Mira Irons, MD, talks COVID-19 numbers and trending topics including Pfizer vaccine

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

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 and also covers the FDA granting emergency use authorization to the nation’s first coronavirus vaccine, the post-Thanksgiving surge, other super-spreader events and subsequent overwhelming hospital admittance. Learn more about the Pfizer vaccine.

Learn more at the AMA COVID-19 resource center.

Speakers

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

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, the first topic that's on everyone's mind is the approval of the Pfizer vaccine on Friday. Can you talk a little bit about this good news and next steps from here?

Dr. Irons: Oh, absolutely, Todd. It is good news. As everybody knows, I think, that the Pfizer vaccine was approved. It was the Pfizer BioNTech MRNA vaccine. The FDA issued the authorization on Friday evening. Prior to that, however, there was a full day meeting of the External Advisory Committee on Thursday that completely interrogated the evidence. That was presented data on both the status of the current pandemic and the evidence and approved the recommendation for the EUA. The FDA acted on that Friday evening.

Saturday, the Advisory Council for Immunization Practices, which is the CDC arm of this process, approving and recommending vaccines in the United States is a two-step process. The FDA approves or issues the authorization for the vaccine itself, and then the ACIP Committee issues recommendations for its use in the United States. And so once again, that committee, which is a different group of people, heard the presentation from Pfizer and went through a decision evidence framework, and they approved the recommendation for the use of the Pfizer BioNTech vaccine in the United States in individuals 16 years of age and over.

Unger: Dr. Irons, who is going to get the vaccine first and then who do we expect to get it next?

Dr. Irons: Ultimately that's up to the states. That committee, the ACIP Committee, two weeks ago I believe, made the recommendation that phase 1A really be focused on health care workers and residents of long-term care facilities and the staff of long-term care facilities because of the significant impact of disease in individuals in those facilities. And it was really a risk-based recommendation. And just today, we're hearing that the vaccine is on its way. Vaccines started moving over the weekend. The first person in the United States who received the vaccine this morning was a critical care nurse in New York. Several other hospitals in other states are also beginning to immunize their staff. And the process is on.

Unger: And it looks like we'll be doing this process again this week for the other vaccine. Is that correct?

Dr. Irons: Absolutely. Same thing. The exact same process for the Moderna application, which is also an MRNA vaccine. The FDA Advisory Committee meeting is on Thursday. ACIP is meeting ... their meeting has been posted for Friday and Sunday. Obviously that is going to depend on whether an authorization comes because they moved up their Sunday meeting to Saturday, this week after the authorization, and the meeting materials for anybody that's interested, will be posted tomorrow on the FDA website, which includes information from both the manufacturer, Moderna and also the CDC recommendations to the committee.

Unger: Well, the arrival of vaccines couldn't come too fast because the numbers continue to be on a terrible trajectory. Can you review, Dr. Irons, what this week's numbers are and what's happening across the country with new cases and deaths?

Dr. Irons: Yeah, absolutely. The numbers, as of this morning, 16,258,147 people who have been confirmed to have COVID since the beginning of the pandemic. We know that probably set an estimated seven to eight times that number have been infected. And as of this morning, 299,191 individuals have died. I don't think we ever thought we'd see numbers that large. Of note, just to give you a sense of the impact, 50,000 of those individuals died in the past four weeks. And if you're listening to public health experts around the country, I think there's an estimate that we may have 3,000 deaths a day for the next two to three months. This is probably part of the Thanksgiving surge that we're seeing. And you look at the seven-day average, over 200,000 new cases a day and deaths are about 2,400 to 3,000. The numbers are jarring.

Unger: That's pretty incredible when you think about 300,000. That's one of every 1,000 Americans died from COVID-19 and appears to be on an accelerating track. Are we seeing any trends at the state level that are different from where they've been?

Dr. Irons: I think that the year is ending pretty much as the pandemic began, with overwhelmed hospitals and thousands of deaths per day across the country. Over one third of Americans now live in locations where hospitals are running critically short of ICU beds. Public health officials in LA County warned that it could see catastrophic suffering and death in the coming weeks as the nation's most popular county reported a record breaking over 13,000 cases on Friday.

If you're looking at deaths per capita, Rhode Island leads the nation in coronavirus cases per capita averaging about 1,240 cases a day. And just to give you some idea of the impact of this on the health care staff, to care for all of these patients, Rhode Island began issuing temporary licenses to doctors and nurses who are retired, visiting the state or have recently completed training programs, just to get that workforce up. And just to comment, the health care workers, we know that the health care workforce has been in this from the very beginning, but I had more than a few calls last Thursday and Friday from physicians and nurses who were sobbing with the news, actually with the news of the EUA, because that group who has put so much into this can see a light at the other end of the tunnel here.

