Joe Rogan Dr. Peter Hotez COVID-19 Podcast Interview Transcript

Joe Rogan: (00:01) Dr. Hotez, how are you sir? Dr. Hotez: (00:03) It's great to see you again, Joe. Always I feel a lot better seeing you now. Joe Rogan: (00:07) I feel a lot better seeing you too. Especially with the bow ties we talked about before, your signature touch. Dr. Hotez: (00:12) Yeah. As I was saying, I tried to start wearing a regular tie for a while. It was like when Dylan started switching to electric instruments at the Newport Folk Festival and there were just cries of outrage. So I had to- Joe Rogan: (00:24) What cries of outrage that you getting about your bow tie, especially in these trying times? Dr. Hotez: (00:29) No, no, they like the bow tie. 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. Joe Rogan: (00:35) Yeah, that's what I meant. I screwed it up. But I meant like who's getting upset at you wearing a regular tie? Those people need to get a life. Dr. Hotez: (00:42) I think it was meant in and in a good natured way [crosstalk 00:00:45]. Joe Rogan: (00:45) I'm sure. So we don't do very many of these Skype ones because they're odd. So I don't know if you've done too many of these, that sometimes people talk over each other. It's very strange. Dr. Hotez: (00:57) Yeah, I guess it's the epidemic, right? Otherwise I'd be on a plane and come to see you in LA and- Joe Rogan: (01:04) Yeah, we'll do that again sometime. So let's get going. So taking it from the top, let's discuss, give us your take on how we got here because it's been very strange. Obviously the president completely miscalculated what was going to happen and the way he was explaining it to the news, he was kind of saying that it was just a few cases and there'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. Dr. Hotez: (01:39) Well, the truth is we knew this was coming or something like it. We had a heads up and even a heads up before last year, because this is now our third major coronavirus disaster of the 21st century. We had a 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 MERS coronavirus infection in 2012 and this is the third one. Dr. Hotez: (02:17) So we actually realized that coronaviruses were going to become a new thing and we embarked on a big coronavirus vaccine program a decade ago. And each time they've caused devastating hospital epidemics, they've affected healthcare workers. So the point is, this unfortunately has become a new normal for the globe, is terrible coronavirus epidemics. And we saw this one coming up in the end of 2019 in China and I knew we were in for trouble because that's what coronaviruses do. Joe Rogan: (02:51) 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? Dr. Hotez: (02:58) Well, the difference with this one compared to the other two, was this the other two, SARS and MERS, now we call this new one SARS-2. So there were SARS-1, then MERS, than SARS-2. So both SARS-1 and MERS made you so sick and had such a high case fatality rate that anybody who got it was almost immediately hospitalized and basically out of the community. The difference with this one ironically is it's pretty lethal. It's about five to 10 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. Dr. Hotez: (03:53) 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 and about in stores and restaurants and infecting everybody. And so this is what's caused the problem. It's highly transmissible and there's a big group of people walking around spreading it and a smaller subset, but a big subset, who are getting very sick and even dying in intensive care units. So that's what's playing out in New York City right now for instance. Joe Rogan: (04:34) Do we know why so many people are asymptomatic? Dr. Hotez: (04:38) We don't. We really don't. There's a a rough correlation with age. So younger people seem to do better and actually kids seem to do really well with this infection with one exception that I'll tell you about in a minute. Most kids don't get very sick at all, but they're helping with the community spread and we don't quite know why. Dr. Hotez: (04:59) Also, but something that's very important and one of the reasons why I really wanted to come on and talk to you about COVID is there's this buzz out there in the community that it's only old people that are getting sick and dying and going to ICUs. But in fact, the Centers for Disease Control came out with this very chilling document a few weeks ago showing that about a third of the very sick people in the hospital are under the age of 40 or 44. So between 20 and 44, young adults, are getting very sick and that word has not gotten out adequately because when 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 and Spain of younger adults and we're seeing that play out in the US. And the people who listen to you and watch you, it's a big group between that age of 20 and 44 and they really need to hear that they're at risk for severe illness despite what they might've heard previously. Joe Rogan: (06:09) 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 COVID-19 in Manhattan and then flew back, got sick. And here's what's really, maybe you could help me with this, he said he was feeling terrible and then took Advil and it got exponentially worse. Is that coincidental, do you think? I mean there's been talks of avoiding ibuprofen. Michael's 45 years old, very healthy, very robust guy. So I mean he was in the hospital for a week and his words were, "I almost died." I mean he was really, really concerned. What about ibuprofen? Dr. Hotez: (06:59) So there's been a lot of buzz on the internet about ibuprofen and then the World Health Organization came out with a specific statement saying those are rumors. So there's not a lot of evidence to say that you get worse with ibuprofen. Probably he was just one of those young adults that's going to get very sick. And that's what this virus does. It has the ability to get deep into the pulmonary system in your lungs, binds to receptors on the cells of your lungs and causes a terrible pneumonia. And on top of it you get a big inflammatory response. So severe pneumonia 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. Joe Rogan: (07:42) That's exactly what happened to Michael. He got pneumonia. So there's a rumor that you shouldn't take ibuprofen, but is that unfounded? Are you advising people to take ibuprofen? Do you think they should just avoid it just in case? And where did this rumor start from and what is the concern with ibuprofen? Dr. Hotez: (08:02) I don't know and then you've got the problem, some people also say don't take aspirin because if this is a respiratory virus infection, there could be a severe reaction with aspirin as well. So for now and I'll say 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 so many things I'm going to say today, if I sound like I'm waffling or hedging, it's because I am. We're learning so much that's new about this virus. So it's really important that everybody be really mindful and pay attention to real health information, that from accurate sources because things