A Conversation with Dr. Anthony Fauci

William Pierce:

Back from our hiatus due to the COVID-19 pandemic is Dr. Anthony Fauci. So welcome Dr. Fauci, we look forward to your remarks.

Anthony Fauci:

Thank you.

William Pierce:

APCO is a proud sponsor of the Brazda Breakfast and proud to be a partner with the Alliance for Health Policy in these very important briefings. And so we’re really, again, looking forward to this morning’s event. I want to just remind people of a couple of things. There is a Q&A session, and please use the hand raising function in order to indicate whether or not you want to ask a question. With that, I’d like to turn it over to my colleague, Sarah Dash, president of the Alliance for Health Policy. Sarah.

Sarah Dash:

Thank you so much, Bill, and thanks to the rest of your team at APCO Worldwide for making this event possible and for your partnership in the Brazda Breakfast series. Good morning, everybody. It’s a real pleasure to be back with our reporter audience. And if this is your first time at an Alliance Reporter Briefing, welcome. We serve the health policy community as an unbiased resource to advanced knowledge and understanding. And an important part of our work is to serve as a resource for reporters and journalists. Today I’m so honored to welcome back to the Brazda Breakfast, our special guest, Dr. Anthony Fauci, who as everybody knows, has been at the epicenter of solving every infectious disease challenge of the last few decades.

Sarah Dash:

Dr. Fauci, the last time we spoke, it was 2018 and we were recognizing 100 years since the 1918 flu pandemic with a briefing about the path to a universal flu vaccine. And of course, today we’re in another precipitous moment in history. We’re definitely glad the science has evolved beyond 1918 standards. And we could not be more honored that you were here to explain to us the latest science and the path to hopefully a coronavirus vaccine and to be here to answer the questions from the reporters. So thank you so much, I’m going to turn it over to you for your opening remarks now.

Anthony Fauci:

Thank you very much, Sarah. It’s really a great pleasure to be with you today to address the Brazda Breakfast for Healthcare Reporters by the Alliance for Health Policy. It was good to see both you and Bill again. I’m going to be talking today about the obvious topic that has essentially gripped the entire planet, and that is COVID-19. And I’m going to talk a little bit about what the scientific and research response is. In January, very soon after it became clear that we were dealing with a brand new pathogen that was a coronavirus, I wrote a perspective in the Journal of the American Medical Association, and I entitled it, Coronavirus Infections- More Than Just the Common Cold.

Anthony Fauci:

And it wasn’t meant to be tongue-in-cheek, but I wanted to get the readers to appreciate as shown on this slide, that the coronavirus phylogenetic tree, if you look at it, there were four historical classical coronaviruses that are highlighted in yellow that are responsible literally forever for the common cold that we see about 15 to 30% of all the recurrent common colds are caused by those four coronaviruses highlighted in yellow.

Anthony Fauci:

However, in 2002 and 2012, we had our first encounter with a coronavirus of pandemic potential and actually pandemic capability. And that was the severe acute respiratory syndrome that we saw in 2002, which was the first pandemic coronavirus and the Middle East respiratory syndrome, which occurred in 2012. I don’t want to go into any amount of discussion about that. Most of you remember that as we had outbreaks that were able to be brought under control by predominantly public health measures. And then we fast forward to the end of 2019 and the beginning of 2020 when what emerged, again, the same sort of pattern as SARS and MERS jumping species from a bat to an intermediate host, to a human, we had the third pandemic potential. And as we know in reality, the true pandemic of a new coronavirus that emerged out of Wuhan in China, again, from a situation where we had a zoonotic jump from an animal to a human.

Anthony Fauci:

And here again in the phylogenetic tree, highlighted in yellow is what we’re dealing with today, the SARS-CoV-2. Just to get everyone on the same page, the disease is called COVID-19 for its appearance in late 2019. The virus itself is referred to as SARS-CoV-2 because of its phylogenetic proximity on the tree to the original SARS-CoV-1. Let’s fast forward to where we are as of yesterday, almost 19 million cases throughout the world and over 700,000 deaths. The United States has been hit harder than any other country in the world with close to five million cases and 156,000 deaths. The patterns of what has happened in our country compared to the European Union is very telling. As you could see in blue, the European Union countries peaked and came down to a relatively manageable baseline.

