White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript March 8: CDC Guidelines For Fully Vaccinated People

Andy Slavitt: (00:00)
… It’s 2.9 million doses reported administered, a new daily record and we’re at pace seen nowhere else around the world. This is a function of everyone executing to their fullest. And it depends on vaccination sites being open late and the tireless effort of vaccinators. While all of this is challenging, our message is keep going. I know the pace is challenging. This is a war and we can’t let up. Last week, the president announced we’d have enough vaccine for every adult in America by the end of May. Turning those vaccine doses into vaccinations requires more vaccinators and more vaccination sites. We must continue to get these vaccinations efficiently and equitably distributed to the public. We’ve already provided more than $4.1 billion to states, tribes and territories to support more than 500 community vaccination sites.

The American Rescue Plan includes tens of billions more in funding to scale up our vaccination program. Many states are now running vaccination sites 24/7. Slots are being reserved for teachers and people in hard hit zip codes. And we’re getting more vaccinators from the military to retired doctors and nurses into the field. We are in a historic crisis and we have reason to have confidence that we will prevail, but we are not done and we must keep up the pace of progress and remain vigilant. Joining me today is Dr. Walensky, Dr. Fauci and Dr. Nunez-Smith. And with that, I will turn it over to Dr. Walensky to talk about our next steps on our path back.

Dr. Rochelle Walensky: (01:50)
Good morning and thank you. I’m glad to be back with you today. Let’s get started with an overview of the pandemic. The most recent seven-day average of cases is about 59,000 cases per day. Importantly on the far right of the graph, you can see that there is a leveling off of the decline. And the most recent seven-day average of deaths is slightly lower than 2000 deaths per day. These numbers show us that the pandemic still remains a very serious situation with the most communities continuing to have high levels of COVID-19 transmission.

We are watching these data closely to see where the pandemic will head in the coming days, but I’m also hopeful. As of today, 59 million people in the United States have received at least one dose of a COVID-19 vaccine and approximately 31 million or 9.2% of the US population is fully vaccinated, putting us on a strong path to eventually and this pandemic. And as you just heard, we are now vaccinating more than two million people per day.

We’ve been through a lot this past year and with more and more people getting vaccinated each day, we are starting to turn a corner. And as more Americans are vaccinated, a growing body of evidence now tells us that there are some activities that fully vaccinated people can resume at low risk to themselves. This is why today CDC is releasing its initial guidance for the public that for the first time lays out some of the activities considered safe for those who are fully vaccinated. When I say fully vaccinated, I mean people who are two weeks after their second dose of either the Pfizer or Moderna vaccines or two weeks after a single dose of the Johnson & Johnson vaccine.

Before I talk about the specific recommendations, I want to underscore a few important points. First, robust clinical trial data demonstrate that the current COVID-19 vaccines are highly effective at protecting vaccinated people against severe illness, hospitalization, or death from COVID-19. However, there is still a small risk that vaccinated people could become infected with milder or asymptomatic disease, and potentially even transmit the virus to others who are not vaccinated. Understanding the size of this risk in vaccinated people and the risk of transmitting the virus to others who are not vaccinated is an ongoing area of research.

Second, it’s important to note that this is initial guidance. The science of COVID-19 is complex and our understanding of the virus continues to rapidly evolve. The recommendations issued today are just a first step. As more people get vaccinated and the science and evidence expands and as the disease dynamics of this country change, we will continue to update this guidance. Importantly, our guidance must balance the risk to people who have been fully vaccinated, the risks to those who have not yet received a vaccine and the impact on the larger community transmission of COVID-19 with what we all recognize to be the overall benefits of resuming everyday activities and getting back to some of the things we love in life.

It’s against this backdrop and the current state of the pandemic that we have developed these new recommendations. With today’s initial guidance, it’s important to note that we are focusing on activities of fully vaccinated people can resume in private settings, such as their homes under two scenarios. The first scenario is fully vaccinated people visiting with other fully vaccinated people. In this slide, these individuals are represented by solid green circles. In this scenario, CDC recommends that fully vaccinated people can visit with other fully vaccinated people in small gatherings indoors without wearing masks or physical distancing.

