Dr. Anthony Fauci had some good news and bad news to share with Silicon Valley's business community at a Friday forum with the country's leading expert on infectious diseases.
The good news, said the country's top infectious disease expert, is that multiple vaccines for COVID-19 are being rapidly developed, with a safe and effective vaccine estimated to be ready as soon as mid- to late November. The bad news is that the research is running parallel to a worsening spread of the virus, with hot spots cropping up all over the country that are leading to more hospitalizations and deaths, Fauci said.
But when asked to grade the public health response of Dr. Sara Cody, health officer of Santa Clara County, specifically on the precarious task of reopening schools, Fauci gave her top marks, calling it the "optimal approach" based on the state's case rates.
"The program and approach that Dr. Cody outlined makes absolutely perfect sense to me for where you are right now in California," Fauci said.
The forum, held by the Silicon Valley Leadership Group, marked a rare opportunity for the region's business community to ask questions of Fauci, who has helped lead the country's response to the coronavirus pandemic. Cody and Santa Clara County's COVID-19 testing officer, Dr. Marty Fenstersheib, participated in a four-way panel with Fauci and Ahmad Thomas, CEO of the leadership group. Questions were generally geared toward the difficult balance of reopening the economy versus public health mandates to prevent the spread of COVID-19.
Fauci was quick to say that the recent spike in cases is not the result of a so-called "second wave" of infections, and that the communities being hammered today are quite literally located all over the country, including those that had been mostly spared from the worst of the pandemic earlier this year. At one point the country hit a baseline of 20,000 new cases per day, but that has since catapulted to weekly averages of 70,000 daily cases.
"Several months ago I testified to a Senate committee and I said if we don't get control of this we might get 100,000 cases a day, and I was blasted for that because they said I was being too alarmist," Fauci said. "We're getting close to that right now."
Adding to the anxiety is that the cold winter months are coming, which is going to push activities indoors — a problematic situation when a respiratory disease is actively spreading.
"Unless we do something to turn this around we're going to have a very difficult, very painful winter as we enter into those cold months," he said.
Speaking plainly, Fauci said there is no appetite for shutting down the country again, but critical steps can be taken to avoid major surges like the one the country is experiencing right now. Universal wearing of masks, physical distancing, avoiding congregate settings and crowds, moving activities outdoors and washing hands are all ways to reduce the rate of transmission, many of which are baked into local public health requirements.
On the vaccine front, five candidates are in what's called "phase 3" clinical trials, and the hope is one or more of those candidates will be found to be both safe and effective either next month or in early December. If so, Fauci said people can expect vaccine doses to be administered by the end of the year or — more likely — the first months of 2021.
"Hopefully by the time we get to the third quarter of 2021 we will have vaccinated the vast majority of people — provided people want to get vaccinated," he said.
A survey conducted by the Public Policy Institute of California found that 2 in 3 Californians are concerned about the vaccine approval moving too fast, without ensuring that it will be safe for use by the public. Thomas said he believes the data shows there is a "high level" of mistrust in the government and information being shared that isn't accurate about the vaccine development.
Fauci said he understood the skepticism, in part because of the "mixed signals and issues that have come out of Washington," but insisted that the process is rigorous with plenty of independent oversight. An independent safety and monitoring board staffed with clinicians and vaccinologists is consistently monitoring the data from the trials to call out concerns about efficacy and safety, and any candidate must get final approval from the FDA and an independent advisory group called the Vaccines and Related Biological Products Advisory Committee.
"I will see it and all of my scientific colleagues will see it," Fauci said. "So if anybody tries to do an end-run about getting something approved before it's ready for the American public, that won't happen, I can promise you that."
Though cases are rising across the country, Fauci said the default position for the country right now is that communities should, as best as possible, try to get children back to school. But he said it needs to be done right, with specific plans to mitigate the spread of infection and a program in place for when children are exposed to the virus.
Cody said the county's goal has been to quickly enable in-person learning for kids by reducing community transmission rates as much as possible while simultaneously building in requirements that safeguard against a school site outbreak. Students and staff are required to wear masks and socially distance when possible, and younger children are put into small and stable cohorts that cannot be easily changed. Schools have been mixed on whether to return to on-campus instruction, Cody said, and it remains a tough balancing act.
"We know that the distance learning has helped to magnify and accelerate educational inequities, however we also know there is great concern, rightly so, by teachers and staff about the risks of coming together for in-person learning," she said.
Though children are less likely to get sick from COVID-19, Fauci said there are still plenty of public health risks with students returning to campus.
"Some children can get seriously ill and they certainly can transmit infection, particularly children from (ages) 10 to 19 who can transmit to adults as easily as adults can transmit to adults," he said.
Fauci and county health officials alike raised concerns about the disparate effect of COVID-19 on communities of color, which have been hit by what Fauci calls a "double whammy." Not only are they disproportionately on the front lines with jobs requiring them to physically interact with people, but they are more likely to have the comorbidities that make COVID-19 so hazardous. Co-morbidities like diabetes, hypertension, obesity, chronic lung disease and heart disease are all considered high-risk diseases, and they are more common in Black and Latino communities.
The rate of hospitalizations for white people infected with COVID-19 is about 82 per 100,000, Fauci said, compared with between 375 and 380 per 100,000 for Black and Latino people. When the vaccine is available for public use, he said it makes sense to target these communities of color first because they are among the more vulnerable.
Another lingering concern for Santa Clara County is how to actually get the vaccines out to the community. Right now the vaccine candidates that are farthest along must be kept at cold temperatures from the moment they're manufactured right up until when they're administered. Each county needs the equipment and training to keep the vaccines from going bad, and planning and logistics for that needs to start now. Cody said the county can't anticipate which vaccine will succeed in the trial phase, but that it is already preparing for a vaccine that will require freezing at very low temperatures.
"Locally we want to plan for whatever comes to pass, and we want to ensure we can distribute it most efficiently to the priority groups when the vaccine comes into our hands," Cody said.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.