In his William C. Menninger Memorial Lecture, Anthony S. Fauci, MD, shared lessons learned and remaining challenges for the COVID-19 pandemic, especially in terms of mental health and behavioral issues.
“Globally, as of the 25th of April, there have been close to 150 million cases and over 3 million deaths,” Anthony S. Fauci, MD, told attendees of the 2021 Annual Meeting of the American Psychiatric Association (APA). “In the United States, we now have over 32 million cases, and about 570,000 deaths, making this unquestionably the worst pandemic of infectious disease that the planet has experienced in over 100 years since the historic influenza pandemic of 1918.”
Fauci, who became the face of COVID-19 in the United States, providing a voice of reason and information from the onset of the pandemic, was invited to deliver the William C. Menninger Memorial Lecture. In introducing Fauci, APA President Jeffrey Geller, MD, MPH, commended Fauci for his “communication of science, the courage in the face of adversity, and the energy he brings to his work,” adding that this commitment “should inspire all of us.”
In his talk, “Lessons Learned and Remaining Challenges,” Fauci succinctly reviewed the epidemiology, clinical course, therapeutics, and vaccines associated with COVID-19, providing attendees with a clear picture of where we have been, where we are, and where we need to go.
Fauci acknowledged the progress we have made in the fight against the pandemic. However, he warned, “Even though we are now below the late fall extraordinary peak [of cases] that we saw that went into the early winter of January and early February [of more than 200,000 new cases per day], we are now stuck on plateau that is precarious, at around 60,000 new infections a day.”
The looming variants have become a particular concern. Currently, the B.1.1.7, originally found in the United Kingdom, has become the predominant variant in the United States, he said. Fortunately, the vaccines seem to do well against this variant, he added. Other variants include B.1.351, originally found in South Africa and problematic on multiple fronts; P.1, originally found in Brazil; B.1.427/B.1.429, originally found in California; and B.1.526 originally found in New York.
The unusual aspect of the virus is that at least a third, and as much as 40%, of the individuals who are infected never have symptoms, yet the virus has been deadly in so many individuals, Fauci noted. Because of this, about 35% of all transmissions were from presymptomatic individuals and 24% from those who never developed symptoms. This, he said, added to the complication of controlling the spread of the virus.
Currently, there are 3 types of test for SARS-CoV-2: molecular tests that detect genetic material from virus; antigen tests that detect proteins from the virus; and antibody tests that detect proteins in the blood made in response to the virus. Symptoms and affects include neurological disorders (eg, bilateral cerebral infarcts), hyperinflammation, acute respiratory distress syndrome, cardiac function, hypercoagulability, acute kidney injury, and multisystem inflammatory syndrome in children.
In addition to the acute infection, there is a syndrome called “Long COVID” or “post-acute sequela of COVID,” which appears to affect between 10% and 30% of individuals, Fauci noted.1 In these cases, patients report persistent symptoms for as long as 9 months following acute illness, with fatigue being most common. Myalgias, temperature disruption, sleep disorders, and cognitive difficulties nicknamed “brain fog” have also been noted.
The pandemic’s effects, especially on mental health, have not been limited to patients infected with the virus. Fauci pointed to a new study of 5470 US adults that found 41% reported at least one behavioral health condition associated with the pandemic.2 The study found anxiety (31%), trauma or stressor-related disorder symptoms (26%), substance use issues (13%), and suicide ideation (11%) were most common among respondents.
Another concern, according to Fauci, is the continued vaccine hesitancy, despite studies noting high safety and efficacy data worldwide, even against the more troublesome variants. “There are a number of reasons why people don’t want to take the vaccine, and we just have to address each of them,” he added.
In a recent study, the top reason for not getting the vaccine was that it was too new/not enough information/unsure about long-term effects (17%).3 Other concerns included: don’t believe it is effective (8%), don’t need it (8%), concern over ingredients (8%), concern over side effects (7%), lack of trust of vaccines in general (6%), among others. As a result, there was a concerted effort to have well-known officials receive their vaccines in a public way, including leaders like Fauci, President Joe Biden, Vice President Kamala Harris, and Reverend Jesse Jackson. There also have been outreach programs to the Navajo Nation, and the US Department of Health and Human Services launched a National Network of Trusted Voices.
There have been “considerable challenges,” Fauci concluded, “but we are doing extraordinarily well. And we hope the next few weeks we see a dramatic remediation in the number of cases.”
1. Logue JK, Franko NM, McCulloch DJ et al. Sequelae in adults at 6 months after COVID-19 infection. JAMA Netw Open. 2021 Feb 1;4(2):e210830.
2. Czeisler MÉ, Lane RI, Wiley JF, et al. Follow-up survey of US adult reports of mental health, substance use, and suicidal ideation during the COVID-19 pandemic, September 2020. JAMA Netw Open. 2021;4(2):e2037665.
3. Hamel L, Lopes L, Kearney A, Brodie M. KFF COVID-19 vaccine monitor: March 2021. KFF. March 30, 2021. Accessed May 3, 2021. https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-march-2021/