Fauci: 'The Virus Is a Formidable Foe'

John Whyte, MD, MPH;  Anthony S. Fauci, MD

Disclosures

July 18, 2020

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  • Young people are driving the latest surge of cases. They are making a big mistake by thinking it doesn't matter if they get infected, even though many of them won't get very sick. But allowing themselves to get infected means they are propagating the pandemic.

  • The anti-science trend mixes with an anti-authority trend, and scientists are often equated with authority. Young people may have been disappointed with government, which unfortunately adds to the anti-science sentiment.

  • A vaccine very likely will be available by the end of 2020, and the process of developing a vaccine is moving much more quickly than previously because of new technologies.

  • An NIH study is underway of 2000 families to look at the incidence of infection among children and the rate of transmission from children to adults, because it is not now clearly understood.

  • "This will end, and we will get back to normal."

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr. Whyte, chief medical officer at WebMD. Today, I have a very special guest, a man who needs no introduction -- Dr. Anthony Fauci, the world's leading authority on infectious disease and the director of the National Institute of Allergy and Infectious Diseases for more than 35 years. Dr. Fauci, thanks for joining us.

Anthony S. Fauci, MD: Good to be with you. Thank you for having me.

Whyte: You said a couple of weeks ago that we might see 100,000 cases a day. Do you think, given the surge of 60,000, 70,000-plus cases a day that we're headed in that direction?

Fauci: Unfortunately we might be. I do hope, and I would like to say I expect, that we won't if we handle this properly by really turning on -- you know, putting our foot on the accelerator -- for the kinds of things that we need to do with regard to mask wearing, physical separation, staying away from crowds, etc. I think we can turn this around.

But when I said I was concerned that we might be heading towards 100,000 per day, I didn't want to inappropriately scare anybody. But if you take a look at what's actually happened, at that time we went from 20,000 to 30,000. Then we doubled it. We went to 40,000, and then 50,000, 60,000. And now we're at 70,000. I don't like to be prophetic, but I do hope we don't reach that and that we actually turn it around in time.

But you know, the virus is a very formidable foe here. The only way we're going to get our arms around it is by doing the things that we know work -- and we do know that avoiding physical contact, putting masks on, not going to crowds, closing the bars -- that's the answer. It really is. We can do it. There's nothing about this that we can't do to turn it around.

Whyte: So why aren't the public health guidances working in some populations, particularly a younger population? Is it a failure of effective communication? What's going wrong here?

Fauci: I think it's multifaceted. But the one thing that I think is important, and I've been analyzing this really for quite a while, is that young people are driving this new surge. If you go back and look at the demography of the new infections, the age group is at least 15 years younger than what we were seeing a few months ago when things were surging in New York when they got hit very badly.

What happens is that younger individuals, who generally are not going to have symptoms to the frequency that elderly people do -- they're not going to get very sick. They know that. So what I think is happening is that innocently, but not correctly, the younger individuals are saying, Well, if I get infected, the chances are that I won't even have any symptoms. So who cares?

That's a big mistake -- because by allowing yourself to get infected or not caring if you do get infected, you are propagating a pandemic. You get infected and have no symptoms, but the chances are that you're going to infect someone else who will then infect someone else. Then, someone who's vulnerable to severe consequences will get infected. That could be somebody's father, mother, or grandmother.

It could be a sick child who's immunodeficient. It could be a woman who's on chemotherapy for breast cancer. All of a sudden, you're not operating in a vacuum. You're part of the problem as opposed to being part of the solution. So somehow, we've got to keep getting that message across. I don't mean that in the sense of blaming anybody, because these are people who are doing this innocently and inadvertently.

Whyte: Do you think language comes into it? You know, we're both interested in public health. We're using words like asymptomatic, pre-symptomatic. Those aren't terms that the public knows, and different groups have used them in different ways.

Fauci: You have a very good point there. We have got to reach out to the individuals involved in a manner in which they pay attention and can understand. That's why I often do discussions and podcasts with groups that they listen to -- otherwise, an old guy in a suit like me is not statistically who they would want to listen to.

I get rap groups and people that they look up to in the entertainment field to help out. You know, I've done Instagrams with people like Julia Roberts and podcasts with rap groups like Lil Wayne and others. I think those are the ones that are going to get to the young people.

