- Hi, everyone.
Welcome to today's homeroom.
We have a very exciting,
special conversation
with Dr. Fauci coming in a few seconds.
But I will make my standard announcement
reminding everyone that Khan Academy
is a not for profit organization.
We can only exist with support
from donors like yourself.
So if you're in a position to do so,
please think about going
to khanacademy.org/donate.
I wanna give a special shout out to
several organizations that
stepped up when they realized
that we were already running
at a deficit pre-COVID.
And in our efforts to support
all the schools and learners
around the world due to school closures
has helped us step up to close that gap.
Special thanks to Bank
of America, Google.org,
AT&T Fastly, Novartis
and the Amgen foundation.
But we're still running at a gap
and so any of y'all can do to
help as very much appreciated.
So with that out of the way,
I'm super excited to have
today Dr. Anthony Fauci,
who I think needs no introduction.
Thank you so much for
joining us, Dr. Fauci.
- Good to be with you Sal,
thank you for having me.
- So as you can imagine,
and I'm sure you're at the center of this,
I've been getting a ton of
questions from everyone I know
for what they wanna go over.
But I actually wanna start
just on you personally.
How are things going for you?
How's the stress level?
How are you handling it?
How are you dealing with
everything that's going on?
- Well, I'm dealing with it
but I think it would not be honest
if I say it wasn't very stressful.
This is a very difficult
situation we're going through,
a historic pandemic and
the amount of demands
for what we need to do.
I'm simultaneously running
the Institute that I direct
which is the
National Institute of
Allergy Infectious Diseases,
which is responsible for most
of the science that goes into
COVID particularly developing a vaccine
and developing therapies and diagnostics.
And I'm also a member of
the coronavirus task force
which is, I know charged
with, as you will know
the responsibility
for trying to provide direction
and guidance to the country.
And we're in a very difficult situation.
So yes, it's extremely stressful
but it is what I do.
I've been doing this my
entire professional life,
going back 40 years for
the beginning of HIV/AIDS
and all the other outbreaks
that we had to contend with.
So this is part of the job,
but it's wearing.
It's not easy.
But-
- I can also.
Well, I can only imagine.
But I think I speak for all Americans
and actually people around
the world saying that,
you've been a source
of comfort throughout.
And my wife's a physician
and if I've ever felt
insecure about my marriage,
it's based on how much she's
been a fan girl of you,
actually have your principles
of internal medicine
right over here.
So this has been,
it's great to talk to you.
But getting into,
I'm sure what you've
been really steeped in
and been talking about a lot.
Before I even start talking
about school closures
and what may or may not make sense,
I'd love to just get our framing
and where we are in this journey together.
There's a lot of conversations
now about vaccines
from Moderna, from AstraZeneca.
Where are we in that journey?
It looks like we're getting
into kind of the phase three.
The more you can explain
that and what you think
how it will play out
over the next few months.
- Well, that's a great question.
If the journey is the vaccine journey,
it's very clear where we are.
So I think one needs to
point out that historically
this is the fastest we've ever launched
into a process of developing
safe and effective vaccines
for an important disease in history.
The speed with which this happened,
it was a combination of the technology
which allowed us to do that
with the new vaccine platforms
which could start on
bonafide vaccine development
literally within days of
knowing what the sequence
of a particular pathogen is as opposed to
having to grow it up and getting
it isolated and purified.
We saved at least a year or more
by technological advances alone.
So a number of trials.
There are dozens of
vaccines that are going into
different phases of trials
which I'll explain in a moment.
About a dozen or between
a 1/2 a dozen and a dozen
are the ones that are really
getting involved in proceeding
in good faith with trials.
Take one for example, the
Moderna one that you mentioned.
So we started a phase
one trial only 62 days
after we actually started
developing the vaccine.
Those results were published
in The New England Journal
of Medicine of medicine
and they look pretty
good in the sense that
even though there's a
limited number of people,
45, 15 per dose, three doses,
that the induction of
neutralizing antibodies
that were comparable to the
levels that you would get
with convalescent plasma
are very promising.
A phase two study has also been done
and literally a couple of days from now,
on July 27th, we're gonna
enter into a phase three trial.
So for your audience so
that people understand,
phase one looks just at safety
and the kind of response that you induce.
Is it safe and does it look like
it's inducing the response
you'd like to see?
Phase two amplifies that.
So phase one has like 45 individuals,
phase two has hundreds of individuals.
Phase three is thousands of individuals.
So on July 27th, 30,000 people.
We're not gonna do them all on July 27th
but there will be a trial
that will be started
with 30,000 people to
determine does it really work.
