- Hey everyone, it's Dr. Z.
So I don't know if you
guys have hear about
this coronavirus thing,
apparently it's in the news.
And there's a lot of sort of panic,
misapprehension,
misunderstanding, miseducation.
And then there's a lot
of good information.
There's questions like, is
the CDC adequately responding?
Did the Chinese government
try to cover it up?
Was the overall response slow?
Is this something that's
been bio-engineered?
When is a vaccine coming?
What's going on with healthcare workers?
And how safe are they gonna be
given what we saw in Wuhan?
Where so many got ill and
at least eight have died.
What's gonna happen to prepare here
in the United States so
that we can be prepared
but not just scared?
Which seems to be the common thing
where people are hoarding masks
and doing things that are
actually counterproductive.
But my guest today, he's a
world expert in this stuff.
He is part of a working group
working on a coronavirus vaccine.
He's the Dean of the School of
Tropical Medicine at Baylor.
Welcome back to the show.
You should see our previous interview.
This guy is awesome; he's
a personal hero of mine.
Dr. Peter Hotez, he is going to talk about
how we can better prepare
for what's happening,
especially from the standpoint
of healthcare workers
who if they get sick, if
there's problems there,
that's the weak link that could cause
everything to be much more difficult.
Peter Hotez, welcome back to the show.
It's so good to see you, brother.
- So good to be back on,
and you're one of my heroes.
Thanks for having me.
- Oh my gosh, your five
bucks in the mail, brother.
That's awesome; so hey
you've been all over the news
talking about this stuff.
So what I want to do
is take your expertise
and bring it to a healthcare
professional audience
that is hearing a lot
of hysteria in the news,
is trying to deal with panicked patients,
and is worried themselves
about getting ill
because in Wuhan, as we saw,
so many healthcare workers
actually came down with this.
And the hospitals were
amplifying sources of infection.
I mean what are your thoughts on this
in terms of what's going on right now
and the current scene of
getting prepared in the U.S.?
- Well you know one of the lessons learned
from all three big coronavirus epidemics,
whether it was SARS in
2003, or MERS in 2012,
and this one is, a lot of the battle
was played out in hospitals.
There was massive amounts
of nosocomial transmission,
lots of front line
healthcare workers affected.
You talked about what's going on in Wuhan.
A new paper just came out in JAMA,
the Journal of the American
Medical Association,
last week and it found that more than 1000
frontline healthcare workers
in Wuhan were infected
and there were six deaths.
And that's pretty important,
but beyond the deaths
15%, I think it was 14.8%,
of hospital workers,
healthcare workers who were affected
wound up with serious pulmonary
disease or in the ICU.
And that's the piece
that not a lot of people
are talking about.
We keep on hearing either
that it's a mild disease
or only if you're older and
have underlying diabetes
or heart disease that
you have to worry about.
It's not the case.
We have a serious threat
to our healthcare workforce
and for me that's the weak link
in the whole system right now.
Because what I think, now
that we're starting to see
the beginnings of community
transmission in the U.S.,
we've had four cases, two in California,
one in Washington state, one in Oregon,
where people have gotten infected
who've never traveled or been exposed
to anyone who knowingly has traveled,
or not exposed to somebody
with the SARS II coronavirus.
What that means is we're
seeing the beginnings
of this community level transmission
and we can now expect
our healthcare providers
to be increasingly exposed to this virus
working in ICUs, working
in emergency rooms,
working in clinics.
And I think that's the
weak link right now,
because I think if they start to go down
the whole system unravels.
It will be an extraordinary
level of concern and panic.
It will cause healthcare workers to doubt
their feelings of working in a safe place.
And things will start
to unravel very quickly.
So what I've been trying to explain
to our national leaders is that's where
we now have to focus
absolutely every effort
on preserving and protecting
our physicians and nurses.
And things that we've actually
talked about in the past
in a different context,
but this is especially true
for this coronavirus.
- Yeah and you know this is so important
because I imagine, as a hospitalist,
if we lose two hospitalists
on my team of ten,
we're screwed, like we can't function.
We can't take care of our other patients.
Imagine three or four or
five of them get sick.
And why is it, so we really
have to plan for this.
There's a couple of things:
How do we prevent it from happening?
What kind of precautions do you take?
But why is that there's such a high
burden of severe disease
in healthcare workers?
Is it an inoculum effect,
where they're just getting
a big hit of this virus?
When you're intubating
are these droplets going?
