Today, Explained - Dr. Fauci’s nightmare before Christmas

Episode Date: December 23, 2020

In the third of our five-part series, “You, Me, and Covid-19,” Dr. Anthony Fauci reflects back on his pandemic year, what he’s learned, and what he’d do differently. Transcript at vox.com/todayexplained. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. It's Today Explained. I'm Sean Ramos-Verm, but my friends call me Ram. We're continuing our You, Me, and COVID-19 series today with a conversation with Dr. Anthony Fauci. I spoke to him a week ago at our second ever live event, which, of course, was a Zoom because of COVID. You already heard the second half of that event last week, a Q&A with Vox science reporter Umair Irfan all about the vaccine. Today, we're

bringing you the other two elements. Dr. Anthony Fauci looking back on his year, and Today Explained producer-reporter Noam Hassenfeld will close it out with a treat for the stans out there. Our nation's top infectious disease doctor was joining us after a very bittersweet day. The United States had just begun administering the BioNTech Pfizer vaccine. And on that same day, we hit 300,000 deaths. I started by asking Dr. Fauci how much of the country would need to get this vaccine or one of the other ones for our living nightmare to end? Well, if you really want true herd immunity where you get a blanket of protection over the country, very similar to the kind of things that we've gotten and successfully done with measles and with polio, you want about 75 to 85 percent of the population of the country to get vaccinated. I would say even closer to 85 percent to see if we can get that. You'll probably start seeing an effect on the dynamics of the outbreak when you get anywhere between 40 and

50 percent of the people vaccinated. But if you really want to have a profound public health effect, we've got to get as many people as we possibly can to get vaccinated. The primary reason, though, we wanted to talk to Dr. Fauci was to hear about his year. So we started in December of 2019. I want to jump back a year here. Do you remember where you were, what you were doing when you first heard of this coronavirus? I imagine around this time last year. You're absolutely correct, Ram. It was at the end of December. We had heard of an unusual

virus. We didn't even know it was a virus, an unusual pneumonia that was being noticed in the Wuhan district in central China. And for those of us, myself and many of my colleagues, both here at the NIH and elsewhere, who had been involved in responding in the year 2002 to the SARS outbreak, the severe acute respiratory syndrome, which was a coronavirus that emerged from Guangdong province in China. It had gone from a bat reservoir to a civet cat to a human. And when we heard that it was associated with a wet market in China in the Wuhan district, many of us felt, you know, the chances of this being another coronavirus that has jumped species, we did not know at the time at all whether it was just jumping from an animal to a human

or whether it was transmitted also from human to human. And if so, how efficient was it being transmitted from human to human? That was the end of December. January 9th, the Chinese isolated the virus and put up the sequence, the genetic sequence of the virus on a public database. And it was clear that here we are yet again dealing with another pandemic coronavirus, similar in some respects to SARS

and similar to MERS, the Middle East Respiratory Syndrome. But what we did not know, but evolved over a period of weeks to months, was how extraordinarily contagious this virus is, number one. And number two, that a substantial proportion of the people had no symptoms. Namely, they could spread the virus without ever getting sick themselves or during a period of time before they got symptoms. That's very unusual for a respiratory virus and that kind of fooled us in the beginning. But then as the months went by it became clear that we were dealing with a historic pandemic of literally, you know, extraordinary historic proportions,

the likes of which we have not seen in 102 years. You know, the first case that was recognized in the United States was January 21st. Then thereafter was the spouse of that person. They had come from Wuhan, China. Then as we went from the end of January into February, it became clear that there was community spread. Not quite sure it was from asymptomatic people, but then as we got from February to March, it was very clear that we had a really serious problem here of the spread of a virus, often without any symptoms in the person who's transmitting it. And we were realizing that among some people, particularly the elderly and those

with underlying comorbidities, that it was very serious and was causing a considerable amount of morbidity and mortality. Fast forward to now, mid-December of 2020, essentially 10 and a half, 11 months later, yesterday was a very difficult day. On the one hand, we had the rollout of the vaccine, but on the other hand, the 300,000th person in this country died from COVID-19. That's historic and really terrible. And that's a number that it's sort of hard to grapple

with for many of us. It's a number that you didn't even predict earlier this year. I mean, if you could talk to, you know, Dr. Fauci in December 2019, what would you tell him? Well, if I were to speak to my other self back then, I would say, you know, you got to keep heads up for where a virus like this could go. Don't make any assumptions, but I wouldn't have expected that it would turn out to be essentially my worst nightmare. Because when people ask me as an infectious disease person, what is the thing that keeps you up at night? Or put another way, what is your worst nightmare? And my worst nightmare is the evolution of a new virus that jumps species from an animal to a human that's respiratory-borne, that's highly, highly efficient in its ability to

spread from person to person, and that can cause a high degree of morbidity and mortality, either in the general population or in a subgroup of people. And then unfortunately for me and the world in general, that's exactly what happened. So one knows that you get emerging infections and no one would have anticipated that it was going to be as terrible and horrible as it's turned out to be. I think a lot of people over the course of this year, at all different education levels, became amateur epidemiologists in 2020. We learned a lot about your world. What did you learn? What did you feel the most surprised about this year?

