北美最帅医生专访美国“钟南山”福奇博士，解读当下如火如荼的美国疫情！（附视频&对话稿）
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美国当地时间3月29日，有着“北美最帅医生”的油管网红博主Mike专访了美国“钟南山”安东尼福奇博士。福奇博士从专业的角度分析了这一次美国面临的新冠疫情，也给出了一些防反病毒的切实建议！
- Hey guys, we're incredibly lucky today to have Dr. Anthony Fauci, who's the director of the Allergy and Infectious Disease branch of the NIH. You may have seen him on stage with Trump as he's part of the Coronavirus Task Force. He's gonna be answering some of our questions today. Let's get right to it!
- Dr. Mike, how are you?
- How's is going?
- Runnin' around like a maniac here, but other than that, I'm good!
- I can only imagine. I heard your wife was forcing you to get at least four or five hours of sleep. I'm proud of her for doing that.
- Yes, four hours is all I'm doing, but she's the one that's doin' it! She's the one that's doin' it.
- All right, fair enough. Well, first of all, let me say a huge thank you for joining us on the YouTube channel. Everyone in the YouTube community really appreciates what you're doing. My whole channel is about fact-checking, putting out accurate info, and you've essentially become the face for that. So huge thanks from all of us for that.
- My pleasure.
- Let's start by talking about social distancing. It's something that I've explained to my audience that's incredibly important, that's how we control the spread of this virus, the run on hospitals. There's been a lot of talk recently about curtailing that. I'm curious not so much about the date, because as you've said, the virus doesn't have a timeline. What is the yardstick that we're gonna be using to measure when it may be safe to curtail the social distancing? Is it number of those who are ill, fatalities, hospital preparedness, what say you?
- Well, it's a combination of things and it's gonna be different through different regions of the country. Because you can't look at it as unidimensional. I mean, New York is clearly different from Washington, and it's clearly different from Alabama. But in direct answer to your question, you look at two things.
You look at the kinetics of the outbreak when you're in the middle of an outbreak. So once it starts reaching that point of plateauing a bit and coming down, you don't wanna stop the social distancing, but you may be able to relieve the restrictions on movement in order to get basic supplies to people, so that they're not just locked down. If you have an area that has very few cases, what you wanna do is you wanna test a lot in that area to get a feel for what the penetrance of the virus is.
And when you get an individual case, you want to immediately identify it, isolate it, contact trace it, and get it out of society. If you do that efficiently, you may be able to open up that community, because you're doing good containment. You know, the two major pillars are containment, where you try to stop the spread, and the other is mitigation, when you say, "Oh my goodness, it's here. "What are we gonna do to prevent it from getting worse?"
- Do you think that there would be any conditions where you think politicians may act too soon and start saying, "Let's start opening up some of these restrictions"? What would happen in a red alert type scenario like that?
- Well, I think that would be unfortunate, and that's the thing that we advise against. If you do open up too soon, you could have the perverse effect that as it's going this way, then it starts going back up. And then you essentially compound the need for the kind of things, respirators, ventilators, hospital beds, ICU, things like that.
- You've talked a little bit about seasonality, the possibility that this virus may go away for the summer, may return in the fall, certainly not a definite. But if that were to happen, what preparations can we take as ordinary citizens for the fall, and myself, as someone who's on the front lines as a family medicine doctor, what can we do?
- Okay, first of all, if that happens, and to be honest with you, I think it's going to happen, I really don't see something as robustly transmitted as this disappearing the way SARS did. Particularly, if we start to see an increase in infections in the Southern Hemisphere, southern Africa, places like that, now, as they enter their winter.
Which means for sure, a cycle will come back. That means that as we go down in our cases, we've gonna use that time to prepare that it doesn't happen to us to the extent that it did the first time around.
That's why we've got to do the vaccine development that we're doing, we've gotta do clinical trials in drugs, randomized controlled trials that prove things work, as opposed to maybe they're gonna work. Those are the things that we need to do, as well as get the kind of testing capabilities so that you can do good containment, without waiting until it gets into mitigation. We may have a window, and it's not gonna be over. We're gonna breathe a sigh of relief when it starts to go down, but we need to gird ourselves that it may come back.
