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--:-- Sean Rameswaram: It's Today Explained.
--:-- Sean Rameswaram: I'm Sean Ramos-Vurm, but my friends call me Rom.
--:-- Sean Rameswaram: We're continuing our You, Me, and COVID-19 series today with a conversation with Dr. Anthony Fauci.
--:-- Sean Rameswaram: I spoke to him a week ago at our second ever live event, which of course was a Zoom because of COVID.
--:-- Sean Rameswaram: You already heard the second half of that event last week, a Q&A with Vox science reporter Umair Irfan all about the vaccine.
--:-- Sean Rameswaram: Today, we're bringing you the other two elements, Dr. Anthony Fauci looking back on his year, and today explained producer reporter Noam Hasenfeld.
--:-- Sean Rameswaram: We'll close it out with a treat for the stands out there.
--:-- Sean Rameswaram: Our nation's top infectious disease doctor was joining us after a very bittersweet day.
--:-- Sean Rameswaram: The United States had just begun administering the BioNTech Pfizer vaccine, and on that same day, we hit 300,000 deaths.
--:-- Sean Rameswaram: I started by asking Dr. Fauci how much of the country would need to get this vaccine or one of the other ones for our living nightmare to end?
--:-- Dr. Anthony Fauci: Well, if you really want true herd immunity, where you get a blanket of protection over the country, very similar to the kind of things that we've gotten and successfully done with measles and with polio, you want about 75 to 85% of the population of the country to get vaccinated.
--:-- Dr. Anthony Fauci: I would say even closer to 85% to see if we can get that.
--:-- Dr. Anthony Fauci: You'll probably start seeing an effect on the dynamics of the outbreak when you get anywhere between 40 and 50% of the people vaccinated.
--:-- Dr. Anthony Fauci: But if you really want to have a profound public health effect, we've got to get as many people as we possibly can to get vaccinated.
--:-- Sean Rameswaram: The primary reason, though, we wanted to talk to Dr. Fauci was to hear about his year.
--:-- Sean Rameswaram: So we started in December of 2019.
--:-- Sean Rameswaram: I want to jump back a year here.
--:-- Sean Rameswaram: Do you remember where you were, what you were doing when you first heard of this coronavirus?
--:-- Dr. Anthony Fauci: I imagine around this time last year.
--:-- Dr. Anthony Fauci: You're absolutely correct, Ram.
--:-- Dr. Anthony Fauci: It was at the end of December.
--:-- Dr. Anthony Fauci: We had heard of an unusual virus.
--:-- Dr. Anthony Fauci: We didn't even know it was a virus, an unusual pneumonia that was being noticed in the Wuhan district in central China.
--:-- Dr. Anthony Fauci: And for those of us, myself and many of my colleagues, both here at the NIH and elsewhere, who had been involved in responding in the year 2002 to the SARS outbreak, the severe acute respiratory syndrome, which was a coronavirus that emerged from Guangdong province in China.
--:-- Dr. Anthony Fauci: It had gone from a bat reservoir to a civet cat to a human.
--:-- Dr. Anthony Fauci: And when we heard that it was associated with a wet market in China in the Wuhan district, many of us felt, you know, the chances of this being another coronavirus that has jumped species.
--:-- Dr. Anthony Fauci: We did not know at the time at all whether it was just jumping from an animal to a human or whether it was transmitted also from human to human.
--:-- Dr. Anthony Fauci: And if so, how efficient was it being transmitted from human to human?
--:-- Sean Rameswaram: That was the end of December.
--:-- Sean Rameswaram: January 9th, the Chinese isolated the virus and put up the sequence, the genetic sequence of the virus on a public database.
--:-- Sean Rameswaram: And it was clear that here we are yet again dealing with another pandemic coronavirus, similar in some respects to SARS and similar to MERS, the Middle East Respiratory Syndrome.
--:-- Sean Rameswaram: But what we did not know, but evolved over a period of weeks to months, was how extraordinarily contagious this virus is, number one.
--:-- Sean Rameswaram: And number two, that a substantial proportion of the people had no symptoms.
--:-- Sean Rameswaram: Namely, they could spread the virus without ever getting sick themselves or during a period of time before they got symptoms.
