Is the Pandemic Over? Fauci Weighs In

 Is the COVID-19 pandemic really over? Could the "lab leak" theory be true? Is President Biden's chief medical advisor and the man who helped (or tried to help) America navigate and contain a deadly global outbreak now eating indoors?

Anthony Fauci, MD, also the long-time director of the National Institute of Allergy and Infectious Diseases (NIAID), answered these and other questions during an online interview with the University of Southern California's Center for Health Journalism on Tuesday.

In August, Fauci, who is both beloved and hated by certain groups of Americans, mostly on the basis of political ideologies, announced that he would be stepping down from his position in December.

The Big Question

Asked whether the pandemic is truly over, Fauci replied, "I don't think we can say 'the end' being no more COVID is in sight."

"We have had multiple waves, we've had valleys and peaks in the evolution of the outbreak as new variants came along. Right now it's all relative," he said.

While cases, hospitalizations, and deaths are "much, much lower" than they were several months ago, "it is still at a level that I have been very public about saying that I'm not comfortable with -- having 300 to 400 deaths per day," he noted.

Fauci also pointed out that winter is approaching and "there's always the risk of an uptick in respiratory diseases." Furthermore, while BA.5 remains dominant, other sublineages like BA.4.6 are "creeping up."

"We don't have much of BA2.75.2 yet, but there are other countries that do have that. So although we can feel good that we're going in the right direction, we can't let our guard down," he stressed.

Fauci also said that he remains concerned about the possibility of a new variant that could escape the immune protection Americans have built up as a result of SARS-CoV-2 infections or vaccinations.

"I hope we don't get that ... but we should not be surprised if we do," he added.

Asked about masking over the upcoming holidays, Fauci said that he hopes it won't be necessary, but that "CDC guidelines will still hold true" -- in other words, masks would be optional but recommended in areas with low transmission, and recommended in areas with high transmission, in indoor congregate settings.

As for his own masking habits, Fauci said, "It's not like I always wear one or I never wear one."

He said that he continues to avoid indoor dining, but he has attended receptions, mostly outdoors, unmasked. "But if I'm in an indoor [public] setting for a considerable period of time, I would keep the mask on."

The 'Lab Leak' Theory

Switching gears to the origins of the virus and the criticism around his agency, Fauci said he was part of the group that called on evolutionary virologists to study the "lab leak" theory. This group of experts looked at the data carefully and concluded that SARS-CoV-2's origins were "likely a natural occurrence."

While there's strong evidence to support that theory "and zero evidence to indicate that it's a lab leak," he said he continues to "keep an open mind," adding "to nail it down, we'd need more cooperation" from China.

When Fauci was asked if he believes he said or did anything wrong in the messaging to the public, he recalled "famous quotes" that his critics like to pin on him. For example, when there were about five known COVID cases in the country, he told Americans they didn't need to do anything differently.

"It was semicolon, 'however,' comma, 'this could change rapidly, and we need to be prepared,'" he explained. However, that part isn't remembered, he added.

Asked whether public health experts have broadly been too reticent to communicate "hard truths" -- for example, that gay men were contracting monkeypox through anonymous sex -- Fauci said "true honesty" and "true transparency" would be easier to achieve when not garbled by social media misinformation and disinformation.

Fauci was also asked about the criticism he received related to NIH's funding of EcoHealth Alliance, a group that conducted "gain-of-function" research. He pointed out that the group conducts other research as well, and that all grants go through a formal process of peer review. When groups are highly recommended, they can't "arbitrarily" be denied, he said.

Looking Ahead

The NIAID director also highlighted the ongoing pandemic-related challenges, including long COVID. "That's something we absolutely have to get our arms around, find out what the pathogenic mechanism of it is, and then hopefully do something about it," he noted.

He also called out the health disparities that the pandemic has cast light on as a "big problem" that emerges every time there's a major health event. These health inequities stem from "very subtle social determinants of health" that can lead to increases in conditions like diabetes, hypertension, obesity, chronic liver disease, and chronic kidney disease.

"Those are not racially determined. Those are due to social determinants of health. We need a decade's long commitment to overcome that," Fauci said.

Disclosures

The online interview was sponsored by the Commonwealth Fund, the National Institute for Health Care Management Foundation, and the California Endowment.

https://www.medpagetoday.com/infectiousdisease/covid19/101071