#1451 - Dr. Peter Hotez

[0] Dr. Hottes, how are you, sir?

[1] Oh, it's great to see you again, Joe.

[2] I feel a lot better seeing you now.

[3] I feel a lot better seeing you, too, especially with the bow tie, as we talked about before, your signature touch.

[4] Yeah, as I was saying, when I tried to start wearing a regular tie for a while.

[5] It was like when Dylan started switching to electric instruments at the Newport Folk Festival, and there were just cries of outrage, so I had to...

[6] What kind of cries of outrage are you getting about your bow tie, especially in these trying ties?

[7] No, no, no, they like the bow tie.

[8] The point was I tried to switch to regular tie for a wire, and they said that there's no way that can happen.

[9] Yeah, that's what I meant.

[10] I mean, who's getting upset of you wearing a regular tie?

[11] Those people need to get alive.

[12] I think it was meant in a good -natured way.

[13] I'm sure.

[14] So we don't do very many of these Skype ones, because they're odd.

[15] So let's, I don't know if you've done too many of these.

[16] Sometimes people talk over each other.

[17] It's very strange.

[18] yeah i guess it's the it's the epidemic right otherwise i'd be on a plane and come to see you in laa and yeah we'll do that again sometime so let's let's get going um so taking it from the top let's let's discuss give us your take on how we got here because this is uh it's been very strange obviously uh 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.

[19] And now obviously New York City shut down.

[20] The entire country is separated from each other.

[21] Everybody is isolating at home.

[22] Give us your take on how we got here.

[23] Well, you know, the truth is we knew this was coming or something like it.

[24] We had a heads up.

[25] And even a heads up before last year, because this is now our third major coronavirus disaster of the 21st century.

[26] We had what's called SARS, severe acute rate.

[27] respiratory syndrome in 2003, that started in China and caused a terrible epidemic in Toronto.

[28] It actually took the Rolling Stones to do a concert to bring the economy back to Toronto in 2003.

[29] And then it was mayor's coronavirus infection in 2012, and this is the third one.

[30] 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.

[31] And each time, they've caused devastating hospital epidemics.

[32] They've affected health care workers.

[33] So the point is this, unfortunately, has become a new normal for the globe is terrible coronavirus epidemics.

[34] And we saw this one coming up at the end of 2019 in China.

[35] And I knew we were in for trouble because that's what coronavirus is due.

[36] So you knew that we were going to be in trouble because there was no way they can contain it and keep it.

[37] in China?

[38] Well, the difference with this one compared to the other two was this.

[39] The other two SARS and mares, now we call this new one SARS -2.

[40] So there were SARS -1, then mares, then SARS -2.

[41] So both SARS -1 and mares 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.

[42] The difference with this one, ironically, is it's pretty lethal.

[43] It's about five to ten times more lethal than regular flu, seasonal flu.

[44] But also there's a big group of people who don't get very sick at all.

[45] And so you have this sort of perfect mix where it's not the most lethal infection we've ever seen.

[46] 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.

[47] 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.

[48] And then a larger group who are only getting mildly sick who could still walk around the community and be out in about in stores and restaurants and infecting everybody.

[49] And so this is what's caused the problem.

[50] It's highly transmissible and there's a big group of people.

[51] walking around spreading it and a smaller subset but a big subset we're 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 they don't they don't get with one exception that I'll tell you about in a minute.

[52] Most kids don't get very sick at all, but they're helping with the community spread.

[53] And we don't quite know why.

[54] 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 ICU.

[55] But in fact, the Centers for Disease Control came out with this very chilling document a few weeks.

[56] ago showing that about a third of the very sick people in the hospital are under the age of 40 or 44.

[57] So between 20 and 44 young adults are getting very sick.

[58] And that word has not gotten out adequately because when the infection first appeared in central China, it was all about older individuals over the age of 70, those with diabetes and hypertension.

[59] And 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 U .S. And I know, and the people who, you know, listen to you and watch you, you know, 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.

[60] Well, we have a friend, Michael Yo, who was actually on a podcast with me the week before he went to New York.

[61] He was there that weekend, actually, and that's when he got it.

[62] So he got COVID -19 in Manhattan and then flew back, got sick.

[63] And here's what's really, maybe you could help me with this.

[64] He said he was feeling terrible and then took Advil and it got exponentially worse.

[65] Is that coincidental, do you think?

[66] I mean, there's been talks of avoiding ibuprofen.

[67] Michael's 45 years old, very healthy, very robust guy.

[68] So when he was, I mean, he was in the hospital for a week.

[69] his words were, I almost died.

[70] I mean, he was really, really concerned.

[71] What about ibuprofen?

[72] 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.

[73] So there's not a lot of evidence to say that you get worse with ibuprofen.

[74] Probably he was just one of those young adults that's going to get very sick, and that's what this virus does.

[75] 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.

[76] So it really can, it's a severe pneumonia, 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.

[77] That's exactly what happened to Michael.

[78] He got pneumonia.

[79] So there's, is that there's a rumor that you shouldn't take ibuprofen, but is that unfounded?

[80] Are you advising people to take ibuprofen?

[81] Do you think they should just avoid it just in case?

[82] And where did this rumor start from?

[83] And what is the concern with ibuprofen?

[84] And then you've got the problem, you know, some people, you know, also say don't take aspirin, because if this is a respiratory virus infection, there could be a severe reaction with aspirin as well.

[85] 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?

[86] So we're on a steep learning curve, so we're learning new things about this virus every day.

[87] So that's why, you know, so many things I'm going to say today, if I sound like I'm waffling or hedging, it's because I am.

[88] 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 from accurate sources because things move, things change as we learn more about this.

[89] This is a virus that we didn't even know existed about four months ago, and we've learned about it an incredible period of time.

[90] The Chinese put up a lot of information on these pre -print servers about what.

[91] what the virus is, what the sequence is, the genetic code, what the receptor binds to.

[92] When we had the original SARS, we call this new one SARS 2, the COVID -19.

[93] So the disease is called COVID -19.

[94] The virus is called SARS -2, SARS -Coronavirus -2.

[95] When we had the original SARS -1, it took us over a year to learn all that information.

[96] Now everything's been compressed in a few weeks.

[97] So it's really extraordinary, but there's still so much, so much we're learning right now.

[98] I'm so glad you brought that up because that is really important.

[99] 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, it's, everyone's learning.

[100] Yeah, and also, you know, and everything we have known so far about the virus is what happened in China.

[101] 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.

[102] So the fact, you know, that the virus affected young adults in Europe and the U .S. in a way that did not necessarily occur in China is important.

[103] And so we are key, and then who knows what happens when this virus goes into Latin America or India or sub -Saharan Africa.

[104] And it's not because the virus is mutating necessarily.

[105] It's just that there's also the host component as well, which is quite important.

[106] Well, that's one of the issues that people are having in terms of blood type there's there's all this talk of certain blood types may be more susceptible to the virus particularly blood type a yeah well actually um this is actually well known in the infectious disease literature there i mean there's a whole i put one up on twitter i think a week or so ago uh there's you know dozens of different pathogens both including viruses and bacteria that behave differently depending on a person's blood type so host genetics influences things quite a bit.

