The Peter Attia Drive - #99 - Peter Hotez, M.D., Ph.D.： Continuing the conversation on COVID-19

00:00:00.000 Hey, everyone. Welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

00:00:15.480 my website, and my weekly newsletter all focus on the goal of translating the science of longevity

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00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay, here's

00:00:48.080 today's episode. Welcome back to another COVID-19 special episode of the drive podcast. I'm once

00:00:55.620 joined by Dr. Peter Hotez, a renowned vaccine scientist, pediatrician, and an expert on the

00:01:00.560 current coronavirus outbreak. We released an episode with Peter on March 14th, which received

00:01:07.220 a lot of feedback. People were very grateful for that and wanted to have him back on with other

00:01:12.920 questions. It is difficult to immediately address questions that are posed in the aftermath of a

00:01:18.480 podcast that's five days old because five days in this outbreak is an eternity. So a lot of the stuff

00:01:24.460 we talked about today is not actually stuff I thought I would talk about with Peter at the

00:01:28.920 time that we finished our last episode. And again, that means it might not be germane a week from

00:01:34.000 now, but nevertheless, this was recorded March 19th in the late afternoon evening. And as such,

00:01:40.480 it's probably only as relevant as that timing. Given the temporal nature of things at this moment in

00:01:46.040 time, I think podcasts become pretty obsolete pretty quickly. So hopefully you're all able to listen to

00:01:50.820 this today, March 20th or shortly thereafter. Moving forward, I will continue to release shorter and

00:01:58.100 more irregular podcasts, probably trying to get out two or three a week. Also, I'll continue to post

00:02:04.240 videos on Instagram and eventually they'll make their way onto YouTube usually the next day. Again,

00:02:10.580 everything at this point in time is open to subscribers, non-subscribers equally. And we're also in the

00:02:16.580 process of putting together a specific page on our site. That's at peteratiamd.com that will house all

00:02:25.000 of the information we're posting on this SARS-CoV-2 virus. That's the responsible agent for the disease

00:02:32.780 known as COVID-19. So again, podcast now with Peter, please enjoy it. Keep in mind, hopefully within a

00:02:39.880 couple of days, we'll aggregate all of this stuff, all podcasts, all videos, plus all of the internal

00:02:45.860 memos that we are sending to our patients. We're just going to start putting all of that stuff out there

00:02:50.340 for everyone. And that'll be on our site. So hopefully you enjoy my discussion here today with Dr. Peter

00:02:55.640 Hey, Peter, thank you so much for making time again to speak. I know it was less than a week ago that

00:03:06.220 we sat down to do this, but a week in terms of this coronavirus seems like a year with respect to the

00:03:14.100 knowledge and insight that we're gaining with respect to everything else in healthcare.

00:03:17.540 I really appreciate the opportunity to be on. This was our first podcast together and

00:03:22.420 maybe it was the topic, but the response has been extraordinary. I've been getting emails and

00:03:28.340 texts from people, so many individuals and all of them really enthusiastic and supportive and

00:03:34.920 saying that we did such a good job explaining some complicated science and asking questions that

00:03:43.300 people actually wanted to know the answer to, but maybe never articulated before and

00:03:48.420 tied so many things together and connected a lot of dots. And then in a few cases, we've even gotten

00:03:55.220 people reaching out, asking if they can help to support our vaccine development efforts. And we've had

00:04:02.500 a lot of really good follow-ups. So thank you again for that opportunity. I was really also impressed with,

00:04:08.040 I expected to hear only from either physicians or healthcare professionals, but I've heard

00:04:13.160 apparently this podcast is reaching people in all walks of life and people who just really

00:04:19.320 are kind of sick of things so dumbed down in the mainstream media. So I think we hit it at a really

00:04:26.120 good level. Well, thank you. That means a lot coming from you. And I agree. I've sort of always rejected

00:04:31.580 the notion that people need dumbed down soundbites. I think that's probably just an assumption

00:04:36.920 that when really vetted is probably not true for the majority of people. I think if people in medicine

00:04:42.020 and science can explain things clearly and patiently, then I don't think you need to have

00:04:46.320 a great background in this to understand complicated topics. And this is a case in point.

00:04:50.200 I think that's also why I've been asked to come back to CNN and Fox and MSNBC is because I'm willing

00:04:57.100 to take a little bit of time and explain complicated concepts. And provided I can get more than 30

00:05:03.160 seconds or a minute or two, it seems to resonate well with people. That's what people want to hear.

00:05:08.500 They don't want to hear dumbed down crap. They want to hear real things and want to understand the

00:05:14.300 nuance and know that certain things are complicated and that we don't have all the answers.

00:05:19.700 Yeah. So Peter, I want to talk about a few things that have sort of changed in the last week.

00:05:25.020 Obviously, from a confirmed cases standpoint, at the time of this recording, which is Thursday

00:05:32.200 afternoon, March 19th, were a little over 13,000 cases confirmed in the United States. But I think

00:05:39.600 it's safe to assume that that's a small fraction of the true number of infected patients. Do you have

00:05:46.640 a sense of what range you would apply to the true number of infected people?

00:05:51.900 A couple of things. First of all, you're seeing every day, it's a big jump. Every day is the

00:05:58.120 largest number of new COVID cases that we've ever seen. When I last looked, it was just this morning,

00:06:04.360 it was just under 10,000. Now you're telling me it's 13. And before then, I think it was 8,500,

00:06:10.980 then 7,000. So undoubtedly, a lot of that is we're finally getting some testing underway.

00:06:16.380 And it's starting to catch up with the actual population who's infected. And where this goes,

00:06:23.280 I think, is going to be very interesting. I don't think we have a real sense of the percentage of

00:06:29.500 the population infected. I think what's happening is not necessarily that this is even new transmission.

00:06:35.360 A lot of this are probably areas that have been undergoing transmission for a few weeks, but we're

00:06:40.440 just picking it up now. So I think that's an important component. And there are models that

00:06:46.420 say for every person you identify, there's 50 more, 20 more, but I don't know how strong the

00:06:52.100 assumptions are for those models. So I think we have a lot, but I think what's more telling

00:06:58.220 is just hearing from physicians at major hospitals from all over the country, from Philadelphia,

00:07:06.920 Baltimore, New York, and elsewhere, saying they are just taking care of a lot of patients

00:07:12.240 and they're already feeling overwhelmed, even this early in the epidemic. And that says to me that

00:07:20.540 this thing is now revving up despite what the actual numbers of tested cases say.

00:07:26.540 And it also tells me that one of my worst fears and nightmares that I talked about on the last

00:07:33.820 podcast that I've been rattling the cage about is coming true, that this thing is rapidly approaching

00:07:40.640 overwhelming health systems and doctors and nurses, other health professionals are starting to get

00:07:48.360 exposed and getting sick. And with that is a lot of worry, also a lot of heroism on the part of

00:07:56.220 health professionals. But I'm very worried right now that we're not doing all we can, even close to

00:08:02.680 protect one of our most cherished resources in this country, which are our healthcare professionals.

