White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript February 22

Andy Slavitt: (00:00)
… with these groups and we’ll continue this engagement throughout the response. Now to continue to inform our efforts around vaccine confidence, over the next two weeks, the White House, along with CDC and HHS will host a series of listening sessions with key stakeholder groups. These meetings will be led by Dr. Nunez-Smith, who is leading our equity work. These conversations will focus on how to strengthen vaccine confidence and how to eliminate barriers that underserved communities are facing to vaccinations, like paid leave, transportation, and scheduling. The meetings are kicking off today, with a conversation with key leaders in the African-American community. And throughout the week, we’ll be meeting with Latino groups, faith leaders, and members of the rural community.

These listening sessions will continue our effort to hear directly from communities who have been hit hardest by this pandemic, and help us build strong partnerships with those who will be key to our efforts to build vaccine confidence and reach everyone in our response. As a part of this effort, beginning today through Wednesday, CDC is hosting a national forum on vaccines, where they’re bringing together thousands of participants from around the country, from practitioners to jurisdictions, to others working on the ground, to discuss practical strategies, technical resources, and best practices for vaccination efforts. In a moment, Dr. Walensky will discuss this.

All of that continues our work on not only a whole of government response, but to leverage the best existing resources outside of government to end this pandemic as quickly as possible. Our third phase, the public education campaign, will be timed for maximum effectiveness and designed based on both our learnings and take full advantage of the participation of many throughout the country. So with that update, I will turn it over to Dr. Walensky, and then from there to Dr. Fauci. And then we’ll take your questions.

Dr. Walensky: (02:17)
Thank you, Andy. I’m glad to be back with you today. We continue to see trends head in the right direction, but cases, hospital admissions and deaths remain at very high levels. COVID-19 in the United States has been declining for five weeks, with the seven day average dropping 74% since the peak seven-day average on January 11th. The current seven day average, approximately 66,000 cases per day, is similar to that seen during last summer’s peak. Cases remain significantly elevated. And the seven day average for new hospital admissions, 6,500 a day, reflects a 60% decline since the peak seven day average on January 9th, the lowest the seven day average in hospital admissions since last fall. The number of reported deaths also continues to decline with the seven day average, slightly more than 1900 deaths, dropping 39% compared to the prior seven day average. This is the lowest since the beginning of December.

However, this seven day average is counterbalanced by the stark reality that this week we will surpass one half million COVID-19 deaths in the United States, a truly tragic reminder of the enormity of this pandemic and the loss it has afflicted on our personal lives and our communities. While the pandemic is heading in the right direction, there is still much work to do. One area that is particularly important is getting students back to in-person instruction while protecting teachers, students, and staff. A little more than a week ago, we released our operational strategy for opening K-12 schools. This strategy provides the long needed, science-based roadmap to help schools open safely and remain open for in-person instruction. Since the release of this strategy, we have been working closely with the Department of Education, public health partners and education partners, including teachers and other school staff, to increase awareness of the guidance and to support its use in ongoing discussions and planning efforts for school re-openings. The goal is to achieve the reopening of schools safely.

In addition, we continue to study COVID-19 spread in schools to identify the factors that contribute to outbreaks and steps that can help prevent spread in schools. Today, CDC published a concerning report in the morbidity and mortality weekly report the details and investigation of COVID-19 spread in eight public elementary schools in a single school district in Georgia during a period of high community spread. In the report, researchers identified nine clusters of COVID-19 cases involving 13 educators and 32 students, at at least six elementary schools. In two of these clusters, COVID-19 was spread first from educator to educator and then from educator to student. These two clusters accounted for half of all the school associated cases.

Across the nine clusters, educators played an important role in the spread of COVID-19 in the schools. COVID-19 spread often occurred during in-person meetings or lunches, and then subsequent spread in classrooms. COVID-19 was also spread from student to educator and from student to student, but this occurred less frequently. The two main reasons for the spread of COVID-19 in these schools were inadequate physical distancing and mask adherence. In the schools, physical distancing of at least six feet was not possible because of the high number of students in class, as well as because of classroom layouts. In addition, COVID-19 may have spread among educators and students during small group discussions, where educators were in close proximity to students.

