NIAID director Dr. Anthony Fauci gives keynote address during American Association of Critical-Care Nurses’ annual conference
ALISO VIEJO, Calif. — May 25, 2021 — Anthony S. Fauci, M.D., director of the National Institute of Allergies and Infectious Diseases (NIAID) and chief medical advisor to the President of the United States, spoke to nurses and other healthcare professionals during the National Teaching Institute & Critical Care Exposition (NTI), the annual conference of the American Association of Critical-Care Nurses (AACN), the world’s largest specialty nursing association with more than 130,000 members.
“ICU nurses throughout the country... They're the great heroes and heroines and everybody in the world knows that,” he said. “You never realize you're living through history when you're living through it. It's tough now, but when it's over and you think back about it, you will have done a historic thing.”
AACN President Elizabeth Bridges, PhD, RN, CCNS, FCCM, FAAN, conducted the virtual interview with Dr. Fauci for NTI attendees, with a discussion about how his past experience with the HIV epidemic almost 40 years ago prepared him for this past year and his hopes for the end of the COVID-19 pandemic.
“Serious COVID-19 is a disease that was made for the intensive care nurse,” he said. “This is a disease that's in your hands. It really is. As much as developing a vaccine and developing drugs is in my hands as a scientist and a public health person, the on-the-ground, in-the-trenches responsibility and success of this is in the hands of the people who are taking care of these people.”
The full transcript of the conversation is available here.
Dr. Fauci, on behalf of the American Association of Critical-Care Nurses, the thousands of acute and critical care nurses in the United States who are attending our annual conference where we will show this video, we're honored to have you join us and to learn from you. So rather than solely focus on COVID, I'd like to start first learning a little bit about how your past prepared you for this pandemic, the groundbreaking experiences and work you did for the HIV epidemic almost 40 years ago.
Dr. Anthony Fauci:
Well, that's really it. But first of all, before I get started, I want to just give a real shout out. I know that there are a least 10 nurses attending from our Clinical Center here at the National Institutes of Health, from our ICU, which we're very, very proud of these nurses. They really are an incredibly important part of our functioning, particularly in so many areas, not only in SARS-CoV-2, but for all the other issues that we have here in our own Clinical Center, which often deals with critically ill patients. So a shout out to our ICU nurses.
Well, my own experience actually dates back to exactly what you refer to, the very early year, months of HIV, where I put together a very small core unit of people.
Henry Masur, who is currently the chief of the Critical Care Medicine Unit at the NIH, and Cliff Lane, who was a Fellow of mine who is now one of the most important people in the country, if not the world, in emerging infectious diseases was just realizing that when you're dealing with a new mysterious disease, until you get countermeasures that are specific for it, like we have with HIV/AIDS, we now have spectacularly effective anti-retroviral drugs that have transformed the lives of HIV-infected individuals. But before we had that, it was all taking care of desperately ill patients, something that I believe critical care ICU nurses know better than anybody else in the world. I mean, that's really what we did for years, what I did myself. I met my wife who was a nurse at the time helping to take care of critically ill patients with HIV.
I've been doing this now, as you said, it seems not that long ago, but it was literally 40 years ago this summer, when we took care of the first desperately ill patient with a disease that didn't have a name and didn't have an etiology. And I spent getting to know ICU nurses very, very well from 1981 through late '80s and into the '90s when we started to develop really good therapies for HIV, culminating in 1996 with the triple combination of drugs, which essentially transformed the lives of HIV-infected individuals.
That really transformed my life. From that I became director of the institute, and I think my experience with HIV and desperately ill individuals really (I would say, and I use the word correctly) inspired me for the importance of addressing serious emerging and re-emerging infectious diseases.
And the ones we've had experience with have been everything from pandemic influenza in 2009 to Zika, to Ebola. We've taken care of Ebola patients at the NIH Clinical Center. Again, involving many of our very talented ICU nurses. I've done that myself personally, taking care of these individuals. And now we're dealing historically with the worst pandemic of a respiratory illness that this world has seen in over 102 years. You never realize you're living through history when you're living through it. It's only after when you look back and you'd say that was historic, but I think all of the ICU nurses throughout the country, well, first of all, they're the great heroes and heroines and everybody in the world knows that. But I think when you think back when this is all over, we're all going to be saying, "Oh my goodness, we actually lived through something that people are going to be talking about a hundred years from now.”
Guaranteed. Guaranteed. There's a lot of pain in that because it wears you out, there's post-traumatic stress, there's people working until they can barely stand up. It's tough now, but when it's over and you think back about it, you will have done a historic thing, I'll guarantee you that.
Let me just follow on with a question then from your lessons learned. It took almost 10 years to come up with a treatment for HIV. Do you see anything on the future for the treatment of COVID? Because right now our management is primarily supportive.
