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.
Is it flu season right now? Is long COVID dangerous? In this episode: long COVID in children and how the number one cause of child death in the US lacks clinical research funding.
Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
- 🦠 CDC COVID Tracker map, charts, and data.
- 🗺️ CDC flu tracker map and weekly FluView Influenza Summary Update.
- 💧 COVID Wastewater data via CDC National Wastewater Surveillance System (NWSS)
- 🔬 New long COVID study data from American Academy of Pediatrics journal on Postacute Sequelae of SARS-CoV-2 in Children,
- 💉 Searching for "COVID vaccine near me", "flu shots near me" or wondering "is it too late to get the flu shot"? It's not! Find vaccines in your area.
- 📬 Wondering "where can I get a free COVID test"? Free COVID-19 tests by mail still available, USPS order free COVID test kits.
- 🧪 Check FDA COVID test expiration date extensions.
- 🥼 CDC Chief Medical Officer, Debra Houry, MD, MPH previous episode available.
- 📈 CDC gun violence statistics and firearm violence prevention research.
- 💻 #AMAEdHub Firearm Safety, Injury Treatment and Risk Factors CME course.
- 🟣 Learn more about AMA gun violence prevention advocacy.
- 📺 Chair of the AMA Gun Violence Task Force discusses what can be done to reduce gun violence.
- ❤️🩹 Learn more about firearm safety, suicide prevention and how to stop gun violence.
- 🩺 The AMA is your powerful ally in patient care. Join now.
- 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. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.
Garcia: Hi, Todd. Thanks for having me.
Unger: Well, let's start today's update with respiratory viruses. Last time we talked, things were beginning to level off, but I'm curious how things are looking now.
Garcia: Yeah, well, after several weeks of a decline, it's been reported that flu activity is starting to pick back up again, and that's really based on test positivity numbers from clinical labs.
If we look at some of that CDC data during the last week of January, we saw more than 82,000 people who visited emergency departments diagnosed with flu. That was about an 8% increase, so 6,000 more than the week before. We know that a second surge of flu activity after the winter holidays is common.
But as we've talked about before, flu is unpredictable. It's hard to know how long or severe a flu season will be. And CDC says sometimes this type of surge is the start of a second wave, but it could also just be a minor blip before we begin to see those more consistent declines. Right now, it's too early to tell which way things are going to go.
Unger: All right. Well, we'll keep our eye on that. I have two friends with COVID. Curious, as we think about COVID, RSV even, how are we doing on that front?
Garcia: COVID and RSV activity is also still high. I think the good news there is that emergency department visits for COVID and RSV have been declining now for about a month. But there were still more than 50,000 emergency department visits and about 23,000 hospitalizations for COVID during that last week of January.
And as a CNN article pointed out, these national trends are helpful in giving us the overall picture, but it's really those local trends that people need to be paying attention to and that's going to be what helps them gauge their personal risk.
Unger: Talk to us a little bit more about that particular angle, about the local risk. Are there certain areas in the United States that we need to be paying more attention to in terms of the risk?
Garcia: Yes. So if we look at the CDC data, there are about 18 states and DC that are still experiencing either high or very high levels of respiratory illnesses overall. If we look at the data from the CDC Center for Forecasting Analytics, flu infections are increasing in four states, so Florida, New York, Oklahoma and Texas, and they're also likely increasing in five others, so Arkansas, Kentucky, Massachusetts, and then North Carolina and South Carolina.
As for COVID, that wastewater surveillance is suggesting that COVID levels are highest in the South and forecasted increases are noted for South Carolina in particular. I think the situation could certainly be worse than it is, but the reality here is that we're still seeing a lot of respiratory illnesses right now in many parts of the country.
Unger: Now as we're all pretty well aware of, some of these diseases, especially with COVID, can have longer-term effects. And this week there were headlines about long COVID in children, which is something we really haven't talked that much about. Andrea, what do we need to know here?
Garcia: Yeah. The New York Times was reporting on a large analysis that was funded by the NIH and published in the Journal of Pediatrics. And that work provided a summary of the current understanding of long COVID, or what is called post-acute sequelae of SARS-CoV-2 in children. And that paper drew on numerous studies of long COVID in kids and showed that the condition can lead to neurological, gastrointestinal, cardiovascular and behavioral symptoms in the months after an acute infection.
That review suggested that 10 to 20% of children in the U.S. who had COVID developed long COVID. As a co-author on the paper pointed out, though, there are a lot of caveats that come with those percentages, and that's due to differences in study design, different settings, different populations and different diagnostic criteria. For example, some of those studies looked at children who were hospitalized for COVID.
So I think those percentages―those estimates of long COVID―really do vary. CDC estimates the prevalence of long COVID in kids to be significantly lower, saying it's closer to about 1% of kids who've had COVID. That estimate in adults, by comparison, is about 7%.
Unger: Andrea, is this something that parents need to be worried about?
