Thursday afternoon, NBA superstar Steph Curry sat down with NIAID director Dr. Anthony Fauci - on Instagram Live - to talk about COVID-19 and its affect on our society. The interview drew thousands of viewers - including former president Barack Obama. Their conversation included a lot of great information, so we decided to transcribe the entire interview.
You can read it in its entirety below:
Stephen Curry: I appreciate you coming on, I know you're a busy man in this time. There's a sense of urgency with everything that you're doing. I appreciate your commitment to protecting the masses and bringing all of your expertise and knowledge of how this virus spreads and informing the people on how we should take this seriously. I just want to thank you for your commitment to that because we all know how important it is for all of us to be in the know - to have the right information to be able to act accordingly. Thank you for your time and hopping on with me.
Dr. Anthony Fauci: My pleasure.
SC: Alright so what we did - I put up a request yesterday. I think everybody knew that I was going to be talking to you so I tried to compile as many questions as possible from all of my followers - anybody who wanted to ask you questions directly. We'll kind of just see how the conversation goes and we'd love your sound advice. I'll start with a pretty simple one, I think, but just in terms of...
How is COVID-19 different from the flu in terms of how it interacts with the body and just how it spreads?
AF: Well, it's similar in some respects, Steph, in that it's a respiratory illness that's transmitted by the respiratory route. It gives a degree of pathology that's mostly pneumonia. The reason it's different is that it's very, very, very much more transmissible than flu and more importantly, it's significantly more serious. Let me give you some very quick numbers. Overall mortality of seasonal flu that you and I confront every year is about 0.1%. The overall mortality of coronavirus is about 1%. Sometimes - like in China - it was up to 2-3%, which means it's at least 10 times more serious than the typical influenza. So when people kind of compare it - in some respects, it has some similarities. But it's really, really different in its degree of seriousness.
SC: I know we've been kind of hearing a lot of rumors around, or numbers around, from when it showed up in China and other different countries, the discrepancy amongst ages and how it affects (people) with underlying health conditions. Or if you're a little older that it affects you a little more seriously. Has that shown differently here in the states in terms of different age brackets and the severity - the cases of death vs. intensive care units and all that?
AF: Yeah. Mostly the same but with some interesting. maybe disturbing differences. You look at China, you look at Europe, you look at South Korea - it predominantly is reasonably benign, if you want to call it that. You get sick, but you don't get into serious trouble if you're young. Very heavily weighted towards the elderly and those with underlying conditions - heart disease, lung disease, diabetes, kidney disease. Those are the people who have a higher degree of mortality. We know that for sure. We're seeing that a lot now in the United States.
But what we are starting to see is that there are some people who are younger - people your age, young, healthy, vigorous, who don't have any underlying conditions who are getting seriously ill. It's still a very, very small minority, but it doesn't mean that young people like yourself should say 'I'm completely exempt from any risk of getting seriously ill.' And that's the reason why when we talk about being careful, of physical distancing, doing the kind of social separation, it means not only for the elderly, but the young people have to do it too for two reasons. One - you need to protect yourself, because you're not completely exempt from serious illness. Two - you could become the vector, or the carrier of infection, where you get infected, you feel well, and you inadvertently and innocently pass it on to your grandfather or your grandmother or your uncle who is on chemotherapy for cancer. That's what we have to be careful of.
SC: That's really one of the reasons that I wanted to have this Q&A and hopefully reach a different demographic or people who are interested in the facts of what's going on. Because you see all of the different visuals of people at the beach or in parks or in crazy public gatherings and not really adhering to that social distancing concept. The sense of urgency of what you just said of how that can continue the spread of the virus and infect people unknowingly - then in their own families, it might show up a little different or lead to some drastic and dire situation that they don't want to find themselves or anybody in their family in.
AF: You're absolutely correct. We really do have a responsibility to protect the vulnerable ones. The vulnerables are the elderly and those with underlying conditions. We've got to make sure that they are clearly protected from this, which could be very serious for them.
SC: We're going into week three since the NBA been shut down in terms of postponing the season. Obviously the Olympics just announced they're moving to next year to do their part in terms of keeping large gatherings from happening and just being smart and cautious. My question - what needs to happen with the numbers, or what metric are you looking at to be able to then determine that large gatherings, sporting events, those types of things are okay to revisit?
