As COVID-19 has changed our lives, Dr. Peter Hotez, a coronavirus vaccine researcher, has become an increasingly familiar presence, a regular in Chronicle coverage and on national cable news channels. . He is the revered expert who clearly, and with increasing passion, explains the science of the virus and what people need to know about it.
Based here in Houston, Hotez is a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, and co-director of the Vaccine Development Center at Texas Children’s Hospital.
We recorded this interview with him on Wednesday June 24. It has been edited for its length and clarity.
I just reread the interview that you and I did two months ago, on April 21st.
[Laughs.] I am afraid to ask what I said.You said: “There is no point in opening the economy prematurely without having everything in place. Then everyone gets sick again, filling the ICU, and we end up looking like New York and New Jersey. ”
Of course, Texas reopened the economy before new cases were dwindling and without our public health infrastructure. Now it is two months later. The regular ICU beds at Texas Medical Center are full, and new Harris County cases are growing exponentially.
Tragically, you called it good. Now, without any of the things I told you, how can we get this genie back in the bottle? What should the state of Texas do now?
It doesn’t give me much satisfaction to know that I predicted it. I think the only thing I couldn’t do is that I didn’t expect to see cases increase exponentially in June. I expected it in July.
Why was this predicted and predictable? Actually, we were doing very well in March and April. The governor, county executives, and mayors were really above this: We implemented an aggressive shutdown. When they saw what was happening in New York, they said, “We don’t want that to happen here.” Closing as soon as community broadcasting started made a difference: it meant having hundreds in our ICUs instead of thousands. That was great.
But the problem was this: Epidemiological modelers told us, “Good job, guys. Now keep this up throughout the month of May. Then it will return to containment mode, which means less than one new case per million residents per day. “
That would also have given us time to build the public health infrastructure we needed to do all the follow-up on contacts, testing, epidemiological modeling and public health messages, and perhaps to create an application-based system for syndromic surveillance. But that did not happen.
There were many economic pressures to open early, and the reopening began on April 30. That was problem number one.
Problem number two: Even though the idea of opening things to 25 percent or 50 percent capacity was well-intentioned, I don’t think many people have understood it. They were on the Galveston beaches and met in bars. I doubt that in most bars in our metropolitan area, there are gorillas who said, “Hey, wait a minute, we’re a quarter full, so we have to start rejecting people.” It was more or less the same as always.
The third mistake was not putting in a public health infrastructure that is proportional to what it needs to maintain the economy. We didn’t have an adequate number of contact trackers or enough evidence. We never implemented a sophisticated application-based system for syndromic surveillance. We had no assertive public health messages. We never obtained these epidemiological models for metropolitan areas.
So now we are in this situation. I’m very worried.
If we do nothing, the spread of the virus will continue unabated until we reach the herd’s immunity. That is the point at which the spread of the virus slows down because there are so many infected people that there are fewer people left to contract it. If we assume that 60 percent of a population has to be infected to achieve herd immunity, and that about 1 percent of infected people will die, that means that to achieve herd immunity in Harris County, we would expect 30,000 deaths here. We cannot tolerate that.
We have to intervene, and we have to intervene now. I want to see a plan before the weekend.
What would that plan be like?
Masks, of course, would be mandatory. And I think it will require a certain level of mandatory social distancing.
I don’t want to be too prescriptive. We need to give our leaders some flexibility. But it will be a combination of restrictions in bars and restaurants, in places of employment, in gyms and in everything else we’ve been talking about.
How long should those restrictions last?
Well, we have to learn our lesson. We have to redo everything we did. Frustrating as it is, we need to return to containment mode. We need to do all the things now that we should have done in late April: keep it closed until we go into containment mode and put in place all the remaining pieces of public health infrastructure.
Right now, I think the battle is, let’s do something now, before the weekend, to save lives. We don’t have to figure out all the plans yet. But as a minimum, we should have something in place for all the major metro areas – Houston, Dallas, Austin, San Antonio – before the weekend.
Later we can be more surgical about how we do this. But if we let it go another week, there will only be more patients entering our ICU. And remember how this works: the number of deaths lags behind the number of cases. First comes the number of cases, then the number of hospitalizations. The increase in deaths is the latest, but the increase in deaths will surely come.
As I understand it, in New York, the jump in the death rate when hospitals were overwhelmed was not just for people hospitalized with COVID-19. There were also deaths of people who were unable to receive treatment or who hesitated to seek treatment for things like heart attacks or strokes. Is that a risk here?
Yes. Deaths increase for various reasons. First, people die in their homes from COVID-19.
Second, people are also afraid to go to the hospital, so they ignore their chest pains and other life-threatening conditions. They don’t get care for their diabetes and other chronic diseases.
And the third reason people die is that as ICUS begins to fill up to capacity, it becomes harder to manage all of those patients, and death rates increase in the hospital. We have seen it in Lombardy, Italy. We have seen it in New York.
We need to intervene. That is why I have been so strident. It is unusual for me. You know what academics are like: we tend to speak in shades of gray, and if we criticize, it’s with praise, right? But we are not there at the moment.
So if you’ve seen my Twitter feed, or seen a flash of anger from me on CNN or MSNBC, that’s why. This is really important