move, things change as we learn more about this. Dr. Hotez: (08:58) This is a virus that we didn't even know existed about four months ago and we've learned about it in an incredible period of time. The Chinese put up a lot of information on these preprint servers about what the virus is, what the sequence is, the genetic code, what the receptor it binds to. When we had the original SAR, we call this new one SARS-2. So the disease is called COVID-19, the virus is called SARS-2, the SARS coronavirus-2. When we had the original SARS-1, it took us over a year to learn all that information. Now everything has been compressed in a few weeks. So it's really extraordinary. But there's still so much we're learning right now. Joe Rogan: (09:38) I'm so glad you brought that up because that is really important for people to understand, people that maybe haven't looked into the complications that are involved in trying to recognize treatments and cures for a virus. That it is, everyone's learning. Dr. Hotez: (09:53) Yeah. And also everything we have known so far about the virus is what happened in China, and it turns out the Chinese have some genetic differences to Europeans and Americans, and things can change depending on, it's not just the pathogen, it's also what we call the host, the person, too. So the fact you know that the virus affected young adults in Europe and the US in a way that did not necessarily occur in China is important. Dr. Hotez: (10:24) And then who knows what happens when this virus goes into Latin America or India or Sub-Saharan Africa. And it's not because the virus is mutating necessarily, it's just that there's also the host component as well, which is quite important. Joe Rogan: (10:37) Well, that's one of the issues that people are having in terms of blood type. There's all this talk of certain blood types may be more susceptible to the virus, particularly Blood Type A. Dr. Hotez: (10:49) Yeah, well actually this is actually well known in the infectious disease literature. I put one up on Twitter, I think a week or so ago. There's dozens of different pathogens, including viruses and bacteria, that behave differently depending on a person's blood type. So host genetics influences things quite a bit. No question [crosstalk 00:11:12]. Joe Rogan: (11:13) Now let's talk about Germany because I found that really fascinating when I was reading on Germany and their low mortality rate. What do you attribute that to? Is that the extraordinary health care they have there or what is that? Dr. Hotez: (11:30) Well, let me give you first the opposite side of the coin and then we'll talk Germany. So the opposite side of the coin, what's happening in Italy, in Spain, 10% mortality. So 10% of the people who are being diagnosed with COVID-19 have died, which is higher than just about anywhere else. Dr. Hotez: (11:49) I think what's happened there is when the health system so overwhelmed, so in other words, if transmission goes on for a long time and you haven't picked it up and then all of a sudden people start showing up in the ICU, then it's too late. Then you start having massive numbers of people come into the ICU. The hospital can't take care of everybody. They can't intubate everyone. They can't give everyone the highest quality care possible. It's no fault of the doctors and nurses. They're heroes, but the fact that they're completely overwhelmed with patients, that's when mortality starts to really rise. Dr. Hotez: (12:26) 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 of that it's been more younger people getting it and the fact that the hospital system was getting ready and they've got that infrastructure in place to manage that surge. Although their worried now too, that it may start going up and overwhelming things. Dr. Hotez: (12:55) And then you look at, okay, so if that's true, what's the story on the mortality rate in the United States? An interestingly so far, one of the highest has been New Orleans. And I think what happened there was they kept the Mardi Gras open, they had lots of mixing, and large numbers of people getting infected. Number one, it overwhelmed the health system just like in Italy. And so in New Orleans right now the case fatality rate is between four and five. But there's another factor going on in New Orleans, lots of people living in extreme poverty, and poverty is very linked to diabetes and hypertension. And we know diabetes and hypertension is a big risk factor for death. So New Orleans is getting hit twice, one because the health system's 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. Dr. Hotez: (13:51) So I was just on the phone today with the leadership of Houston and saying, "We have a similar demographic to New Orleans in many ways. We're sister cities after Katrina, kind of linked at the hip. And they're our sister city, we love them, but we have to recognize that even if we can handle the surge with our Texas Medical Center, we still have that demographic of African Americans, Hispanics with underlying diabetes and hypertension. I'm really worried we're going to see high mortality in Texas. Joe Rogan: (14:23) Now is another factor with Italy and their high mortality rate smoking? Because when I was in Italy I was stunned by how many people smoke. Young people, old people, it seemed like a large percentage of the population smoked. Dr. Hotez: (14:36) Yeah. I'm really glad you brought that up. I've should have remembered to say that. So yeah. So for instance, Chinese, older Chinese men, had really high mortality rates. And here's something very interesting. Smoking actually upregulates the receptor in the lungs that the virus spines to. So it seems to make more copies of the receptor for the virus to bind to, so that may worsen the disease. So I think you're right. I think smoking is a factor. Dr. Hotez: (15:06) The one question that we don't know is what does vaping do? Is vaping also doing that and could that be linked somehow to all the young adults that we're seeing in the United States who are getting hospitalized? They actually don't have higher mortality, but they're still getting very sick and their lives are being saved because they're being intubated and put on the vent. But is there a vaping connection? Again, new question. We don't know. It's something that's going to have to be looked at. Joe Rogan: (15:33) Boy, there's going to be a lot to unravel when all this is over and along the way, people are dealing with a lot of misinformation, which is one of many reasons why I'm so thankful for you, for coming on the podcast and trying to educate us on this thing. What about- Dr. Hotez: (15:50) Yeah, that's the reason I've been going in between where I co-lead a team with my 20 year science partner, Dr. Maria Elena Bottazzi. We develop vaccines, including coronavirus vaccines. We're trying to get those out the door in clinical trials. In between I'm going on Fox News, MSNBC and CNN, and that's not an easy needle to thread either going on Fox News, MSNBC and CNN. That's been really interesting. But I love the opportunity