Recently dr. Anthony fauci, a member of the White House Coronavirus task force, talk about the state of the pandemic in the u. S. At an event hosted by George Washington university. Hi, everybody and welcome to a very special edition of healthy you surviving a pandemic. Im frank sesno. I host the series which is a coproduction of the George Washington universities Milken Institute school of Public Health and the school of media and Public Affairs where i hang out. We are talking to amazing people on the front lines of this pandemic, getting there insight, knowledge and experience how we survive it. To date a very special opportunity to talk with dr. Anthony fauci, director of d. C. Hes been director since 1984 and does work with six president on some of the most difficult, Challenging Health crises to confront humanity, hiv aids, ebola, zika, larry, tuberculosis but probably nothing as dangerous, disruptive and as it turns out divisive as covid19. Which is a speak has claimed more than 175,000 lives in the United States alone,. Tony fauci is a scientist and doctor, researcher, immunologist and i should say i first covered and interviewed him when i was a White House Correspondent for cnn back in the 1980s in hiv aids was exploding, just first on the scene. As one of the first to see the threat, dedicate himself and resources to research and the medicine get to control it, and now covid19. Dr. Fauci, thank you for your time and welcome. Its great to see you. Hanky. Its good to be with you again. Let me first start by saying thank you for your time again, and how are you doing in the middle of all this . This is insanity. Youre right, its really somewhat surreal. But im fine, frank. Its just very intense. Obviously we are working 16, 17 hours a day on this seven days a week, but it something we have to do, frank. This this is a challenge as youl motor its a story in its proportion. We havent seen anything like this in 102 years since the 1918 pandemic. Its challenging to the entire world and we as you know, the United States, have gotten hit worse than virtually any other country when you talk about cases and deaths. This is a real important challenge for us. Is a lot we have to discuss your, and not a lot of time. I should take when we are done i will be joined by the dean of the school of Public Health, dean of the Public School and the crook of the school of Public Affairs to build on some of your comments. I do want to dive right in. I should also say with over 100 questions from faculty and students some going to try my best to leave those in in the existing tie. I saw a story yesterday, dr. Fauci, about boston, this of the pandemic tedious reference. Different time, different sites but the headline haunted me. The headline said, boston refused to close schools during the 1918 flu, then children began to die. He is history about repeat itself as we head to the School Season . I think theres a difference there. If you look at the situation with regard to the current pandemic, is that children clearly have much less of a chance of having a series out, when you look at hospitalization rates per hundred thousand than adults. And, in fact, if you look at the graph, it literally gradually goes up eventually get a very high hospitalization rate, 100,000, among the elderly. So age is an issue. However, we should not neglect the fact that children, some, can get seriously ill, much lesser likelihood than the adults. There are other syndromes were just starting to see right now. Inflammatory symptoms that children have. We dont know the extent to that. It seems to be unusual but we dont know the full extent. But the issue is we are starting to learn a lot about children getting infected. They clearly do and theres thn some study to show that children from ten to 19 can transmit to adults as easily as adults transmit to adults. So some schools are opening. Some schools are not. Some schools are going hybrid. But its a patchwork. Its left to local decisionmakers some of whom may have direct Public Health and medical guidance, the latest science come some not. Are you not concerned about the way this is being done . Of course. That children as transmitters of this. Thats the point of trying make one is talking about the chances of a a child transmittg it to an adult. And even for Young Children have high degree of virus when you look at virus titers. They sold their capable of transmitting the degree to which they do i think youll learn a lot about in the coming weeks and months. We would like to see, i would like to see a consistent message about schooling, consistent to guide the local authorities who make the decisions about school. Where should the consistent message come from . It should come from the federal Health Authorities like myself and i will sit right here to you, frank. That we live in a country that is very heterogeneous with regards to the level of virus. You have to look at whats going on in the community. If youre in a green zone where you have literally less than ten per 100,000 cases per 100,000 population, that you could probably open the schools with a considerable degree of impunity. When you get to a yellow zone that has ten to 100 cases per 100,000 where theres virus in the community, you might want to modify the things that you do. Have some physical separation, mask wearing, outdoor classes if possible, situations we have hybrids, some online, some in person. When you get to the red zone, i zone where there clearly is over 100 cases per 100,000 and theres a lot of virus activity, you really want to think twice before you get the children back to school. I dont think it should be all or none. All the kids go back for all the kids stay locked in. You have to look at extenuating circumstances and look at the location where the school is. Part of the schooling discussion extends to colleges and universities. George Washington University fully intended to bring people back in a hybrid and careful way and then have to change about posture and it is not going to be virtual. Today as we speak Michigan StateUniversity Said its going to go virtual for the semester. Notre dame says it will do it for two we can bring people back, but if there are clusters and it cant do it, it wont. Unc had to flip on this. Dr. Fauci, and juicing schools grapple with this decision