Transcripts For CSPAN3 Dr. Anthony Fauci Provdes Update On C

Transcripts For CSPAN3 Dr. Anthony Fauci Provdes Update On Coronavirus Pandemic 20240711

Technology. This happens time andy came i t again, whether it be new viral, antivirals, cancers, et cetera. And money came in. The idea wasnt so much on the return. Dr. Anthony fauci is getting an update on potential vaccines for covid19. He is speaking today at an event hosted by the university of Virginia School of medicine. Some zoom webinar housekeeping. Slides at the end of this program provide a resource list, information about continuing education credit for clinicians and a link to our centers website where youll find our speakers biography. The slides also give a link to Medical Center hours youtube channel. Todays program is being recorded and closed captioned and will be posted to youtube within days. Today well handle questions using zooms online q a function. Write your questions there, brief and to the point, please, and well draw from them for our speakers consideration after his presentation. This Medical Center hour joins with Medical Center grand rounds for the lecture where an esteemed science addresses matters in virology and epidemiology. The lectureship honors Professor Emeritus Frederick Hayden and remembers our epidemiologist barry farr. Our 2020 lecture disclosed no conflicts of interest. Here to introduce and welcome todays hayden farr lecturer, dr. Anthony fauci, is dr. Wilkes, dean of the school of medicine. Dr. Wilkes . Thank you very much. To begin, id like to thank dr. Hayden and Margaret Childers for extending the invitation to dr. Fauci, and to dr. Fauci for accepting this invitation during this incredibly busy time period. He is the head of Infectious Diseases at the National Institutes of health and hes held that position since 1984 where he oversees Extensive Research on infectious and immunemediated diseases. As a longtime chief at the laboratory of immunization, dr. Fauci has made several contributions to clinical research. His presentations number in the thousands, and hes one of the worlds most cited by a medical scientist. Recognition for his Outstanding Service includes the u. S. President ial medal of freedom ordered by president george w. Bush. In the medical science arena and the public square, dr. Fauci is lauded for his work in epidemic infectious disease. Two local pandemics bookend his career. In the 1990s, it was hiv aids and now covid19. He was one of the architects for the president s emergency plans for relief, known as pepbar, a program launched in 2003 under president george w. Bush that saved millions of lives throughout the developing world. In 2020, dr. Fauci leads nihs Coronavirus Research effort and is a member of the White House Coronavirus task force. He has become the scientific and legal communitys leading spokesperson on the covid19 pandemic and the critical importance of nonpharmaceutical interventions such as masking and social distancing. As you will see, dr. Fauci is a master communicator on matters of concern and consequence to medicine, health care and society. I must mention on a personal note, i was very fortunate to serve on the niaid National Council in 2006 to 2010 when i got a chance to watch dr. Fauci in person. He was the role model of the scientist, educator and so much more. We are gatefrateful and proud t welcome him to the university of school of medicines 2020 hayden farr lecture. Dr. Fauci . Thank you very much, dr. Wilkes. And thank you to the university of virginia for inviting me to give this hayden farr lecture. Its a great pleasure and an honor to be here with you today. As you can see from this first slide, ive chosen as the title, the Public Health and scientific challenges of covid19. Now, i want to start off by showing the cover of this jama viewpoint which my colleagues and i wrote in january of 2020, literally a couple of weeks after the identification of the novel coronavirus, and i entitled it Coronavirus Infections more than just the common cold, and i did not at all mean to be facetious by this title, but i wanted to bring out to the readers of the viewpoint the fact that for decades and decades weve had experience with coronaviruses. So this was just not something that was totally new to us. This is the coronavirus genetic tree. The human coronaviruses are in red letters, and as you can see, four of them that are shaded in yellow are the four human coronaviruses that are responsible for anywhere from 15 to 30 of the common colds that we experience repetitively each year, usually during the winter months. Now, that was essentially considered really not particularly important series of infections until we got into 2002 and 2012 with the first and then the second pandemic coronavirus with sars, the Severe Acute Respiratory Syndrome, and mers. Some of you might recall that in 2002 would emerge from the quangdung province of china the Severe Acute Respiratory Syndrome which came from a bat, similarly to a cat and then leading to humans with about 780 or so, close to 800, deaths. This was the first of the recognizable coronavirus pandemics. Ten years later, in 2012, another pandemic coronavirus called middle east respiratory syndrome. This was a disease that passed from bats to camels to humans. It did not have the capability of spreading rapidly and still smolders somewhat in the middle east. I might add that sars was contained completely through public measures, identification, isolation, Contact Tracing and quarantine. It had a moderately efficient capability of spreading human to human, but good Public Health measures essentially eliminated it. Now lets get to the present time. The third pandemic coronavirus recognized as an unusual pneumonia emanating out of a wet market in the wuhan province in central china, literally within a period of ia couple weeks in early january, the chinese identified this as another strain of coronavirus that was put up on a public database. As you see here, it is, from a genetic standpoint, quite proximal to the original sars, thus the nomenclature was changed where the original sars became sarscov1 and mers became sarscv2. The original sars virus is called covid19 for coronavirus disease 2019 based on its recognition in december of 2019, and as mentioned a moment ago, the virus itself is referred to as sarscov2. So where are we now with that . This virus, as we all sadly know, has exploded upon our planet to be the worst outbreak of a respiratory infection in 102 years, since the 1918 spanish flu. Currently, as of yesterday, there were 56 million cases and over 1. 