Healthcare workers are especially at risk during this coronavirus outbreak, and here’s a world expert on how we can prepare, not panic.

Dr. Peter Hotez is a renowned vaccine scientist, pediatrician, Dean of the National School of Tropical Medicine, and expert on the current coronavirus outbreak. He returns to discuss his group’s work on a coronavirus vaccine, the unique threat to healthcare workers from the epidemic, the adequacy of the public health response so far, misconceptions around masks, and much more.

Watch Dr. Hotez’s prior interview on The ZDoggMD Show here, watch my previous video on coronavirus, and watch our coronavirus My Sharon song (edutainment at it’s finest LOL) here.

– 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. 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. 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.

– 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 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, I’m trying to read the letters on it.

– 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.

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