- You mentioned the clinical trials. There's hundreds of clinical trials going on right now testing all sorts of combinations, remdesivir, hydroxychloroquine, even plasma transfusions, are all on the table. I know that we don't have any randomized controlled results yet. Do you have a medication or a treatment that you think is a front-runner at this time?
- Well, you know, we have a remdesivir trial that we do have a randomized controlled trial. And I would hope that within the next couple of months or less, and I would say "or less," we're either gonna get an efficacy signal, then we could say, "Well, let's do it, "let's let it rip with that drug," or we're gonna get nothing! And then we'll say, "Get it off the table "and stop wasting time!"
- Sure.
- But I think that's gonna be reasonably soon. And also, the plasma transfusions, immune globulin, those kinds of things, monoclonal antibodies, they're all gonna be going into testing.
- Okay, what I meant about the randomized controlled studies, that we don't have the results to those studies yet, because that's why it's difficult to pick a front-runner.
- We don't have the results. The N is not big enough yet. When we get a big enough N, we'll know.
- Absolutely, we need them powered. Young people, they seem to be more affected, or at least that's what the media is telling us here in the United States. Is that true, and if so, why here more than in China?
- That's a good question. Everybody knows that the original China data made it look like young people virtually never got involved in a serious way. Then as we start getting into Italy, looking a little bit more like us, France, European countries and ourselves, we're starting to see individuals in their 30s and 40s.
Now if you look at them, still, many of them have underlying conditions, even though they're 30 or 40. They have diabetes, they have hypertension, they have things like that. But if you look closely, you will see that there are young people, who are otherwise well, who can get seriously ill.
So we need to forget this, that if you're young, you're good to go, you have no problem. There are two issues with younger people you need to consider. A, you need to avoid infection, just like everybody else, not only for your own health, but even if you get trivially involved, you can be a vector that would ultimately infect someone who does have a real risk of serious conditions. It's kind of like the young healthy 25-year-old gets infected, goes home, infects Grandma and Grandpa, or a 40-year-old uncle who has metastatic disease on chemotherapy, that's the problem!
- There's been some talk about the possibility of reinfection with COVID-19. Now do you think that this is more an issue with testing, that the test remains positive, or are they truly being infected for a second time with the virus?
- I don't know the answer to that 100% but I would be willing to bet on my experience, and I'll bet your experience, that any virus that you have, if you do well, recover, and clear the virus, if it acts like any other virus, you're gonna have lasting immunity. You're not gonna get reinfected, you're just not.
- The way that I've thought about it is, there's certain illnesses where you get lifelong immunity, chicken pox, measles with your two vaccinations, so maybe this won't be lifelong immunity, but to say there's none, where you can get reinfected in two weeks, something seems off.
- No, that's inconceivable to me that that's the case. I mean, you're gonna have some degree of durable immunity. You're right, it may not be 50 years, but it's certainly gonna be a matter of a few years, right.
- Sure. For myself as a healthcare provider, this is something my hospital system even asked me to ask you. When is it safe for us to return to work, once we've either tested positive for COVID-19, or you know, with the lack of testing kits, had a upper respiratory viral illness, where we don't know if it was COVID-19, when can we return? Is it when fever subsides, 24 hours after fever subsides, or do we do a full 14-day or 21-day quarantine?
- If you are a healthcare provider or someone who is in a critical infrastructure and you need to get back to work, to assume that you're infected, what you can do is that you can wear a mask, take your temperature daily, monitor yourself. If you get symptoms, get outta circulation! If not, assume you're infected, but do it in a way where you don't infect anybody else. Otherwise, every one of our health care providers are getting exposed every day.
- Of course.
- They can't assume they're infected, they've just gotta go to work, and that's one of the things we're gonna be recommending.
- Makes sense, that brings me to the topic of personal protective equipment, N95 masks. As recently as last week, my hospital was in need of these donations. I actually went on a journey to purchase $50,000 worth of masks, myself, from construction workers, and was able to donate them. Why do you think there's such a shortage? Obviously, there's huge demand, because we need to constantly be using these masks. New York Presbyterian Hospital system, they use 40,000 to 70,000 masks a day. But do you also think there's an issue of hoarding here, or some sort of customs issue of getting these masks shipped over?