In other words, we're doing the trial
in those areas of the country
where there's active virus infection
which is not difficult to find
because we have pretty
widespread active infection
to determine does it really work?
How long does that take?
It generally takes several months at best.
With some vaccines, it might take years
but there's so much
virus activity out there
that it is likely we'll get a good idea
of whether we do have a safe
and effective vaccine or not
within a period of several months
so that you could say
somewhere towards the end
of this calendar year and
the beginning of 2021,
that's just with one candidate.
There are other candidates
that one month later
and one month later, and one month later
will be going into phase three trials.
So it's a group of several,
at least six or more
that are going to be going
gradually into phase three trial.
Now, no one can ever guarantee so,
whether you'll have a safe
and effective vaccine.
The proof of the pudding is
you've got to do the trial
which we're doing.
My projection, which is
just cautious optimism,
there's no guarantee,
is that by the end of the
year, the beginning of 2021,
we'll have a vaccine
that we could start
distributing to people.
So that's the timetable,
it's extremely quick
but it's not sacrificing safety
nor is it sacrificing
scientific integrity.
It's just doing things more quickly
by essentially going to the next step
and taking a financial risk
before you actually get the
answer to the previous step.
- And there's a lot in there
that's really interesting.
One, just to make sure that
folks are tracking with us.
Even in these phase ones,
one, you're just making sure
that the vaccine isn't doing obvious harm
that's do no harm first step.
And also to your point,
the fact that the
antibodies are showing up,
these are the things that
tag parts of the virus
to kind of get cleaned
up by our immune system.
So in theory, if the
antibodies are showing up,
there'll be able to tag the virus
and the virus won't be
able to spread the way
it typically would.
And then in phase two,
you go a little bit further with that.
And then as we go into phase three,
do you focus this on a communities
where there's already a lot of spreads
so that you can really see the difference,
whether the vaccine is
making a difference?
Or are you focused on the antibody still?
Or now, are you focused on,
hey, three months from now,
what percentage of the
people in the treatment group
got the vaccine or the
severity versus didn't get it?
- That's a great, great introduction
to a really important question.
So what it is is that the phase three,
the primary end point
is whether or not you prevent someone
from getting a clinically
recognizable infection.
That's the primary endpoint.
You also are gonna be
measuring the antibodies
'cause you wanna get a
correlate of immunity.
You wanna find out what
you induce in a person
that is directly
associated with protection.
So the bottom line is when
you get to phase three,
you wanna know not just
what the laboratory data is,
you wanna know, have you protected someone
from getting clinically
recognizable infection?
Because then later on
you could do correlates
and use that immune response
to be able to predict
whether other vaccines are
going to be able to protect.
- And one interesting
thing you mentioned is
normally, and to give credit
to this whole system here,
normally a vaccine could take many years,
sometimes as long as a decade to develop.
To your point, the development
started within days
of having the sequence
of the RNA of the virus.
And then what the government is doing
is essentially taking these pre bets,
normally you would wait for
stage three to finish and
say, oh, it works, now
let's start manufacturing
but the government has
already placed orders
with these companies so
they can start manufacturing
just in case it, assuming it's good.
If it's not, lost money.
How has that thinking?
How does that thinking go?
How does the decision tree work?
- Okay, I'll tell you
exactly right, again.
Good introduction to a
very important question.
So in general, pharmaceutical companies,
although they wanna help public health,
they are a business.
They have got to function like a business.
Even though many of them
are very altruistic in what they do.
So they cannot lose a lot of money.
So what they generally do
is that they wait until one step is proven
before they start
manufacturing at big scale
to get it ready.
The good news for them is
that they are playing it safe,
they're not risking.
The bad news is that delays
by months and months,
whether you're gonna a have vaccine
that you can actually distribute.
What the government has done
is to the tune of billions of dollars.
They've invested to do just that
at the risk to the government's money.
They do advanced purchase
agreements to say,
no matter what happens,
we will buy 300 million
doses of the vaccine.
Now, if the vaccine doesn't work,
then the company doesn't really lose much,
but we lose money.
We feel, the government, to
the extent that I represent it,
I don't really represent it
because I'm a scientist
who does the research,
but we feel it is worth the financial risk
to allow us to get that
much more of a headstart
on getting an effective vaccine
to the people who need it.
- Yeah and the math of the way it works
it's all probabilistic but
it makes a ton of sense
that if there's even a
60% chance or 70% chance
that you can get a vaccine into the world
three months faster, four months faster,
that's gonna save maybe
trillions of dollars of savings
and not to mention lives
which seems like a really
smart calculus there.
- Yeah, it is.
