Anthony Fauci's vision for battling a second wave of coronavirus in the fall: Be prepared like we should have been in January
On Wednesday, Dr. Anthony Fauci discussed his playbook for preparing the US for potential future waves of COVID-19 infections, which could come after lockdowns lift or in the fall. Fauci said the US should develop its capacity for widespread testing, contact tracing, and case isolation — "the things that were not in place in January." Antibody testing could help experts understand how many people may be immune to the virus, and how many people are still vulnerable. Even if things go back to normal, Fauci said, we can't "ever let it get out of hand again." Visit Business Insider's homepage for more stories.
Though the US could pass the peak of its coronavirus outbreak in the next week, it won't be the end of the battle. In a livestreamed interview on Wednesday, Dr. Anthony Fauci said he and the rest of the White House coronavirus task force are still trying to figure out what to do after April 30, when federal stay-at-home guidelines are set to expire. Fauci, director of the National Institute of Allergy and Infectious Diseases, spoke with with Howard Bauchner, editor of the Journal of the American Medical Association. He said he had been in the West Wing "until the wee hours" the night before as task force discussed a major question: "What are the kind of things you have to have in place to safely and carefully march towards some sort of normality?" That normality will be hard to come by without risking more death and overwhelmed hospitals, since experts warn of that new infections could surge after lockdowns lift. There's also a chance the virus could make a resurgence in fall weather. In the interview, Fauci laid out a playbook to prepare for potential new waves of COVID-19. 'The things that were not in place in January'
For the next few months and into the fall, Fauci wants the US to get more prepared than it was when the new coronavirus arrived. "The keys are to make sure that we have in place the things that were not in place in January, that we have the capability of mobilizing identification — testing — identification, isolation, contact tracing," Fauci said. "There will be cases. We've got to be able to act on them in a very deliberate way that doesn't allow us to get into the situation [where] we find ourselves right now." That's the tack South Korea took at the beginning of its outbreak. Health officials quickly started testing tens of thousands of people per day and opened COVID-19 drive-thru testing facilities. The government also implemented a robust (though potentially privacy-invading) contact-tracing program: After tests there reveal a positive case, officials use interviews, GPS phone tracking, credit-card records, and video surveillance to trace that person's travel history, according to The Washington Post. In the US, on the other hand, government agencies have been criticized for rolling out testing and isolation policies too slowly. Errors and delays in producing the CDC's coronavirus test led to dangerous shortages, and decisions about lockdowns have been left to states in piecemeal fashion.
Many experts have said that slow response contributed to the virus's rapid spread. "This is such a rapidly moving infection that losing a few days is bad, and losing a couple of weeks is terrible," Ashish Jha, director of the Harvard Global Health Institute, told Bloomberg. "Losing two months is close to disastrous, and that's what we did." Testing in the US is now ramping up, but it's too late to contain the outbreak by testing and contact tracing alone. More than 14,700 people have died nationwide. "Ultimately the answer is going to be a vaccine," Fauci said. However, it could take at least 18 months to develop, test, and distribute a vaccine. That means other interventions are needed during that time. Antibody testing
People who have been infected develop antibodies that can probably fight off the virus if it they encounter it again. This likely makes them immune, though it's unclear how long that protection lasts. "Clearly one of the things is to get a feel for what the penetrance of infection was, and who out there has been infected, recovered, and is now not vulnerable," Fauci said. Fauci said immunity should last at least through September for people who were infected in February. People who are immune, then, could go back to work earlier than others. "Those are the people, when you put them back to particularly critical infrastructure jobs, that you worry less about them driving an outbreak," Fauci said. To identify those people, a handful of companies are developing blood tests that detect COVID-19 antibodies. "We've got to validate [the tests] first," Fauci said. "There has been some unfortunate international experience." He was likely referring to the UK, where the government ordered millions of antibody test kits only to find out that none of them worked. 'Don't ever let it get out of hand again'
"If we get back to some form of normality, we've got to be careful we don't ever let it get out of hand again," Fauci said during the Wednesday interview. "Do not send a sick child to school. Do not send a sick worker into the workplace. Don't anybody ever shake hands again. I mean it sounds crazy, but that's the way it's really got to be, until we get to a point where we know that the population is protected." Even after a vaccine is widely available, Fauci said, the pandemic should prompt the country to rethink its local public-health systems and better prepare for the next infectious disease outbreak. "We have a habit of when we get over a challenge, we say let's move on to the current problem," Fauci said. "We should never be in a position of getting hit like this and have to scramble to respond again."Join the conversation about this story » NOW WATCH: How to help hospitals and healthcare workers fighting the coronavirus
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We've reached the coronavirus pandemic's 6-month mark. 2 leading experts reveal what they think life will look like 1 year in.
