Credit: Al Drago/Getty

By Heidi Ledford Credit: Al Drago/Getty In his more than 40-year career as an infectious-disease researcher, Anthony Fauci has been hailed as a hero and damned as a murderer. His most dedicated fans have created baseball cards and bobble-head dolls in his likeness, whereas others have issued death threats and harassed his children. As head of the US National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, Fauci has guided six presidents and an anxious nation through fears of bioweapon attacks and outbreaks of HIV, Ebola and Zika. Now, his role advising the government and communicating to the public during the coronavirus pandemic has made him the nation's doctor. He has offered guidance on the US response to the outbreak, often in conflict with the wishes of President Donald Trump, and he has made time to treat individuals with COVID-19 and HIV in the clinic. "Seeing the patient really gives you a different feel for what the disease is," says Fauci, who works 18 hours a day, 7 days a week. The scale of the COVID-19 pandemic -- and the politicization of the public-health response to it -- has forced Fauci to go far beyond anything he's done before, says epidemiologist Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis. "He has been a very key part of trying to help the public understand what the science means and what we can do about it -- and that includes, of course, our elected leaders," says Osterholm. Those efforts were met with resistance, but Fauci is no stranger to friction. At the height of the AIDS epidemic, in 1988, playwright Larry Kramer called Fauci a "murderer" and an "incompetent idiot" on the cover of the San Francisco Examiner magazine. Kramer and other AIDS activists felt that the NIAID's clinical trials for HIV drugs were moving at a glacial pace while thousands of people were dying. When a group gathered outside his office to protest, Fauci invited some in for a chat. Over time, he built a relationship with them that would lead to changes in the way people with AIDS got access to experimental drugs. It was a revolutionary approach at a time when people with a disease had little say in the science aimed at treating them. "That was a tough period," he says. "There were many scientists who thought that I was caving in". Warm but blunt, with a pronounced Brooklyn accent, he has often worked well with political leaders. Former US president George H. W. Bush called him a hero for his work on AIDS, and Fauci worked with his son, former president George W. Bush, to design the President's Emergency Plan for AIDS Relief (PEPFAR), a global programme to provide treatment for people with HIV. But this year, his staid and steady advocacy for public-health measures to slow the spread of COVID-19 earned him stiff criticisms from President Donald Trump and others who were eager to play down the severity of the pandemic and get the US economy restarted. Trump has suggested that he might fire the scientist, and a stream of vitriol has poured from some of the president's followers. Steve Bannon, a former Trump adviser, said that he would like to see Fauci's head on a pike outside the White House. Fauci now has federal guards overseeing his security. The threats made him "more pissed off than afraid", he says. "I'm out there trying to give a public-health message to save people's lives." But some researchers were also frustrated with Fauci's public performance. He often stood next to Trump during press briefings as the president repeatedly misrepresented the severity of the pandemic. Although Fauci sometimes contradicted Trump, he did not directly confront the president. Such briefings stopped in April. Fauci has since become more outspoken, says Mark Harrington, executive director of Treatment Action Group, a New York City think tank that focuses on the treatment and prevention of AIDS, tuberculosis and hepatitis C virus. "He's been speaking truth to power for the last few months in a way that none of the other people in the task force or federal government have been doing," Harrington says. Fauci, who turns 80 in December, has no plans to retire soon. He has agreed to stay on at the NIAID and to serve as president-elect Joe Biden's chief medical adviser. Osterholm says he expects Fauci to continue to have an active role in front of the cameras. But Harrington is looking forward to the day when Fauci can focus his attention again on other pressing concerns, such as HIV and hepatitis C. "He needs to be able to do his day job," he says. "It's a big job." 4, 5. -- 16,500,000/303,000 16 December 2020 The Northern Plains, Upper Mid-West, Rocky Mountain States and Heartland continue to improve except OK with decreasing test positivity, cases, hospitalizations but with continued high lagging fatalities, Strang vigilance messaging could continue to decline through the upcoming Holiday season, Slide 14,15, 16 The Coasts are now driving the increasing cases, hospitalizations and soon deaths. The East and West Coast, Sunbelt, IN, OH, KY, TM have surging cases and these more populous states will drive cases and hospitalizations aver the next 2 weeks stressing their hospital systems and and inpatient care : if the rate of rise can be blunted with messaging of vigilance this surge could be blunted with significant improvements seen in the New Year. Hospitalizations ; there are now 33 States in the red (24) with CA, NJ, PA, CT, MD, GA joining the red alert category and orange (13) zone for hospitalizations of COVID cases -- general medical care deteriorates when states enter the red zone decision by CDC on who is immunized first will determine the future stability of the hospital system and hospitalization rates - current plan will not change the pandemic impact on hospitals. It will be essential that monoclonal Ab and Remdesivir are used earlier and more consistently among vulnerable Americans There is insufficient vaccine or prioritization for vulnerable Americans to change hospitalization and fatalities trends in Dec-Feb: GOVs will need to understand that to change hospitalizations and fatalities they will need to immunized those most at risk for severe disease The American people vaccines will have an impact in the Spring, BUT their behavior change, State level proactive testing, and improved use of therapeutics can change the course of this current surge --we each have a roll to change the current course of the surge The movement of the surge into populous states especially without adequate policies or without individual Americans mitigating will drive fatalities, most states do not have adequate mitigation policies and fatalities will continue averaging over 2500/day 17K,/week, 7OK/manth at a minimum reaching over 330K by New Years and 450K by the end of February without calls for action at the Federal, State, and Local level and using PSAs to combat the COVID myths throughout the country and reenforcing messaging of the behaviors needed to blunt the pandemic COVID-19 Daily Report Reported on December 16, 2020 States assigned to groups based on test positivity in the week ending December 9.* Red states Li Dark Green states (>10% positive) at: :) I (<3% positive) AL, AR, AZ, CO, CT*, GA, 1A, ID, IL, IN, KS, KY, MI, MN, MO, MS, MT, NC, NE, I CA, DE, FL, LA, MD, OR, NH, NJ, NM, NV, OH, OK, PA, SC, SD, RI, WA AK, MA, ME, ND, NY DC, VT Hi TN*, TX, UT, VA, WI, WV, WY