Anthony Fauci:

Whereas in the United States, we peaked, but we never fully came down to a baseline which hovered around 20,000 until the surges that we saw in the Southern states of Florida, Texas, Arizona, and California led to daily peaks of cases as high as 70,000, the most recent of which is approximately 60,000. And the reason is we never really fully, as it were, shut down in a uniform way throughout the country, although some states and cities did very well in that regard. Again, look at the disparity in what’s going on at different regions of the country, why it’s very dangerous and sometimes misleading to be able to talk about the country in a unidimensional way. The Northeast, particularly when the pandemic was driven by the New York metropolitan area, had a peak and came right down to baseline. Midwest sort of hovered around a lower level.

Anthony Fauci:

Whereas what we’re seeing in the South and the West now is you can see the peaking of cases, both in the Southern states and in some Midwest and other states. That’s the epi, let’s quickly look at the virology. As I mentioned, this is a beta coronavirus. It has a number of structural proteins. The one that’s important is the spike protein. Actually those spikes that come out of the outer covering of the virus is the reason why when you look at it under electro-microscope, it looks like a crown with the spokes that come out of a crown and hence the word coronavirus, which stands for crown. The receptor is an ACE2 receptor on the body cells. And those cells are distributed widely throughout the body, including the upper and lower respiratory tracks. The transmission is very clear.

Anthony Fauci:

It’s a respiratory virus with transmission among people at close contact, particles that remain in the air over time, infected surfaces, then less so than person to person. The virus is found in multiple body fluids. However, their role in transmission is unknown. Animals, including domesticated ones can be infected, but they are not felt at all to be a source of human infection. One of the most perplexing things about this virus with good news, bad news is that about 40 to 45% of the infections are without symptoms. That’s good. The bad part about that is those people can actually spread infection. So you have insidious spread in the community by individuals who are not even aware that they’re infected. The clinical presentation resembles a flu-like syndrome as shown by the percentages of signs and symptoms on this slide.

Anthony Fauci:

However, there is a very unusual situation that we rarely see in other diseases which is a loss of smell and taste, which actually precedes the onset of the respiratory syndromes. Again, one of the things about this disease, this pathogen that is so unique is the extraordinary, broad spectrum of diseases. Whereas the percentage of 40, 45 people who have no symptoms at all confuse the picture because others can have mild illness, moderate illness requiring staying at home for days to weeks with some sequela following the clearing of the virus, some requiring hospitalizations, and some even intensive care, intubation, ventilation, and even death. So it is a broad spectrum of manifestations. If you look at the relative proportion of those, more than 80% have very mild to moderate symptoms, whereas about 15 to 20% have severe symptoms. And depending upon the age and the underlying condition, the fatality rate really varies from a few percent to well above 15, 20%.

Anthony Fauci:

But as a whole, when you count everyone, including those who are asymptomatic, the fatality rate relatively speaking is quite low. However, if you’re in a risk group for progression, it is relatively high. The manifestations of severe disease are mostly respiratory with acute respiratory syndrome, but we’re starting to see a number of other organ systems that are involved. And we learn more about that literally every day and every week, such as cardiac, kidney, neurological, hypercoagulable leading to microthrombi and emboli, leading to strokes in otherwise relatively healthy people and an unusual syndrome in children of inflammation that resembles a syndrome called Kawasaki disease. Again, we’re just starting to learn more about that. Non-pulmonary complications, as I mentioned in the previous slide, are shown here.

Anthony Fauci:

The people at risk for severe COVID illness are older individuals and those with underlying diseases. What about those underlying diseases? What are they? Those that are associated with absolute a strong increased risk for severe disease are heart conditions, kidney, pulmonary, obesity, sickle cell disease, and immunocompromise from a number of conditions, including transplantation. Those that may confer an increased risk are things like asthma, type one diabetes, hypertension, and a variety of other syndromes that are shown here on this slide. Another thing that we’ve noticed that is very clear is the racial and ethnic disparity with the pervasive disparity among minorities, including African Americans, Latinx, and American and native Indians. Here, we show the relative rate of hospitalization among for example, black non-Hispanics is about five times greater than what we see with whites.