Unger: Thank goodness. One other piece of interesting news. We've talked a lot about super spreader events, but the magnitude of one of the original super spreader events has been measured. You want to talk a little bit about that?

Dr. Irons: Yeah, absolutely. The Boston pandemic, in large part was started by a conference that Biogen had in Boston in the spring. And the geneticists actually have issued several reports over time. But by following the genetic footprint of the virus, they were able to show early on that I think it was about 70,000 individuals in the Boston area may have contracted COVID secondary to that conference. And there's a paper published over the weekend, last week, that actually followed people from that conference outside of the United States. And there's an estimate that the global reach of that conference, in terms of the pandemic, could be up to 300,000 individuals.

Unger: Wow. I guess the way you would summarize it before, we're in for a couple of tough months.

Dr. Irons: Yeah.

Unger: We still haven't seen the complete impact of Thanksgiving. We're coming up to Christmas and the holidays with more travel and people are fatigued.

Dr. Irons: Yeah.

Unger: What do you see coming from the Biden Administration to prepare to take this on?

Dr. Irons: Well, the President Elect, Biden, has said that they want a hundred million doses given within the first 100 days of his presidency. And he's also asked people to wear masks for the first 100 days of his presidency. I think the one thing we really have to remember is that a significant portion of the country has to be vaccinated in order to achieve herd immunity. We can't let our guards down. As soon as people are vaccinated, people are still going to have to wear masks. You're still going to have to socially distance until we can get enough people vaccinated. And it's really important for physicians, nurses, the health care workforce, to not only get vaccinated, but also to start to dispel a lot of the misinformation out there and to provide a lot of information about the need for vaccination to end this pandemic in the United States.

Unger: Well, on that particular topic, of course, the effectiveness of the vaccine relies on people getting it. And vaccine confidence continues to be an issue. Where are you on vaccine confidence? And what can we do to increase that?

Dr. Irons: I think that the different polls are saying different things. An AP poll released this week found that half of Americans were ready to take the vaccine with a considerable partisan divide. A recent Gallup Poll showed more acceptance. It was up to about 63% of Americans now saying they'd be willing to take a vaccine. That was up from 58% in October. But, and this is just my opinion, I think that the slow rollout of the vaccine—and it's slow because it's of such significance and we're going to have a limited number of doses in these early months—may actually be to our advantage because there are some people in that hesitant phase who didn't want to be in the first group. I think once health care providers are vaccinated in the first month or so, we may get more information that may give people some confidence, some more personal confidence in the vaccine.

Unger: Any statements from the AMA that you want to highlight this week?

Dr. Irons: Well, both are vaccine related and both actually had to do with the authorization of the Pfizer vaccine. On Friday, shortly after the FDA authorized the vaccine, the AMA issued a statement, "For much of this year physicians, nurses and frontline health care personnel have done Herculean, unprecedented work to care for patients and prevent the spread of COVID-19 all while scientists and researchers sprinted to develop a safe and effective vaccine. After a thorough, rigorous, transparent review process. Today's decision by the FDA to grant an emergency use authorization for the first COVID-19 vaccine developed by Pfizer and BioNTech is a monumental milestone with the potential to set us on a road to recovery. The comprehensive science-based, transparent nature of this process is critical to inspiring the public's confidence in this vaccine."

 And then Saturday after the Advisory Committee on Immunization Practices issued its recommendations, the statement was, "With the recommendations approved today by the Advisory Committee on Immunization Practices for the use of Pfizer BioNTech COVID-19 vaccine in persons aged 16 or older in the U.S. population, we are one critical step closer to the first vaccines being distributed and administered. We commend ACIP for their transparent, science-based recommendations, which the AMA recognizes as the standard that physicians should follow when making decisions about vaccinating patients."

And we've tried to do this from the beginning. We've tried with the webinars to bring the leading people from the CDC and the FDA. And those webinars are still archived on our website, so that health care workers, physicians and the other health care workers, can actually feel confident about the rigorous, science-based process that has been used.

Unger: Indeed. And if you'd like to take a look at those webinars, you'll also find them on the AMA's YouTube channel. We'll continue to keep you updated with developments on the vaccine front in our future COVID-19 updates. Dr. Irons, thanks for being here today. 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.