Joe Rogan Experience #1451 - Dr. Peter Hotez

1. 0:00 – 15:00

   Dr. Hotez, how are…

   1. JRJoe Rogan0:01

      Dr. Hotez, how are you, sir?

   2. PHDr. Peter Hotez0:03

      Oh, it's great to see you again, Joe. Always, I feel a lot better seeing you now.

   3. JRJoe Rogan0:07

      I feel a lot better seeing you too, especially with the bow tie as we talked about before. Your signature touch.

   4. PHDr. Peter Hotez0:12

      Yeah, as I was saying, uh, I tried to start wearing a regular tie for a while, it was like when, uh, Dylan started switching to electric instruments at the Newport Folk Festival and there were just cries of outrage, so I had to...

   5. JRJoe Rogan0:24

      What kind of cries of outrage are you getting about your bow tie? Especially in these trying times?

   6. PHDr. Peter Hotez0:28

      No, no. They like the bow tie. The point, the point, the point was I tried to switch to a regular tie for a while and they said that, "There's no way that can happen." Uh...

   7. JRJoe Rogan0:35

      Yeah. That's what I meant. I screwed it up, but I meant like what kind... Who's getting upset at you wearing a regular tie? What kin-... Those people need to get a life.

   8. PHDr. Peter Hotez0:41

      (laughs) I think it was meant in, in, in, in a good-natured way.

   9. JRJoe Rogan0:45

      I'm sure.

   10. PHDr. Peter Hotez0:46

       Yeah.

   11. JRJoe Rogan0:46

       Uh, so we don't do very many of these Skype ones, uh, but... 'Cause they're, they're odd. So, uh, let's, uh... I- I- 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.

   12. PHDr. Peter Hotez0:57

       Yeah, I guess it's the, it's the epidemic, right? Otherwise, I'd be on a plane and come to see you in L.A. and...

   13. JRJoe Rogan1:04

       Yeah. We'll do that again sometime.

   14. PHDr. Peter Hotez1:06

       Yeah.

   15. JRJoe Rogan1:06

       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 gonna happen in the way he was explaining it to the news. He was kinda 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.

   16. PHDr. Peter Hotez1:39

       Well, you know, the, the truth is, uh, 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, uh, what's called SARS, severe acute respiratory syndrome, in 2003. That started in China and caused a terrible epidemic in Toronto. It actually took the, uh, the Rolling Stones to do a concert to bring the economy back to Toronto in 2003. And then it was MERS, coronavirus infection, in, uh, 2012, and this is the third one. So we actually knew... realized that coronaviruses were gonna become a new thing and we embarked on a big coronavirus vaccine program a decade ago, and, um, and each time they've caused devastating hospital epidemics, they've affected healthcare workers. So, uh, the point is this, unfortunately, has become a new normal for the globe, is terrible coronavirus, uh, epidemics. And, uh, we saw this one coming up in the end of 2019 in China, and, uh, I knew we were in for trouble because that's what coronaviruses do.

   17. JRJoe Rogan2:52

       So you knew that we were gonna be in trouble because there was no way they could contain it and keep it in China?

   18. PHDr. Peter Hotez2:58

       Well, the, the difference with this one, uh, compared to the other two was this. The other two, SARS and MERS... Now we call this new one SARS II. So there was SARS 1, then MERS, then SARS II. 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 c- community. The, the difference with this one, ironically, is it... It's, it's pretty lethal. It's about five to ten times more lethal than regular flu, seasonal flu, uh, 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, are 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 and about in stores and restaurants and infecting everybody. And so this is what's caused the problem. Uh, it's a, it's highly transmissible and there's a lo- 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.

   19. JRJoe Rogan4:34

       Do we know why so many people are asymptomatic?

   20. PHDr. Peter Hotez4:38

       We don't. Uh, we really don't. Uh, there's a, a rough, uh, correlation with 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, 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, uh, quite know why. Also, but something that's very important, and one of the reasons why, uh, I really wanted to come on and talk to you about COVID, is we s-... 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 fir-... In 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-... uh, Spain of younger adults and we're seeing that play out in the US, and I know, and, um, the people who, you know, listen to you and watch you, 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.

   21. JRJoe Rogan6:09

       Well, we have a friend, uh, 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 COVID-19 in Manhattan and then flew back, got sick. And here's what's really... maybe you could help me with this, uh, 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 i- his words were, "I almost died." I mean he was really-

   22. PHDr. Peter Hotez6:53

       Yeah, yeah.

   23. JRJoe Rogan6:53

       ... really concerned. What-

   24. PHDr. Peter Hotez6:55

       Yeah.

   25. JRJoe Rogan6:56

       What about, what about ibuprofen?

