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00:00Let me start with a question. I think that a lot of people are asking and that is the prospects for another wave of this Covid-19 whether it be a BA.2 or some other. So very. Given the level level of immunity that we believe we have in the country today. Well that is difficult to very accurately predict. David for the following reason you're absolutely correct that when you combine the immunity that many people have following infection with the immunity that people who have been vaccinated and hopefully boosted have there's a significant amount of background immunity. However we know that the Omicron BA.2 is on the ground itself is a highly transmissible virus. The BA.2 has a transmission advantage over BA.1. Now if you look at what happens in other countries that we usually follow their pattern. Take the UK for an example. They have BA.2 and what they've done is two other things. They have this virus that we have in our country about 75 percent now of our isolates B.A. 2. They've had a pullback on many of the mask mandates and restrictions that they've had for indoor settings as well as a waning of immunity. Those conditions are also present in the United States. So I would not be surprised if we see an uptick in cases whether that upticks becomes a surge where there are a lot more cases is difficult to predict. But the one thing that I hope and I believe this reason that this will not happen is that we won't get a very large increase proportionately in hospitalizations because of the background immunity. But I think we should expect David that over the next couple of weeks we are going to see an uptick in cases. And hopefully that is enough background immunity so that we don't wind up with a lot of hospitalizations. The best way to avoid that is as we always said in our previous discussions David is to get more people vaccinated. And if you're vaccinated then wind up making sure you get boosted when your time comes up. That remains the case. I'm sure we sort of know who's been vaccinated. Do we have a take on how many people may have some immune response because they've had the disease they were not vaccine. And how important is it for you to have that data if it's available. Well I mean obviously it would be very important to know the number of people who have been infected in this country. If you do zero surveys and look at the people who have either been vaccinated or who have been infected and have what's called an indication of immunity which can be easily measured by looking at the antibody response you're talking about a very very high percentage of the population perhaps even as high as 90 percent. However one of the things that people need to realize is that immunity wanes. So it isn't like measles. If you measure someone and take a look at their immunity to measles that lasts a lifetime. The immunity to Covid and sores Covid too is something that wanes over a period of months. So that's the wild in this is to be able to predict accurately what level of immunity over time will prevent us from winding up getting either a large surge or a surge associated with hospitalizations. Are we getting better data on that. If I can call it the curve of the waiving of the immunity and I'll make it very personal. I've had three vaccinations and I got Covid but two and a half months ago or so. So I got presuming more immunity from that. Should I be looking at a fourth shot right now. Yeah right now I think with three shots an infection. David it is very unlikely that you'll need a booster for a reason you know for the immediate future. I wouldn't run out and get you a fourth dose right now having been infected. What you might have to do and this is what the FDA advisory committee that's meeting now is looking at is what about the projection the strategic projection as we get into the fall for all of us who will have waning immunity. I have not been infected but I've been vaccinated and boosted and certainly over a period of months it is very likely that my immune protection will diminish to the point of needing yet again another booster. Does the fall look like the last couple of falls in this sense. I mean I didn't even hear about falls and pandemics until Covid came along. But then I learned that you have to be careful I guess because we all go back indoors and the transmissibility goes up. Should we expect that again this year. Should we be bracing for something October time. Well I think where it is it is likely that we. See a surge in the fall again when we talk about these things David these are uncharted waters for us with this virus. If one talks about flu or other infections in which you have decades and decades of experience you can predict with some degree of accuracy what you might see. I would think that we should expect that we are going to see some increase in cases as you get to the colder weather in the fall. And that's the reason why the FDA and their advisory committee are meeting right now to do plan a strategy. And we at the NIH are doing studies now to determine what the best boost would be. Should it be an arm Akron boost or should it be a boost of the original ancestral strain. We don't know. We're going to find out by the studies that we're doing for a Bloomberg television or radio audiences worldwide. We're speaking with Dr. Anthony Fauci of the NIH. When you talk about trying to get your arms around this as one of the people who is leading the charge for his doctor. How important is it to have accurate information about infections. And I asked for this reason. A