AF: That's a great question, Steph, and that's what we deal with on a daily basis. We sit down in the situation room in the White House every day to go over that. What you need to see is the trajectory of the curve start to come down. We've seen that in China - they went up and down. They're starting to get back to some normal life. They've got to be careful they don't reintroduce the virus into China. But they're on the other end of the curve. Korea is doing that, they're starting to come back down.
Europe, particularly Italy, is in a terrible situation. They're still going way up. The United States is a big country. We have so many different regions. New York City, right now, is having a terrible time and yet there are places in the country that are doing quite well. You can probably identify people, contact trace and get them out of circulation. Whereas in New York City, it's doing what's called mitigation, trying to prevent, as best you can, the spread. So the direct answer your question - we can start thinking about getting back to some degree of normality when the country, as a whole, has turned that corner and started coming down. Then you can pinpoint cases much more easily than getting overwhelmed by cases, which is what's going on in New York City.
SC: In terms of testing, the numbers are going through the roof and I know, I think I just checked - in terms of number of cases, we're approaching or maybe even close to surpassing Italy. Obviously we're a bigger country so you have to take that into account, but testing is becoming more accessible than it was three weeks ago. I know there are different efforts in different parts of the country that are trying to address that issue. I myself had flu-like symptoms about two days before the NBA shut down and I got a test pretty much right away and I know that there's a conversation now about the overall accessibility of tests and how those are starting to roll out in different parts of the country. What's your assessment of that process and how important is that process whether you have symptoms or whether you don't? When it comes to dealing with each individual case, how are we addressing the testing issue?
AF: Great question, that's been a real issue. Early on, several weeks ago, we were not in a place where we needed to be or wanted to be. We did not have as much accessibility of testing as we now have and that we will have going forward. Right now there are literally hundreds of thousands of tests that are out there now - mostly because we got the private sector involved. Companies who know how to make it and make it well make large amounts. So we're going very much in the right direction. The specific answer to your question - you did the right thing and if someone right now gets flu-like symptoms - fever, aches and bit of a cough - the first thing you do is stay at home. Don't go to an emergency room because then you might be infecting others. Get on the phone with a physician, a nurse or a healthcare provider, get instructions from them on what to do, and if available, you can get a test. But the critical issue is don't flood the emergency rooms. Stay at home. If you're really seriously ill then you've got to go quickly there, but if you just have aches, pains and a fever, stay where you are but contact your physician.
SC: This is one of the most popular questions I received yesterday - if you contract the virus, you quarantine yourself and you go through the recovery process and the symptoms either wane or sometimes you don't have symptoms, the virus kind of passes through, what does it mean to be recovered? And can you get the virus a second time? If yes or no, does that influence how testing goes in the future in terms of trying to detect an antibody? Or can you address that conversation around herd immunity and how to not let this be a cyclical thing? Or is it a cyclical thing in terms of what to expect in the future?
AF: Let me get to the first one. If you're infected, and you recover, the question is when can you go out and be safe to not infect others? The general rule is you have to have two cultures 24 hours apart that are negative. That's what the rule is now. As more people get infected, that likely is not going to be feasible. So we're going to have to set some guidelines up - days following the diminution of symptoms. We're not there yet because we don't know as much about how far out you can be shedding virus. Secondly, your main question. Once you get infected, can you get reinfected? We haven't done the specific testing to determine that. But if that acts like every virus similar to it that we know, the chances are overwhelming that if you get infected, recover from infection, that you are not going to get infected with the same virus. Which means that you can then safely go out into the community and feel immune. So that you could not only protect yourself, get back to work, get back to your job. But you'll be able to have what you referred to as herd immunity. Enough people who have recovered in the community - that gives the virus very little chance to spread rapidly. That's what's referred to as herd immunity.
SC: In terms of the timeline we're in now, I heard this rumor or belief that kind of like the flu, in warmer weather, or warmer months over the summer, that that diminishes the ability for the virus to spread as it's doing right now. Is there any truth to that?