   26. PHDr. Peter Hotez6:59

       So, uh, 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 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, uh, can, uh, it's a severe pneumonia, it could 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.

   27. JRJoe Rogan7:42

       That's exactly what happened to Michael. He got pneumonia. Um, 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 rumor start from and what, what is the concern with ibuprofen?

   28. PHDr. Peter Hotez8:02

       I, you know, and then, 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, uh, I say 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, uh, every day. So that's why, uh, you know, so many things I'm gonna say today, if I sound like I'm waffling or hedging it's, it's because I am. Uh, um, we're, we're, we're learning so much that's new about this virus so it's really important, uh, that everybody be really mindful and pay attention to real health information, uh, 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, uh, about four months ago and, um, we've learned about it in 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 it binds to. When we had the original SARS, we call this new one SARS2, the COVID-19... so the vi- the disease is called COVID-19, the virus is called SARS2, SARS Coronavirus 2. When we had the original SARS1, 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.

   29. JRJoe Rogan9:38

       That, I'm so glad you brought that up 'cause 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, i- i- it's, you, you, everyone's learning.

   30. PHDr. Peter Hotez9:53

       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 are, have some genetic differences to Europeans and, 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 too. 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, uh, is important and so we are keep... 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.
2. 15:00 – 30:00

   Boy, this, there's gonna…

   1. PHDr. Peter Hotez15:00

      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? Does va- is vaping also doing that and could that be linked somehow to s- the young a- all the young adults that we're seeing, uh, in the United States who are getting hospitalized? They don't actually have higher mortality, but they're still getting very sick and their lives are being saved because they're being intubated or 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.

   2. JRJoe Rogan15:33

      Boy, 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. Um, what about-

   3. PHDr. Peter Hotez15:50

      Yeah. That's, that's the reason I'm going o- been going on, uh, in between where, you know, we, I co-lead a team with my 20-year science partner, Dr. Mariana Bottazzi. We're trying to... We've de- 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, uh, and that's not an easy nee- needle to thread either going on Fox News, MS, MS- MSNBC and CNN. That's been really interesting, but, uh, I love the opportunity and, and I'm doing it because there's a lot of bullshit out. There's a lot of misinformation, trying to get accurate information and also explaining the science behind it 'cause sometimes you hear something that doesn't sound right and, and it sometimes takes a couple of minutes to, 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.

   4. JRJoe Rogan16:44

      That's great. Now l- let's talk about treatments that are being considered. Uh, we know that Z-Paks are one of them, uh, and chloroquine. Can you explain that?

   5. PHDr. Peter Hotez16:55

      Mm-hmm.

   6. JRJoe Rogan16:55

      And, and what went horribly wrong with the couple that took the wrong kind of chloroquine and, uh, turned out to be, uh, koi pond cleaner?

   7. PHDr. Peter Hotez17:04

      Okay. So let me, let me put... give you the framework for that so it makes some sense.

   8. JRJoe Rogan17:09

      Okay.

   9. PHDr. Peter Hotez17:09

      When we talk about all the interventions, you have things that are gonna be ready down the line, things that are gonna be ready a little closer, and things ready now. So and then, and then we can talk about one on o- and then I'll, I'll, I'll... We could... Let me give you the framework, then I'll t- t- answer your chloroquine question. So the highest bar there is in terms of financial investment required and 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 gonna 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 s- relatively safe-... and then showing that those drugs also work against the coronavirus and that's gonna 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, uh, antibody therapy, uh, which I've been pushing very hard on because I think we can actually have it going n- right now. So let's do the, um, uh, let's do the, the chloroquine hydroxychloroquine. This is a, a... 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... 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 it in, 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 treat- treatment of lupus and other autoimmune diseases. It... you can make a bucket of it. It's cheap. Uh, we know the safety profile. We know it can cause arrhythmias in some patient and other toxicities, but it generally has a pretty good safety profile. Um, 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 COVID-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, a colleague of mine is a fascinating guy. Uh, I, I'm, I, I really appreciate his work as a scientist. He's a very serious scientist in Marseille in France named Didier Raoult and he's, I don't know, must have published at least two or three dozen papers in the journal that I, uh, uh, founded called PLoS Neglected Tropical Diseases. 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, found that there's an effect. The problem was, 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." Uh, I, I'm not sure that's gonna 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, uh, you know, nothing to do with, uh, Dr. Professor Raoult is, you know, really important scientist, but it's a small study. We were there about a decade ago with influenza that this hydroxychloroquine also inhibited, uh, the influenza virus in the test tube, but then it didn't pan out in clin- in larger clinical studies. So I think we have to be really careful and don't be too quick to, to say, "Okay, this is, this is gonna be it." I don't... we're not, we're not even close to that yet, but we'll know in the next few weeks 'cause we're real- working hard to scale up, uh, clinical trials looking at that medicine.