Dr. Anthony Fauci:
That's a great question because they're such different diseases, whereas HIV is a disease that is unprecedented in the fact that it is a lifelong chronic virus infection that if it goes untreated will ultimately invariably kill the patient. But if treated properly, people can actually live as close to a normal lifespan if you treat them early and properly. If you just take a deep breath and think about that for a moment, that is amazing that you have a disease if untreated will inevitably kill you, and yet you have a treatment that's so good, that if you give it every day, somebody could essentially lead a normal life. That's because it's a chronic viral infection. That's really so different from the explosive nature of COVID-19, where we've had a scramble and learn how to treat people with advanced disease. The unique nature of this (think about it for a second, I mean, I do all the time because it just consumes me): never in history has there ever been an infection that 40 to 45% of the people get infected and have no symptoms at all. And yet those who get symptoms, 80% of them have mild to moderate symptoms. And then about 20% go on to devastating illness that has killed 560,000 people in this country.
There's never been an infection in my knowledge, historically, that has been so discordant. And it goes from nothing to killing you. Usually when you have an infection that can be devastating in its death toll, what other infections did we ever know of besides the pandemic flu of 1918 that has killed already, and it's not over yet, over half a million people in the United States? Never, not even close, have we had that.
Yet, for most people, at least 40% of them, they don't even get any symptoms. I'm giving you an uncharacteristically long answer to a question which I will get to is: what about therapy? It really depends on the stage of the disease. There's therapy early to prevent someone from going to the hospital. That's what we absolutely need. Once someone goes on that slippery slope of getting enough virus replication to get the aberrant inflammatory and immunological response that really chews up people's lungs, it isn't really a lot of virus that's chewing up the lung. What it is, is the inflammatory response to it, and that's the reason why people get such serious disease. So the real trick is to develop an oral agent that's direct antiviral, like we have with HIV, that when someone comes in with even mildly symptomatic disease, but give them seven to 10 days of that and guarantee that the virus doesn't go from the upper airway into the lung and then become a systemic disease.
What we have is what you're alluding to — we have diseases that are really not very specific. You worry about someone who is getting respiratory distress, which is the modus exodus of most people, and the best drug that we have so far is one we've been using for 50 years, Dexamethasone and keep the patient prone. That's not exactly rocket science there, but it is the best thing we have. And then we're experimenting with a bunch of other drugs that are either going to synergize with Dexamethasone, pyrazinamide, and all the other ones and the monoclonal antibodies against various inflammatory cytokines. That I think is good, but what we really, really do need, which is what you're asking, is a drug similar to anti-HIV drugs that you don't have to give for life, because you're only going to have to give it for seven to 10 days. Because if you can block the virus' replication, and then dissemination you're home free. That's what we were putting a lot of effort on. In fact, as part of the new influx of resources that were getting, targeted antiviral development of drugs is going to be one of the biggest priorities.
Let me switch gears here from specifically from COVID. You are now the Chief Medical Advisor to the President of the United States, and while we associate you with the COVID response, we know your responsibility is much greater than that. Can you just talk a little bit about that? And the question I love to ask is: what's keeping you up at night?
Dr. Anthony Fauci:
My worst nightmare I'm living through right now. If you had asked me that question two years ago, I would have said, "What keeps me up at night, my worst nightmare is all of a sudden a new virus jumping from an animal host to a human that's respiratory borne and that has two major characteristics. It is highly, highly transmissible from person to person, and it has the capability of a high-degree of morbidity and mortality." Well, that's COVID-19. So my next nightmare right now, we are in the nightmare, so it isn't as if the next one, is to make sure that we get as many people vaccinated as we possibly can as quickly as we possibly can. Because as unfortunate as we are as a species of having had to experience this 100-year historic pandemic, scientifically, we're really fortunate that we have the scientific capability to have developed in beyond unbelievable record time a bunch of vaccines that are highly, highly efficacious.
I would have never predicted that right out of the box we would have a 94-95% effective vaccine. But we do. So the only concern I have is that, with these variants around, if we don't get the entire world vaccinated as quickly as we can, there's always the danger of a new variant coming in that would elude the protection of the vaccine. So that's the thing that currently occupies my great concern.
I hope you're getting a little bit of joy out of some of your more recent notoriety. I know you have Tony Fauci bobble head dolls. I saw an entire Etsy page dedicated to you. And if anybody's a Saturday Night Live fan … How has that been for you?
Dr. Anthony Fauci:
That has been, to be quite honest with you, totally surrealistic. It's almost like it's unreal. First of all, if it were all over, it wouldn't be happening. I'm never going to get that controlled study, as it were. But if I had the time to sit around and absorb it, it would be like, "Wow, is this really going on?" But it's almost like a dream because I wake up in the morning, I'm working 18 hours a day trying to get our arms around this pandemic, that it's almost as if it's happening, but it's not really happening to me, because I don't have the chance to say, "Wow, isn't that great." I just have to keep doing what I'm doing. Maybe a couple of years from now, when this is all over, somebody's going to come by and tell you, "Oh, by the way you were mimicked five times on Saturday Night Live," or, "Julia Roberts is in love with you," or something like that. To me, it doesn't make any difference right now. I just have to work my 18 hours a day. And when somebody tells me that, I say, "Oh, okay. That's nice."
