Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and a central figure in the White House Coronavirus Task Force, spoke Tuesday, Nov. 17, at the American Heart Association’s Scientific Sessions 2020 virtual meeting.
His presentation focused on COVID-19, including some of the numerous challenges the country has faced during the ongoing pandemic, and ended on a note of “cautious optimism.”
A bit of background
Fauci, one of the world’s most recognizable experts on COVID-19, began by thanking attendees for their hard work over these last several months. He then examined the recent history of coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
In 2002 and 2003, Fauci explained, SARS resulted in nearly 800 deaths, but its lower degree of efficiency meant that “public health measures including quarantine and contact tracing essentially extinguished the outbreak without any other intervention.” MERS, on the other hand, began in 2012 and never spread much outside of the Middle East. However, he noted, MERS does still occasionally emerge from time to time.
COVID-19, however, has proven to be much more challenging to control than SARS or MERS. Fauci described the situation today—with more than 48 million confirmed cases and more than 1.2 million deaths—as a “global pandemic the likes of which we have not seen in the last 102 years.”
The United States, he added, has been hit harder than any other country, experiencing more than 9.4 million confirmed cases and more than 231,000 deaths. And the country’s number of new cases did begin to drop for a while, particularly during July and August, but the United States is now experiencing higher daily numbers than ever.
So why has COVID-19 impacted the United States to such a high degree? Fauci pointed to numerous factors, including inconsistent lockdown and social distancing policies among different states and the fact that people didn’t work from home as much as in some other countries. In addition, Fauci said, trips to grocery stores and pharmacies did not drop as low in the United States as they did in other countries.
How it spreads—and how to limit that spread
Fauci set aside some time to discuss the different ways COVID-19 appears to transmit from one person to another. Exposure to respiratory droplets when close to an infected person remains the No. 1 way this virus is currently being spread, he said, and contact with contaminated surfaces also plays a role.
A key part of Fauci’s presentation was focused on how people can prevent themselves from acquiring—or transmitting—COVID-19. The advice was not necessarily anything new, especially to the audience of cardiologists and other industry leaders, but it was clear that it was important to Fauci to get this message across. He pushed for people to wear masks and other cloth face coverings, maintain a physical distance of at least six feet from others, avoid crowds, stick to outdoor activities instead of indoor activities and wash their hands frequently.
“If those five public health measures were adhered to universally and consistently over the country, it is clear from our previous experience with other nations and even regions in our own country that we would not be having the degree of surging cases we are currently seeing,” Fauci said.
How COVID-19 is affecting patients
Fauci then spoke about the symptoms COVID-19 patients are currently experiencing, noting that fever, cough and fatigue are at the top of the list. And while research shows that 81% of patients experience mild to moderate symptoms—or even no symptoms at all—symptoms are severe for 14% of patients and critical for 5%.
“The case fatality rate varies from a few percent under certain circumstances to 20 to 25% among people who require mechanical ventilation,” he added.
Also, Fauci emphasized, there is an “extraordinary disparity” between the small number of young patients who are hospitalized for COVID-19 and the alarming number of older patients. This does not mean young patients aren’t impacted by the pandemic, of course; patients of all ages with chronic heart conditions, hypertension, obesity and other conditions are at a much higher risk of severe COVID-19 illness.
“COVID-19 can cause severe cardiovascular complications manifested by arrhythmias, myocardial injury, thromboembolic phenomenon and cardiomyopathies,” he added. “If you look at the manifestations of severe COVID-19, they are plentiful. I mentioned the cardiac ones, but there is also acute respiratory distress syndrome, kidney injury, neurological injury, a hypercoagulable state manifested by microthrombi and small vessels and an acute thrombotic phenomenon sometimes seen in otherwise-well young individuals.”
Multisystem inflammatory syndrome in children (MIS-C) and a “post-COVID-19 syndrome” that causes some patients to ”experience lingering symptoms for weeks or even months” have also been observed.
Reviewing recent cardiology research
Fauci also pointed to some of the biggest studies related to the cardiovascular impact of COVID-19. He mentioned the analysis by Puntmann et al. in JAMA Cardiology, for example, that suggested heart damage is present in 78% of recovered COVID-19 patients.
“This needs to be repeated in other labs and followed up,” he said. “But if it is true, it’s something that needs long-term follow-up, because it might be clinically inconsequential or it could lead to chronic effects."
Another study getting specific attention was the work of Rajpal et al., which was published in JAMA Cardiology in September and found that many college athletes showed MRI findings consistent with myocarditis.
Important notes for physicians—and some hope
Remdesivir and dexamethasone are both now recommended for hospitalized COVID-19 patients experiencing specific symptoms, Fauci explained.
He also mentioned the “very exciting news” of Pfizer and BioNtech’s vaccine candidate, which was announced just last week. Other companies “are not far behind,” Fauci added, and he hopes that high-risk patients are receiving the vaccine by the end of 2020.
“We now look at this with cautious optimism that, by the end of this calendar year and well into 2021, we will be administering doses—first for the highest priority and then ultimately to everyone in the United States—as we get several months into 2021.”
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.