Dec. 28, 2020 -- Anthony Fauci, MD, says the coronavirus pandemic may get worse in coming months, including a post-holiday surge in cases.

In an interview on CNN, Fauci was asked if he thought “the worst was yet to come.” He said, “I do.”

“We very well might see a post-seasonal -- in the sense of Christmas, New Year's -- surge, and, as I have described it, as a surge upon a surge,” said Fauci, the director of the National Institute of Allergy and Infectious Diseases.

Fauci said holiday travel could cause a spike in cases. Besides exposing themselves at airports, travelers usually mix households when they arrive at their destinations, he said. Even though health authorities urge people not to travel, “it’s going to happen,” Fauci said.

Dr. Fauci: Life Could Be Back to Normal by JuneWebMD's Chief Medical Officer, John Whyte, MD, speaks with Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Diseases (NIAID), about the latest news on COVID-19 vaccines and the potential end of the pandemic.1074

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JOHN WHYTE: Welcome, everyone.

You're watching Coronavirus

in Context.

I'm Dr. John Whyte,

chief medical officer at WebMD.

Today I have a very special

guest, Dr. Anthony Fauci,

the world's leading authority

on infectious disease.

Dr. Fauci, thanks for joining.



ANTHONY FAUCI: Thank you.

It's good to be with you.



JOHN WHYTE: Dr. Fauci, I heard

you got the vaccine today,

so I wanted to ask you

about your experience.

How are you feeling?



ANTHONY FAUCI: I'm feeling

perfectly fine, perfectly

normal, nothing so far.

I have no pain in my arm.

I had nothing to even indicate

that I had been vaccinated.

I feel perfectly fine.

That was about,

let's say, about three,

four hours ago.

I'm doing great.



JOHN WHYTE: Now, people ask,

does it feel cold?

They know they're kept

at these super frozen

temperatures, but was there any

tingling or--



ANTHONY FAUCI: No, no.

No, you don't feel it at all

really.

It was even, several of us

remarked because I got it

together with a group of health

care providers, and I'm also

a health care provider,

but I got it with them,

and all of us

agreed that it was even less

of a feeling than the flu shot.

You know, flu shot sometimes

it hurts a little.

It didn't hurt at all.

It was perfectly fine.



JOHN WHYTE: I want to ask you

about the vaccine

because you've talked about how

impressed you have been

with the safety

and efficacy data,

94, 95% effective

for both of these vaccines.

If the data is so compelling,

why have it authorized

under emergency use authority as

opposed to full approval?



ANTHONY FAUCI: That's a very

good question, John.

And the reason is you want

to get it out as quickly

as possible.

To do the full dotting the I

and crossing the T's

of a biological license

application, the BLA,

that would take several more

months to do.

So when you do an EUA,

particularly an EUA that's

granted on the strength

of these data,

which is really quite

impressive,

both of these vaccines not

only were safe, but they were

94% to 95% efficacious

in preventing any clinically

recognizable disease

and even better in preventing

severe disease.



So we felt that we wanted to get

it out quickly while the process

of putting in

for the full license approval.

We didn't want to have months go

by without people having

the advantage of the vaccine

given

the extraordinary situation

in our country.

As you well know,

we're in a very difficult

situation.

We're having between 200

and more thousand cases a day,

anywhere between two and 3,000

deaths per day.

Hospitalizations has reached

a record of 118,000.

Places like California

are being stressed to the point

they may run out of beds.



So you don't want to be delaying

vaccine merely

because bureaucratically you

have to go through a bunch

of hoops

to get the official approval.

The data are quite

strong to grant an emergency use

authorization.



JOHN WHYTE: Some people have

been out there saying, just

to your point,

given the number of infections,

the number of deaths,

the scarcity of the vaccine

right now,

let's not focus on two doses,

but there's some efficacy,

some significant efficacy

after the first dose.

Why not just start giving more

people the first dose?

And one is better than none.

What are your thoughts

about that approach?



ANTHONY FAUCI: That has been

discussed a fair amount.