00:08:08.260 And I think we're really seeing this rev up now. And a few weeks ago, I testified in Congress

00:08:13.200 and I was alarmed at the fact that we weren't paying attention to our nursing facilities and assisted

00:08:20.160 care living facilities. And the fact that we've had 25 deaths in that nursing home in Washington

00:08:26.940 state. In Kirkland, that's when I used deliberately provocative language in Congress and said,

00:08:33.680 this is the angel of death. And I knew it was going to get on, make a lot of headlines and it did,

00:08:39.180 but it got people's attention. This week felt I had to do it again. I went on CNN Newsday with

00:08:46.000 Alison Camerata. And I had to do it again because I'm so frustrated that we're exposing some of our

00:08:54.140 nation's greatest treasures, our healthcare professionals to this virus without making

00:08:58.920 them feel safe or protected in any way. And I said, look, if a significant number of healthcare

00:09:04.160 professionals start either self-quarantining or actually getting sick, or if you have the situation

00:09:11.320 where colleagues are going to start taking care of colleagues who are very sick or in intensive care

00:09:16.840 units, the term I use, it'll be lights out. By lights out, I mean, this whole thing is over.

00:09:21.920 Things will unravel in this nation very fast. And, you know, and I knew I was, again, being very

00:09:27.540 provocative, but sometimes you have to do it to get people's attention. And now I think it's starting

00:09:33.400 to register. The question is, can we mount an efficient response to figure this out?

00:09:39.540 Peter, you alluded to this idea of, do we have a sense of how many people are infected

00:09:43.600 as a function of how many people are confirmed? So the actual to confirmed case multiplier.

00:09:49.220 We've been building one of these models ourselves. We've looked at other people that have built them.

00:09:54.700 I've seen people estimate that, look, it can't be less than 45 to 50. Our internal estimate,

00:10:01.320 which I think is very conservative, is probably closer to 25. And what it's basically doing is trying

00:10:06.920 to figure out what is the assumed number of days from an infection until a fatality. And then what

00:10:15.400 is the assumed infectious fatality rate? And obviously it becomes very sensitive to both of

00:10:20.540 those. But if we pause it for a moment that it's on the most conservative side of those estimates

00:10:26.160 in the neighborhood of 10 to 20, do you consider that a positive or negative sign? In other words,

00:10:31.720 if right now there are quote unquote only 125,000 people infected in the United States,

00:10:38.600 are we in good shape? We may or may not be because remember those 125,000 are not evenly

00:10:46.340 spread across the country. Let's say it's 200,000 just for argument's sake. What that really means

00:10:52.560 is there may be 30 or 40,000 cases in the New York area and things are getting scary very quickly.

00:11:01.780 And there may be another similar number in Washington or California or the couple of places where there's

00:11:08.600 no transmission. And basically just a handful of cases, maybe in Texas or places like that.

00:11:15.980 So the question then is if you're modeling, how are you going to do this? What you really want to look

00:11:20.960 at is a map of the U.S. and you're going to see a bunch of, let's say use red as your color

00:11:27.000 to mark the number of cases. You're going to see a red blob, smallish red blob over New York and

00:11:33.360 Seattle, maybe one or two other places. And it's those blobs that are going to start to grow. And

00:11:39.480 then you're going to see other small red dots appear in the country and they're going to start to

00:11:44.760 grow. And then it's going to be the question of whether those blobs begin to coalesce across the

00:11:50.160 country. So that's how it's going to work. It's not the absolute number of cases in the U.S.

00:11:55.560 You know, it's interesting because the United States is so large. You want to look at those

00:12:00.700 nodes of where there's significant levels of infection and see how they grow and intensify

00:12:07.280 in color. And what I'm hearing from Governor Cuomo, he's really sounded the alarm in a very effective way.

00:12:14.260 And that's what we're going to be in for for the next few weeks or months is a New York-like

00:12:22.560 situation starting to pop up in other parts of the country.

00:12:27.200 Yeah, that makes a lot of sense. Let's go from that then on to some testing because testing is

00:12:31.920 now going to figure into this, of course. I can't get a straight answer from anybody. So I'm curious as

00:12:37.460 to whether you have an insight as to why the CDC and FDA elected to go with Roche for the testing

00:12:45.700 kit when they were very late to this, as opposed to using one of the companies in China that had

00:12:51.640 already done literally millions of tests and had pretty robust data on sensitivity, specificity,

00:12:58.500 et cetera.

00:12:59.060 I don't know how they made any of their decisions around testing. It's clear they should have gone to

00:13:05.180 commercial kits from the very beginning. I'm getting asked a lot of questions about what's

00:13:10.580 gone wrong in the testing, what's gone wrong in the hospital response. And I've sort of deflected

00:13:17.200 the questions a bit because right now we have to really focus on the matter at hand. I think

00:13:23.460 what's going to happen is when we get through all this, whether it's in a year from now or 18 months

00:13:29.220 from now or sooner, there's going to have to be some type of independent committee to really look

00:13:36.900 into the missteps. And it's not for the purposes of being punitive. It's for the purposes of trying

00:13:42.920 to figure out how to fix this when a new pandemic emerges next time so we don't make so many of the

00:13:50.440 mistakes. And I think we'll see a number of flaws that went on with some of the agencies. I think

00:13:57.500 we'll see some of the flaws that went on on the communication between the federal and local

00:14:02.640 governments and state governments. And that may require us to enact some new legislation to fix it.

00:14:09.660 But it's just been so exasperating to see how this has been rolled out. We didn't have a lot of time

00:14:15.980 of notice, but we did have time. It's not like we didn't have any idea it was coming. We had

00:14:21.320 at least a month, arguably two months to know what was going to hit the United States. And we also saw

00:14:28.360 pretty quickly that this was not going to stay confined to central China or even China. It moved

00:14:34.800 pretty quickly to Asian countries. And even when it was starting off in Italy, we were still pretty

00:14:40.720 slow on the uptake. So the fact that we did not have a faster trigger is going to be really

00:14:47.700 interesting. And it's impossible to know right now where the fault lies. I have some suspicions,

00:14:54.420 which I could share in private with you, but I don't think it's going to help us right now to

00:14:59.140 start pointing fingers. But now it's a matter of figuring out how we rapidly fix this. Because now,

00:15:06.060 unfortunately, now that we're starting now to fix the first phase, the testing,

00:15:10.380 that we still have a ways to go. We're already moved into the second phase where health systems

00:15:15.600 are already being stressed. And I'm worried it's going to be close to collapse in a couple of weeks

00:15:22.120 unless we can figure this out. New York is already reeling. We are seeing the anxiety on people's faces

00:15:28.660 in the New York hospital system. And I'm very concerned. Now, Peter, what do you think is going to be

00:15:35.700 the rate limiting step in healthcare delivery in an area like New York or other areas that are going

00:15:42.060 to be sort of epicenters for this? Do you think it will be the healthcare providers? Do you think it

00:15:47.660 will be ventilators? Do you think it will be PPE for the healthcare providers? Where do you actually

00:15:53.680 think the breakdown occurs? Well, I see the first breakdown starting to happen with doctors and

00:16:01.000 nurses already exhausted, already demoralized to some extent, and people feeling that no one is

00:16:08.740 really looking after them and they're kind of on their own. So we've already had that initial

00:16:14.940 breakdown of trust. Can you say more about that, Peter? I want to make sure I understand what is

00:16:19.760 that resulting from? Is that due to a belief that the system isn't providing them with the necessary

00:16:25.040 equipment to protect themselves or the necessary resources to take care of patients? Where is that

00:16:29.500 disdain or lack of trust coming from? Well, I think it's coming from seeing colleagues get sick

00:16:34.800 and inconsistency in what the plan is. A lot of hospitals haven't prepared for this adequately,

00:16:43.120 not seeing also this disconnect from what they're seeing coming out of the state government or federal

00:16:50.460 governments when they're very worried about for themselves and their families. They're seeing

00:16:57.280 colleagues start to get sick. They're hearing stories of some colleagues being seriously ill.

