The Daily - We Need to Talk About Covid, Part 2: A Conversation with Dr. Fauci

Episode Date: January 31, 2022

America, it seems, might be at a turning point in how we think about and respond to the pandemic. Yet, the U.S., at this moment, is still in the midst of crisis — thousands of people are in hospital and dying every day.In the second part of our exploration of the state of the pandemic, we speak with Dr. Anthony Fauci about the conditions under which we could learn to live with the virus and what the next stage of the pandemic looks like. Want more from The Daily? For one big idea on the news each week from our team, subscribe to our newsletter. Background reading: Dr. Anthony Fauci has cautioned against overconfidence but says the U.S. Omicron wave looks like it’s “going in the right direction” and that coronavirus cases could fall to manageable levels in the coming months.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.

From New York Times, I'm Michael Barbaro. This is The Daily. Last week, we began a two-part look at the debate in America over whether it's time to start thinking about COVID in a new way. Today, in part two, we put that question to Dr. Anthony Fauci. It's Monday, January 31st. So, Dr. Fauci, thank you for making time for us, as always. My pleasure. Good to be with you. for making time for us, as always. My pleasure. Good to be with you. So we wanted to talk to you because it feels like we might be at a potential turning point in how we think about and respond to this pandemic and how we learn to live with it, rather than having it be a life-altering,

in some cases, life-dominating virus that people desperately try to avoid. And a few things prompted that question in our minds, and I want to walk through them very briefly. Okay. The first is that at this point, every person over the age of five in the U.S. who wants a vaccine can now have one, and most Americans are now vaccinated.

Second, Omicron is hugely contagious, but meaningfully milder than previous variants. So many people have accepted that infection is likely in their life. Third, the costs of our current approach are becoming very high. There's a well-documented crisis of childhood education and childhood mental health, for example. and childhood mental health, for example. And fourth, and finally, you yourself said about a week ago that we're heading into a phase of this pandemic

where it resembles, and this is a quote from you, the infections that we've learned to live with, end quote. So given all that, let me put this to you very simply. Is it time to perhaps start treating COVID a lot more like the flu? And I didn't pick the flu by accident because statistically speaking, among vaccinated people, even among people 65 and older,

the Omicron variant of COVID seems to present less danger than a normal flu. Okay, so everything you said is correct except a very minor, minor misquote of me. I did not say that we were already at the point. No, no. I said we will, we will, the quote was, we're heading into a phase. Not that we're there. Yeah. I'm hoping that we are. So everything you said has a degree of validity in it, in what we're seeing. One of the things is that you have to look at that, Michael, as the best case scenario.

And the best case scenario would be all the things you said, but also not as many as we want, but a considerable proportion of the population is vaccinated. And you have a substantial number of people that have already been infected and recovered. Hopefully, many of them will also get vaccinated. So you'll have a degree of baseline protection in the community that even though we will likely have other variants, the chances are that there's enough background immunity that you will not have the kinds of surges that disrupted us and have continued to disrupt us, getting back to what you said about getting to some form of normality. That would happen if, and I think it's an if, but it's not necessarily an unlikely if, if we do continue to vaccinate people and we do implement other mitigations,

like frequent testing to let people know if they are infected or spreading it, the proper wearing of masks where appropriate, and antiviral drugs for those who do get infected and are at a higher level of risk. If we had all those, then this virus could integrate itself into the background of viruses that we do deal with. We don't like them. They do cause some deaths. They do cause some morbidity and hospitalization.

But we live with respiratory syncytial virus and parainfluenza, and even influenza, which is much more seasonal, as it were. So that's why I say I'm cautiously optimistic, even though we must be prepared for the worst-case scenario. And the worst-case scenario would be just when we think things are going in the right direction, we get another variant that eludes that background immunity in the community, and that might be very pathogenic. I hope that's not the case. I don't think it will be, but we have to be prepared for it. Okay. So just to go back to my original question, it sounds like you're saying we are not at the phase, we are not at the moment where we can start thinking about treating this virus like those other viruses, like the flu.