What people don't appreciate,

even though there is some degree

of efficacy after a single dose,

it is really not optimal at all,

and we don't know how long it

lasts.

We do know definitively

that when you give a prime,

even though you do get

some degree of immunity

after the prime single dose,

after the second dose,

it's dramatically higher,

and it lasts considerably

longer.



JOHN WHYTE: What about data

in children?

Particularly, let's say less

than 12 years old.

Should we be worrying about

vaccination in children

given we know the journey

of the disease in children

versus really focusing

on teachers and workers

and other adults?



ANTHONY FAUCI: Well, do you want

to do both.

So the reason we traditionally,

when we make a vaccine

and test a vaccine,

is that you don't want to test

it on children because children

are vulnerable.

They do not have the capability

of giving informed consent,

which is important.

It's their life, though they're

very young.

It's still their life.

So you've got to take

extra special care in safety.



So the standard traditional

thing we do is you do a vaccine

study that's a phase three

large study in adults.

When you get good safety

and good data on efficacy,

then you can feel

justified in taking the risk

of trying it in a child.

You can do a phase one,

phase 2A in a child

after you complete the vaccine

trial in the adult

and then quickly get

the children to get

vaccinated by what's called

a bridging study.



A bridging study means you don't

have to spend the entire time

doing tens of thousands

of children the way

we did with the adult.

You can do a couple of thousand,

2,000 to 3,000 or 4,000 kids,

show that it's safe,

and show that it induces

the kind of response that's

comparable to the response that

protected the adult.

Then you can make the assumption

that it will protect children,

and then you license it

because you've proven safety,

and you have a very good

indication that it likely will

protect the children.

We're going to start that, John,

probably the middle to the end

of January.



JOHN WHYTE: Do we need

to vaccinate kids before we can

reopen schools?



ANTHONY FAUCI: No, I don't think

that that's necessary.

I think that the default

position should be as best as

possible to keep the children

in school

or get them back to school

if they're not in school.

We know now that when

all other things being equal,

children in school

get infected less than the

adults in the community.

So if you have the capability

of dealing with kids

when they get infected,

you have reasonably good

surveillance, like maybe

vaccinate the teachers

to protect them in the school

and prevent them from infecting

the children.



JOHN WHYTE: They're

on the next prioritization list

as well.

You know, I want to ask you

about vaccine confidence,

and you might have seen the data

from a USA Today survey that

just came out that talks

about Democrats

are nearly twice as

willing as Republicans

to receive the vaccine,

and even more concerning can be

that 36% of Republicans

say they'll never take

the vaccine.

How do we get to 70, 80% herd

immunity, Dr. Fauci, if we have

these issues with confidence

in the vaccine?

What are the one or two things

that we need to be doing now

to inspire confidence?



ANTHONY FAUCI: Well, I think

we need outreach

to the communities

of all people, Republican

and Democrat minorities

and people

in the general population.

The way we have approached it

is to not essentially confront

people who are hesitant

or who have skepticism but try

and reason with them and say,

what are the reasons why you

have skepticism.

And there are a couple

of well-defined reasons.

If the reason is,

boy, this went really quickly,

was it careless and quick,

and then you show that the speed

of the fact that we went

from a brand new virus

in January to a vaccine

that we're putting into people

in December

is not compromising safety,

nor is it compromising

scientific integrity.

What it is a reflection of

is the extraordinary scientific

advances that have been made

in vaccine platform technology,

which have allowed us to do

things in months that we

normally would have taken years.

There's no compromise in safety.



The next question people ask,

understandably, is, well, you're

saying this is safe,

and you're saying that it's

effective.

Is that true, or is this

the government putting pressure

on you?

Is it

the pharmaceutical companies

wanting to make a lot of money?



JOHN WHYTE: So tell us,

what's the answer?



ANTHONY FAUCI: Actually,

the answer is--

and this is important, John--

is that the decision

of whether something

is safe and effective,

the data that gets examined is

done so by a totally independent

data and safety monitoring board

made up of vaccinologists,

virologists, immunologists,

statisticians, and others,

who look at the data who have

no allegiance, don't answer

to the federal government.