Anthony Fauci:

So not only do they have a greater chance of getting infected, they clearly have a greater chance of having a serious outcome. And as shown here, when you look at death above and beyond hospitalization, take a look at the dark bar on the top of black or African Americans at 71 at 2.5 times [inaudible 00:13:12] in white, which is 28. When you’re looking at the deaths per 100,000. The test for SARS-CoV-2, a molecular test for the virus, antigen test for the protein, as well as antibody test, which does not detect the virus but tells you that you have been exposed and infected and likely recovered. The NIH has put together a guidelines panel, which is a living online document that you can access through COVID-19 treatment guidelines at nih.gov that give you the up to date clinical data on where we are with therapies.

Anthony Fauci:

And in that regard, two therapies, Remdesivir and Dexamethasone, which I’ll get into in a moment, have been shown to be effective, and I’ll get to that. There are other examples of things that we’re investigating such as direct antivirals, convalescent plasma, monoclonal antibodies, two studies which Dr. Francis Collins, Janet Woodcock, and I announced yesterday, and then other companies like Regeneron have already been in clinical trial. There are immunomodulators and anticoagulants, but let’s look at Remdesivir. The first drug that showed in a randomized placebo controlled trial to diminish significantly the time it takes to recover. It was a trial in over 1,000 patients, not only in the United States, but Europe and Asia.

Anthony Fauci:

Another study from the UK showed that the common steroid, Dexamethasone, if given to hospitalized patients with advanced disease, including requirement of a ventilator and requiring oxygen diminish the death rate significantly when compared to control. There are personal things that one can do to prevent acquisition and transmission. Hand-washing, avoiding close contact, avoiding crowds, covering mouth with sneezes and coughing, and regular cleaning and disinfecting of touched objects. When you talk about broad public health measures, there’s the social and physical distancing, the stay at home orders, modification of school schedules, bans on public gatherings, closing bars, travel restrictions as well as contact tracing and quarantine.

Anthony Fauci:

It is shown that the physical distancing, including face masks, eye protection, and others has dramatically decreased both the acquisition and the transmission of this infection. And in fact, if you look at the number of deaths that could have been saved and the decrease in number of new cases that social distancing enacted nationally in multiple countries throughout the world show the same thing consistently. Finally, with regard to vaccines, we’ve taken a strategic approach because multiple vaccine candidates are in the queue to go into advanced testing. Two of them just last week on July 27th, the Pfizer product and the Moderna product went into clinical trial in the phase three. And hopefully in the next several months, we’ll know whether or not they’re safe and effective. These are the entire list of vaccine candidates that the federal government is supporting.

Anthony Fauci:

Others are being done independently in other countries, including the UK, China, and Russia. There are nucleic acid like them MRNA, viral vectors like VSV, protein subunits. As I had mentioned, the one that we spoke about just a moment ago is in a phase three trial of 30,000 individuals. And again, to repeat, hopefully we will get an answer within a reasonable period of time measured by the end of this coming year and the beginning of calendar year 2021. For those who have any interest in getting involved in any of the studies of the prevention studies, you can dial into on your web coronaviruspreventionnetwork.org. And in that group, there are already over 300,000 people who’ve expressed interest in being part of some of the prevention trials, including vaccines.

Anthony Fauci:

So I’d like to stop there and I’d be happy to entertain questions about anything that I’ve said so far or any other issues that you’d like to bring up. Thank you.

Sarah Dash:

Thank you so much, Dr. Fauci. We already have some questions from our reporter audience, and this is really their time. So I want to give them the chance to answer. If you have a question, please use the raise hand feature and I will allow you to talk. Then you will unmute yourself and ask your question. Please identify your name and your affiliation before asking your question. Unfortunately, we will only have time for one question per person. We’ll try to get to as many as we can. Genevieve, please go ahead.

Genevieve:

Good morning, Dr. Fauci. I just want to know if you remember our wonderful meeting on January 3rd, 1992 at the NIH with [inaudible 00:18:42].

Anthony Fauci:

Yes, of course I do [crosstalk 00:18:47]. I hope that you are well, welcome to the program.

Genevieve:

I’m quite well, and I appreciate your continued your work.

Anthony Fauci:

Thank you.

Sarah Dash:

Please ask, did you have a question for Dr. Fauci about the content? Okay. We’ll go to Rich Daly next. Rich, go ahead. Rich, please unmute yourself.

Rich Daly:

Hi. Can you hear me?