Yeah, Michael, I want to be precise about it because I know people take every word we say and analyze it. We should be thinking about that. Are we there yet? In other words, are we at a point where we can say we can now live with this virus? When you have 150,000 people in the hospital, 2,200 deaths a day, and still 600,000 new infections, we are not there yet, clearly in certain regions of the country and likely in other regions. I think it's going to be a little bit more painful in those states and regions that have a low level of vaccination, because if you look at the people who are getting hospitalized now, it's overwhelmingly weighted towards those who are not vaccinated compared to those who are vaccinated and boosted.

But having said all that, we still could be going in the right direction, and I believe that we are. Look at the data. Look at New York City, the upper northeast corridor, the upper middle west. We have a peak of the Omicron and is starting to come down. And there's indication that inherently, or because of background immunity, it does not appear to be as severe as what we've seen with Delta. So if you put those two things together, or three things, background immunity, a virus that appears to be less severe, and a virus that has peaked and is starting to come down, do we have indications that we might be heading there? The answer is yes. But Dr. Fauci, what I'm hearing you saying is that a key part of this hoped-for future state that might not be so far away involves

greater levels of vaccination. But is that really reasonable to ask vaccinated Americans to wait for any longer? And is there any reason to believe that it will happen? Americans have had many, many months at this point to get vaccinated. Their resistance is not passive, right? In many, many cases, it's deeply held skepticism or it's lack of faith in the vaccine. Are you saying that we need to wait for that to change and for meaningfully more Americans to be vaccinated? I guess I'm skeptical that that's anywhere in our near future. Michael, no, I think we're moving towards this ability to, quote, live with the virus as it were, as long as the virus is at a level that it isn't disrupting our society the way it

is now. I believe the people who are vaccinated, if we get the overwhelming majority of them boosted, and we only have about 50% of them boosted, that would hasten and ensure us getting there. So the bottom line and short answer to your question is that we're going to get there, I believe, because once you accumulate enough background immunity, whether it's helped more by more people getting vaccinated or more people getting boosted, sooner or later, we will get to that point. I just hope that more people will get vaccinated to get us there more quickly and with more confidence that it will be a situation that we will be able to live with as we live with many other viruses that are there, but that don't really impact the way we live our lives. So just to be super clear, this future state does or does not

depend on the substantial percentage of Americans who are vaccine resistant, skeptical, what have you, somehow changing their minds and being vaccinated? I don't think it depends on them. I think it would be facilitated if people wound up getting vaccinated. I think to be realistic, it's very clear that there is a hardcore group of people who do not want to get vaccinated. I think

people who are less likely to push back are those who have been vaccinated and we're asking them to get boosted. I think we can appeal successfully to them better than appealing successfully to those who up to this point have made it very clear they don't want to get vaccinated. So I don't think in the strict sense, if what I understand you're asking, Michael, it absolutely depends on those people getting vaccinated. It would make it much easier if they did, but we're going to get there, but much slower. That's what I'm saying. Okay. So given the incredibly low rates of hospitalization and death among the vaccinated and the low risk to unvaccinated children, I just want to be clear. For those of our listeners who are vaccinated and even boosted, are you saying that this remains, to some degree, a story about those Americans needing to, in some cases, dramatically alter their behavior and change their lives to protect Americans who have chosen not to be vaccinated? I think some people do see it that way. The more vulnerable people that are out there, the more the general community has to act in a more cautious, restricted manner. The less vulnerable people out there as a community, we would not have to work and act in a more restricted way.

