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Dr. Sanjay Gupta Interviews Dr. Anthony Fauci. Aired 1:30-2p ET

Aired August 05, 2020 - 13:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

[13:30:00]

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES: I think, the most part, we've been through some terrible times. And once you realize that everybody's in it together -- you know, when we had 9/11, everyone was frightened. Particularly because we had anthrax after that. And that's how I got involved. And you and I spent a lot of time on TV talking about that.

When that happened, everybody felt threatened. So there was this kind of synergy among different demographic groups about hold together as a nation.

Now, there's such a divergence of how people view this and such a divisiveness that is now crept into the political -- remember, a little while ago, you know, it depends whether you wear a mask on how you feel politically, which was completely ridiculous, because a mask is a public health tool. It doesn't make any difference, and yet we've gotten into this.

So the atmosphere that we're in right now is not conducive to -- you know, to the kinds of things you're talking about.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: I do want to talk about the certainty by which we speak of things. You know, I was making a comment the other to someone, Dr. Fauci, that science, health science for public health is not like math. It's not two plus two equals four. There's a process by which we arrive at conclusions and things like that.

When you talk about these five things, wearing a mask, physical distancing, avoiding large crowds, et cetera, how confident are you that those strategies would work?

FAUCI: Well, good. That's the good question. And you're leading up to something that we've discussed a lot over the months and years, Sanjay.

GUPTA: Yes.

FAUCI: That is -- I mean, the scientific process is one that's inherently self-corrective, because you look at data at a given time. You make a decision, a policy, a recommendation, a guideline, whatever want to say, based on that. But the true nature of science is that, particularly when you're in an

evolving situation, you've got to be flexible enough and humble enough to say, you know, two months or three months down the line, we're starting to see a different set of data and a different set of facts that we may want to modify a bit the kinds of decisions and recommendations that we make.

It can't be -- if we were in a completely static situation, the facts wouldn't change. I mean, it just doesn't change.

But we have uncharted territory where have something brand new, historic, nothing like it in 102 years, and it's evolving.

GUPTA: Yes.

FAUCI: As it evolves, that's when you make your recommendation, and particularly things like masks and crowds, indoor/outdoor, aerosol/not aerosol.

These are things we're learning as time goes by. And you do the best you can to make the recommendation based on the data that you have right now.

GUPTA: We do this thing, beginning of the town halls that you've been so kind to join us at, called "WHAT WE KNOW, WHAT WE DON'T KNOW." Let's stick to a couple of basic science questions.

We know this is a virus, correct?

FAUCI: Correct.

GUPTA: Do we know this is a novel coronavirus, novel, meaning unique, something the world hasn't seen before?

FAUCI: Yes. Well, we know the class of virus it is. It's a coronavirus. So the world has seen coronaviruses before.

But if you look at the incredible data bank you have, and go in, you can see that this virus was not in humans. It was evolving in bats to a point where it was very close, likely jumped to an intermediate host, and now it's in humans.

So I am certain that from what we know now and the data available that we've never seen this virus before.

We've seen coronaviruses, as you know, coronaviruses, the benign ones, before, that cause human common colds, have been around forever. And they cause anywhere from 15 to 30 percent of all the common colds that you and I get every year. But this one is new.

GUPTA: There was some recent literature about the fact that there was evidence of T-cell reactivity in 40 percent to 50 percent of the people who were studies, whose blood samples were studied. T-cell reactivity, part of the immune system.

If people have not been exposed to this virus before, how could they have this T-cell reactivity? And is that a good thing? Is that potentially immunity?

FAUCI: OK, I'll tell you what we do know and tell you what we, hopefully, will find out because we're going to start looking at this.

Yes, T-cell immunity has a degree of specificity, or even lack of, so that you could have been exposed to coronaviruses the way that you and I were sure exposed to and you could develop antibodies that likely will diminish over time.

[13:35:17]

But you would have T-cell memory there that could likely cross-react with the current coronavirus.

If that's true, Sanjay, now you've got to get into the realm of are there T-cells that recognize coronavirus? Fact. Yes.

Do those T-cells protect you against the coronavirus we're facing? I don't know. But we're going to try and find out.

Because it is likely that, if they really do recognize epitopes on this particular virus, it could explain why some people, particularly children, who might be closer to the response of the common cold coronavirus, why they may be not getting ill.

Now, how do you do that? You screen a whole bunch of children, and you find out if they have these T-cells, more than adults.

So that's one in which you can make a reasonable assumption, but you don't declare it a fact until you get the data. And that's what we want to do.

GUPTA: Along those lines, there's clearly been some data on who is most vulnerable to getting sick, or even dying from this, people who are elderly, people who have certain preexisting conditions.

