Fauci is giving grand rounds at @JohnsHopkins today. Showing a map of the US covered in red, he says, "We are at the explosive, almost exponential, stage of the pandemic."

The US never got to the low levels of spread as the EU over the summer. The reason: we never locked down as much as places like Spain and Italy did. You can see this through cell phone mobility tracking data

There clearly is a degree of aerosol transmissibility. We don't know how much, but we do know that it occurs. Less commonly transmitted through surfaces.

CDC has calculated risk from different indoor activities. The highest risk locations are indoors with poor ventilation: restaurants, gyms, and religious venues. We're also seeing more spread from small indoor gatherings in people's homes, often due to asymptomatic spread

40-45% of spread is due to asymptomatically infected people. This is why masks are so essential - they protect people even if you're infected and don't know it

Symptoms are very similar to flu but with the unique loss of smell and taste. What makes messaging about this disease so difficult is that 80-85% of people who have get sick have mild to moderate symptoms that don't require hospitalization.

15-20% of people have severe disease that could be lethal, with the elderly and people with pre-existing conditions at the highest risk. 40% of the US population has a pre-existing condition.

Severe Covid is characterized not just by lung problems but seriously scary cardiac, circulatory, neurological, and inflammatory problems that can be fatal

NIH is in the process of planning research and funding for post-Covid-19 syndrome (Covid long-haulers) - people who have cleared the virus but have persistent symptoms (shortness of breath, fatigue, brain fog, aches and pains), even if they only had mild disease initially

Treatments: conflicting studies from US and EU as to whether remdesivir actually improves Covid-19. Fauci says studies aren't actually conflicting - one showed lack of effect on death rate, other showed improvement in recovery from hospitalizations

Vaccines: Pfizer/BioNTech and Moderna have similar 95% efficacy, including in older adults and against severe Covid-19. Both are on track to achieve EUA by the end of December. Pfizer just submitted an EUA to the FDA today

Staged rollout of the vaccine is planned based on people's risk and exposure. Next step is to convince people that the vaccine development process was transparent, independent, and scientifically sound

Just because a vaccine is available, doesn't mean you can abandon public health measures. Depending on how many people in the population get the vaccine, you need to keep up non-pharmacological interventions (masks, distancing, etc)

Q&A portion: NIH took risk on new mRNA vaccine technology because of the speed & potential. And thank god it worked! Two different trials using same platform and getting virtually the same result (95% efficacy) is astounding. Bodes well for using technology for other viruses too

Monoclonal antibodies - want to give as early as possible, but can only give in hospital when it's possibly too late. Difficult dilemma. Fauci still hopes that in the future there will be an oral antiviral that can be given at home that would prevent hyper-inflammatory response

Striking disparities in minority populations. Need to concentrate resources (testing, healthcare) in those areas where people need it the most. Also must think long-term about social determinants of health and make multi-decade commitment to address it

In two completed vaccine trials, 1/3 of participants are healthy under 65, 1/3 are healthy over 65, and 1/3 are any age with underlying conditions, including specifically immunocompromised.

Unfortunately, coronavirus immunity is typically not long-lasting, we know this from common cold coronaviruses. Think immunity will last a few months to a few years for Covid-19. We might have to get vaccine boosters in the future

5% of people in Moderna and Pfizer trials already had antibodies to Covid-19, but Fauci says they should be treated and vaccinated just like anybody else.

Vaccine international distribution - the US is unfortunately not in COVAX international consortium. Pandemics are global diseases and vaccination should not depend on where you're born. Pharma companies are preparing to produce billions of doses for global distribution

If get good safety data from phase 1/2 trials in kids, can bridge that safety data to efficacy data from adults. In other words, if vaccine is safe in kids and effective in adults, you can assume it's effective in kids too. Don't have to redo large phase 3 trial in kids.

Fauci says we're not going to eliminate or eradicate this infection. We've only done that with one virus ever (smallpox). We also need to not forget and move on once the pandemic is over. We need to put in place long-term systems and funding to address racial health inequities

Plug to buy the Fauci bobblehead doll! Proceeds benefit the American Hospital Association. (Great gift for your favorite science writer *hint hint*) https://store.bobbleheadhall.com/products/drfauci