peter hotez peter attia covd-19

COVID-19: Transmissibility, Vaccines, Risk Reduction, and Treatment | Peter Hotez, M.D., Ph.D. on The Drive with Peter Attia

Check out The Peter Attia Drive Episode Page & Show Notes

Key Takeaways

  • Many people don’t show symptoms of SARS-CoV-2/COVID-19 infection (most notably, kids), increasing the odds that a carrier going about their daily life infects someone else
    • (This is why social distancing is so critical)
  • A recent paper suggests SARS-CoV-2 survives for:
    • 72 hours on plastic
    • 48 hours on cardboard
    • 24 hours on steel
    • 8-24 hours on copper
  • Peter Hotez’s colleague, Arturo Casadevall, is pushing the idea of a low-cost, antibody therapy intervention
    • Expanded: we should be taking infected patients who’ve since recovered, collecting their convalescent plasma, isolating their antibodies, and then using them as a treatment

Intro

  • Dr. Peter Hotez (@PeterHotez) is the Dean for the National School of Tropical Medicine Baylor College of Medicine. He’s a renowned vaccine scientist.
  • Host: Peter Attia (@PeterAttiaMD)

The Nomenclature

  • COVID-19 is the name of the disease caused by the SARS-CoV-2 virus
  • SARS-CoV-2 is a member of the coronavirus family
    • There have been 3 significant pandemics caused by coronaviruses in the 21st century: SARS-CoV-1 (2003), MERS-CoV (2013), and now SARS-CoV-2
      • If we compare them: SARS-CoV-1 is more lethal than SARS-CoV-2 (and MERS-CoV-2) but not as contagious 

Why Social Distancing is Essential

  • Many people don’t show symptoms of SARS-CoV-2/COVD-19 infection (most notably, kids), increasing the odds that a carrier going about their daily life infects someone else

Act Quick

  • Studies from Marc Lipsitch show that, in China, the cities hit hardest in terms of hospital workforce depletion/ running out of hospital beds/ventilators are those that allowed transmission to go on for an extended period without intervening 
    • In Wuhan, transmission went on for 6 weeks without intervention = CATASTROPHE
    • Guangzhou, however, acted much quicker (after ~1 week), resulting in a much smaller peak of hospital bed demand
    • In the U.S., transmission began in the middle of February (and it took 3-4 weeks for us to act)
  • Is it too late for the U.S. to shift the growth curve?
    • “If we can get a large order of magnitude level of testing in the next week, and see which communities have high levels of transmission, then potentially, we could intervene. We have to try, but boy, it would have been nice to have that 3 or 4 weeks ago … We lost the opportunity to prevent this from becoming a large epidemic.” – Peter Hotez

An Antibody Therapy Intervention for COVID-19

  • Peter Hotez’s colleague, Arturo Casadevall, is pushing the idea of a low-cost, antibody therapy intervention
    • Expanded: we should be taking infected patients who’ve since recovered, collecting their convalescent plasma, isolating their antibodies, and then using them as a treatment
      • Peter Hotez thinks highly of this approach, especially considering an effective antiviral drug is a long way off
      • (Note: there are some intricacies here. Take this more as a 30,000-foot view of the solution. This method would require blood bank cooperation, centrifuges, etc.)

Why would a vaccine for COVID-19 take so long to develop?

  • It’s not unusual for a clinical development plan for a new vaccine to last 3+ years
    • This process can be sped up, but we need to be careful. Coronavirus vaccines have, in lab animals, been shown to create immune enhancement (where the vaccine makes things worse)—this makes things complicated.

SARS-Cov-2’s Mechanism of Action

  • The virus gains access to type II pneumocytes (a type of cell) that make surfactin through the ACE2 receptor (found most abundant in the lungs)
    • Once the cell is infected, its capacity to make surfactin (which, in the lungs, helps you breathe) is reduced 
    • (ACE2 receptors are also found in the intestinal tract, heart, and blood vessels—this explains the virus’ diverse pathology)
      • For instance, many infected patients in China had—on top of respiratory issues—acute myocardial injury and gastrointestinal issues 

What’s SARS-CoV-2’s primary mode of transmission?

  • We don’t know yet
    • Droplet contact seems to be most prevalent (i.e., people coughing, touching surfaces which contain the virus and then touching your face, etc.)
    • Airborne and fecal transmission is also likely

How long does the SARS-CoV-2 survive outside the human body?

  • A recent paper suggests the virus survives for:
    • 72 hours on plastic
    • 48 hours on cardboard
    • 24 hours on steel
    • 8-24 hours on copper

Ro and Transmissibility

  • A virus’ Ro (pronounced “r naught”) = the average number of cases directly generated by one case in a population where all individuals are subject to infection (AKA there’s no immunity)
    • If a virus’ Ro is 3, on average, every infected person infects 3 additional people
  • It’s yet to be precisely determined, but COVID-19’S r0 seems to be ~2.24-3.58
    • Measles’ Ro: 12-18
    • The seasonal flu’s Ro: ~1.2-1.3

COVID-19’s Mortality Rate

  • COVID-19’s mortality rate is between 0.6-3.4% (4-20x higher than the flu)
    • Among older populations, this number jumps to 10-20%

What geographies is Peter most concerned about?

  • Urban areas are most vulnerable (e.g., NYC, Seattle, etc.)
    • In general, the more sustained community transmission goes on, the higher the burden on healthcare staff & hospitals

Risk Reduction

  • Older individuals need to be VERY careful 
  • With ANY signs of symptoms, self-isolate & quarantine

What will Peter be paying close attention to over the next week?

  • As testing is increased, we’ll start to see the virus’ true toll on the U.S.
  • The vaccine trials which started in the Washington area

Wrapping Up

  • “This is where we are right now, and this virus is racing so quickly … New pathogens, in general, set you [an infrastrucutre] up to look stupid … but this one especially, because it’s so fast-moving and transmissible.” – Peter Hotez

Additional Notes

  • “For all of these odd features of the virus, it starts adding up to become a serious epidemic and highly destabilizing for any countries that have large numbers of people.” Peter Hotez
  • Peter Hotez is the author of Vaccines Did Not Cause Rachel’s Autism, a book written about his daughter
  • Mac Lipsitch has estimated that over 70% of the world’s population may become infected with COVID-19
Drive with Dr. Peter Attia : , , ,
Notes By MMiller

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