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. I'm Todd Unger, AMA's
chief experience officer. Welcome back, Andrea. This is our first discussion
of the year for 2024. Garcia: Happy new year. It's good to be here. Unger: Well, we made it
through the holidays, but now it seems like literally
everyone we know is sick. Andrea, what's
going on with that? Garcia: Well, it certainly
does feel that way. And if you're not
sick, chances are that you know somebody who is. And as we've talked
about before, there are disruptions in
reporting over the holidays for respiratory viruses. There may be limited
appointments for testing. People are traveling and
they might not get tested. Or they might use
an at-home test, which we know are not reported. So even with these
caveats, there's no doubt that we are seeing
a lot of respiratory viruses swirling right
now as we continue to see cases of RSV, COVID
and flu across the country. According to the CDC,
those respiratory illnesses are now elevated in 38 states. Of those, 21 are experiencing
very high activity. So that helps explain why it
feels like almost everyone is getting sick right now. Part of this is seasonality. It's an annual trend. It's fueled in part
by holiday gatherings, travel, colder weather. And that drives a lot
of people indoors, so what we're seeing right now
is not entirely unexpected. Unger: Andrea, when we think
about the kind of three illnesses that are
going around right now, can you take us through how the
numbers break down for each? Garcia: Yeah, so based
on some of the articles, it seems like flu seems to be
increasing most dramatically. And CDC says it expects
that those numbers are going to be continue to be
elevated for several more weeks. We generally do
see flu season peak between December and February. CDC Director Mandy
Cohen said she expects this flu season to
peak by the end of this month. I think the good news is the
flu shot this season is well matched to the strain that we're
seeing circulating the most. So there is still
time, and it's still worth it to get that
vaccine if you haven't yet. Even though cases
tend to taper off, we can still see flu circulate
well into the spring. Unger: And where
do we stand on RSV? Garcia: Well, RSV is
certainly still prevalent. But for the most part, those
cases rose in the fall, and they have plateaued or
even decreasing in some places. If we look at that
CDC data, cases appear to have peaked
around Thanksgiving. I think complicating
the situation right now is that some people, like
particularly children, are getting sick with RSV and
other viruses simultaneously. And that makes
tracking, diagnosing and treating more difficult. One pediatrician
noted that in the past we would have one disease that
we were tracking or monitoring at a time. But now babies and children
have multiple diseases at once. It's not that they
just have RSV, but they're getting RSV and
COVID or influenza and RSV because all of these viruses
are prevalent in our community. Unger: And having any one
of these would be bad. I can't imagine having more
than one at the same time. And Andrea, as we talk
about the three viruses out there, the third
one, of course, is COVID. Tell us a little bit about
how those numbers are looking. Garcia: Yeah, so COVID cases
are certainly increasing. And while CDC data indicates
that COVID hospitalizations aren't increasing as much as
they have in previous years, right now, we are seeing more
people hospitalized with COVID than we are with flu. The CDC has reported that
the wastewater viral activity level for COVID is
the highest that it's been since the
Omicron surge in 2022. And it is increasing
in all regions. And just as a reminder,
we do increasingly rely on that wastewater
data as people are taking at-home tests
more or, in some cases, aren't testing at all. With that new highly
infectious COVID variant, low uptake of the latest COVID
vaccine, we're at about 19% of adults who have
received that, and then, of course, few
people taking precautions, like masking, we
can really expect to see this spread continue. Unger: Andrea, tell
us a little bit more about the variant that is
driving this particular wave. Garcia: Yeah, Todd. So it's JN.1, and the CDC
released an update on January 5 about the prevalence
of that variant, explaining that it may be
intensifying the spread of COVID-19 this winter. It's currently responsible for
about 61% of cases in the U.S., and that's based on data
ending the week of January 6. And that's a sharp rise from the
7% of cases in late November. I think, with that
said, JN.1 doesn't seem to be causing more severe
illness than previous variants. The symptoms you're going to
see if you're infected with JN.1 is going to depend in
part on your underlying health and the level
of immunity you have. But generally speaking,
those symptoms are similar to the viruses
caused by other variants, so sore throat, congestion,
runny nose, cough, fatigue, headache, among others. So although overall
COVID illnesses do seem to be less severe
than in previous years, that CDC data does indicate that
hospital admissions for COVID right now are up 20%
and deaths are up 12.5% from the previous week. We're still losing about 1,500
people per week on average due to COVID. Unger: So a lot. A lot. It continues to be. And because of this
