Fauci: COVID-19 can be crushed, ‘but it’s not going to happen in a few months’
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Despite promising data that have emerged on COVID-19 vaccine candidates, a return to normal “carefree” life is likely years out, according to Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.
In a conversation with ASH President Stephanie J. Lee, MD, MPH, member of Fred Hutchinson Cancer Research Center and professor at University of Washington, Fauci emphasized that billions of vaccine doses will need to be administered before herd immunity is achieved at a global level.
“It’s going to be months and months and months at best before enough people get vaccinated to have that veil or umbrella of herd immunity protection,” Fauci said during a keynote address at the virtual ASH Annual Meeting and Exposition. “We know from surveys that many people are skeptical about the vaccine and don’t want to get vaccinated, so we are going to have a task to convince people that the record speed with which we got a vaccine is really a reflection of the extraordinary scientific and technological advances that have been made in platform technologies for vaccines and the enormous investment of resources that was made by the federal government to prepurchase vaccine before it was even proven that it worked. We have to make sure we don’t have people who misinterpret how that occurred.”
Fauci said the public hasn’t fully appreciated how independent and transparent the process is, with independent data and safety monitoring committees playing a key role in interpreting the data before any vaccines are approved.
When normalcy will return is contingent upon how the national and global community responds, Fauci added.
“We have a history of crushing major global outbreaks,” he said. “We did it with smallpox, to the extent of eradicating it. We did it with polio, to the extent of eliminating it from most countries. There is no reason why we can’t do that with COVID-19. But, it will require public health measures to keep it under control until we get enough vaccine to the tune of billions and billions of doses to vaccinate everyone on the planet, the way we did with polio and measles. When we do that, then we will have crushed this, and we can do whatever we want to do again.
“This is doable, but it’s not going to happen in a few months,” he added. “It’s going to take a while to get that ... and it’s going to take equitable and fair distribution of vaccines. If you have vaccines only for the privileged, developed world, you’re never going to eliminate this infection, because it’s so highly transmissible. Crushing it is going to take a global program of vaccination.”
Hem/onc connection
Lee acknowledged the interactions between hematology and SARS-CoV-2, and the prominent role of the disease in research presented at the ASH meeting.
“A lot of our scientists are studying the immune regulation of viral infections, there are thromboses in patients with COVID-19, convalescent plasma has emergency use authorization, and then of course we have a large population of immunocompromised patients — people with hematologic malignancies or sickle cell disease, and patients [who have undergone] stem cell transplant,” Lee said.
Lee asked Fauci what hematologists and oncologists should tell their patients about vaccination, given that so many of these patients are immunocompromised and that they have not been included in vaccine trials.
“I think we should recommend that they get vaccinated,” Fauci said. “If you are on an immunosuppressant agent, history tells us you won’t have as robust a response as if you had an intact immune system that was not being compromised. But some degree of immunity is better than no degree of immunity. This is one of the reasons why we argue for healthy people to get vaccinated, to create that umbrella of herd immunity to protect those whose immune system itself won’t be able to respond as well.”
Lessons learned
Given that Fauci has served as director of the National Institute of Allergy and Infectious Diseases for 36 years, Lee asked him how this pandemic compares with other global health threats he has observed during his career.
“It is in some respects similar, in the sense of it being an unexpected outbreak of a brand new infection that had a commonality of jumping species as a zoonotic, from an animal to a human. I think that’s where the similarity ends,” Fauci said. “In so many ways, this is unprecedented historically in the impact that it’s had on the entire world.”
Fauci described SARS-CoV-2 as “exploding upon the globe,” after first being identified as a syndrome last December in China, to the first case being diagnosed in the U.S. in January.
“Literally within less than a year, we’ve had more devastation, morbidity and mortality associated with any infectious disease outbreak than we’ve had in 102 years,” he said. “That’s totally unique.”
Given the relative novelty of the virus, there is still much to be learned about it, including how long immunity lasts after clinical infection, Fauci said. He added that conjectures can be made about immunity from knowledge of prior coronaviruses.
“We know, from our decades of history with the four human coronaviruses responsible for about 15% to 30% of all the common colds that we get recurrently ever year, that the duration of immunity is measured not in decades, and certainly not a lifetime the way measles is, but it is measured more in months to years,” he said. “Does that mean that when you get infected with SARS-CoV-2, the immunity is going to be that short-lived? Most of the other coronaviruses that cause the common cold never leave the upper respiratory tract, so you aren’t getting systemic immunity. Whereas, individuals who are sick enough [with COVID-19] to be in bed for weeks or be hospitalized likely will have immunity that will last a little bit more, if not a lot more, than just months to a year. But the proof of the pudding will be experience, what happens 6 months to a year from now. We’re going to find out.”
As more patients recover, Fauci said a distinction must be made between those who are so-called “long-haulers” and those who have long-term organ damage from severe disease.
Long-haulers might be individuals who are infected and symptomatic, taking weeks to recover, but never require hospitalization, Fauci said.
“That group has a persistence of symptoms and signs that are characterized by profound weakness, shortness of breath, sleep disturbance, inability to concentrate or ‘brain fog,’ but when you look at objective laboratory data, you don’t find anything,” he said. “It has something about it resembling, but different from, myalgic encephalomyelitis/chronic fatigue syndrome.”
Fauci said this group needs to be distinguished from patients who might have acute respiratory distress syndrome, microthrombi in organs or lung infiltrates that heal with scarring, who ultimately improve virologically.
“If you look at them, they have decreased diffusion capacity, stroke volumes in their heart, predisposition to arrhythmias,” he said. “That’s not ‘post-COVID syndrome.’ That’s the residue of damage to organ systems. I think as we study this more, we’re going to see these are two different components. The only way to know it is ... by looking at large cohort studies to see the nature of this symptomatology and if it is associated with some identifiable markers.”
Lee also asked Fauci what can be done now so the world is better prepared for the next coronavirus outbreak.
“We absolutely have to start thinking about what components of the coronaviruses in general are constant and yet can be used as an immunogen for a [universal coronavirus vaccine],” Fauci said. “Not to mention, all aspects of the public health system need strengthening. We’ve been negligent in our public health systems. They used to be strong, and we need to get that back.”
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Fireside chat with Dr. Anthony Fauci. Presented at: ASH Annual Meeting and Exposition (virtual meeting); Dec. 5-8, 2020.
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