to try to reconvene across the country, whats reasonable . Is there anyway to bring students back from all parts of the country, have been gathered in dorms and classrooms and hallways, deal with the reality of campus life and be able to safely reopen . So we want to make sure now that the viewers know that we are no longer talk about elementary and middle school. Its a big, big difference. Fraternities and parties. Yeah, its a big difference because youre bringing that really cannot address the concern i have about what the level of infection is in a particular place you are coming from because people come from all over the country. You were having people come from red zones, yellow zones and green zones. It really varies. There are some universities and colleges that have a system set up where they test virtually everybody that comes in before the even get there. To make sure you dont introduce into the community of dorms and in the college infected individual here and then screen individuals and have situations that you have the facilities and the resources to do it or you might have an empty dorm where if someone test positive you can safely isolate them. If they need medical care you can get them the medical care. If you have the capability of doing that, it is conceivable that you may be able to successfully bring people back to colleges and universities. Conceivable but is it feasible . In some cases it might be. Sounds to me like you think in most cases are skeptical. If you can do that then you may well be able to open up the college or university. If you cant, it may be more problematic. Let me ask you about the health effects. Are on the front lines and watching this closer as a doctor, a scientist, a researcher, immunologist. Talking about covid causing heart disease, mio carditis. Inflammation of the heart muscle. A study out of germany looked at a high rate of people suffering from that. Other studies are looking at potential brain damage. There was a study i was reading in the lancet that looked at potential brain microstructural damage. What new, what do we know about the effects of these disease among those who had it at a fairly serious level on to their bodies . Its a work in progress, frank. Literally every week and month, you named some of the reports accurately that have come out. There are now others that are in progress that a lot of different groups are looking at it. And you bring up in my mind, frank, an important point. If you say you worry about people, keeping them alive as long as you want to make sure you decrease the deaths, that is very important for the simple reason that we already have, you know, well over 160,000 deaths, close to 170,000 deaths. However, if it turns out that people, even some who do not require hospitalization because in some of the studies that you just quoted, they were in individuals who were sick at home for maybe a couple of weeks at a time, that werent even sick enough to go to the hospital, yet, when you look at the percentage of them that actually recover and recover within two to three weeks, a substantial proportion of them dont feel right, fatigue, muscle aches, brain slog. The thing that worries me more is what were seeing about the subtle, insidious effects on the cardiovascular system, namely mris and pet scans that show abnormalities of inflammatory processes in the brain and in the heart of some individuals, and it isnt like 1 or 2 . If you look at it, its individuals where it could even be double digit percent where you see this. Now, it may be reversible and they may completely clear after a while. But we dont know that. So we better be careful that just because a person survives and obviously, the overwhelming amount of people do survive, that there may be a certain percentage of people who might have serious residual effects. We need to follow that. It seems to me that that is a vital part of the messaging and its not often not getting out. Its about dying or not dying. Opening or not opening as opposed to how brutal this illness can be just to get it and the potential of longlasting effects that ways that we dont even know. There are layers of risk here. Vaccine, Vladimir Putin, sputnik 5, he says hes gotten. His daughter has gotten the vaccine. Bogus, dangerous, or a credible start . Its not bogus because he has a vaccine. Whats bogus is to say you have a vaccine thats safe and effective. Theres a big difference between saying you have a vaccine and proving in trials that are really welldesigned placebo controlled trials where you start to give it widely to hundreds of millions of people that youre giving a safe and effective vaccine. The russians to my knowledge, and im pretty sure im correct, have not been studying this in very large randomized trials. Im sure that Vladimir Putin will say that its bogus thats not what im saying, im saying that having a vaccine is different from having a vaccine thats safe and effective. We have six vaccines now we havent proven them yet to be safe and effective. When we do, then we can accurately say we feel comfortable with distributing a vaccine to hundreds of millions of people, but before and until you prove its safe and effective, you really dont want to be talking about having a vaccine. And the question youre probably asked most, which is when, today, your answer is what . Well, right now, we have three, at least two and probably a third one soon, that are already in phase three trials to determine safety and efficacy. Two of them started on july 27th and are already enrolling thousands of individuals. The trials are large, frank. One of them is a 30,000person trial. Another one is aiming at 60,000 people. We will likely know within the period of several months, which takes us to the end of this calendar year and maybe to the beginning of 2021, whether or not well have a safe and effective candidate. I believe, based on the preliminary data, that we have that we can be cautiously optimistic. No guarantee, frank. You know, you never can guarantee when you have a vaccine, but we feel cautiously optimistic that we will have one that will be safe and effective. We know that from preliminary data from phase one studies that induces neutralizing antibodies that are at a level comparable to and even better in some respects than convalescent plaza of people