Dr. Fauci to mayors: Beware of ‘blips of infection’ as cities reopen

As cities across the United States begin reopening, mayors need to stand ready to respond quickly to “blips of infection” of COVID-19 that will inevitably pop up in their communities.

That was Dr. Anthony Fauci’s message for hundreds of mayors and city leaders convened yesterday for the latest online coaching and learning session of the COVID-19 Local Response Initiative. Fauci, the nation’s top infectious disease expert, was the guest of session host Michael R. Bloomberg, who called him “a central voice of reason during this time.”

Fauci told mayors that cities “absolutely need to somehow get back to a degree of normality.” At the same time, he added, the dynamics of the outbreak will look different from place to place, and every city will need to be prepared for upticks in infections.

“It is almost unreasonable to think that that’s not going to happen,” Fauci said. “You need to not be discouraged by it, but importantly, you need to have a testing program in place: tests available, the manpower to perform testing and to do the kinds of identification, isolation, and contact tracing that would prevent that blip from becoming a resurgence. Because the danger of that happening is real.”

Fauci’s comments and answers to mayors’ questions covered a wide range of topics, including:

The push to develop a vaccine quickly: The timeline for this is happening at a “very rapid pace,” Fauci said, adding: “I want you to understand that this rapid pace is not putting any safety or integrity of the study at risk. The ‘at risk’ is the financial investment. In other words, we’re going to be making investments in things that we’re not even sure work yet. If it works, we’re ahead of the game, and we could have a vaccine by December or January. If it doesn’t, then all we’ve lost is resources and money. Given the urgency of this situation, that is something we’re willing to sacrifice in order to get a vaccine more quickly.”

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People expanding their social circles in the coming weeks: The factors around this will differ from community to community, depending on the dynamics of the outbreak in that community, Fauci said, adding: “Let me explain what I mean. When my wife and daughter and I go outside into the community, we put a mask on, and we maintain physical distance. As Washington, D.C., starts to open, we are going to want to interact socially with our neighbors, the people who are next door to us or across the street. We can do that in a way that’s safe. And that is again, masks, washing hands, physical distancing, but not social distancing. As the virus goes down even more, you could start to get into crowds of 10 people. As it gets better, you can go maybe to 20 to 25 people. So it’s really a gradual reintroduction into social interaction, so long as you do some minimal things: wearing masks, washing hands and maintaining six-feet distance.”

If the virus will dissipate with warmer weather: “One would expect that a respiratory virus would lessen in its impact in warm weather,” Fauci said. “The only problem is this has not been definitively shown to be the case with this coronavirus. I expect as we get into the summer months in the temperate climates, the Middle-Atlantic States, the Northeast, and others will likely do somewhat better. But you can’t 100-percent predict that.”

The role mayors can play building public-health capacity: Moving forward, a city’s ability to respond effectively to COVID-19 will depend on its ability to, when blips come, “to identify, isolate, and contact trace,” Fauci said, adding: “I would suggest that you [as mayors] use your leadership position to marshal community volunteers. You’re going to need a workforce to go out and do the identification, isolation, and contact tracing. It’s going to happen at the local level.”

Keeping young people safe over summer: “A complete lockdown of children is going to be impossible as the summer months come,” Fauci said, adding that mayors should work to prevent crowds of children by staggering hours at swimming pools or camps. “I don’t think it’s going to be reasonable outside — when kids are running around playing baseball and running around — that they’re going to be wearing masks…. But don’t let it be a crowd of 50 kids. Try to break it down into groups of five to 10 kids playing together. I think that’s the best we can do.”

Racial disparities in COVID-19 cases and deaths: “African-Americans get what I call a double whammy,” Fauci said. “They’re often in an economic and employment situation that prevents them from protecting themselves against infection to begin with. They don’t have as much opportunity, as a cohort, to telework. They’re usually out doing the kinds of jobs that don’t allow them to be as physically separated as we would like them to be. So they have a higher risk. And then as a demographic group, they have a very disproportionate incidence and prevalence of the underlying comorbidities that make [the virus] much more dangerous for them.”

He added that public officials are “morally obligated, on our part, to concentrate the resources in those communities, so that they can do the adequate testing. And when someone gets infected, to do identification, isolation, contact tracing, and provide them with the resources to be able to physically separate.”

The importance of local leadership: “As I talk to people throughout the country, the people who are really doing the good job are yourselves, working with your health commissioners and your health authorities to try and address what is a difficult problem,” Fauci said. “We know it’s not insurmountable. We can do it if we stick together.”