Monkeypox, Omicron BA.5 and Novavax with Andrea Garcia, JD, MPH [Podcast]

AMA Update

Monkeypox, Omicron BA.5, and Novavax with Andrea Garcia, JD, MPH

Jul 27, 2022

In today’s COVID-19 Update, AMA Director of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, details summer spike of COVID-19 cases driven by the highly transmissible Omicron BA.5 subvariant. Also covering Novavax news, as well as monkeypox cases and stats—including the World Health Organization (WHO) declaring it a global health emergency. AMA Chief Experience Officer Todd Unger hosts. 

Learn more at the AMA COVID-19 resource center.

Speaker

• Andrea Garcia, JD, MPH, director of science, medicine & public health, American Medical Association

Unger: Hello, this is the American Medical Association's COVID-19 Update video and podcast. Today we have our weekly look at the numbers, trends and latest news about COVID-19 with the AMA's Director of Science, Medicine, and Public Health, Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Andrea, we continue to hear a lot about BA.5 and we can add President Biden to those who have tested positive for this subvariant. Let's start with how the numbers are looking.

Garcia: Well, thanks for having me back and certainly we wish President Biden a speedy recovery. Cases are higher than they have been nearly at any point this summer, driven as you mentioned, by the Omicron BA.5 subvariant. That's currently the most dominant strain in the U.S. The number of cases reported each day has hovered near 130,000 for several days and all but a few states are seeing steady increases over the past two weeks.

We know that the BA.5 subvariant continues to spread across the U.S. and now accounts for about 82% of new cases. The BA.4 subvariant continues to account for about 12.9% of cases. And again, that official case count is likely a significant undercount because as you know, many people are taking at-home rapid tests or are forgoing testing altogether.

Unger: And then how is that translating to hospitalizations?

Garcia: Hospitalizations are also steadily increasing nationally. More than 43,000 people are currently hospitalized with COVID-19. That's an increase of about 12% over the past two weeks and deaths are also increasing. We've talked about the numbers, for the past two months, they've really rarely rose above 400 but now the average has grown to 439 people dying of COVID each day. So that's an increase of about 34% over the last two weeks. I think it's worth pointing out that most of those deaths are occurring in people who are not up-to-date on their vaccines.

Unger: That's not exactly the kind of context that you want going into the back-to-school period, which really is just a few weeks away. Any talk of state mandates at this point?

Garcia: Well, according to a recent New York Times article, health officials across the country are really, at this point in time holding back on any mandates. The article states that many health officials say that this new wave is a cause for caution and not alarm. We know New York Governor Kathy Hochul said that she did not anticipate school children are going to need to wear masks when they return to school in the fall but she does plan to keep that statewide mask mandate on public transportation for now.

In California, LA County Health Director Barbara Ferrer will reinstate a indoor mask mandate on July 29 if the COVID-19 community level remains high. That county moved into the high category earlier this month. All-in-all, we're not seeing a return to broad indoor mask mandates at this time.

Unger: Well, let's turn to some good news, this in particular about Novavax, a new vaccine for COVID-19. Let's talk first about the details there.

Garcia: So this is good news, the CDC last week recommended the use of the Novavax vaccine in the U.S. population. From an AMA press release, Dr. Sandra Fryhofer, who is our AMA Board Chair and longtime liaison to the ACIP, said that the Advisory Committee on Immunization Practices voted unanimously to recommend the use of Novavax COVID-19 vaccine as a primary series in individuals 18 and older.

We know CDC Director, Rochelle Walensky endorsed the panel's recommendation shortly after and that is paving the way for 3.2 million doses of that vaccine to be shipped to states this week. The CDC recommendation, of course, follows the FDA's EUA for Novavax.

At this time, Novavax is not available as a booster dose. Trials have shown that the Novavax shot works well as a booster. And so we are expecting the company to seek authorization for it to be used that way soon.

Unger: Well, we're going to hear more about Novavax and get other ACIP updates when Dr. Fryhofer is our guest on August 1. But you can give us a brief summary on the difference between this and other vaccines for starters and when will it be available?

