Provided by stephens, inc. Dr. Anthony fauci, welcome to firing line. Good to be with you. Thank you for having me. There are currently an average of 50,000 new covid cases per day in the United States and a number of states are seeing increases. Dr. Fauci, is this where we should be as we head into our first winter of covid19 in the United States . No, unfortunately, its not. And this is one of the things that has troubled me for some time as when we were in the summer. I was hoping w would get the baseline level of daily infections at the Community Level to a very low baseline, hopefully even less than 10,000 per day, and as it turned out we got stuck for a while at around 40,000 per day, and now what were seeing is, unfortunately, going in the opposite direction. I woping we could go into the cooler months of the fall and the ultimately colder months of the winter positioned in a much better place because when youre doing things predominantly indoors as opposed to outdoors, whenever you are dealing with a respiratory infection, that always makes it more problematic. So, no, the answer to your question is, were not in a place where i would have hoped we would have been. A study from the institute for Health Metrics and evaluation at the university of washington suggested that by february 1st, nationwide we could expect to see a total of 395,000 deaths because of covid19 if behaviors and policies remain the same. That would nearly double where we are right now. Do you agree with the modeling there . Well, you know, one has to be careful when youre talking about modeling, margaret, because models are only as good as the assumptions you put into the model. So the assumptions that were put in, as you stated quite correctly, is that if we dont do some changing in what we are doing, it is conceivable if not likely that we will get to that very unfortunate number which, too me, serves as a stimulus of why we have got to be able to do things a bit differently. And i dont mean shuing the country done, because whenever you talk about implementing fundamental principles, peopl say, well, you want to shut the we are not talking about that at all. We are talking about so then what steps should we take . For example, the uniform wearing of masks, the avoiding close contact, the avoiding congregate settings with crowds, particularly indoor and people not wearing masks, there have been some states, cities, regions, counties that have done that well and others have essentially skipped over it either intentionally or they try to do it correctly but the population, the people in our country, felt that that would be an encroachment about their individual right to do what they want to do, forgetting we are all in this together. Early on covid19 was thought to spread easily by contact transmission or by touch. People were sanitizing their groceries up until april, march as they came into the house, and then we became more concerned about respiratory droplets traveling short distances and then most recently it has been confirmed by the cdc, as you know, to be aerosolized as well. So explain, please, for the audience, dr. Fauci, the difference between aerosolized transmission and the spread by droplets. Well, in fact, its confusing for many people, understandably. Let me try to simplify it in a way that people can understand. In essence, its all droplets of different sizes. When we generally talk about droplets, we talk about something thats heavy enough that it will contain virus in it, but it will drop to the ground within a period of a couple of seconds and wont travel anymore than, lets say, six feet or so. Thats the reason why we get the sixfoot distance paradigm. However, there are some situations where droplets are small enough or the aerodynamics in the roomre such that they dont drop right away. They hg around and can float around in the air for anywhere from seconds to minutes or longer. Thats what they refer to as aerosol versus droplets. But in reali its just really droplets of different sizes. Does the enhance the understanding that this is aerosolized and it can live in the air for a period time, does that impact how we think about air travel over thanksgiving or the holidays with our families . Not necessarily. Whatt does underscore is what we have been saying alllong, that one needs to be very careful about weang masks because if you go into a particular place, particularly indoors, is always more vulnerable when youre talking about aerosol and outdoors, which has a by of dispersing things. Are they still minuscule that they can permeate masks . Nothing is 100 . Thats where you have to make sure you are careful about not throwing away the goodecause you want the perfect. Even though it isnt perfect, the difference between having a mask on and getng droplets that you cant see with the naked eye is a substantial difference. We know that from studies. How far can infectious covid19 virus spread in the air . We dont know that. So if i give you a number, it would be a guess. It really depends. I mean, it really depends on the size of the droplet, the aerodynamics. In medicine and in Public Health we have been making statements about aerosol versus not, and then you find out that there are so many other confounding factors that influence how long a particular virus can stay, quote, in the air in a particular particle of a certain size. How much will our understanding continue t develop with respect to how this spreads . I think we are continuing to learn literally on a daily, weekly, and monthly basis. There is a lot of optimism about the speed at which