Latest guidance from FDA & CDC on second booster shots with Andrea Garcia, JD, MPH [Podcast]

AMA Update

Latest guidance from FDA & CDC on second booster shots with Andrea Garcia, JD, MPH

Apr 6, 2022

In today’s COVID-19 Update, AMA Chief Experience Officer Todd Unger reviews rising COVID-19 case numbers and trending topics related to the pandemic over the past week with AMA Director of Science, Medicine and Public Health Andrea Garcia, JD, MPH. Also covering the spread of the BA2 variant, Medicare paying for at-home COVID tests, as well as the latest from the FDA and CDC regarding who may get a second COVID booster shot.

Learn more at the AMA COVID-19 resource center.

Speaker

• Andrea Garcia, JD, MPH, director of science, medicine & public health, American Medical Association

Unger: Hello, this is the American Medical Association's COVID-19 Update video and podcast. Today we have our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Director of Science, Medicine and Public Health Andrea Garcia, in Chicago. I'm Todd Unger, AMA's chief experience officer also in Chicago. Andrea, thanks for joining us this week. After a number of weeks with good news and declining rates, some states are now starting to see an uptick in cases. What is going on?

Garcia: Well, it's good to be here, Todd, and you're right. While COVID cases have fallen nationally to about 27,000 per day on average, some states, mostly in the Northeast, have seen some increase in case members over the past two weeks. So if we look at Connecticut, Massachusetts, New Jersey and New York, they are definitely seeing an increase and some have seen cases jump more than 40% over the last 14 days.

Unger: Wow.

Garcia: Other states on the East Coast and in the Midwest are seeing some slight upticks over the past two weeks, so Delaware, Florida, Illinois, New Hampshire, Wisconsin. I think the thing to keep in mind is that the average new cases we're seeing still remains much lower than during that winter Omicron surge.

Unger: We've been expecting to see an uptick with the BA.2 variant becoming widespread and dominant. Do we know how pervasive it is in the U.S. at this point?

Garcia: Yeah. Last Tuesday, BA.2 became the dominant variant, according to the CDC and that, of course, meant we were more than 50% of all new cases. As of today, so a week later, that number's up to 72.2% of cases and we know in some regions BA.2 is as high as 84% when we look at the Northeast. And according to the WHO, BA.2 is also now the dominant version of Omicron around the world. So given this, the uptick we're seeing is not unexpected. And Dr. Fauci said in an interview on Friday that we should expect to see an uptick in cases because we have a sub-variant that is more contagious than the original Omicron and we're pulling back mitigation measures, namely the requirement for indoor masking in some places. He did point out that, given this, we can't declare victory premature here.

Unger: So that's a bad combination, super contagious variant, possibly pretty quick in terms of incubation at the same time we're lowering the defenses, per se. Do you think we're going to look at a return to some of those restrictions if we continue to see that rapid increase?

Garcia: I think it's difficult to say. In that same interview, Dr. Fauci said, "If we do see a serious uptick, we should be prepared to pivot and at least have masking in some indoor settings." I think the challenge, as you know, is that many people have become tired of these mitigation strategies and I think the other thing is that experts are divided about what we're going to see in the coming weeks. I mean, some have said that we're going to see a small rise in cases but we're not going to see a major surge because of BA.2 and other scientists worry that we're not doing enough to prevent another possible surge. And, of course, complicating this is the fact that at home tests are not officially reported, which makes it hard to know our true case numbers.

Unger: So in areas of our lives where there's still mitigation measures, particularly in the arena of transportation, are we still seeing pushback there?

Garcia: We are. So just last Tuesday, 21 states filed a lawsuit against the Biden administration to block that federal mask mandate on public transit. That lawsuit came on the heels of the TSA extending that mask requirement for airplanes and other forms of public transportation. That extension is through April 18 and, of course, the CDC had recommended that extension. In that lawsuit, the states, which are being led by Florida, argued that the CDC was overreaching its authority with the mandate and was interfering with state laws on masking.

Unger: Well, in addition to the cases, overall down, upticks in some places, how about hospitalizations? What are we seeing there?

Garcia: So hospitalizations, as we've talked about before, are a lagging indicator and some are saying that we could see an uptick potentially in cases leading to an increase in hospitalization in some parts of the country. I think that's particularly true where we have a majority of people who are not up-to-date on their COVID vaccinations inclusive of that booster dose. However, that hasn't happened yet and as of Friday it appeared that hospitalizations were actually at record lows. CNN was reporting that 16,138 people were in the hospital with COVID last Friday and that is fewer than ever since HHS first started tracking in July of 2020.

