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November 23, 2020

Dr. Fauci answers Montana COVID-19 questions

MISSOULA, Mont. — The nation’s top infectious disease expert says Montana, along with other states in the country, is suffering, but Dr. Anthony Fauci has specific concerns about overwhelmed resources in rural states like ours.

In an exclusive one-on-one interview with NBC Montana, Fauci said the rate of cases going up right now is unprecedented, calling the numbers stunning and formidable.

“We now are getting to close to 2,000 deaths per day. You know, anywhere between 150,000 and 200,000 new cases a day, over 80,000 hospitalizations,” Fauci said Monday afternoon. “This is very serious business in places like Montana, in which you're having a substantial surge, is that the concern is that you might run out of the resources or get the resources overwhelmed in intensive care beds, intensive care nurses and other important elements of the response.”

Fauci says it’s why he calls on everyone to keep up with simple measures like wearing masks, staying physically distanced and avoiding crowds, especially indoors. Fauci says he doesn’t think we should shut down the country or a whole state but says more classic public health measures could mean a positive impact on case numbers.

“I know it's cold in Montana this time of the year. It's tough to do things outdoors preferentially or indoors, but to the extent possible, try to keep activities when you're dealing with other people outdoors,” Fauci said.

Montana added another 11 COVID-19 deaths Monday and another 677 confirmed cases, an expected dip as Mondays typically produce lower numbers.

With Thanksgiving days away, Fauci says he doesn’t want to be the guy who says, “Don’t have Thanksgiving.” But he says it’s important to do a risk-benefit analysis.

“Thanksgiving is a sacred and wonderful holiday for families,” Fauci said. “We know the virus spreads from somebody who has no symptoms at all. So you might invite a friend who's not part of the household as part of the meal, and then you wind up two, three weeks later, having a vulnerable person in your family infected.”

Air travel over the weekend hit a pandemic-era record despite pleas from health leaders to stay home.

“I think if the majority of the country breaks that guidance, unfortunately, Maritsa, I think we're going to see a surge upon the surge,” Fauci said. “We're already surging. We might see even yet again another uptick in that surge, which would really be very unfortunate, because we would not realize that until at least two or three weeks later.”

With Christmas and Hanukkah just weeks after Thanksgiving and New Year’s one week after Christmas, Fauci says he thinks the next few months are going to be very challenging.

Promising vaccine news could be a bright spot in those challenging months. It was announced Monday that drug maker AstraZeneca said late-stage trials showed its COVID-19 vaccine is highly effective, joining Pfizer and Moderna with novel vaccines. The latter two are made from messenger RNA, or mRNA, meaning the person gets injected with genetic material that mimics the COVID-19 protein, or the spiky crown. In the past, whole, dead or reduced viruses were used. The mRNA method basically gives your body a preview so your immune system can learn how to make antibodies against the real virus.

The result means a much quicker process of making vaccines without having to grow the virus, purify it, inactivate or attenuate it, which Fauci says is a cumbersome process.

“mRNA is a highly adaptable scale-up-able, easy-to-use technology that I believe is going to play a role in helping to revolutionize how we develop vaccines,” Fauci said Monday.

Republican Sen. Steve Daines revealed last week that he participated in Pfizer’s trial, getting his first dose in August.

Getting other Americans to get vaccinated might not be as easy. An October Montana State University poll showed 59% of the 1,787 Montanans surveyed said they will not or don’t know if they will get vaccinated for COVID-19.

“It’s important for leaders and people who are recognizable and trusted by the community to go out there and explain to the people in the trenches who you hope would be taking a vaccine, to explain to them the process of how you do a vaccine trial and how you get the results,” Fauci said. “Now, the speed does not at all compromise safety, nor does it compromise scientific integrity. It just is a reflection of very impressive scientific advances and the investment of a lot of money to pre-make the vaccine while you're testing it, so that if the vaccine is effective, you've saved multiple months. If it's not effective, you’ve lost a lot of money. And the decision was made by Operation Warp Speed and the U.S. government that it is better to risk money if you can save time than it is to save money but have to prolong the process. Fortunately for us, with this new technology, we had a home run for success.”

Fauci says it’s important to articulate that an independent body called the Data and Safety Monitoring Board examines vaccine data for safety and efficacy during the trials, and is totally independent with no allegiance to the company or an administration. Once the trial is complete, the DSMB gives the data to the company, which then presents it to the FDA for approval, something he calls a very transparent process without outside influences.

We asked Fauci what percentage of people would need to get vaccinated to be effective and what happens if people don’t take it.

“If you have a 95% efficacious vaccine, but only 50% of the people take it, you are not going to get the degree of protection that you'd like to have to give that veil of herd immunity over the population,” Fauci said. “It is estimated, though you don't know yet until you actually do it, it is estimated that anywhere between 70% and 80% of the population would have to be vaccinated, probably closer to 80% to get real herd immunity.”

The Pfizer vaccine must be kept at -94 degrees Fahrenheit on top of requiring two doses, which could present challenges for rural America, especially tribal communities that have already been so disproportionately affected by COVID-19. Native Americans make up less than 7% of Montana’s population but account for 28% of Montana’s deaths where race information was available.

“The situation with a very constrained cold chain is a challenge that we are assured by the people who actually are responsible for the logistics of this, that they have the help from the Department of Defense in the transporting of this,” Fauci said. He added that the Moderna vaccine can be held in a regular freezer or kept in a refrigerator for 30 days and room temperature for 12 hours, meaning that vaccine has fewer constraints for transport to remote areas.

Multiple vaccine candidates shouldn’t lead to abandoning all public health measures, because Fauci says it’s still possible people who have been infected with COVID-19 or vaccinated against it can be carriers of the disease.

“The primary endpoint of the vaccine is to protect you against symptomatic disease,” Fauci said. “We know it does that, for sure. We also know it protects you against severe disease. What we don't know yet, which we're trying to determine, is whether it prevents you from actual infection. We don't know the answer to that question.”

Multiple viewers sent us questions to ask Dr. Fauci, one coming from a health care professional asking, “What more can we do? What can we say to our communities who have basically ignored our advice?”

“You don't want to be confronting them in a hostile way. That will turn them off even more. You would plead with them to look at the data that's staring them right in the face. It's staring them in the face when you look at the numbers -- the quarter of a million people who died, the 12 million people who've gotten infected. That is not fake news. That is not a conspiracy theory. That is reality,” Fauci said. “Tell them to go to the hospitals, including in Montana, and look at the people in there, who are occupying all the intensive care unit beds.”

Fauci isn’t done with Montana. In February, the Maureen and Mike Mansfield Center will host him for the 2021 Mansfield Lecture, in which he will have a public Q&A session. Dr. Marshall Bloom with Rocky Mountain Laboratories will also speak at the event scheduled for Feb. 17 at noon via Zoom. You can find more information here.

Lastly, Fauci left some reassurances for the littlest Montanans out there looking toward Dec. 25.

“I just, you know, was allowed to have the opportunity to get a quick exam of Santa. And I can tell you he's completely protected against COVID-19, and it is impossible for him to spread COVID-19,” Fauci said. “So make sure you have the cookies and the milk and all the things you want as he comes down the chimney. Because he'll be here, for sure, this Christmas.”

You can see the extended interview with Fauci on the article page, originally published by NBC Montana.