Remember here we are talking about private settings where everyone is vaccinated. So what does this mean? If you and a friend or you and a family member are both vaccinated, you can have dinner together wearing masks without distancing. You can visit your grandparents if you have been vaccinated and they have been too.

Now, I want to talk to you about another more complicated scenario. It involves vaccinated people visiting with unvaccinated people. When fully vaccinated people visit with unvaccinated people, we have to consider the underlying risks of the unvaccinated people and any unvaccinated members of their household. We take this approach because all of our guidance is rooted in making sure we are keeping people safe. So CDC recommends that fully vaccinated people can visit with unvaccinated people from one other household indoors without wearing masks or physical distancing as long as the unvaccinated people and any unvaccinated members of their household are not at high risk for severe COVID-19 disease.

In this slide, people who are vaccinated and at low risk for severe COVID-19 are indicated by solid orange circles. This means that none of the unvaccinated people or any unvaccinated members of their households, for example, are an adult over age 65 or have an underlying condition such as cancer, heart disease or diabetes that could increase their risk of COVID-19-related hospitalization or death.

Here’s an example. If grandparents have been vaccinated, they can visit their daughter and her family even if they have not been vaccinated so long as the daughter and her family are not at risk for severe disease. They are solid orange circles. Second, if an unvaccinated individual or any unvaccinated member of their household are at high risk for severe disease shown here by hollow orange circles, everyone regardless of vaccination status should still wear a mask and physically distance and choose to meet outdoors or in a well-ventilated space. This is recommended to keep the individuals at high risk who are unvaccinated safe.

Similarly, when fully vaccinated people are visiting with unvaccinated people from multiple households, everyone should wear masks and physically distance and meet outdoors in a well-ventilated space. Moving on to quarantine away from visiting-

Moving on to quarantine, away from visiting, in addition to these new recommendations on visitation in private settings, CDC’s new guidance also recommends that fully vaccinated people do not need quarantine or get tested following a known exposure to someone with COVID-19 as long as they are asymptomatic. At this time, the CDC is not adjusting current guidance on travel. We believe these new recommendations are an important first step in our efforts to resume everyday activities in our communities. However, we remain in the midst of a serious pandemic, and still over 90% of our population is not fully vaccinated. But we are working hard to get there. Therefore, everyone, whether vaccinated or not, should continue to avoid medium and large-sized gatherings as well as non-essential travel and when in public spaces should continue to wear a well- fitted mask, physically distance, and follow other public health measures to protect themselves and others.

COVID-19 continues to exact a tremendous toll on our nation. Like you, I want to be able to return to everyday activities and engage with our friends, families, and communities. Science and the protection of public health must guide us as we begin to resume these activities. Today’s action represents an important first step. It is not our final destination. As more people get vaccinated, levels of COVID-19 infection decline in communities, and as our understanding of COVID immunity improves, we look forward to updating these recommendations to the public.

I know this is complex and I’ve covered a lot of ground this morning, so I want to recap the main points of our initial guidance released today. In summary, fully vaccinated people can visit with other fully vaccinated people indoors without wearing a mask or physical distancing, visit with unvaccinated people from a single household who are at low risk of severe COVID-19 disease indoors without wearing masks or physical distancing, and refrain from quarantine and testing following a known COVID-19 exposure if the vaccinated person remains asymptomatic.

For now, we will continue to examine this in the upcoming weeks and update our guidance accordingly. Fully vaccinated people should continue to take precautions in public, like wearing masks and physical distancing, wear well-fitted masks and physically distance and adhere to other prevention measures when visiting with unvaccinated people who are at increased risk of severe COVID or who have an unvaccinated family member, household member who has an increased risk of COVID, wear masks, physically distance, and practice other prevention measures when visiting with unvaccinated people from multiple households, avoid medium and large-sized crowds, get tested if experiencing COVID-19 symptoms, follow guidance issued by individual employers, and follow CDC and health department travel recommendations.