AF: With other viruses like seasonal influenza, that we get confronted with every year, and other coronaviruses that are more benign - typical common cold - what you said is true. As the weather gets warmer, the viruses tend to do poorly in the warm, moist weather and do quite well in the cold, dry weather. That's one of the reasons why, in addition to the fact that in the warm weather you're more outside and not confined in a room, that these kind of respiratory viruses tend to go down as you get into the summer months. The only issue is, Steph, we don't know whether this is going to happen with this virus because this is the first time we've dealt with this virus. So it's not an unreasonable assumption to think that it's going to go down, but you don't want to count on it.
SC: Just thinking about it from a general population standpoint - how important that social distancing effort is. Obviously there are people in tough situations having to make tough decisions trying to earn their income whether they're in the essential services category in their industry and they need to go to work. What is the serious risk of lifting those social distancing or shelter-in-place or stay-at-home initiatives too early and that balance of where we're at with shutting down the entire economy?
AF: Well, it's not an all or none process. I mean, locking down, the way Governor Newsom did in California or the way Governor Cuomo did in New York City - that's the extreme. That's the heavy hammer on something. Even if you lessen those restrictions, everybody, until this is over, should practice some degree of physical distancing and care. No big crowds, wash your hands a lot. Be careful. You can do that and still get back to somewhat of a normal life. There's big difference between the extreme of locking a city down and opening up a bit but being more careful than you normally would be. And I think there are places in the country now that you want to look at carefully and say 'you know, maybe you want to pull back a little bit on the restriction' so long as you don't let it rip and say 'I don't care what happens.' So you treat New York City a little bit different than you treat Nebraska.
SC: That's kind of in the spirit of what America is. We're not overreacting right? I've heard that term from people feeling threatened by the change and the reality. But there's no overreaction to this and this is a serious issue?
AF: You're absolutely right. We need to make that point. This is serious business. We're not overreacting.
SC: Going back to testing. On access to testing, currently, just why is it so challenging to get a test if you do have the symptoms? What are the things inhibiting the tests being accessible to the masses?
AF: Well, there should be nothing now that's inhibiting it. But originally, the system, the way it was set up, Steph, was not geared to this kind of massive capability of instantaneously and safely getting a test - getting it done in a really good period of time. Not days and days, but hours. Right now, the system has changed - predominantly because it's been handed over to the commercial firms who know how to do it. It started off as a public health measure from the CDC. It now needs to be and is being handed over to the commercial group.
SC: The test is to understand if you have the virus or not and that being ruled out. Is there another process or test that is being developed to test the development of antibodies? So we know if you've gone through the process or not and you've built up that immunity so you can understand the numbers of how many people have gone through that to get back to normal life quicker?
AF: That's exactly what we are doing and what you need to do. There are two types of tests. You're describing them as well as anybody. One - to determine if you are actually now infected. That's the test that people need to get screened. Another test determines if at some time you were infected. It's an antibody test. It's much quicker, it's much easier, it's much cheaper. Those are the kinds of tests where you can determine out there how many people actually did get infected and recovered. It's a very important piece of information that we need to get.
SC: I know there's a timeline for developing a vaccine. Trials have started in different areas. I heard it's a 12 to 18-month timeline to be able to roll that out in any kind of form. What does that process look like and what is the likelihood that we get to a success in a vaccine in that time? And how does that affect the cyclical nature, possibly, of the coronavirus?
AF: We have started on the development of a vaccine faster than ever in the history of any virus. From the time it was discovered until the time we actually made it and put it into a trial. But when you test a vaccine, it's multiple phases. The first thing you have to do is make sure it's safe. We started that a couple of weeks ago. When you find out it's safe and that it induces the kind of response you want it to, then you do it in a lot of people. The first phase you have to be careful, it's like 45 people. Then you go into hundreds if not thousands in what's called a Phase 2/3 trial to determine if it works. That's the thing that's going to take an additional eight months or so. So when you add up three or four months for the Phase 1 plus the seven or eight months, you get about a year to a year-and-a-half. If we really push, we hope that we will know by the time we get into next winter whether or not we have something that works. A vaccine is going to be totally relevant for if it cycles into another season, which, Steph, quite frankly, I think it's going to do. This virus is very, very transmissible and we're seeing it throughout the world. I cannot imagine it's just going to disappear. So vaccines are going to be important for the next time around, but not for what we're dealing with now.