- It's a combination of all of the above. So one of the things that we've really gotta get away from was, we gotta bake testing in a way that doesn't have the tester consume PPE! PPE should be for the people who are taking care of sick patients. And right now, we've gotta have a system where a person can self-stick the swab in, put it in the vial, give it to somebody, and nobody puts PPE on! So you don't waste it, that's the first thing. The second thing, we've gotta keep manufacturing it at a very, very high level! I mean, there was no anticipation that so many people would need this. So we've gotta get people who don't need it to not use it, and we gotta get a lot more for the people who need it.
- Speaking of those types of quick testing, for point-of-care testing, for those rapid tests, do you see that coming sooner rather than later? For us in the family practice setting, we have the influenza swabs, that in 15 minutes we have an answer. Is there something like that on the horizon?
- Yeah, I mean, I go to these Task Force meetings at the White House every day. I was at one last evening. That was a topic of conversation. How are we gonna scale these up and get these going? I can't give you a timeframe, but there's a lot of enthusiasm about getting the private sector to really scale that up.
- America and Italy seem to be disproportionately affected to other nations that are even closer to Wuhan, China, which seems to be the epicenter, or the original epicenter of this virus. Why do you think that this happened here in the U.S. and in Italy so much so than other nations?
- Well, I think because people travel here and travel to Europe and Italy a lot. I think we really saved ourselves a real bad bullet, if you wanna call that, by very quickly shutting down the influx of cases from China, and then something that was very controversial, you might remember, when we shut down influx from Europe, because Europe is the new China. There's some numbers that you may be aware of, that are really extraordinary. About 60% of all the infections now, if you talk about New York City, how we're getting influx from other countries, particularly China, that's how New York got hit so badly. New York, I mean, I'm a New Yorker, in case you haven't figured that out--
- Same!
- From my accent. But you know, about 56% of the new infections right now in our country are in New York City. New York City has more than half of the action. It's a big city, it's a robust city, people come and go. I think that's the reason why the United States is getting hit, because the kind of country we are.
- It makes sense, and you know, I live a few blocks away from Times Square, my windows actually look at Times Square, and I think there's also a statement, something to celebrate, the fact that there's so much solidarity. This past Saturday, nine p.m., there wasn't a soul in Times Square. The fact that we are coming together and doing the social distancing is not something talked about in media, and I think it should be highlighted. We are doing a good job, especially under these crazy circumstances. Would you agree?
- I totally agree, I was gonna say, "I am amazed," but that's the wrong word. I am impressed, yeah--
- Proud.
- I shouldn't be amazed, I shouldn't be amazed, because the American spirit is amazing. But in fact, what I see here in Washington, D.C. is the same thing. I mean, people are doing things in a calm way that I just think is wonderful.
- For sure.
- It really is, really is.
- Agreed, and my final question is, any guidance for us as physicians, and what role do you think it plays in filling out death certificates? I've filled these out before for my patients when I have done death pronouncements as a resident. If a patient has CHF, they come in with a congestive heart failure exacerbation but they also have a viral illness at the time, what should go on the death certificate as a clinical judgment, and what role do you think that plays in the numbers?
- I think it's gonna influence the numbers. I think you've gotta make it clear. If someone obviously goes into it with acute respiratory distress syndrome and dies on a ventilator, that's coronavirus disease! (laughs) You gotta make sure it gets onto the death certificate.
- Okay. Yeah, 'cause I've seen countries that have been having low numbers of COVID-19 mortality, but then their numbers of pneumonia cases spike, and it's, are you just changing what's on the death certificate there, and that's impacting those numbers?
- Right, right.
- All right, well, thank you so much, Dr. Fauci, very much appreciate your time and everything you've done for our nation. You're a voice of reason in a much-needed time.
- Thank you, it's very much of a pleasure to be with you. Keep up your good work!
- Thank you.
- In the trenches is important, keep it up!
- Dr. Fauci's amazing at fact-checking, especially presidents; he's served six of them. Now, I tried my hand at fact-checking politicians.
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