New long COVID study results, a possible Paxlovid alternative, and RSV vaccine updates for babies – American Medical Association

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A check-in on COVID, flu and RSV cases, and an overview of new COVID and Long COVID studies. AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, reports that the tripledemic wave is declining, but vaccination levels for COVID, flu and RSV among adults are still low. Plus, continued supply issues for the RSV vaccine for children, administration errors for the RSV vaccine, and two new studies that could inform future treatments for COVID and Long COVID. AMA Chief Experience Officer Todd Unger hosts.

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. Andrea, welcome back.

Garcia: Thanks, Todd. It's great to be here.

Unger: Well, let's begin by checking in on the tripledemicthe mix of COVID, RSV and the flu. That has been swirling around. Andrea, are things looking any better this week?

Garcia: So far, yes. I mean, overall, respiratory virus season does seem to be easing up just a bit. We've now seen some of those numbers decrease for a second week in a row. If we look at the CDC data, that week ending January 13 showed 24 states and DC experienced high or very high levels of patients seeking care for respiratory illness symptoms. That's down from 37 states and territories the week ending January 6.

In line with those numbers, respiratory viruses seem to be putting less of a strain on our hospitals. COVID, flu and RSV accounted for a combined 6.3% of total emergency room visits in mid-January. That's down from about 7.9% the week prior and 9.9% that last full week of December.

The percentage positive test nationwide for COVID and RSV also decreased about one percentage point if we look at that week ending January 13, and positive tests for flu remained stable. So at least for right now, things generally seem to be turning a corner and trending in the right direction.

Unger: Well, that's good news. Is there anything that we need to keep an eye on?

Garcia: Well, wastewater data for COVID did find viral activity is still very high, with the South reporting an increase in recent weeks. And if we look at ER and outpatient visits, seven states in particular experienced very high levels of respiratory illness in that week ending January 13. Those are Alabama, Georgia, Louisiana, New Mexico, South Carolina, Tennessee and Wyoming.

So we'll need to keep an eye on those areas. And I think I would also just point out that with flu in particular, it's not unheard of for us to have two peaks in a season. So while numbers are heading down, we couldwe could see them go back up again.

Unger: Well then that's a good entree into this next question. Because we've talked about vaccination rates before. Are we still struggling with vaccination numbers?

Garcia: We are. And the CDC updated data last Friday, and vaccination rates for all three illnesses remain low in both children and adults. So for COVID, we're only seeing about 11% of children, 21.5% of adults between 18 and 65, and about 40.9% of adults over 65 receiving that updated vaccine. The numbers are slightly better for flu.

So around 47% of adults and children have received it, 73% of those over age 65. For both COVID and flu, seniors do have the highest uptake of the vaccine. And then, the vaccination rate for RSV, which is recommended under that shared clinical decision-making framework for adults 60 years and up, is hovering at around 21%.

Unger: Andrea, but RSV immunizations for children are another story. Tell us more about that.

Garcia: Yeah, we're still seeing shortages of the RSV immunization for infants. And demand there continues to outpace supply. As a reminder, we're talking about nirsevimab, which is that monoclonal antibody authorized in August for newborns and babies under one who are born during or entering their first RSV season, and then those children up to 24 months who remain at risk of severe RSV disease.

While the manufacturer does continue to make more of those immunizations available, there's currently enough to immunize about 40% of babies who are eligible for the drug. We do know that earlier this month, White House officials met with reps from the manufacturer to discuss ways to meet that patient demand this year as well as next RSV season.

Unger: That's a challenge. What are we hearing from physicians on this front?

Garcia: Well, many pediatricians offices that were lucky enough to receive the antibody, ran out of that drug in December. I think, aside from the shortage, the other complicating factor is that the drug is distributed in both the 50-milligram and 100-milligram doses, with the smaller ones set aside for infants weighing less than 11 pounds. It can be a bit of a guessing game, as you can imagine, for physicians to predict how much of each shot they need to order, because it's hard to know in advance how many babies they're going to see who weigh less than 11 pounds versus those who may require that larger dose.

Many of these immunizations are also being distributed directly through hospitals for newborns rather than through those individual pediatric practices. A smaller rollout is anticipated for next year, but we know RSV is still circulating. So we do still have a ways to go yet this season.

Unger: Well, we're also seeing a few complications in administering the RSV vaccine. Andrea, what's the story there?

