IT's behind a paywall, but I pasted into a document.

Original link:https://www.nytimes.com/interactive/2023/04/24/magazine/dr-fauci-pandemic.html (Try it, you might have enough free articles to view it, I didn't.)

Copy/paste link I posted: https://justpaste.it/90unx


Some swipes:
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Wallace-Wells: Even now, when we talk about pandemic response, we focus on things like school closures and masks, but it seems to me that Covid mortality has been shaped much more by the country’s vaccination levels. There have been three times as many American deaths since Election Day 2020 as before. And we’ve done much worse, compared with our peers, since vaccination began than we had before.

Fauci: I mean, only 68 percent of the country is vaccinated. If you rank us among both developed and developing countries, we do really poorly. We’re not even in the top 10. We’re way down there.3 And then: Why do you have red states that are unvaccinated and blue states that are vaccinated? Why do you have death rates among Republicans that are higher than death rates among Democrats and independents?4 It should never ever be that way when you’re dealing with a public-health crisis the likes of which we haven’t seen in over a hundred years.

That’s part of it. The other part of it has nothing to do with that divisiveness. It has to do with the fracturing of our health care delivery system in this country. We have let the local public-health and health care delivery system really suffer attrition. And the health disparities — racial and ethnic health disparities. Every country has a little bit of that, but we really have a lot of it.

Footnote: According to a study published by the National Bureau of Economic Research in September 2022, rates of excess deaths were 76 percent higher among Republicans than Democrats throughout the pandemic. The gap was much smaller in 2020; it then grew almost sevenfold with the arrival of vaccines.
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Wallace-Wells: One thing I’ve seen you emphasizing lately is the lesson that you need to act early to stop exponential growth, and that earlier interventions are much more effective than later interventions. But in January and February and even into March of 2020, you and a lot of other folks in the public-health infrastructure were spreading a message that most Americans didn’t really need to worry about the virus, that it wasn’t a real risk to most of us. It wasn’t until later in March that the alarm was really raised. Was that too late? Could we have raised the alarm earlier? And if so, what would the effect have been, do you think?

Fauci: Well, first of all, this is one of the things that keeps getting distorted. When I said we don’t need to do anything different right at this moment, please don’t forget that was followed by a semicolon, and then a “however,” and then by, “This could change rapidly, and we better be prepared for that.” I said that every single time. And the people who want to do gotchas on me only show the first part.

Wallace-Wells: But if you go back in time, if you put yourself in February 2020, you’re telling Helen Branswell,7 for instance, that this virus was low-risk and that you didn’t want to stake your credibility on what could be a false alarm. Do you wish you had said then more emphatically that this is a real, urgent threat and that we need to stand up our defenses immediately?

Footnote: “At present,” Fauci told the veteran journalist at an Aspen Institute panel on Feb. 11, 2020, “the risk is really relatively low.” But he was careful to say: “Is there a risk that this is going to turn into a global pandemic? Absolutely. Yes, there is.” He also added that “if we got up and said … ‘We’ve really, really got a big risk of getting completely wiped out’ and then nothing happens, then your credibility is gone.”

Fauci: Yeah, I think, retrospectively, we certainly should have done that. If you look at what we knew at the time, though — we didn’t know that in January. We were not fully appreciative of the fact that we were dealing with a highly, highly transmissible virus that was clearly spread by ways that were unprecedented and unexperienced by us. And so it fooled us in the beginning and confused us about the need for masks and the need for ventilation and the need for inhibition of social interaction.

Wallace-Wells: The asymptomatic spread.

Fauci: To me, that was the game-changer. And if we knew that very early on, our strategy for dealing with the outbreak in those early weeks would have been different. So when people say to me, “Could we have done better?” Of course, of course. If you knew many of the things then that now you know, definitely you would want to do things differently.

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Wallace-Wells: It was around the same time that the mask guidance wavered — first, masks were not recommended, and then they were.9 But I want to ask you to reflect on the even bigger picture: Were the culture-war fights over masking worth it? Or did those fights have a bigger negative impact on future vaccine uptake among conservatives than the positive impact they had on spread? To be clear: I’m not someone who doesn’t think masks work. I think the science and the data show that they do work, but that they aren’t perfect and that at the population level the effect can be somewhat small. In what was probably our best study, from Bangladesh, in places where mask use tripled, positive tests were reduced by less than 10 percent.

Fauci: It’s a good point in general, but I disagree with your premise a bit. From a broad public-health standpoint, at the population level, masks work at the margins — maybe 10 percent. But for an individual who religiously wears a mask, a well-fitted KN95 or N95, it’s not at the margin. It really does work.

