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‘Here we go again with the theater’: Fauci pushes back on Rand Paul’s amateur epidemiology — again

Anthony S. Fauci, the top infectious disease expert in the U.S., pushed back on Sen. Rand Paul’s (R-Ky.) suggestion that masks are not needed after vaccination. (Video: The Washington Post)
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From the early days of the coronavirus outbreak, Sen. Rand Paul (R-Ky.) has positioned himself as the Senate’s foremost skeptic of coronavirus expert Anthony S. Fauci. The two have tussled repeatedly.

Paul brought it again Thursday, and Fauci again made clear he has little patience for Paul’s nonexpert theories about the outbreak and Paul’s reading of studies about it.

At a Senate hearing, Paul pressed Fauci on health experts’ continued recommendation of masks even for people who have contracted the virus or who have been vaccinated. Paul repeatedly suggested wearing masks in those cases was “theater” — pointing specifically to Fauci wearing masks even though he has been vaccinated.

“You’re telling everybody to wear a mask, whether they’ve had an infection or a vaccine,” Paul said. “What I’m saying is: They have immunity, and everybody agrees they have immunity. What studies do you have that people that have had the vaccine or have had the infection are spreading the infection? If we’re not spreading the infection, isn’t it just theater? … You’ve had the vaccine, and you’re wearing two masks. Is that just theater?”

In fact, not everyone agrees they have full immunity and/or can’t spread the virus.

Fauci said that, despite the lack of reinfections thus far, we don’t have significant data in two very relevant areas: Whether people who get the vaccine or who have contracted the virus can still spread it, and whether variants of the coronavirus might override any existing immunity. He bristled at the idea that his personal use of masks was “theater.”

“No it’s not,” Fauci said before suggesting, as he has previously, that the true theater was being promulgated by Paul. “Here we go again with the theater.”

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Fauci went on to address the specific study Paul had cited that supposedly indicated “everybody agrees they have immunity.” He noted it was not as conclusive as Paul suggested when it came to protection. The study was from, among others, Shane Crotty and Alessandro Sette at the La Jolla Institute for Immunology, whom Fauci referenced.

“Let’s get down to the facts,” Fauci said. “The studies that you quote from Crotty and Sette look at in vitro examination of memory immunity, which in their paper, they specifically say this does not necessarily pertain to the actual protection. It’s in vitro.”

Indeed, the study says exactly that.

“Although immune memory is the source of long-term protective immunity, direct conclusions about protective immunity cannot be made on the basis of quantifying SARS-CoV-2 circulating antibodies,” the study says, “ … because mechanisms of protective immunity against SARS-CoV-2 or COVID-19 are not defined in humans.”

Fauci’s point wasn’t that people definitely can’t spread the virus after infection or vaccination but that it’s hardly as certain as Paul suggested.

Perhaps sensing this hole in his argument, Paul began interrupting. He went back and forth between arguing that people were definitively immune and asking Fauci to prove that they weren’t — a much higher standard.

Fauci, though, noted that we simply don’t have enough information to be able to draw the kind of firm conclusion that Paul had — and that in the absence of that, mitigation is still the name of the game.

“I agree with you that you very likely would have protection from wild type for at least six months if you’re infected,” Fauci conceded, referring to the prevalent strain of the coronavirus. “But we in our country now have variants that are circulating.”

Fauci added that this was “because we don’t have a prevalence of a variant yet. We’re having one … that’s becoming more dominant.”

Paul again cut in, accusing Fauci of making “policy based on conjecture.” Fauci responded that the policy was based not on conjecture but rather on unknowns — things that weren’t nearly as certain as Paul suggested.

Paul responded by accusing Fauci: “You parade around in two masks for show.”

After the exchange, the chairwoman of the committee, Sen. Patty Murray (D-Wash.), gave Fauci more of a chance to respond at length.

Fauci responded:

When you have a variant, you have an immunity that you get … against a wild type, you get a certain level of antibody that’s specific for a particular viral strain. If there’s a circulating variant, you don’t necessarily have it. You have some spillover immunity, to be sure, but you diminish by anywhere from two- to eightfold, the protection. So the point I’m saying is that there are variants now circulating.
The point that Senator Paul was making was that if you look at wild type only, there is some clear-cut credence to what he’s saying. But we are living right now in a situation where we’re having a dominance of ... the original U.K. [variant]. We have a very troublesome variant in New York City. ... We’ve got two variants in California. ... And we have a number of others. So we’re not dealing with a static situation of the same virus. That was the only point I’m making.

This illustrates the tension between Paul and his conservative allies and health officials. Paul’s allies, when they aren’t questioning the efficacy of masks or vaccines, have criticized health officials for saying masks are necessary even after vaccination. Why get vaccinated if you still have to wear a mask?

The answer is pretty obvious, from a health standpoint: They both reduce your chances of getting or spreading the virus. To the extent Paul has a point, it’s that people who are fed up with masks might get vaccinated to rid themselves of that recommendation. But that doesn’t mean masks aren’t still a good idea when it comes to truly getting beyond the pandemic, which is Fauci’s focus. It’s a difference in philosophy: How do you truly tamp this down versus how do you mitigate it without too much inconvenience (and, to the mind of Paul’s allies, subservience to health officials).

If there’s perhaps one big takeaway for Republicans from Paul’s presentation, though, it might be what he said to those who are skeptical about vaccines — a group that skews strongly Republican.

“In fact, I don’t think we have a hospitalization in the United States after the two-week period after the second vaccination,” Paul said while arguing masks weren’t necessary.