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Anthony Fauci, the country’s top infectious disease expert, said Tuesday he should have more aggressively pushed the federal government to flood communities where the coronavirus was starting to spread with testing early in the U.S. outbreak.

“It never became a reality because we never really had enough tests to do the tests that you had to do,” Fauci said Tuesday at the STAT Summit, referencing the testing that needed be conducted to confirm Covid-19 infections in people who were showing symptoms of the illness.

If communities could have implemented widespread testing, it could have helped slow transmission before it took off explosively, said Fauci, the director of the National Institute of Allergy and Infectious Diseases.

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“Community spread doesn’t stop spontaneously unless you do something about it,” Fauci said in an interview with STAT’s senior infectious diseases reporter, Helen Branswell. “It is easier to stop when the level is relatively low. The only way that you can get at community spread is that you need to test people who are without symptoms, in order to show what the degree of penetrance of infection is.” (It can take a few days for people who get sick from Covid-19 to start showing symptoms, and some people never show symptoms, but they can all still spread the virus.)

Fauci said he raised the idea of mass testing early in the U.S. response, but that his message was not heeded. He acknowledged, however, he could have tried harder.

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“Deep down, perhaps I should’ve been much more vocal about saying, we really absolutely gotta do that,” Fauci said.

“I said it, it went nowhere, and maybe I should have kept pushing the envelope on that.”

Snafus and limitations in the U.S. rollout of Covid-19 testing has been identified as one of the major problems of the federal response. The Centers for Disease Control and Prevention initially launched a test that had flaws and wasn’t usable in a number of public health labs around the country. Policies also restricted testing in most cases to people who had traveled to other countries where the virus was spreading, even after the virus started circulating domestically.

Regulators were also slow to allow commercial tests on to the market. And shortages of the supplies needed for tests have been an issue for months.

Asked about his experiences working with President-elect Biden, Fauci said the former vice president has a “considerable, in fact, if not profound” grasp of and appreciation for science, though he said the two have not spoken since Biden left office four years ago.

Both Fauci and Biden have expressed their desire to start working with each other, but President Trump’s refusal to concede the election has stalled the process.

Fauci worked with Biden during the Obama administration’s response to the West African Ebola crisis and said during those meetings, “not infrequently at all the vice president would come in and listen and contribute to the discussions about how we were handling Ebola.” He also noted that Ron Klain, whom Biden has tapped as his chief of staff, served as the Obama administration’s Ebola “czar.”

Biden stressed that he would respect and listen to scientists during the presidential campaign, contrasting his approach with that of Trump, who has repeatedly downplayed the coronavirus pandemic and undermined his own health officials’ recommendations.

Biden’s interest in science in part stemmed from his son Beau’s death from brain cancer, Fauci said, which led Biden to spearhead efforts to develop better cancer therapies.

“He got very much involved in talking to scientists and talking to mostly oncologists, but all kinds of scientists,” Fauci said.

Fauci did praise the Trump administration’s Operation Warp Speed program, particularly for its success in expediting the development of Covid-19 vaccines. Going from the discovery of a new pathogen to multiple vaccines reporting Phase 3 clinical trial data in less than a year, Fauci said, “is beyond historic.”

The federal government has spent billions on vaccine research, trials, and manufacturing — initiatives praised by public health officials in and out of the government. Much of the money went to building a supply of vaccine candidates before they had proven their safety and effectiveness, so that the immunizations could be deployed as widely as possible as soon as authorized.

In recent days, Moderna and a collaboration between Pfizer and BioNTech have reported their vaccines have greater than 90% efficacy in preventing symptomatic Covid-19, which are wildly positive initial results. Fauci said he hoped millions of doses of both vaccines would be available by the end of the year, though he noted that time frames “slip sometimes.” He acknowledged that so far, scientists don’t know how long that protection lasts, but that researchers will keep studying the question, which has implications for when people might need a booster.

“I take one step at a time,” Fauci said. “I’ll take the 94.5% effective for now,” he said, referencing the results of Moderna’s vaccine, “and we’ll worry about the durability of the effect” next.

Fauci stressed, however, that “a substantial proportion of the population” needs to get the vaccines as they become available if the country is going to get back to any sense of normalcy. He said the positive vaccine news should hearten people to keep up with Covid-19 precautions, such as masks, distancing, and avoiding crowds, for a while longer because the tools that could help reshape the pandemic are coming.

“A vaccine should not be considered as a total substitute at this point for public health measures,” Fauci said. “In my mind, it should be an incentive for people who have Covid fatigue and are really tired of public health measures to say, you know there is light at the end of the tunnel, help is coming, let me hang in there a bit longer.”

“If we could just hang on enough to do that until we get enough people vaccinated to turn around the dynamics of the outbreak, we will be OK,” he added. “We will be OK.”

Despite the challenges of the pandemic, Fauci, when asked, said he had never considered quitting.

“Not even close, no,” Fauci said when asked if he had ever thought about leaving his position. “It’s not even in my DNA. To quit? I’m a public health official, I’m a scientist.”

When asked if he was considering retirement, Fauci, who turns 80 next month, said that he would step down if he couldn’t give 100%, something he and other people, including his wife, looked out for.

