Anthony Fauci Explains How To Make It Through His ‘Worst Nightmare’

IRA FLATOW: This is Science Friday. I’m Ira Flatow. I am having a deja vu all over again. Almost 40 years ago in 1981, I began covering a strange outbreak in New York City of a rare form of cancer among young gay men. It was mysterious and baffling to scientists, who would take years to get a handle on what would be later called AIDS and the virus HIV.

And it was at that time that I began interviewing a young NIH disease expert named Anthony Fauci. And since then, over the last 30 years on Science Friday, Fauci has joined us to explain disease outbreaks all over the world, like Ebola, SARS, swine flu, and now the COVID-19 virus. And just this week, he warned a conference of biotech executives that the pandemic was far from over. And lots of questions about the disease remain unanswered and baffling, as they were with AIDS, thus my deja vu moment.

Fauci is the Director of the National Institute of Allergy and Infectious Diseases and the recipient of the Presidential Medal of Freedom. He joins us to talk about where we go from here and how does this disease intersect with a public health crisis impacted by racism and anti-vaccine sentiments.

Welcome back to Science Friday, Tony.

ANTHONY FAUCI: Thank you, Ira. It’s good to be with you.

IRA FLATOW: Can you blame me for having that deja vu moment? Does it happen to you at all about AIDS?

ANTHONY FAUCI: Oh my goodness, there’s so many things that are analogous to what was going on when you and I were talking about it back in the early ’80s– the mysterious nature, the protean manifestations of disease. The more we learn about it, the more we realize how little we know. I mean, it’s just striking.

IRA FLATOW: Except in the meantime, I’m still just a radio talk show host, and you’re now America’s doctor, so.

ANTHONY FAUCI: We haven’t changed that much, Ira.

IRA FLATOW: Well, let’s begin. There’s so much to talk about. Let’s begin, I’m quoting The New York Post of all papers today, a headline that says “Anthony Fauci on Tuesday called the coronavirus his, quote, ‘worst nightmare’ and warned that the fight against its spread is far from over.” An accurate quote?

ANTHONY FAUCI: Yes, it is an accurate quote, Ira, and the reason I say that is that we often get asked that, what is the thing you worry about the most? And I’ve said that so many times over the years. It’s the evolution or the appearance in the human society of a new virus that generally would jump species from an animal to a human that would be a respiratory borne virus that would have the combination of a very efficient capability of spreading from human to human, at the same time having a high degree of morbidity and mortality.

And that’s, unfortunately, what’s happened here. Because remember, when we had the bird flu, it jumped from a chicken to a human, had a high degree of mortality, but it was very poorly efficient in spreading from human to human, so it never went anywhere. And then we had the H5N1, H7N9. But to have the combination of both, something that’s highly, highly efficient in spreading from human to human, and yet has a significant degree of morbidity and mortality is, in fact, the worst-case scenario you would expect with a respiratory virus.

IRA FLATOW: Is this virus still evolving and mutating?

ANTHONY FAUCI: Well, Ira, it’s an RNA virus, and RNA viruses mutate all the time. The issue is, is it mutating in a way that is influencing or impacting its functional capabilities, like its virulence or its ability to spread from human to human? The answer is, we don’t have any evidence that that’s occurring. Certainly, we’re observing mutations, which is expected when you have a virus that’s widely disseminated throughout the population and is an RNA virus. But so far, it has not changed significantly, to our knowledge.

IRA FLATOW: Why are we seeing record-breaking spikes in the numbers of cases and hospitalizations in recently opened states like Texas, Arizona, Utah, North Carolina, and Florida?

ANTHONY FAUCI: Well, it’s not unexpected, Ira, and the reason is that this virus was so easily transmissible that the best way that we did– and we successfully did it- we mitigated it by essentially shutting down the country, going into lockdown. It wasn’t just us. The rest of the world did the same thing.

And you know there’s a recent paper that came out just yesterday or the day before showing that that closing down of society globally has saved hundreds of millions of infections and at least a few million deaths. So we know that mitigation works. When you pull back and try to reenter a degree of normality, you can expect that there will be blips of infection.