and I'm doing it because there's a lot of bullshit out there, there's a lot of misinformation. Trying to get accurate information and also explaining the science behind it because sometimes you hear something that doesn't sound right and it sometimes takes a couple of minutes to explain that. And those three cable news networks have been great about giving me some time to explain the thinking behind it, which they ordinarily wouldn't do. Joe Rogan: (16:44) That's great. Now let's talk about treatments that are being considered. We know that Z-Pak's are one of them, and chloroquine. Can you explain that and what went horribly wrong with the couple that took the wrong kind of chloroquine and it turned out to be a koi pond cleaner? Dr. Hotez: (17:04) Okay. So let me give you the framework for that so it makes some sense. When we talk about all the interventions, you have things that are going to be ready down the line, things are going to be ready a little closer and things ready now. So and then we can talk about one and then I'll ... let me give you the framework then I'll answer your chloroquine question. Dr. Hotez: (17:25) So the highest bar there is in terms of financial investment required, and time to show safety, is a vaccine. So that's what we're doing and other groups are doing. Next tier down, that's going to be 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 re-purposing existing medicines that we already know are relatively safe and then showing- Dr. Hotez: (18:03) Now are relatively safe and then showing that those drugs also work against the Coronavirus and that's going to be the [inaudible 00:18:08] category, and I'll get to your question and then the nearest ones, the one that we could do now is what's called this convalescent antibody therapy, which I've been pushing very hard on because I think we can actually have it going right now. So let's do the chloroquine hydroxychloroquine. This is, and that's one of the repurposed ones. That's not the lowest hanging fruit, but the next lowest hanging fruit. This is a medicine that's used for malaria. It's an anti-malarial drug. It's been around for decades. In fact, the World Health Organization was going to had in the 1960s proposed an elimination strategy for malaria to treat everybody with chloroquine until we had chloroquine resistance and that derailed that. Dr. Hotez: (18:53) But in some parts of the world, it's still works as an anti-malarial drug. It's also used as an antiinflammatory drug for the tree treatment of lupus and other autoimmune diseases. You can make a bucket of it. It's cheap. 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. We know that this drug can block the replication of the virus in the test tube, so it inhibits the virus in what we call it, in vitro in the test tube. Second, we know this drug 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. Dr. Hotez: (19:43) And then the Chinese did a small study and then a colleague of mine is a fascinating guy. I really appreciate his work as a scientist. He's a very serious scientist in Marsay in France named [inaudible 00:19:59] and he's, I don't know, must've published at least two or three dozen papers in the journal that I founded call Plus 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 Zithromycin drug and found that there's an effect. The problem was that it was a very tiny study and so people put those three things together and all of a sudden said we've got the miracle cure. I'm not sure that's going to turn out to be the case. Dr. Hotez: (20:36) I mean we really need to do large studies to show that it really works. And the reason I'm holding back is nothing to do with Dr. Professor O is a 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 in larger clinical studies. So I think we have to be really careful and don't be too quick to say, "Okay, this is going to be it." We're not even close to that yet, but we'll know in the next few weeks because we're working hard to scale up clinical trials looking at that medicine. Joe Rogan: (21:18) Now and in terms of vaccines- Dr. Hotez: (21:22) But wait. There is something new though that we can do right now that I can talk to you about. So this is something called convalescent antibody therapy and it's been known for over a hundred years and it was really scaled up during the 1918 influenza pandemic, where that terrible pandemic that killed tens of millions of people. It was shown that if you took individuals who had recovered from the disease, who had got infected, they survived, they had antibodies in their blood, you could remove their blood in some cases, give them back their red cells and take the plasma component and use that as a therapy to treat patients. And in fact, during the 2003 SARS epidemic, the first SARS, 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 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 the course of infection, it could prevent more serious infection and even death because you're actually giving back antibodies. Dr. Hotez: (22:35) The antibodies won't last forever, but enough to help you survive the infection. So a good friend and colleague I've known for a long time, Arturo Costa Duvall is a brilliant professor of microbiology at Johns Hopkins started talking to me about, "Peter, maybe we should be doing this for COVID-19," and as the numbers started going up, I called him, I said, "Look, Arturo, I'm going on CNN tomorrow. I think this is an opportunity to tell people about this." So I, helped amplify what he was doing. He had written a paper with a colleague from Johns Hopkins, Lee San [inaudible 00:23:19] 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, being on CNN, Fox news, and it's not just to hear myself talk, but to actually raise specific issues to get people to care about certain things. Dr. Hotez: (23:41) And I used it for this purpose and I think it helped to mobilize some action. And now what our terminus colleagues are doing together with the FDA. So there's a branch of the Food And Drug administration called CBRE, the Center For Biologics Evaluation Research, which is this amazing ... You've been hearing a lot of bad things about the FDA. I think the FDA is amazing myself, but CBRE 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 is the head of CBRE and he's teamed up with Arturo to get this network together going, at least among 20 academic health centers so that they're identifying patients who 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. Dr. Hotez: (24:35) But I'm really optimistic about that one for saving lives. The other thing Arturo's talked to me about is could you use it in smaller doses to give the antibody to healthcare workers and to first responders to prevent them from getting sick because you're hearing, I mean I don't know the percentage now of first responders in New York and that's why they turned the empire state building into a siren last night and to honor all of the first responders who've gotten sick. We knew this was going to happen. Maybe this could help them. So I think that's going