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AMA Update
New long-COVID study, vaccines and pregnancy, masking indoors & more with Andrea Garcia, JD, MPH
Dec 19, 2022
Featured topic and speakers
AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses new research on the link between COVID-19 infection and postural orthostatic tachycardia syndrome (POTS) and that seasonal influenza activity remains high across the U.S. Also covering the life-threatening risks of flu and COVID during pregnancy. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Unger: Hello, and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine, and Public Health, Andrea Garcia, in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago.
Andrea, it's our last update with you for the year. Can you believe that? Why don't we start with a last look at the numbers for 2022.
Garcia: Overall, we are seeing a slower rate of increase in the numbers compared to last week. However, I think the important thing to keep in mind is these numbers are still a pretty big increase from where we were just two weeks ago. If we look across the country, COVID cases are still climbing in 43 states. That list is led by Oklahoma, followed by Nevada and South Carolina.
We still have about 40,000 people hospitalized across the country with COVID right now. And we're averaging more than 65,000 cases a day. We're also seeing about 450 deaths a day, and that's up 71% from two weeks ago. And that test positivity rate is remaining pretty steady at 12%.
And even with the increases, we are ending the year much better than where we began it. And as a reminder, around this time last year, we were dealing with that surge in Omicron, and for perspective, on January 20, nearly 160,000 COVID patients were hospitalized. That was the most at any point in the pandemic. And on February 2, the seven-day average of new reported deaths peaked at 2,669.
Unger: It's hard to believe that was less than a year ago. When we started this year, a lot has changed but when you look at those numbers increasing, is there movement toward heading back to masks, for instance?
Garcia: Not much has changed from last week, and I don't think we will head towards requirements. The CDC does continue to urge people to wear masks indoors, obviously, as we're coping with this tripledemic of influenza, RSV and COVID. That's particularly true if you live in a community that has either a high or even a medium at this point, COVID-19 community level. Health officials are concerned that the holiday season could put a significant strain on our U.S. health care system if people don't take those proper precautions. But let's be clear, those health systems in many places are already feeling significantly strained.
Unger: Hard to believe we're nearly three years into this pandemic. Of course we have a lot of experience at this point with the effectiveness of the vaccine and boosters. There's another report now just out that underscores just how beneficial those are. Take us through the details, Andrea.
Garcia: It's a new study from the Commonwealth Fund and the Yale School of Public Health, and we found that COVID vaccines have kept more than 18.5 million people in the U.S. out of the hospital and saved more than 3.2 million lives. And that's really a conservative estimate, according to researchers. As we near that two-year anniversary of our first COVID vaccinations and obviously are still struggling with the uptake of those bivalent booster doses, these numbers are really worth taking a look at.
Unger: How do they actually calculate the numbers in that study?
Garcia: So they used a model of disease transmission. They looked at demographic information, risk factors, the dynamics of infection and general information about vaccination. And then they evaluated the vaccine rollout by simulating the pandemic trajectory under a scenario without vaccination.
And what they learned was that without COVID vaccines, we would have had 1.5 times more infections, 3.8 times more hospitalizations and 4.1 times more deaths than we did between December of 2020 and November of 2022. That's a huge impact. I think the other benefit of vaccines that we really don't talk about much is the economic impact. That study found that vaccines saved the U.S. $1.15 trillion in medical costs. As you start to factor in things like long COVID that the vaccines may prevent, those savings are likely to be even higher.
Unger: Wow. Four x the number of deaths prevented and a trillion and a half dollars. Those are amazing numbers. And that probably, I don't even think, accounts for what we've seen in terms of the impact with long COVID. Will you talk a little bit more about the background there?
Garcia: So finding out more about long COVID all the time. And there's a new study out from CDC that looked at long COVID as an underlying or contributing cause of death and found that that was true for about 3,500 deaths in the U.S. This data is provisional.
It's based on an analysis of death certificates from all 50 states and DC between January of 2020 and June of 2022. While that number is less than 1% of all deaths linked to COVID, this really adds to that growing recognition of just how serious a post-acute infectious syndrome like COVID can be. And it's certainly something that we'll continue to keep an eye on as we head into 2023.
Unger: And speaking of COVID and long COVID, one of the things we've talked about over the course of the past two years, of course, are different things associated with it. And there's additional news about a particular syndrome that's linked to COVID, news there. What is that?
Garcia: Research published Monday confirmed a link between COVID infection and a debilitating heart condition called POTS. And POTS had been diagnosed in some patients with long COVID. These new findings are published in the journal "Nature Cardiovascular Research." They're in line with early reports we've heard from physicians that COVID may trigger POTS, which is a disorder of the autonomic nervous system, and it's often characterized by rapid heart rate, low blood pressure, fainting and lightheadedness.
