New Coronavirus News from 1 Oct 2021

One-on-one with Dr. Fauci: ‘Expect the unexpected’ [National Geographic, 1 Oct 2021]

National Geographic interviewed Anthony Fauci about his personal history, his career, and his role in health crises from HIV/AIDS to COVID-19.

Excerpts from Fauci—Expect the Unexpected: Ten Lessons on Truth, Service, and the Way Forward. The National Geographic book was drawn from interviews for the documentary film Fauci; proceeds from the book benefit conservation.

I was born on Christmas Eve, 1940. As my father tells the tale ... the obstetrician who was taking my mother through her pregnancy happened to have been at a black-tie cocktail party.
And when my mother went into labor, apparently it was pretty quick. My father brought her to Brooklyn Hospital, and he remembers the doctor walking in with a tux on. He had to get into the delivery room very quickly, so he just washed his hands and put the scrubs over the tux ... We always joked about it at home: Just how much had he had to drink before he actually came in to deliver me?
***
Anthony Fauci was almost five years old in 1945 when the United States detonated atomic bombs over the cities of Hiroshima and Nagasaki, unleashing catastrophic damage and spurring Japan’s surrender to the Allies.

That moment when I saw my mother reading the New York Daily News with the big picture on the front page of the devastation in Hiroshima was a memorable moment for me. I had played war games as a child, where the good guys were the GIs and the bad guys were the Japanese, and when I saw the destruction in Japan, I thought, Wow, hey, that’s great.

But I saw in my mother something that puzzled me at first ... Many decades later I still remember that scene in the living room in our apartment in Brooklyn. I can picture my mother sitting on the couch looking at the paper and me looking over her knee. She was really sad.
That was a defining moment, understanding that you can feel empathy toward people who are very different from you—even people who might officially be the enemy.
***
We lived above my father’s pharmacy. I would deliver prescriptions on my bicycle around the neighborhood, and my sister would help out behind the counter. I had a Schwinn bicycle with a basket up in front, and I used to do it for tips. You would zip around the neighborhood, park your bike, knock on the door, deliver, and they would give you a 25-cent tip. That was a big tip!

You’d meet different people, and I got an appreciation of what illness was—you knew they were ill from the way they looked. That was my first introduction to illness and medicine. And helping out in the store, I got a better perspective of the family unit because we all worked together.

The documentary film Fauci explores the life and career of America’s top infectious disease expert. From National Geographic Documentary Films, it begins streaming on Disney+ October 6.
***
Fauci spent his early childhood in the Bensonhurst section of Brooklyn, New York, in a neighborhood he describes as “99.9 percent Italian American.” All four of his grandparents had emigrated from Italy via Ellis Island, then moved from the Lower East Side of Manhattan to raise their families in Brooklyn, where Fauci’s parents met and married.

In the summer, when the windows were open, the smells were everywhere—mostly tomato sauce and sausages being cooked. And it was just something that becomes part of you.
Whenever I happen to smell that now, decades and decades and decades later, it’s an immediate flashback. It puts me right on 79th Street and New Utrecht Avenue, and you just can’t escape it. There was a certain feeling of freedom—fresh air and sunshine and being outdoors on the streets of Brooklyn. It was the safest place in the world to be because all of the storekeepers would be sitting down with their little chairs in front of their shops, watching the kids go by. No one would in their wildest dreams imagine trying to intimidate any of these kids because the entire neighborhood was kind of like a protective squad. We felt perfectly secure all the time. It was an extremely happy childhood.
***
Fauci attended the prestigious Regis High School in Manhattan and went on to Holy Cross, an all-male college in Worcester, Massachusetts. By then, he already knew he was on a pathway to becoming a doctor.

In college I worked every single summer in construction as what’s called a mason tender, who helps a bricklayer (you carry the cement, you carry the bricks, you clean up). I already knew then I wanted to go to Cornell’s medical school, and it was just by happenstance that I got picked to work on the construction of the Samuel J. Wood Library at the medical school, right on York Avenue and East 69th Street in New York City. One day I decided I would get up the courage to go inside.

When the other construction guys sat down for lunch on the wall, whistling at the nurses going by, I walked up the steps and walked in. I looked into the auditorium, and I remember saying to myself, Wow, this is amazing. All of a sudden, the security guard who’s standing at the door comes over to me, a big guy. He says, “Can I help you, sonny?” Sonny. He called me sonny.
I say, “Oh, I’m just looking around here.”