--:-- Sean Rameswaram: That's very unusual for a respiratory virus.
--:-- Sean Rameswaram: And that kind of fooled us in the beginning.
--:-- Sean Rameswaram: But then as the months went by, it became clear that we were dealing with a historic pandemic of literally, you know, extraordinary historic proportions, the likes of which we have not seen in 102 years.
--:-- Sean Rameswaram: You know, the first case that was recognized in the United States was January 21st.
--:-- Sean Rameswaram: Then thereafter was the spouse of that person.
--:-- Sean Rameswaram: They had come from Wuhan, China.
--:-- Sean Rameswaram: Then as we went from the end of January into February it became clear that there was community spread not quite sure it was from asymptomatic people but then as we got from February to March it was very clear that we had a really serious problem here of the spread of a virus often without any symptoms in the person who transmitting it
--:-- Sean Rameswaram: And we were realizing that among some people particularly the elderly and those with underlying comorbidities, that it was very serious and was causing a considerable amount of morbidity and mortality.
--:-- Sean Rameswaram: Fast forward to now, you know, mid-December of 2020, essentially 10 and a half, 11 months later, yesterday was a very difficult day.
--:-- Sean Rameswaram: On the one hand, we had the rollout of the vaccine.
--:-- Sean Rameswaram: But on the other hand, the 300,000th person in this country died from COVID-19.
--:-- Sean Rameswaram: That's historic and really terrible.
--:-- Sean Rameswaram: And that's a number that it's sort of hard to grapple with for many of us.
--:-- Sean Rameswaram: It's a number that you didn't even predict earlier this year.
--:-- Sean Rameswaram: I mean, if you could talk to, you know, Dr. Fauci in December 2019, what would you tell him?
--:-- Dr. Anthony Fauci: Well, if I were to speak to my other self back then, I would say, you know, you got to keep heads up for where a virus like this could go.
--:-- Dr. Anthony Fauci: Don't make any assumptions.
--:-- Dr. Anthony Fauci: But I wouldn't have expected that it would turn out to be essentially my worst nightmare.
--:-- Dr. Anthony Fauci: Because when people ask me as an infectious disease person, what is the thing that keeps you up at night?
--:-- Dr. Anthony Fauci: Or put another way, what is your worst nightmare?
--:-- Dr. Anthony Fauci: And my worst nightmare is the evolution of a new virus that jumps species from an animal to a human that's respiratory born, that's highly, highly efficient in its ability to spread from person to person.
--:-- Dr. Anthony Fauci: And that can cause a high degree of morbidity and mortality, either in the general population or in a subgroup of people.
--:-- Sean Rameswaram: And then unfortunately for me and the world in general, that's exactly what happened.
--:-- Sean Rameswaram: So one knows that you get emerging infections and no one would have anticipated that it was going to be as terrible and horrible as it's turned out to be.
--:-- Sean Rameswaram: I think a lot of people over the course of this year at all different education levels became amateur epidemiologists in 2020.
--:-- Sean Rameswaram: You know, we learned a lot about your world.
--:-- Sean Rameswaram: What did you learn?
--:-- Sean Rameswaram: What did you feel the most surprised about this year?
--:-- Dr. Anthony Fauci: Well, the virus continued to fool us as it evolved until we got to the point where it was so clear what was going on.
--:-- Dr. Anthony Fauci: We're still learning a lot about it, about its ability to make people sick and have symptoms that last for weeks to months, even after the virus is cleared.
--:-- Dr. Anthony Fauci: But as we learned, the surprise was what I had just mentioned, that you could have the same, and this is noteworthy, Ron, because I've never seen anything like this before.
--:-- Dr. Anthony Fauci: And I've been dealing with viruses that emerge in pandemic form for now.
--:-- Dr. Anthony Fauci: This is my 37th year that I've been doing that.
--:-- Dr. Anthony Fauci: And I can tell you that I've never seen a virus that on the one hand can have no symptoms in someone.
--:-- Dr. Anthony Fauci: And in those who do get symptoms, the majority have just very mild symptoms.
--:-- Dr. Anthony Fauci: And yet in other people, it just kills them.
