Dr. Anthony Fauci on COVID-19: What’s Working, What’s Not, and His Advice For America’s Youth

Dr. Anthony Fauci

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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 care 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. One of the world's leading experts on infectious disease
having made significant contributions to HIV / AIDS, Ebola , Zika, and
now COVID - 19. He leads the NIH team addressing the pandemic and is
also serving on the White House Coronavirus Task Force.

Lori Robertson also checks in , the Managing Editor of FactCheck.org
look s at misstatement s spoken about health policy in the public
domain , separating the fake from the facts . W e end with a bright idea
that’s improving health and well - being in everyday lives. If you have
comments please e - mail us at chcr [email protected] or find us on
Facebook , Twitter , or wherever you listen to Podcast . Y ou can also
hear us by asking Alexa to play the program. Now stay tuned for our
interview with Dr. Anthony Fauci here on Conversations on Health
Care .

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Mark Masselli : We're speaking today with Dr. Anthony Fauci, Director of the National
Institute for Allergy and Infectious Disease at the National Institute of
Health. He currently leads the CO VID - 19 response team at the NIH.

Margaret Flinter: Dr. Fauci is one of the wo rld's leading experts on infectious disease,
having made significant contributions to our understanding and
treatment of HIV / AIDS , of Zika , Ebola a nd now , of course . of COVID -
19. Dr. Fauci , welcome back to Conversations on Health Care.

Dr. Anthony Fauci : T hank you. It's good to be with you again.

Mark Masselli: Yeah. Y o u were last j oined us in late February, w here America had 15
cases of coronavirus, and you were worried about containing the virus
but hopeful of the abilities of the CDC to get a handle on i t. S ince
then, there have been 220,000 Americans who have died, more than
8 million have been affected , c harting more casualties than any other
country in the world. N ow you say we're headed for sort of real
trouble, as the nation's infection rates have ri sen to more than 50,000
new cases per day. What are we in for in the coming months , and if
the nation stays on this course? W hat course correction do we need
to take nationally?

Dr. Anthony Fauci: Well, first of all, we are in a precarious position , b ecaus e I would have
hoped that as we enter into the cooler months of the f a ll, and the
colder months of the winter, that the baseline of daily infections

Dr. Anthony Fauci

would be very low , w ell below 10,000. In fact, they range between 40
and 50,000 per day. In addition, if yo u look at the map of the country,
somewhere between 30 and 37 states are having an increased uptick
in the test positivity, which is a very accurate predictor of a surge in
new cases, which already is showing itself in certain areas with an
increase in hos pitalization , and even an increase in deaths . E ven
though the total deaths has come down i n certain areas of the
country , we're seeing hospitalizations, and deaths go up. That's a very
precarious situation to find yourself in as you enter the fall and the
winter months.

W hat we need to do is we just have to double down on some of the
things that we've been talking about all along . The five fundamental
public health measures, 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 of having a
yet again another surging of cases as we enter into the coolest
season.

Margaret Flint er: Well, Dr. Fauci, thank you for laying that out so clearly for our
listeners and the American public to hear. I'd like to add maybe one
more to those might not be on your shortlist. But can we talk about
testing for a moment? We certainly had a bumpy ro ad to testing in
the early months , seems that that has gotten better though not
equally across the country. But what are you seeing in terms of need
to improve enhance or increase testing? D o we think that on the
horizon anytime soon as the longed for simp le at - home test that
people could do themselves?

Dr. Anthony Fauci: You know, that's what we need. I think we're doing much better on
the testing that is available to know if a particular person is infected,
and doing the contact tracing for it . B ut what w e really need more of,
and we've taken a giant step in that direction, with the 1 50,000 Binax
Abbott test , that are going to be made available to schools and to
nursing homes. But what we really do need is what you've just
mentioned, to alleviate the anxie ty of people . Something that people
can get readily in a drugstore. Just like a pregnancy test . T ake it home,
take five minutes , get a result and know it's okay to visit my
grandmother, or my cousin who's got cancer and is on chemotherapy.
That's what we n eed to alleviate the stress and anxiety associated
with this outbreak.

Margaret Flinter: You know the P resident was recently sickened and hospitalized with
coronavirus while holding a large gathering at the White House. The
President did receive some aggre ssive treatment, some of them quite
experimental, such as monoclonal antibodies . I t seems that it might
have been quite effective. You recently had the opportunity to see the

Dr. Anthony Fauci

President's medical information and feel confident that he's no longer
shedding v irus , and you said it's still too soon to call this monoclonal
antibody intervention a cure. But it does look very promising. W e just
recently had Dr. Eric Topol join us and he was talking about the great
potential he thinks it holds for treatment. I'm won dering if you could
help our listeners understand how it works. W hat are some of the
barriers to its wider use as a treatment option?