Whether those infections become real rebounds is going to depend on how effectively you address it by identification, isolation, and contact tracing. So you are correct, Ira, that we are seeing these little blips now in several states throughout the United States. I hope that we can contain them effectively with the tools that we have.

IRA FLATOW: If there were a spike in new cases, how would we know if they were due to the opening of the states or due to the masses of protesters?

ANTHONY FAUCI: I think it’s going to probably be a combination of both. Whenever you get a congregation of people together, hopefully everyone will be wearing a mask, but even with a mask there’s still a risk when you have crowds. It was just reported yesterday evening that certain members of the DC National Guard, who are involved in trying to contain the demonstrations in my city of Washington, DC, have tested positive. Again, that’s unfortunate, but not surprising, because when you have the congregation of people in a crowd, that’s when you get spread, and that’s the thing we’re concerned about.

IRA FLATOW: There have been calls from Governor Andrew Cuomo of New York and others asking for everyone who participated in the marches to be tested. What’s your view on that?

ANTHONY FAUCI: Well, I mean, obviously, if you have the capability and the facilities to do that, you could get a good feel for exactly what impact, if any, that congregation of people during the demonstrations. So I would agree that if you’re able to do that you would get important information.

IRA FLATOW: And are there enough tests out there? I mean, that’s a question we keep hearing over and over. Is that a correct question to ask?

ANTHONY FAUCI: You know, yes. Right now, if you look at the situation with testing, Ira, obviously, we got off to a slow start in the very early weeks of the outbreak as it was recognized here in the United States. But right now the testing numbers and capability and capacity is significantly better than it was. And as we looking forward as we enter into the next weeks and months into the summer, it should get even better. So I do not believe that testing will continue to be a problem going forward.

IRA FLATOW: All right, we opened the phones– actually, we’re not on the phone during our play staying at home, but actually we have our VoxPop app, Twitter and Facebook, and we’ve asked our listeners to ask questions. And let me begin with an AIDS-related question. A listener on Twitter wanted to know why, if we still don’t have a vaccine for HIV after 30-plus years, why can we expect a COVID vaccine in fewer than two years?

ANTHONY FAUCI: That’s a very good question, Ira, and the explanation is really rather simple. With HIV, it’s such a unique virus, the body does not make an adequate response against natural infection. And we know that, and that’s the reason why there are essentially, despite the tens of millions of cases of HIV infection, there are really no documented situations where someone’s immune system completely clears the virus.

There’s a group of elite controllers that can suppress the virus well, but there’s no evidence at all that the body makes an adequate response to natural infection. And when the body doesn’t make a natural good response, that means that it’s going to be very difficult for a vaccine to do something that the body naturally cannot do.

With coronavirus, it’s different. If you look at the situation with coronaviruses, the majority of people spontaneously recover and clear the virus, which means we already know that the body is capable of doing that. So the proof of concept is already there. So we feel if we can respond to natural infection with a good immune response that a vaccine can also do that. So they are really fundamentally very different viruses, and that’s the reason why we feel that we can be cautiously optimistic about our capability of developing, successfully, a safe and effective vaccine for coronavirus.

IRA FLATOW: There have been some recent reports that remdesivir may have some positive effect against the virus. Is it possible that we might have a treatment, like an AIDS, we might have a treatment, before we have a vaccine?

ANTHONY FAUCI: Ira, I would not be surprised if what you said is absolutely correct. Well, remdesivir was a drug that was put into a placebo-controlled randomized trial in hospitalized patients with COVID-19 who have lung disease. It was a statistically significant but modest positive effect of about 32% diminution in the amount of time it takes to recover.

That’s the first step towards developing better drugs and drugs in combination, not only antiviral drugs, but also things like monoclonal antibodies, passive transfer of convalescent plasma, hyperimmune globulin, and even some therapies that blunt the aberrant overactive inflammatory syndrome that we see sometimes in people later in the course of their disease. So there’s a lot of activity going on in the development of countermeasures in the form of therapeutics.

