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, monkeypox, medical education, advocacy issues, burnout, vaccines and more.
In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses the latest research on long COVID, as well as Omicron variant XBB.1.5 and other SARS-CoV-2 subvariants. Also covering how the Biden administration's decision to end COVID-19 national emergency and U.S. public health emergency on May 11 will affect hospitals, physicians and patients—while the World Health Organization (WHO) maintains the COVID-19 pandemic is still a global health emergency. AMA Chief Experience Officer Todd Unger hosts.
Watch, read or listen to Sandra Fryhofer, MD, AMA Board Chair's recent vaccine and bivalent booster episode.
Learn more at the AMA COVID-19 resource center.
- 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: Thanks. It's good to be here.
Unger: Well, big news this week that came out. President Biden said he plans to end the public health emergency in May. Tell us more about that. And what does that really mean in the big picture?
Garcia: Well, to remind everyone, there are two declarations that were made by the Trump administration back in 2020. One was the COVID-19 national emergency and the other was the public health emergency. They are currently set to expire on March 1 and April 11, respectively. And on Monday, the White House released a statement saying that they would briefly extend both of those declarations, and then allow both of them to expire on the same day, May 11. That announcement came the day before the House was scheduled to vote on legislation that would terminate the public health emergency immediately.
White House officials have said that they don't want to end that emergency immediately, that the nation needs an orderly transition. And as we've talked about before, that public health emergency provides administrative and regulatory flexibilities. And keeping it in place for several more months will allow hospitals, health care providers and health officials to prepare for a host of changes when it ends.
Unger: And I know that many view the acute phase of this, obviously, in the rearview mirror, but we do still have more than 500 people dying of COVID every day in the U.S. So Andrea, when we think about this decision, what is driving—putting a date on the end of it?
Garcia: Yeah. I think if you would have told me in 2019 that 500 people were dying per day of an infectious disease, which is more than twice the number of deaths we see during a bad flu season, and it wasn't a public health emergency, that would have been really surprising.
But we're at the three-year mark. We have safe and effective vaccines and treatments. Many people are no longer taking public health precautions. They're not being required by jurisdictions. And much of the population has some protection against the virus, either from vaccination or prior infection. So at least part of the rationale here for this decision is that we are in a different place.
It's also likely that case counts are trending downward after that slight bump we saw over the winter holiday. And cases are significantly below levels we've seen over the last two winters. And so that winter surge that we were expecting wasn't as big as it was in previous years, though we do testing has declined. And so that number of cases that were reported has decreased because of testing as well.
Unger: Now, Andrea, you mentioned up front that there would be changes to hospitals, physicians and others that we need to prepare for, so back to that orderly transition. What are some of the changes that we can expect once this deadline expires?
Garcia: So it's going to formally restructure the COVID response and treat the virus, as you mentioned, to more of an endemic threat to public health that can be managed through the agency's normal authorities. It also means that the cost of COVID vaccines are going to increase. Pfizer is expected to charge as much as $130 per dose. And with only 15% of the eligible U.S. population having received that updated booster dose that's been recommended since fall, we can expect the cost of these vaccines, with people having to pay for them, to be yet another deterrent. People with private insurance could also have some out-of-pocket costs for the vaccines, especially if they go to an out-of-network provider.
Unger: And what about tests and treatments? Because we've talked before in prior episodes about costs associated with those things.
Garcia: Those are likely to be affected as well. We know millions of Americans have received those free COVID tests and treatments during the pandemic. Not all of that is expected to continue and to be free once the emergency is over. Those at-home COVID tests will come to an end. And hospitals will not get extra payments for treating COVID patients.
I think the bright side is legislators did extend some of these provisions, like the telehealth flexibilities, that were introduced as COVID hit, so we can expect those telehealth provisions specifically to be extended for another two years.
Unger: And remember out there, that's a big part of what the AMA has been focused on in our recovery plan for America's physicians, is making sure that those flexibilities do continue well beyond the pandemic. Andrea, we're going to continue to report on what people can expect throughout this transition and how physicians may need to adapt, so we'll cover that in your future episodes.
We've also discussed that we continue to see more than 500 COVID-related deaths per day. Andrea, how are cases looking? And is the XBB.1.5 subvariant still the main driver?
Garcia: Yeah. COVID cases are continuing to decline. We're seeing about 45,000 new cases on average per day. It's more than a 20% drop in cases over a two-week period. And hospitalizations are also declining by about that same percentage. According to The New York Times the West is faring well, with states like Montana and Utah seeing some of their lowest cases and hospitalization rates. If we look at drivers, the CDC data released on Friday shows XBB.1.5 is the dominant variant in the United States. It now accounts for 61.3% of COVID cases for the week ending January 28. And that estimate the previous week was 49.5% of cases.
