>> Howard Bauchner: Hello and welcome to conversations
with Dr. Bauchner. It's Howard Bauchner, Editor-in-Chief
of JAMA once again, I'm pleased to be joined
by Tony Fauci, director of the National Institute
of Allergy and Infectious Diseases and one
of America's great public servants Tony, long
week for America. You've testified twice before
Congress; you've been on a number of different
shows. As of this morning, 49,932 cases yesterday,
642 deaths. What direction we going in?
>> Anthony Fauci: I think it's pretty obvious,
Howard, that we are not going in the right
direction. There are so many conflicting things
going on right now. You know we have areas
of the country where they were at a level
that was difficult and disturbing. Then when
one tries to open up, even in situations in
which governors and mayors were trying to
abide by the guidelines of the different checkpoints,
the gateway, phase 1, phase 2, that there
is this, among some, not among all, there's
this feeling of an all or none phenomenon.
We are either a lockdown or you're just going
to say, you know the devils may care, and
just let it all go. And we saw that in the
way people were congregating in crowds, which
is understandable that people want to get
out there, particularly as the weather gets
so much better in different parts of the country.
But it was done in so many respects at bars
and at congregations without masks on, which
is so highly predictable that you're going
to get into trouble. And what we've seen is
right now a very disturbing week. I mean,
we had a few states of Florida, Arizona, Texas,
and California where areas in those states
together were about 50% of the new infections
that we saw in the entire country. And what
we need to emphasize to people is that even
in those areas that are not showing a substantial
surge, once you get surgencies like that in
some areas the country other areas become
vulnerable. Because even though we're a very
heterogeneous country, we are not without
connection to each other. So, the whole enterprise
could be at risk. So, we've really got to,
and that was what I've been trying to do and
emphasize in the hearings, that we're all
in this together. You know, there's no blame
here. There's none of that. We need to realize
that if we do not adhere to the guidelines
as we're trying to open. And I don't mean
officially, I mean the citizenry, the people
that are out there, we're going to be in some
serious difficulty. Right now, if you look
at the number of cases, it's quite disturbing.
We're setting records, practically every day,
of new cases in the numbers that are reported.
That clearly is not the right direction.
>> Howard Bauchner: Tony, were you gratified
to see some of the Republican leadership finally
talk in a different way about masking? I was
pleased to see it, finally.
>> Anthony Fauci: Yeah, no, very much so,
Howard. I definitely was very pleased to see
that. A realization that we've got to get
away from any kind of implication of what
it signifies. You know, it signifies one common
good and that is you know care for the public
health. I mean there aren't many tools that
we have in the sense of prevention. We don't
have a vaccine yet. We don't have pre-exposure
prophylaxis of any med. So, what we have are
the public health things that we can do. And
without a doubt, the kind of things that you
can do, simply like avoiding crowds, staying
six feet, wearing a mask. It is very important
to wear a mask. And I am very pleased to see,
as you just mentioned, Howard, that now many
of the leaders, regardless of which side of
the aisle you're on are realizing the importance
of wearing masks.
>> Howard Bauchner: I think also, you tried
to emphasize once again, that wearing a mask
protects other people. I still feel frustrated
that it may offer some protection for me to
wear a mask, or to you. But you're really
protecting your friends, your colleagues,
the people around you.
>> Anthony Fauci: Yeah, you know, Howard,
I had mentioned this to you before, in some
of our discussions and I think it's worth
mentioning it again is that it is understandable,
the differences of opinions and even in some
cases confusion about the importance of protecting
yourself. Even though you may think as a younger
person that the numbers, the statistics show
without a doubt that as a young person you
are much less likely of getting a serious
outcome as a person with an underlying condition
or an elderly. But remember, first of all,
there are many young people who have underlying
conditions that put them at risk, number one.
