Dr. Anthony Fauci on COVID-19, the search for a vaccine, and public health initiatives to stop the spread of the virus
Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases (NIAID), attends Yahoo Finance's All Markets Summit.
ANJALEE KHEMLANI: I'm Anjalee Khemlani, senior reporter here who deals with all health care issues, including all of COVID. And that gives me the responsibility and pleasure of introducing you to someone who doesn't need an introduction, Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases. Dr. Fauci, thank you very much for joining us today.
ANTHONY FAUCI: Nice to be with you. Thanks for the invitation.
ANJALEE KHEMLANI: I would like to start with a debate in which you should please be satisfied with me. And that means we're looking at exploding cases across the country right now, setting daily records of more than 80,000 cases a day. You know, people say this is a third wave, but that seemed to have escaped me. So I'd like to ... I want you to sort this out for me. We are clearly on the third summit. What wave are we in? Is that an extended first, a second, a third, please?
ANTHONY FAUCI: You know, I see it more as an extension and a tightening of the original first wave. If you look at when we were badly hit, which was dominated early on by the northeast corridor, especially the New York metropolitan area, the cases went way up and then fell back to a baseline of about 20,000 cases. So we never really cleared up and came up with a very low baseline that I would consider less than 10,000 a day, maybe just a few thousand a day. So we stayed at 20.
Then remember, when we tried to "reopen the economy" and open the country, there were several states that were doing it in slightly different ways. Some did not adhere very well to the proposed guidelines. And what you've seen, especially along the southern states - Florida, Georgia, Texas, Southern California, Arizona - we've seen a high that got us to about 70,000 a day, then it went down again, only to about 30,000 a day 40,000 and stuck at about 40,000 for several weeks to about a month or more. And now that we are approaching the cold weather, we are back to the worst we have ever had, over 80,000 a day.
So if you look at the graph you just showed, we never really had waves in the sense of ups and downs to a good baseline. It's been up and down until now, we're at the highest level we've ever had, which is really quite precarious. So it's kind of semantics. You want to call up the third wave or an extended first wave. No matter how you look at it, it's not good news.
ANJALEE KHEMLANI: That is very sobering, and thank you for arranging it. We see you as a guide for all processes and the advice you give as well as for the mitigation strategies. And it seems like you were able to really get that message out and get it on to a number of very segmented audiences.
We have seen the isolation of some populations in this country as a result of this pandemic. How do you decide to handle some of the media inquiries when it comes to celebrity or kids shows? I've seen you on a couple of these. And you do it all the time, but what's in that decision to target these specific groups?
ANTHONY FAUCI: Well, I'll try and my colleagues too. I believe that when you are in as serious a situation as you are now with this historic pandemic, public communication is absolutely necessary. And you are trying to get to different parts of society. So I mean, yeah, I think you made a good point.
I've done things that you speak to children about to get them to understand the crisis we're going through without scaring them. You also want to get to the people who are on the front lines and putting themselves at risk. They also want to make sure that healthcare providers value them - or realize how much we value them and the risks they take.
But you also need to get to another group, which I think is a little more problematic, namely the people who, for one reason or another, are misinterpreted that public health policies in the economic sense are contrary to a healthy society stand. It's a way of pinning economic interests against health interests. And I'm trying to find a point - the point, as often as I can, that we shouldn't look at public health action as an obstacle to the economy. This is a safe and prudent way to reopen the economy.
We're not talking about turning something off. Because often when people hear that you want to implement things like universally wearing masks, keeping physical distance and avoiding the crowds, we are talking about the extreme of society's closure. We absolutely don't talk about it. We want public health action to be the gate or the road to reopening the economy safely and prudently.
So you could have both. You could take good public health action and keep the economy open. But when you go to extremes, when you either shut down or do something you want to do, it doesn't work that way. In the middle there has to be an average in which you can do both.
ANJALEE KHEMLANI: And that's a message that you definitely got into. And unfortunately, you know that, against your best efforts, you have also encountered a backlash, either from the public or even from the President. So I wonder that as you continue to tirelessly send these messages, unfortunately, you have also had a very public experience of what many of us fear, what is a toxic work environment. And you said you were strictly business on that front, but I wonder, does it undermine your message if the president keeps saying things that are exactly the opposite of what you are saying?
