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.
In today’s AMA Update, the latest on human metapneumovirus (hMPV), RSV vaccine approvals, changes in Medicaid coverage by state, reports about the next CDC director and data from a new study on weight-loss surgery for kids published in JAMA Pediatrics with 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
Unger: Hello and welcome to the AMA Update video and podcast series. 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: Thanks, Todd, it's good to be here today.
Unger: And we have a lot to talk about, from RSV to changes at the CDC and so forth. Let's start off with this RSV vaccine news, which there's been a lot of over the last month. And since we last spoke there's been yet another development. What's the latest news there?
Garcia: Yeah, you're right. There has been a lot of really encouraging news around RSV vaccines lately and that most recent news is last Wednesday the FDA approved Pfizer's RSV vaccine for older adults. That's the second vaccine that's soon going to be available for this age group. We know that earlier last month, the FDA also approved an RSV vaccine from GSK for older adults.
And then just a few weeks ago it approved that first-ever vaccine to protect babies from RSV. Of course, these vaccines all need to be considered by the ACIP, which is CDC's advisory committee. And they'll be making a recommendation to the CDC director on appropriate use in each of these vaccines. And that committee is scheduled to meet on June 21. Like GSK, Pfizer expects its vaccine to be available in the fall, which is just in time for RSV season.
Unger: Andrea, any differences between the two?
Garcia: Well, both of these vaccines are comparable in terms of their effectiveness. An FDA review of Pfizer's vaccine showed that it was 86% protective against lower respiratory tract illness, with three or more symptoms. And a similar review of GSK's vaccine found that it was 83% effective. So like with COVID, people will have vaccines to choose from once they're widely available.
This is excellent news. RSV carries that increased risk for older adults. And we know based on the CDC data, that RSV results in between 60 and 160,000 hospitalizations each year for those adults 65 and older, and between 6 and 10,000 deaths each year as well.
Unger: Well, that is really good news. Andrea, we'll keep an eye on these vaccines and those upcoming recommendations from the CDC. RSV wasn't the only respiratory virus that was making headlines, though, this past week. A new report from the CDC got everybody talking about another virus. What do we need to know about that?
Garcia: The CDC released a report at the end of May saying that cases of a virus known as human metapneumovirus, or hMPV, were higher than normal last winter and spring. That peak occurred in mid-March with nearly 11% of PCR tests showing a positive hMPV diagnosis. And more than 19% of antigen tests were also positive for hMPV. To provide some context, in the months leading up to the pandemic, that percentage for hMPV positive results were really between 4% and 7%. So that was really quite an uptick that we're seeing.
hMPV is a lesser-known virus. But it's certainly been getting a lot more attention after that CDC report. It's a paramyxovirus, so it's like RSV, measles and mumps. For most people who get it, though, it's going to feel like a common cold. They'll experience symptoms like nasal congestion, cough, shortness of breath and fever.
Unger: Yeah, a lot of friends who are kind of suffering from mysterious illnesses over the course of the past fall and couldn't identify what it was. So maybe it was that. There's been obviously a big increase. Do we know what is driving an increase like this?
Garcia: There could be really a couple of factors at play here. And we know that COVID testing has declined overall. But as a country, we're really more focused on identifying the cause of any respiratory illness than we were before. And pre-pandemic, if someone experienced cold-like symptoms, they might have just shrugged it off. But now they're more likely to go to their doctor and get tested.
And so this more regular testing has made it easier for us to identify these trends that we're seeing in things like RSV and hMPV. They're also getting a timing component to it. Like with the spike in RSV cases, it was last year when people really started to emerge from the pandemic. And before that we know people had been masking more consistently and staying home. Now they're masking less and going out more. And as a result, we could be seeing this resurgence of some infectious diseases.
Unger: Now we have a rather long list of viruses that we're worrying about right now. Is hMPV one that we need to be extra-vigilant about?
Garcia: Well, it's certainly something that we'll continue to keep an eye on. But for the most part, it's mild and it's not a cause for concern. I think with that being said, like RSV, it can have more serious consequences for young children, for older adults, for those who are immunocompromised. In general, though, it's a virus that we've been living with for decades. We're accustomed to it.
