Anthony “Tony” Fauci has become the scientific face of the American response COVID-19, and he says that the best evidence shows that the virus behind the pandemic was not made in a laboratory in China.
Fauci, the director of the US National Institute of Allergies and Infectious Diseases, broke down the raging discussion among politicians and experts, calling it “a circular argument” in a conversation on Monday with National Geographic.
“If you look at the evolution of the virus in bats and what exists now, [the scientific evidence] is very, very strongly leaning towards that could not have been artificially or deliberately manipulated … Everything about the progressive evolution over time strongly indicates that [this virus] evolved in the wild, then jumped species, “says Fauci. Based on scientific evidence, he also has no alternative theory: someone found the coronavirus in the wild, brought him to a laboratory, and then accidentally escaped.
Fauci is most concerned that the United States will be put to the test this fall and winter by a second wave of COVID-19 if the country does not reduce the infection rate by summer.
“Shame on us if we don’t have enough testing by the time this so-called return could take place in fall and winter,” he said, noting that the United States must ensure that we don’t not only a sufficient number of tests available before a second wave hits, but also a system for getting those tests to the people who need them most.
“I don’t think there is a chance this virus will go away,” he said. “It will be there, and if the opportunity arises, it will resurface. As such, Fauci says the United States should also focus this summer on adequately strengthening the country’s health care system, ensuring the availability of hospital beds, ventilators and protective equipment. individual for healthcare workers.
He also stressed the importance of maintaining social distance everywhere until the number of cases begins to decrease in cities and states. The United States witnessed about 20,000 to 30,000 new cases every day during the month of April, suggesting that the country is stuck at its peak.
Still, he remains optimistic that a vaccine will be ready in a historically short time, citing a promising candidate who he says could move on to advanced clinical trials by early summer. Fauci said he believed a final vaccine could be available for general use as early as January, which would break records for the speed at which previous vaccines were developed.
One of the reasons for his confidence is the “impressive” results now seen in animals tested with a candidate vaccine manufactured by Moderna Therapeutics, based in Cambridge, Massachusetts, which have tested it in humans in one record time of 42 days. The candidate is what’s called an mRNA vaccine – a drug that uses extracts of genetic material from a virus – rather than the dead or weakened virus itself – to build the proteins that trigger the body’s protective immune response .
To date, no type of mRNA vaccine has been authorized for use in humans, but Fauci believes there is great promise for this technology targeting the coronavirus, based in part on its experience in development treatment for HIV / AIDS in the 1980s and 1990s.
“For a reason that we are still struggling, the body does not provide an adequate immune response to HIV,” he says. To fight this virus, a vaccine must work better than the body’s natural response. In contrast, “it is evident that many people have a very adequate immune response” to the SARS-CoV-2 virus, and animal trials have so far shown that modest doses of the coronavirus mRNA vaccine have been also generated a strong immune response.
He added that NIAID continues to develop and support several immunization efforts, in case those who enter the trials early do not ultimately prove to be safe and effective. “You want a lot of shots on goal. We want four or five candidates, all of whom we present in a timely fashion, ”he says.
Fauci told National Geographic he was concerned about the rush of states to reopen before their infection rates drop. He also shared how he handles the deluge of new scientific information published on COVID-19, and how his family and his faith keep him going despite his increasingly busy schedule.
((The following interview has been edited for clarity and length.)
Fauci on the vaccine
You have been the director of NIAID since 1984, witnessing dozens of epidemic outbreaks. One of the first was the HIV / AIDS epidemic. How does this experience compare to COVID-19?
One of the important benefits is what we call targeted drug development. Viruses cause disease by binding to receptors in your body’s cells, either in your upper respiratory tract or in your lungs, in the case of COVID-19. They then replicate at a rapid rate that triggers a variety of pathogenic processes. Targeting drugs to interfere with one or more vulnerable sites during this replication cycle is something we have learned with HIV.
SARS-CoV-2 [the virus that causes COVID-19] has the same kind of vulnerabilities. We need to identify them and develop drugs, alone or in combination, to block replication.
Are there also lessons from HIV / AIDS related to the development of a COVID-19 vaccine?