   10. JRJoe Rogan21:18

       Now, um, in, in, in terms of vaccines.

   11. PHDr. Peter Hotez21:22

       No, but wait.

   12. JRJoe Rogan21:23

       Uh-

   13. PHDr. Peter Hotez21:23

       But there is a... there is a n- there is a new... there's something new though that we can do right now-

   14. JRJoe Rogan21:27

       Okay.

   15. PHDr. Peter Hotez21:27

       ... uh, that, that talk to you about. So this is, uh, something called convalescent antibody therapy and it was, and it was kn- it's been known for over 100 years and it was really, uh, scaled up during the 1918 influenza pandemic. You know, that terrible pandemic that killed hundred... tens of millions of people. It was shown that if you took individuals had r- who had recovered from the disease, who had gotten 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 if you gave it early on in the course of infection, it could prevent more serious infection and, 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, um, uh, a good friend and colleague who I've known for a long time, Arturo Casadevall, who's a brilliant, uh, professor of microbiology at Johns Hopkins, you know, started talking to me about, you know, "Peter, maybe we should be doing this for, uh, COVID-19." And, and as the numbers started going up, I said... I called him, I said, "Look, Arturo, I'm going on C- CNN tomorrow. Uh, uh, I, I think this is an opportunity to tell people about this." So I, you know, helped amplify, uh, uh, what he was doing. He had written a, a paper, uh, with a, with a colleague, uh, from Johns Hopkins, uh, Elise Sand-Pero- Perfo- I always get her... I always mangle her name, Perfoski, uh, uh, at, 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 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 it... and I think it helped to mobilize some action and now, uh, 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 amaz- you know, you might hear a lot of bad things about the FDA. I, 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, with Arturo to get this network together going at lo- at least among 20 academic health centers so that they're cl- identifying patients who've recovered, taking their blood, giving them back the red cells, collecting the plasma so that when people come in sick, uh, they can give treatment. And they'll have some clinical trial results, I hope, in the next few weeks, but I'm really optimistic a- about that one for, 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, uh, to prevent them from getting sick 'cause you're hear- I mean, I don't know the percentage now of first responders, uh, in New York and that's why they turned the Empire State Building into a siren last night and, and to, to honor all of the, all of the first responders who've gotten sick. We knew this was gonna happen, maybe this, this could help them so I think that's gonna be really important as well.

   16. JRJoe Rogan25:08

       Now, c- the French government, I was reading an article this morning that they've sanctioned chloroquine as, uh, an official treatment and, uh, that they're, they're having some good results with that. Are, are people currently using that in the United States? Are doctors prescribing that with CPAC?

   17. PHDr. Peter Hotez25:21

       It's, it's, there's, 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, uh, you know, I just, I think the... and, and may- and maybe it'll turn out to be a, a, a good treatment, uh, but the evidence is, is not strong, uh, the, there's a study in Shanghai that s- suggested it didn't work, so we really need well-controlled s- uh, 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 gonna work, how you pair it with Azithromax, so it's gonna 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, uh, a, a new virus pathogen that we've never seen before while the epidemic is raging, while the pandemic is raging. It's re- we, we've, we don't have a lot of track record doing this. We did it o- uh, once, uh, with Ebola, uh, if you remember in 2014 there was a, 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, uh, Merck & Company, uh, that looked pretty promising. They had licensed the technology from the Canadians, this group in Manitoba of Public Health, uh, 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's not very transmissible, you just have to have some healthcare infrastructure, make certain that you're not directly handling the, the corpse of someone who's recently, uh, died from, from Ebola virus infection and the e- and we even sent in the 101st Airborne, uh, Division. We sent in the, the Screaming Eagles which made a big impact on helping to, uh, sa- you know, save West Africa from this infection. So the WHO came in, uh, there was, uh, UNICEF, there was, uh, Doctors Without Borders, lots of... I'm sorry, um, the Israeli 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 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, uh, which was under conditions of terrible conflict and war and political strife and, uh, uh, c- civil, civil war, uh, they vaccinated 200,000 people with this vaccine and it largely helped, uh, eliminate Ebola from Democratic Republic of Congo in that, in that during those hostilities last, last year and, uh, essentially saved, uh, I think it s- helped to stabilize the whole African continent, um, so it's an amazing, uh, story and again, it was this multilateral effort that involved also just the US government, the NIH and BARDA and, and all of these organizations, it's an extraordinary story and as a result, uh, we really s- helped stabilize, uh, uh, sub-Saharan Africa but look at the timeframe, 2014 first epidemic to 2019, that's fi- that's five years. That's a more realistic timeframe, uh, for a vaccine just to give people a sense of perspective.

