“The extraordinary bravery of the healthcare providers that threw themselves into this in a way that endangered themselves… is what really impressed me. It says a lot about our community of healthcare providers.”

This was said by Dr Anthony Fauci, the US’s foremost virus chaser and the director of the National Institute of Allergy and Infectious Diseases and a leading member of the White House coronavirus task force.

Fauci was speaking to Professor Linda-Gail Bekker from the University of Cape Town’s Desmond Tutu HIV Centre and Health Foundation about his experience with the coronavirus outbreak in the US, during a webinar organised by MedicalBrief.

Fauci said the “incredible efficiency” with which the coronavirus spreads from person to person made it into a “worst nightmare”.

He said the spectrum of the disease – causing no symptoms in some and very serious symptoms and death in other people – made it very difficult to formulate a public health response to it.

“Particularly young people feel that they will do well and recover. When you try to get the message out that is historic in its seriousness there are still people who do not take it seriously. They still fail to avoid crowds, not wear masks and practise physical distancing,” he said.

He said the US had, in the past weekend, recorded a record 83,000 confirmed cases of the virus in a single day. “I have never seen anything like that,” he said.

Fauci believed a similar response to the HIV pandemic was needed, where the public messaging went from preaching abstinence to safe sex. Similarly, he said, the response to the coronavirus outbreak should shift from isolation to finding safe ways to socialise.

“I have been preaching that we have got to get away from the mentality of either shutting down the country completely or just doing whatever the hell you please. We don’t want to shut down and destroy the economy. But there needs to be things that allow you to safely open the country again, like the wearing of masks and physical distancing,” Fauci said.

He said he believed countries like South Africa that were able to mount a central response to the virus did better in fighting it.

“The United States of America is a very large country. It is quite heterogeneous. It has 50 states with a degree of independence. When you have a pandemic you can have desperate responses. Everyone has got to pull together. My impression is that SA could do things much more centrally. In the United States, 50 states did it in 50 ways and it just didn’t work. We had a resurgence. Our [daily] cases never went below 20,000 and now it is up to 80,000.”

He added that if it were not possible for the US to accomplish the voluntary wearing of masks this should be made compulsory.

Fauci said there were some promising developments in creating a vaccine, with several trials under way.

The first phase of a number of studies showed “robust antibodies with no significant safety signals”.

“We should have an answer by mid-November. We have started producing large amounts that we can start administering in December. Uptake is a big problem in the United States, particularly amongst most vulnerable communities. Those are the ones who are suffering terribly. Anywhere from 15-20% say they don’t want a vaccine or are not sure they would want one.

“We are doing what we did with HIV. We are using our community representatives to convince people – to participate in clinical trials and to take the vaccine. There is a lot of scepticism in our communities.” 

Fauci said they had a moral obligation to make sure that there would be universal access to the vaccine. “We talk about billions of doses with these companies.” 

Fauci explained that the plan was to deploy the vaccine firstly to healthcare workers, then to those with underlying conditions and the elderly, those who operate in critical sectors of society and then to everyone else.

“If all goes well we will have it distributed by the second quarter of 2021,” he said, but warned that non-pharmaceutical interventions would remain crucial.

Fauci said if the vaccine trials do not pan out well, the world “would have to continue to carefully double down on health measures [like wearing masks and practising physical distancing].

“At the same time, we would have to invest in therapies – not only for advanced patients, but for early treatment to keep people out of the hospitals – like targeted antiviral drugs. We are doing it anyway… but if this is our only tool we will have to ratchet it up. We will have to mitigate against hospitalisation and death.” 

He said “non-traditional” advice like taking vitamin D supplements should be taken seriously. “I have a deep-down non-scientific prejudice for vitamin D. I take a few thousand units myself every day anyway.”

Asked about his most memorable moments from the pandemic he said apart from the bravery of the frontline health workers, he would always remember how the Covid-19 outbreak highlighted the search for truth and clarity.

“People are looking for truth and clarity. It is what we all want. We want science and clarity. I am impressed with how the world has galvanised around truth, science, data and evidence. Those are the kinds of things that will prevail.” DM/MC