IRA FLATOW: Mm-hmm. Let me begin going back to our VoxPop. A science writer colleague of ours had this question for you.

UMAIR IRFAN: Hi, Fauci. My name is Umair Irfan, and I’m a staff writer at Vox. My colleagues and I would like to know, given that many states are pursuing different strategies, how do you anticipate the outbreak will play out in the United States over the next year? If infections rise again, can we count on shutdowns being as effective a second time?

ANTHONY FAUCI: Well, yes. I hope that we don’t get into that situation where when we get infections we cannot contain them with an adequate degree of identification, isolation, and contact tracing. We know as we start to open up the country to try and get back to some degree of normality that there will be blips of infection. That’s going to be inevitable.

Whether those infections turn in to a real resurgence of infections and a rebound will depend on how effectively we’re able to identify, isolate, and contact trace. If we don’t do that effectively, we may need to pull back from containment back into mitigation, which we know is effective because we clearly have proof that that did blunt the outbreak.

IRA FLATOW: Are we sort of in a whole national experiment on this now?

ANTHONY FAUCI: You know, in some respects, we are, Ira, because if you look at the history of our response to infectious diseases outbreaks over the decades, well, well, well back in history, we have never had to essentially lock down not only an entire country, but if you look at what the other nations of the world did, we kind of locked down the entire planet for a while. And that certainly contained what would have been a much more massive global outbreak. But you can’t stay locked down forever. And that’s the reason why we’re trying to carefully and prudently, with guidelines, get back to a degree of normality. And we’ve never ever had that situation before.

IRA FLATOW: Just a quick break. I’m Ira Flatow, and this is Science Friday from WNYC Studios. Let’s go to a scientist who is a recent guest on the show, Uché Blackstock had this question for you.

UCHE BLACKSTOCK: Hello. I’m Uché Blackstock. I’m founder and CEO of Advancing Health Equity, which works with health care organizations to close the gap in racialized health disparities. In April at a press conference with respect to racial health disparities in this pandemic you said, so when all this is over, and as we said it will end, we will get coronavirus, but there will still be health disparities, which we really do need to address in the African American community.

However, right now black people are still dying at highly disproportionate rates. More than one in 2,000 black people have died from coronavirus. 13,000 black Americans would still be alive if black people had died at the same rates as white Americans. What specifically would you recommend the federal government do right now to address these racial disparities?

ANTHONY FAUCI: Thank you for that question. And I like the point that you said right now because there are the chronic persistent issues of social determinants of health and disparities in health in the African American population that we need to maintain a commitment to not forget about that. But right now we have a situation where we’ve got to concentrate the resources in areas where you have a high density demographically of African Americans to be able to provide them, when you do see these blips of infections that we’ve been talking about, that we can adequately and effectively identify, isolate, contact trace, and get into care, as quickly as possible, these individuals who do become infected.

Because we do know that not only do they have an increased incidence of getting infected because of the situation economically and otherwise where they find themselves, but once infected, the prevalence and the incidence of the comorbidities that lead to a poor outcome clearly are disproportionately higher in the African American population, including hypertension, diabetes, obesity, and others. So we can do something about that now, both with protecting them from infection, identifying it as soon as they get infected, and getting them into care as quickly as possible.

IRA FLATOW: And what would the long-term plan be then?

ANTHONY FAUCI: Well, you know, Ira, that’s something that we have to have a decades-long commitment, because if you look at the things, the social determinants of health, the situations that African Americans and other minorities are put in with regard to the availability of things like a good diet that prevents things like obesity and diabetes, the access to health care to allow them to get under control any indication of hypertension, those are the kind of things that we need a long-term commitment to because they’re not going to go away spontaneously.

And as I’ve said, one of the things that might be a positive in a real issue of a lot of concerning issues is that this is shedding a very bright light on the disparities that we’ve known about so long and how destructive and harmful to the African American population that these disparities can be. So I would hope that this would re-energize us in a commitment to do something about that.

IRA FLATOW: We’re going to take a break, and afterwards we’re going to come back and talk more with Anthony Fauci, more on the pandemic and what the end might look like.