As I close, I want to stress that we continue to have high levels of virus around the country, and more readily transmissible variants have now been confirmed in nearly every state. While we work to quickly vaccinate people more and more each day, we have to see this through. Let’s stick together. Please keep wearing a well-fitting mask and taking the other public health actions we know work to help stop the spread of this virus. Thank you so much for your time today, and I will now turn things over to Dr. Fauci.

Dr. Fauci: (12:49)
Thank you very much, Dr. Walensky. I’d like to just spend a couple minutes now on a different topic, and that has to do with investigational therapeutics for COVID-19. If I could have the first slide, on a previous briefing, I had mentioned to the group that there were a number of investigational therapeutics, including monoclonal antibodies, convalescent plasma, immunomodulators, et cetera. What I want to do today for a couple of minutes is talk about the issue of direct-acting antivirals, if I could have the next slide.

Dr. Fauci: (13:24)
The strategy for direct-acting antivirals in the future will be a process that we have done with other infections, which I’ll get to in a moment, and that is the identification of vulnerable targets after study of the replication cycle of the virus, in this case, SARS-CoV-2, and then to design drugs to directly inhibit that vulnerable target. Next slide.

Dr. Fauci: (13:55)
We have been extraordinarily successful in this with HIV. Now, targeted drug development, which is the terminology we use for this approach, targeted drug design has occurred before HIV, particularly with the herpes viruses, but it really got into its own frame with HIV. The reason I say that is that that was the first of the extraordinarily successful results of targeted drug design, and the reason and the mechanism that we got there, next slide, was to delineate the replication cycle of the virus.

Dr. Fauci: (14:40)
In this case, you see in the upper left HIV binding to its now well-described receptors, the CD4 molecule and one of its co-receptors. It fuses. It enters. The RNA reverse transcribes. It integrates its DNA into the cellular DNA, then transcribes out and buds off. Over the years of intensive study, next slide, each of those vulnerable targets has led to a different class of a highly effective antiretroviral drug, including the reverse transcriptase inhibitors, the protease inhibitors, the integrase inhibitors, and the fusion and entry inhibitors. Next slide.

Dr. Fauci: (15:31)
This has led to now an extraordinary number of drugs, which when used in combinations have transformed, excuse me, the life of HIV-infected individuals, giving them almost a normal lifespan, although the drug needs to be given essentially for the rest of their lives. Next slide.

Dr. Fauci: (15:54)
That same principle is now being applied to SARS-CoV-2, because here’s a comparable lifecycle. Obviously, there are differences here. Again, in the upper left, you see SARS-CoV-2 by virtue of its spike protein binding to its ACE-2 receptor, binding to the membrane, effusing, entering, and then a whole bunch of steps that I need not go through that involve a variety of enzymes, which ultimately lead to the virion release on the lower right- hand part of the slide. Next slide.

Dr. Fauci: (16:34)
With the same strategy that was used with HIV, we will be screening and then proactively designing entry inhibitors, protease inhibitors, polymerase inhibitors, and others. Next slide.

Dr. Fauci: (16:53)
Then if you look at what’s been going on right now and take each of these very briefly, there are early stage non-monoclonal antibody candidates in preclinical development, such as peptides and small proteins blocking entry. With regard to polymerase inhibitors, the FDA has already approved remdesivir from Gilead. Just this past week, we’ve heard of molnupiravir from Ridgeback Biotherapeutics and Merck, in which they published the preliminary analysis of their Phase 2 trial that showed a quicker decrease of infectious virus in participants with symptomatic disease. Just two days ago, see Atea Pharmaceuticals reported favorable safety and pharmacokinetic data from Phase 1 trial, and Pfizer now is in a Phase 1 trial with a protease inhibitor. I show this to the group because this is really the beginning of the phase of looking in a strategic way for direct-acting-

Dr. Fauci: (18:02)
… Looking in a strategic way for direct-acting antivirals, which are going to be used to prevent people from progressing in their disease, namely keeping them out of the need for hospitalization.

