Public Health

Mira Irons, MD, on what’s behind the continuing high number of new cases


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



In today’s COVID-19 update, Todd Unger, AMA chief experience officer and Mira Irons, MD, AMA chief health and science officer, take a look at the weekly numbers, trends and latest news about COVID-19, including the continuing high number of new cases.

Learn more at the AMA COVID-19 resource center.


  • 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, AMA's chief experience officer also in Chicago. All right, Dr. Irons, let's start by reviewing this week's numbers and this whole month of July, which has set a new record. What's happening across the country with new cases and deaths?

Dr. Irons: Sure, Todd. Well, the numbers are still concerning. The latest figure from this morning is 4,668,408. people who have been infected with COVID. The death rate is now up to 154,861. When we look at that figure today, compared with two weeks ago, the increase in new cases yesterday today was over 47,000, and the deaths were 413. The seven day average of new cases has been about 65,000 and we had numbers as high as 70,000 last week. And the death rate has pretty much been steady at over a thousand. So the question is today, the numbers might look a little better than what we experienced today over the last two weeks, but I'd just like to caution people is that those numbers are still high. I think we've gotten so immune to these large numbers in many ways that we still don't realize that even a death rate of 413 yesterday today is still 413 people that have died.

Unger: Well, let's talk a little bit about what's underneath those numbers. Let's first review geographically, where are you seeing the hotspots continuing or picking up?

Dr. Irons: Sure. So as you said in your intro, July, the U.S. more than doubled the new infections at 1.9 million, that was the only second to April, and that was because we saw this surge in the south. The surge in the south and in the west with certainly Florida, Texas, Arizona and California were hotspots. Florida has more than 480,000 people with the virus. California more than half a million people. They had their first teen death over the weekend. You might remember several teenagers have died in Florida over the last two weeks. But I think that Dr. Birx really encapsulated this by saying that we're in a new phase. What we're seeing now is more widespread activity across the country and even into rural areas where there are very few people and where there was no COVID until recently.

She's characterizing this as different than March and April, and is calling it extraordinarily widespread, which is really concerning because there were parts of the country that were doing well. And we're starting to see some of those cities like Chicago that are experiencing small upticks. And it's these small upticks that really are the signs where people have to start looking for them.

Unger: What's driving those kinds of small upticks. I think we're seeing just people letting their guards down, getting together. What are you seeing?

Dr. Irons: It's probably a combination of things. One is people are certainly letting their guards down. I think that we may have gotten the message out about not having huge gatherings, but we do know, and what we've heard is that people, just within their families and communities are having small gatherings. A lot of cities and towns are saying, "Please keep it to less than 10." And that's because it's important. The virus spreads more easily if there are more people in a small area. So instead of talking about super spreaders that we did... Individual people that might have been spreading going from one place to another, we're starting to think more about super spreading events.

Unger: Well, speaking of which, let's talk a little bit about one of the pieces of feedback that's coming back from a summer camp in Georgia. What have we learned from that particular incident?

Dr. Irons: So the CDC issued the MMWR alert last Friday, and people have probably heard about it. The media has covered this, and it looked at a Georgia overnight camp that identified the spread throughout the camp, that 260 children and staff out of 344 that were tested were positive. But I think that what's really important is what we learned from that. I mean, obviously what it identified is that children can actually catch the virus and spread it. But what is important is what wasn't done, and what we learned from that. So masks weren't required for the campers. Ventilation, keeping windows and doors open weren't done consistently. There were lots of indoor activities where kids were in groups and they were singing and clapping. It was really the yelling and the singing that really reinforced what we've been talking about over the last few weeks about the importance of masks, staying outdoors instead of indoors, singing is a more effective way of spreading.

Unger: So let's talk again about looking at small children or younger people. But for small children, there's been a lot of different information back and forth about whether they can catch it and whether they can spread it. Let's talk about that information about the spread. What have we learned?

Dr. Irons: So there was a JAMA article that came out last week that measured the viral DNA, the viral load within the noses and throats, the nasal pharynx of children as compared to adults. It was a small study. It measured viral nucleic acid and not infectious virus, but it actually showed that children had as much viral material in their noses and throats as adults. So a cautionary study and probably provides some evidence that children can be vectors of the disease, but it's really preliminary.

