Until the formal transition begins, there are critical — and usually routine — things the incoming Biden officials cannot do.

This article was published on Monday, November 23, 2020 in Kaiser Health News.

By Julie Rovner

When Barack Obama was elected president in 2008, the country was in the midst of a dire economic crisis. Twelve years later, his vice president, Joe Biden, has been elected president in the midst of a dire economic crisis and a worldwide, worsening coronavirus pandemic.

In 2008, Obama’s team and that of outgoing President George W. Bush worked together to allow the new administration to be as prepared as possible on Jan. 20, 2009. That’s not happening for Biden, as President Donald Trump continues to fight the election results and block the official transition.

Particularly when it comes to the COVID-19 pandemic, experts say, that delay could cost lives.

“If the new team has to waste time getting up to speed, that’s a huge waste of resources,” said Donald Kettl, a professor at the LBJ School of Public Affairs at the University of Texas-Austin and an expert in presidential transitions.

Until the formal transition begins, there are critical — and usually routine — things the incoming Biden officials cannot do, said Kettl. “Among the things not allowed right now are formal briefings by government officials, including Tony Fauci,” the head of the National Institute of Allergy and Infectious Diseases and the top federal infectious disease expert. In addition, Kettl said, Biden’s landing teams — the handful of people who go inside government agencies to start the actual transition work — “cannot actually land and talk to the people doing front-line planning. And they can’t see some of the front-line documents.”

Biden can — and is — meeting with plenty of people who will be vital to carry out his administration’s fight against COVID. On Thursday, he met remotely with a bipartisan group of governors and vowed afterward to continue to work with state and local officials. He also has his own COVID advisory board, led by former Surgeon General Vivek Murthy; former commissioner of the Food and Drug Administration, David Kessler; and Yale researcher Dr. Marcella Nunez-Smith.

But Kettl warned that it’s not enough for Biden to surround himself with smart, experienced people with good policy ideas. “The biggest risk they face is in managing these details, and that’s where a direct connection with the bureaucracy is so important, and we can’t afford to fumble this handoff,” he said.

So what can Biden do between now and Jan. 20?

Some public health advocates suggest he could set up a shadow COVID effort, to compete with the Trump administration’s task force. “He could do briefings three times a week telling us what we know and what we don’t,” said Dr. Arthur Kellermann, a longtime public health expert who is now CEO of the Virginia Commonwealth University Health System. Without better information for the public, Kellermann said, “we could lose tens of thousands of people between now and” Inauguration Day.

But others worry that Biden needs to be careful not to appear to have more power than he does, lest he end up with the blame if things don’t go well, particularly on the complicated issue of getting a vaccine distributed and accepted by the general public.

“I think we have to have reasonable expectations of what they can do,” said Farzad Mostashari, a senior health official at HHS in the Obama administration. “A lot has got to be planning and creating a ‘whole of government’ approach to tackling COVID.”

Kettl said the incoming Biden administration is better positioned than many others would have been because they have such recent experience running the government. Incoming White House chief of staff Ron Klain, for example, coordinated the federal government’s response to the Ebola outbreak in 2014. “There’s never been a group or team more prepared to run the government than this one,” Kettl said.

But it won’t be as easy as just picking up where they left off, he said, because of how politicized health and science has become. “The places they are walking into are not the same places they walked out of four years ago. The CDC is a shell of itself, the FDA is not the same.”

Mostashari, though, said he is confident the federal government can do more to combat the virus. “There are plenty of experts [still in the government] who are amazing at what they do,” he said. “They just have to unshackle them.”

HealthBent, a regular feature of Kaiser Health News, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years.

As doctors and medical practices nationwide navigate a new normal with COVID-19 again surging, some are relying on urgent care sites and emergency departments to care for sick patients, even those with minor ailments.

This article was published on Monday, November 23, 2020 in Kaiser Health News.

By Kristy P. Kennedy

A mom of eight boys, Kim Gudgeon was at her wits' end when she called her family doctor in suburban Chicago to schedule a sick visit for increasingly fussy, 1-year-old Bryce.

He had been up at night and was disrupting his brothers' e-learning during the day. "He was just miserable," Gudgeon said. "And the older kids were like, 'Mom, I can't hear my teacher.' There's only so much room in the house when you have a crying baby."

She hoped the doctor might just phone in a prescription since Bryce had been seen a few days earlier for a well visit. The doctor had noted redness in one ear but opted to hold off on treatment.

