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At a press conference Monday morning, Gov. Andrew Cuomo and National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci updated New Yorkers on the coronavirus spread. (Images courtesy of the Office of Gov. Andrew M. Cuomo)
At a press conference Monday morning, Gov. Andrew Cuomo and National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci updated New Yorkers on the coronavirus spread. (Images courtesy of the Office of Gov. Andrew M. Cuomo)

COVID-19: Fauci offers Cuomo guidance on potential holiday spikes

Mon, Dec 7th 2020 08:25 pm

On Monday, the nation's top infectious disease expert, Dr. Anthony Fauci, joined Gov. Andrew Cuomo in providing an update on the state's progress during the ongoing COVID-19 pandemic.

Cuomo was warned the period between Thanksgiving and New Year’s Day is primed to spike the number of positive coronavirus cases, as people gather together indoors to celebrate the holidays. That said, he continues to advocate for the wearing of masks, social distancing and avoiding large crowds as deterrents to this increase.

The governor conducted a Q&A with Fauci. An edited transcript follows:

Cuomo: So, a couple of questions for you Dr. Fauci. That's what we're doing in general, your opinion has always been valuable to us. The holiday spread, I think it continues through Christmas, Hanukkah, etc. I'm trying to guess – and I know it is a guess – when we could see the peak of this holiday spread? Is it after New Year's? Is it mid-January? Do you have any guess, an educated point about that? …

Fauci: … In regard to the issue of the holiday spread and the peaks, they are going to be superimposed on each other. So, you would expect the full brunt of the travel and family-setting gatherings with friends that you alluded to as a problem, you would expect the effect of the Thanksgiving surge in probably another week and a half from now. It's usually two weeks from the time of the event. The problem is, that's going to come right up to the beginning of the Christmas and Hanukkah potential surge. So, you have a surge upon a surge, and then before you can handle that, more people are going to travel over Christmas; they're going to have more of those family and friend gatherings that you accurately said are an issue.

So, if those two things happen and we don't mitigate well and we don't listen to the public health measures that we need to follow, then we could start seeing things get really get bad in the middle of January. So, I think not only for New York state but for any state or city that is facing similar problems, without substantial mitigation, the middle of January can be a really dark time for us; but as you said in your presentation coming up there were some things that we can do to mitigate against that. I think particularly the appreciation that it's such a natural thing to think when I have family over, eating and drinking and you don't realize that there may be somebody that you know, that you love, that's a friend, that's a family member, who is perfectly well with no symptoms and yet they got infected in the community and brought it into that small gathering that you're now having in your home. So, that's the reason why I want to underscore what you said, that's one of the issues; but bottom line for your first question, mid-January is probably going to be a bad time.

Cuomo: The small spread, family spread, living room spread – we call it living room spread here – like 16 states have done an order of no more than 10 in a home. The CDC guidance, that's President Trump's CDC, says no more than 10. Some states have gone to no more than eight. Compliance is very low on that. Do you think that is a sound rule, the no more than 10 in a home?

Fauci: Governor, I think that's a very sound rule, and I feel 10 may even be a bit too much. It's not only the number, governor, but it's the people that may be coming in from out of town. You mentioned in your presentation that you don't want somebody who's from New York who wants to go to a restaurant that's closed in New York, they go to New Jersey and then they come back. They travel back and forth in addition to the number of people in a home for a gathering or a social setting.

You want to make sure you don't get people who just got off an airport or a plane or a train and came in from Florida or came in from wherever. That's even more risky than the absolute number. Not only the number of 10 seems reasonable, but make sure that when people come in, that they're not people who have no idea where they've been or who they've been exposed to. You want to be friendly, you want to be collegial, but you really got to be careful about that.

Cuomo: You're so right, doctor. The practical implications are so difficult. … So, you want to go travel and see someone, it's not just that weekend, it's the whole quarantining process before. In this state, we have very strict regulations of when you come in and what you have to do.

On the vaccinations, looking ahead, 75-80% is going to be very hard to reach. New Yorkers are tuned in and we're going to be very aggressive on public education, outreach, etc. But what does your crystal ball say? When is 75-80 even feasible? You know, I hear anywhere from May, June, July, August, September. What would you guess there? Which is when it's really over, right, when the vaccination hits critical mass.

Fauci: Yeah, when you have 75 to 80% of the people vaccinated, you have an umbrella of protection over the community that the level of community spread will be really, really very low. The virus will not have any place to go. It's almost metaphorically, if you think the virus is looking for some victims, when most of the people are protected the virus has a hard time latching on to someone. When that happens, governor, is going to be entirely dependent upon how well we do, how well I do, you do, your health officials, in getting the message out of why it's so important for people to get vaccinated, because if 50% of the people get vaccinated, then we don't have that umbrella of immunity over us.

