Yes. Auci obviously each individual family has to make, as i have said over the past few days, a riskbenefit assessment about the risk you are real you are willing to take in traveling and congregating in the usual warm 10, 15, 20 people at a home dinner. Although those are wonderful parts of our tradition, i would like to have each family make that Risk Assessment and know and understand we are in a very difficult situation where the rate of infection, the slope of infections are very, very steep. You might want to reconsider travel plans and certainly try as best as you can to keep congregant meetings indoors, as innocent and wonderful as they sound, to a minimal number of people, preferably just members of a household. I know this is a difficult thing to do, but we are in a very difficult situation. Better be careful now and look forward to many more in the future then endangering yourself or a vulnerable member of your family or friends, or what have you to the situation we are in right now, which is unprecedented but it will end. Is a very fixed. Of time. Eriod of time,d p a very precious time, but please dont do something that would put you and your family together such as getting a group of people coming together in airports or what have you. Dr. Fauci, millions of americans however might not heed your advice. They might still travel. If an american is traveling this week, what should they do to prevent the spread of the virus. Simpleci its the things we keep talking about over and over again that are not very difficult to implement and just varies a little in the circumstance you are in. Uniform wearing of masks, particularly when you are indoors. Avoiding congregant settings, congregant situations, crowds where you are in a situation where you cannot avoid, it is very difficult, if you are in that situation, always wear, particularly indoors. Outdoors preferentially over indoors. , know this can be difficult and washing your hands frequently. Mask, space, crowds, outdoors, wash your hands. If you did those simple things, you would diminish considerably the likelihood that you would get infected and we know that is a Public Health fact because we have seen situations where one state versus another, one city versus another in comparable circumstances has either implemented these mitigations mitigation procedures or have not. And the differences in infection rate are considerable. So we know it works. We are asking people over this thanksgiving holiday and beyond because, as we get into the Colder Weather of the winter, to do those simple mitigation actions. Robert those mitigation actions certainly apply to things like a train station or an airport. But if you are with a small group, a few family members inside a home or apartment, should you be social distancing inside the home and should you be wearing a mask inside the home . Youfauci the answer is have got to use some common sense in the situation you are in. I think when most people are asking, you are in the home, the safest thing you can do is to confine the activities in your own home with the immediate occupants of that home. Where have a situation you have to, given the social situation, bring in people who, in fact, are not members of the immediate household, try to ascertain whether or not they have been practicing the same sort of safe procedures that you have they created their own bubble, have they avoided the types of contact that put them at risk . If they are in your home, you should wear a mask indoors as much as you possibly can. Sense, youremon sitting at a table over the next couple of days, dealing with the thanksgiving holiday, you cannot have a mask on while you are eating and drinking. But in other areas, at other times, when you are in the house, if you have people in your home that are not members of the immediate household and you are not really sure as to their level of exposure, then to the extent possible, you should wear the mask indoors with the obvious exception of when you are eating or drinking. People need to remember the kinds of infection bomb we are seeing now are infections in the exact setting you are talking about a dinner, a social gathering, five, 10, 15 people seemingly innocently getting together and enjoying themselves. But what we are seeing, given the fact people who are asymptomatic, namely without symptoms, who can come into that sort of setting and inadvertently and innocently infecting people because you are indoors, you are not wearing a mask, you dont have the kind of ventilation and moving of air you have on the outside, and we are seeing, and reality, not hypothetically, but in reality, we are starting to see a considerable number of instances of cases where you have that same sort of innocent family and friends gathering indoors that are turning into places where viruses spread. To the extent possible, as difficult as it is from a social standpoint to avoid that, please try to avoid that and constrain the kinds of things you do to the immediate family and people you are sure they are being careful. Are there ways to be vigilant even in small settings . You have said people can be a symptom addict, but are there any telltale signs or minor symptoms people should be on the lookout for this week . Dr. Fauci yes. Obviously, the early symptoms of covid19 disease are very similar to a flulike syndrome. You may or may not have fever and i dont think you need to rely on fever, that if you dont have a fever, you are ok. Plenty of people very early dont have fever. But Something Like a sore throat, a scratchy feeling, may be some fullness in your upper airway, muscle aches, a feeling of fatigue. Many people now have this curious loss of smell and taste. If any of those symptoms appear, people should be careful and either stay home, try to get tested if you possibly can, to know whether you are infected and if you are, you should isolate yourself. Difficulty,nto some you should notify your physician. If someone comes in and says i feel bushed today, im tired, ive got a scratchy feeling in my throat, i feel a little achy, that is a telltale sign. Robert heres a question from one of our audience members. She