"We Are in a Precarious Position," Fauci Tells Connecticut Interviewers at Community Health Center

“We are in a precarious position,” explained Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, who is leading the COVID-19 response at the NIH.  Fauci returned as a guest this month on Conversations On Health Care, a radio program/podcast on healthcare issues produced by Community Health Center, Inc., based in Middletown, and heard nationally. 

Conversations on Health Care is hosted by Mark Masselli, Founder and President/CEO of Community Health Center (CHC), and Margaret Flinter, Senior Vice President and Clinical Health Director of CHC. The weekly program focuses on opportunities for reform and innovation in the health care system, featuring conversations with innovators in the delivery of care from around the globe.

Fauci, who has advised six Presidential administrations, said that he had hoped, months ago, that by the autumn and winter, the number of daily infections would have dropped to below 10,000.  Instead, that daily number is now routinely topping 40,000 to 50,000 per day. In recent days, it has topped 70,000 new cases daily.  

The recent increases in the number of positive COVID tests in more than half the states, Fauci pointed out, “is a very accurate predictor of a surge in new cases,” which is already, in some locations, also showing an increase in hospitalizations, and “even an increase in deaths.” 

“That’s a very precarious position to find yourself in as you enter the Fall and winter months,” he said.

Fauci urged doubling down on the five priority safeguards that have been urged for months by health officials:  “Universal wearing of masks, avoiding close contact, avoiding crowds and congregate settings, doing things more outdoors than indoors, and washing your hands frequently.  If we just did those simple things, we would mitigate greatly this risk,” Fauci emphasized.  

Masselli noted that Fauci has appeared previously as a guest on the program sharing his expertise as the nations’s leading epidemiologist, most recently back in February when the U.S. had experienced five deaths from COVID-19.  That number has now surpassed 225,000 nationwide. 

Regarding testing, Fauci said the availability of COVID testing is improving, but to “relieve the anxiety of people” the availability needs to be enhanced significantly – so that it becomes easy to obtain at the local pharmacy, much like a pregnancy test.

Asked about the efficacy of monoclonial antibodies, now being researched and which President Trump recently received during his hospitalization, Fauci said it is “very encouraging, potentially important modality of treatment and prevention.” Monoclonal antibodies are used to treat various diseases: researchers can design antibodies that specifically target a certain antigen, and are now looking at this approach to respond to COVID-19.

Noting the community health centers nationwide care for 30 million people nationwide, including many in demographic groups “disproportionately represented” among those hard-hit by COVID-19, racial and ethnic minorities and other vulnerable populations, Margaret Flinter  sought Fauci’s views on how NIH responds to those challenges.

Fauci stressed the importance of what he described as “engaging the community” during clinical trials of any potential treatment or vaccine, to ensure adequate data on the efficacy of any such option on various populations.  The NIH, through the years, has placed a priority to having trusted members of various communities reach out to encourage participation, to ensure that tests would be wide-ranging and that all groups were represented in the clinical trial process. 

Those efforts are essential, Fauci noted, if people are to be convinced that a vaccine will be safe and effective for them if approved.  “The only way you prove that is by making sure you have adequate representation of the various demographic groups, including minorities, in the clinical trial process.”

Fauci’s message to consumers eagerly awaiting a vaccine, particularly if one or two achieve FDA approval sooner than others, is to decide whether to take the first vaccine that becomes available or wait until other options are approved, based on individual risk factors.

“I am certain that there are going to be more than one vaccine that is going to be approved by the FDA,” Fauci said, going on to explain that individuals with greater potential risk from COVID-19 shouldn’t wait for possible later vaccines, but should take the vaccine that is approved first.  Other people, at less risk, may more comfortably wait to assess possible options that may gain approval a month or two later.  The decision, he suggested, “may depend on your state and your particular risk profile.”

Regarding herd immunity, Fauci said that NIH research has indicated that only about 10% of the total U.S. population is currently protected against COVID-19 infection.  To achieve herd immunity, a much greater percentage would be required, probably about 70%, to be either vaccinated or previously infected with the virus.  “We’re not anywhere near that,” Fauci said. “The way we’re going to get near herd immunity is by vaccinating a substantial number of people.”

Fauci also appeared on Conversations on Health Care in 2011, discussing 30 years of fighting AIDS. Fauci was then best known as a leader at the forefront of clinical, research, and advocacy efforts for HIV/AIDS, both in the United States and around the world. He was interviewed again by Masselli and Flinter in 2016, when the focus of the conversation was on efforts in the U.S. and worldwide to contain and control the Zika pandemic.

Appearing on the program on February of this year, as the coronavirus was accelerating its spread around the world, Fauci discussed the impact of travel restrictions, local quarantines, and initial efforts by the CDC to discover “under-the-radar-screen” cases that may be been undetected in the U.S., stating flatly that COVID-19 “really does have the potential to be a global pandemic.”   He predicted then that it would be a year to a year-and-a-half before a vaccine would become widely available to the public in the U.S., even as initial research was proceeding at record speed. The more immediate steps to be taken, and the answer to the “present danger,” he said then, are “pure public health measures - identification, isolation, contact tracing, quarantine where appropriate.”