Dr. Anthony Fauci: A monoclonal antibody is a artificially produced protein that the body
generally normally make s . I f I g et infected with whatever microbe, my
body makes antibodies against it, which are proteins that directly bind
to the virus and block the virus. Those antibodies come from cells
called B cells that stands for bone marrow derived , t hose cells
produce these a ntibodies . Y ou make a monoclonal antibody by
drawing blood from a person like me, and taking my B cells and
cloning them out and picking out the ones that are making a specific
antibody against the coronavirus, that's a monoclonal antibody . Then
you could p r o duce that in very large amounts and then passively
transfer it into someone who is infected, or who you want to prevent
infection from .

I t's mechanism of action . I s it binds directly to the virus and prevents
the virus from infecting your cells. I agree with Eric Topol that that is a
very encouraging potentially important modality of treatments and
prevention that is being very actively pursued now . The president
received a monoclonal antibody from a company called Regeneron . I
believe that it likely pla yed a role , maybe a significant role in why the
President did so well, because as you can see right now, he looks very,
very good and very healthy.

Mark Masselli: J ust follow up , are there clinical trials going on with this ? H ow large
are they?

Dr. Anthony Fauci: There are multiple clinical trials involving hundreds if not thousands,
of people looking at it in the outpatient basis, as an inpatient , as a
prophylaxis in nursing homes, and as a prophylaxis in family settings,
where one member of the family is infected, and you're trying to
prevent the spread of infection to other members of the family.

Mark Masselli: Dr. Top o l , told us that he thought it might be the transition between
where we are today and a vaccine .

Dr. Anthony Fauci: Well, I agree with him completely , because it can prevent infection .
W hen you vaccinate somebody you're trying to induce antibodies to
prevent infection . W hereas a monoclonal antibody , is the antibody is
already pre formed, and you passively transfer it into someone.

Margaret Fl inter: Well, Dr. Fauci that's good news. I think so rt of continuing along those
lines , a s I think , you know, Community Health Centers care for 30

Dr. Anthony Fauci

million people across the country and disproportionately represented
our populations of people that have suffe red some of the worst
consequences of COVID , r acial and ethnic minorities , and members of
other vulnerable groups. As we look at treatments as you've just
described, or other treatments that hopefully maybe they're down
the line to treat COVID infection. H ow are we looking at ensuring that
there's diversity in the people who are enrolling in those clinical trials
so that there's both confidence but also just knowledge about what
works in different populations of people ? F rom all of your history over
the yea rs in treating different infectious diseases, I know this must be
an issue that you've wrestled with over the years.

Dr. Anthony Fauci: Well, it's called engaging the community. W e've been doing that for
decades dating back to the work that we did with HIV / AIDS, when
there was a disproportionate number of minorities that were getting
infected . W e had to get proper representation of minority
populations in our clinical trials. T he only way you do that is that you
get community engagement by having trusted me mbers of the
community, reach out to the community to try and convince them of
the importance of being part of the clinical trial process f or the very
reasons that you bring up, that in order to get people to ultimately
take an intervention , be that a vacc ine or a therapy . They need to be
convinced that it is safe and effective in them. T he only way you prove
that is by making sure you have adequate representation of the
various demographic groups, including minorities , in the actual clinical
trial process. T hat is what we try to do by engaging with the
community to convince them to participate in the clinical trials.

Mark Masselli: We're speaking today with Dr. Anthony Fauci. He leads the COVID - 19
team at the NIH , and is a member of the White House Coronavi rus
Task Force . Dr. Fauci, you've marveled at the rapid pace , and I think
we all have of discovery on vaccine development. W e know that there
are several vaccines are likely to come to fruition in really record time,
although several of those trials ha ve b een halted during phase three
due to unexpected health concerns among participants. I think that's
sort of normal. But you've talked about a new platform that some of
the vaccines are using and , one in particular, I think the NIH is a lead
participant.

W ha t’s your message though to consumers about how to decide what
might be a handful of vaccines that are ultimately approved by the
FDA? Should consumers wait till they look at all of the options, just in
case one is coming through a pipeline, it may not have gotten to
phase three as soon as the other vaccines did , a nd might have gotten
a late start . B ut what's your advice as these vaccines start to be --
receive the approval process?

Dr. Anthony Fauci: Well, that's a very good question because I am certain th at there are

Dr. Anthony Fauci

going to be more than one vaccine that's going to be approved by the
FDA. I t really is going to depends on what your risk category is. I f you
are someone who is at a pretty high risk of if you get infected you will
have a serious outcome. Let' s say you're a 77 - year - old man who's
obese and is im muno - depressed, because you're on chemotherapy
for cancer . I wouldn't wait to try and figure out what the best vaccine
is, I'd get the first one that was available. If you're a 25 - year - old
healthy person with no underlying conditions, you might want to wait
a couple of months to see what turns out to be the best one. I t really
depends on your particular state and your particular risk profile.

