3 years ago
Peter Hotez, M.D., Ph.D. is Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine where he is also the Director of the Texas Children’s Center for Vaccine Development (CVD) and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics.
So let's get going. So taking it from the top, let's discuss, give us your take on how we got here. Because this is, it's been very strange. Obviously the president completely miscalculated what was going to happen and the way he was explaining it to the news, he was kind of saying that it was just a few cases and they'll be gone. And now obviously New York City shut down, the entire country is separated from each other, everybody is isolating at home. Give us your take on how we got here. Well you know the truth is we knew this was coming or something like it. We had a heads up and even a heads up before last year because this is now our third major coronavirus disaster of the 21st century. We had what's called SAR, severe acute respiratory syndrome in 2003 that started in China and caused a terrible epidemic in Toronto. It actually took the Rolling Stones to do a concert to bring the economy back to Toronto in 2003. And then it was mayor's coronavirus infection in 2012 and this is the third one. So we actually realized that coronaviruses were going to become a new thing and we embarked on a big coronavirus vaccine program a decade ago. And each time they've caused devastating hospital epidemics, they've affected healthcare workers. So the point is this unfortunately has become a new normal for the globe is terrible coronavirus epidemics. And we saw this one coming up at the end of 2019 in China and I knew we were in for trouble because that's what coronaviruses do. So you knew that we were going to be in trouble because there was no way they can contain it and keep it in China? Well the difference with this one compared to the other two was this. The other two, SARs and mayors, now we call this new one SARs2. So there were SARs1 then mayors then SARs2. So both SARs1 and mayors made you so sick and had such a high case fatality rate that anybody who got it was almost immediately hospitalized and basically out of the community. The difference with this one ironically is it's pretty lethal. It's about five to ten times more lethal than regular flu, seasonal flu. But also there's a big group of people who don't get very sick at all. And so you have this sort of perfect mix where it's not the most lethal infection we've ever seen. It's not the most transmissible infection we've ever seen but it's high enough in both categories that it combines in this very toxic way. So what you have is you have a group of people who are getting very sick or in the intensive care unit like older people, those with diabetes and hypertension, even a group of younger people who are getting it very sick. And then a larger group who are only getting mildly sick who could still walk around the community and be out and about in stores and restaurants and infecting everybody. And so this is what's caused the problem. It's highly transmissible and there's a big group of people walking around spreading it and a smaller subset but a big subset who are getting very sick and even dying in intensive care units. So that's what's playing out in New York City right now for instance. Do we know why so many people are asymptomatic? We don't. We really don't. There's a rough correlation with age so younger people seem to do better and actually kids seem to do really well with this infection. With one exception that I'll tell you about in a minute, most kids don't get very sick at all but they're helping with the community spread. And we don't quite know why also but something that's very important and one of the reasons why I really wanted to come on and talk to you about COVID is there's this buzz out there in the community that it's only old people that are getting sick and dying and going to ICUs. But in fact, the Centers for Disease Control came out with this very chilling document a few weeks ago showing that about a third of the very sick people in the hospital are under the age of 40 or 44. So between 20 and 44 young adults are getting very sick and that word has not gotten out adequately because when this infection first appeared in central China, it was all about older individuals over the age of 70, those with diabetes and hypertension. We didn't hear about the young adults but then for reasons that we don't understand, we saw this big group in Italy, in France, in Spain of younger adults and we're seeing that play out in the US. And the people who listen to you and watch you, it's a big group between that age of 20 and 44 and they really need to hear that they're at risk for severe illness despite what they might have heard previously. Well we have a friend, Michael Yeoh, who was actually on a podcast with me the week before he went to New York. He was there that weekend actually and that's when he got it. So he got COVID-19 in Manhattan and then flew back, got sick and here's what's really, maybe you could help me with this. He said he was feeling terrible and then took Advil and it got exponentially worse. Is that coincidental do you think? I mean there's been talks of avoiding ibuprofen. Michael's 45 years old, very healthy, very robust guy. So when he was, I mean he was in the hospital for a week and his words were, I almost died. I mean he was really, really concerned. What about ibuprofen? So there's been a lot of buzz on the internet about ibuprofen and then the World Health Organization came out with a specific statement saying those are rumors. So there's not a lot of evidence to say that you get worse with ibuprofen. Probably he was just one of those young adults that's going to get very sick and that's what this virus does. It has the ability to get deep into the pulmonary system in your lungs, binds to receptors on the cells of your lungs and causes a terrible pneumonia and on top of it you get a big inflammatory response so it really can, it's a severe pneumonia, it can even prevent your ability to breathe and that's why so many people who are getting really sick with this virus have to go on respirators. That's exactly what happened to Michael. He got pneumonia. So there's a rumor that you shouldn't take ibuprofen but is that unfounded? Are you advising people to take ibuprofen? Do you think they should just avoid it just in case? And where did this rumor start from and what is the concern with ibuprofen? And then you've got the problem, some people also say don't take aspirin because if this is a respiratory virus infection there could be a severe reaction with aspirin as well. So for now, you know, and I said the other thing Joe is anything we say today I might look like the biggest idiot in the world tomorrow or next week and that's because this is a brand new virus and we've never seen before, right? So we're on a steep learning curve so we're learning new things about this virus every day so that's why you know so many things I'm going to say today by something like I'm waffling or hedging it's because I am. We're learning so much that's new about this virus so it's really important that everybody be really mindful and pay attention to real health information that from accurate sources because things move, things change as we learn more about this. This is a virus that we didn't even know existed about four months ago and we've learned about an incredible period of time. The Chinese put up a lot of information on these pre-print servers about what the virus is, what the sequence is, the genetic code, what the receptor binds to. When we had the original SARS, we call this new one SARS-2, the COVID-19, so the disease is called COVID-19, the virus is called SARS-2, SARS Coronavirus 2. When we had the original SARS-1, it took us over a year to learn all that information. Now everything's been compressed in a few weeks so it's really extraordinary but there's still so much we're learning right now. I'm so glad you brought that up because that is really important for people to understand, people that maybe haven't looked into the complications that are involved in trying to recognize treatments and cures for a virus that it is, everyone's learning. Also, everything we have known so far about the virus is what happened in China and it turns out the Chinese have some genetic differences to Europeans and Americans and things can change depending on, it's not just the pathogen, it's also what we call the host, the person too. The fact that the virus affected young adults in Europe and the US in a way that did not necessarily occur in China is important. Then who knows what happens when this virus goes into Latin America or India or Sub-Saharan Africa. It's not because the virus is mutating necessarily, it's just that there's also the host component as well which is quite important. Well, that's one of the issues that people are having in terms of blood type. There's all this talk of certain blood types may be more susceptible to the virus particularly blood type A. Yeah. Well, actually, this is actually well known in the infectious disease literature. I put one up on Twitter I think a week or so ago. There's dozens of different pathogens including viruses and bacteria that behave differently depending on a person's blood type. Host genetics influences things quite a bit.