Sarah Dash:

Yes.

Rich Daly:

Hi. Rich Daly with Healthcare Financial Management Magazine. I just wanted to check, Dr. Fauci, if you or taskforce is looking or have looked at the possibility, some researchers tell me that this coronavirus is not going away, that it’s going to be with us for decades, and that any vaccines that are approved may only protect half the population and society needs to prepare for that possibility. I just want to know if that’s something that’s been on the table, it’s been looked at. Do you have any thoughts on that and then if it’s affecting what we’re doing now at all?

Anthony Fauci:

Well, I think we need to be careful when you say it’s not going to go away. Remember there’s only been one virus in the history of the planet that has been eradicated, and that’s smallpox. So people get a little bit confused. You can very well control and essentially eliminate from any given country, the virus. We hope we can do that, mainly very adequately control it with a combination of public health measures and a safe and effective vaccine. We don’t know how effective a vaccine is going to be. We hope it’s quite effective to the tune of 70, 80, or more percent effective, but we don’t know that until you do the randomized placebo control trials. So I think when you talk about 50 to 60%, that’s an assumption that’s based on the statistical projection of the number of people you need in the trial to prove or disprove efficacy.

Anthony Fauci:

So be careful about that number. We shouldn’t be saying it’s only going to be 50% effective because it very well may be much more effective than 50 to 60%. But again, we don’t know. Regarding what we need to do and how long this is going to be around, we hope as a pandemic threat that we are really on the cusp of seeing the end of it as we do public health measures and a vaccine. You may have some lingering of infection around that might come back in a seasonal way, but hopefully with the technologies and the vaccines and getting much, much better in our public health measures, that we’ll be able to control it in a way that is not a pandemic or an epidemic threat. But what I want to just mention, that is up to us as a society.

Anthony Fauci:

If we do the fundamental things that we’ve been talking about for so long, masks, physical separation, avoiding crowds, outdoor things better than indoor, you can get the level down low enough that you can then control it much better with or without a vaccine. So on the one hand, we’re dealing with a serious situation, but we shouldn’t be in despair that it is within our power, which it is to control this.

Sarah Dash:

Thank you, Dr. Fauci. Noam Levey, you are next.

Noam Levey:

Hi there. Can you hear me?

Anthony Fauci:

Yup.

Sarah Dash:

Yes.

Noam Levey:

Thanks so much for speaking with us, Dr. Fauci. I’m going to ask this knowing that there are an enormous number of variables with the vaccine, but assuming that a vaccine is found to be roughly 70% effective, can you give us a sense of how widely vaccinations would have to be done in the United States in order to get to a point in which the more extreme measures such as widespread mask wearing and no indoor mixing and so forth could reasonably be [inaudible 00:23:02]?

Anthony Fauci:

We do not know yet what the precise level of protection you need in the community to get what we call herd immunity. And as you know, for those of you not familiar with that, herd immunity is a certain percentage of the people who are protected, even though it isn’t 100% percent, when you get to a certain level that are protected, you have what’s called an umbrella protection of the entire community because so many people are immune that the virus doesn’t have any way to really, really generate any momentum, that’s called herd immunity. We don’t know what that number is. There are some estimates anywhere of 50%, 70%, 75%. We don’t know. But what we want to do is to have a combination of people who are immune because they’ve recovered and there are many of those I can tell you, plus the amount of protection that we can get with a virus, excuse me, a vaccine, which could be 50, 60, 70%.

Anthony Fauci:

I believe we can do that. And that’s the reason why, even though we’re having a very difficult situation right now, I believe that together with a vaccine, we could get to that percentage. Though I wouldn’t want to put a number down because I don’t have scientific firm data. I believe it’s probably somewhere between 50 and 75%, but I don’t know for sure.

Sarah Dash:

Thank you, Dr. Fauci. We have another question in the chat about the vaccine. So I’ll ask it now, from Drew Armstrong at Bloomberg News, can you lay out the distribution plan for a vaccine, whether it be for small, early group or wider use, if it’s going to be high risk groups first, can you comment a little bit about the current thinking about who gets it first and maybe also, if you could comment on some of the racial and ethnic disparities that you alluded to when it comes to what a distribution plan for a vaccine might look like. Thanks.

