Special edition

Greetings,

Earlier today I sent you a link to a streaming interview with one of our nation’s longest-serving public health officials, Anthony “Tony” Fauci, MD, who for nearly four decades has helmed the National Institute of Allergies and Infectious Diseases. He was in conversation with the editor-in-chief of JAMA (Journal of the American Medical Association), Howard Bauchner, MD. They were sifting through what is known and unknown currently about the coronavirus, COVID-19.

The conversation between them is a bit more clinical than you might be used to, but it’s not above comprehension. Still, to help make it easier, below I have gathered what I think are the highlights of Dr. Fauci’s comments.

First, here are some of my overall impressions. One is that the severity of this virus is still unknown, but it is behaving more like previous viral infections such as MERS and SARS with one exception: it doesn’t seem to impact children in measurable ways. We aren’t sure why yet. It’s not a cause for celebration, since it’s possible that younger immune systems are processing the virus differently and could present with symptoms or ill-effect at a later date. The point is, WE DON’T KNOW.

Another impression I got is that even if we don’t know how serious COVID-19 is, it’s not the bubonic plague that will wipe out vast numbers of the population. Generally, evidence points to the most at risk being the elderly and anyone with a compromised immune system, usually from what are called “comorbidities”, which means other underlying health concerns such as chronic heart failure or emphysema, among other ailments.

As for whether the flu is “worse”, WE DON’T KNOW. There aren’t enough reliable data for a number of reasons, including that we don’t know how many unreported cases there are here and abroad, nor do we know who among those who were infected and subsequently treated with various interventions spontaneously healed or responded to those treatments.

The key is prevention through common sense precautions like handwashing, not touching stuff and people, and tele-working/schooling.

Which leads to the key take-away: if you can tune out those among us with the loudest mouths and the least knowledge, and go to the real experts, then I think it’s easier to put this virus in perspective. Here is the CDC’s web page for COVID-19 guidance. It is sound and I recommend it as a former infectious disease reporter and editor.

Unfortunately, any attempts at consistent public health messaging are undercut by the president’s bizarre riffs. His specious knowledge about the real or perceived dangers of this virus are apparently based on conversations with “many people”, the ones neither he nor the media, nor Fox News, ever seem to manage to identify by name.

These dubious (and I believe nonexistent) conversations contravene what the experts in infectious disease management are saying, muddying the message that panic is actually unwarranted but that taking serious precautions are very much warranted.

Ironically, between the economic impact of the virus overseas where virtually all our manufacturing now takes place (which is why the markets began to tank: there has been a virtual standstill on our goods and materials shipped from China), and the muddle-headed meddling into messaging, what we end up with is panic.

Here’re the highlights of the video given below with time stamps:

10:35 — Dr. Fauci discusses the timeline for vaccine creation

19:13 — Drs. Fauci and Bauchner review the differences between “quarantine”, “containment”, and “mitigation”

23:20 — Dr. Fauci’s thoughts on the value of spontaneous self-regulated preventive behaviors overtaking any mandated public health measures

26:50 — Dr. Fauci discusses the challenges to global containment and mitigation of the virus posed by countries that lack adequate public health resources

29:40 — A tactful conversation about why there is more panic about COVID-19 than there has been in the past about Ebola, MERS, and SARS. (See my comments above about riffs)

I hope this is helpful to you. I guess once a health policy/clinical medicine reporter, always such a reporter. When I see and hear bullpuckey about public health, I can’t let it go unremarked, particularly when we really do have excellent public health officials working in the one cabinet department (HHS), which for all its faults, still has its act together as much as one can in this administration.

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Before I go, thank you to a former public health official here in Washington who sent me this NYT interview with an expert in the spread of epidemics. I think it will help you get a clearer understanding on the science and math involved in COVID-19.

We’ve still got one more docu-mental for the week still to come. It’s an alternate point of view on my defense of psychiatry from my most recent podcast guest, Paula Caplan, PhD. It will be delivered to you within the hour.

Thanks for reading. Be healthy.

Whitney