• A Tale of Two Pandemics: In Conversation With Dr. Fauci

    AAO 2021’s Closing Session on Monday featured a conversation between NEI Director Michael F. Chiang, MD, and Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases. Some highlights from their discussion:

    An unexpected journey. Before the COVID-19 pandemic, many ophthalmologists first became aware of Dr. Fauci’s work during the 1980s, when the HIV crisis began.

    “I got involved literally in the first week of the recognition of this new outbreak, when I received that issue of Morbidity and Mortality Weekly Report,” which included a report of pneumocystis pneumonia cases in Los Angeles,1 Dr. Fauci said.

    At the beginning of the AIDS epidemic, he spent most of his time taking care of wards full of “desperately ill people who never came to the attention of the medical system” until they had advanced disease, Dr. Fauci said. “We didn’t have any tests to determine if somebody was HIV positive, because we didn’t know it was HIV.”

    By 1996, lifesaving drugs were available. This trajectory — from those first few years, “when every one of your patients with very few exceptions dies,” to a time when “virtually everybody’s leading a normal lifespan, presuming they get diagnosed in time” — is an experience “that few of us go through in medicine,” Dr. Fauci said.

    His experience with the AIDS activist community was equally uncommon, he said, as he watched the activists transform from “people who are vehemently against you, because they don’t think that the government is doing enough, to people who become colleagues and friends and collaborators.”

    Living through your worst nightmare. The first cases of SARS-CoV2 in the United States were reported in January 2021.2

    For many years before this point, he said, “People would ask me, ‘What is your worst nightmare?’” His reply: “My worst nightmare is a brand-new virus that jumps species from an animal host, that’s respiratory-borne, and that has two simultaneous characteristics: 1) It spreads enormously efficiently from person to person; and 2) It has a high degree of morbidity and mortality.”

    Sure enough, Dr. Fauci said, “We are living through my worst nightmare.” But more than that, “We’re living through history,” he said. “Because when this is all over, and we talk to our students and to our children and grandchildren, we’ll say that we lived through the most devastating pandemic in well over 100 years.”

    A word of advice re: vaccine hesitancy. What advice would Dr. Fauci give ophthalmologists who are dealing with those who are hesitant to be vaccinated? To start with, it’s important to remember that most people trust their physicians, Dr. Fauci said. “The best way to convince someone who has a variable degree of hesitancy is, first, don’t ridicule or attack them in a pejorative way, because that only makes people defensive. Instead, use your status as a trusted messenger to try to unpack why it is that they’re hesitant.” — Jean Shaw

    1 CDC. MMWR. 1981;30(21):250-252.

    2 Galloway SE et al. MMWR. 2021;70(3):95-99.

    Financial disclosures: Dr. Chiang: NIH: E. Dr. Fauci: NIH: E.