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July 22, 2022 Kevin O'Connor called me this morning at 10 48 AM to give me an update on the president's condition. He is quite stable has a slight fever up to 99F that is easily brought down by tylenol. He has a cough which started off as dry but now is a bit "loose" as described by Kevin which means it seems deeper in the chest. However, the president feels well enough to continue to work from the White House although he is a bit fatigued as you might expect. More later. PHYSICIAN TO THE PRESIDENT THE WHITE HOUSE 22 July 2022 MEMORANDUM FOR: KARINE JEAN-PIERRE ASSISTANT TO THE PRESIDENT AND WHITE HOUSE PRESS SECRETARY
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July 23, 2022 Yesterday I spoke with dawn O'Connell and told her that I would be very much in favor of the secretary declaring a public health emergency for monkeypox. She is now running it up the chain to see what others think about that.. I had my usual call this morning with Kevin O'Connor, the president's physician. It was a disturbing call because Kevin told me that Ashish is really trying to manipulate what Kevin says regarding the health of the president and Kevin is starting to get very aggravated by this. For example, Ashish did not want Kevin to mention that the president's temperature was 99.4F because then that would be a topic for the news discussion. That is completely ridiculous because it is totally expected that someone with a URI would have a mild temperature responsive to Tylenol. In addition, Ashish did not like the use of the word "malaise" which was the exact word the president used to describe how he felt. Ashish was afraid that that word would bring up recall of president Jimmy Carter and the negative response that the country had to his describing "malaise" in the country. And then finally in today's report Kevin wanted to put in a new symptom that the president complained of which was muscle aches, an entirely understandable symptom that has nothing to do with progression of disease. They insisted that he not add that. Kevin pushed back and said that he would not sign off on anything if they force him to hold back on what the true symptoms are. The = Menu Weekly edition Q. Search v Economist Graphic detail I It could have been worse Covid-19 vaccines saved an estimated 20m lives during their first year Their impact in poor countries depends on how effectively governments prioritised recipients Jul 7th 2022 < Share Estimated daily excess deaths, '000 First person given First COVAX- WHO labels WHO labels clinically approved funded doses Delta a variant Omicron a variant covid-19 vaccine given of concern of concern Deaths without vaccines Deaths averted directly Actual deaths, by income group of country High Upper-middle Lower-middle Fe Low May I jun I Jul I Aug I Sep I Oct I Nov I Dec "Among individuals who avoided infection thanks to other people's vaccinations Call from Larry Horowitz regarding Ron Klain saying to him (Larry) that the President wants to make some changes since Health area (COVID/MPX) is not going well. "Someone needs to get fired." Primary target is Becerra, but they feel that they cannot fire him since they never would get a replacement confirmed in he Senate. Next in line in Rochelle. They really are disappointed with Rochelle and want to fire her. They asked Larry for suggestions for replacements. Larry called me about this. He suggests Mark McLellan or Anne Schuchat. Wants names from me. Larry also called Jeff Z. They do not know that Jeff is working with me regarding my stepping down. Could get complicated. I called Jeff and we discussed the situation. See below my discussion the next day (Sunday) with Jeff. Had a long conversation with Jeff about the above issue concerning firing someone at HHS/CDC. Similar to the situation that I faced years ago with Secretary Burwell wanting to fire Tom Frieden because of poor performance with Ebola where I defended Tom, I found myself defending Rochelle. Rochelle is a wonderful person, but she does not have control over her agency and she has to learn to balance the politically expedient thing while still maintaining solid scientific principles. The problem is she relies too heavily on the entrenched people at CDC who are smart and will meaning but who have no oversight or quality control from the outside. This allows them to proceed with somewhat antiquated if not ossified ideas. As the discussion went the options were to fire Secretary Becerra; however, this would be very difficult since it would be tough to get a Senate confirmation for a secretary within a relatively acceptable period of time. The other option is to fire Rochelle, but now is not the time to do that and it would be against my recommendation. One of the points that Jeff made is that they are considering in a humane way to ask Rochelle to step down at the end of the year before the beginning of the second-half of the first term. Despite my trying to protect Rochelle there is a very good chance that that will happen. Kevin O'Connor continues to call me 2x/day. The president continues to improve and is completed his 4th day on Paxlovid. .He was out for four hours today by the pool doing reading work. The next big question is whether to give him eight days or 10 days instead of five days of pax livid. That would be a problem since it would be against FDA authorization and the public would cry out that we had treating him differently than other people. the concern on the part of the White House is that if he rebounds after he is negative for several days, he will likely be out talking and mingling with people. If he infects someone following an inadvertent rebound, he will be blamed for infecting other people. My suggestion would be to treat him for five days have him stay in the White House virtually