To Gudgeon's surprise, that's not what happened. Instead, when she called, her son was referred to urgent care, a practice that has become common for the Edward Medical Group, which included her family doctor and more than 100 other doctors affiliated with local urgent care and hospital facilities. Because of concerns about the transmission of the coronavirus, the group is now generally relying on virtual visits for the sick, but often refers infants and young children to urgent care to be seen in person.

"We have to take into consideration the risk of exposing chronically ill and well patients, staff and visitors in offices, waiting areas or public spaces," said Adam Schriedel, chief medical officer and a practicing internist with the group.

Gudgeon's experience is not unusual. As doctors and medical practices nationwide navigate a new normal with COVID-19 again surging, some are relying on urgent care sites and emergency departments to care for sick patients, even those with minor ailments.

That policy is troubling to Dr. Arthur "Tim" Garson Jr., a clinical professor in the College of Medicine at the University of Houston who studies community health and medical management issues. "It's a practice's responsibility to take care of patients," Garson said. He worries about patients who can't do video visits if they don't have a smartphone or access to the internet or simply aren't comfortable using that technology.

Garson supports protocols to protect staff and patients, including in some instances referrals to urgent care. In those cases, practices should be making sure their patients are referred to good providers, he said. For instance, children should be seen by urgent care facilities with pediatric specialists.

Referrals for children have become so prevalent that the American Academy of Pediatrics came out with interim guidance on how practices can safely see patients, in an effort to promote patient-centered care and to ease the strain on other medical facilities as the peak of flu season approaches. The academy recommended that pediatricians strive "to provide care for the same variety of visits that they provided prior to the public health emergency."

The academy raises concerns about unintended consequences of referrals, such as the fragmentation of care and increased exposure to other illnesses, both caused by patients seeing multiple providers; higher out-of-pocket costs for families; and an unfair burden shifting to the urgent care system as illnesses surge.

"I think this is all being driven by fear, not really knowing how to do this safely, and not really thinking about all of the sorts of consequences that are going to come as flu and other respiratory illnesses surge this fall and winter," said Dr. Susan Kressly, who recently retired from her practice in Warrington, Pennsylvania, and authored the AAP guidance.

Fear is not unfounded. More than 900 healthcare workers, 20 of them pediatricians and pediatric nurses, have died of COVID-19, according to a KHN-Guardian database of front-line healthcare workers lost to the coronavirus.

For the Edward Medical Group, referrals are a safe way to treat patients by using all the resources of its medical system, Schriedel said.

"We can assure patients, regardless of COVID-19, we have multiple options to provide the care and services they need," he said.

Besides urgent care referrals and virtual visits, doctors have been given guidelines on how to safely see sick patients. That might mean requesting a negative COVID test before a doctor visit or having staff escort a sick patient from the car directly to an exam room. Also, a pilot program is underway with designated offices taking patients with a respiratory illness that could be flu or COVID-19.

It is a balancing act with some risks. In August, friends sent Kressly screenshots of parents' online message boards from states such as Texas, Indiana and Florida that were seeing a summer spike in COVID-19 cases. Mothers felt abandoned by their pediatricians because they were being sent to urgent care and emergency departments. Kressly fears some patients will fall through the cracks if they are seen by several different providers and don't have a continuity of care.

Also, there's the expense. Bryce's case is a good example. Gudgeon reluctantly took him to an urgent care facility, worried about exposure and frustrated because she felt her doctor knew Bryce best. His exam included a COVID test. "They barely looked in his ears, and we went home to wait for the results," she said, and got no medicine to treat Bryce. The next day, she had a negative test and still a fussy, sick baby.

Urgent care facilities across the country are reporting higher numbers of patients, said Dr. Franz Ritucci, president of the American Board of Urgent Care Medicine. His clinic in Orlando, Florida, is seeing twice as many patients, both children and adults, as it did at this time last year.

"In urgent care, we're seeing all comers, whether they are sick with COVID or not," he said.

Meanwhile, ERs are seeing far fewer pediatric patients than usual, said Alfred Sacchetti, a spokesperson for the American College of Emergency Physicians and the director of clinical services at Virtua Our Lady of Lourdes Emergency Department in Camden, New Jersey. Although adult emergency room visits have largely returned to pre-COVID levels, pediatric visits are 30% to 40% lower, he said. Sacchetti suspects several factors are at play, including fewer kids in daycare and school with less opportunity to spread illness and people avoiding emergency rooms for fear of the coronavirus.

