COVID-19’s Global Spread: NIH’s Lead on Coronavirus, Dr. Anthony Fauci, Talks about the Growing Epidemic and Whether America is Safe

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

[M us ic]

Female : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the health ca re
of the future.

This week , Mark and Margaret speak with Dr. Anthony Fauci ,
Director of the National Institute for Allergy and Infectious
Diseases at the National Institutes of Health. He's leading a
large global team working to understand the outbreak of
COVID 19 and the strain of Coronavirus that has infected tens
of thousands , killed more than 2 , 000 and is fast approaching
pandemic status. He talks ab out public health interventions,
precautions that should be taken and development of
vaccines.

Lori Robertson als o checks in , Managing Editor of
FactCheck.org looks at m i sstatements spoken about health
policy in the public domain, separating the fa ke from the facts .
We end with a bright idea that's improving health and
wellbeing in everyday lives. If you have comment s, please
email us at [email protected] or find us on Facebook,
Twitter, or wherever you listen to podcast. You can also hear
us by asking Alexa to play the program Conversations on
Health Care . Now stay tuned for our interview with Dr.
Anthony Fauci on Conversations on Health Care .

[Music]

Mark Masselli: We're speaking today with Dr. Anthony Fauci , Director since
1984, of the National Institute of Allergy and Infectious
Diseases, the NIH division leading global res earch on the
current outbreak of COVID - 19 , a new strain of Coronavirus. Dr.
Fauci has advised six presidential administrations on a variety
of global health issues and was the principal architect of the
President's Emergency Plan for AIDS Relief or PEPFAR. He is an
inaugural inductee into the government executive ,
Government Hall of Fame. Dr. Fauci, welcome back to
Conversations on Health Care .

Dr. Anthony Fauci: Good to be with you.

Mark Masselli: Yeah, it's been a while since you've joined us in 2016 duri ng
the outbreak of Zika virus . N ow you're on t he frontlines of a
new epidemic, w hich you say is fast approaching pandemic
status COVID - 19 a new strain of Coronavirus first identified in
Wuhan , China in December, and it has spread to some 30

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

countries . I th ink past the spread of 30 countries , we had a
professor from the School of Medicine at U - Penn here
yesterday , and she was noting that she has two young
children, a six year old and a four year old and came home and
her six year old gave her a whole lecture on Coronavirus . W e
know it's spread past countries. It's really animated so much of
the conversations around kitchen tables, and yet the scientific
community has learned much about this new pathogens in
really very short period of time. I wonder if you ca n bring our
listeners up to speed how does COVID - 19 compared to other
infectious diseases you studied and what has you most
con cerned about the this pathogen?

Dr. Anthony Fauci: Well, what concerns me the most is what you mentioned just
a moment ago, it re ally does have the potential to become a
global pandemic. It transmits extremely efficiently among
humans. Remember with SARS back in 2002, there were a
total of about 8 , 000 cases over about a year and a couple of
months. Right now, we're only literally le ss than two months
into this outbreak , and we have about 10 times as many
transmissions as we had in a year and a couple of months with
SARS. As the makings of the ability to be able to really spread
globally in a pandemic way , t he mortality is about 2% , 2 .5%
calculated on the basis of the number of cases that get to the
attention of the health care system.

But I think and most of my colleagues believe that the
denominator of that is much, much larger . T here are prob ably
many fold more individuals who are e ither without symptoms
or a minimally symptomatic and are not getting counted. The
bad news about that is that there are likely many, many more
infections tha n we realized . The somewhat good news about it
is that that makes the denominator much larger, whi ch means
that the death rate is very likely not 2%, but more towards 1%
or less than 1%.

Remember SARS was 9% to 10% and MERS was 36%. W e're
dealing with a highly transmissible brand new virus that
started off in China, and 99% of what's going on is taking place
in China. But we have a number , as you mentioned correctly,
of travel related cases so more than 27 countries . I n some of
those countries, we're starting to see person to person
transmissibility. T his whole thing is going to turnaround on the
abilit y of those other countries to be able to contain the travel
related cases in their own country , and countries with good
health care systems are clearly going to be able to do it better
than countries th at don't have those facilities.

