Latest from the CDC on fall COVID variants, new flu guidelines, plus malaria health alert
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.
In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses the recent uptick in COVID cases and hospitalizations, what we've learned about new variants EG.5 or Eris, and the highly mutated BA.2.86 or Pirola variant. She also reviews changes in this year's flu vaccine guidelines and just how concerned we need to be about locally acquired malaria in response to a recent CDC Health Alert. AMA Chief Experience Officer Todd Unger hosts.
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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. Welcome back, Andrea.
Garcia: Thanks, Todd. Appreciate the opportunity to be here.
Unger: Well, Andrea, summer isn't even over and we keep hearing about climbing COVID numbers. I think a lot of us didn't expect to be having these conversations until at least a couple months from now. What's going on with this?
Garcia: Yeah, that's definitely been in the headlines and according to a New York Times article that was published earlier this week that the summer wave of COVID infections is hitting schools and workplaces. And we can expect more cases as we head into fall and winter.
And we don't need an article to tell us how things are trending. I think many of us are hearing about more and more people having COVID in our social circles. The CDC reported that hospitalizations increased 24% in the two-week period ending August 12. And we know that that wastewater monitoring data is suggesting that both the West and the Northeast are now seeing a rise in cases.
To put it in perspective, though, overall hospitalization numbers are still low compared to the numbers we saw during the public health emergency. And the vast majority of people getting COVID are really experiencing mild symptoms. The majority of those who are hospitalized are tending to have pre-existing conditions or are immunocompromised, making them more susceptible to severe disease.
Unger: So are there any other kind of big takeaways for right now?
Garcia: Well, I think that we know that there is a little willingness by most people to return to those days of frequent testing, mask wearing and isolation. So I don't think we're going to be seeing those prevention measures widely required in the way that we once did. Although we could see some schools and hospitals going back to mask mandates, I think this is going to largely be determined at the institution or local community level.
I think it is a reminder, though, that we're still living in a world that very much includes the virus. And there are still things that we can do to help prevent spread. People can get that new booster when it's available. It's likely going to be mid-September. Stay home if you're sick. Wash your hands frequently. And you may want to consider masking if you're going to be in a crowded indoor setting.
Unger: Don't forget to test. I did stop by my local drugstore to buy a test. And they didn't even have any. So it is a very different era than we were in before. Speaking of the word "era," close to this new variant's name Eris. Is there anything we've learned about this particular variant at this point?
Garcia: So yeah, this uptick in cases is—it's being driven by both XBB and EG.5 or Eris. It's being called the grandchild of Omicron and is currently that dominant variant in the U.S. making up just over about 20% of cases. We're also seeing several of the BA.2.86 cases that have been announced in this past week. And I think that's something to watch.
BA.2.86 has been nicknamed Pirola. It stands out because it has more than 30 mutations on its spike protein. And that's the part of the virus that allows it to enter our cells. And it's also the part that vaccines are training our body to fend off.
That said, there's only about a dozen cases of that new variant reported worldwide. Three are in the U.S., one discovered in Michigan in an older adult that was not hospitalized, another in a traveler arriving to Dulles in Virginia and then a third detected in Ohio in a wastewater sample.
Unger: Have we learned anything new about this particular variant?
Garcia: Well, there was an article in The Washington Post indicating that some experts are seeing that this variant could be the most adept yet at slipping past the body's immune defenses. The CDC also put out a risk assessment last Wednesday indicating that it does not appear to make people sicker than earlier iterations of the virus. Antiviral treatments should still work against it. And tests should still detect it.
And we haven't yet seen a disproportionate increase in hospitalizations in the area where that variant has been detected. That suggests that it's not necessarily more likely to cause more severe illness than the other Omicron subvariants.
But it's still early. We're also starting to hear some questions as to how protective our newly formulated COVID vaccines will be and whether the variant will be transmissible enough to cause a surge.
A variant that's adept at evading immunity would not necessarily take off in a population if it doesn't spread efficiently. So officials have said they should have a clearer understanding of the variant's transmissibility in the coming weeks as we know the surveillance is ramping up in response to this new threat.
Unger: Andrea, thanks for the COVID update. Unfortunately, COVID isn't the only concern we've got as we head into the fall. We're ramping up to flu season, which is going to be here in a few short weeks. And there have been some recent changes to vaccine guidelines. What do we need to know?