for an additional five days testing him everyday if he turns negative as soon as he turns negative send him out even if it's before the 10 day. And have him wear a mask in order to avoid him inadvertently infecting people if he rebounds, I would just test him every morning before he gets up and goes out to meet with people. If he is negative he will be OK, if he is positive continued isolating. Emergency phone call among HHS people (Becerra, Dawn et al) regarding convincing POTUS (and Ron) to declare a Public Health Emergency (PHE) for MPX. Becerra says that POTUS will rely heavily on my opinion. Problem is that they are concerned that if you declare a PHE for monkey pox then why not declare it for gun violence or for reproductive rights. That sounds very much like the negativistic attitude of RON. --_- -- etiieeatieatinetidimedtinetne Mieatitdiatin' Mieiiediendmadtied SUBJECT: President Biden SARS-CoV-2 Update President Biden completed his second full day of PAXLOVID last night. His symptoms continue to improve. His primary symptoms, though less troublesome, now include sore throat, rhinorrhea, loose cough and body aches. His voice remains deep. His pulse, blood pressure, respiratory rate and temperature remain entirely normal. His oxygen saturation continues to be excellent on room air. His lungs remain clear. The President continues to tolerate treatment well. We will continue PAXLOVID as planned. His symptoms will continue to be treated supportively with oral hydration, acetaminophen (TYLENOL), and the albuterol inhaler that he uses as needed for cough (2-3 times a day). He is experiencing no shortness of breath at all. He will continue low dose aspirin as an alternative type of blood thinner. Our preliminary sequencing results have returned. The President's causative agent is most likely the BAS variant. This is the SARS-CoV-2 variant which is responsible for 75-80% of infections in the United States at this time. This data does not affect the treatment plan in any way. The President is responding to therapy as expected. The BAS variant is particularly transmissible and he will continue to isolate in accordance with Centers for Disease Control and Prevention (CDC) recommendations. We will continue to monitor him closely, during this very common outpatient treatment regimen. As promised, I will keep your office updated with any changes in his condition or treatment plan. Respectfully submitted, TOC ae Kevin C. O'Connor, D.O., FAAFP Physician to the President Associate Professor, The George Washington University School of Medicine & Health Sciences PRESS: ABC "Good Morning America" Weekend; CBS Mornings (Weekend); CNN "New Day" Weekend; Fox News with Neil Cavuto
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July 24, 2022 Kevin O'Connor continues to call me 2x/day. The President continues to improve and is completed his 4th day (Sunday) on Paxlovid. He was out for four hours today by the pool doing reading work. The next big question is whether to give him eight days or 10 days instead of five days of Paxlovid. That would be a problem since it would be against FDA authorization and the public would cry out that we had treating him differently than other people. The concern on the part of the White House is that if he rebounds after he is negative for several days, he will likely be out talking and mingling with people. If he infects someone following an unrecognized rebound, he will be blamed for infecting other people. My suggestion would be to treat him for five days, have him stay in the White House virtually up to an additional five days testing him everyday. If he turns negative, as soon as he turns negative send him out even if it's before the 10 day period. And have him wear a mask in order to avoid him inadvertently infecting people if he rebounds, I would be OK, if he is positive continued isolating. Had long conversation with Ashish who was asking my advice. He started off the conversation by saying that the White House continues to have a lot of problems with Rochelle, the latest of which was the apportionment of vaccine doses. (See discussion above about strong consideration of asking her to step down). Ashish said that Ron wants my take on the situation with Rochelle/CDC and the distribution of vaccine doses. She wants to divide the vaccines for monkey pox according to the formula of 25% according to cases and 75% according to risk. This is something that we had discussed yesterday in a call with the secretary. During that call I promised that I would back Rochelle's proposal because of the fact that if they do not distribute more, namely 75%, according to risk, when we have outbreaks related to "Southern Decadence" and other gay pride functions we will not have vaccine in place to counter it. However Ron Klain is adamant that he does not want vaccines shipped to locations in which there are few cases and when they do not get cases or they do not administer vaccine to their case countthat the vaccine goes to waste (you cannot reship vaccine). I made the following point to the secretary yesterday and I repeated it word for word to Ron today. I would be supportive of a 25% for cases and 75% for risk distribution only if the jurisdictions that received the 75% for risk are given the vaccines in small apportionments. For example if they were scheduled to get 400 vaccines, you would give them 100 and tell them that if they don't use that 100 expeditiously the next shipment of 100 would not be given to them but would be given to a jurisdiction that has a high number of cases. I explained this to Ron when he called me today and told him that that would be my position. He said that Ron is very interested in what I would do and that this would hold a great deal of weight in the discussions that we will have tomorrow, which is Monday. Had a long conversation