00:17:04.480 And either it's the White House still two or three weeks behind, still having the testing discussion,

00:17:12.520 or state governors not really saying, we hear you, we know you're concerned. Here's what our plan is,

00:17:21.800 is chilling, actually. I think the, as I say, the only one now, because it's New York, it's higher

00:17:27.240 profile, and all the media outlets are in New York. The only governor I'm hearing from on a regular

00:17:32.060 basis is Cuomo, and he clearly gets it and has sounded the alarm. But I'm concerned. And I'm also hearing

00:17:39.500 about from parents of residents or residents themselves. And then on top of that, now the latest story

00:17:48.020 that's come out of both MMWR, the Morbidity and Mortality Weekly Reports from the CDC, as well as

00:17:54.780 Italy, is that this is no longer a disease of the old and infirm. It's significant numbers of young

00:18:01.760 adults, people who are residents, fellows, young attending age, actually now with severe illness

00:18:08.820 and going into ICUs in this country. And that buzz is already catching on among young physicians.

00:18:17.600 And that's highly destabilizing. And I think that's probably our biggest link right now. Eventually,

00:18:23.340 it will be the lack of respirators and lack of PPE. But I think right now, it's the fact that you're

00:18:31.040 seeing young physicians and nurses, people in the best years of their life now getting sick,

00:18:36.960 and the feeling that they're feeling abandoned. And I'm getting that sense from either direct emails

00:18:43.420 from nurses and physicians thanking me for speaking out and echoing their concerns. And in many cases,

00:18:49.720 it's parents of resident physicians and young and nurses as well. And that we're starting to see that

00:18:57.040 being a regular occurrence right now.

00:18:58.840 So what is the solution to that, Peter? Because we can't, obviously, on a moment's notice,

00:19:03.620 ramp up the number of doctors, nurses, respiratory therapists, hospital staff. I mean, everybody in

00:19:09.780 the hospital, right? It's the people that we don't even necessarily immediately think about,

00:19:13.580 the people who clean the ventilators, the people who clean the hospitals. I mean,

00:19:16.900 all of these people are not going to be trained overnight. So how do we solve this problem when

00:19:23.100 going back to your earlier point, if you look at average numbers across the United States,

00:19:28.280 it's very easy to be misled? This is really going to be probably about local waves of this. So is the

00:19:36.260 solution that we are mobilizing physicians from geographies that are underutilized into higher

00:19:44.520 utilization areas? How do we actually go about solving this problem?

00:19:48.480 Well, the problem is the areas that are likely COVID-19 are also probably underserved already by

00:19:54.760 physicians. I know we're all sort of thinking out loud, and I thought about that too. But realistically,

00:19:59.660 what do you do? Take a physician who's serving the entire county, an entire county in western

00:20:04.580 Nebraska, and take them to New York to help out. That's probably not realistic either.

00:20:11.520 Maybe not as outrageous as an example, but again, I don't know what it's like in the Houston area right

00:20:16.340 now or in Dallas or other major metropolitan areas that are not New York. I mean, could one

00:20:21.040 repurpose medical staff from those areas to deal with the first wave in the places that are very

00:20:27.100 likely to be overwhelmed quickly? Yeah. On the other hand, it could be. But then if you actually

00:20:33.020 talk to physicians in areas where there's not COVID-19, it's not like they're not already stressed

00:20:40.760 out and already overburdened with their daily activities and the electronic health records and

00:20:46.560 everything else. So the whole system to begin with has been pretty fragile with very high rates of

00:20:53.760 what some people call physician burnout, which is a term I don't like at all, but it's not really

00:21:00.140 burnout. It's making these horrible, unreasonable demands on physicians and healthcare providers

00:21:08.100 to benefit the insurance companies. So you've already got stressed out young physicians who are heavily

00:21:15.380 under siege and now you're going to bring them into a COVID-19 area. I'm not sure. So the bottom line

00:21:22.100 is I don't have, I don't have any obvious solution to figuring this out. One possibility that I've

00:21:29.860 thought about and haven't introduced it to anybody yet is could we dramatically expand the U.S. public

00:21:38.480 health service, especially with all these individuals who are at home now and in some cases

00:21:45.080 not receiving a paycheck? Would there be any advantage offered to have this use a commissioned

00:21:52.300 corps of the public health service or even the military to bring in a whole cadre of not highly

00:21:58.900 trained individuals, but individuals that you could train like medics to help out just to provide an

00:22:05.360 increase in the number of people who can help manage ventilators and that sort of thing? So that's one

00:22:13.020 potential possibility. And then the question is, if we're not quite there yet, it's going to be very

00:22:18.200 hard to persuade Congress to take that kind of action. So Peter, what is the latest thinking you have

00:22:26.160 on things that people who are presumably not infected, so either asymptomatic or confirmed to be not

00:22:33.660 infected, which is a very small number in the latter category because of the dearth of testing, that things

00:22:38.700 can do to sort of reduce the probability of getting infected. So the obvious one that we've discussed, of

00:22:44.720 course, is social distancing. But let's say someone has already sort of adopted that posture. And now they're

00:22:49.680 sort of asking the second order question, which is, look, I'm basically working from home, my kids are no

00:22:55.660 longer in school. What am I supposed to do with my Amazon package when it arrives? What's the probability

00:23:01.680 that virus is being transmitted across that? How much insight do we have into the real transmissibility

00:23:09.740 of this? I don't think we have a lot of data. You saw this week, this paper in the New England Journal

00:23:14.660 of Medicine that measured length of time on the virus on inert surfaces. And I actually did an interview

00:23:21.500 with ProPublica asking me about the U.S. mail. Is that contaminated with virus and what should we do?

00:23:27.240 And maybe we know that the virus can live for a certain number of hours on cardboard. That's been

00:23:33.340 looked at. But then the question is, how relevant is that really? And what's the real risk? I think

00:23:39.100 for me, the priority is protecting people who are coming into contact with sick individuals. And I come back

00:23:48.500 to the health care providers and the first responders. And you saw how the CDC has now managed it. So they came

00:23:56.160 out with new guidelines this week, which kind of loosened the criteria for exposure and what exposure

00:24:03.840 means and basically saying you could stay in the workforce and keep doing what you're doing, depending on the

00:24:10.520 intensity of the exposure. And I think it's sort of a desperation move, but it may be something that we need to do

00:24:17.540 in order to keep people in the workforce. I come back to what we introduced last time we spoke, which is the

00:24:25.560 antibody therapy, but not using it as a treatment, but using as prophylaxis. I think that could potentially

00:24:34.080 help a lot. So the idea is when you harvest antibodies from individuals who've gotten sick and recovered, have

00:24:41.220 antibodies. You apherese their blood, you recover the plasma component, maybe isolate the antibodies.

