Dr. Fauci: I Won’t Be Distracted By Death Threats

CHRISTIANE AMANPOUR: Now, even as life and death amongst this pandemic continues, President Trump has launched an on-again, off-again verbal war with the infectious disease expert, his own top adviser. But Anthony Fauci is, in fact, going to be sitting down right now talking to our Walter Isaacson about the challenges, about the opportunities and about where he sees this coronavirus pandemic leading.

WALTER ISAACSON: Thank you, Christiane. And Dr. Tony Fauci, thank you for being on the show and for all you’re doing for the country.

ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES: Thank you, Walter. Thank you for having me.

ISAACSON: There is a great divergence in how this disease is affecting people, especially young people. What do you think is most misunderstood right now?

FAUCI: You know, Walter, that’s a very good question and a very good point because of all the viral diseases I’ve had to deal with over the last four decades from HIV to Ebola to Zika, I’ve never seen a virus where you can go from 40 to 45 percent of the people have no symptoms at all, and then some get minor symptoms, some get sick enough to be in bed for weeks at a time and then have residual symptoms, some go to the hospital, some require intensive care, ventilation, and then some die. And usually, with some exceptions, usually you find out that the elderly and those with underlying conditions get into trouble and have the greatest chance of a severe outcome, whereas younger individuals, you know, the 20, 30-year-old individuals, they generally, with some exceptions that they need to be careful of, do reasonably well. So, when you’re trying to get country, as a whole, to do things, to keep the infections down, you’ve got to have everybody singing the same tune. But what we’ve seen, unfortunately, particularly now in the southern states that have tried to open, and we’ve seen those surges going up from 20,000 cases a day up to as high as 70,000, what the younger people don’t fully realize is that even though they feel somewhat, you know, immune to this in the sense of they’re not going to get sick so who cares? I’m not bothering anybody. Why don’t I go out and have a good time? I know they’re innocent about that, but what they don’t realize is that when they get infected, they propagate the outbreak. And they may not get sick, but they’ll infect someone who gets sick, and then they’ll infect another person then, and before you know it you have people in the hospital. And that’s what we’re seeing right now.

ISAACSON: I spoke to your colleague, Dr. Francis Collins, last night on this show, and he said that many nights you and he just talk late at night and say, how did we get into this position, especially how do we get into a situation where everything became so polarized and so politicized? What’s your answer to that? How did this become so polarized?

FAUCI: What happens, Walter, is that you know better than I do that we live right now in a very unusually divisive society from a political standpoint, and when you have two things converging, a historic pandemic that you’re trying to deal with and a divisive political society in an election year, my goodness, that makes things quite complicated.

ISAACSON: You know, the president said a couple days ago on his HBO Jonathan Swan interview, when pressed about how bad things go, he says, well, it is what it is. What’s your reaction to that? Could we be doing better?

FAUCI: You know, Walter, we always could be doing better, and it really gets back to what I was saying just a moment ago about the idea that we’ve all got to pull together. We live in a big country with a great deal of divergence of opinions and a variety of other things that differ. There’s good news about that. We embrace that difference. The trouble is, sometimes that difference allows for a not uniformed type response. So, we have some governors, some mayors or whatever doing things one way, others wanting to do it another way. That’s the reason why we whenever get the opportunity, I appeal to people to use the four or five or six easy things, Walter, washing hands, physical distance, wear masks, avoid crowds, stay away from bars, and outside is always better than inside. If we do those things, which are not rocket science, public health things, we can make that curve go down. The trouble is, when one segment of society is not doing that, it influences everybody. That’s the point.

ISAACSON: The president keeps saying we’re doing very well on testing and on the disease compared to other nations. Has he explained to you why he thinks that?

FAUCI: Well, Walter, what I think it is, is that as the president he’s trying to keep the spirits up for people in the country and saying we’re doing well. I mean, you know, in some aspects, if you look at some of the curves, they’re going down, but as public health officials, we look at the whole picture. And it’s a serious situation that you’ve got to address in a very serious way.

ISAACSON: Do you think we are addressing in nationally in a very serious way?

FAUCI: You know, we are. We had some significant issues that we’re trying — and, again, I think the issue gets back to, we would have liked to have seen the baseline get down to a very low level. And we were not successful. We plateaued at 27,000 cases per day. And then, when we tried to open, open the country economically and otherwise, we had a great diversity of people doing it correctly and people essentially letting caution to the wind. And then what happened is that we had an increase to 30,000, 40,000, 50,000, 60,000, 70,000 cases. That is not good, by anybody’s definition. We have got to get that down. And when we do, we will find that it’s going to be easier for us to prudently and carefully get back to some form of normality. But we have got to get that baseline down.