[107] Now, let's talk about Germany, because I found that really fascinating when I was reading on Germany and their low mortality rate.

[108] What do you attribute that to?

[109] Is that the extraordinary health care they have there?

[110] What is that?

[111] Well, let me give you first the opposite side of the coin, and then we'll talk about Germany.

[112] So the opposite side of the coin, what's happening in Italy, in Spain, 10 % mortality.

[113] So 10 % of the people who are being diagnosed with COVID -19 have died, which is higher than just about anywhere else.

[114] I think what's happened there is when the health system gets so overwhelmed that so many, so in other words, if transmission goes on for a long time and you haven't picked it up, and then all of a sudden people start showing up in the ICU, then it's too late.

[115] Then you start having massive numbers of people come into the ICU.

[116] The hospital can't take care of everybody.

[117] They can't intubate everyone.

[118] They can't give everyone the highest quality care possible.

[119] It's no fault of the doctors and nurses.

[120] They're heroes.

[121] But the fact that they're completely overwhelmed with patients, that's when mortality starts to really rise.

[122] So we saw this in parts of Wuhan and we saw this in Italy.

[123] And that was the big worry about New York, that the same thing would happen to New York.

[124] but I'll hold that thought for a second.

[125] In Germany, so far, we think it's a combination that it's been more younger people getting it and the fact that the hospital system was getting ready and they've got that infrastructure in place to manage that surge, although they're worried now too that it may start going up and overwhelming things.

[126] And then you look at, okay, so if that's true, what's the story on the mortality rate in the United States?

[127] And interestingly, so far one of the highest has been in Orleans.

[128] And I think what happened there was they kept the Mardi Gras open.

[129] They had lots of mixing and large numbers of people getting infected.

[130] Number one, it overwhelmed the health system, just like in Italy.

[131] So in New Orleans, right now the case fatality rate is between four and five.

[132] But there's another factor going on in New Orleans, lots of people living in extreme poverty.

[133] And poverty is very linked to diabetes and hypertension.

[134] And we know diabetes and hypertension is a big risk factor for death.

[135] So New Orleans is getting hit twice, one, because the health system is getting overwhelmed.

[136] And second, I think you have a lot of African Americans living in poverty with underlying diabetes and hypertension.

[137] And that's causing that to skyrocket.

[138] So, you know, I was just on the phone today with the leadership of Houston and saying, you know, we have a similar demographic to New Orleans in many ways.

[139] We're sister cities after Katrina kind of linked at the health.

[140] hip and and you know there are a sister city we love them but you know we have to recognize that even though if we can handle the surge with our texas medical center we still have that demographic of african -americans aspanics with underlying diabetes and hypertension i'm really worried we're going to see high mortality in texas now is another factor with italy and their high mortality rate smoking because when i was in italy i was stunned by how many people smoke young people, old people, it seemed like a large percentage of the population smoked.

[141] Yeah, I'm really glad you brought that up.

[142] I should have remembered to say that.

[143] So, yeah, so in China, so for instance, Chinese, older Chinese men at really high mortality rates.

[144] And here's something very interesting.

[145] Smoking actually upregulates the receptor and the lungs that the virus binds to.

[146] So it seems to make more copies of the receptor for the virus to bind to so that may worsen the disease.

[147] So I think you're right.

[148] I think smoking is a factor.

[149] The one question that we don't know is what does vaping do?

[150] Is vaping also doing that?

[151] And could that be linked somehow to all the young adults that we're seeing in the United States who are getting hospitalized?

[152] They actually don't have higher mortality, but they're still getting very sick and their lives are being saved because they're being intubated and put on the vent.

[153] but is there a vaping connection?

[154] Again, new question.

[155] We don't know.

[156] It's something that's going to have to be looked at.

[157] Boy, there's going to be a lot to unravel when all this is over.

[158] And along the way, people are dealing with a lot of misinformation, which is one of the reasons, one of many reasons why I'm so thankful for you for coming on the podcast and trying to educate us on this thing.

[159] Yeah, that's the reason I've been going on in between where, you know, I co -lead a team with my 20 -year science partner, Dr. Mary -Laina -Batazzi, we've developed vaccines, including coronavirus vaccines.

[160] We're trying to get those out the door in clinical trials.

[161] In between, I'm going on Fox News, MSNBC, and CNN.

[162] And that's not an easy needle to thread either, going on Fox News, MSNBC, and CNN.

[163] That's been really interesting, but I love the opportunity.

[164] And I'm doing it because there's a lot of bullshit out.

[165] There's a lot of misinformation trying to get accurate information and also explaining the science behind it.

[166] Because sometimes you hear something that doesn't sound right.

[167] And it sometimes takes a couple of minutes to explain that.

[168] And those three cable news networks have been great about giving me some time to explain the thinking behind it, which they ordinarily wouldn't do.

[169] That's great.

[170] Now, let's talk about treatments that are being considered.

[171] We know that Z -Pax are one of them and chloroquine.

[172] Can you explain that?

[173] And what went horribly wrong with the couple that took the wrong kind of chloroquine and it turned out to be a koi pond cleaner?

[174] Okay, so let me give you the framework for that so it makes some sense.

[175] When we talk about all the interventions, you have things that are going to be ready down the line, things are going to be ready a little closer, and things ready now.

[176] And then we can talk about one on one.

[177] And then I'll let me give you the framework that I'll answer your chloroquine question.

[178] So the highest bar there is in terms of financial investment required in time to show safety is a vaccine.

[179] So that's what we're doing and other groups are doing.

[180] Next tier down, that's going to be, you know, a year, 18 months away, according to Dr. Fauci, could be longer than that.

[181] Next tier down are what we call small molecule drugs, new drugs that have never been discovered before.

[182] It still takes a while, maybe not as high a bar as vaccine in terms of time.

[183] the next tier down is repurposing existing medicines that we already know are relatively safe and then showing that those drugs also work against the coronavirus and that's going to be the chloroquine category and I'll get to your question and then the nearest ones the one that we could do now is what's called this convalescent antibody therapy which I've been pushing very hard on because I think we can actually have it going right now.

[184] So let's do the chloroquine hydroxychloroquine.

[185] This is, and that's one of the repurposed ones.

[186] That's not the lowest hanging fruit, but the next lowest hanging fruit.

[187] This is a medicine that's used for malaria.

[188] It's an anti -malarial drug.

[189] It's been around for decades.

[190] In fact, the World Health Organization was going to have in the 1960s proposed an elimination strategy for malaria to treat everybody with chloroquine until we had chloroquine resistance and that derailed that.

[191] But in some parts of the world, it still works as an anti -malarial drug.

[192] It's also used as an anti -inflammatory drug for the treatment of lupus and other autoimmune diseases.

[193] You can make a bucket of it.

[194] It's cheap.

[195] We know the safety profile.

