Monkeypox, Omicron BA.5 and Novavax with Andrea Garcia, JD, MPH [Podcast]

In today’s COVID-19 update, AMA Director of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, details the summer spike in COVID-19 cases caused by the highly transmissible Omicron BA.5 subvariant. Also covering Novavax news, as well as monkeypox cases and statistics, including the World Health Organization (WHO) declaring it a global health emergency. Todd Unger, AMA Experience Director, is the host.

Learn more at the AMA COVID-19 Resource Center.


  • Andrea Garcia, JD, MPH, Director of Science, Medicine and Public Health, American Medical Association

Unger: Hello, here is the American Medical Association’s COVID-19 Update video and podcast. Today we have our weekly look at the numbers, trends and breaking news on COVID-19 with AMA Director of Science, Medicine and Public Health Andrea Garcia in Chicago. I’m Todd Unger, director of experience at AMA, also in Chicago. Andrea, we continue to hear a lot about BA.5 and we can add President Biden to those who tested positive for this sub-variant. Let’s start with the appearance of the numbers.

Garcia: Well, thanks for having me back and we certainly wish President Biden a speedy recovery. Cases are higher than they have been at almost any time this summer, driven as you mentioned, by the Omicron BA.5 subvariant. It is currently the most dominant strain in the United States. The number of cases reported each day hovered around 130,000 for several days, and all but a few states have seen steady increases over the past two weeks.

We know that the BA.5 subvariant continues to spread in the United States and now accounts for approximately 82% of new cases. The BA.4 subvariant continues to account for approximately 12.9% of cases. And again, that official case count is likely a significant undercount because, as you know, many people are taking rapid home tests or forgoing tests altogether.

Unger: And how does that translate into hospitalizations?

Garcia: Hospitalizations are also steadily increasing nationally. More than 43,000 people are currently hospitalized with COVID-19. That’s an increase of about 12% over the past two weeks and deaths are also increasing. We talked about the numbers, in the last two months they have very rarely exceeded 400, but now the average has risen to 439 people dying from COVID every day. So that’s an increase of about 34% over the last two weeks. I think it’s worth pointing out that most of these deaths occur in people who are not up to date on their vaccines.

Unger: It’s not exactly the kind of backdrop you want for back to school, which is really only a few weeks away. Are you talking about state warrants at this point?

Garcia: Well, according to a recent New York Times article, health officials across the country are really, right now, holding back any mandate. The article says many health officials say this new wave is cause for caution, not alarm. We know that New York Governor Kathy Hochul said she doesn’t anticipate school children will need to wear masks when they return to school in the fall, but she plans to keep it for the now this statewide mask mandate on public transportation.

In California, LA County Health Director Barbara Ferrer will reinstate an indoor mask mandate on July 29 if the community level of COVID-19 remains high. This county moved into the top category earlier this month. Overall, we don’t see a return to broad indoor mask mandates at this time.

Unger: Alright, let’s get to some good news, especially about Novavax, a new vaccine against COVID-19. Let’s talk about the details there first.

Garcia: So it’s good news, the CDC last week recommended the use of the Novavax vaccine in the US population. In a WADA press release, Dr. Sandra Fryhofer, who is our chair of the WADA Board of Directors and our long-time ACIP liaison, said the Advisory Committee on Immunization Practices voted unanimously to recommend the use of the Novavax COVID-19 vaccine as the primary series in individuals. 18 and over.

We know that CDC Director Rochelle Walensky endorsed the group’s recommendation shortly thereafter, which clears the way for 3.2 million doses of this vaccine to be shipped to states this week. The CDC’s recommendation, of course, follows the FDA’s EUA for Novavax.

Currently, Novavax is not available as a booster dose. Testing has shown that the Novavax shot works well as a booster. And so we expect the company to seek permission to use it in this way soon.

Unger: Well, we’ll find out more about Novavax and get more ACIP updates when Dr. Fryhofer is our guest on August 1st. But can you give us a brief summary of the difference between this vaccine and other vaccines for beginners and when will it be available?