This is Science Friday from WNYC Studios.

IRA FLATOW: This is Science Friday. I’m Ira Flatow. We’re talking this hour about the coronavirus pandemic with Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, and now a household name, as the nation’s leading scientific voice during this crisis.

Let’s turn now towards the search for a vaccine– when we could expect a vaccine, and has your view changed on it?

ANTHONY FAUCI: No, my view hasn’t changed. So let me just reiterate it again. We’re going to go into an advanced phase 3 trial in the beginning of the summer with more than one candidate. And it’s going to be a very large trial, involving tens of thousands of individuals. And we hope that by the time we get into the mid to late fall, if things work out OK, and we don’t get into any unanticipated speed bumps, that by the end of this calendar year, and the beginning of 2021, that we will have a vaccine, or maybe more than one vaccine that we will be able to deploy and utilize to protect people.

IRA FLATOW: Are you worried that we will see hesitancy from people about getting the vaccine, driven by misinformation that seems to be proliferating already?

ANTHONY FAUCI: Yeah, that’s always a worry that I have, Ira. You know, it dates back to the vaccine hesitancy around measles that we saw resulted in the unfortunate rebound and resurgence of measles in a country that had essentially eliminated measles. I’m always concerned about the general anti-science attitude, and particularly the anti-vaccine attitude.

So what we have to do is we have to intensify what we call community outreach, to be very transparent with the community, to talk to them about the trials, to ensure that in the conduct of trials we don’t compromise safety, and we don’t compromise scientific integrity. We’ve got to be very open and honest and transparent about that, and reach out to the community so they won’t be hesitant to take a vaccine, which could be lifesaving for them.

IRA FLATOW: A question from another researcher, Columbia University virologist, Angela Rasmussen.

ANGELA RASMUSSEN: Fauci, I’d like to know specifically what kind of evidence of vaccine efficacy would meaningfully accelerate vaccine approval in the US. I’d also like to know if trial enrollment is sufficient to get that evidence by the fall.

IRA FLATOW: Can you explain what she’s asking?

ANTHONY FAUCI: Yeah. She wants to know what level of efficacy is going to be adequate. I mean, obviously what we would like to see is something that approaches 70%. Because if you do the calculations of modeling, 70% protection in the community would give you what we call herd immunity. We’re hoping for that.

She also asked a question that’s important, is that, what about the amount of enrollment? I don’t have any difficulty in thinking that we’re going to enroll 30,000 people per vaccine, 15,000 in the control arm and 15,000 in the experimental. So all you need is a certain number of infections in the trial, and you have a statistical projection of how many infections you would need to be able to determine if the vaccine works or not. If we get those number of infections, we should be able to have a determination of whether or not the vaccine is effective. And obviously throughout the entire trial, you’re looking at safety.

IRA FLATOW: When we talked about medical disparities on this program, especially when it comes to testing out new candidate medicines, we’ve had experts from African-American communities also point to a reason people of color may not wish to participate. And it’s really a question of trust. They point to the Tuskegee syphilis experiments, the exploitation of people like Henrietta Lacks. Is this a part of the problem of testing, and something that NIH can fix?

ANTHONY FAUCI: I don’t think NIH can fix it alone. But we certainly can pay attention to it, Ira. And that’s what I mean about community outreach. We’re doing that already, right now. We’re reaching out to communities of different demographic groups, but particularly focusing on those who have a reason for distrust, because of the history of being mistreated.

So we have a very special effort to do outreach to minority communities, not only African-Americans but Latinx as well as Native Americans. Because those are the minority populations that always seem to get the short end of the stick on things. We want to make sure they understand that this is something that could be very beneficial to them, particularly, since as we know so well, that with coronavirus, there’s a disproportionate burden of infection and complications leading to serious outcomes among the minority populations, particularly African-Americans. So we really do want to get them into the vaccine trials, because we need to know if it does work, in them in a safe way, so that when a vaccine becomes available we can make sure it’s equitably distributed to the people who need it the most.