We all are connected with each other. Right. Okay, so because it sounds like you're starting to see a way to this new phase and that you're beginning to envision it, and with all the caveats you just mentioned about why we're not quite there and what it would take to get there,

we want to start to talk about what it's going to look like to enter this new phase of the pandemic, one that feels less like an emergency. And we want to talk about it in a pretty practical way. We started this conversation with our colleague David Leonhardt late last week. On a practical level, what will the next phase of this look like? The phase where perhaps our collective guard starts to come down and our behaviors change. Can you just start to spell that out? Sure. I think you've already started describing what I think is going to happen.

And that is we will have a gradual diminution of the high alert as it were. as it were. And what I mean by that is that we will have, and we're already there, literally a billion tests available for people so that they could very easily test themselves and families so you could feel much more comfortable when you're at gatherings, dinners, social events, which we don't have that right now. We have a lot of anxiety associated with mingling in indoor congregate settings. I believe we'll start to see much more being open about indoor situations, be they theaters, be they restaurants, be they schools, be they workplaces.

That doesn't mean that it's going to be exactly the way it was three or four years ago. But I think when it comes to travel, school, workplace, entertainment, we'll start to see a gradual return to normal, even though normal will not be exactly the way it was before all of this. Let's dig into that a little bit more, Dr. Fauci. You mentioned schools, and I want to ask about that very specifically because I want to understand how things will change in spaces that have been the most disrupted over the past two years, and obviously schools are one of them. So in this new phase, should the expectation be that all schools stay open, even if there's an infection or an exposure, given the relatively

low risk of severe illness to kids and vaccinated adults, teachers, and the severe educational and emotional cost to kids of remote learning and the disruption it represents to their parents? You know, I think in general, the answer to that should be yes. But every time I give a definitive answer like yes or no, it has the danger, and I understand that, I'm living with that, of being taken completely out of context and used in a different way. But let's pursue this with a degree of openness and honesty and rationale. The idea is that if we get more and more people vaccinated and you have the overwhelming proportion of teachers and personnel associated with the school vaccinated, you have enough tests that when one or more or several of them get infected, which they will because there will be breakthrough infections, even though people are vaccinated and boosted. Testing will be a very

important component of that. Children five and older are eligible to be vaccinated. We've got to do much better in getting those children vaccinated. Data are being collected right now with children six months through four years. So hopefully within a reasonable period of time, measured in months at the most, we will have vaccines available virtually for all children who will be going to school and preschool. If we have that, then I do think what you're saying is not only feasible, it is likely that you have a situation where you could have all the schools open and that when a child or a couple of kids in school get infected, you don't have to shut anything down. You'll just continue, namely

maximal protection and care for the kids at the same time that you have an uninterrupted school curriculum and year. Got it. But you think vaccinations are prerequisite for that? I do. I mean, you're talking about, why don't we turn the clock back to way, way before COVID-19? Vaccinations for children, for the common childhood diseases, which is universal in this country, is one of the reasons why pre-COVID never got involved in shutting down

daycare centers or schools when a child would call in or a parent would call in sick for the child. We can get to the pre-COVID level if we do the things that you and I have just been discussing. Well, let me just represent a parent with a child in schools who does not want to wait any longer for this moment to arrive. Dr. Fauci, a parent who says, look, vaccinations of teachers should obviously be mandatory. Children are at very low risk, vaccinated or not. With those realities in place, the trade-offs, the costs of going to remote learning or quarantining for days every time a kid tests positive, they are already not worth it, if I'm this parent. Low risk, high, high cost. And so the feeling is we need to get rid of these five, 10-day mandatory quarantines, and we need to get rid of these five, 10 day mandatory

quarantines and we need to do it now. What do you say to that? Well, be careful because I want to make sure, I think you said something inadvertently incorrectly. Okay. You don't quarantine a kid who tests positive, you isolate him. You quarantine the kids that are in contact with that person. And what the CDC is saying, we can facilitate keeping schools open by certainly always isolating the truly infected child. But instead of sending home for five days, sending home for five days the person who was exposed, test that person to stay. If he's negative, he can come to school the next day. Interesting. And you've now mentioned a couple of times the abundance of testing that will want to be present in this next phase of the pandemic. I'm curious, and I'm sure you've thought about this, does more testing result in more confirmed COVID cases in a way that might actually exacerbate the already difficult situation at schools?