[196] We know it can cause arrhythmias in some patient and other toxicities, but it generally has a pretty good safety profile.

[197] We know that this drug can block the replication of the virus in the test tube.

[198] So it inhibits the virus in what we call in vitro in the test tube.

[199] Second, we know this drug reduces inflammation, and that's nice because one of the things you get with COVID -19 pneumonia is you not only get the virus infection in the lung, you got a lot of inflammation.

[200] So it checks a couple of boxes in terms of why it's attractive to look at it.

[201] And then the Chinese did a small study, and then a colleague of mine is a fascinating guy.

[202] I really appreciate his work as a scientist.

[203] He's a very serious scientist in Marseille, in France, named Didier Raul.

[204] And he must have published at least two or three dozen papers in the journal that I found called Ploss Neglected Tropical Diseases.

[205] He's a serious scientist, works on all sorts of intracellular bacteria and that kind of thing.

[206] Tick -borne diseases did a small study showing that it worked in COVID patients.

[207] and what he did was he combined hydroxychloroquine with this Zipak, the Zythromycin drug, and found that there's an effect.

[208] The problem was it was a very tiny study, and so people put those three things together, and all of a sudden said we've got the miracle cure.

[209] I'm not sure that's going to turn out to be the case.

[210] I mean, we really need to do large studies to show that it really works, and the reason I'm holding back is, you know, nothing to do with Dr. Professor was a really important scientist, but it's a small study.

[211] We were there about a decade ago with influenza, that this hydroxychloroquine also inhibited the influenza virus in the test tube, but then it didn't pan out in larger clinical studies.

[212] So I think we have to be really careful and don't be too quick to say, okay, this is going to be it.

[213] We're not even close to that yet, but we'll know in the next few weeks because we're working hard to scale up clinical trials looking at that medicine.

[214] Now, in terms of vaccines...

[215] But there is a new...

[216] There is something new, though, that we can do right now.

[217] Okay.

[218] That we'll talk to you about.

[219] So this is something called convalescent antibody therapy.

[220] And it was, and it was, it's been known for over 100 years, and it was really scaled up during the 1918 influenza pandemic.

[221] You know, you were that terrible pandemic that killed hundreds, tens of millions of people.

[222] It was shown that if you took individuals who had recovered from the disease, who had got infected, they survived, they had antibodies in their blood, you could remove their blood, in some cases, give them back their red cells, and take the plasma component and use that as a therapy to treat patients.

[223] And in fact, during the 2003 SARS epidemic, the first SARS -1, there's been a number of studies showing that it worked.

[224] It actually, you could treat patients for it, especially if you gave it early out in the course of the infection.

[225] If you waited too long, then it didn't have nearly the same benefit.

[226] But you gave it early on the course of infection, it could prevent more serious infection and even death because you're actually giving back antibodies.

[227] The antibodies won't last forever, but enough to help you survive the infection.

[228] So a good friend and colleague, I've known for a long time, Arturo Casa Deval, is a brilliant professor of microbiology at Johns Hopkins, you know, started talking to me about, you know, Peter, maybe we should be doing this for COVID -19.

[229] And as the number started going up, I said, I called him.

[230] I said, look, Arturo, I'm going on, it seems.

[231] CNN tomorrow, I think this is an opportunity to tell people about this.

[232] So I, you know, helped amplify what he was doing.

[233] He had written a paper with a colleague from Johns Hopkins, Lise and Perfavre, I always get her, I always mangled her name, Profoski at Albert Einstein.

[234] And I talked to him about this, and that really got things moving along.

[235] So I've been trying to use my voice on, you know, being on CNN and Fox News, and it's not not just to hear myself talk, but to actually raise specific issues to get people to care about certain things.

[236] And I used it for this purpose.

[237] And I think it helped to mobilize some action.

[238] And now what our turn and his colleagues are doing together with the FDA.

[239] So there's a branch of the Food and Drug Administration called Seber, the Center for Biologics Evaluation Research, which is this amazing, you know, you hear a lot of bad things about the FDA.

[240] I think the FDA is amazing myself.

[241] But Seber is something very special, all these brilliant scientists who deal with vaccines and biologic.

[242] They're on board with it.

[243] I've been talking with Peter Marks, Dr. Peter Marks, who's the head of Seber, and he's teamed up with Arturo to get this network together going, at least among 20 academic health centers, so that they're identifying patients who've recovered, taking their blood, giving them back the red cells, collecting the plasma, so that when people come in sick, they can give treatment.

[244] And they'll have some clinical trial results, I hope, in the next few weeks, but I'm really optimistic about that one for saving lives.

[245] The other thing Arturo's talked to me about is, you know, could you use it in smaller doses to give the antibody to health care workers and to first responders to prevent them from getting sick?

[246] Because you're here, I mean, I don't know the percentage now first responders in New York, and that's why they turned the Empire State Building into a siren last night and to honor all of the all of the, all of the, the first responders who have gotten sick.

[247] We knew this was going to happen.

[248] Maybe this could help them.

[249] So I think that's going to be really important as well.

[250] Now, the French government, I was reading an article this morning, that they've sanctioned chloroquine as an official treatment, and they're having some good results with that.

[251] Are people currently using that in the United States?

[252] Are doctors prescribing that with CPACs?

[253] There's a lot of what's called off -label use, meaning that it's not an improved indication, but they're going ahead and use it.

[254] and you know I just I think and maybe it'll turn out to be a good treatment but the evidence is is not strong the there's a study in Shanghai that suggests that it didn't work so we really need well -controlled trials we really need to pin down the dose because maybe it's a dosing thing maybe if you give too high or too low a dose it's not going to work how you pair it with the xithromax so it's going to take a little bit of time to work out and this is the frustration that people have, you know, you're saying, my God, we have this terrible pandemic now, we need to get these new therapies and vaccines out very quickly.

[255] It's the hardest thing to do.

[256] It's the hardest thing to do is to accelerate new technologies for a new virus pathogen that we've never seen before while the epidemic is raging, while the pandemic is raging.

[257] It's really, we don't have a lot of track record doing this.

[258] We did it once with Ebola.

[259] If you remember in 2014, there was a terrible Ebola epidemic in West Africa, affected 33 ,000 people, 11 ,000 people died.

[260] That was in Guinea, Liberia, Sierra Leone.

[261] And there was some initial vaccine trials started by a Merck and company that looked pretty promising.

[262] They had licensed to technology from the Canadians, this group in Manitoba, public health Canada.

[263] And it looked promising But as the trials got underway, what happened was there was an international response to put in a health system because it turns out Ebola is not very transmissible.

[264] You just have to have some health care infrastructure, make certain that you're not directly handling the corpse of someone who's recently died from Ebola virus infection.

[265] And we even sent in the 101st Airborne Division.

[266] We sent in the Screaming Eagles, which made a big impact on helping to, save West Africa from this infection.

[267] So the WHO came in.

[268] There was UNICEF.

[269] There was Doctors Without Borders.

[270] I'm sorry, the Israeli army came in.