Maybe help us understand
how it's transmitted now,
to our understanding, and
what might be going on.
- So I've been wondering the same thing.
First of all, I don't think we know.
We're still in a steep learning
curve about this virus.
There's more we don't
know than we do know.
Almost certainly this virus is transmitted
by respiratory droplet contact.
Meaning you sneeze or you cough,
and small micro-droplets land on your face
that you rub into your mucus membranes
of your eyes or your mouth,
or they land on surfaces
and people come into contact with them
and then rub it into their mucus membranes
of their mouth and their eyes and nose.
That's almost certainly a
major method of transmission.
The thing we don't know, that
I'm just starting to suspect
is important, is true
airborne transmission.
Meaning very tiny, less than
5 micron particles in the air,
that can travel for feet
or sometimes meters.
It turns out that not many
respiratory viruses do that,
or not many viruses do that at all.
But when they do, those
diseases are highly contagious.
So measles virus does this.
Chicken pox virus,
varicella virus does this.
And the fact that we're starting to see
so many people infected,
and the Chinese scientists
have come up with a pretty high
reproductive number for this virus.
That means if a single individual gets it,
how many other people get it.
We're looking at reproductive numbers now
coming out of China of
between three and four.
That's at least two or
three times higher than flu,
which has a reproductive
number of between one and two,
seasonal flu anyway.
So this is a pretty contagious virus.
And we'll see what kind of numbers
we come up with in the U.S.
- So to clarify reproductive numbers,
for every infected
patient, if it's a four,
then four people can
get infected typically?
- On average, so the two extremes I like
to talk about is, measles is
one of the most contagious
viruses we know about.
If a single individual
gets measles, on average,
12 to 18 others will get it
if they're not vaccinated.
That's why you see these big epidemics
that are so hard to
control and you have to
trace down contacts, and
contacts of the contacts.
And part of that is because
it is a true airborne virus.
The other extreme is Ebola.
Unless you're taking
care of a dead or dying
Ebola patient, you're not gonna get Ebola.
It has a pretty low reproductive number
of between one and two, according to some.
Some will put it a little higher.
And it looks like this coronavirus
is somewhere in between,
which is pretty contagious,
more contagious than flu.
And the fact that it's landing
so many healthcare workers
in the hospital, to me is a red flag
on the first major thing that can go wrong
right now in this epidemic.
- And that's real important,
because even in Ebola
when we had that patient in Dallas right,
that's almost your neck
of the woods right there,
we had a couple, one
or two nurses get sick.
And if you're talking about a
higher reproductive number now
and what we've seen in China with so many
healthcare workers including
the whistleblower guy,
Dr. Lee, and getting sick.
How are we going to
prepare healthcare workers
in the U.S. for what
seems now increasingly
inevitable that there's gonna be a lot of
community transmission.
What type of masks should they be using?
What are the sort of scenarios?
What should we be thinking
about for our folks?
- And this is why we
had some email exchanges
and I said, I think we should do something
about this topic because
we're not really hearing
about it that much.
Anytime I go on Fox News or MSNBC,
it's not easy going back and forth
between Fox News and MSNBC.
- For real
- That's a whole other story
- Political backlash, or whiplash.
- But trying to get this point across,
and for instance today
the White House held
a press conference and this
topic was not raised at all.
And yet I see it as the biggest issue
in this early part of the epidemic.
So the question is, okay
what do we have to do?
I think there's a few things that I've
been talking about that come to mind.
Some are obvious, some are less obvious.
I think one of the obvious ones of course
is we have to make sure
that every hospital
in the country has adequate
personal protective equipment, PPE.
And we're hearing stories
that many hospitals don't.
I think we're better off now
than we were five years
ago because after Ebola
I think a lot of hospitals sort of got it
and realized they had to stock up.
So hopefully that's
still on their inventory.
I think we're a little better prepared
than we were a few years ago.
I don't know quite what that means
for non hospital like settings where
you're seeing a lot of patients.
Either outpatient
facilities or some of these,
you know, 24 hour free
standing emergency rooms,
whether they're adequately
prepared or not.
So that's a top priority.
But I have two other ones
that are a little less obvious
that people aren't talking about.
The second one is,
the clinical guidelines that
I'm reading about from CDC
for testing, and our algorithms for this.
So what we're seeing is
that we're only recommending
testing for three categories of patients.
One: individuals who
have respiratory symptoms
such as fever, cough, shortness of breath
and who came from one of the
known infected countries.