to be really important as well. Joe Rogan: (25:08) 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 Z-Pak? Dr. Hotez: (25:22) 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 maybe it'll turn out to be a good treatment, but the evidence is not strong. There's a study in Shanghai that suggested it didn't work. So we really need well controlled trials. We really need to pin down the dose because maybe it's a dosing thing. Maybe if you give too high or too low a dose, it's not going to work how you pair it with the Zithromax. So it's going to take a little bit of time to work out. And this is the frustration that people have. You know, you're saying, my God, we have this terrible pandemic now. We need to get these new therapies and vaccines are very quickly. Dr. Hotez: (26:06) 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. We don't have a lot of track record doing this. We did a 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 an American company that looked pretty promising. They had licensed the technology from the Canadians, this group in Manitoba, public health Canada, and it looked promising, but as the trials got underway, what happened was there was an international response to put in a health system because it turns out Ebola is not very transmissible. You just have to have some healthcare infrastructure, make certain that you're not directly handling the corpse of someone who's recently died from Ebola virus infection. Dr. Hotez: (27:16) And we even sent in the hundred and first airborne division. We sent in the Screaming Eagles, which made a big impact on helping to save West Africa from this infection. So the WHO came in, there was UNICEF, there was Doctors Without Borders, 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, which was under conditions of terrible conflict and war and political strife and civil war, they vaccinated 200,000 people with this vaccine and it largely help eliminate Ebola from Democratic Republic of Congo in that during those hostilities last year. Dr. Hotez: (28:21) 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 US government, the NIH and Barta and all of these organizations. It's extraordinary story and as a result we really help stabilized sub Saharan Africa, but the look at the timeframe. 2014 first epidemic to 2019. That's five years. That's a more realistic timeframe for a vaccine. Just to give people a sense of perspective. Joe Rogan: (28:59) 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, obviously we're learning about this as a new virus, but 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? Dr. Hotez: (29:29) 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. It turns out even before those three big pandemic Coronavirus I was talking to you about, we've known about Coronaviruses for even longer than that because kids get a lot of upper respiratory infections with these other type of Coronaviruses that rarely cause serious illness deep in the lungs and the testing for those viruses is a mess because number one, you're often not actually culturing the virus. You're doing what's called PCR to look for the genome of the virus and you don't know if the virus is really there or just bits and fragments of destroyed virus that are testing positive for PCR and we have all of 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. Dr. Hotez: (30:34) It takes a lot of time to do the quality control and really figure out all the testing. And the Gates Foundation has a very significant respiratory virus pathogens program, which has been looking into this for a few years now. Not necessarily for Coronavirus but for other respiratory viruses and other respiratory pathogens. It's not as straightforward to diagnose respiratory infections as it is say for things that are in the blood because a lot of these respiratory viruses never get actually bloodborne. Dr. Hotez: (31:07) So you're sampling mucus from the nose or washings from the mouth or the throat. There's probably inconsistency in the sampling. So, it's really problematic and I think that may have been partly responsible for the delays. The CDC kind of work it out and get it perfect and it just took longer than perhaps they expected. Joe Rogan: (31:31) 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? Dr. Hotez: (31:49) 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. Joe Rogan: (31:59) Right, but nothing's ever shut down the country like this. Dr. Hotez: (32:02) [inaudible 00:32:02] 2014 right. But the point is after every pandemic, everyone says, "Oh, now we're going to put some infrastructure in place." And the truth is things are better now than they were. So after SARS in 2003 they implemented this set of international health regulations, IHR 2005 and a lot of that was led by a friend and colleague of mine David Hayman, who's now at the London School Of Hygiene And Tropical Medicine and with a Chatham House in London. And I think he was assistant director general of the WHO then, and they put that in place and a global health security agenda. Dr. Hotez: (32:38) Now we have this thing called CEPI, this Coalition For Epidemic Preparedness Innovation. So there's no question things are a little better, substantially better than they were. But it's still not enough. It's still, we don't have the infrastructure in place we need to rapidly accelerate vaccines because a lot of the times, and I get involved in this because I've devoted my whole life to developing vaccines for diseases nobody else will make vaccines for it because there's no financial return. And we've been doing this for parasitic disease vaccines and that's what we spoke about last time. Dr. Hotez: (33:14) 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 smaller bio techs, which are mainly focused on accelerating their unique technologies or this handful of nonprofits like ours at Texas Children's and Baylor College Of Medicine. We call our Texas Children's Center For Vaccine Development at Baylor College Of Medicine. And it's a fragmented infrastructure and we're always scrambling for funds. I mean, even now when we've got two vaccines we're ready to move on. I'm still spending, I don't know how many hours a day on teleconferences, with potential donors trying to get this out into clinical trials. So it's definitely problematic. Joe Rogan: (34:05) 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 U S economy is totally shut down. I mean if anything is going to be a wake up call for industry, if anything's going to be a wake up call for people with money, this is going to be it because this is devastating for everybody. Dr. Hotez: (34:24) You, would think so, 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 move it forward. Even with a crisis going on like this. Joe Rogan: (34:44) Have we stopped you from eating fast food because of this? Because I know that you had a terrible diet and we were joking around about it. Dr. Hotez: (34:53) Well I'll tell you, I've actually lost about six pounds. Joe Rogan: (34:57) Hey! Dr. Hotez: (34:57) Since the start of this epidemic