wow, that is a big change. Andrea, last week, you said also that flu was increasing the most. What's going on there?
Garcia: So after several weeks of increases in those key flu indicators, the CDC has noted a single week of decrease. Now, that single week doesn't represent a trend, and the agency has said it's going to continue to monitor that data for a second period of increased influenza activity that we know often occurs after the winter holidays. Seasonal flu remains elevated in most parts of the country, but the numbers of reported weekly flu hospital admissions did decrease slightly.
Those outpatient respiratory illnesses in general, which is fever plus cough or sore throat, is still above baseline nationally. And that's for the tenth consecutive week. Unfortunately, the data to date still does suggest that flu vaccination uptake among both adults and children is down compared to last season.
Unger: And that is too bad because we talked about last week getting that shot, so important, and of course, still something that you can do, even late in the season. Andrea, stepping away from respiratory viruses for a moment, a recent health care conference indicated two main trends to watch in health care in 2024. Tell us more about that.
Garcia: Yeah, those trends were reported by Axios as key takeaways from the JPMorgan Chase Annual Healthcare Conference. And that took place last week in San Francisco.
I think, not surprising, the first is obesity treatments, like GLP-1s, which is that new class of weight loss drugs that Ozempic and others belong to. Right now, the challenge for drug manufacturers is being able to make enough supply to meet the enormous demand that they're seeing. And data from Epic Research, which is a data analysis company, showed that prescriptions for these drugs rose dramatically when they hit the U.S. market, increasing by 4,200% between 2018 and 2023.
Cost is also a factor here. And I think that's in part because it's still not clear how long patients should take these drugs. Some evidence suggests that when people stop taking them they do regain weight. I think the other point the Axios article makes is that data is still being collected about the impacts of these medications on a wide range of other diseases. If it does turn out that they can reduce the risk of stroke, heart attack, kidney disease or other conditions, I think it would be a game changer and significantly increase their demand in other ways.
Unger: And we'll continue to track that because, although that sounds like a lot of good news, there are, of course, stories about possible side effects. One that is particularly worrisome is that we may see increases in suicidal ideation in certain people. Andrea, has there been any more news on that?
Garcia: There has. There was a study published earlier this month in Nature Medicine, and that study analyzed medical records of nearly 1.6 million patients with type 2 diabetes and more than 240,000 patients with overweight or obesity. Those findings did not support high risk of suicidal ideation with semaglutide, which is that active ingredient in Ozempic and Wegovy. And that's in comparison to those non-GLP-1 based anti-obesity or antidiabetes medication. In fact, that study did find a lower risk of suicidal thoughts in patients taking semaglutide as compared to other diabetes and weight loss drugs.
And of course, there have been those anecdotal and case reports of suicidal ideation resulting from semaglutide. We know FDA has been investigating those reports. Semaglutide is under investigation as a potential treatment for addiction and substance use disorder, so it's really important that we understand the side effects.
Of course, long-term research is still going to be needed. The NIDA study looked at six-months worth of data. And we know that some people could be on these medications for years, that more research is needed.
Unger: Well, thank you for that update on trend number one. Andrea, what was the second trend to watch in 2024?
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Garcia: Also not particularly surprising is AI. And several leaders at the conference focused on AI's potential to enhance drug discovery and design. As reported by Axios, former FDA Commissioner Scott Gottlieb predicted that more drugs will go into development this year that are wholly derived from AI and machine learning. As the article pointed out, AI is dominating the conversation, but its actual applications are still in their infancy. At CES, which is a powerful tech event that was held in Las Vegas, AMA President Dr. Jesse Ehrenfeld sat on two panels about this topic and discussed other potential applications as well as his biggest worry and biggest hope for AI.
Unger: Tell us more about that. What is the AMA's position on this?
Garcia: Well, AMA leadership is working to ensure that healthcare AI improves patient care in a way that is both transparent and trustworthy. As Dr. Ehrenfeld said at the conference, there is a lot of room for hope, and I think one area is related to wellness and burnout among the health care workforce. Many tools are showing tremendous promise in helping to alleviate those physician administrative burdens and allowing physicians to get back to what they do best, which is caring for patients.
His worry is related to bias and trust. He noted that we've seen too many examples of systems found to have biased training data or a failure to imagine design flaws. And if those problems are not addressed at the outset, these can lead to systems that invisibly and unintentionally reproduce and normalize racial and other biases in their training sets. So in short, there's definitely a lot more to talk about here.
Unger: And it's something we're going to certainly keep tabs on in future AMA Updates. Andrea, as usual, thanks so much for keeping us up to date. That wraps up today's episode. If you enjoyed this discussion, I encourage you to support more programming like it by becoming an AMA member at ama-assn.org/join.
We'll be back soon with another AMA Update in time. 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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