"You see parents looking around the department and if someone clears their throat, you can look in their eyes and see the concern," Sacchetti said. "We reassure them" that the precautions taken in hospitals will help keep them safe, he added.

Gudgeon considered taking Bryce to an emergency room, but she felt increasingly uncomfortable both with the thought of exposing him to another healthcare facility and the cost. In the end, she called an out-of-state doctor she had seen often years before moving to Illinois. That doctor phoned in an antibiotic prescription, and Bryce quickly improved, she said.

"I just wish he didn't have to suffer for so long," Gudgeon said.

Kressly hopes doctors become more creative in finding ways to provide direct care. She likes the "Swiss cheese" approach of layering several imperfect solutions to see patients and offer protection from COVID-19: screening for symptoms before the patient comes in, requiring everyone to wear masks, allowing only one caregiver to accompany a sick child and offering parking lot visits for sick kids in their cars.

Most important is good communication, Kressly said. Not only does that help the patient, it can also help protect the doctor from patients who may not want to admit they have COVID symptoms.

"We can't create this barrier to care for uncomplicated, acute illnesses," Kressly said. "This is not temporary. We all have to creatively figure out how to get patients and families connected to the right care at the right place at the right time."

Kristy P. Kennedy: @kristypkennedy

Americans who do choose to fly will be subject to evolving COVID safety policies that vary by airline, a result of the continuing lack of a unified federal strategy.

This article was published on Friday, November 20, 2020 in Kaiser Health News.

By Victoria Knight

The holidays are approaching just as COVID-19 case rates nationwide are increasing at a record-breaking pace, leading to dire warnings from public health experts.

The Centers for Disease Control and Prevention has issued cautions and updated guidelines related to family gatherings. Dr. Anthony Fauci, a White House coronavirus adviser and director of the National Institute of Allergy and Infectious Diseases, said in interviews that his kids won’t be coming home for Thanksgiving because of coronavirus risks. “Relatives getting on a plane, being exposed in an airport,” he told CBS News. “And then walking in the door and saying ‘Happy Thanksgiving’ — that you have to be concerned about.”

Are Americans listening? Maybe not. Especially as airlines, reeling from major revenue blows since the pandemic took hold in March, tell passengers they can travel with peace of mind and sweeten the deal with special holiday fares.

The airlines argue more is now known about the virus and recent industry-sponsored studies show flying is just as safe as regular daily activities. They also tout policies such as mask mandates and enhanced cleaning to protect travelers from the coronavirus.

Time for a reality check.

Americans who do choose to fly will be subject to evolving COVID safety policies that vary by airline, a result of the continuing lack of a unified federal strategy. Under the Trump administration, government agencies such as the Federal Aviation Administration and the Centers for Disease Control and Prevention have failed to issue and enforce any national directives for air travel.

And, though President-elect Joe Biden has signaled he will take a more robust federal approach to addressing COVID-19, which may result in such actions, the Trump administration remains in charge during the upcoming holiday season.

Here’s what you need to know before you book.

Airlines Say It’s Safe to Fly During the Pandemic. Is it?

The airline industry pins its safety clearance to a study funded by its leading trade group, Airlines for America, and conducted by Harvard University researchers, as well as one headed by the Department of Defense, with assistance from United Airlines.

Both reports modeled disease transmission on a plane, assuming all individuals were masked and the airplane’s highly effective air filtration systems were working. The Harvard report concluded the risk of in-flight COVID-19 transmission was “below that of other routine activities during the pandemic, such as grocery shopping or eating out,” while the DOD study concluded an individual would need to, hypothetically, sit for 54 straight hours on an airplane to catch COVID-19 from another passenger.

But these studies’ assumptions have limitations.

Despite airlines’ ramped-up enforcement of mask-wearing, reports of noncompliance among passengers continue. Most airlines say passengers who outright refuse to wear masks will not only be refused boarding, but will also be putting their future travel privileges at risk. Recent press reports indicate Delta has placed hundreds of these passengers on a no-fly list. Some passengers may still try to skirt around the rule by removing their mask to eat or drink for an extended time on the flight, and flight attendants may or may not feel they can stop them.

And though public health experts agree that airplanes do have highly effective filtration systems spaced throughout the cabin that filter and circulate the air every couple of minutes, if someone who unknowingly has COVID-19 takes off their mask to eat or drink, there is still time for viral particles to reach others seated nearby before they get sucked up by the filter.