Right now, I feel like there's relatively strong incentive not to get tested because a positive COVID test leads to a kid missing several days of school. And I know parents who have admitted this to me. kid missing several days of school. And I know parents who have admitted this to me. I'm not going to name names, but they have suspected their child is COVID positive, but they've not tested them because the child seems fine and they don't want to miss classes for the child and work for the parents. That's unfortunate. And that's a poor public health practice. That's a poor public health practice. You do not want a child who's known to be infected to be in a classroom. You want that child five days isolated. Okay.

Let's turn to offices, Dr. Fauci. Lots of Americans still work from home. I'm one of them. It's a privilege. But it's been the case since March of 2020, almost two years, in this new phase that we keep talking about and are defining, is there any public health reason to keep having so many people working from home? No, I think the workplace is one of those locations and venues that will be subject to gradual and hopefully within a reasonable time, complete normalization.

What's going to happen very likely is that there was an experiment, an unwilling experiment, as it were, that has been done over the last two years, that a lot of people who are in jobs have found that they could function as well, if not better, virtually from home. So I don't think it's going to be exactly the way it was pre-COVID, but I think for those who want to and should, because of the nature of their jobs, be in the physical presence of the workplace, I believe you're going to see that happen very, very quickly if we get back to the area and the type of situation that we have with living with the virus. And what about masks? Will office workers,

for example, or teachers in schools or students in schools, will they be required to wear masks? Should they be required to wear masks in this phase that we've been- Again, Michael, you've got to make sure you define so that it doesn't get misinterpreted. Yep. What we mean by this phase. If this phase means- Young people vaccinated. Right, exactly.

Their level of infection is so low. Testing expands. Right, and that it is not a threat. I do not see that we will be indefinitely in a mask requirement situation. Got it. So mask wearing may not be an indefinite part of our culture and our new life at some point in the next few months. Right. Okay.

Be careful about in the next. I'm sorry for being so. No, we sorry for being so weird checking on you, Michael. It's a mushy concept of what this next phase is. Okay. And I appreciate that you're saying that. It may be a couple of months. It may be longer than a couple of months. Okay?

We'll be right back. We've been talking so far about practical questions of how we might change our relationship to COVID in the next era of the pandemic. And I want to turn to the idea that there's a psychological level to this. When we had our colleague David Leonhard on, Dr. Fauci, we talked about a poll the Times conducted that found different groups of people express different views about COVID. And some of those views, in his words, can be disconnected from the science. In some cases, they can even be kind of irrational, given the scientific data we've accumulated over the past two years. For example, young people, the poll found, are as worried about getting sick from COVID as older Americans, which doesn't make a lot of sense since they face a lot less risk. And unvaccinated Americans are less worried about getting COVID than boosted Americans. Again,

that doesn't make sense because they are at greater risk. And after we analyzed this poll and looked at the party affiliation of those who participated in it, what David told us is that a major reason for this is political identification, basically tribalism. I'm a Democrat. I take the virus very seriously. I care about preventing spread. I live cautiously. Or I'm a Republican, and I won't let the virus dominate my life. I won't live in fear. This is a generalization, but this was borne out in the poll. Can I just get your reaction to that? Does that ring true, that tribalism, that political identification is coloring people's view of this pandemic in a way that can be disconnected from science? You know, I think David hit the nail right on the head.