Anthony Fauci:

Okay. Let’s assume the scenario that I believe we’ll be able to reach that within a reasonable period of time as we’re into 2021 if we get a safe and effective vaccine, which as I mentioned, I’m cautiously optimistic that we will, that we will have enough vaccine to the tune of hundreds of millions of doses. That what you would like to see is to ultimately get everybody vaccinated. Because if you want to control a pandemic, you really want as many people as possible. So I would see something similar to what we see with influenza, where you really recommend that everybody can get a vaccine and should be vaccinated. But having said that, to the precise question of the person who asked that question, that is that when you start off doing vaccinations, you’re not going to have hundreds of millions of doses on day one.

Anthony Fauci:

So you’ll likely have to do some sort of prioritization, both for the numbers of doses, as well as for the logistics of just getting the vaccination done. Traditionally, when you’ve asked that question, the advisory committee on immunization practices, which is a committee that advises the CDC, would come out with a prioritization. This time, that process is being complimented by a group put together by the National Academy of Medicine, which was solicited by the NIH and CDC to compliment that decision-making process. And that’s when you get together a group of ethicists, vaccinologists, scientists, community people to try and figure out what the type of priority. Generally, though I’m not going to speak for them yet.

Anthony Fauci:

Generally, the priority is to get healthcare providers who are going to be putting themselves at risk to take care of people, namely, the first responders, as well as those at high risk for complications like as the elderly and those who have underlying conditions. Regarding the racial disparities, we are putting a lot of attention and work into making sure we have equitable distribution, both in the vaccine trial itself, as well as in the distribution so that we don’t have a disparity where those who are in the racial and ethnic minorities do not have what I call equitable and fair representation, both in the trial and in the distribution. We’re going to be trying very hard by community outreach and community engagement to get those people involved in the trials.

Sarah Dash:

Thank you, Dr. Fauci. Shannon Firth, you can go next. Go ahead and unmute yourself.

Shannon Firth:

I’m I unmuted? Hello?

Sarah Dash:

All set.

Shannon Firth:

Okay. Thank you. Hi, Dr. Fauci. Thank you for doing this interview. I wanted to ask you a little more on vaccines directly. If African Americans and the people in the black community are two and a half times more likely to become sicker than white people, should they be given priority? And since you sort of touched on that already, can you say any more about what we should be doing to ensure strong access to care given that patients who are more likely to get to the richer hospitals, academic centers may receive better treatment?

Anthony Fauci:

That’s a very good question. I’m going to leave the prioritization. I don’t want to jump ahead of the group that’s going to recommend it, but as I said, it’s likely going to be those who are at higher risk. And clearly, when you look at the ethnic and racial minorities, they in fact in many respects are at higher risk. So let’s talk about those risks. There are two types of risks and I have called it kind of like a double whammy of a disparity. One, the risk of getting infected. And the other, two is the risk of getting a serious outcome if you are infected. Racial and ethnic minorities, including as I mentioned, black African Americans, Latinx, and native Americans have a high risk of getting infected. Because if you look as a demographic group, though you don’t like to generalize, here is where generalization makes sense.

Anthony Fauci:

Because as a group, on the nature of the kinds of jobs they have, it is less likely that they can protect themselves by being in a position where they can do things virtually. They’re usually out in the community with the essential jobs that require contact, contact with people who might be infected. So we do know they have a high risk of getting infected. The other thing is that they have a higher risk of getting complications. The one about risk of infection, that’s something you could do something about right now. You can make sure that resources for testing the return of the result of the testing, the access to healthcare, you can concentrate resources now in areas where you have demographic concentration of populations at risk, that’s something that would require mobilization of resources, like testing and access to clinics.

Anthony Fauci:

The longer term one, the social determinants of health, which allow minorities to have a higher incidence of diabetes, hypertension, heart disease, obesity, are things that we require a decades long commitment to change those determinants so that over time you won’t have people who have such a higher incidence of those underlying conditions. It’s not something you could change overnight, but it’s something you could start doing something about right now.

Sarah Dash:

Thank you, Dr. Fauci. We have a question from Patrick Martin of NBC, and I’m going to let him go ahead and ask it live. Patrick.

Patrick Martin:

Yeah, I’m here. Hi, Dr. Fauci. Thank you for taking the time. The biggest thing or what we’re seeing lately is spread in a younger population. So I was just wondering, what is the strategy to reach this younger population and have them know how dangerous this spread is in the younger population?