3 Million Deaths globally. Unfortunately for us in the United States, we are the country that was hit the hardest and continues to be hit the hardest by this outbreak with more than 11 million cases and now over 245,000 deaths. The current cases per 100,000 is shown here on this colorcoded slide with the usual dark being the worst and light being the lightest. Now, if you look at the risk levels in the United States by county, you can see where we are now in the hottest levels. We are in the processes ill get to in a moment of another resurgence as we enter into the much colder months of the late fall and early winter, and people go indoors much more than outdoors, in their gatherings with friends and with families. I want to point something out that i think is worth noting, is the difference in dynamics, response and baseline between the United States and the European Union. If you look at the blue, you recall europe, particularly northern italy, had their peak a week or two before ours. In fact, the new york city metropolitan area was seeded not from china but from europe, particularly northern italy. When they reached their peak with the blue line, they came down to a baseline that was quite low. In contrast, with the United States burst of cases dominated by the new york city metropolitan area, we never got down to a real baseline. Because as things got under control in new york city, we had outbreaks in various parts of the country, keeping the baseline at about 40,000 until we tried to socall reopen the country and reopen the economy. As you can see from june to august, we had a surge up to about 70,000 cases per day, which after a while leveled off and hung around 40,000 a day. A very bad position to be in when you enter into the vulnerable position of the winter months and people going indoors. As you can see right now, we, and European Union is right there with us, in a major surge of cases where we are now breaking all current records that weve had before with over 1,000 deaths per day over 100,000. The last was about 150,000 cases in a day. I testified before the congress a couple months ago when we were at 40,000 and said if we do not do Something Different and contain this, it is conceivable we would get to 100,000 cases a day. I was severely criticized by some members of the congress for being hyperbolic, and now weve been as high as 180,000 cases a day with hospitalizations over 70,000, and the numbers totality of cases i showed you a little bit ago. So why was there this difference of baselines . If you look in the United States and you look at a parameter of movement, namely how much did you actually shut down, well, in the United States, although we were talking about shutting down following the new york city outbreak, in fact, the percentage of people who visited parks and outdoor spaces that decreased looking at italy and spain as representative of the European Union, we did not shut down nearly as much as they did. We in the dark line, italy and spain in the lighter lines. If you look at presence in the workplace, in other words, how many people didnt go to the workplace, look at the shutdown in spain and italy versus the United States. And then if you look at grossry and Pharmacy Store visits, again, what you can see, that spain and italy shut down certainly much more than we did. So thats a glimpse of the epidemiology. Lets take a look at the virology. So what we see here is that something i told you and alluded to a moment ago. Its a beta coronavirus, an rna virus, so you would expect it to mutate somewhat. There were four structural proteins, the most prominent and important of which is the spike protein, whose receptor domain is shown in green there. Binding to the ace receptor, which is the cellular receptor, which is distributed widely in the upper and lower airways, the g. I. Tract and other organ systems, including the heart. This structure has been now determined in its prefusion form by Barney Graham and jason mclevin and others at the nih and is now actual the prototype immunogen thats used in some of the vaccines that ill talk about in just a little bit. What about transmission . Now, obviously this is a respiratoryborn virus, transmitted by the classic respiratory droplets which tend to drop to the ground within a few feet, hence, the sixfoot distance discussion that we have. However, recently it has been clear that a certain proportion of the transmission do occur for what we refer to as aerosol, namely particles containing virus that are light enough that they stay suspended over time and through various distances for various periods of time. The virus can be found on contaminated surfaces. The role in transmission is unclear, and the virus is found in multiple body fluids. But here again, the role in transmission is unclear and likely not significant. If you look at the risk of transmission, we know it varies by the type and the duration of exposure as well as the viral load in the upper respiratory tract. Transmissions are common among household contacts and in congregate