Interview With Dr. Fauci August 6, 2020

Notes from the Alliance for Health Policy journalist webinar on August 6, 2020, with Dr. Anthony Fauci. If you want to skip to the Q&A, head down below all slides he presented.

4 historical classical coronaviruses responsible for the common cold – 15-30% of the recurrent common colds caused by these coronaviruses.

SARS and MERS – past coronavirus diseases brought under control predominantly by public health measures.

COVID19 is the 3rd coronavirus with pandemic potential, from zoonotic jump from animal to humans.

Disease is called COVID19. Virus is SARS-CoV-2 because it’s in the SARS family.

Currently almost 19 million cases in world; almost 700k deaths.

U.S. hit harder than any other country in world – close to 5 million cases in U.S., 156k deaths at this time.

EU countries peaked and came down to lower levels. U.S. peaked but didn’t come down to baseline. Recent surges in CA, FL, AZ, TX led to daily peaks as high as 70,000. Most recent peak 60,000. Reason: we never fully shut down in a uniform way throughout the country. Stats not uniform in the U.S. Regional differences.

It's misleading to talk about the COVID19 cases in the country in a unified way.

Beta coronavirus. Important: spike protein. That’s the reason it looks like a crown with spokes. Hence CORONA virus – crown. ACE2 receptor on cells, which are distributed widely throughout the body including upper/lower respiratory tract.

Virus can be found in bodily fluids, but role of transmission through bodily fluids is not known. Animals getting it are not known to be an infection source.

40-45% of those with infections are without symptoms, but these infected people can still spread the disease.

An unusual situation with COVID19 – rarely seen elsewhere: loss of smell/taste before symptoms present. Also unique: broad spectrum of manifestation. Some with no symptoms.

More than 80% of those infected have mild/moderate disease. Fatality rate varies from a few % to 15-20%. When counting everyone, including asymptomatic people, the fatality rate is relatively quite low. But if you’re in a risk group for progression, it’s quite high.

Many systems involved with the disease. Learning more every day about the systems involved.

Huge racial disparity

Living document you can consult.

Diminished death rate with dexamethasone – given to those with severe disease - those on ventilators.

Pfizer and Moderna in clinical trial phase 3. Hopefully in several months, we’ll know if they’re safe/effective. Hopefully by the end of 2020 or beginning of 2021.

These (below) are the vaccine trials receiving U.S. government support. Others are done independently or in other countries. Moderna recruiting 30,000 for testing.

If you want to get involved in studies, go to this website below. 300,000 people already interested in being in prevention trials including vaccines.

Dr. Fauci's answers below are not direct quotes.

Q: Is task force looking at virus not going away or whether vaccines will only protect half the population?

Fauci: We need to be careful saying it won’t go away. Only one virus in the history of the planet eradicated was smallpox. You can very well control and eliminate the virus from a country. We hope we can do that – very adequately control that with a safe and effective vaccine and public health measures. We don’t know how effective a vaccine will be – we hope it will be 70-80% effective. We don’t know until we do randomized placebo-controlled trials.

How long will COVID-19 be around? We hope as a pandemic threat that we are on the cusp of seeing the end of it as we do public health measures and a vaccine. There may be some lingering disease coming back seasonally. Hopefully we can control it in a way that is not a pandemic/epidemic threat. That is up to us as a society. If we do the fundamental things we’ve been talking about for so long (avoid crowds, spend time outdoor v. indoor, masks, social distancing, hand washing), we can control this without a vaccine. We shouldn’t despair. It is within our power to control this.

Q: Assuming 70% vaccine effectiveness, please give a sense of how widely vaccinations have to be done in the U.S. to get to a point where public health measures aren’t needed.

Fauci: We do not know yet the precise level of herd immunity needed, the percentage of people who should be protected. Herd immunity: Even though we won’t get to 100%, when you get to a certain level of protection, you have umbrella protection for the entire community because so many are immune that the virus can’t generate momentum. We don’t know what the number is. Estimate: 50, 70, 75%. Don’t know. We want to have a combination of people who are immune: those are recovered, and the protection gained through vaccine use. I believe we can do that. We don’t yet have firm scientific data of the percentage needed for herd immunity - believes it’s 50-75% but he doesn’t know for sure.

Q: Distribution plan for vaccine?

Fauci: Assuming it’s ready within a reasonable period of time into 2021, and if it’s safe and effective, I’m cautiously optimistic we will have hundreds of millions of doses. We would like to see everybody vaccinated. If you want to control a pandemic, you want as many people as possible vaccinated. We see something similar to influenza where you recommend that everybody can get a vaccine. When starting off doing vaccination, we won’t have hundreds of millions of doses on day 1. We have to do some sort of prioritization for the number of doses and logistics of getting vaccination done. Traditionally when asked that question, the Advisory Committee on Immunization Practices advises the CDC and determines prioritization. This time the process is being complemented by a group put together by the National Academy of Medicine, solicited by the NIH and CDC to complement that decision-making. It includes vaccinologists, scientists, community members and ethicists, to determine priority. Generally first priority is getting healthcare providers who put themselves at risk, first responders, and those at high risk for complications, like the elderly and those with underlying conditions. Re: racial disparities – lots of attention and work to ensure equitable distribution in the trial itself and in vaccine distribution, so there’s not a disparity sothose who are in racial/ethnic minorities get equitable and fair representation in trials and distribution. Trying hard with community outreach and engagement to get them involved in the trials.

Q:  What more should we be doing to ensure strong access to care for those in minority/at-risk groups?

