Joe Rogan Experience #1451 - Dr. Peter Hotez

dr. Hotez how are you sir oh it's great. to see you again Joe oh he's I feel a. lot better seeing you now I feel a lot. better seeing you too especially with. the bowtie as we talked about before. your signature touch yes I was saying. and I try to start wearing a regular tie. for a while it was like when Dylan. started switching to electric. instruments 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 not a like the bow tie at. the fight the fight the point was I.

tried to switch to regular tie for a. wire and they said that there's no way. that can happen yeah that's what I meant. I screwed it up but I meant like what. kind of who's getting upset are you. wearing a regular time to get a life I. think it was venting in a good-natured. way I'm sure so we don't do very many. these Skype ones but because they're odd. so let's I don't know if you've done too. many of these that 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 you know let's let's. get going. so taking it from the top let's let's. discuss give us your take on how we got. here. because this is it's been very strange. obviously the president completely. miscalculated what was going to happen. in 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 and and even a 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. SAR severe acute respiratory syndrome in. 2003 that 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 mayors. virus infection in 2012 and this is the. third one so we actually realized that. corona viruses were going to become a. new thing and we embarked on a big run a. virus vaccine program a decade ago and. and each time they've caused devastating. Hospital epidemics they've affected.

healthcare workers so the point is this. unfortunately has become an e normal for. the globe is terrible corona virus. epidemics and we saw this one coming up. in at 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. the difference what this one compared to.

the other two was this the other two. SARS and mayor's now we call this new. one SARS too so the Rahsaan than mayors. than SARS too so both SARS one and. mayor's made you so sick and that's 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 as 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 could still walk around. the community and be out in about and. stores and restaurants and infecting. everybody and so this is what's caused. the problem it's a it's highly. transmissible there's a big group of. people walking around spreading it. and a smaller subset but a big subset. we're getting very sick and even dying.

in intensive care unit 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. age so younger people seem to do better. and actually kids seem to do really well. with this infection they don't they. don't get with it 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 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. kovat is we there's this buzz out there. in the community that it's only old. people that are getting sick and dying. and going to I see use but in fact the. Centers for Disease Control came out. with this very chilling document a few. weeks ago showing that about 1/3 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 fact this. infection 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 US and I know in the. people who you know listen to you and.

watch you know 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 yo 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 kovat 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 Michaels 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. what about what about an 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 that a lot of evidence. to say that you get worse with ibuprofen. probably he was just one of those young. adults that's gonna 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 is that 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 rumors start from and what what is.

the concern the territory and then and. then you've got the problem you know. some people you know also say don't take. aspirin because if this is a respiratory. virus infection there could be a severe. reaction with with aspirin as well so. for now you know and I said the other. thing Joe is anything we say today 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 by. something like I'm waffling or hedging. it's it's because I am where 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 and. information that 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. an incredible period of time the Chinese. put up a lot of information on these pre. print servers about what the virus is. what the sequence is the genetic code. what the receptor binds to when we had. the original sock that we call this new. one SARS to the Cova night so the but. the diseases called covin 19 the virus. is called SARS - SARS coronavirus - when. we had the original SARS one 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. so much we're learning right now that. 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 it's you you everyone's learning yeah. and also you know and everything we have. known so far about the viruses what. happened in China and it turns out the.

Chinese start to have some genetic. differences to Europeans and Americans. and and things can change depending on. it's not just the pathogen it's also. what we call the host the person - so. the fact you know that the virus. affected young adults in Europe and the. US in a way that did not necessarily. occur in China is important and so we. owe or keep we and then who knows what. happens when this virus goes into Latin. America or India or sub-saharan Africa. it may 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 there's all. this talk of certain blood types may be. more susceptible to the virus. particularly blood type a yeah well. actually 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 there's. you know dozens of different pathogens.