[271] Israeli Defense Force came in.

[272] A lot of groups came in to help West Africa.

[273] And so the vaccine never really got fully tested.

[274] But then five years later, when there was the terrible epidemic and Democratic Republic of Congo, that's when the vaccine really came into widespread use.

[275] And it's probably one of the most important public health stories never told, which was under conditions of terrible conflict and war and political strife and civil war, they vaccinated 200 ,000 people with this vaccine.

[276] And it largely helped eliminate Ebola from Democratic Republic of Congo in that during those hostilities last year.

[277] And essentially saved, I think, it helped to stabilize the whole African continent.

[278] So it's an amazing story.

[279] And again, it was this multilateral effort that involved also the U .S. government, the NIH and Barta and all of these organizations.

[280] It's an extraordinary story.

[281] And as a result, we really helped stabilize a sub -Saharan Africa.

[282] But we'll look at the time frame.

[283] 2014, first epidemic to 2019, that's five years.

[284] That's a more realistic time frame.

[285] for a vaccine just to give people a sense of perspective.

[286] Peter, one of the things that I was reading about Wuhan is there was an NPR article recently that was talking about people testing positive after they had tested negative, where they had tested negative and then a time period had gone by and then they had tested positive again.

[287] Are we learning, obviously we're learning about this as a new virus, but is it possible that this is something you can recatch in a short period of time, like within a few months?

[288] months?

[289] Or do you think that these people had false negatives?

[290] We don't know.

[291] I think there's a high likelihood that they're not getting reinfected once they develop antibodies, but we don't know for sure.

[292] The problem with respiratory virus testing is this.

[293] And it turns out even before those three big pandemic coronavirus I was talking to you about, we've known about coronaviruses for even longer than that because kids get a lot of upper respiratory infections with these other type of coronaviruses that rarely cause serious illness deep in the lungs and the testing for those viruses is a mess because number one you're often not actually culturing the virus you're doing what's called PCR to look for the genome of the virus and you don't know if the virus is really there are just bits and fragments of destroyed virus that are testing positive for PCR and we have all All of these odd results, like kids with no symptoms at all are testing positive, and then kids with symptoms are testing positive and negative.

[294] And it turns out diagnosing respiratory virus pathogens is not easy.

[295] It takes a lot of time to do the quality control and really figure out all the testing.

[296] And the Gates Foundation has a very significant respiratory virus pathogens program, which has been looking into this for a few years now, not necessarily for coronavirus.

[297] for other respiratory viruses.

[298] It's very, and other respiratory pathogens.

[299] It's not as straightforward to diagnose respiratory infections as it is, as it is safe for things that are in the blood because a lot of these respiratory viruses never get actually blood -borne.

[300] So you're sampling mucus from the nose or the, or your washings from the mouth or the throat, there's probably inconsistency in the sampling.

[301] So it's really problematic.

[302] And I think that may have been partly responsible for the delays, the CDC trying to work it out and get it perfect.

[303] And it just took longer than maybe perhaps they expected.

[304] Peter, is the possible silver lining to this cloud that this is a wake -up call for people to really take serious the funding of vaccines, the funding for pandemic research to make sure that we never let something like this ever happen again?

[305] Well, of course, we always say that.

[306] But then again, we said this after SARS in 2003.

[307] We said it after H1N1 in 2009.

[308] We said it after Mares in 2012.

[309] Right, but nothing's ever shut down the country like this.

[310] But the point is after every pandemic, you know, everyone says, oh, now we're going to put some infrastructure in place.

[311] And the truth is, things are better now than they were.

[312] So after SARS in 2003, they implemented this set of international health regulations.

[313] and IHR 2005, and a lot of that was led by a friend and colleague of my David Heyman, who's now at the London School of Hygiene Tropical Medicine and with Chatham House in London.

[314] And I think he was assistant director general of the WHO then.

[315] And they put that in place in a global health security agenda.

[316] Now we have this thing called CEPI, this coalition for epidemic preparedness innovation.

[317] So there's no question things are a little better, substantially better than they were, but it's still not enough.

[318] We don't have the infrastructure in place.

[319] We need to rapidly accelerate vaccines.

[320] Because a lot of the times, and I get involved in this because I've been devoted my whole life to developing vaccines for diseases, nobody else will make vaccines for it because there's no financial return.

[321] We've been doing this for parasitic disease vaccines, and that's what we spoke about last time, but also we've had this coronavirus vaccine program.

[322] And the problem is the big industry partners, the multinationals, sometimes they get involved in this, sometimes they don't.

[323] This leaves it to, you know, smaller biotechs, which are mainly focused on accelerating their unique technologies or this handful of nonprofits like ours at Texas Children's and Baylor College of Medicine.

[324] We call our Texas Children's Center for Vaccine Development at Baylor College of Medicine.

[325] and it's a fragmented infrastructure, and we're always scrambling for funds.

[326] I mean, even now, when we've got two vaccines, we're ready to move on, I'm still spending, I don't know how many hours a day on teleconferences, you know, with potential donors trying to get this out at clinical trials.

[327] So it's definitely problematic.

[328] But, Peter, I think we'd both agree this is a very different situation than SARS or Mears or any of those other things, and that the entire U .S. economy, is totally shut down.

[329] I mean, if anything is going to be a wake -up call for industry, if anything is going to be a wake -up call for people with money, this is going to be it, because this is devastating for everybody.

[330] You would think so, and I'm hopeful that things will change, but we'll have to see.

[331] I mean, so far we've had some good responses in terms of our vaccine.

[332] We've gotten contacts from a few individual donors, so we're in those discussions, but it's still been really tough to move it forward, even with a crisis going on like this.

[333] Have we stopped you from eating fast food because of this?

[334] Because I know you had a terrible diet.

[335] We were joking around about it.

[336] Well, I'll tell you, you know, I have an interesting, I've actually lost about six pounds since the start of this epidemic.

[337] And I think, well, one is I've stopped sleeping, right?

[338] Because I'm waking up doing teleconferences with Asia or Europe and going to bed with teleconferences with Asia.

[339] trying to figure out how we're going to do our vaccine and not that we're making a unique vaccine that's a low cost one that would be used not only in the u .s but but globally and then all the calls and everything else and the one good thing is that i've stopped traveling and i realized that the travel was really knocking the crap out of me in terms of my health so yeah we've talked about that on the show all the different comedians that i i tour with all the time we're all at home now for the past month and we're like god it feel great it's it's amazing what an impact it has on your health to travel all the time negative impact yeah the travel really not so it's you know we've got a group of scientists really dedicated even though uh the labs are largely closed down at baylor and texas children we got special permission because they're working on the covid vaccine so they're coming in some amazing dedicated group of scientists um and then i've been basically you know on teleconferences all the time.

[340] I said to my wife, Anne, I said, I feel like I have to press star six just to talk to you.

[341] It's just been so crazy.

[342] And then doing all the media hits.

[343] And I was going to the studio for a while, but I'm just doing it from my Skype.

