Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease answers questions about COVID-19 vaccines, future testing, and treatment assessment. He offers recommendations to oncologists from the perspective of an infectious disease expert.
Twitter @PennMDForum Dr. Aggarwal’s physician profile Dr. Vonderheide’s physician profile Thank you so much, Dr Fauci. That was a very comprehensive overview off the current state of affairs as it relates to covert 19 and our future. And we have a few questions for you, Dr. Wanda High. Dr. Fauci, thank you so much. You're truly an inspiration. We appreciate your service and all your colleagues at the N i h. The questions air pouring in. And so we hope to get to as many as we can. Everyone is asking about vaccines, and when will the vaccine to be ready? And we really appreciate your comments on that topic tonight. But scientifically, could you share your insight with regard to what have we learned immunologically about this virus and about our immune response to the virus that would inform how best to make a vaccine? Not all the vaccines do all all the same things. Antibodies, T cells, CD, eight CD for what have we learned that can direct us best? Yeah, Bob, that's a great question. And we've learned a lot. But there are still some gaps that are going to wait. Actually, for the proof of the pudding in the clinical observation, what we do know is that the durability of protection both by anybody's that are measurable as well as T cell responses that are measurable but not Azizi tend to do in anybody tighter that in the common cold coronaviruses, the durability of anybody protection and actual clinical protection is measured in several months to a year and slightly mawr. And that's the reason why we keep getting reinfected with the same for common cold coronaviruses year after year, year after year. Now, is that going to extend to the situation of a pandemic coronavirus, which really is more of a systemic infection in those who become clinically ill, as opposed to the common cold, which is generally reserved or restricted to the upper airway? We don't know the answer to that. We do know that people who got SARS had immunity that lasted for well over a year. The question that you're asking, I believe that that underlies that very interesting, simple question is what are we gonna expect from a vaccine? A. Is a vaccine going to induce protection that would last for a reasonable period of time? Or are we going to be faced with the need to re vaccinate? Not because it's mutating, but because the durability of immunity is not the way we see with measles or polio or rubella. I don't know the answer to that, Bob. We're just gonna happen. Yearly yearly vaccine like the yearly flu shot type of. Exactly. But for a different reason, because I don't think it's gonna be mutating away from the vaccine protection. I think it's just gonna be durability of immunity. Okay, Charlie, what do you think are hoped for? Areas of progress. Um, for testing. What do we need to do to transform testing in the future? Should we be relying on saliva based testing or what do you think we should? Dio is going to get me in trouble, but Okay. You know, I actually, you know, there's testing for a couple of reasons. Charo. There's testing when you want to do the identification, isolation and contact tracing. And then there's the surveillance testing for public health reasons and a lot of the colleges of doing that. You test everybody before you let them in, and then you do surveillance testing a couple of times a week to see whether or not there is the insidious insertion of infection in the community. That's the kind of of infection. Excuse me of testing that we need for pure public health practices. Then there's another kind of testing that I would like to see. I would like to see a point of care, extremely cheap test that doesn't require relying on a supply of swabs where you could just spit into a little tube, stick a piece of paper in, look at it and say, I'm infected or not. And if you are and you feel reasonably OK, stay home. If you're not, then you could go out. I think that that would ease that extraordinary tension that people have about being restricted in doing anything because of the uncertainty. So the bottom line is, I think we really do, and we're doing it when I mean when I say we I mean the government, not me personally, is to really put a lot of effort into getting point of care test that virtually everybody could have any time they want it. Yes, the Dr Fat you some questions about treatment. So we're seven months into this pandemic, and how would you assess our ability to treat those who get infected it seems like there hasn't been a silver bullet, but yet we're doing better in terms of maybe hospitalization or the death rate. So are we. What happened? Did we just learn so quickly? Our frontline folks, What's going on with that? Yeah, there is a Gap Bob in early treatments. In other words, right now, what we really want to do, We know that with the severe and with Texan methods own, particularly that you can really have a significant diminution in 28 day mortality. What we really need to focus on is the primary, uh, anti virals that you give to a person as soon as they have a symptom, or you give it to someone who's infected and you want to profile, act them against getting symptoms. We've got to keep the vulnerable out of the hospital. So if you look at monoclonal antibodies, I think that that is gonna be a giant step forward in the treatment of early disease. The only thing wrong with that is that it is difficult to scale up quantitatively how much anybody you can get for the hundreds of thousands of people that getting infected. But that's the direction that we're going Give those antibodies not necessarily by vain, but by injection. Oh, I think we should be able to do with sub Q. I mean, that's the That's the endgame here to make it an outpatient procedure. Ciara Dr. Fauci, you spoke about this during your talk. Doctor Sharpless is article in science about, you know, predicting excess cumulative deaths from colorectal and breast tumors. This is largely an oncology audience tonight. Um, what are your recommendations to us? Is oncologists to, you know, as we normalize cancer care, what should What are the opportunities that we should not miss? And what should we be careful about? Well, you know, I'm not an oncologist, Tariffs. So I'm a little bit insecure giving recommendations. You know, one of the reasons I stay in pretty good shape is I don't talk about things I don't know, But what I would think just from a 40,000 ft look, you should try to get back to the normal type of screening that you've done as quickly as you possibly can. And if you could do that with the kind of testing that you asked for, you know, get people to come in test them when they're right out the door, get him in in 10 minutes and do the kind of screening it's It's people not doing the simple things that you all have done in the oncology community so well for so many years. I would use testing to get back to where you wanna be. Exactly. Yes, it's a major effort here as it is. That's very good advice. I was, uh, being reminded in the questions that in addition to the racial and ethnic disparities emerging in Cove in 19, we face that in cancer Major. And so now, a patient with cancer and being infected with CO. It's almost 22 disparities coming together. What? What can we do for these vulnerable populations? Um, to make a difference? Yeah, well, I get asked that question multiple times a day because, like just today, I spent two separate zoom sessions with the Congressional Hispanic Caucus and a group of Hispanics in the business field, and they ask the same question. So there are two things I think you could do about their the immediate things. And then there's the long range thing. The immediate things is to concentrate resource is like testing capability and access to care to the best you possibly can for co vid. For individuals who generally are in a situation where they are going to get infected more often, when they do, they don't get to care very quickly, and when they do, they don't even know they're infected. And when you don't know you're infected, you spread it in your own community, and that's when you get the exponential explosion. So those are the things now you try to concentrate. Resource is, that would have an impact. And that's mostly in the arena of testing in the long range. What I always say, It sounds very idealistic, and maybe it is, is that maybe we can use this horrible experience we're going through. So finally, get us to try and do something for the decades and decades long problem of the social determinants of health that allowed the minorities to be in the vulnerable position that they're in. It's not something we're going to cure overnight, but we need to make sure that we address that in the coming decades. I don't even say years. I say decades because you don't reverse social determinants of health overnight, but that's what it keeps coming back. Thio We see the same thing with HIV. E mean you have 13% of the population is African American. 45% of all the new infections are in African Americans. I mean, yes, it just repeats itself all the time.