Vaccines are a little different. We have a better chance of getting a relatively new vaccine against the coronavirus sooner, relatively speaking than we did for HIV, because for some unknown reason, the body does not provide an adequate immune response to HIV.
We do not necessarily have this challenge with this coronavirus because it is obvious that many people make a very adequate immune response. They eliminate the virus and they do well. As we know from the natural history of this disease, the majority of people actually recover without any symptoms – they are called asymptomatic – or they have minimal symptoms, where they have a fever, a few ailments, and then recover .
The fact that the majority of people can actually eliminate the virus is a very good sign for the feasibility of developing a vaccine.
The two most discussed vaccine candidates are Moderna’s mRNA vaccine, which reached human trials in a record time of 42 days, and the University of Oxford candidate, based on what is known as a non-viral vector. replicative. However, no vaccine based on these two technologies has ever been authorized for human use. What makes these two vaccines look so promising, especially in this accelerated time frame?
These vaccines induce, at least in animal models, really quite important immune responses, in particular the mRNA vaccine. When we look at the immune response that you can induce with a modest dose – a dose that can be translated in humans – and the time it takes to reach that level of immunity, it’s really quite impressive . It’s also very easy to scale up with these two, in the sense of making lots of doses fairly quickly. So you’re right, they haven’t been approved like many other vaccine platforms, but the promise is great.
At NIAID, we develop or support the development of several candidates. You want a lot of shots on goal. We want four or five candidates whom we all present in a reasonable time – perhaps June, July or August – to have them proceed to an advanced trial. The mRNA is already well in phase one of the clinical trials, and we are preparing to enter phase two and three early in the summer.
Fauci on reopening and masks
As states prepare to reopen businesses and warm weather is drawing people outside, are you concerned about a new outbreak of infections in the United States?
Take a look at the guidelines for reopening America. There are very well defined checkpoints. There is a gateway where infections must drop for 14 days before you can enter phase one for reopening. If you meet the conditions of phase one, you go to phase two. If you do it there, you go to phase three.
So when you see someone in an environment where the infections do not decrease, and then you see 30 to 40 people on a beach without a mask… well it’s very nice to have fun in the sun, but you put yourself really and everyone who risks creating an even bigger spike in infections.
Do you fear a second wave?
What impressed me most, but clearly disturbingly, was the extraordinary spread of the virus. It spreads much more effectively than the flu. You see situations where people at home are trying to separate physically; they have no contact, except that they touched the plate or a door handle, and they end up getting infected.
Clusters of families, outbreaks on the Teddy roosevelt aircraft carrier, the huge spread on the Diamond Princess cruise ship in Yokohama harbor – it’s a very, very transmissible virus.
We are going to be tested as we head into fall and winter this year. If we do it right, we could reduce and decrease the daily rate of infections in this country as summer approaches. I can’t guarantee it, but if we do it right, it will probably happen.
But I don’t think there is a chance this virus will go away. It’s going to be there, and if we have the opportunity, it will resurface. We will now have a few months – May June, July, August – to prepare, ensuring that our health system is adequately supplied with ventilators, intensive care beds, personal protective equipment, etc. We not only need to get tested, but we also need to make sure that people who need testing can get tested.
So that by the time we arrive in September we don’t have the dialogue continually fixed, do you have enough tests? Shame on us if we don’t have enough tests by the time this so-called comeback could take place in fall and winter.
What is your position on the general public wearing facial masks?
I’m glad you asked because it has changed over the weeks and months. During the first discussion, it was at a time when face masks – surgical masks or N95 respirators – were very rare.
Suppose we now have enough masks or you can easily make a fabric blanket, as has been appropriately suggested by the Centers for Disease Control and Prevention. I think these are reasonable assumptions. We know that masks are better in healthcare to prevent an infected person from coughing, sneezing and infecting people in the environment. When you look at what the mask does for the general population, the data isn’t 100%: it doesn’t protect you 100% from someone else’s infection and it certainly doesn’t prevent 100 % someone else to infect you.
But if you wear a mask, you get some protection for yourself, and if you are infected and you don’t know it, you prevent transmission to someone else to some extent. Given this, it makes sense that first, the best way to prevent spread is to maintain the physical distance of six feet.