settings and in those Health Care Settings where ppe is not used. Its reasonably good protection if Health Care Workers have adequate and appropriate ppe. But weve seen outbreaks in closed settings, such as cruise ships, Nursing Homes and prisons. The factors that increase the risk are crowded, enclosed spaces with poor ventilation. And, interestingly, it isnt only coughing and sneezing. But its singing, speaking loudly or breathing heavily. This is a typical example that is well known of an outbreak during choir practice in skagit county, state of washington, last march where a single symptomatic person indicated in red infected 87 of the group who were practicing their choir songs in an indoor space. There are also Community Transmissions at family gatherings. Ill get back to that in a moment as well as Church Events where people crowd together without masks. Right now today, in mid to late november, were finding that innocent occurrences such as groups of friends and family, meeting indoors because of the cold weather for dinner, are becoming a major source of asymptomatic spread to the group in the dinner party or in the social event. That seems to be driving infections much more so now than the more obvious settings of bars and other places, which also, obviously, are important but were having the contribution of these family gatherings. The cdc recently published some of the exposures and the risks that you have in different places. Note restaurants in the top there is very high among it, with gyms and bars and various gatherings such as Church Gatherings for social function, particularly in unmasked indoor situations becomes a high risk for transmission. And, again, as i mentioned a little bit ago, this is particularly relevant as we approach the thanksgiving season of which were in and next week being thanksgiving is the concern that as people travel and friends and family gather together, particularly given the percentage of asymptomatic spread, which well get to in a moment, is something that is a cause of concern and families need to make an individual decision based on those in the family that might be vulnerable, such as elderly and those with underlying conditions, again, all of which ill get into in a moment. The fundamentals to prevent acquisition and transmission are fivefold. The universal wearing of masks and face coverings, maintaining a physical distance that i mentioned a moment ago, the avoiding of crowds in congregate settings, particularly indoors and certainly wearing a mask must be done under those circumstances. Doing things outdoors better than indoors, this becomes a little more difficult now as we get into the colder weather. But frequent washing of hands. As i alluded to a little while ago, one of the most unusual aspects of this disease, this infection, is that about 40 to 45 of infected people are without symptoms. And we know now from modeling studies that a substantial portion of transmissions occur from an asymptomatic person to an uninfected individual, which makes Contact Tracing all the more problematic, particularly when you have a high degree of Community Spread the way we have right now. What about the clinical manifestations . Early on in infection, confusing matters is the fact that the presenting symptoms are often indistinguishable from a flu and a flulike syndrome. One exception, though, in a certain percentage of people, there is a curious loss of smell and taste which precedes the onset of the respiratory symptoms. Now, superimposed upon the 40 to 45 of people who have no symptoms at all, those who do, 80 or so have mild to moderate symptoms that does not require hospitalization or significant medical attention, other than staying home and waiting until the symptoms resolve, as significant as they may be. About 15 to 20 of people will have severe or critical symptoms, of which the state mortality rate varies from a few percent among those to about 20 to 25 for those requiring mechanical ventilation. This becomes so confusing when you have a virus, and ive never seen anything like it, where you go from no symptoms at all of a substantial amount to mild symptoms to situations where individuals, because of age or underlying condition, have a serious risk of highmore bidty and mortality. That is just so unprecedented to see a virus that can kill you and can cause severe morbidity and mortality, and yet so many people have absolutely no symptoms at all. Now, who are at risk for this covid virus . You see a dramatic variation between the discrepancy of hospital rate per 100,000 population of younger individuals on the lefthand part of the slide compared to the elderly as you get to the righthand part of the slide. A profound difference. When you talk about people of any age who have certain underlying medical conditions, there are those that are clearly associated with severity of disease, and that is individuals with the conditions on this slide. As you can see, i put these in alphabetical order. But the ones that dominate are obesity, diabetes and chronic obstruct acti obstructive pulmonary disease, as well as smoking. Obesity looms large in this. There are those who may confer an increased risk, but not as clearly as those on the prior slide, and that is hypertension and overweight and cerebral vascular disease and immunocompromised individuals. Those on chemotherapy, individuals who are immunosuppressed for a variety of reasons. Now, if you look at in our country, what percentage of people have an underlying condition . It is significant. About 40 . About 30 of the individuals are obese by the definition of a bmi equal to greater than 30. Thats important. Now, what about the manifestations of severe covid19 disease . The dominating manifestation is the acute respiratory dist

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