--:-- Sean Rameswaram: So usually when you have a virus that's capable of so quickly killing someone, that almost everybody who gets infected has some degree of illness, but isn't.
--:-- Sean Rameswaram: This is like a lot of people, it doesn't bother even a little bit.
--:-- Sean Rameswaram: And then some people it kills, which makes it very difficult to message this, to get the message across, particularly to young people who have much less of a chance, not zero by any means, but much less of a chance of having a serious outcome, because they realize that most of the people who get into trouble are either elderly or those with underlying conditions.
--:-- Sean Rameswaram: So they tend to feel, what's the big deal if I get infected?
--:-- Sean Rameswaram: You know, I'm probably not going to wind up getting any symptoms.
--:-- Sean Rameswaram: That's a bad attitude and the wrong attitude, because what you're doing is you're propagating the outbreak.
--:-- Sean Rameswaram: You're becoming part of the transmission chain.
--:-- Sean Rameswaram: And ultimately, that transmission chain is killing people.
--:-- Sean Rameswaram: So do you really want to be a part of a process that's a transmission chain of infection?
--:-- Sean Rameswaram: Or do you want to protect yourself from getting infected so that you don't pass it on to anybody else?
--:-- Sean Rameswaram: Again, a very difficult message to get across.
--:-- Sean Rameswaram: Do you think to some extent now it's been almost a year of this, people have become numb to the suffering?
--:-- Sean Rameswaram: I mean, when New York was really in its darkest moments earlier this year, it felt like everyone was paying attention.
--:-- Sean Rameswaram: But now you see cases like New York across this country, and it doesn't feel like we're all on the same page.
--:-- Dr. Anthony Fauci: You know, unfortunately, that's what happens when you have something as serious as this be as chronic and prolonged.
--:-- Dr. Anthony Fauci: You know, some refer to it as COVID fatigue.
--:-- Dr. Anthony Fauci: You're fatigued with sort of locking down a bit, but you're also fatigued with the numbing numbers.
--:-- Dr. Anthony Fauci: You know, if you're in a hospital room like I was seeing patients and you see someone suffering, it's a real phenomenon there.
--:-- Dr. Anthony Fauci: That's a human being that's in danger of dying.
--:-- Sean Rameswaram: And you're trying to do something about it.
--:-- Sean Rameswaram: When you get a number that's 300,000, that becomes like a statistic that you can't get your arms around.
--:-- Sean Rameswaram: You're right.
--:-- Sean Rameswaram: You do get numb to it.
--:-- Sean Rameswaram: The thing that I find astounding in this country, that this outbreak has evolved in the context of an extraordinary degree of divisiveness in our society, divisiveness where the pandemic itself has undertaken a political connotation so that things like wearing masks or not wearing masks, avoiding crowds or being in crowds, it depends on almost what your political ideology is that you do or do not abide by what the recommendations are.
--:-- Sean Rameswaram: That's extraordinary.
--:-- Sean Rameswaram: In fact, there are parts of the country where the hospitals are overflowing with patients, the intensive care units are being stressed and still a certain proportion of the people in that city that state that region think it a hoax
--:-- Sean Rameswaram: They think it fake news
--:-- Sean Rameswaram: They don't believe that we in the middle of an outbreak when we just broke an extraordinary record of 300 people having died
--:-- Sean Rameswaram: That's the worst that's ever happened in this country in 102 years.
--:-- Sean Rameswaram: So how people can look at that number and say it's fake news or it's a hoax, I can't imagine that, but it's happening.
--:-- Sean Rameswaram: And now that's coupled with the sense that we have a vaccine.
--:-- Sean Rameswaram: And maybe to some people that means this is ending, that we're in the clear.
--:-- Sean Rameswaram: But the numbers are the worst they've ever been, which is important to remember.
--:-- Sean Rameswaram: Every day it seems like we're seeing new records.
--:-- Sean Rameswaram: What do you say to people who are fearful about getting through these winter months?
--:-- Sean Rameswaram: And also what do you say to the people who are feeling cavalier again?
--:-- Dr. Anthony Fauci: I think what you have to stress is what we are stressing.
--:-- Dr. Anthony Fauci: That although the end game solution to this is going to be and is a vaccine, you really have to get 75 to 85 percent of the population vaccinated if you want to just crush this outbreak.
