Recently, Dr. Anthony S. Fauci offered Jefferson Health clinicians some expert insights into the public health and scientific challenges associated with the COVID-19 pandemic.
COVID-19, caused by a new strain of coronavirus, SARS-Coronavirus-2, was first recognized last December in China. In the ensuing 10 months, it has been the center of a historic global pandemic, the likes of which has not been seen since the 1918 “Spanish flu.” As of late October, COVID-19 has reached almost 39 million cases and more than one million deaths worldwide, with no end in sight. The U.S. has been hit hardest with nearly nine million cases and over 225,000 deaths.
Recently, Dr. Anthony S. Fauci, Director for the National Institute of Allergy and Infectious Diseases at NIH, shared with Jefferson Health clinicians his expert insights about the public health and scientific challenges associated with the COVID-19 pandemic. Here are some highlights of what Dr. Fauci had to say on transmissibility, the economy, herd immunity and more during Jefferson’s virtual “Grand Rounds.”
On COVID-19 transmissibility:
“You don’t need to be coughing or sneezing. Anything as simple as breathing, speaking loudly or singing has been demonstrated to be responsible for transmission. Places of higher risk are indoor dining and restaurants–particularly at full capacity and with poor circulation–gyms, bars, coffee shops, and certain church and religious gatherings. A very important component of this disease, which really distinguishes it strongly from other respiratory infections, is that about 40 to 45% of infected people are asymptomatic, and individuals without symptoms can account for a substantial proportion of the transmission to uninfected individuals.”
On public health vs. the economy:
“Taking public health measures to reduce transmission–such as universal wearing of masks and cloth face coverings, maintaining physical distances of at least six feet where possible, avoiding crowds and frequent washing of hands – does not mean shutting the country down. You can cautiously and prudently continue to try to open up the economy. But opening up carelessly would be amenable to the easy spread of this virus.”
On herd immunity:
“The reason why we’re very concerned about herd immunity if we just protect the elderly is that people of any age are at increased risk for severe COVID-19 illness if they have certain underlying medical conditions. They account for about 40% of the general population. Among the most important of these comorbidities are obesity, diabetes, COPD and smoking. Also disturbing are the profound racial and ethnic disparities, with African American, Latinx, Native Americans, Alaska natives, and Pacific Islanders having what I call a ‘double whammy’: the first, a higher incidence and prevalence of infection because of employment that can increase their risk of exposure; the second, their higher percentage of those underlying co-morbidities. So if we decided to let everybody get infected to build up herd immunity, a lot of people would have to die before we achieved it.”
“The way you build up herd immunity is by developing a safe and effective vaccine.”
On vaccine development progress:
“We are cautiously optimistic that we will know by November or December whether we have a successful, safe and effective vaccine. The government has already put hundreds of millions of dollars into the production of vaccine doses. So if, in fact, we do have successful vaccines by the end of this year, we will start distribution then or at the beginning of 2021. Distribution will very likely start with individuals with the most need, such as healthcare providers who put themselves at risk, as well as those with underlying conditions.
“To me, the biggest obstacle is getting the people who need vaccination vaccinated. We are in a very difficult, complicated situation right now, with an anti-vaccine sentiment prevalent in the country. To solve that, I think we’ve got to put a lot of effort into community outreach. Years ago, during the HIV era, NIH put together programs to get community people–reps who the people in the community trusted–not people who they didn’t understand or didn’t relate to, but people they trusted and understood. The most paradoxically tragic thing we could have is a really safe and effective vaccine and the right people don’t want to take it because they don’t trust us. That is a possibility that we’ve got to address and make sure we do something about, which we are trying to do.”
On how long we’ll need to wear masks:
“I don’t anticipate that like measles, we’re going to get a vaccine that’s 98% effective. I would be happy if we had one that is 70-75% effective. I don’t think there’s going to be a lot of enthusiasm to take it early on, which means we’re not going to have a profound degree of herd immunity for a considerable period of time–maybe not until toward the end of 2021 or into 2022. Until then, I feel very strongly that we’re going to need to have some degree of public health measures continue–maybe not as stringent as they are right now, but certainly mask-wearing and avoiding congregate settings.”
On healthcare disparities:
“Healthcare professionals are witnessing profound disparities. We want to make sure that we push society to address the social determinants of health that are at the root cause of all of this. This isn’t something that just happened overnight. This is what’s been going on for decades and decades. If we get one lesson out of this, we’ve got to commit our country, and what we do as citizens, to make sure that these are unacceptable.
“So when we get out of this, which we will, we’ve got to have corporate memory that when the next challenge comes back, it’s going to be the people who are the minorities, who are poor economically, and others who are going to suffer the most. So I think what we need to do is to act as citizens, and not just as healthcare providers.”
Watch the entire Jefferson virtual “Grand Rounds” here: