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
RSV vaccines, measles outbreaks & cardiovascular risks from long COVID with Andrea Garcia, JD, MPH
Mar 8, 2023
Featured topic and speakers
In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, shares new study findings on increased risk of severe health complications linked to patients with long COVID, including: arrhythmias, stroke, heart failure, coronary artery disease, COPD and pulmonary embolisms. Also discussing growing measles outbreaks. Measles are extremely contagious, can cause life-threatening illness and an immediately notifiable disease. Physicians should promptly report cases to state health departments to notify the CDC within 24 hours via the National Notifiable Disease Surveillance System. AMA Chief Experience Officer Todd Unger hosts.
Learn more at the AMA COVID-19 resource center.
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, Andrea.
Garcia: Thanks. It's good to be here.
Unger: Well, despite the fact that I keep hearing about people that are having COVID, the numbers are actually going down. What's the story this week?
Garcia: Well, if we look at the New York Times data, cases and hospitalizations are right. They both continue to decline nationally over the past two weeks. Both those metrics are at the lowest point since October. And similar to last week, we're seeing an average of about 34,000 new COVID cases being reported daily. About 26,000 people are hospitalized with COVID. And both of those are small decreases from the prior two weeks.
And we know that declines in the Northeast, in Massachusetts, in New Jersey, in New York are part of that national picture. Cases in those jurisdictions have fallen about 20% since mid-February and hospitalizations have decreased by about 10% there.
Unger: That is good news. Now, what about deaths? Are we still seeing a decrease there?
Garcia: So deaths are a little more complicated. And last week, we talked about how deaths were finally decreasing, but now it's being reported that death figures were artificially low due to delays in processing that data and that information came from a CDC source. That latest data now includes deaths from the start of the year and it shows at least 25,000 people have died so far in 2023.
If we look at the March 5 data, we're seeing a daily average of about 538 deaths per day, which is a 40% increase over the past two weeks. But again, there have been delays in reporting that information.
Unger: That's because we were talking more in the 300s, I believe, in our last discussion. So that is a significant difference. And although deaths are still too high, we are seeing some states relaxing prevention measures as we get closer to May 11 and the end of the public health emergency. What is the latest story there, Andrea?
Garcia: So most places no longer require masks and many haven't for some time, but the one exception has really been in some jurisdictions around health care facilities. And we're now seeing officials in California, in Oregon and in Washington State announced that clinicians and patients and visitors will no longer be required to wear masks in hospitals and other health care facilities, and that'll be effective starting April 3.
Health officials are saying that they're dropping the mask requirement now because we've seen those rates of COVID and RSV and influenza steadily decline since the end of last year. We do know that some local or tribal jurisdictions or health care settings may decide to continue requiring masks even when those state requirements are lifted and that's because masks are important in settings where vulnerable people are residing or being cared for.
So it'll be important to keep an eye on those transmission levels in the community to guide those prevention strategies going forward.
Unger: Andrea, we haven't talked in a little bit about long COVID, but that continues to be a challenge. And there was a new study that was published in JAMA Health Forum last Friday. What did that new study tell us?
Garcia: Well, we know many people experience those ongoing symptoms following a COVID infection, but we know less about the long term outcomes from those individuals and that is what this particular study looked at. It used insurance claim data for more than 13,000 adults with long COVID and more than 26,000 without COVID during a 24-month—or a 12-month follow-up period.
Researchers also controlled for other factors that were present prior to infection. And what they found was that individuals who experienced long COVID are at high risk for a range of adverse health outcomes, and that included a double risk of death in the year following the infection.
Unger: Andrea, that is a really startling statistic. What other adverse health outcomes are we talking about here?
Garcia: Those with long COVID were also roughly two times more likely to experience cardiovascular events—so think arrhythmia, stroke, heart failure, coronary artery disease. Pulmonary conditions were also common. The risk of pulmonary embolism more than tripled, while the risk of COPD and moderate or severe asthma nearly doubled for those with long COVID.
And those results certainly indicate a need for continuing monitoring of at-risk individuals, particularly in those areas of cardiovascular and pulmonary management. And as we move out of this acute phase of the pandemic, this will continue to be an area requiring further study so we can better care for individuals who are still suffering.
Unger: Andrea, COVID is, of course, not our only concern now. And as we talked last week, it feels like every week we've got a new public health challenge out there. Last week, we heard about a CDC health alert for shigellosis. And this week, we've got another one for a disease that we really thought we were not going to have to worry about in the U.S. Tell us more about that.
Garcia: Yeah. So on Friday, CDC issued a health advisory or HAN to measles exposure and this was at a large event in Kentucky. And their purpose was to notify clinicians and public health officials of the situation. On February 24, the Kentucky Department of Public Health identified a confirmed case of measles in an unvaccinated individual with a history of recent international travel.
And while infectious, that individual attended a large religious gathering on February 17 and 18 at Asbury University in Wimore, Kentucky. There are about 20,000 people who attended that gathering from Kentucky, from other U.S. states, from other countries and an undetermined number of those people may have been exposed to that health advisory highlight that event.
But also, other recent large measles outbreaks and travel-related cases and really focuses on that importance of early recognition, diagnosis and appropriate treatment. So CDC is recommending that physicians be on alert for cases of measles that meet the case definition.
Unger: Andrea, what do physicians need to know if they suspect a patient has measles?
Garcia: So physicians should immediately notify local or state health departments about any suspected case of measles, and that's to ensure rapid testing and investigation. The MMR vaccine is recommended for patients who are unvaccinated or who are not fully vaccinated. And physicians should take precautions to prevent spread.
So patients with suspected measles should not be allowed to remain in waiting rooms or common areas of a facility. They should be isolated immediately, ideally in a single patient, airborne infection isolation room if that's available. And health care professionals should use respiratory protection upon entering that room for a patient with known or suspected measles.
And the CDC also shared information about their testing recommendations, which call for a nasal swab or throat swab or a PCR test as well as a blood specimen for serology for all patients with symptoms compatible with measles. It's extremely contagious. It can cause life-threatening illness and it's immediately notifiable, so state health departments should also report those cases to CDC within 24 hours.
Unger: Andrea, as we begin to see more of resurgences like this, what do patients do to protect themselves?
Garcia: Well, with the declines in measles vaccination rates during the pandemic, the U.S. is joining other countries in seeing this increase in measles cases over the last couple of years. So we went from about 49 cases in 2021 to 121 cases in 2022 among children who weren't fully vaccinated and that includes outbreaks in both Minnesota and Ohio.
Physicians can help ensure patients are up to date on MMR vaccines and other recommended vaccines as well. And for people traveling abroad, the CDC also recommends that U.S. residents who are six months or older be protected from measles and receive the MMR vaccine prior to departure. And anyone who's not protected against measles is at risk and can get measles while traveling abroad or in the U.S.
And so, it's really those two doses of MMR vaccine that provide the best protection against measles rather than one dose.
Unger: Again, the answer—vaccine for a preventable disease like that. Andrea, we'll keep an eye on that. And I know we'll get updates from you in the future. One thing we haven't talked about recently also is RSV as the numbers continue to decline there as well, but there has been progress on a vaccine. What can you tell us about it?
Garcia: Well, it's actually two vaccines. And last week, there were two days of discussion with the FDA's advisory panel VRBPAC, and they voted in favor of RSV vaccines—one by Pfizer, the other by GSK—and those would become available for adults age 60 and older.
And just a reminder about how that advisory council process works—that committee makes a recommendation to the agency, and then the FDA will decide whether or not to accept that recommendation. If they do, we could see FDA grant formal approval for those vaccines within months, and some estimates suggest by May. And if those vaccines are approved by FDA, they're going to be those first vaccines publicly available against RSV.
Unger: That is more good news. Andrea, thanks so much for being here today. That wraps up our episode. We'll be back soon with another AMA Update. You can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. 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.
