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


In today’s COVID-19 Update, AMA's Chief Health and Science Officer Mira Irons, MD, reviews COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Dr. Irons also covers new obstacles and continuing challenges faced by the U.S. as we approach the president's July 4 vaccination goal.

Learn more at the AMA COVID-19 resource center.

Speaker

  • 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 have our weekly look at the numbers, trends and latest news about COVID-19 with AMA Chief Health and Science Officer Dr. Mira Irons in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Irons, let's first talk about vaccines. As we talked about last week, young adults continue to be the single biggest obstacle to meeting the president's Fourth of July goal, vaccination goal. Can you talk about what we are seeing with this particular group?

Dr. Irons: Well, you're correct, Todd. Many young adults are foregoing COVID vaccines for a complex mix of reasons. It's become clear that one of the biggest barriers to mass immunity will be persuading skeptical young adults of all backgrounds to get shots. But the straightforward sales pitch for older people, a vaccine could very possibly save your life, doesn't always work on healthy 20-somethings. Public health experts say vaccinating young adults is essential to keeping infection numbers low and preventing new case outbreaks, especially as the Delta variants spread. You know, White House officials have said that they expect 70% of people 27 and older to receive at least a first dose by July 4. But if you add in Americans aged 18 to 26 and the country is likely to fall short of the president's goal for all adults.

Unger: I'm curious, are you surprised by this? We've talked about so many different kinds of vaccine hesitancy and now we're to this group of young people. Did we expect to see this kind of hesitancy with young adults?

Dr. Irons: You know, I think we expected to see some hesitancy but I personally didn't think we'd see this much. There's no easy explanation and it's likely due to a variety of reasons. Many young adults are relatively healthy and they often have work, school and young children to worry about. Getting vaccinated doesn't always register as a top priority. Some aren't as connected to a health system, they may not have a doctor. They may still go to their parents' doctor. And throughout the pandemic, the public health messages emphasize that older people were at greatest risk, which had an unintended consequence of helping young people feel as though it wouldn't be a big deal if they got COVID. The thinking now is that we really have to meet young people where they are online through social media to get the word out and combat misinformation. Great example of this, a junior at Cornell founded the COVID Campus Coalition, which now has people at more than 25 universities running Instagram accounts that debunk myths and tell students how to get vaccinated.

Unger: And this is a pretty serious need as we've seen with the Delta variant and then possible side effects, even with asymptomatic cases. Why take that chance? Get vaccinated. Well, it probably hasn't helped that there have been some reports of heart inflammation that have emerged in teens and young adults after being vaccinated. Can you give us the lowdown on what we found here?

Dr. Irons: Yes. You know, as you've discussed on previous episodes, we're seeing more than 300 confirmed cases of myocarditis or pericarditis following mRNA COVID-19 vaccines, mostly in male adolescents or young adults, mostly after the second shot. That's a figure that's higher than what one would usually expect. The CDC's Advisory Committee on Immunization Practices, or ACIP, met to discuss this issue last week. While the CDC did determine the mRNA COVID-19 vaccines can, in rare instances, be linked to myocarditis or pericarditis, they determined that the benefits of COVID-19 vaccination far outweigh the risks of heart inflammation in young people.

Still, ACIP agreed that a warning about the potential risks should be added to the FDA's official fact sheets on the vaccine so that people would not ignore symptoms. It's important to remember that the risk for COVID is far higher. Teens and young adults account for the largest proportion of new cases in the United States, and we know that COVID infection itself can affect the heart. So myocarditis after COVID vaccination is still a rare event and the vast majority of patients have recovered.

Unger: That's an important closing statement there, that rare event. And the vast majority of patients have recovered and compare that, the downside of getting COVID-19, obviously, is still experiencing cases and deaths this week. Can you give us a broader overview of what we're seeing there?

Dr. Irons: Well, the numbers continue to climb, but certainly not by the amounts we were talking about months ago. So currently 33,642,146 people have been diagnosed with COVID in the U.S. and 604,179 people have died from COVID. New cases are emerging at their lowest level since testing became widely available. Relatively few cases are being detected in most urban areas. The rural hotspots have emerged in parts of Missouri and Arkansas. And specifically in states where the vaccination rates are low. Deaths and hospitalizations continue to decline, but around 300 coronavirus deaths continue to be reported most days.

Unger: You know, I was speaking with a physician a couple of weeks ago and they were just saying when they see a case like this, it is heartbreaking because at this point it's largely preventable. Can you talk a little bit more about the findings that we're seeing? The differences between vaccinated and unvaccinated?