They don't answer

to the pharmaceutical company.

They're an independent group.

When they decide

that the vaccine data look

really good,

and it's safe and effective,

they then give the data

to the company who presents it

to the FDA, who then, the career

scientist at the FDA, not

political appointees,

but the career scientists work

with their own independent

advisory committee, which they

have an established

committee called the Vaccine

and Related Biological Products

Advisory Committee, or VRBPAC.

They then say, OK, it's cleared.

Let's give it.



So in reality,

the entire process

is independent and transparent,

and that's what people need

to know, and when they do,

I believe they will be much,

much more amenable to getting

vaccinated.



JOHN WHYTE: Everyone's talking

about the variant,

you know this, and the concern

that will the vaccine be

effective.

What are the countermeasures

that we need to be taking now?

You've been talking about we

don't want to overreact,

and others are saying,

you know, now is the time

that we need to be overly

cautious in a way.

What's your response to assuage

people's concerns about what

they might be hearing

on the news

or reading online

about the impact

of these potential variants?



ANTHONY FAUCI: Well, I think

they need to understand

something broadly at 40,000

feet that this is an RNA virus,

and RNA viruses mutate all

the time.

That's their occupation

is mutating.

The more they replicate,

the more they mutate.

Most of the mutations

do not have

any functional significance or

functional relevance.

The one that's being looked

at now, the one that's

dominant in the United Kingdom

is one that appears--

we don't know for sure--

but it looks like that it has

a better capability

of transmitting of going

from person to person.

There's no evidence that it has

any effect on its virulence,

or namely, does it make people

more sick, it doesn't.



The other important issue, is it

true or not

that it's evading the protection

of a vaccine,

and it doesn't appear

that that's the case at all.

So what we need to do

is we need to watch it very,

very carefully.

We need to do surveillance

in this country.

And then there is discussion

about if it isn't already here,

which it might well be here,

and we don't know it yet,

what do you do?

And there's been discussions--

some people, I know the European

Union is banning travel

from the UK.

I think that may be

an overreaction now.

I would not be against at least

seriously considering making

sure that people who fly here

or come here from England,

the UK, to the United States,

that you require they be tested

before they get on the plane

so that you know they're

negative when they get here.

That, I think's something that

might be considered.

I'm not saying we should do it,

but we should consider it.



JOHN WHYTE: Those are all

good points.

You know, I always ask

my colleagues, what should we

ask Dr. Fauci?

So I want to give them

an opportunity, and you know,

I have to use a crystal ball.

And you don't have one there,

but I have one here, Dr. Fauci.

Our producer sent it.

And the question

was that many people have

postponed their weddings

from last year

to March or April of this year.

Do they need to postpone it

again?



ANTHONY FAUCI: You know, they

should have done it till June,

July.

And the reason is--



JOHN WHYTE: Not going to be

happy to hear that.



ANTHONY FAUCI: I'm sorry, John.

You know, we don't know--

I have been saying,

and I think it's going to work

out that way,

that if we do it efficiently,

and it depends on how efficient

we are,

if we get the priority people

vaccinated,

the ones that the ACIP is

recommending, if we get them

vaccinated between now,

and let's

say, March, beginning of April,

and we could start in April

doing what I call open season

on vaccinations,

namely anybody

in the general population who

wants to get vaccinated

will get vaccinated.

If that's the case, when we go

through April, May, June, July,

by the time we get

into the middle

or end of the summer,

I believe we will have-- if we

do it correctly,

we can have 70% to 85%

of the population vaccinated.



When that occurs, there will be

an umbrella of protection

over the entire country

that the level of virus

will be so low that you will

essentially have been

able to establish herd immunity.

So I'm looking forward to as we

finish the second quarter

and go into the third quarter

of 2021.



JOHN WHYTE: And finally, I want

to ask you about the Fauci

effect, the impact

that you're having

on young students who are

saying,

I want to go into medicine,

I want to go into science.

When you heard about the Fauci

effect, how did you feel?



ANTHONY FAUCI: Well, I felt good

that young people want to go

into a profession that I love

and that I have been in for so

many years.

