Fauci’s Prejudice: How the HIV/AIDS Playbook Has Foiled The Search For A COVID-19 Therapy

Dr. Fauci and his colleagues are still starstruck by their success with anti-replication agents against HIV/AIDS. But their prejudice in favor of anti-replication and viral neutralization agents has almost entirely foiled the search for an effective COVID-19 therapy. Because, COVID-19 disease is NOT HIV/AIDS. COVID-19 is, dominantly, an inflammatory disease.

I am a fan of Dr. Fauci’s. I respect his intellectual and personal qualities.

But, I also know that it is highly likely that a dangerous scientific prejudice he holds is responsible for foiling our nation’s ability to quickly achieve an effective therapy for COVID-19 disease.

Let me explain.

The only partially effective therapy we currently know of, for treatment of COVID-19 disease, is the anti-inflammatory steroid, dexamethasone.

COVID-19 disease is, in fact, an inflammatory disease.

Specifically, the SARS-CoV-2 virus triggers an inflammatory response in the patient, which seems to affect many organ systems.

But when the COVID-19 inflammation severely affects the lungs and blood vessels, it can cause respiratory failure and life-threatening blood clots. This is how the infection is able to kill somewhere around 2–5% of those it infects — at the tune of 250,000 Americans dead so far.

So it makes sense that the steroid, dexamethasone, works to block the deadly inflammation in some patients.

But, Dr. Fauci and the vast majority of the infectious disease specialists, who are leading our nation’s search for a therapeutic have a dangerous prejudice: They are not focused on blocking the deadly inflammation. Instead, they are focused on blocking viral replication or neutralizing the virus with antibodies. Because they believe that reducing SARS-CoV-2 replication, is what will block progression of COVID-19 disease. THIS, is likely to be their serious error and deadly scientific prejudice.

Simply put, Dr. Fauci’s prejudice as a virologist has deviated our nation’s effort to find a therapy away from blocking the inflammatory reaction that is COVID-19’s real kill mechanism.

I am not suggesting that the good doctor is doing so with any negative intent — he is a leading physician-scientist with a decorated history in the fight against HIV/AIDS, and he is a good man. But, he is a virologist. He is not a specialist in inflammatory diseases: he is not a rheumatologist, nor a cellular immunologist.

And as such, given his dominant scientific voice leading the charge to find a COVID-19 therapy, he has foiled our nation’s success by not focusing on COVID-19 inflammation.

I want to explain my perspective.

Dr. Fauci’s worldview on viral disease was shaped dominantly by his success in the fight against HIV/AIDS. So, it’s critical to understand how HIV kills its host and how this differs from SARS-CoV-2.

Here’s a synopsis of HIV’s “kill-mechanism”.

The HIV virus, directly targets and kills a population of T-lymphocytes called “CD4 T-cells”, which are critical for our ability to fight off opportunistic infections. The more HIV viral particles present in the infected patient’s body, the more CD4 T-cells are killed. Eventually, over the course of months to years, when HIV kills off enough of these CD4 T-cells, the patient will become immunodeficient and susceptible to all kinds of other bacterial, fungal and viral infections. This is the disease state caused by HIV, which we know as AIDS: uncontrollable opportunistic infections caused by an HIV-mediated deficiency of CD4 T-cells.

Dr. Fauci’s entire world view as a virologist is shaped by the success America found in blocking the replication of HIV. It makes a lot of sense too: block HIV replication, reduce the “viral load” in the patient, and you will stop the death of CD4 T-cells and prevent AIDS. This is, in fact, how we, as a nation, managed to help the world bring the HIV pandemic under control. Kudos in large part to Dr. Fauci and his colleagues.

But, SARS-CoV-2 is NOT HIV.

For starters, the effect of the SARS-CoV-2 virus on patients is a lot more rapid than for HIV — because it is inflammation, not passive killing of billions of CD4 T-cells over years. While the inflammatory response to SARS-CoV-2 takes off within 5–10 days of infection, and could get patients critically ill quickly, HIV takes months to years chipping away at CD4 T-cells, before it makes the patient susceptible to other deadly infections.

So, even though it could be true that blocking replication of the SARS-CoV-2 virus early in the infection might prevent progression of COVID-19 disease, once the inflammatory process has taken off, it’s out of control inflammation that kills.

Dr. Fauci’s overt focus on developing therapies to block viral replication, and antibodies that neutralize the virus, has almost entirely ignored the immediately visible fact that inflammation is the hallmark of COVID-19 disease — and that HYPER-INFLAMMATION is its “kill-mechanism”.

This is Fauci’s prejudice.

So while America has wasted precious time for the past 8 month devoting billions of dollars to developing anti-replication agents and neutralizing antibodies — we have missed the mark on COVID-19’s kill-mechanism. And, I am almost certain, that this is because of Fauci’s prejudice and the disproportionate power he wields and wielded early in leading the scientific fight to find a therapy for COVID-19 disease.

No data point makes my point clearer than the fact that the most effective therapy we do know of against COVID-19 disease is the anti-inflammatory steroid, dexamethasone.

It may be that Dr. Fauci’s replication inhibitors and neutralizing antibodies could help a fraction of patients treated very early, but these will almost certainly not help those patients whose COVID-19 disease is active and progressing.

The therapy for COVID-19 disease is highly likely to be an anti-inflammatory one — not an anti-replication or neutralizing antibody mediated one.

My personal bet is that a combination of the calcineurin inhibitor drug, cyclosporine, and dexamethsone will prevent a majority of infected patients from progressing to critical illness.

Dr. Janet Woodcock is a leading FDA regulator and leader in Operation Warp Speed. She is also a rheumatologist by training, who fully understands inflammatory diseases. But her voice within OWS has been almost entirely blunted by Fauci’s prejudice in favor of anti-viral replication and neutralization agents.

The trouble is that Dr. Fauci and his colleagues at Operation Warp Speed (OWS) have not yet taken stock of their prejudice against aggressively controlling COVID-19 inflammation. There’s a reason why even dexamethasone was studies and delivered to the world as a partially effective therapy by the British, not by the United States.

Dr. Fauci and his colleagues are still star struck by their success with replication inhibitors in the fight against HIV/AIDS. But, COVID-19 is NOT killing Americans the same way HIV does.

It’s not too late for Dr. Fauci and OWS to recognize their dangerous prejudice in favor of replication inhibition and viral neutrlaization, and to correct course.

It’s time for Dr. Fauci and America’s public health experts to accept and act on the fact that COVID-19 is an inflammatory disease triggered by a virus. Once the COVID-19 inflammation gets out of control, the virus itself is almost irrelevant.

Here, I write for the historic record. So that, perhaps, Dr. Fauci and his colleagues at OWS will take stock of the notion that their prejudice in favor of viral replication/neutralization agents in the fight against COVID-19 disease may become America’s undoing in this pandemic.

Dr Fauci, COVID-19 kills by inflammation. Stop the inflammation.

Hooman Noorchashm MD, PhD is a physician-scientist. He is an advocate for ethics, patient safety and women’s health. He and his 6 children live in Pennsylvania.