Dr. Irons: Absolutely. You know, this past week CDC director Dr. Rochelle Walensky said nearly every adult death from COVID-19 is "At this point entirely preventable," due to the effectiveness of vaccines. A news analysis from the AP confirms what Dr. Walensky said. The analysis shows that 99.2% of all U.S. COVID deaths are unvaccinated individuals. You know, according to the analysis of government data for May released last Thursday, out of the 18,000 COVID deaths during that month, approximately 150 were in vaccinated people. That comes out to 0.8% or an average of five deaths per day out of more than 200 average daily deaths. If you recall back in January at the height of the pandemic, average daily deaths were above 3,400 per day. These are powerful numbers to support what we've been saying all along. The vaccines are remarkably effective.

Unger: That's a stark difference; 99.2% are unvaccinated individuals, can't see anything more decisive than that. Can you talk to us about the vaccination numbers that we're seeing this week? You did earlier mentioned that we were probably not on track to hit the president's goal by this weekend, but are we going to get close?

Dr. Irons: Right. You know, providers are administering about 0.83 million doses per day on average, about a 75% decrease from a peak of 3.38 million reported on April 13. The CDC said on Monday about 179.6 million people, or 54.1%, have received at least one dose of the COVID-19 vaccine, including about 153.8 million people, or 46.3%, who had been fully vaccinated. In terms of how close we are to the president's goal, slightly more than 66% of adult Americans have received at least one shot.

Unger: So the good news is we have a large percentage of Americans who have received at least one shot, but we're also hearing about a new challenge and a growing number of people, in fact, more than one in 10 have missed their second dose in the U.S. What are we seeing? Why is this an issue right now?

Dr. Irons: It's really important to get that second vaccine, that second shot in the two-dose regiments to complete your vaccinations. We know that completing both rounds of the two-dose vaccines is crucial to have the best protection against COVID-19, especially with the new variants that are spreading. As this virus has mutated, there are versions of it that are better able to escape some ... immune protection that we get from the vaccine. Case in point, a study by the CDC of adults above the age of 65, the population most at risk, found that seniors who received partial vaccination were 64% less likely to be hospitalized but fully vaccinated seniors were 94% less likely to be admitted to a hospital.

Another study published in June in nature found that the two doses of the Pfizer vaccine were 88% effective in preventing illness caused by the Delta variant, but one dose was only 33% effective. As Dr. Paul Offit explained on NBC News this week, the second shot is critical. We know from the phase one studies that the second shot induces a level of virus-specific neutralizing antibodies that's about tenfold greater than after that first dose.

Unger: Wow. That's big news and friend of the show, Dr. Paul Offit, that's saying it well. And again, very convincing data to suggest getting that second shot is a requirement, so go get that. And just this week, the WHO came out with a new set of mask guidance. Can you tell us the thinking behind that and if we should expect to see that guidance implemented in the states?

Dr. Irons: Well, it's confusing and it's unclear whether we're going to see new guidance. So WHO officials concerned about the easing of precautions meant to stop the spread of the coronavirus have urged even fully vaccinated people to continue wearing masks and to keep taking other measures to prevent infection. CDC on the other hand told fully vaccinated Americans in May that they no longer needed to wear masks indoors or to maintain a distance of six feet from other people.

On Monday when asked about the new cautions expressed by the WHO, a CDC spokesman pointed to the existing guidance and gave no indication it would change. There's some debate around this. Some scientists say we're not at a point where we can just release the brakes on everything, especially when we haven't reached herd immunity. Others on the other hand say that guidance needs to be tailored to local communities, varying according to vaccination rates and infection rates. The WHO is looking at a world that is largely unvaccinated, so its guidance makes sense in that respect. In parts of the United States with low vaccination rates, masks may be appropriate there also.

Unger: Well, thanks for the update on all these important COVID topics. Are there any other messages that you'd like to share from the AMA this week?

Dr. Irons: Sure. On Wednesday, June 23, the AMA was part of a joint statement by HHS and other health care leaders following the ACIP meeting on myocarditis that we discussed. The statement read in part as physicians, nurses, public health and health care professionals. And for many of us parents, we understand the significant interest many Americans have in the safety as a COVID-19 vaccines, especially for younger people. The facts are clear. This is an extremely rare side effects and only an exceedingly small number of people will experience it after vaccination. Importantly, for the young people who do, most cases are mild and individuals recover often on their own or with minimal treatment. The vaccines are safe and effective and they prevent COVID-19 illness. We recommend getting vaccinated right away. If you haven't yet, it's the best way to protect yourselves, your loved ones, your community and to return to a more normal lifestyle safely and quickly.

Unger: Absolutely. Well, thanks again, Dr. Irons for being with us here today and sharing your perspectives. That's it for today's COVID-19 Update. We'll be back with another segment shortly. 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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