I think the other good news we heard from CDC was about the vaccine. The updated bivalent COVID booster from Pfizer and Moderna help protect against symptomatic infections from these new XBB-related subvariants.
Unger: And that's something that came up yesterday, too, in our conversation with the AMA board chair, Dr. Sandra Fryhofer, who stressed that the best thing that people can do right now is get that bivalent vaccine if they haven't gotten it already. And she also talked about efforts to simplify COVID vaccines and what to expect with vaccine development in the months ahead. We've got a link to that episode in the description of this one, so check that out, and you can listen to or watch and find out more about that.
Another topic that came up in our conversation with Dr. Fryhofer was, as she put it, the fall of Evusheld and how it's no longer authorized for use in the U.S. because it's no longer effective against these new variants. Andrea, what options are still out there for those that need COVID treatment?
Garcia: Well, we know that people who are immunocompromised and older adults continue to be at increased risk from COVID-19, and HHS has really ramped up efforts to get those high-risk populations vaccinated and to also help ensure timely access to test and treatment. Treatments that are still considered effective against COVID are Paxlovid, Lagevrio and Veklury, and COVID-convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. So there are still options out there.
And physicians can visit the FDA website or view ASPR's information sheet for additional details. They may also contact ASPR at COVID-19 therapeutics at hhs.gov if they have specific questions.
Unger: Well, that's good to know. And again, COVID-19 therapeutics at hhs.gov for questions on that. It sounds like overall, if I'm hearing you correctly, that we're moving toward, of course, treating COVID as an endemic issue and that the trends are looking better right now.
But we do know that many people are still suffering from long COVID. And that's not going to go away anytime soon. In fact, a new study shows that people are still missing work due to long COVID. Andrea, what can you tell us about that study?
Garcia: According to a New York Times article which showed an analysis of workers' compensation claims in New York, 71% of claimants with long COVID needed continuing medical treatment or were unable to work for six months or more, and more than a year after contracting COVID, about 18% of those long COVID patients hadn't returned to work, and more than three-fourths of them were younger than 60. That study, which was published by New York's largest worker's compensation insurer, analyzed COVID-related claims from patients exposed to the virus at work. And those claims were filed between January of 2020 and the end of March of 2022.
And that's not—the study really shows a snapshot of the larger problem. And we know that long COVID is having a significant effect on America's workforce and preventing a substantial number of people from going back to work. And still others are continuing to need medical care long after returning to their jobs.
Unger: Those are pretty startling numbers and a very, very tough situation. Have we learned anything about how long COVID—about long COVID that can help patients like that, identify it, and get the right treatment?
Garcia: Well, there was recently a new study published in Nature Medicine that really divided long COVID symptoms into four major categories, and those were heart, kidney and circulatory problems; respiratory issues, anxiety, sleep disorders and chest pain; musculoskeletal and nervous system issues, including arthritis; and then digestive and respiratory issues. Those results indicated which long COVID symptoms were the most prevalent. And heart, kidney and circulatory system subtype affected about 34% of people, followed by respiratory, anxiety and sleep issues at 33% of people.
I think another finding worth noting from that study is that two-thirds of the people that were affected by respiratory issues, sleep disorders, anxiety, and chest pain were women. Of course, long COVID is going to be something that we'll continue to monitor and study to find out more.
Unger: Yes. And in line with this, and coming full circle, while the U.S. now has plans to remove its public health emergency designation, the World Health Organization came out on the same day and said the pandemic is still a global health emergency. Talk to us about that.
Garcia: Well, that decision followed a meeting by the WHO's International Health Regulation Emergency Committee last Friday, and then the WHO director accepted its recommendation to extend that emergency declaration. The agency did, however, acknowledge that the crisis is likely at an inflection point, where higher levels of immunity may soon lead to lower virus-related deaths. We did hear the WHO director say that we're in a far better situation now than a year ago when the Omicron variant was at its peak.
Still, he warned that in the last eight weeks, at least 170,000 people have died around the world in connection with COVID. He called for at-risk groups to be fully vaccinated, an increase in testing, and early use of antivirals, an expansion of lab networks, and a fight against misinformation about the pandemic. That emergency committee called on the WHO to take steps to prepare for that end of the emergency designation and said it would reconsider that status in three months.
Unger: 170,000 deaths in the last—did you say eight weeks? That's a pretty astounding figure. So folks out there, get that bivalent booster. Andrea, we're going to keep an eye on the situation here in the U.S. and around the globe as well. That's it for today's episode. Thanks for being here. We'll be back with another update next week. 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 podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.