The Joe Rogan Experience - #1451 - Dr. Peter Hotez

Episode Date: April 1, 2020

Peter Hotez, M.D., Ph.D. is Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine where he is also the Director of the Texas Children’s Center for Vaccine Development (CVD) and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics.

Dr. Hotez, how are you, sir? Oh, it's great to see you again, Joe. I feel a lot better seeing you now. I feel a lot better seeing you, too, especially with the bow tie, as we talked about before, your signature touch. Yeah, as I was saying, when I tried to start wearing a regular tie for a while, 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... What kind of cries of outrage are you getting about your bow tie,

especially in these trying times? No, no, they like the bow tie. The point was I tried to switch to a regular tie for a while, and they said there's no way that can happen. Yeah, that's what I meant. I screwed it up. But I meant, who's getting upset at you wearing a regular tie? Those people need to get a life.

I think it was meant in a good-natured way i'm sure uh so we don't do very many of these skype ones uh but because they're odd so uh let's uh i don't know if you've done too many of these sometimes people talk over each other it's it's very strange yeah i guess it's the it's the epidemic right otherwise i'd be on a plane and come to see you in la 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.

And now, obviously, New York City shut down. The entire country is separated from each other. Everybody is isolating at home. Give us your take on how we got here. Well, you know, the truth is we knew this was coming or something like it. We had a heads up and even a heads up before last year, because this is now our third major coronavirus disaster of the 21st century. We had what's called SARS, severe acute respiratory syndrome, in 2003. That started in China and caused a terrible epidemic in Toronto. started in China and caused a terrible epidemic in Toronto. It actually took the Rolling Stones to do a concert to bring the economy back to Toronto in 2003. And then it was Mayer's

coronavirus infection in 2012. And this is the third one. 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 and each time they've caused devastating hospital epidemics, they've affected healthcare workers. So the point is this unfortunately has become a new normal for the globe is terrible coronavirus epidemics and we saw this one coming up in the end of 2019 in China. And I knew we were in for trouble because that's what coronaviruses do. So you knew that we were going to be in trouble because there was no way they can contain it and keep it in China? Well, the difference with this one compared to the other two was this. The two SARS and MERS now we call this new one

SARS-2 so there was SARS-1 then MERS then SARS-2 so both SARS-1 and MERS 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 the the difference with this one, ironically, is it's pretty lethal. It's about five to ten times more lethal than regular flu, seasonal flu. But also there's a big group of people who don't get very sick at all. And so you have this sort of perfect mix where it's not the most lethal infection we've ever seen. 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.

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. And then a larger group who are only getting mildly sick who can still walk around the community and be out and about in stores and restaurants and infecting everybody. And so this is what's caused the problem. It's highly transmissible, and there's a big group of people walking around spreading it, and a smaller subset but a big subset who are 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. With one exception that I'll tell you about in a minute, most kids don't get very sick at all, but they're helping with the community spread. And we don't quite know why. 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 ICUs. But in fact, the Centers for Disease Control came out with this very chilling document a few weeks ago showing that about a third of the very sick people in the hospital

are under the age of 40 or 44. So between 20 and 44 young adults are getting very sick and that word has not gotten out adequately because when the disinfection first appeared in central China it was all about older individuals over the age of 70, those with diabetes and hypertension. 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 and France, Spain of younger adults, and we're seeing that play out in the U.S. And I know the people who listen to you and watch you, 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. Well, we have a friend, Michael Yeo, who was actually on a podcast with me the week before he went to New York. He was there that weekend, actually, and that's when he got it. So he got COVID-19 in Manhattan and then flew back, got sick. And here's what's really maybe you could help me with this. He said he was feeling terrible and then took Advil and it got exponentially worse. Is that coincidental, do you think? I mean, there's there's been talks of avoiding ibuprofen.

Michael's 45 years old, very healthy, very robust guy. So when he was, I mean, he was in the hospital for a week and his words were, I almost died. I mean, he was really, really concerned. What about ibuprofen? 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. So there's not a lot of evidence to say that you get worse with ibuprofen. Probably he was just one of those young adults that's going to get very sick, and that's what this virus does. 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. 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. That's exactly what happened to Michael. He got pneumonia. So there's a rumor that you shouldn't take ibuprofen, but is that unfounded? Are you advising people to take ibuprofen? Do you think they should just avoid it just in case? And where did this rumor start from? And what is the concern with ibuprofen and then you've got the problem you know some people uh you know also say don't take aspirin because if this is a respiratory virus infection there could be a severe reaction uh with with aspirin as well so for now uh you know and i said

the other thing joe is anything we say today uh 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? So we're on a steep learning curve. So we're learning new things about this virus every day. 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. 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. This is a virus that we didn't even know existed about four months ago. And we've learned about it in an incredible period of time. The Chinese put up a lot of information on these preprint servers about what the virus is, what the sequence is, the genetic code, what the receptor binds to. When we had the original SARS, we call this new one SARS-2, so the disease is called COVID-19.