Dr. Fauci: (18:14)
And on this final slide, for those of you who want to get more detail, just this past November, the NIH had an NIH SARS-CoV-2 Antiviral Therapeutic Summit, looking at the state of therapeutics, gaps in the field, in a number of public private partnerships. You can get this on the NIH website. And I encourage you for those who have any interest in it to take a look at that, because that is the direction that we will be going over the next weeks to months to years. I’ll stop there and hand it over to Dr. Marcella Nunez-Smith.

Marcella Nunez-Smith: (18:52)
Thank you so much, Dr. Fauci, and good morning to everyone. I’m going to talk, of course, today about equity. And you’ve heard us describe that equity is at the foundation, the center, of this administration’s COVID-19 response. Over the last month, in my time with you, I’ve detailed why that needs to be the case. We’ve taken a look at the differences in COVID-19 outcomes, for instance, by race and ethnicity. And since the beginning of this pandemic, we have all seen that factors like race, ethnicity, rural versus urban geography, poverty, disability, living situation, and type of employment, they all are exerting tremendous influence on the outcomes we’ve seen in COVID-19.

I want to begin this morning by giving an update on the ongoing inequities related to COVID-19. First let’s take a look at the rates of COVID-19 cases, deaths, and vaccination by race and ethnicity. As you can see here, Latino individuals continue to bear more than their share of COVID-19 cases, while black people continue to bear more than their share of deaths. Notably, you see the share of vaccinations is significantly lower for Latino and non-Hispanic black individuals relative to their share of the general population. And the same is true for Asian individuals.

But this all still only tells part of the story as we remain limited by the completeness of our data. We only have race ethnicity data for 53% of those who have received their first dose of a COVID-19 vaccine. This varies widely among the States, as you can see on the next slide. And we’re not getting from individuals, from providers, and from states, the critical information about who has access to these three life-saving vaccines that need to be equitably distributed across our country. I want to emphasize here it is possible to do better.

The final slide shows us the information that providers and states are reporting to us and the age of people who they’re vaccinating. Contrast that with the data on the race and ethnicity of those same individuals. Again, we have critical ground that we must make up, but we cannot get discouraged or feel like it’s insurmountable. All of the evidence points to one simple truth, we can do this.

So like many of you, we’ve also seen a lot of conversation about vaccine confidence, about how some communities due to a range of historical as well as contemporary factors are less inclined to believe that these vaccines are safe and effective, less inclined to trust the systems offering these vaccines, and less inclined to trust the government asking them to get vaccinated. So we still have some work to do to meet people where they are.

The administration is implementing a comprehensive and national public education campaign, and where I’ve been hosting round tables with key constituencies to make sure that we get that effort right. We’re building relationships with trusted messengers all over the country to make sure they have the best information possible to share with their communities. But we cannot and we will not accept that these differences in vaccine confidence are the end all and be all of the difference in vaccine uptake that we’re already seeing.

In the context of inequitable systems, we must take significant steps at every level of intervention to bend the vaccination process towards justice. Our success depends on our ability to build a robust and coordinated effort at the local, state and federal level to overcome all of the dynamics that are in place. And this moment absolutely calls for that kind of effort.

In light of everything that we’ve seen in the 84 days since our nation began administrating COVID-19 vaccines, we’re turning up the expectations for this vaccine program on all fronts. We have a series of federal programs that are a key part of our approach to ensuring that all communities have vaccination access.

First, we have our large community vaccination sites all over the country. So far, we have over 580 operational federally-supported sites. And over 170 sites are actively receiving onsite support by federal personnel. And we’ve also been able to stand up a series of federally-established community vaccination centers. And by the end of this week, we’ll have 18 of those sites running across seven states, with the ability to administer 61,000 total shots per week.

And each of our federal sites has been designed with key equity-oriented features, so targeted geographic eligibility, weekend extended hours, reserved slots for registration through faith-based and community-based organizations, as well as deployment alongside mobile vaccination units to help vaccinate surrounding communities. We’re going to keep pushing to launch more and more of these sites and dive into the data on each site to make sure they’re achieving their goal of improving vaccine equity in those communities.

