While conceding missteps in the federal response to the coronavirus, Dr. Anthony Fauci said Wednesday it is not too late to avoid the dire picture he outlined in congressional testimony of 100,000 coronavirus cases a day.
The nation's leading infectious disease experts said the conflicting advice offered by federal leaders around face masks in the early days of the pandemic helped sow distrust and continues to hamper the government's ability to slow the outbreak.
"We have to admit it, that that mixed message in the beginning, even though it was well meant to allow masks to be available for health workers, that was detrimental in getting the message across," Fauci said in an interview with Mary Louise Kelly of NPR's All Things Considered. "No doubt about it."
Despite the overwhelming consensus among public-health experts that face masks can help prevent the spread of the coronavirus, face coverings have become a partisan issue, something critics of the federal response have blamed on what they say has been a confusing back-and-forth on the issue from the Trump administration.
As late as February 29, Surgeon General Jerome Adams was telling Americans on Twitter to stop buying masks, saying they are "NOT effective." But the guidance soon changed, and by early April the Centers for Disease Control and Prevention began recommending that Americans wear face coverings in public. Even then, however, President Trump said he would not be wearing a mask himself.
"I think that that did have an effect," said Fauci, the director of the National Institute of Allergy and Infectious Diseases, of the conflicting guidance. "The message early on became confusing," he said.
But, he added, once it became clear people can spread the virus without knowing they're sick, public health leaders realized the message needed to change.
"We have people who may not even know they're infected and are inadvertently infecting others," said Fauci.
And the latest evidence shows some protection to the wearer too. "It isn't 100% protection by any means, but certainly the amount that you get is worth wearing it, not only worth wearing it, but really compels you to wear it."
Fauci said he has been encouraged by a growing chorus among Republican leaders in recent days encouraging Americans to wear masks. That list has grown to include not only Vice President Mike Pence, but top Republicans in the Senate, including Majority Leader Mitch McConnell, Tim Scott of South Carolina, Lamar Alexander of Tennessee and Marco Rubio of Florida.
That's been matched by a rising number of states that now require that masks be worn in public. Eighteen states and the District of Columbia now mandate masks in public — a list that was joined by Pennsylvania on Wednesday.
The tightening of coronavirus-related restrictions in many states comes amid a rapidly escalating surge in new cases that has eclipsed some of the worst days of the pandemic during the spring. More than 44,000 cases were reported Tuesday, according to data from Johns Hopkins University, one of the highest daily totals yet.
And the worst may still be to come. In testimony before the Senate on Tuesday, Fauci warned that the virus could soon reach 100,000 cases per day.
In his testimony, Fauci said one reason cases continue to climb is because the nation may not have shut down as aggressively as it needed to early in the crisis. He noted that in Europe, as much as 95% of the population was effectively shut down, while in the U.S., the figure was closer to 50%.
"If you look at the Europeans, they got the curve way down," he told NPR. "Once the curve is way down ... it is much easier, when you do get blips of infection as you try to open up, to contain those infections. And if you look at our curve, it peaked, it came down a little and then it stayed about flat until just recently when it resurged up again. It makes it much more difficult because ... you're sort of chasing after things as opposed to getting your thumb on them. So we're in a bad position because of what happened early on."
Fauci said he believes the country can avoid another lockdown, "but we have to do things a bit differently than what we've been doing."
He said activities like "congregating in bars, congregating in crowds, people getting together in a celebratory way ... without wearing masks" contributed to recent case surges. This behavior, he said, while understandable because people "felt cooped up," represented "a violation of the principles of what we're trying to do, and that is the social distancing, the wearing of masks."
"It's really in our hands as a community, as a nation, as a populace to make this happen," he said. "It does not have to be 100,000 cases a day."
MARY LOUISE KELLY, HOST:
And we are beginning this hour of the program doing something we almost never do, playing exactly the same piece of tape we played you yesterday, playing it again because it is so striking and it raises so many questions. Here it is. This is Anthony Fauci, the top infectious disease expert in this country, on how COVID-19 could be about to get much worse.
