When Does Dr. Fauci Think "Normal" Will Come Back?

26:22And it's such a complicated disease as you get into the advanced stage with people, where virological mechanisms are not the only things that are causing the morbidity and mortality. It's some sort of uncontrolled, aberrant inflammatory response that leads to many of the severe outcomes that we face, that even in that context, when you take care of a lot of sick people, and there have been a lot of sick people around, you get better at it. You learn things that are not necessarily specific therapies, but that are things that you can do much better with regard to mortality rate, things that you just learn along the way.

27:03Having said that, there have been some therapies, particularly in advanced disease, that have shown to be effective. For example, the use of dexamethasone in hospitalized patients with advanced disease requiring a ventilator or requiring high-flow oxygen. Clearly, that has a considerable significant impact on diminishing 28-day mortality. Then there are other drugs like remdesivir that have a moderate effect on people with moderate to advanced disease. Monoclonal antibodies have been used. We have to make sure we get data that has to do with randomized placebo-controlled trials because they have gotten emergency use authorization.

27:49and yet we want to make sure we get it to the people who need it, namely those with early disease. But since it requires an intravenous infusion, it's logistically difficult to get that therapy to people at a point when it would do them most benefit, namely early on. So we've done much, much better, significantly better in the arena of vaccines than we have in the arena of therapy. And we do need to do better, particularly for things that I would feel very enthusiastic about pursuing, is that direct antiviral drugs to be given orally to people very early in the course of disease to prevent them from needing to go to a hospital.

28:37But that's not something that's easily done. You've got to develop drugs the way we develop for HIV. And that endeavor, as you remember, was spectacularly successful in prolonging the lives in a meaningful way, almost to a normal type of a lifespan for HIV, persons with HIV. And that required lifelong therapy. I don't think you would need that. I think you would need maybe two weeks of therapy for individuals if you get a good direct antiviral drug. So there's a lot that needs to be done. But the big success obviously has been in prevention by vaccine. So, Dr. Fauci, there are scores of working parents watching this show while overseeing their kids' online learning at home.

29:23Pfizer was the first COVID-19 vaccine developer to include children in trials back in September. Moderna is reportedly struggling to recruit enough 12 to 17-year-olds to take part in their clinical trials. In your opinion, will a vaccine for kids be ready for the 2021 school year? You know, I can't guarantee that, Octavia. It might not be. You know, there's always a delicate balance when you're talking about children who are vulnerable. They are the vulnerable population. It's tough for them to give informed consent. And you always want to make sure that you have something that clearly is safe and effective in an adult population before you start testing it on children.

30:06So right now, what we will be doing is going into children at age de-escalation, starting off with a certain age, you're going down and down so that you get enough phase one safety as well as immunogenicity data that you could bridge it to the results of the big efficacy trial, the phase three that you did in adults. I'm not sure you're going to be able to get every age group vaccinated before the fall term of 2021, Octavia. I hope that we do get enough data to begin approaching that so that the children could be protected by vaccine. But again, I can't guarantee that right now. I hope we do do that.

30:50But it should be close, because once you get the trial and you really feel confident of the safety and the efficacy and the immunogenicity in the children, then we could go ahead and start vaccinating them. Yeah, understood. My daughters will be encouraged to hear that. This has been a year unlike any other for us, but you leave me constantly wondering, how does Dr. Fauci do it? In addition to government briefings and countless media interviews, I read that you're still an attending physician and treat patients every week. How do you manage your time and how do you deal with burnout? Well, you know, that's a good question.

31:34People ask me that all the time. And when you, you know, integrate into the way you look at your own life as to the enormity of this problem, and the fact that what you are doing could have such a substantial impact, you get a certain degree of energy and resiliency that, you know, you're not really even sure you ever had. And it's one of those things that, you know, to use the words of some people colloquially, you just suck it up and do it. It takes, you know, a lot of time and a lot of energy. But when you focus on what your primary goal is and how important it is to the health of this country and ultimately extrapolated to the health of the world, you just do it.

32:23It's my life. It's all I do. I mean, that's it. And someday, sometime I could maybe catch up on things that I might have liked to have been done. But right now, this just consumes me and I don't resent it. I mean, I I want it to consume me because, you know, the stakes are such that there's nothing else more important to me than this. OK, now we have some questions from lots and lots of questions from the crowd. By the way, Dr. Fauci, I know you do lots and lots of interviews, but after this is all over and you do go to a baseball game, the three interviewers here, you're going to go with us, right?