with Jeff about the above issue concerning firing someone at HHS/CDC. Similar to the situation that I faced years ago with Secretary Burwell wanting to fire Tom Frieden because of poor performance with Ebola where I defended Tom, I found myself defending Rochelle. Rochelle is a wonderful person, but she does not have control over her agency and she has to learn to balance the politically expedient thing while still maintaining solid scientific principles. The problem is she relies too heavily on the entrenched people at CDC who are smart and will meaning but who have no oversight or quality control from the outside. This allows them to proceed with somewhat antiquated if not ossified ideas. As the discussion went the options were to fire Secretary Becerra; however, this would be very difficult since it would be tough to get a Senate confirmation for a secretary within a relatively acceptable period of time. The other option is to fire Rochelle, but now is not the time to do that and it would be against my recommendation. One of the points that Jeff made is that they are considering in a humane way to ask Rochelle to step down at the end of the year before the beginning of the second-half of the first term. Despite my trying to protect Rochelle there is a very good chance that that will happen. Kevin O'Connor continues to call me 2x/day. The president continues to improve and is completed his 4th day on Paxlovid. He was out for four hours today by the pool doing reading work. The next big question is whether to give him eight days or 10 days instead of five days of pax livid. That would be a problem since it would be against FDA authorization and the public would cry out that we had treating him differently than other people. the concern on the part of the White House is that if he rebounds after he is negative for several days, he will likely be out talking and mingling with people. If he infects someone following an inadvertent rebound, he will be blamed for infecting other people. My suggestion would be to treat him for five days have him stay in the White House virtually for an additional five days testing him every day if he turns negative as soon as he turns negative send him out even if it's before the 10 day. And have him wear a mask in order to avoid him inadvertently infecting people if he rebounds, I would just test him every morning before he gets up and goes out to meet with people. If he is negative he will be OK, if he is positive continued isolating. Of note, Ashish states that he wants Kevin to go up in front of the cameras to describe the President's condition, but it is Ron who does not want him to go up as well as Karine JeanPierre. That is interesting because I am hearing that it is Ron who does not want Kevin to get up in front of a camera. PRESS: MSNBC with Jonathan Capehart
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July 25, 2022 Spoke with Kevin O'Connor again this morning and evening. the president is doing extremely well and continues to improve. He we'll complete his fifth day of Paxlovid today. The next question will be when he can go out into society. I have a phone call with Ashish this afternoon and I will recommend that we not give him additional days of drug but that we have him stay masked inside for 5 days or until he tests negative by antigen test. They are concerned about rebound; however, I have told them that if he tests every morning for five to 10 days after his Paxlovid course ends and he does not show any positivity, he can go out that day and proceed with business. That would be much more acceptable to the general public then to give him an extra few days of drug which would not actually guarantee that he does not rebound. PHYSICIAN TO THE PRESIDENT THE WHITE HOUSE 25 July 2022 MEMORANDUM FOR: KARINE JEAN-PIERRE ASSISTANT TO THE PRESIDENT AND WHITE HOUSE PRESS SECRETARY
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2022-07-26 00:00
Anthony S. Fauci
July 26, 2022 Continuing my twice per day discussion with Kevin O'Connor regarding the president's condition. The POTUS Is doing very well and improving substantially each day. Today is one day following the termination of his Paxlovid therapy and his CT level is 35 which means that he has very little replication competent virus in his nasopharynx. He feels very well and we had a long discussion this evening with Kevin, Ashish Jha, and Ron Klain as to what the presidents activities could be looking forward. He tested negative today by antigen test and has a very nice CT level as mentioned above. The White House staff is concerned about possible rebound and I made a suggestion that he stay masked and in isolation until he gets two negative antigen tests in a row. After that he can go out and do duties on the outside provided that he does not travel and that he wears a mask. I would test him intimately a few times a week to see if he rebounds. It became clear to me that Ron Klain and the president rely heavily upon my advice but what to do with the president's condition. I have developed a very good relationship with Kevin O'Connor and he calls me twice a day. We had some serious discussions with secretary Becerra about having a consistent message about the distribution of the monkey pox vaccine. See above about the concern of having vaccine in places that are not being utilized well there are lines in other jurisdictions. I supported the CDC recommendation of distributing the vaccine with 75% to risk areas and 25% to actual cases so long as individual jurisdictions utilize the vaccine. The CDC will send out the vaccine in tranches that will not be followed up with more vaccine until the jurisdiction actually utilizes the vaccine so that we don't have unused doses in one area and demands more than supply in another area. We also discussed whether or not we should declare monkeypox a public health emergency. I argued strongly that we do that in order to send a signal to the MSM community that we are very serious about the situation that they find themselves under. We had the vaccine summit today in the Indian treaty room of the executive office building. I gave a talk on the NIH research agenda. Also I did an enormous amount of press today which overlapped with a number of meetings with the White House as well as with secretary becerra. Big time stressed today and I feel it. PRESS: CNN "New Day" with John Berman; MSNBC "Morning Joe"; NPR "All things Considered"; News Nation Now TV; MSNBC "The Reid Out" with Jason Johnson