who have actually recovered. So, were feeling good about it even though one cannot guarantee it. Let me ask you a question, very closely related to that, which and the question itself actually comes from one of the students at the school of Public Health at George Washington university. And its about people getting the vaccine. Gallop had a poll that whether they would get vaccinated. When its available to the public, how can providers combat Vaccine Hesitancy and i might throw in there, vaccine disinformation. Vaccine disinformation can clearly lead to vaccine hesitan hesitancy. Theres some Vaccine Hesitancy thats fundamental without disinformation. What we can do whenever we see a situation, and people are hesitant to get a vaccine that they need. They need it for themselves and they need it for the protection. Community and thats definitely not criticizing that, criticizing people for that, but trying to engage them and to do that through community engagement, particularly when youre dealing with minority communities who often and understandably are reluctant to believe what authorities tell them about health, that you get out there and you get Community Representatives to engage them, to try and be as transparent as you possibly can, with the data, answer the questions they have, and trying to convince them that vaccinations in general, particularly a safe and effective vaccine for covid19, is something thats important for them, their families, and society in general. Another question from another student, would you support a nationwide mandate of the Covid Vaccine once it comes out. Definitely not. You dont want a mandate to try and force anyone to take a vaccine. You can mandate to certain groups of people like health workers, but for the general population, you cant. I mean, here at my own hospital at the nih, we get influenza vaccines and if you refuse with no good reason other than you just dont want to take it, then we dont allow you to take care of patients on the wards during the influenza season. So thats a mandate that we dont want to be mandating from the federal government to the general population. It would be unenforceable and not appropriate. So lets talk about how we do get out of this. And one of the things i know youre tracking very closely is a rapid test. I have a question from a faculty member from that. Could dr. Fauci explain the bottlenecks, for fast administered selftesting that would allow the country to reopen faster than the vaccine is available. And thats from the nih and others interest discussed, rapid diagnostic tests. That will be coming, already considerable amount of growing enthusiasm. We are going to see that relatively soon. The critical issue to make sure when they have the tests. They have a degree of sensitivity thats appropriate. When you do general screening, you dont need, 98, 99 sensitivity which the pcr molecular test gives you when you know whether this person is infected or not. If youre screening youre going to be looking at the penetrant of it is in any given population. You can live with one will he is than 98, 99 effective. One that might be even though you miss some and you do the tests and repeat it enough youll make up for the lack of sensitivity. Those tests can be available right now. What were seeing is that the private sector is gearing up to really make them available to the tune of many, many, many millions. Theres a lot of concern, a lot of focus on whether these the vaccine when its out and some of these other tests and resources are going to be equitably distributed and most in need and that includes lower income people, people of color, people disproportionately carrying the cost of this disease on their backs. What is being done to address that very serious problem . Well, there are very serious attention to that is being paid. We have an entire group of people who are committed to making sure that that happens. One of the first things you do is that whenever you have early on, which will be the case, as the vaccine starts to roll out. I mean, by the end of 2021, were told by the manufacturers that there will be enough vaccine essentially for everybody in the country. But before then, there will be prioritization and when you prioritize, what you do, you get an independent group, in this case you have the Advisory Committee on immunization practices which traditionally has advised the c. D. C. Which has the responsibility for making the prioritization. Thats going to be complemented this year by another independent group from the National Academy of medicine, to get the prioritization such that youll see publicly published what we call a prioritization rank. Now, i cant tell you what thats going to be right now, frank, but i can tell you if it is similar to what weve seen in the past, youre going to see high priority to Health Care Providers and social responders because theyre putting themselves in harms way to take care of people. Yeah, likely to then be individuals who will benefit the most. The elderly and those with underlying conditions. Another question from a colleague of mine, who has, among other things, looked at some of the covid disinformation that weve experienced and the other information. And he writes, were trained to communicate just the facts, however, the past several months have demonstrated beyond a shadow of a doubt that those are prone to interpretation and malicious actors will intentionally distort and misinterpret those facts for preferred narratives. Some are injurious to health. And what is your role and others by extension for the facts in the correct context. Sometimes youre out there, dr. Fauci and youre attacked by the president of the United States. This is not an easy thing. Well, we stand by certain fundamental principles, frank, that you make recommendations and policy based on data and evidence, speculation anecdotal, those kinds of opinions need to be put aside. Everything were talking about in the arena of Public Health, particularly recommendations and policy recording any intervention, it could be a diagnostic, a vaccine, it has to be made on the basis of sound, Scientific Data and evidence and thats the kind of thing that i do and my colleagues, who are Public Health officials out there like me, do the same thing, make statements based on solid Scientific