From personal reveals such as who he watched Super Bowl LV with to sage advice on pressing public health questions about COVID-19, Dr. Anthony Fauci informed and charmed more than 2,500 viewers who tuned in to his virtual interview at Duke Global Health Institute (DGHI) with former Blue Devil David M. Rubenstein ’70 this week.
The chat, introduced by Kuleni Abebe, a second-year master’s student at DGHI, was a refreshing and informative peek inside the life and work of one of today’s biggest icons. Below is a recap of the visit with Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases for 35-plus years. A physician, scientist and immunologist, he also currently serves as the chief medical advisor to U.S. President Joe Biden.
Host Rubenstein is the co-founder and co-chairman of The Carlyle Group and host of The David Rubenstein Show. The talk was supported by a gift from Victor J. Dzau, president of the U.S. National Academy of Medicine and former chancellor of health affairs at Duke.
Dr. Fauci is the recipient of the Presidential Medal of Freedom, the highest civilian honor our country can give, and holds an honorary degree from Duke University bestowed in 1995.
Is the worst over yet in this pandemic?
“It is really tough to definitively predict that. Right now, fortunately we’re seeing a rather significant downturn in the number of daily infections where for the first time in quite a while we’re below 100,000 new infections a day. There was a time back in November, December and early January when it was awful. We were getting between 300,000 to 400,000 new infections a day and up to 4,000 deaths. That has turned around. Right now if we continue that momentum, and double down on the public health measures – the typical simple things such as the wearing masks, physical distancing and avoiding congregate settings — and we roll out vaccine, particularly with the increased doses that will be available as we go into March and April, we could see the worst is behind us.”
“But we have the challenge of variants, or mutants, that have now entered into the country, particularly the one that is dominant in the U.K. It has the capability of transmitting more efficiently from person to person. Thank goodness the vaccine we’re distributing currently is quite effective against that particular mutant. There are other mutants such as ones dominating in South Africa that are actually a little bit more formidable than that, so we’re keeping an eye on that.”
“It is conceivable that we are turning the corner on this, but we've been fooled before with different surges that came back. If you look at the pattern of the last year and a couple of months, there were times when we thought things were getting under control and then it exploded again. So, although we're going in the right direction, we’ve got to keep our foot on the peddle with regard to public health measures."
Why weren’t more vaccines produced early on?
“We contracted for more vaccines than we’d actually need to vaccinate everybody in the country. The issue is it takes time to actually get them produced. Right now, production from Moderna and Pfizer are going as quickly as it can. As we get into March and April, production will accelerate. Right now, the demand is far greater than the supply, but that should improve.”
How effective are the two vaccines currently approved and available at preventing disease?
The primary endpoint was the prevention of symptomatic disease and the Moderna and Pfizer each had about a 94 – 95% efficacy in that regard.
Can you pick which vaccine you want when you're Dr. Fauci?
No special treatment there. Dr. Fauci took the one that was available at NIH, where he works — the Moderna vaccine.
“But there really isn’t much difference between the two.”
Did Dr. Fauci experience vaccine side effects?
After the prime, my arm at the injection site ached a bit. The following day it ached less. And by the evening of the following day it was gone. Following the boost, he felt rather fatigued and achy and some chills. But he was feeling better again within a couple of days.
Why do we need two doses of vaccine?
From the clinical data, the evidence, if you give a ‘prime’ about halfway thru the cycle — 14 days — you get a certain level of protective antibodies and the boost increases that level of antibodies 10-fold.
Any goals/hopes when it comes to vaccinating the U.S. population?
Vaccine hesitancy is a concern. I hope we can get at least 85% of the people in the U.S. vaccinated.
What percent of the population needs to be vaccinated to establish “herd immunity”?
“I don’t think anybody has a totally accurate number for when we’d reach herd immunity” with COVID-19. With measles, about 90% or more is required for herd immunity. With COVID-19, it may be 70% to 85%.
In the early days of the pandemic many didn’t survive? Are we any better now at treating COVID-19?
