Public Health

RSV, flu trends plus COVID predictions with Andrea Garcia, JD, MPH


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, monkeypox, medical education, advocacy issues, burnout, vaccines and more.



In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, shares the latest post-Thanksgiving "tripledemic" trends, as well as findings from a new CDC study on how the updated boosters performed in the real world. AMA Chief Experience Officer Todd Unger hosts.

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  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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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. Well, first off, welcome back, Andrea.

Garcia: Thanks. It's good to be here.

Unger: It's been a couple of weeks since we talked last. Unfortunately, it doesn't look like COVID went away over the holiday break. Why don't we just start with a quick rundown of the latest news about the Omicron subvariants.

Garcia: Well, as always is the case with a holiday season, we're going to see some delays in reporting that are going to impact the data. That being said, prior to the holiday, the CDC was reporting that the new subvariants BQ.1 and BQ.1.1 now account for the majority, so over 50% of new COVID cases here in the U.S. You may recall that at the end of October, both of those variants combined totaled only about 20% of new cases.

The BA.5 subvariant is still circulating. It's now accounting for about 19% of new cases. If we look back to just a month ago, BA.5 was still responsible for over half of the new cases we were seeing. So this shows how quickly BQ.1 and BQ.1.1 have taken over as the dominant subvariants. And we're likely to see increases in their prevalence after the holiday season and once reporting catches up.

Unger: Andrea, with those subvariants on the holiday menu, so to speak, are we seeing an increase in the number of cases?

Garcia: So if we look at The New York Times data, the average daily number of reported cases is around 42,000. That number had been fairly stable going into the holiday but we have seen a modest increase of about 7% in the past two weeks. Cases are rising in about half of the states, falling in the other half. So we'll need to keep a close eye to see which way we're trending after the holiday weekend when many people, we know, traveled and gathered indoors.

Unger: How does that impact hospitalizations and deaths?

Garcia: Well, the good news is the average hospitalizations due to COVID have been nearly flat for the past two weeks and that number stands around 28,000. The average number of daily deaths reported each day has fallen slowly but steadily since September. We've seen a very slight increase of about 4% in the last two weeks. And if we look at deaths, there are about 330 deaths per day being reported due to COVID.

Unger: Well, the really big message, an important one, coming from the AMA and other stakeholders given what we're seeing out there is to get the new bivalent booster as soon as you can, especially with the holidays approaching. Andrea, how are numbers looking for the booster shots? Are we seeing any kind of uptick at this point?

Garcia: According to the CDC, we have more than 37 million people in the U.S. who've received the new bivalent booster shot. And while that seems like a lot of people, it's only about 12% of people who are eligible for that new updated booster dose. And just as a reminder, those who are five years and up are eligible to receive that updated shot.

Unger: So really important to get it given what we're seeing out there in the world, and also because we got some encouraging news from a CDC study on the effectiveness of the new bivalent boosters. Andrea, tell us more about the study and what it means.

Garcia: So this is the first study that looked into how the updated boosters performed in the real world. And the CDC study showed that the updated booster shots performed better in preventing symptomatic infections in all adult age groups, with higher levels of protection seen in people who waited longer since their last dose of the original shot before getting that updated booster. These CDC results are based on more than 360,000 symptomatic adults that tested for COVID at pharmacies nationwide between September and November when the Omicron subvariants BA.4 and BA.5 were the dominant strains in the U.S.

Unger: Andrea, in that study, did the researchers compare the bivalent booster to earlier formulations of the vaccine?

Garcia: So I think it's important to note that it was not a direct comparison between a monovalent booster dose and a bivalent booster dose. So the study does not address the question about whether the bivalent shot offers better protection than a booster dose of the original formulation would have. But the study looked at people who got the updated shots after two or more shots of the original vaccine compared to those who had received two or more doses of the original monovalent vaccine.

With that being said, the CDC findings show that the bivalent booster provided significant additional protection against symptomatic COVID infection in persons who had been—in persons who had received two, three, or four monovalent vaccine doses. I think it's important to note that Pfizer and Moderna have indicated that they've seen improved immunogenicity data from those updated shots that could indicate they're more protective than the original shots against the Omicron strain.

Unger: Well, that is good news then. And recently, the AMA, along with other health care organizations and professional associations, released a statement urging health care professionals to promote the updated COVID vaccine and the flu vaccine at every interaction with patients. How are we doing now with the flu?