Whyte: Is there a distrust of science? You've talked a little bit about that. Have people lost their way? As I'm sure you know, sometimes you are referred to as Saint Anthony. He's the patron saint of lost things. My mother loved St. Anthony. But has the public lost their faith in science?

Fauci: Well, I think we have to face the reality that we do have an anti-science trend in this country that mixes with an anti-authority trend. And, scientists and regulators are often equated with authority. There is that pushback particularly on the part of young people, maybe for some good reasons -- that they've been disappointed in authority and a bit disappointed in government. And they get disillusioned.

That kind of translates into an anti-science attitude, which is very unfortunate. Particularly when you're in the middle of a pandemic and you're trying to deal with it, there isn't anything worse than someone who doesn't care about the science.

Whyte: It seems as if almost everyone is their own expert. You have your opinion as an infectious disease expert, yet someone else will say, 'Well, that's your opinion, Dr. Fauci. I have mine.' Isn't that part of the problem?

Fauci:  Yes. I mean, people's opinions are a fact of life. What gets troublesome is when people develop their own set of "facts." Facts don't change. You may have a different opinion, but facts are consistent. That's the problem.

Whyte: Well, let's talk about facts and vaccines, because you've been very positive about having a vaccine very soon. I don't know if you saw an article by the CEO of Merck, who talked about how the "vaccine hype" is doing a disservice to the public. How confident are you, Dr. Fauci, that we're going to have a safe and effective vaccine within the next few months?

Fauci: Well, I wouldn't say the next few months, but let me tell you what the timetable is. I wouldn't call it hype. I think what it is, is utilizing the current 21st century technology platform -- technology that we have -- to really make advances quickly. What would have taken years before now takes weeks to months.

We've already shown that by going from the sequencing of the virus in early January when it was put on a public database to go literally within days -- within days -- into a vaccine trial, because you could put it into an mRNA platform or another platform. Then 62 days later, we entered into a phase I trial -- that is amazingly unprecedented in every respect. Right now we're going to go into a phase III trial at the end of July. And, there are several candidates that are also lined up to go into a phase III trial soon thereafter.

Whyte: At least four candidates?

Fauci: Yes, at least four that the NIH and the federal government are helping to subsidize and to collaborate on, with regard to clinical sites. So I don't think that it's hype. It's real. There are risks that we'll be taking, but they are financial risks, not risks to safety. They are not compromising scientific integrity. But whoever made that comment is right that you could never guarantee something.

I would say that I'm cautiously optimistic that we're going to get there. Anyone who guarantees something when it comes to vaccines hasn't been involved in developing vaccines, because we know we can't guarantee it. But we can be pretty optimistic that we're on a timeline that we should know by the end of this calendar year, the beginning of 2021, whether we have a safe and effective vaccine.

Looking at the preliminary data of immunogenicity from the phase I study, which showed robust levels of neutralizing antibodies even with the moderate dose of the vaccine, again makes me cautiously optimistic that we will get there.

Whyte: This is a little bit in the weeds, but do you expect it to be a full approval by the FDA that it's safe and effective? Or do you think it'll be utilized under an emergency use authorization?

Fauci: That's a good question. It's really going to depend on the level of infection in the community. Right now there are enough infections going around in the United States. We even have sites in other countries, like Brazil and South Africa, that if you get enough hits -- in other words, enough infections -- and you have enough people in the trial, you likely would get an efficacy signal. We have 30,000 people per trial, and if you get an efficacy signal, then you will get a full approval by the FDA.

If you don't get that, because the cases tend to simmer down a bit, then you're thinking maybe in terms of an emergency use authorization. I don't want to get ahead of, nor speak for the FDA. But generally they are telling us that they want to see a safety and efficacy signal on the vaccine as opposed to anything less than that.

Whyte: Back to this infection rate in the community. The CDC director has said if we would all just wear a mask for three to four weeks, we could decrease incidence dramatically. What are your thoughts about the need for a full lockdown for a couple of weeks to truly stop the spread of the virus?

Fauci: We would like to avoid a full lockdown if we possibly can. But we have to pull back a little. You know, in the guidelines that we put out some time ago, we said there's a gateway, which means a preliminary look to keep the infections going down for 14 days. Then you go to phase one. And then if that works you go to phase two, then to phase three. What states and cities might have to do is to backtrack a bit and come back a little.