but including viruses and bacteria that. behave differently depending on 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 would what do you. attribute that to is that the 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 your kids to the opposite side of. the clay what's happening in Italy in. Spain 10% mortality so 10% of the people. who are who are being diagnosed with. Kovan 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 that. in other words the 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 take care of everybody they. can intubate everyone they can't give. everyone the highest quality care. possible is no fault of the doctors and. nurses there are heroes but the the fact. that they're completely overwhelmed with. patients 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 has 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 in overwhelming things and then you. look at okay 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 Orleans and. I think what happened there was they. kept the Mardi Gras open they had lots. of mixing and people a lot large numbers. of people getting infected number one. and overwhelm the health system just. like in it. so there is so in New Orleans right now. the case fatality rate is between four. and five but there's another factor go. 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 systems. 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 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 and you know. there 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 really worried we're gonna. 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 smoked young people old people it. seemed like a large percentage of the. population smoked yeah really glad you. brought that up I should have I should. have remembered to say that so yeah so. in Charlotte so for instance Chinese. older Chinese men at really high. mortality rates and here's something. very interesting smoking actually up. regulates the receptor and the lungs. that the burner spines too 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 is. vaping do does vais is vaping also doing. that and could that be linked somehow to. the young and 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 gonna have to be looked. at. well this there's gonna 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 and trying to educate us on. this thing what about just that's the. reason I'm going I've been going on in. between word you know we I co-lead a. team with my 20 year science partner dr. Mary Elena patate see we're trying it.

we've developed 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 see and then that's been really. interesting but I love the opportunity. and and I'm doing it because this is. there's a lot of [ __ ] out 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 it sometimes takes a couple of. minutes to explain that and and those. three cable news networks have been. great about giving me some time to 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 packs. are one of them and chloroquine can you. explain that and and what went horribly. wrong with the couple that took the. wrong kind of chloroquine and turned out.

to be a koi pond cleaner okay so let me. let me put give me 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 are gonna be ready a. little closer and things ready now so. and then and then we can talk about what. I meant all we could let me give you the. framework that I'll to answer your. chloroquine question so the highest bar. there is in terms of financial. investment required in time to show.

Safety's 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. pouchy. could be. longer than that next here down are what. we call small molecule drugs new drugs. that have never been discovered before. it still takes a while maybe not as high. a bar as vaccine in terms of time the. next tear down is repurposing existing. medicines that we already know are.

relatively safe and then showing that. those drugs also work against the corona. virus 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 that right now so let's do. the let's do the 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 gonna head in. the 1960s proposed an elimination. strategy for malaria to treat everybody. with chloroquine until we had Klerk own. resistance and that derailed that but in. some parts of the world that 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 it you can make a bucket of it. it's cheap. we know the safety profile we know it. can cause arrhythmias in some patient in. other toxicities but it is generally has. a pretty good profile we know that the. drug can block the replication of the. virus and the test tube so in hip it's. the virus in the in what we call in. vitro and the test tube ii we know this. drug reduces inflammation and that's.

nice because one of the things you get. with kovin 19 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. I'm I really appreciate his work as a. scientist if she's a very serious. scientists in Marseille in France named. Didier rah old and he's must have.

published at least two or three dozen. papers in the journal that I found it. called plus neglected tropical diseases. 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 köppen. patients and what he did was he combined. hydroxychloroquine with the z-pak the. zither Meissen drug and found found that. there's an effect the problems 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 the show that it really. works and the reason I'm holding back is. you know nothing to do with doctor. professor all is you know really. important scientists 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 and Clint in.

larger clinical studies so I think we. have to be really careful and don't be. too quick to say okay this is this is. going to be it I don't 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 in terms of. vaccine weight but there is a there is. an there is a new there's something new. though that we can do right now ok I'll. talk to you about so this is something.

called convalescent antibody therapy and. it was and it was no it's been known for. over a hundred years and it was really. scaled up during the 1918 influenza. pandemic you know where that terrible. pandemic that killed hundred 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.

giving them back their red cells and. take the plasma. component and used that as a therapy to. treat patients and and in fact during. the 2003 SARS epidemic. the first are SARS one there's been a. number of studies showing that it worked. it actually you could treat patients for. it especially if you gave it early out. in the course of the infection if you. waited too long then it didn't have. nearly the same benefit but you give it. or really on 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 going on for a long. time our Toro Casa de Valle was 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 kovin 19and and. as the number 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 you know helped amplify what he was. doing he had written a paper with it. with a colleague from Johns Hopkins Lisa. Ann Peron profile I always get her I. always mangle her name preposterous tyne. 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 or Fox News and it's not. not just to hear myself talk but to. actually raise specific issues to get. people to care about about certain. things and I and I used it for this. purpose and I think it helped to. mobilize some action and now but our. terminus colleagues are doing together. with the FDA so there's a branch of the. Food and Drug Administration called. Sieber the Center for biologics. Evaluation Research which is this amazed. you may hear a lot of bad things about. the FDA I think the FDA is amazing.

