Fauci, a member of the White House Coronavirus task force. Dr. Fauci took part in a virtual discussion on the pandemic with Georgetown University students. Good afternoon, everyone, and thank you for joining todays Virtual Event hosted by the Global Health initiative, the Oneill Institute for national and Global Health law, the Kalmanovitz Initiative for labor and the working poor, and the institute of politics and Public Service at the Mccourt School of public policy, which is known to many of you as gu politics. I am a health law student at georgetown law. I am focusing my studies on access to health care. I am also working with the Oneill Institute on various projects. Recently the collaborative project on covid19 laws and policies. Before joining georgetown, i received my bachelors degree in law from kingstown university in saudi arabia. I am pleased to introduce our guest today, dr. Anthony fauci. Dr. Fauci is one of the u. S. s most visible leaders in Public Health. Dr. Fauci also currently serves as the director of the National Institutes of allergy and Infectious Diseases at the National Institutes of health. He is also a member of the White House Coronavirus task force. We are thrilled to have dr. Fauci with us today to discuss the covid19 pandemic and the unique risks and responsibilities young people have in mitigating the spread of covid19. Please join the conversation on social media using the hashtag fauciatgu. For our students, please remember to submit your questions for dr. Fauci using the q a feature at the bottom of your screen. Please remember to include your school and year. This event will be moderated by mr. John monahan, a Senior Advisor to the president who helped organize georgetowns Global Health initiative over the past three years. Prior to this role, mr. Monahan served as senior Global Health physician at the department of health and Human Services and the state department during the obama administration. Our second moderator is the gu politics executive director. I will turn it over to them now to kick us off. Thank you very much. John thank you. That was terrific. I appreciate it. Off by wanted to start thanking you for joining us on the webinar today. Over the years, you have been so generous in sharing your time with our students. We are delighted you are able to join us today. I should also add we deeply appreciate your enduring commitment to Public Service, your commitment to Public Health and science, in your many years at nih, so thank you for being here. In. S just jump to set the stage, it would be terrific if you can provide us with an overview of where we the covid19h pandemic, hotspots, how the u. S. Compares. Cases,ates have rising what populations are most at risk and have been most impacted. And if you could because i know you take history seriously if you could put this in some context. 1918red to the pandemic of or other coronavirus outbreaks we have seen, if you could help put this experience we are going through in that context as well. Dr. Fauci thank you, john. You asked a lot of questions. [laughter] i will do it sis and like. We are in the middle of the sebel it sis inked uccinctly. Ravagedd19 pandemic many parts of the world. It is a mixed bag in the United States. We have areas that have been hit very badly like the new york metropolitan area, doing quite well now in getting the outbreak under control and trying in a prudent fashion to open. The numbers are quite sobering. We had over 135,000 deaths in this pandemic for the United States. We have over 3 million cases. If you look globally, there is close to 600,000 deaths and about 13 or 14 million infections. This is a pandemic of historic proportions. We cant deny that fact. It is something that, when history looks back on it, it will be comparable to what we saw in 1918. The current challenge that we are facing right now is the resurgences of infections in the south and southwestern part of the country, particularly in areas like california, florida, arizona, and texas. They are seeing record numbers of cases, mostly among young individuals, strongly suggesting the link between attempting to asn, and in many respects, we saw pictures and photos and films and i will get back to this in a moment about response esponsibility, where young people were seen without masks, which adds fuel to the fire. Our challenge tomorrow and next week is to get back on track of not only being able to contain, but open safely. It is a serious situation in the United States, the United States being very heterogeneous demographically and in many other ways it is a mixed bag. Some areas of the country are doing quite well and others are being challenged. You said to compare it. If you look at the magnitude of the 1918 pandemic, where to 100e from 75 million Million People died globally, that was the mother of all pandemics. I hope we dont even approach that with this, but it has the inings of approaching that seriousness. I hope the interventions we are implementing will not allow that to happen. It does have strong similarities with that in that it was the emergence of a brandnew infection, influenza. This is coronavirus. That essentially thrusts itself onto the human population. It had two characteristics that make it the perfect storm. That is a virus that jumps species, but that almost immediately has a capable and efficient way of spreading from human to human, simultaneously with having a considerable degree of mortality. You asked me to compare it with other outbreaks. I can give you examples of each of those. One or the other of those characteristics, but not both. That is what i refer to when i say the perfect storm. Lets take the threat of the bird flu that you and i had a lot of experience when we were at the department. It jumped from a chicken to a human. It had prepandemic potential, but it didnt spread from human to human. If you were unlucky enough