So just 2% of hospital beds are currently in use for COVID patients. A previous low was in late June of 2021 just before Delta became the dominant variant and, of course, that peak was just in January of 2022 during the surge when we reached about 160,000 people hospitalized at one time with COVID. We are hearing some good news from some hospital systems. In California on Thursday, UC Davis tweeted that its ICU had no COVID patients for two consecutive days and that's for the first time in two years, which is pretty incredible.

Unger: Well, thankfully, I hope that translates into some much needed relief for hospital staffs who have been enduring successive waves of surges here for the last few years. It's got to have taken quite a bit of toll on everyone there. We don't want to head back into a situation where we're experiencing these kinds of surges and key to that, of course, is continued vigilance and funding of our public health infrastructure. Last week, we talked about this lack of support to fund some of these key measures to prevent it from happening again. What's the progress there?

Garcia: On Monday, Senate negotiators announced a deal on a smaller $10 billion COVID aid pack. That package does not include the global vaccine funding. This came as a result of an effort to get additional aid for domestic testing, vaccination and treatment before Congress leaves town at the end of the week. Agreement requires at least five billion to be set aside for therapeutics, 750 million for research and clinical trials to prepare for future variants, and then the remaining is for vaccines and testing.

Unger: Well, that does sound like relatively good news. What's the response from the administration on that?

Garcia: It's good news, but I think the bad news is less than half of what the president originally requested, which was 2.25 billion. Senator Schumer said that this will give the federal government the tools it needs to continue economic recovery, keep our schools open and keep families safe. But he also added that while this emergency injection of additional funding is necessary, it's short of what's truly needed in the long-term to keep us safe from COVID. And the White House press secretary also said in a statement that every dollar the administration requested is essential and they're going to continue to work with Congress to get all of the funding that's needed. Of course, time is of the essence and this $10 billion package is funding those most immediate needs but if this doesn't pass, we run the risk of not having those critical tools like we've talked about, testing and treatment, starting in May and June.

Unger: So do you think we'll see negotiations continue or is that it?

Garcia: I think it's likely we'll see continued negotiations and a potential other emergency aid package that could include that global vaccination effort and additional assistance from Ukraine but we'll have to wait and see.

Unger: But even with that funding cut, at home tests will now be easier to get for some people who need them most. Tell us more about that.

Garcia: So Medicare is going to start paying pharmacies and health care providers to supply up to eight tests a month. And that will be for the duration of the public health emergency. It covers roughly 60 million enrollees, and that is people enrolled in Medicare Part B and those on a Medicare Advantage Plan. It's good news. It's the first time Medicare is offering over the counter tests and the move has been praised as really significantly increasing testing for those most vulnerable to COVID.

Unger: Well, speaking of those most vulnerable to COVID, the FDA authorized a second booster of the Pfizer and Moderna vaccines for people 50 and up and some immunocompromised folks, as we discussed last week. But the wording was a little confusing to some people. What's the latest there?

Garcia: Yeah. So, over the past week, there have been a lot of articles and discussions about who exactly should be getting that second booster dose and the timing of that shot. And, of course, there are different views. The CDC did, after we spoke last week, release a recommendation via a media statement and they have updated their clinical vaccine guidance. That guidance gives some individuals the option to receive a second booster dose using an mRNA vaccine. So it's people age 50 and older, those 12 and older who are moderately or severely immunocompromised, and those 18 and older who received both a primary and a booster dose of a J&J vaccine.

So the timing for all of those is at least four months past the previous booster dose and, again, this is a recommendation that says these groups can choose to receive a booster dose based on their individual circumstances and if people have questions, they should talk to their physician. And as we mentioned last week, the FDA's Vaccine Advisory Committee is meeting this week to talk about the overall booster strategy and that's going to inform when, how and whether to modify boosters to fight future variants. So more to come on that.

Unger: So a lot to worry about, people getting first boosters, second boosters and, of course, getting traction on people getting their first shots. What's the story there?

Garcia: So CDC figures show that about 65.5% of those eligible in the U.S. population are fully vaccinated. Of course, that varies by state. In some states, we're barely over 50%. And among those who are fully vaccinated, fewer than half have received that recommended first booster dose. Dr. Harmon, our AMA president, published a viewpoint on that subject and in it he noted that the real fight that we are facing is building widespread immunity to COVID by increasing the number of people who are vaccinated. We know that vaccination remains our most potent weapon to blunt the impact of the virus, not only today, but this fall, next year and beyond. And he called on physicians to continue to encourage patient and people within their sphere of influence to get vaccinated and to get boosted. And he also noted that we build confidence in vaccines by taking patients' questions and concerns seriously and then pointing them to credible evidence.

Unger: Yes and thank you to Dr. Harmon for all the work that he's been doing on behalf of the AMA and physicians everywhere. Andrea, thanks to you for being here. That's it for today's episode. We'll be back with another COVID-19 Update shortly. In the meantime, visit ama-assn.org/COVID-19 for resources on COVID. And thanks for being here today. 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.