Although the school’s district mandated in classroom mask wearing except while eating and mask wearing was reportedly high, the study found that there were instances where lack or inadequate mask wearing by students occurred. In these situations, lack of physical distancing likely increase the risk of spread. In addition, students ate lunch in their classrooms, which may have also contributed to spread. These findings underscore the importance of strict mass adherence to the five key layered mitigation strategies outlined in the CDCs K-12 operational strategy. In particular, universal mask wearing, physical distancing of at least six feet and using cohorting or podding of students are important to minimize spread throughout the school environment. This is especially true for schools that have high rates of COVID-19 in their community.

As we have noted, distancing requirements, which we recognize are very challenging, can be relaxed as community rates come down. It’s also worth noting that approximately 60% of close contacts of the cases agreed to be tested for COVID-19. And for those who were tested, testing took five to seven days, a delay that makes it incredibly difficult to rapidly contain spread. These findings highlight an additional key mitigation strategy recommended in CDC’s school guidance, the need for diagnostic testing and rapid and efficient contact tracing, in combination with isolation and quarantine, in collaboration with the health department.

The findings also highlight the importance of scaling up vaccination efforts across the country, including the continued need to prioritize teachers and other school staff for vaccination as part of the frontline essential workers, consistent with the recommendation of the advisory committee on immunization practices. CDC’s operational strategy specifically includes vaccination for teachers and school staff as an additional layer of protection that can be added to the five key layered mitigation strategies.

Finally, I want to emphasize that while CDCs operational strategy does provide for in-person instruction during all levels of community spread, the safest and quickest way to open schools and keep them open is to have as little COVID-19 in the community as possible. Enabling schools to open and remain open is therefore a shared responsibility. Encouragingly, consistent with the recent declines in COVID-19 cases in the United States, the percentage of counties with the highest level of COVID-19 transmission continued to drop, declining from approximately 90% when we released our school guidance about 10 days ago, to 60% as of yesterday. Now, approximately 18% of counties have COVID-19 levels at the low or moderate levels, that’s consistent with full in-person learning for all K-12 schools in CDC guidance.

And 22% are at the substantial level, consistent with hybrid learning or reduced in-person attendance for all K-12 schools. For the 60% of counties that remain in the red zone, the counties with high transmission, we encourage at least the K-5 students to return to school in hybrid or reduced in-person attendance, and for middle and high schools virtually, unless they can strictly implement mitigation measures and have few cases. Schools that are already open should continue to provide in-person instruction, as long as cases are low and they strictly use mitigation measures to keep them low. I hope these findings serve as a catalyst to…

… to keep them well. I hope these findings serve as a catalyst to each of us to continue to do our part, to drive down the number of cases and reduce the spread of COVID-19. I know this is not easy, and so many of us are frustrated with the disruption the pandemic has had on our lives and our children’s education. But working together as a nation, we can turn the tide.

Finally, I want to share some news about our virtual national vaccine forum that kicked off this morning. I’m excited to share that we have over 11,000 participants from 6,000 organizations across all 50 states, nearly all territories and 128 tribes and tribal organizations. Over the next three days, these participants will share information and best practices on how to build trust and confidence in COVID-19 vaccines, use data to optimize vaccine implementation and provide practical real-world experience on how to increase vaccination capacities in our communities. I encourage each of you to watch the livestream plenary sessions throughout the day, and get engaged in your community vaccination efforts. Before I turned to Dr. Fauci, I want to reiterate to everyone to continue to do your part to protect yourselves and each other. By wearing a well-fitting mask, staying six feet apart from the people you do not live with, avoiding travel and crowds, washing your hands often and getting vaccinated when the vaccine is available to you. And now I will turn it over to Dr. Fauci. I look forward to your questions. Dr. Fauci?