00:24:48.860 If you give a big dose of that, you could potentially treat someone who's sick, but a small dose of it,

00:24:53.600 like a 5ml dose, you could use that as a form of prophylaxis. And the antibody would last a couple of

00:25:00.280 weeks so that a single injection can potentially greatly reduce the likelihood you're going to become

00:25:07.640 infected as a healthcare provider or a first responder for a period of two weeks. And then you

00:25:13.140 subsequently get another dose. As we discussed, it's an ancient method, but now refined using better

00:25:20.040 technology. So the White House actually came out today in their press conference and actually talked

00:25:26.740 about this. I brought it on national TV on CNN and Fox a week ago, and now it's out there saying that

00:25:34.020 the federal government's going to do it. What's interesting is in the meantime, over the last

00:25:38.140 couple of weeks, a number of academic health centers have started to put together a network

00:25:43.920 of blood banks to actually start this. And what I've heard is that none of them have actually been

00:25:50.460 contacted by the federal government yet. So I think we got to resolve that, why there's that disconnect

00:25:55.860 that this informal network that's already started is not better linked with the White House

00:26:02.360 announcement today in the comments of the new FDA commissioner, Steve Hahn.

00:26:07.880 What did you make of the recent study looking at blood type, ABO, and susceptibility?

00:26:15.540 Yeah, I thought it was interesting. I'm not sure what it means, and I'm not sure how it's

00:26:20.200 necessarily relevant to developing the plasma therapy. So I think it's an interesting finding,

00:26:27.420 but I'm not sure how it applies just yet.

00:26:30.820 Yeah. I mean, I think just for folks listening, so they understand that it was looking at data

00:26:34.460 from China and basically observing that people with A type blood had an increased risk of infection.

00:26:41.300 People with O type had a reduced risk. I think the hazard ratio on the downside was more impressive

00:26:47.020 than on the upside. In other words, it was more about having O blood and therefore anti-A antibodies

00:26:52.740 that seem to be somewhat protective. So again, does that really matter? As you said, maybe,

00:26:59.580 maybe not. It certainly isn't immunity. That's the point in the way that potentially convalescent serum

00:27:05.160 could be.

00:27:06.220 Since we spoke, there's been a few interesting observations now, and people are scrambling

00:27:12.340 to understand it better. I think one, of course, is in parallel, the studies out of Italy and the

00:27:19.040 younger age group getting infected and seriously ill. And the question is, why didn't we see that in

00:27:25.380 China? I think that is interesting, this very high number of seriously ill hospitalized people

00:27:33.260 between the ages of 20 and 40. I think it's now in the US accounting for a third of the hospitalized.

00:27:39.960 Is it that high? I saw a report today that was about 25%. And I was going to ask you the question

00:27:46.500 you're posing, which is what on earth can account for this difference in the United States? It's the

00:27:51.120 most disturbing thing I think I've seen today. Yeah. So I think the number that I saw was around

00:27:56.360 about a third. First of all, half of those hospitalized are under the age of 54, which is

00:28:04.900 very different from what you saw in China. And those, and about a third between 20 and 44

00:28:10.960 is the number, 29, 30% is the number that I saw. And there was even a blip of people under 19.

00:28:18.020 So that's a big question. And I think the numbers are going to turn out to be somewhat similar

00:28:24.320 in Italy. Now, it's been pointed out that those individuals are not dying. But I said this morning

00:28:31.840 that, well, even if they're not dying, if they're can imagine if they're being in ICUs and intubated,

00:28:38.260 that is still a horrible ordeal for a young person to go through. And if we have that happening over and

00:28:44.580 over again, that's a huge tax on the system. I don't know. I mean, the question of whether smoking

00:28:50.620 is responsible or even vaping has been raised. We'll have to do the epidemiology of that and what

00:28:58.100 the mechanism is. We know smoking can upregulate the ACE2 receptor for the virus. I don't know that

00:29:05.220 anybody's looked at vaping, but trying to understand what it is about young people that's different in

00:29:11.540 Europe, in the US, or maybe it's just post-genetic, some genetic factor.

00:29:15.960 Well, there's something different. And I'll read to you something. It's a photo that was taken and

00:29:20.480 sent to one of my colleagues from someone he knows in London today. So the piece of paper is just the

00:29:26.880 ages of the people they admitted to the ICU today. This is a hospital in London. I'll read them off to

00:29:33.520 you 46, 22, 68, 61, 51, 71, 32, 29, 28, 37, 34, 32. He then also showed me a picture of the 34-year-old's

00:29:49.760 chest X-ray, and it is effectively a complete whiteout. So again, will these patients survive? Hopefully, most

00:29:58.460 of them will. But as you said, they're not out of the woods because the long-term, the tail of this

00:30:03.400 morbidity is significant. I found a study yesterday that looked at 10-year follow-up on the SARS-CoV-1

00:30:09.860 patients, the survivors, and the amount of cardiac disease and pulmonary disease in those patients was

00:30:15.800 not trivial, suggesting there was some lingering effect of that virus. Yeah. And the other interesting

00:30:21.200 finding, when you look at the papers on MedArchive from the Chinese experience, there's a lot of what

00:30:26.980 they're calling acute heart injury. And it's not really clear what's going on there, whether that's

00:30:33.840 a viral myocarditis or whether it potentially, whether they're just having myocardial infarcts

00:30:40.440 because of the ARDS and shock, but you're seeing a lot of heart injury. And I suspect that's probably

00:30:46.660 accounting for a high percentage of the deaths as well. So the first thing people want to say is,

00:30:53.260 is this virus mutating? And I'm always suspicious when people are quick to claim its mutation. I'm

00:30:59.200 guessing not, but we'll have to unravel that. But we need really good epidemiology now on those

00:31:05.760 younger patients to try to understand what the differences are. You know, Peter, I've been asked

00:31:11.660 this question a bunch and my usual answer is probably in the short term, but not sure in the

00:31:16.340 long term. And the question is, once a person is infected and recovers, do they have lasting immunity?

00:31:22.400 And obviously the convalescent serum experiments would suggest at least in the short term, there's

00:31:26.800 immunity. Do we think we have an insight into that? In other words, just to speculate, is this

00:31:32.040 something in your mind based on other coronaviruses that looks like a seasonal virus like influenza

00:31:37.680 influenza or more of the type of virus where once you have immunity, it's largely life lasting?

00:31:44.580 I think there's a paper on MedArchive or BioArchive out this week on non-human primates

00:31:50.020 showing that once you're infected, they're immune to reinfection. Whether that's applicable to humans

00:31:56.200 is hard to know, but I'm going to work on the premise that that exposure infection will probably

00:32:03.620 confer immunity. But the flu, of course, is a different story because of all the antigenic

00:32:08.960 drift and variation. But then the other questions that have come up this week are around these

00:32:15.920 projections from the federal government in their report that they just released saying that they

00:32:22.320 think this pandemic will last 18 months. And I'm trying to understand what those assumptions are.