It is very troubling that this is the case, but I think the polls are telling us what the reality is. I think if you go back and look at that, you have to scratch your head and say, how the heck did this happen? People are going to do analysis of this for years and years to come, so I don't have a ready explanation for it except to say that it is in general unfortunate that that is going on because that is one of the things that's getting in the way of our getting this outbreak in a comprehensive way under control. I've often said, and I'll say it again, that we seem to not be acting on the principle that the common enemy is the virus, not each other. And it's almost like you're in a war. And we have the people who are the potential victims of the war fighting with each other about how you're going to address the common enemy, which is the

virus, not each other. Well, I think some people, based on this poll the Times did, mostly Republicans, but maybe a growing segment of the country as well, not Republican, would say, perhaps this isn't a war. Maybe this used to be a war. Maybe we used to be at war with a virus, but it doesn't feel like a war anymore because a war implies defeating an enemy. And where we are at now, for many, is it's time to learn to live with the enemy, right? Or reframing. And that actually, to continue to treat this as a war against COVID

is to perhaps further divide this country because if we don't find some middle ground here, we're going to exacerbate the politics surrounding this virus. And I know, Dr. Fauci, your job is to be a scientist, not a politician. But do you worry that by not saying to the country, look, I understand you live in a part of the country

where risk is very low right now. You've been doing this for two years. I get it. You're going to start modifying your behavior. That by not doing that, you may seem to reject the reality for millions of Americans. And that could exacerbate the divisions

that we're talking about. You're right. I have said and continue to say that currently we are still at war with the virus because we have 2,300 deaths a day, 156,000 hospitalizations, and we have the danger of new variants occurring. Are we heading towards the point where we may be able to live with the virus as we've lived with other viruses like RSV and paraflu and flu? At that point, you're right. We can't continue to have the metaphor that we're at war with the virus because being at war with the virus, particularly when you have two opposing ideological groups that have very, very different viewpoints on that, that that could exacerbate the differences. So I don't think we're going to cure the differences. They antedate and permeate and will go on beyond COVID, those ideological differences. But you make a good point that there will be a time less looking at it as a war against

the virus, but an armistice and a truce. Let me keep pushing on this. It's very important and it's very fascinating. And let's focus for just a moment on Democrats, because many Republicans are ready for this pivot that we're theorizing about here, this change in approach. A meaningful number of Democrats we have found in this poll are not as ready. Their anxiety levels remain high. And what they will tell you is that they're not ready to lower their guard because for two years they've been told by many people, including Dr. Fauci, you, that they have to behave cautiously for the sake of others, not just themselves, for the very young, for the very old, for the unvaccinated, the immunocompromised. So does entering this new portion of the pandemic mean eventually changing that mode of thinking?

And how would that work while keeping the risks of those other people in mind? Right. So, Michael, I think that I know you're saying it, not me, again, just making sure I don't get out of context here, that most or in general not me. Again, just making sure I don't get out of context here. That most or in general. Many. Yeah, many Democrats feel still very cautious about lowering their level of risk mitigation. And that in some respects, and in fact, in many respects, where we are at this moment

with 2,300 deaths a day. Makes sense. It makes sense. I believe, and again, I don't know for sure, but I believe that those people who appear to be quite cautious now in relinquishing their mitigation approach will come along and enter a world approaching normality. I don't think that we've created an immutable group of highly, highly anxious people. I believe that they are going to turn around and welcome the degree of normality at an appropriate time.

But I don't think it's now. That's interesting. So, Michael, nothing is absolute, but in general terms, the people who are concerned are really, in fact, abiding by sound, true, and tried scientific principles. Do vaccines work? Are they safe? Yes, they get vaccinated. Are masks shown to be protective and to have an impact on spread? Yes, they wear a mask. Is avoiding congregate settings indoors in an unmasked way risky? Yes, they don't do that.

doors in an unmasked way risky? Yes, they don't do that. So what I believe is going to happen is that the people who are still more risk averse based on sound scientific principles, when the science tells us that that risk is much, much lower, then I believe that the people right now who are being more risk-averse than others are going to come along and acclimate themselves to the new normal. Do you foresee a moment when you personally may have to go out, it sounds like you're starting to envision this, and say to the public, I have reached the conclusion, the moment has come where the cost of caution now looks too high. The risks are low enough, and you're going to have to kind of give people, I wonder if you think about it this way, kind of permission to stop being so anxious and to lower their guards.

