Live coverage here on cspan. Let me first off start by saying thank you for your time. How are you doing . This is insanity . This is insanity. You are right. It is surreal. It is very intense. 15 tosly, we are working 17 hours a day on this seven days a week, but it is something we have to do. Is historic in its proportions. We have not seen anything like this since the 1918 pandemic. It is challenging for the entire world, and we, the United States, have gotten hit worse than virtually any other country when you talk about cases and deaths. This is an important challenge for us. There is a lot we have to discuss here and not a lot of time. When we are done, we will be joined by the school of Public Health and the director of the school of Public Affairs to build on your comments, but i want to die right in. We got 100 questions from faculty and students. Im going to do my best to weave those in. I saw a story the other day about boston. The pandemic you just referenced. The headline haunted me. The headline said, boston refused to close schools during the 1918 flu. Then children began to die. His history about to repeat itself as we had is history about to repeat itself as we head to the School Season . If you look at the situation with regards to the current clearly haveldren much less of a chance of having a serious outcome when you look at hospitalization rates per hundred thousand than adults. If you look at the graph, it literally gradually goes up until you get a very high among theation rate elderly. Age is an issue. However, we should not neglect the fact that children can get. Eriously ill much less likelihood than the adults. There are other syndromes we are just starting to see, inflammatory syndromes that childrens have children have. We do not know the extent of that. It seems to be unusual, but we do not know the full extent. The issue is we are starting to learn a lot about children getting infected. They clearly do, and there have been studies to show children from 10 to 19 can transmit to adults as easily as adults transmit to adults. Some schools are opening. Some schools are not. Some schools are going hybrid. It is patchwork left to local decisionmakers, some of whom may have guidance and some not. Are you concerned about the way this is being done . Of course. Children as transmitters of this that is the point i was trying to make without talking about the chances of a child transmitting this to an adult. Even Young Children have a high virus. Of they are capable of transmitting. The degree to which they do you are going to learn a lot about in the coming weeks and months. I would like to see a consistent message about schooling, consistent to guide local authorities who make the decisions about school. Where should that consistent message come from . From the federal Health Authorities like myself, and i have said it and will say it right here to you. We live in a big country that is very heterogeneous with regard to the level of virus. You have to look at the level of what is going on in the community. If you are in a green zone where you have literally less than 10 per hundred thousand cases per 100 thousand population, you could probably open the schools with a considerable degree of impunity. When you to a yellow zone that ,as 10 to 100 cases per 100,000 you might want to modify the things you do. Physical separation, mask wearing, outdoor classes of possible. Situations where you have hybrids, some online, some in person. , an you get to the red zone zone that is clearly over 100 cases per 100,000 and there is a lot of virus activity, you want to think twice before you get children back to school. I do not think it should be all or none. All the kids go back or all the kids stay locked in. You have to look at extenuating circumstances and the location where the school is. Sure. 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 had to change that posture and it is now going to be virtual. As we speak, Michigan State university has said it is going to go virtual for the semester. Notre dame says it is going to do it for two weeks, bring people back. If there are clusters and it cannot do it, it will not. Dr. Fauci, as you are seeing schools grapple with this position and try to reconvene, what is reasonable . Is there anyway to bring students back from all parts of the country, have them gather in dorms and classrooms and hallways, deal with the reality of campus life, and be able to safely reopen . We want to make sure now that the viewers know we are no longer talking about elementary and middle school. It is a big difference. Fraternities and parties and other things. Is a big difference. It is a big difference. That cannot address the concern i have about what the level of infection is any particular place because people are coming from all over the country. You have people coming from red zones, yellow zones, and green zones. It varies. There are some universities and colleges that have a set up where they test virtually everybody that comes in for they get there. Then screen individuals and have situations if you have facilities and resources to do it where you might have an empty if someone tests positive you can safely isolate them. If they need medical care, you can get the medical care. If you have capability of doing that, it is conceivable that you may be able to successfully bring people back to colleges and universities. It is conceivable, but is it feasible . In some cases, it might be. In most cases, you are skeptical. I cannot say most pure and you have to go university by university. Where they are, what resources they have to be able to do some of the things that universities are already showing they are doing. You can test everybody before they come in. You can do intermittent