Coronavirus expert Peter Hotez: Now’s the time when you’re at greatest risk of contracting the virus by being in crowds. – Houston Chronicle

Since early March, when coronavirus began to appear in Texas, weve been checking in with Peter Hotez, a vaccine researcher who lately has become a familiar bow-tied presence on national cable news channels.

Hes a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, and co-director of the Texas Childrens Hospital Center for Vaccine Development.

His lab developed a vaccine to protect against SARS, a deadly strain of coronavirus, but in 2016 wasnt able to get money to test it in humans. Now theyre racing to create a vaccine to protect against the new coronavirus thats wreaking global havoc.

Earlier this week, on Twitter, he wrote:

There's a misunderstanding out there that America just hunkers down for a year, then a #vaccine magically appears, and everyone goes out to have a nice picnic on the National Mall. It would be nice, it's not impossible, our lab working 24/7, but I think a low probability scenario.

This interview has been edited for length and clarity.

Could you talk about those tweets and the expectation that we'll have a coronavirus vaccine within the next year to 18 months?

That's certainly the aspirational goal. That was the charge from Dr. Anthony Fauci, whos advising the president. And that's what we're all working toward. Our scientists are in the lab day and night trying to make this happen and trying to accelerate it, but it's a tough goal.

Sometimes people forget how long it really does take to make a vaccine. Dr. Fauci knows this as well as anybody: He's devoted his life to the HIV AIDS vaccine the development of which has taken 30 years and counting.

Most vaccines take 10 to 25 years. That's the timeframe. My colleague Paul Offi points out that the record is probably four years from start to finish in terms of developmental licensure. That was for the mumps vaccine.

The time horizons are huge for vaccines. So then you say, Okay, well, how do you stack that up against a year to 18 months?

It's going to be very tough. We're clearly putting a lot of resources into it. A lot of smart people are thinking in innovative ways about how we could do more things in parallel. But we have to also set some realistic expectations that we might not have that vaccine in a year or 18 months and maybe not for two or three or four years.

So how do we manage? How do we manage expectations and what our country looks like during that time?

Do you have any idea where that goal of a year to 18 months comes from?

I don't know. There's a new international organization called CEPI, the Coalition for Epidemic Preparedness Innovation, that's been charged to fix the long timelines of vaccines and to come up with new ways to accelerate. And there are some theoretical reasons to say we can do more things in parallel. The regulatory agencies are all looking at this.

So we're all going to try, but the the history says that's not a high probability. I'm listening to some of the cable news networks saying, Well, we just got to hunker down for a year and then we'll have the vaccine.

That's not a wise strategy. Or maybe we can have that as one strategy, but don't put all of our eggs in that basket. Let's have another strategy with a more realistic timeframe for vaccines.

This disease may come in waves, like the flu pandemic of 1918. That came in several waves between the beginning of 1918 and the end of 1920. That was a three-year pandemic, and that's a possibility for us as well.

Figuring out a plan for the country in the event that we don't have a vaccine is going to be very important for us. Some people are not happy that I said that because it sounds so pessimistic. It isn't.

I do think we will have other technologies coming out. We've already got the convalescing the antibody therapy. We've got some new drugs that will come online.

But let's consider a realistic timeframe too, in case the vaccines are not out, and figuring out if this virus comes in waves.

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What would that look like in terms of getting people to back to work? How would we manage that? That includes mental health aspects. Will people have PTSD in terms of going back to work?

Well also have governors from some states unwilling to go back to social distancing once we're off that first hook. Even in this month, when things are so dire in the country, you've got about a third of the governors who are pushing back against aggressive social distancing.

What's it going to be a year from now if we're off social distancing, then we have to go back on?

And who organizes it? Who organizes the response? Who charts the plan for us?

How do we figure this out as a nation? How do we look at all the models and say, what's a realistic model? And and if this virus does show a waxing and waning course, how do we deal with that, working with governments, working with businesses, and working with health systems? This is going to be a very complicated situation.

Right now we're going mainly state by state, and looking at things like closing state borders or at least requiring self-quarantine for people traveling to Texas from Louisiana. How do you think that works?

It doesn't reflect the reality of the situation. COVID-19 is in every state in the country right now.

Travel restrictions sound appealing because they make it seem like, Well, it's over. We just shut that travel down, and that will prevent the virus from coming in. The president has said that he slowed things down by closing down travel with China. But we have reports now, based on the genetic sequence of the virus, that the virus in New York came in from Europe.

At this point, we have to recognize that the virus is probably everywhere. There's a diminishing return at this point of cutting down traffic between states.

I've seen estimates that we are maybe two weeks away from the peak here in Houston or maybe I should say, our first peak.

Thats according to the IHME model from the University of Washington.

So what should Houstonians be doing right now?