Whether it's China or Iran or Korea.
That's one, the second one
is those same set of symptoms
and having known contact with somebody
who's already had that diagnosis.
Those two are pretty obvious.
And now recently, on the recognition
that we're starting to see some community
level transmission, they're
opening up the option
of doing diagnostic testing for someone
who has just severe respiratory symptoms,
hospitalized with pneumonia,
maybe intubated in an ICU.
You can't figure out
what the heck's going on,
then you can test those patients too.
And I think those
guidelines may not reflect
a new reality of what's gonna
be happening in the U.S.,
which are individuals
who are not that sick,
maybe have mild respiratory symptoms,
yet are transmitting the coronavirus.
And also individuals who are presenting
even with surgical symptoms,
abdominal symptoms.
So one of the things that
was reported in JAMA,
the Journal of the American
Medical Association,
about a month ago was the fact that
they have a number of
patients on surgical wards
in the hospitals in Wuhan
who were thought to have,
whether it was a rule out appendectomy
or something along those lines,
turned out that they had the virus
and they wound up infected
10 healthcare workers.
- Yeah
- So this is going to get
very murky very quickly.
And I think, so the second piece to this
beyond the PPE, is I think CDC
is gonna have to double
down and really think harder
about these clinical guidelines.
That that's going to be an important one.
And then the last one,
and then we can have
a conversation, is our diagnostic testing.
Which is, first we're about
two degrees of separation
from where we need to be.
One, right now we don't have enough
diagnostic testing kits.
Finally the CDC just kinda
released a lift on it
saying that other hospitals can develop
and validate their own test
kit, provided that they
submit an emergency
authorization to the FDA.
So that's better than it
was, because otherwise
we had to wait days sending
things to reference labs
or the kits weren't available.
But the thing I'm
worried about there again
is are we going to, what we really need
is more of a rapid test,
like a rapid flu test,
where people in emergency rooms, in ICUs,
can rapidly triage patients
to isolation facilities
if somebody becomes, if they
know somebody is infected.
And it's still too cumbersome.
So we've got a lot of work cut out for us
in order to get up to speed where we can
one, help to control this epidemic,
and also second, really protect
our healthcare providers.
And that's where I see our
big vulnerability currently.
- Yeah, I'm absolutely
with you because again,
as it is we're gonna see
surges in capacity requirements
in hospitals like we did
even during H1N1 swine flu.
We're also going to see
interesting logistic dilemmas.
By the way, speaking of rapid testing,
so we worked with a
company on the show once
called Cepheid that does
rapid molecular PCR for flu
and they are, I think,
currently in the process
of working on a rapid test.
So I'm sure there's
companies working on this,
which is good, the
interesting logistical issues
apart from finding coverage,
making sure people stay
home when they're having symptoms,
wearing masks when you're having symptoms,
what type of PPE you need to
wear and all those protocols.
As it is, my hospital in Las
Vegas just sent out a memo
saying these are the indications for N95,
these are the indications for
standard procedural masks.
Don't hoard them; reuse them.
Sort of trying to control resources.
Are things like CT scans,
so when SARS happened
you know Stanford had to kind of start to
reduce the number of CT scans they did
on patients they were concerned about
because the turn around time
to disinfect a CT scanner
is roughly 45 minutes.
So it gums up the entire
work flow for radiology.
So there's lots of downstream issues,
and then of course the supply chain stuff
with getting the PPE and all of that.
Have you run into any of that too
in your work with public
health authorities?
- Yeah all of this is now being discussed
and it's gonna have to
dominate the conversation.
You know right now we
don't know how extensive
this epidemic is going to
be in the United States.
We're starting to see the beginnings
of community level transmission.
We've already got handful
of sporadic cases.
As time goes on we'll have
to see where this goes.
I mean there's two possible directions
that I could envision.
One is we'll continue
to see small outbreaks,
small levels of community transmission
here and there scattered
across the country.
That would be sort of
the best case scenario.
Or, things will become more confluent
and we'll start seeing a
pretty significant level
of serious illness.
And that's the one that I'm
particularly worried about
where we'll start knocking
out healthcare workers.
Because the study out of JAMA last week
showed that 14.8% of healthcare workers
landed either in the ICU or were
seriously ill with pneumonia.
And you can imagine the
emotional and physical impact
of that if this occurs
on a pretty big scale.
You may, who knows where that will go,
but almost certainly it will
become highly destabilizing.
I mean look what happened in Hong Kong.