Risk of complications. And number two, you've
got to realize that even if you get infected
and get no symptoms at all, you are propagating
the pandemic dynamic. Because you get infected,
you may have no symptoms. The chances are
you're going to infect someone else, who then
will infect someone else, and then a vulnerable
person will get infected. That could be a
younger vulnerable person with an underlying
condition, that could be an elderly person,
that could be someone's grandfather, grandmother,
aunt who has breast cancer and is on chemotherapy,
a child with leukemia who's receiving chemotherapy.
So, you're not in it alone. You're not in
it in a vacuum. You may feel like you're in
a vacuum and say well, if I get infected who
cares, I want to go have fun. No. You don't
want to be part of the problem. You want to
be part of the solution. And then, again,
I don't want to see that I'm blaming anybody
because it's not. Because people doing this
innocently, Howard. I don't think anybody's
doing it with the deliberate feeling that
they may be part of the process that's hurting
people. But you've got to remember we're all
in this together and we have to take some
societal responsibility. And that's the thing
that I hope these sobering numbers that we're
seeing are getting people to be jolted into
realizing that not only do we have the responsibility
to ourselves, we have societal responsibility
to help put an end to this epidemic. And one
final thing, I know I'm going on long, but
I think it's an important message, Howard,
is that rather than the mindset of there are
opposing forces. There's the public health
forces and there's the open up the country,
let's get back to normal forces. They're not
opposing the best way as the vehicle to opening
the country in a safe way is to prudently
use public health measures. So, it's not public
health against opening. It's the public health
measures to help you to open. And I think
we have to keep stressing that as opposed
to being opposing forces. No, they're complementary
forces in so many respects
>> Howard Bauchner: Tony, there's a slight
change in the ratio of cases to death. So,
as I said 50,000 yesterday, 600 deaths. I
look back you know at the height of New York,
Connecticut, New Jersey. Then, it was about
30,000 cases and 2500 deaths. So, the ratio's
changed a little bit. Are we doing a better
job protecting the frail elderly? When you
see that ratio change, what's your sense of
it?
>> Anthony Fauci: Well, I think there's three
aspects of it, the way I think about it, Howard.
And I've obviously been thinking about this
very intensively. Number one, if you look
at the people who are getting infected, now.
there's about a decade and a half on average
younger than back then. So, right away, the
people who are getting initially infected
are younger. Number two, you're correct. We
know now how devastating this could be for
the elderly and people with underlying conditions.
So, we are protecting them to a much better
extent. Protecting them better in nursing
homes, protecting them better within one's
own home. That's issue number two. Issue number
three is that we better be careful, because
there may be a secondary, tertiary, and quaternary
before you get to the deaths going up again.
So, we may be seeing a delay. So, I think
it's a, younger people; b, we're protecting
the vulnerable better, but c, be careful as
the weeks go by, we may start seeing the uptick
of the deaths.
>> Howard Bauchner: Yeah, I think you know
I had Mike Osterholm on about a week ago.
And Mike said, could you have me back in two
weeks so I can correct all the things I said
that may not have been right. I mean he was
so humble in just saying, I mean he, like
you has been watching epidemics, pandemics
for 30 or 40 years, and he's still learning
a lot. Tony, I just want to make sure I go
through some questions, because I know people
are interested. Pooling all of the sudden
has come up. And pooling started with HIV
disease. Could you explain what people mean
by pooling? And it's implications potentially
for schools and colleges because that's where
it may be very helpful. But can you talk about
pooling in terms of testing?
>> Anthony Fauci: Yeah, so pooling is a phenomenon
where you do it more for surveillance than
to do things like individual people that you're
trying to see if they're infected and do contact
tracing. Pooling means that if you wanted
to test everyone to see if there were infected,
and you wanted to test may be 10 people, you
would use up the resources, the PPE, all of
the material to do 10 separate testing. If
you want to get a feel for the penetrance
of an infection in a community, you pool samples.
Which means you take 10 samples instead of
doing 10 separate tests, you take an aliquot
of each and you do one test. And if that one
test is negative, then now you've shown that
there are 10 people that are not infected,
and you only used one test. If that test shows
that it's positive, then you have to go backtrack
and find out who that individual is. So, if
you have a situation where you have very low
penetrance, but you want to make sure it's
low, it's so much better to do pool testing
than it is to try and do individual testing
in the community. It saves resources, it saves
time, it saves equipment, and it saves money.