Dr. Fauci: (11:30)
Thank you very much, Dr. Walensky. I’m going to talk for a few minutes today on updating you on where we are on some selected therapeutics for COVID-19. So if we can move ahead to my first slide. In general, when one thinks of therapeutics, you think of them as therapeutics for early or moderate disease versus therapeutics for moderate to advanced disease.

Dr. Fauci: (11:55)
Clearly the strategy early on is to block the replication of virus and prevent it from going from the upper airway to the lungs and other organ systems. However, we have found through experience over the past many months that when one gets advanced disease, the hyper or aberrant inflammatory or immunological response gives as much to the morbidity and mortality as the actual virus replication itself. And in that regard, a variety of drugs have been tested. One such as remdisivir has gained FDA approval. Its effect is clear, but modest. When we got to getting early intervention, monoclonal antibodies, both from Lilly and from Regeneron have received emergency use authorization.

Dr. Fauci: (12:55)
Here again, the earlier one uses, the better. These are as efficient and more efficient in those individuals who don’t necessarily have a good antibody response. The same can be said of convalescent plasma, which has also earned an emergency use authorization. Again, because of the variability in the titer of antibody in various plasma aliquots. The issue here is getting this as early as possible.

Dr. Fauci: (13:32)
There have been a number of trials of a variety of antivirals or other agents that are off the shelf that have not been targeted. I’ll get to targeted intervention in just a moment. And then hyper-immune globulin is also in clinical trial and we await the results of all of these. With regard to therapeutics for advanced disease, as I mentioned, that is generally aimed at blocking an apparent inflammatory or immunological response as well as other pathogenic mechanisms, which are not necessarily that well understood. We have dexamethazone, a drug approved for many, many, many years is the standard of care for advanced disease, particularly people in the hospital on respirators and or requiring high flow oxygen. [inaudible 00:14:31] and remdisivir have earned emergency use authorization and a number of immunomodulators, including those that block a variety of cytokines and cytokine receptors are currently in clinical trials.

Dr. Fauci: (14:49)
Can I have the next slide? The bottom line of what we need to do looking forward and the clear need in this is the development of potent antivirals directly acting on SARS-CoV2, very similar to what was done with the highly successful drug development program for HIV, as well as for hepatitis C. And what I refer to is the future development of therapeutics will be based on the identification of vulnerable targets in the SARS-CoV2 replication cycle and the design of drugs to inhibit these vulnerable targets. As I mentioned, we are beginning this and this is going to be the direction of the future. I want to point out to the group that the NIH in April put together a treatment guidelines panel that is a living document of clinicians and people involved in the care of SARS-CoV2 infected individuals who analyze the literature as well as the now very common pre-print literature and updated in meaningfully in very frequent intervals.

Dr. Fauci: (16:18)
It is a living document. As I mentioned, there are 47 voting members of this. And since this was put online in April of 2020, easily accessible by COVID-19 treatmentguidelines.nih.gov, there have been over 11 million hits to this. The reason we feel this is important, and I want to again, bring it to everyone’s attention is that it is an easy way to get experienced clinicians to analyze data that’s already in the literature, as well as data there that is in pre- print form and involved in just clinical experience. It has been very advantageous to clinicians, not only in the United States, but worldwide. And if I could have the next slide.

Dr. Fauci: (17:13)
Finally, I want to just bring to your attention something that the FDA has done today and having a press briefing, I believe at 1:30. I want to bring it to their attention because although they delineated the aspects of it, I want to make sure everyone is aware of the very important work that the FDA is doing. And that is they are guiding the medical product developers by updating their guidelines on how they address the virus variants.

Dr. Fauci: (17:50)
And the products involved that are impacted by this updated guidance are vaccines, COVID-19 tests and therapeutics. Why is this important? It is very clear that we are faced right now, and will be in the future with variants that are already present and that with all of the immunologic and other pressures that are going on and the high degree of replication throughout the world, that there will be the selecting of a variety of variants. We ourselves in this country are already facing variants that are having impact such as the UK variant. We have the South African variant in our nation, and we’re even having the evolution of variants within our own country. With regards to vaccines, the FDA outlines the scientific recommendations for the modification to authorized vaccines.