The virus is called SARS-CoV-2. When we had the original SARS-1, it took us over a year to learn all that information. Now everything's been compressed in a few weeks. So it's really extraordinary. But there's still so much we're learning right now. I'm so glad you brought that up because that is really important 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, everyone's learning. Yeah, and also, you know, and everything we have known so far about the virus is what happened in China. 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. 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.

And so we keep we and then who knows what happens when this virus goes into Latin America or India or sub-Saharan Africa. And it's not because the virus is mutating necessarily, it's just that there's also the host component as well, which is quite important. Well, that's one of the issues that people are having in terms of blood type. There's all this talk of certain blood types may be more susceptible to the virus, 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. Now, let's talk about Germany, because I found that really fascinating when I was reading on Germany and their low mortality rate. What do you attribute that to? Is that the extraordinary health care they have there or what is that well let me give you first the opposite side of the coin and then we'll talk about germany's the opposite side of the coin what's happening in italy and spain 10 mortality so uh 10 of the people who are who are being diagnosed with COVID-19 have died, which is higher than just about anywhere else.

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 then you start having massive numbers of people come into the ICU the hospital can't take care of everybody they can't intubate everyone they can't give everyone the highest quality care possible it's no fault of the doctors and nurses they're heroes but uh the the fact that they're completely overwhelmed with patients that that's when mortality starts to really rise. So we saw this in parts of Wuhan and we saw this in Italy. And that was the big worry about New York, that the same thing would happen to New York.

But I'll hold that thought for a second. 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. And then you look at, OK, so if that's true, what's the story on the mortality rate in the United States? And interestingly, so far, one of the highest has been New Orleans. And I think what happened there was they kept the Mardi Gras open, they had lots of mixing, and people, large numbers

of people getting infected. Number one, it overwhelmed the health system, just like in Italy. So there, so in New Orleans right now, the case fatality rate is between four and five. But there's another factor going on in New Orleans, lots of people living in extreme poverty. And poverty is very linked to diabetes and hypertension. And we know diabetes and hypertension is a big risk factor for death. So New Orleans is getting hit twice. One, because the health system is getting overwhelmed. And second, I think you have a lot of african americans living in

poverty with underlying diabetes and hypertension and that's causing that to to skyrocket so you know i was just on the phone today with the leadership of houston and saying you know you know we have a similar demographic to new orleans in many ways we're sister cities after katrina kind of linked at the hip and um and you know, they're our 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, Hispanics with underlying diabetes and hypertension. I'm really worried we're going to see high mortality in Texas. 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. Yeah, I'm really glad you brought that up. I should have remembered to say that. So yeah, so for instance, Chinese, older Chinese men had really high mortality rates. And here's something very interesting. Smoking actually upregulates the receptor in the lungs that the virus binds to. So it seems to make more copies of the receptor for the virus to bind to, so that may worsen the disease. So I think you're right. I think smoking is a factor.

The one question that we don't know is what does vaping do? Is vaping also doing that? And could that be linked somehow to all the young adults that we're seeing in the United States who are getting hospitalized? 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. But is there a vaping connection? Again, new question. We don't know. It's something that's going to have to be looked at. Boy, there's going to be a lot to unravel when all this is over. 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. 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. Marilena Patazzi. We develop vaccines, including coronavirus vaccines. We're trying to get those out the door in clinical trials in between. I'm going on Fox News, MSNBC and CNN. And that's not an easy needle to thread either going on Fox News, MSNBC and CNN.

