AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
AMA Update
New studies on teen mental health and stroke risk, plus trends from the CDC flu report and more
Oct 18, 2023
Featured topic and speakers
Flu activity and hospital admissions remain low so far into this year’s flu season but new evidence of “long colds” underscores the need to minimize infections and avoid the tripledemic. AMA’s Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the latest respiratory disease season developments, including supply and access issues with the new RSV shot for infants. Plus, the rising risk of stroke and sobering new reports about young people’s mental health. AMA Chief Experience Officer Todd Unger hosts.
- JAMA Pediatrics study "Estimates of Major Depressive Disorder and Treatment Among Adolescents by Race and Ethnicity"
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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. Welcome back, Andrea.
Garcia: Thanks. It's great to be here.
Unger: Well, Andrea, we've been talking a lot about the tripledemic lately. And the CDC just released its first FluView Report for the year. What are some of the key takeaways from it?
Garcia: Yeah so, FluView is this weekly surveillance report that the CDC puts out throughout flu season. And that first report came out on October 13. I think the good news is that, so far, flu activity and hospital admissions for flu remain low nationally. Among those labs that report to CDC, there's about a 1.1% test positivity rate for flu, which is low.
The report also noted that now is a great time to get the flu vaccine. And, of course, the CDC recommends getting that vaccine before the end of October. As of September 30, we knew that about 116 million doses of the flu vaccine have been distributed.
It looks like so far, about 16.8% of adults have gotten their flu vaccine. And about 17.8% of kids have been vaccinated. Hopefully, we're going to see those numbers increase since many people tend to get that vaccine in late October and even into November.
Unger: Yeah, it looks like by the numbers, we have a ways to go. But, hopefully, people will get the message and get that flu shot. Another story we've been getting attention on is long COVID. But last week, the big news was all about a discovery about something different, long colds. Andrea, what's a long cold? And what's the story there?
Garcia: Yeah, so there is evidence on long colds. This is coming from a study that was published in The Lancet. And researchers looked at data of over 10,000 adults in the UK. They found that both SARS-CoV-2, which is the virus that causes COVID, and then non-COVID acute respiratory infections are associated with a wide range of symptoms more than four weeks after you have that acute infection.
Those symptoms of a long cold included coughing, stomach pain and diarrhea. They're different from the common symptoms they saw in long COVID, which included lightheadedness, dizziness and the problems with taste and smell, which we've heard about throughout the pandemic.
The researchers said it's not clear what is leading to these lingering symptoms and why some people develop them, and others don't. People with more severe symptoms during their infection were more likely to develop what is called a long cold. I think, with that being said, these long-lasting symptoms can develop, even in people who have a mild case.
Unger: That's a pretty significant finding. Andrea, what does it mean for physicians and patients going forward?
Garcia: Well, like with long COVID, we just need a lot more research in this area to better understand this. I think one of the most significant takeaways from this study is that COVID isn't the only infection that causes long-lasting symptoms. Another important takeaway, especially while researchers are getting to the bottom of what causes these long-lasting symptoms, is what we can do to minimize these infections in the first place.
And we spend a lot of time talking about getting vaccinated, which we know is a very important step. But you can also take steps like masking, especially when your risk of infection is high, such as in crowded indoor settings.
Unger: All right, well, on the topic of protecting ourselves from respiratory illnesses, we're hearing about issues with the rollout of the new RSV shot. Andrea, what do we need to know about that?
Garcia: Yeah, earlier this month, we talked a bit about the challenges we were seeing with the rollout of the updated COVID vaccines. And I think we're now also seeing those challenges play out with nirsevimab, which is the monoclonal antibody for RSV, which is recommended for infants. There was a CVS article that shared some stories about pediatricians who were having trouble getting enough supply of the shot to meet demand. I know that is also true here locally with pediatricians being told by the manufacturer that due to supply shortages, those shipments are being delayed.
I think the other issue is cost. The RSV shot is nearly $500 a dose. It's expected to be covered by most insurance plans. But pharmacies and physician practices have to order supplies before they're going to know how much they'll be reimbursed.
So not all practices, especially if we think about smaller or more rural practices, are able to buy as much as they'd like, given that uncertainty. So going forward, it would certainly be helpful for insurance companies to provide more clarity on how they're going to cover the shot.