So if you’re in a situation where you’re not in contact with anyone, you don’t have to walk around with a mask all day, that’s for sure. But if you’re in a situation where you’re going to be in the six foot field – the grocery store or even walking down the street – then wear it.
Fauci on the deluge of information and the claim of “virus made in Chinese laboratory”.
How can you track the barrage of information and filter down to the most important science?
It’s like drinking from a fire hydrant. It really is. Fortunately for me, I have a staff of three to four really good people who sift through the newspapers and when something seems unreasonable or “pie in the sky”, they don’t bother me with that. Then, when all these studies fell on my desk, I read the title and the summary. If it seems feasible, I will put it aside and try to read it. When it’s something they think I should read, they make sure I read it.
Even with this selection process, it is still very difficult to consume everything that exists, especially with this relatively recent trend with these non-peer-reviewed pre-publications. [that have not gone through traditional vetting to appear in major journals].
So what advice would you give the general public to browse the headlines and make sense of it all?
Anyone can claim to be an expert even if they have no idea what they are talking about – and it is very difficult for the general public to distinguish. So make sure the study comes from a reputable organization that usually gives you the truth – even if, with some reputable organizations, you sometimes get an outlier who says nonsense. If something is posted in places like New England Medical Journal, Science, Nature, Cell, or JAMA—you know, in general, it’s pretty well peer-reviewed because the publishers and editorial staff of these journals really take things very seriously.
Recently, a hot topic has been the origins of SAR-CoV-2. Do you believe or is there any evidence that the virus was made in a laboratory in China or accidentally released from a laboratory in China?
If you look at the evolution of the virus in bats, and what exists now is very, very strongly leaning towards that [virus] could not have been manipulated artificially or deliberately – the way mutations have naturally evolved. A number of highly qualified evolutionary biologists have said that anything about progressive evolution over time strongly indicates that it evolved in nature and then jumped out of species.
Sure, but what if scientists find the virus outside the laboratory, bring it back, and then escape?
But that means he was in the wild at the start. That’s why i don’t understand what they’re talking about [and] why I don’t spend a lot of time on this circular argument.
Fauci’s life right now
What does your typical day look like?
I get up around five in the morning, and usually end up running downstairs, having a quick breakfast and looking at a thousand emails, literally a thousand.
I then head to the NIH [National Institutes of Health] for my day job – trying to develop a vaccine and drugs and running a $ 6 billion institution. I stay there for about an hour, then I go down to the White House for several meetings. First, I meet the group of doctors – myself, coronavirus response coordinator Debbie Birx, director Bob Redfield of the CDC, commissioner Steve Hahn of the FDA, and others. Then we go to the working group meeting chaired by the vice-president [Mike Pence], which usually lasts about an hour and a half. We summarize this pre-brief with the vice-president, then briefly go to the president [Donald Trump] for the press conference.
Then the work begins … I go home or go back to the NIH and work until the wee hours of the morning. The whole day is punctuated by all those who need to speak to you: each governor of the states, each head of Congress, each head of the White House. These are constant conference calls. It’s an almost impossible situation – and it’s seven days a week.
Then you overlay all the press that you do – television or radio or interviews. It’s kind of a surreal state. I have to wake up in the morning and literally, without being facetious, ask my wife, what day is it?
I walk with my wife, usually at night or on weekends. It’s dark, but we do it anyway.
Has it ever been too trying?
A few months ago, I was stupid and I just thought I could get by without almost sleeping. I mean, like three hours a night. I did this for a few weeks, and it almost killed me. It really exhausted me. Thank goodness I have a very intelligent and clinically qualified woman who made a difference and said: You have to remember to eat and you have to remember to sleep. The day is still impossible, but I don’t think I’m going to die from it. I hope not.
You went to a Jesuit high school, where you learned the importance of doing good to the public. How did this experience influence your professional life?
My whole life has almost been served me because my mother and father were very service oriented. They were never really interested in money or material things. This is how they were both. So I never knew there was something like going there and making a lot of money, and it was really cemented when I went to both a Jesuit high school and a Jesuit college, where everything the theme was service for others.
I almost never had any other idea to do anything except something that would have an element of public service. I am really a human person, but I am also inclined to science. All of my training is grounded in the humanities, and when you combine that with an aptitude for science, you end up being a doctor.