>> Howard Bauchner: Tony, you bring a few
thousand people back to a college campus and
you know, you think there's not much disease,
but you want to test them once a week or twice
a week. Is this a place where pooling may
work?
>> Anthony Fauci: Absolutely. It is more a
surveillance than it is the kind of classical
paradigm of individual testing, identification
contact tracing.
>> Howard Bauchner: A couple questions keep
coming up concerns about genetic shift. This
is reinfection with a second strain, is there
anything new about that? II know the data,
you know Anne talked about data from the CDC.
I'm sure it's also from the NIH. Much of the
east coast infected by Europe and China. Much
of the West Coast more from China anything
about genetic drift or strains?
>> Anthony Fauci: Yeah. There's work that's
coming out now. It has been shown in some
in vitro examination of mutations. You know
a typical, single mutation at a particular
amino acid, you know there's the D614, and
the D614G, which is what looks like, and again
there's some little dispute about it, but
I think the data are showing that there is
a single mutation that actually makes the
virus be able to replicate better and maybe
have high viral loads. We don't have a connection
to whether an individual does worse with this
or not. It just seems that the virus replicates
better and maybe more transmissible. But this
is still at the stage of trying to confirm
that. But some very good viral phylogeneticists
are working on that right now. And it does
look like ap articular mutation may make the
virus more transmissible.
>> Howard Bauchner: Anything new with vaccines
and bridging therapies? We talked briefly.
Well, we talked about vaccines quite a bit,
but anything new around the vaccine trials
and the bridging therapies, monoclonal antibodies,
hyperimmunoglobulin convalescent plasma.
>> Anthony Fauci: Since we spoke last which
was, you know, just a short while ago, Howard,
things are moving along, on track, a few of
the vaccines now we have data on the phase
1 study of one of them. And the neutralizing
antibody titers look pretty good. Always a
caveat there, you know, that's a big leap
from what you see in a study to what you're
going to see as you get into tens of thousands
of people tested. Vaccines going into phase
3 trial end of July, others beginning August,
September, and October. Projection, as we
said that we may be able to at least know
whether we're dealing with a safe and effective
vaccine, by the early winter, late winter
beginning of 2021. Multiple candidates are
at different stages of development. So, we're
hopeful that one or more of them may actually
show a good degree of safety and immunogenicity
and efficacy, which is important that we'll
have a vaccine that might be available. Therapies,
you know some good news, you know you heard
about the dexamethasone for people on ventilators
and requiring oxygen. Remdesivir is showing
a diminution in the time to recovery. Clinical
trials now ongoing with convalescent plasma,
with monoclonal antibodies and with other
agents that are primary antiviral agents.
Like they're going into clinical trial, hopefully
within a reasonable period of time we'll have
a result.
>> Howard Bauchner: Tony, if more than one
vaccine becomes available, how will that get
sorted out in the US firstly. And then how
do you think about the vaccine in the US versus
in other countries. Or, if a vaccine, not
one of the five is successful outside the
US. How do you think through that?
>> Anthony Fauci: Well, several of the manufacturers,
the companies that are responsible are making
projections and already starting, right now.
Some with considerable resources from the
federal government in the form of BARDA, the
Biomedical Advanced Research and Development
Authority. Where they're subsidizing them
to start manufacturing at risk now. So, several
of the companies, I don't want to name them,
because there's all difficulties when you
do that, are really promising that they would
have a couple of hundred million doses as
we go into the early part of 2021. And then
after a year, saying they likely could get
a billion doses. So, when you have two or
three companies, which you hope will be successful,
they are going to be making vaccine not only
for their own country, but availability in
other countries. You know this is misperception
that everybody's racing to be the winner.
