Since mid-January, when it became clear that the novel coronavirus had escaped from Wuhan and would make its way to the United States, Dr. Anthony Fauci has been waging a war—a war of persuasion. He’s had to convince a diverse, federalist, hyper-partisan country to take the threat of the virus seriously. And in order to do that, he’s had to first convince President Donald Trump. This has posed certain challenges, and certain risks. “I take the tack that I will say what’s true and whatever happens, happens,” Fauci told me. And lately, that approach has been winning. On Sunday, Trump extended the national social-distancing guidelines for another 30 days after Fauci showed Trump models that projected 2.2 million Americans could die if nothing was done; Trump had proposed reopening the country for Easter. This morning, Vanity Fair spoke by phone with Fauci from his office at the National Institutes of Health as he raced between meetings. The interview has been edited for space and clarity.
Vanity Fair: Off the top, I wanted to know: Where are we now? How are you feeling about how we've marshaled the response?
Anthony Fauci: Well, I mean, obviously we’re still right in the middle of a very serious situation. The United States is a very large country. We have different levels of activity in different parts of the country. I mean, as you know, New York has been hit particularly hard and they’ve suffered greatly. They’ve responded, I think in an extraordinarily powerful way. We hope—we don’t know for sure—that we’re starting to see the leveling off of new admissions to hospitals. That’s the first sign that we may be making some headway with our mitigation strategies. But multiple cities are at different timing of what their problem is. We have New Orleans now, we have a situation in Detroit and Chicago. So you will see different waves of increases, sharp inflections, peaks, and then turn arounds. I think the most important thing that we need to do as a nation is to very aggressively implement the mitigation strategies.
How has it complicated our response that we’ve had so many different approaches across the states? You have some governors and mayors taking aggressive approaches and then in Florida, until recently, the beaches were open. How would it have helped us if we had a uniform national response?
Well, you know, certainly the recommendations that came out in the original guidelines we put up almost 15 days ago [could have been followed]. We live in a country where there’s a lot of independence. Some governors and states followed the guidelines most times, but sometimes they didn’t. And I think in those situations in which they didn’t, you could have avoided difficulties. But right now, there’s no doubt that even though it’s difficult to quantify precisely, there’s no doubt that the mitigation implementation is having an impact. I cannot imagine anybody disagrees with that. I believe you would be much worse off if we didn’t institute these physical separation guidelines. I think that that is why it is a proper, correct, and prudent decision to extend these another 30 days because we are by no means out of the woods. It’s still very difficult.
I know that it was touch-and-go for a while whether Trump would extend the guidelines. I’m glad that your point of view prevailed. Backing up, when did you first get a call that there was a novel coronavirus outbreak in China? I mean, how early were you attuned to this?
Well, it was the very beginning of January when there was a report from China that there were about 24 cases and it was incorrectly thought to be only animal-to-human spreading. And in Wuhan, as it turned out there, it was very likely that there was human-to-human spreading weeks before the outbreak in the wet market.
Where were you when you first got that report?
Well, I was sitting right where I’m sitting right now, right in my office [at the National Institutes of Health in Bethesda, Maryland].
When did you realize the scale of what we’re facing?
It was really gradually over a period of a few weeks as we began to see the very efficient human-to-human spread, even before the numbers came. When you look at the pattern of the initial infections, we knew from the beginning and we discussed this, that it was very clear that we were going to get cases in the United States for absolutely certain.
You knew that immediately.
Oh yeah. I mean, you know, with the travel that’s going on, I think that’s the thing that spurred me to make a strong recommendation to the president that we block any travel from China. Because it was very clear that that’s where it emerged.
That was the end of January. I know there was debate from the people I talked to at the White House about balancing the public health part of it versus what message shutting down flights would send to the markets. So there was concern that taking such a drastic early step would, you know, have economic consequences.
Well, yeah, I know, but we put the economic consequences behind and the public health mandate prevailed and it prevails to this day, as you can see of what dramatic things have been done with shutting down, you know, a major component of the United States.
Also the World Health Organization put out over the wires in mid-January that there was still no evidence of human-to-human spread, which I think gave people false hope.
Yeah. But as soon as we started to see that there were cases in the United States, and then at the time when it became clear that there was community spread, then we knew that we really were in for a very difficult situation. Once you had community spread, we realized all bets are off. And we knew we were in for a very serious problem.
What was your first meeting with the president like? This was in January. Had you dealt with him on other public health issues or was this a new relationship?
Well, I had some interaction. And now I see him for at least an hour or more every single day.
I mean, you’re a New Yorker. He’s a New Yorker. What was your first real meeting with him? Like what was your impression?
He’s an action person. I mean he likes to get things done. He doesn’t want to waste a lot of time. He wants to just get right to it.
We live in a time now with like hyper-partisan media where both sides have their megaphones. How has that complicated your ability to get a message that’s absorbed by the public?
Well, I just stick very strictly to the science and the evidence base. I’m not new to this. I’ve been doing this now for over 30 years, starting with the HIV/AIDS issues with President [Ronald] Reagan, and I have found, and it’s proven time and time again: stick with the science, stay completely out of the politics. I have no ideology. My ideology is health, public health, and science. You do that. You can make it uncomplicated. If you get involved in political rhetoric, then it gets complicated.
