April 20, 2020

Doctor Fauci and the Pandemic

By Kenneth Ring, Ph.D.

You’ve seen his face. You’ve heard his raspy voice. But what do you know about the man himself?

I confess I didn't know much about him at all until I read a recent twelve-page profile of him in The New Yorker entitled "How Anthony Fauci Became America's Doctor" (April 20, 2020) by one of its veteran staff writers, Michael Specter, who often writes on medical subjects. Specter was a perfect choice for this piece since he has known Fauci beginning in the mid-1980s and has followed his career closely ever since. Virtually everything that follows, with the exception of a few personal asides and my concluding remarks, is drawn from Specter's article. My hope is that my little blog will stimulate you to look up and read Specter’s profile, but for those of you who don’t read The New Yorker or don’t know much about Fauci from other sources, I can at least provide something of a thumbnail sketch of this remarkable man.

So who is Anthony S. Fauci, the country’s leading and now very prominent expert on infectious diseases? Since I mean to introduce you to the man before briefly discussing his career and especially his role the corona pandemic, let’s begin at the beginning when Fauci was a kid growing up in Brooklyn in the early 1940s.

Perhaps significantly, he made his debut into this world on Christmas eve of 1940, when his parents were living in an area of Brooklyn called Bensonhurst. Oddly enough, a few years later, I spent a summer there myself just before the end of WW II when I was nine years old. I still remember a kid yelling after me, "Hey, California, you wanna play stickball?" Tony might have been living in the same neighborhood then, but even if so, stickball was not to be his game; he would be keen for hoops.

Tony's parents were Catholics, and he would wind up having a thorough and very superior Catholic education, but as a kid he was also busy making deliveries on his Schwinn bicycle for his father, a pharmacist, and playing basketball. But he had an interest in baseball, too, as Brooklyn was then still the home of the Dodgers, affectionately known as "dem bums." Oddly enough, however, Tony was a Yankee fan, and those were the days to be one since as of 1947, they were almost always World Champions for the next sixteen years. Reflecting on those years, he told Specter, "You probably are unaware, but half the kids in Brooklyn were Yankee fans. We spent our days arguing who was better: Duke Snider versus Mickey Mantle; Roy Campanella versus Yogi Berra; Pee Wee Reese versus Phil Rizzuto and on and on. Those were the days, my friend."

They were indeed. I was an ardent Yankee fan myself in those years, after seeing my first big league game at Yankee Stadium in 1945, and grew up worshipping those Yankee idols during that team's glory years. But that's the last thing Tony and I had in common when we were both kids, so let's get back to him and his story.

In 1954, he began attending Regis, a very elite private Jesuit high school on the Upper East Side. It was quite a hike from Brooklyn to 84th and Madison and Fauci estimates that he had spent the equivalent of seventy days of his teen-age life on the various subways and buses he took to get to and from school.

But he loved it there and quickly showed himself to be a very gifted student. And in those days, especially at schools where the teaching regimen was rigorous, the curriculum was very demanding. "We took four years of Greek, four years of Latin, three years of French, ancient history, theology," he told Specter who also observes that at Regis, "he developed an ability to set out an argument and to bolster it with evidence -- good preparation, it turned out, for testifying before Congress."

