Today, TWiV interviewed Dr. Anthony Fauci and Rich Condit and Vince Raccaniello asked all the right questions, to which Dr. Fauci responded as best he could.
https://www.microbe.tv/twiv/twiv-641/
Above is the link, which is well worth the 30 minutes, but for those with tight schedules, here are some highlights:
These are old friends to Dr. Fauci, and he clearly was happier talking to these folks than to most reporters, because among these colleagues he didn't have to shape his answers to his audience, but could simply talk freely with people who would understand the subtexts.
One of his off the cuff remarks was revealing, in answering a question he said, "That's one of those questions where you have to say you don't know, but they ask but what's your best guess? So you give your best guess and then they come back to you months later and say, 'You were so wrong!'"
We know what he's talking about here.
At 79, he clearly has not lost a step: In answering a 5 part question he said, "Usually with these multipart questions I cannot remember the questions after the first one, but with this one all 5 questions are related, so I can take a shot." And he worked methodically, flawlessly through each one. So there was that capacity to sound humble and then demonstrate sharpness.
This is not "humble bragging," where someone complains about his sore hand from shaking the hands of the throngs who adore him. This is simply Fauci being confident that even if he cannot recall all the parts, he still has something to offer.
It's just the sort of intellectual confidence Trump and all his FOX News acolytes lack. They ramble and digress; he focuses.
His TWiV interlocutors focused on basic themes, which the TWiV folks have dissected and elaborated upon previously, to get Fauci's take.
1/ What is the behavior of this disease?
Is it a virus which mostly sticks to mucosal surfaces (lining of the mouth, nose, throat and lungs) or is it significantly viremic (blood borne)?
This is important because a respiratory coronavirus which sticks mostly to the mucosal surface typically provokes an immune response which is ordinarily transient, lasts only weeks or a few months.
If SARS COV-2 is like its cousin coronaviruses, then any vaccine we make to it may be only able to protect for a few months, or even less.
Dr. Fauci said only autopsy studies will be able to answer this question and there are not enough data yet. "A data free zone" as he put it.
What he did not say is autopsies are no longer routine in America--pathologists don't want to do them, especially when they may get infected in the process and typically only university hospitals do them, and not many at that.
When a virus is blood borne like measles or small pox, then the immune system activates B cells and T cells and immunity can last for years. But, so far, this virus does not look like it has much blood borne time. And case reports suggest patients who were sick with COVID19 in March are getting sick again with + PCR in June. Recrudescence or re infection? Nobody knows.
Questions about death rates, prevalence could not be answered with good data, but as Fauci pointed out (and as TWiV has elucidate previously) if the virus is really lethal, it tends to burn itself out (like MERS) because it cannot leap from a dead person who is not out there in the community the way it can if it has asymptomatic or pre symptomatic people spreading it as they go out among the community. When a virus is killing only 1% of its hosts, it can spread more widely--it can infect nearly the entire population, over time. But if only 1% of 300 million people die, that is still 3 million people.
2/ Vaccines:
Much discussion was given over to a discussion of vaccines and Raccaniello pressed Fauci on the topic Brianne Barker and others had examined: Are we putting all our eggs into one basket with vaccines aimed only at the spike protein (which attaches the virus to the ACE receptor on cells as it opens the door, yanking on that door knob)?
Barker and others noted that vaccines which elicit immunity to other parts of the viral genome may be necessary to elicit robust protection. There are many steps in the invasion of the cell, in the process by which the virus takes over the wheels of the cell, but going after only the spike protein is like having all the defenders on the front line, with nothing behind them if the wall is breached.
And, as Barker noted, it's not even clear that B cell antibodies are what really confers protection--T cells may be more important and we have very few studies showing how well vaccines work on T cells.
Antibody levels may not tell you much about levels of protection: Antibody levels can rapidly stoke up with the second exposure, so low levels may not mean much. On the other hand, if antibodies are not protective, they may not tell you much.
Fauci, typically, responded that going after spike proteins has worked for other viruses and the idea is to go for what has worked for other viruses in the past. He wants to see "neutralizing antibodies."
When pressed, he did say other targets on the virus have been identified by some of the other companies working on vaccines.
3/ Masks:
Do masks work and are we making a mistake opening schools even with them?
