>> Where does Dr. Anthony Fauci say the pandemic is headed?

This week on "Firing Line."

>> We talk about a second wave.

We have never really gotten out of the first wave.

>> An infectious disease specialist who has advised six presidents, Dr. Fauci has faced challenges before... >> ACT UP!

>> ...the AIDS epidemic, SARS, Ebola, but nothing like COVID-19 and this White House.

With cases rising across the country, winter is coming... along with hope that a vaccine is on the horizon.

What does Dr. Anthony Fauci say now?

>> "Firing Line with Margaret Hoover" is made possible in part by... And by... Corporate funding is provided by... >> Dr. Anthony Fauci, welcome to "Firing Line."

>> Good to be with you.

Thank you for having me.

>> There are currently an average of 50,000 new COVID cases per day in the United States, and a number of states are seeing increases.

Dr. Fauci, is this where we should be as we head into our first winter of COVID-19 in the United States?

>> No, unfortunately, it's not, and this is one of the things that has troubled me for some time, as when we were in the summer -- I was hoping we would get the baseline level of daily infections at the community level to a very low baseline, hopefully even less than 10,000 per day.

And as it turned out, we got stuck for a while at around 40,000 per day.

And now what we're seeing is unfortunately going in the opposite direction.

I was hoping we could go into the cooler months of the fall and the ultimately colder months of the winter positioned in a much better place, because when you're doing things predominantly indoors, as opposed to outdoors, whenever you're dealing with a respiratory infection, that always makes it more problematic.

So, no, the answer to your question is we're not in a place where I would have hoped we would have been.

>> So, a study from the Institute for Health Metrics and Evaluation at the University of Washington suggested that by February 1st, nationwide, we could expect to see a total of 395,000 deaths because of COVID-19 if behaviors and policies remain the same -- that would nearly double where we are right now.

Do you agree with the modeling there?

>> Well, you know, one -- we have -- one has to be careful when you're talking about modeling, Margaret, because models are only as good as the assumptions you put into the model.

So the assumptions that were put in, as you stated quite correctly, is that, if we don't do some changing in what we're doing, it is conceivable, if not likely, that we will get to that very unfortunate number, which, to me, serves as a stimulus of why we've got to be able to do things a bit differently.

And I don't mean shutting the country down, because whenever you talk about implementing fundamental principles, people say, "Well, you want to shut the --" We're not talking about that at all.

We're talking about... >> So then, what steps should we take?

>> I mean, for example, the uniform wearing of masks, the avoiding close contact, the avoiding congregate settings with crowds, particularly indoor and people not wearing masks.

There have been some states, cities, regions, counties that have done that well and others have essentially skipped over it, either intentionally or they try to do it correctly, but the population, the people in our country, felt that that would be an encroachment upon their own individual right to do what they want to do, forgetting that we are all in this together.

>> So early on, COVID-19 was thought to spread easily by contact transmission or by touch.

I mean, people were sanitizing their groceries up until April, March as they came into the house.

And then we became more concerned about respiratory droplets traveling short distances.

And then even most recently, it has been confirmed by the CDC, as you know, to be aerosolized, as well.

So explain, please, for the audience, Dr. Fauci, the difference between aerosolized transmission and the spread by droplets.

>> Yeah, well, in fact, it's confusing to -- for some -- for many people, understandably.

Let me try to simplify it in a way that people can understand.

In essence, it's all droplets of different sizes.

When we generally talk about droplets, we talk about something that's heavy enough that it will contain virus in it, but it will drop to the ground within a period of a couple of seconds and won't travel any more than, let's say, 6 feet or so.

And that's the reason why we get the 6-foot-distance paradigm.

However, there are some situations where droplets are small enough or the aerodynamics in a room are such that they don't drop right away -- they hang around and can float around in the air for anywhere from seconds to minutes or longer.

That's what they refer to as "aerosol," versus droplets.

But in reality, it's just really droplets of different sizes.

>> Does the enhanced understanding that this is aerosolized and that it can live in the air for a period of time, does that impact how we think about air travel over Thanksgiving or the holidays with our families?

>> Not necessarily.

What it does underscore is what we had been saying all along, that one needs to be very careful about wearing masks because, if you go into a particular place, particularly indoors, is always more vulnerable when you're talking about aerosol than outdoors, which has the way of just dispersing things and diluting it.

>> The aerosolized droplets that you mentioned, however, are they so minuscule that they can permeate masks?

Are masks enough?

>> Nothing is -- Nothing is 100%.

And I think that's where you got to make sure you're careful about not throwing away the good because you want the perfect.

And even though it isn't perfect, the difference between having a mask on and getting droplets that you can't see with the naked eye is a substantial difference.

We know that from studies.

>> How far can infectious COVID-19 virus spread in the air?