to get infected, you had a 37 , 45 mortality, but it was a dead end mostly with humans. It did not go from human to human. Then you had the situation with the h1n1, which was very efficiently transmitted from human to human. Yeargenically, deaths that were less than the seasonal flu. One transmitted well, didnt kill. One killed, but didnt transmit well. What we have now is a virus that is capable of spreading from human to human. Even though it has a wide range of impacts, from 2 to 40 20 to 40 of those without symptoms, to those serious enough to go to the hospital, serious enough to get to intensive care, ventilation and even death. So the range of severity is great and wide, which leads to confusion on the part of people as to whether this is serious as some people say it is. It is not serious for some people, but deadly serious for others. That is the overview. John my followup is, because i think the virus has this disparate impact, as you described, there are issues in the public debate that you could help clear up. There is this discussion about whether a rise in total u. S. Cases is the result of testing alone. Two, should we take comfort that death rates are declining even as infection rates increase . Then this recent discussion about the stability of the virus aerosolized form rather than droplets. If you would be able to help us understand what the science shows us. On, i want tog write down your questions. [laughter] okay, sorry, i was distracted with that. The first question is, is this just an increase because of testing there is no doubt it is both. The more you test, the more you pick up. Increased testing will give you increases. There is no doubt there are more infections. We know that because of the percentage of the cases tested that are positive is increasing, therefore you are seeing truly more new cases. In addition, we are seeing now more hospitalizations, which lag behind infections. We will see, though not as much as we have seen, very likely more deaths. Clearly there are more infections. The second question is itn should we take comfort is the death rate is declining . Dr. Fauci the big spike in the death rates we saw with the terrible situation in the new york city metropolitan area and situations in chicago, new orleans, detroit, that death rate is happily going way down. We will likely see more deaths as people get hospitalized, but i doubt it is going to go up to the extent we have seen before, mostly for a couple reasons. One is that if you look at the age range of the individuals getting infected now as opposed to a few months ago, it is about a decade to a decade and a half younger. Even if young people, which some do, get sick enough to be hospitalized, it is highly unlikely that the death rate among them will be the death rate that we saw in the real core of the explosion that we saw in the northeastern part of the country. John the last question is the extent to which the virus is transmitted through aerosol. Dr. Fauci that is still debatable. Two minutes before i came in, i just read an analysis of it. It is almost certain that there is a degree of aerosol occurrence. The degree of transmission aerosolwise is unclear. Most people think it is not the dominant modality of transmission, but the definitive proof has not been put. I dont think it is dominant. I think it occurs. For those listening, to know the difference, that droplet type of transmission goes beyond six feet. If you talk or cost, a droplet cough, a droplet would drop to the ground, which is why we talk about staying six feet away. An parasol is less than five micrometers parasol i ae rosol has the capability of getting behind or in the mask. That is what they talk about with aerosol. John let me turn this over for the next question. Thank you for joining us. Lets turn to the response. As we already talked about, the disease has hit the u. S. Harder than many other nations around the world. It is not entirely because of testing. Picture first, some of the nations that have dealt with this more effectively have had more of a coordinated national response, whereas we have opted for more of a statebased, Regional Response in the United States. Is that part of the disparity . Can we even have a National Coordinated response . Dr. Fauci it is always easy to look back and say, if we had done this, would it have been different . It everyn analyze which way. Some of the things i believe have an impact on the differences and i dont think we can fully explain it in europe and in some of the asian countries, where they shut down, they locked down to the tune of 90 plus. They really locked down. We have a large and really heterogeneous country with different risks geographically and demographically. Even though we locked down considerably, the estimate is only around 50 , 55 or so. When we had the outbreak in europe, they peaked, then they came down to baseline. They really did go down from thousands of infections to handfuls or so of infections. Whereas in the United States, if you look at our curve, for better or worse, we peaked, we came down, and we never came down to baseline. We stayed around 20,000 a day of new cases until the most recent surge where we went to 30,000, then 60,000. The issue is we never got down to the baseline so that when you started to open up you had relatively few amounts of infections to deal with. Whereas when we opened up now, you are seeing the search. The reasons for that are complicated, and there are many. The issue of how one does a response we live in a country that from its founding had a federalist bent. States had independent rights of doing things their own way. In many respects, that works to our advantage in other situations. Possibly that was a disadvantage here. Very difficult to make a definitive comment about the paid and the that difference between what we see here and in europe. Mo we all have so many more