Rolling Stone contributing editor Jeff Goodell spoke with Dr. Anthony Fauci via Zoom this week ahead of Election Day to discuss the ongoing coronavirus pandemic caused by SARS CoV-2 and the disease Covid-19. The director of the National Institute of Allergy and Infectious Diseases has been sidelined by President Trump, despite the fact that the country continues to see surges in rates of new infections and deaths attributed to Covid-19, and he and Goodell spoke about the parallels between the HIV/AIDS crisis and the current pandemic, and the promise of a vaccine.
Watch the video above and read an edited transcript of their conversation below.
Jeff Goodell: I want to get your reaction to what President Trump’s chief of staff, Mark Meadows, said the other day about, you know, we’re not going to be able to kind of contain this virus. It sounded like a kind of surrender to the virus to a lot of people. What was your reaction to those remarks?
Dr. Anthony Fauci: I don’t necessarily think that Mark Meadows was surrendering to it. I think he was probably expressing some frustration that, when you look at the number of daily cases now, it’s really quite concerning. There’s, you know, 80,000 with a weekly average of around 70,000. And the thing that is disconcerting is that when you look at the heat map of the country with the states that light up red, when you have an increase in test positivity, you have more than 30 states that are going in the wrong direction. And I believe, quite frankly, that if, as a country, we uniformly follow some fundamental public-health tenets, we will be able to curb the increase and prevent further increases. And I’m talking about simple things: universal masking, which we don’t do in this country. It’s very frustrating when you look and you see on television different places, people not doing that — in the middle of what’s going on right now. It just is such a common-sense thing to do that: keeping physical distance, avoiding crowds in congregate settings, doing things indoor much more preferentially than outdoor — to the extent that we can — as the weather gets cooler, and frequent washing of hands.
We feel — I do strongly — that you can have an impact if you do that. What we have not done very well is that we’ve been rather inconsistent in region to region, state to state, and city to city about adhering to that. The other thing that’s frustrating — because I’m talking about what might be frustration on the part of Mark Meadows as well as myself — is that when we try to do these things, that there is this perception that you want to lock down and everybody has “lockdown-itis,” in the sense that they say, “My goodness, we have Covid fatigue and it will destroy the economy.” I’m not talking about “locking down.” I’m talking about some fundamental basic principles of public health that I just mentioned. So we need people to get away from the “all-or-none” phenomenon. Either you lock down — which we don’t want to do — or you just don’t do anything to precaution. You go out, you go in crowds. You don’t wear masks. That’s one of the reasons why we’re seeing these uptick in cases. And we’d better be careful because we’re entering the cool months of the mid fall, and soon the cold months of the winter. And we could be in a very precarious situation if we don’t do something about it, short of shutting down.
Last summer, you said what seemed kind of an apocalyptic possibility: that we could see 100,000 cases a day. And we’re near that now, and we’re heading in that direction. And there is a University of Washington study that came out the other day that said that we could have more than a half-million deaths by the end of February. Is that the kind of trajectory you’re on? Is that plausible? Is that where we’re going?
Yeah. You know, unfortunately, again, as I said, unless we as a society do something about it and not just throw up our hands and say, “It’s futile; we can’t do anything about it.” We’ve got to work together as a country. We’ve all got to be on the same page; we’ve got to pull together to do something about this, because you’re quite correct. It is feasible, if not likely, that we’ll see those kinds of disturbing numbers if we don’t turn this around and do something about it.
The good news in this is that we’re in, you know — if there’s one bright light in what’s going on — it’s the issue of vaccines, because the vaccine development process is right on target, going along really quite well. And as I’ve said multiple times in the past, and I think it’s going to turn out to be correct, that by the time we get to the middle of November, the beginning of December, we will have one or maybe two vaccines that have been shown to be safe and effective. I’m cautiously optimistic about that — even though there’s never a guarantee when you’re dealing with vaccines from the preliminary data that we have from animal studies, as well as from the Phase One study in which robust antibody levels were induced. … We could start vaccinating people by the end of this year or the beginning of 2021 and then gradually over a period of months. Given the prioritization, you can get a substantial proportion of the population if they want to get vaccinated, because that’s another challenge. We have the reluctance of people to get vaccinated. So there are many things that we can do. I get, you know, somewhat dismayed when people throw up their hands and feel, “Well, there’s nothing we can do, we might as well just go ahead and enjoy what we’re doing. … That’s not the case. There’s a lot that we can do.