>> We don't know that.

I mean, so if I would give you a number, it would be a guess.

It really depends.

I mean, it really depends on the size of the droplet, the aerodynamics.

In medicine and in public health, we have been making statements about aerosol versus non, and then you find out that there are so many other confounding factors that influence how long a particular virus can stay, quote, "in the air" in a particular particle of a certain size.

>> So, how much will our understanding continue to develop, with respect to how this spreads?

>> You know, I think we're continuing to learn literally on a daily, weekly, and monthly basis.

>> There's a lot of optimism about the speed at which a COVID-19 vaccine is being developed.

Two vaccines, as you know, are in their final stages of trials here in the United States.

When do you think realistically we will expect the announcement for a vaccine?

>> There is never a guarantee that you will have it.

But the way things are going with the clinical trial now, with the number of infections in the community, with the number of people enrolled in the clinical trial, we will likely have an answer by the end of this calendar year, November or December.

What about the efficacy and the safety?

I would do and say that I'm cautiously optimistic, though you can never guarantee it, that we will have a vaccine that has a considerable degree of efficacy in one or more of the candidates that are being tested.

If that's true -- >> Is that 70%, 80%, 90%?

>> Again, we don't know, Margaret.

it would be a pure guess.

The trials themselves -- >> What's "considerable"?

>> Well, I'll give you the range.

The trial is geared to be able to detect pretty clearly a 60% efficacy, a 50% to 60% efficacy.

I would hope that we would get at least 70%, 75%.

It would be wonderful if we had the degree of efficacy that we have, for example, with a measles vaccine.

The measles vaccine is 97% to 98% effective.

If we had that, I would be very, very pleased.

I'm not so sure we're going to get to that level.

We're going to shoot for it, but I'm not so sure.

I would accept something that would be 70%, 75% as being a very important step forward.

>> The US just had its first documented case of COVID reinfection -- the 25-year-old man in Nevada, who was infected with COVID in April, and then with a different strain of COVID in June.

So, what do we know, Dr. Fauci, about how long someone is protected from reinfection once they have contracted the virus?

>> Okay, so in the spirit of what I've said a couple of times during this discussion of humility and modesty, we don't know right now.

We will know as we follow more and more people for longer periods of time.

And we know that, when people get infected, often, those antibodies don't last very long.

Maybe after a couple of months, they're no longer there.

Does that mean the person is no longer protected?

We don't know that.

>> Help me understand, then -- since we don't know how much a person's antibodies protect them, what does that do to this argument in favor of herd immunity?

>> It depends on what you mean by "herd immunity."

If you're -- >> Well, herd immunity by antibody, by people getting the virus and then developing their own antibodies and that being then the way that the virus will die out from the population.

>> It's a big, open question.

We don't know how long someone who gets infected and recovers, how long that protection lasts.

What we do know -- and I'm not sure it can be a complete extrapolation -- but what we do know is that the four common cold coronaviruses that you and I get exposed to repetitively all the time, usually in the winter months -- we know that you can get reinfected with the same virus, that you're not protected.

So it is conceivable that, if you think by building up herd immunity of getting infected, which has a lot of danger to it, that that, in fact, isn't a surefire way of protecting over a long period of time the population.

>> Look, if we do develop a vaccine, it sounds like what you're saying is we would have to take the vaccine on a pretty regular basis in order to keep up... >> Right.

That is conceiv-- >> ...their resistance.

>> That is conceivable, Margaret.

You have to do the experiment to find out how long it lasts.

The first step is to develop protection.

The next step is to figure out if it's durable.

If it isn't durable, then you may need to give intermittent booster shots the way we do with other types of infections that require an intermittent booster, like tetanus and other types of infections.

>> Mm-hmm.

So, either way, it sounds like COVID is here to stay.

>> Well, I think some aspect of it is I don't think it's just going to disappear.

I do believe that, with a combination of good public health measures implemented at the global level and a good, effective vaccine that is taken up by the overwhelming majority of the population, that we could get the level of infection so low that, in and of itself, it peters out -- not eradicate.

I don't think we're going to eradicate it, but I think we can get much better control than we have right now with a universally implemented vaccine and good public health measures.

>> There are a group of scientists who have signed a letter called the Great Barrington Declaration, which the White House has embraced, and it argues that the central focus of public health policy should be, quote, "focused protection," right?

That protecting those who are the most vulnerable should be our primary focus and that the rest of the population should just live their daily lives and take on the risk that is getting the coronavirus and enduring it and building the antibodies.

You've said that it is impossible to fully protect the vulnerable population, and that's why this is a bad idea.

Why is it impossible to fully protect those who are vulnerable?

>> Well, so, in the declaration, it says, "We don't want to shut down and lock down."

I totally agree with that.

And I say that almost every day that that's not the solution.