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

Margaret Flinter: Well , Dr. Fauci , there is so much in what you just said, which is
on the minds of people . I think often the comparison is made
to influenza or flu when we're talking about these epidemics
that occur that people are somewhat familiar with. But I think
the point here that everyone is hearing is that COVID - 19 is
more infectious and deadlier than the flu . W e worry plenty
about the deadliness of flu every year on an annual basis
during the flu season. We know COVID - 19 can be spread while
people are still without sym ptoms, which is a huge concern, I
think , and we've certainly seen that in the densely populated
city of Wuhan, and on those cruise ships which are a living
example of densely populated, and it's spread rapidly there.
Share with us again, what exactly do we know about the
transmission of COVID - 19? What do we still need to learn?
What answers are you seeking , or what questions are you
seeking to answer about how the disease spread so that we
can better protec t populations across the globe?

Dr. Anthony Fauci: Right , yeah that obviously a key question. W e know for sure
that people have asymptomatic infection. We also know from
anecdotal reports that are solid, they're not just off - the - cuff,
they're solid that there have been well documented instances
of people t ransmitting the infection when they are
asymptomatic. Now what we don't know is the full extent of
what the a symptomatic transmission is to the kinetics of the
outbreak . We know that it does occur, but is it a major driver
of the outbreak or is still sympt omatic people the major
drivers?

When you look at influenza , clearly , the major driver of
influen za are people who have over clearly recognizable
symptoms. Right now the big unknown is that the
phenomenon of asymptomatic transmission we know exist ,
but to what extent does it exis t, b ecause that's going to totally
impact how you screen people . I t's going to totally impact the
scope of the outbreak so that there will be people out there
who have no idea that they're infected that might be infecting
other peop le. W e need to learn that really quickly.

Mark Masselli: Dr. Fauci , other things that will learn is sort of how a country
reacts. Certainly China's reaction has been quite dramatic and
they've issued a strict quarantine for all of Wuhan and much of
Hubei p rovince. According to some estimates, maybe 700
million Chinese citizens are under some kind of quarantine or
travel restrictions . Y ou say this is unprecedented response and
maybe help our listeners understand why these mass
quaranti ne approaches may do mo re harm, and why you
suggest that the classic well tried public health response of

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

identification, isolation and contact tracking might be more
beneficial ?

Dr. Anthony Fauci : Well, first of all the latter, which you said, are beneficial and
more beneficial than anything else, identification, isolation,
contact tracing . B ut an interesting thing has happened with
this outbreak that is, I would say , humbled me in the following
way. I'll explain what I mean, b ecause for years before this
outbreak I had been say ing travel restrictions really don't help
when you're in a pandemic. They may make matters worse by
creating fear , by creating anxiety , by blocking off the ability to
have access to resources. Well, you know, that's still true, but
what we've seen here tha t since this outbreak was
concentrated so intensely in a single country, the idea about
temporarily giving travel restrictions, not permanently, not
thinking that you're going to stop the outbreak . B ut if it could
buy you time, interestingly, despite all t he caveats that I and
my colleagues have been saying about travel restrictions , i t
seems to have worked, because we have 15 people in the
country who are infected , 13 w ere direct travelers from
W uhan , and t w o were the spouses of those travelers.

Now, prior to the travel restriction, something that I totally
didn't realize and it kind of shook me because of the numbers ,
is that every day 22,000 people would come from China to the
United States. If you have a hot spot like W uhan , could you
imagine how many pe ople who were infected would have
come to the United States if we didn't have the travel
restriction ? E ven though it isn't a permanent solution, because
once you get a pandemic that's diffuse d throughout the world,
you got to throw travel restrictions out the window, because
you can't restrict travel from every place in the world , t hat's
inappropriate and non tenable . B ut the temporary restriction
on a particular country or region that is the sole source of the
outbreak , i nterestingly, did work this time.

M ark Masselli: That’s great.

Margaret Flinter: Well, Dr. Fa uci , I really admire and respect that you're willing
to say yeah might have been wrong, those preconceptions is
so important that we continue to try and learn with every one
of these unfortunately, recurring epidemics . B ut I want to get
to the question maybe on the minds of people here at home.
You've said that the risk of infection for COVID - 19 is currently
very low in the US, but it could change. CDC is conducting test
in five major cities randomly testing people for both flu as well
as COVID - 19 w ith this goal of allowing epidemiologists to get a
better handle on cases that might be missed or overlooked.

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

Tell us more about this approach. I imagine it's been done
before, but I'm not aware of it. B eyo nd that, how should public
health departments here in the US , which we have
everywhere in the US, be anticipating and preparing for a
buildup of their capacity to manage a response to an outbreak
here , should one occur?