Fauci mentioned the NIH has a 6000 person, 2000 family study about how children get and transmit viruses to their families and others and once this is done, we'll know more about what we need to do about schools. He did say schools have got to open but the way this is done will have to vary by locale. In some counties, no masks no precautions may be necessary but in other places, all precautions will have to be tried. [Subsequent episodes of TWiV mention the report of 3 hairdressers, all SARS CO-2 positive but wearing masks worked on 139 customers and none of the customers turned positive, suggesting masks are effective in blocking transmission.]
4/ Asymptomatic illness and transmission:
Fauci refers to the incident on the aircraft carrier Theodore Roosevelt where only 20 sailors were ill but 1000 sailors tested positive and said, "Hard to imagine those 20 sailors directly coughed on all 1000 other sailors."
Fauci has been attacked, predictably, because he is the messenger but there's more to it than this. As Trump noted, early on, he's become a rock star and he eclipsed President Trump on the stage, stole his spotlight and Trump could not abide that.
Fauci is everything Trump is not: Fauci is short, humble and understated.
But he has the quality Trump strives for: the common touch.
His language is scaled down to conversational.
He does not strut or try to impress.
He doesn't have to try to impress. His reputation, his back story precedes him.
He went to an Ivy League medical school, from there to the NIH where he became the youngest man to head an Institute and where he organized the campaign to bring AIDS under control, which turned out to be one of the most successful public health efforts "ever." Of course, he did not do this alone--he was an organizer, not a bench researcher and he did not make scientific breakthroughs. He was an Eisenhower, organizing talented generals to galvanize a victory.
He can afford to be humble, because respect precedes him into the room, and it must have, mortified Trump to see the members of the press listen with rolling eyes as he spewed out his daily fantasies and delusions about the virus melting away like magic, only to see these same people sit up and urgently raise their hands when Dr. Fauci took his turn at the podium.
Trump saw what so many kings and politicians have seen before him: Political power is a construct, a social game we play, but when people are really worried and looking for leadership, it's the physicians they worship.
But when the physician plays the role of the parent and tells people they cannot go out and play and do the pleasurable things they adore, they react as children do--with petulance. Or they take the warnings as insults to their own parenting and they accuse the government officials of acting like parents who smother their children and do not allow their children to risk and to learn.
Fauci is "the real deal" while Trump, even to his fans, must be the entertainer, the fantasy spinner.
Not to say we do not need fantasy spinners.
Humankind cannot bear too much reality. (Eliot)
https://www.microbe.tv/twiv/twiv-641/
Above is the link, which is well worth the 30 minutes, but for those with tight schedules, here are some highlights:
These are old friends to Dr. Fauci, and he clearly was happier talking to these folks than to most reporters, because among these colleagues he didn't have to shape his answers to his audience, but could simply talk freely with people who would understand the subtexts.
One of his off the cuff remarks was revealing, in answering a question he said, "That's one of those questions where you have to say you don't know, but they ask but what's your best guess? So you give your best guess and then they come back to you months later and say, 'You were so wrong!'"
We know what he's talking about here.
At 79, he clearly has not lost a step: In answering a 5 part question he said, "Usually with these multipart questions I cannot remember the questions after the first one, but with this one all 5 questions are related, so I can take a shot." And he worked methodically, flawlessly through each one. So there was that capacity to sound humble and then demonstrate sharpness.
This is not "humble bragging," where someone complains about his sore hand from shaking the hands of the throngs who adore him. This is simply Fauci being confident that even if he cannot recall all the parts, he still has something to offer.
It's just the sort of intellectual confidence Trump and all his FOX News acolytes lack. They ramble and digress; he focuses.
His TWiV interlocutors focused on basic themes, which the TWiV folks have dissected and elaborated upon previously, to get Fauci's take.
1/ What is the behavior of this disease?
Is it a virus which mostly sticks to mucosal surfaces (lining of the mouth, nose, throat and lungs) or is it significantly viremic (blood borne)?
This is important because a respiratory coronavirus which sticks mostly to the mucosal surface typically provokes an immune response which is ordinarily transient, lasts only weeks or a few months.
If SARS COV-2 is like its cousin coronaviruses, then any vaccine we make to it may be only able to protect for a few months, or even less.
Dr. Fauci said only autopsy studies will be able to answer this question and there are not enough data yet. "A data free zone" as he put it.
What he did not say is autopsies are no longer routine in America--pathologists don't want to do them, especially when they may get infected in the process and typically only university hospitals do them, and not many at that.
