Dr. Fauci COVID-19 Update with US Chamber of Commerce Transcript July 17

Anne Gill: (00:22) Good morning, Dr. Fauci. My name is Anne Gill and I'm the president and CEO of the Tempe Chamber of Commerce in Tempe, Arizona. And my question for you today is did things open up too early or was it the way that we reopened that resulted in the current spike in cases? Dr. Fauci: (00:42) That's a very good question and it is a mixed bag. I'm not going to name any individual states, but if you look at the criteria for the stepwise fashion of so-called reopening, we put out guidelines from the coronavirus taskforce that had what's called a gateway, which is criteria of the lessening of number of cases over a certain number of days. If you pass that gateway, you would then go to phase one. And if you were there at a certain amount of time and the cases was steady and going down, you could go to phase two and phase three. So when you look at that, clearly there are some states that actually skipped over one or more of those, what you call, benchmarks or checkpoints. That could have been one of the issues that led to the surge. Dr. Fauci: (01:34) There are other situations where the states and the cities essentially efficiently did it perfectly correctly, but the citizenry, the people themselves did not abide by what those recommendations were from the state and the city. And that's what we have seen so dramatically with film clips that we've seen on TV of people congregating in crowds at bars, without masks, or in crowded places without masks. Be it beaches, boardwalks, or whatever. And that in fact almost certainly has led at least in part as a partial explanation to the kind of resurgences that we've seen. So it's a mixed bag. It's doing a bit too quickly on the part of some and they are trying to do it correctly, but people did not cooperate on the part of other locations. Suzanne Clark: (02:32) We've talked a lot [inaudible 00:02:34] country about testing and how testing is under control. Why do you think it's hard for the United States to get effective testing in place? Dr. Fauci: (02:46) Well, obviously, we got off to a slow start with regard to testing for a number of reasons that have been very much dissected considerably. So we need not go back and then now, but things right now regard to testing clearly are much better than they were before. And if you look at the number of tests that have been done, as well as the projection over the next month or two of the number of tests that we can be able to do, I believe you're going to start to see, and hopefully will see, a change for the better in both the availability of the test, when you get the results back a more quickly than in some cases we got them back. All of those things can certainly use a degree of improvement, but they are much better now than they were in the past. Suzanne Clark: (03:33) The US chamber as you know represents businesses of every size, every sector, every community across the country. And one of the things we hear a lot from business leaders and community leaders is which data should we be watching? How do we know what is actionable for us? Where do we look for information? What would you advise those business leaders? Dr. Fauci: (03:56) Well, the CDC forever has been the lead agency in both surveillance and response outbreaks. And you can get on a daily basis and even some real time information not only about the extent and the location and the dynamics of the outbreak on the country as a whole, but you can also get it city by city and state by state. So I would point you to the CDC website to get the kind of information that I think would be very valuable to you. There are other websites, independent non-government websites, that have very similar information. The Johns Hopkins website has one. There are other websites, but I would recommend that for the purposes that you're asking that you stick with the CDC. Suzanne Clark: (04:52) So this idea of advising people in their communities leads right into the next audience question, which comes from California and a gentleman named Kirk Rosberg. Kirk Rosberg: (05:03) Hi there. My name is Kirk Rosberg with Torrance Bakery in Torrance, California. And my question is what is the best advice that I can give to my staff who are fearful? Dr. Fauci: (05:16) What you need to do... That's a very good question. A very commonly asked question, Kirk. So you're in California. California is responding now. I know I've been in contact multiple times with your governor and with also mayors in California. The thing you do is to take a look at the state in which your particular location is. Are you at gateway? Are you at phase one? Are you at phase two? And to follow the guidelines that are very clearly delineated and all you need to go is to coronavirus.gov. And you will see what are called the criteria for opening or the guidelines for opening America. Having looked at them, the minimal thing that you should do is the kinds of things that we've been talking about constantly. Wearing a mask, maintaining six feet of distance, avoiding crowds, washing your hands where possible as much as you can, either with soap and water or with the kinds of substances that are around in Purell or whatever, the one that happens to be available to you, those are the fundamental things that you need to do because the virus will not be able to do anything if you keep physical distance. If you're in the bakery and you're open and therefore you have to be physically closer, wearing a mask is something everyone