Fauci on making a choice between closing schools or bars: ‘Close the bars’

n an interview with Yahoo News National Correspondent Alexander Nazaryan, Dr. Anthony Fauci discusses the COVID-19 pandemic and issues such as school closures, rapid testing and the anticipated rise in cases during the holiday season.

Video Transcript

ALEXANDER NAZARYAN: Can we start by talking about schools? As you obviously know, New York shut down its schools after hitting a 3% positivity rate in the city at large. Was that a good idea, do you think?

ANTHONY FAUCI: You know, I don't want to pass judgment as to good or bad idea, but I can maybe tell you a bit about what I have been saying consistently now, that we should try to keep as a default position that keeping the kids in school or getting them back to school, for a number of reasons. If you look at the children's test positivity, the number of infections you're seeing in school, it's really less than the general population.

You must always be sensitive to the safety and the health of the children and the teachers. But it appears that obviously, there will be some exceptions, so you have to, in essence, not necessarily have one size fits all for wherever you are. But for the most part, the general rule should be, is it possible, and if so should, we do it, to have as the preference of what you want to do keeping the kids in school not only because of the negative deleterious consequences of keeping them out of school for the children themselves, but also for the secondary outlier effects that you have on families, particularly working families, and what that would mean about having the kids back home. So again, not absolute, one size fits all. But to the best of your capability, try to keep the kids in school.

ALEXANDER NAZARYAN: So why do you think in so many-- especially every larger district here in Washington, New York now-- elected leaders say we listen to the science, and then the science comes back saying children are not-- schools are not sites of super-spreader events, they still don't open?

ANTHONY FAUCI: Well, I think there may be a number of reasons for that. And that's the reason why I say without evading the question, it's really complicated. For example, teachers often when they're in a hot zone of being in a situation where they're concerned, understandably concerned about coming to school in a person-to-person way as opposed to virtually-- so you may have a situation where you want to get the schools open, but the teachers, be it through the teacher union are individual teachers, essentially make their intentions known by their feet. They say, I just don't feel safe coming in. So you could wind up almost having to have a school that doesn't open not on the basis of the signs of the kids getting infected, but the perception on the part of the teachers that they're at risk. And those are things that you have to work out at the local level.

ALEXANDER NAZARYAN: Do you think if the federal Department of Education had-- or the White House had come out and worked with the big teachers unions nationally and had given funding to schools that they asked for, we could be in a different place today?

ANTHONY FAUCI: Well, there are a couple of questions subdivided into that one question. I think if you look at the CDC website, it's very clear there that they are really articulating very clearly what I'm trying to articulate to you right now not only about the preference for keeping the schools open, but what one can do to keep the schools as safe as possible.

So the CDC really is the arm of public health recommendations. So you would expect that, as I do now, encourage people who are a little bit on the fence of trying to make decisions about what they're going to do-- check out the CDC website. And they really have some good information there.

ALEXANDER NAZARYAN: Let me ask you this. Should we-- let's just take New York or DC. Should we be closing bars and restaurants right now and trying to reopen schools?

ANTHONY FAUCI: Yeah. I think you're hitting on something. You're asking a question that is out there that's constantly going to be asked and answered, hopefully correctly. If you have a choice between closing the schools and closing the bars, close the bars.

ALEXANDER NAZARYAN: Let me ask you about another thing. Michael Min at Harvard and some Colorado researchers just did a study on rapid tests. And they believe that frequency of testing is more important than accuracy of testing. And if we could do rapid testing on a large scale, we could get this thing, in their estimation, in just a few weeks. Without discussing the particulars of that study, do you see rapid testing as a game changer?

ANTHONY FAUCI: I don't know if I'd call it a game changer, but I do feel that it is an important tool in our armamentarium of addressing something that I don't believe we have thus far addressed adequately, is that the capability of spreading in the community by people without symptoms. We clearly need the classic tests that if you want to know if a particular individual is infected because you want to do identification, isolation, and contact tracing.

I'm all for doing that-- getting sensitive and accurate tests, which we do have, getting the results back quickly enough so that they are meaningful. Because one of the things that we have faced in the past-- it's gotten better in some places, but you have to be honest-- in other places, it has not gotten that much better, namely how long it takes for you to get a test back and how long it takes to even get a test.

Putting that aside, there's another strategy of testing, and that is the surveillance testing when, be they colleges or other institutions, factories, people where you have large numbers of people coming into work and employment, where you would want to know what the status is of the penetrance of infection in the group. If you can get a rapid, cheap, quick test that maybe is not as sensitive to answer the question, is this person definitely infected as opposed to saying, is this person transmitting infection-- in other words, that if you repetitively do surveillance, we know you can make up for a relative lack of exquisite sensitivity of the test.

And even in the tests that are not sensitive, what you might see is that you might miss someone who is, strictly speaking, positive, but the level of virus is so low in them that they're not going to transmit. So if the question you're asking-- is this particular college, is this particular factory, is this particular-- whatever institution you're talking about-- at a situation where it is unlikely you're going to be having spread, then frequent, rapid, point-of-care type tests that are given repetitively has a very important place in how we address this outbreak.

ALEXANDER NAZARYAN: So most likely, that's not going to come in time, I think it's safe to say, for Thanksgiving, or most likely for the Christmas, Hanukkah holidays. Let me ask you about Easter and Passover. Do you think we'll be able to gather safely with our friends and family by then?

ANTHONY FAUCI: You know, I hope so. If not completely back to normal-- I don't think it will be by the spring. I think that would be unrealistic because you're going to have the start of the rollout of the vaccine in mid to late December for those at the high-priority groups. By the time you get the high-priority individuals done, you're going to be well into the first quarter of 2021.