He says, “You got concrete all over your boots. Why don’t you just step outside?” I looked at him, a little bit indignant. I said, “Someday I’m going to be a student in this medical school.”
He looked at me with a straight face and he says, “Yes, sonny. Someday I’m going to be police commissioner of New York City.”

But a year later I was a student there.

(Stopping Pandemics: An exclusive National Geographic event with Dr. Fauci and other experts)
***
When you’re a physician, it’s just as important to know human nature as it is to know human physiology. The most important thing in the care of a patient is caring for the patient. You’ve really got to care about them as a person, not as a statistic or as somebody that you’re going to bill or somebody that’s one of a number of people.
***
Let me give you a personal example of the kinds of dramatic evolutions and changes that can occur totally beyond your control and that can profoundly impact the direction of your career and your life.

In 1968 I finished my medical training in internal medicine at the New York Hospital-Cornell Medical Center. That very same year, noted public health scholars ... were opining and even testifying before the United States Congress that with the advent of antibiotics, vaccines, and public health measures, the war against infectious diseases had been won, and we should focus our efforts on other areas of research and public health.

As fate would have it, at that time I was on my way to begin, of all things, a fellowship for training in infectious diseases at the National Institutes of Health. I remember reflecting as I drove from New York City to the NIH in Bethesda, Maryland, with the words of the wise pundits resonating in my mind, that I felt somewhat ambivalent about my career choice, to say the least. Was I entering into a disappearing subspecialty? I sort of felt like I was going to Miami to become a ski instructor.

Fortunately for my career, but unfortunately and sadly for the world, even surgeons general are not always correct. Indeed, 13 years later, in 1981, the AIDS epidemic had emerged and transformed my professional career, if not my entire life.
***
You must be prepared at any moment to enter uncharted territory, to expect the unexpected, and where possible, seize the opportunities.
***
Fauci was working as one of the leading researchers on immunology and autoimmune diseases at the National Institutes of Health in 1981 when an unidentified infectious disease came onto his radar. The scientific publication Morbidity and Mortality Weekly Report (MMWR), published by the Centers for Disease Control and Prevention, reported that five gay men from Los Angeles with no apparent underlying illnesses had developed a very rare pneumonia called Pneumocystis pneumonia.

I was sitting in my little office on the 11th floor of the NIH Clinical Center on a hot summer day, the first week in June, when I saw the report. I had been studying drugs that suppressed the immune system, and we were seeing Pneumocystis cases. So I said, “There’s something strange going on here,” and put it into my desk drawer.

One month later, on the fifth of July of 1981, another MMWR appears on my desk. This time, 26 men. Amazingly, all gay men. Not only from Los Angeles, but from San Francisco and New York, who not only had Pneumocystis pneumonia but had Kaposi’s sarcoma: a tumor, a cancer seen in people whose immune system is dramatically damaged.

I remember looking at that and going, Oh my God, this is a brand-new infectious disease. I actually got goose bumps. I had no idea what the cause of the infection was, but I did know it destroys the immune system. As a physician/scientist trained in infectious diseases and immunology, if ever there was the disease that was made for me, it’s this.

I made a decision then that I was going to completely change the direction of my research. I had been extremely successful in my career, and my mentors, the people who recruited me here years ago, told me I was crazy. They said, “Why are you throwing away a promising career to go chasing after a disease that’s a fluke?” I decided that I was going to do it anyway. I felt obliged to explain it to the world.

Unfortunately, it turned out that I was right. It exploded into one of the most extraordinary pandemics in the history of our civilization.
(How devastating pandemics change us)
***
Homophobia was clearly pervasive at the outbreak of AIDS. Because I was spending most of my time with sick gay men, I would see homophobia in society—and by association as their physician be on the receiving end of homophobic attacks.

I don’t think I ever had any element of homophobia or even any inkling of that in me. I think it gets back to my parents and their tolerance for other people. Empathy was a big component of my growing up in the family in which I grew up—and again, it was solidified and underscored in the training, in Jesuit training in high school and in college.