should do, both you, and you should ask it of your customers to also do that. Suzanne Clark: (06:48) So if France just mandated masks in all public indoor places, is that something that we're going to need local and state governments to do? Dr. Fauci: (07:02) I think it's going to be, as we all know, our society from the beginning of the founding fathers is a Federalist society in which the states have certain prerogatives and powers and responsibilities. I can say as a public health official, that I would urge the leaders, the local political and other leaders in states and cities and towns to be as forceful as possible in getting your citizenry to wear masks. Masks are important as part of the physical distancing. Physical distancing is the most important, but practically when you're living your life and trying to open up the country, you are going to come into contact with people. And for that reason, we know that masks are really important and we should be using them, everyone. Suzanne Clark: (07:57) That leads directly into a question we got from this member of Michigan. Michelle Rahl: (08:04) Good morning. My name is Michelle Rahl and I am with the Lansing Regional Chamber of Commerce in Lansing, Michigan. Thank you, Dr. Fauci, for joining us. And my question is around masks and businesses. And today, businesses are in the unfortunate position of being the mask police. They are anxious for the revenue, but are desperate to stay healthy and open. And they often have to confront patrons who are not wearing a mask. This has led to uncomfortable and even dangerous encounters. What advice would you have for the business owners and the staff members to manage or address this situation and what would be your message to the community at large to drive home the critical importance of wearing a mask? Dr. Fauci: (08:49) Well, thank you, Michelle. The answer to the second part of your question really [inaudible 00:08:56] is probably the answer to the first part. I am totally aware because I've spoken to so many people who are in the same situation as the commercial people in Lansing, and that is it gets difficult when people don't want to cooperate and you don't want to have a hostile environment in your business for obvious reasons. But on the other hand, you want to maintain the highest levels of safety. Dr. Fauci: (09:23) So what I have been trying to do in my discussions, and I'll mention it briefly now because I do it at every opportunity that I can to get people to appreciate that you have both an individual responsibility to protect yourself. Because if you get infected, even if you're a young person and have a higher chance of not having a serious outcome, by getting infected, even if you never get symptoms, that you are part of the propagation of the pandemic. Dr. Fauci: (09:56) So even though deep down, you want to open up the country and you want to get back to normal, by getting infected, you are propagating the process of the pandemic and you are slowing down the process of opening up. Because even though you think it only involves you in a vacuum, it doesn't, because if you get infected, the chances are you're going to infect someone else. And the chance is that person is going to infect someone else. And then sooner or later, probably sooner, you're going to infect someone who is a vulnerable person who could get seriously ill. That could be someone's grandfather, grandmother, father, mother, the child on chemotherapy for leukemia, a woman getting radiation or chemotherapy for breast cancer, all of the kinds of people that are at a higher risk of a serious outcome. Dr. Fauci: (10:48) So we need to try to engender all of us a feeling of both personal and societal responsibility. So it isn't just, I don't want to wear a mask when I go into your place to buy a loaf of bread or whatever it is that you're going to buy, because I don't want anybody telling me what to do. I understand that we have a spirit of independence in our country that was there from the very birth of our country, but this is really different. This is everybody pulling together in a very serious situation. If we could get more people to understand that, hopefully we'll get more people who'd be willing to wear masks. Suzanne Clark: (11:32) Speaking of being a good public citizen and personal and civic responsibility, a number of chamber leaders and business leaders play other roles in their communities. They tend to be thought leaders and volunteers, and a number of them are being called on, a number of the people in this audience are being called on by their local school boards and their local government officials to help grapple with how, when to open schools. And so speaking specifically to thought leaders in communities across the country, how should they- Suzanne Clark: (12:03) ... Thought leaders in communities across the country, how should they be participating in those conversation and what factors should they be considering on the ground? Dr. Fauci: (12:09) Yeah. A very important point that you bring up, because this is obviously being discussed intensively as we get into the summer and prepare for the end of the summer and the early fall, particularly when children in lower intermediate and high school will be going back to school, but particularly children. Children who are going into lower or elementary schools as we used to call it. So my advice is that we need to first take a look, go to 40,000 feet and look at the big picture. If you look at things that come out from the American Academy of Pediatrics, if