One of the obvious things that you’ve talked about a lot, and you mentioned earlier, is cloth masks. And you’ve talked about the possibility of a national mask “mandate.” But, you know, there’s still a lot of pushback on the efficacy of masks. I mean, Senator Rand Paul just [the other day] was talking about citing some study from Vietnam or something that said that 97 percent of particles get through masks. And there’s still a lot of people who — nine months into this pandemic, 227,000 deaths later — still do not believe that masks are effective. What do you make of that?
I mean, that’s, you know — I don’t know. It’s so frustrating when we hear that. They are not perfect. Some of the studies to show their efficacy are compounded by the fact that other things were done simultaneously with masks. But the one thing that we do know for sure — and there are, by the way, good studies indicating that masks work — you don’t want the perfect to be the enemy of the good. They’re not 100 percent protective. People have worn masks and gotten infected, usually in places like restaurants or even on planes, where they put the mask down to drink or to eat. I mean, if you had the mask on all the time, that would be different. You know, sometimes it’s not feasible to do that. But if you look at the situations where masks were done together with other interventions, there’s no doubt that it makes a difference. So, we shouldn’t be arguing about that, even though they’re not 100 percent protective. It’s clear that they are.
As we’ve talked about, we’re at a kind of dark moment here going into the winter with these rising cases. And I know you don’t really want to talk about politics, but it is an election year and we have a really big election. And this is an important moment. I want to ask you directly: How responsible do you feel President Trump is for where we are today with this pandemic?
Yeah, I mean, I’m not going to comment on that because that is bringing me into politics. You know, I can tell you that we could have done better. I mean, I would really have liked to have seen — particularly as we were trying to “open up the economy” — we put together some well-thought-out guidelines; the task force did, myself, and Dr. Birx, and others. … Things got out of hand for us when there was a great deal of disparity in how different states did that. Some immediately jumped over the gateway points and went right into a phase where they should not have been. They should have gradually eased into it. Other states decided to do it correctly, but for reasons related to the fundamental character of independence and not being told what to do on the part of the American public, people ignored the guidelines and you saw pictures of people crowded in bars drinking with no masks on. I mean, that’s asking for trouble. If we had done things in a more uniform, consistent way … I always say that I’m such a great fan, I love how our country was formed and all the things that the Founding Fathers put together. One of them being the Federalist approach. We have states rights and states can do what they want to do. That works beautifully under certain circumstances. But when you have a global pandemic that is involving the entire country, maybe that’s the time to say we better do some things uniformly and centrally rather than letting everybody do what they want to do. And I think that’s been one of the real weak links in how we made the response in our country.
When you look back on these nine months from January — when you first got an indication of what was happening until where we are today — do you think about things that you would have done differently? Are there mistakes that you personally feel like you made in thinking about this and in advising the president and in your response to this?
You know, for me to say that I could not have done anything better would really be, I think, ridiculous because everybody could have done things better. And I think you have to have enough humility and modesty to realize that you could have done things better. The only thing that I think people should try and understand when you make a decision at Time A, it’s based on the information you have at Time A, and then you find out that, when you go to Time B, the data are different. And if you had known that, you wouldn’t have done that at Time A. Does that mean that Time A was a mistake? Well, I guess, technically speaking, it was. But in the context of what you knew at the time, you acted, I think, appropriately. So, I think we could have done things a little better. I mean, for example, in the very beginning, we could have said, you know, the chances are that this is going to be a virus that’s spreading very, very rapidly. Even though we have no cases or one case in the country. Should we have really clamped down then as opposed to wait until there was more penetrance of community spread? Retrospectively, that probably would have been the better thing to do. But would the country have accepted shutting down with one case in the country? I don’t think so. Maybe we should have been a little bit more forceful in saying, knowing what we know about the spread of viral diseases with the degree of efficiency that this has in spreading from human to human. We’d better anticipate this is going to happen. So I said we shouldn’t change anything right now, but we should be prepared for the worst because this could change rapidly. Perhaps I could have said, “You know what? It is going to change for the worse. Let’s do it right now.” But I’m not so sure how effective that would have been. Bottom line is, of course, we could have done things better.