Six months ago, Chinese officials in Wuhan reported the coronavirus outbreak to the World Health Organization....Six months ago, Chinese officials in Wuhan reported the coronavirus outbreak to the World Health Organization. Since then, more than 510,000 people have died and 10.5 million have been infected worldwide. Cases continue to climb in the US. But public-health experts think the next six months will bring better news and no more lockdowns. By December, we'll know whether the leading vaccine candidates are safe and effective. Doctors may have better treatment options, and more testing could become available. Visit Business Insider's homepage for more stories. We are officially six months into the coronavirus pandemic. More than 10.5 million people have been infected, a quarter of whom are in the US. The death toll stands at a staggering 512,000. So far, the US seems to have little to show for its efforts to stop the virus' spread. Cases surged in a majority of states in June, leading the country to set four new records for daily case totals within a week. "In these six months, I think the virus has been far more effective than most of our responses," Stephen Morse, an epidemiologist at Columbia University's Mailman School of Public Health, told Business Insider. "I never anticipated that a pandemic would become a political issue." Although many aspects of the US's COVID-19 outbreak and slow, piecemeal response have surprised experts like Morse over the last six months, we asked him and another leading scientist, Amesh Adalja at the Johns Hopkins University Center for Health Security, for their predictions about the next six. Both are hopeful that the US and the world will have a better handle on the pandemic by the end of December. Here's what they expect life to be like at the coronavirus one-year mark. A vaccine will be 'within our grasp' "I'm very reluctant to predict anything, as I never imagined the response would be so disorganized six months later," Morse said. But he added optimistically, "by December 30, 2020, I'm hopeful that we may have a vaccine within our grasp." Adalja's prediction was similar. "We'll have an idea of the efficacy and safety of the vaccine," he said. At least 30 coronavirus vaccines are expected to start human testing before the end of the year, and 16 leading candidates already being tested on humans in clinical trials, according to a Business Insider review. One of the promising candidates is a vaccine developed by the biotech company Moderna, which was the first to publish early results in humans after starting its first trial on March 16. Moderna aims to start a late-stage efficacy trial with 30,000 people in July. The US government hopes to have hundreds of millions of vaccine doses ready by January 2021, however. If that happens, it would be a record timeline in the history of vaccines. Dr. Anthony Fauci told Congress on June 23 that he was "cautiously optimistic" that a vaccine could be made available to the American public by "the end of this calendar year and the beginning of 2021." But Adalja said it's more likely that the early vaccine doses will be available for high-risk individuals and healthcare workers, not a majority of the US population. At-home testing could be possible Morse and Adalja are also both hopeful that the US and other countries could end the year with more options for coronavirus testing. "Our diagnostic capacity is still a shambles. I hope to see that improve in the next six months, and perhaps we can even get a picture of the real incidence and community spread of the virus, which has eluded us so far," Morse said. Researchers think the actual number of cases is far, far larger than the official tallies now. Expanded testing would give experts a better idea of how many people the virus has hit. People might even be able to test themselves for the virus at home, Adalja said. Morse was skeptical about that though: "Rapid testing at home would be nice, but I don't know when we'll have that," he said. Other treatments could be on the table There's not yet any slam-dunk treatment for the coronavirus or its symptoms. The most promising drug is remdesivir, an antiviral chemical that the FDA approved for emergency use on May 1. It seems to help hospitalized coronavirus patients recover more quickly. Clinical trials have also shown that dexamethasone, a common, cheap, steroid, can reduce deaths in severely ill COVID-19 patients. Adalja expects that by December, more doctors will be leveraging those drugs to treat patients. Doing so could reduce suffering, ease the burdens on healthcare systems, and save lives. "It could attenuate mortality from the virus," he said, adding that even now, experts have "more tools to deal with coronavirus than we did in the early days of the pandemic." Lockdowns are a thing of the past As cases surge across more than half of US states, governors in Texas, Colorado, Florida, and more have started shutting down bars and postponing the next planned phases of the reopening process. But neither Morse nor Adalja thinks widespread stay-at-home orders will return. "There's probably little appetite for lockdowns either among the public or among our political leadership," Morse said. Instead, Adalja suggested, states will likely target hotspots with tailored restrictions to get the virus' spread under control. "The blanket shutdowns that did occur in March and April were