you look at the well known downstream unintended consequences that are ripple effects of keeping children out of school, namely the impact on the kids themselves, the impact logistically on the parents, because of the fact that it impacts their ability to go to work. That the default position should always be, we need to do as best as we possibly can within the framework of safety, but the best we possibly can to have our default position, to get the children back to school. Dr. Fauci: (13:28) Having said that, living in a big country that is geographically and demographically diverse that we are not uni-dimensional. There'll be parts of the country where the level of virus activity is so low that you don't have to modify anything at all. Just send the children back to school, but clearly, if you just look at what's going on right now. There are parts of the country that have a significant degree of viral activity that make you want to pause and say, "Okay, wait a minute. If we are going to bring the children back to school, we've got to make sure that paramount is safety for the children and safety for the teachers." Dr. Fauci: (14:08) So we may want to modify logistically or otherwise what we do. Separate the desks by a certain amount, wearing masks for children within an age group, in which masks are at least feasible. Perhaps rotating the kinds of schedule, morning, afternoon every other day, or what have you. Always thinking, we're going to do whatever we can to get the schools open and the children back to school, but always remember that safety and the health of the children and the teachers comes first. And I think if we keep that in mind, we'll go a long way to getting the schools open safely. Suzanne Clark: (14:51) It was a summer of intern and there's always a summer intern, we're all trying to help our interns have different experiences this year, given how complicated the virus has made it. And we have an intern who asks the question, are schools ever going to go back to normal, to the way that they were? Dr. Fauci: (15:08) The answer to that is yes. I mean, we're going to get over this. It seems, we've been going through this very difficult period for the last five and a half, six months. And sometimes you get so exasperated and run down by it, that you think it's never going to end. It will end. It will end through public health measures and science, I can tell you will come to our rescue. Hopefully sooner, rather than later, we're going as fast as we possibly can with the development of therapeutics and the development of a vaccine, which as you know we've been speaking about a while. We got some pretty favorable results in early studies of vaccines. One of the candidates will be going into an advanced phase three trial by the end of this month, by the end of July. Dr. Fauci: (16:03) And other candidates will be entering advanced clinical trials as we get into the mid summer, late summer and early fall. So we feel cautiously optimistic that we are on the road, as bleak as it may sound right now. That we are on the road of getting this on the control. So you can tell your intern, yes. We will get back to normal with schools and we will ultimately get back to normal with every other aspect of our lives. Suzanne Clark: (16:33) That's a wonderful thing. I think for us all to center on and to make us all more serious about masks and social distancing and washing our hands, because there is a normal on the other side. And probably the sooner we can interact appropriately, the better. That's an optimistic note. Let me ask you a question on another optimistic note, which is we hear a lot about how the virus has impacted business, but it's also true that business has impacted the virus. And so you just talked about vaccines. We know there are therapeutics and there are other things, but can you talk a little bit about the role of the private sector in fighting this pandemic? Dr. Fauci: (17:11) The role of the private sector is paramount. The federal government, academia is part of the private sector. Pharmaceutical companies are part of the private sector. So every single candidate, therapeutic, diagnostic, and certainly vaccine that we're dealing with right now and trying to develop, has a major input from the private sector. So there's no way government alone, be it a federal government or state and local government is going to fix this. It's a marriage and a collaboration between government authorities and the private sector. It has always been that way. It is that way now, and I believe it always will be that way. So the answer to your question is absolutely the private sector plays a major role. Suzanne Clark: (18:06) You mentioned, and the chamber is obviously a firm believer in that, in the role of the private sector and how important it is, but also how these public private partnerships across a lot of society's challenges are so important to success for all of us. Speaking of other partnerships, we have another question from the audience, from yet another sector. You mentioned academia. We have a question here from Enid Roemer, who I think is at John Hopkins. Enid Roemer: (18:33) Hi, good morning Dr. Fauci. My name is Enid Chung Roemer. I'm the deputy director of the Institute for Health and Productivity Studies from John Hopkins. My question is how can the business community best help achieve public health priorities in improving the public health infrastructure needs to manage the current crisis? Dr. Fauci: (18:55) Well, you make a good point. I'm expecting that