Garcia: Well, Todd, vaccine administration errors are generally pretty rare, but they are routinely monitored through the Vaccine Adverse Event Reporting System, or VAERS. Since approval of the RSV vaccine, CDC and FDA have received some reports of the Pfizer and GSK RSV vaccines, which are approved for adults, being administered to young children. The agencies have also received reports of the GSK RSV vaccine being administered in error to pregnant people. That Pfizer RSV vaccine is the only vaccine approved for use during pregnancy. Thankfully, most of the reports had no adverse events, or if they did, they were classified as non-serious.

Unger: That's good. Andrea, all of these vaccines are new. Is that where confusion of this kind is coming from? And what do physicians do if their patients have been given the wrong vaccine?

Garcia: Well, these recommendations do vary. For infants and children, it's recommended they receive a dose of nirsevimab to ensure they're protected. The other option available to protect babies is that maternal vaccine. So the Pfizer RSV vaccine is recommended for use during pregnancy, for people who are at the 32 to 36 weeks of pregnancy during the months of September through January.

It's unclear why these errors happened, but as you said, these are new vaccines this year. It is recommended that facilities do take steps that can help reduce errors like automating prevention alerts in the EHR, ensuring proper education, and training on vaccine recommendations, and paying close attention to labeling following proper storage and administration best practices. If mistakes do occur, it should be reported to us as soon as possible. And if there are questions about vaccine administration errors, physicians can email [emailprotected].

Unger: Excellent. And you can see that on the screen there, [emailprotected]. Andrea, RSV isn't the only virus with breakthroughs. Researchers also continue to study COVID. And we heard about a promising new treatment just last week. Tell us more about it.

Garcia: Yeah, last Thursday, in the New England Journal of Medicine, Chinese researchers published positive trial results of simnotrelvir, which is an oral antiviral that can shorten the duration of mild to moderate COVID symptoms. According to the Center for Infectious Disease Research and Policy, unlike with Paxlovid or other antivirals, that were tested against COVID, this trial was conducted mostly on healthy young adults, none of whom had severe symptoms.

The formulation used in the study included ritonavir, which acted as a booster to the antiviral. And among patients who began that treatment within 72 hours of symptom onset, the length of COVID symptoms was, on average, 36 hours shorter in that treatment group than in the control group. The viral loads were also significantly lower among the treatment group by day five, dropping 30-fold more than the load seen in that control group. So this is good news, something we'll definitely be continuing to follow.

Unger: Absolutely. That sounds very promising. There's also been a new development with long COVID, Andrea. What can you tell us about that?

Garcia: Yeah, so scientists have identified a persistent change in a handful of blood proteins in people with long COVID, which indicates that an important part of the immune system remains on high alert for months after an acute infection. These findings were published last Thursday in the journal Science, and they could help explain what causes that persistent fatigue, brain fog and other debilitating symptoms of long COVID. Experts think this could help pave that way for diagnostic tests and, potentially, a long-waited treatment.

That study followed 113 COVID patients for up to a year after they were first infected along with 39 healthy controls. At the six-month mark, 40 patients had long COVID symptoms. So repeated blood samples in those patients turned up important differences in their blood. A group of proteins indicated that a part of the body's immune system, called the complement system, remained activated long after it should have returned to normal.

Unger: So what is the significance of that particular finding, Andrea?

Garcia: Well, one of the study's investigators explained to NBC News that when you have a viral or bacterial infection, the complement system becomes activated, and it binds to these viruses and bacteria, and then eliminates them. The system then returns to its resting state, where its regular job is to clear the body of dead cells. But if the complement system remains in its microbe-fighting state after the viruses and bacteria are eliminated, it starts damaging healthy cells. And the result is tissue damage and microclots in the blood, which can lead to those symptoms of long COVID. Understanding these mechanisms could help scientists confirm diagnosis and develop effective treatments. The next step here is likely more and larger trials.

Unger: That really sounds like some exciting developments for something that's been debilitating for so many people out there. And we've heard from you and seen your comments on the videos out there on YouTube. And so, we'll continue to track that.

Andrea, as usual, thanks so much for keeping us up to date. That wraps up today's episode. If you enjoyed this discussion, you can support more programming like it by becoming an AMA 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.

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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New long COVID study results, a possible Paxlovid alternative, and RSV vaccine updates for babies - American Medical Association