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.
Featured topic and speakers
COVID cases continue to rise in the U.S. due to the new EG.5, or Eris, variant. AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, analyzes the increase in COVID hospitalizations and shares the latest news about the EG.5 and BA.2.86, or Pirola, variants. Plus, the CDC Health Advisory on fatal Vibrio vulnificus (or V. vulnificus) infections and what physicians and patients need to know about it. AMA Chief Experience Officer Todd Unger hosts.
- Centers for Disease Control and Prevention "Severe Vibrio vulnificus Infections in the United States Associated with Warming Coastal Waters"
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Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today we're taking our weekly look at the headlines, including COVID and flesh-eating bacteria 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: Thanks, Todd. It's really good to be here.
Unger: Well, I hope you had a lovely Labor Day holiday weekend. Over the weekend, of course, COVID headlines all over the place. Andrea, what do we need to know?
Garcia: Yeah, according to the CDC, even before we hit the holiday weekend we were seeing a significant rise in cases and hospitalizations. There were more than 15,000 new COVID hospital admissions for that week ending August 19. That was about an 18% increase from the week before. Overall, though, we've seen nearly an 87% increase over the past month.
And that increase has been happening now for seven straight weeks and it's expected to continue. The CDC reported, based on some modeling forecasts, that it expects anywhere from 1,700 to 9,700 daily COVID hospital admissions by the end of September.
And while none of this sounds like great news, if we put it in context, we're still down almost 61% in COVID hospitalizations compared to where we were last year at this time.
Unger: And again, I've been reading that it's largely being driven by a new variant. Have we learned anything new about that?
Garcia: Well, EG.5, or Eris, is continuing to spread quickly. And as a reminder, EG.5 became that dominant variant here in the U.S. in August. It has been classified as a variant of interest by the World Health Organization. And that hasn't changed.
According to the New York Times experts still believe that EG.5 does not pose a serious threat. Like previous variants, those who are older, those who have underlying conditions are at higher risk of severe outcomes. The WHO stated in a recent announcement that based on the available evidence, the overall public health risk posed by EG.5 is evaluated as low at the global level. So that's good news.
Unger: Andrea, why does it seem to be spreading so rapidly right now?
Garcia: Well, EG.5 has one notable mutation that helps it evade antibodies developed by our immune system in response to earlier variants and vaccines. That's most likely why it's become not only the dominant strain here in the U.S., but in the world right now.
Cases, however, from this variant seem to be relatively mild and the new vaccine formulation that is expected to be rolled out later this month is being developed based on another variant, XBB.1.5, and that's more genetically similar to EG.5. So in theory, it should provide better protection than our current vaccines do once it's available. And as we discussed last week, treatments like Paxlovid are still effective against it.
Unger: That's good news. What about the other variant that we talked about last week? I think you called it Pirola?
Garcia: Yeah, Pirola or BA.2.86. It's also spreading and it's now tied to about 29 cases worldwide. However, experts expect that is likely an undercount. In the U.S., it's now identified in five states, so Michigan, New York, Virginia, as well as Ohio and Texas.
And scientists continue to be a little more concerned about this one, even though that case count is still very low. And that's because there are so many mutations, and many of them are in the spike protein. So it could make it more difficult for our immune system to recognize it.
Unger: So Andrea, does that have implications for the new vaccines that we're expecting?
Garcia: Yes, so the concern is that those updated vaccines may be less effective against it. However, over the past week there have been several studies posted on social media. These studies have not been peer reviewed, but overall this early data shows that the evasion of existing protection is not as bad as we initially feared, and this new variant might not be as transmissible.
One study showed that across a range of different types of immunity, people were able to neutralize BA.2.86 and sometimes even more effectively than other circulating variants. Those people with the highest neutralizing antibodies were those that had recently recovered from an XBB infection.
This suggests that the new vaccines should provide pretty good protection against BA.2.86. Again, that's encouraging. It's still early. Studies are still ongoing. So this is an area that we're going to continue to track.
Unger: And with fewer people testing, how can we expect to get and track the kind of data that it's going to take to keep an eye on this?
Garcia: Yeah, well, surveillance efforts have certainly decreased. I think one important tool that continues to be available is wastewater data. That wastewater sampling is how officials in New York City first detected BA.2.86.