and I think, well one is I've stopped sleeping, right? Because I'm waking up doing teleconferences with Asia or Europe and going to bed with teleconferences with Asia, trying to figure out how we're going to do our vaccine. And not that we're making a unique vaccine that's a low cost one that would be, it's not only in the US but, but globally. And then all the calls and everything else. And the one good thing is that I've stopped traveling and I realized that the travel was really knocking the crap out of me in terms of my health. Joe Rogan: (35:34) 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 we're like, "God, I feel great." It's amazing what an impact it has on your health to travel all the time. Negative impact. Dr. Hotez: (35:48) Yeah. The travel really knocks ... So we've got a group of scientists really dedicated, even though the labs are largely closed down at Baylor and Texas Children's, we got special permission because they're working on the COVID vaccine. So they're coming in, this amazing dedicated group of scientists. Dr. Hotez: (36:03) COVID vaccine, so they're coming in some amazing dedicated group of scientists. And then I've been basically, I'm teleconferences all the time. I said to my wife, Anne I said, "I feel like I have to press star six just to talk to you since it's just been so crazy." And then doing all the media hits and I was going to the studio for a while, but I'm just doing it from my Skype. So I have sort of this weird subterranean existence right now. I mean, the good news, the thing that people, I feel so terrible for, those who now, are not getting paychecks because of this crisis. And there's so many people suffering economic hardships. All the people who used to make my breakfast sandwich in the morning, now I don't see them. They're presumably not getting a paycheck or all those things, the dry cleaners and all that kind of stuff. I feel so bad for them because I'm sure they don't have much of a safety net at all. Joe Rogan: (36:57) No, there's never been a time where it's no one's fault, but half the country's out of work, at least. You know, it's not like anybody did anything wrong. Like you could have showed up for work every day, worked hard, planned ahead, done all the things that you need to do to have a successful business and all of a sudden the carpet gets pulled out from under you. Dr. Hotez: (37:19) Yeah. No, it's just so heartbreaking. And we're hearing so many heartbreaking stories. I mean, the good news is, the white house and Congress is the one thing that I seem to be collaborating on is getting that stimulus package out there to people who need it. And I hope there's some funds for those people, but it's- Joe Rogan: (37:38) Yes, I hope so too. What's your take on Sweden and Sweden's, the way they're handling this, which is essentially they're giving people the freedom to go to restaurants and bars and they're shutting some things down, but they're quite a bit more open than the rest of the world. And subsequently they're experiencing a spike in cases. Dr. Hotez: (37:59) Yeah. I mean, the problem again is without a vaccine or other technologies we have to go back to the 14th century. That's when quarantine was invented. It was when ships would come into the Harbor in Croatia and coming from Asia Minor and they were fearful, they were bringing plague and they kept the ships for 40 days. That's where the word quarantine came from. And that's all we've got right now. So, we know social distancing is probably our only hope and there's a few pieces of evidence for that. I mean it's real serious social distancing, not going to restaurants and things. So my colleague [Mark Lipsitch 00:38:36] is a brilliant epidemiologist at Harvard has been doing a lot of analysis and modeling. And one of the things he's shown is that when he looks at the cities in China for instance, where they did social distancing and other aggressive measures and some of them were pretty aggressive that you couldn't even do in the United States. Dr. Hotez: (38:58) But these showed the longer you allow transmission to go on before you intervene with social distancing and other things, the worst the surge and the worst, the epidemic. And therefore as we talked about in Italy, the worst the mortality. So for instance in Wuhan where he estimates, I forget the exact numbers, I think he's found about six weeks of transmission going on before you intervene. Then it was lights out. It was a massive surge in hospital systems getting overwhelmed and a lot of healthcare workers getting sick and I want to come back to that point and after we finished this. As opposed to in other places in China where you intervened after a week, then you got, there was the difference between having 2,000 patients in your ICUs across the city versus 20 that's how the dramatic a different. Dr. Hotez: (39:47) So that's a lesson we need to learn for the US is that's the only thing we have. And to really push hard on the social distancing. And I think it's especially important in the cities because it looks to me, like what we're seeing so far in the US is more of an urban slash suburban versus rural divide. We're seeing the big surges in ICU patients more in cities than rural areas. Although Dr. Fauci I forget was 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 fucked up with the testing that we've not, 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. Dr. Hotez: (40:40) This is what is probably happening in Detroit. The mayor of Atlanta just said, all of a sudden we've had all of these people show up in the ICU. So that's another lesson learned. We really not only doing 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 hurting the economy in so many ways. But you know, if you want to prevent Houston from replicating the New Orleans experience, I've been saying to the mayor and everyone else in Houston, this is unfortunately what we're going to have to do and the models are showing, [inaudible 00:05:28]. Dr. Hotez: (41:27) Organ Institute in Seattle, Washington called the Institute for Health Metrics and Evaluation and they've now been looking at this, they do all these amazing things to look at the not only epidemic diseases but also chronic noncommunicable diseases, diabetes and heart disease and mental health issues. But they've been all hands on deck at this COVID epidemic and they've just put it out on their website. It's healthdata.org and you can go to the COVID-19 site and what they're showing is that they anticipate the peak of this epidemic in the US is going to hit about the middle of April. So we're not even at the peak yet. And so we're in another two weeks of this is going to continue to go up. And in some places like in Texas, it's going to be delayed. It's probably going to be around May 2nd and I think California was 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. Dr. Hotez: (42:29) And then as we move into later in May, it'll start to go down and maybe really bottom out by June. Of course, again, it's a model, it's a new virus pathogen. But what I've been saying is the President yesterday or the day before said, "Okay, I understand and I said Easter, now we're going to go to April 30th." And my point is, well April 30th things are still going to be peaking in parts of the country, let's use April 30th as a time to reassess and then make a decision whether we go another month, let's go a month at a time for now until we know where this is heading. Joe Rogan: (43:05) How long can we go? 