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Since 1984, he’s been at the table and helping lead the fight to keep Americans healthy and virus-free.
Dr. Fauci sat down with Healthline for an exclusive interview on Friday to talk about the COVID-19 pandemic, working with six presidential administrations, and what he does to deal with pandemic stress.
Here are some excerpts from our conversation with the director of the National Institute of Allergy and Infectious Diseases (NIAID), who served as a member of President Trump’s task force on COVID-19.
You’ve been in this arena since 1984 and through six administrations. Can you recall a time even remotely similar to this challenge?
Dr. Anthony Fauci: It’s interesting we are speaking today. On June 4, 1981, the first report of the Centers for Disease Control and Prevention morbidity and mortality weekly report showed that five gay men, all from Los Angeles, had presented with a strange new syndrome.
In 1984, when I became director of [the NIAID], it was the very beginning of an outbreak that we didn’t fully understand the full implications of. We thought incorrectly that it was restricted to the gay community and to injecting drug users.
We didn’t realize that throughout the world and in Africa it was bubbling up as a mostly heterosexual disease, which right now, today, fast-forward, more than 80 million people have been infected, more than 37 million people have died, and there are 37 million people living with HIV. That was my first interaction with the presidency, with the administration of Ronald Reagan.
So it wasn’t the explosive, immediate nature of COVID-19, which essentially impacts, directly or indirectly, everybody in the world because everyone feels they are at risk. That’s different than with HIV, when it was clear it was defined by a risk behavior and not something that was completely out of your control, like respiratory illness.
And then we had the anthrax attacks and the pandemic flu, and we had Ebola and Zika, so for better or worse I’ve had the opportunity to be involved in six different administrations through outbreaks, some of which were much more severe than others; some of which were threatening, but they didn’t really impact us like [COVID-19]. You know, there were headlines, but there was never really any risk in the United States that there would be an outbreak.
But to answer your question: This, that we are living through now, is truly unprecedented.
People have asked me this because of the length of time I’ve been doing this, that throughout all the years, what’s your worst nightmare?
And I always say my worst nightmare — and I said this years ago, not just recently to coincide with COVID — I’ve been saying for decades that my worst nightmare is the evolution of a new infection that jumps species easily from an animal model to a human that’s a respiratory virus, because those are the ones that can spread easily, and that it is highly efficient in its ability to spread from person to person, and that it has a high degree of morbidity and mortality. That’s what I was always saying would be my worst nightmare.
And here we are.
Fauci: Here we are, folks. My worst nightmare. To put it bluntly, I’ve been doing this for 36 years, and this is the most unprecedented, disturbing situation we’ve had because of the potential of being what it is and not just potential. It’s a global pandemic.
Let’s talk about balancing hope with pragmatism, which is kind of what the public part of your job is. What have you seen since January that’s amped up your hope? What makes you feel positive as we move forward?
Fauci: I think it’s the capability of our scientific community to come up with solutions. I mean, we are well into the development of a vaccine, which is the fastest that we’ve ever gone from the recognition of a new pathogen, in this case a virus. And starting off on vaccine development with multiple candidates [being tested] in humans already.
Hopefully by the end of this year we will develop a vaccine we can deploy. We can never guarantee that. You can never, ever guarantee the success of a vaccine. We just have good experience to know that we are aspirationally, cautiously optimistic that we will have one by the end of the year.
If we do that, that will overwhelmingly be the fastest we’ve ever gotten a vaccine. That gives me hope. The fact that we are working hard on developing different therapies so that as we get into the fall and winter season we hopefully will have a couple of therapies that have shown to be effective.
We’ve already proven in one randomized control trial with remdesivir that it has a statistically significant but modest effect on decreasing the time it takes to recover in hospitalized patients with lung disease.
The other thing is that we know that when we do physical separation, we can actually blunt the effect of the spread of the virus. The only difficulty with that, as you well know, is that when you shut down society to prevent physical closeness and interaction, it has unintended consequences on the economy, on employment, even on the health of individuals who need medical care for other things besides coronavirus. So, it’s a complicated situation.
Now the flip side. What’s perking up your pragmatism? What are you more concerned about now than when we dove into this in January?
Fauci: I’m worried on two sides of the coin. Well, I mean, I’m not worried, I don’t worry about things. I try to do things about it. I’m attentive to and concerned about making sure we indeed get good control of this outbreak.
We’ve seen it going in the right direction over the last couple of weeks with a major decrease in the number of deaths in this country, and certainly a decrease in hospitalizations. We have a less dramatic but nonetheless real gradual decline in the number of new cases, so we’re going in the right direction.
But I want to make sure we stay in the right direction, and that as we begin to reopen, we don’t have a surge of cases.
I also am, as someone who realizes that we need to have society function, that we’ve got to try to get back to normal in a safe and prudent way because, if not, the unintended consequences of shutting down can be really serious.
What’s the importance of patience here, both in the vaccination and treatment creation process, and in the public’s expectations and actions? Is patience an important weapon here?
Fauci: You want to make sure that, in your desire to get back to normal, that we don’t leapfrog over some of the benchmarks we need to reach in order to get to the next stage.
We’ve put out a series of guidelines that are very well delineated. We do need to be patient and careful, but we need to proceed both to try and suppress the virus and to get back to normality.
So when you say a vaccine could be produced and available by early 2021, do you mean it could actually be easily available for all, or what will have to happen after it’s produced?
Fauci: It’s a combination. We are producing vaccine at risk, which means we are producing it even though we don’t know yet if the vaccine works, which means if we are lucky and it does work, we will have saved several months and made it available as soon as the winter.
If we are wrong and it doesn’t work, then we will have essentially wasted a few hundred million dollars. We feel it is worth the risk because the consequences of not having a vaccine ready by the winter for those who need it.
So, America, and perhaps the world, looks to you to calm them and keep them reassured, as well as give them a place to feel understood. Whom do you turn to for that, because you must need it in these times as well? Who’s your Dr. Fauci?
Fauci: My wife Christine is always the “go to” person when I have to talk through a particularly difficult issue, or when I need an outside trusted judgment on a particularly thorny problem. She is an amazing, levelheaded, analytical person with a heavy dose of common sense.
Also, running has been my major stress reducers for decades. The combination of those two is critical in getting me through highly stressful times.
As we close, what can you tell readers in terms of hope, and what warnings might you have?
Fauci: The things we’ve discussed, the therapies and vaccines: We should all be hopeful about those. I think they need to be heads-up and cautious that this is not over yet.
We are still in the middle of an outbreak, and we’ve got to all pull together as a community, as a nation, and as a global population. Because we’re all in the same boat here. This is threatening to all of us, and we cannot forget that. We’ve got to continue to work hard to get control of it.
Is it a new and unique challenge for you to work with this administration in a crisis, or is it similar to other administrations in times of crisis?
Fauci: You know, there are a lot of similarities and differences. It isn’t as if this is different than all the others. Each is different. Reagan was different than Clinton, and Clinton was different than Bush. Bush was different from Obama, and this is different than Obama.
I don’t think you can pull this [administration] out and say this is unique. You know, we have a big government, and it generally works very well.
Last question: How will this end?
Fauci: How will it end? We will have control over it. Unfortunately, we will have suffered a terrible burden, but it will end, and we will get back to normal, hopefully sooner rather than later.
I think as a word of hope, people should realize: Don’t despair. This will end, and we will get control over it.