coming from Hopkins, that you would do that. And that is, I'll put in a plug here for something that I want everybody to appreciate. Is that one of the most important aspects of responding to an outbreak of both the healthcare infrastructure locally and the public health infrastructure locally. It becomes very, very difficult to adequately respond, including things like identification, isolation, contact tracing, if you do not have an adequate local public health infrastructure, manpower, and capability. And unfortunately, in some respects historically, we have been the victims of our own success because we've done so well in containing, controlling, and even eliminating some of the big killers and mamers and diseases that cause a great degree of morbidity over the decades and decades that we have maybe declared our success too prematurely and let the local public health capability kind of dwindle a bit. Dr. Fauci: (20:13) So that's something we need to build up now, but we need to remember in the future that if we want to respond adequately to an outbreak, we really need to make sure that our local public health apparatus is very much intact and very vital and very ready to respond. Suzanne Clark: (20:36) Okay, that makes me want to ask you 12 questions. I'll try to limit it to one at a time here. You mentioned the importance of the local infrastructure and the domestic infrastructure, but as we're seeing these global pandemics. Of course, there's an international infrastructure and there's been a lot of conversation about the World Health Organization and why it's important that the United States have a connection with these global health organizations. Can you explain that? Dr. Fauci: (21:03) Well, I think if you look at the meaning, the Latin derived meaning of pandemic, it's pan meaning all. So when you're dealing with an infectious disease, this is a global issue by definition. There are very, very few, Ebola, maybe one of them, where you have an infectious disease that just by the nature of the disease itself is combined geographically. But when you get a respiratory illness, which most pandemics are. Influenza, COVID, respiratory illnesses, then by definition, you're global. Particularly in the 20th century, 21st century, where we are, where we in fact wind up being able to travel from one part of the globe around the world, 180 degrees around in 18 hours. Dr. Fauci: (21:58) So you have to look at the global connectivity. And that's the reason why organizations that are global in nature, as well as the public health security networks that we have put up are so important, because we are all connected and we need to be connected and be transparent. We need to be connected to exchange information, and we need to be connected in our response because, if you have something like a COVID-19 outbreak, if it's smoldering in another part of the world, we're vulnerable here. I mean, we saw that absolutely when it emerged in a well defined geographic area in China. And then all of a sudden, the entire world with more than 220 countries have been involved. So that's the answer to your question. It is global by nature. So we need global organizations and global cooperation. Suzanne Clark: (23:02) The other thing your earlier answer made me think about is, you mentioned the successes we've had in combating other diseases. And it made me think about how important immunity is to that at some point. And so these questions about COVID-19, and I know that we don't know the answers, but what do you think the odds are that people could get reinfected, that you could get this virus over and over again? And how does that change how we treat this particular disease? Dr. Fauci: (23:31) Well, first of all, we don't know the answer to that question. You're absolutely right. We can make some extrapolations based on a long backlog of knowledge of other viruses. That if you get infected and you recover, which almost by definition means you've made an adequate immune response against the virus and recovered from the virus and that virus does not substantially change. So it's the same. Dr. Fauci: (24:03) [inaudible 00:24:00] does not substantially change, so it's the same virus. That the chances are that at least for a finite period of time, and we don't know now today what the definition for finite means. Is it three months, six months, a year? We don't know that yet. We're learning that, but we don't know that yet. You can assume that you're going to be protected for some period of time after you recover. The question that we need to know for the purpose, for example, of vaccinations is how long does that protection last? Because it will guide us to get the optimal vaccination. Dr. Fauci: (24:39) I mean you vaccinate someone, you hope you get a response that protects them for X amount of months or years you hope. Likely we'll be able to do that. If the immunity wanes the way immunity does wane with some infections and with some vaccinations, the response is, you do something like give a booster shot, which is something that is not that difficult to do. So you need to be aware of the potential finite nature of protection, but there are also multiple ways that you can overcome that and respond to it. Suzanne Clark: (25:19) Yeah. I mean we're all used to getting boosters. Right? I mean that's something that happens as we vaccinate our children and ourselves. You just learn how often you need them. That becomes part of how you take care of yourself. We have another question coming in from Hope Cupit in Virginia. Hope