Garcia: So the CDC has issued new recommendations for flu this season. And I think the one notable change that's been getting attention from previous years is that the agency's changed its position on which flu vaccines people with egg allergies can receive.
The ACIP has recommended that, and the CDC has agreed with that recommendation, that people with egg allergies can now get any flu vaccine, egg based or non-egg based, that is otherwise appropriate for their age and their health status.
Previous recommendations had been that people with severe egg allergies should avoid those egg-based vaccines. But additional safety measures are no longer recommended for flu vaccine beyond those that we see for any other vaccine. And there was data supporting this change which showed that people with egg allergies don't have a major contraindication to egg-based flu vaccine.
Now, this is new for us here in the U.S. It's not new in other parts of the world. Other countries like Canada and Europe have studied rare but serious allergic reactions with the flu vaccine and have concluded that eggs almost have nothing to do with it. So for those with egg allergies who are still nervous to get an egg-based vaccine, egg-free vaccines will continue to still be available.
Unger: All right. And when should people consider getting their flu vaccine?
Garcia: So it's best to get your flu vaccine before it starts spreading in your community. September and October are generally good times for most people to be vaccinated against flu. The CDC specifically recommends that people get vaccinated before the end of October.
But some experts have suggested that waiting until later in that window may be better to ensure that your immunity doesn't wane and that you have adequate protection through the peak of flu season. Flu is really difficult to predict. But we know that flu season, according to the CDC, usually peaks between December and February.
Unger: And I know that AMA is in on helping out with this effort. Tell us a little bit more about what we're doing.
Garcia: Yeah, so the AMA in collaboration with the Ad Council and CDC will be kicking off our annual flu campaign on September 19. And that's aimed at increasing vaccine uptake. Although we know flu activity is low right now that timing and intensity and severity of the upcoming flu season is unpredictable. And the flu vaccine is our best tool to prevent those serious outcomes from the virus. So everyone six months or older with rare exceptions should be getting a flu vaccine every season.
Unger: All right. Thank you, Andrea. And I'm sure we're going to be talking a lot more about flu season and that campaign specifically in the weeks to come. But now we're going to turn to another thread I didn't think we'd be talking about right now. And that is locally acquired malaria in the United States. Andrea, what is happening there?
Garcia: Yeah, so we have seen the CDC issue a health alert, or a HAN, to share new information with clinicians and public health authorities and also the public about locally acquired malaria cases here in the U.S. On August 18, we know that there was a single case of locally acquired malaria reported in Maryland.
This case is caused by a different species and is unrelated to the cases of local transmission we saw reported in Florida and Texas back in June. In an update to that report in June, Florida has identified seven cases. And Texas has identified one case of locally acquired malaria.
There have been no reports of local transmission of malaria in Florida and Texas since mid-July. But to put this in perspective, before this year, locally acquired, mosquito-borne malaria hadn't occurred in the U.S. since 2003.
Unger: Wow. So that's the first time then in really 20 years. It kind of goes without saying, but why is this such a concern? And what should physicians be looking for?
Garcia: Yeah, so we know that malaria can rapidly cause severe illness and even death if it's not quickly diagnosed. It is a medical emergency. It should be treated accordingly. Patients suspected of having malaria should be urgently evaluated in a facility that's able to provide rapid diagnosis and treatment as soon as possible within 24 hours of the patient's presentation.
I think in addition to routinely considering malaria as a cause for febrile illness in patients with a history of international travel to areas where we know malaria is transmitted, clinicians should also consider a malaria diagnosis in any person who has that unexplained cause of fever regardless of their travel history.
I think it's also important for physicians to know that suspected or confirmed locally acquired malaria is a public health emergency. It should be reported immediately to your state, territorial, local or tribal health department. Those travel-associated malaria cases are also reportable in all states through routine reporting methods.
And while that risk in the U.S. to the public for locally acquired malaria remains very low, the most effective way to prevent malaria in the U.S. is for travelers to those endemic areas to take appropriate steps to prevent acquiring malaria while traveling. That includes taking medication as well as preventing mosquito bites.
Unger: Well, we'll certainly continue to watch that. Andrea, thanks again for being here today and for all your updates. That's it for today's episode. 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 video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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