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Wallace-Wells: But when I watched your recent lecture at Georgetown, you didn’t talk about herd immunity at all. Nobody does. Which makes sense, given that perhaps 95 percent of the country has had the disease, on top of the almost 70 percent who have been vaccinated, and the virus is obviously still circulating. And in fact a number of epidemiologists I’ve spoken to have told me that given the nature of this virus, we should have never entertained herd immunity as a possibility, given the way SARS-CoV-2 replicates in the body. What went wrong there?

Fauci: Well, I don’t think anybody did anything wrong. What went wrong was that the virus did not act the way one would have thought the virus would act. We made an assumption that turned out to be an incorrect assumption — that this was going to act like other viruses.
The classical definition of herd immunity has been completely turned upside down by Covid. And let me go through the steps. Herd immunity is based on two premises: one, that the virus doesn’t change, and two, that when you get infected or vaccinated, the durability of protection is measured in decades, if not a lifetime. With SARS-CoV-2, we thought protection against infection was going to be measured in a long period of time. And we found out — wait a minute, protection against infection, and against severe disease, is measured in months, not decades. No. 2, the virus that you got infected with in January 2020 is very different from the virus that you’re going to get infected with in 2021 and 2022.

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Wallace-Wells: So were we wrong to ever expect that after a given amount of infection and vaccination, the disease would disappear? Because that was an extremely conventional view in 2020.

Fauci: It depends on what you mean by “disappear.” If you control community infection at a low-enough level that it doesn’t disrupt society, to some people that means it disappears. To other people, it means, well, it’s there, but it doesn’t bother society very much.
But be careful: No, it was not completely out of line to think that you could get protection against infection — that even if you got some virus in you, it wouldn’t be of a high-enough titer to transmit to somebody else.

And then we found out something that was stunning. When you looked at the titer of the virus in infected and asymptomatic people and a virus in the nose of symptomatic infected people, it was the same. What the hell is going on here? That was a big surprise. So we were wrong, but we weren’t wrong because we didn’t interpret data in front of us. We never had those data. We did not know early on that 50 to 60 percent of the transmissions would be asymptomatic. That was like, whoa. When I saw those data, I said: This is different. We’re dealing with a disease the likes of which we’ve never seen before.

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Wallace-Wells: In the vaccine rollout, did we make a mistake in prioritizing health care workers as opposed to seniors?

Fauci: I don’t know if it was a mistake. A mistake is such a charged word. “Fauci made a mistake, people died. Fauci lied, people died.” Come on. I don’t know if it was a mistake. I think the standard way of protecting people who are at greater risk every day was a sound principle.

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Wallace-Wells: But the particular responsibility shakes out a little bit differently if it’s ultimately some vendor in a wet market who is illegally transporting animals or if it’s the product of this international research apparatus, right? I don’t want to overstate the American authority or oversight over every experiment at the Wuhan Institute of Virology — let alone the Wuhan C.D.C. But there is a large American component to the development of this whole international enterprise, going back several decades, and you’ve played a role in developing and funding that.

Fauci: First of all, all of the intelligence groups agree that this was not an engineered virus. And if it’s not an engineered virus, what actually leaked from the lab? If it wasn’t an engineered virus, somebody went out into the field, got infected, came back to the lab and then spread it out to other people. That ain’t a lab leak, strictly speaking. That’s a natural occurrence.

Wallace-Wells: Even in that case, the research itself is still playing a role. But when you say everyone agrees it was not an engineered virus — I don’t think they do. I think they generally agree it was not purposefully engineered to be a bioweapon. I don’t believe they’ve ruled out other forms of engineering — direct genetic interventions or serial passage of viruses.

Fauci: David, you could have taken a virus and serially passaged it in 1920. I could do that tomorrow in your kitchen. You don’t need to do engineering.13

Footnote: 13
The term “gain of function” is used by different people in different ways. To some, it refers to any effort to produce new features in a virus, whether through direct genetic manipulation or simply accelerating natural evolution. When the N.I.H. resumed funding gain-of-function research after a three-year safety review, they did so under what was called the "P3CO" framework, under which research with pathogens known to be infectious and dangerous to humans was held to a higher level of scrutiny.

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Read the whole thing it's get a little heated.

And if you look at the viruses that the $120,000-a-year grant was given through EcoHealth to the Wuhan Institute to do surveillance on, and you look at the viruses that they studied that they published in the literature, and that was in all of their progress reports, those viruses could not possibly ever turn into SARS-CoV-2, even if they tried to turn them into SARS-CoV-2, because they were evolutionarily so far from SARS-CoV-2 that anybody who knows anything about virology would say there’s nothing you could do to those viruses that would turn them into SARS-CoV-2. Yet what gets conflated is that the N.I.H. funded them, therefore you are liable for the lab leak if it’s a lab leak. It had nothing to do with what we did, because the viruses were unable to be made into SARS-CoV-2.