Second, we have our federal retail pharmacy program, and this program features chain and independent pharmacies across the country. And as of last week, we’re administering 2.5 million doses of the Pfizer and Moderna vaccines, plus the additional supply that they received with the Johnson & Johnson vaccine. We designed this retail pharmacy program to ensure that one third of the pharmacy sites were placed in communities with higher scores on the CDC Social Vulnerability Index. Those are populations at higher risk due to factors like socioeconomic status, the composition of the household, people of color, as well as housing types and transportation dynamics. We’re going to press toward this mark to ensure that pharmacies are selecting the communities with the greatest need. And we’re going to prioritize those pharmacies that do a better job addressing equity.

And finally, we rolled out our federal community health centers partnership program. And over the past three weeks, we have been onboarding the first 250 centers. They collectively serve 12 and a half million people and span all 50 states. As a whole these community health centers provide services for large numbers of public housing residents, people of color and individuals with limited English proficiency.

So as we look to the next phase of this program, we will prioritize filling gaps in our coverage to the highest hit… I’m sorry, hardest hit, highest risk communities, whether they be urban or rural. And as we double down on the reach and impact of our federal programs, we’ll continue increasing our vaccine supply to the states.

And as we move forward, we’re calling at every state to show their work too. We’re asking our partners in the states to offer clear, transparent equity goals for their residents. And we’re also calling on the states to help us get the data. We need to know where we are, and to work with us to find creative solutions to the inequitable vaccine uptake that has already emerged in these first months of the vaccination program.

I just want to be clear that achievement equity is not an aspirational goal. This is mission critical. Absent equity, we will not be able to stop this pandemic from continuing to claim lives, strain our healthcare system, and weaken our economy. But by working together, we believe we can hit the Mark. I thank you for your time. And with that, I’ll turn it back over to Andy.

Thank you. We covered a lot of ground in our report apps. Before I turn for questions, I just want to maybe briefly summarize a few things that we heard today. Today, I think we’ve begun to describe what a world looks like where we move beyond COVID-19. Dr. Walensky outlined a first step for those of us who’ve been vaccinated. And I think it’s important to note that as more and more people get vaccinated, Dr. Walensky will continue to update us and that list of activities will continue to grow. Dr. Fauci outlined ongoing strategies to allow for a life-

… to allow for a life post-COVID to become safer and safer. Dr. Nunez-Smith, I think, importantly points out that this recovery is not an even picture and, in fact, we cannot fully get back to a place where we are approaching where we were before COVID unless we do an important and good job reaching equity. So I think a very hopeful morning, but with some continued warning signs and hope for the future. So with that, let’s take some questions.

Kevin: (27:39)
Thanks, Andy, and we’re running a few minutes late today, so we’re going to have to take a couple of less questions, but first we’ll go to Ed O’Keeffe at CBS.

Ed O’Keeffe: (27:51)
Hey, guys. [crosstalk 00:27:53]. Obviously this is … We’re overlapping with the … Can you hear me?

We can hear you both, yeah.

All right, Kevin, go to a different question. Yeah.

Kevin: (28:10)
We’ll going to Zeke at AP.

Zeke: (28:15)
Thanks you all for the call. For Dr. Walensky, I was hoping you can clarify why the CDC hasn’t … What the limiting factor is in CDC not sort of putting out guidance to the effect of those who have been fully vaccinated not having to wear masks and being able to travel and things like that. What is the limiting factor? Is that the background cases of the virus in the community? Is it the fact that not enough people are vaccinated just yet to get there? Then could you just provide potentially a step of sort of what the next set of guidance is going to be and what the triggers would be for people who are fully vaccinated, being advised to be able to remove their masks in public and go about a somewhat normal life?

Yeah. Thank you for that question. I think it’s important to realize as we’re working through this that still over 90% of the population is not yet vaccinated, and that it’s our responsibility to make sure in the context of 60,000 new cases a day that we protect those who remain unvaccinated or remain vulnerable. So we’re doing our best to do that. I think it’s also important to remember that people who are vaccinated, there’s increasing data now that suggests that they might get breakthrough infections with lesser amount of virus, lesser amounts of disease, lesser symptomatic disease, milder disease.

