The Daily - A Conversation With Dr. Anthony Fauci

Episode Date: April 2, 2020

Today, we speak with Dr. Anthony S. Fauci, the nation’s leading expert on infectious diseases, about his experience in the trenches of the government’s response to the coronavirus crisis. “We are in a war. I mean, I actually think this is exactly what generals or leaders in real, you know, violent combat wars feel.”For more information on today’s episode, visit nytimes.com/thedaily. Background reading: Dr. Fauci has been clear about the need to practice social distancing to contain the spread of the virus, but that stance has made him the target of online conspiracy theorists.This week, scientists with the coronavirus task force used models to deliver an update on the expected spread of the disease, projecting the coronavirus could kill up to 240,000 Americans. They pledged to do everything possible to reduce that number.

And I'll just be over here. What do I need to do? Put on the headset. Just one piece. Put the one with the... Yep, that one. Under... Oh, I see.

I see. Hello? Dr. Fauci. Yes, hi. How are you, sir? Yeah, I'm fine, thanks. How are you doing? I'm doing great.

Thank you very much for being with us and for recording yourself above and beyond. Thank you. Thank you. So, Dr. Fauci, you became head of the National Institute of Allergy and Infectious Disease in the 1980s when the AIDS crisis was becoming a national issue. And then you stayed in that role through the Ebola outbreaks, SARS, H1N1, swine flu. At what point did you realize that the coronavirus was going to be of an entirely different speed and scale than those when it came to the U.S.? Was there a moment where that became clear to you? Yeah, I think it relates to the issue of its efficiency of transmissibility. So the thing that rang the bell for me that made me say, uh-oh, we really have a problem here, is when the coronavirus was

first identified in very early January, it was clear that this was something that had jumped from an animal species in Wuhan, China, to humans. So that was the first red flag for me. Then as soon as I found out, which was literally days to a week or so later, that it was really circulating in China, likely for several weeks, it became clear to me that we could potentially be dealing with a global catastrophe. And that was somewhere in the middle of January when it was clear that China was seeing not only extremely efficient transmissibility, but also a disturbing degree of morbidity and mortality. Those two things together are the things that really are

the makings of a public health nightmare. And that's exactly when I realized we were in really bad trouble. From The New York Times, I'm Michael Barbaro. This is The Daily. Today, a conversation with Dr. Anthony Fauci. It's Thursday, April 2nd. Let's explore how we got to where we are. You came out a few days ago and you told Americans that up to a quarter of a million of us could ultimately die from this moment where the situation is so dire.

But I want to focus for a moment on the steps that could be taken to limit that back in the beginning. I know people like you are loathe, justifiably, to second-guess decisions in the middle of a crisis. But I want to zero in on a couple of items in particular. For example, by the time you all decided to ban travel from China, I think that was the end of January, January 31st, the WHO had detected infections in multiple countries, not just China, but I think it was South Korea and Japan, meaning that any travelers from those countries could bring the virus to the U.S. Was this a moment to begin essentially sealing off the U.S. from international travel, or was the die already cast by that point? realization of what might happen. In fact, you might recall, we received a lot of criticism for doing that, and even more criticism for sealing off and restricting travel from Europe.

So I think that given the circumstances, we were ahead of the curve, and we acted, you know, quickly, relatively speaking. I mean, obviously, if you knew everything that was going on as it was happening, you might have acted sooner. But when you're dealing with viruses, they stay silent. And what you see now is the reflection of what likely happened a few weeks ago. And that's the reason why you probably remember, I have always said that if I get accused of overreacting, I feel good, because it's probably that I'm acting appropriately enough as opposed of overreacting, I feel good because it's probably that I'm acting appropriately enough as opposed to overreacting. But when it comes to overreacting, if you suspect a virus like this is invisible, why not restrict travel earlier, right? I mean, I think the gap

between when we restricted travel from China and Europe was over a month or so. Yeah. Yeah. No, I mean, I don't think we could have done it early. I think we did it quite early and even- And why couldn't we have done it early? Because of the resistance? Because it wasn't practical? Because people wouldn't have understood it? No, it wasn't very clear.

