Public Health

XBB.1.5 now dominant in the U.S. as China eases COVID restrictions 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, returns to discuss a kids strep throat warning issued by CDC (Group A streptococcus bacteria or Strep A) as well as the latest on RSV, influenza, and COVID cases in China and the U.S. AMA Chief Experience Officer Todd Unger hosts.

Learn more at the AMA COVID-19 resource center.


  • 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. We're back for 2023 with our first 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, welcome back.

Garcia: Thanks. It's good to be here. I hope you had a good holiday.

Unger: I did and I hope the same for you as well. Well, let's get right into it. A lot of people did run into major flight cancellations and things like that. But heading into what Dr. Hotez called the septodemic phase of the holiday here, I'm curious to find out, even though it felt more normal than it did last year, how are we looking on the numbers?

Garcia: Well, as always is the case with the holidays, we won't have an accurate picture of those trends for a little while because of those interruptions to data reporting around both Christmas and New Year's. Heading into the new year, COVID metrics really remained relatively steady. And again, that could be due to the lull in data reporting. Most of that data has been flat in recent days, but test positivity is rising sharply and that suggests that there are far more new cases than what those official reports are showing at this point.

As of January 1, we were seeing a daily average of more than 58,000 cases. That's down 11% from two weeks ago. We had more than 44,000 people hospitalized with COVID. That's up 7% from the previous two weeks. And we're seeing about 317 deaths per day. Still far too many, but it's more than a 20% decrease from two weeks ago, so that's good news.

Unger: Well, it's hard to remember a year ago, but we are looking a lot better in terms of numbers than we were. Just for the sake of comparison, how are we looking versus last January?

Garcia: It is hard to remember and it feels like a really long time ago. But last year, we were dealing with that huge surge in the Omicron variant. If we look at January 20 of last year, there were nearly 160,000 COVID patients hospitalized, the most at any point in the pandemic and that's nearly four times what we're seeing now. And February 2 of last year, the seven-day average of new deaths peaked at 2,669.

Obviously, that's substantially higher than the just over 300 we are seeing right now. If we do look at The New York Times data, though, New Jersey and New York are those spots to watch. They continue to see some of the country's worst per capita case rates. And many scientists believe that that is being fueled by the newer Omicron subvariants XBB and XBB.1.5. And there are also a couple of Southern states, if you look at Kentucky and South Carolina, that are also seeing increases in cases and hospitalizations.

Unger: Well, that variant XBB is gaining traction fast. Reading a lot about that. Can you tell us more about what we know about it?

Garcia: Yeah, so scientists are really still in the early stages of studying that XBB subvariant and that even newer version, the XBB.1.5. Preliminary studies have shown that the newer version is adept at evading existing immune response and at binding to human cells. Both XBB and XBB.1.5 are recombinants of the BA.2 variant.

And according to CDC data, over 40% of COVID cases in the U.S. are now caused by the XBB.1.5 subvariant. And that's doubled from the previous week. And if you look at the data in the Northeast, about 75% of confirmed cases are reported to be XBB.1.5. So these appear to be very contagious.

I think the good news so far is there's no indication at this point that it causes more severe illness than the other Omicron variants do. I think experts do agree that getting that bivalent booster dose to bolster your immune system against these newer subvariants is the most important thing to do and we'll definitely continue to watch as things progress with these variants.

Unger: Indeed. Andrea, let's shift our focus here to China, where they're facing a lot of difficulties in the transition that's going on there. A lot of headlines about the country's worsening conditions with COVID over the last few weeks. What's the status there?

Garcia: Yeah, China unfortunately is seeing the highest number of cases per day since the start of the pandemic and there are increasing reports of severe disease there. The outbreak has gone from bad to worse since that sudden reversal of its zero-COVID policy last month. And that zero-COVID rule basically prevented people from leaving their home if cases were detected in their area. People were undergoing regular testing.

And they also required overseas travelers, including Chinese nationals, to stay in quarantine for as long as two months before entering the country. That reversal of those policies has likely exposed two vulnerabilities. And the first is that a lot of the country has not been vaccinated, including its most vulnerable older population. And second, because of the many lockdowns that they've undergone, they don't have much natural immunity from some of the previous COVID waves.