wonders can someone who has tested positive and recovered two months ago spread the virus to others if they are exposed to it again . That is a mixed question. If you were infected once and you have tested positive and a couple of months later, there have been instances, unusual, of reinfection. Out,f you are two months even some of the really sensitive tests indicated the degree of positivity, if you are that far out, it is extraordinarily unlikely that you would. Have are fragments of the virus that are not infectious, that the very sensitive tests can pick up. The general rule is if you are 10 days from the onset of symptoms, you are in good say it you are in good shape. You want to get tested and if you have availability of testing, the original recommendation was to tests, 24 hours apart. But we are finding people from 10 days from the onset of symptoms if your symptoms persist, it is conceivable you might still be. You dont want to be out there if you are symptomatic. That is when you should stay at home. Question abouter thanksgiving. With so Many Americans choosing to travel, we have seen over 250 thousand americans already die from this pandemic. How could this escalation and travel for thanksgiving effects the number of cases and the death toll moving forward . Thats a very important question and thats one of the things we are really concerned about. Curves, we at the are in a very steep escalation of cases right now in the mid fall season. If you look at the slope of the increases in the early spring that we had the northeastern part of the country, dominated by the new york city metropolitan area, then we had the early summer, mid summer when we were trying to open up the country in the south dominated it. Now what we are seeing, almost the entire map of the country is lighting up with the dark colors which indicate increased test positivity and the slope is like that which means if in fact you are in a situation where you do the things that are increasing the risk, the travel, the congregants setting, not wearing masks, the chances are you will ae a surge superimposed upon surge and you are not going to see the results of that because things lag by a couple of weeks. Iswhat we are seeing now what happened two plus weeks ago. What we are doing now is going to be reflected to, three weeks from now. What we want to make sure we dont do is as we enter into the more risky part of the year, the weather gets colder, more people stay indoors, that you dont exacerbate the problem that already exists. Is reason i think it important, doubly sure of that, is help is on the way. We have at least two highly efficacious vaccines that will likely start to be given to people at the highest risk and highest priority toward the middle and end of december. The subsequent months, more and more people will be able to be vaccinated. Goode this not only as news in and of itself because of the benefit of adding the vaccine to your toolkit of prevention, but it should be, in my mind, an incentive for people despite the fact that we all have covid fatigue, an incentive to double down and be even more conscientious about the Public Health measures i have asked because if help is on the way, you want to hang in there, not get infected, not in fact your loved ones because there is help that is close by and it will be Getting Better and better as the months go by. That is the message. If you possibly can, please hang in there with Public Health measures. That is the carrot of the message, but what about the stick . You mentioned a surge upon a surge. Can you be blunt, dr. Fauci what does a surge upon a surge actually look like in the United States . Dr. Fauci if you look at the surge we are in right now, you newtalking about 200,000 cases a day. We have been over 100,000 a day for the last 20 days. High 1000,of between close to 2000 deaths, 80,000 plus hospitalizations. If you look at the number of cases that goes from 10 million to 11, two we are now at 12 million and you look at the number of deaths and you count the days between now and the end overe year, we are now at 250 thousand deaths a quarter of a million deaths. 300000ld get well over and close to more than that if we dont turn things around. In the same breath i say that, i want people to realize i dont want this to be a doomsday statement. Nots within our power to let those numbers happen. Just because you hear numbers from the models and you wanted concrete numbers, i gave them to dont havect is you to accept those numbers as being inevitable. I showed you the curve has that steepness you can do that to the curve. We know those things work when you compare those who have done it with those who have not. The numbers can be stark, they can be sobering and in many respects, they can be frightening. But we have the tools to prevent that from happening. It is literally within our power to do that. Dr. Fauci, what is herd immunity and when do you expect United States to get there . Fauci herd immunity sometimes the terminologies we use can confuse people. What herd immunity means is when you get a certain percentage of the population that is protected against infection either by natural infection and we are not even close to hugh to herd immunity now as proven by the fact that we have had spikes previousthat have had spikes. So the previous spike did not prevent them from the subsequent spike. Herd immunity is when you get a large proportion of the population that is protected. Which means those who are vulnerable or not, the vaccine doesnt work in them, they have a bigger susceptibility to getting adverse effects and deleterious consequences, the fact that you have so many people that are protected, the virus, if you want to use a metaphor, has no place to go. Its looking for Vulnerable People and most of the population is protected. That is how viruses die out. That is how we smashed measles. That is how we smashed polio. That is how we smashed smallpox. Why youthe reason havent efficacious vaccine, you want to get as many people protected so that its almost like if you have a herd of strong animals, you see it in the movies about going into africa and the beautiful