Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, and a member of the White House COVID-19 Task Force, discussed the current pandemic response efforts as the guest speaker for the first combined virtual Uniformed Services University-Walter Reed National Military Medical Department of Medicine Grand Rounds held in mid-August.
“It was an absolute privilege and honor to have Dr. Fauci speak to our military medical community today,” said Army Lt. Col. (Dr.) Jason Blaylock, chief of the Department of Medicine at WRNMMC. “As one of the world’s leading experts in infectious diseases, he has played a pivotal role in orchestrating our nation’s response to numerous infectious disease outbreaks over the past 40 years, and most recently to the COVID-19 pandemic.”
Fauci discussed the origins of the SARS-CoV-2 strain of coronavirus, and its subsequent transmission throughout the world, calling it the “worst respiratory pandemic we’ve had in 102 years since the now-infamous 1918 flu.” He said that, although the numbers change daily, currently there are more than 20 million cases worldwide resulting in 749,039 deaths. Fauci said that the U.S. has suffered the worst of the insult, with more than 5 million cases and 164,000 deaths to date. Although initially the northeastern U.S. was hardest hit, the southern and western regions now have the highest number of cases.
He gave an overview of transmission, risks for infection, and personal and public health preventive measures. Fauci also discussed how to effectively and safely bring children back into the classroom.
“We know from the American Academy of Pediatrics that it’s important that when children are not in school there are deleterious consequences that are psychological … and in some parts of the country, children depend on school for breakfast and lunch. The underlying predominant factor is the safety of children, teachers, etc.” He went on to say that there are different levels of infection within the U.S. that have been categorized as green, yellow, or red.
“With green, I can say somewhat with impunity, that it’s good to send kids back. Yellow: Schools must have the capability of mitigating any risk of infection through wearing masks, separating desks, [having children go] outdoors more than indoors, opening windows where possible, having susceptible children be online, alternating days, etc. And red: Be careful. Try to get the city, county, or state down to yellow. The best way to open schools is to get closer to green. The bottom line is, we’ve got to be flexible.”
Fauci also discussed the merits of conducting temperature checks at entrances to medical facilities, saying that the benefit of doing so is “marginal.”
“We have found at the NIH that it’s much better to just question people when they come in and save the time because the temperatures are notoriously inaccurate at times. At the NIH Clinical Center and at the White House, we’ve abandoned entry by determination of temperature for the following reason: It’s the middle of the summer; we’ve had what…15 days, 90 degrees in a row. I went to the White House the other day. My temp was like 103 until I took it in the air-conditioned car and then it was 97.4. When I tried to get into another facility, my temperature was 93, which means I probably should’ve been on a respirator. So I think we’ve just got to abandon that [temperature-taking], be prudent, ask questions, and do it that way,” he said.
During the Q&A session, Blaylock asked Fauci about the likelihood of reinfection by the virus once initially infected. “It has been purely rare and anecdotal. In every anecdotal case I’ve seen, there could have been another explanation for that. So, I can say that although we have to leave open the possibility, it is likely so, so rare that right now with what we know, it’s not an issue,” he responded. “We must be humble and honest enough to realize that as we gain more data, this could change, but based on what we know today, in the middle of August, there does not appear to be any indication that that’s occurring.”
Fauci talked about the virus’s ability to mutate and the impact to vaccine candidates, saying that SARS-CoV-2 is an RNA virus, so “it absolutely mutates.” He said that most mutations in an RNA virus do not have any functional consequences.
“We do know – and this is important – there has been now an association of a mutation of one amino acid to another at position 614 that leads to a better binding to the ACE2 receptor, which hints that it is going to be much easier to transmit. We need to get more definitive indication of that. I think it might actually be the case, but we don’t know,” he said, urging caution. “We took the structural confirmation and looked at where the mutation was and it doesn’t seem at all to interfere with any of the antibodies that are important that are being induced by the vaccine. So it may make something a bit more transmissible but doesn’t negatively impact the vaccine issue.”
Fauci was asked about current vaccine candidates and whether he had a sense of how long any of them might confer immunity.
“The answer is no. We’ll find that out. The reason is we don’t know it right now. We’ve given the vaccine in a Phase 1 study and Phase 2 study, which was just a couple of months ago, so we know it lasts a couple of months. Whether it’s three months, six months, a year, a year and a half, we just don’t know. We’re hoping that it lasts a full cycle of a season so that it protects, and if, in fact, it wanes, we can give it a boost. And that’s what we’re hoping for. We’re hoping we get sustained immunity but if we don’t, I think we can easily use a boost to bring it back up,” Fauci responded.
Fauci said that convalescent plasma as an effective treatment for COVID-19 infection is “suggestive, not definitive.” He said that the Food and Drug Administration is carefully looking at some data from non-placebo, controlled trials that were given on an expanded access program, and that within the next two weeks he will know whether there is indication of efficacy. “If not, then we’ll have to wait for the randomized placebo-controlled trial,” he said. He went on to say that there is suggestive evidence that it is protective if administered as early as possible in the onset of infection, and that they are currently collecting convalescent plasma to determine its potential uses.
Although grand rounds are typically localized events, the talk was broadcast live on social media by NIAID and WRNMMC to maximize exposure for providers throughout the Military Health System. More than 1,100 attendees tuned in live from around the country for the nearly one-hour session organized by Blaylock and USU Department of Medicine Chair, Army Col. (Dr.) Kevin Chung. Within 24 hours, the recorded session had been viewed more than 60,000 times combined on the NIAID and WRNNMC social media sites.
"This event was a smashing success by any measure. Goes to show what can happen when we combine the organizational talents of USU, Walter Reed, and the NIH,” said Chung. “We are grateful to Dr. Fauci for accepting our invitation to speak, and to NIAID and Walter Reed for allowing the event to be broadcast widely, not only throughout the MHS but also to the public."
“He is truly one of our finest leaders, and we are incredibly grateful that he was able to provide some remarkable insight into the many challenges that our military medical treatment facilities have been facing over the past several months,” Blaylock said.
The grand rounds talk was recorded and is available for viewing on Facebook.