It's a bet, but it's a good bet.
- What do you see as the probability?
Let's say you're already making the bet
of the manufacturing,
you're already essentially
kind of buying the vaccine
hoping that it will work.
Assuming that the stage
three trials go well
and the doses start hitting the
market in January, February,
how long will it be
before we have a critical
mass of the vaccine out there
that it can really start to affect
how much virus is out
there in the population?
- That's a good question.
You're talking about
vaccinating a few hundred million people
in the United States,
not withstanding that you also
have a global responsibility
all of us have taking care of countries
that don't have the resources to do it.
Logistically alone, that takes time.
So you wouldn't be able.
It will take months to do that,
months to vaccinate that many people.
But we've done major
vaccination campaigns before.
We did it with polio globally.
We did it with smallpox.
It can be done, but it's not easy
because it isn't like you
can go into the office
and get your shot for this
and your shot for that.
This is a massive public health campaign.
- And what, is there a
threshold in epidemiology
that if x% get the vaccine
then we've essentially turned the tide.
- You know, it's called herd immunity.
In other words, if you get
enough people protected,
that means that the rest of the people
who are not protected will be protected
because there's so much
a blocking of the virus
in the community, an
umbrella of protection.
The virus has no place to go
'cause it can't find susceptible people
because most of them are protected.
That critical level varies
from pathogen to pathogen,
from virus, the virus.
We don't know exactly what
that number is four COVID,
but we assume it's
somewhere around 70, 75%.
But we don't know, so we
have to be humble and realize
we don't know what that is
'cause there are so many
moving target factors here.
- Is there a sense of that the vaccine,
if it's effective and
the antibodies are there
that it's essentially a
permanent of vaccination
or is there some possibility
that there's something unique about COVID
that it's something of
a temporary immunity?
- Well, there was some somewhat
sobering information we get.
If you look now,
even though we're only six
months into the outbreak,
and it's very difficult
to give a projection
of durability of immunity,
one, two, three years out.
We have no idea
because we've only been
involved with this infection
for six months.
But a sobering aspect of the information
is that in people who've
been infected and recovered
and you follow them and find out
how long the antibodies
last, it's variable.
Some it lasts for as
long as you follow them
which would be at the most six months.
For others in several weeks,
it goes down significantly
which means that the
immunity that's durable,
isn't like measles which is like
for the rest of your
life, you're protected,
the durability of the
immunities is so great.
So this means that we have
to keep an eye out on this.
That it likely will protect
enough for the season
as it were.
But then you got to follow people
and if a certain percentage of them
fall below a critical level
after x number of months
or a year or two years,
you may have to think
about giving them a boost.
The way we give many things,
many pathogens that we have vaccines for,
we have to boost them.
Tetanus, you have to boost every 10 years.
Some of the others you have to
boost every once in a while.
- And given that this could be
based on this analysis,
many months, it could go
well through the school year.
Obviously, we're an online
learning organization,
a lot of the interest has been around
what to do with schools
this coming back to school.
Maybe a good place to start is
what do we know about
how well or not so well,
kids can be vectors for the virus.
I've seen some research that 10 and under
there doesn't seem to be a lot of evidence
that the kids are spreading it.
What do you know about that?
What's the latest there?
- Well, that's the same Korean study
that you're referring to
that everybody's quoting out.
It came out last week
and it showed exactly what you said Sal
that children up to 10
don't seem to be transmitting
to adults as efficiently
as adults transmit to adults.
Whereas 10 to 19,
it appears that children
transmit to adults
as well as adults transmit to adults.
What we really don't know
because there are so many studies
and the percentage varies from
country to country is that
do children get as easily
infected as adults?
The way you know that is that you look
at the percent of infection
in children compared
to the percent of infection
in the general population.
If it's significantly less,
that means children don't
get infected as much.
If it's more or the same,
that means they easily get infected.
What we're doing here at the NIH,
we're doing a study it's called HEROS
for Human Epidemiology of COVID Infection.
And what it does, it looks at
it started on May 1st and
we'll get significant data
by December, 2020.
And what it is,
It's a study of 6,000
people in 2000 families
looking at the rate and the prevalence
and the incidence of infection in children
and whether or not they
transmitted to adults
or do adults transmit it to them.
We should know the answer
to that in a good study
by the end of December of 2020.
- And so given that...
If you were a district
superintendent or a school principal,
how would you be thinking about that?
I've seen guidelines from folks like
the Harvard Global Health Initiative
where they essentially have
kind of a colored ranking
based on the prevalence of
new cases in a geography
and if it's red, you're at full distance.
