The number of Americans who have died from COVID-19 is “almost certainly” higher than the more than 80,000 fatalities officially recorded in the United States, and reopening cities and states too soon could launch serious outbreaks, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health Dr. Anthony Fauci told the Senate Health, Education, Labor and Pensions Committee on Tuesday.
Fauci told lawmakers that there are “a number of broad-spectrum antivirals that are in various stages of testing” as researchers race to find a treatment for the coronavirus. “In addition, we will be looking at convalescent plasma, which is plasma from individuals who have recovered from COVID-19, to be used in passive transfer either in prevention or treatment; in addition, hyperimmunoglobulin, which can be used as a gamma globulin shot,” he said. “We’ll be looking at repurposed drugs as well as immune-based therapies and host modifiers, and finally monoclonal antibodies.”
Remdesivir, he stressed, showed “only a modest result” in hospitalized COVID-19 patients with lung disease, “showing that the drug made a 31 percent faster time to recovery,” but “we hope to build on this modest success with combinations of drugs and better drugs.”
On the vaccine front, “there are at least eight candidate COVID-19 vaccines in clinical development” and “if we are successful, we hope to know that in the late fall and early winter.”
“I must warn that there’s also the possibility of negative consequences where certain vaccines can actually enhance the negative effect of the infection,” he said. “The big unknown is efficacy.”
Chairman Lamar Alexander (R-Tenn.) asked Fauci to look ahead three months when “there will be about 5,000 campuses across the country trying to welcome 20 million college students, 100,000 public schools welcoming 50 million students,” and college presidents and principals would have to “persuade parents and students to return to school in August.”
“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,” Fauci said. “…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, even at the top speed we’re going we don’t see a vaccine playing in the ability of individuals to get to school this term.”
As far as safely opening America again, Fauci said that has to be determined by the dynamics of an outbreak in a particular region, state, city, or area.
“I get concerned if you have a situation where the dynamics of an outbreak of an area are such that you are not seeing that gradual over 14 day decrease that would allow you to go to phase 1. And then if you pass the checkpoints of phase 1, go to phase 2 and phase 3,” he said. “What I’ve expressed then and again is my concern that if some areas, cities, states, or what have you jump over those various checkpoints and prematurely open up without having the capability of being able to respond effectively and efficiently, my concern is that we will start to see little spikes that might turn into outbreaks.”
If jurisdictions don’t follow the guidelines and rush reopening, “the consequences could be really serious.”
States must “have in place already the capability that when there will be cases — there is no doubt, even in the best of circumstances, when you pull back on mitigation you will see some cases appear — it’s the ability and the capability of responding to those cases with good identification, isolation, and contact tracing [that] will determine whether you can continue to go forward as you try to reopen America.”
“So, it’s not only doing it at the appropriate time with the appropriate constraints, but having in place the capability of responding when the inevitable return of infections occurs,” he added.
“The official statistic Dr. Fauci is that 80,000 Americans have died from the pandemic; there are some epidemiologists who suggest the number may be 50 percent higher than that. What do you think?” asked Sen. Bernie Sanders (I-Vt.).
“I’m not sure, Senator Sanders, if it’s going to be 50 percent higher but most of us feel that the number of deaths are likely higher than that number because given the situation particularly in New York City, when they were really strapped with a very serious challenge to their healthcare system, that there may have been people who died at home who did have COVID who were not counted as COVID because they never really got to the hospital,” Fauci replied. “So in direct answer to your question, I think you are correct that the number is likely higher. I don’t know exactly what percent higher, but almost certainly it is higher.”
Fauci stressed that COVID-19 is not going to “disappear” even if it wanes over the summer. “I hope that if we do have the threat of a second wave we will be able to deal with it very effectively to prevent it from becoming an outbreak not only worse than now but much, much less,” he said.
He also noted that if someone has contracted the virus and developed antibodies “you can make a reasonable assumption that it would be protective, but natural history studies over a period of months to years will then tell you definitively if that’s the case.”
“We really better be very careful, particularly when it comes to children, because the more and more we learn we are seeing things about what this virus can do that we didn’t see from the studies in China or in Europe,” Fauci warned. “For example, right now children presenting with COVID-19 who actually have a very strange inflammatory syndrome very similar to Kawasaki syndrome. I think we had better be careful if we are not cavalier in thinking that children are completely immune to the deleterious effects … I am very careful and hopefully humble in knowing that I don’t know everything about this disease and that is why I am very reserved in making broad predictions.”