We hope that by the end of the first quarter, end of April into May and June, that we will get a substantial proportion of the people vaccinated. But one of the things you need to make sure you understand, you and us as a community, being the US public, is that even though we have, at least at this point and maybe more, two highly efficacious vaccines, getting back to normal is also going to depend on what proportion of the population actually gets the vaccine.

So if you have a highly efficacious vaccine, which we do have-- however, let's say 50% of the people want it, and 50% don't-- you're going to stretch out the length of time that it's going to take to get back to normal. So that's the reason why I have spoken and written that a vaccine itself, even though it's highly efficacious, does not mean you can abandon public health measures like mask wearing, avoiding crowds, keeping distance. You may have a less stringent implementation of those that would be required because vaccine would be an extraordinary addition to your armamentarium of safety measures.

But unless you get 75%, 80% or whatever it is, between 70% and 80% of the population vaccinated, you're not going to get the blanket or the umbrella of immunity over the community that would make you feel that you're almost getting back to normal, which is one of the reasons why we have to be very transparent in our articulation to the community of why and how the decision of whether or not these vaccines are safe and effective has been made independently, apart from any influence by the administration, by the companies, by anyone. But it also has been not only an independent process, but a very transparent process.

So our job now, in addition to getting those other vaccine candidates to be proven to be safe and effective, which I hope they will be, is to convince the American public that the process is going to be quite transparent and quite independent.

ALEXANDER NAZARYAN: Do you do you believe before the vaccine comes we could see as many as-- I don't know-- do you think we could reach half a million deaths from this pandemic?

ANTHONY FAUCI: Well, if you look at where we are right now at over a quarter of a million deaths over a relatively brief period of time in which you've had a early spring surge, and early summer surge, and now a full surge, we're entering into a very vulnerable period, vulnerable for a couple of reasons. One-- it's the cooler season where people, naturally, out of necessity, have to do things indoor as opposed to outdoors. And we know that indoor spread in a respiratory disease clearly facilitates the spread.

Number two-- we're entering into two sequential holiday seasons where people tend to travel and tend to congregate. If we do not adhere to the public health measures that we try now multiple times per day every day to get the message to the American public, it is conceivable that the 200,000 cases that we see per day, between 100,000 and 200,000 cases, and the deaths that are now between 1,000 and 2,000 a day-- if they go up, if it continues to surge up in the next couple of months before we can get a substantial number of people vaccinated, you do the math on that. 2,000 to 3,000 deaths a day times a couple of months, and you're approaching a really stunning number of deaths.

So I always say as I give that message so that people don't get panicked about it that it is within our capability of preventing that from happening. It isn't inevitable that that will happen. If we adhere to those public health measures that we're talking about, if we limit indoor gatherings, even innocently of larger members of family and friends-- if we do that, we can blunt the curve and blunt that trajectory, which is almost exponential.

It's possible. We've seen it happen in locations where people have implemented those public health measures. So whenever we talk about the predictions of stark numbers that are really, in some respects, frightening, we shouldn't say, oh, that's inevitable, throw our hands up, and panic. We should say, wait a minute. We can do something about that as a society. We can.

ALEXANDER NAZARYAN: So it must be stunning to you to see governors in South Dakota and Florida act like the virus is just over with, and people can congregate as they wish without any-- seemingly, they're endorsing a lack of any kind of public health measures.

ANTHONY FAUCI: Well, it's beyond stunning to me. It's almost incomprehensible how, in places where you have the intensive care beds completely full and intensive care patients needing to be housed in other places, and you have the possibility of pending shortages of staff, that in those same places, they're still saying it's fake news. It's a hoax.

How could you possibly do that when it's staring you right in the face in the place where you live, that people are dying in intensive care units? I just-- I don't get that at all. And I think there are going to be people that are going to be analyzing that every which way when this is all over, how that possibly could have happened.

ALEXANDER NAZARYAN: What number for you, either at the beginning of the day or the end, tells you-- what metric tells you, this is how we're doing today?

ANTHONY FAUCI: You know, it's a couple, but one of the most predictable ones is the test positivity where when you do test, and you get up where you want to be at around 3%, and you're of a sudden-- some places are, like, 40%. it's extraordinary. And then when you get around 10%, 15%, 20%, you're in trouble. That's telling you.

I think the thing about this that gets people confused-- there's a lag time. There's the test positivity. There's the cases that require hospitalization. There's the cases that require intensive care, and then there's the deaths. And they lag, usually, from one place to another by a couple of weeks.

So what's going on right now is what actually happened a couple of weeks ago. And what's going on now is going to indicate what will happen a couple of weeks from now.

ALEXANDER NAZARYAN: I'm sorry. One last question. There was the Dutch study on masks, and many in the conservative media seized on it to say masks don't work. As you said, it's just-- this many months in, when you see that kind of discourse, what goes through your head?

ANTHONY FAUCI: Frustration leading up to pain. The data are so clear when you look at so many of the studies, which done correctly, indicate how mitigation works. You can compare comparable locations, one of which mitigates, the other one doesn't, and you see the level of cases and hospitalizations.

It's painful because you don't-- as a public health figure, as a physician, as a scientist, you don't want to see suffering, and you don't want to see death. And you know when you have something that you can do about it, if you don't see those tools being used, it's a combination of frustration and pain to see that happen.

ALEXANDER NAZARYAN: Thank you so much for your time.

ANTHONY FAUCI: Thank you very much for having me. I appreciate.

ALEXANDER NAZARYAN: Really appreciate it. Thank you.