--:-- Dr. Anthony Fauci: But up until that point, we can't abandon the classical public health measures that we keep talking about.
--:-- Dr. Anthony Fauci: The uniform wearing of masks, the keeping physical distance, the avoiding crowds in congregate settings, particularly indoors, to wash your hands as frequently as you possibly can.
--:-- Dr. Anthony Fauci: Things as simple as that can have a profound effect on the dynamics of an outbreak.
--:-- Sean Rameswaram: As enormous as this problem is, things as simple as what I just mentioned can do it until we get a vaccine.
--:-- Sean Rameswaram: So maybe the realization that we now have a vaccine, and over the next few months, we're going to be rolling it out to the tune of tens and tens of millions of doses until we get most of the people in the country vaccinated, that there's light at the end of the tunnel.
--:-- Sean Rameswaram: Which it served almost as an incentive to keep doubling down on the public health measures so that by the time we get to a vaccine, you're still healthy and your family is still healthy.
--:-- Sean Rameswaram: More with Dr. Fauci in a minute.
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--:-- Sean Rameswaram: Dr. Fauci, the thing people can't wait to get back to is normal.
--:-- Sean Rameswaram: And I wonder, how far away do you think normal is?
--:-- Dr. Anthony Fauci: Well, normal is as far away as we want it to be because it is in our hands.
--:-- Dr. Anthony Fauci: If we as a society practice good public health measures while we are rolling out the vaccine, and if we get the majority of the population vaccinated in a few months and the overwhelming majority, 75 to 85% vaccinated, by the time we get into the summer, we could probably approach a significant degree of normality as we get to the end of the third quarter, the fall and the early winter of 2021.
--:-- Dr. Anthony Fauci: It is entirely conceivable and doable that we can do that, but we've got to get a lot of people vaccinated before we can do that.
--:-- Sean Rameswaram: Normal was a world in which we didn't think this could really even happen, which makes me wonder, you know, should we just be going back to normal or should we be going back to a, you know, a little smarter, more cautious place?
--:-- Dr. Anthony Fauci: Well, if a smarter, more cautious place, you mean lessons learned of what we've been through.
--:-- Dr. Anthony Fauci: I would hope so.
--:-- Dr. Anthony Fauci: And I would hope that we would have the kind of preparedness so that this doesn't happen again.
--:-- Dr. Anthony Fauci: We will get emerging new infections.
--:-- Dr. Anthony Fauci: I mean, that's gone on as long as recorded history and well beyond have been the emerging of infections.
--:-- Dr. Anthony Fauci: You're not going to stop that.
--:-- Dr. Anthony Fauci: What you can stop is getting that emerging infection to become a catastrophic pandemic.
--:-- Dr. Anthony Fauci: And that's by doing the kinds of things that we maybe could have done a lot better in identifying contact tracing, doing the kinds of public health measures.
--:-- Dr. Anthony Fauci: We have a very disparate response in this country.
--:-- Dr. Anthony Fauci: We have 50 states that tend to want to do things understandably on their own a little bit differently.
--:-- Dr. Anthony Fauci: Well that works well for a lot of things because there so much diversity that you want the states to have the ability to do things differently than other states.
--:-- Dr. Anthony Fauci: But when it comes to fighting a pandemic that involves the entire country as well as the world, I think it's much better if we do things in a much more uniform, coordinated way when it comes to public health.
--:-- Dr. Anthony Fauci: If we had done that, I think we could have done much better than we did.
--:-- Sean Rameswaram: Dr. Fauci, you turn 80 in a few weeks.
--:-- Sean Rameswaram: Is that right?
--:-- Dr. Anthony Fauci: Sadly, that is true.
--:-- Dr. Anthony Fauci: Well, I don't say sadly.
--:-- Dr. Anthony Fauci: It's better than the alternative.
--:-- Dr. Anthony Fauci: But you're correct.
--:-- Sean Rameswaram: You've had the kind of year that would make a lot of people want to retire, but you've already signed up for more of this with President-elect Biden.
--:-- Sean Rameswaram: Where do you hope to leave the country and the National Institutes of Health before you do one day retire as surely you've earned that retirement?