But let's say it works out well, let me answer your question specifically, and we do a really good job of convincing people between now and the end of December. You'd likely get a substantial proportion of health care providers and people in your nursing homes. As you get into January, you'll get the second level, and then February, the third. I would think by the time you get to the beginning of April, you'll start getting people who have no high priority, just a normal man and woman New Yorker on the street who's well, has no underlying conditions. If we get them vaccinated in a full-court press, get them really going, and you do that through April, May and June, by the time you get to the summer – because, remember, it's a prime boost, which means you get vaccinated today, you get a boost 28 days from now, and then seven to 10 days following that, you're optimally protected. Even through you could get some protection even after the first shot, but optimally it's within seven to 10 days following the second shot. If we do that well, by the time we get into the core of the summer and get to the end of the summer and into the start of the third quarter of 2021, we should be in good shape. That's what I'm hoping for, and that's the reason why it's so important to extend ourselves out to the community, particularly to the Black, African-American, Latino, the people who are undocumented, the people who we really need to get vaccinated.

Cuomo: Well doctor, I couldn't agree with you more on that. I'm pushing the Congress right now. New York, look, I think it would be discriminatory not to understand the situation that exists with the Black and Latino population, who, by the way, had – Blacks had the twice the death rate of whites, Latinos had one and a half times the death rate of whites. Higher infection rate, higher percentage of essential workers. We're going to need a whole effort just to educate, and outreach, and get into public housing, and communicate with their communities, because otherwise, they're not going to flock to the local Walmart or K-Mart or Walgreens to take this vaccine. I think we're going to need an affirmative effort to do that.

Let me ask you this, our school positivity rate is amazingly low. Even in communities that have higher spread, we're seeing much, much lower infection rates in schools. It's almost a universal statement that the school is the safest place to be in the community. Does that surprise you?

Fauci: You know, it originally did surprise me, because we were always concerned; if you look at the influenza model, the issue is the kids are in school, they get infected, they come home and they infect their parents and their relatives. We're not finding that with this coronavirus. In fact, to our, I think, real positive spinoff of this is the realization that schools appear to be a place where the positivity rate – just like you all are seeing it in New York, the whole state including New York City, you're not alone. We're seeing that in other parts of the country that the test positivity rate is actually really low, which is really a good thing. Which is one of the reasons why when we were talking about what the best strategy would be, we would say something like close the bars, keep the schools open is the best thing to do – so long as you subsidize and help the restauranteurs and the bar owners so that they don't go down and essentially crash because of the economic strain. But if we can keep those things under control, subsidize those people, as well as keep the schools open, we'd be in good shape.

Cuomo: And I think you're exactly right. The CDC says more restrictions on indoor dining which I understand, and again, changing positions when facts change is intelligent. People say, “Well, remain consistent.” I'm not going to be consistent when the facts are inconsistent; and if I see a different situation I'm going to change my opinion. But the Congress, Washington, also has to understand those bars, those restaurants, they need financial assistance, because this has been a long year and they have bills to pay; so you can't tell them we have to close you down without saying here is the economic reality and we're going to help.

Fauci: Absolutely.

Cuomo: On the question of this state's infection rate versus other states, we're lower than all states besides Vermont, Maine, Hawaii – does that surprise you and how do you explain that?

Fauci: You know, I have to say, being a New Yorker, governor, it doesn't surprise me. You guys, as you and I have discussed on many phone calls that we've had, you got hit with a sucker punch right from the beginning when the cases came in from Europe and the Northeastern corridor, particularly New York state, particularly the metropolitan area got hit really, really badly. You recovered from that – was after you got hit badly, your baseline level went way, way down and very, very low, and then you did things which were the appropriate way to avoid … resurging.

So the bad news and it's painful for me to see it from a distance to my place of birth, but you guys got really slammed and then you rebounded. And you rebounded in a way that you kept your test positivity low, because you did the prudent things that you need to do. I was following it from here in Washington and I was seeing that whenever it looked like things were getting a little out of hand, you'd tighten the rope a little bit and then when things went back, you eased up a little bit. So I'm not surprised that your infection rate is really low, because I think you were doing the right things after you had a really serious hit in the beginning when you were there in the late-winter, early-spring.

Cuomo: Doctor, on this education of the population – on both the small spreads and even more the vaccine, take the vaccine it's safe – I think that's going to be difficult to do. I think you have tremendous credibility, not just across the country, but across this state, and I think your voice on saying that the vaccines are safe would be important. I said that as soon as the vaccine is deemed ready and safe, I'll be the first one to take a vaccine. Maybe we enlist you, I'll do it with you – we'll do an ad telling New Yorkers it's safe to take the vaccine, to you know, put us together. We're like the modern-day DeNiro and Pacino.

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