00:32:30.340 I think they might be out of models from an Imperial College, which look at the fact that this virus may

00:32:37.940 go down in the summer but come back in the fall and then potentially be seasonal after that until

00:32:45.440 eventually enough people are infected and therefore rendered immune from the virus. And I'm guessing

00:32:51.940 that's how the 18-month estimate is coming from. The other thing I'm hearing, and I hope it's not the

00:32:58.160 case, is that I've been told that the 18-month is because they're anticipating after that we're

00:33:03.340 going to have the vaccine ready to go. And I've really been downplaying expectations of having a

00:33:11.060 vaccine in 18 months or at least a rapidly deployable vaccine in 18 months. I think we have to be more

00:33:18.080 realistic about that in terms of going through all of the adequate safety. We just now only have the

00:33:23.480 first vaccine in clinical trials with a technology that's never been shown to turn into a licensed

00:33:31.460 vaccine. So I think we're going to be looking at five or six. We won't even be fully underway for a

00:33:37.620 while. So even though I think we're hearing numbers like a year, 18 months, from my estimate, I think it's

00:33:44.000 probably more likely much longer than that. So I hope that the models of ending this pandemic are not

00:33:51.260 depending on having the availability of a vaccine. I think we have to proceed as though we're not

00:33:56.920 going to have one in the near future. Now, having said that, I'm more optimistic about having a lot

00:34:02.140 of new technologies come out like the convalescent antibody. But we're hearing some interesting things

00:34:08.640 about new drugs, especially some of the repurposed drugs, because the new chemical entities will also

00:34:14.840 take a while, but not nearly as long as a vaccine. Speaking of repurposed drugs, yesterday, the New

00:34:21.180 England Journal of Medicine published a paper looking at Coletra. It was at the top level viewed

00:34:26.460 as a negative study, but I think many people, ourselves included, have looked at that and said,

00:34:31.780 I think the only thing we learn from that is giving Coletra to people who are on death's door

00:34:35.580 is probably not helpful. How did you interpret that paper?

00:34:38.600 It could be. People often think that antiviral drugs are like antibacterial drugs, and they seldom

00:34:45.460 have that same dramatic effect. I mean, clearly the HIV story is amazing, and the lamivudine story

00:34:53.440 for hepatitis C is amazing. But more typically, you don't see that dramatic impact of antiviral drugs.

00:35:01.240 So you very well might be right. I wouldn't throw it out just yet. There's been a lot of discussion

00:35:06.620 about hydroxychloroquine, and there's some interesting in vitro data on showing hydroxychloroquine

00:35:13.340 inhibits replication of the virus. Also, it has some anti-inflammatory effects. And then

00:35:18.440 Didier Raoul from Marseille, who I've known him for years, he's an amazing infectious disease

00:35:25.860 microbiologist, mainly focused on rickettsial-like pathogens, published a small study showing maybe

00:35:33.460 there's some effect of hydroxychloroquine. I think people are over maybe hyping it a little

00:35:39.520 much, saying we have a cure. We clearly have to do much larger studies. But if hydroxychloroquine

00:35:44.840 could ever work out or have an impact, I mean, it would be perfect, right? It'd be cheap. You can

00:35:50.560 make a bucket of it. It's orally bioavailable. The nice thing is you could use it not only for the US

00:35:58.600 in Europe, but it'd be relatively straightforward to use in low-income countries, and especially if

00:36:04.540 this virus is now in Africa, we don't even know about it, or parts of Asia. So that, if I had a

00:36:10.780 wish list, and it would be ixnay on wishing for my vaccine, it would be, I think, around something

00:36:17.940 like a chloroquine. We've also been reading about some of the ACE2 inhibitors and the angiotensin

00:36:24.980 receptor blockers. And we're getting sort of a mixed picture about that, depending on what

00:36:31.560 paper you're reading. So, and especially around the ARBs, the ARBs, as they sometimes call them,

00:36:37.780 claiming that some of the common antihypertensives that we use, where they're saying, well, on the one

00:36:44.040 hand, it has the ability to interfere with the ligand attachment of the virus to the ACE2, and

00:36:52.140 therefore, that blocking effect should have an antiviral property. Others saying, no, no, no,

00:36:57.980 it's actually going to upregulate the receptor and make things worse. And I got an interesting

00:37:04.840 email, and I wound up talking to him, a professor at Nova Southeastern University, Robert Speth, who's

00:37:10.780 in the School of Pharmacy, who's been looking at this. And he actually thinks that it could work for a

00:37:16.140 totally different reason, that it actually doesn't, a lot of the ARBs don't bind actually to ACE2,

00:37:22.300 but other components of the angiotensin pathway, and they have anti-inflammatory effects. So I think

00:37:29.160 we're in a steep learning curve about these class of drugs in terms of their effect, but we certainly

00:37:35.500 should be evaluating them, especially now that we're starting to get mouse-adapted virus and maybe

00:37:41.860 transgenic mice with the receptor. I think it's going to be a high priority to look at some of

00:37:46.580 these drugs. Have you looked at all at Camostat? It's a pretty esoteric drug. It's a serine protease

00:37:53.020 inhibitor. I think it's only used in Japan to treat pancreatitis, but some of the preliminary work

00:37:58.460 looks really interesting. It's a transmembrane protein, and it appears to interfere with the ability

00:38:05.060 of the virus to gain entry. Actually, I think it sits right next to the ACE2 receptor and impairs

00:38:11.640 binding. Because there's a protease that's involved in SARS-CoV-2, and it's a subtlysin-like

00:38:19.320 protease, which means it's a serine protease and known as furin, F-U-R-I-N. So I'm wondering if that

00:38:26.660 molecule works by interfering with the furin. So that'll be an interesting story. And that's

00:38:33.280 potentially a good drug target. So there was a paper that came out not too long ago about the

00:38:39.240 furin from this. And it's relatively unique among the beta coronaviruses that this virus has it.

00:38:46.620 And I can't remember if SARS-1 has it as well or not.

00:38:51.140 The homology between SARS, the CoV-1 and CoV-2 is similar, but not enough that... I mean,

00:38:56.940 there's enough commonality to them in the spike protein, isn't there? That if you had an effective

00:39:01.380 target for one, you might have luck against others, which I guess is really less germane to

00:39:06.480 the question today and more about the ongoing probability that these viruses aren't really

00:39:11.940 going away, are they? Yeah. And we're starting to think about what is the kind of vaccine that

00:39:17.760 we want to develop. We have this SARS-1 vaccine that looks great against SARS-1, and we think it

00:39:24.480 could be repurposed against SARS-2. And then the question is, what should be the goal? Should we be

00:39:30.160 focusing only on SARS-2 or should we really start thinking about a universal SARS vaccine? And I

00:39:36.000 think before SARS-2 came along, we saw how all these other beta coronaviruses were emerging out

00:39:42.300 of bats. And we wrote a grant to the NIH. And I don't know if that one even got scored, but I think

00:39:49.100 that's going to be an important approach. I mean, we have to learn our lesson. Now, this is our third

00:39:53.800 coronavirus pandemic in the 21st century. So we have to reconcile the fact that these are going

00:40:00.460 to come out on a regular basis. Although technically, really, SARS and MERS probably weren't really

00:40:06.240 constituted as pandemics, were they? I mean, they were probably closer to epidemics and this being a

00:40:11.040 true pandemic potentially, yes? I don't remember how they are classified. So SARS-1, of course, emerged out

00:40:17.060 of southern China and severely affected Canada. So maybe it wasn't classified as a pandemic. And

00:40:24.740 the MERS coronavirus emerged out of the Arabian Peninsula and then affected Korea, where it decimated

00:40:31.120 hospitals in Korea. Which brings us to the other point, as this is the modus operandi of coronaviruses.