Let me now simply quote a couple of paragraphs from Specter’s profile that will make it clear how Tony was obliged to give up a career in basketball and to become a doctor instead. This will also help you to see how the boy developed into the man we know today.
At the time, though, Fauci had no interest in becoming a doctor. "I was captain of the Regis High School basketball team," he once told me. "I thought this was what I wanted to do with myself. But, being a realist, I very quickly found out that a five-seven, really fast, good-shooting point guard will never be as good as a really fast, good-shooting seven-footer. I decided to change the direction of my career."
At school, Fauci’s accomplished peers were headed to careers in medicine, engineering, and the law. At home, he was steeped in the humanities: "Virtually all my relatives on my mother’s side -- her father, her brother, and her sister’s children -- are artists." His mother helped tip the balance. "She never really pressured me in any way, but I think I subtly picked up the vibrations that she wanted very much for me to be a physician," Fauci said. "There was this tension -- would it be humanities and classics, or would it be science? As I analyzed that, it seemed to me that being a physician was the perfect melding of both of those aspirations."
Fauci wanted to attend an Ivy League school, but his Jesuit teachers wouldn’t permit it! He would have to choose a Catholic institution, and his choice was to go to Holy Cross in Worchester, Massachusetts. But as he did at Regis, Fauci was to thrive there. He enrolled in a program called Bachelor of Arts -- Greek Classics -- Premed. "It was really kind of bizarre," he recalled. "We did a lot of classics, Greek, Latin, Romance languages... We took many credits of philosophy, everything from epistemology to philosophical psychology, logic, etc. But we took enough biology and physics and science to get you into medical school."

Fauci was now bound for medical school at Cornell, but in those years he had to spend summers working construction jobs. And here again, I can’t resist quoting another delightful anecdote from Specter’s article:
One year, he found himself assigned to a crew that was building a new library at Cornell Medical College, on the Upper East Side. "On lunch break, when the crew were eating their hero sandwiches and making catcalls to nurses, I snuck into the auditorium to take a peek," Fauci recalled in 1998, at the medical school’s centennial celebration. "I got goose bumps as I entered, looked around the empty room, and imagined what it would be like to attend this extraordinary institution. After a few minutes at the doorway, a guard came and politely told me to leave, since my dirty boots were soiling the floor. I looked at him and said proudly that I would be attending this institution a year from now. He laughed and said, ‘Right, kid, and next year I am going to be Police Commissioner.'"
Fauci graduated first in his class in 1966, which of course was during America's involvement in the Vietnam War. At that time, every new physician had to select some form of military service. Public Health Service was one of the options, and Fauci went for that. The dye was cast.

Fauci in the five decades since as the country’s leading infectious disease expert has gone on to have a storied career, garnering more laurels than a dozen Olympic champions, and Specter’s profile provides many such accolades. You will need to read Specter’s article to follow the course of Fauci’s career, but he provides a very full account of Fauci’s involvement with the AIDS crisis, which came to his attention in 1981 and consumed much of his time for the following decade. Did you know he made fundamental contributions to the understanding and treatment of AIDS? I didn’t. That part of his story is fascinating. He went from being a stickler for rigorous testing to becoming an advocate and activist for people suffering from AIDS. "I went to the gay bathhouses and spoke to them. I went to San Francisco, to the Castro District, and I discussed the problems they were having, the degree of suffering that was going on in the community, the need for them to get involved in clinical trials, since there were no other possibilities for them to get access to drugs. And I earned their confidence."

Larry Kramer, one of the most important AIDS activists, had spent years vilifying Fauci, but after Fauci confessed his errors and joined the cause they became friends. Each of them came to value the other’s contributions to medicine greatly, so much so that Kramer ultimately gave Fauci his highest accolade, calling him, "the only true and great hero" among government officials in the AIDS crisis.

I wish I had time to review Fauci’s career, but this is a blog, not a real essay, so I must move things along. But if what I have written so far has made you curious to learn more about this extraordinary man, who, pushing eighty, still works 18 hours a day, and who has been the one indispensable figure in helping us understand the current pandemic, I can only urge you again to consult Specter’s article or other sources of information about Fauci. For now, before we turn to his role in the COVID crisis, let it suffice for me to quote just two brief appraisals of Fauci’s importance.

David Baltimore, a Nobel laureate and a pioneer of molecular biology, told Specter, "Tony is unique, in that he has such credibility with politicians that he’s been able to insert hard facts into the conversation. That has been wonderful for our country and the world." According to David Relman, a microbiologist at Stanford University who for years has advised the government on biological threats, "Tony has essentially become the embodiment of the biomedical and public-health research enterprise in the United States. Nobody is a more tireless champion of the truth and the facts. I am not entirely sure what we would do without him."

