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.
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, shares the latest on China's pneumonia outbreak and mysterious wave of respiratory infections. Also covering updates for flu season, COVID trends and RSV surges. AMA Chief Experience Officer Todd Unger hosts.
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- 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, also in Chicago.
Welcome back, Andrea.
Garcia: Hi, Todd. It's good to see you. Thanks for having me back.
Unger: It is good to be back from our holidays. The last time we talked, just before Thanksgiving, we were starting to see some surges in respiratory illnesses. Andrea, where do we stand right now after the holiday?
Garcia: Well, we know data reporting will lag a bit after the holiday, but most experts are expecting a post-Thanksgiving spike in illnesses as respiratory virus season picks up and we know fewer people are taking precautions. And that really goes for all three respiratory viruses we've been talking about, RSV, COVID and flu.
As you mentioned, before the holiday, we were already starting to see signs of surges. And according to CDC data, in the weeks leading up to the holiday, there was a sharp rise in RSV cases. And if we look at the CDC's most recent FluView report, the same can be said for flu most notably in the South Central, Southeast, Mountain and West Coast regions.
These increases are really expected to continue in the coming weeks. And we know possibly flu season can last into the spring of next year. Outpatient respiratory illnesses in general, which is a fever plus cough or sore throat, is above the baseline nationally for the third week in a row. And the number of weekly flu hospital admissions is also increasing.
Unger: Andrea, what about COVID?
Garcia: Well, prior to the holiday, the highest rates of positive COVID tests were seen right here in the Midwest, as well as in the Western states. And nationwide, COVID hospitalizations were up but still far below those pandemic levels.
According to the latest CDC data, COVID hospitalizations and deaths rose by about 9% during that week ending November 11. Overall, that's still low for this time of year when we compare that to previous years.
Earlier this week, though, CDC did release an update on BA.2.86, which is a COVID variant that we first saw the agency reference back in August. That variant is projected to now compromise about 8.8% of circulating variants, and that's nearly triple the estimated prevalence of two weeks ago.
At this time, the CDC says the expected public health risk of this variant, including its offshoot, JN.1, which we talked about last time, is low. But the agency will continue to track it as it steadily increases. And as we talked about in previous updates, tests and treatments are expected to be effective against this variant, including JN.1.
And at this time, it's not possible to know whether BA.2.86 produces different symptoms from other variants. But generally, we've seen similar symptoms across variants. And we know that in general, symptoms and how severe they are generally depend in part on a person's individual immunity.
Unger: Well, Andrea, given that information, would you say that it's time to worry?
Garcia: I think the problem right now is the lagging vaccination rates for all three respiratory viruses. And we know that health officials and clinicians continue to urge vaccinations to head off another severe respiratory virus season like we experienced last year.
But so far, those vaccination rates are not promising. Whether it's vaccine fatigue, misinformation, barriers to access, people are just not getting vaccinated in the numbers that we would have hoped for. And that, we know, could lead to crowded emergency departments and hospitals later this winter.
Unger: Well, let's talk a little bit more about vaccination rates. Where are we at this point?
Garcia: Well, CDC is actually making it easier to answer that question. And they recently created a weekly COVID-19 vaccine dashboard and a weekly RSV vaccination dashboard that helps ensure we're getting that accurate and timely information about vaccination against respiratory viruses.
The dashboards complement that existing CDC weekly flu vaccine dashboard. So all three of those dashboards are now available under the new RespVaxView page. And that'll allow people to monitor vaccination trends more easily. We're going to put a link to that page in the description of this episode.
So far, the data on that dashboard really reveals persistent disparities in vaccination coverage. That's based on race and ethnicity and geography. And it shows that COVID and flu vaccination remains low among children and pregnant people, which is concerning. So CDC is continuing to call on physicians to help improve those numbers, urge their patients to take advantage of the safe and effective immunizations as soon as possible.
Unger: Absolutely. And, Andrea, with COVID in particular, people can also test, of course, to reduce spread. And you mentioned earlier that the tests we have remain effective at detecting the new variants. However, for a lot of people, home test prices have become a problem, and in fact prohibitive once insurance stopped covering them. Do we have any options here?
Garcia: Yeah, the good news is the federal government is now offering a new batch of free COVID tests. So each household can order four more free COVID tests to be sent out by the federal government starting this week. As with those previous five rounds of government-issued COVID tests, orders can be placed online at covid.gov.
People who didn't take advantage of the last offer, which was back in September, can still order the four rapid tests made available then for a total of eight tests. It's really easy to order them. The only information you need is your name and an address to send them to. No health insurance information is needed.
I think it's also important to note that although some of these tests might arrive with expiration dates that have passed, the FDA has extended the dates for most approved tests. So users can check that true expiration date of the COVID test on the FDA's regularly updated site. And many of the reasons why testing is helpful are that it can narrow down which virus you have, which we know can help inform available treatment options.
Unger: Well, that's good news. And everybody order those free COVID tests, covid.gov, find out more information. Andrea, to your point about testing, we know that catching these viruses early is really important. Over the weekend, we also saw multiple headlines about an outbreak in China. It feels a little bit like deja vu to many of us. What's going on there and do we need to be concerned?
Garcia: Those headlines were triggered by a reported surge in respiratory illnesses in children in recent weeks. And news reports and social media posts really caught the attention of the WHO and members of ProMED, which is a disease tracking site run by the International Society for Infectious Diseases that health officials monitor for early warnings of potential emerging diseases.
Those reports did prompt the WHO to formally request that China provide information about the potentially worrying spike in respiratory illnesses and clusters of pneumonia in children. The WHO said that Chinese health officials provided the data it requested last Thursday during a teleconference. And that showed the increase in hospital admissions of children were due to diseases, including bacterial infections, RSV, influenza and the common cold virus since October.
On Sunday, the country's health ministry confirmed this data, saying that the surge in illnesses were caused by flu and other known pathogens, not by a novel virus.
Unger: Well, I guess that's good news. It sounds a lot like the mix of things going on here. So I'm just going to summarize. Does that mean we don't have something to worry about at this point?
Garcia: Well, based on what's being reported, it seems we don't need to be concerned about a novel pathogen at this time. I think that concern was not necessarily unwarranted because we know the emergence of new flu strains or other viruses capable of triggering pandemics typically start with these undiagnosed clusters of respiratory illness. Both SARS and COVID-19 were first reported as unusual types of pneumonia.
China lifted their COVID restrictions much later than most other countries. This is technically their first full winter since they removed those restrictions. Other countries, like here in the U.S., we saw that increase in respiratory diseases such as RSV when our pandemic precautions ended. The acting director of the WHO's department of epidemic and pandemic preparedness and prevention said these increases appear to be driven by the rise in the number of children contracting pathogens that they had avoided during the two years of COVID restrictions.
Unger: Well, we're going to certainly continue to keep an eye on that. Andrea, thanks so much for joining us and sharing these updates. That wraps up today's episode.
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Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.