Data. As i mentioned at the outset, youve been in this job since 1984. You and i first met when aids was exploding. I remember i was a young guy at the white house and you were a young guy at nih, i guess, and i remember that first briefing that you did. And i remember the incredible Politics Around that. The collision of pandemic and politics as weve seen here is amazing, but its not the first time medicine and politics have collided. Youve been through hiv aids. Youve been through sars, youve been through anthrax. Youve been through zika. What do you make of the political division, every political poll shows whether its masks, to actually believing whether this whole thing is somehow a hoax . Youre right in your description of my experiences, fra frank. And even in the early days of hiv there was stigma associated with it wasnt thick, hard core politics, it was different ideologies about how much attention you pay to disenfranchised groups like the gay population, which were really, obviously, did not get the attention to this that it deserved until the activists got it and thats different from what we see how. What were seeing is divisiveness thats there even without the covid19 and the perfect negative storm that makes it difficult and problematic when youre trying to deal with a Public Health challenge is that you have that divisiveness that makes the politicalization of the response which were seeing very, very difficult, where you have people who are on political different sides of whatever a particular issue is, but its thrown into the Public Health. So, its a statement. Masks, no masks. This or not that. It shouldnt be that way. The Public Health challenge is a challenge for everybody. It doesnt make any difference what your political ideology is or what you feel strongly about one way or the other. You should be completely in line with each other that this is a serious Public Health problem. Have you tried affecting us all. Have you tried saying that to the president of the United States, to conservatives on the hill who grilled you in your congressional testimony . Yeah, all you need to do is look at the record and see me on my testimony. I say the same thing im telling you right now. I dont change what i say, frank. We need to pull together. We are all in this together and we have to work together. If you dont have a complete consistency in what you do, the weak links in the chain of a Public Health crisis will make it very difficult to get your arms around it and ultimately suppress this. Which is what were trying to do. I want to ask, i know youre tight on time. Another question from a student, which i think is a really important one. The questions as follows many of us who are in the masters of Public Health problem in George WashingtonUniversity Work in Public Health many are faced with situations in this pandemic that test our ethics, our academics and our training. My question to you, doctor fauci, the question from the student, how do you maintain your ethics during such a Political Climate . I have to tell you, its very easy because you dont change your ethics because of the situation youre in. There are certain things that are constant, science, data, and really good evidence are consta constant. If the data changes and you make your decision, what doesnt change are ethical principles. They are clear and immutable. A lightning round and youre done, just to show there are some with still a sense of humor and theres some humanity here, here is a question i got for you. Dr. Fauci, which was scarier for you, testifying before congress or throwing out the first pitch at nats park . Unquestionably throwing out the first pitch at nats park. Amid this environment. Disinformation, the pandemic on the rise in some places and disputed in others and some control elsewhere, conclude with what concerns you the most and what encourages you the most. Well, what concerns me the most is what is going on right now throughout the world and even in our own country that we want to make sure that we all abide by certain fundamental principles that can get us out of this. It is completely in our power, frank, even prior to a vaccine to be able to control this outbreak if we abide by the certain fundamental Public Health principles we talk about, wearing a mask, physical distancing, avoiding crowds, outdoor more than indoor, sanitation, washing hands with soap and water. If you do you that, you could influence the course of the outbreak. What id love to see is the United States as a country pull together in a consistent way and realize that Public Health measure is the gateway and the road and the path to opening up the economy and getting the jobs back. Its not an obstacle in the way of opening the economy, so if what we do in the proper Public Health, prudent, careful way, we can have both. We can have control of the outbreak and we can carefully and prudently open up the economy to get back to normal. Thats what id like to see everyone realize that we can do it. It is within our power to do it. When we get a vaccine, its going to be much easier, but we can start on that road right now, even before we have a vaccine. Dr. Fauci, i know youve got to run. I want to thank you for your time, for your generosity of spirit, for your intrepid attitude as you encounter this stuff. Thank you very much and we wish you on behalf of George Washington university and all of us, the very best of luck and the speedy results that youre doing on behalf of the rest of us. Thank you, frank, over many years with you, its always good to be with you. I look forward to doing it again. Im sorry we didnt get to the other 132 questions that we got, but hopefully an encore performance and thanks again to you. Thank you. Okay, well, thank you. What were going to do now is switch over to the group of people who are able to respond to what we just heard from tony fauci and more. And its my pleasure to introduce the panel to you, dr. Lynn goldman, she is the michael and lori milken dean of the Milken Institute school of Public Health. A pediatrician, environmental epidemiologist and had a distinguished career in medical health. And the dean of the gw school of medicine and health sciences, and before coming to gw, department of surgery at houston Methodist Hospital a leader in surgery and when i say