Public health experts said comparing time on an airplane with time at the grocery store is apples and oranges.

Even if you wear a mask in both places, said Dr. Henry Wu, director of Emory TravelWell Center and associate professor of infectious diseases at Emory University School of Medicine, the duration of contact in both locales can be very different.

“If it’s a long flight and you are in that situation for several hours, then you are accumulating exposure over time. So a one-hour flight is 1/10 the risk of a 10-hour flight,” said Wu. “Whereas most people don’t spend more than an hour in the grocery store.”

Also, both studies analyzed only one aspect of a travel itinerary — risk on board the aircraft. Neither considered the related risks involved in air travel, such as getting to the airport or waiting in security lines. And public health experts say those activities pose opportunities for COVID exposure.

“Between when you arrive in the airport and you get into a plane seat, there is a lot of interaction that happens,” said Lisa Lee, a former CDC official and associate vice president for research and innovation at Virginia Tech.

And while Wu said he agrees that an airplane cabin is likely safer than other environments, with high rates of COVID-19 in communities across the U.S., “there is no doubt people are flying when they’re sick, whether they know it or not.”

Another data point touted by the airline industry has been that out of the estimated 1.2 billion people who have flown so far in 2020, only 44 cases of COVID-19 have been associated with air travel, according to data from the International Air Transport Association, a worldwide trade group.

But this number reflects only case reports published in the academic literature and isn’t likely capturing the true picture of how many COVID cases are associated with flights, experts said.

“It’s very difficult to prove, if you get sick after a trip, where exactly you got exposed,” said Wu.

The low count could also stem from systemic contact-tracing inconsistencies after a person with COVID-19 has traveled on a flight. In a recent case, a woman infected with the coronavirus died during a flight and fellow passengers weren’t notified of their exposure.

That may be due to the decentralized public health system the U.S. has in place, said Lee, the former CDC official, since contact tracing is done through state and local health departments. The CDC will step in to help with contact tracing only if there is interstate travel, which is likely during a flight — but, during the pandemic, the agency has “been less consistently effective than in the past,” said Lee.

“Let’s say there is a case of COVID on a flight. The question is, who is supposed to deal with that? The state that [the flight] started in? That it ended in? The CDC? It’s not clear,” said Lee.

Is Now the Time to Fly?

Most airlines have implemented safety measures beyond requiring masks, such as asking passengers to fill out health questionnaires, enhancing cleaning on planes, reducing interactions between crew members and passengers, and installing plexiglass stations and touchless check-in at service desks.

But many have also stepped back from other efforts, such as pledging to block middle seats. United relaxed its social distancing policy for allowing empty middle seats between customers at the end of May, though there were complaints from customers before then about flights being full. American Airlines stopped blocking middle seats in July. Other airlines plan to fill seats after the Thanksgiving holiday, with Southwest stopping the practice of blocking middle seats starting Dec. 1, and JetBlue planning to increase capacity to 85% on Dec. 2. In January, Alaska Airlines plans to stop blocking middle seats and JetBlue will fly at full capacity. Delta announced this week that it will continue to block the middle seat until March 30.

This policy change is a result of airlines’ lack of cash on hand, said Robert Mann, an aviation analyst. It also reflects a rising demand from consumers who feel increasingly comfortable traveling again, especially as holiday gatherings beckon.

“It was easy to keep middle seats empty when there wasn’t much demand,” said Mann.

Now, they’re instead hoping that new COVID-era services will calm passengers’ fears.

American, United, Alaskan and Hawaiian, among others, offer some form of preflight COVID test for customers traveling to Hawaii or specific foreign destinations that also require a negative test or quarantine upon arrival. JetBlue recently partnered with a company to offer at-home COVID tests that give rapid results for those traveling to Aruba.

Airlines are likely to expand their preflight COVID testing options in the next couple of months. “This is the new dimension of airline competition,” said Mann.

But is it a new dimension of travel safety?

Emory’s Wu said there is certainly a risk of catching the coronavirus if you travel by plane, and travelers should have a higher threshold in making the decision to travel home for the holidays than they would in years past.

After all, COVID case rates are surging nationwide.

“I think the less folks crowding the airports, the less movement in general around the country, will help us control the epidemic,” said Wu. “We are worried things will get worse with the colder weather.”