Garcia: According to data from the CDC, seasonal influenza activity is elevated across the country. We've seen two more influenza-associated pediatric deaths last week. There are a total of seven pediatric flu deaths already reported this season.

And the CDC estimates that flu, so far, has caused at least 4.4 million illnesses, 38,000 hospitalizations, and 2,100 deaths. We do know that an annual flu vaccine is the best way to protect against the flu, and the CDC recommends that everyone six month and—six months and older get that flu vaccine annually. And we think it's also important to remember that patients can get the flu vaccine and the COVID vaccine at the same time.

Unger: Well, that brings us to the third leg of our "triple-demic." We talked about COVID. We talked about the flu. Let's talk a little bit about RSV and its circulation here in the U.S. We did have a chance to talk to Dr. Paul Offit at length about RSV prior to the holiday. I encourage everyone to check out that episode on our YouTube channel. Andrea, how are we doing on the RSV front right now?

Garcia: Well, if we look at CDC data, the RSV hospitalization rate is 10 times higher than usual for this point in the season. We know that more than three-quarters of pediatric hospital beds are in use nationwide. That's up from about two-thirds over the past two years. And 171 out of every 100,000 infants younger than six months were hospitalized with RSV for the week ending November 12. That is more than double the RSV hospitalization rate for newborns last year and seven times the rate in 2018, which is the last complete season we saw before the pandemic.

Unger: Obviously, I think from our discussions between us and between Dr. Offit, there's not a lot we can do necessarily to prevent that. There's not a vaccine yet for RSV and we have this surge in cases. How are states and the government responding to numbers like this?

Garcia: Well, last week heading into the holiday, we saw the American Academy of Pediatrics and the Children's Hospital Association request a formal emergency declaration from the federal government to support hospitals and communities amid the alarming surge of pediatric respiratory illnesses, including RSV and influenza. The health care leaders wrote that we need emergency funding support and flexibilities along the same lines of what was provided to respond to COVID surges. And Oregon last week became the first state to declare an emergency in response to that RSV surge.

Unger: So, Andrea, given everything we've talked about and the trends that you're seeing so far, what's the sense about what's in store for us this winter given the kind of "triple-demic" that we're facing?

Garcia: While we're seeing those elevated numbers for flu and RSV heading into the holiday, we did hear federal health officials really sounding optimistic that we're better prepared for a COVID surge this winter compared with last year. And while we can never be too certain about what the virus has in store for us, Dr. Fauci said that the administration was hopeful that the combination of infections and vaccinations had created enough community protection that we're not going to see a repeat of what we saw last year at this time when the Omicron variant emerged, seemingly out of the blue.

Dr. Ashish Jha confirmed this assessment, saying that he was confident about the holiday season as long as Americans continue to get vaccinated and boosted. And to quote him directly, he said, "Nothing I have seen in the subvariants makes me believe that we can't manage our way through it effectively, especially if people step up and get their vaccine." And he said this at a White House briefing earlier in the holiday week.

Unger: It sounds like that would be a spectacular early gift to yourself. Make sure you get both the bivalent booster and flu shot. Andrea, it does sound like relatively good news. Any kind of caveats in there?

Garcia: Always. There's always caveats, I think. The ones we think about here are the things we've discussed earlier. The number of people getting the updated booster is well short of really where we would like to be at this point. I think we also need to make sure we're making use of effective treatments for COVID-19, including Paxlovid, so people test positive to get tested and go see their health care professional.

And of course, we can never predict the nature of new subvariants. For example, federal officials have been watching the new subvariant of Omicron called XBB. It currently accounts for a very small percentage of cases in the U.S., but it is showing up here. It is on the CDC tracker. It's taken hold in India and Singapore, so we'll need to keep an eye on that.

Unger: Well, Andrea, in closing, the White House briefing beyond the numbers and talking about subvariants was very significant for another reason. Let's talk a little bit about that.

Garcia: So as we know and we've talked about before, Dr. Fauci is retiring from government service at the end of the year. So this was likely his last appearance in the White House briefing room. It feels like that really marks the end of an era. He'll always be remembered as a voice of science that helped get us through the worst days of the pandemic.

Unger: Well, we certainly wish him luck and thank him immensely for his service and leadership for decades and at a time when the country needed him the most. Andrea, that wraps up today's episode. Thanks for being here with us. We'll be back soon with another AMA Update. You can find all our other videos and podcasts at Thanks for joining us 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.