Dr. Fauci: (18:51)
In other words, we have vaccines that are out there that are highly efficacious. The manufacturers of these are going to want to know how they can address and modify their vaccines to address the ongoing evolution of variants. And we expect the manufacturing recommendations to remain the same. And the effectiveness is going to be determined by immunogenicity studies. In other words, likely not have to prove efficacy in a large study. The same holds true for COVID-19 tests. The updated guidelines describes the FDA’s activities to better understand the public health impact on the variants and the impact on the test performances and provide recommendations to the developers of these tests regarding the future genetic mutations and what they need to do when designing or modifying their existing tests. And finally the same holds true for therapeutics, both drugs and biologics. The FDA will provide recommendations on the efficient-

Dr. Fauci: (20:03)
The FDA will provide recommendations on the efficient approaches, how to generate data that potentially could support an EUA for monoclonal antibody products that might actually be effective against emerging variants, which obviously will be an issue because we already know particularly that the South African variant is in fact obviating the effect of several of the monoclonal antibodies that people have developed and former guidances on therapeutics will also be updated to address the evolving landscape of the COVID-19 drug development again, in the context of emerging SARS COV-V2 variants. In summary, the FDA will give guidance to how these companies can address a problem that we know is with us already and that will be a problem in the future. I’ll stop there and back to you, Andy.

Thank you. Thank you, Dr. Fauci. Dr. Willinsky, let’s take a few questions.

Speaker 1: (21:12)
Great. And if you haven’t raised your hand yet, you can go ahead and do that and that’s how we can select you. First up, we’ll go to Catherine [inaudible 00:21:18].

Catherine: (21:21)
Thanks so much for having this briefing. It’s very helpful. My question is, what is the Biden administration’s policy for vaccinating federal employees? How are they prioritized? And a few other add-on questions. Do you know if the Biden administration’s policy contrasts with that of the Trump administration regarding who was vaccinated when and in accounting for the missing doses of vaccine, have all of the doses that have been administered to federal employment employees been accounted for? Thank you.

Okay. Multiple parts of the question. I’ll do my best to answer. Does it respect federal employees? What I can tell you is that the federal government is following the ACEP guidelines. And if you’d like more detail or if you have more specific detailed questions on aspects of federal employees, frontline workers versus others, we will follow up with you and answer those questions. When you say missing doses, can you clarify what you’re referring to please?

Catherine: (22:57)
Yeah. Dr. Willinsky had spoken some time ago about vaccine doses that could not be accounted for. And there was a question of whether that was due to a lag of reporting from the states to Tiberius. And my question is, have all of the doses that have been used for federal employees been fully accounted for, and is there somebody whose job it is to track that?

Look, Dr. Willinksy can comment after me if you’d like, but I believe what you’re referring to is a comment made some number of weeks ago right after we arrived here. At that point in time when we arrived here, about 46% of the vaccines that had been distributed to states had been administered. And so I think what Dr Willinsky was saying is we have a whole lot of vaccines that have been delivered that need to now be administered. Now, today that number is about 80%, so we were at 46% and now we’re at 80% and we applaud the states and the vaccinators and everyone involved in improving that effectiveness. So I don’t think, and again, I will invite Dr. Willinksy to of course correct me if I’m wrong, that she was referring to “missing” vaccines, simply that we needed to get the vaccines that had been delivered to be administered more effectively and more efficiently and more equitably, Dr. Willinsky.

Yeah, I don’t have much to add. I think when we came into the administration, we had to make sure we could follow all the paths of where all the doses were and I think we’ve done so just as you comment.

Thank you. Next question.

Speaker 1: (24:49)
Next, we’ll go to Chrisman [inaudible 00:24:51] Los Angeles Times.