[344] So I've sort of this weird subterranean existence right now.

[345] I mean, the good news, you know, the thing that people I feel so terrible for are those who, you know, now are not getting paychecks because of this crisis.

[346] and there's so many people suffering economic hardships right now.

[347] You know, all the people who used to make my breakfast sandwich in the morning.

[348] Now I don't see them.

[349] They're presumably not getting a paycheck or all those things.

[350] The dry cleaners and all that kind of stuff, I feel so bad for them, because I'm sure they don't have much of a safety net at all.

[351] No, there's never been a time where it's no one's fault, but half the country's out of work, at least.

[352] You know, but it's not like anybody did anything wrong.

[353] Like you could have showed up for work every day, worked hard, planned ahead, done all the things that you need to do to have a successful business, and all of a sudden the carpet gets pulled out from under you.

[354] Yeah, no, it's just so heartbreaking.

[355] We're hearing so many heartbreaking stories.

[356] I mean, the good news is, you know, the White House and Congress is the one thing that I seem to be collaborating on is getting that stimulus package out there to people who need it.

[357] And I hope there's some funds for those people.

[358] Yes, I hope so too.

[359] What's your take on Sweden and Sweden's the way they're handling this, which is essentially they're giving people the freedom to go to restaurants and bars and they're shutting some things down, but they're quite a bit more open than the rest of the world.

[360] And subsequently, they're experiencing a spike in cases.

[361] Yeah, I mean, the problem, again, is without a vaccine or other technology, we have to go back to the 14th century.

[362] That's when quarantine was invented.

[363] It was when ships would come into the harbor in Croatia and coming from Asia Minor and they were fearful they were bringing plague and they kept the ships for 40 days.

[364] That's the word where the word quarantines came from and that's all we've got right now.

[365] So we know social distancing is probably our only hope and there's a few pieces of evidence for that.

[366] I mean, it's real serious social distancing, not going to restaurants, think so.

[367] My colleague, Mark Lipsich, who's a brilliant epidemiologist at Harvard, has been, you know, doing a lot of analyses and modeling.

[368] And one of the things he's shown is that when he looks at the cities in China, for instance, where they did social distancing and other aggressive measures, and some of them that were pretty aggressive that you couldn't even do in the United States, But he showed that the longer you allow transmission to go on before you intervene with social distancing and other things, the worst the surge and the worst the epidemic, and therefore, as we talked about in Italy, the worst, the mortality.

[369] So, for instance, in Wuhan, where he estimates, I forget the exact numbers, I think he found about six weeks of transmission going out before you intervene, then it was lights out.

[370] It was a massive surge in hospital systems getting overwhelmed.

[371] and a lot of health care workers getting sick.

[372] And I want to come back to that point after we finish this, as opposed to in southern China and other places in China where you intervened after a week, then you got, you know, there was the difference being having 2 ,000 patients in your ICU across the city versus 20.

[373] That's how the dramatic difference.

[374] So that's a lesson we need to learn for the U .S. is that's the only thing we have and to really push hard on the social distancing.

[375] And I think it's especially important in the cities because it looks to me like what we're seeing so far in the U .S. is more of an urban slash suburban versus rural divide.

[376] We're seeing the big surges and ICU patients more in cities than rural areas, although Dr. Fauci, I figure it was last night or the other night, said don't ignore the rural areas either because we don't know what's going to happen there.

[377] So social distancing is absolutely paramount.

[378] And unfortunately, what's happening, because things got so fucked up with the testing, that we've not, we've some, unfortunately, we've often found out that transmission is going out for several weeks only when a lot of ICU patients started hitting the door.

[379] So this is what happened in New Orleans.

[380] This is what happened, is probably happening in Detroit.

[381] The mayor of Atlanta just said, you know, all of a sudden, we've had all of these people show up in the ICU.

[382] So that's another lesson learned.

[383] And we really, not only doing the diagnostic testing, but the social distancing is really important.

[384] And I've been on calls with the leadership of people in Houston because, you know, you're right, it's hurting the economy in so many ways.

[385] But, you know, if you want to prevent Houston from replicating the New Orleans experience, I've been saying to the mayor and everyone else in Houston, this is unfortunately what we're going to have to do.

[386] And the models are showing now a Festic Organ Institute in Seattle, Washington called the Institute for Health Metrics and Evaluation.

[387] And they've now been looking at this, they do all these amazing things to look at the not only epidemic diseases, but also chronic non -communicable diseases, diabetes and heart disease and mental health issues.

[388] But they've been, you know, all hands on deck at this COVID epidemic.

[389] epidemic, and they've just put it out on their website, it's health data .org, and you can go to the COVID -19 site, and what they're showing is that they anticipate the peak of this epidemic in the U .S. is going to hit about the middle of April.

[390] So we're not even at the peak yet.

[391] And so another two weeks of this is going to continue to go up.

[392] And in some places, like in Texas, it's going to be delayed.

[393] It's probably going to be around May 2nd.

[394] And I think California was around there.

[395] well.

[396] So their numbers say it's going to be the next two months that are going to be the crunch time when it's going to start really going up.

[397] And then as we move into later in May, it'll start to go down and maybe really bottom out by June.

[398] Of course, again, it's a model.

[399] It's a new virus pathogen.

[400] But what I've been saying is, you know, the president yesterday or the day before said, okay, I understand.

[401] I said Easter, now we're going to go to April 30th.

[402] And my point is, well, April 30th, things are still going to be peaking in parts of the country.

[403] Let's use April 30 as a time to reassess and then make a decision whether we go another months.

[404] Let's go a month at a time for now until we know where this is heading.

[405] How long can we go?

[406] I mean, let's take economics out of it.

[407] What would you think if there was no concern whatsoever about economic loss and the damage to the economy, what would you recommend in terms of, just from clearly, just purely from a medical perspective?

[408] Well, the problem is from a medical and public health perspective.

[409] We don't really know where this virus is heading.

[410] You know, it's, I'll figure what Dr. Fauci said.

[411] The virus makes the decisions.

[412] We don't make the decisions.

[413] So, although not entirely true because we can make, we can enact an intervention.

[414] So hopefully by the summer, this is not going to be.

[415] a huge problem but but we don't know and then we also don't know if this thing's coming back so what did the out years look like is this does that even if it goes down this summer does it does it come back up again in the fall does it come back up again early what's that why would that happen why would it come back why would it why would it go away and then come back in the fall well there's a few things that are happening one all the social distancing uh potentially could interrupt the transmission.

[416] We use this number called the reproductive number, which describes the number of people that get infected if a single individual has it.

[417] So the number right now is between two and four, depending on whose numbers you look at.

[418] The idea is you bring that below one by the social distancing.

[419] There's also the question of whether there's seasonality to this virus.

[420] And again, this guy Mark Lipsich has done some studies to show that there seems the virus infection doesn't seem to be as severe in areas that have higher temperatures and greater humidity, it's a bit of a soft call, but maybe there's going to be some seasonality to this as well.