the result of us having no idea who was infected, and state governors saw no way out of it except for a blunt tool," he said. "Now we have some idea of what activities are driving infections so we can use a more tactical, surgical approach to closing places." Coronavirus challenges to expect in 2021 As the pandemic drags on, Americans' complacency about their infection risk is a concern, according to Morse. "Whatever the virus does, I wonder if we'll be able to sustain any interest for as long as another six months," he said. "Maintaining the precautions we're using now, like social distancing, masks, hand hygiene, will reduce transmission considerably, but over time it's easy to become careless or blasé." Adalja said another major challenge after the pandemic's one-year mark will be ensuring that enough Americans get a vaccine once it's widely available. "If there is a vaccine by 2021, distributing it and getting the highest amount of vaccine uptake you can get will be critical," he said. The time for public information campaigns about the vaccine is now, he added, because "the anti-vaccine community is already agitating against it." A poll published in May found that about one in five Americans said they'd refuse a COVID-19 vaccine should one become available. Andy Dunn contributed reporting to this story.SEE ALSO: 11 critical, unanswered questions about the coronavirus and COVID-19, the diseases it causes Join the conversation about this story » NOW WATCH: 'At some point I'll get sick': 4 coronavirus doctors expose the overwhelmed U.S. healthcare system through daily diaries
Scientists predicted that the coronavirus death rate would fall over time, but instead it doubled. Here's why it now hovers at 6%.
The coronavirus' death rate — a calculation of deaths out of total confirmed cases — varies by...The coronavirus' death rate — a calculation of deaths out of total confirmed cases — varies by place and population. Worldwide, the death rate, or "case-fatality rate," has doubled since March. Business Insider asked three epidemiologists why the death rate has grown, and they pointed to two problems with the calculation: The metric relies on testing, and there's a delay in data. Visit Business Insider's homepage for more stories. Many countries' coronavirus curves are flattening, at least for now. Yet somehow, the global case-fatality rate has increased significantly since March, when it was around 3.4%. The rate was 5.8% on Tuesday, according to tallies from the World Health Organization, and it hovered around 7% from mid-April through May. The trend runs contrary to many experts' earlier expectations: that testing would increase, leading more mild cases to be recorded and the death rate to go down. But it seems testing has not increased enough to result in a significant downward trajectory. The coronavirus death rate is not as simple as it appears As governments prepare for new waves of infection and consider the tradeoffs of lockdowns, a crucial question informs how they move forward: Just how deadly is COVID-19? The most straightforward answer may seem to be the case-fatality rate, a calculation of the number of known deaths out of the total number of confirmed cases. But because coronavirus cases progress over a period of weeks, and because the numbers are constantly changing, the death rate is always in flux. Some epidemiologists say that because death rates are so heavily influenced by testing and delays in reported cases and deaths, they're simply not a reliable measure of the virus's toll over time. Many countries aren't testing enough When asked about the increase in global death rate, Ben Cowling, head of epidemiology and biostatistics at the University of Hong Kong School of Public Health, had a simple answer: "Not enough testing of mild cases." In general, the more cases that are included in the data — including people with mild or no symptoms — the lower the death rate. In that sense, case-fatality rates "are more a measure of how much testing and case finding you do," John Edmunds, a professor of infectious-disease modeling at the London School of Hygiene & Tropical Medicine, told Business Insider. "Look at Singapore and South Korea for comparison, where there is a lot of testing," Cowling said. South Korea, which has tested more than 1 million people, far outpaced other countries in early case detection and contact tracing. While US labs waited for weeks for instructions on how to fix faulty test kits in February, South Korea was testing tens of thousands of people. The country's death rate was 2.3% as of Wednesday. Singapore, which has also been lauded for its wide-reaching testing, had a death rate of just 0.1%. Limited testing in other countries, like Sweden and the US, make their case counts inaccurately low. In the US, experts think we need to multiply the official confirmed case count by 10 to get an accurate estimate of true infections nationwide. "There is no way that we record all the cases, though we probably record most of the deaths," Edmunds said. When countries miss many mild cases, deadly cases seem like a higher proportion of infections than they really are. Countries like the US and Sweden, therefore — which have case-fatality rates of 5.7% and 10.3%, respectively — could be inflating the global death rate. Death rates can seem highest after an epidemic peak New deaths reported now are generally people who fell ill