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Anthony Fauci, using a baseball analogy for the fight against COVID-19, warns the U.S. may not be halfway through and "certainly we're not winning the game right now." Photo: Al Drago/AFP via Getty Images

The unique characteristics of this pandemic may not allow people to completely eradicate it, but public health measures and good vaccines should bring "very good control," NIAID director Anthony Fauci said Wednesday.

Driving the news: "We are living, right now, through a historic pandemic outbreak. And, we are, right now, in a situation where we do not see any particular end in sight," Fauci told a panel hosted by the not-for-profit TB Alliance.

"It's the perfect storm," Fauci says. "We often talk about outbreaks and pandemics, be they influenza or other pathogens, that have to have a few characteristics that make them particularly formidable. Well, this particular virus has that."

  • For a public health official, this is "almost your worst nightmare," Fauci adds.
  • He points out that SARS-CoV-2 jumps species, is a new pathogen with no known innate human immunity, and is a respiratory-borne virus that is "spectacularly efficient" at spreading from human to human and has a "substantial degree of morbidity and mortality, particularly in certain populations of people."

Plus, "the spectrum of involvement with the same pathogen is very unique," Fauci says.

  • "I've never seen an infection in which you have such a broad range — of literally nothing, namely no symptoms at all, in a substantial proportion of the population; to some who get ill with minor symptoms; to some who get ill enough to be in bed for weeks and have post-viral syndromes; [to] others [who] get hospitalized, require oxygen, intensive care, ventilation and death."
  • From what doctors can tell right now, Fauci says the pathogenesis of the disease indicates "you want to block the virus and keep the immune systems intact early on. But, you want to block inflammation later on, because that assumes a much greater role."

What to watch: Several vaccines are in or will soon be entering phase 3 clinical testing, Fauci says. While the FDA gave a 50% efficacy benchmark for the vaccine, "they're shooting" for a vaccine with 70% or higher effectiveness.

  • One safety concern they're watching for during phase 3 trials are for possible "vaccine-induced immune enhancement" that can sometimes occur if there's suboptimal antibodies in a vaccine that actually enhance the infection once you're exposed later.
  • While there is no "particular reason" to believe this will happen with COVID-19 vaccines, there had been issues before with animals tested with the SARS vaccine, so "we want to pay attention to it."

Fauci says he's "cautiously optimistic" a good vaccine will be available soon.

  • "I don't really see us eradicating it. I think with a combination of good public health measures, a degree of global herd immunity, and a good vaccine ... I think we'll get very good control of this. Whether it's this year or next year, I'm not certain," Fauci says.

Meanwhile, other panel members also expressed concern that the pandemic may cause an uptick in diseases like tuberculosis, HIV and malaria.

  • Soumya Swaminathan, chief scientist for the World Health Organization, pointed out that there's a need to continually address those devastating diseases as well as work on developing new antibiotics.
  • TB Alliance founding board member Ariel Pablos-Mendez, who has worked with both COVID-19 patients and multidrug resistant TB patients, says "I have seen firsthand how deadly diseases are, and the threats they pose to global health and stability."
  • "But I also see signs of hope," Pablos-Mendez added, such as with India's recent approval of TB Alliance’s pretomanid drug, commercialized by Mylan, to be included in a regimen to fight multidrug-resistant TB.

Editor's note: This piece was updated to clarify pretomanid is TB Alliance’s drug that Mylan will commercialize.

Go deeper

Updated 16 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Emergency room visits of all kinds dropped amid the pandemic — NY smart-thermometer network could predict next COVID wave.
  2. Vaccines: FDA clears 10 million J&J vaccine doses from contaminated Baltimore plant — Moderna asks FDA to expand COVID-19 vaccine authorization to adolescents.
  3. Cities: Seattle becomes first major city to get 70% fully vaccinated — Schools nationwide prepare for packed kindergartens this fall.
  4. Work: Goldman Sachs requires U.S. employees to report vaccination status.
  5. Politics: U.S. to buy 500 million Pfizer doses to share with the world — State Department eases travel advisories for dozens of countries.
  6. World: Moscow orders new restrictions amid surge in COVID-19 cases — 12 Venezuela players, staff contract COVID-19 before Copa America opener — 2021 already has a higher global coronavirus death toll than 2020.
  7. 🎧 Podcast: Back to normal without herd immunity.
  8. Variant tracker: Where different strains are spreading.
Oct 30, 2020 - World

Belgium imposes lockdown, citing "health emergency" due to influx of COVID-19 cases

Belgium Prime Minister Alexander De Croo. Photo: THIERRY ROGE/BELGA MAG/AFP via Getty Images

Belgium is enforcing a strict lockdown starting Sunday amid rising coronavirus infections, hospital admissions and a surge of deaths, Prime Minister Alexander De Croo announced on Friday.

Why it matters: De Croo said the government saw no choice but to lock down "to ensure that our health care system does not collapse." Scientists and health officials said deaths have doubled every six days, per the Guardian.

Oct 30, 2020 - Health

CDC replaces COVID-19 cruise ban with less restrictive "conditional sailing order"

The Pacific Princess cruise ship is shown docked at the Port of Los Angeles. Photo: Mario Tama/Getty Images

The Centers for Disease Control and Prevention announced Friday it's replacing its "no-sail" order on U.S. cruises with a less restrictive "Conditional Sailing Order," setting the stage for the phased resumption of passenger cruise line travel.

Why it matters: Cruise ships were the sites of some of the most severe coronavirus outbreaks early in the pandemic, before the industry shut down in March.