But for now, he said, “I feel and I’m pretty sure that I’m on top of my game.”

This story has been updated with more from the interview. 

  • This is a fine article about a great man, Dr. Anthony Fauci. His honesty is so refreshing and welcome! If he approves of these vaccines, it will encourage many people to get them which is paramount now. Thank you for this article and thank you, Dr. Fauci, for your honesty and directness!

    • Maybe well intentioned, but great? I don’t think so. He advocated against wearing masks early on. Either he knew masks worked and was lying or really believed masks wouldn’t make a difference and was naive. He was a student of the 1918 flu pandemic and should have known masks made a difference. If he says he was trying to save masks for healthcare workers and those at risk, then he was deceiving the general population and at least his ongoing credibility should be held in question.

  • There may well be a good reason, but I do not understand why, if mass population testing was not feasible across the country, which is plausible, then repeated survey sample testing of deliberately chosen population strata wasn’t done in order to inform actual take-up of the virus, and its spread. I mean, this is exactly what market researchers do to understand the effectiveness of advertising campaigns.

    It’s possible that the consumers of this information at the top levels of the administration were not open to being informed by these results. It could be many other things. But, in the absence of resources to do comprehensive testing, and solely to inform policy, this is what I would have done.

    Moreover, it could have been done from the baselines of what tests were administered as long as the descriptive and metadata associated with patients being tested were available. In other words, in the set of tests performs, after the fact, take the appropriate random samples and strata and conduct the prevalence assessments needed.

  • even biden with his respect for science can’t lead us through the pandemic if no one discusses policy.

  • As if screaming louder would have made any difference. Most sentient beings have a pretty good grasp of where the fault lies.
    This is a NOVEL coronavirus; Fauci should not be blamed for not knowing beforehand what would be needed to manage the pandemic.

  • I understand the praise for Fauci as he is the only face of the administration that has any intelligence. HOWEVER, a true leader knows how to lead up and stand by his conviction. A little late know to say he should have done better as it won’t bring those people back who were failed by him.

  • Anthony Fauci is an American hero of the highest order. He should not be hard on himself for not advocating for increased testing more vigorously. He did advocate for testing, along with masks, social distancing and the other health measures that are our only defense against getting Covid until we are all vaccinated. He had to work in the shadow of a corrupt and self-serving administration which was not at all concerned with the well-being of the American public. Somehow, despite all the efforts to quiet him and the CDC and the FDA, Tony Fauci got his message out. Thank God for Anthony Fauci. Donald Trump is the one who will have to answer for his criminally-negligent ignoring of science in his response to Covid and the tens of thousands of unnecessary deaths he caused.

  • I suggest we proclaim a National Dr. Tony Fauci Day not after the pandemic finally subsides but now when the conviction that he is a living national treasure of truth and wisdom will and should give covid fatigue a reason to know its end and not ours is nigh.

  • Dr Fauci is a bright epidemiologist for sure in fact he went to the same school I graduated from in 1979 with honors ; the one problem I have with most media stories regarding this virus covid 19 is they criticize many people regarding their response to this virus but if one looks overseas and around the world almost all countries had similar problems with the virus but are never mentioned in these articles

    • I noticed this, too, Geoff. The only countries to escape were isolated islands, areas of Africa, and the far east. In the far east countries were prone to wear masks before covid hit. Also, SARS covid 1 could have given some cross immunity. It’s probably going to be years before we have the truth. One thing I am grateful for…fewer are dying because treatment seems to have improved.

  • I respect Dr. Fauci, and he has had a very frustrating year, risking his life, as a man who is 79 years old, trying to distance but with people who will not cooperate at all.
    BUT, three things I think he got wrong.
    The first one is contact tracing. As he says, they did not have the tests. But I also think he is subconsciously doing what most people do when they have nothing else- going to the familiar and comforting – contact tracing is an old standby of public health – since Typhoid Mary I guess ? And it works for TB and VD – but the Wuhan novel coronavirus -is not like TB or VD at all – a carrier of TB or VD can have it for years- certainly not two weeks like Wuhan – and, if contacted successfully, that person has high motivation to get treated and stop spreading – the TB patient does not want to die – the VD patient does not want to drive away sex partners. With this virus, by the time you find someone, because someone they were in close contact with discovers they are sick, the contacted person may be already better – and, large numbers of people will get infected on very casual contact, unlike TB and VD. Was it ever realistic to try to trace it?
    My second point is, the ambivalence about mask usage – Trump made it worse, but CDC would not say masks were important, very early on, when the epidemic was raging the most (I know, far more cases now but the growth as a percent of existing cases was probably highest then). We were later told healthcare professionals needed the masks, so they wanted to prevent us from buying them all – but is that justification? Bad homemade masks are supposedly “50 % effective” – if that means reducing new cases by a factor of 2, that would have been huge.
    3. And my last rant, the refusal to do human challenge testing of the vaccine candidates – it’s been reported both the Moderna and the Pfizer current vaccines were first produced, and began testing, in March and April – obviously, the future of the pandemic could not be known perfect, but the approximate 1M deaths since then were mostly foreseeable – aggressive human challenge testing might have saved hundreds of thousands, and stopped the worldwide economic meltdown.

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