[421] And then, and so let's use an example of another seasonal virus, influenza, you know, which peaks, of course, in the winter and then goes down in the summer months.

[422] It never really disappears, but it goes down.

[423] But then in the southern hemisphere, it's the opposite.

[424] So in the southern hemisphere, peak flu season is our summer, their winter, in places like Australia, and then in the tropics, it's about the same all year round.

[425] So we don't really understand seasonality.

[426] Potentially, the virus could start showing a pattern like that.

[427] And then the question is, does it come back year after year after year like flu does and show some kind of seasonality?

[428] These are all scenarios that are being looked at.

[429] So, for instance, our vaccine, if it's used and goes through all the clinical testing hurdles, probably is not going to be used for this 2020 epidemic.

[430] If it's used at all, it's going to be used in the out years if this virus starts to come back on a regular basis.

[431] Is there any other way to handle this in terms of quarantining or social distancing?

[432] Like, is there – would it be possible?

[433] to quarantine the people that are at most risk instead of the general population?

[434] Well, again, the problem gets to the fact that, you know, again, there's this idea that this is only among older Americans and people over the age of 70, diabetes hypertension.

[435] But now, as the sinister disease control has been reporting, we've had this big flux of young adults getting very sick and in the ICU.

[436] So at what point do you say, pretty much everybody potentially is at risk?

[437] Then among the children, even though the children generally are children adolescents seem to do pretty well with this virus, now we realize from studies coming out of China that was published in the journal called Pediatrics put out by the American Academy of Pediatrics.

[438] About 10 % of infants are getting very sick with this virus, so infants are at risk.

[439] So you start adding it up, okay, older people, those are.

[440] underlying diabetes and hypertension and younger adults and 40 and 50 year olds as well and we're hearing all these stories on CNN and elsewhere about you know valued colleagues you know in their 50s and that kind of thing getting really sick or even even dying and then infants after a while it's just it's you can't you can't slice it that fine it's it becomes impossible to do it is it one of the things that's come up about this is people are now aware, people like myself, are aware of the number of people that die every year in the United States from the flu, which is staggering.

[441] It's a lot more than I ever thought before.

[442] Do you know the numbers?

[443] Like what?

[444] Yeah.

[445] So, you know, seasonal flu is really bad.

[446] It's, uh, uh, and it varies year to year, different variances of the flu.

[447] So it usually goes between 12 and 50 ,000 people.

[448] people die every year of influenza.

[449] And the vast majority of those, by the way, are not vaccinated.

[450] So even in years where there's not a good match between the flu vaccine and the flu, it could still reduce your likelihood of hospitalization and death.

[451] So that's an important message to get out.

[452] The numbers here, unfortunately, are looking worse.

[453] Can I pause you for a second?

[454] How does that work?

[455] How, even if it's not matched up to the correct seasonal flu, how does it prevent you from being hospitalized?

[456] Because it's partially protective.

[457] So if you imagine a virus that has all of these different pieces to it and all the antibodies each reacting to a different piece of the virus and a perfect match, all of the antibodies target the virus.

[458] And in a less than perfect match, only some of the antibodies target the virus.

[459] And therefore, it's partially protective and can have a partial effect.

[460] and so what was I going to say oh so the the institute and now the numbers of the of Americans who are dying are all over the map so if you if you believe the numbers saying that they're between four and ten times the number of Americans and that's forget about America four to ten times the SARS two virus that causes COVID -19 is four to ten times more lethal than regular flu so that'll give you the bracket so So if the minimum is 12 ,000 from flu, the minimum that's going to die from COVID -19 is around 50 ,000, and at the high end times 10 could be between 500 ,000.

[461] So that's where you're hearing those numbers from the White House press conference saying maybe 100 to 200 ,000 Americans could die.

[462] I think it's probably, I like the Institute for Health Metrics numbers that just came out.

[463] They say 84 ,000 Americans will die.

[464] that peak season going from April, May, May, and June, but we don't know what will happen again in the out year.

[465] So the point is a lot of Americans are going to die.

[466] I'm hoping it doesn't get as high as 200 ,000.

[467] And again, the modelers are really looking at this.

[468] The way, those numbers that I gave you, that estimate was a sort of simplistic version.

[469] There's much more sophisticated models.

[470] But again, they're models based on assumptions with the new virus pathogen.

[471] It's hard to get all the assumptions right.

[472] But the point is many more people will die of this virus than even in a bad flu season.

[473] I think people are concerned that this is kind of setting a precedent and that this is going to be something that we have to do in the future.

[474] Is there a way to prevent something like this, a full shutdown of the country, to happen in the future?

[475] Well, the way is, you know, we've got this incredible scientific infrastructure in America, right?

[476] The best research universities and institutes in the world.

[477] And I work at of them, Baylor College of Medicine and Texas Children's Hospital and now I'm doing a few things with Texas A &M University and Baylor University as well and Rice.

[478] And so the answer is this is why we have an NIH with a budget of $36 billion annually.

[479] We need to have a pipeline of technologies getting ready for this epidemic.

[480] should have, you know, if we had, you know, all the funding we needed for our coronavirus vaccine program, we would have had several coronavirus vaccines and clinical trials and potentially we could have combined them in a way to be ready to go now.

[481] So having, figuring out a way to support organizations that don't are, that are looking at vaccines and other countermeasures, not in terms of products they can sell, that are going to help the, help the health security of the country, I think, is really important.

[482] So one of the books that I wrote is called Blue Marble Health, and it finds this unusual, and we spoke a little bit about this last time, the unusual number of illnesses from emerging infections like this one and poverty -related neglected diseases actually in the G20 countries, the G20 economies, the 20 wealthiest economies, especially the poor living in those, actually, for most of these diseases.

[483] And the problem is the G20 economies are not stepping up to support these technologies.

[484] We still rely too much on the U .S. and the U .K. and the European Union.

[485] We've got to do better with China and Brazil and some of these countries to help fund these global health technologies because that's all we have.

[486] Otherwise, we go again, back to the 14th century in terms of social isolation.

[487] It seems one of the critical aspects of getting through this is having a strong immune system.

[488] what emphasis, if any, are you guys putting on developing techniques or at least educating people on how to strengthen their immune system and how to keep their body healthy?

[489] Certainly keeping the body healthy is key, right?

[490] I mean, one of the populations that this virus is devastating are those with hypertension and underlying heart disease.

[491] And actually, we're learning this virus itself not only causes lung disease, but heart disease is.

[492] well so we could talk about that but you know keeping your you know keeping yourself healthy could make the difference between life or life or death but even in a healthy individual with a new virus pathogen and you've never seen before it takes time to train the immune system and then it's too late because the virus has already done incredible damage to your lungs so no question about it don't smoke don't vape you know drinking in moderation and and And, you know, keeping fit, you know, avoiding hypertension and diabetes, if you can, especially type 2 diabetes, not everybody can do it.

[493] There's some genetic predisposition to it, but if you can keep your body healthy, that will definitely stack the deck in your favor.