If it's green full,
somewhat normalcy with social distancing.
In between, maybe you open
for the kindergartners
or for the 10 and under,
and then you kind of play it
by ear for middle school students.
How would you be thinking about it
as a district official right now?
- The same way.
I think the critical issue and
you could break it down
into green, yellow, and red,
but what the officials need to do
is to look at the level of activity
of virus in the community
because what we get confused
at is we make the United States
a uni dimensional phenomenon.
It's not, it's very much different,
geographically, demographically
and the level of infection.
So there will be some states,
cities, districts, counties
where the level of infection is so low
that you don't have to
worry about anything
regarding bringing your
children back to school.
Just bring them back
to school, no problem.
But there are some in which
you have a level of activity
where you got to balance
if you are gonna bring the children back,
what do you need to worry about?
What should you do?
And it's a whole set of recommendations
that come from the CDC.
And they are things like
alternating classes,
morning, afternoon,
alternating days, Monday,
Wednesday, Friday,
Tuesday, Thursday, what have you.
Physical separation in class,
seating people, six feet apart.
Having who can tolerate it,
wear a mask all the time,
have the teachers wear a mask.
There are so many things you could do.
Alternate between online and in person,
those are the things you need to do
and then you can make a decision.
As you said, if I were a superintendent,
I would look at where my district was,
what the risk is, and
I'd fashion the process
of getting kids back to school
based on that estimation.
- And would you say that,
I think what a lot of districts
officials are looking for
is some type of a threshold
so they can be confident that
they're doing the right thing.
'Cause they're feeling like
these are life and death situations.
I know the Harvard
global health initiative,
that's just the one that I looked at
where they have thresholds like,
10 new cases per a
hundred thousand per day.
This is the scenario that
you should think about,
25 new cases per a hundred thousand.
Do you think those are
the right types of things
that district officials should anchor on?
- Yeah, absolutely.
Take a look at what the
percent positivity is.
- And from a teacher's point of view,
I think we've all heard in
the press teacher fears,
especially if some of them
are in higher risk groups.
I have this question from Facebook,
Diane Newman's asking,
"If people over 60 are
more likely to get this
and have severe symptoms,
should they be forced
to go back to school?
Do you recommend they go back?"
And then it says,
"Currently many districts
are requiring all their employees
to come back to school unless
they have a doctor's note."
How do you, how do you think about that?
- You asked about three
or four questions there.
Sal, what I think is that obviously
you've got to pay attention
to the concerns of teachers
who are entering into the
elderly demographic bracket
particularly those who
have underlying conditions.
You talk about the elderly,
there aren't a lot,
I think at least the
elderly people that I know.
There, aren't a lot of elderly people
that don't have at least
one underlying condition
besides old age.
And that is,
they're either hypertensive,
they have mild cardiovascular disease,
a little chronic lung
disease, maybe diabetes.
There are a lot of people
with underlying conditions out there.
So I think when you talk
about forcing teachers
to come back to school, you
better be careful about that
and make sure you pay attention to
a, keeping them safe and
key, keeping them healthy.
- And in terms of the actual
implementation of that,
a lot of questions,
I'll just try to group them together
that am getting off of
YouTube and Facebook right now
is questions about,
you mentioned things
like socially distance
how do you do that within
a physical environment?
I am curious some people ask
questions about outdoor school.
You know, there's previous
epidemics, tuberculosis,
where even in fairly cold places,
they seemingly effectively
did school outdoors.
Well, is that something
that you would recommend
folks go in that direction
or it's really district by district?
- Well, I think district by district,
but I can tell you as a
public health paradigm,
outdoors is always better than indoors
when it comes to COVID or any
other respiratory infection
'cause when you get re
circulating air indoor,
you gotta be careful.
So if there's anything
that you could do outdoors,
as opposed to indoors, I would do it.
That could be school, certainly
it could be restaurants.
I mean, restaurants,
if they possibly have the capability
of having outdoor siting,
as opposed to indoor siting.
I would stress that.
- That's super helpful and from Facebook ,
we have this question from Erin Elizabeth.
We live in a state where
cases are on the rise
and schools are starting
to formulate plans.
The latest is that they
may not mandate masks.
Can you share your opinion
of masks in school?
- Yes, I believe that if you're
dealing with a situation,
which is almost everywhere
in the United States,
where there like activity
that you wear masks
that children who can tolerate,
'cause I mean, I have three
girls they're adults now.
But I remember them lovingly very well
when they were young kids.
I don't think I could keep a mask
when a kid who's really young.
But to the extent that you can,
I would and certainly teachers.