33:00Right. I mean, we'll be distance and we're in that. Right. But we're gone. Brooke from Boston, actually, right where I am, asked a nice question here, which is just once I'm vaccinated, what can I do to help? You know, once you're vaccinated, what you can do to help, you know, is to continue to try and encourage people around you, maybe your family and your friends, to get vaccinated. Because, you know, vaccination, as I've mentioned so many times, will protect you against clinically apparent disease, symptomatology. it's that's about 94 to 95 percent efficacious it's almost 100 percent efficacious in preventing you from getting serious disease and and death it's so it's really good in that regard but if we want to get back to normal just you or a few other people being vaccinated doesn't change the dynamics of the outbreak we want to change the dynamics of the outbreak so to get as many people vaccinated and say, you know, here I am, I got vaccinated, I'm doing fine, you know, no big deal, no adverse events, and now I'm one of the people that are protected against symptomatic disease.

34:27You're not necessarily protected against getting infected, because we don't know yet whether the vaccine prevents you from getting infected but not having any symptoms. Namely, you could still have virus in your nasopharynx. We're working on understanding that better. But the beauty of a mass of people getting vaccinated is that when you do that, the virus, if you want to make it a metaphor, is looking around for people to infect, and there's not a lot of people to infect. So the entire dynamics of the outbreak gets turned around. And that's what you talk about when you say you've crushed the outbreak.

35:07You know, we did it with polio. We did it globally with smallpox. We did it with measles in most of the countries in the developed world, except for the anti-vax movement, which has kind of gotten in the way of that. But you can take the most formidable virus if you have a good vaccine and essentially box it out. And that's what we hope to do. So if you want to help, get your friends, your colleagues, and your family to get vaccinated. So, Dr. Fauci, we have a question from Tapua from Zimbabwe. Tapua asks, when do you expect global herd immunity to be achieved? Which regions do you see lagging behind?

35:48And what initiatives do you see happening to bring these regions forward? Well, that's a great question. And I think the first thing we need to realize is that we live in a global community. and what happens in another country, be it Zimbabwe or Kenya or South Africa or wherever, it's going to have an impact on the world. I think, practically speaking, when you think about the logistics of companies, and there will be multiple companies making enough vaccine to be able to, as you say, Octavia, vaccinate the world, it likely will take at least a year or two to do that. When we do that, we've got to be prepared that there will be, and we've heard about, mutants arising to be able to modify vaccines, to be able to come in and maybe after a couple of years or so give someone a boost.

36:44We've got to be able to be nimble, but we've got to do it as a global community. I don't know how long it takes. It's not going to happen completely in this calendar year. I'll guarantee you that. There's just not enough vaccine that will have been produced to do that. But I think in a couple of years, we may be able to do that. So I have a question, Dr. Fauci. I mean, there has been this conflict over what's the right thing to do? There have been disagreements. I guess my question is, do you have any regrets in how you have responded to the crisis and how you've tried to message a response to the crisis.

37:25Do you have any regrets with how it's rolled out since this all started? Well, you know, regrets for myself personally or for regrets of what happened? Yeah, well, it's a funny regret for what happened. Those are two separate questions, Adi. You know, it's interesting when people ask you that question, you know, if, well, put it this way, this was a completely unknown situation that was evolving right before our eyes. So if you knew in January 21st, what we know now, you know, when we got the first case in this country, you know, would you call it a regret? Well, I didn't know back then. We didn't have any idea how much transmission was from an asymptomatic person to a person who was uninfected.

38:27We just didn't know that. We didn't know that masks worked. And we had a shortage of masks at the time. So if we knew that this virus had the capability of spreading insidiously without any symptoms in an individual who's spreading it, we would have probably done things much differently earlier on. But we didn't. Is that a regret? Yeah, I guess so. I would have loved to have been totally knowledgeable on January 21st about what was ahead of us in the subsequent months. But we didn't know. So, I mean, you know, to say regret, the mistake or whatever, it really depends on the context in which you ask that question.

39:16You've got to act on the science that you know it at the time. When the evidence changes, you've got to be humble enough and nimble enough to change policy, to change recommendations. So Volcker from Frankfurt has a question about the vaccine technology, essentially asking that it seems that the mRNA technology is very, very effective, at least for this disease that we're facing, but will this change how we develop vaccines for other diseases? That's a very good question. And the answer is likely yes. We have learned, you know, when we started with the mRNA technology for COVID-19, you know, with two companies using the same platform, there was skepticism, concern, and maybe even criticism that we were doing something that was unproven technology with regard to the development of vaccines.

40:14Fortunately, the people who were skeptical were proven to be, you know, maybe understandably skeptical, but incorrect in that it worked out very, very well. So in answer to your question, I'm sure we're starting and we'll start to see the attempts to use this platform technology for other pathogens that we have been unsuccessful in developing a vaccine for. And that is, you know, HIV, malaria, tuberculosis, and maybe even influenza, because this seems to be a pretty flexible, adaptable platform technology. So we have a question from Pierre Paolo from Naples, Italy. How did the media and social media influence the perception of the pandemic?

