Six months since Covid-19 was declared a pandemic, the world has learned difficult lessons on how to respond — and not respond — to such a crisis.

Anthony Fauci, who has spent nearly 40 years at the helm of the National Institute of Allergy and Infectious Diseases, is particularly well-suited to weigh in on what we’ve learned so far. He has helped steer the government response to a number of outbreaks, including the HIV/AIDS epidemic, and has now become one of the most prominent voices in the U.S. response to the coronavirus pandemic.

In a Harvard Medical School Grand Rounds session on Thursday, Fauci shared his takeaways on how Covid-19 has been handled and what this crisis can tell us about how to combat the next one. His remarks have been lightly edited for clarity.

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Don’t underestimate its impact

When you’re experiencing an outbreak, don’t ever, ever underestimate the potential of the pandemic. We’ve been through this before. Remember HIV. Five gay men, then 26 gay men, and then it’s only a gay man’s disease and then it’s this and then it’s that. And then fast-forward a few decades. You have 78 million people who have been infected, and 28, 30, 30-plus million have died. Don’t ever estimate [an outbreak] as it evolves and don’t try to look at the rosy side of things.

Stick to the science

Number two, we can do and should always do good, ethically sound, scientifically sound research during the outbreak. This idea of throwing everything to somebody because it’s desperate doesn’t work. It’s gotten us into trouble with other diseases. So let’s not forget the fact that although you want to get the best intervention to someone as quickly as possible, that there is a major role for ethically sound, controlled clinical trials. We have to do that.

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Adapt to new information

The other one is …. We’ve really got to realize that, from day one, you don’t know it all. And you’ve got to be flexible enough to change your recommendations, your guidelines, your policies, depending upon the information and the data as it evolves. If you look at what we knew in February compared to what we know now [about Covid-19], there really are a lot of differences. The role of masks, the role of aerosol, the role of indoor vs. outdoors, closed spaces. You’ve just got to be humble enough to realize that we don’t know it all from the get-go and even as we get into it.

Address existing health care disparities

And finally … if ever there is going to be a real incentive for us to now make a commitment to address the social determinants of health, it’s got to be now. We’ve seen it with HIV. … We have 13% African Americans and close to 50% of new [Covid-19] infections in the United States are African Americans. We have 13% African Americans and now look at the number of hospitalizations with Covid with African Americans and Latinx. We have got to address that. This has to be a real eye-opener for us to do that.

I’m sure there are many more lessons, but those are just a few.

  • There should be a law that a President can Never dictate the course of action regarding a Pandemic. We should be planning for the next by insuring/investing in more hospital beds, arrangements with Pharmacy companies and manufacturing firms of all related PPE to be ready to beef up production. There was a similar plan but Trump killed it.

  • I have a lot of respect for Dr. Fauci and I realize he has a tough job dealing with Trump, and he is taking risk to be out speaking and dealing with people generally, he could get sick, particularly if those around him are not careful.

    But, the lessons I would take forward, the big ones:

    1. Despite modernization and incredibly rapid advances in their technical level, some countries still have a political system which can not be at all trusted- China’s inherent corruption, their political system which allows extreme punishments for any perceived criticism, allowed the local officials in Wuhan area to silence the heroes trying to warn their fellow countrymen and the world about the new disease. Following that, on the national level Xi JinPing lied to the world about human to human transmission of the disease. Certainly the doctors getting sick from their patients in Wuhan in December 2019 knew the disease was highly contagious – unless he was mislead after months of the epidemic, Xi knew.

    So, a society advanced in technics, including medicine and virology – if corrupt – can be as bad as just about anywhere.

    I know the US did not do a great job either – so that was, in my view, a combination of Trump, deBlasio (the worst performance of any elected official in the US IMO), Cuomo and Dr. Fauci’s mistakes. But the biggest villians by far are government officials in China.

    So, the lesson to be learned is, we need to SPY on them, extensively, never letting up on this – hindsight is 20/20, but it is clear now we should have had specially trained people in Wuhan getting virus samples and sending or carrying them back.

    • 2. Another thing to be learned – the public health response of New York City – and every state public health department – by tradition, and because he controls international travel, the President is the most important official – BUT, New York City Public Health Dept, according to their website, is one of the biggest in the world and has a budget of $1.6B – and 6,000 employees – but NYC was probably the worst entities in the history of the epidemic.
      Partly in bad synergism with New York State- but also deBlasio being blinded by his good intentions – they would not close schools – deBlasio said the kids needed their free lunches – they did not close bars and restaurants – they did not enforce prophylactic measures in public – and though I blame Fauci then Trump for not pushing mask wearing – with a budget of $1.6B, was there no one in NYC Public Health making independent evaluations of the evidence?

    • Not to rant on and on but in 20/20 hindsight, there should be some duplication of effort, and the states with the resources to independently evaluate the science should do so and take aggressive action on their own to protect themselves. The states should not be so utterly dependent on the Federal Government, especially if they are large enough and wealthy enough to take actions on their own.

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