Yet, there are these stories, as you know, Dr. Fauci, of young people, seemingly otherwise healthy, maybe not kids, but in their 30s and 40s, not vulnerable patients who also get very sick all of a sudden, and need the ventilator, need to be on medication and all of this.

Is it still random or do you have any better idea why some of these other patients get so sick?

FAUCI: Yes. The answer is we have some clear idea, and there's still some things that are unknown.

So in the typical biological world that you and I live in, there's a famous bell-shaped curve. OK?

So if the big part of the bell is the people you know have a higher degree of likelihood of a serious outcome, the elderly and those with the underlying conditions we know so well, diabetes, obesity, hypertension, cardiovascular disease, et cetera, they have a much higher likelihood.

You look at data. Data nails that down. And 90 percent-plus of the people who die are over a certain age.

Then you get the people on the tails of the bell-shaped curve. And that is the people who are young, seemingly healthy. And we're seeing more and more of them who get a serious outcome to the point they get hospitalized and sometimes die.

I have to tell you, without any names, I have, even close to me, in the brother of a very close relative of mine, a 32-year-old young man, vibrant man, otherwise healthy, got a typical coronavirus infection, got symptoms, developed a cardio myopathy and died. That happens. That just happens.

It isn't the -- the majority by any means. Because if you look at the bar graphs that you're familiar with, when you look at the hospitalization per 100,000, and you look at the age, it goes like this. Where it's hundreds per 100,000 when you're an elderly individual. And it's like four to five when you get down here. There's no doubt.

But that doesn't mean that there are individuals there who are not going to suffer like the person I'm referring to.

However, we don't know why. I mean, if a person had diabetes or obesity, good explanation. But some people are otherwise perfectly normal.

Is that a genetic thing? Don't know. Is that a big expression of ACE-2 receptors in their airways and lungs? Could be. We don't know yet.

And that's where, when I say, Sanjay, we've got to be humble that we don't know. We can give the possibilities, but we don't know.

GUPTA: The things we talk about, like this and this will come up a couple more times, are they knowable and we just don't know yet? This gets back to the intricacies of science.

Again, you say this -- and I'm sorry to hear about your friend's brother.

FAUCI: Thank you.

GUPTA: I have a friend, a nurse, I know as well, 34 years old who died. And the question that comes up, I think, from families, obviously, and people, was there any way to have known and predict. You're saying, no, at this point. We don't know.

But is it knowable? Will we know at one point that a 30-year-old, despite otherwise a fine medical history, is vulnerable to this disease?

[13:40:05]

FAUCI: Could be genetic. It could be -- we know from good studies there are certain infections that some individuals can lead a perfectly normal life so long as they don't come into contact with a particular pathogen. It isn't every pathogen. You know and I know, and probably many viewers, that if you have a

true immunodeficiency, there are multiple infections you are susceptible to.

But there are some genetic polymorphisms where you have a defect that would never bother you at all unless you came into contact with a particular virus, like a herpes virus or whatever, and then all hell breaks loose.

It could be that. And we can find that out with enough clinical experience.

GUPTA: Let's get to another question. This one coming from Professor Joe Allen at the School of Public health.

(BEGIN VIDEO CLIP)

JOSEPH ALLEN, PROFESSOR, T.H. CHAN SCHOOL OF PUBLIC HEALTH, HARVARD UNIVERSITY: I'm asking about the airborne transmission and healthy buildings as the first line of defense for coronavirus since February. Having done forensic investigations of sick buildings, there were telltale signs from the cruise ship, bio-gen outbreaks, that airborne transmission was happening. And we had examples from SARS and MERS that airborne spread could happen.

Basically, to me, we knew enough to act at that time and there seemed little downside in taking precautions like higher ventilation rates and filtration. Every piece of evidence since then has supported this hypothesis. In fact, experts in my field wrote a letter to WHO, 239 of us.

Why do you think CCC (ph) and WHO have been reluctant to acknowledge airborne transmission? Do you think airborne transmission is happening? If so, are you a proponent of including healthy building strategies, like enhanced ventilation and filtration and the sweep of control measures people should take, including mask wearing, hand washing and distancing?

And thanks for your work.

(END VIDEO CLIP)

FAUCI: Great question. I'm glad he's one of the signatures of that -- of that the letter sent.

This is an area, that right now, I have brought this myself to the task force to really take a really good look at this. And what the individual was saying is something, again, about the humbleness of science.

We were always hearing that the six-foot distance, saying that if you have a particle that's greater than five micrometers, it's likely going to fall down. If you have one that's less than five micrometers, then you can get aerosol floating.

That was embedded in the literature, until some very smart -- and I'm going to be on a conference call with them in a next couple of days, maybe tomorrow, I don't know -- write to me and say these are people who make a living with the physics of particle and aerosolization. Not reading the literature. This is what they do.