The other one is -- >> There's an implication that somehow you want to shut down the economy.

I mean, that's what's implied.

>> Absolutely, totally, totally, totally incorrect, okay?

Now, next is, we want to protect the vulnerable.

I'm all for that.

That's what's in the declaration.

But what is implied from that is, if you let anybody and everybody get it, that you do nothing to block infection -- no masks, don't worry about crowds, do whatever you want -- let everybody get infected as long as you focus, as they say, on the vulnerable, which means protect the people in the nursing homes, protect the people in the extended-care facilities.

There are some things about that that are really problematic.

One is, if you look at the general population, a substantial proportion -- by some estimates up to 30% -- fall into the category that they are at risk of a severe consequence after you get infected -- namely, hospitalization and possibly death.

So if you think that you have the capability, which we have shown thus far we're not capable of doing that, of all of a sudden magically protecting all the obese people, the people with diabetes, the people with hypertension, the people with chronic lung disease, I say -- and many, many, many of my public health colleagues say -- if you think you're going to do that, you're going to wind up with a lot of dead people.

And that's something we really want to avoid.

So, "A," we do want to protect the vulnerable and we don't want to shut down.

But don't equate that with a successful way to deal with an outbreak by letting anybody and everybody get infected.

>> To those who tout the example of Sweden as sort of a rebuttal to not having shut down the economy, what do you say?

>> I say, why don't you compare Sweden with the countries that are comparable to them -- namely, the other Scandinavian countries, like Norway and Denmark?

They do terrible compared to Norway and Denmark when it comes to deaths.

>> President Trump has said that he was cured and that he is now immune from the virus.

Is this true?

>> Well, I'm very pleased that he's doing very well -- I mean, that's for sure.

I mean, he's a strong man.

He's done quite, quite well.

I think you have to be careful what the nuances of cure are.

Has he recovered from infection?

Yes.

Infectious disease people and others sometimes have a little nuance -- what you mean by cure -- like, if you have an infection or a condition in which the majority of people get better on their own and you'd give an intervention that facilitates that, most people won't say you cured it.

Some people would say you hastened the recovery, but he received some interventions that look promising -- so, in that respect.

Now, when you say you're immune, I have no doubt that, after he's been -- infection, that he is protected for a finite period of time.

I don't know how long that is, but the President is absolutely correct -- when he says he's recovered, he almost certainly has a degree of immunity that will protect him for a finite period of time against reinfection.

So he's quite correct in that regard.

>> He took off his mask at the White House four days after testing positive for the virus and said to the American people in a message, "Don't be afraid of COVID.

Don't let it dominate your life."

What is the impact of that messaging for ordinary Americans?

>> Well, you know, I don't want to get into a situation where we're pitting statements that the President makes against statements that I make.

I could only -- >> No, I want the science from you.

>> Yeah, the science is that most people -- and it is correct -- will, in fact, particularly if you're young and healthy, if you get infected, you may not have any negative consequences.

But one of the things we have to be careful of is the mentality to think because you may be a young, healthy person, that it doesn't make any difference if you get infected.

Well, it does because you don't live in a vacuum.

And if you get infected and even if you get no symptoms, you are propagating a pandemic that is killing a lot of people.

So what do I mean when I say you're propagating a pandemic?

>> Yeah.

>> Maybe you have no symptoms, but the chances are that you might infect someone who then infect someone who then does get serious consequences.

That could be someone's grandparent.

That can be someone's wife who's on chemotherapy for breast cancer.

That can be an immunodeficient child.

So you can't think of yourself of being in a vacuum where you're getting infected doesn't make any difference to anybody else.

It really does.

>> You have worked with six presidents, Dr. Fauci, both Republicans and Democrats.

George W. Bush gave you the Presidential Medal of Freedom for your work on AIDS.

And you have been in public health for decades.

During the beginning of the AIDS epidemic, you faced criticism from both activists who thought that the government wasn't doing enough to provide a vaccine and treatment, as well as from people who thought that you shouldn't be, quote, "wasting your time on HIV."

What did you learn from that period of time that you've brought with you today?

>> You've done your homework.

Thank you.

[ Laughs ] In the history -- very well.

Yes, that's exactly what happened.

You know, what I did learn is that you were going to have obstacles when you have an evolving, charged situation.

And there's nothing in some respects that is more charged than in an evolving, scary outbreak.

And that's what we had early on with HIV.

And there were opposing opinions.

There were people who disagreed -- what you did.

So the one thing I did learn then and I'm trying to the best of my capabilities to apply it now, multiple decades later, is that you've got to stick by the scientific data and the evidence, keep an open mind, admit when you've been incorrect, and move on and learn as the situation goes on.

Because, when you have an evolving outbreak over time, the way we had with HIV in the early '80s and the way we're facing with it right now, there's going to be a lot of complicating issues that are going to arise.