There's not going to be a winner. I would
imagine from what we see that several of these
vaccines are going to be very similar in their
effect. And hopefully more than one of them
will be successful. If so, we hope, as we
should, that there would be some degree of
equitable distribution so that people in a
part of the world that can't afford it or
don't do their own vaccine trial will have
a fair accessibility to doses of the vaccine.
>> Howard Bauchner: Tony any new data, a hundred
people infected, the majority do develop IgG
and IgM, I don't know what percent. The figures
I've seen is 85-90%. Do you have a sense of
what percent are developing neutralizing antibodies
and how long it lasts? Or are we still in
the development phase of the data?
>> Anthony Fauci: You know we're looking at
that right now. That's a great question. And
what is the difference? Is there any negative
aspects of binding antibodies that you know
in some respects interfere with the full function
of the neutralizing antibodies? That's being
looked at very carefully now. And it will
be looked at in the clinical trials, as well
as in the people who are recovering from infection.
There are natural history studies that looking
at that.
>> Howard Bauchner: Do you have a sense? You
had commented, Tony, coronavirus occurs naturally,
and people get infected with it. Immunity
from MERS and SARS, the data are very limited,
lasted 6 months, a year, 18 months. Do you
have any sense from the data you've seen or
is it so preliminary with vaccines about how
long you'd expect immunity to last from a
successful vaccine?
>> Anthony Fauci: Yeah, good question. Because
there is a big difference between the induction
of immunity when you have natural infection
and that virus is replicating in your system
for a considerable period of time. And what
you get when you use now the artificial infection
model, a vaccine. So, we don't know how long
it's going to last. We do know that there
have been some reports showing the limited
durability of detectable immunity in people
actually are asymptomatic infected, as well
as those with symptoms. And I'm sure you've
seen the data. It may have been in JAMA for
all I know. It was that it wasn't like years.
But you don't know because you're only months
into this process. So, you really can't tell
what the percentage of people who are going
to have long range immunity. I mean I think
people sometimes forget, because we're so
knee-deep in this, that we're only five to
six months into this right now. So, any projections
of durability of things are almost, have to
be projections. Because we're not there with
regard to real time.
>> Howard Bauchner: Yeah, your first paper,
our first paper on this was published January
23, 2026, coronavirus infections more than
the common cold. Authors Paulus, Marston,
and Fauci, and so it's five months ago. Tony,
there have been struggles with the quality
of PCR and the quality of serology tests.
Are they better?
>> Anthony Fauci: You know, in some respects,
yes. We are now working, and I'm glad you
asked that question, Howard. A substantial
amount of resources, you know to the tune
of about half a billion dollars is being given
to try to develop in a RADx program advanced
point of care sensitive specific diagnostics,
of the like that we've done with other infections.
And hopefully we will get a much better approach
on diagnostics that are very, well I mean
obviously a PCR is very specific. You know,
and in many aspects very sensitive. But how
do you get it done in a way that's very rapid
that you can scale up? That's what we really
need.
>> Howard Bauchner: I want to go to kind of
big event. And for the first time, we're seeing
a lot of attention spent to the reopening
of schools, kindergarten through 12th grade,
colleges. And then, you've made quite a few
comments about sporting events, NFL, NBA.
I want to give you a chance to clarify your
comments about the sporting events, but can
you talk about schools, colleges, and then
go on to sporting events. You're widely quoted
whenever you say anything, Tony, I will not
cut you off.
>> Anthony Fauci: I appreciate that, Howard,
thank you. So, you know when you look at schools
there really is a delicate balance there,
because obviously if you have massive, massive
outbreaks where you have an exponential elevation
of a curve of new infections in a particular
area that you really don't want to have the
kids go to school there. But we really need
to be much more flexible in what we can do
to get the children back to school. Because
just as a reflex reaction of closing the schools,
sometimes has some downstream effects that
make things even worse for you with regard
to homecare, families, daycare, things like
that. So, a fundamental principle is within
the realm of some prudent evaluation of the
safety to the children and the impact on the
community, we should try as best as possible
to get the kids back to school. In certain
circumstances, where you get them back, but
there's still viral dynamics in the community
there are a lot of creative ways that superintendents
of schools are thinking about, seriously,
about how you can mitigate the possibility
of there being children being the vehicle
spread. Alternating days of classes, morning
after versus afternoon. The wearing of masks
for children who are old enough to be able
to understand what it means to have a mask.