00:40:40.060 They tear through hospitals, causing a lot of death and destruction to hospital personnel. This is

00:40:47.400 what they do. This was true of SARS-1. It was true of MERS. And now it's looking like it's true of this

00:40:53.560 one as well. That nosocomial transmission is a huge factor in this group of viruses. And if I were

00:41:01.740 going to design a vaccine, which we're doing in terms of the target product profile, I would say a

00:41:07.940 highest priority, our healthcare provider. So I think, again, to revisit this, I know we started

00:41:13.320 the discussion on this, but to revisit it, unless we can deal with the healthcare provider issue and

00:41:20.040 making hospitals safe places, we're going to be in very deep trouble. So I think that has to be

00:41:27.260 a national priority. And maybe the White House needs to create a specific task force around this,

00:41:33.240 is what are we doing to protect our frontline healthcare providers? Is it the antibody therapy?

00:41:39.800 Should we be looking at angiotensin receptor blockers? Should we be looking at other,

00:41:46.720 the chloroquine for prophylactic purposes? If we can't fix this problem really quickly,

00:41:52.840 I said on CNN, it's lights out, but you know what I mean. I think there's just no way we'll be able

00:41:57.700 to manage this epidemic. Speaking of designing, we touched on this very briefly. I think the

00:42:03.220 first time we spoke, or maybe it was just on a time when we spoke and it was not part of the podcast,

00:42:07.540 but I've had discussions with some of the most intelligent people I know, and they've asked,

00:42:13.420 not in a sort of conspiracy theory way, but they've asked, isn't it possible that this was a virus that

00:42:19.140 was designed for biowarfare that was either inadvertently got out of the lab or something?

00:42:25.040 I have my own logic for why I find that theory very, very implausible. What's your response to the

00:42:33.040 implausibility or plausibility of that thesis? Well, when the epidemic was unfolding in China,

00:42:38.880 and I started hearing these conspiracy theories, it was easy to debunk it. Who's going to design a

00:42:44.740 bioweapon that's going to kill grandma and grandpa? I mean, that's not an effective

00:42:51.360 biowarfare strategy. But now that we're seeing, now I don't have that pat answer, not that it's an

00:42:57.240 appropriate answer anyway, but now that we're seeing a number of young people affected, the

00:43:02.300 plausibility goes up, but not by much. And I just like to say, you don't have to, why go in that

00:43:08.960 direction when we already know mother nature is one of the best bioweapons producer there is. And,

00:43:15.880 and we know that these viruses have been, it's not likely we didn't know where these viruses

00:43:20.740 viruses were before. We've seen a whole family of these viruses that we actually call them SL

00:43:27.920 viruses, SARS-like viruses in bats. And even before SARS-2, we were investigating our vaccine

00:43:36.240 to see if it cross-protected against the various SARS-like viruses that were emerging out of bats. And,

00:43:43.540 and, and it did sometimes it didn't others. And so we knew that there was this whole family of

00:43:50.460 bat coronaviruses that are emerging on a regular basis. So if you don't have to postulate a bioweapon,

00:43:59.540 why do it when it's so obvious that we've got all of these viruses, the enzoatic viruses that are

00:44:06.160 circulating? Yeah. I mean, my response was probably a little more theoretical, but it was

00:44:11.660 the best bioengineers of the past two decades can barely get a crop to grow any better using GMO

00:44:20.140 or insert gene vectors through genetic engineering into adenovirus. I mean, it's not like genetic

00:44:27.080 engineering and GMO crops have been a robust success. And if that's the best and the brightest

00:44:32.400 for 20 years, I don't know where they found the people that could make such a good virus.

00:44:37.000 I mean, let's, you know, first sort of being diabolical, let's think for a minute,

00:44:40.300 if you were designing a bioweapon, most bioweapons, people would design SARS-1, right? A highly lethal

00:44:47.100 virus. But we actually saw that even though it was a devastating disease and people who got it,

00:44:54.020 if you were infected, you were sick pretty quickly and you were going into the hospital and you weren't

00:44:59.920 walking around the community infecting others. So that's why I think SARS-1 snuffed out pretty quickly.

00:45:07.380 This one is really problematic because it's not as lethal as SARS-1, but it's number one.

00:45:14.840 Number two, it's more transmissible. And number three, there is a large group of asymptomatic

00:45:20.520 individuals. And that's what creates a toxic mix for this virus because it quickly spreads

00:45:27.460 throughout the community and infects, it kills a small number of people, but still five to 20 times

00:45:34.220 more than influenza. So it is that very toxic combination of not being the most lethal, not

00:45:42.420 being the most transmissible, but high enough in both categories and all those asymptomatic

00:45:46.800 individuals. So in some ways, it's hard to imagine one that's more diabolical, but I can't imagine

00:45:53.140 anybody being that clever to think about designing it in that way.

00:45:58.120 Peter, you mentioned something on Twitter today that just assume that when your mail is delivered

00:46:01.900 to your house, basically assume it's been delivered by someone who's carrying the infection, whether

00:46:06.560 they realize it or not. What does that mean practically? What can we tell people who are,

00:46:11.920 again, getting their Amazon packages, getting their mail, trying to limit their exposure? What

00:46:17.740 actually can be done to dramatically reduce the risk of transmission through these fomites based on

00:46:24.900 the study you just quoted from the New England Journal of Medicine that came out, I think, last

00:46:28.540 Friday or this week, and other things we've learned just through the field of virology?

00:46:33.820 Well, we don't have a lot of data. My gut tells me that the risk is still pretty low. I mean,

00:46:39.020 the things that I worry about, I just don't worry about getting the mail. So right now, I'm not doing

00:46:44.760 anything. I think if you're concerned, you can certainly take a Clorox. First of all,

00:46:50.120 who gets mail anymore? I guess we get Amazon packages. So if you get your Amazon package,

00:46:55.040 wipe it down with a Clorox wipe or one of the approved alcohol wipes, you can certainly do that.

00:47:01.200 I don't see any harm in doing that. My sense is, what's your real risk? Your real risk is close

00:47:08.600 personal contact with somebody with this virus. I still think that's probably the most likely mode

00:47:16.600 of transmission. What about food? A lot of people these days are in the process of ordering food.

00:47:22.840 Now, whether that be if you live in a city like New York, you're doing takeout. What do we know

00:47:26.520 about the temperature that is required to be confident you've killed the virus? And then what

00:47:32.060 about when you're talking about groceries, things that are very difficult to wash like lettuce or

00:47:36.580 strawberries? Is this just a time to say, don't eat these things? Or do we think that, hey, if you

00:47:42.680 leave it out of the fridge for a couple of days, it's probably fine. Although not that you'd want

00:47:46.340 to eat your lettuce if it's been sitting out of the fridge for a couple of days.

