Dr. Anthony Fauci on the pandemic’s future.
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Strained Massachusetts hospitals will cut back on elective procedures starting Monday.
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Italy announced new restrictions for the unvaccinated.
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New Zealand plans to reopen to international visitors by the end of April.
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Dr. Fauci on the holidays, boosters and pandemic’s future
On the eve of Thanksgiving, we’re having déjà vu.
As in 2020, cases and hospitalizations are again ticking up in the U.S. ahead of the holidays, just as families begin to gather after another year of surges, stress and dashed hopes for a return to normality.
So, once again, in the prelude to winter, we turned to Dr. Anthony Fauci, the nation’s top infectious disease expert, for a look at what’s in store in the coming year. Our conversation has been condensed and edited.
Jonathan: We spoke almost exactly one year ago, before Thanksgiving 2020. Now we have the vaccines, but the U.S. is still averaging more than 90,000 cases per day, and we’re trending up again before the holidays. Where do you think we are headed during the next few months?
Fauci: The big difference between now and our conversation one year ago is what you yourself mentioned, and that is the vaccines. That’s the really good news. It is unambiguous that someone who is vaccinated has a very higher likelihood of being protected against infection, hospitalization and death compared to a very vulnerable, unvaccinated person.
The sobering news is that what we are starting to see, as the Israelis have seen before us, is that over time, usually measured in several months, immunity wanes. You start to see an uptick in infection, hospitalizations and deaths across all age groups — although it’s more pronounced with the elderly. When you look at the Israelis, when they boosted, they found a rather dramatic enhancement of protection that reverses the waning and gets you to the point where people who have been boosted are like 10 times less likely to get infected than unboosted people.
This means there is another moving target for us in the United States. If we want to start mitigating against a winter surge, we’ve got to start right now. We’re doing a good job because right now 30 million people have been boosted. We got to get that up to hundreds of millions of people boosted and vaccinated.
Adam: Do you think there’s a scenario where we would need another round of boosters, given the course of the virus?
Fauci: We don’t know because we’ve never been in this situation with this virus before. There were still many gaps in our knowledge. What are the possibilities?
It is conceivable that the third boost of an mRNA vaccine might actually be what should have been the original full components of an immunization regimen. But we didn’t know that because, when we were making the vaccine and testing it, we did not have the time to spend a year trying to figure out what the best dose of the best interval was. That’s one scenario.
The second scenario is that when we give a boost, that we get people through this winter and the spring, and then, all of a sudden a year later, you find out that my hope for durability of response isn’t true, and we need to be boosting somebody next year, or a year and a half, or two years later.
Adam: There have been more boosters given out in rich countries than there have been first doses in many poor countries. So how do you balance the benefit of the boosters against the potential rise of more variants when you have huge unvaccinated populations in the developing world?
Fauci: I think it is absolutely essential, and we have a moral responsibility to the developed world, to make sure that there’s equity in the global distribution of vaccines. We need the developed world to make sure that at the same time that they boost themselves, they have equity for the low- and middle-income countries. And in fact, in the United States, for every one dose that we give as a boost, or any one dose of vaccine, we give three doses to the developing world.
Adam: But isn’t vaccine manufacturing a zero-sum game? Ultimately, if we wanted to direct even more doses to the developing world, we could do that if we had a lower booster supply.
Fauci: Well, no, actually. Right now, unfortunately, many of the doses that are getting sent are not even being used, because of the lack of ability in distribution capability. I’m not saying that that’s an excuse, but you’ve got to look into that. That is a problem. So, I personally, and the government now is very keenly aware that we need to do both. We need to optimize the protection here with boosting at the same time — not before, or after, but at the same time — as we provide primary immunization doses to the low- and middle-income countries.
Jonathan: Do you think boosters are going to have a big impact on the pandemic if, one, not everyone’s getting them — uptake has been generally slow — and, two, if they’re not adopted by a wide cross-section of society?
Fauci: When you have a number of moving parts, with disparities of different groups, who — either willingly or because of lack of access — either don’t get vaccinated or don’t get boosted, then you’re going to have a disparity of the impact of the pandemic on different groups of people.
So if you look at the pandemic as a broad 40,000-foot phenomenon, and you have 62 million people, the way we have right now, who are not yet vaccinated — and many more people who might not get boosted — that’s going to have an impact on the broad concept of the outbreak. But if you take people who are vaccinated and boosted, they’re going to be walking through the outbreak and have much less of a risk than anybody else.
Adam: Why have we not seen a major variant since Delta that has really spread through the global population?