Unger: How was that affecting the discussions about school reopenings both college and high school and elementary?

Dr. Irons: Well, certainly it encourages caution in thinking about how the virus is spread. You can't assume that kids can't spread the virus. So the mitigating factors that we talk about, masks, social distancing, small groups, staying outside are really important. But what also is important, and I think that we've heard Dr. Fauci talk about it, and we've heard Dr. Birx talk about it, is the activity of COVID in your community is really going to be important to schools in how they think about reopening.

Unger: So already with some of the initial schools going back in session with colleges, we're seeing an uptick in cases, is that true?

Dr. Irons: Yep. We definitely are seeing uptick in cases, and we actually should expect to see an uptick in cases. People can catch COVID anywhere, so it'll be important, as we move into school reopenings for that contact tracing to be done, for people to be notified, the contact racing to be done, to show where people are catching the virus and how to mitigate its spread. The "New York Times" issued a survey they did amongst colleges, and they found that since the beginning of the pandemic, 6,600 cases have been tied to about 270 colleges. So it reinforces what we already know about the spread.

Unger: And we do continue to see disparate impacts with some vulnerable populations. Can you talk about that, particularly about Native Americans?

Dr. Irons: Absolutely. So we do have data that the eight counties with the largest population of Native Americans have case rates that are nearly double the national average. It just reinforces what we know about minoritized and vulnerable populations.

Unger: One thing that has fallen out of the news, and it seems to be back into it, is about vaping and about the correlation with or at least about diagnosis relative to COVID. Can you talk a little bit about that?

Dr. Irons: Yep. So vaping injuries are climbing again in some places, but COVID is making them harder to diagnose because when people come in with pulmonary symptoms, everybody thinks of COVID first, and health officials are seeing a rise in e-cigarette or vaping related lung disease. It just reinforces the fact that the medical problems that we talked about prior to the pandemic, lung disease due to vaping, the need to vaccinate people, this all doesn't go away, but it has really... And it's important that we keep an eye on that also.

Unger: Well, speaking of vaccines, can you tell us a little bit about the coverage that we're seeing on vaccine trials in the news. Anything new to report?

Dr. Irons: Nothing new. Still two vaccines and phase three trials in the US began last week. One was from Pfizer and the other is the Moderna NIH vaccine that entered phase three trials. The Oxford AstraZeneca vaccine that we've also heard a lot about has started phase three trials outside of the United States and plans to enter US trials sometime later this summer. But the really positive news is that there were two reports of the preclinical studies, one of the Moderna NIH vaccine, and the other of a Johnson and Johnson vaccine that actually showed positive results in preclinical studies, in non primate human. So all of that is positive, but we still have to wait the results of the phase three trials in humans to see where we are.

Unger: Okay. Continuing torrent of misinformation across social media, particularly around masks and continuing discussions about hydroxychloroquine. Any guidance there?

Dr. Irons: Well, I think that what we heard, as you said, there was a lot of false information about masks are unnecessary, hydroxychloroquine is effective in curing the virus, but it just reinforces the need to follow the evidence, follow the data, and make sure that what we're saying is backed up by science.

Unger: In closing, any key messages from the AMA that you want people to hear this week?

Dr. Irons: Absolutely. So last week, the AMA along with the American Hospital Association and the American Nursing Association started a public service campaign urging the wearing of masks to stop the spread of COVID. So we hope that many people hear about that. We hope that many people actually listen to that. The take home messages are the same as they always were. Wear masks, socially distance, and hand hygiene. And we're really all in this together.

Unger: Indeed, that that messaging remains consistent, so everyone out there please do wear a mask, practice physical distancing, and wash hands frequently. That's it for today's COVID-19 update. Dr. Irons, thanks so much for being with us here today and sharing your perspective and information. We'll look forward to talking with you again next week. We'll be back tomorrow with another COVID-19 update. For resources on COVID-19 visit Thanks for being with us here today, and 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.