#99 - Peter Hotez, M.D., Ph.D.: Continuing the conversation on COVID-19
Dr. Peter Hotez, a renowned vaccine scientist, discusses COVID-19, covering true infection numbers, practical risk reduction, the concerning rise in young adult hospitalizations, vaccine development, and the significant mental health impacts of the pandemic.
Deep Dive Analysis
11 Topic Outline
Estimating the True Number of COVID-19 Cases in the US
Challenges and Failures in US Testing and Pandemic Response
Rate-Limiting Factors in Healthcare Delivery and Provider Morale
Protecting Healthcare Workers: Prophylaxis and Systemic Issues
COVID-19 in Younger Adults: US vs. China and Potential Causes
Immunity After Infection and Virus Seasonality
Vaccine Development Timeline and Repurposed Drug Therapies
Practical Behaviors to Reduce Infection Risk from Fomites and Food
Addressing the Mental Health Impact of the Pandemic
Optimism and Positive Outcomes from the Pandemic Response
The Role of the Military in Pandemic Response
4 Key Concepts
Convalescent Antibody Therapy
This therapy involves harvesting antibodies from individuals who have recovered from an infection and developed antibodies. These antibodies can then be used as a treatment for sick patients or, in smaller doses, as a form of prophylaxis to temporarily reduce the likelihood of infection for a couple of weeks.
Nosocomial Transmission
This refers to the transmission of a virus or disease within a hospital setting. Coronaviruses, including SARS-CoV-1, MERS, and SARS-CoV-2, are known for their ability to spread rapidly through hospitals, causing significant impact on healthcare personnel.
Furin Protease
A specific type of serine protease found in SARS-CoV-2, which is relatively unique among beta coronaviruses. This protease is involved in the virus's ability to gain entry into cells and represents a potential drug target for antiviral therapies.
SL Viruses
This term refers to SARS-like viruses found in bats, which are a family of bat coronaviruses that have been emerging regularly. This natural circulation of such viruses suggests that new coronavirus pandemics are likely to occur on a regular basis.
7 Questions Answered
The confirmed case count is a small fraction of the true number of infected people, with models suggesting a multiplier of 10 to 50 times more actual cases. The distribution of these cases is not even across the country, forming 'red blobs' in specific areas like New York and Seattle that are expected to grow and coalesce.
Healthcare providers are seeing colleagues get sick, observing inconsistencies in plans, and feeling that hospitals haven't adequately prepared. There's a disconnect between what they're experiencing and what's communicated by state or federal governments, leading to a feeling of abandonment.
Unlike initial observations in China, a significant number of hospitalized COVID-19 patients in the US and Europe are young adults, with about a third of hospitalized cases being between 20 and 44 years old. While not dying at the same rate as older patients, severe illness requiring ICU admission is a huge tax on the healthcare system and highly destabilizing for young physicians and nurses.
Preliminary studies in non-human primates suggest that once infected, they are immune to reinfection. While applicability to humans is still being studied, the premise is that exposure and infection will likely confer immunity, unlike the flu which has antigenic drift.
Expectations for a rapidly deployable vaccine within 18 months are being downplayed due to safety trials and the novel technology of the first vaccine in trials. Repurposed drugs like hydroxychloroquine are being investigated, with potential benefits due to their availability, low cost, and anti-inflammatory effects, but require larger studies.
While the virus can live on inert surfaces like cardboard for several hours, the actual risk of transmission from mail or Amazon packages is considered low. For food, there's no specific CDC guidance, but heating food to high temperatures (e.g., 56 degrees Celsius for 15 minutes for SARS-CoV-1) could kill the virus. The primary risk remains close personal contact with an infected individual.
Prolonged social isolation and constant exposure to dreary news can significantly affect mental health, potentially leading to increased anxiety, irritability, and even higher suicide rates. There's a need for low-cost mental health support, such as networks of counselors, to address the psychological devastation on the population.
7 Actionable Insights
1. Practice Social Distancing
Prioritize social distancing and avoiding close personal contact with others outside your immediate bubble, as this is considered the most likely mode of virus transmission.
2. Seek Nuanced Information
Actively seek out clear, patient explanations of complex topics, valuing nuance and acknowledging when full answers are not yet available, rather than settling for “dumbed down” soundbites.
3. Prioritize Mental Well-being
Recognize the significant psychological impact of prolonged social isolation and austerity measures, and be mindful of diminishing returns from extreme precautions to protect your mental health.
4. Cultivate Optimistic Mindset
Avoid being passive or just “hunkering down”; instead, embrace the idea that great things can still be achieved by pursuing big, audacious goals and building new technologies, fostering a realistic but upbeat outlook.
5. Disinfect Delivered Packages
If you are concerned about virus transmission via surfaces, wipe down Amazon packages or mail with a Clorox wipe or approved alcohol wipe, though the risk is considered low.
6. Heat Takeout Food
To potentially kill the virus, heat takeout or cooked food to above 140-150 degrees Fahrenheit (56 degrees Celsius) for at least 15 minutes, especially if you are unsure of its handling.
7. Wash Produce More
Wash produce more thoroughly with water than usual if you are concerned about virus transmission, though there is no specific new protocol beyond this.
5 Key Quotes
I've sort of always rejected the notion that people need dumbed down soundbites. I think that's probably just an assumption that when really vetted is probably not true for the majority of people.
Peter Attia
If a significant number of healthcare professionals start either self-quarantining or actually getting sick, or if you have the situation where colleagues are going to start taking care of colleagues who are very sick or in intensive care units, the term I use, it'll be lights out. By lights out, I mean this whole thing is over. Things will unravel in this nation very fast.
Dr. Peter Hotez
This one is really problematic because it's not as lethal as SARS-1, but it's number one. Number two, it's more transmissible. And number three, there is a large group of asymptomatic individuals. And that's what creates a toxic mix for this virus because it quickly spreads throughout the community and infects, it kills a small number of people, but still five to 20 times more than influenza.
Dr. Peter Hotez
I often say our model of how we publish science was invented in the 1850s by the German scientific institutions. And it worked for a while, but believe it or not, communicating science according to the rules of 1850 Germany is probably no longer adequate.
Dr. Peter Hotez
I hope they make us look bad by saying we over-responded than we under-responded.
Peter Attia