Rand Paul is an anti-science troll. I happened to hear a horrible exchange between him and Dr. Fauci at a hearing. It was incredible. What an awful person!
Dr. Abdul El-Sayed interviewed Dr. Anthony Fauci for the second time. The first time was in July 2020. America dissected podcast dated Tuesday August 17, 2021. It is well worth a listen.
Below is a paraphrased transcript of the interview.
Abdul: had you known what you do now, would your advice a year ago have been the same?
No, for a number of reasons. First, we are fortunate that we have highly effective vaccines. But he didn’t realize they would be as effective as they are. However, the virus has an incredible ability to adapt … which they didn’t know a year ago. It has an amazing ability to create variants. We can see this Delta variant came in and swent through the world, right after the original one. Fortunately the vaccines do well in protectinhg from serius disease, but it’s multiple times more transmissible so for the unvaccinated, it makes things really really bad. Hence, the cases that are skyrocketing here in the US and the rest of the world.
There is a great deal of divisiveness. But the idea that we STILL have, a year later, such ideological difference where you have people that politicize things like vaccines and mask-wearing. It’s almost inexorable that you have a vaccine that’s killed over 650,000 Americans but you still have people that don’t want to be told or even be suggested what to do, which is bad for them, their families, and their community. And it allows this wily virus to freely circulate in society which is what you will do if you don’t get vaccinated. We have 93 million people in this country who are eligible to get vaccinated but are not yet vaccinated. If we had the overwhelming majority of them vaccinated, we wouldn’t be in the difficult situation that we are now. It’s complicated, both good and bad sides. He doesn’t think he would have known that back in 2020.
Abdul: There are a confluence of a couple of pieces in this pandemic that have mutually intertwined.. One is the adaptiveness of this virus regarding variants, the Delta in particular; and the other is the polarization around very basic public health recommenations that have been norms in this country, for a half-century or more. Regarding the CDC’s guidance regarding masking in areas with a high number of cases, evidence now shows that transmission is possible from the vaccinated, but it’s translated to the public as “probable.” People are saying “I don’t know if this thing works the way they told me it would.” Those that are vaccinated are saying “I don’t know whether or not this vaccine is going to buy me the freedoms that it was promised to do.” Can you speak to this?
This reflects the dynamic nature of what is going on. It’s entirely understandable that people expect clarity and immutability. You say something, “it’s done,” you never can change the recommendation. That would work if you were dealing with a virus that doesn’t change. Sometimes as it’s changing, you can’t quantitate the degree of change. So we didn’t appreciate, and had no way of appreciating, that if you get a really good vaccine, that when you are dealing with the Alpha variant, if you get vaccinated the chances of your getting a breakthrough infection are very low. And if you do, the chances of your transmitting it to someone are very low. Then, you get the Delta variant which has characteristics that are very different from the Alpha variant. It spreads much more readily and when it gets into the nasal passage it’s 1,000 more concentrated. This means that even though the vaccines are still really good in protecting you from getting severe disease and death, what’s changed is that even if you’re vaccinated, and you can get a breakthrough infection, unlike the Alpha variant from 6 months ago, the level of virus in your nasal pharynx with the Delta is high enough that even if your vaccinated and have very few synmptoms, you are still capable of transmitting it to somebody else. So then all of a sudden you have to explain to the public something that’s complicated. You woiuldn’t expect them to immediately figure it out that there is a separation now between the proteciton against getting sick which is really what the vaccine is supposed to do, but it doesn’t now protect you nearly as well from getting infected. Even though your infection may be without or with minimal symptoms. But, you can transmit it somebody else. How probable? We don’t know yet. It’s so recent, this realization, you can transmit even if you are vaccinated and protected from disease, that we are trying to figure it out. So in that context, the recommendation is that if we aren’t sure about this, we need to protect the vulnerable. So even though the vaccine protects you fine, you can be in a gathering with people and inadvertently get the infection, now know it, and go home and give it to someone vulnerable, such as the elderly that may or may not be vaccinated, someone with an underlying condition, or children or someone that’s immunocompromised. This is where the masking indoors comes in. People ask, “why should I have to wear a mask if I’ve been vaccinated?” The answer is, the vaccination is not just to keep you free from wearing a mask, but to protect others from infection. Overwhelmingly 99% of the deaths are from the unvaccinated. So you can’t say, “wait a minute, why should I get vaccinated if I still under certain circumtances have to wear a mask?” Look at the 600K plus people that have died because they weren’t vaccinated, THAT is why you want to get vaccinated. Not for the freedom of not wearing a mask.