Of course. But, for example, early on you had Fox News downplaying the crisis. Did you go on Fox more to try to get your message out? How do you counter that? Even if you’re not playing politics, other people are.
By just being consistent. One of the great things about messaging is consistency. If you consistently stick with the science, sometimes you might be contradicting something that someone says and sometimes you may be agreeing with it, but as long as you’re consistent with the science then you are fine.
Going back to what you said about when you were concerned early on about community spread. The president and others were saying, Oh, we have 15 cases and we’re going to go to zero. At that moment you were in conflict with him. Other times you’ve been in agreement. I think there are times where your job forces you into difficult positions where you have to speak truth to power.
That is true. And thus far it’s worked. Has it been stressful? Uh, yeah. This is a very, very stressful situation for everybody, including me.
Yeah. I mean, I’ve seen in interviews. You’re sleeping like, four hours a night.
Right. That’s not good.
The press has written a lot about your relationship with Trump and the fears that your contradictions of him would force him to either sideline you or fire you. Have you worried about that? How much has that been on your mind?
Not at all. I take the tack that I will say what’s true and whatever happens, happens. As a matter of fact, in fairness to him, the president has listened very carefully to what I’ve said. He’s taken my recommendations almost invariably, and he has never really contradicted things that I have recommended to him. He listens. I mean, there’s a lot out there in the press about conflict between the both of us. There’s absolutely none. There really isn’t.
But so, even when he’ll say things like, you know, we’ve got this totally contained, it’s going to go to zero. I mean, that’s clearly at odds with the data that you are seeing. That couldn’t have been an easy conversation between you two.
No, but substantively he comes around.
I see. So you just have to stick to your message.
Exactly. As I said, I’ll repeat: It’s consistency, which counts.
The New York Times and others have reported about the quote last month we had between mid-January and mid-February before the task force was convened. I mean, obviously hindsight is 20-20, but I mean, how much did that slow ramp-up set us back in your mind?
I don’t think very much. I mean, there’s understandable Monday morning quarterbacking about what we could have, should have done. I think the important thing is look ahead and you can do all the analysis later on now.
Got it. I’ve read been reading history about the 1918 pandemic and a lot of people are now starting to talk about the quote “second wave” that could be coming our way in the fall. How prepared should we be? Some people have the notion that once the restrictions are lifted, whether it’s in May or June, that we’re going to be out of the woods. Is that true?
As I’ve said at the press conference at the White House yesterday [Monday], I feel that it is highly likely that we will have—I don’t know whether you want to call it a second wave—but we will have a return of infections as we get into the next season. I believe given the fact that we’ll be much, much better prepared, there will be a number of people who have already been infected so that they will be immune. The second iteration of this will very likely be much less severe. That’s for a number of reasons. So I don’t see this coming back and hitting us the way it hit us the first time around.
Well, that's good! What’s been your hardest moment or day so far throughout this? I know every day is hard, but is there one where you look back now and you’re, it really sticks with you?
It wasn’t any particular event that happened. It was just a realization a few weeks ago when the stress was overwhelming. I was getting 3,000 emails, a couple of hundred phone calls, every senator, every governor, every congressman wanted to speak to me and I was getting like two to three hours sleep. I realized then that I could not go on that way. I’m a very conscientious person. I like to answer calls. But I had to get myself used to the fact that I cannot do that. I’ve got to focus on what my primary responsibility is. And if people get upset that I don’t respond to them immediately. So you know…
You were losing your voice. Was your body breaking down a bit?
I was getting very, very fatigued. I’m much better now.
Yeah, you sound better.
Unfortunately I’m having trouble getting my complete voice back, but at least it’s better than it was a couple of weeks ago.
Do you have any personal friends or family that have had COVID-19? The president talked about a real estate friend from New York who has it.
Fortunately, I have not.
That’s great. So, Dr. Deborah Birx has also emerged over the last few days as someone who is very much the face of this crisis. Her style seems to be much more attuned to the politics. Do you guys have like a good cop, bad cop setup where you approach Trump differently but you all want the same goals?
We’re good friends. We’ve been good friends for decades. We’re very comfortable working with each other.
There was that interview she gave a few days ago where she praised Trump and people were saying, Oh, she’s now drinking the Koolaid. Did you guys talk about that?
No, we didn’t talk about it.
I guess you’re probably too busy to actually follow what’s being written about you guys.
I don't read 95% of the things that are written about me because I just don’t have time.
Of course. One last thing: Do you have the kind of relationship with Trump where you can call him directly or do you see him in more structured settings?
I see him so often and for so long I almost never have to call him directly because I know that literally I’m within a few feet of talking to him if I want to anyway.
So when he tweets something like, The cure can’t be worse than the disease, is that something that you can correct or address in real time with him?
You know, we don’t talk about things that he says. He’s always had an open mind to figure out whether it was, whether it was okay or not. He’s open-minded about speaking with us behind closed doors.
You extended the guidelines through the end of April. Should we be prepared that this is a fluid situation and there could be another extension?
That’s possible. I hope not, but it’s certainly possible. As I’ve always said, we’ve got to leave everything on the table. Everything is discussable.
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