That doesn't mean you have to go all the way back to lockdown, but you need to pause and take a look at what's going on and why it's not working, and then say, OK, we have a problem: close the bars, everybody wear a mask, physical distancing, no crowds, wash your hands. I agree completely with Bob Redfield, the CDC director, when he says that if we do that, we can turn this around. We can turn it around.

Whyte:  You know, part of the challenge of getting people to adopt these behaviors is misinformation. How do we counter the misinformation out there that masks don't work, that physical distancing doesn't work?

Fauci: It's not easy, but we've got to counter it by pounding away at the real truth. When you have misperceptions, let's get the right perceptions out there. We need to keep going out and talking about it more and more, very much like we're doing right now.

Whyte: What's on everyone's mind right now is the reopening of schools and having to make decisions now when they don't know what things are going to look like in late August or September. Can you talk a little bit about what we know about COVID in children and how parents can make decisions about whether or not to send their kids back to school?

Fauci: That's a critical question, because it's on everybody's minds right now. In my mind and the minds of people who really care about this, like the American Academy of Pediatrics, we say the default position is that we should try to the best of our ability to get children back to school and keep the schools open because of the considerable, deleterious, downstream ripple effects and negative consequences of keeping kids out of school.

That's a default, but it really is going to depend on what the viral activity is in the place where you are right now. There are some counties where there's so little viral activity, you can just say don't worry about it, go back to school. But there are others where there's enough activity that you have got to make a choice. That choice can be not to bring kids back, or preferably bring them back in a way that is geared towards guaranteeing their safety and their welfare, and the safety and the welfare of the teachers. That might involve simple logistic things like spacing of desks, alternating schedules and cleaning down the classes, being outside as much as you possibly can.

There are creative ways of doing that. I think to say it's unidimensional is missing the point. To say we are going to open up schools in the United States or not -- that doesn't make any sense, because we're such a big country that things are going to be different in one region vs the other. But getting back to what I said, the default should be to try as best as possible to get the children back to school.

Whyte: Does age matter? Do we need to be more focused on our younger kids getting back to school, because there may be less transmission? They don't really serve as a vector as opposed to some of the older kids.

Fauci: That's a good point. There's not a lot of data on the infection susceptibility of kids and how well or not they transmit to adults. That's the big question.

We're doing a study at NIH called the HEROS study (Human Epidemiology and Response to SARS-CoV-2), looking at 6,000 people in 2,000 families to examine the incidence and prevalence of infection in children, the relationship between their infection and family members, do they transmit it to the family or does the family transmit to them, what is the impact of having underlying asthma and underlying allergic conditions, etc. So, there's an ongoing study that's going to answer the questions that you and I are asking, but we don't have an answer now.

Whyte: At WebMD, we're seeing a lot of traffic to articles about anxiety and stress. We've been addressing how people can take care of their mental health, and a lot of folks want to know, What does Dr. Fauci do to take a break? I saw that you've been an avid jogger, and now, you're a power walker. Some of my colleagues said I must ask you, What's on your playlist if you have one? Or do you walk in silence to power walk?

Fauci: I walk with my wife and my daughter's dog. It's interesting. I would love to have more conversations with my wife, who's the closest person in the world to me. But we're so busy, both of us, that we often don't have a chance to talk. When we're out on our 3 and a half-, 4-mile walks, it's a wonderful time. It's wonderful, because I get a chance to talk to my wife. It's also wonderful, because we love the dog and it's nice being with the dog.

Whyte: What kind of dog is it?

Fauci: It's a mutt, but it's heavily genetically programmed towards being a Rhodesian Ridgeback. It's really a nice dog, a very kind and very lovely dog.

Whyte: Finally, what are you hopeful for, Dr. Fauci?

Fauci: You know, we all are going through a terrible experience right now. We've got to get control of it, get it behind us, and keep it behind us. We're going to do it with a combination of public health measures and scientific advances, like vaccines and therapeutics.

This will end. It doesn't seem that way now, because we've been immersed in it for the last five to six months. But it will end, and we will get back to normal.

Whyte: When's it going to end?

Fauci: You know, I hope sooner rather than later. I don't think it's going to be next month. And it may not be for another year. But it's going end.

Whyte: Dr. Fauci, I want to thank you for taking the time today, as well as all you're doing to keep America and the entire world safe. You truly are a hero. Thank you.

Fauci: Thank you very much, John. It's good to be with you. Take care.

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