4 Fauci quotes that illuminate this week's most frustrating Covid-19 questions

The newly available Dr. Anthony Fauci bobblehead is capable of only yes or no answers. The real Anthony Fauci has been dealing with questions that, even moths into this pandemic, feel extremely unanswerable.

This week, Fauci spoke to medical societies, news outlets, and Matthew McConaughey's Instagram followers about a series of vexing Covid-19 questions. Here’s Fauci on whether we should mandate a vaccine, how long it takes to recover from a mild case of coronavirus, what happens to the body after Covid-19, and more.

As a public service, Inverse is aggregating Fauci's comments regularly in the "Fauci Dispatch" series, as the White House has severely limited his visibility to the public.

• Read the Fauci Dispatch from August 13, 2020 here
• Read the Fauci Dispatch from August 5, 2020 here
• Read the Fauci Dispatch from July 29, 2020 here
• Read the Fauci Dispatch from July 22, 2020 here

Fauci on mandating a vaccine – In an interview with Healthline on Tuesday, Fauci responded to questions over whether the Covid-19 vaccine would be mandated for the general public.

“I don’t think you’ll ever see a mandating of vaccine,” Fauci said.

The backdrop – State and city governments technically do have the power to mandate a person to get a vaccine or be subject to a fine (New York City did so to combat measles in 2019).

However, the FDA, which licenses vaccines, does not have that authority. The closest thing to a true vaccine requirement for the general public is a vaccination requirement for enrolling school – though many states still allow for medical and “non-medical” exemptions that allow enrollment to continue anyway.

Non-medical exemptions to vaccines have caused significant controversy and, in part, the resurgence of preventable diseases. Prior to the 2019 outbreak of measles, scientists were able to pinpoint communities where nonmedical exemptions to vaccines were particularly high – like Portland, Oregon. In 2019, measles tore through those communities after decades of little activity in the United States, raising the question of whether we should ban non-medical exemptions. Only five states have banned all exemptions to vaccines that are non-medical: New York, Maine, Mississippi, California, and West Virginia.

"I don’t think you’ll ever see a mandating of vaccine."

Despite the breadth of the coronavirus pandemic, Fauci’s comments suggest that we are unlikely to see a change in vaccine policy – but it's possible there may be exceptions. For instance, healthcare workers who treat patients with the disease may need to get the vaccine to enter the Covid-19 wards.

Importantly, most people plan to get the Covid-19 vaccine on their own, without a mandate. Polls suggest that about two-thirds of Americans would get the vaccine. For those who are unsure, there are ways to get that conversation rolling in lieu of policy that has yet to materialize (and likely never will).

Fauci on the long road to recovery – Speaking to the American Society for Microbiology, Fauci pointed out that the road to recovery from Covid-19 is often not easy, even for young adults.

“In individuals who are young and otherwise healthy, who don't require hospitalization but do get sick and symptomatic enough to be in bed for a week or two or three and then get better, they clear the virus — they have residual symptoms for weeks and sometimes months,” Fauci said.

The backdrop – Scientists are still untangling what the Covid-19 recovery process looks like for people who get a mild form of the disease.

Several patients with mild illness told Inverse in June that they “never expected recovery to drag on like this.” In the United Kingdom and Italy, government health authorities have set up Covid-19 rehab institutes for those who experience longer recovery times.

A July CDC survey confirmed that some people see longer-than-expected returns to health. Of the 274 symptomatic patients surveyed, the team found that 35 percent didn’t feel normal by the time they were interviewed, a median of 16 days after they tested positive. Those symptoms included cough (experienced by 43 percent of people), fatigue (35 percent), and shortness of breath (29 percent). A study in Italy found that 87.4 percent of 143 hospitalized patients had persistent symptoms, especially fatigue, months after they had left the hospital.

As Fauci noted in his talk, young people may also experience longer recovery times. Twenty-six percent of people between the ages of 18 to 34 didn’t feel normal when they were interviewed by the CDC.

Fauci on the consequences of Covid-19 in the body – Also at the briefing with the American Society of Microbiology, Fauci spoke about the long-term consequences of Covid-19 on the body, even for people with mild cases.

“I'll guarantee you if we have this conversation again, six months to a year from now, we’ll be reviewing the literature about talking about the long-term deleterious effects of non-hospitalized patients,” he continued.

The backdrop – The novel coronavirus is treated like a respiratory illness, but it actually affects many different tissues in the body. One place that’s drawing increased medical attention is the heart.

In July, a study published in JAMA Cardiology showed that the disease appeared to be linked to damaging cardiovascular changes. Scientists compared MRIs of the hearts of 100 people with and without coronavirus and found that 60 of those patients showed signs of inflammation even if they didn't have a preexisting condition.

Commenting on this study in a New York Times op-ed, Harvard cardiologist Haider Warraich noted that the study wasn’t perfect, but that there also seem to be anecdotal reports of myocarditis associated with Covid-19, or inflammation of the heart muscle. Specifically, he points to five infected college football players who have signs of myocarditis.

It’s not unheard of for a virus to cause inflammation of the heart – myocarditis can also be caused by flu viruses. Even if it’s rare, it does pose a risk for athletes who push their hearts hard, especially college athletes who may be more at-risk as schools reopen. In an August 13 call, NCAA chief medical officer said that between one and two percent of college athletes were testing positive for Covid-19 and at least 12 were later found to have had myocarditis.

Fauci on convalescent plasma therapy – Since April, there have been ongoing clinical trials investigating whether convalescent plasma donated from recovered Covid-19 patients may be useful as treatment for severe and non-severe cases.

Fauci has regularly discussed convalescent plasma trials as a potential way to treat patients before they need to go to the hospital. “That’s really what convalescent plasma is,” he said during a White House roundtable on plasma donation in late July.

The backdrop – Promising, yet incomplete trials on convalescent plasma in China suggested it could be effective. However, in the absence of a randomized, controlled clinical trial, scientists still don’t know if this method really works. Recently a pre-print paper (not peer-reviewed) from the Mayo Clinic’s large-scale convalescent plasma study suggested that it might be helpful for severe patients and appeared to reduce mortality rates.

That said, the Mayo Clinic study only reports partial results from the trial. The FDA’s initial plan to provide an emergency use authorization that would allow for convalescent plasma treatment to be used regularly is now stalled, The New York Times reported Wednesday.

Fauci, as well as Francis Collins, Director of the National Institutes of Health and H. Clifford Lane, the clinical director at the National Institute of Allergy and Infectious Diseases, are reviewing the data again.

“The three of us are pretty aligned on the importance of robust data through randomized control trials, and that a pandemic does not change that,” Lane said.