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? Dr. Hotez: (43:24) Well, the problem is from a medical and public health perspective, we don't really know where this virus is heading. I forget what Dr. Fauci said. The virus makes the decisions. We don't make the decisions. So although not entirely true because we can enact an intervention. So, hopefully by the summer this is not going to be a huge problem. But we don't know. And then we also don't know if this thing's coming back. So what are the out years look like? Even if it goes down this summer, does it come back up again in the fall? Does it come back up again early the same time? Joe Rogan: (44:04) Can I pause you for a second there? Dr. Hotez: (44:05) What's that? Joe Rogan: (44:05) Why would that happen? Why would it come back? Why would it go away and then come back in the fall? Dr. Hotez: (44:11) Well, there's a few things that are happening. One, all the social distancing potentially could interrupt the transmission. We use this number called the reproductive number, which describes the number of people that get infected if a single individual has it. So the number right now is between two and four depending on whose numbers you look at. The idea is you bring up below one by the social distancing. There's also the question of whether there's seasonality to this virus. And again, this guy Mark Lipsitch has done some studies to show that the virus infection doesn't seem to be as severe in areas that have higher temperatures and greater humidity. It's a bit of a soft call, but maybe there's to be some seasonality to this as well. And so let's use another example of another seasonal virus. Influenza, which peaks of course in the winter and then goes down in the summer months. Dr. Hotez: (45:07) It never really disappears, but it goes down. But then in the southern hemisphere it's the opposite. So in the southern hemisphere, peak flu season is our summer, their winter in places like Australia and then in the tropics it's about the same all year round. So we don't really understand seasonality. Potentially the virus could start showing a pattern like that. And then the question is does it come back year after year after year, like flu does or and has show some kind of seasonality? These are all scenarios that are being looked at. So for instance, our vaccine, if it's used and goes through all the clinical testing hurdles, probably is not going to be used for this 2020 epidemic if it's used at all, it's going to be used in the out years. If this virus starts to come back on a regular basis. Joe Rogan: (45:59) Is there any other way to handle this in terms of quarantining or social distancing? Would it be possible to quarantine the people that are at most risk instead of the general population? Dr. Hotez: (46:17) Well, again, the problem gets to the fact that, again, there's this [inaudible 00:46:25] this is only among older Americans and people over the age of 70, diabetes, hypertension. But now as the Center for 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 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, 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 valued colleagues in their 50s and that kind of thing, getting really sick or even dying and then infants after a while it's just, you can't slice it that fine. It becomes impossible to do it. Joe Rogan: (47:37) One of the things that's come up about this is people are now aware, people like myself are aware of the number of people that die every year in the United States from the flu, which is staggering. It's a lot more than I ever thought before. Do you know the numbers? Dr. Hotez: (47:56) Yeah, so seasonal flu is really bad. And it varies year to year, different variants 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 was not a good match between the flu vaccine and the flu, it could still reduce your likelihood of hospitalization and death. So that's an important message to get out. The numbers here, unfortunately are looking worse. Joe Rogan: (48:27) Can I pause you for a second? How does that work? How even if it's not matched up to the correct seasonal flu, how does it prevent you from being hospitalized? Dr. Hotez: (48:37) Because it's partially protective. So if you imagine a virus that has all of these different pieces to it and all the antibodies, each reacting to a different piece of the virus and a perfect match, all of the antibodies target the virus, in a less than perfect match, only some of the antibodies target the virus and therefore it's partially protective and you have a partial effect. And so what was I going to say? Oh, and now the numbers of Americans who are dying are all over the map. So if you believe the numbers saying that they're between four and 10 times the number of Americans under, four to 10 times the SARS-2 virus that causes COVID-19 is four to 10 times more lethal than regular flu. Dr. Hotez: (49:32) So that'll give you the bracket. So if the minimum is 12,000 from flu, the minimum that's going to die from COVID-19 is around 50,000 and at the high end times 10 could be between 500,000. So that's where you're hearing those numbers from the white house press conference saying maybe a hundred to 200,000 Americans could die. I think it's probably, I like the Institute for Health Metrics numbers that just came out. They say 84,000 Americans will die in that peak season going from April, May, May and June and then, but we don't know what will happen again in the out years. So the point is a lot of Americans are going to die. I'm hoping it doesn't get as high as 200,000 and again, the modelers are really looking at this. The way those numbers that I gave you, that estimate was a sort of simplistic version, but there's much more sophisticated models. But again, their model is based on assumptions of what 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 then even in a bad flu season. Joe Rogan: (50:40) I think people are concerned that this is kind of setting a precedent and that this is going to be something that we have to do in the future. Is there a way to prevent something like this, a full shutdown of the country to happen in the future? Dr. Hotez: (50:53) Well, we've got this incredible scientific infrastructure in America, right? The best research universities and institutes in the world. And I work at two of them, Baylor College of Medicine and Texas Children's Hospital. And now I'm doing a few things with Texas A&M University and Baylor University as well, and Rice. And so the answer is this is why we have [inaudible 00:51:26] budget of $36 billion annually. We need to