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COVID-19 Dec. 2, 2020 update: Dr. Irons update

In today’s COVID-19 update, a discussion with AMA's Chief Health and Science Officer, Mira Irons, MD, to review COVID-19 numbers and trending topics related to the pandemic over the past week. Also addressing the latest on vaccines, post-holiday travel precautions and updated guidance from the CDC.

Learn more at the AMA COVID-19 resource center.

Speakers

  • Mira Irons, MD, chief health and science officer, AMA

AMA COVID-19 Daily Video Update

AMA’s video collection features experts and physician leaders discussing the latest on the pandemic.


Unger: Hello, this is the American Medical Association's COVID-19 Update. Today, we're taking our weekly look at the numbers, trends and latest news about COVID-19 with AMA's chief health and science officer, Dr. Mira Irons in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Irons, more movement, thankfully, on the vaccine front this week. Can you share the latest developments on vaccines?

Dr. Irons: Oh, absolutely, Todd, it's been a huge vaccine week, and to be honest, it's going to be a huge vaccine month. Last week, we talked about the fact that Pfizer submitted their application for emergency use authorization for its vaccine to the FDA. That meeting is going to happen on the 10th of December. Since last week, Moderna submitted their application for emergency use authorization to the FDA. The preliminary data that they shared from the company said that that vaccine was 94.1% effective, so as effective as the Pfizer vaccine, which was great news. That meeting is scheduled for December 17th, with the External Advisory Committee at the FDA. So, we'll be hearing information next week on Pfizer, at least from the committee's perspective, and also the following week on the Moderna vaccine.

The Advisory Council of Immunization Practices from the CDC yesterday held a meeting and made their recommendations for prioritization for the first phase. We know that there are really going to be limited doses in December, and so their recommendation was that phase 1A be reserved for health care personnel, people at higher risk, health care personnel and residents in long-term care facilities.

Unger: Can you give us an update on the AstraZeneca setback?

Dr. Irons: Yeah, absolutely. You know, the story is still evolving. And I think the important thing here is that what we're hearing in the media is really preliminary information that was released and really have to wait for the full data to be submitted and looked at. But what was released last week or the week before said that it gave three efficacy percentages or rates, an overall efficacy of 70% for its vaccine, but then it appears that there were two different groups in that study. It's a two-dose vaccine, one group got a half dose and then a full dose, and that group had a higher efficacy. And then another group got two full doses with a little bit of a lower efficacy. And then they reported a 70% overall efficacy, which just didn't make sense in terms of a statistical analysis.

It's also unclear why one group got a half dose. It appears that that might have been an error, but they decided to go along with it and gather information, and so we'll have to see. We'll have to wait and see when all the data is submitted and how the experts really analyze it.

Unger: For physicians who are interested in learning more about the EUA process, we'll be having a webinar. Would you like to share some details about that?

Dr. Irons: Sure. So, this'll be the fourth webinar in the series that we've had to try to bring information on the vaccine development process and also the distribution process to physicians. And this Thursday at one o'clock Central, we'll be having Dr. Peter Marks, who actually is the career scientist at the FDA that manages the vaccine authorization process. He will be speaking, talking about the authorization process and also providing more information so that people understand that the accelerated process approval was still being arrived at safely, that there weren't corners that were being cut. It still will be a rigorous approval process, and he'll provide some background information. And then Dr. Bailey, the AMA president, will be moderating a question and answer period.

Unger: Excellent. Again, that is Thursday, 1:00 p.m. Central time. If you miss that, you'll be able to catch that on demand on our YouTube channel. Dr. Irons, let's now turn to the numbers. You could say that the vaccine cannot come fast enough, because we're seeing just a pretty bad trajectory here. Can we go over the trends that you're seeing at this point?

Dr. Irons: Absolutely. You know, this is what we were worried for. You remember last spring, we kept talking about the fall, and the fall has come. So, the numbers earlier today, 13,783,886 people diagnosed. We know that the estimates are that for every person diagnosed, there are probably eight more that haven't been confirmed, and 272,009 people have died in the United States of COVID-19. The global numbers are greater than 64 million affected and just shy of 1.5 million deaths.

Unger: So, we're looking at quite a bit of a seven-day average of, I guess, 176,000 reported cases last Wednesday. So, this is earning the new surge on surge terminology.

Dr. Irons: Absolutely. Absolutely. And just to give you a sense of the numbers, because sometimes I think we get immune to these really high numbers, they just keep going up. We're still on the rising part of that curve. And on this third surge, that peak's going up a lot longer than even in the first two surges, but in November alone, we had four million new cases. And in October, that number was 1.9 million. And so, I think that kind of gives you a sense of how rapidly this is progressing around the country.