Subscribe to KHN's free Morning Briefing.

All this time, the person I've most wanted to hear from is Fauci. He's a straight shooter, with no apparent conflicts of interest — political or financial — or, at 79, career ambition. He seemingly has no interests other than yours and mine.

This article was published on Thursday, November 19, 2020 in Kaiser Health News.

By Elisabeth Rosenthal

As a health journalist, a physician and a former foreign correspondent who lived through SARS in Beijing, I often get questions from friends, colleagues and people I don’t even know about how to live during the pandemic. Do I think it’s safe to plan a real wedding next June? Would I send my kids to school, with appropriate precautions? When will I trust a vaccine?

To the last question, I always answer: When I see Anthony Fauci take one.

Like many Americans, I take my signals from Dr. Fauci, the country’s top infectious disease expert and a member of the White House task force on the coronavirus. When he told The Washington Post that he was not wiping down packages but just letting them sit for a couple of days, I started doing the same. In October, he remarked that he was bringing shopping bags into the house. He merely washes his hands after unpacking them. (Me too!)

Now we are in a dangerous political transition, with cases spiking in much of the country and Fauci and the original task force largely sidelined. President-elect Joe Biden has appointed his own, but it can’t do much until the General Services Administration signals that it accepts the results of the election. And Fauci told me he has not yet spoken with the Biden task force. President Donald Trump has resisted the norms on government transition, in which the old and new teams brief each other and coordinate.

The past tumultuous months have been filled with information gaps (we’re still learning about the novel coronavirus), misinformation (often from the president) and a host of “experts” — public health folks, mathematical modelers, cardiologists and emergency room doctors like me — offering opinions on TV. But all this time, the person I’ve most wanted to hear from is Fauci. He’s a straight shooter, with no apparent conflicts of interest — political or financial — or, at 79, career ambition. He seemingly has no interests other than yours and mine.

So I asked him how Americans might expect to live in the next six to nine months. How should we behave? And what should the next administration do? Some answers have been edited for clarity and brevity.

Q: Are there two or three things you think a Biden administration should do on Day One?

There were some states in some regions of the country that somehow didn’t seem to have learned the lessons that could have been learned or should have been learned when New York City and other big cities got hit. And that is to do some fundamental public health measures. I want to really be explicit about this, because whenever I talk about simple things like uniform wearing of masks, keeping physical distance, avoiding crowds (particularly indoors), doing things outdoors to the extent possible with the weather, and washing hands frequently, that doesn’t mean shutting down the country. You can still have a considerable amount of leeway for business, for economic recovery, if you just do those simple things. But what we’re seeing, unfortunately, is a very disparate response to that. And that inevitably leads to the kind of surges that we see now.

Q: Do you think we need a national policy like a national mask mandate? The current administration has left a lot of COVID-19 management to the states.

I think that there should be universal wearing of masks. If we can accomplish that with local mayors, governors, local authorities, fine. If not, we should seriously consider national. The only reason that I shy away from making a strong recommendation in that regard is that things that come from the national level down generally engender a bit of pushback from an already reluctant populace that doesn’t like to be told what to do. So you might wind up having the countereffect of people pushing back even more.

Q: What would a national mask mandate look like to you? It means different things in different states. Many states require face coverings, but not specifically masks. Many 20-somethings use only a bandanna.

I think it is unlikely that there’s a substantial difference. I mean, the typical type of a mask is the surgical mask. It’s not an N95 mask. One that has thick cloth, you know, can be equally as effective. We believe there may be some small differences between them, but the main purpose is that you prevent yourself from infecting others. Recent studies have shown that [wearing a mask] also has the good effect of partially protecting you. So it goes both ways.

Q: Many places that have mask mandates have had trouble enforcing them.

That’s really one of the reasons there’s a reticence on the part of many people, including myself [to support a national mandate]. If you have a mandate, you have to enforce it. And, hopefully, we can convince people when they see what is going on in the country. But I have to tell you, Elisabeth, I was stunned by the fact that in certain areas of the country, even though the devastation of the outbreak is clear, some people are still saying it’s fake news. That is a very difficult thing to get over: why people still insist that something that’s staring you right in the face is not real.

Q: People often think of shutdowns as binary. You’re open or you’re shut. Often, when you answer questions about how to live, you start with. ‘Well, I’m in a high-risk group. …” So I would love to hear Dr. Fauci’s hierarchy of “Safe and important to keep open with precautions” and “Things that aren’t safe under any circumstances.”

