Becker's Clinical Quality & Infection Control

7 INFECTION CONTROL Dr. Fauci's worst fear post-COVID-19: A short memory By Erica Carbajal I n the 38 years Anthony Fauci, MD, spent as director of the National Institute of Allergy and Infectious Diseases, he was often asked what his worst nightmare was. His answer remained consistent: The emergence of a new viral pathogen capable of spreading quickly and causing significant morbidity and mortality. "For the past three and a half years, we all have been living my worst nightmare: a deadly pandemic caused by SARS-CoV-2, exactly the type of virus that I most feared," the former director of the National Institute of Allergy and Infectious Diseases wrote in an article published Oct. 18 in Science Translational Medicine. "COVID-19 has exacted a toll that truly is nightmarish, claiming the lives of more than 1.1 million people in the United States and, according to some estimates, [more than] 20 million people globally." Now, Dr. Fauci's primary worry is that lessons learned from the nation's COVID-19 response will be forgotten. The nation is in a much better position to handle COVID-19 today and can reflect on what went right and what went wrong, though he worries sustained focus will dwindle and ultimately hamper preparedness in the face of the next "inevitable pandemic," he said. When it comes to the nation's COVID-19 response, key lessons were learned from both a scientific and public health standpoint. On the scientific front, the response was largely successful, with a new vaccine developed in a record 11 months from the time the sequence of the virus was known. However, he said the public health response largely fell short amid a lack of communication between states and the federal government, a disconnect between the public health infrastructure and healthcare organizations, as well as misinformation and vaccine hesitancy. "Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest and support of both the scientific and public health buckets. If not, many of us will be spending a lot of time awake in bed or having nightmares when asleep," Dr. Fauci wrote. n treats surgical and medical masks as personal protective equipment and respiratory protection. Hospitals and other healthcare settings typically look to the guidance to set infection control practices within their organizations. "A surgical or medical mask does not provide protection against inhalation of infectious aerosols," Jane omason, lead industrial hygienist at the NNU, said in a statement to Becker's. "e CDC must redo the biased evidence review on respiratory protection for healthcare workers, taking into account all the available evidence from multiple disciplines. NNU urges CDC to fully recognize the science on aerosol transmission of infectious diseases and respiratory protection (including N95s, powered air purifying respirators, and elastomeric respirators) in creating infection prevention guidance." e NNU and other clinicians have previously urged the CDC's Healthcare Infection Control Practices Advisory Committee to strengthen the proposals by making a firm recommendation on the use of N95s, noting that common viruses like the flu and other airborne pathogens in hospitals can still harm vulnerable populations. HICPAC's dra guidance does state that healthcare personnel may "choose voluntarily" to wear an N95 for routine air precautions, though the NNU says this inappropriately shis "responsibility and risk to individual workers to protect corporate profits." In emailed comments to Becker's, a spokesperson for the CDC said, "the process has been misunderstood," and reiterated that the recommendations are not final. "e advisory committee has not introduced any binding recommendations, but is instead kicking off a process that includes a transparent, lengthy public comment period." Now that the committee has voted to finalize the guidance, which includes a collection of infection control recommendations beyond masking, it will go to the CDC to review. If approved by the agency, the dra recommendations will be published to the Federal Register and the public would have 60 days to comment. e guidelines would then potentially be revised based on public comments, according to the CDC. e CDC's Isolation Precautions Guidance was last updated in 2007. e updates are not expected to be finalized until 2024. n "Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest and support of both the scientific and public health buckets. If not, many of us will be spending a lot of time awake in bed or having nightmares when asleep." — Anthony Fauci, MD

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