Garcia: So this is the two-dose primary series. It's given three to eight weeks apart, it uses a traditional protein-based technology and that is unlike the three other COVID vaccines currently available in the U.S. vaccine types like Novavax have been around for more than 30 years. They're used against Hep-B, influenza and whooping cough. And for this reason, it might be a good option for those who remain concerned about the mRNA vaccines or who have an allergy to a component of the mRNA vaccines. We know that about 10% of people 18 and older in the U.S. haven't received a dose of COVID-19 vaccine. We are expecting this vaccine to be available throughout the U.S. in the coming weeks.

Unger: Well, yesterday the White House hosted a summit on the future of COVID-19 vaccines what did we hear?

Garcia: So that summit was held with scientists, with public health experts, with vaccine manufacturers and the purpose was to kick-start efforts to develop the next generation of COVID vaccines. We know that the current generation of vaccines have helped prevent severe outcomes. The hope is that this new version could better protect against future variants. But also to dramatically decrease rates of infection or transmission. Attendees of the summit included representatives from Pfizer and Moderna, and they discussed new technologies and a roadmap to develop them.

Unger: So clearly the work cut out there and there's more to come about any outcomes from this important summit. Let's switch over now to monkeypox. The news there is the World Health Organization just declared monkeypox a global health emergency. What does that mean to achieve that designation?

Garcia: So a public health emergency of international concern is defined in international health regulations. It means it's an extraordinary event that constitutes a public health risk to other countries through the international spread of the disease and it potentially requires a coordinated international response. It was just a month ago that the WHO said that monkeypox was not a public health emergency but the situation has certainly evolved since then.

This emergency declaration serves as a plea to draw more global resources and attention to the outbreak. It is the organization's highest alert level but it doesn't always mean a disease is necessarily lethal. The WHO previously declared public health emergencies for the COVID-19 pandemic, the 2014 West African Ebola outbreak, the Zika virus in Latin America in 2016, and of course, the ongoing effort to eradicate polio. We did see the CDC issue a statement of support saying that this could galvanize the international community to more quickly and effectively respond and combat the virus.

Unger: I guess it shows you how fast things can change. Big difference versus a month ago. Now we have cases rising not only in the States but around the world, what do we see in terms of the latest numbers here in the U.S.?

Garcia: There are a reported 3,847 cases nationwide. That's up from 1,500 last week. We only have five states in the U.S. now that have not reported a monkeypox case. Those are Montana, Wyoming, Vermont, Maine and Alaska. Globally, we're at nearly 18,000 reported cases in 69 countries. These are countries that have not historically reported monkeypox. Those numbers are up from 11,000 cases in 65 countries globally last week.

On Friday, we saw the U.S. report the first two cases of monkeypox in children. CDC indicated that those pediatric cases are probably the result of household transmission. We know that there have been zero deaths in the U.S. from monkeypox to date.

We expect that the number of cases is going to continue to go up as testing capacity is expanded. The Biden administration has increased its capacity to test for monkeypox, we're now at about 80,000 tests per week with those major commercial labs now online. And when we first began this outbreak we were only at about 6,000 tests per week through the CDC's Laboratory Response Network.

Unger: Well, that's good news then that we're seeing an increase in testing capacity like that. Do you think that the U.S. will consider declaring monkeypox a public health emergency and what would it mean if we did?

Garcia: So the White House COVID Response Coordinator, Dr. Ashish Jha has said that the Department of Health and Human Services is weighing whether or not to declare a public health emergency and that's sort of dependent on if current management tactics can get the virus under control. They're looking at how the response to the outbreak could be enhanced and whether this emergency declaration would help.

We do know that the supply of monkeypox vaccine while improving, is still being outstripped by demand. And if HHS declares monkeypox a public health emergency, that could result in increased federal funding to fight the outbreak and it could also bring about an official requirement to report data to the CDC. As we talked about early in the COVID pandemic, there is a long way to go with public health data modernization and that includes getting that data efficiently from jurisdictions to the CDC.

Unger: Well, whether it's COVID-19 or monkeypox, we're going to keep you up-to-date as news develops on both those fronts. That's it for today's COVID-19 Update. Andrea, thanks for being with us today and sharing that news.

We'll be back soon with another COVID-19 Update video and podcast. You want to find all our resources on COVID-19, ama-assn.org/COVID-19. Thanks for joining us today and 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.