myself but Sieber 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 Marx dr. Peter marks. is the head of Sieber and he's teamed up. with with arturo to get this network. going at least among 20 academic health. centers so that their identification. soup 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 for saving. lives. the other thing our Toros talked to me. about is you know could use them in. smaller doses to give the antibody to. healthcare workers and to first. responders to pretend them from getting. sick because you're here I mean I don't. know the percentage of our first. responders in New York and that's why. they turned the Empire State Building. into a siren last night and into until. honor all of the all of the first.

responders who have gotten sick we knew. this was going to happen. maybe this 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. that they're having some good results. with that are people currently using. that in the United States are doctors. prescribing that with just a lot of. what's called off-label use meaning that. it's not an improved indication but. they're going ahead and use it and you. know I just I think and and maybe it'll.

turn out to be a good treatment but the. evidence is is not strong the 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 really we we've. we don't have a lot of track record. doing this we did it once with Ebola. if you. remember in 2014 there was a terrible.

Ebola epidemic in West Africa affected. 33,000 people 11,000 people died that. was in Guinea Liberia and Sierra Leone. and there were some initial vaccine. trials started by American company that. looked pretty promising they had. licensed the technology from the. Canadians this group in Manitoba a. public health Canada and it looked. promising but as the trials got underway. what happened there was the resiliency. National Response to put in a health.

system because 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 the corpse of someone who's. recently died from from Ebola virus. infection and the and we even sent in. the hundred and first Airborne Division. we said in the Screaming Eagles which. made a big impact on helping to say you. know save West Africa from this. infection so the WHL came in there was.

UNICEF there was Doctors Without Borders. lots of I'm firmly army came in Israeli. Defense Force came in a lot of groups. came in to help West Africa and so the. vaccine never really got fully tested. but then five years later when there was. the terrible epidemic and 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 civil civil war they. vaccinated 200,000 people with this. vaccine and it largely help eliminate. Ebola from Democratic Republic of Congo. in that in that during those hostilities. last 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. and all of these organizations. extraordinary story and as a result we. really help stabilize a sub-saharan. Africa but but look at the timeframe. 2014 first epidemic to 2019 that's far. that's five years that's a more. realistic timeframe 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 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 and we obviously. we're learning about this as a new virus. but is it is it possible that this is. something you can recatch 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 we even and we and that. turns out even before those three big. pandemic coronavirus I was talking to. you about we've known about corona. viruses for even longer than that. because kids get a lot of upper. respiratory infections with these other. type of corona viruses 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 are 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. corona virus or for other respiratory. viruses it's very 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 the or for your washings from the. mouth of the throat just probably. inconsistency in the sampling so it's. really problematic and I think that may. have been partly responsible the delays. this the CDC steep and to work it out. and get it perfect and it just took. longer than they 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 mares in 2012 right but. nothing's ever shut down the country.

like 2014 right but the point is after. every pandemic you know everyone says oh. now we're gonna put some infrastructure. in place and the truth is there have. 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. Heyman who's now at the London School of. Hygiene and Tropical Medicine and with. Chatham House in London and he was I.

think he was assistant director-general. of the w-h-o then so that 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 the. better it's 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. and I get involved in this because I've.

been devoted my whole life to developing. vaccines for diseases nobody else will. make vaccines for because there's no. financial return we've been doing this. for. stupid 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. this leaves it to you know 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 and it's 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 we're I'm still. spending I don't know how many hours a. day on teleconferences you know with. with potential donors trying to get this.

out of clinical trials so it's it's it's. definitely problematic but Peter I think. we'd both agree this is a very different. situation than SARS or Mears or any of. those other things and that the entire. US economy is totally shut down I mean. yeah if anything is gonna be a wake-up. call for industry if anything's gonna be. a wake-up call for people with money. this is going to be yet because this is. devastating for everybody you you would. think so but I'm and I'm hopeful that. things will change but what 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 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 they've had a terrible diet we. were joking around about it well I'll. tell you you know I have an interesting. I have actually lost about six pounds. since it started this epidemic and I.

think well one is I'm I've stopped. sleeping right because I'm waking up. doing teleconferences with Asia or. Europe and going to bed with. teleconferences with with Asia trying to. you know figure out how we're going to. do our vaccine and not that we're making. YOUnique faxing us a low-cost one that. would be is not only in the US but but. globally and then all the calls and. everything else and and the one good. thing is that I stopped traveling and I. realized that the travel was really.

