Flu shot, COVID boosters, TPOXX treatments and more with Andrea Garcia, JD, MPH – American Medical Association

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 inmedicineon COVID-19, monkeypox, medical education, advocacy issues, burnout, vaccines and more.

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In todays AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses preparing for flu season, changes to CDC's TPOXX guidance, as well as the latest data and findings from new physician burnout research study published in Mayo Clinic Proceedings. AMA Chief Experience Officer Todd Unger hosts.

Read more about the AMA, Mayo Clinic, and Stanford Medicine research findings on physician burnout.

Learn how the AMA is #FightingForDocs and access resources from the AMA Recovery Plan for Americas Physicians.

Visit AMA's monkeypox resource center.

Learn more at the AMA COVID-19 resource center.

Unger: Hello and welcome to the AMA Update video and podcast, an ongoing series covering a range of health care topics affecting the lives of physicians and patients. 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. It's good to be here.

Unger: Well, let's start off by talking about Omicron boosters. They've been out now for about two weeks. I got mine. Any data on how the response has been at this point?

Garcia: Well, we know the Biden administration bought 171 million doses of the new bivalent vaccines. And that millions of those doses have been shipped and arrived within the last two weeks in pharmacies, nursing homes and in clinics across the country. But federal data on how many shots of the updated booster doses have been administered is not yet available.

According to The New York Times, early numbers from some states and several cities showed what health officials are describing as a robust early response. So if you look at California, they've administered about 397,000 doses. In Texas, about 116,000 people got the new booster in a few days. And clinicians in Illinois had administered at least 137,900 shots.

I think, with that being said, others have called this rollout muted as the new shots have been barely noticed by some people. So we still have our work cut out for us.

Unger: Well, let's unmute that. Why don't you remind folks why it is so important to get the booster right now?

Garcia: So these updated COVID boosters can both help restore protection that has waned since previous vaccination and provide broader protection against the new variants. The U.S. COVID-19 vaccines authorized in the U.S. continue to reduce the risk of severe disease, hospitalization and death. And now that much of the population has stopped masking and quarantining, these boosters are our best defense against COVID-19 and the variants that are currently circulating in our communities.

Although people may be getting weary of getting shots, the administration has indicated that they expect COVID-19 shots will be administered annually, similar to a flu shot. And they're urging everyone 12 and older to receive the updated booster as soon as they are able to.

Unger: And get your flu shot at the same time in time to prepare for the fall right now. How are the COVID numbers looking this week?

Garcia: Overall, it's good news. We're seeing cases continuing to fall in nearly every state. If you look at The New York Times, less than 62,000 COVID cases are being reported daily. That's the lowest level since early May. And it's almost a 30% decrease than from two weeks ago.

Many areas are showing significant declines. And over a dozen states and territories have seen cases go down by 40% or more since the start of September.

Unger: And how about on the hospitalization and on deaths?

Garcia: There's been a sustained improvement in hospitalizations. We're looking at about less than 33,000 people in U.S. hospitals with COVID every day. That's down about 12% over the past two weeks.

And the average daily deaths due to COVID is around 426. That's a 13% decrease from two weeks ago. And while we know the number of deaths is unacceptable, this number is much lower than a year ago at this time when Delta was causing around 2,000 deaths per day.

Unger: Well, I want to take a little time and discuss a piece of news that came out last week that relates to physicians. And we know physicians have been taking care of this nation, its patients for the past two and a half years. And that has taken a toll on them.

This new study shows some interesting numbers about burnout that, I guess, people wouldn't be surprised to hear. Tell us more about that.

Garcia: Yeah, so those findings were really pretty dramatic. And it's a new study conducted by researchers from the AMA, the Mayo Clinic, Stanford University School of Medicine and the University of Colorado School of Medicine. And it found that the physician burnout rate spiked during the first two years of the pandemic, hitting an all-time high.

That data was gathered from a survey of nearly 2,500 U.S. physicians. It found the overall physician burnout rate was almost 63% in 2021. If we compare that to the number in prior years, it was 38.2% in 2020, 43.9% in 2017 and 54.4% in 2014. So these trends were consistent across nearly all specialties. And that spike came just after a six-year period of a decline in burnout.

Unger: And that's really important when you think about that trend. A lot of work by the AMA and partners out there to shine a spotlight on physician burnout and really address some of the systemic factors that are really at the root cause. But then something like the pandemic comes in and we see this really dramatic increase. What else did the survey have to tell us?

Garcia: The survey also looked at personal fulfillment scores, which also fell, with only 57.5% of physicians indicating that they would choose to become a doctor again. And that dropped from more than 72% in 2020. In a statement, AMA President Dr. Jack Resneck said that the worst days of the COVID-19 pandemic are hopefully behind us. And there is an urgent need to attend to physicians who put everything into our nation's COVID-19 response, too often, at the expense of their own well-being.