surveillance testing. You need the capability of identifying, isolating, and contact tracing. If you can do that, you may be able to open colleges and universities. If you cannot, it would be more problematic. Let me ask you about health effects. Youre watching this closely as a doctor, scientist, researcher. Story recentlys talked about covid creating a wave of potentially heart disease, microcodeitis thearditis, inflammation of heart muscle. Another study out of germany looked at a high rate of people who have been suffering from that. Other studies are looking at potential brain damage. There was a study i was reading potentialcet about structural damage. What new do we know about the effects of this disease among those who have had it at a ferry cearleys fairly serious level . Is a work in progress. Literally every week and every month. You named some of the reports accurately that have come out. There are now others in progress that a lot of different groups are looking into. You bring up an important point. Let me explain why. If you say that you worry about as long as you want to make sure we decrease the deaths, that is important. We already have well over 160,000 deaths, close to 170,000 deaths. However, if it turns out people, even some who do not require , because in some studies you just quoted they were in individuals who were sick at home for maybe a couple weeks at a time that were not even sick enough to go to the hospital, yet when you look at the percentage of them to actually recover and recover within two to three weeks, a substantial portion of them do not feel right. Fatigue, muscle aches, brain fog. The thing that worries me more is what we are seeing about the on the insidious effects cardiovascular system and m. R. I. system, namely that show abnormalities of inflammatory processes in the brain and heart of some individuals. 1 or 2 . It couldividuals where even be doubledigit presents. S. Percent they may be reversible, but we do not know that. We have to 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. You need to follow that. It seems that is a vital part of the messaging. It is often not getting out. It is about dying or not diane, opening or not opening as opposed to how brutal this illness can be to get it and the potential of longlasting effects in ways we do not even know. There are liars of risk here. Layers of risk. Vaccine. Putin says he has a vaccine. Bogus or credible . It is not bogus because he has a vaccine. The is bogus is to say vaccine is safe and effective. There is a difference between having a vaccine improving in trials that a well designed, we startd trials that to give it widely to hundreds of millions of people that you are giving a safe and effective vaccine. The russians, to my knowledge, and im pretty sure i am correct, have not been studying large,tensively in very randomized trials. I am sure Vladimir Putin will be happy to hear you say it is bogus. I am not calling him bogus. I am saying having a vaccine is very different from proving that a vaccine is safe and effective. For that matter, we have six vaccines now. We have not 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. Prove it isntil you safe and effective, you really do not want to be talking about having a vaccine. The question you are probably asked most, which is when. Today, your answer is what . We have three, at least two and probably a third soon, already in phase three trial to determine safety and efficacy. Two of them started on july 27. The trials are large. One of them is a 30,000 person trial. At 60,000 people. We will likely know within a period of several months, which takes us to the end of this calendar year, and may be to the beginning of 21, whether or not 2021, whether or not we have a candidate. I believe we can be cautiously optimistic. No guarantee. You never can guarantee 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 that it reduces neutralizing antibodies comparable to or even better than convalescent plasma of people who have recovered. We are feeling good about it, even though one cannot guarantee it. Let me ask you a question very closely related to that in the question itself comes from at thethe Students School of Public Health at george Washington University. It is about people getting the vaccine. Gallup had a poll that 35 of respondents said they would not get vaccinated. Many vaccine does become available to the public, how can providers combat Vaccine Hesitancy . I might throw in their vaccine disinformation. Vaccine disinformation can lead clearly to vaccine vacciney, but there is hesitancy that is fundamental without necessarily misinformation. What we need to do is what we have done whenever we see a situation where people are hesitant to get a vaccine that they really need. They need it for themselves and they need it for the protection of the q unity. That is Community Parent that is not criticizing people for that but trying to engage them. You do that through community engagement, particularly when you are dealing with minority andunities who often understandably are reluctant to believe what authorities tell them about health. You get out there and you get Community Representatives to engage them, to try to be as transparent as you can with the data, answer the questions they have, and try to convince them ,accinations in general particularly a safe and effective vaccine for covid19, is something that is import and for them, their families, and society in general important for them, their families, and society in general. Would you support a nationwide mandate of the Covid Vaccine . Definitely not. You do not want to force anyone to take a vaccine. For certainate groups of people, like health workers, but for the general population you cannot. Here