Cupit: (25:35) Good morning, Dr. Fauci. My name is Hope Cubit, President and CEO of Southeast RCAP. My question for you today is, why is COVID-19 impacting Black and brown people disproportionately, and what does this demographic need to know to better protect themselves? Thank you. Dr. Fauci: (25:56) Thank you, Hope, for that extraordinarily relevant question, because this is a real problem that we're facing. So if you look at the data, what you said is absolutely correct. If you look at minority populations, particularly African-Americans, Latinx to some extent too, Native Americans, that there are two things that go on with them that make them bear a disproportionately more serious burden of COVID-19. That is, even though you don't like to generalize, but in this case generalization makes you understand it better, that in general, the kinds of jobs and the kind of economic strata in which minority populations, particularly African Americans, find themselves in, put them in a more vulnerable position to get infected. Dr. Fauci: (26:46) It's less likely, by the jobs that many of them have, that they're able to protect themselves by being at home, doing work through telework, looking at a computer and being safe in your own home. Generally, they are disproportionately more out there, exposed, in situations where they may not be able to prevent themselves from getting infected. So their risk of getting infected is likely more, not major studies, but they get infected more so therefore you could make a reasonable assumption that the risk they have of getting infected is more. Then, the important issue that's more problematic because it's going to take a much longer time to address and fix, and that is the social determinants of disease. Dr. Fauci: (27:35) The things that go into making someone have a higher incidence of diabetes, of hypertension, of obesity, of asthma, of any of a variety of illnesses, which we know if you do get infected, and you have one of those underlying conditions, that the chances of your getting a serious deleterious negative outcome of getting infected is much greater than if you didn't have those underlying conditions. So when you look at the African American and the minority population in general, they have a significantly higher incidence of those underlying conditions that lead to a poor outcome. Dr. Fauci: (28:20) So when you put those things together, greater incidence of getting infected, greater prevalence and incidence of co-morbidities, which make your outcome worse, it's entirely easy to understand the data that you just mentioned, that the minority communities are at much greater risk of getting into trouble with COVID-19. You can address some of them immediately by putting resources for better and easier testing, identification, isolation, contact tracing, in areas where there's demographic overrepresentation of this minority so they have easy accessibility to these things to get them diagnosed and into care quickly. Dr. Fauci: (29:07) We can do that now. What's going to take longer to fix is the decades, and decades, and decades old social determinants of health, which we must address because they can be overcome, and over a period of time we can diminish that disparity of these underlying conditions in the minority population. Suzanne Clark: (29:33) It's such an important point. You know, one of the pieces of work we do at the Chamber is doing everything we can to support job creators. We just held a national town hall about what we can do to impact the equality of opportunity because we know that employment leads to better health outcomes. So we know that whatever we can do to help people who've been traditionally left out of those circumstances, enter and have more opportunity also over the long run helps their health outcome. [inaudible 00:30:02] issue very near and dear to our heart. You earlier this week talking about you and saying what will be important is concentrating health resources, access to testing, et cetera, in minority communities in order to really fight this trend. Have you seen any place that's doing that well that might serve as a model for the rest of us? Dr. Fauci: (30:21) Yeah. We're trying to do that right now. I mean if you look at the total response involving FEMA, involving the CDC, the ones that are out there in the field. I mean I at NIH, we do research to develop therapeutics and vaccines, so we're not specifically out there in the community at that level. But organizations like FEMA, and particularly the CDC who actually has done that historically for what they do, is to go out into the community and interact with the state and local health authorities to do just what we're saying right now. Suzanne Clark: (30:59) You know, I think it's so important and anything that we can do in partnership with you to highlight the best practices, anything that you're seeing that we can get out to the state and local Chambers as they're advising their governors, their mayors, and their communities, we want to help be part of the transmission of those best practices. We have another question. This one from Washington, D.C. If you can roll that question please. Radhika Chinoy: (31:25) Good morning. My name is Radhika Chinoy, and I'm with Southwest Airlines in Washington, D.C. I reside in Alexandria, Virginia. Dr. Fauci, I'm a working mom, mother of two young boys, and the last few months my husband and I have had many sleepless nights because of this virus, and what we can do in our communities, and in our controllable behaviors. But I