A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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March 3, 2015 - Testified before the House Labor - HHS Appropriations Subcommittee for the NIH budget. As usual for the past few years, it was only a 2 hour Hearing with Francis Collins testifying and me backing him up at the table together with Gary Gibbons (NHLBI), Tom Insel (NIMH), Nora Volkow (NIDA) and Jon Lorsch (NIGMS). Hearing started early (8:30 AM) since Benjamin Netanyahu was speaking before a Joint Session of Congress at the invitation of Speaker Boehner and against the wishes of Obama. He was making the argument that the USA was making a "bad deal" with Iran on nuclear control versus sanctions. During the Hearing Congressman Andy Harris (R-MD) made the point that he felt that we were spending too much on AIDS compared to other diseases with much more of a morbidity and mortality impact on the USA. He wants to allocate money strictly according the disease burden in the USA. Hence, this would destroy funding for malaria and TB and greatly hurt funding for AIDS. Obviously, I will be opposing this. Still record cold weather and lots of snow in DC.
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March 5, 2015 - Was supposed to go to Boston yesterday evening in order to speak at an Ebola Forum at Harvard today. However, a big snow storm was forecast for DC for today and I was afraid that I would get stuck in Boston. I wisely, did not go and actually gave my talk and Panel discussion via "GoToMeeting", which worked very well. Paul Farmer was on the panel in Boston. Good thing that I did not go since DC got 8 inches lical of snow and all flights were cancelled from Boston to DC. I would have been stuck there.
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March 6, 2015 - Met with Nina Russell and Emilio Emini from the Bill and Melinda Gates foundation (BMGF), Emilio is taking over as the Director of Global Health for BMGF and he wanted to review our mutual commitments for the AIDS vaccine plans (i.e. the P5 follow-up of the RV144 study). He wanted to re-examine the criteria for moving forward with candidates. Emilio generaly thinks that he knows everything; however, on this one he has a valid point and so we will do this together. Cliff Lane in Liberia (also Sierra Leone) now for the 7th time in a few months trying now to expand the RCT vaccine trial to Guinea and also expand the therapeutic trials with ZMapp to Sierra Leone and possibly Guinea since there are virtually no patients in Liberia. Cliff and I had phone call early (6:30 AM) with Cliff in Sierra Leone, me in DC at home, and Yves Levy and Jean-Francois Delfraissy in Paris to try and get a collaboration going in Guinea for the trials since the French have a presence in Guinea.
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March 9, 2015 - Went downtown today to be the BBC studio to do the final taping of the segment that they will be doing on HIV/AIDS were I am the moderator and narrator. In the afternoon, I attended the FDA/NIH Leadership Council meeting to discuss better ways of collaboration between the NIH and FDA.
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2015-03-10 00:00
Anthony S. Fauci
March 10, 2015 - Gave the after dinner talk at the Project Hope Board meeting at the Willard Hotel in Washington DC. I spoke on Ebola: The Perfect Storm. It was extremely well received and the evening was pleasant. Ran into former Secretary of HHS Louis Sullivan.
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March 11, 2015 - Was Visiting Professor at the John's Hopkins Hospital and Medical School. Gave two major talks: 1) a formal lecture on Ebola, and 2) a lecture to the students and fellows on my career as a scientist, clinician, policymaker.
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March 12, 2015 - There was a considerable misunderstanding involving a situation in Sierra Leone. Cliff Lane is trying to expand the randomized controlled trial of ZMapp versus standard of care in countries in addition to Liberia with the protocol he has already started. As it turns out the commanding general in charge of the British military hospital in Sierra Leone, Brig. Gen. Tim Hodgetts, was under the misimpression regarding the protocol was standard of care to see ZMapp + standard of care versus standard of care alone . And so he said that this trial was unethical and refused to participate in it. The reason why this is important is because an American citizen who works for Partners in Health became infected while working in Sierra Leone. We had made arrangements to air evacuate the patient to the NIH clinical Center as soon as possible. Because the patient was in the British facility, we wanted to start the randomization to one or the other arm of the protocol while the patient was still in Sierra Leone before flying back the United States. Brigadier General Hodgetts stated that he would give ZMapp as a compassionate use but would not participate in the randomized protocol. He felt it was unethical to delay the flight to the USA by giving the person a placebo if in fact the person randomized to placebo limb. We arranged a teleconference with him and I led the teleconference. I explained to the general that there was no placebo and that if the patient randomized to the standard of care alone arm we would not delay the flight and he would immediately come to the United States. If the patient randomized to the ZMapp arm we would give the personZMapp right away and then put him on a plane. When he heard that, he apologized blocking this protocol and we agreed that with the next patient who came through, he would be able to help us by participating in the protocol. However, it was too late for this patient since we had already arranged to put the patient on the plane to come back here to the United States.