“Yes. The bottom-line answer is that not only are we better off at treating people because we have more experience in the general clinical care of people with advanced disease, but we do have interventions that have been proven by clinical trial to be beneficial to people, particularly in those with advanced disease.”
The use of high-flow oxygen and the drug dexamethasone — if given to individuals at 6 milligrams for 10 days — can help reduce mortality. A number of other drugs have received emergency use authorization, including certain monoclonal antibodies, convalescent plasma and a few other drugs.
Can you stop wearing a mask after you get vaccinated?
No, you may be protected from getting symptoms once you’re vaccinated, but the virus can still be present in your nasopharynx and you could infect other people inadvertently. So, keep wearing a mask.
If you’ve had COVID-19, are there any long-term effects to worry about?
There is a syndrome called Post-Acute Covid-19 Syndrome or PACS. A certain percentage of people who have symptomatic disease — whether they’ve been hospitalized or not — have lingering symptoms for variable periods of time after the virus has cleared from the body: extreme fatigue, muscle ache, sleep disorder, temperature dysregulation (chills) and brain fog. It’s being studied intensively in cohort studies but doctors do not know how to treat it.
Many people describe the COVID-19 screening test, where a long swab is stuck deep into the nose, as a feeling of having their brain poked. Is there any alternative to this method?
Originally people got a nasopharyngeal swab that feels like it’s going through your eye into the brain. But that’s not necessary. A mid-nose swab is equally as accurate.
Do we know yet if COVID-19 came from a market in China near Wuhan? Or could it have come from a lab?
It certainly came from a bat or other animal. And World Health Organization team has been in China investigating its origins, including whether it came from a lab, but there’s no data that indicates that.
Will we have access to home COVID-19 screening tests any time soon?
The U.S. government has contracted with a company that makes a rapid point-of-care, sensitive and specific home test that people will soon be able to obtain at a pharmacy and you can use it to test yourself any time you want.
How often are you working on pandemic-related issues with the Biden White House team and what’s the focus?
Decisions regarding COVID-19 are science-driven. As chief medical advisor to President Biden, Dr. Fauci meets with a medical team every single day on Zoom, and they hold a press conference three times a week, bringing to the American public relevant public health and scientific information about the pandemic.
Are we better prepared now if another virus jumps from a bat or other animal to humans again?
Yes, we’re better prepared. mRNA vaccine technology has been "an overhwhelming success." And we also know better now what our public health weaknesses/failings were. Better collaboration between the cities, states and country as a whole is needed.
What appeals to Dr. Fauci about infectious diseases?
"I came at it through the specialty of immunology. I got very interested in the body's response to pathogens. You can prevent them, treat them, and they have global implications. It's very exciting."
Regarding Dr. Fauci’s HIV/AIDS work in the 1980s and 90s:
“The early years of HIV were some of the darkest years of my career and my life.” Virtually all of his patients died early on, until drugs were developed to treat HIV.
"When we began to develop and have highly effective therapies for HIV, one of the things that stood out to me was that people in the developing world did not have access to drugs and were dying at a high rate when developed world patients were leading normal lives."
“We as a rich nation had a moral responsibility to make sure those who didn't have resources didn't suffer and die.”
In 2003, Dr. Fauci was pivotal in launching PEPFAR, the President’s Emergency Plan for AIDS Relief, in response to the burgeoning global epidemic of HIV. It was, says Fauci, the brainchild of President George W. Bush. Thus far, it has saved more than 18 million lives. You can learn more about PEPFAR here: https://www.hiv.gov/federal-response/pepfar-global-aids/pepfar
Does Dr. Fauci still see patients?
Yes! "I didn't want to give up my patients. At my core I am a physician and will always be a physician. I don't want to get too far removed from my patients."
Did Dr. Fauci have a lot of friends over for the Super Bowl last weekend?
"My wife. She's my best friend. She’s the only one who was there."
When was the last time Dr. Fauci had a vacation?
"I don't even remember."