However, we’re still waiting for data to emerge about whether they could transmit that virus to other people. So our next steps in terms of putting out the guidance, as I mentioned, is really to see a larger swath of the population vaccinated. We’re actively on our way to doing that, as well as to hopefully see further cases decline in the country, as well as waiting for new data to emerge. So we’re hoping it’s in the relatively short period of time, but we do need to see some more new data as well.

Next question.

Kevin: (30:09)
Next we’ll go to Shira Stein at Bloomberg.

Shira Stein: (30:14)
Hi, thanks so much for doing this. Can you explain what the scientific justification is for not changing the travel guidance to telling folks that who are fully vaccinated that they should not be traveling and how will this guidance affect folks’ willingness to get vaccinated?

In terms of travel, here’s what we know. Every time that there’s a surge in travel, we have a surge of cases in this country. We know that many of our variants have emerged from international places and we know that the travel corridor is a place where people are mixing a lot. We are really trying to restrain travel at this current period of time, and we’re hopeful that our next set of guidance will have more science around what a vaccinated people can do, perhaps travel being among them.

To the second part of your question, obviously it would be pure speculation on our part, but we think that this is part of a growing list of reasons why Americans do want to get vaccinated. We are already seeing increasing numbers of people wanting to get vaccinated, given the highly effective vaccines and given the very good safety profiles. This list, which as Dr. Walensky pointed out, will continue to grow … We think are a growing set of reasons why people will want to get vaccinated. Having said that, I think it’s important to note that the CDC makes its decisions based upon what the science and the data tells them are the right decisions. Not for any other reasons. Next question.

Kevin: (31:50)
All right. I’m going to try Ed one more time. I think he figured it out.

Ed O’Keeffe: (31:55)
I did. Thank you, and let me follow up on the travel question there, because director Walensky, you explicitly said grandparents now could go visit their daughter’s house and see the grandkids. But in many cases, that’s going to result in grandparents probably getting on a train or a plane to go to a neighboring state or some other state to see them. If a governor calls you today and says, “Okay, you just said people can gather in homes and this is going to cause people to start traveling despite the urge not to,” what guidance would you give that governor regarding vaccinated people coming back to their state? Do they still have to quarantine for a certain amount of time, or at this point can they sort of disregard those travel restrictions if they’ve been vaccinated and have been fully vaccinated and waited those two weeks after their final shot?

Our travel guidance is unchanged, and so we would maintain whatever travel guidance is currently in place. We would like to give the opportunity for vaccinated grandparents to visit their children and grandchildren who are healthy and who are local, but our travel guidance currently has been unchanged.

Kevin, next question.

Kevin: (33:11)
All right, and final question. We’ll go to Alice Park at Time.

Alice Park: (33:22)
Hello. Can you hear me?

We can.

Alice Park: (33:25)
Great. This is a question for Dr. Fauci, and this has to do with the studies you mentioned last week on the third dose. Can you outline for us what the metrics are that you’re going to be looking at in those studies and what thresholds you will set for success or to determine whether a third dose might be necessary or not?

Dr. Fauci: (33:50)
Alice, there were two third dose scenario. One was one that Pfizer is pursuing where they’re talking about giving a third dose against the wild type virus to boost up the level of neutralizing antibodies. The parameter there will be taking a look at what the level of boost of antibody, because we do know from in vitro studies that when you get a high level of antibody against the wild type, it gives you a cushion of effect against the variant. The second third boost is one that we are doing in collaboration with Moderna where the boost will actually be a boost of a vaccine that is directed specifically against the variant. So there are two issues there. What we’re looking for in the second one is the level of antibody that we will have boosted against specifically the variant, as opposed to the level of antibody against wild type, which you will assume will give you some cross protection against the variant.

Thank you. Thank you all for joining. I hope people view this as a hopeful day in the next steps of the pandemic, and we are here in no small measure because of the safety and protection that many, many Americans have taken with regard to their family, friends, and neighbors. We ask people to continue to do that so we can get there as quickly and as permanently as possible. Thank you very much, and we’ll be here again on Wednesday.

White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript March 8: CDC Guidelines For Fully Vaccinated People

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