scenery , you see herds of wildebeest or what have you, you have the herd that is really strong. You have some weak ones in their so when someone, may be the metaphorical lion is trying to get in there and take care of the weak ones, the strength of the herd protects the vulnerable ones. That is what you mean by herd immunity. So it is a question of two components an efficacious vaccine and getting as many people vaccinated as you can. Those two combinations together, those two ingredients could protect everyone, which gets to another important question that people keep asking weve got to make sure we engage the community to realize that the decision about the safety and efficacy of a vaccine and the speed with which we did it the speed was based on exquisite scientific advances and an enormous amount of resources that were put into operation warp speed to make this happen. There was no compromise of safety, nor was there compromise of scientific integrity. Now go ahead. Robert i didnt mean to interrupt. Sayfauci the decision to this vaccine is safe and effective, the data are analyzed by a completely independent andd, the date it dater data and safety monitoring board which doesnt have to answer to the administration or to the company. They are independent. They look at the data and said in both of those vaccines, both the moderna and the pfizer, that it is efficacious and it is safe and it protects you even against serious disease. Get wereid not when that decision is made, all the data is going to be seen by scientists like myself and my colleagues. Independentss is and transparent. I know there has been a lot of has been a lot of mixed messages that maybe have come out, but one needs to appreciate that this is a solid process. When they say the vaccine is safe and effective, if we want to protect the individual and all of our society, we should take the vaccine. I can tell you when my turn has come up and the fda says this is safe and effective, i will get vaccinated and recommend my family gets vaccinated. Robert you just outlined why you believe the process is independent and valid and should be trusted. Do you then approve of the efforts by states like new york and california to review the vaccines for safety and efficacy on their own . Are those efforts necessary . Dr. Fauci i can understand, though i dont agree with their doing that, because i think what they have referred, unfortunately what i referred to a moment ago as mixed messages from washington. I dont fault them for wondering whats going on, but i can tell them if they are listening, and i hope they are, the process really is sound. One of the difficulties about taking that approach is it may be sheds some doubt on the process i am extolling now as being a firm process. I understand why they may want to do it, because of the mixed messages, but hopefully i can appeal to them to say, yes, you can look at the data everybody should be looking at the data, nothing wrong with that but trust the process because it is sound. Robert beyond sending mixed messages, could reviews by states delay americans from having access to a vaccine . Dr. Fauci i hope not. Like i mentioned, i understand why the governors want to do that, even though i disagree with it. I would hope if they do that, they do it in an expeditious manner that does not delay anything. Robert you mentioned the two vaccines. What about the news of astrazeneca . What is your response to their report on monday about an effective vaccine . Dr. Fauci the data from what i have seen remember, this is press release. I am going to be briefed no later than tomorrow morning by the company. I was going to try to squeeze it in today, but today has been very busy. No later than tomorrow morning. When someone says that at least in one component of the trial, it was a little confusing about the doses. That might be too granular for our discussion today. But to have a 90 efficacy in one of the opponents, one dose range of the components, which was a half dose first followed by a full dose, thats good news. That tells us this is the third vaccine that has given a very high degree of efficacy, which bodes well for vax analogy vaccinology in general for covid19, but also something i spoke about in one of our previous interviews, that we would like to have multiple candidates that are highly efficacious so that companies can pump out vaccine doses not only for the United States but for the entire world. That would be a positive thing. Robert you have a good memory, thats exactly right. I would like to come back to the science of this virus. What are the longterm side effects . Are you learning anything new . Dr. Fauci when you are talking about longterm side effects, that will remain to be seen as we follow these individuals, because many of the protocols are twoyear protocols, and the fda and Companies Set processes where they can work can look longterm. Let me explain to the public listening. There is immediate, intermediate, and longterm adverse events. The immediate ones almost invariably our discomfort in the arm, swelling late, fever for 24 hours, and it is gone. Intermediate may be a few hours later where you get a reaction, the way it has happened with other vaccines years and years ago. We have not seen any of those serious adverse events we would be worried about. Longerrange about , when you look at the history of vaccines, more than 90 , closer to 95 , of the longerrange effects occur somewhere between 30 to 45 days, Something Like that, give or take a few days. Fdas the reason why the appropriately said, we dont want to think in terms of an emergency use authorization until we get 60 days beyond when 50 of the people in the trial have gotten their last dose. That may seem a little strange to people, but the fact is that is a very prudent way to rule out any overwhelming majority of any serious effects. They are still going to be looking a year or two later, but the bulk of things that might happen have already been looked at by that 60 day wait before to actually beua issued so people can get the vaccine. The fda, primary and the career scientists who have been doing this their entire career