[494] I was reading something about sauna use, regular sauna use, and viral infections and the diminished impact of viral infections on people who regularly use the sauna because of heat shock proteins and cytokines.

[495] aware of anything that goes along those lines that's a new one for me that's a new one for you interesting idea now as far as yourself like i joked around about the the fast food stuff because we joked around about that last time you were here but have you altered your approach to food because of this and diet i i i well i have partly because i've been so upset and so anxious to eat that you know i've it's just been i've been on teleconferences and my wife will actually We set up a little study here in our bedroom, and it's not much, but my wife will just bring me a plate of food, and I'll just, you know, eat it and then whatever's, but I, it's not that I've, I can't say that I've been trying to eat, certainly eat a healthier diet and be more careful, and my wife spends a lot of time trying to take care of me, but right now I've just been so upset about what I'm seeing, not only with people suffering in the hospital, but people economically put out of work.

[496] And I'm so worried about all of these health care providers who are getting sick that, you know, I just don't even want to eat.

[497] And I don't sleep much either.

[498] I'll wake up, you know, four in the morning, you know, look at the numbers from the night before and where COVID is heading.

[499] And then I'm on teleconferences all day trying to figure out how we accelerate this vaccine.

[500] And it's interesting.

[501] I've even noticed that I've become a lot more emotional in my meetings.

[502] And, you know, I'm known as a pretty even -tempered person, never getting upset.

[503] I've gotten really upset a few times over the last couple of months, surprising my colleagues.

[504] And I think what's bothering me the most is what I see happening to the nurses and the docs and the respiratory therapists.

[505] They're just getting so hammered.

[506] And a lot of them are my former students, my medical students.

[507] And, you know, I remember, you know, we have something.

[508] In medicine, you have something called Match Day, you know, where if you're a fourth -year medical student, you open this envelope and figure out and you learn where you're going to do your residency, whether it's in internal medicine or surgery or your nose and throat or neurosurgery or whatever.

[509] And, you know, a lot of the medical students would come and see me. Dr. Hote says, hey, where should I go do residency?

[510] And a lot of them, I would say, you know, it's great spending some time in New York.

[511] You know, I did my MD and my Ph .D. in New York.

[512] My wife in New York is a great city, great medical centers on Sinai and Columbia and Cornell and NYU and Einstein.

[513] It's fantastic living the city and I'm really, what the hell did I send them into?

[514] They're there with no, with inadequate protective equipment, you know, scared as hell of getting sick or worse and being overwhelmed by patients.

[515] I think I said, I don't forget with CNN or MSNBC or whatever is.

[516] I feel like I sent them to hell, you know, and feeling a lot of guilt for being so enthusiastic about having them go to the hospitals in New York.

[517] Of course, you can never know what was going to happen.

[518] But that's been bothering me as well.

[519] So this has been a very emotional time for me. The lack of sleep also has a big impact on the immune system.

[520] Oh, yeah.

[521] It really sets up your immune system, no doubt about it.

[522] Now, with you, is it simply just because?

[523] of anxiety, is it a lack of time to sleep properly and have you looked into any sort of meditative practices or anything that can calm the mind and allow you to perhaps get a little bit more sleep, which would significantly probably improve your immune system?

[524] Yeah, no question.

[525] Well, I've looked in, well, one of the reasons is a practical matter because I've been doing some evening TV interviews and they're great opportunities because they reach such large audiences.

[526] I mean, I've been on everything from Chris Hayes to Tucker Carlson to Hannity and how many people do that, right?

[527] Going to the extremes on the political spectrum, but it's been a great opportunity.

[528] But I, you know, deliberately try to be on all those networks to show that I don't give a shit about the politics.

[529] This is about, you know, saving people's lives and they've been great to be a void.

[530] So I don't want to lose that opportunity.

[531] But then I'm getting up, you know, early in the morning either for teleconferences or, you know, do CNN New Day or or our American Newsroom with, you know, Sandra Smith and Ed Henry and those.

[532] These are an amazing opportunity.

[533] Well, I'll never get a, who knows will ever get a chance to talk to the country like that, although I, you know, do a little bit with Ebola and then with Zika.

[534] So, and then to talk about our vaccine.

[535] And it's also really important for Americans to hear about scientists because working scientists tend to be invisible in this country.

[536] And I have a paper that I just put out in the public library science.

[537] and plus biology about how the fact that scientists are invisible and are enabling for anti -science movements to rise and I think part I blame part of it in our scientific profession that were too quiet so here I have this chance I'm trying to take advantage of that but then I'm in teleconference after teleconference all day you know trying to get this vaccine moving so you can't even take a nap sometimes and so it catches catches up to you so yeah I've got a I still have to figure that one out, but it's...

[538] It's something you're concentrating on.

[539] Yeah.

[540] One of the things that you brought up that I wanted to discuss is the damage that this virus does to the lungs and to the heart as well.

[541] What they're scarring on people's lungs.

[542] Talk about that and what, if anything, can be done to try to heal those people post -infection.

[543] Well, so what happens is, you know, the virus gains.

[544] entry into the deep passages of the lungs, you know, all the airway spaces.

[545] And then it has, if you ever see a cartoon, a schematic drawing of a coronavirus, it looks like a little ball with spikes sticking out of it.

[546] And those spikes are called the S protein.

[547] And actually the vaccine that we're making interferes with the binding of a part of that S protein called the receptor binding domain for binding into the receptor.

[548] So it uses those spikes, the tip of the spikes, to get entry to bind to the receptors in the lung, which is actually an enzyme called acetylcholine esterase, and it gets into the lung cells.

[549] So the first thing that happens is a large amount of virus is getting into the lungs, and that triggers what's called the innate immune system, meaning your natural first -line body of defense, and it signals something called toll -like receptors, which cause a lot of inflammation.

[550] And so you're seeing a big inflammatory response.

[551] to the virus.

[552] So the two components are a lot of virus causing direct damage and then the host all the inflammatory response.

[553] And that's one of the reasons why, you know, when I heard about hydroxychloric, when I had some enthusiasm, because it can maybe suppress the inflammatory component, whether it clinically has the ability to make a difference.

[554] I think the jury's still out yet.

[555] So you've got those two things going on.

[556] The other thing that's happening, and that's causing severe lung disease, and there's all that inflammation, and it causes a condition known as ARDS, acute respiratory distress syndrome, where there's so much inflammation and scarring that it becomes difficult to oxygenate the lungs, and people go into shock because of this ARDS syndrome.

[557] So that's why a lot of people are dying.

[558] The other thing that happens, though, and we don't really understand the mechanism, has been a lot of reports.

[559] And by the way, anybody can download this.

[560] There's this fantastic pre -print server called Bio Archive and Med Archive.

[561] It's put up by Cold Spring Harbor Labor Laboratories.

[562] And I check it every morning.

[563] It's called B -I -O -R -X -V, and Med -Archive is M -E -D -R -X -I -V.

[564] It's put up by Cold Spring Harbor Laboratories.

[565] So scientists have been great about sharing information.

