Dr. Anthony Fauci, the nation’s top infectious disease expert, said in a televised town hall Friday night that the pandemic sweeping through the nation has yet to see “the full effect of a potential surge upon a surge” following the Thanksgiving holiday.
Fauci, who will be staying on as chief medical advisor to President-elect Joe Biden, was taking part in a discussion on the coronavirus with CNN’s Anderson Cooper and Dr. Sanjay Gupta when he was asked about a model from the University of Washington’s Institute for Health Metrics and Evaluation that is projecting more than 530,000 deaths from the virus in the United States by April.
It was only this past week that Robert Redfield, the head of the Centers for Disease Control and Prevention, said that the upcoming months could be “the most difficult in the public health history of this nation” due to the strain placed on the country’s health care system as a consequence of the pandemic.
The number of deaths projected from the coronavirus in the model could reach that point, Fauci said, due to several “conflating events occurring.”
Fauci pointed to the surge that was ongoing prior to Thanksgiving — a “very steep inflection of cases that has led” to record numbers — and the holiday itself, including associated factors like travel and gatherings.
Public health officials, including in Massachusetts, have warned that the fallout from the holiday could intensify challenges as states continue to battle a worsening pandemic through December.
It is typically two to three weeks after a major event that a sharp increase in cases is notable, Fauci said.
That peak may occur “right at the cusp before the Christmas holiday, where you’re going to have more travel and more congregating in a way that’s natural and understandable — families and friends getting together,” Fauci said. “So we’re really very concerned.”
Between a likely Thanksgiving and Christmas surge, the numbers projected in the model could “very well” occur, Fauci said.
But, Fauci said, with a uniform response on behalf of the nation’s citizens — such as the universal wearing of masks, social distancing, and avoiding crowds and congregate settings, particularly indoors — a dramatic rise in cases and deaths can be combated.
“We all need to pull together to do that because as I’ve said so many times, help is on the way,” Fauci said. “Vaccines are imminent.”
One such state is California, where Governor Gavin Newsom last week warned that an influx of patients with a severe case of the virus may force overwhelmed hospitals to turn some people away before Christmas even arrives.
Fauci touched on the compounding pressure on medical systems and health care workers, particularly those in California, during the interview. He was on the phone with colleagues recently in Los Angeles, “where their system is really strained.”
In scenarios like that, more drastic measures may have to be taken to prevent additional problems from developing, he said.
“If it requires doing more drastic things, or Draconian things, like maybe some temporary shutdown in some areas, I think some of the areas of the country are thinking of that,” Fauci said. “I know as a fact, in California, in some places of California, they are thinking about that.”
The “unimaginable” outcome that leaders are trying to prevent — one that “no one wants to see happen,” Fauci said — is arriving at a point where people are going to be deprived “from the kind of care that they need.”
Though the vaccine rollout could begin as early as mid-December, key groups will be prioritized first, among them health care workers and the residents and staff of long-term care facilities. It’s likely, Fauci said, that “essentially a healthy, non-elderly person with no recognizable underlying conditions,” will not get the vaccine until March or early April.
It’s vitally important when the vaccine is readily available, Fauci said, that “we really have a full-court press” on people getting inoculated — with in all probability a vaccine from either Pfizer or Moderna.
“Because the quicker you get the overwhelming majority of the country vaccinated, the quicker you’re going to have that umbrella of herd immunity, which would be so, so important in bringing the level of that virus way, way down to below the threatening level,” Fauci said. “The sooner we get there, the better we are.”
It’s for this reason that Fauci and other leaders are preemptively taking steps to address any skepticism and fears people may have about a coronavirus vaccine, especially Black and brown communities — among those hardest hit by the pandemic.
Community outreach efforts, Fauci said, are the crux of the plan to engage those who may be distrustful of a vaccine.
“There already is a plan to get people who are respected by the community — athletes, faith-based organizations, personalities, celebrities — to go out there and get people to be vaccinated,” Fauci said.
Fauci said the medical community has a responsibility in particular to Black Americans — whose treatment by health care professionals over history is “something that we are certainly not proud of” — to communicate that the process of creating and eventually distributing a vaccine has been “transparent and independent.”
“We have one of the two ingredients — the one-two punch that could knock out a pandemic,” Fauci said. The first are two “very, very efficacious” vaccines.
“I would not have expected it would be this efficacious. 94 to 95 percent is as good as you get,” he said. “It’s almost as good as the gold standard, which is measles, which is about 98 percent.”
And the second part, Fauci said, is a “very, very high uptake of the vaccine,” again highlighting the need to explain anything that people may be cautious about.
One such worry people may have, Fauci said, is that the process of getting a vaccine developed was rushed — and therefore safety was sacrificed in the interest of expediency.
But, Fauci said, that’s not the case.
“We had technological advances that allowed us to do things in weeks to months that would have normally taken several years. That didn’t compromise any safety, it didn’t compromise any scientific integrity,” Fauci said. “We invested an extraordinary amount of money to get the doses ready as soon as the vaccine was ready to be administered.”
He also emphasized that the decision of determining whether a vaccine is safe and effective — a process happening now, Fauci said — is not made by the presidential administration or the company involved.
“It’s made by an independent data safety monitoring board who look at the data, scrutinize it, then they allow the company to see it,” Fauci said. Then the company gives it to the Food and Drug Administration to apply for Emergency Use Authorization, at which point another independent advisory committee makes its evaluations and determines whether to grant the EUA.
As soon as the EUA is officially administered, then people can start getting vaccinated, Fauci said.
“Essentially, immediately after that, it will likely be a day or at the most a couple of days,” before hospitals can start inoculating people, Fauci said. “But it is essentially right from the time that you get the official authorization.”
The vaccine will be available at pharmacies, clinics, doctor’s offices, and hospitals, Fauci said.
But Fauci cautioned that the arrival of a vaccine — while groundbreaking during this stage of the pandemic — will not be a cure-all immediately.
For instance, there won’t be a “complete abandonment” of coronavirus safety measures like wearing masks, watching one’s distance from others, staying away from crowds to the extent possible, and doing more things outdoors than indoors, Fauci said.
“We’re going to be suggesting that no matter what because not everybody is going to be vaccinated at the same time,” Fauci said.
While it’s known that the “vaccine is 95 percent effective in preventing you from getting sick,” Fauci said, it remains unknown “if it’s protecting you against infection.”
“If it doesn’t protect you against infection, it’s likely that the degree of immunity that you have is going to diminish the level of virus in your nasal pharynx,” Fauci said. “And even though you might be infected, it is likely — but not proven yet — but likely that it would be very less likely that you are going to transmit it.”
It’s for this reason, Fauci said, that we can’t “abandon all public health measures.”
“You can gradually attenuate them the more and more people that get vaccinated — the less and less the threat to society is,” Fauci said. “Until you get to the point where if you have the overwhelming majority of people vaccinated, and you have a good umbrella of herd immunity, then I think you can get back to as close to normal as you would really want. But that’s not going to be immediately.”