ANTHONY FAUCI: Well I would say it's certainly not helpful, but that's something I really don't think I should be. Focus your energy like I said before, like a laser on what you are as the right and appropriate public health measure, and hope that people hear you and understand that following public health measures now makes it easier and faster to get where we need to go we are approaching a form of normality.
Fortunately, despite the fact that we are in a very, very challenging period, vaccinations are progressing all the more as we enter the cooler months of autumn and the colder months of winter. And we should be on time for a response - and I think it will be a positive response - by the end of this year - late November, early December - so we can start distributing vaccines to those most in need, especially the workers in healthcare and the vulnerable in the population.
This will help a lot, but it won't solve the problem by itself. We will not be able to abandon prudent public health measures for some time. We need to make sure this is part of what we do without closing the country and without closing the economy. We can do this. I am absolutely convinced. If we unite as a nation and take some basic public health measures with a common denominator, with much help from vaccines and adequate therapies, we can do that in the future.
ANJALEE KHEMLANI: Glad you brought up the vaccines because that is definitely something, you know, everyone is focused on it, especially as we know the deadline comes to get some of these interim results and look at the data first . I am amazed at the effectiveness. That was a topic of conversation and I've heard a wide variety of comments that you know will completely block the virus for easy mitigation of the most serious cases. And when someone experiences the virus, it will actually just be some kind of milder version. So, based on what you now know and what you see, do you expect the first few vaccine sets out the door to be more of a less effective blocker of the virus?
ANTHONY FAUCI: Well, that's the primary - it's a great question, and that's the primary endpoint of most of the virus, to prevent clinical disease, prevent symptomatic disease, not necessarily prevent infection. That is a secondary endpoint. But the most important thing you want to do is make sure that people who become infected don't get sick. And if you prevent them from getting sick, you are ultimately preventing them from getting seriously sick. So that's what we want to do.
The first point we call the primary endpoint is this. If the vaccine also allows you to prevent first-time infection that would be great. But I'd be fine with it - and all my colleagues would be fine with it - the primary endpoint is to prevent clinically identifiable disease. And that's exactly what we hope for. And if we do that, it will go a long way in spreading this very difficult crisis that we are in.
ANJALEE KHEMLANI: Of course. And, to the point where you've determined that the vaccine won't be the end of the story, harm control measures will definitely remain in place for some time. It seems like the UK is attempting a challenge. And while we already have some vaccines in late-stage trials here, given the number of candidates, there seems to be some leeway in using this strategy. Is the US also preparing for a challenge attempt?
ANTHONY FAUCI: You know, we really don't think that's necessary. If you have that many infections - I mean, in this country when we started this discussion, we have over 80,000 infections a day. Basically, with challenge studies there are a number of reasons, one of the most important of which is that there is not enough disease activity for your vaccine study to give you a definitive answer.
And while challenge studies may have a place in certain circumstances, it is not the same as the actual circumstances that naturally infect a person. Although you can get some good information from a challenge, the information you want is available in the office when someone is actually exposed to a natural infection and to see if the vaccine prevents it.
So we are not currently planning any challenge studies with so many infections going on. We have five or six vaccines being tested amid those 80,000 infections a day. I think we will get enough information to make a decision about a vaccine's safety and effectiveness without resorting to a challenge study.
ANJALEE KHEMLANI: OK. And when we speak of this unfortunate number of cases in the country, we know that as the number of cases increases, it becomes more dangerous to be in contact with people. If we look at the political climate we are in and are involved in the campaign, we still see rallies. And I just wonder, do you know that given the positive reports from aides to Vice President Mike Pence, these rallies should be canceled at this time, just before election day?
ANTHONY FAUCI: Well I am not going to comment on whether this or that rally should be canceled, except to reiterate what I have said many, many times - and I will repeat it here - that we should avoid it as best we can Congregation settings where people are huddled together. In this case, it should be outdoors. And when that happens, it should be virtually anyone wearing a mask.
So you know there are five things that I talk about all the time - wearing masks in the universe, keeping your distance, avoiding congregational settings, avoiding indoor things with crowds of people, and that Wash your hands as often as possible. That goes for every circumstance, no matter where it is and who does it.
ANJALEE KHEMLANI: When we talk about the campaigns, we know that election day is near and there will either be a continuation of this government or a change. I just wonder what that means for you and your work, what a continuation of the Trump administration means and what expectations you have of a Biden administration when it comes to dealing with the coronavirus.