And they say, you know, you really better take a bigger look at this. Because from what we know about particle physics and air flows, that there may be droplets much larger than five micrometers that continue to go around, which means it gives you some pause to think about, do we know what to do and should we investigate, and make some changes. Exactly what that individual is saying?

What about -- I mean, it gives you a greater reason for wearing a mask at all times. But it also tells you that outdoors will likely be much better than indoors. That when you are indoors, you've really got to look at what the circulation is. And should you be doing things like filtering? With epi-filters?

These are things that are unknown now, but that we are going to address, because it's something that has always been kind of hanging out there without really understanding the role of aerosol.

And importantly, Sanjay, exactly what aerosol is. I mean, here we are, we're going with a's definition of a particle size, and then you get people who really know what they're talking about tell us, wait a minute, you've got to relook at that because it isn't what you think.

So I'm going to -- not me personally. Yes, me personally, but with the team at the task force, are going to take a careful look at that.

GUPTA: Coming back to the point that we keep hitting on, the pace of science, how we know something is conclusive. Maybe because I'm a surgeon I get impatient.

But take something like this issue, shouldn't we know this by now? Whether it's a potentially aerosolized virus versus something that spreads via droplets alone?

It seems we could, given we're in the middle of the worst public health crisis, and that's such a salient central point, why don't we already know the answer?

[13:45:06]

FAUCI: It's not an easy answer to get, because you can talk about droplets that hang around. The question is, you've got to do a study to show that the virus actually transmits that way. And when you do it, you've got to do it in a VSL3 facility, of which there are limited amounts.

So right now, as we're speaking, even before I got on, we were on the phone with all the different groups that are saying, here's an important question, we better answer it, and we better answer it quickly.

However, it's not going to change much. What it tells me, that if this is true that aerosol plays a much greater role than we think, then, for goodness sakes, the five or six things I mentioned beginning of this discussion are in spades what you've got to do. You've got to wear a mask, avoid crowds, outdoor better than indoor, all the same stuff.

GUPTA: It also makes a strategy with regard to ventilation inside buildings, especially as we think about kids going back to school. If we have the answer to this aerosolization question -- let's just assume it is, yes --

FAUCI: Right.

GUPTA: -- that it is aerosolized, can be aerosolized. What does that mean then for indoor buildings as kids go back to school? Do you see special filters, HEPA filters, have to be in place?

FAUCI: Those are things that are actually being discussed.

But the one thing you can do is try and say as best as possible, particularly in a climate you were do it, keep the windows open. I mean, that, to me, when dealing with a respiratory virus, it's simplicity. It's so, so obvious that people don't pay attention to it.

Like you tell me, we've got a big crisis and you're telling me to open up a window? Yes. I'm telling you to open up the window.

GUPTA: Let's keep going with another line of thinking here. This is a question from Professor Mary Bisset (ph).

(BEGIN VIDEO CLIP)

MARY BISSET (ph), PROFESSOR: Dr. Fauci, before I get to my question, I just want to say a couple of things.

One is how relieved and proud we all are that you continue to navigate the corridors of power in defense of the public's health.

As you know, we have documented very large racial disparities in the occurrence of COVID-19 both in infection rates and in mortality. A lot has been said about co-morbidity but not much said about exposure.

Of course, in public health, our main interests is always in what we call primary prevention or reducing exposure.

Could you talk a little bit about that? My this, I mean exposure at home. Exposure while getting to work. And exposure at work, if you have to continue to work outside of your home.

FAUCI: Yes. Thank you, Mary. Great to see you again.

Mary and I were in contingent to be colleagues.

Great to see you again, Mary. Thank you for the question.

So when I talk about the -- the racial and ethnic disparities among minorities, including, in particular, African-Americans, Latinos and Native Americans, I call it a double negative disparity. First of all, whether or not you have a greater chance of getting

infected. One does not like it as a generalize when dealing with ethnic demography, racial demography.

The fact is that the likelihood that an African-American or a Latinos has a job that would require their being in a risk situation is greater than those of us who have a job where I can talk a computer and be completely safe from getting exposures.

They are part of the workforce that comes into contact with people. So right from the get-go, you have the likelihood much more than others of getting infected.

The second part of this double negative whammy, that I call it, is that, because of the social determinants of health that has been decades and decades in the making, that African-Americans and other minorities have a much greater incidence and prevalence of the underlying conditions that lead to a severe outcome.

And those are the ones that are so familiar. Because we, as physicians, see it all the time, diabetes, hypertension, obesity, renal disease, cardiovascular disease. Those are the kind of things that make that death rate very high in that group.

