Published on Jul 17, 2020

  • 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."

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: You're watching Coronavirus in Context. I'm Dr. John 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 FAUCI: Good to be with you. Thank you for having me.

JOHN WHYTE: I want to start off with, you had 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?

ANTHONY FAUCI: You know, unfortunately, we might be. I do hope, uh, 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 kind of things that we need to do with regard to mask wearing, physical separation, staying away from crowds, et cetera.

I think we can turn this around. But when I said I was concerned that we might be heading towards 100,000 per day, you know, I-- I didn't want to, you know, inappropriately scare anybody. But if you just take a look at what's actually happened, at that time, we went from 20 to 30, and then we doubled it. We went to 40, and then 50, 60, and now we're at 70.

You know, 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-- is a very formidable foe here. And 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. So we can do it. There's nothing about this that we can't do to turn it around.

JOHN WHYTE: So why aren't the public health guidances working in some populations, particularly a younger population, which is attributing for some of that surge in cases? Is it-- is it a failure of effective communication? Wh-- what's going wrong here?

ANTHONY FAUCI: No, I think they're-- I think it's multifaceted. I don't think you could put your finger on one thing. But the one thing that I think is important, and I've been analyzing this, really, for quite a while, is that, particularly with young people, and clearly young people are driving this new surge.

Because 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. So what happens is that younger individuals who generally, statistically, 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, understandably, innocently, but not correctly, the younger individuals are saying, well, if I get infected, so the chances of it is that I won't even have any symptoms, so who cares? That's a big mistake.

Because by allowing yourself to getting infected or not caring if you do get infected, you are propagating a pandemic. Because it doesn't end with you. You get infected and have no symptoms. The chances are you're going to infect someone else, who will then infect someone else.

And then someone who's vulnerable to severe consequences will get infected. That could be somebody father, mother, or grandmother. It could be a sick child who's an immunodeficient child. It could be a woman who's on chemotherapy for breast cancer. Then 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. And I don't mean in the sense of blaming anybody. Because these are people that are doing this innocently and inadvertently.

JOHN WHYTE: Do you think language comes into it? You know, we're both interested in the public health. We're using words like asymptomatic, presymptomatic. Those aren't terms that the public knows. And often, different groups have used them in different ways.

ANTHONY FAUCI: You know, you had a very good point there. We have got to outreach to the individuals involved in a manner in which they pay attention and can understand. And that's the reason why I often do discussions and podcasts with groups that they listen to, as opposed to, you know, an old guy in a suit like me, who is not, you know, really, statistically, why they would want to listen to somebody like that.

And get rap groups and-- 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-- 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.

JOHN WHYTE: Is there a distrust of science? You've talked a little bit about that. Have people lost their way? I was saying to a friend earlier, as-- as I'm sure you know, sometimes you're referred to as St. Anthony. He's that patron saint of lost things, as I'm sure you know. My mother loved St. Anthony. But have the public lost their faith in science?

ANTHONY 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. And there is that pushback, particularly on the part of young people, maybe for some good reasons, that they've been disappointed in authority and have been disappointed in government.

And they get disillusioned. And that kind of translates or measures 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 that you have as someone who doesn't care about the science, which is clearly trying to tell you to act in a certain way.

JOHN WHYTE: It seems as if almost everyone is their own expert. From the perspective of, you have your opinion as a-- as a, you know, infectious disease expert. And someone else will say, well, that's your opinion, Dr. Fauci. I have mine. Isn't that part of the problem?

ANTHONY FAUCI: Yeah. I mean, people's opinions are a fact of life. What gets, um, I think troublesome, is when people develop their own set of facts. Facts don't change. So you can have a different opinion, but facts are consistent. That's the problem.

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

ANTHONY FAUCI: Well, I-- I wouldn't say the next few months. But let me tell you what the timetable is. I-- 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 in ways that would have taken years before that now takes weeks to months.

And we've already shown that by going from the sequence 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. And then 62 days later, enter into a phase one trial.

That is amazingly unprecedented in every respect. Right now, we're going to go into a phase III trial at the end of Ju-- July. And there are several candidates that are also lined up to go into a phase III trial soon thereafter.

JOHN WHYTE: At least four candidates.

ANTHONY FAUCI: Yes. Yes, at least four. At least four that the NIH and the federal government is helping to subsidize and to collaborate with with regard to clinical sites. So, you know, I-- I don't think that it's hype. It's real. There is risks to be taking, but they're financial risks.

They're not risks to safety. They're not compromising scientific integrity. So if things turn out the way we would hope they do, and-- and whoever makes that comment is right that you can never guarantee something. I would use the words that I'm cautiously optimistic that we're going to get there.

Anyone who guarantees something when it comes to vaccine 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.

And looking at the preliminary data of immunogenicity from the phase I study, which showed levels, robust levels of neutralizing antibodies, even with the moderate dose of the vaccine, again, makes me cautiously optimistic that we will get there. So that's something that I think we don't-- we really don't think is hype. We think it's realistic, as long as you don't feel that you're going to guarantee something but you're optimistic that we're going to get there.

