Rand Paul was right on some issues with Tony Fauci.

Doctors Rand Paul (Senator) and Anthony Fauci had another testy exchange yesterday as Dr. Fauci testified before a Senate committee. One could boil down the argument on the need to wear masks after being vaccinated to this dichotomy: Dr. Fauci argued it was crucial to continue to mask for COVID-19 protection, and Senator Paul disputed that assertion and stated it was merely theater that undermined vaccination confidence and increased vaccine hesitancy. 

Unfortunately, this type of polar discussion undermines the confidence of the American people in their government and in both the individuals who are speaking. Emblematic of this, opinions on the exchange on social media were widely split to the degree that essentially there was no common ground. From my perspective, both men were somewhat correct and made legitimate points. 

Senator Paul is right that people cannot be told that the vaccines are highly effective and provide essentially complete protection against infection (and more importantly severe illness and death) from the COVID-19 virus, but then require them to continue all of the same social restriction requirements. Once substantially all the adults in the United states are immunized people should be allowed to go back to their normal activity. Otherwise, many individuals will believe either that the vaccines are really not effective or that the government is merely trying to control their activity by continuing to scare them with the coronavirus pandemic. 

Dr. Fauci actually admitted that the likelihood of reinfection with COVID in the presence of the current vaccines is essentially nil. He seemed to say that if we were simply worried about that issue, once everyone was immunized, we would not have to wear masks. This supported the new CDC guidelines for vaccinated individuals’ activity and mask use. However, then he went in another direction justifying continued public mask usage.

Dr. Fauci suggested that the major reason for continued mask wearing was because of variant viruses. These viruses have mutations that appear in some studies to have conferred increased infectivity and to have escaped from immunity.  Since these variants are now present in the United States, this is a reason to continue to wear masks even when immunized. 

Senator Paul suggested that this was only a theoretical concern, but Dr. Fauci responded by citing a Johnson and Johnson phase three vaccine study in South Africa as evidence that reinfection and lack of vaccine protection were real issues with variant viruses.  On this point there are two reasons why I have to agree with Senator Paul and not Dr. Fauci. 

First, the RNA vaccines (Pfizer and Moderna) approved in the U.S. have been shown to protect against the known variant viruses. While there is more concern about the Johnson and Johnson vaccine which allows some infections with variants to continue, it still provides protection against severe illness from variants. In contrast, if the vaccines don’t work at all against the variants and the variants become predominant in the U.S., we should stop vaccinating people and go back to masks. 

This was done yesterday in South Africa where the government stopped using the AstraZeneca vaccine when it was shown not to work against their virus variant. Interestingly, what was the vaccine that South Africa has turned to for protection after abandoning AstraZeneca — the Pfizer vaccine that was tested in the study that Dr. Fauci noted in his testimony, which does protect against severe disease or death. It is really a binary issue for public health — the vaccines are much better in protecting us than masks, unless they don’t work. 

Second, several studies have documented reinfection is rare with COVID-19. More importantly, no study has shown that reinfection results in severe illness or hospitalization and death, like primary infection. It is logical to think that if partial immunity from a single dose vaccine, like Johnson and Johnson’s, protects against severe illness and death, then partial immunity from prior SARS-CoV-2 infection (even from a different virus variant) would likely do the same thing. 

In this regard, a recent study from the Netherlands highly touted by critics of Senator Paul showed an increase rate of SARS-CoV-2 reinfection in a small number of elderly individuals as compared with those under 65. But this study only showed the presence of the virus (PCR positivity) in these individuals; it did not document any clinical illness, let alone severe illness or death in these individuals. Partial immunity should protect against disease much better than masks. 

My perspective is that once everyone is vaccinated for COVID-19, people should be allowed in public without being forced to wear masks. If enforced masks are truly needed at that point to prevent further COVID-19 infections, then we need to admit the vaccine effort was a failure.