That's been really interesting. But I love the opportunity. And and I'm doing it because there's a lot of bullshit out there. There's a lot of misinformation trying to get accurate information and also explaining the science behind it. Because sometimes you hear something that doesn't sound right, and it sometimes takes a couple of minutes to explain that. 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. That's great. Now, let's talk about treatments that are being considered. We know that Z-Paks are one of them and chloroquine. Can you explain that? And what went horribly wrong with the couple that took the wrong kind of chloroquine and turned out to be

Koi pond cleaner? Okay, so let me give you the framework for that so it makes some sense. When we talk about all the interventions, you have things that are going to be ready down the line, things that are going to be ready a little closer, and things ready now. And then we can talk about what I want. Let me give you the framework to answer your chloroquine question so the highest bar there is in terms of financial investment required in time to show safety is a vaccine so that's what that's what we're doing and other groups are doing next tier down that's going to be you know a year 18 months away according to dr fauci

could be longer than that next tier down are what we call small molecule drugs, new drugs that have never been discovered before. Still takes a while, maybe not as high a bar as vaccine in terms of time. 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 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. So let's do the chloroquine, hydroxychloroquine. This is, and that's one of the repurposed ones.

That's not the lowest hanging fruit, but the next lowest hanging fruit. This is a medicine that's used for malaria. It's an anti-malarial drug. It's been around for decades. In fact, the World Health Organization was was going to had in the 1960s proposed an elimination strategy for malaria to treat everybody with chloroquine until we had chloroquine resistance and that derailed that but in in some parts of the world still works as an anti-malarial drug it's also used as an anti-inflammatory drug for the treatment of

lupus and other autoimmune diseases you can make make a bucket of it. It's cheap. We know the safety profile. We know it can cause arrhythmias in some patients and other toxicities, but it generally has a pretty good safety profile. We know that this drug can block the replication of the virus in the test tube so it inhibits the virus in the in in what we call in vitro in the test tube second we know this drug uh reduces inflammation and that's nice because one of the things you get with covet 19 pneumonia is you not only get the virus infection in the lung you got a lot of inflammation so it checks a couple of boxes in terms of why it's attractive to look at it and then the chinese did a small study and then a colleague of mine is a fascinating guy uh i'm i really appreciate his work as a

scientist he's a very serious scientist in marseille in france named didier raoul and he's i don't know must have published at least two or three dozen papers in the journal that i found it called plus neglected tropical. He's a serious scientist, works on all sorts of intracellular bacteria and that kind of thing. Tick-borne diseases. Did a small study showing that it worked in COVID patients. And what he did was he combined hydroxychloroquine with the Z-Pak, the azithromycin drug, and found that there's an effect. 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. I'm not sure that's going to turn out to be the case. 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 Rao, who's a really important scientist, but it's a small study. 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. So I think we have to be really careful and don't be too quick to say, okay, this is going to be it. 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.

Now, in terms of vaccines... But wait, there is a new... There's something new, though, that we can do right now that I'll talk to you about. So this is something called convalescent antibody therapy. And it's been known for over 100 years. And it was really scaled up during the 1918 influenza pandemic. You know, that terrible pandemic that killed hundreds tens of millions of people it was shown that if you took individuals had 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 and uh and in fact during the 2003 uh SARS epidemic the first SARS SARS-1 there's been a number of studies showing that it worked it actually you could treat patients for it uh especially if you gave it early on in the course of the infection if you waited too long then it didn't have nearly the same benefit but you gave it early on in the course of the infection. If you waited too long, then it didn't have nearly the same benefit. But if you gave it early on in the course of infection, it could prevent more serious infection and even death because you're actually giving back antibodies.

The antibodies won't last forever, but enough to help you survive the infection. So a good friend and colleague who I've known for a long time, Arturo Casadevall, 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. And as the numbers started going up, I said, I called him. I said, look, Arturo, I'm going on CNN tomorrow. I think this is an opportunity to tell people about this. So I helped amplify what he was doing. He had written a paper with a colleague from Johns Hopkins, Lisa Perfoski at Albert Einstein. And I talked to him about this, and that really got things moving along.

So I've been trying to use my voice on, you know, being on CNN and Fox News. And it's not just to hear myself talk, but to actually raise specific issues to get people to care about certain things. And I used it for this purpose. And I think it helped to mobilize some action. And now what Arturo and his colleagues are doing together with the FDA, so there's a branch of the Food and Drug Administration called CBER, the Center for Biologics Evaluation Research, which is this amazing, you know, you hear a lot of bad things about the FDA. I think the FDA is amazing myself. But CBER is something very special. All these brilliant scientists who deal with vaccines and biologic, they're on board with it.

I've been talking with Peter Marks, Dr. Peter Marks, who's the head of CBER, 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. 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. The other thing Arturo's talked to me about is, you know,

could you use it in smaller doses to give the antibody to healthcare workers and to first responders to prevent them from getting sick? Because you're hearing, I mean, I don't know the percentage now of 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 first responders who've gotten sick. We knew this was going to happen. Maybe this could help them. So I think that's going to be really important as well. 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.