Dr. Anthony Fauci : Okay, so that's a great question. What the CDC is doing is
what's called surveillance for undetected under the radar
screen. W e now , as I mentioned , have 15 individuals , actually
there's an additional 14 because we brought the people over
from the Diamond Prin cess ship and brought them here.
They're in the University of Nebraska now being taken care of
under containment . But if you look at it right now, we're not
seeing any recognizable unexplained coronavirus infection , but
the question is maybe because we're not looking f or it
properly. Wh at the CDC has done, they've taken five cities,
New York, LA, San Francisco, Chicago and Seattle. What
they're doing is that in a surveillance way, when people come
into their surveillance clinic with flu like symptoms, if they're
negativ e for the flu, they'll get tested for Coronavirus . I f you
do that you'll pick up these undetected flu like illnesses that
might be Coronaviruses . We're going to quickly expand that to
many more cities.

If you do that, I think we'll get a good handle on whe ther or
not we're missing these unde tected Coronavirus infection . It
will be really very important, because what you don't want is
to have this under the radar screen and then all of a sudden,
you wind up with sustained transmission in your country a nd
you didn't realize it until it was too late, which was exactly
what happened in China . B ecause in the early weeks of the
outbreak, the Chinese were insisting that it's only animal to
human. In the meanwhile, for previous three weeks there was
transmission fro m human to human , so t hey didn't recognize
it . I nstead of doing the social distancing, and things that you
would do if you were having an outbreak , t hey were sort of
acting like there was no human to human transmission , and
there really was . We want to mak e sure that that doesn't
happen in the United States.

Mark Masselli : That's a great strategy canary in the coal mine, just making
sure . W e're speaking today with Dr. Anthony Fa u ci, Director of
the National Institute of Allergy and Infectious Diseases, the
division at NIH which is leading Global Research on the current
outbreak of COVID - 19 . Dr. Fauci , your division is now
overseeing thousands of scientist around the globe or
collegially working with them who are researching various

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

aspects of this emerging p athogen. There's a high level of
scientific interplay going on here. I'm wondering if you could
talk about that vast network. Margaret mentioned earlier that
we had these , or you did , the mathematical epidemiologists
who are trying to frame up the numerato r and the
denominator . W e've seen a number of those models. You
talked a little bit about the denominator, always wonder is if
the numerator is right if the denominator is wrong . B ut talk
about those folks th e genomics and folks who are doing
crispers a n d the like and how that's changing how large scale
research gets done on an event like this?

Dr. Anthony Fauci : Well, that's a great question and it really is truly team work .
The idea of an individual person no matter how bright they
might be, being the one that's going to solve all of this is just
not the way things work. We interestingly, we have been
studying Coronavirus es for some time because prior to these
outbreaks, Coronavirus was accountable about 10 to 30% of all
of the common colds that we get eac h year. W e know a lot
about Coronavirus es . Only in 2002, when we had SARS, we
realized that it could be a deadly virus, not just a trivial
common cold .

But what we're seeing now, as you mentioned quite correctly,
that we have a multi disciplinary approach. We have the
evolutionary biologist, we got vaccinolog ist because we're
going to develop a vaccine. We have clinicians , we have clinical
trialis t, we have virologists , we have immunologists, we have a
whole group of people now coming together, working
toge ther to try and solve this no t only at the national level, but
at an international level, because many of our colleagues who
study these respiratory illnesses are in China. I mean, many of
the Chinese scientists and physicians who are addressing this
now i n China, many of them trained right here in the United
States. W e've developed a collegial relationship with them
over the years. It's a team effort and it's multi disciplinary.

Margaret Flinter: You know Dr. Fauci we go back a long time in terms of
followi ng your work certainly during the early days of the AIDS
epidemic and onward over the last couple of decades. The
Ebola epidemic when that happened we watched and in that
one we watch ed really with such heartbreak as people to
succumb to the illness and we re particularly struck by how
devastating it was to the health care workforce in those
countries that were deeply affected . W e're seeing some o f
that here with this epidemic, w e certainly have seen just tragic
stories out of China about health care workers doing a
mag nificent job on the front lines, doing the very best they

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

can , but we have seen people succumb to the virus .

Maybe talk with us a little bit, again, with your great
perspective over these death decades about health care
workforce preparedness t o respond , and to respond with as
much safety for the health care workforce as we possibly can
to protect them and to make sure that they're there to take
care of patients. Do you think we've made the progress with
our training protocols and our drills and our preparedness to
be able to really mount the appropriate response relative to
our health care workforce if we were to have an epidemic like
this here in the United States ?