You have legendary experiences in your work in public health and dealing with pandemics. When I started out as a journalist, the first things I covered was the AIDS epidemic in Manhattan. I knew Larry Kramer, the AIDS activist, very well, and you, I know, kind of locked horns with him. When President Trump recently called you a “complete idiot,” or people like you complete idiots, it reminded me that Kramer also called you an idiot and a murderer. Right?
And then we became really good friends. And he was one of my really good, dear friends. Yeah, I mourn very much the loss of Larry. But in the beginning, he wanted to attract my attention, and he did. And he did it by being very public. It was a different situation than what we’re having right now. Larry, you know, I represented the federal government [to him], and I did because I was one of the few people that was out there pushing for things to do about this. But to him, I became the face of the federal government and he wanted to get my attention about things that we were not doing correctly or appropriately in the context of what the gay community needed at the time. And he was right. And he got my attention by calling me an incompetent idiot and a murderer.
Maybe President Trump just wants your attention.
I don’t think that’s the case.
Maybe you guys will end up as friends like you and Larry?
How is the experience with a coronavirus and Covid-19 different than your experience with the AIDS crisis?
It has some similarities in that it’s a new, emerging infection, but the differences are really stark and very, very, very clear. You know, HIV/AIDS was one that very selectively in our own country attacked a certain demographic group that suffered immeasurably from it. And it took a long time to get full consciousness of it, of the seriousness of it. It was gradual, insidious, under the radar — because of the silent spread of it — since it didn’t threaten everyone in society, society at first didn’t take it very seriously. And it spread and spread. So right now, if you look at the 40-year impact, 39-and-a-half-year impact of HIV AIDS, you get close to 80 million infections. Over 35 million deaths in the United States alone. … So in magnitude, in many respects, it dwarfs what we’re seeing now. But it was extended over a long period of time.
The reason this is different, and why it’s gripping everyone, is that it’s concentrated within months and it appears that everybody is at risk as opposed to only some people being at risk. So the degree of anxiety of society as a whole is much, much different. And it’s sort of interesting and somewhat paradoxical that — something that had so much suffering and death — it took such a long time for people to realize how serious it is. Right now, this exploded on us in a matter of months. Very different. You know, you were there back in the day.
One of the things that one of the tragic aspects of Covid-19 is the racial division in. The rate of death in this disease. I mean, black Americans are basically dying at twice the rate of white Americans. Is that something that you ever discuss that directly with the president?
No, I haven’t. But he has to know how I feel about it because I’m very vocal about it. It is extremely distressing to me. Every time I get a chance publicly to talk about it, I do. Just like now. You’re right. The deaths doubled. But the hospitalization is like of four or five times greater of hospitalizations among African Americans and Latinx. It really sheds a very bright light on the health disparities and the social determinants of health. Because African Americans and Latinx have what I call a double whammy against them, one by the nature of the jobs that they generally have outside frontline people interacting in society. They’re exposed more than you and I are talking to each other over a computer. So, they have a high incidence of infection in the first place. Once they are infected, they have a higher incidence of the co-morbidities, which would predispose them to a serious, if not fatal, outcome. So, they are suffering immeasurably. Yet again, another example of how racial and ethnic disparities in our society.
What we notice then, when we get them thrown in our face like now — and even with HIV, you know, 13 percent of the population of the United States is African-American. Forty-five percent of all of the new cases of HIV are among African-Americans. So the disparity is rather profound. And maybe if there’s anything that comes out of this terrible ordeal is a realization and a commitment that we’ve got to make a decades-long commitment to changing and essentially countering those social determinants of health that allow African-Americans to have a higher incidence of diabetes, obesity, hypertension, kidney disease. That’s not racial. That’s the social determinants of health.
In a talk at Yale, you mentioned that a really important thing for scientists to communicate is what they don’t know. That’s a really interesting idea. And when you when you think about where we are with the pandemic right now and the risks that we face and where this trajectory is going what, to your mind, is the most important thing you still don’t know?