Are people currently using that in the United States? Are doctors prescribing that with CPACs? There's a lot of what's called off-label use, meaning that it's not an approved indication, but they're going ahead and use it. And, you know, I just – I think – and maybe it'll turn out to be a good treatment, but the evidence is not strong. There's a study in Shanghai that suggested 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 Zithromax. 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 it's the hardest thing to do 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 it's we we've we don't have a lot of track record doing this we did it once uh with ebola if you remember in 2014 there was a terrible ebola epidemic in west africa affected 33 000 people 11 000 people died uh that was in guinea liberia and sierra leone and there were some

initial vaccine trials started by a American company that looked pretty promising. They had licensed the technology from the Canadians, this group in Manitoba, Public Health Canada, 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. 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. And we even sent in the 101st Airborne Division.

We sent in the Screaming Eagles, which made a big impact on helping to save West Africa from this infection. So the WHO came in. There was UNICEF. There was Doctors Without Borders. I'm sorry, the Israeli Army came in. The Israeli Defense Force came in. A lot of groups came in to help West Africa. And so the vaccine never really got fully tested. help West Africa. And so the vaccine never really got fully tested. But then five years later, when there was the terrible epidemic in Democratic Republic of Congo, that's when the vaccine really came into widespread use. 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

under conditions of terrible conflict and war and political strife and civil war, they vaccinated 200,000 people with this vaccine. And it largely helped eliminate Ebola from Democratic Republic of Congo during those hostilities last year and essentially saved, I think it's helped to stabilize the whole African continent. So it's an amazing story. And again, it was this multilateral effort that involved also the US government, the NIH and BARDA, and all of these organizations, extraordinary story. And as a result, we really helped stabilize sub-Saharan Africa. But we'll look at the time frame, 2014, first epidemic to 2019.

That's five years. That's a more realistic time frame for a vaccine, just to give people a sense of perspective. Peter, one of the things that I was reading about Wuhan is there was an NPR article recently that was talking about people testing that 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. Are we learning, obviously we're learning about this as a new virus, but is it possible that this is something you can re-catch in a short period of time, like within a few months?

Or do you think that these people had false negatives? We don't know. I think there's a high likelihood that they're not getting reinfected once they develop antibodies. But we don't know for sure. The problem with respiratory virus testing is this. 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 or just bits and fragments of destroyed virus that are testing positive for PCR. And we have all these odd results, like kids with no symptoms at all are testing positive, and then kids with symptoms are testing positive and negative. And it turns out diagnosing respiratory virus pathogens is not easy. It takes a lot of time to do the quality control and really figure out all the testing. 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, but for other respiratory viruses. It's very, and other respiratory pathogens. 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. So you're sampling mucus from the nose or your washings from the mouth or the throat. There's probably inconsistency in the sampling. So it's really problematic. And I think that may have been partly responsible for some of the delays.

The CDC might have worked it out and get it perfect, and it just took longer than perhaps they expected. 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? Well, of course, we always say that. But then again, we said this after SARS in 2003. We said it after H1N1 in 2009. We said it after MERS in 2012. Right, but nothing's ever shut down the country like this. 2014, right. But the point is, after every pandemic, everyone says, oh, now we're going to put some infrastructure in place. And the truth is, things are better now than they were. So after SARS in 2003, they implemented this set of international health regulations, IHR 2005.

And a lot of that was led by a friend and colleague of mine david hayman who's now at the london school of hygiene and tropical medicine and with uh chatham house in london and he was i think he was assistant director general of the who then so and they put that in place and a global health security agenda now we have this thing called sepi this coalition for epidemic preparedness innovation so there's no question things are a little better better substantially better than they were but it's still not enough it's still we don't have the infrastructure in place we need to rapidly accelerate vaccines because a lot of the times and i get involved in this because i've been uh devoted my whole life to developing vaccines for diseases nobody else will make vaccines for because there's no financial return.