IRA FLATOW: In an interview recently with the AMA Editor, Howard Bauchner, you said that research shows that even with a vaccine, immunization will not grant people long-lasting protection, and we could still be reinfected.

ANTHONY FAUCI: Yeah. I want to make sure that that’s not taken out of context. And so let me clarify, because there was some misunderstanding with that statement. What I was saying is that the normal type of common cold coronaviruses that we have decades and decades of experience with, the ones that are relatively trivial in their clinical effect– the common cold– immunity to those generally doesn’t last 10, 20 years. It generally lasts about a year.

We do not know at this point, and I emphasize, we do not know how long protection would last after someone recovers from infection. We do know that we can induce a good response with a vaccine, at least in the phase 1 studies that we’ve done. The question is, how long is that protection going to last? If it lasts a year or more or two or three or four, that would be great. We don’t know that. But if it does have a finite, limited amount of durability, we can always boost it. So I’m really not concerned about the durability. I just want to get to step one, which is that it does protect, at least for a reasonable period of time.

IRA FLATOW: A question from the science communication world, Scientific American Editor, Tanya Lewis.

TANYA LEWIS: Do you think the pandemic is likely to continue spreading until a vaccine is ready, or could it burn out on its own with possible later spikes of re-infection. Or are we just going to see infections plateau at a very high rate? And lastly, how optimistic are you?

ANTHONY FAUCI: Well, I’m always cautiously optimistic about these things, because I feel that we can put an effort that could contain it. I mean, the virus, if left to its own devices would be out of control. But that’s not happening, because we’re doing something to contain it.

You asked about different potential scenarios. You know, all of the above are possible. I do not think– and one of the things I’m fairly certain about is that this virus is not going to disappear from the planet the way SARS did, because it is such a highly efficient spreader from human to human that some where, some place on the planet, we’re always going to have infection. It’s going to be up to us to contain it. If we get a successful vaccine, obviously, as with other viral infections, we will be able to control and maybe even eliminate it in certain countries, in certain regions of the world.

I do believe that for some time we will see continued infections. Whether those infections become true outbreaks again is going to really depend on our ability to identify, isolate, and contact trace so that blips of infection don’t turn out to be true rebounding and resurging of a lot of infections.

IRA FLATOW: Should we expect this to be the new normal– viruses like these popping up now, and how do we prepare for that?

ANTHONY FAUCI: Well, Ira, you and I have been talking about this, as you said at the beginning of the program, for now, you know, like, almost 40 years. There will be emerging and reemerging infections– in our history have been that way forever. And we will continue to see emerging and reemerging infections.

What we need to do is learn the lesson, that now that we’ve seen this– we’ve been through pandemic flu of 2009 h1n1. We have seen the outbreaks of Ebola, of Zika, of HIV. We always have the threat of a pandemic flu. And now we have a pandemic in something that isn’t the flu. It’s another virus. We can expect– but you can’t predict when. It may be well beyond the lifespan of you and I. But sooner or later, we’re going to get other serious outbreaks. So we have to maintain the corporate memory of a degree of preparedness that would allow us to respond in an effective way the next time we get something like this.

IRA FLATOW: Do we have to restrengthen our international cooperation and conferencing with other nations, to head off a future pandemic?

ANTHONY FAUCI: The answer is yes. You know, we were going in that direction, and still are with the Global Health Security Network and the Security Agenda, where you have communication connection and inter-digitization of the health components of nations throughout the world to be transparent when there’s an outbreak, to share samples, to talk about the kind of surveillance that can detect something well before it gets out of control. So the short answer to your question is, absolutely yes.

IRA FLATOW: You’ve often been seen as the voice of reason in the White House pandemic task force, especially when it comes to advice about social distancing and tempering some of the effusive praise for the untested hydroxychloroquine. What do you believe your role is in making sure outright falsehoods don’t perpetuate?