for vaccine after vaccine, know what they are doing. Thats why they made the safety clause in the eua. Robert can you walk through the accuracy of current tests . People are wondering this week went to do, which test to take. Dr. Fauci there are a number of tests, three general types. Tests for the virus itself, it is a pcr, a molecular test. Tests for a component of the virus, which is an antigen test. And tests for the antibody to see if you have been infected and exposed. If you want to find out if a person absolutely is infected or are for example if you doing identification, isolation, contact tracing, someone has symptoms and you want to know if they are infected, those are highly sensitive and highly specific. They are more expensive, they take a little longer to get the results. You would like to get it in one to two days. Many people have to wait multiple days to get it, even though we are doing much better now than months ago. Testther one is an antigen that is generally done for screening. It isnt as sensitive, but if you repeat it over and over again, it makes up for the lack of sensitivity. If you want to find out in general in a college, what is the level of infection of people, you would test them all and do surveillance testing. You dont want to know whether this or that person is infected, you just want to find out if there is infection in the group. The group could be a college, nursing home, school, factory, or what have you. Those are mostly surveillance tests. If somebody wants to know absolutely if they are infected, they should go with the more sensitive pcr test that may take a little longer. If you want to find out if a group is infected were not and do surveillance, thats when you do something less sensitive, but if you do it often enough, it makes up for it. Robert we only have a minute or so left. You mentioned the longterm effects possibly of a vaccine. What about of contracting the virus itself . Other brain issues, other Health Issues . Dr. Fauci there are two aspects of that, bob. Great question. For those people who really get seriously ill, in an icu ventilated, even if it is not covid19, anyone who goes through that is not going to feel normal for a considerable time. There is Something Else going on with covid19. Those are individuals who have not necessarily had advanced disease. They could have been in the hospital, could have been in bed for a few weeks, but they had symptomatic disease. We are finding that a certain percentage and we dont know what that is yet because we are doing a larger cohort study anywhere from 25 , 30 , we think , have whats called a postcovid syndrome. They no longer have virus in them, they cant infect anybody, but it takes them anywhere from weeks to months, it may, to feel perfectly normal, and they have a constellation of symptoms and signs that seem to be consistent when you talk to people. It is extreme fatigue, shortness of breath even among people who are athletes and well conditioned. They have trouble going up a flight of chairs stairs. They have temperature control problems, they feel chilly, they feel warm. They have sleep disturbances. Some describe what is called brain fog, which is not an appropriate term, but they mean they have difficulty focusing or concentrating. There are effects we are concerned about. We are also doing imaging studies to make sure there is not residual inflammation in the heart or Central Nervous system or things like that. We are learning that once you get rid of the virus in a certain proportion of people, they still cannot necessarily feel normal for a variable periods of time, and we are investigating that. Robert one more question. Have you spoken to president elect biden since election day . Dr. Fauci i have not. Dr. Fauci, i really appreciate you taking the time this afternoon to walk through where everything stands with the pandemic and offer insights for people as they head home, or perhaps take your advice and stay at their residence and dont go home for thanksgiving. Thanks again. Dr. Fauci i appreciate you having me on the show. Robert thank you all for joining me on Washington Post live. This interview is available at Washington Post live as well as linkedin and the streaming service viewit. Com. If you missed any of these interviews, whether it was president obama earlier today or dr. Fauci just now, go to washingtonpost. Com, also linkedin and viewit. Com. We are moving to those platforms and you can access Washington Post live there in the future. Next week we have a slate of guests, including paul romer and senator mark warner of virginia. For now, please enjoy the holiday this week and stay safe. With coronavirus cases increasing across the country, use our website, cspan. Org coronavirus, to follow trends, track the spread with interactive maps, and watch updates on demand anytime at cspan. Org coronavirus. Tonight, former president barack obama on his new memoir, a promised land, reflecting on his life and political career. He is interviewed by Michelle Norris and elizabeth alexander. Former president barack obama, tonight at 8 30 eastern on cspan two. Journal,s washington every day taking your calls live on the air on the news of the day, and we will discuss policy issues that impact you. Tuesday morning, billy sure of share our strengths discusses how the pandemic has exacerbated Food Insecurity in the United States. Then the heritage foundations dakota would talks about the 2021 index of the u. S. Military strength report. Watch washington journal live at 7 00 eastern tuesday morning. Join the discussion with your phone calls, facebook comments, text messages, and tweets. Now, remarks by former Homeland Security secretary jeh johnson on threats against america and what policies president elect biden might enact to address them. He was joined by sue gordon at this event held by the center for new american security. Its an hour. I am richard fontaine, ceo of the center for new american security. I would like to welcome everyone to the discussion on law enforcement, Homeland Security, and intelligence on the biden administration. This session pulls together several critical issues, all of