covid19 vaccine is being developed. Two vaccines are in the final stages of trials here in the United States. When do you think realistically we will expect the announcement for a vaccine . There is never a guarantee that you will have it. But the way things are going with the Clinical Trial now, with the number of infections in the communi, with the number of people enrolled i the Clinical Trial, we will likely have an answer by the end of this calendar year, november or december. What about the efficacy and the safety . I would do and say that i am cautiously optimistic, though you can never guarantee it, that we will have a vaccine that has a considerable agree of efficacy in one or more of the candidates that are being tested. If thats true is that 70 , 80 , 90 . We dont know, margaret. It would be a pure guess. The trials what is considerable . Well, ill give you the range. The trial is geared to be able to detect pretty clearly a 60 efficacy. A 50 to 60 efficacy. I would hope that we would get at least 70 , 75 . It would be wonderful if we had the degree of efficacy that we have, for example, with the measles vaccine. The measles vaccine is 97 to 98 effective. If we had that, i would be very, very pleased. Im not so sure we are going to get it that level. We are going to shoot for it, but i am not so sure. I would accept something that would be 70 , 75 as being a verymportant step forward. The u. S. Just had its first documented case of covid reinfection. A 25yearold man in nevada was infected with covid in april and then with a different strain of covid in june. So what do we know, dr. Fauci, about how long someone is protected from reinfection once they have contracted the virus . Okay. So, in the spirit of what i have said a couple of times during this discussion of humility and modesty, we dont know right now. We will know as we follow more and more people for longer periods of time. And we know that when people get infected, often those antibodies dont last very long. Maybe after a couple of months, they are no longer there. Does that mean the person is no longer protected . We dont know that. Help me understand then. Since we dont know how much a persons antibodies protect them, what does that do to this argument in favor of herd immunity . It depends on what you mean by herd immunity. If you are well, herd immunity by antibody, by people getting the virus and then developing their own antibodies and that being then the way that the virus will die out from the its a big open question. We dont know how long someone who gets infected and recovers, how long that protection lasts. What we do know, and im not sure it can be a complete extrapolation, but what we do know is that the four common cold coronaviruses that you and i get exposed to repetitively all the time, usually in the winter months, we know that you can get reinfected with the same virus, that you are not protected. So it is conceivable that if you think by building up herd immunity of getting infected, which has a lot of danger to it, that that, in fact, isnt a surefire way of protecting over a long teperiod of time the population. Look, if we develop a vaccine, it sounds like what you are saying is we would have to take the vaccine on a pretty regular basis in order to keep up. Right. That is conceivable, margaret. You have to do the experiment to find out how long it lasts. The first step is to develop protection. The next step is to figure out if its durable. T isnt durable, then you may need to give intermittent booster shots the way we do with other types of infections that require an intermittent booster like tetanus and other types of infections. So either way, it sounds like covid is here to stay . Well, think some aspect is. I dont think its just going to disappear. I do believe with a combination of good Public Health measures, implemented at the global level, and a good effective vaccine that is taken up by the overwhelming majorit of the population, that we could get the level of infection so low that in and of itself it peters out. Not eradicate. I dont think we are going to eradicate it, but i think we can t much better control than we have right now with a univsally implemented vaccine and good Public Health msures. There are a group of scientists who have signed a letter called the Great Barrington declaration which the white house has embraced and it argues that the central focus of Public Health policy should be, quote, focused protection, right, that protecting those who are the most vulnerable should be our primary focus, and that the rest of the population should just live their daily lives and take on the risk that is getting the coronavirus and enduring it and building the antibodies. You said that it is impossible to fully protect the vulnerable population, and thats why this is a bad idea. Why is it impossible to fully protect those who are vulnerable . Well, so in the declaration it says we dont want to shut down and lock down. I totally agree with that and i say that almost every day, that thats not the solution. The other one is there is an implication somehow you want to shut down the economy. Thats totally, totally, totally incorrect. Okay . Now, next is, we want to protect the vulnerable. I am all for that. Thats whats in the declarat but what is implied from that is, if you let anybody and everybody get you do nothing to block infection. No masks, dont worry about crowds, do whatever you want, let everybody get infected, as long as you focus, as they say, on the vulnerable, which means protect the people in the nursing homes, protect