Garcia: This is therefore the primary two-dose series. It’s spaced three to eight weeks apart, it uses traditional protein-based technology, and unlike the other three COVID vaccines currently available in the United States, types of vaccines like Novavax have been around for more than 30 years. They are used against hepatitis B, influenza and whooping cough. And for that reason, it might be a good option for those who remain concerned about mRNA vaccines or have an allergy to a component of mRNA vaccines. We know that approximately 10% of people 18 and older in the United States have not received a dose of the COVID-19 vaccine. We expect this vaccine to be available across the United States in the coming weeks.

Unger: Well, yesterday the White House hosted a summit on the future of COVID-19 vaccines, what did we hear?

Garcia: This summit was therefore organized with scientists, public health experts, vaccine manufacturers and the aim was to launch the efforts to develop the next generation of COVID vaccines. We know that the current generation of vaccines has helped prevent serious consequences. The hope is that this new version might better protect against future variants. But also to considerably reduce the rates of infection or transmission. Summit attendees included representatives from Pfizer and Moderna, and they discussed new technologies and a roadmap for developing them.

Unger: It is therefore clear that the work has been reduced and much remains to be done for the results of this important summit. Now let’s move on to monkeypox. The news is that the World Health Organization has just declared monkeypox a global health emergency. What does it mean to get this designation?

Garcia: Thus, a public health emergency of international concern is defined in the international health regulations. This means that this is an extraordinary event that poses a public health risk to other countries due to the international spread of the disease and potentially requires a coordinated international response. Just a month ago, the WHO declared monkeypox not a public health emergency, but the situation has certainly evolved since then.

This emergency declaration is a plea to attract more resources and global attention to the epidemic. This is the organization’s highest alert level, but it does not always mean that a disease is necessarily fatal. The WHO has previously declared public health emergencies for the COVID-19 pandemic, the Ebola outbreak in West Africa in 2014, the Zika virus in Latin America in 2016 and, of course, the effort in progress to eradicate poliomyelitis. We saw the CDC issue a statement of support saying it could galvanize the international community to respond and fight the virus faster and more effectively.

Unger: I guess that shows you how quickly things can change. Big difference from a month ago. Now that we have cases increasing not just in the United States but around the world, what are we seeing in terms of the latest numbers here in the United States?

Garcia: There are 3,847 reported cases nationwide. That’s up from 1,500 last week. We now only have five US states that have not reported cases of monkeypox. These are Montana, Wyoming, Vermont, Maine and Alaska. Globally, we are at almost 18,000 reported cases in 69 countries. These are countries that have never reported monkeypox. Those numbers are up from 11,000 cases in 65 countries around the world last week.

On Friday, we saw the United States report the first two cases of monkeypox in children. The CDC said these pediatric cases are likely the result of family transmission. We know that there have been no deaths in the United States from monkeypox to date.

We expect the number of cases to continue to rise as testing capacity is expanded. The Biden administration has increased its capacity to test for monkeypox, we are now at around 80,000 tests per week with these major commercial labs now online. And when we started this outbreak, we were only at about 6,000 tests per week through the CDC’s lab response network.

Unger: Well, that’s good news as we see an increase in testing capacity like this. Do you think the United States will consider declaring monkeypox a public health emergency and what would that mean if we did?

Garcia: So White House COVID Response Coordinator Dr Ashish Jha said the Department of Health and Human Services is considering whether or not to declare a public health emergency and it kind of depends whether current management tactics can bring the virus under control. They consider how the response to the epidemic could be improved and whether this declaration of emergency would be useful.

We know that the supply of monkeypox vaccine, while improving, is still outpaced by demand. And if HHS declares monkeypox a public health emergency, it could result in increased federal funding to fight the outbreak and it could also result in an official requirement to report data to the CDC. As we talked about at the start of the COVID pandemic, there is a long way to go with the modernization of public health data and that includes the efficient transmission of this data from jurisdictions to the CDC.

Unger: Well, whether it’s COVID-19 or monkeypox, we’re going to keep you updated on evolving news on both fronts. That’s it for today’s COVID-19 update. Andrea, thank you for being with us today and sharing this news.

We’ll be back soon with another COVID-19 update video and podcast. You want to find all our resources on COVID-19, Thank you for joining us today and take care of yourself.

Disclaimer: The views expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of WADA.

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