- Yeah, our 5 1/2 year old,
we've had to just make him
play like he is a Ninja
and then it becomes that much better.
(both laugh)
So this is a question,
actually this is one I've
been wondering myself.
From Facebook and Marie Baron's asks,
"Dear Dr. Fauci,
is it okay to wear a face shield
instead of a mask in the classroom?"
I guess you could say, even in general.
"I think students need to
see their teachers faces
so much of encouragement and engagement
comes through a teacher smile."
- Well, this is a face shield.
It's not a mask it's cloth.
I wear this all the time.
I rotate, I usually wear a
Washington nationals face mask
to cheer on my team.
But these are fine, these
types of things are fine.
- And I've seen there's
some new things coming out
where the mouth part is clear
so that I guess people can
see you're you're smiling.
What about the kind of
the plastic full shields,
do those provide any protection?
- Yeah, yeah, they do it.
So you'll see, the only trouble is that
someone will bring up the
possibility that they're...
Okay, my staff just
brought this in (laughs)
- There you go, that's
exactly what I was talking of.
- Like that?
Yeah, so this is good.
Yeah, this is good for
droplets 'cause it'll block it.
The only trouble is
if you have any degree of aerosol,
what happens is that all of this see
it can go right in like
that, that's the problem.
So these are good for droplets,
but you have to be careful
if there's a degree of aerosolization.
- 'Cause part of the mask or the shield,
it's protecting yourself.
But part of it is also
protecting other people.
Does the shield help at all
with protecting other people?
I guess things won't get projected as far.
- There's no way, they would go around.
They would go around.
See, I think people
need to understand that
and this may be a good rationale
because you really want to get people
to rationally go along with
why you should wear a mask.
Is that we became really bullish on masks,
when it was came clear that
a substantial proportion of people,
20 to 45% are asymptomatic,
they don't even know they're infected.
And we know that someone
who is asymptomatic
can pass the virus on to another person
which is innocent and inadvertent.
Nobody's trying to infect anybody,
you just don't know you're infected.
So what we do know is that a face covering
or a mask can prevent me,
if I were inadvertently
and unknowingly infected,
it would prevent me from infecting you.
So it's almost like a responsibility.
You wear a mask to protect me
and I wear a mask to protect you.
So we're all in this together.
And when people realize that,
that may be more of a
motivation of them to do that.
That it's almost like you're
a societal responsibility
to not be part of the problem
of propagating an outbreak
as opposed to saying,
oh, I'm a young person.
I don't care if I get infected
doesn't make any difference, it does.
Because even if you don't get any symptoms
and you're infected it, don't know it,
the chances are you're
gonna pass your infection
onto someone else who'll then
pass it on to someone else.
And then you'll pass it onto someone
who could be someone's mother
who's undergoing chemotherapy for cancer
or an immune deficient child
or someone who has another
condition, diabetes,
very common condition and then that person
is at high risk for a bad outcome.
- That's super important.
And I know we're almost out of time,
first of all, Dr. Fauci,
I genuinely want to thank you
and I think I'm speaking on behalf of
tens of millions of
people around the world
that you are a source
of grounding and comfort
in this very, very tough time.
And I can only imagine
the weight you feel on your shoulders.
Are there any parting messages
that you'd like to share?
I mean, you just shared a few
just things that people haven't
fully grokked or digested
that you just really
wanna doubly underline.
- Yeah, I think what
you'll start to see so
is fatigue on people.
No one likes to be isolated,
relatively speaking from society.
I certainly miss it.
I know everyone that I come
into contact feels that way.
Just keep in mind, this will end.
We will end this terrible
scourge that we're under.
So hang in there, don't get discouraged,
throw up your hands and say,
oh, I'm just tired of it.
I'm just gonna do things,
I don't care if I wind
up getting infected.
Hold tight, hang in there.
We're all in it together and it will end
and we will get back to our normal lives
within a reasonable period of time.
That's a message I'd like people to hear.
- Definitely appreciate that
and I think a lot of
people need to hear that.
Thank you so much, Dr. Fauci,
this was super valuable.
- Thank you and I appreciate
your giving me the opportunity
to be on your show.
- So thanks everyone for joining
once again, another
incredible conversation.
I thank Dr. Fauci, for
those of you who don't know,
he's obviously been catapulted into fame
because of this unfortunate
situation we're in.
But my wife's a physician
and she's been following for a while.
He's one of the top
physicians in the field
for many decades now.
So we're very lucky to be able to have him
and we're frankly very lucky to have him
in this position of leadership right now.
But thanks everyone for
joining this live stream
and I look forward to more
conversations like this
in the weeks ahead.