Margaret Flinter: Well, that's really interesting. Dr. Fauci, I think the entire country's
gotten kind of a crash course in infectious disease. You hear people in
the streets using phrases that you usually only heard clinical people
talking about . B ut one that was introduced recently to the public was
herd immunity , a n d this idea of at some point there's enough
protection in the community that maybe life goes back to something
akin to normal. I wonder if you could just , for the sake of our listeners,
just opine on that a bit. At what point , what percentage of the
popula tion , or is there such a cutoff, even general , of people who've
either been ill or been immunized that we can assume that this level
of herd immunity exists in the general population ? Is that even on the
horizon down the road with a vaccine?

Dr. Anthony Fa uci: Well, the CDC did a sero survey, a representative of the United States.
T hey found that the percentage of people in different regions of the
country that have been infected namely are assumed to be protected ,
ranges from a few percent to 20 plus percen t, which was the New
York numbers since they got hit so badly . The average was about 10%,
which means that about 90% of the population is not protected.
When you say herd immunity, that really means a substantial
proportion of the population has been infec ted, and is thus protected,
that they will in fact indirectly protect the rest of the population
because the virus would have no place to essentially accelerate. We
don't know what that percentage is.

We know for other diseases, like measles and other dise ases what it
is, we suspect that for COVID - 19, it's somewhere around 70%. But
we're not a 100% sure of that. We're not anywhere near that. The
way we're going to get near herd immunity is by vaccinating a
substantial number of people . Then you're going to get a combination
of those that were already infected, plus those that are vaccinated,
that would give the level of herd immunity that we need.

Mark Masselli: Dr. Fauci, my youngest, Coby [PH] is in high school. I think the
question he'd like to hear you r espond to is, what would you say to
young people about the role of their generation in dealing with this
life altering pandemic? I think he understands, and many of them do,

Dr. Anthony Fauci

the five criteria laid out . He ’s certainly wearing masks, social
distancing, but w hat's the bigger message to this generation about
their role in the impact and the vital contributions they can make?

Dr. Anthony Fauci: Well, they have a very important role , b ecause unfortunately, given
the real data, that young people have far less of a chance to have a
serious outcome from infection . M any of them may not have any
symptoms at all, that they could fall under the false impression that
they're getting infected doesn't have any impact on anybody else.
W ho cares if I get infected, I'll just l ikely have no symptoms , a nd why
don't I do whatever I want and not try to avoid infection. That would
be a big mistake , b ecause even though as a young person, a high
schooler or older, or what have you, even though you may not get any
symptoms from being i nfected, the very fact that you've allowed
yourself to be infected means that you are propagating a pandemic.
E ven though you don't have any symptoms, it is likely that you will
transmit the infection to someone else who will then transmit it to
someone el se who then might be someone who is vulnerable.
So meone's grandfather, someone's wife, who's on chemotherapy for
breast cancer , a n immunodeficient child, an African - American child
with sickle cell disease . You are not in a vacuum, you would tell a
young pe rson , because even though you don't think you're getting
infected is hurting anybody indirectly , y ou may be part of the problem
as far as being part of the solution, which is what you should be.

Margaret Flinter: We've been speaking today with Dr. Anthony Fauci, Director of the
National Institute for Allergy and Infectious Diseases at the National
Institutes of Health. Dr. Fauci, we thank you for your lifelong
dedication to medicine and public health for your steadfast leadership
during this COVID pandemic. As a member of the American Academy
of Nursing , I also want to welcome you and congratulate you just
being named an Honorary Fellow of the Academy. T hank you for
joining us again on Conversations on Health Care .

Dr. Anthony Fauci: My pleasure, good to be with you, Margaret.

Margaret Flinter: Thank you , so much .

Dr. Anthony Fauci: Thanks Mark, appreciate it.

Mark Masselli: Thank you so much.

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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 U.S. politics.
Lori, what have you got for us this week?

Dr. Anthony Fauci

Lori Robertson : In a video posted to Twitter, President Donald Trump incorrectly said
antibody cocktail therapies, including one he received when he was
infected with COVID - 19 had been authorized and that hundreds of
thousan ds of doses were nearly ready. He called the drug s cures. The
drugs in question are monoclonal antibodies, which are synthetic
proteins optimized to recognize the coronavirus and , in theory , should
help clear the virus from the body. While many experts vie w them as
promising , the products are still in clinical trials and have not been
proven to be effective for COVID - 19 patients, much less cure the
disease.