Dr. Anthony Fauci: Well, the answer is yes we have. The tragic si tuation in Chin a
that they felt, the number is that at least 1700 health care
workers have gotten infected in China. It isn't because they're
careless , t hey're running out of personal protective equipment
and they are bravely taking care of people even without the
most b asic of the personal protective equipment , so that's one
of the problems. They always have to reuse them when they
shouldn't be reusing them.

In the United States th ere are certain medical centers, my own
here at NIH included, in which we train and retrain ourselves
periodically through the year about how to properly dawn and
doff in personal protective equipment. We did that when I
took care of a couple of Ebola patients in my hospital here at
NIH . As soon as we found out about this COVID - 19 we and I
mysel f personally went back and retrained about how to get in
and out of the most recent iterations of the personal
protective equipment . We do have good training for that.

Unfortunately, in some of the countries in the developing
world they don't have those ki nd s of resources . T hey are
probably going to be more vulnerable to being infected as a
healthcare worker than those of us who are in Washington or
New York or San Francisco.

Mark Masselli: Doctor Fauci, you painted that picture of a collegial
international group working on understanding and hopefully
trying to develop potential vaccines for COVID - 19. I
understand there are a couple of dozen of entities, startups
pharmaceutical companies and academic institutions who
already have some vaccine candidates in t he research pipeline.
Can you , maybe , shed some more light on the timeline for a
vaccine? I think the public wo uld be very interested in that.

Dr. Anthony Fauci: Okay, very good. Well, there are, I would say, just almost a
dozen about ten or so candidates that are at various stages of

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

preclinical development . The stepwise fashion of developing a
vaccine, I think I could describe by a prototype that we are
working on here with the NIH it’s an mRNA platform , w e're
doing it in collaboration with a company call ed Moderna , but
we're not the only ones by any means that are doing this. But
let me show you what the timetable is.

We're projecting to go into phase one study in about two
months. I f you think about that from the time that we got the
sequence of the viru s to the time you go with the phase one,
this would be the world's indoor record. It’s absolutely sure,
no doubt, because years ago we would have taken well over a
year, a year and a half to do. W e'll be in a phase one trial in
about two months, which mean s three months from the
beginning of the outbreak . It’ll take about another three
months to show safety and w hether or not it's immunogenic.

Then we'll go to phase two trial, that wi ll take another six to
eight months to show that it works. E ven though thi s is the
fastest we've gone from sequence to phase one trial, it's still
even though we're going at rocket speed , it will not be for at
least a year to a year and a half at the earliest that we would
have a vaccine that would be deployable. W hat that tells us (a)
we're moving really fast but (b) the answer to the present
danger is not a vaccine , it’s pure public health measures,
identification, isolation, contact tracing, quarantine where
appropriate.

Margaret Flinter: We've been speaking today with Dr. Ant hony Fauci the
Director of the National Institute of Allergy and Infectious
Diseases at the National Institutes of Health. Learn more about
his very important work by going to www.niaidnih.gov or
follow their work on Twitter @NIAIDNews. Dr. Fauci we want
to thank you for the enormous contributions that you have
made that you are making to understanding some of the
world's biggest health challenges for your dedication to
research and to improving public health and for joining us
today on Conversations on Health Care.

Dr. Anthony Fauci: It's good to be with you , it’s a great pleasure. Thank you.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in US p olitics. Lori, what have

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

you go t for us this week?

Lori Robertson: Democrats and Republicans are waging a war of words over
the President's proposed budget and how it would affect
programs for seniors. President Donald Trump tweeted that he
quote , “We’ ll not be touching your s ocial s ecu rity or
Medicare ” in the budget , while Democrats have charged it
does exactly that. The budget does propose reductions in
future projected Medicare spending. But experts say they are
similar to last year's budget proposal which included bipartisan
ideas al so supported by former President Barack Obama.

On social security, the budget calls for changes to disability
benefit . O n Medicaid there are more significant but not well
defined cut. Before we look more closely at the numbers, it's
important to note that we're talking about a budget that won't
actually be enacted. Any President's budget is largely a
symbolic statement of priorities, not a piece of legislation on
which Congress would vote. In fact, the Republican Senate
Budget Committee chairman has said he won't hold a hearing
on Trump's budget , j ust as he didn't hold one on Obama's final
budget.

Senator Mike Enzi said, “Congress doesn't pay any attention to
the President's budget exercise”. Back to Medicare , Trump
goes too far in claiming that he's not tou ching Medicare in the
2021 budget. There are several proposals to reduce the
growth in spending over the next 10 years by about $600
billion. But democrats , as they did last year , have spun those
proposals as a flashing. Former Vice President Joe Biden sai d
the budget , “ E viscerates Medicare . “ $600 billion over 10 years
would be a 6% decrease from projected spending a ccording to
the watchdog group committee for a Responsible Federal
Budget. Three of Trumps proposals, making one payment to
post acute care pr oviders instead of different payments based
on site of care, reducing bad debt and equalizing site of service
payments, meaning paying the same amount whether services
are performed at hospital facilities or doctor’s offices are
similar to O bama A dministra tion proposals .