I have always felt an empathy towards people who were being treated unfairly, as well as the unfairness of the prejudice against a person whose sexual persuasion is beyond their control. It’s just who they are. The injustice of that dominated my attitude about what homophobia was and is. It made me angry to see people have that attitude. It made me a defender of someone’s right to be who they are.
***
My optimism is that there are going to be bad actors and there are going to be better angels.
But I think there are more better angels than bad actors.
***
I’m really not afraid of very many things. But what I’m most concerned about is not getting the opportunity to finish the things that I started decades ago and to add the finishing touches. I would like to see the defining public health challenge of my professional career, HIV, ended as an epidemiological pandemic. Everyone thought ... we could cure or eradicate AIDS. And that turned out to be very difficult and could actually be impossible. I don’t think we’re going to eradicate HIV—in fact, I know we’re not—but I think we can almost eliminate it gradually throughout the world. First in countries that have more resources, like the developing countries, but then, ultimately, in sub-Saharan Africa ... My fear is that I may not necessarily see that. But I hope I do. And I think I will.
***
Fauci’s work at the NIH made him uniquely prepared to face the coronavirus pandemic: He had already worked on treatment and prevention efforts for the Zika virus, Ebola, anthrax, pandemic flu, HIV, tuberculosis, and others. But he’s acutely aware of the public’s short memory. We say we learn from experience, but how can we make sure that’s really true?

I think when you get further and further away from a really profoundly defining event, the impact of that just attenuates. In 1918, during the Spanish flu pandemic, my father was eight years old. I’m sure the horror of that year and a half influenced him as he got into his teenage years and his 20s and his 30s. And then it probably got less and less, but he never forgot it.

For those of us like myself who only read about it as a vague story in a history book, it doesn’t have the same impact of being there yourself or being intimately connected with someone who experienced it ...

World War II ended when I was five years old. The people who came back from the war and the experience they had could never be translated to people 40 years later: What do you mean you were in a place where you invaded an island and 10,000 of your friends got killed?

I don’t think not understanding is a failing. It’s just the way life is. Unless you’re connected with something directly, it doesn’t mean much to you. The COVID-19 epidemic is like nothing we have experienced in the past 102 years. Let us not forget that we were not as prepared as we thought we were or as we should have been. So let’s get to being able to say, “Never again.
We’re never going to let this happen again.” What I’m afraid of as we get out of this is that it’s going to be five years from now, 10 years from now, and people are just going to either forget or not care how this outbreak completely gripped the world. They’re going to forget.

And I say this with a little bit of despair: that we’ve always been aware of health disparities.
We’re always aware that African Americans and Hispanics get the short end of the stick when it has to do with diseases. And their disproportionate burden with COVID-19 now is staring us right in the face.

Let us make a commitment that in the next three or four decades, we’re going to do something about that. Sounds great. But five years from now some other problem is going to come along, and we’re going to forget about COVID-19.
***
I have worked with seven presidents over the course of 11 terms. I learned from the very beginning, you’re doomed to failure if you are afraid of not getting asked back, if you’re afraid of saying something that’s going to get somebody upset. Nobody wants the president of the United States to be upset with you.

During the Trump administration, every once in a while, I would say something that they didn’t like, and then I would be off television for a week or so. But I would always come back. I didn’t want to lose that. I didn’t want to lose the direct messaging to the American public.

Donald J. Trump and I kind of liked each other. I don’t know ... maybe it was the having-New-York-in-common thing ... And we developed, as I think both of us have described, an interesting relationship, a good relationship. But more than once, as we would get into the press conferences, I would have to fine-tune something that he said. That seemed to be surprisingly OK until things started to get a little bit more tense. And yet when I would see him two days later in the Oval Office, it was like we were buddies again. I don’t think he had a deliberate, malicious disdain for science. I think he just didn’t think it was important. It’s not even disdain; it’s a disregard ...

I felt my job was to do whatever I can to get us out of this outbreak. So, leaving was not an option. The only option I had was to take the chance, right in that venue, to contradict him. I could either keep quiet, which would be violating my own principles, or leave, which would have meant I can’t do any good anymore. I felt the only way I could maintain scientific integrity was to speak up.

It was clear that my message to the American public was contrary to his message, so he allowed the legions around him to try and undermine my credibility. On the other hand, he had this interesting, complicated relationship with me, and I really don’t think he wanted to hurt me.
I think he was torn by the fact that, deep down, he knew that what I was saying was true. He liked me, but what I was saying was unacceptable to him.
***
One of the things that still completely baffles me is the lack of acceptance by some people in this country that COVID is a problem. There are people who think that this is a hoax, that this is some made-up thing for one reason or another, when the facts are staring us right in the face.
That tells me that we have some fundamental lesions in this country that need to be addressed and healed. I know that people who are feeling that way are looking at me and saying I’m the crazy one. But I’m sorry, I have to call you on this. That’s crazy to think that this is not real.
***
I hope that if historians look back at what I’ve done in my life, they see a life of commitment to having a positive impact on society. And I have had some degree of success in doing so.
Maybe somebody many, many years from now goes back and reads about this and says, Hey, that guy was pretty good.