I mean, right? When you're dealing with situations like that, retrospective scopes are really great. Fair enough. It makes things very, very clear. But when you're living through the fog of war, it isn't that easy. You will always say everything I've ever been through in the 36 years that I've been doing this as director of the Institute, there's always that what could have been or what should have been. I mean, that's

always the case. But I think in this case, really, just looking at it the way it is, I think that we acted pretty quickly in trying to cut off travel. So I wouldn't dwell on that as being, you know, what might have happened. It has felt like the delay in testing meant we didn't recognize the scale of the problem early on. Because as you said, this is invisible, but it's not invisible to tests. It may just be invisible symptomatically. So assuming that the horse had left the barn and the virus had gotten into our system, I know you don't run the CDC, but I assume you realized pretty quickly

what it meant that the U.S. was testing so few Americans. Where does that rank for you as a problem in our early response as this was starting to spread? That's a reasonable question. I think it, you know, it obviously was a problem. I perceived it as a problem early on. Unfortunately, the systems that were originally set up in the relationship between the CDC and the public health community in the state and local level, was really not geared for the massive type of testing that would be needed, that would embrace and require the participation of the private sector, particularly the companies that do the kinds of lab tests that you and I get when we go to a regular doctor's

appointment. So it was not suited for that. It is right now, today, ramping up to essentially make the private sector the major driving force of the testing. But you're absolutely correct. Back then, early on, that was not in place, and that's unfortunate. Okay, so that brings us to federal guidance to states and cities to begin social distancing, to shut down life as we kind of normally operate. And when we spoke to Governor Andrew Cuomo a few weeks ago, he said that governors like him, and really kind of the American public, assume that the federal government, the president, vice president, the head of HHS, and someone like you, frankly, would definitively signal when it was time to take decisive action, whether that meant shutting down schools, closing restaurants, bars, issuing stay-at-home orders.

And in his feeling, and we hear this from other state leaders as well, is that the federal direction didn't come in time. And I wonder what you make of that. Yeah, I mean, there will always be criticism about something was not done in time. There is, in this country, and as always has been, a degree of independence that is given to the local components, the states, the governors, etc. So guidelines that are out now for mitigation, they are very, very clear and says, this is what everyone must do, and we're telling you, you really shouldn't think of it as optional? You have a valid point there. I mean, I think people have different perspectives about how much central mandating should occur. It's something that is argued all the time. And where do you come down on that?

You know, myself, I mean, I'm one that tends to be not overbearing, but somewhat more directive than others. I like clarity of message. That has always been something that I've guided myself by throughout my career in medicine and science. But not everybody feels that way. But when we go back and look in that retrospective scope, do you think we will look back and say we wished that we had favored federal decisiveness and communication over allowing states to act as their own decision makers? You know, I'm not sure about that. I think that's certainly a possibility. I mean, there's always these, you know, hypothetical scenarios that we put up that are very difficult, you know, to come to a firm statement on it. I

mean, obviously, that if something doesn't go as well as you'd like it to go, you always examine saying, well, if we had done it differently, would it have made a difference? You know, and I don't know, to be honest with you. We'll be right back. We'll be right back. Let's talk about where we are now and the federal government's efforts to achieve the best case scenario that you and the president outlined a couple of days ago. Everyone tends to use military metaphors in talking about this public health crisis.

And in keeping with that, it very much feels like you are a general in this war, in this moment. So what is a typical day like for you, starting at what I assume is some ungodly hour of the morning? You're right. We are in a war. I mean, I actually, I think this is exactly what generals or leaders in real, you know, violent combat wars feel. I mean, it's impossible day. I mean, there's so much to do. It's like drinking out of a fire hose. I mean, you get up, you know, there's a lot of people who need information, which is the reason why I'm talking to you right now. There are journalists, there are congressmen, there are governors, there are legislators, there are people in the federal government that constantly need briefing. And I also am running a very large

institute that's responsible for making the vaccines and for developing the drugs. So I come in for a couple of hours, get things on the right track here, and then I spend more than half the day at the White House with various meetings, the task force meeting. I'm with the vice president for hours at a time. I see the president himself at least an hour a day and maybe more. And then I go back home and I have a thousand things to do. And then you're lucky if you get to bed before midnight and then you get up at four or five

in the morning. I mean, if you had to say what your single biggest focus is right now, what would you say it was? My biggest concern is that we now have a 30-day extension of the guideline mitigation. And we've got to get the American people to really appreciate that it is absolutely critical to the best of their ability to abide by those recommendations, because we know from experience in other countries and our own experience thus far, that mitigation does have an impact on whether or not we're going to have X number of cases and deaths or X minus whatever the number is. And it's really in our hands. So I want to make sure that we get the American public to abide by that. But also, another concern is that even if you

mitigate down to the lowest possible number of deaths, it's not going to disappear. This isn't something that's just going to go away. When you pull back on mitigation, there's the risk of rebound. One of the things that concerns me is that we should be prepared to adequately address the inevitable rebound that you will see once you start pulling back on the restrictions and the mitigations. That's of concern. So you seem to be raising the prospect of how much of a lockdown there should be in the U.S. And so I want to talk about that for a minute. Many mid-sized cities are now reporting outbreaks. It's not just New York.