ANTHONY FAUCI: Well, from my standpoint, I will continue to do the exact same things that I am doing right now - go to great lengths to get safe and effective vaccines as well as better treatments. We have some good treatments. We can do better. We conducted a number of clinical studies for early detection to avoid the need for hospitalization. That won't change, regardless of the administration.
And my message, which is a consistent message, is not going to change because it really goes beyond any administration. The message is the same. The kind of prudent and diligent public health action that I believe can contain the surges is the one we're seeing right now - none of that is going to change.
ANJALEE KHEMLANI: It seems like everything you do has some isolation from outside forces. Unfortunately, we didn't see that at the FDA and the CDC. And when we go global, we've also seen the US fail to participate in some of these vaccination efforts and other responses. Just wondering - you know, we heard Bill Gates talk earlier about China actually not in the driver's seat on the vaccine - but when it comes to the work your agency can do when a one country how China is indeed getting more attention. Will this affect the ability of the US and your agency to conduct research in the future and have a commanding voice in responding to the virus?
ANTHONY FAUCI: Not at all. I mean, we - the NIH and our biomedical research community have been and always are, and I hope it will always be the dominant biomedical research force in the world, and almost everyone admits it. That hasn't changed. Whether China does what China wants to do or Russia does what Russia wants to do, what we do about science, therapeutic drug development, and vaccine development, the world has always viewed us as leaders and it goes on to this day.
ANJALEE KHEMLANI: When you speak to some of your foreign colleagues - I am sure you are in constant contact - is there anything that we could do better and that we should implement or other strategies that we have not yet tried?
ANTHONY FAUCI: Well, I mean, you are absolutely right. I'm in close contact with my academic and public health colleagues who have long, long, long predetermined COVID-19 so those relationships stay the same. The part of your question - if you look at what we did, we could have done something else - really depends on what you mean.
From a scientific point of view, I think what will turn out - and I hope so. I don't want to get too confident. But I think one of the real successes that we're going to see in the next few months is what has happened in the vaccines field, as well as, to some extent, new and better therapeutics. I think we can look forward to something positive there.
Could we do things better from a public health perspective? Naturally. Whenever you are faced with a very difficult situation like this, you can always look back and say that there were things that we could have done better and that we should have done better, but that is just the type of situation that we are in who we are. I think anyone who says we did everything perfectly really doesn't see the reality of the fact that we can when you face challenges like this, whether you are in Europe or Asia or the United States, always look back and say we could have done a better job.
ANJALEE KHEMLANI: Absolutely. And with the information changing that I've said many times, we're watching the scientific process, you know, in one - under a very public light in a way that we've never had before. And I think everyone is familiar with it now.
When I look at some of the things we have learned, I think that this still weighs on some people's minds. Where exactly should we do? For example, when you bring in your groceries, should you still wipe them off, your mail? What are you doing Dr. Fauci?
ANTHONY FAUCI: I get that question all the time. Well, we know that this virus is transmitted predominantly through the respiratory tract, either through droplets that are essentially large enough to get a little bit of your nose, eyes, mouth, or aerosol. We don't know exactly how big the aerosol is. We know it matters. Exactly how much is still being worked out.
We also know that the virus can live on inanimate objects. But if you look at portability, the epidemiology that we have a lot of experience on now, it's very, very likely, a very, very small, small aspect of portability. We can't say it's zero. It is certainly real and finite, but it is insignificant.
I think we should spend less time worrying about wiping a grocery bag than just washing our hands frequently. So they ask me what I do when I come out of the grocery store or if someone gives me a bag to take away, which I often do now because I don't go to restaurants and sit down. I want to keep them going financially, so I do a lot of take-away. So I have a bag that I bring to my house.
Instead of worrying about the bag, I open the bag and then wash my hands thoroughly, which is what you should be doing. I think if you are doing this natural public health measure and you don't care about touching things that may or may not have something to do with portability, just focus on hand washing.
ANJALEE KHEMLANI: Well, thank you for replying to that. That was a personal one for me. Dr. Anthony Fauci, thank you again for your time, Director of the National Institute for Allergies and Infectious Diseases and Leading Epidemiologist in the United States. Thanks again.
ANTHONY FAUCI: Nice to be with you. Thanks for the invitation.
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