Fauci Predicts Decline of COVID-19 Cases but Warns Against Complacency

In a wide-ranging interview with the editor-in-chief of JAMA Wednesday, Anthony Fauci, MD, said he thinks the country will soon start to see a plateauing and decline of illness and death from the coronavirus disease 2019 (COVID-19) and held out hope that serological testing could show which individuals have antibodies to the virus and can return to work or ease up on physical distancing.

However, Fauci, the director of the National Institute of Allergies and Infectious Diseases, said life will not go back to the way it was before.

“Don’t anybody ever shake hands again,” Fauci told Howard Bauchner, MD.

Fauci spoke a day after the FDA released an update on serological tests. The FDA said 70 developers have notified the agency that they have serological tests available for use; the agency is able to authorize such tests for COVID-19 under an Emergency Use Authorization (EUA). So far, the FDA has authorized 1 EUA for a serological test that is intended for use by clinical laboratories.

Such tests might allow people to get back to “critical infrastructure jobs,” Fauci said. The shutdowns triggered by physical distancing has put millions of people out of work.

Discussing a possible plateau in disease over the next week or two, Fauci said the real challenge will be for the public and locales to not become overly confident and allow rampant community transmission to take hold again, especially in metropolitan areas.

The swiftly spreading respiratory disease has led to more than 400,000 confirmed cases in the United States and over 13,000 deaths.

At the end of last week, the CDC recommended that individuals who do make necessary trips out of their home wear a nonmedical cloth mask to reduce asymptomatic spread of the virus.

Bauchner said he was “surprised” the CDC took a month or more to make that recommendation, but said he realized that healthcare workers themselves could not find necessary equipment.

The length of time for the CDC to make the call “was driven by exactly what you said,” Fauci said, including “healthcare workers who were putting their lives on the line every day, saying we don’t have enough PPE [personal protective equipment], including masks.”

Although homemade masks are not perfect, Fauci said, “If you do not know you are infected, wearing a mask will go a long way to prevent you from infecting someone else.”

At the beginning of the interview, Bauchner brought up President Donald Trump, who has spent many of his most recent daily news briefings touting the supposed benefits of 2 available but unproven drugs, hydroxychloroquine and chloroquine, which are used for malaria, lupus, and other rare conditions.

The administration has added the drugs to the national stockpile. Over the weekend, the coronavirus task force sent shipments of the drug to metropolitan hospitals hammered by the virus. But the divide between Trump and some medical experts like Fauci became apparent Sunday when the president cut him off at the microphone, not allowing him to answer a reporter’s question about the evidence of the medications for COVID-19.

“President Trump looks at science a bit differently than scientists do and medicine people do,” Bauchner said. “When he says things that are interesting to you, or you’re thinking, not consistent with how I think of science or medicine or clinical research, how do you process it, Tony?”

“As a scientist, it’s kind of tough when you hear things that don’t fit in with the scientific method,” the veteran infectious disease expert responded.

“But you know, in fairness to him, after its over, I get the opportunity to just go back and in a [nonconfrontational] way, discuss it with him.” The president does listen, Fauci said.

“He’s different than other presidents,” he said, adding quickly, “and other presidents are different than other presidents.”

After Fauci’s interview, Bauchner interviewed former Utah Governor Michael Leavitt, who served as HHS secretary from 2005 to 2009 under President George W. Bush. During that time, the country saw the spread of the H5N1 avian influenza strain, known to the public as “bird flu.” The foundation of the nation’s pandemic response was built during that era, Leavitt said, after it was clear the federal government was poorly prepared.

There’s been a lot of debate about what the federal government should be doing vs the states, and Bauchner asked Leavitt to evaluate the current federal response having served at both levels. In a pandemic, compared with a hurricane or a tornado, Leavitt said, “It became clear there is a role for everyone.”

Only the federal government can develop vaccines, manage the monetary system, and provide interstate coordination through the Federal Emergency Management Agency (FEMA), Leavitt said. Each state, he said, has to have some available resources, “and some boots on the ground.”

When asked about the role of the federal stockpile, which is managed by HHS, Leavitt said it’s unrealistic for states to think that all their needs can be met by this, because the 12 sites are designed to be short-term, regional resources. However, Leavitt said, “I’m not sure the federal government has done the best job of explaining that.”

“It’s not just a function of a lack of preparedness, but a lack of understanding,” the former governor said, adding that he was highly sympathetic to governors lacking resources.

The shortfall became visible when FEMA did not to act to coordinate the shipment of ventilators from the West Coast to New York City, where the need is most urgent. In recent days, the nation’s governors have organized these exchanges themselves.

Leavitt said the COVID-19 pandemic is revealing weaknesses in the nation’s public health infrastructure, including the lack of awareness among major healthcare players who their local public health leaders are. Ongoing work on healthcare transformation should have made public health and primary prevention a higher priority—to avoid the underlying conditions that are contributing to COVID-19 deaths—and Leavitt believes this will be a lasting lesson.

“In the course of time, we will have to learn what we did that was inadequate, and what we did that was adequate,” he said. “These things only happen every 30 to 40 years. Entire generations of leaders are not aware of what a powerful reshaper of the world these events are.”

The pandemic, Leavitt said, “will change the social makeup of not just the country but the world.”