Is that a message you have perhaps envisioned in your head? Absolutely. I wouldn't use the word permission. That has certain connotations that I don't like, but I would say that I would be certainly articulating that when the science gets to the point to get the message to the American public, when the science leads us to that conclusion, I would be the first and most enthusiastic person to get out there and say, OK, we're at a point that we can essentially turn that balance around and make sure we don't let the things that we're doing to mitigate interfere with some of the even more important things. When the science tells us that we're there, I will be very, very vocal about that. Today, we are not there yet.

You know, returning to this idea of whether we're in a war and whether that war is with COVID or with each other, it's occurring to me as we're talking, Dr. Fauci, that you are not at all describing a world in which the COVID cautious are at war with the COVID skeptical or those who are just ready to resume quote-unquote normalcy. Because what you really keep coming back to as the thing that's preventing us from returning to normal is these 2,200 people dying, these tens of thousands in the hospital. And again, these are wildly disproportionately the unvaccinated.

in the hospital. And again, these are wildly disproportionately the unvaccinated. In that sense, in the way you're describing this, aren't the COVID cautious actually fighting kind of their own war against COVID, but one which, ironically, is really on behalf of the COVID skeptical and those who don't think that that level of caution is necessary or useful at this point. The very people who are becoming increasingly disillusioned with the government and with figures like you for not telling them, you're right, it's time for us to just start living with COVID. Yeah. Well, the answer is, yeah, it's a complicated issue and there's no easy answer to it. So I don't really want to give you an answer to that, Michael. It's just too complicated. I'm sorry. I love you. You're great, but no. I mean, I guess what I'm getting at is the politics of COVID are very weird. And they bounce back and they swerve and they do things that we didn't expect.

Exactly. Well, that'll go along with. They are. They're very weird. They are. It's funny to me that you didn't want to engage the question, because basically the question is, I think in some ways kind of simple. The vaccinated are cautious on behalf of the unvaccinated who resent the caution and just think that it reinforces their view

that the whole policy is nuts. No, you're right. It's a circular, I don't know what the right word, but there's something circular about it that you're describing, which is true, is what you're saying. That the cautious are being cautious a lot because the uncautious are not being cautious. Right. And the uncautious resent the caution of the cautious. Right. Now, if you talk about circular, that's really circular.

Right. And it's really complicated. And it means that you end up speaking to one group, triggering the other, all in name of public health and leading to a tremendous amount of frustration. Yes. I think that we all can agree upon. It's very frustrating. All right, Dr. Fauci, thank you as always for your time. You're very generous. It's always nice to be with you, Michael. Thank you. Take care.

Okay. Bye. Bye-bye. We'll be right back. Here's what else you need to know today. On Sunday, Republican Senator Lindsey Graham of South Carolina seemed to endorse one of President Biden's potential choices to replace Stephen Breyer on the Supreme Court, raising the possibility that Biden's nominee could win bipartisan support. I can't think of a better person for President Biden to consider for the Supreme Court than Michelle Childs. In an interview with CBS News, Graham repeatedly praised South Carolina Federal District Judge

Michelle Childs, who the White House has said is under consideration. She has wide support in our state. She's considered to be a fair-minded, highly gifted jurist. She's one of the most decent people I've ever met.

Graham's views are especially notable because he is a member of the Senate Judiciary Committee, which must approve any Supreme Court nominee. In the interview with CBS, Graham said it was time for a black woman to be on the Supreme Court. Put me in the camp of making sure the court and other engineered by Dan Powell. Our theme music is by Jim Brunberg and Ben Lansford of Wonderland. That's it for The Daily. I'm Michael Bilbaro. See you tomorrow.