Highlights From IDWeek 2020: Fauci on COVID-19

Paul G. Auwaerter, MD


October 27, 2020

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This transcript has been edited for clarity.

Hello. I'm Paul Auwaerter with Medscape Infectious Diseases, speaking from the virtual IDWeek. I wanted to try to capture some high points from the 24 hours of the COVID-19 Chasing the Sun event. It was a fabulous attempt to capture so many aspects of the COVID-19 pandemic that have affected countries and people throughout the world.

I am only going to concentrate on a few of the initial talks — obviously, 24 hours is a lot to capture — and I'll try to do this in a few segments.

Dr Anthony Fauci, who has become a household name in infectious diseases, kicked off the event. There was an amazing and touching tribute, with many people giving verbal and visual thanks to Dr Fauci, including President George W. Bush, the 43rd President of the United States, for his leadership and commitment to helping our country and many others throughout the world get through this pandemic.

Epidemiology, Transmission, and Treatment

Dr Fauci started by noting the public health and scientific challenges, which, of course, are many. The United States is the most affected country in the world, although Europe has just recently, as a continent, outstripped the United States with a daily average of 88,200 (determined over 7 days). But the US is still far in the lead in total numbers.

The difference, he pointed out, was that the United States remained more mobile with more workplace engagement than Europe, which shut down and had minimal levels through the summer until there was a general relaxation and return to some travel in Europe.

Dr Fauci also recognized that aerosol is a component of transmission; droplet remains predominant. The exact percentage of aerosol transmission is unclear.

He also reiterated what appears to be the characterization of COVID-19 symptomatic disease, with about 80% of people having mild to moderate disease, 14% severe (meaning they are ill enough to be hospitalized), and about 5% with critical illness. Much of this is based on early data from China. Of course, this may change, as we've gotten better at treating this disease. Members of the Latinx and Black communities do make up a disproportionate amount of hospitalizations.

He also highlighted the NIH treatment guidelines, which do endorse using remdesivir and dexamethasone. He also commented on some encouraging results with monoclonal antibodies.

On Vaccines and Vaccine Hesitancy

On vaccines, he noted that we are going to soon have lots of clinical information beyond phase 1 and 2 data, from phase 3 trials. He is "cautiously optimistic" that potentially by November or December, these efficacy and safety data would be available. I think this is very encouraging.

Except for one of the phase 3 vaccines that the United States has engaged with, the Pfizer vaccine, Dr Fauci is the scientific representative who takes the first look at vaccine data before it heads over to the FDA. I think his perspective is especially meaningful.

Dr Fauci ended with concerns about vaccine hesitancy and skepticism. There's been some politicization about this, but he did not really speak to it. Of course, vaccine hesitancy preexisted the pandemic.

He pointed out that people in the United States who are perhaps more hesitant are those in minority communities. These are the same populations that appear to be disproportionately affected by the pandemic, with more severe disease and mortality because of a number of factors, some of which could be health problems, barriers to access to care, and socioeconomic issues where people are living in more confined conditions.

I think a great deal of work needs to go in, because if we can get a good vaccine across a large percentage of the population, we'll be in far better shape in terms of our health and our economy.

Dr Fauci gave a great overview in 30 minutes. I have only touched on some of his high points, but hopefully this is helpful for those of you who may have missed his session.

Thanks very much for listening.

Paul G. Auwaerter, MD, is a professor of medicine at the Johns Hopkins University School of Medicine and clinical director of the Division of Infectious Diseases. His areas of clinical expertise include Lyme disease, Epstein-Barr virus, and fever of unknown origin. He has been a Medscape contributor since 2008.

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