Chrisman: (24:56)
Hi everyone. I was interested in your thoughts on the messaging around the vaccines. There’s a lot of conversation about how you need to keep doing the same things even after you get vaccinated, like wearing a mask, not seeing your family, things like that. You think that’s preventing people from being more enthusiastic about getting vaccines and may we see that change in the future?

Well, I’m going to invite both Dr. Willinsky and Dr. Fauci to comment on that and I will as well if there’s anything to add.

Dr. Fauci: (25:31)
Actually, I’ll start. Whatever. I’ll start off and be very brief and hand it to Dr. Willinsky. There are certain aspects of being vaccinated and what that means to you personally and your own personal safety and that of your family, versus what vaccines will allow you to do in society. One relates to you yourself being vaccinated and the other relates to the number of people and the relative percentage of people in society that will be vaccinated because there will be things that you will not be able to do because the burden of virus in society will be very high, which it is right now, even though we’re going way down on the decline that Dr. Willinsky showed you. We are still at an unacceptably high baseline level with a seven day average being quite high. So there are things even if you’re vaccinated that you’re not going to be able to do in society, for example, indoor dining, theaters, places where people congregate that’s because of the safety of society. You, yourself, what you can do when you are together with another person, we are looking at that and we’re going to try and find out very quickly what recommendations could be made about what people can do.

Dr. Fauci: (26:57)
One of the things that’s universal here that we know that at this point in time, it is unclear whether when you get vaccinated and you might be protected from clinical disease, which is the primary end point of the vaccine studies that you could conceivably be infected, have virus in your nasal pharynx and at that same time have no symptoms, which is the reason why we recommend and say you still need to wear a mask because if you do have virus in your nasal pharynx, even though we hope that when the data comes in, it’s going to show that the very virus level is quite low and you’re not transmitting it, we don’t know that now. And for that reason, we want to make sure that people continue to wear masks despite the fact that they’re vaccinated. So Dr. Willinsky, why don’t you add to that?

Great, thank you. I will say we’ve already started to come out with some guidance that demonstrates a difference if you’ve been vaccinated versus if you haven’t. So for example, if you’ve been exposed and you’ve been fully vaccinated two doses, there is no longer a need to quarantine after you’ve been exposed. So we are starting to emerge with some guidance in this area, and more will be forthcoming. I would echo exactly what Dr. Fauci said. We are working on rolling out a lot of vaccine to a lot of people, and yet we still have a lot of disease, 66,000 cases a day. So what we might be proposing in terms of guidance will really likely be at the individual level and not at the community level.

Let me just follow up to make a broader point. The broader point that Dr. Fauci and Dr. Willinsky both alluded to this, the President as the scientific team, including prominently Dr. Fauci and Dr. Willinsky are very much working together on those sets of recommendations. And I think it is in our interest to make sure they release information based on data, not, to your tenor of your question, trying to convince the public of something that isn’t necessarily based on data. I think that you will hear that consistently from this administration. I will tell you that people are interested in taking the vaccine in large numbers. For the same reason, people are interested in taking the vaccine for MMR and for the flu because they want to live. They don’t want to be sick and they don’t want to die and that is a very important benefit that people don’t often talk about quite as much, but that the public we believe clearly understands. So beyond that, what we are able to do as a society, the scientific team is going to continue to study based upon prevalence, based upon vaccination levels, and based upon the data. And we’ll come out with more. And there are plenty of commentators outside of the government.

Come out with more. And there are plenty of commentators outside of the government that, of course, expressing their own views and their own opinions. And so I think that’s a part of the discourse, but it’s not one that we are going to jump into too hastily. Next question.

Speaker 2: (30:18)
We’ll go to Erin [inaudible 00:30:19] at the Daily [inaudible 00:30:20].