Anthony Fauci:

That’s a great question. And that is what I spend most of my outreach effort in the press talking to people like yourselves who can get the word out. And that’s the reason why I enthusiastically do this, because if you look at what’s going on right now, as I said in my formal presentation, there’s good news, bad news about the percentage of people who don’t have symptoms. Because if you look at the charts, it is much, much more likely that a young person will not have a serious consequence of infection. Namely, they could go without symptoms at all, or the symptoms might be minor and mild, which means that the general understandable feeling in an innocent, inadvertent way is that if I get infected, the likelihood is that I’m not going to have any problem. So why worry about changing my behavior if I’m not going to have any problem with it?

Anthony Fauci:

That assumes that you are in a vacuum and that your getting infected has nothing to do with anybody else. That is incorrect. And the message is, even though as a young, healthy, vibrant person who likes to go out and do the kind of fun things that we all like to do, be in a crowd, why wear a mask, go to a bar, do those kinds of things. What you don’t realize is that if you get infected, even if you have no symptoms, you are part of the propagation of the pandemic because your getting infected even though you’re without symptoms means it’s likely you’re going to innocently and inadvertently infect someone else who will then infect someone else who may wind up having a serious consequence. So you’re not in a vacuum. You can be part of the problem of propagating the outbreak, or you can be part of the solution of protecting yourself.

Anthony Fauci:

Because if we want to get those numbers down and we want to open up the economy and open up the country so that you can actually ultimately get back to some form of normality, you are part of the process of getting us there. And so don’t be the weak link in the chain, be a very strong part of the chain of ultimately getting us down. That’s the message we’ve got to get to young people, because obviously they’re not doing anything deliberately or maliciously, but what they’re doing is inadvertently, they’re propagating the outbreak.

Sarah Dash:

Thank you, Dr. Fauci. And if I could maybe follow up on that, speaking of the risk communication, we know people with underlying conditions are at higher risk, older people are at higher risk, but we’ve also read and heard tragic stories about younger people who do get sick and who do even die. And we’ve also been hearing that even those who recover, it’s not necessarily a complete and total bounce back. Could you speak to that a little bit?

Anthony Fauci:

Sure.

Sarah Dash:

And how do we communicate that to folks?

Anthony Fauci:

Well, and this is not a scare tactic. You got to look at the science and go by the data. Yes, the chances of your getting a serious outcome is much, much less than an individual who goes on because of an underlying condition. But what we’re seeing more and more of now are two things. Young people who actually get a serious outcome of the disease itself before they even recover and clear the virus. I have seen situations, one close to home where a very close friend of a member of my family was a 32 year old, vibrant, healthy, wonderful young man who got COVID and actually died of complications involving his heart. So it can occur. Also, we’re seeing a much larger number of people who get COVID, have to stay in bed for a while, get some symptoms, but then when they think they recover, they come back and find their energy level is low.

Anthony Fauci:

They can’t do some of the things they want to do. They have chronic fatigue type symptoms. They just don’t get back to normal very quickly. In fact, the study showed that a substantial proportion of people, even after they’ve cleared the virus can go anywhere from three to four weeks or more not feeling normal. And I personally know colleagues, scientific and public health colleagues who’ve gotten ill and months later have still not got back to normal. So this is not a trivial infection. For most people do really, really, really well, but you don’t want to be one of the smaller percentage that get into trouble.

Sarah Dash:

Thank you so much. All right. We have a question from Christine Lehmann, and I will say we have about seven minutes left. So we’re going to try to keep them quick and keep them moving. Thank you. Christine, go ahead.

Christine Lehmann:

Hi, Dr. Fauci. I’m representing WebMD Health News. I wanted to ask a little bit more, if you could explain the risk of eye infection from COVID and I think you may have said something about wearing goggles to protect your eyes-

Sarah Dash:

Dr. Fauci, just to repeat the question, the question was about eye protection and wearing goggles. So what is that new guidance about, and what can you say about that?