The reason I answer with some degree of trepidation is because the people who are the proprietors of these businesses start getting very, very upset with me. There are some essential businesses that you want to keep open. You want to keep grocery stores open, supermarkets open, things that people need for their subsistence. You might, if it’s done properly, keep open some nonessential businesses, you know, things like clothing stores, department stores.

Q: We’re heading into the winter months. You could social distance in a restaurant or in an indoor gathering. But would you feel OK being in there without a mask?

If we’re in the hot zone the way we are now, where there’s so many infections around, I would feel quite uncomfortable even being in a restaurant. And particularly if it was at full capacity.

Q: I see you’ve been getting your hair cut. What do you think about hair salons?

I mean, again, it depends. I used to get a haircut every five weeks. I get a haircut every 12 weeks now — with a mask on me, as well as a mask on the person who’s cutting the hair, for sure.

Q: Transportation? Trains? Planes? Metro? Where are we at the moment?

It depends on your individual circumstances. If you are someone who is in the highest risk category, as best as possible, don’t travel anywhere. Or if you go someplace, you have a car, you’re in your car by yourself, not getting on a crowded subway, not getting on a crowded bus or even flying in an airplane. If you’re a 25-year-old who has no underlying conditions, that’s much different.

Q: Bars?

Bars are really problematic. I have to tell you, if you look at some of the outbreaks that we’ve seen, it’s when people go into bars, crowded bars. You know, I used to go to a bar. I used to like to sit at a bar and grab a hamburger and a beer. But when you’re at a bar, people are leaning over your shoulder to get a drink, people next to each other like this. It’s kind of fun because it’s social, but it’s not fun when this virus is in the air. So I would think that if there’s anything you want to clamp down on, for the time being, it’s bars.

Q: Some airlines and some states are telling people you have to get a coronavirus test before you get on the plane or visit another state. Does that make sense medically?

If you’re negative when you get on the plane — except in the rare circumstance that you’re in that little incubation window before you turn positive — that’s a good thing.

Q: If you had a national plan for testing, what would it be?

Surveillance testing. Literally flooding the system with tests. Getting a home test that you could do yourself, that’s highly sensitive and highly specific. And you know why that would be terrific? Because if you decided that you wanted to have a small gathering with your mother-in-law and father-in-law and a couple of children, and you had a test right there. It isn’t 100%. Don’t let the perfect be the enemy of the good. But the risk that you have — if everyone is tested before you get together to sit down for dinner — dramatically decreases. It might not ever be zero but, you know, we don’t live in a completely risk-free society.

Q: There are a number of vaccine candidates that are promising. But there’s also a lot of skepticism because we’ve seen the FDA come under both commercial and, increasingly, political pressure. When will we know it’s OK to take a vaccine? And which?

It’s pretty easy when you have vaccines that are 95% effective. Can’t get much better than that. I think what people need to appreciate — and that’s why I have said it like maybe 100 times in the last week or two — is the process by which a decision is made. The company looks at the data. I look at the data. Then the company puts the data to the FDA. The FDA will make the decision to do an emergency use authorization or a license application approval. And they have career scientists who are really independent. They’re not beholden to anybody. Then there’s another independent group, the Vaccines and Related Biological Products Advisory Committee. The FDA commissioner has vowed publicly that he will go according to the opinion of the career scientists and the advisory board.

Q: You feel the career scientists will have the final say?

Yes, yes.

Q: And will the decisions that are being made in this transition period — like the vaccine distribution plan — in any way limit the options of a new administration?

No, I don’t think so. I think a new administration will have the choice of doing what they feel. But I can tell you what’s going to happen, regardless of the transition or not, is that we have people totally committed to doing it right that are going to be involved in this. So I have confidence in that.

Q: When do you think we’ll all be able to throw our masks away?

I think that we’re going to have some degree of public health measures together with the vaccine for a considerable period of time. But we’ll start approaching normal — if the overwhelming majority of people take the vaccine — as we get into the third or fourth quarter [of 2021].

Q: Thank you so much. And have a nice Thanksgiving.

Take care, and you too.

[Editor’s note: Dr. Fauci has said his family is forgoing the usual family Thanksgiving gathering this year because his adult children would have to fly home and that travel would expose him to risk.] 

You can listen to the full interview on KHN’s “What the Health?” podcast.