--:-- Dr. Anthony Fauci: Well, certainly the most immediate thing is to crush this COVID-19 pandemic and just put it in the rearview mirror and not have to worry about it.
--:-- Dr. Anthony Fauci: But, you know, I've been working for decades on trying to develop lasting solutions, particularly in the form of vaccines and more user-friendly therapies for HIV.
--:-- Dr. Anthony Fauci: My career has been defined by HIV.
--:-- Dr. Anthony Fauci: You know, in the very early years, in the early 80s, when I took over as director, that's what my own research endeavor is.
--:-- Dr. Anthony Fauci: And that's one of the major goals of my institute is to end the epidemic of HIV, as well as a couple of other world global killers, including malaria and tuberculosis.
--:-- Sean Rameswaram: So I think I still have some time to put in, because those are challenges that we're not going to fix in a few months to a year.
--:-- Sean Rameswaram: And do you think the National Institutes of Health, after this pandemic, after what this country's been through this year, do you think there'll be more political will, more public support for investing in preparedness for potentially the next one of these?
--:-- Dr. Anthony Fauci: Well, Ram, I hope that's the case.
--:-- Dr. Anthony Fauci: I mean, we fortunately have been treated very well by multiple administrations and we have bipartisan congressional support for what we do.
--:-- Dr. Anthony Fauci: But you're right.
--:-- Dr. Anthony Fauci: We do need more resources now, given the lessons learned about how to better prepare for the next outbreak.
--:-- Sean Rameswaram: You know, I must point out, with all of the extraordinary things that have gone on over the last year, the thing that will ultimately bail us out is the vaccine that was developed in large part based on science that has been funded for decades by the NIH.
--:-- Sean Rameswaram: In fact, one of the vaccine candidates was co-developed right here on campus, literally within a few hundred yards from where I'm sitting right now.
--:-- Sean Rameswaram: And how amazed are you?
--:-- Sean Rameswaram: I mean, you were promising earlier this year that things looked good for a vaccine before the end of the year.
--:-- Sean Rameswaram: And as we said, like people didn't quite buy it when you were first making that known.
--:-- Sean Rameswaram: Now we're there.
--:-- Sean Rameswaram: How does it feel to have reached that historic milestone?
--:-- Dr. Anthony Fauci: It feels wonderful.
--:-- Dr. Anthony Fauci: I mean, it was the work of a lot of people.
--:-- Dr. Anthony Fauci: I'm very pleased that my projection and my prediction came out exactly.
--:-- Dr. Anthony Fauci: Like I said, if we go back on the records in January when we started, I said a year to 18 months, I hope we would have a vaccine.
--:-- Dr. Anthony Fauci: So it was on the low side of what I said.
--:-- Dr. Anthony Fauci: One year from January is December.
--:-- Dr. Anthony Fauci: And here we are in December and we're already distributing vaccines.
--:-- Sean Rameswaram: Well, congratulations.
--:-- Sean Rameswaram: A lot of people wrote in with questions for you, Dr. Fauci, but the vast majority just asked us to thank you.
--:-- Sean Rameswaram: So thank you for being out there this year and helping people through this pandemic.
--:-- Sean Rameswaram: We appreciate your time.
--:-- Dr. Anthony Fauci: Well, thank you very much.
--:-- Dr. Anthony Fauci: I appreciate you having me on your show.
--:-- Sean Rameswaram: Thanks again.
--:-- Sean Rameswaram: Take care.
--:-- Sean Rameswaram: Take care.
--:-- Sean Rameswaram: You called me up just to ask if we could hang out, maybe outside.
--:-- Sean Rameswaram: I said you still need a mask and I need you to know, I need you to know.
--:-- Sean Rameswaram: You need to stay six feet away, six feet away.
--:-- Sean Rameswaram: You need to stay six feet away, six feet away.
--:-- Sean Rameswaram: If you were my hands I would wash you like the CDC says you deserve
--:-- Sean Rameswaram: And if you were Corona I would flatten your curve, flatten your curve
--:-- Sean Rameswaram: You need to stay six feet away, six feet away
--:-- Sean Rameswaram: You need to stay six feet away, six feet away
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