Dear Dr Fauci,
I would like to commend you on the phenomenal job you have been doing as chief medical advisor to the President during the COVID-19 pandemic. Your efforts are all the more heroic, given how little we knew at first about this ever-evolving illness, the unbearable strain that it has placed on hospitals and health care workers, and the extreme hostility and politicization that have evolved regarding necessary public health recommendations. Your leadership recalls that of C. Everett Koop, who rose up against the antagonism of the Reagan administration during the early days of the HIV epidemic.
Although I could never praise you sufficiently for all you have done, I would like to take this opportunity to point out some of the shortcomings in this country’s handling of the pandemic in order to satisfy my need to speak out. I apologize in advance for suggesting that I am in a position to criticize you, given your credentials. After all, I am just a mild-mannered physician, caring for patients amid a health crisis of unparalleled significance. What my position does afford me is the opportunity to listen to a group of the “walking wounded.” Most of my patients are afflicted with CLL, which enables them to avoid the toxic treatments that leave most patients treated for cancer physically devastated. Thus, my patients are “walking.” Unfortunately, the profound immune dysfunction associated with CLL leaves them prone to the mildest infections. Thus, my patients are “wounded.”
At the beginning of the pandemic, my patients barricaded themselves indoors, isolating themselves in the hope of riding out the pandemic. Unfortunately, we did not pull together sufficiently as a nation and universally follow the CDC guidance regarding isolation and mask wearing. It quickly became apparent that the virus was not going to be a one-wave phenomenon. During the first wave in New York City, isolation precautions were sufficiently successful to bring down the daily number of new cases to a low of 145 on August 2, 2020, according to COVID-19 data from the NYC Department of Health (https://www1.nyc.gov/site/doh/index.page). But the virus came roaring back, and with a more contagious variant, ending any hope of riding out the pandemic. Then, when vaccines became available, immunocompromised patients anxiously waited for the rest of the eligible population to be vaccinated, so that herd immunity would develop. Herd immunity still has not been realized, however, and my patients remained stuck at home in isolation.
We are now confronted with another variant—Omicron. Although Omicron appears to be far less deadly than earlier variants, it is far more contagious. Omicron raises two very important issues that I believe you need to address.
First, we need much better messaging regarding vaccines. Many anti-vaxxers point to the number of vaccinated people in whom symptomatic infections with Omicron develop as a sign that COVID-19 vaccines are unhelpful. Although it is true that Omicron is resulting in large numbers of breakthrough infections, vaccination remains extremely effective at reducing serious illnesses, hospitalizations, and deaths. Data from the NYC Department of Health show that in the week ending January 8, 95% of the people hospitalized for COVID-19 in New York City were unvaccinated. In fact, unvaccinated New Yorkers were about 13 times more likely than vaccinated New Yorkers to contract COVID-19, 18 times more likely to be hospitalized, and 17 times more likely to die of the disease. These types of data need to be reported far and wide—they should be trumpeted from the rooftops!
Second, we need quicker access to variant-specific boosters. How will it be possible to develop a vaccine for a variant given the timelines required for authorization and approval? Just as Omicron evolved owing to the selective pressure applied by earlier immune responses, other variants will arise. As Michael Crichton wrote in the 1990 novel Jurassic Park, “Life will find a way.” Starting from scratch and going through the whole process for each variant is unthinkable. What plans are in place to address this issue?
Omicron may very well represent the beginning of the end for COVID-19, as its contagiousness may lead to herd immunity without everyone being vaccinated. This pattern of mutation to a benign variant is how the 1918 influenza pandemic ended (and served as the plot ending for Michael Crichton’s 1969 novel, The Andromeda Strain). But we may very well be back to where we were in March 2020 with the next variant. Please do everything you can to prevent that from happening. We all need you to be as heroic now as you were in the first days of the pandemic.
Richard R. Furman, MD