And if you look at the disparities that Mary talked about, I mean, if you look at the hospitalization per 100,000, in African-Americans, they are at least five times what whites and Caucasians are in hospitalization all other parameters being equal. And it's because of that that we get these extraordinary disparities.

[13:50:18]

Now, you can do something about the immediate. And you need a commitment, a decade's-long commitment looking forward to getting rid of the others.

The things we can do now is to make sure we get things like testing availability and availability to get immediately into care in those areas, those regions, those counties, those cities, that are over- represented with the demographic group that's at risk.

We can do that right now. We have an obligation. In fact, as part of the NIH's RADx, that you're familiar with, Sanjay, because I know you spoke about it on your program, that there's an underserved population, in which we're trying to create the infrastructure that we get these diagnostics to these individuals so they can get diagnosed quickly and get into care quickly.

GUPTA: It's a question about testing that comes up quite a bit. As I mention, I've got three girls who are going back to school and there's a lot of question about testing at their school, should it happen. We've talked, you and I, a few months ago, about needed breakthroughs in testing.

Leaving aside the numbers, for a second, of tests that we need, what is a breakthrough in testing look like? You're testing for the virus. Can you get a breakthrough that allows widespread testing that is rapid, that is accurate, that is actionable in some ways? And if so, why aren't we there yet?

FAUCI: You just described it perfectly, Sanjay. That's exactly what we need. And that's exactly what -- I have been pushing for some time right now, as you know. I've spoken to you about this both publicly and privately.

We don't have it yet. I hope now, with the investment that has been made about really getting point of care under the characteristics you're talking about. In the perfect world -- which I think we can get there. We're a rich country. We've done amazing things -- to get a test that is very specific.

Because right now, you have tests that you want to determine if an individual is infected for contact tracing.

The weakness of that is -- although in some areas it's doing fine, in others, the gap between the time you get the tests and the time you get the result, in some respect, only obviates the reason why you did the test. Because if you have five to seven days, we've got to correct that.

But we've got to do even much better than that. The ultimate goal is you have a test you could do and get a result in 10 minutes, that's sensitive, specific, and can be upscaled in the sense that you can do, at any place and anywhere, where you could have schools and working places, where you could tell somebody's infected or not.

Now obviously, people will say, well, if you're not infected now, do you know tomorrow? That's true. That's absolutely true. But it would still be good from a surveillance standpoint to get your arms around what the totality of infection is.

Right now, what we're trying to do to decompress the load -- and we were talking about this just today on a phone call, and yesterday, at the task force meeting -- is to get surveillance testing done in a way that you don't absolutely need to crowd out the testing that you need to know tomorrow whether someone's infected.

When you're doing surveillance, like you need to know in the general population, you can give it to universities, get them get their tests activated, and decompress the demand when you get a surge of infections, when you need to do contact tracing.

If we do that, I think we can get those days down. But what we ultimately are what you just proposed.

GUPTA: And I don't want to keep belaboring the point. But one has to ask why don't we have it yet? If this is doable. I'm not asking for a fantasy here.

I got to tell you, Dr. Fauci -- I made this case to Admiral Giroir the other day. I was in the operating room this past Monday. I got a CAT scan on my patients, got coagulations numbers on my patient, got a cardiac echo on my patient, I was performing brain surgery on this patient. Could not get a COVID result.

As a result, we all had to put on N-95 masks, use PPE, which is also hard to get, put ourselves at increased risk.

A COVID test, even within the situation, why do we have the situation I described?

[13:55:09]

FAUCI: You know, Sanjay, I could bend myself into a pretzel trying to get out of that question. It's unacceptable, period. And I don't know why, because it's not what I do every day.

But I can tell you they're trying but -- obviously, again, when you say something like that, it gets distorted. You are a real-world example of why we've got to do better.

I mean, to say -- and I know, I've been in situations like that. I can get things done medically so fast it will spin your head. There you were in the operating room having to put on PPE because you didn't know what you patient -- I mean, that is totally unacceptable.

And for me to say anything different is distorting reality.

GUPTA: Well, I appreciate that.

And I'm not trying to put you in any tough spot. It's just that --

BRIANNA KEILAR, CNN HOST: So, we've been listening to Dr. Sanjay Gupta and Dr. Anthony Fauci as they've been talking about the state of affairs with the coronavirus.

So much here we heard from Anthony Fauci. He detailed a lot of things including the fact that his family has received death threats, that his children have been harassed, his grown children.

But he also talked more broadly about the pandemics, saying that everyone needs to be essentially rowing in unison when it comes to public health measures. And he said they're not. And he lamented that the atmosphere is not conducive right now to that happening.

And he talked about all of the things that need to be done.

So, we're going to be looking to this in a moment with a viral specialist. We'll be right back after a quick break.

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