Anthony Fauci:

Well, it isn’t a new guidance. It isn’t a formal recommendation, but we know that the virus can enter through mucosal surfaces, and mucosal surfaces on the upper face here it’s the mouth, the nose, and the eyes. So that came about because when I was speaking to a group of teachers, one of the teachers who asked a question in the Q&A similar to the Q&A we’re doing now said in the classroom, many of us, because we get such close contact with the children and children often, they don’t cover their sneeze or their cough, we want to make sure we add an extra degree of protection. So many of us wear either goggles or face shields, and face shield’s something like this, which is a face shield. Some of the teachers are doing that.

Anthony Fauci:

So the question is, if you have the availability and the capability of wearing goggles, it’s not a formal recommendation yet because studies have not been done as together with masks where studies have clearly been done. You could do it. If I were in a situation where I were in a classroom and I had a lot of children with sniffles and things, I might very well do it. It certainly can’t hurt, and if you can do it, it might help.

Sarah Dash:

Great. Thank you. Well, since you mentioned schools, we do have a question in the chat from Stephanie Abs at ABC News. I’ll ask that. Are you concerned, Dr. Fauci, that the media or the public are putting too much emphasis on a potential vaccine? And as we’re seeing schools start to reopen and rallies, et cetera, are there other things that, is that going to create a false sense of security or are there other things we ought to be focused on?

Anthony Fauci:

I don’t think we’re putting any emphasis on a vaccine. We don’t have it yet. So let me make it clear about emphasis. What we’re saying is that we’re trying very hard to ultimately get a vaccine that might be available by the end of the year or the beginning of 2021, but that’s many months away and children will be going back to school in certain regions between now and then. So let me make sure there’s clarity of message here. Do not abandon by any means the public health measures in anticipation of a vaccine. When you’re talking about public health measures, there are many, many things that we can do, but you can distill them down to five or six that everyone should be doing, masks, physical distancing, avoiding crowds, outdoor better than indoor, washing your hands with soap and water or with an alcohol-based type of sanitizer. And if you’re in a particular region and the type of person that would do, stay away from bars.

Anthony Fauci:

With regard to schools, it’s important that the general default position should be we should try as best as we possibly can to bring the children back to school for a number of reasons, the two most important. A, important for their psychological health, and in some sections, regions, counties, the school provides a source of nourishment for the children because they get their breakfast and lunch there. Also, the secondary, downstream, unintended ripple effects on families who have to dramatically modify their work schedule if the children are not in school. Having said that, there’s a big however or a but there, and the however is primary and paramount consideration is the safety, the health, and the welfare of the children and the teachers. So when you look at the United States as a big country, we have certain areas refer to green states and regions where the level of infection is so low, we should have no trouble getting the children back to school.

Anthony Fauci:

There are others with this level of infection that is modest, kind of yellow states as it were where you may do some modification, alternating hybrid, in-person by virtual, some physical distancing, maybe some outside classes. We leave that to the locals to figure out a way, how you can safeguard the children and still do that. And then there are some areas like we’ve seen over the last couple of weeks to months of very significant viral activity. Under those circumstances, you’ve got to use common sense. You look at the CDC guidelines and you look at the common sense that it may not be prudent to get the children back to school in those areas. So you’ve got to say, try as best as you can to get the children back to school, but one size does not fit all. And I refer you to your local health authorities, but also to the CDC guidelines on opening schools and what one can do to mitigate against infections in schools.

Sarah Dash:

Great. Thank you, Dr. Fauci. And we do have one other vaccine question, but I do just want to ask since there’s a question about the fall. Meg Tirell, do you want to go ahead and ask your question? Unmute yourself please.

Meg Tirell:

Sure. Thank you. Hi, Dr. Fauci. I’m just wondering your thoughts on the upcoming fall and flu season potentially. How are you looking at that? How it might coincide with COVID-19. We know the flu shot makers are increasing their supply this season. Is there any possibility we could also see a milder flu season if we’re all doing this physical distancing and better hygiene?

Anthony Fauci:

Thanks, Meg. Nice to hear from you. Yes, that’s a great question. There are a couple of potential scenarios, some that we can guarantee and some that we have to wait and see. First of all, as we get into the fall and the flu season that we experience every year, the first thing we want to make sure is that as many people get vaccinated against influenza as we can possibly get vaccinated. We did, I think 170 something million people last year. We want to do even more than that this year. And as you know, the recommendation for flu shots has always been that anyone six months of age or older should get vaccinated. Now, what about what we’re going to see? A couple of potential scenarios. It might be that the mask wearing, the physical separation, the avoiding crowds, the hand washing that we’re doing now for COVID might really, really blunt the flu season.