Officials said that that sample did not come from a local resident, but whenever you find a variant present in wastewater, it means that it's circulating. Public health experts have previously said that wastewater tracking is a good early detection tool for monitoring potential future upticks. And this is going to become even more important as people continue either to not test or to test at home and then not report results.
With that being said, I think we're hearing those anecdotal reports that pharmacies are seeing that increased demand for both in-person and at-home COVID tests. And some have even said that we could see a temporary or isolated shortage in these tests. So many people are still testing, which is good news.
Unger: As always seems to be the case, COVID is not our only concern. Last week we had a CDC health alert about malaria. And this week we have a new alert. And newsflash—it does contain the words "flesh-eating bacteria." That is certain to generate a lot of headlines and a lot of concern. Andrea, what's the scoop here?
Garcia: So the CDC issued its latest Health Alert Network, or HAN advisory, on Friday. And that was about a recent report of fatal Vibrio vulnificus infections, including both wound and foodborne infections.
Vibrio are bacteria that caused an estimated 80,000 illnesses each year in the U.S. And about a dozen species of Vibrio are pathogenic to humans. Most people with Vibrio infection have diarrhea. Some might also have stomach cramping, nausea, vomiting, fever and chills.
However, the species that is the subject of this particular alert is known to cause life-threatening infections. And these cases are usually the result of being exposed to bacteria in warm coastal waters where it thrives. But the infection can also be obtained through contact with contaminated shellfish, such as oysters.
It's especially dangerous if it comes into contact with open cuts or insect bites or other exposed wounds, because it can cause necrotizing fasciitis, which kills the skin around a wound and can rapidly make some people very ill. And that's why it's sometimes more commonly referred to as flesh-eating bacteria.
We know that about 150 to 200 V. vulnificus infections are reported to the CDC each year, and one in five people with this infection die, and sometimes within one to two days of becoming ill.
Unger: Well, that's pretty scary. And it seems like we've been hearing about this problem for some time. Why all of a sudden are we getting an alert now?
Garcia: Well, most cases happen between May and October. And it's obviously become worse with climate change. Vibrio naturally live in coastal waters, including saltwater, brackish water, which is a mixture of salt and freshwater. The bacteria thrive in unusually warm water and increase with extreme weather events, such as heat waves, flooding and severe storms.
During July and August we've experienced above-average coastal sea surface temperatures and widespread heat waves. During that period several East Coast states, including Connecticut, New York, North Carolina, have reported severe and fatal V. vulnificus infections, which is why we're seeing this alert come now.
Unger: So kind of another reminder about climate change and the impacts that we can experience from that. Andrea, what do people need to know?
Garcia: Well, people who are at increased risk for infection should exercise caution when engaging in coastal water activities, stay out of saltwater and brackish water if you have an open wound or a cut. If you get a cut while you're in the water, leave the water immediately.
If open wounds or cuts come in contact with salt or brackish water or drippings from undercooked seafood, wash them thoroughly with soap and clean running water. And then prompt treatment is really crucial. So it's important to seek medical attention immediately if you suspect an infection.
Unger: And how about physicians? What do they need to know?
Garcia: Well, physicians should consider V. vulnificus as a possible cause of infection in wounds that were exposed to coastal waters, especially in patients at higher risk for severe infection. That includes those with underlying health conditions, such as liver disease, diabetes or other immunocompromising conditions.
If infection is suspected, obtain cultures, send them to your public health laboratory, ask the patient or family about relevant exposures and initiate treatment promptly. Early antibiotic therapy and surgical interventions do improve survival. It's important not to wait for consultation with an ID specialist or laboratory confirmation and just to initiate that treatment.
Vibriosis is a nationally notifiable disease. Health care professionals and clinical labs should report all of those cases to their state, local, tribal or territorial health department.
And we should also just be informing residents and tourists in these coastal communities about the risk of V. vulnificus infection with signage on beaches and near waters that may be affected.
Unger: Andrea, that's all very helpful information. Note to self—I probably shouldn't have gone kayaking in the Long Island Sound last weekend. But I'm still here this week, so that's good news.
Andrea, thanks for being here and taking us through all this important information. That's it for today's AMA Update. You can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. Please take care.
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.