Fauci: Two types of risks – double whammy of disparity. #1 - Risk of getting infected. #2 Risk of serious outcome. For minorities including Black, Latinx, and Native Americans, there’s a higher risk of getting infected as a demographic group. This is due to the types of jobs they have generally; less likely to be able to protect themselves. In a position where the jobs can’t be done remotely. Essential jobs requiring contact with people who might be infected, so they have a higher risk of getting infected. #2 – higher risk of getting complications.

Something that can be done now: ensure resources for testing, faster return of results, access to healthcare - concentrate resources now in areas where the demographic concentration of populations is at risk. Requires mobilization of resources like access to testing and clinics for care.

Social determinants of health – longer-term issue. Minorities have higher incidences of heart disease, obesity, diabetes – requires decades-long commitment to change SDOH. Can start working on this now but will take time.

Q: Strategy to reach younger population and have them know how dangerous spread is in younger population

Fauci: I spend most outreach efforts in the press trying to get the word out. If you look at what’s going on right now, good news/bad news about the percentage of people without symptoms. Much more likely that a young person will not have a serious consequence of infection. That leads to a general feeling in an innocent/inadvertent way is that if I get infected, there’s a high likelihood I may not have problems, so why worry about changing my behavior? That assumes you’re in a vacuum and getting infected has nothing to do with anyone else. That is incorrect. The message is that young, healthy, vibrant people should still stay out of a crowd, wear a mask, because if you get infected, even if no symptoms, you’re part of the propagation of the pandemic. If you get infected, you can inadvertently infect someone else who will infect someone else who may end ill. You can be part of the problem or part of the solution. If we get numbers down – then we can open up the economy and the country – so that you can ultimately get back to some form of normality. You’re part of the process to get us there. Don’t be a weak link in the chain. That’s the message we have to get to young people. They’re not doing this deliberately, but are still propagating the outbreak.

Q: Some younger people are having serious complications.

Fauci: Looking at science/data, the chances of getting a serious outcome is much less than for individuals with underlying conditions. Seeing more and more now are young people who get a serious outcome of disease itself, before even recovering and clearing the virus. Seen situations including one close to home where close friend of a family member, 32 year old vibrant healthy man, got COVID19 and died of heart complications. Also seeing much larger number of people getting COVID19 and having to stay in bed awhile. But when they think they’re recovered, they find they have low energy levels and can’t do some things they want to. Chronic fatigue symptoms, not getting back to normal quickly. Study showed a substantial number of people – even after clearing the virus - can go 3-4 weeks or more not feeling normal. I know public health/science colleagues who got ill and months later have not gotten back to normal. Most do really well but you don’t want to be a smaller percentage who get into trouble.

Q: Are goggles recommended?

Fauci: it isn’t a new guidance and isn’t a formal recommendation. We know that the virus can enter through mucosal surfaces: upper face, mouth, nose eyes. The goggles discussion came about because he was speaking with a group of teachers, and one asked a question, said in the classroom many have close contact with children who don’t cover their mouths when sneezing/coughing. They add an extra degree of protection with face shields or goggles. Fauci: if you have goggles or face shield available, go for it. It’s not a formal recommendation yet – studies not done. If I were in a classroom with sniffling children, I might well do it. It can’t hurt, and might help.

Q: Is there too much emphasis on vaccine? As schools reopen, will this create false sense of security?

Fauci: I'm not putting an emphasis on the vaccine. We don’t have it yet. We’re trying very hard to ultimately get a vaccine that might be available by end of 2020 or early 20201. That is many months away. Children going back to school between now and then. Do not abandon the public health measures in anticipation of a vaccine. When talking about public health measures, many things we can do but you can distill them down to 5-6: wear a mask, physical distance, avoid crowds, outdoor is better than indoor, wash hands with soap and water or alcohol-based sanitizer, and stay away from bars.

Re: schools, general default position should be try as best as you can to bring children back to school. Two reasons. Important for psychological health. In some regions, school provides a source of nourishment (breakfast/lunch). Second: downstream ripple effects – families will need to modify their work schedule if kids not in school. BUT primary and paramount consideration is safety, health, and welfare of children and teachers. When look at the U.S. – big country. Certain areas are green stage – where the level of infection is low - no problem getting back to school. Yellow states/areas – may want to do some modification – hybrid plan. Physical distancing, some outside classes. Leave it to the locals to figure out best way to safeguard. Some areas in the last few weeks/months have significant viral activity. Use common sense and CDC guidelines – may not be prudent to get back to school in those areas.

Try as best you can to get back to school. but one size does not fit all.

Q: Flu season

Fauci: A couple of potential scenarios. As we get into fall and the flu season we experience every year – make sure as many as possible get the flu vaccine. Last year: 170+ million Americans received the vaccine. Hopefully more this year. Recommend it for those 6+ months.

A few scenarios could impact flu severity/incidence. Public health measures for COVID19 (mask, distancing, washing) might blunt the flu season. Also there are niches for respiratory viruses. In spring 2009 when H1N1 swine flu cases happened, in fall, expected typical flu season for H3N2. The respiratory H1N1 swine flu bumped it off the map. The flu season was predominantly H1N1. So COVID19 might result in less flu (and more COVID19). Public health measures could blunt impact. Hopefully cases of both will be down.

Q: Public/private collaborations – how is that going?

Fauci: It’s been spectacular. Operation Warpspeed with Department of Defense, HHS, working in a way that’s gratifying. Scientists exchanging ideas/data. Publications coming out in weeks instead of 7 months.

Q: Last thoughts?

Fauci: It is up to us. We can control this, get it down to non-pandemic level. Get it to where we can open the country and get back to some form of normality. It can feel despairing. But if everyone pulls together with no weak links in the chain – we can get it down and under control without needing to lockdown. Prudent opening up according to the guidelines - shouldn’t be lockdown or let it fly. Should be middle ground with prudent guideline following.