Well, the virus continued to fool us as it evolved until we got to the point where it was so clear what was going on. We're still learning a lot about it, about its ability to make people sick and have symptoms that last for weeks to months, even after the virus is cleared. But as we learned, the surprise was what I had just mentioned, that you could have the same. And this is noteworthy, Ron, because I've never seen anything like this before. And I've been dealing with viruses that emerge in pandemic form for now, this is my 37th year that I've been doing that. And I can tell you that I've never seen a virus that on the one hand can have no symptoms in someone. And in those who do get symptoms, the majority have just very mild symptoms. And yet in other people, it just kills them. So usually when you have a virus

that's capable of so quickly killing someone, that almost everybody who gets infected has some degree of illness, but isn't. This is like a lot of people it doesn't bother even a little bit and then some people it kills which makes it very difficult to message this, to get the message across particularly to young people who have much less of a chance, not zero by any means, but much less of a chance of having a serious outcome because they realize that most of the people who get into trouble are either elderly or those with underlying conditions. So they tend to feel, what's the big deal if I get infected? I'm probably not going to wind up getting any symptoms. That's a bad attitude and the wrong attitude because what you're doing is you're propagating

the outbreak. You're becoming part of the transmission chain. And ultimately, that transmission chain is killing people. So do you really want to be a part of a process that's a transmission chain of infection? Or do you want to protect yourself from getting infected so that you don't pass it on to anybody else? Again, a very difficult message to get across. Do you think to some extent now, it's been almost a year of this, people have become numb to the suffering? I mean, when New York was really in its darkest moments earlier this year, it felt like everyone was paying attention.

But now you see cases like New York across this country, and it doesn't feel like we're all on the same page. You know, unfortunately, that's what happens when you have something as serious as this be as chronic and prolonged. You know, some refer to it as COVID fatigue. You're fatigued with sort of locking down a bit, but you're also fatigued with the numbing numbers. You know, if you're in a hospital room, like I was seeing patients and you see someone suffering, it's a real phenomenon there. That's a human being that's in danger of dying

and you're trying to do something about it. When you get a number that's 300,000, that becomes like a statistic that you can't get your arms around. You're right, you do get numb to it. The thing that I find astounding in this country, that this outbreak has evolved in the context of an extraordinary degree of divisiveness in our society. Divisiveness where the pandemic itself has undertaken a political connotation so that things like wearing masks or not wearing masks, avoiding crowds or being in crowds, it depends on almost

what your political ideology is that you do or do not abide by what the recommendations are. That's extraordinary. In fact, there are parts of the country where the hospitals are overflowing with patients, the intensive care units are being stressed, and still a certain proportion of the people in that city, that state, that region think it's a hoax. They think it's fake news. They don't believe that we're in the middle of an outbreak when we just broke an extraordinary record of 300,000 people having died. That's the worst that's ever happened in this country in 102 years. So how people can look at that number and say it's fake news or it's a hoax, just it, I can't imagine that, but it's happening. And now that's coupled with the sense that we have a vaccine.

And maybe to some people, that means this is ending, that we're in the clear. But the numbers are the worst they've ever been, which is important to remember. Every day, it seems like we're seeing new records. What do you say to people who are fearful about getting through these winter months? And also, what do you say to the people who are feeling cavalier again? I think what you have to stress is what we are stressing, that although the end game solution to this is going to be and is a vaccine, you really have to get 75 to 85% of the population vaccinated if you want to just crush this outbreak. But up until that point, we can't abandon the classical public

health measures that we keep talking about. The uniform wearing of masks, the keeping physical distance, the avoiding crowds in congregate settings, particularly indoors, to wash your hands as frequently as you possibly can. Things as simple as that can have a profound effect on the dynamics of an outbreak. As enormous as this problem is, things as simple as what I just mentioned can do it until we get a vaccine. So maybe the realization that we now have a vaccine and over the next few months, we're going to be rolling it out to the tune of tens and tens of millions of doses until we get most of the people in the country vaccinated, that there's light at the end of the tunnel, which should serve

almost as an incentive to keep doubling down on the public health measures so that by the time we get to a vaccine, you're still healthy and your family is still healthy. More with Dr. Fauci in a minute. Thank you. back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained, ramp.com slash explained,

R-A-M-P dot com slash explained. Cards issued by Sutton Bank, member FDIC. Terms and conditions apply. with our new favorite and recently played games tabs. And to top it all off, quick and secure withdrawals. Get more everything with FanDuel Sportsbook and Casino. Gambling problem? Call 1-866-531-2600. Visit connectsontario.ca. Dr. Fauci, the thing people can't wait to get back to is normal. And I wonder, how far away do you think normal is?