Anthony Fauci:

And we hope that that’s the case in the sense of less flu infections. The other thing that’s interesting is that there are things called niches for respiratory viruses. Remember, in 2009, in the spring, Meg, when we had the cases of H1N1 swine flu that came in the spring, disappeared in the summer, and then as we got into the fall, we were expecting a typical flu season of H3N2, and the respiratory infections of H1N1 completely bumped off the map H3N2 and you add a flu season that was predominantly H1N1. So it is conceivable that this niche type of approach would be that if you have COVID of any extent, you might have two reasons to have less flu. One, because you’re doing the kinds of things of public health, masks, et cetera. And two, it might get bumped out by COVID. What my hope is that both of those will be down.

Anthony Fauci:

That vaccination for flu, public health measures for flu and COVID would have us be in the situation where both the flu season is blunted and we have very little COVID. That’s a goal that we should aspire to that I think is possible.

Sarah Dash:

Thanks, Dr. Fauci. May I ask you, we haven’t talked a lot about the business community and the private sector here. What is their role in communicating the risk and facilitating some of these public health measures? What would you say to the business community?

Anthony Fauci:

Well, I think the business community is absolutely critical, both in propagating the message and operationalizing the message, because I can see, in stores that I go in, you see signs, “No entry without a mask,” “Stay six feet apart.” That’s the private sector. That’s not a government sign up there. So when you have public health officials and scientists and physicians like myself and Dr. Burks and Dr. Redfield and others talking about these things, those are government officials, but there’s so much out there in the private sector, not only to talk about it, but to operationalize it, I think their role is absolutely critical.

Sarah Dash:

Great. Thank you, Dr. Fauci. And I know we’re getting close to our time. I’d just like to ask you one more question that ties up some of the questions we’ve gotten in the chat. As you look at the respective roles of the government and the private sector, now, again, back to developing the vaccine, back to developing the treatments and the unprecedented research collaborations that are taking place, has the scale of this pandemic changed your views at all on how they work together? What can you say about the research collaborations and what we can learn from that going forward?

Anthony Fauci:

Well, it’s been spectacular, I have to say, Sarah. I’ve seen collaborations to a greater or lesser extent, but the public private partnerships, the collaborations within government of different government agencies like Operation Warp Speed is the DOD, Department of Defense and HHS, Health and Human Services working together in a way that’s really, really very gratifying to see scientists working together, exchanging ideas, exchanging data, publications coming out rapidly. You could send something in that used to take seven months to come out. It comes out in a week or two. So we’re really getting a lot of synergy and cooperation and collaboration, which is really, really good to see.

Sarah Dash:

Well, that’s great to hear. I know we’re really getting close to time and we want to respect your time. We know that you are one of really the most in demand people in the world right now as it relates to the science. Is there anything else you’d like to share with this audience, with the scientific community, with the general public? Anything else we didn’t cover?

Anthony Fauci:

No, I didn’t, but I think what I always like to leave a message is that it is up to us. If we pull together, we can control this. We can get it down to a level that’s not pandemic or not epidemic. We can get it to a way where we can open the country and get back to some form of normality. We can do it. Sometimes when you’re really almost fatigued with this, you get to spare and say, no. If everyone pulls together with no weak links in the chain, I am absolutely certain because it’s been shown to happen that we can get this down and under control without necessarily needing to lock down. We can do it by prudent, opening up according to the guidelines.

Anthony Fauci:

It shouldn’t be lock down or let it fly. There’s a way in the middle there where we can open up the country and get the economy back. We can do it by prudent following of the guidelines.

Sarah Dash:

Thank you so much, Dr. Fauci. Well, on that note, we are so grateful for your time and for your incredible expertise. Thank you so much for your service and for joining us today. Thanks to our audience. Sorry, we couldn’t get to all of our questions, but check out our website, allhealthpolicy.org for a recording later and for your evaluation form that you will receive in the email. Dr. Fauci, it’s been a true honor.

Anthony Fauci:

Thank you, Sarah. Thank you, Bill. Thank you for having me with you. I appreciate it.

Sarah Dash:

[crosstalk 00:51:08]. Thank you.