   18. JRJoe Rogan28:59

       Peter, one of the things that I was reading about Wuhan is 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. Uh, are we learning... I mean, obviously we're learning about this is a new virus but is it, 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?

   19. PHDr. Peter Hotez29:29

       We don't know. I think there's a high likelihood, uh, that they're not getting re-infected once they develop antibodies but we don't know for sure. The problem with respiratory virus testing is, is this, uh, we, we've n- and we a- and there 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 rare- rarely cause serious illness deep in the lungs

3. 30:00 – 45:00

   Peter, uh, i- is…

   1. PHDr. Peter Hotez30:00

      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, 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, it takes a lot of time to do the quality control and really figure out all the testing and the Gates Foundation has a, a very significant, uh, 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, other respiratory pathogens. It's not as straightforward to diagnose respiratory, uh, infections as it is, uh, as it is, say, for things that are in the blood 'cause a lot of these respiratory viruses never get actually blood-borne so you're sampling, uh, mucus from the nose or, or the, or for your washings from the mouth, the throat. There's probably inconsistency in the sampling. So, so it's really problematic and I think that may have been partly responsible for some of the delays is the CDC trying to work it out, uh, and get it perfect and it just took longer than maybe perhaps they expected.

   2. JRJoe Rogan31:31

      Peter, uh, i- 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, we never let something like this ever happen again?

   3. PHDr. Peter Hotez31:49

      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-

   4. JRJoe Rogan31:59

      Right, but nothing's ever shut down the country like this.

   5. PHDr. Peter Hotez32:02

      After COVID in 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 Heymann, who's, uh, 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 th- and they put that in place and a global health security agenda and now we have this thing called CEPI, this Coalition for Epidemic Preparedness Innovation. So there's no question things are a little better th- uh, better, substantially better than they were, but it's still not enough. It's still n- 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 'cause 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 I, we spoke about last time, uh, 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. Uh, this leaves it to, you know, smaller biotechs which are mainly focused on accelerating their unique technologies or this handful of non-profits like ours at Texas Children's and Baylor College of Medicine. We call it our Texas Children's Center for Vaccine Development at Baylor, uh, College of Medicine and, uh, 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 s- 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 into, of clinical trials. Uh, so it's, it's, it's definitely problematic.

   6. JRJoe Rogan34:06

      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 this-

   7. PHDr. Peter Hotez34:15

      Yeah. Well, well, well-

   8. JRJoe Rogan34:15

      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 gonna be it because this is devastating for everybody.

   9. PHDr. Peter Hotez34:24

      You, you would think so, but I'm... And I'm hopeful that things will change, but we'll, we'll have to see. I mean, so far we've had some good responses in terms of our vaccine. We've gotten, uh, contacts from a few individual donors, uh, so we're in those discussions, but it's still been really tough to, to, to move it forward even with a crisis going on like this.

   10. JRJoe Rogan34:44

       Have we stopped you from eating fast food because of this?

   11. PHDr. Peter Hotez34:49

       Well-

   12. JRJoe Rogan34:49

       'Cause I know you've had a terrible diet and we were joking around about it.

   13. PHDr. Peter Hotez34:53

       Well, well I'll tell you, you know, I have an interesting... Uh, I, I've actually lost about six pounds since-

   14. JRJoe Rogan34:58

       Hey.

   15. PHDr. Peter Hotez34:58

       ... th- the start of this epidemic and I think, well one is I'm, I've stopped sleeping, right? 'Cause I'm waking up, doing teleconferences, uh, with Asia or Europe and going to bed with teleconferences with, with Asia trying to, you know, figure out how we're gonna do our vaccine and not... And we're making a unique vaccine that's a low-cost one that would be used not only in the US but, but globally and then all the calls and everything else and, and the one good thing, uh, is, is that I've stopped traveling and I realized that the travel was really knocking the crap out of me in ter- in terms of my health. So-

   16. JRJoe Rogan35:34

       Yeah, we 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-

   17. PHDr. Peter Hotez35:44

       Yeah.

   18. JRJoe Rogan35:44

       It's, it's amazing what an impact it has on your health to travel all the time. Negative impact.

