Harvard Medical School Grand Rounds with Dr. Anthony Fauci

September 10, 2020

At a time when people are becoming frustrated by the pandemic, and there are competing interests of politics with science and public health, I believe we should ask questions and then look at the answers and. #TrustTheScience. As I look for trustworthy information about COVID-19 and the pandemic in journals and on the internet, I’ll bring it to you with a brief recap and link. What better way to start than with Dr. Anthony Fauci’s Grand Rounds at Harvard Medical School. Dr. Anthony Fauci continues to be a trusted port in the storm of COVID-19. Thank you, Dr. Fauci, for your work in getting us through this pandemic.

On Sunday night I watched Dr. Anthony Fauci’s presentation on COVID-19: Public Health and Scientific Challenges. Over 6000 people attended his Grand Rounds live that day, and I highly recommend you watch it too. The link to the conference is here.

A couple of new nuggets I learned from hearing him speak included the following.

Epidemiology. He offered a new rate of asymptomatic carriers at about 40–50% of people infected with the virus, as opposed to 30% suggested in the beginning, and he stated that the mortality of patients who are on the ventilator is about 20%. The way I interpret these data is that over time these numbers are either improving as the pandemic evolves or we are learning more.

He also reminded us about how not only age, but comorbid medical conditions are significant risk factors for COVID-19, especially obesity, hypertension, and diabetes, among other conditions. That is why, he said, just isolating older people will not reduce the risk of transmission as these other medical conditions are extremely common.

He also emphasized the racial disparities that have been unmasked by the pandemic, with the rate of hospitalization among Black Americans being 333 per 100,000, Latinx being 331 per 100,000, and Native Americans 328 per 100,000, compared to 71 per 100,000 white Americans. This has highlighted longstanding racial/ethnic disparities in our health care system.

Transmission. He mentioned that physicists have shown now that the virus and large droplets persist in the air longer than we once thought. The concept that large droplets come out and then fall to the ground rapidly is oversimplified.

Presentation. He shared a couple of really interesting thoughts in response to questions regarding why the presentation of COVID-19 illness is so variable among people, spanning from asymptomatic to critically ill. Someone asked if this was due to different levels of exposure to viral inoculum. His answer (and the consensus of the panelists) is that this is multifactorial. While the amount of viral exposure likely plays a role, he also talked about how the patient’s response to the infection and genetic factors likely play a role, and he emphasized that he believes the level of ACE2 expression in different tissues (upper airway, etc) is also likely very important.

On vaccines. Dr. Fauci talked about how because there is a lot of public fear about a vaccine being rushed through the vaccine manufacturers have done something completely unprecedented by making a pledge to not rush a vaccine to the front lines until it passes rigorous science. You can read more about the pledge here.

At the end, the panelists were asked what they thought were the most important lessons learned from this pandemic.

Dr. Fauci’s lessons from the pandemic:

• Humility underlies all of these lessons learned.
• When you experience an outbreak, don’t ever underestimate the potential severity of the pandemic as it evolves. Don’t try to look at the rosy side of things.
• We should always do ethically sound, controlled clinical trials during the outbreak.
• From day 1, you don’t know it all. You have to change your recommendations and guidelines as the data and understanding of the outbreak evolve.
• We must now make a commitment to address the social determinants of health. Our population is comprised of 13% African Americans, but 50% of new cases are African American. If ever there were a time to address social determinants of health, the time is NOW.