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 to claim your free COVID tests from the federal government and get the most accurate results from COVID rapid tests. AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, also discusses the latest COVID case numbers and the CDC’s recommendation on the RSV vaccine for pregnant people. Plus, a WHO report on hypertension and a study on ultraprocessed foods and depression in women. 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. Thanks for having me. It's good to be here.
Unger: Well, let's get right into talking about COVID. The last time we talked, we saw some signs that COVID hospitalizations were beginning to slow. Andrea, what are the latest numbers showing? And is that trend continued?
Garcia: It is. And according to that latest data from the CDC, we saw COVID hospital admissions still rising. But once again, the increase is not as high as it was the previous week. For that week ending September 9, there were just about 20,000 people hospitalized with COVID in the U.S. It's a 7.7% increase from the previous week. But the week prior, we saw an 8.7% increase. And before that, you'll recall a 16% increase.
So we're seeing those numbers from that late summer surge start to level off. And in fact, both test positivity and ED visits for COVID are also decreasing. But as we talked about last week, we're facing the threat of a serious respiratory virus season, where flu, COVID and RSV are all spreading. And that means we need to be vigilant and we need to take the necessary precautions. Top of that list is getting vaccinated for flu and COVID and potentially RSV if you're eligible and if it's recommended based on a conversation with your clinician.
Unger: Well, let's talk a little bit more about how to keep from getting caught up in the tripledemic. We used to be able to do that by, of course, masking and testing and staying home when we're sick. On one of those fronts, the federal government is stepping in to help. And it's once again offering free COVID tests. Tell us more about that.
Garcia: Yeah. So as of Monday, you could head over to COVIDtests.gov and order your free test. And the government will send up to four rapid tests per household for anyone who requests them. This is a much needed development. It comes at a critical moment. And unlike last year around this time, it's no longer as easy or as affordable to test yourself for COVID.
We know most of those dedicated testing centers in communities have closed. And with the end of the public health emergency earlier this year, we also know that insurers are no longer required to cover the cost of those at-home tests. However, the need to test is still very much here. And these free tests are here to help meet that need.
Unger: Excellent. COVIDtest.gov, make sure to go ahead and claim yours. Andrea, on the topic of testing, as COVID variants continue to emerge, we're seeing an uptick in questions from patients about the reliability of at-home tests. Are these tests still accurate despite all these new variants?
Garcia: Yeah. The rapid tests are still effective even with the latest variants. We know most rapid tests target the nucleus capsid protein or the N protein of COVID. And that protein doesn't change much with each variant, it's pretty stable. The spike protein has changed. And that's why there have been some concerns around vaccines, which we know target the spike protein and can become less effective over time.
To get the most accurate test results, though, from those rapid tests, you really need to consider when to test, how often, and whether or not you have symptoms. And if we think about timing, the CDC says if you're experiencing symptoms, you should test immediately. If you do not have symptoms but you know you've been exposed to COVID-19, the CDC recommends waiting five full days after exposure before you take a test. And that's because the virus needs time to build up in your body before a rapid test can detect it. So if you test one or two days after an exposure, that may be too early.
Unger: Andrea, what's the latest guidance on how often you should test if you have symptoms or had a known exposure?
Garcia: When it comes to frequency, we've seen some changes since the beginning of the pandemic. And I think it's important to keep in mind that a single negative antigen test can't rule out an infection. So if you have symptoms and you test negative with a rapid test, CDC recommends that you do another rapid test within 48 hours or take a PCR test as soon as you can.
If you've been exposed but you don't yet have symptoms, you're going to want three rapid antigen tests, each performed 48 hours apart, or a single PCR, which can be used to confirm an antigen test result. The recommendation to test repeatedly was announced by FDA in August of last year.
And I would just like to point out the other ongoing debate we've been hearing about rapid tests. And that's whether doing a throat swab is a good idea in addition to a nasal swab. And there's some reports that increases the accuracy of rapid tests. To date, the FDA has not authorized any rapid test that involves a throat swab. And in fact, they see that swabbing the throat with the currently authorized test, which are only for nasal swabs, could cause harm. More research is definitely needed here in this area before we're going to see any changes in those recommendations.
Unger: All right. Well, thanks for that overview, Andrea. Before we move on to or on from the tripledemic, the CDC's Advisory Committee on Immunization Practices met last Friday about the RSV vaccine for pregnant people. I'm talking with the AMA's ACIP liaison Dr. Sandra Fryhofer about this meeting in depth later this week. Andrea, in the meantime, can you share some of the high-level takeaways with us?
Garcia: Yeah, I would be happy to. So at the meeting last week, ACIP voted to recommend that maternal RSV vaccine for use in weeks 32 through 36 of pregnancy. And they recommended using it during a specific season. So that's from September through January. We did see the CDC director sign off on that recommendation. That vaccine helps protect infants up to six months of age against those severe outcomes from RSV.
And then we also know that CDC has previously recommended nirsevimab, which is the monoclonal antibody shot that protects infants who are less than eight months old against RSV as well as some children up to 19 months if they're at risk for severe illness. Both of those products are safe and effective. For most infants, they're only going to be recommended to get one of those products. So the maternal RSV vaccine provides protection immediately after birth. And studies suggest it may be more resistant to virus mutation. And nirsevimab provides antibodies directly to the infant. And studies suggest that protection might wane more slowly.
I think Dr. Fryhofer will be able to offer even more insights based on that meeting. When you do interview her and that's live, we'll update the description for this episode to include a link to it.
Unger: And I'm looking forward to that discussion. Dr. Fryhofer always has tremendous amounts to say, so stay tuned for that. In other news, the World Health Organization had a big announcement last week about the number of adults with hypertension. Andrea, what can you tell us about that?
Garcia: Yeah. That new report from the WHO said that an estimated one in three adults worldwide live with hypertension. And half of adults with high blood pressure don't know that they have it. The WHO report also cited a 2020 study from The Lancet, which found that hypertension is the single most important risk factor for early death.
The number of people with hypertension is on the rise. According to the WHO, that number doubled from an estimated 650 million 1990 to 1.3 billion in 2019. Taken all together, we have a serious health condition that's on the rise. It's affecting a significant number of people. And many of them don't even know they have it.
Clearly, more action is needed here. And we know the AMA actually has a wealth of tools and resources on hypertension for physicians that includes our SMB quick guide. And that helps care teams train patients on how to measure their own blood pressure. We have courses on the AMA Ed Hub, and of course, our TargetBP™ recognition program.
Unger: Andrea, in another story that drove headlines this week, there was a study that looked at the effects of ultra-processed foods. What do we need to know there?
Garcia: Yeah. That was a really interesting study that was published in JAMA Network Open. And it examined the association between ultra-processed foods and depression among females age 42 to 62. It found that the women who ate the most ultra-processed food were about 50% more likely to develop depression than those who ate the least. It was an observational study. So it can only note an association between the symptoms of depression and the intake of ultra-processed foods. It doesn't show causation.
According to a report from the CDC published in July of this year, one in five adults in the U.S. in 2020 reported receiving a diagnosis of depression at some point. So any new research in this area is welcome. It helps us to continue the discussion about how we can best help people who are suffering.
Unger: Absolutely. And Andrea, thanks so much for being here today and sharing these updates. That wraps up our episode today. If you enjoyed the discussion, you can support more programming like this by becoming an AMA member. Please join us 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.