Well, normal is as far away as we want it to be because it is in our hands. If we as a society practice good public health measures while we are rolling out the vaccine. And if we get the majority of the population vaccinated in a few months and the overwhelming majority, 75 to 85 percent vaccinated, by the time we get into the summer, we could probably approach a significant degree of normality as we get to the end of the third quarter, the fall and the early winter of 2021. It is entirely conceivable and doable that we can do that, but we've got to get a lot of people vaccinated before we can do that. Normal was a world in which we didn't think this could really even happen, which makes me wonder, you know, should we just be going back to normal or should we be

going back to a, you know, a little smarter, more cautious place? Well, if a smarter, more cautious place, you mean lessons learned of what we've been through. I would hope so. And I would hope that we would have the kind of preparedness so that this doesn't happen again. We will get emerging new infections. I mean, that's gone on as long as recorded history and well beyond have been the emerging of infections. You're not going to stop that. What you can stop is getting that emerging infection to become a catastrophic pandemic. And that's by doing the kinds of things that we maybe could have done a lot better in identifying, contact tracing, doing the kinds of public health measures. We have a very disparate response in this country.

We have 50 states that tend to want to do things understandably on their own a little bit differently. Well, that works well for a lot of things because there's so much diversity that you want think it's much better if we do things in a much more uniform, coordinated way when it comes to public health. If we had done that, I think we could have done much better than we did. Dr. Fauci, you turn 80 in a few weeks. Is that right? Sadly, that is true. Well, I don't say sadly. It's better than the alternative. But you're correct. Yes. You've had the kind of year that would make a lot of people want to retire, but you've already signed up for more of this with President-elect Biden. Where do you hope to leave the country and the National Institutes of Health before you do one day retire, as surely you've earned that retirement. Well, certainly the most immediate thing is to crush this COVID-19 pandemic and just put it in the rear view mirror and not have to worry about it.

But I've been working for decades on trying to develop lasting solutions, particularly in the form of vaccines and more user-friendly therapies for HIV. My career has been defined by HIV. In the very early years, in the early 80s, when I took over as director, that's what my own research endeavor is. And that's one of the major goals of my institute, is to end the epidemic of HIV, as well as a couple of other world global killers, including malaria and

tuberculosis. So I think I still have some time to put in because those are challenges that we're not going to fix in a few months to a year. And do you think the National Institutes of Health, after this pandemic, after what this country's been through this year, do you think there'll be more political will, more public support for investing in preparedness for potentially the next one of these? Well, Rahm, I hope that's the case. I mean, we fortunately have been treated very well by multiple administrations and we have bipartisan congressional support for what we do. But you're right. We do need more resources now, given the lessons learned about how to better prepare for the next outbreak. So let's hope that the generosity and attention to the National Institutes of Health will not only continue, but will increase. You know,

I must point out, with all of the extraordinary things that have gone on over the last year, the thing that will ultimately bail us out is the vaccine that was developed in large part based on science that has been funded for decades by the NIH. In fact, one of the vaccine candidates was co-developed right here on campus, literally within a few hundred yards from where I'm sitting right now. And how amazed are you? I mean, you were promising earlier this year that things looked good for a vaccine before the end of the year. And as we said, like, people didn't quite buy it when you were first making that known. Now we're there. How does it feel to have reached that historic milestone?

It feels wonderful. I mean, it was the work of a lot of people. I'm very pleased that my projection and my prediction came out exactly. Like I said, if we go back on the records in January, when we started, I said a year to 18 months, I hope we would have a vaccine. So it was on the low side of what I said. One year from January is December. And here we are in majority just asked us to thank you. So thank you for being out there this year and helping people through this pandemic. We appreciate your time. Well, thank you very much. I appreciate you having me on your show. Thanks again. Take care. Take care. You called me up just to ask if we could hang out, maybe outside. I said you still need a mask and I need you to know, need you to know.

And you need to stay six feet away, six feet away. You need to stay six feet away, six feet away. If you were my hands I would wash you like the CDC says you deserve And if you were Corona I would flatten your curve Flatten your curve You need to stay Six feet away

Six feet away You need to stay Six feet away Six feet away Six feet away