Unger: And that really is at the foundation of the AMA's Recovery Plan for America's Physicians. It's recognizing that after two and a half years of serving this nation's patients, it's time to take care of our physicians and the key issues that are affecting them and driving these record levels of burnout. Turning now to other diseases that continue to make headlines, the CDC has issued new guidance on a monkeypox treatment. What do we need to know about that, Andrea?

Garcia: Yeah, so CDC, last week, issued new guidance on TPOXX, which is the antiviral that is being made available through an expanded access investigational new drug protocol to treat monkeypox. And the agency is recommending that this treatment be limited to people at high risk for severe disease. This CDC decision is a result of recent data from the FDA, which suggests that broad use of TPOXX could promote resistance and render those antivirals ineffective for some patients.

According to the CDC's recommendation, TPOXX should be reserved for people with severely weakened immune systems. So think of those with HIV that is not controlled, people with leukemia, lymphoma or those who've had solid organ transplants, as well as people who are pregnant or breastfeeding, children under age eight. And people within that is vulnerable to injury.

Unger: Well, for the last several weeks, we've been talking about the monkeypox numbers. I think the story there was still more cases than we hope. But, hopefully, the rate of the outbreak seem to be declining. Is that still where we are?

Garcia: Yeah, so the CDC is indicating there are about 24,000 reported cases of monkeypox in the U.S. since the outbreak began. That rate of new cases has been declining for weeks and is showing signs of plateauing. I think it's unfortunate that last week, we saw the first death due to monkeypox, which was a case in LA County.

We know that deaths from monkeypox are rare. But they can occur among vulnerable groups, such as babies, pregnant women and those with weakened immune systems, like we just talked about. The patient who died was severely immunocompromised and had been hospitalized prior to death.

Unger: Well, we're also on the verge of entering flu season. It's going to be a little bit different this year. Many people back to work, out on public transportation, maybe not wearing a mask. What do people need to be thinking about when it comes to the flu? And what we can expect this season?

Garcia: Yeah, I mean, I think the concern here is we may be more susceptible to the flu virus than in past years and that's for a number of reasons. Flu activity tends to ramp up starting in October, though we know according to New York Times and other data that the virus has already been circulating this month in Texas, New Mexico, Delaware and Georgia. We know the Southern Hemisphere, which is finishing up its flu season, has seen a lot of flu this year. And that's typically an indicator of what we can expect for our flu season.

And this year could be worse because of COVID restrictions. As you mentioned, people aren't wearing masks like they were before. And those measures we take to protect us from COVID also prevent the spread of flu.

So we could be seeing people travel more than they did over the past two years. And people's immune system, they haven't been exposed to the flu virus in a while. So that can make them more susceptible as well.

Unger: Well, I know of one really effective way to help protect yourself and your families this fall and winter. I'll bet you're going to tell me what that is.

Garcia: Yeah and much of this is the same as the advice we always give, which is get your flu shot. Even in years when the vaccine does not match well against the circulating strain, it's still important. It protects people against serious illness and complications. It's our best defense.

This year, you can get your flu shot and COVID booster at the same time. And many experts are still recommending wearing a mask when you're in a crowded indoor space. And, of course, wash your hands regularly.

I think people may want to stock up on at-home COVID tests. We know that flu and COVID symptoms can be similar. It will be important to determine which you have if you become sick so you can follow that recommended isolation guidance. And you also may be eligible for treatments, like Paxlovid for COVID or Tamiflu for influenza. I think the bottom line message, regardless of what you have here, is get vaccinated and stay home if you're sick.

Unger: Well, just in closing, just want to highlight some important news on the advocacy front, including some big news from areas of the AMA's Recovery Plan for America's Physicians that we mentioned earlier in the segment. What news do we have there?

Garcia: For one, last week, a group of 375 employers and health groups, including AMA, Amazon, the American Nurses Association, Google and Walmart, sent a letter to the Senate, urging lawmakers to continue COVID-19 era telehealth flexibilities for another two years. And there was also some movement on a bill to streamline prior authorization requirements. The measure will now move to the Senate for a vote. And health care advocates are hoping it will pass by the end of the year.

Unger: So that's great news. Two very important pillars of the recovery plan that you just talked there about supporting telehealth and, of course, prior authorization. We'll hear more about that when we talk to Jason Marino, the AMA's director of Congressional affairs, next week. We'll be back soon with another AMA Update. And you can find all our videos and podcasts at ama-assn.org/podcasts. 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.

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Flu shot, COVID boosters, TPOXX treatments and more with Andrea Garcia, JD, MPH - American Medical Association