The Washington Post. This is a half an hour. Robert welcome to Washington Post live. Im robert costa. Today, on our path forward series, which focuses on the pandemic, im pleased to welcome back dr. Anthony fauci. Dr. Fauci, as you all know, is leading the nations fight against the coronavirus. He is director of the National Institute of allergies and infectious diseases. He has advised president s for decades, including President Trump, and he has been praised by president elect biden. Dr. Fauci, welcome back. Fauci. Dr. Fauci thank you, bob. Its good to be with you. Robert we had questions for our audience members. We will get to them in a moment. Its thanksgiving week. Any lastminute messages for americans who are still undecided on traveling . Dr. Fauci yes, bob, thank you. Obviously each individual family has to make, as i have said over the past few days, a riskbenefit assessment about the risk you are willing to take in traveling and in congregating in the usual warm atmosphere of 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 that we are in a very difficult situation where the rate of infection, the slope of infections, are really 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. So better be careful now and look forward to many more in the future then either 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. So this is a very fixed period of time, i know its a very time, the Holiday Season when we get together. But please dont do something that would put you and your family together such as getting a group of people coming from different places and or what have you. Robert dr. Fauci, millions of americans, however, might not heed your advice. They might still travel. So if an american is traveling this week, what should they do to prevent the spread of the virus . Dr. Fauci well, bob, its the simple things we keep talking about over and over again that are not very difficult to implement and just varies a little bit 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 a mask, particularly indoors. Do things outdoors preferentially over indoors. I know this can be difficult, given the constraints with the weather that we have. And washing your hands frequently. So masks, 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 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 . Dr. Fauci the answer is you 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. If you have a situation where 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 safe procedures as you have. 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. Obviously, common sense, youre sitting at a table, particularly 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. I think people need to remember that the kinds of infections 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 and inadvertently 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 that you have on the outside, and we are actually seeing, in 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 the virus is spread. So 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 that you are sure they are being careful. Robert dr. Fauci, are there ways to be vigilant even in small settings . You have said people can be a asymptomatic. 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. Because plenty of people in the very early dont have fever. But Something Like a sore throat, a scratchy feeling, maybe some fullness in your upper airway, some muscle aches, a feeling of fatigue. Then many people now have this curious loss of smell and taste. So 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 or not you are infected and if you are, you should isolate yourself. If you get into some difficulty, you should notify your physician. Stayhe best thing to do is home. 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 . Dr. Fauci 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. But if you are two months out, even though some of the really sensitive tests indicate a degree of positivity, if you are that far out, it is extraordinarily unlikely that very likelyctious, that you are not. What you have, periods of time, fragments of the virus that are not infectious that the very tests can pick up. So the general rule is if you are 10 days from the onset of symptoms, you are in good shape. To get tested, you can get tested. If you have availability of testing, the original recommendation was two 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. So you got to be careful. You dont want to be out there if you are symptomatic. That is when you should stay at home. Robert one other question about 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 affect the number of cases and the death toll moving forward . Dr. Fauci thats a very important question and thats one of the things we are really concerned about. If you look at the curves, we 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, and 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 see a surge superimposed upon a surge and you are not going to see the results of that because things lag by a couple of weeks. So what we are seeing now is what happened two plus weeks ago. What we are doing now is going to be reflected two, three weeks from now. So 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. The reason i think it is important, doubly sure of that, is that 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 the highest priority towards the middle and end of december. As we get into the subsequent months, more and more people will be able to be vaccinated. So i take this not only as good 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 infect your loved ones because there is help that is close by and it will be Getting Better and better as the months go by. So that is the message. If you possibly can, please hang in there with Public Health measures. Robert that is the carrot of the message, but what about the stick . You mentioned a surge upon a surge. Also have access to the modeling. Can you be blunt, dr. Fauci what does a surge upon a surge actually look like in the United States . Dr. Fauci well, bob, if you look at the surge we are in right now, you are talking about 200,000 new cases a day. We have been over 100,000 a day for the last 20 days. An average of between high 1000, close to 2000 deaths, 80,000 plus hospitalizations. If you look at the number of cases that goes from 10 million to 11, to now we are now at 12 million, and you look at the number of deaths and you count the days between now and the end of the year, we are now at over 250,000 deaths a quarter of a million deaths. You could get well over 300,000 and close to even 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. It is within our power to not let those numbers happen. So just because you hear numbers from the models and you wanted concrete numbers, i gave them to you, the fact is you dont have to accept those numbers as being inevitable. Are things you can do about it. I showed you the curve has that steepness you can do that to the curve. We know that those things work when you compare those who have done it with those who have not. So 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. Robert dr. Fauci, what is herd immunity and when do you expect the United States to get there . Dr. 