   19. PHDr. Peter Hotez35:48

       Yeah, the travel really knocks... So it's, you know, we've got a, a group of scientists really dedicated. Even though, uh, the labs are largely closed down at Baylor and Texas Children's, we got special permission 'cause they're working on the COVID vaccine, so they're coming in. This amazing, dedicated group of scientists. Um, and then I've been basically, you know, on teleconferences all the time. I, I said to my wife, Ann, I said, "I feel like I have to press *6 just to talk to you." (laughs)

   20. JRJoe Rogan36:15

       (laughs)

   21. PHDr. Peter Hotez36:16

       It's, it's, it's just been so crazy and then, uh-... 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 have sort of this weird subterranean existence right now. I mean, the g- the good news, you know, the- the thing that people I feel so terrible for are those who, you know, now are not getting paychecks, uh-

   22. JRJoe Rogan36:34

       Yeah.

   23. PHDr. Peter Hotez36:34

       ... because of this crisis and, and there are 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, or, uh, uh, all- all those things, uh, the dry cleaners and all that kind of stuff. I feel so bad for them 'cause I'm sure they don't have much of a safety net at all.

   24. JRJoe Rogan36:58

       No, w- there's n- never been a time where it's no one's fault, but half the country's outta work, at least.

   25. PHDr. Peter Hotez37:05

       Yeah. Yeah, it's not-

   26. JRJoe Rogan37:05

       You know what I mean? It's not, it's not like anybody did anything wrong. Like, you could've 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.

   27. PHDr. Peter Hotez37:19

       Yeah, no, it's just so heartbreaking and we're hearing so many heartbreaking stories. I mean, the- the good news is, you know, the- the White House and Congress, it's the one thing they all seem to be collaborating on is getting that stimulus package out there to people who need it and, uh, I- I hope, I hope there's some, some funds for those people, but it's-

   28. JRJoe Rogan37:38

       Yes. I- I hope so too. Uh, what- what's your take on Sweden, and Sweden's, uh, th- 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- they're experiencing a spike in cases?

   29. PHDr. Peter Hotez37:59

       Yeah, I mean, the problem g- again, is without a vaccine or 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, and coming from Asia Minor and they were fearful they were bringing plague and they kept the ships for 40 days. That's the word, 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, uh, Marc Lipsitch, who's a brilliant, uh, epidemiologist at Harvard has been, you know, doing a lot of analyses and modeling and one of the things he's shown is that, you know, when he looks at the cities in China, for instance, where they did social, uh, distancing and other aggressive measures, and some of them were pretty aggressive that you couldn't even do in, in the United States, but they showed that the longer you allow transmission to go on, uh, 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 think, I forget the exact numbers, I think he's f- found about six weeks of transmission going on before you intervene, then it was lights out. It was a massive surge and hospital systems getting overwhelmed and a lot of healthcare workers getting sick and, and I wanna come back to that point af- 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. Uh, th- that's how the dramatic a difference. So, that's a lesson we need to learn for the US is, uh, 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 US is more of an urban/suburban versus rural divide. Uh, we're seeing the big surges in ICU patients more in cities than 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 gonna 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 sum- unfortunately, we've often found out that transmission is going on for several weeks only when a lot of ICU patients started hitting the door. So, this is what happened in New Orleans, this is what happened in, is probably happening in Detroit. The mayor of Atlanta just said, you know, "All of a sudden we've had all of these people show up in, in, in the I- in the ICU." So that's 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, if you wanna 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 gonna have to do." And the models, uh, are showing now... (audio cuts out) Oregon Institute, uh, at- at in Washing- Seattle, Washington called the Institute for Health Metrics and Evaluation and it's, uh, they've now been, uh, looking at this c- they, they do all these amazing things to look at the, uh, uh, not only epidemic diseases, but also chronic noncommunicable 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 s- 19 site and what they're showing is that they anticipate the peak of this epidemic in the US is gonna hit about the middle of April, so we're not even at the peak yet, uh, and so we're lo- another two weeks, uh, of this is gonna continue to go up and in some places, like in Texas, it's gonna be delayed. It's probably gonna be around, around May 2nd and I think California was, was around there as well. So-... their numbers say it's gonna be the next two months that are gonna be the crunch time when it's gonna start really going up and then, as we move into later in May, uh, it'll start to go down and maybe really bottom out by, 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, "Okay, I understand I said Easter, now we're gonna go to April 30th." And my point is, well, April 30th s- things are still gonna be peaking in parts of the country. Let's use April 30 as a, as a time to reassess and then make a decision whether we go another month. So let's go a month at a time for now until we know where this is heading.

   30. JRJoe Rogan43:05

       W- how long can we go? I mean, w- what, if you, uh, if, if ... Look, 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?
4. 45:00 – 1:00:00

   Is there any other…

   1. PHDr. Peter Hotez45:00

      ano- example of another seasonal virus, influenza, you know, which peaks of course in the winter then goes down, uh, in the summer months. It never really disappears but it, it, 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, start showing a, a pattern like that. And then the question is does it come back year after year after year like flu does, uh, or, or and has shown some kind of seasonality? These are all scenarios that, that are being looked at. So for instance our, our vaccine, if it's used, uh, and goes s- you know, goes through all the clinical testing hurdles probably is not gonna be used for this 2020 epidemic. If it's used at all it's gonna be used in the out years, um, if, if this virus starts to come back o- on a regular basis.