This condition is one of those that can be really difficult to diagnose because it can be confused with many other health problems, including chronic fatigue syndrome. And that study also showed that COVID vaccination with an mRNA vaccine posed some level of risk for POTS. I think the important caveat there is the risk is much greater following a COVID infection itself than it is with the vaccine. So that suggests, of course, that the vaccination can help reduce that risk of developing POTS.
Unger: Moving from COVID to leg two of the tripledemic going on right now, let's talk about the flu. Any updates that we need to know now?
Garcia: I think the biggest thing to keep in mind is seasonal influenza activity remains high across the country. If we look at the latest CDC numbers, there have been at least 13 million illnesses, 120,000 hospitalizations and 7,300 deaths from flu. That annual flu vaccine is the best way to protect against flu. If you've been vaccinated and still get the flu, that vaccine is really going to help protect you from those more serious outcomes.
We do know the vaccine this year is a good match for the virus that is circulating. We also have effective antivirals, so that's good news. It of course, and we've talked about this before, it's really important with those antivirals that they be started as soon as possible to treat patients who are hospitalized with flu, people who are sick with flu but don't need to be hospitalized, and those with flu who are at a higher risk based on their age or health.
Unger: Andrea, let's talk about a couple of special groups and vaccines. One where there's some real concern is around pregnancy. Let's talk first with that group.
Garcia: Yeah. So unfortunately, only 37% of pregnant persons have been vaccinated for flu as of the end of October, and that's compared with nearly 60% at the end of September of 2020. Unfortunately, we're seeing low vaccine uptake overall among pregnant persons. That is true for both flu vaccines and for COVID vaccines. All the respiratory viruses we're seeing right now can cause serious illnesses in pregnant persons. And I think that risk is still not being communicated and is not well-understood by that population.
These viruses among pregnant persons can be really serious, and they can result in miscarriage, preterm birth, stillbirth. And that's even with an asymptomatic or a mild illness. We know that these vaccines are safe in pregnant persons and even pass along protective antibodies to the fetus. So it's really important to get this message out.
Unger: Well, turning to one other group where there are some additional tools available, I should say, seniors. Let's talk specifically about the flu and a different shot that's available to those that are 65 and older.
Garcia: CDC is recommending those 65 and older get these specially formulated vaccines this year. And while this age group has had that option in the past, CDC have never officially recommended it. And this year that is changed. It reflects an extensive review of the evidence on how well the different kinds of flu vaccines work in older populations.
If you're 65 and older, you should try to find one of these three shots, the Fluzone High-Dose, the Fluad, or the Flublok. And these are the quadrivalent vaccines. They protect against four different strains of influenza and give your immune system that added boost, which is important because older people are at higher risk for serious outcomes due to flu.
Unger: Well, Andrea, since this is our last episode of the year and we're about to head into holiday celebrations and New Year's celebrations, do you have any final advice that you would like to gift our audience out there about how to stay happy and healthy into the new year?
Garcia: I think the main message is to take those steps to protect yourself and your loved ones this holiday season. It's no fun being sick, and it's important to remember that people have different levels of risk. If you're planning to see elderly or immunocompromised relatives, you'll want to take those extra precautions. There are things that you can do to make any gathering safe.
You can do sort of a mini-quarantine, consider minimizing your interactions with people the week before you plan together, avoid those crowded indoor spaces or other high-risk situation. If you do have to go into those crowded indoor places, wear a mask. Wearing a mask while you're traveling on a train or plane is also important. Test before gathering, wash your hands and stay home if you're not feeling well.
Unger: And speaking of testing, that just got easier too.
Garcia: It did, and I think that's good news. And those free COVID tests are available now to residential households in the U.S. You can order one set of four of the free at-home tests from USPS.com. There's a limited number of one order per residential address, and those orders will start shipping this week.
So you can visit COVID.gov/test to find more details about those at-home tests. I ordered mine yesterday, it was really easy. And I think the other thing to note is there's information about extended shelf life and updated expiration dates. If you do still have some tests at home, you'll want to check that out.
Unger: Well, Andrea, it's hard to believe that we're finishing out another year together. Getting a little misty here. I'm going to miss you over the holidays. But let's look forward to a healthier 2023. Thanks for being here with us today.
Our next update together will be on January 4. In the meantime, you can catch all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Have a healthy, safe holiday, and happy new year to all of you out there. 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.