Fauci: It’s pure virology. Delta has adapted itself to be a highly, highly transmissible virus that has essentially bumped off the radar screen virtually every other one. We knew that when you look at how rapidly Delta took over the United States. It depends on the fitness of the virus to transmit. And it just so happens that even though there are a lot of other viruses out there that have different variants, Delta has emerged as the big bully on the block.
Jonathan: What do you think the virus becoming endemic looks like and when is this going to happen?
Fauci: You know, guys, I don’t know. We don’t know. The one thing I’ve said multiple times is that the multiple phases of an outbreak are pandemic deceleration, control, elimination and eradication.
There’s no way we’re going to eradicate, I doubt, because of the transmissibility that we just mentioned. I doubt very seriously whether we’re going to eliminate it, like we’ve eliminated polio, and we’ve eliminated measles, and a century ago we eliminated malaria from the United States. But there’s control and it’s going to be up to us what level of control that we are willing to accept.
If you’re willing to accept control at 70,000 per day, that’s wrong. No way we can accept 70,000, 80,000 infections a day. You have to get it down so low that it doesn’t impact, in a negative way, society. So we don’t worry about getting sick and dying. Our economy is essentially held hostage to it. That’s the control. When we get there, I can’t predict. I hope it’s relatively soon, and it’s going to depend a lot on how well we do in vaccinating the population.
Jonathan: How should people approach the holidays?
Fauci: What an individual can feel comfortable in doing depends on their status. So if you’ve got a family where people are vaccinated — the family’s vaccinated, the children who can be vaccinated are vaccinated, that kind of situation — people should feel very, very free and un-anxious about having an enjoyable Thanksgiving holiday. Those who are unvaccinated, they can also have an enjoyable holiday. They’re just going to do it at a greater risk.
For very young children who can’t yet be vaccinated because it’s not authorized yet, the best way to protect them is to surround them with vaccinated adults.
Adam: Last year we asked you what you’re thankful for, you very sweetly talked about your wife. What in the last 12 months are you thankful for — personally, professionally, or both?
Fauci: Well, I’ll give you one of each. I’m professionally thankful that we successfully did something that was unprecedented in the history of vaccinology. And that is, we went from the sequence of a virus to a vaccine that was highly effective and safe. And we’ve been able to vaccinate a substantial proportion, although not as much as I would want, but a substantial proportion of the of the population. That’s professional.
Personally, it’s the same thing. It’s no secret that I have been clearly targeted by rather radical elements who just keep attacking me every day, all day — Fox News, Breitbart — all those other crazies. And what I’m thankful for is what I said last year, that I have an incredible partner who is really amazing in her understanding of me and just keeps me grounded in reality when you have hand grenades being thrown at you every day. To have somebody that reminds you that what you’re doing is absolutely important for the health and the safety of the country, so don’t pay any attention to all that nonsense. That’s what I’m thankful for.
What else we’re following
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The European Centre for Disease Prevention and Control warned that the burden on European health systems from Covid will be “very high” in December and January unless governments ramp up prevention.
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Germany, facing a dire phase of the pandemic, got a new chancellor.
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In the largest revision of state vaccination numbers to date, the C.D.C. said it counted about 1.2 million more doses in Pennsylvania than had actually been administered.
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A claim of herd immunity is reigniting a debate over U.K. Covid policy.
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Republicans have fought Covid mandates, but as infections rise again, they are blaming the president for failing to end the crisis.
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Here’s a look at where cases are surging in the U.S.
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A photographer followed one pharmacist’s quest to bring health care to those hardest to reach in New Mexico.
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In today’s edition of the Morning newsletter, David Leonhardt has a guide to using rapid tests.
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Lisa, a star of the K-pop group Blackpink, tested positive for coronavirus.
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Two actors left the soap opera “General Hospital” over its vaccine mandate.
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Aaron Rodgers, the Green Bay Packers star quarterback, confirmed his toe injury was actually a case of “Covid toe,” The Wall Street Journal reports.
What you’re doing
Coping is a useless word. I’m not coping. I take all precautions seriously. My family, children, and grandchildren are all vaccinated and have had boosters. We were finally going to have our first small Thanksgiving when our 5-month-old great-grandchild contracted Covid from an unvaccinated attendee at a wake. She is suffering but hopefully strong enough to pull through. Thanksgiving is canceled again. Definitely not coping.
— Harriet Hersh, Bloomfield, Conn.
We usually host 25 family members for Thanksgiving. The dietary highlight is the dozen homemade pies. Last year we did Zoom pie eating. This year we will host everyone again: 20 adults and 5 children. House rules: all guests 5 and older fully vaccinated. All guests must be Covid-test negative within 5 days of arrival. Everyone agreed without protest.
— Thomas Benedetti, Seattle, Wash.
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We’re off tomorrow for the holiday, but will be back Friday. Have a safe and Happy Thanksgiving!
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