O n social security Trump's budget proposes reductions to the
disability programs but not the retirement portion totaling
about $80 billion over 10 years . T he savings would come from
reducing retroactive benefits and benefits If more than on e
family member gets supplemental security income and testing
methods to increase work participation.

One expert told us a proposal to restrict eligibility for disability
benefits would affect Medicare as well , b ecause qualifying for

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

the Social Security Di sability Insurance Program is a pathway
to qualifying for Medicare for those with disabilities. On
Medicaid the budget is less specific on the details, but the left
leaning Center on Budget and Policy Priorities estimated the
reduction to Medicaid and Affo rdable Care Act spending over
a decade at $1 trillion. Part of that would come from ending
the enhanced to federal funding to states for the ACAs
Medicaid expansion.

Medicaid covers long term care for seniors with low incomes
and assets. One provision in t he budget would change the
asset test, a move that likely would cause seniors in states
with high home values to either not qualify or have to sell their
homes. T hat's my fact check for this week. I'm Lori Robertson,
Managing Editor of F act C heck.org.

[Musi c]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, email
us at chcradio.com, we'll have FactCheck.org's Lori Robertson
check it out for you here on Conversations on Health Care.

[Music]

Margaret Flinter: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives.
Tens of millions of people around the world have conditions
that make it impossible for them to speak on their own,
requiring them to adopt a computerized voice box for
communicating. Perhaps the most well known of these folks is
the physicist Step hen Hawking.

Stephen Hawking: I would have thought it was fairly obvious what I meant.

Margaret Flinter: The problem is that sound of Hawking speaking through his
voice box is the same voice sound , say , that a 10 year old girl
with a neurologic disorder mi ght be forced to use as well,
because there just haven't been many voice options on the
market.

Dr. Rupa Patel : In the US alone, there are 2.5 million Americans who are
unable to speak , and many of whom use computerized devices
to communicate.

Margaret Fli nter: At a recent TED Talks speech researcher and innovator Dr.
Rupa Patel shared a program she has launched that can
change that reality vocal ID.

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

Dr. Rupa Patel : I thought there had to be a way to reverse engineer a voice
from whatever little is left ove r , so we decided to do exactly
that. We set out to create custom crafted voices that captured
their unique vocal identities.

Margaret Flinter: Creating a voice bank of donor voices that will allow voices to
be individualized for each unique patient seeking to
communicate through an electronic voice box.

Dr. Rupa Patel : Why don't we take the source from the person we want the
voice to sound like and borrow the filter from someone about
the same age and size because they can articulate speech and
then mix the m because when we mix them, we can get a voice
as clear as our surrogate talker, and is as similar in identity to
our target talker. It's that simple.

Margaret Flinter: 16,000 people have signed up to be voice donors at the human
voice bank initiative. V ol unteers like this little girl will read a
series of simple phrases over a several hour period.

Female: Things happen in pairs. I love to sleep . The sky is blue without
clouds.

Margaret Flinter: T hen those phrases are matched with the voice footprint of
the patient being provided for.

Female: This voice is only for me. I can't wait to use my new voice with
my friends.

Margaret Flinter: Such speech synthesis will give that person the dignity of a
speaking voice that is as closely matched to their own identity
as possible. Dr. Patel, who's a professor of computer
engineering at Northeastern University has launched the
website vocalID.com.

Dr. Rupa Patel : I imagine a whole world of surrogate donors from all walks of
life, different sizes, different ages coming t ogether to give
people voices that are as colorful as their personalities.

Margaret Flinter: With the Bank of voice donors now building around the world,
Dr. Patel expects that patients with conditions ranging from
Muscular Dystrophy to Lou Gehrig's diseas e or stroke will one
day be given the chance to communicate in a voice may just
for them . T he human voice bank initiative, matching vocal
donors with millions of people who seek to authentically
communicate with friends and family and a voice that most
clo sely matches what would be their own. Now that's a bright
idea.

[Music]

Dr. Anthony Fauci of the National Institutes of Health on emerging Coronavirus

Mark Masselli: You've been listening to Conversations on Health Care. I'm
Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Female : Conversati ons on Health Care is recorded at WESU at
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