I sat down with Dr. Jeremy Faust, for a “give to me straight” talk on COVID.
So, we’re back for Round Two.
Bottom line: things are looking up.
But we’re not quite there, yet.
DR. JEREMY FAUST: Oh, I took so much heat.
ALINA CHO: You made it very clear that based on the data we have right now, you would not give [your 3-year-old daughter] the vaccine.
[Last month, Pfizer applied for emergency use authorization of its COVID vaccine for the under-five set based on data showing that a two-dose series was safe but not effective. The FDA asked for more data and Pfizer is now testing whether a three-dose series is effective and safe].
DR. JEREMY FAUST: I wrote that because I felt that we were not going to succeed with the plan of giving two doses to kids under five without knowing how effective that was and without knowing how effective the third dose would be.
ALINA CHO: Right.
DR. JEREMY FAUST: I also was very, very worried, and I continue to be a little worried that if the third dose doesn't work, which is what they're studying now, then it's back to square one. It’s one thing to have a trial of several thousand kids and say, "Well, sorry. It didn't work out." But if you vaccinate millions of kids and then find out that the three-dose series doesn't work, now you better hope that when you start over and shake the Etch A Sketch, that the higher dose that you're going to use is both effective and still safe given the previous doses. And I felt very strongly that it was a gamble not worth taking.
ALINA CHO: And you took a lot of heat.
DR. JEREMY FAUST: So, a lot of my colleagues felt that this notion of two [doses] while waiting for the results on the third was a completely great idea with no thought to the possibility that if it fails, we are not just at square one, we are at a negative.
ALINA CHO: Yeah.
DR. JEREMY FAUST: So, many of my own colleagues really came after me. And I just felt that it was really disheartening because I want this vaccine more than anybody because I got a kid who's literally the reason why I don't do stuff. Everyone else in my life is protected. And so, I'm waiting [for the data that shows the three-dose series is safe and effective] and I'm being a good soldier.
ALINA CHO: It’s incredible how polarizing this vaccine is.
DR. JEREMY FAUST: On both sides. Like, the anti-vaxxers were saying, "How dare you say that you would ever vaccinate your child," and the people on the other side were saying, "How dare you give anti-vaxxers…
ALINA CHO: Ammunition.”
DR. JEREMY FAUST: And you're going to hurt our vaccine advocacy.
ALINA CHO: So, let me ask you this. Let's say the trial shows that the three-dose series is not just safe but effective for the under-five set. And it gets FDA approval. What are you going to do with your daughter?
DR. JEREMY FAUST: I'll be first in line to get it. No question.
ALINA CHO: Let's talk about mask mandates because as you very well know, many states are rolling back their mask mandates.
And I wonder what your thoughts are on that.
DR. JEREMY FAUST: We're still in the emergency phase of this pandemic. There are still more deaths than usual for all causes, but COVID's driving that. That's called excess mortality. 20% of the country still has hospitals that are more than 80% full.
ALINA CHO: What?
DR. JEREMY FAUST: Yeah. I mean, we can handle it, but we're teetering.
ALINA CHO: Wow.
DR. JEREMY FAUST: So, we've gotten better, but we're still in this very tenuous place. So, the way I look at it is let's imagine that things will be great in April, May, or June. If that's true and if we are on mile 25 of the marathon, then I've got my last wind. I can do it. And therefore, I'm willing to keep masking. I personally think that given the state of emergency we are in, it's too soon to declare masking a thing of the past.
ALINA CHO: Right.
DR. JEREMY FAUST: [That said], I think the mask fatigue thing is real. And I don’t know the answer to this, but it's an important question. Does deescalating mask mandates at times like now, or maybe in the summer is even better, even if that causes a little bit more spread than there would be, is that worth it in exchange for the goodwill we need to ask people to put a mask back on should there be a terrible surge in the future?
ALINA CHO: Good point.
DR. JEREMY FAUST: Some people argue that it's a one-way ticket. Like, once they're used to not wearing masks, they'll never put it on again, so just extend it for as long as possible. And others like me and [CDC Director] Rochelle Walensky said publicly, “Look. We need to give people a break so that when it matters, they do it." And it kind of makes sense.
ALINA CHO: Yeah, it does.
DR. JEREMY FAUST: There’s no data to support that, but I'm very sympathetic.
ALINA CHO: Psychologically, it makes sense.
DR. JEREMY FAUST: So, I think that pulling back mask mandates when things are better might cause a slight increase in transmission but might be really worth it for later. I think that it's a decent idea to give people a break as soon as we possibly can.
ALINA CHO: I'm sure people like you hate this question but it's the question on everyone’s mind, which is, "Is the worst behind us?"
DR. JEREMY FAUST: I hope so. I hope so.
ALINA CHO: Me, too
DR. JEREMY FAUST: I've always insisted that we resist the urge to forecast when we're not even very good at nowcasting, which is knowing where we are right this second.
ALINA CHO: Right.
DR. JEREMY FAUST: But I hope the worst is behind us. We have many reasons to be optimistic. We have a vaccine that works. We have a booster that keeps people out of the hospital if given to the right groups. We have these antivirals that even if they work anywhere near as well as advertised, will make a big dent. We have rapid testing in our homes finally, which we didn't have for so long. We have wastewater to detect outbreaks before they happen.
ALINA CHO: Yeah. How crazy is that?
DR. JEREMY FAUST: Yeah. I know. We have so many tools. And now we know that small little behavioral changes like throwing on a mask when there's a surge or decreasing your indoor dining can keep our hospitals safe.
What I can tell you is that no matter what happens, we will do far better than we did last time, and the time before that, and the time before that.
ALINA CHO: For sure because of all the things you just said; we have more tools in the toolbox. Period.
DR. JEREMY FAUST: Yeah. And for me, what boils my blood is not the hand that we're dealt because we cannot really control that. But rather, are we performing at our highest potential?
ALINA CHO: Totally.
DR. JEREMY FAUST: Who can blame 1918 for not having antivirals and not having vaccines? But historians would look at us and say, "They had a vaccine, and they didn't get everyone vaccinated in a week?"
ALINA CHO: I know.
DR. JEREMY FAUST: That’s the part that's frustrating is that we have the tools, not to eliminate this, not to make it go away forever, and not to dodge every bullet, but we have the tools to succeed in ways that we have not yet succeeded. And I hope that whatever comes next, we demonstrate those abilities.