The public seems to agree with these assessments, too. According to a recent poll, 78% of Americans approve of Fauci's handling of the pandemic while only 7% disapprove. Contrast that with Trump’s ratings where 65%, according to the latest poll I’ve seen, disapprove of the President's performance during this crisis.

Indeed, rather like Ruth Bader Ginsberg, Fauci has seemingly become in a very short time, something of a cultural icon, as Spectator amusingly recounts:
These days, nearly everyone has heard of Fauci. Pandemic-memorabilia entrepreneurs have put his face on bottle openers, coffee mugs, and bumper stickers: "In Dr. Fauci we trust." The National Bobblehead Hall of Fame and Museum has produced a seven-inch likeness of him, partly to raise money to produce protective gear for medical workers. There’s a Facebook group called Dr. Fauci Speaks, We Listen, and another called Dr. Fauci Memes for Social Distance Teens. A petition has circulated to nominate him as People’s "sexiest man alive."
But let’s get serious now and turn our attention back to the pandemic. As we have been made well aware now, we should have seen this coming. Virtually every reputable epidemiologist and virologist anticipated one or more as a certainty, not an if, but a when. Fauci, too, had warned that we should have been prepared for one, certainly much better prepared than we were, as he has admitted.

We have been preparing for the wrong war. "We spend many billions of dollars every year on missile-defense systems," Seth Berkley, a medical epidemiologist who leads the Global Vaccine Alliance," told Spector. "And yet we will not spend pennies on the dollar to prepare for a catastrophe that is far more likely to affect us all."

The Nobel Prize-winning molecular biologist Joshua Lederberg, another expert on infectious diseases, wrote years ago that "We live in evolutionary competition with microbes -- bacteria and viruses. There is no guarantee that we will be the survivors." We just haven’t been paying attention to the invisible threat to humanity's future, but we have been forced by circumstances to wake up, and to pay urgent heed to what Fauci and other experts have been telling us for years.

Fauci himself has long advocated the development of a universal influenza vaccine, which would provide lasting defense against all strains. "Similar to tetanus, a universal flu vaccine probably would be given every ten years," he said. "And, if you get one that is really universal, you can vaccinate just about everyone in the world." But such a vaccine would cost hundreds of millions of dollars to develop and test. Still, we now spend many billions on defense, which really means war preparedness and serving the interests of arms manufacturers and the military. How much will Congress be willing to appropriate to defend us from our real enemy?

Spector himself is not optimistic.
Even Fauci’s current value as a scientific adviser has been limited by the President's contempt for expertise. Trump's coronavirus kitchen cabinet consists of people like his son-in-law, Jared Kushner, who has no medical knowledge or experience managing crises -- yet has been appointed to direct the response to the biggest medical emergency since the influenza pandemic of 1918. Trump has also turned for advice to Dr. Mehmet Oz, who for years has endorsed worthless treatments and used his television show to promote notorious quacks. Trump even seems to think that his trade adviser, Peter Navarro, should debate Fauci about the value of specific drugs. When Navarro, who has a doctoral degree in economics, was asked about his medical qualifications, he said, "I have a Ph.D. And I understand how to read statistical studies, whether it’s in medicine, the law, economics, or whatever."
The President, clearly, is more focused on "re-opening the economy" and bolstering his chances for re-election than in following the advice of his public health experts like Fauci whom he seemingly only grudgingly listens to and is doing his best to sideline. And that's where we seem to stand now, trying to contain a virus in a kind of ad hoc half-assed way that we were woefully unprepared for and that the President seems to want to wish away by a kind of magical incantation.

But if after all this, if we will have failed to learn that we must make a massive investment in public health in order to be much better prepared for the next pandemic than we were for this one, the voices of experts like Dr. Fauci will again be voices in the wilderness. We cannot afford to let that happen.


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