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March 13, 2015 - Woke up at 1:45 AM to get to the NIH in time to greet the patient who was being flown in by chartered flight to Dulles Airport to then come to the NIH by He was working fo: Over the past 48 hours in i i has written me several e-mails indicating that he told the patient and the patient's uly that since I was taking care of the patient that he would be getting the best care in the world. The patient arrived rather sick with nausea, vomiting, liver function abnormalities, lactic acidosis, and profound weakness. His condition was deemed to be "serious". He arrived at Dulles Airport at 3:16 AM. He arrived by ground transportation at the NIH at 4:45 AM. We admitted him to the special clinical studies unit (SCSU) and he was randomized into the protocol. As it turned out he was randomized to the supportive therapy and general medical care alone. In other words, he did not get ZMapp. In some respects, this is good since if he was randomized to ZMapp, it is certain that some people would have said that we actually put him on the ZMapp deliberately because he was an American citizen. More later on this patient.
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March 14, 2015 - Today was a very important day in my personal experience with the Ebola Virus Disease. Nothing like on-hands experience. vie was in the hospital, I had the opportunity to put on personal protective equipment (PPE) and mostly observe and certainly not get involved in her direct care. Although she sick, she was not acutely ill and there was little chance of coming into contact with infected bodily fluid. However, the situation with was entirely different; he is one of the sickest people I have ever had experience with. It was a rainy day today, Saturday in Bethesda. I went over to the SCSU and put on the PPE. I went into the room with Anthony Suffredini and Rick Davey together with nurse Megan. It was an entirely different situation. I I had a rectal tube in and was putting out copious diarrhea that he was also leaking around the rectal tube. His urinary catheter was putting out good urine. He had a temperature of 39° ; his blood pressure was okay when he had diffuse maculopapular rash throughout his entire body. He was extremely weak and could barely talk. His liver enzymes were elevated and his lactate level was 2.9. His electrolytes were reasonably good. However his D-dimer was 20, which is about as high as it can get on the scale of measurement. He was thrombocytopenic and went from 140,000 platelets to 70,000 to 50,000 to 30,000. We will hold off platelet transfusions until he either bleeds and/or goes below 20,000. I assisted in all aspects of his care for an hour and 45 min. in the hot zone. This included moving and turning him in order to do an echocardiogram, examining his extremities and listening to him speak as he was coughing directly at us. I did not see any droplets coming out of his mouth as he coughed; however, I remember thinking thank goodness for the PPE. This experience brought into sharp relief for me the reason for the high case fatality of Ebola and why so many HCWs get infected. If were in West Africa, would be dead and Rick, Anthony and I would have gotten infected taking care of him if we did not have the state-of-the-art PPE. After an hour and 45 min. we doffed and waited for his parents. They came with Bible in hand to visit their son. Rick Davey, Cliff Lane, and I spent well over an hour with them explaining the situation and the seriousness of it. We then brought them into the nurse's station where they were able to speak with their son through video link. They could see him but he could not see them. Of note before we brought them into the nurse's station to see him through the video, we mentioned to that we were going to bring them into the room. He got very concerned that he wanted to get cleaned up from the diarrhea that soiled his bed and was over parts of his leg. In addition, his PIC line was bleeding around site and so that needed to be cleaned up. It took the nurses about 45 min. to an hour to get him perfectly clean so that he could feel comfortable talking to his parents even though his parents would not be able to see any of the soiled linen or pajamas from the distance that they were at the video link. It was a very moving conversation between the parents and ended up the conversation by reading a passage from the Old Testament. And then he turned to us in the room and said "what a wonderful country we live in that would put so much effort into the saving the life of one person - our son. There was not a dry eye in the room. I went home that night completely exhausted and went with Christine to Bourbon Steak bar and restaurant at the Four Seasons Hotel in Georgetown to unwind.