   2. JRJoe Rogan45:59

      Is there any other way to handle this in terms of, uh, quarantining or social distancing? Like is there ... Would there, would it be possible to quarantine the people that are m- are at most risk instead of the general population?

   3. PHDr. Peter Hotez46:16

      Well, the p- 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 we as a, as the Centers for Disease Control has been reporting, uh, 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, the children generally are, children adolescents seem to do pretty well with this virus, now we realize, uh, from studies coming out of China that was published in, uh, 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 with underlying diabetes and 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, it becomes impossible to do it.

   4. JRJoe Rogan47:35

      Is it, uh ... One of the things that's come up about this is people are now aware, um, um, 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. Um, you know, like wh- uh, do you know the numbers? Like what, what, different-

   5. PHDr. Peter Hotez47:56

      Yeah, so um, you know, seasonal flu is really bad. It's, uh, uh, and it varies year to year d- different virulence of the flu. So it usually goes between 12 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, uh, and, and death, so that's an important message to get out. The numbers here unfortunately are looking worse so if you-

   6. JRJoe Rogan48:27

      Can I pause you for a second?

   7. PHDr. Peter Hotez48:28

      Yeah.

   8. JRJoe Rogan48:28

      How does that, how does that work? How even if-

   9. PHDr. Peter Hotez48:30

      Well-

   10. JRJoe Rogan48:30

       ... it's not matched up to this, the, the correct seasonal flu, how does it-... prevent you from being hospitalized?

   11. PHDr. Peter Hotez48:37

       Because it, it's partially protective. So if you imagine, uh, a virus that has all of these different pieces to it, uh, and, uh, and the an- 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, in a less than perfect match, only some of the antibodies, uh, target the virus and therefore it's partially protective and can-

   12. JRJoe Rogan49:02

       Okay.

   13. PHDr. Peter Hotez49:02

       ... you know, ha-have a, have a partial effect. And, um, so what was I gonna say? Oh, so the, the institute for... And now the numbers of the, 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 10 times the number of Americans... I, uh, forget about American. Four to 10 times COVID... S- the SARS-2 virus that causes COVID-19 is, uh, four to 10 times more lethal than regular flu, so that'll give you the bracket. So the, the minimum is 12,000 from flu, the minimum that's gonna 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, uh, from the White House press conference they're saying maybe 100 to 200,000 Americans could die. Uh, I think it's probably, uh, I, I like the Institute for Health Metrics' numbers that just came out. They say 84,000 Americans will die, uh, in that peak season going from, uh, April, May, may and June and then, but we don't know what'll happen again, uh, uh, in the out year. So the point is a lot of Americans are gonna die. Uh, 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, 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 a new virus pathogen it's hard to get all, all the assumptions right. But the point is, many more people will die of this virus than even in a bad flu season.

   14. JRJoe Rogan50:39

       Um, I think people are concerned that this is kind of setting a precedent and that this is gonna be something that we have to do in the future. Is there a way to prevent something like this, uh, a full shutdown of the, of the country to happen in the future?

   15. PHDr. Peter Hotez50:53

       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, the 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 a... uh, uh, uh, an NIH with a budget of $36 billion annually. We need to have a pipeline of technologies getting ready for this, uh, e- epidemic. We, we should have, um... You know, if we had, you know, all the funding we needed for a coronavirus vaccine program, we would have had several coronavirus vaccines in clinical trials and potentially we could've combined them in a way to be ready to go now. Um, so having, figuring out a way to support organizations that don't... are, are, that are looking at vaccines and other countermeasures, not in terms of products that they can sell, but that are gonna help the, uh, help the health security of the country I think is, 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, uh, uh, illnesses from emerging infections like this one and poverty-related neglected diseases actually in the G20 countries, the G20 economies. The 20 wealthiest economies, u- 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 'cause that's all we have, otherwise we go b- again, back to the 14th century in terms of social isolation.

   16. JRJoe Rogan52:59

       Uh, it seems one of the critical aspects of getting through this is having a strong immune system. What, uh, what emphasis, if any, uh, 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?

   17. PHDr. Peter Hotez53:18

       Cer- you know, certainly keeping the body healthy is, 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, 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 'cause the virus has already done incredible damage to your lungs. So no question about it, don't smoke, don't vape. You know, drinking in moderation and, and, um, uh, you know, keeping, keeping fit. You know, avoiding hypertension and, and diabetes if you can, especially type 2 diabetes is... Not everybody can do it and there's some genetic predisposi- dis- disposition to it, but if you can keep your body healthy, that will definitely stack the deck in your favor.

