It’s been a bleak December, and January seems to be just as bleak as the coronavirus continues to devastate California and the country.
In a conversation broadcast online on Wednesday, Dr. Anthony Fauci, the US government’s leading infectious disease specialist, spoke with Governor Gavin Newsom about why the pandemic has been so difficult to control in California and across USA
But he also offered some hope for the future, outlining his most recent estimate of when things can return to an appearance of normalcy and whether schools can reopen safely.
Here are some of Fauci’s ideas about what 2021 might look like:
Fauci said the coronavirus acts very differently from influenza when it comes to children.
With coronavirus, children appear to have lower levels of infection than the wider community.
“It was almost counterintuitive, but it ended up being that way,” said Fauci.
“What we must do is do everything to support the maintenance of children at school. … If you really want society to return to some form of normalcy, one of the first things we have to do is bring the children back to school. “
Vaccines for a wider audience to be distributed in late spring, early summer
Initial distribution of the vaccine to the top priority group, including healthcare professionals and people in nursing homes, was slower than initially promised. But Fauci said there was a feeling that by January there would be more momentum and that the rate of inoculations would be accelerated.
Before the general public receives the vaccine, however, there are other priority groups that are close in line. It will probably be in late March or early April before the vaccine is available to everyone.
At that point, the race will begin to vaccinate as many people as possible during the spring and summer, with the goal that everyone will be vaccinated when the coldest weather comes, next fall.
‘Strong appearance of normality’ in early autumn – if enough people are vaccinated
If the United States is diligent in vaccinating many people between April and July, “I believe … when we get to the beginning of autumn, we will have herd immunity good enough that we can really go back to some strong appearance of normality – schools, theaters, sporting events, restaurants. I believe that if we do it correctly, we will be there in the beginning of autumn, ”said Fauci.
No one is sure what percentage of the population needs to be immunized to stop the spread of the virus, said Fauci. He guessed it would be somewhere between 70% and 85%.
“If you have the opportunity to be vaccinated, please be vaccinated,” said Fauci. “It is a safe and highly effective vaccine that can save your life, the lives of your family and the community.
“So I believe that with these two things – adherence to the kind of things you’ve been talking about in California, public health measures and, as we gradually vaccinate more and more people, let’s look at that thing in the rear view mirror,” he said. Fauci to Newsom.
Failure to contain the coronavirus would be disastrous for the economy
Some people consider the trade restrictions implemented to control the pandemic to be too high a price to pay. But Fauci said the pandemic needs to be controlled to allow the economy to return to normal.
“We need to use public health measures – like a vehicle, a gateway, a tool – to recover the economy. It is not economics versus public health. It is public health linking you to recover the economy, ”said Fauci.
The economy will reopen “when you lower the level of infection,” said Fauci. “And the only way to lower the level of infection before the vaccine kicks in is through the public health measures you’re talking about.”
Fauci also looked at the challenges of 2020. Here are some key points:
The asymptomatic spread of the virus makes this pandemic much more difficult to control
The initial information from China at the end of 2019 about the coronavirus was misleading, Fauci said.
Initially, it was rumored that the virus did not transmit efficiently between humans, which ended up going wrong. So it was rumored that it was being broadcast mainly by visibly sick people.
The worrying reality was that even people with no visible symptoms were transmitting the virus.
“This, for me, is something that changed the game,” said Fauci. “Because you can’t just test people with symptoms, because you’re going to miss asymptomatic people.”
Second, it means that wearing a mask has become very important. “If you don’t know who is infected, everyone should wear a mask, which is the real fundamental reason for saying that we need universal and uniform use of masks,” said Fauci.
A wide range of results – from no symptoms to death – made it very easy to rule out the virus
Fauci said he has never seen a virus like this, in which 40% of those infected have no symptoms, while 20% to 25% have symptoms so severe that they may need hospitalization or die.
“The mystery of how you can have so many people who have no symptoms and so many people who are severely affected is one of the reasons why we have difficulty sending messages,” said Fauci. “Because most people who do well are young, and they say, ‘What do I have to worry about?’ … So they say to themselves, ‘Why do I need to interrupt my life?’ “
But that sentiment had serious consequences and was a factor in the worst death toll of any nation in the world – more than 335,000 deaths. And public health activities, such as wearing masks, have become politicized.
In Los Angeles County, the cumulative number of COVID-19 deaths of more than 10,000 is now triple the number of cumulative deaths from influenza in the last flu season, which was 3,133.
This has been the most politicized public health crisis in modern US history
The best public health messages are consistent and simple. But the coronavirus pandemic has become so police that it is very difficult to have a consistent public health message, said Fauci.
It was even worse than efforts to raise awareness about HIV and AIDS, public health crises that political leaders did not pay enough attention to in their early years. “It was nothing like the division we’re seeing now, which really makes implementing public health measures and public health messages very difficult,” said Fauci.
The US should have done much better in controlling the pandemic
Asked by Newsom if he expected the United States to be dealing with a national death toll in excess of 335,000, Fauci admitted that he thought the United States would be in a much better place now.
Even when New York was being hit hard in the late winter and early spring of 2020, Fauci hoped the country would lower coronavirus levels and that public health officials would find out how to contain the outbreaks.
But the United States never reached a low baseline, said Fauci. Many states abandoned home stay requests too early, so when the cooler weather came with autumn, “we just fell off the roof,” said Fauci.
“What surprised and really disappointed me was that I thought that if we reached a very, very low baseline, as we had these little individual points, we could do identification, isolation and contact tracking in good shape,” said Fauci.
“The only problem is that when you have … 100,000 community cases on any given day, it becomes almost impossible to do effective identification, isolation and contact tracking,” he said. “So we were hit hard and, unfortunately, California is being hit now as much as anyone, if not worse.”
We should do even more tests
As we look to the future, Fauci said that we should seek to flood schools and bring together residential environments with tests, particularly with so-called antigen tests, which are easier to process and can be widely used in environments such as schools.
“If we use this test a lot, a lot – in schools for teachers, and even ultimately, for students, intermittently – you can get a good sense of what infection penetration is and you can do something about it,” said Fauci.
“We should put a lot more emphasis on community-type surveillance tests, so that you have an idea of where you are – where you are, with schools, prisons, nursing homes. This is the way to go, ”said Fauci. As the virus is usually transmitted by people without signs of illness, “you will not catch them just by testing people with symptoms.”
Colleges that have implemented this type of routine testing have found this approach successful in maintaining a low level of virus transmission, he said. That’s because this approach early identifies people with a positive virus and puts them in isolation until they recover, instead of allowing the virus to spread so far that authorities are forced to close the campus.