the people in the extended care facilities. There are some things about that that are reall problematic. One is, if you look at the general population, a substantial proportion by some estimates up to 30 fall into the category that they are at risk of a severe consequence after you get infected, namely, hospitalization and possibly death. So, if you think that you have the capability, which we have shown thus far we are in the capable of doing that, of all of a sudden magically protecting all the obese people, the people with diabetes, the people with hypertension, the people with chronic lung disease, i say, and many, many, many of my Public Health colleagues say, if you think youre going to do that, youre going to wind up with lot of dead people. And thats something we really want to avoid. So, a, we do want torotect the vulnerable and we dont want to shut down, but dont equate that with a successful way to deal with an outbreak by letting anybody and everybody get infected. To those who taught the example of sweden as sort of a rebuttal to not having shut down the economy, what do you say . I say why dont youompare sweden with the countries that are comparable to them . Namely, the other scandinavian countries like norway and denmark. They do terrible compared to norway and denmark when it comes to deaths. President rump has said that he was cured and that he is now immune from the virus. Is this true . Well, im very pleased he is doing very well. I mean, thats for sure. He is a strong man. He has done quite, quite well. I think you have to be careful what the nuances of cure are. Has he recovered from infecti . Yes. Infectious disease people and others sometimes have a little nuance what you mean by cure. Like if you have an infection or a condition in which the majority of people get better on their own and you give an intervention that facilitates that, most people wont say you cured it. Some people would say you hastened the recovery. But he received some interventions that look promising. So, in that respect, when you say youre immune, i have no doubt that he is protected for a finite period of time. I dont know how long that is. But the president is absolutely correct when he says hes recovered, he almost certainly has a degree of immunity that will protect him for a finite period of time against reinfection. So he is quite correct in that regard. He took off his mask at the white house four days after testing positive for the virus and said to thamerican people in message, dont be afraid of covid, dont let it dominate your life. What is the impact of that messaging for ordinary americans snrchlts i dont want to get into a situation where we are pitting statements that the president makes against statements that i make. O, i want the science from you. Yeah, the science is that most people, and it is correct, will, in fact,articularly if you are young and healthy, if you get infecd you may not have any negative consequences. But one of the things we have to be careful of is the mentality to think, because you may be a young, healthy person, that it doesnt make any difference if you get infected. Well, it does, because you dont live in a vacuum. And if you get infected and even if you get no symptoms, you are propagate ago pandem propagating a pandemic that is killing a lot of people. What do i mean when i say you are propagating a pandemic . Maybe you have no symptoms, but the chances are that you might infect someone who then infects someone who then does get serious consequences. That could be soones grandparent. That could be someones wife on chemotherapy for breast cancer, a immunodeficient child. You cant think of youelf being in a vacuum where your getting infected doesnt make any difference to anybody else. It really does. You have worked with six president s, dr. Fauci, republicans and democrats. George w. Bush gave you the president ial medal of freedom for your work on aids and you have been in Public Health for decades. During the beginning of the aids epidemic you faced criticism from activists who thought that the government wasnt doing enough to provide a vaccine and treatment as well as from people who thought that you shouldnt be, quote, wasting your time o hiv. What did you learn from that period of tim that you have brout with you today . You have done your homework, thank you. In the story, veryell, yes, thats exactly what happened. You know, what i did learn is that you are going to have obstacles when you have an evolving, charged situation, and there is nothing in some respects that is more charged than in an evolving, scary outbreak. And thats what we had early on with hiv, and there were opposing opinions. There were people who disagreed with what you did. The one thing i did learn then, and im trying to the best of my capabilities to apply it now, multiple decades later, is that you have got to stick about i the Scientific Data and the evidence, keep an open mind, admit when you have been incorrect, and move on and learn as the situation goes on because when you have an evolving outbreak over time, the way we had with hiv in the early 80s and the way we are facing with it right now, there is going to be a lot of complicating issues that are going to arise. U just need to keep an open mind, be flexible, and be humble to admit that you dont know everything from day one. You just dont. You cant. What weve noticed is that hiv and covid are both very different viruses. Obviously, different modes of transition. Both disproportionately have impacted minority communities. Epidemiologically speaking, why is that happening . I think what it has to do with a variety of things. One of which is the social determinates of health. The situation people find themselves in. Economically and socially and otherwise. Lets take covid19. If you look at the disproportionate number of africanamericans and latinx who actually get infected, the nature of their jobs puts them out into the environment in the front line getting exposed. Thats bad enough. But when y look at when they do get infected, they have a much greater incidence and prevalence of the underlying comorbidities which make it more likely to have a severe outcome from covid19. Diabetes, obesity, hypertension, renal disease, cardiovascular disease. These things are due to decades and decades and decades of social determinants of health, which put them in the compromised position of their own health. So, the solution to that, and one of the things i would hope that we would get jarred into realizing now, is that this happens over and over again. You brought up two good examples. Hiv and covid19. Maybe we will have, as a society, a commitment to address these social determinants of health and somehow neutralize them so that three or four or five decades from now we are not talking about the same disparities. You were featured in a campaign ad for President Trump and said about that, that, quote, by doing this against my will, they are in effect harassing me. Apparently, a super pac for joe biden has used your image also to make their argument to t public s it worth denouncing joe bidens super pac . I havent seen any of those things. I will go back and look at them. But the ad that i saw from the gop campaign, the juxtaposition of my statement at the end of that clearly ilied that i was favoring a political candidate. That is something that i have said, and please give me the opportunity to say, that i have been doing this in Public Service for five decades, and i have never, ever either directly or indirectly endorsed a tical candidate. And the implication of that, the way it was juxtaposed at the end of the ad implied that i was endorsing someone. And thats not. I dont have anything for or against anybody. I want to do my job as a Public Health person, a physician, and a scientist. That was the reason why i was a bit upset by that. So when you look at the biden super pac, will you look at it and weigh in on that as well . Chron. Maybe i will, maybe i wont. I thinker getting complicated enough here. I want to continue to do my job. Last month you wrote in the scientific journal we are entering a pandemic era in which covid19 is the first in an accelerating wave of epidemics into the future. Tell me what you mean by that and if we are going to be ready, because we thought we were ready for this one. We did. Thats a ver good point. What i was mentioning in that article with my colleagues, david moran and others, was that if you look upon whats going on now in society, particularly the encroachment upon the human animal interface we are setting up a situation where we are going to be exposed to things in ways that they were never exposed to. There are so many other aspects of that. But i think one of the things that weve seen exemplified by the outbreak that we are involved in right now is the wet markets in asia where people bring animals from the forest into markets when they have no idea what the microorganisms or path agains are in those animals. We have to be careful about that, careful how we interact with the environment, careful about how we interact with other species. Thats what i meant by that. You are a classic major and studied no doubt the great plague of athens almost 2,500 years ago. The plague mar the beginning of a decline to greater lawlessness in the city and causes the citizens to lose respect for their leaders, laws and institutions. Many scholars say that this led to the death of athenian dr. Conley is i itself. Does this give you pause as you confront our Current Crisis today . You are getting pretty heavy here, margaret. This is pbs, dr. Fauci. We go deep. You are going very deep. You know, i dont think its comparable, margaret. Back then, to the best of my remembrance from my college and high school days, that that was just something that was destructive to everyone and democracy tended to collapse because of the disorder that left. We are not seeing that right now. We are seeing a good degree of divisiveness by some people who think this is not a problem and others that are seeing hundreds thousands of people dying. Thats really the problem. We have got to pull together and be on the same wavelength that the enemy here is the virus. The enemy is not one side or the other of an argumen the only way to counter that is to do things together as a nation. Thats the only way. We cant be fighting with each other if were trying to contain a potentially historic outbreak. Dr. Fauci, thank you very much for being with us on firing line. I appreciate your time. Thank you very much, margaret. I appreciate you having me. Announcer firing line with Margaret Hoover is made possible in part by charles b. Schwab and by corporate fundings provided by stephens, inc. It used to be considered a normal part of aging. Even doctors used to say, youre old, get used to it. Welcome everyone. We know now that theres something that we can do to increase strength, and simple exercises we can do to enhance balance, which results in a steadier, more active life. Slowly slide out your right foot and then test your balance. I think strength and balance are absolutely key. The balance particularly. Can you hold that ft out