lot of you are doing home tests now. I'm not sure we know if they get a positive test. How would we know that. Put it in the model. Yeah that's a very good point. And that's something that I think we need to seriously consider as more and more home 15 minute tests become available. What are you're going to miss. David. A people who get infected and are either without symptoms or have mild symptoms so they don't come to the attention of a health care provider or they don't wind up getting a PCR. Because when you get a PCR and it's positive that gets reported whereas your home test you have no reason or even mechanism of reporting it unless you go through the health care system. So you're right we are probably underestimating the number of infections that we're having right now because many of the infections are either without symptoms or minimally symptomatic. And you'll miss that if people do it at home. And it's not reported to a central bank. We've all learned an awful lot. Maybe even you've lot learned a lot about the TV allergy through this entire experience. And that includes the CDC certified. If I can call that a sister organization to you. We now see the head of the CDC saying they're going to take a look at it try to modernize trying to prove what they've done. What do you think we've learned that could be helpful to the CDC and changing the way they do business going forward. Well I think what Dr. Walensky the CDC director is doing is very important and I'm very much in favor of that is to take almost a diagnostic look over the next month at the kinds of things that they feel that they can do better. One of the things that we are all aware of. And Dr. Wilensky certainly is aware is that the way the system is set up now which is partly due to our own health care system where we don't have a unified system where you can get data in real time when you're dealing with an evolving outbreak and you need to make real time and real world decisions. You need to know data. That is one day one week old not data that's three months old. And the older systems that we had did not allow us to get data in real time. We're getting better at it. And the CDC has already instituted mechanisms of being able to get data in a much more expeditious manner. But we still need to do much better. And that's one of the things that they're talking about when they're looking at how they can make it a better organization. Doctor the federal government has appointed up if I can put it that way a lot of money to fight this disease and properly so. There's talk about more money now. There was an original proposal for something above 20 billion dollars. Now that's been whittled down to ten billion dollars. Even that's being held up. Could you give us some sense of how important it is that that money is appropriate. What would it go for. Well David that's absolutely critical that we get that money for a number of reasons. So you can work from the bottom up. You know the 5 billion dollars was taken out of the 15 and that 5 billion was for international Covid to get vaccines to people in the developed world and to be able to get those vaccines into vaccinations into people's arms. That is important because if we don't do that and you have a lot of viral dynamics in other parts of the world that leads to the likelihood that you're going to see another variant. That's the first thing. The second thing we in the next few months will run out of tests run out of monoclonal antibody. Run out of antiviral drugs as well as the important work that needs to be done to do studies to determine what the best booster should be. As I mentioned a moment ago should it be a combination of a hybrid of different boosts. Should it be an arm Akron boost. Should it be a boost of another variant like beta. We don't know that. And we can't do those studies David unless we get the money because we in fact will run out in a very reasonably short period of time. One last question Doctor. You mentioned antiviral drugs. At one point there was a lot of promise held out for antiviral drugs. How does that fit into the overall strategy at this point. There are accounts that perhaps a good part of the money being for freedom might go actually for some of the antiviral drugs. They are very important David. Particularly when you have a virus that is so highly transmissible that even people who are vaccinated will get infected. Now most healthy people who are vaccinated might get infected but they'll get minimum or no symptoms. But people who have underlying conditions particularly the elderly whose immune status often is compromised merely on the basis of their age as well as people with underlying conditions who if they do get infected they are at a higher risk of a serious complication. We absolutely need antiviral drugs for those people. And it has to be given within the first few days of the infection or at least a recognition of the infection. So this the short answer to your question. Any virals are extremely important. If we don't get additional money we're not going to be able in the long range to have enough antivirals to give to people.

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Fauci on Possible Covid Surge, Waning Immunity, Funding

Dr. Anthony Fauci, the top medical adviser to U.S. President Joe Biden, says a surge in Covid-19 cases is likely toward the end of the year and warns the U.S. will run out of tests, monoclonal antibodies and antiviral drugs if more funding is not provided. He speaks with David Westin. (Source: Bloomberg)

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