I think it's-- well, it goes

beyond me.

I mean, they're calling it

the Fauci effect,

and I'm very

flattered that that's the case.

But I think it also relates

to the courage of the health

care providers in the emergency

rooms, in the intensive care

units.

I think people are seeing a face

of medicine

that they may not have seen

before, of people who are really

stepping up to the plate

and doing their job.

I'm doing it by trying to speak

truth to the country

and trying to be

clear in the explanation of what

is going on in a way

that they understand.

The health care providers are

risking themselves, their health

and their lives every day

to take care of people.

So I think that the face

of medicine is a much, much more

attractive face now than it may

have been in the past.



JOHN WHYTE: My colleagues have

also wanted to ask you in terms

of your professional career,

you've dealt with HIV, Ebola,

other pandemics

around the world.

Why has COVID-19 been so

difficult?

Is it the politics

around this issue?

Is it the impact of social media

that didn't exist before?

Why so hard now?



ANTHONY FAUCI: Well, whenever

you have a public health

outbreak, a really transforming

outbreak the likes of which we

haven't seen in 102 years,

everyone has got to pull

together to get a maximum impact

on addressing it.

Unfortunately, we are living

in a very divisive society.

I think anybody that looks

and what's going on

in the United States

has to realize that there is

a lot of divisiveness.

That makes it much, much more

difficult

because simple public health

measures take

on a political connotation.



You said it yourself when you

gave the numbers.

Why should there

be any difference

between a Republican

and a Democrat

as to whether they want to take

a vaccine or not?

There's no reason why there

should be.

I mean, because it's

a public health issue.

I think it's just a reflection

of the kind of divisiveness

we see.

So you're right.



That has made it difficult

because it has led

to mixed messaging,

and when you get

mixed messaging,

people get confused as to what's

the best thing to do.

And you've really got to be

uniform and consistent when

you're fighting something as

serious as a pandemic.



JOHN WHYTE: Dr. Fauci, I want

to thank you for all the work

that you've been doing for 40

plus years running the National

Allergy and Infectious

Disease, as well as all you are

doing to keep us

safe during a type of pandemic

that occurs once a century.



ANTHONY FAUCI: Thank you, John.

Good to be with you.



John Whyte, MD, MPH, Chief Medical Officer, WebMD.<br>Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Diseases (NIAID)./delivery/aws/b9/09/b909485e-f78b-332b-bd9d-d41c76d75385/Fauci_122220_v3_,4500k,2500k,1000k,750k,400k,.mp412/23/2020 12:30:0018001200Fauci_122220_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Fauci_122220_1800x1200.jpg091e9c5e820b7ed1

"We are really at a very critical point. ... So I share the concern of President-elect (Joe) Biden that as we get into the next few weeks, it might actually get worse,” Fauci said.

Biden recently said that the "darkest days" in the coronavirus pandemic are ahead and urged Americans to prepare themselves for a difficult struggle. Fauci has agreed to serve as Biden’s top health adviser.

December has already been the hardest month for the COVID-19 pandemic in the United States.

More than 65,000 people have died of coronavirus-related reasons so far this month, compared to only about 37,000 in November, according to the Covid Tracking Project. Hospitalizations are up, with more than 100,000 people in the hospital per day since Dec. 2.

Overall, there have been more than 19 million confirmed cases in the United States and more than 333,000 COVID-related deaths -- the most of any nation in the world.

COVID-19 vaccinations should bring the pandemic under control, but it will take many months for the United States to develop herd immunity, Fauci said. Health care workers and residents of long-term care facilities are the top priority groups receiving the vaccine.

“I hope that by the time we get to the fall we will reach that critical percentage of people that we can really start thinking about a return to some form of normality,” Fauci said.

Fauci, who just turned 80, got a COVID-19 vaccination recently. He said he had no side effects besides arm soreness for about 24 hours.

WebMD Health News

Sources

CNN: "Fauci: The worst is yet to come in Covid fight," "Biden says 'our darkest days' in battling Covid-19 'are ahead of us.'"

Covid Tracking Project: “Historical Data.”

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