This story appears in the November 2021 issue of National Geographic magazine.

COVID-19 origins: Closest viruses to SARS-CoV-2 found in Laos [Medical News Today, 1 Oct 2021]

by Hannah Flynn

Since SARS-CoV-2, the virus that causes COVID-19, was first detected in Wuhan, China, in December 2019, there have been global efforts to determine its origins.
As the pandemic was thought to originate in Wuhan, many efforts have foc
used on China, with the assumption that, as the virus was first detected there, it probably started there.

Now, two papers under review by the journal Nature and published as preprints are casting some doubt on these assumptions and indicate that in order to discover the origins of the virus, researchers may have to look farther afield.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Infecting human cells
One of the reasons SARS-CoV-2 is so infectious is a region on its spike protein that gives it its ability to bind to a receptor present on the surface of many human cells called ACE2.

In a paper submitted to Nature, researchers from the Pasteur Institute in Paris, France, and from Laos have now reported finding viruses with receptor binding domains very similar to those found on SARS-CoV-2 in cave bats in North Laos.

The researchers took blood, saliva, anal feces, and urine samples from 645 bats from 46 different species found in limestone caves in North Laos, which is close to the Southwest China border.

They discovered three separate virus strains in three different species of Rhinolophus bat, commonly known as horseshoe bat. RNA sequencing revealed that these viruses were over 95% identical to SARS-CoV-2, and one, the closest virus to SARS-CoV-2 found so far, was 96.8% similar.

Further experiments showed that the receptor binding domain of the viruses had a high affinity for human ACE2 receptors. This was comparable to the affinity of SARS-CoV-2 strains that scientists discovered at the beginning of the pandemic, suggesting these viruses could infect humans directly.

Last year, scientists detected a similar virus in Yunnan, in Southwest China. It was 96.1% similar to SARS-CoV-2, meaning the present paper describes the closest virus detected yet.

Prof. Edward Holmes from the University of Sydney, Australia, who has studied the emergence and spread of SARS-CoV-2 but was not involved in this research, told Medical News Today the paper was “really significant.”

“In my opinion, these viruses won’t just be found in bats and pangolins. Ecology isn’t like that. I suspect that they will also be found in other mammalian species but have not yet been sampled,” Prof. Holmes said.

“Some of these Laotian viruses are extremely close to SARS-CoV-2 in the key receptor binding domain (part of the spike protein) of the virus. This means that the functional core of the virus exists in nature, so there is no need to think that the virus was somehow created or adapted in a lab.” – Prof. Edward Holmes

Not the ‘China virus’ after all?
Further doubt was cast on the assumption that the virus responsible for the COVID-19 pandemic originated in Wuhan with another preprint submitted to Nature.

A study by a team from the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing has suggested that SARS-CoV-2-related viruses are “extremely rare” in bats in China, after taking nose and anal swabs from over 13,000 bats between 2016 and 2021 at 703 locations across the country.

The paper also showed that SARS-CoV-2 was undetectable in samples taken from Wuhan Huanan Market, 40 days after the closure of the market, which was due to fears that the initial infection event had occurred there.

Authors conclude that further research should be done south and southwest of China to determine whether the SARS-CoV-2 virus originated there.

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Finding the origins of SARS-CoV-2
One of the reasons it has been so hard to establish where the coronavirus originated is viral genomes that change through a process called recombination, rather than just through mutations. Viral recombination occurs when two different strains infect the same host cell.
As they replicate in the same cell, they can interact, and the virus progeny they generate can have some genes from both parents. This can make it hard to work out the lineage of that virus.

“Recombination seems to be important for how these viruses evolve overall,” Spyros Lytras, an evolutionary virologist from the University of Glasgow in the United Kingdom, told MNT.

“So, essentially we are saying these viruses switch bits of their genome all the time, and the new viruses from Laos really highlight that. Even though [these viruses] are found in the same place, the same cave essentially, they all have different bits of their genome that have different combinations of recombinant parts.”