And 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. And the problem is the big industry partners, the multinationals, sometimes they get involved in this, sometimes they don't. the multinationals, sometimes they get involved in this, sometimes they don't. This leaves it to 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. We call our Texas Children's Center for Vaccine Development at Baylor College of Medicine. And it's a fragmented infrastructure. And we're

always scrambling for funds. 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. So it's definitely problematic. But Peter, I think we'd both agree this is a very different situation than SARS or MERS or any of those other things in that the entire US economy is totally shut down. 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. You would think so. And I'm hopeful that things will change. But we'll have to see. I mean,

so far, we've had some good responses in terms of our vaccine. 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. Have we stopped you from eating fast food because of this? Because I know you had a terrible diet, and we were joking around about it. Well, I'll tell you, I have an interesting – I've actually lost about six pounds since the start of this epidemic. And I think, well, one is I've stopped sleeping, right, because I'm waking up doing teleconferences with Asia or Europe and going to bed with teleconferences with Asia trying to figure out how we're going to do our vaccine. And we're making a unique vaccine that's a low-cost one that would be used not only in the U.S. but globally.

And then all the calls and everything else. And the one good thing uh 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 i feel great it's yeah 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 covet vaccine so they're coming in this amazing, dedicated group of scientists. And then I've been basically, you know, on teleconferences all the time. I, I said to my wife, and I said, I feel like I have to press star six just to talk to you. It's just been so crazy. And then, and then doing all the media hits, and I was going to the studio for a while, but I'm just doing it from my Skype. So I've sort of this weird subterranean existence right now i mean the good news you know the thing the people i feel so terrible for those who you know now are not getting paychecks because of this crisis and and there's so many people suffering economic hardships uh right now you know all the all the people who used to make my breakfast sandwich in the morning, now I don't see them.

They're presumably not getting a paycheck or all those things. 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. No, there's never been a time where it's no one's fault, but half the country's out of work, at least. Yeah. You know, it's not like anybody did anything wrong. 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.

Yeah, no, it's just so heartbreaking. We're hearing so many heartbreaking stories. I mean, the good news is, you know, the White House and Congress is the one thing they seem to be collaborating on is getting that stimulus package out there to people who need it. And I hope there's some funds for those people. Yes, I hope so too. 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. And subsequently, they're experiencing a spike in cases. Yeah, I mean, the problem, again, is without a vaccine or other technologies, we have to go back to the 14th century.

That's when quarantine was invented. 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. That's where the word quarantine came from, and that's all we've got right now. So we know social distancing is probably our only hope and and there's a few pieces of evidence for that i mean it's real serious social distancing not going to restaurants and things so my colleague mark lipsitch who's a brilliant epidemiologist at harvard has been you know doing a lot of analyses and modeling. 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 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 worse the surge and the worse the epidemic. And therefore, as we talked about in Italy, the worse the mortality. So for instance, in Wuhan, where he estimates, I forget the exact numbers, I think he found about six weeks of transmission going on before you intervene. Then it was lights out. It was a massive surge in hospital systems getting overwhelmed and a lot of health care workers getting sick and 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 between having 2 000 patients in your icUs across the city versus 20. That's how the dramatic difference. 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. 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.

We're seeing the big surges in ICU patients more in cities and rural areas, although Dr. Fauci, I forget 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. So social distancing is absolutely paramount. 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. So this is what happened in New Orleans is what happened is probably happening in Detroit. The mayor of Atlanta just said just said you know all of a

sudden we've had all of these people show up in in the eye in the icu so that's a another lesson learned we really not only doing the the diagnostic testing but the social distancing is really important and i've been on calls with the leadership of people in houston because you know you're right it's it's it it's hurting the economy in in so many ways uh but you know, you're right, it's hurting the economy in so many ways. 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. And the models are showing now the Festick Organ Institute in Seattle, Washington, called the Institute for Health Metrics and Evaluation. 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. But they've been, you know, all hands on deck at this COVID epidemic. And they've just put it out on their website. It's healthdata.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 US is going to hit about the middle of April. So we're not even at the peak yet. And so another two weeks of this is going to continue to go up. And in some places, like in Texas, it's going to be delayed.

It's probably going to be around May 2nd. And I think California was around there as well. 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. And then as we move into later in May, it'll start to go down and maybe really bottom out by June. Of course, again, it's a model, it's a new virus pathogen. But what I've been saying is, you know, the president yesterday or the day before said, OK, I understand. I said Easter. Now we're going to go to April 30th.

And my point is, well, April 30th, things are still going to be peaking in parts of the country. Let's use April 30th as a time to reassess and then make a decision whether we go another month. Let's go a month at a time for now until we know where this is heading. How long can we go? I mean, if you if let's take economics out of it, 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? Well, the problem is from a medical and public health perspective, we don't really know where this virus is heading. You know, it's, I forget what Dr. Fauci said, the virus makes the decisions,

we don't make the decisions. So, although not entirely true, because we can make, we can enact an intervention. So hopefully, by the summer, this is not going to be a huge problem, 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 the, 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? Can I pause you for a second there? What's that? Why would that happen? Why would it come back? 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 potentially could interrupt the transmission. We use this number called the reproductive number, which describes the number of people that get infected if a single individual has it.