The President received an antibody cocktail made by the biotech
company Regeneron . It was one of seve ral drugs he received after he
tested positive for the coronavirus. Trump claimed that after he
received the antibody drug, “ I felt good immediately. ” He said,
“ We've authorized it. ” But that's not the case yet. As of October 8, a
day after the President's video, no monoclonal antibody for COVID - 19
has received emergency use authorization from the Food and Drug
Administration , a lthough two companies have submitted those
applications , Regeneron and Eli Lilly . Trump received the
investigational drug that larg ely isn't available to the public. S tat News
reported that fewer than 10 patients had been provided the cocktail
outside of its trials.

Trump also gave a misleading impression of how available the
antibody cocktails would be should they receive FDA authori zation .
Along with his figure of “ hundreds of thousands of doses that are just
about ready ” Trump said near the end of the video that “ the drug
companies have just made a lot of it. ” Statements from the two
companies suggest that at most about a 150,000 do ses of these drugs
would be immediately available with the potential FDA
authorizations. Production of monoclonal antibodies isn't easily scaled
up so there is concern that supplies won't be able to meet demand.
As for whether Trump benefited from Regenero n ’ s cocktail , that's
impossible to know , o nly through clinical trials is it possible to know if
the drugs are safe and effective . So far the data on the various
monoclonal antibodies is generally positive, but hardly conclusive ,
That's my fact check for th is week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

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Margaret Flinter: F act C heck.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 P ennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com . We'll have
FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

Dr. Anthony Fauci

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Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. It's estimated
that a majority of a person's lifelong health expenditures are often
spent in the final months of life , b ut death is on e of those topics that
generates the least amount of conversation in the clinical setting in
American Health Care. For folks who end up critically ill or facing a
terminal diagnosis like late stage cancer, this can often lead to poorly
communicated end of life wishes being discussed with the clinician
who then often resorts to extreme interventions

Dr. Manali Patel : In oncology , notoriously we are underprepared to have these
conversations with patients. There's a desire to want to provide
patients with trut h. However, there's this unspoken misconception
that by having honest conversations about prognosis that we are
somehow removing the hope that patients are coming to us looking
for. Actually most studies that have evaluated this have shown that
when you pr ovide honest prognostic information to patients and
allow patients to be part of the decision making about their goals of
care, they are more appreciative of it and actually have more
understanding of their disease process and better satisfaction with
thei r care overall.

Margaret Flinter: Dr. Manali Patel sought to find interventions that might give clinicians
and families a more useful tool to address this gap in communication.
Her earlier research at Stanford had yielded an interesting finding.
Late stage cancer patients felt more comfortable talking abou t end of
life issues with a lay person as opposed to a clinician . Patel set up a
study to examine that finding further . S he and her fellow researchers
followed patients at the Veterans Administration Palo A lto Health
Care System for 15 months after they were diagnosed with stage
three or four or recurrent cancer. Half the people were random ly
assigned to speak with a lay worker abo ut the goals of care over a six -
month period . T he control group was given no s uch intervention. T he
lay w orkers were given a rigorous 80 - hour course and clinical
observations before being assigned to the study .

Dr. Manali Patel : We found during the intervention was that she learned as she went .
A s the project went through the cycles of starting the implementation
and ramping up , and then at the end she was completely proficient
with having these conversations such that she came to that
realization that these conversations really are not scary and shouldn't
be scary and shouldn't be m edicalized. M aybe she didn't need all that
training to begin with. We had hired her specifically because of her
service orientation a nd because she had a very supportive ear. T hat's
really the main crux of this intervention w as finding the right person
who can engage in these conversations without needing a lot of

Dr. Anthony Fauci

training to do so .

Margaret Flinter: 92% of the participants who received the layperson intervention,
compared to only 18% of the control group were likely to have end of
life directives in their electronic health record, and more likely to have
communicated their wishes to their clinicians as well , o ften choosing
hospice over emergency room interventions. The health cost of both
groups varied as well. The average cost of care for the intervention
group in the last month of life was about $1,000 versus $ 23,000 for
the control group . Dr. Patel said one of the more interesting findings
was much higher patient satisfaction among those who receive d the
intervention.

Dr. Manali Patel : We found that the s atisfaction scores went up for the patients in the
intervention arm , but they went down for patients in the control arm
across all six scores of the satisfaction with decision scale. We found
overwhelmingly that the patients in the intervention arm were ve ry
satisfied with the decisions that they had made regarding their
medical treatments and regarding their life . B ut the patients in the
control arm really did not have much movement at all in terms of how
satisfied they were .

Margaret Flinter: A low resour ce compassionate patient centered intervention that
assists terminally ill patients, their families and their clinicians to have
a frank discussion about end of life wishes, improving patient
satisfaction a t such a s sensitive and challenging time and savin g
significant costs as well. That's a bright idea.

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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 h ealth.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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