Kate McKinnon was on last night or something. Dr. Fauci, I do want to be respectful of your time, so as we wrap up today, sir, you have an open microphone to over a half a million acute and critical care nurses. Sir, the floor is yours.
Dr. Anthony Fauci:
Well, a couple of things. First of all, a really profoundly sincere thank you for everything you've done. This is a disease … I often say that when HIV came along I happened to be trained as an immunologist, as an infectious disease person. And when HIV came along, which was an infectious disease that destroyed the immune system, I would often say, "Oh, my goodness, this is the opportunity of a lifetime. As terrible as it is, this disease was made for me. I have to get involved with this disease."
People with serious COVID-19 is a disease that was made for the intensive care nurse. I mean, this is a disease that's in your hands. It really is. As much as developing a vaccine and developing drugs is in my hands as a scientist and a public health person, the on-the-ground, in the trenches responsibility and success of this is in the hands of the people who are taking care of these people. It's extraordinary the burden and responsibility. Again and again, a profound thank you. You are truly, and I don't mean this saying it only because I'm talking to you, you are truly the heroes and heroines of this pandemic. Thank you, keep it up.
However, on a more bright note, it is going to end. I promise you that it will end. The vaccines are going to be the answer. I keep getting asked, "When are we going to get back to normal?" Well, we'll get back to normal when the overwhelming majority of the people get vaccinated with very safe and effective vaccines, which is what we have.
If you just look at what's going on in Israel, they have vaccinated about 69 or so percent of their population has received at least one dose of a two dose regiment. And if you look at the number of cases in Israel, it's come down to practically nothing. The other day, one person died or no people died. And even with the variants, I think it's important for the nurses to understand that even if you have a variant that eludes the overall protective effect of a vaccine-induced antibody, so that you may get infected and may get some symptoms, what it is really good at is it prevents serious disease like hospitalizations and deaths. And things lag, the nurses know that. Epidemiologists live with it all the time. There's a couple of week lag in everything. If you have a lot of infections now and a few weeks later you're going to get hospitalizations, and a few weeks later you're going to get deaths, if the infections go down, you're still going to get a lot of hospitalizations, because it lags by a few weeks and you're going to still have people dying after the hospitalizations go down, because they're the ones that are going to be even a few weeks later.
It's going to take a while for all the components, infection, hospitalization, and death to finally equilibrate down to a low level. And that's what I mean when I say this is going to end provided we get people to get vaccinated. And you asked me a little while ago, what my nightmare is, what keeps me up at night? I should have said one of the things that does keep me up at night, if we have the ironic situation where you have a spectacularly effective vaccine and not everybody's taking it. That would be really horrendous if that's the case.
I know that when the people who were looking up close and personal see what the effect of this disease could be, we would hope that you would encourage people to get vaccinated, because it's not only good for the individual to save them from getting ill, but there's almost a societal responsibility that is very difficult to get the message across. And the message is that if you think because you're young and because it's unlikely that you're going to get a serious outcome, therefore you say, "What's the difference? I don't care if I get vaccinated," the virus is spread 50% to 60% of the transmissions are transmitted by somebody who has no symptoms. So even though you could rationalize and say, "I'm young, I'm healthy, it's likely if I get infected I won't get symptoms," what you might do inadvertently and I would say even innocently is that you could get infected, not know it, inadvertently transmit it to someone else who then transmits it to somebody else who then dies from it. So no way you had an intention of hurting anybody, but you have to appreciate this is such a crazily unique infection that by not getting vaccinated, you can be actually part of the propagation of the outbreak that's going to ultimately kill somebody.
I look at it as a personal responsibility to yourself and to your family, but also a bit of a societal responsibility to contribute to ending the dynamics of this outbreak.
Dr. Fauci, it has been an honor to have these few minutes with you this morning and on behalf of the American Association of Critical-Care Nurses, I want to thank you for allowing us to get to know you a little bit better and for your extraordinary service to our country and your ongoing leadership. We wish you well as well. We are here to support you.
Dr. Anthony Fauci:
Thank you very much, Liz, and thank you for having me on. It really is a privilege and a pleasure. And greetings to all the ICU nurses, particularly the ICU nurses from the NIH.
There we go.
Dr. Anthony Fauci:
About the National Teaching Institute & Critical Care Exposition: Established in 1974, AACN’s National Teaching Institute & Critical Care Exposition (NTI) represents the world’s largest educational conference and trade show for nurses who care for acutely and critically ill patients and their families. Bedside nurses, nurse educators, nurse managers, clinical nurse specialists and nurse practitioners attend NTI.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme