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What can we expect from the pandemic this winter?


And we begin this hour with the pandemic and the question of what course the U.S. is on. COVID-19 is still killing more than a thousand people in this country every day. New cases are hovering at around 70,000 a day, and infections are ticking up in some pockets of the U.S. Amid this backdrop, some new developments this week - the Biden administration rolled out vaccine requirements that cover more than 100 million American workers. Also, children ages 5 to 11 can now get the shots, too. Hooray. And today there is news of a new anti-COVID pill, which is showing promise in reducing hospitalizations and deaths. Well, here to talk it all through is Dr. Anthony Fauci, chief medical adviser to the president.

Dr. Fauci, welcome back.

ANTHONY FAUCI: Thank you - good to be with you.

KELLY: Let's start with this new pill. It is still experimental. It is not approved. But Pfizer says it seems to reduce the risk of hospitalization and death by 89%, which sounds pretty good. What should we know about it? How promising is it?

FAUCI: Well, it is really quite promising. We went over the data the night before they made the announcement, and they did it with some other colleagues - myself and other people at the NIH and CDC and FDA and others who were interested, obviously, in this - I believe to be an important advance. It's important for the following reason. It is a pill that is given early within five days but preferably within three days of the onset of symptoms. And the endpoint of the study is whether or not it diminished hospitalization or death.

KELLY: So serious illness.

FAUCI: The primary - serious illness. And it has been given to people who have one or more of underlying risks that would make them more likely to have an advanced progression of disease, namely people with diabetes, hypertension or smokers. And the results were really quite striking, so much so that the Data and Safety Monitoring Board, which monitors both the safety as well as if a product is good enough with regard to benefit, that you would have to ethically stop this study so that not to prevent those who are in the placebo group from getting the benefit...


FAUCI: ...Of those who are in the treatment group. And what it did is that it diminished by 89% the likelihood that you would have a hospitalization in the placebo versus the the drug group and by about 85% if you started within five days. So the earlier you give it, obviously...

KELLY: The better the results.

FAUCI: Yeah, which is really...

KELLY: And I gather that this is - Pfizer isn't the only pharmaceutical company working on this. Merck has another antiviral pill.

FAUCI: Yeah.

KELLY: Works in a different way but similar goal. I have to ask because people will be thinking, hey; great. if I get sick, I can just take the pill.


KELLY: I think I know the answer to this. But for the record, even when and if we get these pills, does it negate the need for a vaccine?

FAUCI: Mary Louise, absolutely not. And I hope people don't take that approach because it is always, always better not to get infected than to get infected and then have a situation where you can either progress to severe disease, which - this pill thankfully is able to inhibit the likelihood of that progression. But also, you know, getting infected, you can have mild to moderate illness that never requires your going to the hospital and being hospitalized and needing organ system support in the hospital. It's not something to be taken lightly. Yes, there are many people who can get infected and be either without symptoms or minimally symptomatic. But the best way traditionally, not only with COVID-19 but with any infection - it is always, always better to prevent it than to have to worry about treating it.

KELLY: Just not to get sick in the first place, which leads me to the other big COVID news this week. Kids - 5- to 11-year-olds can now get their shots. I said hooray when I mentioned that while introducing you. And I think that's a direct quote from some of the kids we have been talking to on the show, many of whom told us they're thrilled. What is your basic take, though, on how parents who are weighing risks, benefits - how they should think this through?

FAUCI: Well, first of all, we have to always respect when parents have questions - reasonable questions about this. And what you do is you take them to the data. This is a study that very clearly showed a high degree of efficacy. If you look at the clinical trial, the degree of efficacy is substantial. It's about 91% or so. That is really very good for a vaccine. No. 2, there are about 1.9 million reported cases of children between the ages of 5 and 11 and about 8,300 hospitalizations and over 2,000 of that multisystem inflammatory syndrome in children, which can really be quite severe, and about 100 deaths thus far within that age group, the 5 to 11. So I would tell the parents, although it is less likely for a child to get a serious result from infection than an adult, particularly an elderly adult, it is not something that you - that's trivial...

KELLY: Right.

FAUCI: ...With children. So that's the first thing. The other thing is that the vaccine - the safety profile in the clinical trial, Mary Louise, was really quite good. So it had really good efficacy and really good safety profile.

KELLY: OK, so it's safe. It works. One question we are hearing from parents is, if my kid has already tested positive, you know, going back to school or whatever, do they still need to get the vaccine? If they've tested positive, we think they have antibodies.

FAUCI: Yeah. And this is something that has been discussed at the adult level, and it's certainly - this is brand-new now because we're just essentially having this go through with the EUA. So there's not a lot of experience yet. But the fact is...

KELLY: The EUA, the emergency use authorization.

FAUCI: The emergency use authorization - that's correct - is that it is very clear that when you superimpose vaccination upon someone who has been infected and recovered, the subsequent degree of protection of them against subsequent reinfection is rather strong. So it's a strong degree of protection. And that's the reason why, with adults and essentially ultimately for everyone, that you would want to see that other people should get vaccinated even if they had been prior infected.

KELLY: Big picture, how are you defining the goal at this point in the pandemic? I ask because it feels fuzzier than it maybe did early on. I mentioned we're still logging more than 70,000 cases a day, new cases. And yet in many parts of the country, life feels - I don't want to say normal but something maybe starting to approach normal.

FAUCI: Yeah. Well, certainly things are going in the right direction with a diminution of cases, hospitalizations and deaths. The steepness of the deflection is not as good as it was, let's say, a month or so ago because we were getting, you know, 10, 15, 20% decrease from week to week for the prior week. It's down to a lower number.

KELLY: Do you think that's because we're all going back inside? It's getting cold.

FAUCI: You know, I think that the trouble is, Mary Louise, when you go back inside, sometimes that makes things worse because when you're dealing with respiratory illnesses when you're in a closed place, specifically those that don't have good ventilation - so, you know, there's a mixed bag about that. But the one thing that we've learned now from close to 20 months of experience is don't take the virus lightly. We're going in the right direction.

And what you said earlier is something that's in our favor. No. 1, we now have 28 million children from 5 to 11 who now are eligible to be vaccinated. We have adolescents who we've already started some months ago to vaccinate, but we need to do better with them. And then we have about 60-plus million people in the country who are eligible for vaccinations who have not yet been vaccinated.

So as we go into the winter months with the challenge of a respiratory infection being worse in the winter months, we can get through this if we really put a lot of effort into getting as many people vaccinated as we possibly can. So what are we looking for? We're looking for a level of control ultimately - I can't tell you exactly when that would be - where the level of infection due to vaccination predominantly - but also, people who may have been infected and have some degree of protection - it doesn't disrupt society the way the COVID-19 outbreak is currently doing with us. We all want to get back to normal. But, you know, what do you mean by normal? I mean, how normal - exactly the way it was before the outbreak? But at least a low level...

KELLY: I would take that (laughter)...

FAUCI: Yeah.

KELLY: ...For the record.

FAUCI: I would, too. Any day of the year, I would take that, absolutely.

KELLY: I wonder; that may mean - this next question of mine is overly simplistic. But I wonder; is there a particular number that is the biggie at this point when you try to figure out how we're doing? Are we succeeding? Are we beating this thing? Is it reducing case numbers? Is it reducing deaths? Is it more shots into arms?

FAUCI: It's multiphase. The most important thing that has been the challenge because we've been through that painful experience - you want to get deaths and hospitalization as low as you possibly can. You get there by getting the cases lower, but you get there by getting the cases lower and diminishing hospitalization and death by vaccination because we know vaccination - even when it doesn't always prevent infection, it goes a long way to preventing the progression to severe disease. So we want to do all of the above. You mentioned three things - all of the above, Mary Louise.

KELLY: All of the above is the answer.

FAUCI: Yeah.

KELLY: Just a minute or so left, Dr. Fauci, but I wonder; how worried are you as you gaze across the Atlantic and see what's happening in Europe? It's like deja vu all over again, with case numbers exploding.

FAUCI: Yeah. You know, Mary Louise, if you look at the numbers, though, it is a little bit of a disparity there because the countries in Europe in the European Union that have greater than 77% of their population receiving at least one dose of vaccine looks pretty good. The numbers came down and stayed down. It's those European countries, which are mostly Eastern European countries, who have less than 60% of their population with one at least one dose. Those are the ones that are surging back up. So that just tells us again why we should continue to get people vaccinated.

KELLY: The messaging is consistent on that. Get vaccinated. That is Dr. Anthony Fauci, chief medical adviser to the president and head of the National Institute of Allergy and Infectious Diseases.

Dr. Fauci, thank you. Happy weekend.

FAUCI: Thank you for having me - good to be with you.

(SOUNDBITE OF VHS OR BETA'S "SOLID GOLD") Transcript provided by NPR, Copyright NPR.

Mary Louise Kelly is a co-host of All Things Considered, NPR's award-winning afternoon newsmagazine.
Casey Morell (he/him) is an associate producer/director of All Things Considered.
Christopher Intagliata is an editor at All Things Considered, where he writes news and edits interviews with politicians, musicians, restaurant owners, scientists and many of the other voices heard on the air.