ANTHONY FAUCI: Well, the only thing I can do, Ira, is continue to make any statement and policy and suggestions and advice that, as a scientist, as a physician, to do it the way I’ve been doing it my entire career is that, use evidence-based and data. And if you don’t know the answer to something, admit it. If you do, make sure your statements are based on data and evidence. And that’s all you can do. If you consistently do that, then I think you’re going to be in good shape. And that’s what we’ve been doing all along.

IRA FLATOW: I’m Ira Flatow, and this is Science Friday from WNYC Studios. I was shocked and saddened to learn last week, I know as you were, about the death of Larry Kramer. I remember in 1981, Larry Kramer was my guide through the AIDS epidemic in New York, taking me around and showing me everything I needed to know about the spread, introducing me to the founders of the Gay Men’s Health Crisis. And I know you and he had your ups and downs over his career and your career.

ANTHONY FAUCI: We did. I mean, we had, what I would– and both Larry and I have described it independently as a very interesting, complicated relationship, which ultimately eventuated into a deep bond friendship, and even love for each other. He started off, as you know– you were there– in a very confrontative way.

The government, authorities, scientists, regulators, the public in general, even the media were not treating HIV/AIDS with the seriousness in which it deserved. Larry recognized that, and he tried to call attention to that. But he did it in a very confrontative, iconoclastic, and sometimes even outrageous way. I, being a government official, was the target of that. So our first interaction was one in which he was very abusive, in fact attacking me in extraordinary ways.

And then I did something that I think was a good decision on my part. Rather than get blinded by the confrontational nature and the theatrics of it, I decided to listen to what he was trying to say. And he made sense. And that’s when I developed a relationship that went from adversaries to acquaintances to friends to good friends to really very good friends.

And at the end of the day, we realized, throughout many years, that our goals were common goals. We wanted to get to the same endpoint. He had his way of doing it, and I had my way of doing it. But Larry Kramer was an iconic figure. I mean, there’s no doubt about it. He was just an extraordinary person, who transformed the way the community interacts with the so-called authoritative scientific regulatory government and established community, to get the people who were involved, the people who are at risk, or who actually have a particular disease to have a major say in the development of the research agenda, and the implementation of things like clinical trials. Larry changed all that. And that’s why he’s really a historic figure. And I feel very privileged to have had him as a very dear friend.

IRA FLATOW: You know, hearing you say that, and watching your actions, it almost appears to me like you’re channeling a little bit of Larry Kramer during this pandemic.

ANTHONY FAUCI: Well, you know, in some respects, Larry would speak the truth. And you have to speak the truth. And that’s what we’re doing.

IRA FLATOW: One last question, because I just have to ask you this question, because it’s something that’s been bugging me on and off, watching you on television, all those times I saw you standing up on the podium with the president and other officials, all huddled together, while you were asking the country to socially distance. And I would yell at the screen sometimes. I’d say, Tony, why did you insist that they all do what they say they want you to do and spread out before they go to the microphone?

ANTHONY FAUCI: We ultimately did that. We finally got it to be. And now if you look at a conference, they’ve spread them out. So we finally got that goal accomplished.

IRA FLATOW: Well, I finally got my goal accomplished of getting you to appear on Science Friday after three months. So I want to thank you very, very much for taking time to be with us today.

ANTHONY FAUCI: It’s always good to be with you, Ira. Any time. It’s always good. It’s always good to see you and talk to you.

IRA FLATOW: Stay well. We’ll talk again.

ANTHONY FAUCI: You too. Thank you.

IRA FLATOW: Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.

Charles Bergquist is our director. Our producers are Alexa Lim, Christie Taylor, Katie Feather, and Kathleen Davis. BJ Lederman composed our theme music. And if you missed any part of this program, or you’d like to hear it again, subscribe to our podcasts, and ask your smart speaker to play Science Friday.

And we have a new question this week up on our Science Friday VoxPop app. We want to know, “Are you a health care worker feeling burnt out right now? There’s a lot happening in the world. If your job is taking care of other people physically and mentally, how are you doing?” Tell us on the Science Friday VoxPop app, wherever you get your apps.

You can email us too. Our address is SciFri@ScienceFriday.com. Have a great and safe weekend. I’m Ira Flatow.

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