As we've talked about before, RSV is very dangerous to infants. The shot is an incredible opportunity to protect this vulnerable group during this respiratory virus season. But it's only truly going to make a difference if it's accessible.
Unger: I guess the good news is that there is demand for the shot, but bad news is that these barriers to access are a real issue. Andrea, in other vaccine news, the Department of Health and Human Services announced funding for the next generation of COVID-19 vaccines and more. Tell us more about that.
Garcia: Yeah, so this funding is part of Project NextGen, which is that initiative to advance the development of the new and innovative vaccines and treatments for COVID-19. We saw HHS through the Administration for Strategic Preparedness and Response, or ASPR, award over 500 million for Project NextGen. A portion of that funding is going to help three next-generation vaccines.
These vaccines each have the potential for stronger, broader and longer-lasting immune response. For example, two of the vaccine candidates are intranasal vaccines, which could stop viruses at the site of infection. The remaining funds are going to support future clinical studies and new technologies that will improve national preparedness as well as help prevent future outbreaks.
Unger: Those all sound like very promising developments. And in another story that was driving headlines concern the rising risk of stroke. Andrea, tell us more about that.
Garcia: The World Stroke Organization and Lancet Neurology Commission issued a report that said the number of people who die from stroke worldwide will jump 50% by 2050 if no significant action is taken. That would amount to about 10 million deaths in 2050, up from 6.6 million in 2020. This report says that 91% of these projected stroke deaths would occur in low and middle-income countries.
However, underserved and low-income communities in the U.S. and other high-income countries are also at risk. As we see, with treatment for COVID-19 and nearly every other disease, there are inequities, and stroke is no exception. The report really underscores the need to act now.
And the president of the World Stroke Organization cited telehealth as one of the most impactful solutions, the reason for that being that sometimes countries have the necessary medications. But they don't have the physicians to provide treatment. And telehealth can really help to bridge that gap.
Unger: Well, thank you for that update. And we'll continue to track that as more information becomes available. Andrea, on a different topic last week, we also saw two new reports come out around World Mental Health Day with sobering new information about young people's mental health. And one of them focused on the impact that climate change is having. What can you tell us about that?
Garcia: So the report comes from the American Psychological Association and ecoAmerica. And it studied the environmental events linked to climate change and noted that they can trigger or exacerbate mental health issues for kids and teens. We know that natural disasters can lead to PTSD. Longer-term issues, like extreme heat, drought or air quality, can increase that risk of anxiety, depression, bipolar disorder, aggression and more.
While climate change is an issue that affects us all, children are particularly vulnerable. They don't often have the coping mechanisms that adults do. And they're dependent on the support of their parents and caregivers, who could also be stressed by environmental events as well.
And we know when parents are under stress, that may have an impact on children's mental health too. I think we have a lot of work to do to combat climate change. In the meantime, we know that schools and parents can help support children. And this goes for physicians too. I think there are really important roles to play in teaching children about climate change, helping them to manage their fears, take action and sort of nurture that resilience, which is going to be important.
Unger: Wow. Well, Andrea, the other report looked at adolescent mental health in the pandemic. What were some of the key findings there?
Garcia: That study was published in JAMA Pediatrics. It analyzed data from the 2021 U.S. National Survey on Drug Use and Health. It was a nationally representative sample of U.S. adolescents between the ages of 12 and 17. And it showed that, approximately, 20% of adolescents had symptoms of major depressive disorder in 2021. But less than half that needed treatment actually received it.
I think we all know that pandemic was an especially difficult time for that age group. This study certainly underscores that. But it also illuminated the treatment gap and also shows sharp differences across racial and ethnic groups. Mixed race adolescents had the highest rate of major depressive disorder at about 26.5%. That was followed by Latinx adolescents at around 23%.
And although those groups have the highest rates of major depressive disorder, they had the lowest rates of treatment. So these findings certainly underscore the need for schools and communities to better support this age group. And then the authors of the study also noted that policy and clinical efforts should target adolescents as a whole and marginalized populations in particular to ensure that timely access to high-quality mental health treatment.
Unger: All right, well, Andrea, a lot to cover this week. Thanks so much for joining us and sharing these important updates. That wraps up today's episode. If you enjoyed this discussion, you can support more programming like it by becoming an AMA member. Find that at ama-assn.org/join.
We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. 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.