00:47:49.440 Right now, I personally have not really been doing much with produce that's different from what we

00:47:55.580 usually do. I mean, maybe wash it more with water. Has the CDC put out any guidance about that? I haven't

00:48:02.540 even... I have not seen it. Yeah. The only thing I've seen is from the WHO looking at SARS-CoV-1,

00:48:08.560 they published some data on temperature. And again, that basically suggested that 56 degrees Celsius

00:48:16.160 for 15 minutes was about required to kill that virus. And so you could extrapolate from that,

00:48:23.800 hey, if you get your takeout and you at least heat it up, or if you're cooking food that you can't

00:48:28.460 speak to how it's been handled, or it hasn't been, you know, otherwise sitting in your freezer for a month,

00:48:32.580 you want to make sure this is north of 140, 150 degrees Fahrenheit. For me, I just think it's

00:48:37.720 the produce that strike me as a little bit more concerning just because the virus is going to

00:48:42.340 survive a little bit longer in the cold based on the WHO report I saw. And again, maybe this is

00:48:48.520 marginal. Maybe this doesn't matter compared to what you said a moment ago. Maybe just not being in

00:48:53.180 close proximity to other people or people who are not inside your bubble is first, second,

00:48:59.600 third order reduction strategy. It also becomes the point, I mean, we're already living under such

00:49:05.520 austerity measures as it is with the social isolation gets to the point where we're going

00:49:11.900 to have such a huge percentage of the population having their mental health affected by this. I think

00:49:17.740 there starts to be diminishing returns by doing this. So unless we get some clear guidance from the

00:49:24.920 CDC or FDA saying, this is what we found, and we're particularly concerned about that. At this

00:49:30.800 point, I'm not doing this, which gets to the whole mental health aspect. Just the thought of people

00:49:37.240 being in their houses day in and day out. It's been great for my TV ratings, but quite honestly,

00:49:44.000 I would not want to be watching Peter Hotez day in and day out. It's such dreary news that I have to

00:49:51.460 believe we're going to start seeing some significant psychological impacts. And I'm worried about

00:49:56.680 suicide rates. I'm worried about, and I hope we're looking out for that because especially this drags

00:50:03.480 on. So I think it's really important for the government to be a little more clear when they

00:50:08.300 said it could be an 18 month pandemic to specify this doesn't mean that you live like you're living

00:50:15.440 right now for 18 months. I just don't think that's doable for a large population. So there's going

00:50:21.340 to have to be some kind of assessment there. And I'm almost as worried about the mental health

00:50:28.420 status of millions of Americans or people all over the world as I am the actual virus. And I'm starting

00:50:35.300 to hear from colleagues and family members that it's already creating a lot of hardship. And also

00:50:43.080 people of certain categories, for instance, I have a special needs adult daughter, and now her routine

00:50:49.560 is totally halted now. And this is putting a huge amount of stress on her and then our family as

00:50:56.200 well. So I would imagine people with special needs, family members in the house are really struggling

00:51:03.880 right now. And I don't think we're too consumed with the actual infection to even think about this. And

00:51:09.600 should we as a nation start thinking about some kind of low cost mental health activity? And I don't know

00:51:16.960 what that would be, whether we create a network of providers, mental health counselors who make

00:51:23.420 themselves available, mental health counselors without borders, something where people can maybe

00:51:29.860 either it's for free or maybe just at some really low cost where they could Skype with somebody and have

00:51:35.760 that discussion. I think that potentially could be a national priority as well, or have the academic

00:51:42.040 health centers take this on. I can't agree with you more, Peter. I've been commenting to my wife for the

00:51:49.120 past few days that the days seem to be going by very quickly in isolation, but the overall time seems to

00:51:56.580 be going very slowly. And the irritability within me is unbelievable. I mean, I'm not the most sanguine

00:52:03.080 guy to begin with, but I think the lack of control, which is probably what every person on some level

00:52:09.260 feels right now. I guess different people internalize that in different ways, but certainly

00:52:13.620 in me, it just comes out as incredible irritability, which may pose a greater long-term risk to my health

00:52:20.060 than any coronavirus could. Well, it's interesting. My reputation is being someone who never gets angry,

00:52:26.200 never gets visibly upset or seldom does. And within the last month at a lab meeting where I

00:52:33.060 wasn't happy with the way things were going, I got pretty upset and sort of an important meeting

00:52:38.440 with colleagues, I also got very upset and reacted in an emotional way that afterwards I'd kind of

00:52:46.200 sort of scared myself. I said, wow, I can't believe I did that and sent an apology. And I said, what's

00:52:52.280 going on here? In my case, it's, I'm not sleeping and that's, I'm not sleeping because of the anxiety.

00:52:58.020 I'm not sleeping because we're trying to get this vaccine started through into clinical trials. And

00:53:02.880 all the teleconferences and documents that we have to put together. And then all the media stuff,

00:53:09.380 because I'm doing a lot of early morning and oftentimes late night. And then when that happens,

00:53:14.740 you're only getting three or four hours sleep and you're doing that several days in a row. And,

00:53:19.060 but I think being given the opportunity by Fox news and CNN and MSNBC to talk to the country and explain

00:53:26.580 things about this virus in a way that we're not necessarily hearing from our leaders. I think that's an

00:53:32.740 important opportunity. So I'm doing it, but that in itself is stressful, also threading the needle

00:53:37.820 because all three of the cable news networks are fairly politically charged and you're being asked

00:53:43.460 provocative questions all the time about this and that, and trying to thread that needle to say things

00:53:49.520 in a way that goes beyond the politics and really addresses the virus. I think it is taking its toll.

00:53:55.120 I'm sort of lucky because at least I have two really big activities that I'm doing that keep me

00:54:02.420 occupied with my wife, Anne. She's at home and with Rachel, our special needs adult daughter. And I

00:54:08.540 think in all she's got on all day is the cable news, which is so dreary. And I just imagine that

00:54:15.700 happening millions of times over, this is not going to be good for our country. And, and so one of the

00:54:21.620 things I've started to do now, it's a small thing, but I've been trying to, in my messaging, talking

00:54:28.240 about the science and a few times I've been doing this, I think I'm going to be more of it is, is to

00:54:33.160 be upbeat about certain things, not to drift into the, the happy talk that's not backed by data, but

00:54:39.820 just talk about the fact that the United States has got this great history in times of adversity of

00:54:46.660 taking on big audacious goals and, and building out new technologies for this virus is one of them.

00:54:54.560 And that's where America shines is those big audacious goals and taking on complicated projects

00:55:01.160 and coming out ahead at the end. I think those kinds of things, I think we need to hear more about.

00:55:07.420 And again, I, it's not, some people say, oh, does that mean you're going to do, you're going to do the

00:55:11.760 happy talk thing? I said, no, I, that's very different. I think it's, it's a realistic goal.

00:55:16.780 And to say that we don't have to be passive about this simply just hunkering down in our apartments or

00:55:24.180 our houses there, we still can do great things. And there's probably better messages out there than

00:55:29.880 just that, but I think it's going to be important to hear more of that. But again, the psychological

00:55:34.440 devastation on the United States, I think is going to be almost as big as the damage from the infection.