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July 27, 2022 Paper in Nature today validates my disagreement with the CDC last year when Vivek and I pushed back against their saying that you do not need to test after 5 days of isolation after infection since most of the transmissions occur in the first few days of infection and after day 10 you are OK (see prior notes): How long is COVID infectious? What scientists know so far "ay PHYSICIAN TO THE PRESIDENT THE WHITE HOUSE 27 July 2022 MEMORANDUM FOR: KARINE JEAN-PIERRE ASSISTANT TO THE PRESIDENT AND WHITE HOUSE PRESS SECRETARY
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July 27, 2022 at 2:51 p.m. EDT Variety: Dr. Fauci, Roberta Flack and Zora Neale Hurston Documentaries on the Way, PBS Boss Announces Went to a terrific social function at the incredible home of Adrienne Arsht at 6 Chevy Chase Circle. It was a cabaret night where American Pops Orchestra founder/leader had a contest played old songs and had the audience guess the singer. I thought that I might win since I got only 2 wrong, but Renee Fleming won with an even better score. Had interesting conversation with Brett Baier where he finally admitted that the 2 recent Science papers by Worobey, Andersen, Rasmussen et al convince him that the lab leak theory is really not true. PRESS: New York Daily News interview with Tim Balk; NPR WBUR Boston with John Ringer; Dr. Anthony Fauci says government response to monkeypox must address anti-gay stigmas Muri Assunção, New York Daily News
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July 28, 2022 Cases and hospitalizations continue to rise slowly with very little increase in deaths. I recommend to Becerra to declare PHE. Monkeypox: Global.health: 20,671 confirmed MPX cases, 42 suspected in 84 non-endemic countries. 4600 in USA. 2 children infected in USA from mother who had sex with bisexual man The Montreal Gazette concerning my comments (virtually at the UNAIDS report unveiling): Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the United States and chief medical adviser to U.S. President Joe Biden, said the UNAIDS report is "a reminder that the global plague" of HIV/AIDS "continues to rage," even though much of our attention diverted to the global pandemic of COVID and now, monkeypox. "All of us in the global HIV community must work to reach vulnerable communities," he said, and the report is a reminder that "we can do better in this, the fifth decade of AIDS. The priority must be to )fda.hhs.gov>; Dawn.Oconnell@hhs.gov>; Levine, Rachel YASH) <Vivek.Murthy@hhs.gov Michael.Varroneé€ implement better treatment modalities, while improving and optimizing the next generation of interventions." The COVID pandemic and, now, monkeypox, mean "people are exhausted with epidemics and pandemics. We have to fight twice as hard to get HIV back on the radar screen, where it belongs," Fauci said. I was involved in a very difficult zoom cool this evening with Peter Marks. Rob Califf, Vivek, David Kessler, Julia Tierney (FDA), Hillary Marston, among others about the potential conflict that might occur tomorrow when Ashish has convinced the president to come out and say that anyone who's not been boosted recently should get boosted. However, we now know that both moderna and Pfizer will have the BA.5 bivalent boost available the first week of September. This will create a major messaging problem since we are telling people to get boosted with the vaccine that doesn't cover the current BA.5 variant when the actual variant-specific boost will be available 5 weeks from now. Somehow or other Ashish took the initiative to convince the president to say this without consulting with the FDA or the CDC. If these mixed messages go out it will be a major cluster. I tried to bring this up to them and suggested strongly that they have a zoom in the morning before any of these announcements are made in order to get a common message otherwise it will look like one of the worst mixed messages to come out in a long time. I'm starting to see right now the advantage of having Jeff as the coordinator since he understands the interactions among the different agencies of government whereas Ashish is smart, a very good communicator and is well meaning, but he is more about looking like he's taking the lead on things than coordinating. Later in the evening, I had dinner over jeff's and Mary's house which was a great evening. Guests at the dinner besides Chris and I were: Susan Rice, Secretary of Defense Lloyd Austin and his wife Charlene, Deb Harmon, Wally Adeyemo. The discussion was very stimulating particularly Susan Rice telling us stories of her escapades during the Obama administration and secretary Austin telling us about the tension in his multiple responsibilities. One of those discussions of the night was the desire of Nancy Pelosi to go to Taiwan which everybody feels is a very bad idea given the geopolitical situation. However for some reason she feels she needs to go there and everyone seems to be against it.
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July 29, 2022 See e-mail chain below regarding the confusion about mixed messages related to my note yesterday: