A Conversation With Dr. Anthony Fauci

This week on The Daily podcast from The New York Times, host Michael Barbaro interviewed Anthony Fauci, the nation’s leading expert on infectious diseases, about the US response to coronavirus. It’s worth a listen. You can find it here.

Fauci touches on three key points during the interview:

1. On travel restrictions: "When you’re living through the fog of war, it isn’t that easy. You will always say — everything I’ve ever been through in the 36 years that I’ve been doing this as director of the Institute, there’s always that what could have been or what should have been. I mean, that’s always the case. But I think in this case, really, just looking at it the way it is, I think that we acted pretty quickly in trying to cut off travel. So I wouldn’t dwell on that."
2. On working with the president: "The president has his own style. That’s obvious to the American public. When I speak to him about issues that are substantive, he listens. I think he always understood the seriousness of it. Right now, as the numbers are becoming crystal clear, he himself is articulating an awareness of that seriousness. But from the beginning, he always took it seriously."
3. On testing: "The systems that were originally set up in the relationship between the C.D.C. and the public health community in the state and local level was really not geared for the massive type of testing that would be needed that would embrace and require the participation of the private sector, particularly the companies that do the kinds of lab tests that you and I get when we go to a regular doctor’s appointment. So it was not suited for that. It is right now, today, ramping up to essentially make the private sector the major driving force of the testing. But you’re absolutely correct. Back then, early on, that was not in place. And that’s unfortunate."

The equation for dealing with this early on was relatively simple: Travel restrictions + early aggressive testing + aggressive contact tracing = minimizing the spread.

For what it is worth, here is my interpretation of Fauci’s comments: 

• The travel restriction was a good move. In retrospect it could have happened earlier, but who among us would have really argued that at the time?
• Fauci is saying in this interview recorded April 1 that the president is finally taking things seriously enough to articulate how serious things are. The way I see it, the president should have been articulating that seriousness to the public sooner
• The system was not set up to handle early aggressive testing and contact tracing. Many things are handed off from one administration to another, and the incoming administration makes choices about what does and doesn’t need to be dealt with. For things it chooses to address, it must determine what level of attention to give it. In this case, the administration decided to either 1) not deal with a pandemic response or 2) deal with it in a way that, in retrospect, was flawed. So the administration is dealing with the fallout instead.

Additionally, while it is admittedly impossible to make a direct connection, the aforementioned lack of seriousness early on has arguably contributed to the testing and contract tracing deficiencies. To be sure, it created a laissez-faire attitude on the part of many, who continued to socialize when they should not have. It also caused leaders in many municipalities and several states to delay stay-at-home mandates.

The equation for dealing with this early on was relatively simple: Travel restrictions + early aggressive testing + aggressive contact tracing = minimizing the spread. Only the first part of the equation was handled well. The rest wasn’t, which means the only approaches we have left are mitigation strategies.

And it has led us to where we are today.