ISAACSON: So, do we need a national strategy, a national sort of mandate?

FAUCI: Well, I’m not sure we could say strategy. What we do need is a consistent, strong message that you keep hammering home, particularly with regard to masks, physical distance, those kinds of things.

ISAACSON: Are we getting that consistent, strong message?

FAUCI: Well, it’s getting better now. I’m very pleased to see that. Now we’re seeing the very highest level. The vice president consistently wears a mask. We see the president wearing a mask. We need to keep that message up. It’s a powerful message when it comes from the top.

ISAACSON: Well, the president met with you yesterday for the first time in a while for a — for one of the COVID briefings. I think only you and Dr. Birx and one other were wearing a mask. Tell me about that meeting and what we should make of it, why there was a meeting like that yesterday.

FAUCI: Well, you know, the president — previously, we would have those daily press conferences, where we would have the consistent task force meeting led by the vice president, and then, every day, we would go out and have some sort of meeting with the president, where we would brief him, and then we would get up together. Right now, that’s pivoted a bit more towards the economic reopening of the country. So, every once in a while, the president would like to say, OK, I know I’m not seeing you guys and ladies every day. He wanted to see us. So, essentially, what we did is that we brought the task force meeting to the Oval Office, as opposed to having him come down and talk to us. That’s what that was all about. It was…

ISAACSON: And what was the outcome of that?

FAUCI: You know, it was a good discussion. We were talking to the president about the things we need to do. In fact, Walter, I told the president almost word for word everything I just told you about what we need to do, about the consistency, of the fact that we can end this. One of the problems is that, when people are cooped up, they have a natural feeling that, is this ever going to end? Are we just going to be this way all the time? So, when given the opportunity, they go all the way to the other extreme, and instead of being careful. Those are the kind of things that I was telling the president, that we need to get that message, A, we can end this if we do some fundamental simple things.

ISAACSON: Dr. Birx has been saying, and you have agreed with her, that we’re in a new level, going to a new level of community spread. Does the president believe that now?

FAUCI: Well, we spoke to him and explained to him, because there was some misunderstanding about what was meant. I agree with Dr. Birx completely. What she was referring to is that, when you have community spread, it permeates the community. It’s very difficult to identify who the index case is, because many people don’t have any symptoms. That’s very different, Walter, from when you have a nursing home outbreak. You know exactly what — the constraints of the outbreak, or a meatpacking plant or a prison. When you have community spread, it’s kind of very insidious out there, and you really have to get your arms around it. And that’s the reason why I get back to what I said before. We all have to pull together in the community. Everyone needs to assume that they might be infected without any symptoms, which means you wear a mask to prevent you from infecting others. You avoid crowds. You wash your hands. You do things outdoors vs. indoors. Those are not difficult things to do.

ISAACSON: In theory, could we have — would a one-month just sort of shutdown again, would that help us bring it back to a manageable level, so it wouldn’t be community spread?

FAUCI: Well, the answer is probably, theoretically, yes. But the country is really not going to be accepting a month shutdown. I think the reality is, if you want to live in a theoretical world, certainly, you could do that, but it would have a significant impact on the economy, which health comes first in many respects. But, also, I think the country — would not be acceptance of that, because of the fact that they have been — many of them have been restrained for so long that they would likely rebel against that.

ISAACSON: One of your causes for optimism, I have been reading, is about monoclonal antibodies. Explain to me what they are and why you think that might even come along even faster than a full-fledged vaccine.

FAUCI: Yes, right, right. Good question, Walter. Well, yesterday, Francis Collins I and Janet Woodcock announced a product that we’re putting into clinical trials for both outpatients, as well as inpatients who are not in advanced disease. And a monoclonal antibody is a natural product that the body makes. So, what we did is that we got a patient, one of the early patients from Washington state, who was infected and recovered. So, his body was making anybody that fights the virus. We took blood from them. And the cells that make antibody are called B-cells, because they evolve from the bone marrow. Those individual B-cells make specific antibodies. So, we screened all the B-cells and picked out one of the cells that specifically makes an antibody against that part of the virus that binds to your cell, which means it’s going to block the virus. And then you could make that cell have antibodies in unlimited quantities. You purify it, and you passably infuse it intravenously to try and treat someone to prevent them from getting advanced disease. So, we’re cautiously optimistic, since we know that antibody is directly against the virus, that we may be able to have a good early treatment.