surgery, im signing up, i hope i dont need it, but when i do, im there. Finally, sylvia, dr. Sylvia, director of gw school of media and Public Affairs and expertise and includes global media. Dr. Goldman, can we start with you . You heard tony fauci right now, what we need to create a better Public Health environment. What do you see as the principal challenge that he and we are up against . Well, i thought that dr. Fauci put it very well when he talked about we need to be working together. We need to be unified in our approach across this country and what has been the most frustrating for many of us in Public Health is how our inability to do that has allowed the virus to continue to be moving around the country, amplifying and then able to turn back around and come back into areas where we had it under control. It has probably been understandable that for many communities, until they saw the virus in their communities, they didnt see any reason to start, you know, staying at home, social distancing, using masks, but the problem with that is by the time you see this virus, you have way too much of it to be able to control it. When you see it, its upon you because of the fact that so much of the transmission is asymptomatic. Dr. Goldman, i started with tony fauci on the subject of schools and opening of schools. You were actively working with the gw, and determine whether and how gw would reopen. And there was a time that you were fairly optimistic and that changed because of the numbers and the disease. And i put that question to you because i know also as a pediatrician, you have thought about this a lot about the health, safety and wellbeing of the kids. See whats happening on campuses and universities. What is your feeling about the risks and the ability of schools to reopen . Because everybody wants to. Everybody wants to reopen school. Everybody wants to at the present time go to school and pediatricians think that schools is the place where kids belong. Its important to develop mentally and in terms of the association they receive and learning and we know that especially younger children have a hard time learning online and so we want them to be in school, but the rush to get them to school regardless of the ability to make the schools safe has been the problem and especially as dr. Fauci said in the states that have very high transmission of the virus and where maybe its that the parents who think theyre transmitting it, they can transmit it to their family. Here at gw. We did everything that dr. Fauci was talking about, put those in place, test the kids, have a cycle of testing to monitor the virus, and make sure we dont have outbreaks and we couldnt reopen because of the fact that across our country so much virus is still circulating. We had kids who would be coming in from georgia, from florida, from california where, you know, and of course in d. C. We have a really good situation. We have been able to keep the transmission below one, which means that gradually, gradually declining numbers of cases, bringing in students from all around the country, at the end of the day we realized, even with all the measures we were putting in place, that would be too risky. And im hoping for spring, but when i look at the outbreaks that have been happening in high schools across the country and outbreaks certainly in other universities, im glad that weve been cautious because doctor, let me come over to you, as dean of the medical school, what did you hear from tony fauci and what do you think of thats resonating most with you these days with this crisis . Yeah, you know, i think we all have come to really admire dr. Fauci during this pandemic. The thing that inspires all of us the most is the clear insistence upon science and evolving evidence, as a format by which we make all of our decisions. I dont think weve had a more clear spokesperson in any format to help guide us and remind us of the principles that science is science and evidence is evidence. The other thing he said thats really important and really been i say both a dressing and a curse to be in health care at this time. Its a curse in the time that its kind of scary to be on the front lines after disease that we dont know the impact of. We know its a really bad disease for some people and certainly a disease nobody wants to have. And presented as dean goldman just said although we havent been good at that in many parts of our country, but i think what weve but the excitement is to see to become part of the group that is treating an entirely new disease and the amount that weve learned on a weekly basis, that has transformed both of our intervention strategies in terms of broader application and how we actually treat our patients to riding this rollercoaster of early adoption based on evolving evidence and knowledge of this is really exciting. If wed had more time with him and maybe this is something you can touch on because i think this cuts through so much of the challenge and problems, is that part of the conversation we had where he talks about so much is unknown, how much is going on to figure out what the effects of this disease are on us, if we have it. I mean, its not if you live or die, right . Maybe theres going to be brain damage, maybe theres going to be the lungs, inflammation of the heart. How closely are you watching this kind of body of research and how concerned are you that this is not like the flu or a cold, you get over and move on, but there could be permanent, lasting effects . No question this has probably been one of the most scrutinized new diseases and reported diseases that weve ever had. If you think about the pace of publication, the discovery of science, both the fundamental science level, as well as in terms of this disease management. Its been extraordinary. So were watching it really, really closely and already thats changed the way weve practiced and weve learned that this massive inflammation that can come with a bad thing. And were learning more about the extra pulmonary, in order not just lung related, but all the other symptoms impacted by this inflammatory process. As dr. Fauci said. We dont know what the longterm impact of that will be. We learned that theres a microvascular inflammatory process. And it comes with the unusual patterns of clotting that can be dangerous from