Rand Paul was right on some issues with Dr. Fauci.

Doctors Rand Paul (Senator) and Anthony Fauci had several testy exchanges when 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 has 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.

California recently extended their mask advisory until fall. This recommendation was based, as Dr. Fauci has suggested, 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 most people are vaccinated for COVID-19, people should be allowed in any public place 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.

One thought on “Rand Paul was right on some issues with Dr. Fauci.

  1. I find the current arguments pro and con masks to be little more than a method of continuing the highly politicized environment of our current times. I also find it symptomatic of a “spoiled” and egocentric populace. Wearing a mask in public should be the worst experience we have to bear!
    A few of my concerns: “herd immunity” numbers have NOT yet been reached; living in a city of almost 9 million people, I experience daily the “herd” reaction of people who respond to the easing of the pandemic by failing to follow any of the social distancing protocol; the same people who don’t even carry masks in their pockets no longer eat soft-cooked eggs (for fear of salmonella); still wear their seat belts in the car (even though they haven’t had an accident in decades); wipe down the kitchen counter after cutting raw meat (but have stopped using hand wipes); and vaccinate their children for diseases most people in my generation contracted and survived. Although I am fully vaccinated, I have five as yet unvaccinated grandchildren, one of whom has just been diagnosed with Type 1 diabetes. I will do anything to be sure I can’t carry the virus to any of them (or anyone else’s grandchildren.)
    My point is simple. How hard is it, REALLY, to continue to wear a mask – just in case? One can find arguments on both sides to support one’s beliefs.
    Interesting that for all the new liberties being taken, I have yet to find a healthcare worker, or store clerk who’s in contact with large numbers of the public daily, who are fighting for everyone to remove their masks.
    It’s not all theater – it’s a thought that if it doesn’t hurt, and it might help, why not? How quickly we forget all we’ve been through. I, for one, will do all I can to help ensure that we won’t go back.

    Liked by 1 person

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