   18. JRJoe Rogan54:23

       I was reading something about, uh, 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?

   19. PHDr. Peter Hotez54:36

       That, that's, that's a new one for me. That's just a new one.

   20. JRJoe Rogan54:37

       That's a new one for you?

   21. PHDr. Peter Hotez54:38

       Interesting idea, yeah.

   22. JRJoe Rogan54:39

       Now, w- as far as yourself, like w- I joked around about the, the fast food stuff because, uh, we joked around about that last time you were here, but have you, uh, altered your approach to food because of this and diet?

   23. PHDr. Peter Hotez54:52

       I, I, I, well, I have, um, partly because I've been so upset and so anxious to eat, uh, that, you know, I've, I've, it's just been a, been a... Teleconferences and my wife will actually... I, we set up a little study here in our, in our bedroom and, uh, it's not much but, uh, my wife will just bring me a plate of floo- food and I'll just, you know, eat it and then whatevers. 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, and I'm so worried about all of these healthcare providers who are getting sick that, you know, I just don't even wanna eat. Uh, 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 where COVID is heading and then I'm on teleconferences all day trying to figure out how we accelerate this vaccine. And I... It's interesting, I've even noticed that, uh, I've become a lot more emotional, uh, in my meetings. Uh, and, uh, uh, you know, I'm known as a pretty even-tempered person, never getting upset. I've gotten really upset a few times, uh, 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. Uh, and a- and a lot of them are, are, are my former students, my medical students. Uh, and, you know, I remember, you know, we have so- in, in medicine, we 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 gonna 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 to do residency?" And, and a lot of them, I would say, "You know, it's great spending some time in New York." Uh, you know, I did my MD and my PhD in New York. I met my wife in New York. It's a great city, great medical centers, Mount Sinai and Columbia and Cornell and NYU and Einstein. It's fantastic living in the city and, and I'm really like, "What the hell did I send them into?" Uh, they're, they're there with no, with inadequate protective equipment, um, you know, scared as hell of getting, getting sick or, or worse and, and being overwhelmed by patients. Uh, I think I said on, I forget if it was CNN or whether 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 in New York. Of course, you can never know what, what was gonna happen but, uh, that's been bothering me as, as well as, so, so this has been a very emotional time for me.

   24. JRJoe Rogan57:44

       The lack of sleep also has, uh, a big impact on the, the immune system.

   25. PHDr. Peter Hotez57:49

       Oh, yeah.

   26. JRJoe Rogan57:50

       Hasn't it? Yeah.

   27. PHDr. Peter Hotez57:50

       It really ****** up your immune system, no doubt about it.

   28. JRJoe Rogan57:53

       Now with you, uh, i- is it simply just, uh, 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?

   29. PHDr. Peter Hotez58:11

       Yeah, no question. Well, I've looked in... Well, f- one of the reasons is a practical matter 'cause I've been doing, um, some evening TV, uh, interviews and, and they're great opportunities 'cause 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? (laughs)

   30. JRJoe Rogan58:31

       No.
5. 1:00:00 – 1:11:35

   Well, so what happens…

   1. JRJoe Rogan1:00:00

      is the damage that this virus does to the lungs and, um, to, to the heart as well. What... There's scarring on, on people's he- uh, lungs, uh, d- d- talk about that and what, if anything, can be done to try to heal those people post-infection?

   2. PHDr. Peter Hotez1:00:18

      Well, so what happens is, uh, 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 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, in the lung, which is actually, uh, an enzyme called an acetylcholinesterase and then 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, uh, toll-like receptors which cause a lot of inflammation.And so you're seeing a big inflammatory response to the com- to the virus. So the two components are, are a lot, 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 'cause it can maybe suppress the inflammatory component whether it clinically has the ability to make a difference, I th- I think the jury's still out yet. But, uh, so you've got those two things going on. The other thing that's happening beside ... 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, is there's been a lot of reports ... And by the way, you can, anybody can download this. There's this fantastic pre-print server called bioRxiv and medRXiv. It's put out by Cold Spring Harbor Laboratories. It's ... 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 out by Cold Spring Harbor Laboratories. So scientists have been great about sharing information. They're putting all their stuff up on these pre-print 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, uh, a lot of heart injury where they're ... 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-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, that are getting, uh, knocked out. There's also some evidence that the virus can go into the intestinal tract, uh, as well. And so that, uh, could actually be a potential m- route of transmission, uh, uh, 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.