SC: So on that front, right now we're dealing with the first wave. There's a potential, in terms of what you just said, that there could be multiple periods of - whether it's New York or it's California - or more responsibility of social distancing or sheltering in place down the road, next flu season, etc. - could that be a possibility?
AF: It's a possibility, but I think and I hope, and it's not just hope because I think if we do it right, it will happen this way, that we will get enough experience so that when it does come back, we will immediately be able to identify, isolate and contact trace. If you do that effectively, you don't have an outbreak. You contain it at a very low level. Which would mean we won't have to lock down again. We could great individual ones and prevent the outbreak. Prevent what we're seeing in New York City. Prevent what we're starting to see in New Orleans. Those are the kinds of things if we go around that cycle, I think we can avoid that. It will be much different than what we're doing right now.
SC: In terms of masks, there's a conversation around the N95 respirator mask and your standard surgical mask. Whether you're sick or healthy, whether you should wear one. Whether you're going out in public. Can you speak on the effectiveness of masks to address the problem and how the access to those N95 masks around the country is going - are we in short supply? Do we need more? How is that process going?
AF: We certainly need more. We have much more supply now than we had just literally a week or two ago. You have to prioritize who needs the mask and who should wear it. First and foremost, healthcare providers - doctors, nurses and health providers - who are taking care of a person with coronavirus disease. Protect them from getting infected. Because what's happened in Italy and what happened in China is you can knock out your healthcare force. And then you're really in trouble. So protect that person. The other one is - if you are infected, to put a mask on to prevent you from spreading it to someone else. The third priority is the general population, who if they wear a mask, they may assume that it's 100% protective. It's just not. It's probably, you can guess a number, maybe 50%. So when we say that you don't need to wear a mask, what we're really saying is make sure you prioritize it first to the people who need the masks. In a perfect world, if you had all the masks you wanted, then someone walking the street with a mask doesn't bother me, you can get something for your protection. But make sure you prioritize it well.
SC: Thinking about all of the ways to address that issue - the federal government down to your state governments. I heard that a lot of state governments are having to go buy them on their own and supply them to wear they're needed. Are we going about that the right way in terms of that process and getting that access?
AF: There's a stockpile of tens and tens of millions of masks. But you know, we live in a country where we can do things pretty efficiently. Once you get the private sector involved, they can whip out millions and millions of masks. So, literally at the last meeting we had, we said 'okay, enough is enough, let's get them and flood it, let's get those companies to make them.' And they're willing to do it. You know, it's very interesting that you'd think the federal government would almost have to force them to do it. We're not seeing that. We're seeing them stepping forward and wanting to do it themselves.
SC: From your vantage point, you've been front and center from the start spreading accurate and truthful information. I know things change on the daily and you're following that trend, but what's the biggest piece of misinformation that you know of that's been out for public consumption and what would you say to correct whatever issue that is?
AF: You brought it up in one of the questions that you asked me. This dichotomy between people who are being frightened to death of it versus people who don't even believe it and that it's something trivial that you don't have to worry about. I'd like to get the people in the country to realize that we are dealing with a serious problem. It's something that we've modified our lives for - it's not convenient to lock yourself in. It's not convenient to not do these kinds of things. It's not convenient for you to not be playing basketball. But we're going through a period of time now where we've got to, as a country, pull together, don't get frightened, don't get intimidated, use the energy to be able to confront it and do the kinds of things that will put an end to it. So I want to get rid of that misconception that there are extremes - either the world is going to end or we don't want to do anything. It isn't that. It's somewhere in the middle.
SC: I think that's what we all needed to hear. It's the reason I wanted to do this and be able to have this face time with you just because when anybody's life has been interrupted whether you've been affected personally by COVID or not, that level of comfort that what we're doing is in the right spirit of trying to stop the spread as fast as possible and return people to their normal lives (is important). Taking this seriously and understanding that there is a strategy to doing that and that we all have to adhere to it. In that respect, where would you send your everyday person to find that information?
AF: There are a couple of websites. There's one called coronavirus.gov. It's part of the CDC website. You can either go into cdc.gov and get into it or go right to coronavirus.gov. All the information you want it right there.
Here's video of their chat, if you have time to take a listen:
Our thoughts are with anyone currently affected by the coronavirus pandemic.