have a pipeline of technologies getting ready for this epidemic. We should have, if we had all the funding we needed for our coronavirus vaccine program, we would have had several coronavirus vaccines and clinical trials. And potentially we could have combined them in a way to be ready to go now. Dr. Hotez: (51:49) So having, figuring out a way to support organizations that are looking at vaccines and other countermeasures, not in terms of products they can sell that are going to help the health security of the country I think is really important. So one of the books that I wrote is called Blue Marble Health and it finds this unusual and we spoke a little bit about this last time, the unusual number of illnesses from emerging infections like this one and poverty related and neglected diseases actually in the G20 countries, the G20 economies, the 20 wealthiest economies, especially the poor living in those actually account for most of these diseases. And the problem is the G20 economies are not stepping up to support these technologies. We still relied 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 have. Otherwise we go back, again back to the 14th century. In terms of social isolation. Joe Rogan: (52:59) It seems one of the critical aspects of getting through this is having a strong immune system. What emphasis, if any, are you guys putting on developing techniques or at least educating people on how to strengthen their immune system and how to keep their body healthy? Dr. Hotez: (53:19) Certainly keeping the body healthy is key, right? I mean one of the populations that this virus is devastating are those with hypertension and underlying heart disease. And actually we're learning this virus itself not only causes lung disease but heart disease as well. So we could talk about that. But keeping yourself healthy could make the difference between a life or death, but even in a healthy individual with a new virus pathogen and you've never seen before, it takes time to train the immune system and then it's too late because the virus is already done incredible damage to your lungs. So no question about it. Don't smoke, don't vape, drinking in moderation. Dr. Hotez: (54:02) Don't vape, drinking in moderation and keeping fit, avoiding hypertension and diabetes if you can, especially type two diabetes. Not everybody can do it, there's some genetic predisposition disposition to it, but if you can keep your body healthy, that will definitely stack the deck in your favor. Joe Rogan: (54:22) I was reading something about a 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? Dr. Hotez: (54:36) That's a new one for me. Joe Rogan: (54:38) That's a new one for you. Dr. Hotez: (54:38) Interesting idea. Joe Rogan: (54:39) Now as far as yourself, I joked around about the fast food stuff because we joked around about that last time you were here, but have you altered your approach to food because of this and diet? Dr. Hotez: (54:53) Well, I have. Partly because I've been so upset and so anxious to eat that it's just I've been on teleconferences and my wife will actually ... We set up a little study here in our, in our bedroom, and it's not much, but my wife will just bring me a plate of flu food and I'll just eat it and then whatever's. But it's not that I've ... I can't say that I've been trying to eat, certainly eat a healthier diet and be more careful. And my wife spends a lot that I've tried 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 that people economically put out of work and I'm so worried about all of these healthcare providers who are getting sick that I just don't even want to eat. Dr. Hotez: (55:41) And I don't sleep much either. I'll wake up at four in the morning, 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. Dr. Hotez: (55:53) And it's interesting, I've even noticed that I've become a lot more emotional in my meetings. And you know, I'm known as a pretty even tempered person, never getting upset. I've gotten really upset a few times over the last couple of months. Surprising my colleagues And I think what's bothering me the most is what I see happening to the nurses and the docs and the respiratory therapists. They're just getting so hammered. And a lot of them are my former students, my medical students. And you know, I remember we have something in medicine we have something called match day. You know, where if you're a fourth year medical student, you open this envelope and figure out and you learn where you're going to do your residency. Whether it's an internal medicine or surgery or ear, nose and throat or neurosurgery or whatever. Dr. Hotez: (56:44) And you know, a lot of the medical students would come and see me, "Dr. Hotez, hey, where should I go do residency?" And a lot of them I would say it's great spending some time in New York. I did my MD and my PhD in New York, met 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 that I send them into? Dr. Hotez: (57:10) They're there with no, with inadequate protective equipment, scared as hell of getting sick or worse and being overwhelmed by patients. I think I said on, I forget it was CNN or MSNBC or whatever it is, I felt like I sent them to hell. And feeling a lot of guilt for being so enthusiastic about having them go to the hospitals in New York. Of course you can never know what was going to happen, but that's been bothering me is as well as, so this has been a very emotional time for me. Joe Rogan: (57:44) The lack of sleep also has a big impact on the immune system. Dr. Hotez: (57:50) Oh yeah. It really [inaudible 00:57:51] up your immune system. No doubt about it. Joe Rogan: (57:53) 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? Dr. Hotez: (58:11) 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 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? You're going to the extremes on the political spectrum, but it's been a great opportunity. Dr. Hotez: (58:36) But I deliberately try to be on all those networks to show that I don't give a shit about the politics. This is about saving people's lives and they've been great to be [inaudible 00:04:43]. So I don't want to lose that opportunity. But then I'm getting up early in the morning, either for teleconferences or you know, to do CNN new day or American newsroom with Sandra Smith and Ed Henry and those guys. These are amazing ... I'll never get it ... Who knows if I'll ever get a chance to talk to the country like that. Although I did a little bit with Ebola and then with Zika and, so. Dr. Hotez: (59:09) 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 I just put out in the Public Library of Science and Plus Biology about how the fact that scientists are invisible and are enabling for anti-science movements to rise. And I think I blame part of it on our scientific profession, that we're too quiet. So here I have this chance, so I'm trying to take advantage of that. But then I'm in teleconference after teleconference all day trying to get this vaccine moving, so you can't even take a nap sometimes. And so it catches up to you. So, yeah, I've got to figure, I still have to figure that one out, but it's- Joe Rogan: (59:55) It's something you're concentrating on? Dr. Hotez: (59:57) Yeah. Joe Rogan: (59:58) One of the things that you brought up that I wanted to discuss is the damage that this virus does to the lungs and to the heart as well. What there's scarring on people's lungs? Talk about that and what if anything can be done to try to heal those people post infection. Dr. Hotez: (01:00:18) Well, so what happens is the virus gains entry into the deep passages of the lungs, you know, 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. Dr. Hotez: (01:00:47) So it uses those spikes, the tip of the spikes, to get entry to bind to the receptors in the lung, which is actually an enzyme called the acetylcholine esterase. 