So the number right now is between two and four, depending on whose numbers you look at. The idea is you bring that below one by the social distancing. There's also the question of whether there's seasonality to this virus. And again, this guy Mark Lipsitch has done some studies to show that 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. And so let's use an example of another seasonal virus, influenza, which peaks, of course, in the winter and then goes down in the summer months. It never really disappears, but it goes down. But then in the southern hemisphere, it's the opposite. 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. So we don't really understand seasonality. Potentially, the virus could start showing a pattern like that. And then the question is, does it come back year after year after year like flu does and show some kind of seasonality? These are all scenarios that are being looked at. 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. 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. Is there any other way to handle this in terms of quarantining or social distancing like is there would there would it be possible to quarantine the people that are at most risk instead of the general population

well well again the problem gets to the fact that um you know, again, there's this idea that this is only among older Americans and people over the age of 70, diabetes, hypertension. But now, as the Centers for Disease Control has been reporting, we've had this big flux of young adults getting very sick and in the ICU. So at what point do you say pretty much everybody potentially is at risk? 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, that about 10% of infants are getting very sick with this virus.

So infants are at risk so you start adding it up okay older people uh those underlying diabetes 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 the number of people that die every year in the United States from the flu, which is staggering.

It's a lot more than I ever thought before. Do you know the numbers? Yeah, so seasonal flu is really bad. And it varies year to year, different variances of the flu. So it usually goes between 12,000 and 50,000 people die every year of influenza. And the vast majority of those, by the way, are not vaccinated. 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.

So that's an important message to get out. The numbers here, unfortunately, are looking worse. Can I pause you for a second? How does that work? Even if it's not matched up to the correct seasonal flu, how does it prevent you from being hospitalized? Because it's partially protective. 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. In a perfect match, all of the antibodies target the virus. In a less than perfect match, only some of the antibodies target the virus. Therefore, it's partially protective and can have a partial effect.

and therefore it's partially protective and can have a partial effect. And so what was I going to say? Oh, so the Institute for, and now the numbers of Americans who are dying are all over the map. So if you believe the numbers saying that they're between four and ten times the number of Americans, forget about Americans, four to ten times the SARS-2 virus that causes covid-19 is four to ten times more lethal than regular flu so that'll give you the bracket 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. So that's where you're hearing those numbers from the White House press conference saying maybe 100 to 200,000 Americans could die.

I think it's probably, I like the Institute for Health Metrics numbers that just came out. They say 84,000 Americans will die in that peak season going from april may may and june and then but we don't know what will happen again in the out year so the point is a lot of americans are going to die i don't i'm hoping it doesn't get as high as 200 000 and again the modelers are really looking at this the way those numbers that i gave you that estimate was a sort of simplistic version but there's much more sophisticated models. But again, they're models based on assumptions. And with the new virus pathogen, it's hard to get all the assumptions right. But the point is, many more people will die of this virus than even in a bad flu season.

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. Is there a way to prevent something like this, a full shutdown of the country, to happen in the future? Well, the way is, you know, we've got this incredible scientific infrastructure in America, right? The best research universities and institutes in the world. And I work at two of them baylor college of medicine and texas children's hospital and um and now i'm doing a few things with texas a&m university and baylor university as well and and and rice and so the uh the the answer is This is why we have an NIH with a budget of $36 billion annually.

We need to have a pipeline of technologies getting ready for this epidemic. We 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. So figuring out a way to support organizations that are looking at vaccines and other countermeasures, not in terms of products they can sell, but that are going to help the health security of the country, I think is really important. 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 account for most of these diseases and the problem is the g20 economies are not stepping up to support these technologies we still rely too much on the U.S. and the U.K. and the European Union. 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. Otherwise, we go, again, back to the 14th century in terms of social isolation. It seems one of the critical aspects of getting through this is having a strong immune system. 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? Certainly keeping the body healthy is key, right? I mean, one of the populations