The physicians actually went on strike
because of their concern about this issue.
I would hate to see
anything even close to that
happening in this country.
- You know and already
the National Nurses United
and others have talked about what happened
at UC Davis where I think
the patient was there
and they felt there
wasn't potentially enough
protection for staff.
And as it is they're
the victims of violence
and other things, especially
front line nurses.
So this is a big issue and
I think no one's talking
about it really because it's not a,
the public doesn't see
that as the central issue.
But the truth is, without our caregivers
we don't have a response.
- Right, and also remember this builds
on all the great stuff that
you've been talking about.
I mean not great in a good way, but great
in a terrible way, which
is don't call it burnout,
call it moral injury.
Between electronic health records,
and how we treat our healthcare providers,
and their debt, and how
demoralized they are
to begin with, if you now
throw this on top of it,
you know it could cause
irreparable damage to our profession.
- Well you know Peter, so
I'm glad you brought that up.
Before we get into things like vaccine
and the response and the CDC and all that,
because I think people
want to know about that,
but I want to dwell on this for a second.
One of the, I think,
imperatives of managing
large numbers of patients is
to, during a crisis like this,
say you know what, I am
not clicking boxes in Epic
or Cerner or Meditech.
I'm gonna take care of
the patient and scribble
some notes about this
and we're worry about
the documentation second.
Because you know, you even worry about
these keyboards and
other things like that,
if we don't have proper
sterilization of that stuff
being another problem.
But it's really the time
and the documentation.
In times like this, this is when people
step up and actually
perform at their best,
even under great danger.
You can imagine medical students
who are doing their first rotation
going into the room with someone with
an ICU level infection of COVID-19
getting intubated and
feeling that sense of,
oh my gosh, this is a real
potentially dangerous situation
but that's why I went into this.
You don't want to distract people with,
oh but you also haven't clicked the box
that said I washed my hands, you know.
- This is not to the time to be sitting
behind a large keyboard
that you bring down
and start looking at
the patient and clicking
on a computer and doing data entry.
- Bingo
- So who knows,
maybe there'll be a silver lining to this
that may be a wake up call for,
that we could start practicing medicine
the way we should be
practicing medicine again.
- Heaven forbid, so back to this thing.
So what would, if you
were going to give advice,
say before we move on to
vaccines and things like that,
if you were going to give advice to say,
nurses, medical students,
others who are taking care
of patients and we're starting
to see an influx let's say,
what would you say?
Just listen to the
protocols of your hospital?
Is there any other sort
of common sense things
that they can do to keep safe themselves
so they can continue to care for patients?
- Well I think one, we're gonna have to
see this sea change coming
out of the federal government
and CDC on the guidelines
for clinical testing.
Because it's not, it's
clear that it's not really
reflecting the realities of what doctors
and nurses are going to be
seeing in the hospitals.
So that's number one.
Number two, I think with
the Chief Medical Officer
of the hospital, it's
going to be very important
to sit down with that individual,
have a frank discussion,
and do some reality testing
of what's gonna be the most
practical solution for this.
And it can't be top down.
There's gotta be some consensus built in.
There's got to be, I
think the frontline staff,
the nurses, the techs, the docs,
have to be part of the discussion with the
Chief Medical Officer and
the hospital leadership
on what makes sense.
Because if they feel
that unrealistic things
are being put down their throat,
that's gonna go very badly as well.
- Yeah, I agree, I agree.
So let's move on to vaccine
because I think people
are really interested in hearing from you,
the expert on this, who's working on this.
What are the prospects for vaccine?
What's the process?
What's the timeframe?
And how effective will it be?
And was SARS a good primer for this
given the work done on a SARS vaccine
that never ultimately
was fully implemented
because SARS mostly was controlled?
- Well we learned a lot
about, after SARS in 2003,
then MERS in 2012, we learned a lot about
what we need to do to
make an effective and safe
coronavirus vaccine.
And our effort to make a vaccine
is building on that effort.
In fact, we actually developed,
as a consortium with,
when I say we, Baylor College of Medicine,
Texas Children's Hospital, the
Galveston National Laboratory
and New York Blood Center,
we developed a prototype
vaccine based on SARS that was both
highly effective in laboratory animals
at preventing challenge
infections and was also very safe.
And I'll come back to that
safety issue in a minute,
cause it's a huge one.
And what we found was,
it was a great vaccine
but that at the time we could never get
anybody interested in supporting us
to move it into clinical trials
because nobody cared about SARS anymore.