41:03And do you think they could have done more to better inform and warn people? Oh, you know, I think it's absolutely a double-edged sword, Octavia, because, I mean, the social media gets important information out when it's true information. It's a good positivity. But it is also the source of an extraordinary amount of misrepresentation, conspiracy theories, hoax theories and things like that. So, you know, social media certainly it cuts both ways. It certainly gets information out quickly, but it can be absolutely destructive when it comes to the spreading of completely false information. Are you, Dr.

41:48Fauci, are you changing your lifestyle at all these days? Is there anything that you're doing again that you hadn't done since March or April? Are you allowing yourself any little bit of normalcy at this point? I'm sorry to laugh, Adi, but my life is pretty unidimensional. You know, you get up at five o 'clock in the morning and you just work like crazy until late at night. You go to bed, you wake up and you do the same thing. I don't allow myself doing anything other than just exercising for about an hour or so. I used to do it out during lunchtime here in the beautiful park areas around the NIH, but now I do it late at night when I go home.

42:40I take maybe 45 minutes or an hour out. I used to run, but I power walk now, then come back and continue to work. There really isn't much that I do. It's 24-7 the same thing over and over again. So another person here, Lorraine from Ireland, she wants to know if this shot or the shots that we're getting now, is this going to become an annual thing? Or when might we know that? You know, that's a great question. We don't know that right now because we don't know two things. We don't know the durability of the protection against what we call the wild-type virus. We know that viruses evolve. You get variants, you get mutants.

43:27We already know that in the UK, they had one that, and it's in this country too, that is much more efficient in transmissibility, doesn't appear to have any impact on virulence at this point. We're looking very carefully at the potential impact on vaccine protection and monoclonal antibody protection. The one in South Africa is more formidable to be more concerned. It seems to be one that might have a significant impact on some of the monoclonal antibodies that we're hearing that, but we don't know for sure. So when you talk about requiring a vaccine that you might have to give every year, every other year, you have to take into account how durable is the immunity.

44:14And as the virus evolves, does the protection that's afforded by the vaccine in question cover the evolving virus? Right now, it looks like the vaccines that we have now, despite the evolving of the virus, seems to be one that still is under the umbrella of protection from the immune response that it's induced. But you've got to follow that really carefully. You've got to make sure you're all over following in surveillance the evolution of the virus, so that if it does change enough that you want to update your vaccine and maybe give another booster after a year or so or what have you, I'm not saying we have to do that.

45:02I'm saying we have to be prepared that that is a possibility. And the variant that we've seen out of the UK or that gets talked about is talked about is just being a lot more contagious or transmissible. It's not, as opposed to being a worse, getting a worse case of it, right? There's a distinction there. Yeah, there is, Joshua. But the only problem with that is that we shouldn't be lulled into complacency and say, well, maybe it's more transmissible, but it isn't a more serious disease. Well, the more people that get infected, quantitatively, the more people that are going to get hospitalized.

45:39And quantitatively, the more people that get hospitalized, the more people are going to be seriously ill and die. So you don't have to impact on a one-to-one basis the virulence of a virus or the strength of the virus to hurt you. But the more people you get infected, the more serious situation you're going to be in. And that's exactly what's happening in the UK.

46:05You're muted, Octavia. So sorry about that. Dr. Fauci, Alejandra from Illinois would love to know, when will it be safe for employees to go back to the office? Well, you know, that really depends, as I mentioned, in answer to a few other questions. It depends on where you work, what the nature of the work is, I think we better be careful about when you say, it's a reasonable question, Octavia, go back to the office. Right now, I can work virtually. Many things of what I need is in my office. So I'm back in my office. But there's almost nobody here. It's a building that can contain a couple of thousand people.

46:54There may maybe five people in the whole building. So it really is safe for me. When you say, go back to the normality of a congregating, I think it's going to have to wait until the level of infection in the community is low enough that the virus is not a threat in the sense of people who, if you put them in a congregate setting indoors, you're having a high risk of infection. So again, it gets back to what I mentioned before. It's really going to depend on getting the overwhelming proportion of the population vaccinated so that you can approach some degree of normality. It's going to be gradual.

47:32I don't think that once people get vaccinated, you just throw the mask away or say, it doesn't matter where I go or what I do, I'm okay. I think it's going to be gradual. Hopefully that will be in a period of several months so that we're still in 2021 when that happens. But there's no guarantee because I can't guarantee how many of the people are going to get vaccinated. So one thing I don't think we've covered yet, and I'm just seeing there are a lot of audience questions on this topic. Here's one, Abby, from Massachusetts. Really a question, will there be enough timely vaccines for the second round for Americans who are receiving round one now?