particular wave, I have been seeing some
stories about the return of masks and mask mandates. Is that something that you
think we're going to see again as a preventative measure? Garcia: I don't think we're
going to see widespread masking requirements return. But we're certainly seeing some
hospital systems resume masking requirements in some states. So Reuters reported
that we're seeing this in medical settings in New York,
here in Illinois, Massachusetts and California. I think of greatest concern
are those older adults, infants, people with
compromised immune system or with chronic
medical conditions and people who are pregnant. Part of the problem
is people may not be isolating if they have
the virus because they either can't because they don't have
access or don't want to test. So if someone assumes they
have a cold, it could be COVID. The Federal Government
has continued to make some free
at-home tests available. But testing is certainly
not as accessible as it was during the
public health emergency. And we are likely
seeing employers who are less willing
to accommodate those COVID-related absences. That's why, even if you're
not required to wear a mask, experts say now is a good time
to wear your N95 or your KN95, especially if you're
going to be indoors in close quarters with others. Unger: Right. And Andrea, as COVID
cases rise, Paxlovid is once again in the news. What do we need to
know about that? Garcia: So there were some
recent articles in The New York Times and Washington
Post that were reporting on the results of a
new study conducted by the NIH. And that looked at a million
high-risk people with COVID and found that only
about 15% of those who are eligible for
Paxlovid actually took it. And the authors
of the study found that if even half of the
eligible patients in the U.S. had gotten Paxlovid during
the time of the research, 48,000 deaths and
135,000 hospitalizations could have been prevented. Paxlovid was found to
cut the risk of death by 73% for high-risk
patients in this NIH study. Unger: Those are some pretty
extraordinary numbers and a bit surprising. Did they talk about why? Garcia: So we haven't
seen a study that's focused on clarifying
why so few people have used the medication. Anecdotally, we don't
think it's because people don't know about the drug. Most people do. The New York Times suggests
that some of the reluctance may come from doctors who are
worried about interactions with other drugs. People worry about
the rebound cases or the metallic aftertaste. However, in a recent
review of studies, the CDC did say that there
is no consistent association with Paxlovid use
and COVID rebound. And we know studies have also
shown that that rebound can happen even without treatment. Others claim they
want to wait and see if things will get worse. But the problem is,
if you wait to see, that treatment is
no longer effective. You need to start it early. And some individuals
may not recognize that they are themselves
at risk of severe disease. Of course, cost can
also be a factor. It's priced now at
about $1,400 per course, though private insurance
are expected to cover some portion of that price. And Pfizer is also offering
copayment assistance for the drug. I think, regardless
of the reason, this is something we need to
pay attention to right now. COVID deaths have been
elevated since September at about 1,200 to
1,300 deaths per week. But as we just talked about,
those numbers are inching up, and we're now at about
1,500 per week in December. Unger: Right. Well, a word we haven't
heard in a while-- hydroxychloroquine. On the other end of the
spectrum, so to speak, there is a new study out
about the potential harm that hydroxychloroquine
may have caused. Andrea, can you tell
us more about that? Garcia: Yeah, certainly. This was a study done
by French researchers, and it suggested that nearly
17,000 people in six countries, so France, Belgium, Italy,
Spain, Turkey and the U.S., may have died after
taking hydroxychloroquine during that first wave of COVID. As a reminder,
hydroxychloroquine is an antimalarial drug. It was prescribed off label
to some patients hospitalized with COVID during that
first wave of the pandemic. And that was despite
the fact that there was an absence of
evidence documenting its clinical benefit. That study was
published in Biomedicine and Pharmacotherapy. And that figure 17,000
stems from a study published in the journal
Nature in 2021 that reported an 11% increase in
the mortality rate linked to the drug's prescription
against COVID-19 because of potential adverse effects,
like heart rhythm disorders, and its use instead of
other effective treatments. And this is a good reminder of
the damage that misinformation can cause and the importance of
using evidence-based treatments that we know work,
like Paxlovid. Unger: Well, that
is excellent advice and conclusion
coming out of this and, I guess, a good way
to wrap up today's episode. Andrea, thanks so much for
kicking us off for 2024. Everyone out there, if you
enjoyed this discussion and you want to support
more programming like it, I encourage you to join the AMA. Become a member 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 today. Please take care. [MUSIC PLAYING]