- Wow
- So that was very frustrating
Here we have this vaccine.
It was actually manufactured under good
manufacturing practices
with Walter Reed Army
Institute of Research.
We were ready to go; you
know it's what we do.
We are, my day job is a vaccine scientist
developing vaccines for neglected
and emerging infections,
the ones the big pharma
companies are not interested in
because there's no big financial profit,
or any financial profit to be made.
And coronavirus vaccines
are included among that.
So we made this vaccine and
then nobody cared about it.
But fortunately, my science
partner of 20 years,
who co-directs the vaccine center with me,
Maria Elena Bottazzi,
had the wisdom to keep it
on stability protocols so
we know it's still good
even after a number of years.
So it's ready to go
now and so we're trying
to move it into clinical trials.
So we have our vaccine that
will go into clinical trials.
There's some other platform
technologies around RNA and DNA
vaccines and other
interesting technologies.
So we'll have about half a dozen vaccines
that can move into clinical testing.
That's the good news.
The difficult news is this: despite what
the anti-vaccine lobby likes to claim
that vaccines are not
adequately tested for safety,
quite the opposite is true.
Among pharmaceuticals,
vaccines are the single most
heavily tested pharmaceuticals
we have for safety.
And that, and it's hard to
compress those timelines
to go through Phase I, II,
and III clinical trials.
So we're probably looking
at, at least a year
before we're gonna have
both a safe and effective
vaccine ready to distribute to population.
So I doubt very much we're
going to have a vaccine
in time for this epidemic.
Despite what you're
hearing from all the hype
from the biotechs you know
pushing their technology.
And their sending out these
ridiculous press releases
saying we're gonna have
a coronavirus vaccine
in a period of weeks.
It's only a half truth.
They'll have a coronavirus
ready for clinical testing
like ours perhaps in a few weeks.
But it's gonna have to go through
that long arduous process.
The other piece to this
is, there's a particular
problem with coronavirus and respiratory
virus vaccines in general.
You know a vaccine for each disease
has its own unique difficulties.
In the case of respiratory
viruses what happens is,
in the 60s there was a group at the NIH
and Children's National Medical Center
that developed a formal and
inactivated RSV vaccine,
Respiratory Syncytial Virus vaccine,
and that vaccine actually
wound up making kids worse.
And I think there were even two deaths
in those clinical trials.
- Wow
- From the vaccinated group
And it turns out that certain
respiratory virus vaccines
can trigger, through
mechanisms that we don't
entirely understand, something
called immune enhancement,
where you get eosinophils
filtering into the lung
and actually will make things worse.
And what we found was
that when we started,
when scientists started
making the first generation
coronavirus vaccines after
SARS using killed vaccines
or even the whole spike
protein from the virus,
it actually made things worse just like,
almost like what we saw with RSV.
So we said, holy crap, this
is gonna be a big issue
now for coronavirus vaccines.
And our collaborators, our colleagues
at the New York Blood
Center, had found that if
they only used the receptor binding domain
of the virus it actually seemed to prevent
the immune enhancement.
So that's the reason we chose that
and why we're excited about this vaccine.
But the relevance here is the regulators,
the FDA, the scientists at the FDA,
are going to want to be very careful
and very cautious how they
proceed with clinical trials
because what happens when
you do a Phase I trial
or a Phase II trial in healthy volunteers
in an area where you have
sustained community transmission?
Will some of those vaccinated individuals,
will they develop immune enhancement?
And so that's gonna be
looked at very closely.
It's really gonna slow things
down for vaccine development.
So unfortunately, I think
that's a long way of saying
we're not gonna have a vaccine
in time for this epidemic.
- See that's really important.
And one thing I wanted
to ask you about that was
when you say immune enhancement,
does that mean you get that phenomenon
after vaccination without infection,
or when you get infected?
- No, no, what happens
is you get vaccinated
and then you're exposed to the virus.
- Right
- In the community,
and in the case of RSV, that
first generation RSV vaccine,
that's what happens.
The kids did actually worse
than the non vaccinated kids.
So they had to go back
to the drawing board.
It actually killed vaccine development
for RSV for a generation.
Now, the Gates Foundation and others
are trying to support new
generation RSV vaccines.
With the idea that as you
do your clinical development
you work hard to avoid it,
and make certain you design
your vaccine to minimize that.
- Yeah and we have not seen that with
influenza vaccination, though.