knocking the crap out of me in turn in. terms of my health so yeah we've talked. about that on the show all the different. comedians that I tour with all the time. we're all at home now for the past month. and 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. knocked so it's you know we've got a. group of scientist really dedicated even. though the labs are largely closed down. at Baylor and Texas children we got. special permission because they're. working on the kovat 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-6. just to talk to you yeah 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 now 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 think that.

people I feel so terrible for those who. you know now we're not getting paychecks. because of this listen and there's so. many people suffering economic hardships. 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 or all those things or the. dry cleaners and all that kind of stuff. eels so bad for them because I'm sure. they don't have much of a safety net at. all know what 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 yeah it's not 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 the sudden the carpet. gets pulled out from under you ya know. it's just so heartbreaking we're hearing. so many heartbreaking stories I mean the. the good news is you know the the. in Congress is the one thing there seem. to be collaborating on is getting that.

stimulus package out there to people who. need it and I hope I hope there's some. some funds for those people but yes I. hope so too. what's your take on sweet 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 there are quite a bit more open than. the rest of the world and subsequently. they're they're experiencing a spike in. cases yeah I mean the problem again is.

without a vaccine there are other. technologies we have to use go back to. the 14th century that's when quarantine. was invented it was when ships would. come into the harbor on Croatia and. coming from Asia Minor and they were. fearful they're bringing plague and they. kept the ships for 40 days that's the. word where the word quarantine came from. and that's well 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 distance he's not. going to restaurants and things so my. colleague Mark lip stitch is 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 something that. were pretty aggressively couldn't even. do in the United States but they showed. that the longer you allowed transmission.

to go on before you intervene with. social distancing and other things the. worse the surge and the worst the. epidemic and there for us we talked. about in Italy the worse the mortality. so for instance in Wuhan where he. estimates I think I forget the exact. numbers I think he's found about 6 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.

finished those 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 two thousand patients in. your ICU across the city versus 20. that's how the dramatic a difference so. that's a lesson we need to learn for the. u.s. is it'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 / suburban. versus rural divide we're seeing the big. surges and I see patients more in cities. in rural areas although dr. Fadi. Africans last night 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. [ __ ] 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. you know all of a sudden we found all of. these people show up in the I and the. ICU so that's a another lesson learned. we're 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 so many ways but you know. if you want to prevent Houston from. replicating the New Orleans experience. I've been saying to the to the mayor and. everyone else in Houston this is. unfortunately what we're going to have. to do and the models are showing that. that's the Oregon Institute in. Washington Seattle Washington called the.

Institute for Health metrics and. evaluation and it's 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 the. heart disease and mental health issues. but they've been you know all hands on. deck at this kovat epidemic and they've. just put it out on. website it's health data or Gandy go to. the co vid 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 we're. 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 around May. second 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 bottomed 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 gonna. 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 30 as a time to reassess and. then make a decision whether we go in. other months let's go a month at a time.

for now until we know where this is. heading how long can we go I mean what. 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 the. medical and public health perspective we. don't really know where this virus is. heading you know it's a freak about dr.

prade she said the virus makes the. decisions we don't make the decision 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 what 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. what's that why would that happen why. would it come back why would it 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 a reproductive number which. describes the number of people that get. infected if a single individual has it. so the number right now is between 2 & 4. 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 the to this virus and again this guy. mark lipstick has done some studies to. show that there there seems 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. then and so let's use an example of.

another seasonal virus influenza you. know which Peaks of course in the winter. and then goes down in the summer months. it never really disappears but it 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 show it. starts showing a pattern like that and.

then the question is does a come back. year after year after year like flu does. or or and have shows some kind of. seasonality these are all scenarios that. that are being looked at so for instance. our vaccine if it's used and goes you. know 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 quarantine 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 you know again there's this I. the this is only among older Americans. and people over the age of 70 diabetes.

hypertension but now we as the Sinister. disease control has been reporting we've. had this big flux of young adults. getting very sick and in the ICU so what. point do you say pretty much everybody. potentially is at risk then among the. children even though the 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 thought 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. 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 awhile it's just it's you. can't you can't slice it that fine.

that'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 you know like do you know. the numbers like what would yeah so you. know seasonal flu is really bad it's at.

various year-to-year different variants. of the flu so it usually goes between 12. and 50,000 people die of a 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 looking worse for a. second how does that how does. work how even if it's not matched up to.