kidneys to liver and weve learned already to adopt in terms of how to manage or prevent the vascular problems and coagulation. Bottom line, were watching this and recording the beauty of this, being here at this time. Were documenting and recording and saving specimens and i think the amount of Discovery Science that comes out of this that will translate into targeted therapy, for more effective therapeutic and match the longterm consequences, its going to happen and this is the focus of the nation and the International Health community very sharp focus on this disease. Its going to make that process a condensed and rapidly relatable. Condensed for a normal time and for those who are locked down in their homes and its forever, forever. Doctor, the school of median Public Affairs. Youve covered Health Communication in detail and weve talked with dr. Fauci on unprecedented challenges. When he took on aids there was a social resistance and hostility and some called it the gay plague or gods revenge and thats different, when we see the response to the mask, to getting the vaccine that this is a it splits down the middle. Weve got alternate universes of information coming to people. How much does this complicate the issue . I think the big difference compared because a little political and many who follow the degree to which the pandemic and responses to the pandem pandemic as i was listening to dr. Fauci my concern was some of the fundamentals, the change, science communication, and Health Communication might not be enough. The facts, the evidence, might not be sufficient. And some are confronting very high resistance in all kinds of patients. And it seems that that is something that requires us to have smarter targeted approach, reasons why people would resist, believing that this pandemic is that recommendations that dr. Fauci how to tackle this misinformation thats grounded in a different kind of what could be done differently. You said we might need to communicate differently. Interesting to hear you put some ideas out there and ask dr. Bass and dr. Goldman to react to that. In terms of telling the facts in terms of transmission and prevent. The language that most people can understand, thats line, thats necessary, but its not sufficient when we have the evidence and follow Public Health recommendations, and while we need to address head on is other than telling people, in order to be more effecti effective. We need to be smarter and understand those kind of consideratio considerations. Host dr. Bass and dr. Goldman, before you respond, let me share something. A colleague of ours wrote article of nature from his research and tracking Public Health, science and all, and he was able to map this battlefield of disinformation, and here is what he found. He was looking at the antivax debate if you can call it that. He found that antivaccinations seems to be more numerous and connected to undecided groups so they were targeting more undecideds, that they had more m mistrust in conspiracy and reinforced to other organizations, they would link out to other organizations that werent related, like mothers for breastfeeding, and they were everywhere and sort of suggests his work, that the antivaxers are outmaneuvering in this asymmetry warfare, the pro vaxers like the c. D. C. And others. When you think about what the doctor was coming from, interested in your thoughts. I have several thoughts there. One is that one of the greatest challenges weve had is that theres been such an evolution of knowledge during this period of time. We havent had a static body of knowledge to say, okay, this is just this is how this disease works, this is who gets it. And it has been an incredible rollercoaster of discovery and i think that has made the messaging even more the likes of dr. Fauci, more challenging because what you thought was true today actually two weeks from know you might not be true anymore, we actually have learned a lot during the last few weeks, which therefore creates not a consistent message this notion that you have to adapt to this, in a rapidly evolving disease like this, makes it extra, extra hard to communicate consistently and openly and honestly and have people believe you. Especially if its around a part of your life that requires you to change the way you live on a daily basis. You say what do you mean . Two weeks ago you said i didnt have to do this and now youre telling me ive got to wear a mask . People dont have the trust or dont have the instinct to adapt that rapidly to the evolving guidance that comes with this. I also think, obviously, we cant do this without using the word social media, right . And the notion that the sources where people get their quote, information, is so subject to error ap disinformation, some intentional, some unintentional. But the fact is that our sources providing reliable information, each comes from the publics eye of what some form of painted perspective, and i would up to our media people to try and address because so many people distrust different forms of even, quote, established mainstream media. Its a real challenge. So ill have some of that back to you. Dean goldman . I certainly dont think theres anything knew about Public Health being encircled by those who are putting forth nonhelpful behaviors, for example, the Tobacco Industry has been very, very good at marketing a product that is has no benefits and nothing, but health risk. I think weve learned lessons in terms of trying to be a lot smarter how we had behavior. How we understand stand communication and looking at the science around that, and we teach that in the school of Public Health. We can get a doctorate and we used to call Health Communications. And with a fact sheet, if we put the facts out that that would be our job. We understand now that that is not enough at all. That we need to make it interesting, we need to make it culturally relevant. We need to be as Twoway Communications between Health Experts and communities that were not just talking to them, were listening to them. And ill tell you one thing that i think ive heard here is that for many, many people who live very close to the edge financially, staying at home has created a tremendous amount of pain and this pain impacts their sufficiency for their family. It affects their health. It has an extremely