Garcia: I think we all just need a better awareness of the possibility of post-acute infection syndromes and the fact that there are chronic illnesses that can occur after an infection. I think we still have a lot to learn in this area. And as we know, long COVID, whether it's in adults or in children, can be difficult to diagnose. Of course, that could be even trickier in kids because the symptoms might present differently than they do in adults. And we know young children often don't have the language to describe what exactly they're feeling. So because of this, researchers are advising parents to look for changes in behavior.
Unger: I'm curious what are the common symptoms in children and how they affect kids in the long term? Are these kind of a different set of things we might see in adults?
Garcia: Well, the most common symptoms that were reported among kids were fatigue, brain fog and headaches. So those seem pretty similar to what we see in adults. While they can be―the symptoms can be mild―they can also prevent kids from participating in school or participating in recreational activities. And because of this, some young children may act out and they could be really frustrated that they can't do what they were once able to.
Experts say that most symptoms do seem to improve within a year. But for some kids, they can definitely last longer. And we still don't know how this may impact kids' development in the long term.
Unger: Well, I certainly know there's a lot of research that's being undertaken to continue to understand long COVID more. Is there any news on treatments for long COVID?
Garcia: We don't have any drugs approved to treat long COVID. So right now physicians can really only manage symptoms and help patients function day to day. Of course, some physicians may prescribe medications to help with certain aspects of long COVID, like relieving headaches and muscle pain.
As is the case with adults, a lot of these children were previously healthy and their symptoms might be vague. So this really becomes for the physician about being empathetic, listening to the patient's experience and really validating that experience. We know many people, especially early on in the pandemic, were doubted or were made to feel like their symptoms weren't real.
I think schools, this also needs to be on their radar, because they're likely going to need to deal with this and make accommodations for kids who are struggling, like providing breaks during the day or extra time for tests. And hopefully, with the ongoing research in this area, we'll get improved diagnosis and available treatments.
Unger: Absolutely. And we'll continue to follow that research on long COVID. There's just so much interest and so many people affected. And obviously, both adults and children at this point.
Andrea, switching topics. Another aspect of children's health made headlines this week. It's not about a virus. Tell us more.
Garcia: Yeah, this was also reported by CNN, but it's something that we've talked about here before. And that headline is that tragically firearms became the leading cause of death among children in the U.S. in 2020. That has only risen. But research funding to support that prevention is not keeping pace.
To put this into context, from 2008 to 2017, about $12 million in federal research awards were granted to study pediatric firearm mortality each year. That's about $600 per life lost. And that's according to a study published in Health Affairs.
We can contrast that with motor vehicle injuries, which we know was the leading cause of death among children prior to 2020. That received about $26,000 of research funding per death. And then if we looked at pediatric cancer, which is the third-leading cause of death, that received about $195,000 per death.
Unger: Wow. That is just stunning that guns have become the leading cause of death among children. Andrea, you talked about the funding. Where do we stand for funding right now on important studies and research like that?
Garcia: Well, Congress has appropriated about $25 million for firearm injury prevention research each year since 2020. And that amount we know is split evenly between CDC and NIH. Even if all of those dollars were spent on studies that focused on pediatric deaths from firearms, it'd still be less than $6,000 per death.
I think with that being said, it's made some difference. From 2020 to 2022, we saw about 90% more registered clinical trials and publications related to firearm injury prevention than there were in 2017 to 2019. And those numbers are from a research letter that was published in JAMA Surgery.
As Dr. Deb Houry, who we know is the CDC'S Chief Medical Officer, someone who's been on AMA Update said, everybody's realized that firearms are a leading mechanism for violent death. That's never really been questioned. But what's been harder to say is what we can do about it. We know these deaths are preventable. We need research to help build that evidence base to show those steps that we can take, like we did with motor vehicle injuries when we moved to require seat belts and other safety measures.
Unger: Andrea, and I know the AMA has been committed to helping achieve the goal that you talked about, can you give us some background on what the AMA is doing to help address this?
Garcia: Yes. The AMA has established a task force that is focused on firearm injury prevention, including firearm-involved suicide. They actually had their meeting in December here at AMA headquarters. We’ve brought together thought leaders in this space.
We're also collaborating with interested state and specialty societies to bring that physician perspective on this issue to some important cases that are being heard in the courts. In 2016, we declared firearm violence a public health crisis and the task force is really moving us towards action.
Dr. Resnick, back when the task force was announced, noted that we can't continue to live this way. Our children spend portions of their school days running active shooter drills, knowing full well that their classroom could be next. And as physicians and healers, we're committed to ending firearm violence by advocating for common-sense, evidence-based solutions.
Unger: Absolutely. And I know we're working with you on future AMA Updates to talk more about the progress that the task force has already made.
Andrea, thanks so much for being here today and keeping us informed as usual. If you found this discussion helpful, you can support more programming like it by becoming an AMA member at 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.