Yeah, well, there are a few things that I don’t know. I don’t know where this is going to go. If we don’t do something about it. I mean, what kind of ultimate devastation it might have. The other thing we don’t know, and this is troublesome to me, is what we’re learning a fair amount about — but we don’t totally grasp — is what the longterm effects on people who recover from clinical disease. I think if you get a symptomatic disease, no problem. But people who are either in the hospital or even at home and wind up being in bed for two or three weeks, can’t get up, and then they go out. They take a long time to recover. But what effect is it going to have one, two, three years from now? We’re going to see an increased incidence of other diseases: heart diseases, strokes, Parkinsonism? There are a lot of things that I’m concerned about that this isn’t just it kills you or you’re OK. It may be that there’s a group of people — maybe a lot in there — who are going to wind up seeing effects later on. So we don’t know that yet. We need to study it, but we need to keep an open mind that could make matters much worse.
You talked earlier in this conversation about vaccines and what you see coming down the pike. But by the end of the year, I want to talk a little bit more about that, because I think there’s a lot of sort of magical thinking around vaccines, this notion that we’re going to develop a vaccine and suddenly this will be over and we’ll go back to our regular lives and everything will be fine. I mean, there’s still a lot of unknowns. Even when we have a vaccine developed. We have questions about the efficacy of it. We have questions about distribution of it. Who gets it first? We have questions about how long an immunity it will. How effective it will be for how long. Talk about some of the uncertainties that you’re concerned about in the near term with this.
Well, you mentioned several of them, but let me amplify them a bit, Jeff. First of all, if you had a 98 percent effective vaccine and you vaccinated 98 percent of the people, that would be it. We wouldn’t have to worry about it. But that’s not going to happen on either ends of that spectrum. So we’re going to have to realize that vaccines will be an important tool. But we’re not going to be able for quite a while to abandon fundamental public health staple measures. That’s what I think people need to understand. We talk a lot about vaccines but, first of all, we have to have make sure how effective the vaccine is. I would accept the 70/75 percent-effective vaccine. I’d love a 98 percent-effective, like measles. And that’s the reason why you could almost eliminate measles from society — as long as you vaccinate everybody. I’d love to be able to do that with Covid-19, but you have to get most everybody vaccinated and there’s a lot of anti-vaccine feeling in here, and that’s the first thing. The second thing, that’s an unknown. Getting back to what you’re pointing out, we’ve got to not be afraid to say we don’t know. We don’t know what the durability of protection is. We don’t know whether it’s going to last months, a year, or more.
It’s a little bit sobering that the common cold coronaviruses that you and I get exposed to repetitively each year and get a common cold — usually a bit of a sniffles and a sinusitis or something like that — the immunity to that is not durable. So that’s why people keep getting infected with the same coronaviruses, which account for about 15 to 30 percent of all the common colds that we get each year. So that’s another uncertainty. How long it’s going to last, whether or not we’re going to have to boost people at certain times. You’re right. There are several things we do not know. What we do know is that, even if we get a vaccine and deploy it and get most of the people vaccinated — which I hope that’s the case — we still, as we get into the middle and the end of 2021, we’ll have to practice some measure of public health practices. Otherwise, we’re going to wind up continuing to get people infected.
You are co-author of a paper this summer that talked about entering a new age of pandemics because of climate change, because of the way we travel our modern lives, environmental changes that we’re entering, a new era of pandemics. Is the coronavirus what we’re seeing today, the shape of things to come?
You know, I believe it is, Jeff, and that’s the reason why we really need to be prepared — both from a public health standpoint as well as from a scientific standpoint — the way we are now interacting on our planet with the environment, with the animal-human interface, with encroachment upon that interface, with climate issues clearly changing, for sure, and have a great effect on vector-borne diseases, on diseases that relate to animals, that relate to the host and the environment. We’ve just got to be prepared that this is something that of our own doing in many respects. Some of it we can reverse, some of it we can’t. But what I wrote in that paper with my colleague, David Morens, is that we’ve got to make sure that we are aware that this will happen and our preparedness has to be commensurate with that risk.
We’re all a few days away from having to make a big vote. Can you articulate what’s at stake in this election? From your point of view, from the point of view of this disease and this pandemic?
You know, Jeff, I don’t want to do that because it will it will be making judgments that are political things. I really, I would like you to help me to stay out of that because I want to be able to continue to do my job.