was curious to know, Dr. Fauci, what keeps you up at night knowing that there's still so much that we don't know about this vicious virus? Dr. Fauci: (32:01) Thank you for that question. Things like this happening have kept me up at night before it happened, and I'll get to what keeps me up at night right now. But I have always said, the thing that I've always been very concerned with is the emergence of a new virus that we've never been exposed to before that has a couple of characteristics. One of which is that it's easily transmissible from person to person, and two, that it actually has a significant degree of morbidity and mortality. Because we've had examples of outbreaks that are new infections, but they have one but not the other of those characteristics, and the reason I've lost sleep about that was the concern of what happens if those two come together. Dr. Fauci: (32:55) We had the famous bird flu in 2005, which jumped from a chicken to a human. High degree of morbidity and mortality like 37, 40% mortality, but it didn't transmit from human to human very well. It was kind of like a dead end in one human. So if you were unlucky to get infected, too bad because you have a high degree of mortality, but it's unlikely you're going to infect anybody else. Then came the 2009 H1N1 swine flu, the first pandemic of the 21st century, and what we saw with that was a virus that jumped species from a swine to a human, very, very capable of spreading from human to human, but its pathogenesis was very minor. It didn't kill very many people at all. Dr. Fauci: (33:47) Then along comes COVID-19 and the SARS-CoV-2 which is the perfect storm. It has both characteristics. It's spectacularly capable of transmitting from human to human, and it has a significant degree in some people of morbidity and mortality. So that's what up to now. What bothers me the most now is the absolute need to get control of what's going on right now globally. The United States of America has been hit very severely by this. You just need to look at the numbers and see the number of infections in the millions and the number of deaths, 140,000 deaths or around that number right now, keeps going up. You know, each day we're still seeing increasing hospitalizations. Dr. Fauci: (34:38) We need to get better control over things, and we need to open up the country because staying shut down has economic, employment, health, and other negative consequences that are significant. So we've got to have a delicate balance of carefully and prudently going towards normality and opening up at the same time that we contain and not allow these surgings that we're seeing in certain Southern states. That's a big challenge. That's the thing that I get concerned about most. How well we're doing about that, can we do better, and can we turn this around? I believe we can. This will end, but I want to do it sooner rather than later. That's what continually causes me what I would call a relative lack of sleep. Suzanne Clark: (35:33) Well, amen to a quick end. You know, I was mentioning to you in the green room that I remember having dinner with you back about the bird flu all those years ago, and remember you specifically saying that this type of outbreak was your worst nightmare. I guess what worries me, not having any of your experience, is that these things that used to be once-in-a-hundred-year pandemics seem to be coming more quickly together. I mean we're optimistic that we get to the end of COVID-19, but are these pandemics going to become more- Suzanne Clark: (36:03) ... COVID-19, but are these pandemics going to become more frequent occurrences? Dr. Fauci: (36:06) I think that A), they likely are for an even number of reasons because we continually encroach a bit sometimes inappropriately on the human-animal interface. And if you look at how many of these outbreaks, first of all, if you look at the numbers about 70% of all the new infections, namely infections that we've never experienced before, they are what is called zoonotic, mainly they're fundamentally an animal reservoir and for one reason or other they've jumped species. HIV AIDS did that. Ebola did that. Influenza does that. And coronavirus, SARS coronavirus number two has done that. So it clearly happens. Dr. Fauci: (36:55) What we tend to do is that as we've seen in China with the wet markets where you bring animals in from the wild who have these viruses that can be adaptable to human and you have such a close human-animal interface with no regulation, that that can do it. It's also when you encroach upon things like the rain forest, when you go out and build and do building up of civilizing certain parts of the country, and you come into contact with species of animals that harbor viruses that can in fact efficiently spread from human. That's the reason why we continue to see new infections. It's at least 70% being zoonotic. Suzanne Clark: (37:43) Okay. Lots of questions there, but we know the country wants you to get back to fighting this disease. I'm going to ask you two quick final questions. One is to look into the camera and give people as individuals advice. We're getting questions in the chat about should I get tested even if I've been tested before? Should I go see my doctor? It's time for my annual mammogram? Should I go? Should I go to the dentist? I know that you're a personal physician, but what are you advising the individuals watching this about COVID-19 testing and about their regular doctor visits? Dr. Fauci: (38:18) Well, there really is no reason just to get