- No, it doesn't seem to be a problem
with the influenza vaccines,
or at least the ones we
use for seasonal flu.
But it is, has been a problem with RSV.
And in laboratory animals
it's been a problem
for coronavirus vaccines.
- Yeah, makes sense.
- So what do we do?
So I think antiviral drug development
for people who are seriously ill,
I think that's proceeding pretty quickly.
You know and if you look at the tiers
of difficulty for getting
something licensed,
vaccines are always the highest bar.
That takes the longest.
Then comes small molecule drugs,
antiviral drugs in this case,
and then diagnostics are sort of
somewhat lower hanging fruit.
So hopefully we'll get
some new diagnostics
in there very quickly.
Followed by small molecule drugs.
And then, if we can work out
the business model and other things,
have a vaccine maybe
a year from now or so.
One of the other problems
we're seeing with
coronavirus vaccines
is nobody's rushing in
in terms of the big
pharmaceutical companies.
They don't see this as a
money making proposition.
So what you're seeing
is, either academic based
research groups like ours, which is called
a product development
partnership and it's a nonprofit,
developing vaccines, or
some of the biotechs,
smaller mid-sized biotechs.
And a lot of the biotechs are pushing it
because not necessarily
that they see money
to be made on coronavirus vaccines,
but it's a way to accelerate
their platform technologies.
So if we can move this along,
then later on they can
say, well we already have
precedent from the FDA
that licensed this vaccine,
now we can apply it to the others.
- Yeah makes sense, and one thing that
you've recommended and I agree with,
is the one thing we don't want to do
is deal with three epidemics at once.
So we have coronavirus, okay
we're doing what we can.
But influenza and measles, these things
are seasonal as well and they
may overlap the seasonality,
which we should talk about
with coronavirus as well,
if there is seasonality with coronavirus.
So definitely make sure
you get your flu shot,
and make sure you are, and
your family and your children
are vaccinated against measles.
Because as it is, capacity
will be strained, correct?
- Yeah, I mean remember if we start seeing
an uptick now in this SARS II coronavirus,
we have other things going on.
And one of them is, it's a
bad flu season this year.
We've had at least 16,000 deaths,
most among un-vaccinated individuals,
including about a 100 un-vaccinated kids.
So flu is still raging right now.
So this is a bad flu season
and it'll probably go
until late in the Spring, maybe till May.
So that's going on.
We also have this problem that measles
came back last year and it might come back
again this year and if it does,
historically measles peaks
late Winter, early Spring.
So that's what we're also looking out for.
Measles as you know, it really occupies
the full time of any
healthcare department.
So if we have to start
battling measles and flu
at the same time as this
coronavirus, it's undoable.
That will be a no-win proposition.
- Well so Peter I think what we should do
is we should have coronavirus
parties, COVID-19 parties,
where we all fly to Wuhan,
go hang out in a meat market
or in a healthcare facility,
and get exposed naturally.
Because Peter first of all,
A, you're a vaccine shill.
B, this is all natural immunity.
So why would I inject myself with toxins?
Should we go ahead and send anti-vaccers
to China to test this theory?
- Well we're already seeing now,
I'm already seeing on
Twitter I'm being accused
of secretly engineering and
creating this coronavirus.
(laughing)
So I could sell more of my vaccine.
That's a great one.
I think the best one was,
turned out that it was me
and Bill Gates making coronavirus,
making this coronavirus,
and I think I replied,
yeah except you got the place wrong.
We actually did it in a
secret lab in Area 51.
- See they don't understand;
it's always Area 51.
So you know they'd be
singing songs like, you know,
♪ Bill and Peter sitting in a tree. ♪
♪ K-I-L-L-I-N-G ♪
I mean these people are
really something, man.
- Yeah and remember
what's the biggest city
near Area 51, that's
Las Vegas, right buddy?
I'm just saying.
- You're welcome, we
keeps it real in my 'hood.
Back in the yea, oh speaking of which.
So I am in, I'm in the
epicenter of some potential
community transmission here
and it's interesting to see
people walking around
with masks and stuff.
Is that as dumb a thing to do
as I might suspect it might
be out in the community?
- Well you know, first of all,
it has to be the right kind of mask.
The typical surgical
masks don't do very much
to prevent infection.
What it will do, is if you're sick,
it may prevent the droplets from spreading
to other people.
- Yep.
- And that's fine, but
if you're wearing a mask
cause you think it's gonna protect you
against coronavirus, that's
just a false sense of security.