Having capabilities of online for children
who have underlying conditions that might
put them at risk. Protecting the teachers.
Making sure that they have the capability
of not being part of an issue of spreading
infections. So that you just do things in
the school to mitigate it. But the principle
should be how can we prudently, with sensitivity
to the safety of the kids get the children
back to school. A little bit different with
the universities. You know there are some
creative ways that some of the university
presidents are doing such as, you know, test
everybody once before they go back so you
know what the baseline is, and then do intermittent
screening to determine, is there anything
under the radar screen. Maybe have a separate
dorm so that when a person does get infected,
they can go there if they are otherwise healthy
and be sequestered the rest of the campus
or the rest of the university. There are a
lot of things that are going on right now.
I believe in a very thoughtful way, how we
can get the educational system somewhat back
to normal. Bottom line, also, Howard to just
get this in before we move onto the sports
thing is the issue of making sure that you
make your judgment, depending particularly
with the elementary schools, the lower education
schools, not the higher education of colleges.
That is going to depend on the level of viral
activity in the location where you're at.
So, we make sure we don't make any unidimensional
statements like in the United States we should
do this. Because there are to be some counties,
maybe even some regions where the infection
is so low, there's absolutely no problem whatsoever
with just making no changes in schools. And
there may be other areas of the country where
the viral dynamics is so intense that you've
really got to be really, really careful when
you make that decision. So, we've got to be
making sure we don't make blanket statements
for the country and talk in terms of the activity
in different regions of the country.
>> Howard Bauchner: Sporting events.
>> Anthony Fauci: Yeah, the thing I want to
clarify, because we had a little discussion
about this at the Senate hearing with my good
friend Senator Rand Paul. And that is, that
I mean do not make any determinations about
what sport can or should be played. What I
think got misinterpreted, a little bit of
confusion about quotes and things, is that
I've gotten asked by anywhere from the commissioners
in charge of a particular professional organization
to the Players Association, to the health
people associated with different sports. And
that's everything from baseball, to football,
to hockey, to soccer, and you know all the
sports. And what I do is I answer questions
based on scientific evidence and public health
judgment. I don't tell anybody whether they
should, or could, or might, or not play a
season or not play season. And yet that has
somehow, beyond me, gotten to the point that
all of a sudden, I've become like a gatekeeper
for professional sports. Which no way am I
at all that. And in fact, as I mentioned to
Senator Rand Paul when he asked me, I am not
qualified at all to decide what sport is played
and what sport is not play. They have very
qualified people making that decision. I can
only give to them my public-health opinion
about the current dynamics of the outbreak
and the kinds of things that need to be done.
The one thing I tell them all is that in their
deliberations, they should pay special attention
to make sure that they safeguard the safety
and the health of the players and the people
involved, as well as the spectators who are
going to rely on the judgment of the clubs
as to whether or not they're going to open
up a stadium or arena. That's all I ask. I
don't make any judgments on what they're trying
to do.
>> Howard Bauchner: Tony, there's dozens of
questions, but I'm going to stop, I'm going
to ask a couple final questions. You've testified
hundreds of times in front of Congress. You've
advised, I think now it's six presidents,
Tony?
>> Anthony Fauci: Yes.
>> Howard Bauchner: It was like a marathon
last week, you told me it was over five hours.
I felt like it was a slow running marathon.
What's been the most interesting testimony
you've given to Congress. If you rank ordered
them, what are the three that either for good
reasons, or not good reasons, what were the
ones that were so striking that you remember
them to this day?