JOHN 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?

ANTHONY FAUCI: You know, that's a good question. And it's really going to depend on the level of infection in the community. Right now, there's enough infections going around in the United States, and 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 on the trial and it's 30,000 people per trial, that you likely would get an efficacy signal.

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-- we're working very closely with the FDA, and they are telling us that they want to see a safety and efficacy signal on the vaccine as opposed to anything less than that.

JOHN WHYTE: And back to this infection rate in the community. The CDC director has talked about if we would all just wear a mask for three to four weeks, we could decrease incidents dramatically. What's your thoughts about the need for a full lockdown for a couple of weeks to truly stop the spread of the virus?

ANTHONY FAUCI: We would like to avoid a full lockdown if we possibly can. What we feel we have to do is 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 I. And then if that works, you go to phase II, then to phase III.

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 what you do, you may need to pull back a little on the phase you're in and then say, OK, we have a problem.

Close the bars. Everybody wear a mask. Physical distancing. No crowds. Wash your hands. And I agree completely with Bob Redfield, the CDC director, when he says that-- that if we do that, we can turn this around. We can turn it around.

JOHN WHYTE: You know, part of the challenge of getting people to adopt these behaviors is misinformation. You know, how do we counter that misinformation out there? That masks don't work, that physical distancing doesn't work. How do we be more effective in getting people to adopt these strategies through communication?

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

JOHN WHYTE: You know, 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, you know, what we know about COVID in children, and how parents, we have a lot of parents that-- that watch the show, how parents can make decisions about whether or not to send their kids back to school?

ANTHONY FAUCI: Great. That's a critical question, because it's on everybody's minds right now. So the way I look at it, I want to go to 40,000 feet and say, let's take a concept. And in my mind and the mind of-- of people who really care about this, like representatives in the American Academy of Pediatrics, who say the default position is that we should try to the best of our ability to get the children back to school and keep the schools open because of the considerable deleterious downstream ripple effect negative consequences of keeping the kids out of school.

That's a default. But it really is going to depend on what the viral activity is in the place that you are right now. So there are some counties, you know, we have 3,007 counties in the United States. Google it. I didn't know that.

JOHN WHYTE: I did not know that. That's good to know. All right.

ANTHONY FAUCI: And as a matter of fact, as a matter of fact, there are some counties where there's so little viral activity, you could just say, don't worry about it. Go back to school. But there are others, and I think these are the ones that you're referring to, where there's enough activity where you've got to make a choice.

And the choice can either be, don't bring the kids back or, preferably, bring them back in a way that is very, very geared towards guaranteeing their safety, and their welfare, and the safety and the welfare of the teachers. And that might be simple logistic things, like spacing of desks, alternating schedules, and cleaning down the classes.

Outside as much as you possibly can versus inside. 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, big country, that things are going to be different in one region versus the other. But getting back to what I said. The default should be, try as best as possible to get the children back to school.

JOHN WHYTE: Does it matter by age? 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?

ANTHONY FAUCI: Well, you know, that's a good point. And-- and we, you know, there's not a lot of data, even though there's a lot of anecdotes. 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 that we started on May 1 called the HERO study, which is Human Epidemiology, et cetera, et cetera, looking at 6,000 people in 2,000 families to look at the incidence and the prevalence of infection in children.

What the relationship between their infection and family members, do they transmit it to the family or does the family transmitted to them, what is the impact of having underlying asthma and underlying allergic conditions, et cetera. So this is an ongoing study that's going to answer the questions that you and I are asking but we don't have an answer to.

JOHN WHYTE: Now Dr. Fauci, at WebMD, we're seeing a lot of traffic in terms of anxiety and stress. And one of the things that we've been talking about to people that come to our site is, you know, taking care of their mental health, taking a break from the news. So I know a lot of folks want to know what does Dr. Fauci do to take a break.

And I saw that, you know, you've been an avid jogger. 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 when you're power walking?

ANTHONY FAUCI: No, I walk with my wife and my daughter's dog. And I-- and I use it as to have-- you know, it's interesting. I would love it to be some conversations that I have 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.

But when we're out on a three and a half, four mile walks, it's a wonderful time. It's wonderful because I get a chance to talk to my wife. But it's also wonderful because we love the dog and it's nice being with the dog.

JOHN WHYTE: What kind of dog is it?

ANTHONY FAUCI: You know, it's a mutt, but it's-- it's very heavily genetically programmed towards being a Rhodesian Ridgeback. A nice dog. A very kind and very lovely dog.

JOHN WHYTE: And finally, what-- what are you hopeful for, Dr. Fauci?

ANTHONY FAUCI: You know, I'm-- I'm hopeful to what I think we all all are, that we're going through a terrible experience right now. We've got to get control of it, get it behind us, and keep it behind us. And we're going to do it with a combination of public health measures and scientific advances, like vaccines and therapeutics. This will end. 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.

JOHN WHYTE: When's it going to end?

ANTHONY 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.

JOHN 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.

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