three to four weeks ago. That's when many countries' outbreaks were still peaking. So even once daily case counts fall, daily deaths can continue to climb. "Mortality will spuriously spike when cases are decreasing," William Hanage, an epidemiologist at Harvard's TH Chan School of Public Health, told Business Insider. "The reason is that you are seeing the deaths from when the epidemic was expanding, or at least more intense than it is now, while your total case counts are up to the present." The fact that death tolls lag behind case counts can briefly create a very high death rate. That's what seems to have happened in April and May. (And limited testing can magnify that effect.) To get a more accurate picture of how deadly the virus is, Edmunds said, "what you need to do is take account of the delays properly, so effectively you need to divide deaths today by cases that occurred three to four weeks ago." That math suggests the virus has killed roughly 1% of the people who tested positive four weeks ago. But again, since that doesn't include many people with mild or asymptomatic cases, the true proportion of people who die after being infected is probably much lower. Experts like Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have also estimated that the true death rate is closer to 1%. A May study from the University of Washington suggested that if all infections were known, the true death rate for Americans who show symptoms would be about 1.3%. That's far lower than what case-fatality rates suggest, but it's still 13 times higher than the death rate of the seasonal flu.SEE ALSO: The coronavirus was likely in the US before anyone knew it existed. It's now hard to believe we ever assumed otherwise. Join the conversation about this story » NOW WATCH: Hydroxychloroquine, what it is, and what it does to your body
Fauci offers an optimistic timeline for a coronavirus vaccine: a trial of 30,000 people next month, and 200 million doses by 2021
Anthony Fauci said this week that hundreds of millions of coronavirus vaccine doses could be ready...Anthony Fauci said this week that hundreds of millions of coronavirus vaccine doses could be ready by early 2021. Moderna will begin testing its vaccine candidate on 30,000 people in July, Fauci said, and other companies are expected to start that final trial phase this summer as well. The US plans to mass-produce vaccines before knowing whether they work. Fauci still worries about how much protection they'll confer. Visit Business Insider's homepage for more stories. Pharmaceutical companies are preparing to test their coronavirus vaccines on tens of thousands of people this summer. The fast-moving process has garnered an optimistic outlook from Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who said on Tuesday that the US could have hundreds of millions of approved vaccines by 2021. Moderna will begin giving its COVID-19 vaccine to 30,000 people in the first week of July, Fauci told JAMA editor Howard Bauchner in a livestreamed conversation. That's phase three of the clinical-development process — the final trial stage before a vaccine can gain approval from the US Food and Drug Administration. In the meantime, Fauci said, the US will begin mass-producing the vaccines so it can distribute them once they gain FDA approval. "We're going to start manufacturing doses of the vaccines way before we even know that the vaccine works," Fauci said. "We may know whether it's efficacious or not by maybe November, December. Which means that by that time, we hopefully would have close to 100 million doses. And by the beginning of 2021, we hope to have a couple of hundred million doses." Fauci added that he was involved in at least four other vaccine trials that will start throughout the summer. Among all these efforts, he's "cautiously optimistic" that one will produce an effective vaccine that can be distributed to the public. "If the body is capable of making an immune response to clear the virus in natural infection, that's a pretty good proof of concept to say that you're going to make an immune response in response to a vaccine," Fauci said. But he added: "There's never a guarantee, ever, that you're going to get an effective vaccine." Lingering questions about immunity and vaccines Researchers are still missing two key pieces of information about immunity to the coronavirus: whether everybody who gets infected develops immunity, and how long that protection lasts. "I have examples of people who were clearly infected, who are antibody-negative," Fauci said, adding that those people likely have antibody counts too low for the test to detect. It's unclear if such low antibody levels are enough to protect someone from reinfection. Other recovered patients, meanwhile, show high antibody counts. "It isn't a uniformly robust antibody response," Fauci added. That could mean that a vaccine might not produce high levels of antibodies in some people. For those who do gain immunity from a vaccine, it's also unclear how long that protection would last. Other coronaviruses — the kind that cause common cold — produce immunity that lasts less than a year, and in some cases just a few months. "It may be completely different with this coronavirus," Fauci said. "We don't know."Join the conversation about this story » NOW WATCH: The coronavirus could affect the accuracy of the 2020 census — and that could decide who gets a vaccine