ISAACSON: You have been urging people, and so has Dr. Collins, to go into these clinical trials, to sign up for them. So, I did, and I’m now part of the clinical trial, and I will be taking it this afternoon, getting my first vaccine or placebo for the Pfizer, which is a — as you know, an RNA, new type of vaccine. Do you want a lot of people to do that? And how do you answer the question of, if you’re in one of these trials, and somebody else comes up with a vaccine, is it safe, not knowing whether you got the placebo or the vaccine, for you to just go get the new vaccine?

FAUCI: No. Well, Walter, thank you very much. I think somebody with your visibility and reputation and intelligence getting a vaccine is a good sign for other people to do that. We need to be sure that we’re careful when we’re doing things, particularly with people who are perfectly normal. And vaccine trials unnecessary, because, when you make a decision about a vaccine, you are going to be administering it globally, literally, Walter, to billions of people. In the United States, it will be hundreds of millions of people. So, you want to make sure, as much as you want to get something that works, it’s got to be in a clinical trial to prove, A, is it safe, and, B, is it effective? And until you know that, it is definitely a good idea to be in a clinical trial. Well, people say, well, you know, the only way you get a good answer is the intervention vs. the placebo. Well, do I really want to get the placebo? The answer is, there are vaccines that may actually be harmful. And that’s the reason why, when you go clearly into these trials, you want to make sure you give it to somebody that’s safe. And that’s why the trials start off with phase one, then go to phase two. And the vaccine that you got, or placebo, or will get, we have a pretty good idea that it’s safe. But we want to prove it, and that’s the reason why we’re putting 30,000 people into these trials. You’re getting…

ISAACSON: Now, if we prove it’s safe, and nobody has bad adverse reaction, but we’re not quite sure if it’s effective, it just seems effective, why not just roll it out, since they’re already manufacturing it, and let people, hundreds of thousands of people, do this?

FAUCI: That’s a reasonable question. The only thing that you want to make sure, in addition to safety, is, you don’t want to be distributing a vaccine to hundreds of millions of people that doesn’t work, so that, if you get one that’s safe, but you haven’t proven it’s worked, the only reason that you might want to give it is to people who, at the risk/benefit, are at a very, very high risk. But you don’t want to give it to everybody, for sure, because, when you start to give it to the hundreds of millions of people, you must know that it is effective. Otherwise, you may have what we call perpetual ambiguity. You will never know if it works. So, if you are going to be giving it to people year after year, you really want to know if it works.

ISAACSON: So, how do you think this ends for the country?

FAUCI: You know, I think it ends. And I hope that we can get the people who are the ones that are inadvertently and innocently spreading this to understand their societal responsibility, at the same time as we get good therapies, as we get a vaccine. I think, if you put those things together, this will end, Walter. It will end. We can get the infection rate so low that it doesn’t impact how we live. If you get a vaccine that you can give essentially to everybody who wants and needs a vaccine, that could be the nail in the coffin of this. So, I do see an end to this, but it’s up to us to do it.

ISAACSON: And let me just ask you a personal question. You have been hit from all sides. You have been criticized. You have been praised, by the way, and put on baseball cards. It’s being even more intense that when you went through the HIV/AIDS crisis 20 or so years ago. How do you get through this? How do you have time to reflect and to think about the people who are being affected by this disease, and for you to even mourn and process some of the horrors you’re having to go through?

FAUCI: Well, Walter, that’s a great question. It’s not easy. I have phenomenal support from my wife and my children, who are really great about this. It is really somewhat surrealistic. And what I have been able to do, and I think I can do it pretty well, although it gets painful sometimes, is to compartmentalize and focus like a laser beam on what my job is. And I’m a public health official. I’m a scientist. I’m a physician. That’s my identity. The only thing that I care about professionally is to put an end to this outbreak. The other things are distractions. It’s a distraction that I don’t pay attention to, because, if you pay attention to it, you can’t focus like a laser. So, on the one hand, I’m on baseball cards, and I’m all these other things that are completely surreal. And, on the other hand, you have people, even within what you think is your own group, that are terribly criticizing you. And then you get death threats all over the place from crazy people, who harass my wife and harass my children and make death threats against me. If I concentrated on them, I wouldn’t be able to do my job. So, I just focus on the outbreak. I don’t get a big head about the baseball cards, and I’m not frightened by the other nonsense. So, that’s how I handle it.

ISAACSON: Dr. Tony Fauci, thank you, and thank you for handling it that way. It’s great to be with you.

FAUCI: Thank you, Walter. It’s always good to be with you. Thank you for having me.