[566] They're putting all their stuff up on these pre -printed servers.

[567] They're not peer -reviewed yet, but just so we can get information into the hands of the scientists and anybody could look at them but one of the other things we're seeing with that is a lot of heart injury whether people are having heart attacks because they're intubated in the ICU and under stress and they're in shock so they're not profusing the heart or and we know that the old SARS virus SARS -1 had the ability to go into the heart tissue and cause what's called myocarditis actual infection of the heart so it's really the heart and lungs that are getting knocked out there's also some evidence that the virus can go into the intestinal track as well.

[568] And so that could actually be a potential route of transmission, meaning fecal oral transmission as well.

[569] So this is why people are getting so hammered is this direct damage from the virus and the inflammatory component to the heart and the lung.

[570] Is there any understanding of what, if anything, can be done to try to heal these people post -infection, particularly like damage to the lungs?

[571] Yeah, I think, you know, there's a question of whether steroids actually help or hurt.

[572] Steroids are always a mixed bag because steroids can suppress inflammation and help the inflammatory component, but they also suppress the immune response to the virus.

[573] So you can have an increased number of virus particles potentially.

[574] So people are definitely looking into steroids, other anti -inflammatory drugs.

[575] But, you know, those who survive this, and fortunately most do, you know, you'll find that they'll probably tell you they've been hacking and coughing for a long time afterwards.

[576] And a lot of that is, and we see this with flu as well.

[577] And other viral pneumonia, it's not because they're still infected with the virus.

[578] It's all that scarring is, it takes the body a long time to remodel all the scar tissue and before the coughing stops.

[579] so we can anticipate that happening as well.

[580] Do we think it's possible to fully recover from this for people that do experience these lung -scaring issues?

[581] Yeah, I think so, especially for younger people, for older people.

[582] You know, they may have some permanent pulmonary deficits, but we don't know.

[583] It's still too early in this epidemic to know.

[584] Is that a big part of what's going on is that it's just really too early for so many of these things?

[585] The treatments, the cures, dealing with the immune systems, finding out which people are genetically more predisposed to the virus.

[586] Just trying to buy time.

[587] And, you know, typically it can take years and years to figure all of this on.

[588] And we're all, you know, everybody's working overtime trying to try to make a contribution and figure this out.

[589] The great news is the data sharing among scientists has just been amazing.

[590] Everyone's, you know, putting aside their eco, putting all their stuff up on bioarchive, Met Archive, and the major journals are doing incredible things, also expediting publication of paper.

[591] So, you know, the flagship journals like New England Journal of Medicine, Lancet, JAMA, they're all putting that stuff out there as fast as they can, you know, ensuring quality and a level of peer review are plus family of journals, public library science.

[592] So, you know, if you look at the good stories that are happening around this, definitely the data sharing, the journals not conducting business as usual, recognizing that the stuff that they're publishing could be life -saving and responding to a public health crisis.

[593] I think that's been a nice part of the story.

[594] I'm hoping so much of what comes out of this is a wake -up call.

[595] So much of the newfound understanding and appreciation for the science behind dealing with these diseases, appreciation of health.

[596] care workers and first responders.

[597] I mean, if there's any bright lining to this, that's what I'm really hoping for, is that people wake up and recognize the good work that people like you have been doing.

[598] And also, you know, that this is where we live in strange times and these things can happen again.

[599] And we need to be prepared.

[600] And we need to put a lot of emphasis and effort and thought to that as a whole, as a whole society.

[601] Right.

[602] That's right.

[603] I think, you know, maybe this will help us reassess some of our values.

[604] and you know appreciate some of the some of the things that the health care professions especially are doing and you know you're seeing people volunteer you know to go right you know right into the belly of the beast you know people you know who might have subspecialty practices just at the hell with them I'm just going to put on my N95 mask and my PPE and dive in and help and that's really moving.

[605] Why have there been such a shortage of masks and safety equipment for health care workers?

[606] And how did this ever happen?

[607] Well, we just, we didn't get ready for the surgeon time.

[608] I think, you know, I'm sort of holding back trying to throw stones at this agency or this person or this group because we don't really know what happened.

[609] I think it's going to be really important that Congress.

[610] Congress after this, conduct an investigation, not from the standpoint of prosecuting people or calling them out, but just say, hey, what the hell went wrong here?

[611] And how do we avoid this again?

[612] I mean, the problems with the testing and not having all the protective equipment.

[613] Now we're getting geared up and mobilizing industry.

[614] But what could we have done better, especially in that window period when things were collapsing in Wuhan and the other cities in central China?

[615] When we knew this was going to be bad and we knew this could become, you know, one of the great pandemic threats, you know, why, how could we have better used those six weeks in order to get ready and what didn't we do?

[616] And now's not the time to do it because the last thing you want to do is start distracting people and worrying about, you know, congressional hearings and that sort of thing.

[617] but when all this is said and done it has to be done in the right spirit not again we have to figure out a way to stop these partisan lines to say you know as a country we've got to figure out of the work together I know that sounds polyanish but you know when I was in you know before I moved to Texas a decade ago I was chair of microbiology at George Washington University for 10 years and I worked with Congress a lot to get legislation passed around neglected tropical diseases.

[618] And it was a different Washington then.

[619] I mean, I would go, you know, to Sam Brownback's prayer breakfast.

[620] Sam Brownback's governor of Kansas before he was senator from Kansas, very conservative, Republican senator, walk across the hall and go talk to Senator to Senator Leahy's people from Vermont or Sherrod Brown's people.

[621] And, you know, far, far to the left.

[622] And nobody thought any twice about that.

[623] You know, we all knew we had to go across the aisle to work together and it's just not happening anymore and it's and it's tearing apart our country so i hope the other thing that we we get out of this is figuring out a way that republicans start talking to democrats again and democrats talk to republicans again uh and uh and figure that out as well well peter i i appreciate your time and i know i know you're incredibly busy is there anything else that you need to say or you think should be said about this before we wrap this up yeah i i thought we talked a lot.

[624] You know, I can't tell you how important it is to use your voice to amplify, you know, a straightforward discussion about this epidemic.

[625] I think, you know, you're, and just by doing that, you're making a huge contribution because you have incredible bandwidth and an extraordinary audience.

[626] I mean, the last, I can't tell you the last time I did, did talk about your, I was on your show.

[627] I think it was last year around this time, actually.

[628] You know, the response I got about neglect.

[629] the diseases of poverty in the U .S. and vaccines, and you have so much, you're such a powerful show and powerful guy and, you know, being able to use this time to talk about COVID is 19 and what SARS is and why and how we deal with pandemic threats.

[630] It's absolutely huge.

[631] So I'm very grateful for the opportunity.

[632] Well, we're very, very grateful for you, Peter.

[633] And let's talk again in person during better times.

[634] Absolutely.

[635] Thank you, sir.

[636] Take care.

[637] And be safe.

[638] there.

[639] All the best.

[640] God bless.

[641] All right.

[642] Bye -bye.