at my own hospital at the nih, we get influenza vaccines. If you refuse with no good reason other than you do not want to take it, we do not allow you to take care of patients on the wards during influenza season. That is a mandate. We do not want to be mandating from the federal government to the general population. It would be unenforceable and inappropriate. Lets talk about how we do get out of this. One of the things youre tracking closely is a rapid test. I have a question from a faculty member. Can dr. Fauci explain the bottlenecks making it so to ramp up productions of self administered tests that would allow the country to more safely reopen . I am referring to the sorts of diagnostic tests. Already there is a considerable amount of growing enthusiasm, so we are going to see that relatively soon. The critical issue is to make sure, when we get those tests, they have a degree of sensitivity which is appropriate. When you doing general screening, you do not need a 98 , 99 sensitivity, which the pcr molecular tests give you. When you absolutely note need to know if this person is infected or not. If you are screening, you are looking at the penetrance of the infection in any given group, any given population. One that is with less than 90 effective, one that might be 85 effective because even though you may miss some, if you do the test enough and repeat it enough, you will make up for the lack of sensitivity. Those tests can be available. Right now, what we are seeing is the private sector is gearing up to really make them available to the tune of many millions. There is a lot of concern, a lot of focus on these tests and whether these tests are going to be equally distributed. That includes people of color, people who are disproportionately carrying the cost of this disease on their backs. What is being done to address that serious problem . Are very serious attention to that is being paid. We have an entire group of people committed to making sure 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 by the end of 2021, we are told by manufacturers that there will be enough vaccine for everybody in the country. Before then, we need prioritization. When you prioritize, what you do is you get an independent group, in this case the Advisory Committee of immunization practices which traditionally has advised the cdc, which has a responsibility, that is going to become lamented this year let another complemented this year by another independent group to get the prioritization such that you will see publicly published what we call a prioritization range. I cannot tell you what that is going to be now, but i can tell you, if it is similar to what it is we have seen in the past, you will probably see a high priority to Health Care Providers and First Responders because they are putting themselves in harms way to take care of people. Likely it will then be individuals who would benefit the most, the elderly and those with underlying conditions. Another question from a colleague of mine, who has among other things looked at covid disinformation that we have experienced and other disinformation. Arerites, as scientists, we trained to communicate just facts. The past several months have demonstrated those facts are prone to interpretation and malicious actors will intentionally distort and misinterpret those facts to support their preferred narratives. Some are injurious to Public Health. What you see as the role of top experts such as yourself and many others to help people understand how to correctly interpret the facts in their current context . You are out there and sometimes you get attacked by the president of the United States. This is not an easy thing. We stand by certain fundamental principles. You make recommendations and policies based on data and evidence. Speculation, anecdotal, those kinds of opinions really need to be put aside. Everything we are talking about in the arena of Public Health, particularly recommendations and informationding any it could be a diagnostic, a vaccine, or therapy. It has to be made on the basis of sound Scientific Data and evidence. That is the kind of thing i do and my colleagues, who are Public Health officials out there like me, do the same thing. Solidtatements based on make statements based on solid Scientific Data. I mentioned at the outset you have 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 remember that first briefing and the incredible Politics Around that. The collision of pandemic and politics as we have seen here is not the first time medicine and politics have collided. You have been through hivaids. You have been through sars. You have been through anthrax. You have been through all of these things. Have you ever seen anything like this . What you make of the great Political Division . Every poll shows this in the country, whether it is masks, believing whether this whole thing is somehow a hoax. You are right in your description of my experiences. Ofn back in the early days hiv, there was a stigma associated. It was not really hardcore 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 they deserved until the activists demanded it and appropriate league got it. That is different appropriately got it. That is different what we are seeing now. What we are seeing now is intense divisiveness that transcends covid19. It is there even without covid19. The perfect negative storm that makes it difficult and problematic when you try to deal with a Public Health challenge is that you have that divisiveness that makes the politicization of the response, which we are seeing, very, very difficult. We have people who are on political different sides of whatever a particular issue is but it gets thrown into Public Health. It is a statement. Masks, no masks. This or not tha