The country still has 70,000 new infections per day; 62 million people ages 12 and older who are eligible to be vaccinated still have not gotten their shots. The number doesn't include the latest eligible group of 5- to-11-year-olds, he said.
"We're vulnerable. We could get a surge unless we get more people vaccinated," said Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to President Joe Biden.
Fauci spoke of the ongoing threat as well as about vaccines, new drugs on the horizon and the post-pandemic future during the hourlong event, which was hosted and moderated by Rep. Anna Eshoo, D-Palo Alto.
Eshoo, who chairs the House subcommittee on health, presented Fauci with audience questions about all sides of the pandemic, including the overall pandemic, long COVID-19 and childhood vaccinations.
With the holiday season kicking off with Thanksgiving in about two weeks, the first question on many minds was whether it will be safe to gather inside.
"Clearly, if you are fully vaccinated, you can enjoy the holiday with your children, grandchildren and families," Fauci said.
But for people who have had just one shot out of the recommended two, the risk is "obviously present" although diminished, he said. People who have had just one shot should take a rapid COVID-19 test before they gather with loved ones to minimize infection, he said.
The country still has a long way to go to be safe. Among people of all ages, only 58% have been fully vaccinated; 67% have received one dose. Of those who are 12 and older, 68% are fully vaccinated and 79% have had only one dose, he said.
Not getting vaccinated is "inexcusable," Fauci said. The vaccines are a very effective tool to control the virus.
He recommended every eligible person get a booster shot. Studies show the booster shots greatly improve immunity against the virus. Protection from the initial series of shots begins to wane in the months afterward. People who have had COVID-19 infections and who later received the complete vaccination regimen should also still get the booster shot because of waning immunity months later and the possibility of being reinfected, he said.
Currently, only people ages 65 and older or those who have medical conditions that make them vulnerable to serious illness can receive a booster shot. Drugmaker Pfizer submitted data to the Food and Drug Administration on Tuesday for an emergency use authorization of booster shots for anyone ages 18 and older, he noted. On Wednesday, the Santa Clara County public health department encouraged anyone who lives or works in the county to get a booster shot.
Children ages 5 to 11 who are now receiving their initial vaccinations also will likely need booster shots, but studies on that are still underway, he said. Although vaccine doses for that age group are only one-third the dose of an adult vaccine, Fauci said that doesn't decrease the vaccine's efficacy. The children are receiving reduced doses because they are smaller, he said.
Eshoo noted that Lucile Packard Children's Hospital Stanford is among the facilities doing clinical trials using the Pfizer-BioNTech vaccine for children.
"The clinical trials done in children are quite gratifying," Fauci said.
In 5- to-11-year-olds, it is 91% effective in preventing symptomatic disease. In children ages 12 to 15, the efficacy is close to 100%. In both age groups, the safety profile is also high, he said.
Trials are also underway for two younger age groups: children ages 2 to 5 years old and those ages six months to 2 years. The data will likely be available in the first quarter of 2022, he said.
Many people are concerned about what the government is doing about "long COVID," the mysterious syndrome that causes some people to remain sick with heart, lung and neurological problems, among other issues, for many months after their initial COVID-19 infection. When the House subcommittee on health held hearings on long COVID-19, patients said they couldn't work or attend school because of the debilitating effects, Eshoo noted.
"Patients that testified were deeply frustrated. None of the doctors came up with a diagnosis that (their symptoms) could be long COVID," she said.
Fauci said $1.15 billion has been dedicated to the National Institutes of Health to study long COVID-19 and ways to recognize, intervene or prevent the syndrome after a COVID-19 infection. An estimated 10% to 30% of patients have persistent symptoms that measure in months or longer, including debilitating fatigue, tachycardia (a heart condition) and brain fog, he said.
The future of COVID-19
Fauci also touched on potential societal changes after the pandemic has ended. It's likely some people will continue to voluntarily wear masks long after the pandemic is over, he said.
For some, it may become the "new normal" during the winter months. Many people have noticed a marked decrease in influenza cases last winter and may think it's a good idea to continue wearing masks during the winter flu and cold season, he said.
Buildings, shops and restaurants are also likely to be more attentive to good air ventilation, which will probably become part of building codes, he said.
On the drug front, COVID-19 has kickstarted much research into antiviral medications. Merck's new oral medication, molnupiravir, in clinical trials diminished the likelihood of hospitalization and death among COVID-19 patients if given in the early course of the infection. The United Kingdom's medicine regulator approved its use on Nov. 4.
Last week, Pfizer announced that research on its promising oral drug called paxlovid, a protease inhibitor, showed 89% efficacy in preventing hospitalization and death from COVID-19 when given within three to five days of the initial symptoms, he said. The National Institutes of Health has also invested $3.2 billion in antiviral drugs to prevent the progression of the disease, Fauci said.
Eshoo called these developments "a blockbuster."
Asked what one piece of legislation he would like to write to change society, Fauci said he wouldn't rely on legislation. Funding for research and development and to rebuild the country's decimated public health system would go a long way to securing a safer future, he said.
But he did note one desirable change.
"I would love to change the divisiveness in our society. The common enemy is the virus and not each other," he said.
Asked about religious exemptions, Fauci added that when a health emergency of such magnitude is occurring, there can be exceptions from religious traditions. It's rare that religions have any belief or code preventing people from being vaccinated in the first place. Some people are going to say it's against their religious beliefs, but that might not be part of their established religion, he said.
Fauci trod directly but cautiously when offering an opinion on the subject.
"Sometimes the good of society has to supersede your own individual right to choose. There needs to be exceptions," he said. "It's going to be tough to sort out. It's going to be a contentious issue."
He noted that other countries, notably England, have again seen recent spikes in their COVID-19 cases because they pulled back on precautions such as mask requirements and they didn't have children vaccinated. Cases surged when the cold weather started and people began indoor activities. In countries where cases went up, they'd also pulled back on the vaccine push, he said.
"Here, it depends entirely on what we do" to prevent another surge this winter in the U.S., Fauci said. He encouraged anyone who was vaccinated six or more months ago to get a booster shot and those who haven't yet been vaccinated to receive their shots as soon as they can.
The $64,000 question is how to talk to people who are misinformed about the pandemic and vaccines, Eshoo noted. Fauci said U.S. Surgeon General Dr. Vivek Murthy recently put out an online tool kit to address helping those who are vaccine hesitant.
"Many people have valid questions that have never been answered. There's a lot of disinformation and misinformation," he said, distinguishing between deliberate falsehoods and mistaken or inaccurate information.
"Be patient; don't be accusatory," Fauci said.