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. 

Published by jbakerjrblog

Immunologist, former Army MD, former head of allergy and clinical immunology at University of Michigan, vaccine developer and opinionated guy.

8 thoughts on “Rand Paul was right on some issues with Tony Fauci.

  1. “Once everyone is vaccinated” is the key. it is really unhelpful of Rand Paul to undermine the message on the importance of masks and socially distancing until then. So many people going around without masks are NOT vaccinated and can infect grocery clerks and other front line workers who can’t know who is vaccinated or not. That seems a far larger problem than a supposed undermining of onfidence in vaccination by telling the vaccinated to continue to be careful.

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  2. It is really unhelpful of Rand Paul to continue to undermine the efforts to get people to mask and socially distance. We are far from widespread vaccination. Pity the poor clerk not knowing if the unmasked person breathing on her is vaccinated and unlikely to infect her or just one of the anti- maskers who could infect her and others.

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  3. Agree with your comments. Dr. Fauci should not be mentioning masking in 2022. It flies against what all of us are witnessing the past few months with the vaccines and Covid numbers. We are all focused on our lives the next 3-6 months. On the other hand if people start talking about “unmasking in public” especially indoors without distancing the public will not focus on the second part of the statement “in several months when most of us are fully immunized”. I think Dr. Fauci’s comments emanate from this concern… most of us would aggree unmasking especially indoor in close quarters will likely have major deleterious consequences. With Texas and several other states unmasking and relaxing requirement now we should have a lot of data for the rest of us to be thoughtful with relaxing these measures.

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  4. Thank you Doctor Baker! I’ve been following your blog since you started last year and I must say that it is the only place I feel I get Covid related issues cut straight. Thank you for cutting it straight Doc! You are so appreciated 😊
    RB Novi MI

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  5. My subjective opinion. We are dealing with two issues. Vaccine effectiveness and practical public policies; especially in light of vaccine skepticism. Assume vaccines are effective against severe infection and likely reduce transmission. The vaccinated could go without masks. However, if that happens, cheaters will cheat and infections may likely rise again. The practical public health policy is to keep everyone masked in public until everyone that wants a vaccine gets it. Then drop the masks and let nature take over. It will be an interesting study. Choice to have the vaccine or not will be honored. Natural selection will then be an impartial judge.

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  6. This is all well and good so people who are vaccinated don’t wear masks and people who aren’t do? And at the rate they are getting people to decline the vaccine we will never get to enough vaccinated to have herd immunity. All the Trumpers say no vaccine.

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