   3. JRJoe Rogan1:03:35

      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?

   4. PHDr. Peter Hotez1:03:44

      Yeah. I think, you know, there are ... And there, there's a question of whether steroids actually help or hurt. Steroids are always a mixed bag because steroids, uh, s- 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, of virus particles potentially. So people are definitely looking into steroids, uh, other, uh, anti-inflammatory drugs, but, you know, those who survive this, and fortunately most do, uh, you know, you'll find that they're ... 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 pneumonias, it's not because they're still infected with the virus, it's all that scarring is, is ... It takes the body a long time to remodel all the scar tissue, uh, and, and before the coughing stops. So we can anticipate that happening as well.

   5. JRJoe Rogan1:04:41

      But do we think it's possible to fully recover from this for people that do experience these lung scarring issues?

   6. PHDr. Peter Hotez1:04:47

      Yeah, I think so, especially for younger people. Uh, for older people, you know, they may have some permanent pulmonary deficits, but we don't know. It's still too early in this, uh, in this, uh, epidemic to know.

   7. JRJoe Rogan1:04:59

      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 d- d- dealing with the immune systems, finding out which people are genetically more predisposed to the virus?

   8. PHDr. Peter Hotez1:05:11

      They are just trying to buy time and, uh, you know, typically it can take years and years to figure all of this out. And we're all ... You know, everybody's, uh, working overtime trying to fi- try to make a contribution figure, figure this out. The great news is the, the data sharing among scientists has just been a- been amazing. Everyone's, you know, putting aside their ego, putting all their stuff up on bioRxiv, medRxiv and, and the, and the major journals are doing incredible things also expediting, uh, publication of papers so, you know, the, 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, uh, ens- ensuring quality and, and, and a level of peer review, R plus family of journals, Public Library of Science. So, so in a few ... 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 their ... the stuff that they're publishing could be lifesaving in responding to a public health crisis, I think that, that's been a nice part of the story.

   9. JRJoe Rogan1:06:24

      I'm hoping so much of what comes out of this is a wake-up call, so much of, uh, the, the new-found understanding and appreciation for the science behind dealing with these diseases, uh, 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, and recognize the good work that people like you have been doing and also, you know, that this is ... We're ... 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.

   10. PHDr. Peter Hotez1:07:01

       Right. That's right. I think, you know, maybe this will help us reassess some of our values and, and, you know, appreciate the s- some of the, some of the things that the healthcare professions especially are doing and, you know, you're seeing people volunteer, you know, to ... They're going right, you know, right into the belly of the beast. You know, people, you know, who might have subspecialty practices ...... just said, "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.

   11. JRJoe Rogan1:07:32

       Why have there been such a shortage of masks and safety equipment for healthcare workers?

   12. PHDr. Peter Hotez1:07:40

       Hmm. Uh-

   13. JRJoe Rogan1:07:40

       And how, how did this ever happen?

   14. PHDr. Peter Hotez1:07:43

       Well, we just, we didn't get ready for the surge in time. I think, uh, you know, I think, you know what? I'm sorta 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 gonna be really important that Congress, after this, uh, 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 h- 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 gonna 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, uh, in, in order to get ready and, and what didn't we do? And, and, and now's not the time to do it because the, the last thing you wanna do is start distracting people and worrying about, you know, congressional hearings and, and that sort of thing. But when all this is said and done, it, it has to be d- it has to be done in the right spirit, not... Again, we have to figure out a way to stop these partisan lines and say, you know, as a, as a country, we've gotta figure out how to work together. I know that sounds Pollyannaish 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, uh, for, for 10 years and, ah, 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 Kar- Kansas. Very conservative Republican Senator. Walk across the hall and go talk to Senator Leahy's people from Vermont or S- Sherrod Brown's people and, um, you know, far, 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, and it's tearing apart our country. So, I hope the other thing that we, we get out of this is, uh, figuring out a way that Republicans start talking to Democrats again and Democrats talk to Republicans again, uh, and, uh, and figure that out as well.

   15. JRJoe Rogan1:10:16

       Well, Peter, I, I appreciate your time and I kn- 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?

   16. PHDr. Peter Hotez1:10:25

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

   17. JRJoe Rogan1:11:16

       Well, we're, we're very, very grateful for you, Peter, and, uh, let's talk again in person during better times.

   18. PHDr. Peter Hotez1:11:22

       Abs- absolutely.

   19. JRJoe Rogan1:11:23

       Thank you, sir. Take care and, uh, be safe out there.

   20. PHDr. Peter Hotez1:11:27

       A- all the best. God bless.

   21. JRJoe Rogan1:11:29

       All right. Bye-bye.

Episode duration: 1:11:36