- Right because you have your ocular
mucus membranes too, right?
If someone's coughing out there,
can't the respiratory
droplets end up in your eyes
and your nose, around the mask?
- Yeah, you can walk
around wearing PPE too.
(laughing)
I mean I guess, I mean look right now,
and it's very hard.
One of the hardest things
to do in public health
communication in the middle
of a serious epidemic
like this one, is to somehow provide
reassurance without overly simplifying it.
Without just saying, oh yeah
it's just a cold, right?
Cause it's not.
- Right.
- It's got a pretty
high case fatality rate.
And that 2% number seems to be turning out
to be the case.
At first people were saying, well no,
that doesn't really account
for a big denominator
of people with low grade symptoms.
But now the World Health Organization
has come out and said, nope that 2% number
is looking like it might real.
Which is significant, right?
That's 10, 20 times
higher than seasonal flu
in terms of mortality rates.
And we already heard about the high
case rate of serious
illness or critical illness
among healthcare professionals.
And it's pretty highly
transmissible as well
with that reproductive
number between three or four.
So if you add all those things together,
this is gonna be a
pretty serious epidemic.
But on the other hand, we don't right now
have a level of serious, of
high levels of transmission
going on in the U.S.
We have four cases, so it's something
that we're just gonna
have to be mindful of
to watch over time.
I mean, you know if we replay
this two weeks from now,
the world may look very different,
and what we're saying
may seem out of touch.
- Yeah
- But we'll have to see
how this proceeds; it's
a brand new virus agent.
We don't know what's going to happen.
You know there are some who are saying,
well coronaviruses, some
of them are seasonal,
the peak in the winter.
And that's true, some of them do,
particularly in the northern hemisphere.
But again, this is a
brand new virus agent.
We have no way to know.
And that doesn't, we've never gone through
a whole year of this
new SARS II coronavirus.
It started at the end of last year.
- Yeah
- And we don't know
what happens in the tropics.
Like flu is all year round in the tropics,
or in the southern hemisphere
where it's inverted
and it peaks in July and August.
So we don't really understand the basis
of seasonality either.
So it's very hard to
predict where this thing
is gonna head and how
destabilizing it's gonna be
in terms of stock market
and whether it will trigger
something like a recession,
or whether it'll even
affect the outcome of the election.
Lots, lots we don't know.
And one of the things that
I'm very interested in
is looking at the whole
geo-political space
for serious infectious diseases.
So I have just finished writing a new book
that we haven't come
up with the title yet.
I'm working with Johns
Hopkins University Press
to find a good title,
but it's got the very
unwieldy working title of:
Vaccines in an Age of
War, Political Collapse,
Climate Change and Anti-Science.
(laughing)
- It's like the four horsemen
of the apocalypse, plus three.
- Yeah, you get the idea
that there's all of these new
social and physical
determinants that we never had
to really think about before.
And now, having big effects
on the rise of disease.
- Well so, and it's
interesting, so I want to bring
that back to the communication of this.
Because there is so much uncertainty.
The CDC has been criticized.
The Chinese government
has been criticized.
There have been all kinds
of conspiracy theories
as you've seen online.
How do you parse this criticism of CDC
and the overall response to this,
given that the first cases were discovered
in December, potentially?
- Well you know I also
try to emphasis a lot
what's gone right in
terms of our response.
Look, I mean this virus,
we didn't know it existed
until the end of last year, in December.
And that's only a few weeks ago.
And within a very short period of time,
the Chinese, all that
investment in science in China
really paid off.
- Via SARS you mean?
- Within a short time
they actually isolated
the virus, knew what it
was, we had the full genetic
code of the virus, we knew
what receptor in the lungs
this virus was binding to.
I mean just incredible
amounts of information
in a short period of time.
And the Chinese, you
know all the accusations
about them not being transparent,
on the scientist side, they
were putting all this stuff
up on Bio Archive which
is a pre-print server
that anybody can download and access.
And that made it possible for us to say,
hey we might have a good vaccine here.
So that's gone really well.
- So let me put a point on that,
because when I did my
first video on coronavirus,
I said exactly that.
I actually said the Chinese
government did something
quite remarkable here, which is this early
and aggressive intervention.
It's almost like, you have
a very difficult situation
and they actually did decent job.
A lot of people were like,
oh you're under playing this.
You don't understand;
it's all a conspiracy.
And this has been totally covered up.
And so on, and so forth.