This reflects the dynamic nature of what is going on. It’s entirely understandable that people expect clarity and immutability. You say something, “it’s done,” you never can change the recommendation. That would work if you were dealing with a virus that doesn’t change. Sometimes as it’s changing, you can’t quantitate the degree of change. So we didn’t appreciate, and had no way of appreciating, that if you get a really good vaccine, that when you are dealing with the Alpha variant, if you get vaccinated the chances of your getting a breakthrough infection are very low. And if you do, the chances of your transmitting it to someone are very low. Then, you get the Delta variant which has characteristics that are very different from the Alpha variant. It spreads much more readily and when it gets into the nasal passage it’s 1,000 more concentrated. This means that even though the vaccines are still really good in protecting you from getting severe disease and death, what’s changed is that even if you’re vaccinated, and you can get a breakthrough infection, unlike the Alpha variant from 6 months ago, the level of virus in your nasal pharynx with the Delta is high enough that even if your vaccinated and have very few synmptoms, you are still capable of transmitting it to somebody else. So then all of a sudden you have to explain to the public something that’s complicated. You woiuldn’t expect them to immediately figure it out that there is a separation now between the proteciton against getting sick which is really what the vaccine is supposed to do, but it doesn’t now protect you nearly as well from getting infected. Even though your infection may be without or with minimal symptoms. But, you can transmit it somebody else. How probable? We don’t know yet. It’s so recent, this realization, you can transmit even if you are vaccinated and protected from disease, that we are trying to figure it out. So in that context, the recommendation is that if we aren’t sure about this, we need to protect the vulnerable. So even though the vaccine protects you fine, you can be in a gathering with people and inadvertently get the infection, now know it, and go home and give it to someone vulnerable, such as the elderly that may or may not be vaccinated, someone with an underlying condition, or children or someone that’s immunocompromised. This is where the masking indoors comes in. People ask, “why should I have to wear a mask if I’ve been vaccinated?” The answer is, the vaccination is not just to keep you free from wearing a mask, but to protect others from infection. Overwhelmingly 99% of the deaths are from the unvaccinated. So you can’t say, “wait a minute, why should I get vaccinated if I still under certain circumtances have to wear a mask?” Look at the 600K plus people that have died because they weren’t vaccinated, THAT is why you want to get vaccinated. Not for the freedom of not wearing a mask.
Abdul: Public understanding is a real challenge when it comes to baseline science. Do you feel the CDC might have jumped the gun when they actually allowed vaccinated people to go without masks for guidelines?
In retrospect, they jumped the gun, but if you put yourself in their position back then, they did not fully realize at the time that Delta was as aggressive as it turned out to be. They thought then that by the summer most people would be vaccinated, and there wouldn’t be a spread since the vaccinated couldn’t spread the virus. Well, then there was the Delta spread. If they knew then … what they know now …. so is it jumping the gun when you don’t know the data?? It’s tricky.
The other thing that is detrimental is the amount of disinformation and misinformation that there is under social media and people that have other agendas and political motivations that are really getting in the way of a really good unified public health response. There is NO ROOM FOR THAT KIND OF STUFF when you are dealing with a very serious pandemic that’s costing lives and causing suffering.
Abdul: Early on the pandemic during the first year, we saw how public policy was set aside. We thought that the technology regarding these vaccines was going to finally allow us to get a handle on the pandemic, and what has happened is the lack of public trust that was undercutting public health has also undercut our capacity to get vaccines out there. This is because social media has been able to accelerate disinformation and misinformation. Regarding the new guidance, it was thought that if enough people were vaccinated, or were otherwise immune, and we reached herd immunity, you could stop the spread of the virus because enough people around you could not pass it on to you or others. But given the new evidence that suggests that vaccinated people can in fact pass along the virus, what does that mean for the way we think about herd immunity when it comes to the Delta and Covid 19 in general?
It means that when you have a virus as transmissible as this and as mutation-prone as this, you have to get the overwhelming proportion of the population vaccinated because even though the vaccine is not 100% protection against infection, it’s 95% protective against hospitalization. But even if it goes down to 79% efficacy, if you get enough vaccinated, you “crowd out the virus” and you don’t give it as many opportunities to spread. The more transmissible the virus is, the more people you need to get vaccinated to really get good protection. You have to go one step further when you have a virus that is able to mutate and get a new variant. Get the overwhelming majority of people vaccinated. It is really frustrating. We have the solution to the problem. If everyone that’s eligible to get vaccinated did so, we would not be having this conversation.
Abdul: The same disinformation that’s been coming at you have been doing so in a very harsh way. The things you say get parsed and taken out of context. How have you dealt with this politicization and this attack on your name? And what do we do when we are debating something with someone that should be based on evidence and data, but ultimately becomes extremely ideological and emotionally fraught? What is your advice?
I am the bogeyman for the extreme “out there” people. I don’t like it, but I have it. My job is to preserve the health and safety of the peole that we have devoted our careers to. I keep my focus on that, and then the other stuff that is thrown at me is just a bunch of junk. Stick with the truth and integrity. Sooner or later all of that other stuff will go away. It’s painful but there it is. At the end of the day, the truth will prevail.
Abdul: Rand Paul debacle … what’s it like to deal with him?
I worry less about myself than I do the country. I worry that in upper levels members of the Senate propagate nonsense. It is painful. I respect the government bodies and the members of the senate. But there is no way I was going to let him get away with propagating nonsense. It hurts me more that I have to do that, but I have to do it.
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