Catherine: (30:22)
Hey there, thanks so much for doing this. I have two questions for you all. The first question is about issues surrounding the CDC vaccination tracker. A lot of state officials that we spoke to over the past couple of weeks were dissatisfied with how their state was being reflected in that vaccine tracker. I want to know if there have been any steps to clear up that data, whether those concerns have been dealt with, and what the issue was there.

Dr. Walensky.

Yeah. Thank you for that. We are actively working on the vaccine tracker. We recognize there are challenges in rolling it out to, and we are working to fix them imminently.

Catherine: (31:07)
Great. Thanks so much. My second question is, we hit the 500,000 mark today, or I guess late last night. Some officials and health experts have said that we are almost certainly under counting COVID-19 deaths in this country. I wonder if any of you could speak to that and whether, or how confident you are, in whether more than 500,000 people have died as a result of COVID-19 in this country. And I also haven’t seen a mortality study done yet since the pandemic began. Is that going to happen? And when might that be published? Thanks.

Dr. Walensky?

Yeah, I think we can… Even if we were perfectly precise in how we defined COVID-19 early on, as we were learning about the disease, and we were accurate in our counting, I think we can understand that there has been excess mortality from this pandemic outside of COVID-19 specifically. So, people who delayed in getting medical care… Many delayed in coming in. So I think that when history writes this, we will understand that the mortality related to this pandemic is far greater than the numbers that we have been counting, for numerous reasons. There have been numerous mortality studies that have been done, and I’m certain there will be more forthcoming because we are continuing to accumulate mortality, unfortunately.

Okay. Next question.

Speaker 2: (32:41)
Last question will go to Maggie Fox at CNN.

Maggie Fox: (32:44)
Thanks very much. Can I ask about the Johnson & Johnson vaccine, if it wins emergency use authorization, what are the plans for distributing the initial supply? Have you got a number in mind for how many doses you think you’ll have, and will they go to the states? Will they go to retail pharmacies? Will they go to some of these independent retail pharmacies? Can you talk a little bit about what your plans for that are?

So I think we’re going to wait on that until after the FDA does its work and then after the ACEP does its work, all consistent with our philosophy of letting the science go first. Once we understand what the scientific community has to say, we will then be in a position to answer, I think, the very relevant questions that we need scientists’ advice on. And again, this is the President’s directive to let science lead, and then we will rapidly follow that up with a strategy, both distribution and targeting and otherwise, that reflects that. Dr. Walensky or Dr. Fauci, are there anything you would add to that?

Dr. Fauci: (33:51)
No, that’s precisely correct. It’s very important because the FDA is going over the data very, very carefully. They’re meeting with [inaudible 00:33:58] and that in the data there may be hints about just how this would be used most appropriately and most effectively. When we find that out, then the policy of the distribution would become much more scientifically based, as Andy has said.

And then right on its heels will be the ACIP from the CDC to give some guidance as to how it should be rolled out from.

Maggie Fox: (34:23)
Can I just follow up a bit, though? Do you have any idea of how many doses there will be? The science isn’t guiding that, you know whether they’re manufacturing and where they are in that?

Dr. Fauci: (34:33)
[crosstalk 00:34:33] No, they’ve been contracted for 100 million doses, which we will hopefully get by the end of June, the beginning of July. The rollout of that, there will not be a lot of doses right on the heels of the EUA, but that will accelerate as we get into the months towards the contractual arrangement of when 100 million doses will be given.

Yeah. And we’ll be speaking to that also. But again, we’re going to wait for the FDA and the ACEP to do their work. And then I commit to you, you will be hearing a lot more, presuming that the [EUA 00:35:13] is granted, and we’re not, of course, going to take anything for granted, but presuming that that happens, I commit to you, you’ll be hearing a lot more about all of those topics.

I want to take the opportunity again to thank you for listening into the briefing, and on this solemn day, to encourage you to watch the President’s remarks this evening with the Vice-president, the first lady, and the second gentleman, to remember the 500,000 people that we’ve lost. And we will look forward to bringing you more information later in the week, of course. Thank you.

White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript February 22

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