It's not just Washington State. It's now Detroit, New Orleans, to some degree Chicago. And I have to assume their suburbs are next, right? So this is still spreading. It's spreading quickly, despite all the mitigation efforts. You yourself, in public appearances, have resisted calls for what we might describe as, you know, kind of a nationwide lockdown. And as a result, parts or entire states are operating somewhat like normal, take parts of Florida. Why are you not prepared for a total

lockdown? No, I don't think it's accurate to say that I'm not prepared for a total lockdown. I'm saying that if people really do the kinds of physical separations that we indicate in the guidelines, that you can, you know, almost functionally have a lockdown without using the kinds of sometimes draconian things that have been done in China to get to the end game of where you want to be. So it isn't as if I'm against what the ultimate impact of a lockdown would be. I think we can get there without necessarily having literally a forcible lockdown. But where there isn't a functional lockdown, is there not a greater risk of transmission? You know, I don't know.

I really don't. I think that you can accomplish this if you do it properly. I mean, obviously, if you do a sloppy job of trying to do the mitigation and the physical separation, you're not going to be as effective as if you do it in a more rigid way. I mean, I was very concerned about seeing videos in Florida of people frolicking on the beach and going to bars and things like that. I mean, we were very, very articulate and vocal about how that's the wrong thing to do.

So what do you do in that case? Do you call the governor of Florida and say, hey, I don't like what I'm seeing, and I'm telling you, given my expertise, that has to stop? I don't have to call him. I get on national TV and say it. I make it pretty vocal about it. I mean, that's a big message. You mentioned, Dr. Fauci, your daily interactions with the president. It has seemed that he's been on a bit of a long and zigzagging journey, starting with skepticism of this threat and downplaying of it and projecting a lot of optimism to sounding the alarm, conveying the serious of it in the last 24 hours or, and telling Americans to take it very seriously. Does that characterization feel fair? He was, you know, the president has his own style that's obvious to the American public. When I speak to him about issues that are substantive, he listens. I think he always

understood the seriousness of it. Right now, as the numbers are becoming crystal clear, he himself is articulating an awareness of that seriousness. But from the beginning, he always took it seriously. Do you see it as your job to influence how he not only understands it, but how he talks about it to the country? how he not only understands it, but how he talks about it to the country? That is very difficult. I mean, I actually, I see my job as the person who is the scientist, the public health official, the physician who understands disease, and to get the information, correct information, correct evidence to him so that he could make decisions that are based on evidence and based on data. I don't think it would be possible for me to influence another person's style. I mean, that just doesn't happen. I think the question at this point on everyone's mind is how long we're going to be in the situation we're in with social distancing, school shutdowns,

working from home or not working at all. And you have said repeatedly that the federal government reevaluates where we are week to week, maybe even day to day. Is there a version of this where we need to remain in this position, social distancing, state by state patchwork, but a functional kind of version of a lockdown, not just through April, maybe even through the entire summer and maybe even into the fall? Is it a possibility? You know, when you say into the fall, I would be really surprised if that's the case. I think when you talk about, is it going to be 30 days or 60 days or longer? You know, as I've said, the virus determines the timeline, not us. We manage and formulate a timeline

depending upon how successful we have been in containing the virus and what the patterns and the dynamics of the virus are. So I always say, without any regret at all, or hesitation is a better word, that you evaluate it really as the time goes on. And I had a very interesting conversation just this morning with colleagues from literally all over the world on the weekly telephone conference call that the WHO sponsors. And it was interesting to me that some of the most cogent concerns of people from different countries, I mean, all over, European, African,

Australian, Canadian, was that we need to make sure we keep our eye on the balance of if you're too stringent in things like lockdowns and keeping people under wraps for a long period of time, you may have the unintended consequence of triggering, from an economic and societal standpoint, such a disruption that you get things like poverty and health issues unrelated to coronavirus. I mean, it was really a serious concern. Like what? I mean, what are the worst case scenarios for unintended costs? Right. So many people need medications. Many people are dependent on supply chains for nutrition, for food, that they might starve, that people who have illnesses, if you dramatically interrupt that to the point where it no longer exists, the disruption of society can be really quite catastrophic. I mean, that's the one of the things you want to avoid. And that's one of the pushbacks you have when you have people who say, we really need to lock down everything and lock it down indefinitely. Well, you might get an extra mile or two out of suppressing the virus there, but you've got to make sure that you health that's the most important thing. But I have very

good people, and many of them were on that international phone call that I was on, who were saying, yes, we agree with you, but let's be careful that we don't do such a disruption of society that we really hurt it as much or more than what we're trying to prevent. or more than what we're trying to prevent. I want to turn to how we will understand when this is over. And I wonder if you think we have enough measures in place to understand when we've reached that point, when this has peaked, and when this has actually bottomed out. And will that mean, for example, doing millions of tests a day to understand where the virus is? I mean, what evidence will you need to see to feel confident that we can kind of call this over? You know, there's infections, there's illness, there's hospitalizations, there's intensive care, and there's death. And the one that's the furthest out is the deaths. That lags behind the others.

So you will continue to see deaths at a time when you have actually very good control of the new infections and the outbreak itself. of the new infections and the outbreak itself. So when I start to see the number of new infections essentially approaching almost zero and the number of deaths being close to that, then I think we are through with this phase of it. But that gets to the long term, because we have a large planet here, and we may be in a situation where we've got it really under control here, but in other parts of the world, it still smolders, which always gives the possibility of the reinsertion of the outbreak back into your own country. Now, several things will mitigate against that being something that is a really serious problem. One, we will obviously have been much better prepared. We will likely have enough tests to flood the entire country, which we don't have

right now. We very likely would have some therapeutic interventions. And importantly, hopefully, as we get on a year, a year and a half from now or more, we'll have a vaccine that works. But Dr. Fauci, I guess I need to ask the question I think a lot of listeners are going to be thinking as they hear you say this. Are you saying we may not be done with this functionally until we have a vaccine, which could be 18 months from now? Yeah. Well, make sure that the listeners understand it isn't a year of the intensity of what we're going through now. I believe that in a few months, hopefully, that we'll get it under control enough that it won't be as frightening as it is now. But it will not be an absent threat.

It will be a threat that is there. And the threat of resurgence will be something that we need to make sure that we're prepared for. The ultimate weapon against a resurgence is a vaccine. But before we get a vaccine, we want to make sure that we have the wherewithal that when we turn the corner and that curve goes down to practically nothing, that we realize and are not naive in thinking that the threat is no longer there. Because as long as there's virus circulating in the world, there will be a threat of a resurgence if we're not properly prepared. I have one last question for you.

And I was going to say when this is over, but now I'm going to revise that language to when the worst of this is over. Right, okay. How do you hope America will be remembered when it comes to this pandemic? And how do you hope that you, in your role, will be remembered when it comes to this pandemic? And how do you hope that you, in your role, will be remembered? Well, I mean, I hope that America is, and I think it will be, remembered of really showing what a great country we are. We have been through, as I've said, if you look at the history of our country, some extraordinary ordeals. I mean, world wars and diseases and depressions and things

like that. And we've gotten through it. I have a great deal of faith in the spirit of the American people. We're resilient. We're going to get over this and this is going to end. For myself, you know, I just would hope that I'm remembered for what I think I'm doing is that I'm doing the very best that I possibly can. I've been a public servant all my life, and this is right now, you know, kind of almost the epitome of being a public servant, of trying to mitigate against a terrible disease that afflicted us. You know, it came out of nowhere, and we need to deal with it, and we will deal with it. Dr. Fauci, thank you very much for your time. We really appreciate it. I know every second of your day is precious, so good luck to you. All right, thank you. It was good being with you. Thank you very much.

Okay, bye. Bye. Bye. residents to stay home to contain the coronavirus. At the same time, the governors of Georgia, Mississippi, and Nevada also announced orders to stay at home. As of now, the majority of Americans, more than 290 million people across 37 states, are under orders or instructions to stay home, or will be in the coming days. We'll be right back. Here's what else you need to know today. On Wednesday, the Times reported that the U.S. emergency stockpile of protective medical supplies, like masks, gowns, and gloves, is nearly empty. Since the beginning of the crisis, the government has delivered more than 11 million N95 masks,

5 million face shields, 22 million gloves, and 7,000 ventilators, exhausting its supplies. The shortages mean that the federal government must now compete with states and other countries to purchase essential medical gear at the height of the pandemic. So a state, and every governor will tell you this, they're trying to buy, I'm trying to buy, I'm calling everyone I know. So really, the only hope for a state at this point is the federal government's capacity to deliver. Governors across the country, including Andrew Cuomo in New York and Ned Lamont in Connecticut, expressed disappointment and anger over the state of the stockpile. A little disturbing today to find out that the national strategic stockpile is now empty.

For now, we are on our own. And for now, we are working our heart out, scouring the globe for PPE as best we can. And I got to tell you, as your governor, this breaks my heart. That's it for The Daily. I'm Michael Bavaro. See you tomorrow.