Merck says COVID-19 pill cuts risk of death, hospitalization [Associated Press, 1 Oct 2021]

By MATTHEW PERRONE

WASHINGTON (AP) — In a potential leap forward in the global fight against the pandemic, drugmaker Merck said Friday that its experimental pill for people sick with COVID-19 reduced hospitalizations and deaths by half.

If cleared by regulators, it would be the first pill shown to treat COVID-19, adding a whole new, easy-to-use weapon to an arsenal that already includes the vaccine.

The company said it will soon ask health officials in the U.S. and around the world to authorize the pill’s use. A decision from the U.S. Food and Drug Administration could come within weeks after that, and the drug, if it gets the OK, could be distributed quickly soon afterward.

All other COVID-19 treatments now authorized in the U.S. require an IV or injection. A pill taken at home, by contrast, would ease pressure on hospitals and could also help curb outbreaks in poorer and more remote corners of the world that don’t have access to the more expensive infusion therapies.

“This would allow us to treat many more people much more quickly and, we trust, much less expensively,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University who was not involved in the research.

Merck and its partner Ridgeback Biotherapeutics said early results showed patients who received the drug, molnupiravir, within five days of COVID-19 symptoms had about half the rate of hospitalization and death as those who received a dummy pill.

The study tracked 775 adults with mild-to-moderate COVID-19 who were considered high risk for severe disease because of health problems such as obesity, diabetes or heart disease. The results have not been reviewed by outside experts, the usual procedure for vetting new medical research.

Among patients taking molnupiravir, 7.3% were either hospitalized or died at the end of 30 days, compared with 14.1% of those getting the dummy pill. After that time period, there were no deaths among those who received the drug, compared with eight in the placebo group, according to Merck.

The results were so strong that an independent group of medical experts monitoring the trial recommended stopping it early.

Company executives said they plan to submit the data to the FDA in the coming days.

Even with the news of a potentially effective new treatment, experts stressed the importance of vaccines for controlling the pandemic, given that they help prevent transmission and also reduce the severity of illness in those who do get infected.

White House coronavirus coordinator Jeff Zients said that vaccination will remain the government’s main strategy for controlling the pandemic. “We want to prevent infections, not just wait to treat them when they happen,” he said.

Dr. Anthony Fauci, the government’s foremost authority on infectious diseases, called the results from Merck “very good news.”

Merck only studied its drug in people who were not vaccinated. But FDA regulators may consider authorizing it for broader use in vaccinated patients who get breakthrough COVID-19 symptoms.

Andrew Pekosz of Johns Hopkins University predicted vaccines and antiviral drugs would ultimately be used together to protect against the worst effects of COVID-19.

“These shouldn’t be seen as replacements for vaccination — the two should be seen as two strategies that can be used together to significantly reduce severe disease,” said Pekosz, a virology specialist.

Patients take four pills of molnupiravir twice a day for five days. Side effects were reported by both groups in the Merck trial, but they were slightly more common among those who received a dummy pill. The company did not specify the problems.

Earlier study results showed the drug did not benefit patients who were already hospitalized with severe disease. That’s not surprising, given that antiviral drugs are most effective when used before the virus ramps up in the body.

The U.S. has approved one antiviral drug, remdesivir, for COVID-19, and allowed emergency use of three antibody therapies that help the immune system fight the virus. But all the drugs are expensive and have to given by IV or injection at hospitals or clinics, and supplies have been stretched by the latest surge of the delta variant.

The antibody drugs have been shown to reduce hospitalization and death by roughly 70% when given to high-risk patients, roughly 20 percentage points more than Merck’s pill. But experts cautioned against comparing results from the two, given the preliminary nature of Merck’s data.

Health experts, including Fauci, have long called for a convenient pill that patients could take when COVID-19 symptoms first appear, much the way Tamiflu is given to help speed recovery from the flu.

Like other antivirals, Merck’s pill works by interfering with the virus’s ability to copy its genetic code and reproduce itself.

The U.S. government has committed to purchasing enough pills to treat 1.7 million people, assuming the FDA authorizes the drug. Merck said it can produce pills for 10 million patients by the end of the year and has contracts with governments worldwide. The company has not announced prices.

Several other companies, including Pfizer and Roche, are studying similar drugs and could report results in the coming weeks and months.

Merck had planned to enroll more than 1,500 patients in its late-stage trial before the independent board stopped it early. The results reported Friday included patients across Latin America, Europe and Africa. Executives estimated 10% of patients studied were from the U.S.
___
This story has been updated to correct that patients take eight pills per day, not two.