Fauci et al on what to expect come Fall

WASHINGTON—The United States does not have the coronavirus under control, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said in testimony to members of the Senate Health, Education, Labor, & Pensions Committee.

At the same hearing, CDC Director Robert Redfield, MD, told the Senators “we are not out of the woods yet;” coronavirus testing czar Admiral Brett Giroir said machines processing the rapid Covid-19 tests can only process four tests an hour; but FDA Director Stephen Hahn, MD, confirmed that the vaccine initiative dubbed “Operation Warp Speed” will have sufficient “needles” to deliver the vaccine when it is discovered.

Committee chairman Lamar Alexander (R-Tenn) opened the hearing by asking Fauci what reassurance he had to offer educators about opening schools in the Fall.

“Well, I would be very realistic… the idea of having treatments available or a vaccine to facilitate the re-entry of students into the Fall term would be something that would be a bit of a bridge too far… So if the issue is that the young individuals who will be going back to school would like to have some comfort and that there’s a treatment, probably the thing that would be closest to utilization then would likely be passive transfer of convalescent serum. But we’re really not talking about necessarily treating a student who gets ill, but how the student will feel safe and going back to school. If this were a situation where we had a vaccine, that would really be the end of that issue in a positive way, but as I mentioned in my opening remarks… we don’t see a vaccine, playing in the ability of individuals to get back to school, this term.”

Students and parents really want to know if it is safe to go back to school, Fauci said, and for that answer he turned to Giroir, MD, the s0-called “testing czar” member of the coronavirus task force. Giroir said that the nation will have the capability of providing supplies for as many as 40 million tests by the end of August-early September, but the testing strategy would vary by school.

“It is certainly possible to test all the students, or it is much more likely that there would be a surveillance strategy done where you may test some of the students at different times, to give an assurance that there was no circulation. That testing would be done in conjunction with the CDC and the local health departments. There are also strategies — still needing to be validated — of pooling samples. We know in some experimental labs as many as 10 or 20 samples can be pooled. So, essentially one test could test 20 students. And finally, there are some experimental approaches that look interesting, if not promising, that for example wastewater from an entire dorm or an entire segment of a campus could be tested to determine whether there’s coronavirus in that sewerage,” Giroir said.

Fauci was clearly the star witness during the much hyped hearing, which was convened to take testimony on the nation’s response to the Covid-19 pandemic, but his fellow task force members, Giroir, Hahn, and Redfield, each were pressed on testing, therapeutics, and vaccines, as well as the politics of the pandemic.

Administration officials — including President Donald J. Trump — permitted four members of the president’s coronavirus task force to give testimony in the Republican-controlled Senate, but thus far are refusing to permit task force members to testify before committees in the Democratic-controlled House of Representatives. But against that partisan background, Alexander was mostly successful at holding partisan politics at bay — in fact, most political broadsides were delivered by Democrats, who missed no opportunity to slam the administration, with few Republicans rising to the bait.

But there was also almost no praise for the administration — although Senator Richard Burr (R-N.C.) asked each of the four task force members if they had ever been instructed to “take your foot off the gas” in seeking ways to combat the coronavirus spread, each assured the Senator that they had kept the pedal to the metal.

Over the course of close to three hours, the Senators’ questions ranged from local — Maine’s Senator Susan Collins (R) said dentists in her state want to know why they can’t reopen their offices if they meet Covid-19 control recommendations from the American Dental Association, and Redfield opined that ADA’s recommendations are most likely adequate — to national — Senator Elizabeth Warren (D-Massachusetts) asked Fauci if the U.S. had Covid-19 contained, but Fauci said that it “depended upon what you mean by containment… I think we are going in the right direction, but the right direction does not mean we have by any means total control of this outbreak.”

While many of his colleagues wanted best guess scenarios about vaccine development, Senator Mike Enzi (R-Wyoming) asked Hahn if there was any assurance that there would be enough needles available to handle the injections needed with a successful vaccine, especially if it became available in the midst of the flu season. Hahn said that the s0-called “Warp Speed Project” for vaccine development includes developing the infrastructure (needles included) to deliver the vaccine.

Kansas Senator Pat Roberts (R) warned that the agriculture industry is in crisis and he asked about the availability of rapid testing for meat processing plant workers. Giroir explained that the rapid point of care tests, along with other tests, were being deployed to Kansas, but he explained that the so-called rapid test machines can only process four tests per hour. “Four tests an hour? I don’t know how you define rapid, I think that’s a slow test,” Roberts said.

The most heated exchange of the hearing was between Senator Rand Paul (R-Kentucky) and Fauci. Paul is by training an ophthalmologist, and he challenged Fauci on science.

Paul expressed exasperation at media reporting. He alleged the media consistently refused to acknowledge that survivors of Covid-19 developed immunity in the face of what Paul called significant evidence that survivors do have immunity, and he asked Fauci to “set the record straight.”

Fauci agreed that is was most likely that survivors had immunity, but he held fast to his contention that immunity could only be proven with long-term natural history studies.

Paul then pressed Fauci on mortality, noting that the Covid-19 mortality rate among children is very low, which, Paul suggested, supports the case for reopening schools, which would be benefit the children and the economy.

“So, I think we ought to have a little bit of humility in our belief that we know what’s best for the economy, and as much as I respect you, Dr. Fauci, I don’t think you’re the end all, I don’t think you’re the one person that gets to make a decision. We can listen to your advice, but there are people on the other side saying there’s not going to be a surge and that we can safely open the economy, and the facts will to bear this out. But if we keep kids out of school for another year, what’s going to happen is the poor and underprivileged kids who don’t have a parent that’s able to teach them at home are not going to learn for a full year.”

Alexander allowed Fauci to respond and asked him to clarify “whether or not you suggested we shouldn’t go back to school in the Fall.”

“Well, first of all, Senator Paul, thank you for your comments,” Fauci said. “I have never made myself out to be the end all, and only voice in this. I’m a scientist, a physician, and a public health official. I give advice according to the best scientific evidence. There are a number of other people who come into that and give advice, that are more related to the things that you spoke about, the need to get the country back open again economically. I don’t give advice about economic things. I don’t give advice about anything other than public health. So, I want to respond to that.

“The second thing is that you use the word we should be humble about what we don’t know. And I think that pulls on the fact that we don’t know everything about this virus, and we really better be very careful, particularly when it comes to children, because the more and more we learn, we’re seeing things about what this virus can do that we didn’t see from the studies in China, or in Europe. For example, right now, children are presenting with Covid-19 who actually have a very strange inflammatory syndrome, very similar to Kawasaki syndrome. I think we’ve got to be careful that we are not cavalier and thinking that children are completely immune to the deleterious effects.

“So, again, you’re right that children, in general, do much, much better than adults and the elderly and particularly those with underlying conditions. I am very careful to be humble and knowing that I don’t know everything about this disease. And that’s why I’m very reserved in making broad predictions.”

Peggy Peck, Editor-in-Chief, BreakingMED™

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