questions. People will try to get through john and mine before we get to the students. This is a reminder to students, you can still submit your questions using the q a tab at the bottom of your zoom screen. John speaking of the schools and students, many schools around the country are announcing hteir guidance their guidance for the fall. Just yesterday, the l. A. County and San Diego CountyPublic Schools announced they would be online for the entire fall. The president and many others were talking about reopening schools fully as quickly as possible. ,he cdc issued guidance describing steps schools can take to open safely. I would like you to step back and help us think how should schools approach the upcoming epidemic Academic Year . The risk k12, higher ed present to themselves and their families, what is the right way to think about this Going Forward . Dr. Fauci for clarity, lets talk about elementary, middle, high school, and not university, because there are major differences. I think people are much more focused on school. I start off with a general principle, and work toward the operational aspects and the exceptions. Wea general principle, should try as best as possible to keep the children in school for the reasons that the unintended downstream Ripple Effect consequences of keeping the kids out of school and the impact on working families and on other aspects of society can be profound, not to mention the negative effect on the children. As a principal, we should try principle, we should try as a default to get kids in school. However, that will vary where you are in the country and the dynamics of the outbreak in you r particular region. The one other guiding principle that is overriding is the safety and welfare of the children and of the teachers. Eve got to take youve got to take that into consideration. If you are in a part of the country where the dynamics of the outbreak are minimal, there is no problem in getting back. If you are in outbreak mode, the you leave it up to local individuals, as you said, in certain california and making sureols, that the safety of the students and teachers are paramount. Lets try and get them open to the extent that we can, but lets look at the dynamics of the infection in the area that youre in. This maybe is a bit less about the response from the government, more about the response from citizens. Glad you are here. Im glad youre speaking out. I am glad you are giving students a chance to speak with the. A lot of people are confused about the state of the pandemic and what they should be doing. My wife and i every night try to sit down and figure out what we are allowed to do with our kids based on pieces of guidance we picked up. The confusion can be attributed to three main issues. One, the evolving nature of the pandemic has resulted in new information. Two, a growing body of deliberate misinformation and disinformation that is being spread, much of it online. Andthree, the polarization growing politicalization of the pandemic. Even the past weekend, the white house pointing to some of your tovious comments in order question the guidance. Misinformation, evolving guidance, increased politics in the conversation, how do people synthesize this information to make the right decision . How do they know who to trust . Dr. Fauci that is a good question. You adifficult to give definitive answer, except that, truste most part you can respected medical authorities. I believe i am one of them, so i think you can trust me. But i would stick with respected medical authorities who have a track record of telling the truth, who have a track record of giving information and policy and recommendations based on Scientific Evidence and good data. Advice to youive and your family and friends, i would say that is the safest bet, to listen to the recommendations from that category of people. It is entirely understandable how the public can get mixed messages and get confused about what they should do. Mo let me ask one quick followup. Just mentioned data. There was a story that broke moments before we convened here today about that Data Collection will bypass the cdc and go straight to hhs. I wonder if you have any thoughts on that latebreaking news. Dr. Fauci one of the bad ideas about commenting on breaking news that you didnt read is a surefire way to shoot yourself in the foot. I think i will pass. Mo we will go to john, and after that, right to student questions, which will be better than any of my questions. Is i last question know we asked a lot of questions, but it does so far get to the complexity of the experience most of the country is going through. Most of the people on this webinar are students. They are young adults. As we start to bring people on, given everything we have talked tout, what is your message young adults, teenagers . As more states open up, some are pausing, but focusing on the risks and response abilities of onsibilities resp of young people . Dr. Fauci it is key to what is going on right now with the resurgence is a resurgences in some of the southern states. Some this with trepidation, because i dont want to seem preachy. If you look at what is going on in the country, that the infections among young people contributed in part to what you see on tv, of young people gathering at bars, crowded places, congregating, many without masks. There is an understandable situation where a young person could say, you know, statistically the chances of my getting into trouble by getting infected are much smaller than an elderly person and a person with an underlying condition. Sense i as since i as a young mindn am healthy, i dont sipping my margarita in a crowd. However, what they need to understand is that, given the nature of this outbreak, even if you get infected and have no symptoms and never get sick, you are inadvertently propagating the pandemic. You are part of the problem and not th