>> Anthony Fauci: Well, I think they'd be
in clusters. And the ones that were clearly
defining were the very difficult years in
the very early eighties when we were trying
to figure out what was going on with what
turned out to be HIV AIDS. I mean to testify
before the Congress in such a moving target
with so much suffering, and pain, and disbelief,
and stigma, and things like that that were
going on. I think those early testimonies
before the Congress. When you were trying
to explain the kinds of things you would want
to do when we didn't have drugs and we needed
drugs. We didn't have anything at all. And
yet, there was such an intense need to get
information out in a straight way. That was
one series. The other one was following 9/11
when we had the anthrax attack. When the country
did not know at any given moment whether we
were going to get attacked by a bioterror
attack. And the Congress needed to know what
we knew. And the intensity of that was most
extraordinary. Another group is what we're
going through right now. This is really unprecedented.
I've been in situations when there were, oh
and Ebola was another one I shouldn't forget
that one. We were going to get overwhelmed
with Ebola. And I was trying to explain to
the committees, the Senate and the house committees
that although we need to be very careful and
pay attention to this, there was very little
chance that you're going to get a major outbreak
of Ebola in this country, without lessening
the impact that African countries were seeing.
And then, where we are right now. We're in
an unprecedented pandemic, Howard. We haven't
seen anything like this for the last 102 years,
in 1918. And this is something that we need
to take very seriously because there's so
many implications of it. You know on the one
hand you have people who are understandably
concerned about the economy. And how, if we
let the economy crash there are going to be
more deleterious effects on people than others.
>> Howard Bauchner: That balance, yeah.
>> Anthony Fauci: That balance. And the same
time when you're dealing with a very serious
public health issue. And you don't want to
balance lives against economy, but you have
people who think in one direction, and those
who think in the other. And you're trying
to get people to understand that we're all
in the same boat together. You know, so let's
get public health to help us to get the economy
opened. As opposed to two opposing forces.
>> Howard Bauchner: Last question. So, over
all of these years, these four or five decades,
Tony, did you have favorite congresspeople
that you know, if they were asking you questions,
you go, God, let them ask the next question.
Did you have like favor congresspeople who
you really enjoyed working with?
>> Anthony Fauci: Well, that is dangerous,
because.
>> Howard Bauchner: I'm not asking the opposite.
Only your favorites.
>> Anthony Fauci: No, no, no. But the reason
is if I give. Oh, Howard I've been there.
I know this is going to get me in trouble.
But I'm not going to allow it to, except to
say what I will do is that excluding current
members of Congress.
>> Howard Bauchner: Okay, let's exclude current
members of Congress.
>> Anthony Fauci: Good. Because I don't want
there to be a comparison. But I mean it was
always a thrill testifying before Ted Kennedy,
you know. I mean he was somebody with such
a passion for the health and the welfare of
the country that even when there were times
during the Reagan administration when he would
be criticizing me as the representative. And
I have so many great stories about Teddy Kennedy
where he would just rake me over the coals
at a hearing because I was "in the Reagan
administration." And then, after the hearing,
when the cameras were off, he would come down
to the table, put his arm around me and say,
Tony I love you. Nothing personal. It's just
strictly business. And it was just I mean
to have that kind of a person was just really
extraordinary. And there was so many others
that we had that were so important. You know
Henry Waxman during the early years of HIV,
he was such a passionate person. And on, and
on. But we're excluding the very, very good
members, current members.
>> Howard Bauchner: This is Howard Bauchner,
I've been talking with Tony Fauci, I think
people know who he is. He's really been in
the American consciousness. And to everyone
watching or listening, if you want to know
what a true public servant is, you just have
to know Tony Fauci. And Tony, there's some
comments. Please convey our thanks. You might
want to tell Tony he is our true Obi-Wan Kenobi.
With that, I'll leave you, Tony. Thanks again.
Good health, stay well and keep telling us
what we should do.
>> Anthony Fauci: Thank you, Howard, I appreciate
you having me on your show, as always, thank
you.
>> Howard Bauchner: Stay healthy.
>> Anthony Fauci: You too, Howard. Take care.
Bye.