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ANTHONY FAUCI: We are now having 40 plus thousand new cases a day. I would not be surprised if we go up to 100,000 a day if this does not turn around. And so I am very concerned.
KELLY: Dr. Fauci testifying there before Congress yesterday. So what would it take to turn this around? Well, we've asked him to take our questions today. And he is here with us now. Dr. Fauci, welcome to ALL THINGS CONSIDERED.
FAUCI: Thank you very much. It's good to be with you.
KELLY: Allow me to sharpen that question. Can we turn this around - can we turn these numbers around without an even more aggressive shutdown than we had in March and in April?
FAUCI: I believe the answer is yes, but we have to do things a bit differently than what we've been doing because when you talk about the goal of everyone to try and proceed towards normalization by taking steps in the Opening America Again Program, which were guidelines that had good and well-demarcated benchmarks, what we saw - and it really varied from state to state - were people out there congregating in bars, congregating in crowds, in a celebratory way, understandably, because they felt cooped up, without wearing masks. That is, you know, in many respects, if I might use the word, it's a violation of the principles of what we're trying to do, and that is the social distancing, the wearing of masks. So it's really in our hands as a community, as a nation, as a populace, to make this happen. It does not have to be 100,000 cases a day. I used that number because I wanted to jolt people into realizing...
KELLY: Yeah. You got our attention.
FAUCI: No, we did. And that's exactly what I wanted to do because as I've said so many times over the previous weeks to months, if you leave the virus to its own devices, it will take off on you. The control of an outbreak is what we do to oppose the dynamics of the outbreak. And if you do things that essentially enhance the outbreak, then you're part of the problem. You're not part of the solution.
KELLY: You've just said a couple of things I want to follow up on. You talked about how things have varied so much state to state. You used the word guidelines as opposed to requirements. Does there need to be more of a coordinated federal plan? Do there need to be requirements? Or is it wise to have the strategy remain, leaving this largely to states and local governments to figure it out?
FAUCI: You know, Mary Louise, you bring up a good point. And there's a lot of argument about that, about how this country is set up, where you have the states that have the capability of making decisions because of the different and peculiar nature of things that go on in different states.
KELLY: From a public health perspective, would it be better if the federal government were taking a more assertive role?
FAUCI: Well, it might not be. I mean, I'm one that does take an assertive role. If you hear what I say whenever I'm talking, as I am on this program, you know, it is really saying that we must do these things. Hopefully - and I'm seeing it right now after yesterday's numbers came out - that many of the governors and the mayors are actually demanding and saying it is mandatory now if you're going to go out, you have to have a mask on. That is something that is absolutely essential. But you're right. There will be arguments. I'm one for more directive way of doing things. But in many respects, that's not the way this country works.
KELLY: So what do you say to the governors or to local leaders who are not rolling things back? Somebody like Florida governor Ron DeSantis, where they on Saturday recorded the highest single day increase thus far, nearly 10,000 new cases, and he says Florida is open, and he's not going to go back on reopening.
FAUCI: Well, what I'd do is two things, and I've been doing it consistently and intensively - is I do it publicly, like I have the opportunity to do on your program, and I get on the phone. And I've been on the phone with a lot of different governors talking to them about what I think should be done. I have been very prescriptive in what I've said. I've said not think about it, maybe you want to do it. I say do it. This is what you really need to do if you want to contain the outbreak in your state or in your city, depending upon whether I'm talking to a governor or a mayor or someone else.
KELLY: And may I just push you on your hope that we can turn things around, turn these numbers around without shutting down at least as aggressively as things were in March and April? I'm thinking of another thing you said in your testimony yesterday, which is that you were talking about why Europe has largely succeeded and the U.S. has failed to control the virus. And you talked about how when the U.S. shut down, it was, in reality, only about 50% of the activity was really shutting down, whereas in Europe it was more like 90 or 95%.
KELLY: I mean, that makes it sound like we had a shot, and we blew it.