this 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 and the. end and all the antibodies each reacting. to a different piece of the virus and a. perfect match all of the antibodies. target the virus in the in a less than. perfect match only some of the. antibodies target the virus and.

therefore it's partially protective and. can you know have a have a partial. effect and so was I gonna say oh so the. it's different and now the numbers of. them of Americans who are dying are all. over the map so if you if you believe. the numbers saying that they're between. four and ten times the number of. Americans and I forget about America. four to ten times covetous ours to virus. that causes clove in nineteen is four to. ten times more lethal than regular flu.

so that'll give you the bracket so the. minimum is twelve thousand from flu the. minimum that's going to die from Kovan. nineteen is around fifty thousand and. that the high end times ten could be. between five hundred thousand so that's. where you're hearing those numbers from. the White House press conference saying. maybe a hundred to two hundred thousand. Americans could die I think it's. probably I like the Institute for Health. metrics numbers that just came out they.

say eighty four thousand 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 here so the point is a lot of. Americans are going to die. I 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 that. there's much more sophisticated models. but again they're models based on. assumptions over 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. 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 of the country to happen in the. future. well the way is you know we you know. we've got this incredible scientific. infrastructure in America right the best.

research universities and institutes in. the world and and I work at two of them. Baylor College of Medicine and Texas. Children's Hospital and 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 the the. answer is this is why we have a and then. I aim for the budget of thirty six. billion dollars annually we need to have.

a pipeline of technologies getting ready. for this epidemic we 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. current uh virus vaccines and clinical. trials and potentially we could have. combined them in a way to be ready to go. now. so having figuring out a way to support. organizations that don't are that are. looking at vaccines and other. countermeasures not in terms of promise.

they can sell that are going to help the. 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. disease is 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 US and the UK 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. 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 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 so. yeah certainly keeping the body healthy. is key right I mean who this 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 you know keeping your you. know keeping yourself healthy could make. the difference between life or life or. death but even at 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 lung so no. question about it don't smoke don't vape.

you know drinking in moderation and and. you know keeping keeping fit you know. avoiding hypertension and diabetes if. you can especially type 2 diabetes he's. 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 is 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 for me that's a. new one now as far as yourself like I. joked around about the 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 I well I have apparently. because I've been so upset and so. anxious to eat that you know I it's just.

been I've been on teleconferences and my. wife will actually we set up a little. study here in our and. our bedroom and it's not much but my. wife will just bring me a plate of food. and I'll just you know he did and then. what Evers but I 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 her and I don't. sleep much either I'll wake up you know. 4:00 in the morning you know look at the. numbers from the night before and we're. kovat is heading and then I'm on. teleconferences all day trying to figure. out how we accelerate this vaccine and. now 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 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 and a lot of. them my former students medical students. and you know I remember you know we have. some medicine yeah 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 gonna do your your. residency whether it's an internal. medicine or surgery or your nose and. throat or or no surgery or whatever and. you know a lot of the medical students. would come and see me dr. ho's hey where. should I go do residency and in a lot of. the medicine 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 Mount Sinai and Columbia. and Cornell and NYU and Einstein it's. fantastic live in the city and I'm. really what the hell did I send him into. there there. with no with inadequate protective. equipment you know scared as hell of. getting getting sick or worse and and. being overwhelmed by patients I think I. said I don't forget what CNN or what. MSNBC or whatever is I felt like I sent. them to hell you know and and feeling a. lot of guilt for being so enthusiastic.

about having them go to the hospitals. and your crusty can never know what 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 yeah really. except 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 I've looked in well one. of the reasons is a practical matter. because I've been doing some evening TV. interviews and 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 now going to the. extremes of the political spectrum but. it's a great opportunity but I you know. deliberately try to be on all those. networks the show that I don't give a. [ __ ] about the politics this is about. you know saving people's lives and they. will be avoided 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 our American newsroom with you. know Sandra Smith and and at Henry and. those these are amazing opportunity ever.

get a chance to talk to the country like. that although I you know do a little bit. with Ebola and then with the Zika so 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 and I have a paper that just put. out in the public library science in. PLoS Biology about. how the fact that scientists are. invisible and are enabling for anti. science movements to rise and I think.

part I believe part of it on our. scientific profession that were too. quiet so here I have this chance of. 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 then so it. catches catches up to you. so yeah I've got a figure I start to. figure that one out but it's it's. something you're concentrating on yeah. well one of the things he brought up. that I wanted to discuss is the damage.