that this virus is devastating are those with hypertension and underlying heart disease and actually we're learning this virus itself not only causes lung disease but heart disease as well so we could talk about that but um you know keeping your you know keeping yourself healthy could make the difference between uh 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. Drinking in moderation and keeping fit, avoiding hypertension and diabetes if you can, especially type 2 diabetes. Not everybody can do it. There's some genetic predisposition to it. But if you can keep your body healthy, that will definitely stack the deck in your favor. 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 a sauna because of heat shock proteins and cytokines. Are you 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, I joked around about 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? Well, I have, partly because I've been so upset and so anxious to eat that it's just been on teleconferences and my wife will actually i we set up a little study here in our 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 i uh it's not that i've i can't say that i've been trying to eat certainly eat a healthier diet 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 and 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 and i don't sleep much either i'll wake up you know four in the morning know, look at the numbers from the night before and where COVID is heading, and then I'm on teleconferences all day trying to figure out how we accelerate this vaccine. And it's interesting. I've even noticed that I've become a lot more emotional in my meetings. And, you know, I'm known as a pretty even-tempered person never getting upset I've gotten really upset a few times over the last couple of months surprising my colleagues and I think what's bothering me the most is what I see happening to the nurses and the docs and the respiratory

therapists they're just getting so hammered you know and a lot of them are my former students my medical students uh and you know i remember you know we have something in medicine you have something called match day you know where 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 your residency whether it's in internal medicine or surgery or ear nose and throat or or neurosurgery or whatever and you know a lot of the medical students would come and see me dr hotez hey where should i go do residency and and a lot of them i would say you know it's great spending some time in new york you know i did my md and my phd in new york my wife in new york is a great city great medical centers mont sinai and columbia

and cornell and nyu and Einstein. It's fantastic living in the city. And I'm really, what the hell did I send them into? They're there with inadequate protective equipment, you know, scared as hell of getting sick or worse and being overwhelmed by patients. I think I said, I forget if it was CNN or MSNBC or whatever, I felt 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. Of course, you can never know what was going to happen, but that's been bothering me as well. So this has been a very emotional time for me.

The lack of sleep also has a big impact on the the immune system oh yeah it really sets up your immune system no doubt about it now with you is it simply just because 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? Yeah, no question. 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. And they're great opportunities because they reach such large audiences.

I mean, I've been on everything from Chris Hayes to Tucker Carlson to Hannity and, you know, how many people do that, right? Going through the extremes on the political spectrum, but it's been a great opportunity. But I, you know, deliberately try to be on all those networks to show that I don't give a shit about the politics. This is about, you know, saving people's lives, and they've been great to be a voice. So I don't want to lose that opportunity but then i'm getting up you know early in the morning either for teleconferences or you know do cnn new day or or um our american newsroom with you know sandra smith and and ed henry and those guys these are amazing opportunity well i'll never get it who knows if i ever get a chance to talk to the country like that, although I did a little bit with Ebola and then with Zika. And then to talk about our vaccine. And it's also really important for Americans to hear about scientists because working scientists tend to be invisible in this country.

in the public library of science and plus biology about how the fact that scientists are invisible and are enabling for anti-science movements to rise. And I think, and I blame part of it on our scientific profession that we're 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 to figure, I still have to figure that one out, but it's. It's something you're concentrating on. Yeah. 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. There's scarring on people's lungs.

Talk about that and what, if anything, can be done to try to heal those people post-infection. Well, so what happens is the virus gains entry into the deep passages of the lungs, all the airway spaces. 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. And those spikes are called the S protein. 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. 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 the acetylcholinesterase, and it gets into the lung cells. 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 and so you're seeing a big inflammatory response to the to the virus so the two components are a lot of virus causing direct damage and then the host all the inflammatory response and that's one of the reasons why you know when i heard about hydroxychloroquine i had some enthusiasm because it can maybe suppress the inflammatory component whether it clinically has the ability to make a difference i think the jury's still out yet but so you've got those two things going on.

The other thing that's happening besides 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 so that's why a lot of people are dying the other thing that happens though and we don't really understand the mechanism has been a lot of reports and by the way you can anybody can download this there's this fantastic pre-print server called bio archive and med archive it's put up by Cold Spring Harbor Laboratories.

And I check it every morning. It's called B-I-O-R-X-I-V, and MedRxiv is M-E-D-R-X-I-V. It's put up by Cold Spring Harbor Laboratories. So scientists have been great about sharing information. They're putting all their stuff up on these preprint servers. They're not peer-reviewed yet, but just so we can get information into the hands of the scientists and anybody can 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 perfusing 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 tract as well and so that could actually be a potential route of transmission being fecal oral transmission as well. 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. 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?