00:55:41.760 Well, on that, Peter, I wanted to, it's almost like you read my mind. I did want to end with

00:55:45.720 something sort of positive. What are you most optimistic about? I mean, we've spent a lot of

00:55:50.240 time talking about things that concern us with respect to the burden on the healthcare system,

00:55:55.480 the properties of the virus that make it especially troublesome if you're trying to fight it. But if

00:56:01.900 you think about where we are today versus where we are a week ago, even, what are you optimistic

00:56:06.440 about? What's moving in the right direction? What trend do you see that you want to

00:56:11.660 see continue? There's a few things going from not very impressive sounding to more impressive

00:56:17.620 things. I think just from a not selfish side, but I think we're seeing scientists being put

00:56:24.520 in higher esteem. We were trending the wrong way for a long time because of this anti-vaccine

00:56:30.400 movement. But when you hear the esteem that people like Anthony Fauci have in the country,

00:56:37.160 because he is a scientist, I think that's kind of reassuring that in times of stress,

00:56:44.140 people are looking to scientists for guidance, not only to solve problems, but also for leadership

00:56:51.360 roles. And I think that could be a positive outcome of this. And people writing letters to

00:56:58.940 our team of vaccine scientists trying to develop the vaccine. We just had this thing.

00:57:04.480 I was very moved. There are vaccine scientists are still working through this because they have

00:57:09.480 to, because they have to make this coronavirus vaccine. We just had a massive donation of Girl

00:57:15.160 Scout cookies for the scientists, really showing that the community is out there behind us. So that

00:57:21.580 for me was really positive. Also, science communication was already starting to trend in the right direction,

00:57:30.180 but I think it's really taken off. The data sharing that's going on, putting things up on BioRxiv,

00:57:37.280 on MedRxiv, these preprint servers, has now become a routine form of science communication. It was already

00:57:43.540 starting to take off, but now it's done regularly. And the fact that even the established journals like

00:57:51.560 JAMA and the New England Journal of Medicine, Lancet, are putting their stuff out there quickly in the

00:57:57.560 public domain. If we keep doing this, it's going to change the way we do science publishing.

00:58:03.340 I often say our model of how we publish science was invented in the 1850s by the German scientific

00:58:12.020 institutions. And it worked for a while, but believe it or not, communicating science according to the

00:58:19.340 rules of 1850s. Germany is probably no longer adequate. And I think we started to see this

00:58:26.920 with SARS-1 and MERS and then Ebola, and I think it's going to reach its full fruition through this

00:58:33.560 epidemic. So the fact that scientists are being held in higher esteem recognizes important people,

00:58:39.900 the way scientific communication is done. I think, and the same is true of our physicians and nurses.

00:58:46.700 I think the fact, the heroism we're seeing of physicians and nurses, and you saw those stories

00:58:53.720 from Italy of the whole nation standing out in the balcony and cheering for physicians and the nurses

00:58:59.780 and the healthcare professionals. I think there's maybe going to be a new awakening of the humanity

00:59:05.800 behind the medical profession that I think we're starting to hear. And it works both ways, not only

00:59:11.580 just people standing up and cheering, but more and more doctors and nurses telling their story of

00:59:18.220 sacrifice and knowing that when they go into work, saying goodbye to their kids or their significant

00:59:25.160 others, knowing that they may have to be in a unique kind of quarantine after that, not knowing

00:59:31.420 if they're going home or going to get sick. I think people seeing the sacrifice that physicians and

00:59:38.440 healthcare professionals and nurses make. Stuff that we do every day that gets unnoticed

00:59:43.200 is now being noticed. So I think that's also going to be a potentially very positive outcome

00:59:50.120 of all this. I mean, the worry, of course, is out of sight, out of mind. We might've said some of

00:59:55.440 that after SARS-1 and MERS. I said, the whole vaccine infrastructure will change. We'll be able to

01:00:01.380 change the whole vaccine ecosystem on the basis of those epidemics. And really not all that much

01:00:06.420 happen. A few things happen, but not much. I always think maybe this will be the one

01:00:10.900 that will happen. In terms of more immediate successes that you might see, what can we look

01:00:17.980 for for things that are going to work? The one thing that I saw was last Sunday morning when Andrew

01:00:24.380 Cuomo, Governor Cuomo, wrote that, what I thought was a very courageous op-ed piece in the New York Times

01:00:29.880 saying what was on my mind for a while, but I didn't want to say, and he just said it,

01:00:34.980 we're going to need to bring in the Army Corps of Engineers. And I think that was an important

01:00:40.240 piece to this, recognizing that we may need to bring in our military and maybe sooner rather

01:00:46.700 than later. So we're already hearing about National Guard units being called up. I think we're going to

01:00:52.240 need our military to build temporary hospitals and facilities. Maybe some of the human capital we're

01:00:59.380 going to need for this is going to become an important piece to this as well.

01:01:04.180 Well, Peter, on that note, we've gone a little over the time. I know we both set aside for this

01:01:08.100 and we've got a lot to get done, even though we're sort of late in the day. But I want to thank you

01:01:11.980 again for the time and obviously for the hat you're wearing, which is sort of being one of the important

01:01:17.640 faces of this in the public. I do think it's important that people have sort of credible information

01:01:24.160 and you're speaking to a lot of people, not just to the public, but also to policymakers.

01:01:29.140 For what it's worth, I'm a little bit more optimistic this week than I was last week in

01:01:34.780 terms of the seriousness with which this is being taken, especially inside government based on a

01:01:40.600 number of personal discussions and some secondhand discussions. So I guess that's the thing I'm

01:01:45.540 personally most optimistic about.

01:01:48.260 I mean, there are some people on the federal side who've definitely been doing this. And people

01:01:52.000 like Deborah Birx have been good. And Tony, of course, is always great. And Brett Gerard is not

01:01:57.400 a household name, but he's Assistant Secretary of Health and was with us for a while here in Texas.

01:02:03.000 And he's been the one assigned to finally ramp up the testing. And he's been doing that,

01:02:07.980 I think, but doing a great job. To me, I think the profile that Governor Cuomo's had is the one that

01:02:15.760 really woke us up and who got on, has been getting on there every day and saying, what the hell's going

01:02:21.520 on? Where are my respirators? Where are my beds? These are the projections. These are what we're

01:02:27.260 going to need. This is what's going to happen to our hospitals and being overrun. So I give a lot

01:02:34.340 of courage points to the governor in New York on that front.

01:02:37.860 All right, Peter. Well, thank you very much. I want to let you get back to work. And I know we'll

01:02:42.120 be in touch again soon. And we'll pick it up then.

01:02:44.520 I think what impresses me about our discussion today is how different it was compared to a week

01:02:50.320 ago and shows you how quickly this thing is moving. And so always happy to do this again.

01:02:56.960 At some point, we'll see how this thing continues to change. Because I said it last week, I'll say

01:03:02.400 it again this week, the stuff we're saying today may look totally ridiculous in a few days or a week

01:03:07.700 because this thing is moving so fast. These virus pandemics, emerging threats set you up to make you

01:03:13.920 look bad. And they do that with our federal leaders or state leaders and even doctors and

01:03:19.000 scientists who go on TV. So you continue to need to refresh.

01:03:23.460 Yeah. I hope they make us look bad by saying we over responded than we under responded.

01:03:28.840 I'll say amen to that.

01:03:31.260 All right. Good night, Peter.

01:03:32.880 Thanks again. All the best.

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The Peter Attia Drive - March 20, 2020

#99 - Peter Hotez, M.D., Ph.D.： Continuing the conversation on COVID-19

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