Fauci offers mayors candid advice on what to expect as nation begins to reopen

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Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), emerged from self-imposed quarantine on Thursday to offer candid advice to a virtual gathering of municipal leaders on what to expect as the nation begins to reopen amid the COVID-19 pandemic, the limits of safeguarding children in summer, and the elevated vulnerability of African Americans in cities, likening their risk to that of those in nursing homes.

Widely viewed as the nation’s leading infectious disease expert, Fauci told mayors and city leaders in a private session hosted by Bloomberg Harvard City Leadership Initiative at Harvard Kennedy School that they should “expect” to see new “blips of infections” as communities begin to reopen, but not to be “discouraged.”

Instead, he said, they should ensure they have in place robust testing programs, along with adequate stores of equipment and supplies, and enough personnel to do the level of identification and isolation of patients and contact tracing that will prevent blips from becoming resurgences, he said. “Because the danger of that is real.”

A physician and immunologist, Fauci is a trusted voice on the White House coronavirus task force, known for his direct, sometimes blunt, assessments and observations. He has been out of the public eye since early May after two White House staffers tested positive for COVID-19, prompting him and the directors of the Food and Drug Administration (FDA) and the Centers of Disease Control (CDC) to self-quarantine because of possible exposure.

With summer approaching, Fauci made clear that while it’s “likely” that the coronavirus will not be as virulent, given the way viruses of its type typically behave in moist, warm air, so far, there’s been “no definitive proof” that will be the case.

As communities begin to return to some aspects of normal life, people can start to socialize again with family, friends and others, Fauci said, but only if they do so gradually and by adhering to safety practices of wearing masks, washing hands, and keeping 6 feet apart. Once infection rates decline in an area, people can start to gather in small groups of 10, then 20.

But “a complete lockdown of children is going to be impossible as the summer months come,” Fauci acknowledged. “I don’t think it’s going to be reasonable outside when kids are running around, playing baseball, that they’re going to be wearing masks and staying [6 feet apart].”

So parents, camp instructors, coaches, and other adults should make sure children play together in groups no larger than five to 10 at a time. Municipal officials who oversee swimming pools and other child-friendly recreational facilities will need to stagger access to limit density of contact.

“I think that’s the best we can do,” he said.

Though nearly 100 vaccine candidates are under investigation worldwide, Fauci said “one or two” show potential, though he did not identify them.

Fauci also sought to reassure the city officials that the Trump administration’s push for the development of a vaccine by January, a process that typically takes years, would not cut corners on efficacy and safety. Widespread public concern has emerged in recent days that the project, dubbed “Operation Warp Speed” by the White House, may be too rushed and end up doing more harm than good.

“If it works, we’re ahead of the game, and we could have a vaccine by December or January,” he said. “If it doesn’t, then all we’ve lost is research and money,” things worth risking given the “urgency” of the crisis, he added.

The Department of Health and Human Services announced Thursday that it was working with AstraZeneca to make available 300 million doses of a COVID-19 vaccine starting in October if the preventative is approved by the federal Food and Drug Administration. A Phase 1/Phase 2 clinical study has been running in the U.K. since the end of April, and a Phase 3 trial is planned for the U.S. this summer.

Fauci was asked about the unusually high rate of infection and morbidity from COVID-19 among African Americans and what can be done about it. He said African Americans are an at-risk population because so many face a “double whammy.” A significant number have jobs that can’t be done remotely and don’t always provide adequate protections, which puts them at elevated risk for infection. And higher percentages of African Americans suffer from chronic conditions like hypertension, obesity, asthma, and diabetes, which makes a COVID-19 infection much more dangerous.

But minority groups, particularly African Americans, who live in the inner city are extremely vulnerable, “on a scale of a nursing home or a prison or a meat-packing plant” in terms of risk and how devastating an outbreak can be, Fauci said.

“We are really almost morally obligated on our part to concentrate the resources in those communities so that they can do the adequate testing, and then, when someone gets infected, identification, isolation and contact tracing, and provide them with the resources to be able to physically separate when they do get an infected individual,” he said.

Over the course of the outbreak, the Trump administration has been stepping back and putting COVID response in the hands of governors. Fauci said the federal government should provide both guidance and “backup assistance, when necessary, in the form of economic relief” to help cities remain “viable” while they fight the pandemic.

 But when a resurgence does occur in a city or town, Fauci warned the mayors against depending heavily on assistance from the administration with identification, isolation, and contact tracing. Cities need to be prepared for such an eventuality and have those resources in place when the CDC arrives to help.

The weekly seminar, started by the Bloomberg Harvard City Leadership Initiative in collaboration with Johns Hopkins University under the umbrella of Bloomberg Philanthropies’ Coronavirus Local Response Initiative, began in mid-March to provide mayors with relevant, up-to-date information and best practices and presentations from experts in public health, crisis management, and other disciplines. Past VIP guests have included former presidents Bill Clinton, George W. Bush, and Barack Obama, Microsoft founder and philanthropist Bill Gates, House Speaker Nancy Pelosi, and former Vice President Joe Biden.