You just need to keep an open mind, be flexible, and be humble to admit that you don't know everything from Day One.

You just don't.

You can't.

>> What we've noticed is that HIV and COVID are both very different viruses, obviously with different modes of transmission, but both disproportionately have impacted minority communities.

>> Yeah.

>> Epidemiologically speaking, why is that happening?

>> I think what it has to do with a variety of things, one of which is the social determinants of health, the situation people find themselves in economically and socially and otherwise.

Let's take COVID-19 -- if you look at the disproportionate number of African-Americans and Latinx who actually get infected, the nature of their jobs puts them out into the environment in the front line, getting exposed -- that's bad enough.

But when you look at when they do get infected, they have a much greater incidence and prevalence of the underlying comorbidities, which make it more likely to have a severe outcome from COVID-19 -- diabetes, obesity, hypertension, renal disease, cardiovascular disease.

These things are due to decades and decades and decades of social determinants of health, which put them in a compromised position of their own health.

So the solution to that and one of the things I would hope that we would get jarred into realizing now is that this happens over and over again.

You brought up two good examples -- HIV and COVID-19 -- that maybe we'll have, as a society, a commitment to address these social determinants of health and somehow neutralize them so that three or four or five decades from now, we're not talking about the same disparities.

>> You were recently featured in a campaign ad for President Trump and said about that that quote, "By doing this against my will, they are, in effect, harassing me."

Did you know apparently a super PAC for Joe Biden has also used your image to make their argument to the public?

Is it worth denouncing Joe Biden's super PAC's use of your image, as well?

>> You know, I -- to be honest with you, Margaret, I haven't seen any of those things.

I'll go back and look at them.

But the ad that I saw from the GOP campaign, the juxtaposition of my statement at the end of that clearly implied that I was favoring a political candidate.

That is something that I've said -- and please give me the opportunity to say -- that I've been doing this in public service for five decades, and I have never, ever, either directly or indirectly, endorsed a political candidate.

And the implication of that, the way it was juxtaposed at the end of the ad, implied that I was endorsing someone.

And that's not -- I don't have anything for or against anybody.

I want to do my job as a public health person, a physician, and a scientist.

That was the reason why I was a bit upset by that.

>> So, will you look at the Biden super PAC ad and weigh in on that, as well?

>> I don't know.

Maybe I will.

Maybe I won't.

I mean, I think we're getting complicated enough here.

I want to continue to do my job.

>> Last month, you wrote in the scientific journal Cell that we are entering a, quote, "pandemic era" in which COVID is just the first of an accelerating wave of epidemics into the future.

Tell me what you mean by that and if we're going to be ready because we thought we were ready for this one.

>> No, we did.

That's a very good point.

What I was mentioning in that article with my colleagues, David Morens and others, was that, if you look upon what's going on now in society, particularly the encroachment upon the human-animal interface, that we're setting up a situation where we're going to be exposed to things in ways that we were never exposed to, and there are so many other aspects of that.

But I think one of the things that we've seen exemplified by the outbreak that we're involved right now is the wet markets in Asia, where people bring animals from the forest into market when they have no idea what the microorganisms or pathogens are in those animals.

We've got to be careful about that.

We've got to be careful about how we interact with the environment.

We've got to be careful about how we interact with other species.

That's what I meant by that.

>> You are a classics major and studied, no doubt, the great plague of Athens almost 2,500 years ago.

And Thucydides wrote... And it caused the citizens to lose respect for their leaders, their laws, and their institutions.

Now, many scholars say that this led to the death of Athenian democracy itself.

And I wonder, does this give you pause as you confront our current crisis today?

>> You're getting pretty heavy here, Margaret.

[ Laughs ] >> This is PBS, Dr. Fauci.

We go deep.

>> I know -- you're going very deep.

You know, I don't think it's comparable, Margaret.

Back then, to the best of my remembrance from my college and high-school days, that that was just something that was destructive to everyone, and democracy tended to collapse because of the disorder that left.

We're not seeing that right now.

We're seeing a good degree of divisiveness about some people who think this is not a problem and others that are seeing hundreds of thousands of people dying.

That's really the problem.

We've got to pull together and be on the same wavelength that the enemy here is the virus.

The enemy is not one side or the other of an argument.

And the only way to counter that is to do things together as a nation -- you know, that's the only way.

We can't be fighting with each other if we're trying to contain a potentially historic outbreak.

>> Dr. Fauci, thank you very much for being with us on "Firing Line."

I appreciate your time.

>> Thank you very much, Margaret.

I appreciate you having me.

>> "Firing Line with Margaret Hoover" is made possible in part by... And by... Corporate funding is provided by... ♪♪ ♪♪ ♪♪ >> You're watching PBS.