Now it's crunch time. Now's the time when you're at greatest risk of contracting the virus by being in crowds or being with people outside your home. We're trying to do everything we can to minimize the number of people that have to be brought into the hospital, who need ICUS.

Its really important now that we aggressively pursue social distancing, especially to prevent a surge on Texas Medical Center. Even though the leaders of the TMC been meeting daily, we need to do our part as citizens of Houston to minimize the number of people that go into the hospital.

It's easier for some than others. Weve talked before about the poor neighborhoods in Houston, and how social distancing is more complicated in areas of poverty and crowding, or for families where lots of people live in one house or one apartment.

Its one thing to say, Okay, everybody now has to social distance. I don't know how we do that easily in Fifth Ward or in Acres Home or in northeast Houston.

I know the mayor's worried about it, and so is the county judge and our congressional delegation from Texas. Everyone's trying to think hard how to deal with this problem.

Right now, without a vaccine, we unfortunately have to use a 14th-century approach. Thats quarantine.

Assuming that its a long time until we get a vaccine, what sorts of things do you see happening? Between waves of the virus, could we begin loosening restrictions and starting the economy up again?

The models say, as we move through the month of May, the number of transmissions will go way down. Maybe at that point we could begin opening things up.

I don't know, though. At what point do we risk the disease immediately coming back if we do that? We're starting to hear that from Singapore and elsewhere.

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We're going to need outside help here in Houston, getting advice about that. Hopefully the federal government will provide some support.

Then let's say the levels of transmission continue to stay down for the next few months. When are the predictions this virus might return? Is in the fall of this year? Is it January of next year? April next year? Getting guidance about that will be really helpful.

Other questions are, who goes back into the workforce? Is that only people that have been infected and have antibodies that make them resistant to infection? Or is it or is it everyone?

I certainly don't have the answers to that. We're going to have to have some meaningful dialogue and convene some of the best minds in the country. I suggested on CNN that bringing in the National Academy of Sciences, or a similar organization, would be very helpful. We need some of the best scientists in the country around the table, looking at the models and charting a path.

Adding to the problem is the fact that we're in an election year. Things will be so heated politically that decisions made both on the Republican side and the Democratic side may put political expediency over public health. How do you deal with that?

It's really hard. Im hearing from people who look at the relatively low number of people hospitalized in Houston, or the small number of deaths here. Theyre asking whether the cost of social distancing has been worth it, and whether we should continue staying at home. What would you say to them?

First of all, I don't know that we really know the number of people in ICUS or of deaths. And remember, we still have another two weeks before we reach our peak. So we're certainly not out of the woods by any means.

If it turns out that the data are not as high as we thought then the question always comes: Did that happen because of what we did? Or in spite of what we did?

We had this discussion before about Zika. I met with Houstons mayor and strongly recommended cleaning up the tires that breed Aedes Aegypti mosquitoes in places like the Fifth Ward. He did it.

Then we didn't have Zika. Was that because of my recommendation? We have no idea. You cant prove a negative.

But based on the experience we're seeing elsewhere, we know social distancing is really important for the next few weeks.

What else is on your mind these days? What are you watching?

Im really scratching my head figuring out what the next two and three years look like. That's a big one.

We've also now heard a lot about health, about COVID-19 as a health disparity among the African American and Hispanic communities in the southern parts of the U.S. I put that out there about almost three weeks ago: This is going to be a concern. And thats turning out to be the case, unfortunately. Fighting that in Houston is going to be really important .

How are you doing personally?

Oh, we're hanging in there. I'm spending a lot of time writing papers, and documents related to getting our vaccine off the ground, and writing some thought papers also about what the ideal characteristics are for the vaccine and how we advance the Global Health vaccine.

Im also trying to raise the funding to make it happen. Vaccine developments are expensive.

And Im also talking to people like you, to get the word out, so we get good accurate science messaging. I'm going on CNN or MSNBC and Fox News, and sometimes I'm not telling people good news.

I've been getting a bit of pushback from people I've known for years, people who are not happy that I'm not painting a very rosy picture of things.

Its taken me time to figure out how to tell real information without alarming people. I veer a little too much on the rosy. Sometimes I veer a little too much on the dark side. The best critic of all is my wife, who lets me know about it.

How is she doing?

I think good. She sees how stressed I am.

It's not just me it's our whole group, and Dr. Maria Elena Bottazzi, my science partner for 20 years. I'll text her at 4 a.m. when I wake up, and find out that she's already texted me at 3:30 a.m. when she's woken up. It's crazy. I'll wake up in the middle of the night and send a text, not expecting an answer to the next morning, and she's responding right away.

We're all kind of sleepless.

lisa.gray@chron.com, @LisaGray_HouTX

Original post:

Coronavirus expert Peter Hotez: Now's the time when you're at greatest risk of contracting the virus by being in crowds. - Houston Chronicle