Yeah, I think there's a question of whether steroids actually help or hurt. these people post-infection particularly like damage to the lungs yeah i think you know there are you know there's a question of whether steroids actually help or hurt steroids are always a mixed bag because steroids uh can suppress inflammation and help the inflammatory component but they also suppress the immune response to the virus so you can have an increased number of virus particles potentially. So people are definitely looking into steroids, other anti-inflammatory drugs. But those who survive this, and fortunately most do, you'll find that they'll probably tell you they've been hacking and coughing for a long time afterwards. And we see this with flu as well and other

viral pneumonias, it's not because they're still infected with the virus. It's all that scarring is, it takes the body a long time to remodel all the scar tissue and before the coughing stops. So we can anticipate that happening as well. Do we think it's possible to fully recover from this for people that do experience these lung scarring issues? Yeah, I think so, especially for younger people. For older people, they may have some permanent pulmonary deficits, but we don't know. It's still too early in this epidemic to know. Is that a big part of what's going on, is that it's just really too early for so many of these things? The treatments, the cures, dealing with the immune systems, finding out which people are genetically more predisposed to the virus?

Just trying to buy time. And, you know, typically it can take years and years to figure all of this out. And we're all, you know, everybody's working overtime trying to make a contribution and figure this out. The great news is the data sharing among scientists has just been amazing. Everyone's putting aside their eco, putting all their stuff up on BioRxiv, MedRxiv, and the major journals are doing incredible things also, expediting publication of paper.

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. R plus Family of Journals, Public Library of Science. So, you know, if you look at the good stories that are happening around this definitely the data sharing uh the uh the uh you know journals not conducting business as usual recognizing that they're the stuff that they're publishing could be life-saving and responding to a public health crisis i think that that's been a nice part of the story i'm hoping so much of what comes out of this is a wake-up call. So much of the newfound

understanding and appreciation for the science behind dealing with these diseases, appreciation of healthcare workers and first responders. I mean, if there's any bright lining to this, that's what I'm really hoping for is that people wake up and and recognize the good work that people like you have been doing and also you know that this is where we live in strange times and these things can happen again and we need to be prepared and we need to put a lot of emphasis and effort and thought to that as a whole as a whole society right that's right i think you know maybe this will help us reassess some of our values and, you know, appreciate some of the things that the healthcare professions especially are doing. And, you know, you're seeing people volunteer, you know, they're going right, you

know, right into the belly of the beast, you know, people, you know, who might have subspecialty practices. They just said, to hell with it. I'm just going to put on my N95 mask and my PPE and dive in and help. And that's really moving. Why have there been such a shortage of masks and safety equipment for health care workers? And how did this ever happen? Well, we just we didn't get ready for the surgeon time. I think, you know, I think, you know, I'm sort of holding back trying to from the standpoint of prosecuting people or calling them out, but just say, hey, what the hell went wrong here?

And how do we avoid this again? I mean, the problems with the testing and not having all the protective equipment. Now we're getting geared up and mobilizing industry 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 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? And now's not the time to do it, because the last thing you want to do is start distracting people and worrying about congressional hearings and that sort of thing.

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 how to work together. I know that sounds Pollyannish, 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. at George Washington University for 10 years. And I worked with Congress a lot to get legislation passed around neglected tropical diseases. And it was a different Washington then. I mean, I would go, you know, to Sam Brownback's prayer breakfast, 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 Leahy's people from Vermont or Sherrod Brown's people. And, you know, far to the left, and nobody thought any twice about that. 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 tearing apart our country. So I hope the other thing that we get out of this is figuring out a way that Republicans start talking to Democrats again and Democrats talk to Republicans again and figure that out as well. Well, Peter, I appreciate your time, and 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? I thought we talked a lot.

I can't tell you how important it is to use your voice to amplify a straightforward discussion about this epidemic. I think just by doing that, you're making a huge contribution because you have incredible bandwidth and an extraordinary audience. I mean, I can't tell you the last time I did talk about your, I was on your show, I think it was last year around this time, actually. You know, the response I got about neglected diseases of poverty in the U.S. and vaccines, and you have so much, you're such a powerful show and powerful guy, is such a powerful show and powerful guy. And being able to use this time to talk about COVID-19 and what SARS is and how we deal with pandemic threats, it's absolutely huge.

So I'm very grateful for the opportunity. Well, we're very, very grateful for you, Peter. And let's talk again in person during better times. Absolutely. Thank you, sir. Take care and be safe out there. All the best. God bless.

All right. Bye-bye.