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Looking Back (and Forward) on COVID-19 with Anthony Fauci

Jon and Esther Cohen and Anthony Fauci
Science correspondent Jon Cohen (left) and his mother Esther talk with Anthony Fauci after the plenary address. | AAAS

COVID-19 is the leading cause of death in the United States, but an extraordinary year of vaccine science offers hope that the country can return to something resembling normal life by the end of 2021, said Anthony Fauci in a plenary address at the AAAS Annual Meeting.

Fauci, director of the National Institute of Allergies and Infectious Diseases and a prominent advocate for science in the United States' coronavirus response, said the 2020 race to develop and deliver COVID-19 vaccines was "the major success story thus far" of the pandemic.

The unprecedented sprint to a vaccine was aided by a decade's worth of science surrounding vaccine platform technology and vaccine design based on viral molecular structure that began with HIV research, he said.

The vaccines are arriving after a bleak autumn and holiday season in the U.S. that saw up to 400,000 new cases of the disease a day and up to 4,000 deaths per day, Fauci noted, with Black, Latino and Native American communities disproportionately affected. As measured by average daily deaths, COVID-19 now surpasses heart disease, cancer and other common causes as the leading cause of death in the U.S.

The goal now is to increase the number of vaccines going into the arms of Americans throughout the spring, said Fauci, to get "up to 85% of people vaccinated before we get to the middle and end of the summer."

Among the newly-vaccinated is Esther Cohen, the 91-year-old mother of Science senior news correspondent Jon Cohen. She joined her son in a Q&A session after the plenary to ask Fauci an important question of her own: "I play mahjong, like all the Jewish yentas, with four other women. Now that we've all had our second shot, can we play?"

"Hang on," Fauci advised. The existing guidelines recommend continued masking and maintaining social distance between fully vaccinated people, he said, "but I believe that's going to change, because people are asking, like you, a very obvious question: What's the reason to get vaccinated in the first place if you don't want to get to normal?'"

Fauci is the recipient of the 2021 Philip Hauge Abelson Prize, awarded annually by the American Association for the Advancement of Science to a scientist or public servant who has contributed significantly to the advancement of science in the United States.

Divided Nation

A member of President Donald Trump's coronavirus task force, Fauci said he "survived the grief" he received from administration officials after a March 2020 Science interview with Jon Cohen in which he spoke candidly about the challenges of working with Trump on the pandemic.

It was difficult sometimes to contradict the president and others in coronavirus press conferences, he said, but he felt it was essential to have a voice at the podium representing the science.

It "dampened a bit the complete unleashing of pure anecdote, which really would have been a disaster," said Fauci.

One of the lessons he learned was that "if you're going to fight a public health challenge, do it when society is in unison and all agreed upon what you need to do," he said. "We were fighting a very serious pandemic in the midst of an extremely divisive society."

The Trump administration's inconsistent messages on masking and social distancing, combined with policies on business and school openings that varied considerably from state to state, was frustrating, Fauci said.

"When you have a brand-new emerging pandemic infectious disease, it doesn't know the difference between Mississippi and Alabama or New Orleans and Texas… it doesn't really care, and yet we were acting like each individual state had their own separate virus and they could do things very differently," he added.

Instead of leaving states to fend for themselves, the Biden administration is seeking close cooperation and collaboration between states and cities, he noted.

"We're not dictating to the states what to do but we're making it very clear that we have a very, very strong partnership with the states, not only in providing resources but in helping them with a plan," said Fauci, who now serves as the chief medical adviser to President Joe Biden.

Underestimated Virus

Another lesson Fauci learned in 2020: "Don't ever underestimate what an emerging virus can do."

One of the most surprising aspects of the pandemic has been the asymptomatic spread of the coronavirus, he said, with at least one-third and perhaps up to 45% of people who get infected but never develop symptoms. "That really makes it different than virtually any other respiratory virus that we've encountered."

More than half of all cases are transmitted by people before they show symptoms or who never show symptoms, which has made it difficult to identify, isolate and do contact tracing for people who are infected.

At-home antigen testing kits now available in pharmacies could make COVID-19 less invisible, and repeated and frequent testing will be key to opening schools and businesses safely, Fauci said. "The federal government is making major investments, to the tune of hundreds of millions of dollars, to contract to make millions and millions of tests, as many as 19 million per month."

COVID-19 therapies have not kept pace with vaccine development so far, but the National Institutes of Health maintains a website with frequently updated recommendations and guidelines for treating the disease.

The ideal future treatment would be an antiviral medicine that directly targets the virus, Fauci said. "The combination of a vaccine that prevents severe disease and a direct antiviral agent is going to completely transform how we think of COVID-19."