negative consequence and that can cause people to be anxious, it can cause depression, it can cause anger and i think that it creates a situation where negative communications can tap into that. What i dont understand, frank, and maybe your researchers that youre aware of, have done this, where is all the money coming from for these antivaxer messages . That doesnt happen kind of thats not cheap, i know that, i know what theyre doing isnt cheap. I know it isnt free. Yes, weve all had access to the internet and we can all tweet, but these are very sophisticated efforts that are underway. Someone is supporting them. When its tobacco, i understand where its coming from, who is selling that, who is selling antivaccine, i dont understand that. And what david looked into, a lot of it is coming frankly from russia and its for no particular purpose other than to cause confusion and concern. Here is what id like to do, weve got so many questions from people to the audience for dr. Fauci. I had limited time and got what i could. Id like to ask them to you. And raise your hands if you want to, ive got a gallery up here if you want to. So if you want it. And they came from students, staff and faculty and let me just sort of throw this out and if you you know, you want it, go for it. If you dont, ill drop it in your lap or something. But how about this one. How will the how will from a student. How will covid19 be affected by the flu season . We dont really know. One thing that i think is quite probable is that where people are wearing masks, they will have less transmission. We know that some communities like our own is trying to immunize everyone for flu. And dr. Fauci mentioned population, health care, the elderly. Were trying in Public Health to get the flu vaccine. It doesnt give 100 immunity, but if people distance and wear masks, we may not see as much flu as we usually do. Ill turn to dr. Bass to see if she knows anything. I dont know if we have data for coinfection and for sure its going to create confusion in Public Health and is that your nightmare, dr. Bass, suddenly weve got covid and influenza coexisting in the high season . I think that everyone is very concerned about that in terms of, especially if were in a surge of our existing covid in terms of Hospital Capacity and many are hospitals already full with very sick people. So, we are concerned about capacity issues during that time. I think were also, fortunately, with the flu, if we catch it early. If we have rapid diagnostic tools for this. We have our greatest opportunity for covid and influenza and we have therapy. We have those with the potential harm that comes with influenza. That said, its still im hoping that people are still practicing covid prevention measures we may have less of a burden of flu to deal with, but its to be seen. We really do not when does influenza season, when does that normally start . Its sort of a wave of it across the country as early as october and lasts all the way into april, april and may, depending as it sort of moves from north to south through the country. But its and what do we have typically 40, 50, 60 of people get a flu vaccine . How many people i dont know. Not even that much. I dont think that much, no. So this year whats the role of a flu vaccine, theres flu and covid and all of this stuff. One thing we know people who have underlying pulmonary disease are at adverse risk. Lets say you have the flu, too, a respiratory virus, yes, its a systemic virus, but pulmonary effects in most people, thats sort of a double whammy. We think it could certainly, certainly make your covid or your flu experience worse although really, as dr. Fauci would say, its speculation, but we think that may be the case so, obviously, you dont want to have them both at the same time. We dont know whether you can get both at the same time. But reasonably you can in the right circumstances. I think this one, you might want to start this one and interesting to hear your colleagues, their thoughts on it. This, i believe, is also from a faculty member that came in via the question line. Concerned about what appears to be questionable information disseminated early on and then seems to change. First were told to wear masks, then not, and now its reported that using masks is inconclusive and thats the question of their effectiveness. Not sure whether thats accurate or not. And similarly with hydroxychloroquine and this was directed to the tony fauci. And studying this level of doubt and question, and in fact, tony fauci has changed his position as have many experts on the subject of mask and thats dead to additional doubt, perhaps, skepticism among many . Yeah, i think that dr. Fauci mentioned the changing of what aspects of the pandemic have been changing. It was typical we communicate things that we know, and a body of evidence that supports the message. Some messages need to be chang changed, and we do more resear research. In communicating the changes that is very difficult. Second, communicating uncertainty. Which still exists, which is more difficult. And its something that [inaudible] i think that that injects some more confusion. I think that that goes into, i will say it pulls information, suspicious suspicion, lack of trust, and thats just one. Ap thats what really works. Dr. Fauci talks about the perfect storm and talks about the pandemic. If we look at information and disinformation, and plan to worry about it and sort of finding its the perfect storm and were trying to pump facts and information into the wider public sphere that you have all kind of misinformation and thoughts and thats what really works. Well think about this thing and hope theyre thinking what are the strategies to implement in order to fend off what we know coming up is a vaccines. Especially you know you know what i think the hardest thing is, my perspective as a journalist and i looked closely at science and were on different planets. The political world, the world of journalism in many cases, the public, they want certainty and they want answer. The problem, the dishes part of science, its built around uncertainty. We dont know what we dont know well, we know a lot of things we dont know about covid and we discover as we go. What some people may think about masks one day may dually change. But in the public realm