But honestly seeing what's gone right,
now you've dealt with
epidemics over 20 years.
Is this vastly different than
other things you've seen?
- Well certainly the level
and flow of information
and the science, you can't
compare this to any others.
I was impressed with SARS in 2003,
how over a period of a year we had
the virus and the sequence
and we learned about
its mode of transmission.
This is compressed to weeks;
so this really impressive.
You know nothing has gone perfectly.
Epidemics with new pathogens
set up government leaders to look bad
because there's always
gonna be missed steps.
And everybody knows what the missteps are.
And you know, what I
notice is when I'm going on
cable news networks, the
journalist often will want
to do a lot of gotcha stuff with whoever
is making decisions, and they're sometimes
frustrated with me cause
I temper that to say,
look, I saw this with anthrax in 2001,
I saw it with H1N1 in 2009,
I saw it with Ebola in 2014,
and then Zika; this is what happens.
There's always stumbles;
there are always missteps
early on in the course.
And I make that statement,
that again epidemics
with new pathogens set you
up to make you look bad.
And that's what's happening here.
There's a lot of accusations;
some of it deserved,
but a lot of it not justified.
I think everybody at CDC and
Health and Human Services
is working overtime trying
to figure this thing out,
working with the state and
local health departments.
I actually think the team
that's been put in place
in terms of the people,
are looking pretty good
at CDC and Health and Human Services.
I think the other thing that people forget
is they somehow think that the
CDC's gonna fight this thing.
And that's not the way it works.
The CDC gets called in
in an advisory capacity.
It falls to the local and
state health departments,
along with hospital
personnel, that are going to
lead the defense against this coronavirus.
And that's another vulnerability.
Some of our county and
local health departments
are outstanding, like what
we have here in Houston
and Harris County, some of
the best health department
staffs in the world.
New York City is great.
San Francisco I'm sure is great.
But some of the smaller rural counties
just don't have adequate capacity.
They've been chronically underfunded.
They don't have the staff or the training.
And that's a vulnerability as well,
other than the hospital
staff, is trying to shore up
our depleted health system,
particularly with some of
the smaller local health departments.
And hopefully that traunch
of funding from Congress,
who knows what the number is gonna be,
whether it's 2.5 billion or 8 billion,
hopefully a good chunk
of that will filter down
to the local health departments.
- Yeah it makes perfect sense.
And actually, again to emphasize that,
all healthcare is local and
public health is no exception.
There's a big local
component like you said.
So they are jack hammering
my street outside,
so it's probably a good sign to,
we've covered quite a bit of ground,
- Absolutely
- to try to start to
start to wrap up here.
So I have a sort of related
but unrelated question,
have you seen My
Coronavirus music video yet?
- I have not, but I've been traveling,
but I promise to look at it.
- All right, I'm gonna send it to you
and force you to undergo.
It's like A Clockwork Orange,
it's just eyes held open
forced to watch this terrible music video
that has some education in it.
- Well what you could
do is either end this
with that video or begin it,
or have it as the background.
- I don't want to taint
the conversation with
too much rock and roll, Peter.
Because Rock and Roll has
gotta stand on it own.
But listen, so
(laughing)
I want to thank you for, first of all,
all the work you've done over the years.
For working on this vaccine.
For being a source of reason
and knowledge for the press.
You know you're bouncing between MSNBC
and Fox and you're actually
having to deal with
the political ramifications,
the whiplash from that,
and doing the science that you're doing.
So I want to thank you
on behalf of the Z Pack
for all taking into account
the healthcare professionals
that are at risk with this
and how they can stay safe.
So thank you so much for that, Peter.
- Thanks so much, and again thanks for all
your great work and advocacy.
What you're doing is so important.
- Thank you, coming from
you that means a lot.
Guys, I gotta say, Z Pack
if you can do me a favor
and share this video so that we can get
actually knowledge out there.
Can you guys hear the jack hammering?
That's the CDC black helicopters
that are coming with
the boots, right Peter?
That's a thing, right?
- Well the irony is, now
there's a leaf blower
in front of my house so,
(laughing)
I'm trying to read the letters on it.
(laughing)
- Oh man, after my coronavirus video
I think I might be persona non grata
with the Chinese government
cause I made a few jokes
about them redacting my cough,
but that's neither here nor there.
So Peter thanks again,
and we're really excited
for any updates you have.
Please come back on the
show to keep us posted
as this thing evolves
and everybody out there
please stay safe and prepared.
All right guys, we out.