The other thing to keep in mind is that the situation on the ground there is difficult to track because China is not releasing reliable COVID data. The stories and videos coming out do suggest that the crisis there is worsening. And if you look at some of the recent New York Times reporting, local governments have reported hundreds of thousands of infections a day. And sick patients are crowding hospital hallways, which is reminiscent of the early days of the pandemic.

Unger: Absolutely. And we know from those early days that things that happen in a place that seems far away can have repercussions here in the States. What could this mean for us and the rest of the world?

Garcia: Well, I think this is almost the exact opposite situation in many other countries, including the U.S., where the majority of the population 65 and older have been vaccinated against COVID, though we certainly still do have a lot of work to do on the booster front. Many Americans have also been exposed to the virus during prior COVID waves and have some natural immunity.

Think that combination along with therapeutics has allowed many here to return to some sense of normalcy without the levels of hospitalizations and deaths we've seen in past years. I think the concern here and the concern in any country where you're seeing rapid unchecked outbreaks is the opportunity for that virus to mutate into a more contagious or deadlier variant, which we've seen happen throughout the course of the pandemic.

Unger: Well, given that situation, the U.S. has also responded with new travel policies. What do we need to know about those?

Garcia: Last Wednesday, the Biden administration announced that it will require travelers from China, including Hong Kong and Macau, to present negative COVID tests no more than two days before their flight departs for the United States. According to the CDC, this new requirement is going to take effect beginning January 5 and that gives the airlines some time to put these policies in place. It will apply to passengers regardless of their nationality, regardless of their vaccination status.

Will include travelers coming from China who enter the U.S. through a third country, like Seoul, Toronto or Vancouver, or who are connecting through the U.S. to other destinations. The agency also announced that it's expanding voluntary genomic surveillance program and that's to look for those new variants in anonymous swabs taken from international travelers at major U.S. airports. And that's going to include LA and Seattle.

Unger: Well, thanks for the update on COVID there. Let's now take a look at two of the other legs of our tripledemic, the RSV and the flu. Those were obviously big concerns prior to the holidays. What do we need to know about what's happening there now?

Garcia: I think the good news is that while RSV arrived early this year, cases have now dropped dramatically over the past month. In terms of flu, seasonal flu remains high, but it continues to decline in most areas of the country. Heading into the holidays, the proportion of laboratory specimens testing positive for influenza had declined two weeks in a row. And that system that we use for tracking flu hospitalizations was also showing declines.

So things on the RSV and flu front are definitely heading in the right direction. We could, of course, see that post-holiday bump in respiratory virus numbers. Kids are coming back to school. And we're beginning to begin to see that impact of traveling and getting together with family, and that could certainly put a greater strain on supplies of some medications that we've seen this season.

Unger: Let's talk a little bit more about that because before the holidays, we were seeing some shortages of some key treatments. What's going on right now?

Garcia: Yeah, that high flu activity meant high demand for children's pain and fever medications, and those have been among the hardest to find. Over the past few weeks, we've seen Walgreens, CVS, Rite Aid, and others impose limits on children's pain and fever medications.

And that was to help ensure equitable access. And then some pharmacies have reported sporadic shortfalls of Tamiflu and other over-the-counter cold and flu medicine for adults. So even if you do have a prescription for Tamiflu, it's best to call your pharmacy to make sure it's available before you go and pick it up.

Unger: Well, Andrea, there's also been another concern that cropped up right before the holidays that physicians should be on the lookout for. Let's talk a little bit about the situation with strep.

Garcia: Yeah, so it was right before Christmas that the CDC issued a health alert to notify clinicians and public health authorities of an increase in severe infections involving group-based streptococcus bacteria, also known as strep A, among children. Most people with strep A recover without any complications, but in rare circumstances, cases can develop into infections known as invasive group A strep, which can be fatal. And the risk there is the greatest among children and the elderly.

While overall, the number of cases has remained relatively low of invasive group A strep infections, the CDC said it's going to investigate reports of increased cases in some states like Colorado. There's no strep A vaccine available, and most cases are treated with a course of antibiotics. So teaching kids good hand-washing, to cover their mouth when they're coughing or sneezing, or using alcohol-based hand sanitizer before eating is really the best way to prevent the spread.

Unger: Well, Andrea, that sounds like good advice for all the infections that are swirling around right now. That's it for today's episode. Thanks again for being with us here today. We'll be back soon with another AMA Update. You can find all our videos and podcasts at Thanks for joining us, 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.