FAUCI: You know, I wouldn't - you know, that's a very provocative word, blew it. But certainly, if you look at it - and I meant it; the numbers are true - if you look at the Europeans, they got the curve way down. Once the curve is way down, Mary Louise, it is much easier when you do get blips of infection as you try to open up to contain those infections. And if you look at our curve, it peaked, it came down a little, and then it stayed about flat until just recently when it resurged up again. It makes it much more difficult because you're not in containment. You're in mitigation. You're sort of chasing after things as opposed to getting your thumb on them. So we were in a bad position because of what happened early on. You're right. We only shut down about 50%. That's in the past. What we've got to do now is we can get control of it if we do the things that I spoke about at the hearing yesterday.
KELLY: Let me turn you to vaccines. You have said we should have a vaccine by the end of this year with production ramping up next year. Whether that vaccine works and how long it may work for, whether we may be protected for life or just for a few months, are those still open questions?
FAUCI: They are. They are because right now the one thing that is going well is the procedure of multiple different candidates. And there are candidates all over the world. There are several that are being looked at here in the United States. They're on track for going into advanced trials sometime this summer. It's something that we are not compromising safety nor scientific integrity to move quickly. Having said that, given the size of the trials and given the fact that there's so much viral activity, we should get an answer sometime by the end of the year. And as I've said, say it again, Mary Louise, there's no guarantee that you're going to get a safe and effective vaccine. But the early indications from the trial make me, I use that word, cautiously optimistic that we are on the right track.
KELLY: I join you in hoping that we stay on that right track. But I have to ask, what if people won't get it? You'll have seen the same polls I have showing that half of the U.S. is reluctant to get a coronavirus vaccine.
FAUCI: Yeah. And that gets back to another thing that we've spoken about, that there is an anti-vaccine type of an attitude and even an anti-science attitude. It is up to us to mitigate that by getting a very strong degree of community engagement. We did that with interventions with HIV back in the '80s and the '90s, and we did it very successfully. You need to engage the community that's involved. You can't expect them to just take your word because you are authority or government. It was very successful with HIV. I hope we can do the same engagement of the community with COVID-19.
KELLY: On face masks, I know you have talked about the early guidance to Americans not to wear them. You've said you don't regret that guidance, that there weren't enough masks, and health care providers needed them first in the early days. My question is, why were Americans told masks don't work? If the problem was we don't have enough of them, they could help, but we don't have them, why weren't we told that?
FAUCI: Well, you know, it was I think a lot of confusion about what you mean by work. I think what was really, I think, miscommunicated was that they are not perfect. It isn't like there's 100% protection. But one of the...
KELLY: We were told, if I may, sir, by the Surgeon General, stop buying masks. They're not effective...
FAUCI: Yeah but - yeah.
KELLY: ...In preventing the general public from catching coronavirus. That's what we were told. That's a tweet from him, Feb. 29.
FAUCI: Yeah, I know. I - you know, I don't want to go back and analyze a tweet. But to tell you now the data that we have right now - one of the things that has actually happened was a realization that we have such a high percentage of people who are asymptomatic and who we know can spread the infection. And that was one of the major driving forces of getting people to say, wait a minute, we have a different situation now. We have people who may not even know they're infected and are inadvertently infecting others. Those are the ones that we want to have masks on. And we know we can protect the others who are on the other side of that mask. It isn't 100% protection by any means. But certainly the amount that you get is worth wearing it.
KELLY: I suppose my question that I'm driving at is, did you lose trust? Does this account for some of the anti-mask sentiment that we're seeing and hearing today? Because Americans were told by their government one thing in February, March and pretty much the direct opposite now.
FAUCI: I think that did have an effect. I think you have to be realistic that when the message early on became confusing, particularly when now we have such a strong - but there's so many other things that you're well aware of that get into this idea about people wanting to wear masks or not. But you are right, and we have to admit it, that that mixed message in the beginning, even though it was well meant to allow masks to be available for health workers, that was detrimental in getting the message across right now. No doubt about it.
KELLY: Are you encouraged by developments this week - the vice president and other senior leaders, senior Republicans coming out and saying wear a mask?
FAUCI: I'm very encouraged by that. I think it was very important to see senior leaders and to see the vice president out on his trip when he went out to some of those states to wear the mask.
KELLY: That is Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force.
Dr. Fauci, thank you.
FAUCI: Thank you for giving me the opportunity to be with you.
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