Unger: Not surprisingly, we're starting to see capacity issues across the country. Anything in particular?

Dr. Irons: Oh, absolutely. As opposed to earlier, the first two surges, there were parts of the country that weren't affected. And so, people could move equipment. People could move staff around to help. And now, pretty much the entire country is affected. Governor Newsom of California said that the explosive growth could overwhelm the state's hospital. There's a field hospital opened in Cranston, Rhode Island to take care of recovering patients. In New Mexico, a vacant medical center in Albuquerque was being used for recovering patients. North Dakota, military nurses have been brought in to help, because it really doesn't help you to have an empty bed when you don't have anybody to staff that bed and care for the patient. And so pretty much around the country, we're hearing that there are no available beds, ICU beds are being full and staff shortages are happening.

Unger: I guess the biggest fear at this point is that the amount of travel over the Thanksgiving holiday might lead to an even greater peak in the coming weeks. Any perspective there?

Dr. Irons: Oh, absolutely. The TSA reported that nearly 4.6 million passengers traveled between November 25th and 29th. Now, that is down significantly since last year, but that's a lot of people that were traveling and were not able to socially distance. Even if you try, it's really hard in crowded airports, and were spending time with families and with people that they hadn't been with. Dr. Deborah Birx, I think she said it last Sunday, when she said that if you traveled, you have to assume that you were exposed and infected. And so, you should get yourself tested. Now, you have to wait until an appropriate interval to get tested, and quarantine, and especially not expose yourself to older people in your family or those who may be at increased risk.

Unger: There seems to be some confusion around what was first interpreted as kind of falling death rates, the numbers kind of going up and down. Can you give some explanation about what's going on there with the numbers?

Dr. Irons: Yeah. I think that what we've experienced, even throughout the pandemic, is that I think a lot of this is just reporting intervals. We always see that the numbers seem to be lower on Saturdays and Sundays, and then they seem to go up on Mondays. And I think that that's why, when we look at the numbers, we've been looking at seven-day averages, because it gives you the best idea of really what's happening. And it could be that some of the differences just had to do with decreased reporting over the Thanksgiving holiday.

Unger: Well, in other news, we've got some updated guidance from the CDC. Can you outline what's new there?

Dr. Irons: Yeah. So, the guidance until now has been that people that have been exposed or in close contact with someone with COVID should quarantine for 14 days. So that guidance was changed over the last day or two to indicate that the quarantine could last as little as seven days, if you've had a test and were negative, or as long as 10 days if you haven't been tested. So, it was decreased. And I think the CDC did weigh the evidence, and people are most infectious two days before symptoms or five days after symptoms. There's a seven-day period. And also I think they looked at the fact that many people just can't quarantine for a full 14 days, so that if you're able to have more people quarantine for a shorter period of time, especially taking away those final days, when you're less likely to transmit, it may be better off in the end.

Unger: So not perfect, but could be offset by increased compliance by those who might be infected. Finally, let's talk about key messages coming out of the AMA, a lot of announcements this week. Let's hit the top notes there.

Dr. Irons: Yeah, December 1st was a big day. So, the AMA issued a statement on December 1st, commending the Advisory Council on Immunization Practices, ACIP, for their efforts to ensure equitable allocation of the COVID-19 vaccines as soon as they become available. The announcement, the statement said we strongly support ACIP's evidence-based interim recommendation adopted today, yesterday, for phase 1A of the COVID-19 vaccine allocation process, which aligned with AMA's public health policy and code of medical ethics. By first vaccinating our frontline health care personnel and residents of long-term care facilities against COVID-19, we will help ensure patients continue to receive vital care during the pandemic and safeguard those who are most at risk for severe illness and death.

The next statement was a joint statement that was issued by the AMA, the American Hospital Association, and the American Nursing Association, issued an open letter backing science-based COVID-19 vaccine development and urging the public to remain vigilant until widespread vaccination, really endorsing that the three organizations really believe in a scientific and regulatory process that's rigorous, and also acknowledging that people are going to have to keep doing those mitigation measures, wearing a mask, socially distancing, washing your hands, until we can get enough of the population vaccinated, because that's going to take months. And so, we are seeing a bright light out there, but it's going to take a while to get there.

Unger: Well, thanks so much, Dr. Irons. There's a lot to talk about, and I appreciate your perspective. Again, if you're able to, please tune in to our webinar on Thursday, December 3rd, at 1:00 p.m. Central time with Dr. Peter Marks from the FDA. And if you miss it, you can catch that on our YouTube channel on demand. That's it for today's COVID 19 Update. We'll be back soon with another segment. In the meantime, for resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us. 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

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