And while there's no vaccines available, physicians are prepared to help patients treat their symptoms. And recovery time is typically three to seven days.
Unger: Well, good. I'm going to put that in the not-worry-about column on the virus sheet. Andrea, thanks so much for that overview. In more CDC-related news, there's been some early talk about who's going to be the new head of the CDC. What can you tell us there?
Garcia: So the White House has not yet made any official announcements. But the media is reporting that President Biden plans to select Dr. Mandy Cohen to lead the CDC. She would of course replace Dr. Rochelle Walensky, who is stepping down on June 30. Dr. Cohen is an internal medicine physician. She was formerly the North Carolina Health Secretary.
And she'd really bring her experience at both the state and federal level to the position. So prior to her role in North Carolina, she served in the Obama administration and was a senior official at CMS. She helped oversee federal health insurance programs that provided coverage to more than 140 million people. And actually last year the AMA presented Dr. Cohen with the AMA Award for Outstanding Government Service for her leadership through the COVID-19 pandemic and her tireless work to close the coverage gap in her state. So we'll definitely be sure to check back on this once there are more details available.
Unger: Well, I'm looking forward to hearing more about that transition. Another issue that's been making headlines is Medicaid. Earlier this year a pandemic-era policy that prohibited states from removing people from the program expired. And now we're starting to see the full impact of that change. Andrea, tell us more about what's happening there.
Garcia: Yeah, so that early data shows that in recent weeks, hundreds of thousands of people have lost their Medicaid coverage. At the start of the pandemic, Congress had passed that Families First Coronavirus Response Act, which included a provision that Medicaid programs must keep people enrolled. As you noted, that provision expired earlier this year, on March 31. So far we've seen at least 19 states starting to remove people.
In Arkansas, 73,000 people lost coverage in April alone. That same month 250,000 people lost coverage in Florida. And I think while we don't know the exact total of how many people will lose coverage, the federal government is projecting that it'll be around 15 million people who will be affected. Early data shows that many people may lose coverage due to procedural reasons, such as not returning their paperwork to verify their eligibility, or the state wasn't able to contact them.
So people that were dropped could still qualify. However for others, this change has really left them with no choice but to look for other coverage options.
Unger: Well, thank you, Andrea. This is just the beginning of a big change that we'll no doubt be hearing more about in the months to come. To close out the week, there's new research in JAMA that's been sparking a lot of discussion, weight loss surgery among children and teens. This is a new thing we've been reading about. Is it a trend as we emerge from the pandemic? What's going on there?
Garcia: Yeah, so that data was published in JAMA Pediatrics. And that number of metabolic and bariatric surgeries in kids ages 10 to 19 has been on the rise since 2016. So it was definitely a trend we were seeing even before the pandemic. Even during the pandemic, though, weight loss surgeries among youth jumped 19% between 2020 and 2021, and during that same time frame, surgeries among adults increased 24%.
Unger: And we know that obesity is an ongoing health problem in the U.S. and it affects about one in five children and teens, according to the CDC. Why are more people turning to surgery now as a treatment for it? And is it safe to have it so young?
Garcia: Yeah, so that study noted that traditionally these procedures have been underutilized due to a lack of access and for insurance coverage, but also a low rate of referral from pediatricians. And earlier this year we saw the American Academy of Pediatrics publish new guidelines for the treatment of obesity. And for the first time, those guidelines provided that teens age 13 and older with severe obesity should be evaluated for metabolic and bariatric surgery. This study notes that, in the case of severe obesity, behavioral interventions do not result in long-term clinically important weight loss.
Unger: Well, I'm sure we'll continue to hear more about that as well. Andrea, that wraps up our episode today. Thanks so much for joining us. Next week is the AMA's Annual Meeting of the House of Delegates. So we'll be back with another episode the following week on June 21. In the meantime, you can find all our episodes at ama-assn.org/podcasts. Have a good week. 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.