48:10Yes. Any chance we're going to run out of that? That's a great question. And thank you for asking it to give me the opportunity. The confidence now that people like General Perna, who's responsible for this, have that the cadence of the rollout of doses would be such that if you got a first dose, you will be prioritized that when vaccine comes out, you will get your second dose. So as vaccine is rolled out, the first thing you want to do is make sure that those who've gotten their first dose and their second doses do, that those people get their second dose. Then the next priority is to give the first dose with the number of vaccine doses that you have available.

49:01You give it to people for their first dose. And then when the next round comes, those people who've gotten the first dose and their second doses do have priority over people who are going to be able to get first doses. So we should put aside the concern because there appears to be, and I mean, that's not what I do, but I have confidence in what General Perner is saying, that the rolling out of doses should be in a way that there's enough confidence in the ability of the companies to produce it that getting a person a second dose will always be the first priority. And just to follow up so that it's clear to everyone, if you don't get that second dose, or if you're late in missing the window for the second dose, what happens?

49:51What's the risk? Well, the risk is that you're not going to get the 94 to 95 % protection. And number two, the durability of the response is unclear because the study showed that with Moderna, you should get the dose 28 days later, the boost. And with Pfizer, you should get it 21 days later with the boost. So A, you're not going to get complete protection, and it won't be durable. I mean, you could miss it, Adi, by a day or two. But when you're talking about either not giving it or missing it by several months, that's not good. Okay. We appreciate that. So we're out of time. There are a lot more questions that we just can't asked.

50:30But Dr. Fauci, I want to thank you. You have, you know, it's been great. You have been bestowed a number of honors, but the big one is you're our first and only second time guest. So I really thank you. That was a fantastic discussion and we really are appreciative of the work that you're doing. Thank you. All right. Thank you, Adi. Thanks, Joshua. Thanks, Octavia. Great to see you guys. You too. All right. So I want to thank Accenture for coming along for the ride during season two and being our sponsor. I want to thank my co-hosts, Josh and Octavia, for what was another really fun and productive season.

51:06And I want to thank the whole team, Dave, Scott, Kelsey, Alex, Andy, Dustin, Julia, Emily, and anyone I may have forgotten. Just a great team. It's been a joy putting this second season out. I want to thank all of you who've watched this season. I hope we've helped as we're all trying to navigate these complex issues. So that is it. We do not have a show next week. We'll be back when we're back, but thank you all for, for watching season two.

51:58Hello. There's an echo which made the song sound kind of cool. It has a phasing sound to it, yeah. That's just how hip we are. We just don't know it. I thought somebody was playing lead on top of the canned music. It's Ellie in the other studio. I was tempted to do that during the Panera. I got the guitar close enough. I was like, oh, maybe I should play some lead here. That would have been awesome. No, it wouldn't. I have to say, Octavia, you joined us for season two. That was amazing working with you. You were a fantastic co-host, came up with a lot of interesting questions, interesting angles.

52:39It was really a joy to work with you. Thank you. Oh, well, thank you. And thank you, guys, all of you. It's just been so fantastic. I don't know what I'm going to do with my Tuesdays. We still do this. We don't have to broadcast. We do this for fun. yeah we're gonna sponsor if we don't i guess we could do a kickstarter you know a dollar at a time eventually we'll get the sponsorship money that's about what we get too out there who say you enjoy

53:04Dr. Anthony Fauci:the show you're talking in the in the team chat while this was going on we think we should do a kickstarter for dr fauci to have a vacation with him he wouldn't want to go on a vacation well not currently, but I'm saying we'll put it in that scrofer. I think he loves what he does so much. He really does. I mean, he's so obsessed by it. I mean, I was talking to his assistant and he just, this is his life. This is what he wants to do more than anything else. I know. It's incredible when you think that President-elect Biden will be the seventh president. That's crazy. I know. I had messed up the beginning, so I didn't even get to show the montage.

53:52But if you see sort of all the presidents, you know, there's a young spry. You know, look at George H., Clinton. It's all about David and Hoover. You know, Hoover stayed in a job like this for so long. Exactly. Similarities end there, though. Yeah. So good stuff. Yeah. No, it was great. good note to end on so what a season I don't want to talk about it because then we'll get sad but I know I'm such an ugly crier too I want to see oh god yeah I'll turn on the waterworks after the show we don't do this Dave you have we'll be doing a cooking show together I'm quite sure of it I love it I can do that I would watch that That's your new Tuesday spot right there.

54:47Dr. Anthony Fauci:Oh, yeah. Yeah, if I can, yeah, let's cook it up. Let's do it. All right, folks. Great show. All right, guys. What a bummer. Hopefully we reconvene soon. But until then, I love you guys. Love you guys. Right back at you, Dave.

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