tested because you want to get tested. I mean, if there is a reason like you've been exposed, contact tracing, or what have you, one of the reasons if you want to get tested, even though there's no risk, that you're, is that to accumulate data as to what the penetrance is. So you could be part of the process where we're doing more blanket testing to understand what the level of infection is in community, but you shouldn't wake up in the morning with nothing different from any other day and say, oops, I absolutely need to get tested. If you want to get tested, there are enough tests around that you can get tested. But there may be good reasons why you want to get tested, and that would be, I think, something to drive you to get tested. Dr. Fauci: (39:02) The other thing that I think is important is depending upon where you live and with the status of the outbreak is for the most part, you should try if it's safe to do to continue to do the kind of things that look after your general health. You mentioned routine screening, routine doctor visits, routine procedures like mammograms, oral dental care. The one thing we don't want is for people to stay away from things that later on because they didn't do proper screening would lead to infections or cancers or cardiovascular disease that you could have avoided if you got routine medical care. So you want to be careful. You want to do all the things we've spoken about over the last half an hour, 45 minutes about protecting yourself, but you want to pay attention to your normal attention and normal application of things that are important for your health. Suzanne Clark: (40:17) I do want to get to the last question, but a quick followup on that. I live in Fairfax County, Virginia, if I want to know what's going on in my community, am I looking at percent positive tests, am I looking at hospitalizations? Am I looking at deaths? How am I judging what's happening in my community as I'm making personal decisions? Dr. Fauci: (40:38) Yeah, I mean, I think you said them all. I mean, if you do more testing, you're going to get more positives. But if there are more cases that are going up that are independent of how much you're testing, but the cases are going up, then the percentage of the number of tests you do that are positive are going to go up. That's a sure fire indication. Number two, you will see more hospitalizations. And number three, when you have more hospitalizations, inevitably you're going to see more deaths because if people are serious enough to get hospitalized, a certain percentage of them are going to be very sick and a certain percentage of them are going to die, and that's exactly what you're seeing in certain areas. Dr. Fauci: (41:26) Fortunately, where you live and where I live in the Washington DC area, things are pretty much under control, but we've got to be prepared that we might see increases and we've got to be responsive to them and being able to prevent them from becoming serious surges the way we're seeing in some of the states that we spoke about in the beginning of the program like Florida and Texas, and California and Arizona where they're seeing significant increases. Suzanne Clark: (41:56) Final question. Now, you gave individual advice and I'm going to ask you to look into the camera and give a business owner advice. I mean, these business owners are really trying to balance health and their livelihood, the risk of reopening and the risk of staying closed. And so what's your final word of advice to the business community in America? Dr. Fauci: (42:16) Well, the final, I don't like to say advice because sometimes that gets presumptuous, but my final reflection on the business community is that the business community is so essential to everything we do, even our health. I mean, we have to have a healthy community. You have to have a healthy business community. You are really important, so you've got to try within the framework of safety and attention to your health and your safety and your welfare to try and get back to normal and open America again in a way that's prudent, that's careful, and that follows the guidelines that we spent considerable time putting together, the guidelines for opening America. Dr. Fauci: (43:05) Again, with the gateway, the phase one, the phase two, the phase three, take a look at those guidelines and follow them because the public health apparatus shouldn't be looked upon as the obstacle in the way of opening. It should be a gateway, a vehicle, and a facilitation of opening because if you follow them, it is unlikely you will have to backtrack because of a surge the way we're seeing going on in several states right now. So if you do it prudently, then I believe you can in most instances continue to progress along to bringing back and opening up America again. Suzanne Clark: (43:54) Dr. Fauci, thank you for everything you're doing for our country. Thank you for helping us think through these issues today. Please count on the US Chamber of Commerce as an information and best practice disseminator at any time that we can be helpful to you, and God bless you in your work. Dr. Fauci: (44:11) Thank you very much, and I appreciate the opportunity to join you today. Thanks again. Stay safe and stay healthy. Suzanne Clark: (44:17) Thank you so much. And to the audience, if you've missed any of the prior episodes, they're on uschamberfoundation.org, Apple Podcasts, and YouTube. You heard it from the expert yourself. Wear your mask, wash your hands, and stay safe. Thank you so much for joining us today.