thats seen as a flipflop, learning as you go. Youre muted, dr. Goldman. The message about masks have flip flopped at all. I think the questioner has had a bias. Gradually over time evidence accumulated that masks are beneficial and with some authorities were quicker to glom onto that and to recommend them and others. The last to go is who who is very conservative about a longstanding position theyve held against masks. If that didnt go one way or the other way, it just gradually accumulated and more and more benefitting, including most recent data that says you yourself are protected when wearing a mask. Up to a week or so ago i would say wear a mask, its the kind of thing you can do for everybody else, since evidence is very clear about that, now it turns out it helps to protect you as well. I dont buy the idea that its flip flopped. I think where the media sometimes helped to create this. I in theed each time. Whether its the other country, than you know, the White House Task force and who, each time they changed their position, and this is the news. From my viewpoint, the scientists, that wasnt news. It took them a long time to change their policy, to assimilate the new evidence, to really review the evidence. They bring together their committees and everybody has their own process. And each time its a news alert. I guess the same that is been true for the hydroxychloroquine. Once the actual trials started coming out, i really didnt see flipflops. I just saw those every time there was another trial. There would be another headline, oh, now we know how hydroxychloroquine, blah, blah, but perhaps some over simplifying the Clinical Evidence in that. If i could comment a little on the hydroxychloroquine thing. Its one that has taken on a very special political place. That said, there are certain pieces of that debate that gets back to the fundamental value of science and Clinical Trials. So far the Clinical Trials have been done have been hydroxychloroquine plus hydroxychloroquine alone, a very small trial and none of them have showed evidence that they are effective in treating or preventing this disease. That said theres a school of thought, hydroxychloroquine plus this, plus whatever. Maybe that will work, thats just the trial that hasnt been done and is it a trial that is worth doing . Perhaps. Right now in this wave of where the goal is to save people critically dieing. The emphasis is creating the Clinical Trials and around shaping those people. So its like remdesvir, could it be could hydroxychloroquine be a trial that is worth doing in the future . Perhaps. And a different answer. Perhaps. Today the evidence does not support that as a priority of investigation for a science and medical community. Let me first of all, thank everybody who submitted a question for this, and if dr. Fauci had more time to get questions in. They request questions around therapeutics, and issues around Contact Tracing and mobile technology and disinformation campaigns that weve talked about that so vex this. Let me ask you about what you think about in your lives on a daily basis when youre working with professionals and clinicians and others with covid. When youre on the campus, if you can even be on the campus of the George Washington university and you consider what an institution like this and others are going to have to see happen before they can reopen. Before people can safely gather. Before people can have a vaccine where they feel they can go into a restaurant. They can get on an airplane. They can be in a stadium full of 100,000 people. And maybe give us a sense of, if you had a score card and looking forward, what are some of the key indicators of progress that youre going to be looking at in your field. Dr. Bass, you can go first. Well, i think weve seen some of that. When is our rate of transmission getting down to the port that people who have the kweez dont have to fair people. To build our infrastructure, when were ready to have an outbre outbreak, and keeping under wraps until, until we have effective therapy or vaccinations or heaven forbid, if we live long enough, for herd immunity. And i dont want to leave, which my campus is worrying about every day. And the disproportionate burden to communities of color, workers who provide care to us every day, service industries, emt, whole nine yards and people who live in multigenerational homes that cannot have the privilege of social distancing and i think if theres one really raw awakening that i hope our nation sees, this pandemic more than any other, the inherent that americans living in this country when it comes to something vast. I can tell you thats what i worry about. Its not been a fair disease in our country and we need to be really aware of that and focus on remedying those disparities in a really proactive way. Thank you. Thats so important, such a vital part of it. Of silvio, your thoughts . Yes, following up on the doctor, when the workplace, the pandemics had unveiled and de deepened some of what we have. Not jis that, but awareness, you have compassion, empathy. You need to figure out ways to report. So were to dids i think that wi with [inaudible] Something Else that dr. Fauci, communicated that quote, unquote, hard to reach or more at risk. Thats the kind of work, communication while the pandemic, figure it out with the people who are most disadvantaged and affected, that one size fits all should not work. And thats something consistently for everybody. Were leaving the last few minutes of that discussion, but you can find all of our programs online at cspan. Org. Well take you live to capitol hill where postmaster louis dejoy is testifying about operations. This is live on cspan2. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] naude [inaudible conversations] [inaudible conversations]. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] mr. Dejoy testified friday on the same issue at a senate hearing. This is live coverage on cspan2. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] welcome, everybody, todays hybrid hearing. Pursuant house rules some members will appear in person and others will appear remotely via webex. Since some members are appearing in person let me first remind everyone that pursuant to the latest guidance from the house attending physician all individuals attending this