that this virus does to the lungs and to. the heart as well what there's scarring. on people's heart lungs did talk about. that and what if anything can be done to. try to heal those people post infection. well so what happens is you know the. virus gains entry into the deep passages. of the lungs you know the the all the. airway spaces and then it has if you. ever see a cartoon a schematic drawing.

of a corona virus 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 and in the lung which. is actually an enzyme called. 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's 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 or 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 you know. Nitori 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 a RDS 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 a RDS 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. it's been a lot of reports and by the. way you can anybody can download this. there's this fantastic preprint server. called bio archive and med archive it's. fed up by Cold Spring Harbor. laboratories it's and I can check it. every morning it's called bi Oh our XIV. and Med archive is meed our XIV's but if.

I Cold Spring Harbor Laboratory 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. that we get information into the hands. of the scientist and anybody could 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 and they're in. shock so they're not perfusing the heart. or and we know that the old SARS virus.

SARS one 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 mean 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. alone. 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. you know there are you know there's a. question of whether steroids actually. help or hurt steroids are always a. bag because steroids can suppress. inflammation and help the inflammatory. component but they also suppress the. immune response to the virus.

so you could have an increased number of. virus particles potentially so people. are definitely looking into steroids. other anti-inflammatory drugs but you. know those who survive this and. fortunately most do you know you'll find. that there they'll probably tell you. they've been hacking and coughing for a. long time afterwards and a lot of that. is and we see this with flu as well and. other viral pneumonia is 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 and before the coughing. stops so we can anticipate that. happening as well what 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 you know they may have some. permanent pulmonary deficits but we. don't know it's still too early in this. 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. the dealing with the immune system is. finding out which people are genetically. more predisposed to by 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 try to make a contribution figure it. figure this out okay the great news is. the the data sharing among scientists. has just been been amazing everyone's.

you know putting aside the Ricoh putting. all their stuff up on bio archive med. archiving and the and the major journals. are doing incredible things also. expediting publication of paper so you. know the the flagship journals like New. England Journal of Medicine Lancet JAMA. they're all putting that stuff out. there's fast as they can you know as. ensuring quality and a level of peer. review our plus family journals Public.

Library of Science so. so you know if you if you look at the. good stories that are happening around. this definitely the data sharing the the. 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 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 and you. know appreciate some of the some of the. things that the health care 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 there set the hell with it I'm. just gonna 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 healthcare workers and how did this. ever happen well we just we didn't get. ready for the surgeon time and I think. you know I think you know I I'm sort of. holding back trying to throw stones at. this this agency or this person or this. group because we don't really know what. happened I think it's going to be really.

important that Congress after this and. conduct an investigation not from the. standpoint of prosecuting people or or. calling them out but just say hey what. the hell went wrong here and 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 in 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 and in order to get. ready and what didn't we do and and and. now is not the time to do it because. though the last thing you want to do is. start distracting people and worrying. about you know congressional hearings. and and and that sort of thing but when.

all this is said and done it has to be. it has to be done the right spirit not. again we have to figure out a way to. stop these partisan lines to say there. was as a country we've got to figure out. the work together 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 for. ten years and I worked with Congress a. lot to get legislation passed around the. collected tropical diseases and it was a.

different Washington than I mean I would. go you know to sam Brownback's prayer. breakfast sam Brownback's governor of. kansas before the senator from Kansas. very conservative Republican senator. walk across the hall and go talk to. Senator Leahy's people from Vermont or. sherrod Browns people and you know it's. far far to the left and nobody thought. any twice about that you know we all. knew we ought to go across the aisle to. work together and it's just not. happening anymore nuts 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 yeah I thought we talked a lot I you. know I can't tell you how. coordinate is to use your voice to.

amplify you know a straightforward. discussion about about this epidemic I. think you know a year and just by doing. that you're making a huge contribution. because you have incredible bandwidth. and an extraordinary audience I mean I. have to last I can't tell you it last. time I did did talked about your I was. on your show I think was last year. around this time actually you know the. response I got about neglected diseases. of poverty in the US and vaccines and. you have so much is such a powerful show.

and powerful guy and you know being able. to use this time to talk about kovat is. 19 and in what's ours is and why and how. we deal with pandemic threats it's it's. 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 all. right bye-bye.

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