When a virus is blood borne like measles or small pox, then the immune system activates B cells and T cells and immunity can last for years. But, so far, this virus does not look like it has much blood borne time. And case reports suggest patients who were sick with COVID19 in March are getting sick again with + PCR in June. Recrudescence or re infection? Nobody knows.
Questions about death rates, prevalence could not be answered with good data, but as Fauci pointed out (and as TWiV has elucidate previously) if the virus is really lethal, it tends to burn itself out (like MERS) because it cannot leap from a dead person who is not out there in the community the way it can if it has asymptomatic or pre symptomatic people spreading it as they go out among the community. When a virus is killing only 1% of its hosts, it can spread more widely--it can infect nearly the entire population, over time. But if only 1% of 300 million people die, that is still 3 million people.
2/ Vaccines:
Much discussion was given over to a discussion of vaccines and Raccaniello pressed Fauci on the topic Brianne Barker and others had examined: Are we putting all our eggs into one basket with vaccines aimed only at the spike protein (which attaches the virus to the ACE receptor on cells as it opens the door, yanking on that door knob)?
Barker and others noted that vaccines which elicit immunity to other parts of the viral genome may be necessary to elicit robust protection. There are many steps in the invasion of the cell, in the process by which the virus takes over the wheels of the cell, but going after only the spike protein is like having all the defenders on the front line, with nothing behind them if the wall is breached.
And, as Barker noted, it's not even clear that B cell antibodies are what really confers protection--T cells may be more important and we have very few studies showing how well vaccines work on T cells.
Antibody levels may not tell you much about levels of protection: Antibody levels can rapidly stoke up with the second exposure, so low levels may not mean much. On the other hand, if antibodies are not protective, they may not tell you much.
Fauci, typically, responded that going after spike proteins has worked for other viruses and the idea is to go for what has worked for other viruses in the past. He wants to see "neutralizing antibodies."
When pressed, he did say other targets on the virus have been identified by some of the other companies working on vaccines.
3/ Masks:
Do masks work and are we making a mistake opening schools even with them?
Fauci mentioned the NIH has a 6000 person, 2000 family study about how children get and transmit viruses to their families and others and once this is done, we'll know more about what we need to do about schools. He did say schools have got to open but the way this is done will have to vary by locale. In some counties, no masks no precautions may be necessary but in other places, all precautions will have to be tried. [Subsequent episodes of TWiV mention the report of 3 hairdressers, all SARS CO-2 positive but wearing masks worked on 139 customers and none of the customers turned positive, suggesting masks are effective in blocking transmission.]
4/ Asymptomatic illness and transmission:
Fauci refers to the incident on the aircraft carrier Theodore Roosevelt where only 20 sailors were ill but 1000 sailors tested positive and said, "Hard to imagine those 20 sailors directly coughed on all 1000 other sailors."
Fauci has been attacked, predictably, because he is the messenger but there's more to it than this. As Trump noted, early on, he's become a rock star and he eclipsed President Trump on the stage, stole his spotlight and Trump could not abide that.
Fauci is everything Trump is not: Fauci is short, humble and understated.
But he has the quality Trump strives for: the common touch.
His language is scaled down to conversational.
He does not strut or try to impress.
He doesn't have to try to impress. His reputation, his back story precedes him.
He went to an Ivy League medical school, from there to the NIH where he became the youngest man to head an Institute and where he organized the campaign to bring AIDS under control, which turned out to be one of the most successful public health efforts "ever." Of course, he did not do this alone--he was an organizer, not a bench researcher and he did not make scientific breakthroughs. He was an Eisenhower, organizing talented generals to galvanize a victory.
He can afford to be humble, because respect precedes him into the room, and it must have, mortified Trump to see the members of the press listen with rolling eyes as he spewed out his daily fantasies and delusions about the virus melting away like magic, only to see these same people sit up and urgently raise their hands when Dr. Fauci took his turn at the podium.
Trump saw what so many kings and politicians have seen before him: Political power is a construct, a social game we play, but when people are really worried and looking for leadership, it's the physicians they worship.
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| Click on this to get the real effect |
But when the physician plays the role of the parent and tells people they cannot go out and play and do the pleasurable things they adore, they react as children do--with petulance. Or they take the warnings as insults to their own parenting and they accuse the government officials of acting like parents who smother their children and do not allow their children to risk and to learn.
Fauci is "the real deal" while Trump, even to his fans, must be the entertainer, the fantasy spinner.
Not to say we do not need fantasy spinners.
Humankind cannot bear too much reality. (Eliot)
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