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 herd immunity now as proven by the fact that we have had spikes in areas that had previous spikes. So the previous spike did not prevent them from the subsequent spike. So 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 of the infection, 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. So that is the reason why you have an 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 there, so when someone, maybe 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 the 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. Weve got to go ahead. Robert i didnt mean to interrupt. Dr. Fauci the decision to say this vaccine is safe and effective, the data are analyzed by a completely independent board, the data and safety monitoring board, which doesnt have to answer to the administration, doesnt have to company. The 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. Those data didnt get analyzed scientists in the f. D. A. In association with an again iscommittee that independent. When that decision is made, all of the data is going to be seen by scientists like myself and my colleagues. So the process is independent and its transparent. I know there has been a lot of mixed messages that maybe have come out but one needs to appreciate this is a solid process. So when they say the vaccine is effective, if we want to protect the individual, and we should society, 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 heard, unfortunately what i had referred to a moment ago as mixed messages from washington. So i dont fault them for wondering whats going on, but i can tell them if they are listening, and i hope they are, that the process really is a sound process. One of the difficulties about taking that approach is it maybe sheds some doubt on the process i am extolling now as being a firm process. So 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, theres nothing wrong with that but trust the process because it is sound. Robert beyond sending mixed messages, could those reviews by states also delay americans from having access to a vaccine . Dr. Fauci i hope not. Like i mentioned, i understand question,overnors in why they 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 on 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. The data, when someone says that in at least one component of the trial it was a little bit doses. Ng about the that. Get into it might be too granular for our discussion today. But to have a 90 efficacy in one of the components, namely one dose range of the components, which was a half dose first followed by a full dose, thats good news. What that tells us, this is the third vaccine that has given a very high degree of efficacy, which bodes well for vaccinology in general in the context of 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 these companies can start pumping 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, bob, that will remain to be seen as we follow these individuals, because many of the protocols are twoyear protocols, and the fda and the companies have processes where they can look longterm. Let me explain to the public listening. There is immediate, intermediate, and longterm adverse events. So the immediate ones almost invariably are discomfort in the arm, swelling, fever for 24 hours, and it is gone. Intermediate may be a few days later where you get a reaction, the way it has happened with other vaccines years and years ago. Associated with the pandemic flu vaccine. We have not seen any of those serious adverse events we would be worried about. When you talk about longerrange, if you look at the history of vaccines, more than 90 , closer to 95 , of the longerrange effects occur somewhere between 30 and 45 days, Something Like that, give or take a few days. Thats the reason why the fda appropriately said, we dont want to think in terms of an e. U. A. , emergency use authorization until we get 60 days beyond when 50 of the people in the trial have gotten their last dose. So 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 and two later, but the bulk of things that might happen have already been looked at by that 60day wait before you allow the eua to actually be issued so people will get the vaccine. Safety is primary and the fda, 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 what 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 not, for example if you are doing identification, isolation, contact tracing, someone has symptoms and you want to know if theyre infected and the people in contact with 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 unfortunately still have to wait multiple days to get it. Even though we are doing much better now than months ago. The other one is an antigen test 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. So 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 then you 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. So if somebody wants to know absolutely if they are infected, they should go with the more sensitive pcr test that may take a little bit longer. If you want to find out if a group is infected or not and do surveillance, thats when you do something thats 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 . Youve picked up . Dr. Fauci there are two aspects of that, bob. Great question. For those people who really get seriously ill, theyre in an icu vintilation. Even if it isnt covid19, anyone who goes through that is feel perfectly normal for a considerable period of time. There is Something Else going on with covid19. Anywhere from 25 to 30 have a postcovid syndrome. They know under have the virus in them and cannot affect anybody, but it takes them anywhere from weeks to months, and maybe beyond to feel perfectly normal. They have a constellation of symptoms and signs that seem to be consistent when you talk to different people. Its extreme fatigue, shortness of breath, even among athletes and were well conditioned, have trouble going up a flight of stairs. They have temperature control problems. They feel chilly, they feel warm. Some of them describe what is called brain fog. What they mean by that is that they have difficulty focusing or concentrating. Wereare these effects concerned about. Imaginging to be doing studies to make sure there is not residual inflammation in places like the heart or the Central Nervous system. Were learning that once you get rid of the virus, in a certain proportion of people, they cannot necessarily feel normal for variable periods of time. Were going to be investigating that. One more question. Have you spoken to president elect biden since election day . Dr. Fauci no, i have not. We really appreciate you taking the time this afternoon to walk through where everything stands with this pandemic and to at homesight for people as they take your advice and dont go home for thanksgiving. And iuci thank you appreciate you having the on the show. Host thank you for joining us here at Washington Post live. This interview is available a Washington Post live and on a streaming service, viewit. Com. If you missed any of the interviews whether it was president obama earlier today or dr. Fauci just now, you can go to our website and also linked in. We are moving across the platforms and you can access Washington Post live there and in the future. Fullweek, well have a slate of conversations, including paul romer and senator mark warner of tonight, the Senate Rules Committee hearing for this mess million museums, the American History of women museum. Senators spoke in favor of the proposal, highlighting the need for the experiences of american women and latinos to be included in American History. Watch that tonight at 8 00 p. M. Eastern here on cspan. Eastern, here on cspan. Corrects the u. S. Supreme Court Hears Oral Argument in trump v new york, monday at 10 a. M. Eastern on cspan. The court will hear whether President Trump has the authority to exclude undocumented individuals living in the u. S. From the census apportionment race. This into the oral argument live , on0 a. M. Eastern on monday cspan, on demand at cspan. Org or on the cspan radio app