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. Dr. Hotez: (01:01:11) And it signals something called a toll-like receptors, which cause a lot of inflammation. And so you're seeing a big inflammatory response to the virus. Dr. Hotez: (01:01:22) So the two components are a lot of virus causing direct damage and then the host all the inflammatory response. And that's one of the reasons why when I heard about Hydroxychloroquine I had some enthusiasm, because it can maybe suppress the inflammatory component. Whether it clinically has the ability to make a difference, I just think the jury is still out yet. But so you've got those two things going on. Dr. Hotez: (01:01:46) The other thing that's happening besides, and that's causing severe lung disease and there's all that inflammation and it causes, a condition known as ARDS, acute respiratory distress syndrome, where there's so much inflammation and scarring that it becomes difficult to oxygenate the lungs. And people go into shock because of this ARDS syndrome. So that's why a lot of people are dying. Dr. Hotez: (01:02:09) 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 pre-print server called bioRxiv and medRxiv, it's put out by Cold Spring Harbor Laboratories. And I check it every morning, it's called B-I-O-R-X-I-V. And medRxiv is M-E-D-R-X-I-V, it's put on by 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 so we can get information into the hands of the scientists and anybody can look at them. Dr. Hotez: (01:02:46) But one of the other things we're seeing with that is a lot of heart injury. Whether people are having heart attacks because they're intubated in the ICU and under stress and they're in shock so they're not perfusing the heart or, and we know that the old SARS virus, SARS1 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. Dr. Hotez: (01:03:14) 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. Meaning 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. Joe Rogan: (01:03:35) 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? Dr. Hotez: (01:03:44) Yeah, I think you know there's a question of whether steroids actually help or hurt. Steroids are always a mixed bag, because steroids can suppress inflammation and help the inflammatory component, but they also suppress the immune response to the virus. So you can have an increased number of virus particles potentially. So people are definitely looking into steroids, other anti inflammatory drugs. Dr. Hotez: (01:04:11) But you know, those who survive this, and fortunately most do, you'll find that they'll probably tell you they've been hacking and coughing for a long time afterwards. And 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, it takes the body a long time to remodel all the scar tissue and before the coughing stops. So we can anticipate that happening as well. Joe Rogan: (01:04:41) But do we think it's possible to fully recover from this for people that do experience these lung scarring issues? Dr. Hotez: (01:04:47) Yeah, I think so. Especially for younger people. For older people they may have some permanent pulmonary deficits, but we don't know. It's still too early in this epidemic to know. Joe Rogan: (01:04:59) 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 dealing with the immune systems, finding out which people are genetically more predisposed to the virus. Dr. Hotez: (01:05:11) Just trying to buy time and you know, typically it can take years and years to figure all of this out. And we're all, everybody's, working overtime, trying to make a contribution and figure this out. The great news is the data sharing among scientists has just been amazing. Everyone's putting aside their ego, putting all their stuff up on bioRxiv, medRxiv and the major journals are doing incredible things also. Expediting publication of papers. So you know the flagship journals like New England Journal of Medicine, Lancet, JAMA, they're all putting that stuff out there as fast as they can. Ensuring quality and a level of peer review. RR Plus Family Journals, Public Library Science. So you know, if you look at the good stories that are happening around this, definitely the data sharing, the journals not conducting business as usual, recognizing that 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. Joe Rogan: (01:06:24) I'm hoping so much of what comes out of this is a wake up call. So much of the new found 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 recognize the good work that people like you have been doing. And also, you know that this is ... 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. Dr. Hotez: (01:07:01) Right. That's right. I think maybe this will help us reassess some of our values and you know, appreciate some of the things that the healthcare professions especially are doing. And you know, you're seeing people volunteer, they're going right into the belly of the beast. You know, people who might have subspecialty practices they just said the hell with it, I'm just going to put on my N95 mask and my PPE and dive in and help. And that's really moving. Joe Rogan: (01:07:32) Why have there been such a shortage of masks and safety equipment for healthcare workers? And how did this ever happen? Dr. Hotez: (01:07:43) Well, we didn't get ready for the surge in time. And I think I'm sort of holding back trying to throw stones at 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, conduct an investigation, not from the standpoint of prosecuting people or calling them out, but just say, Hey, what the hell went wrong here? And how do we avoid this again? Dr. Hotez: (01:08:16) 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 and Wuhan and the other cities in central China, when we knew this was going to be bad and we knew this could become one of the great pandemic threats, how could we have better use those six weeks in order to get ready and what didn't we do? Dr. Hotez: (01:08:47) And now's not the time to do it, because the last thing you want to do is start distracting people and worrying about congressional hearings and that sort of thing. But when all this is said and done, it has to be done in the right spirit. Again, we have to figure out a way to stop these partisan lines, as a country we've got to figure how to work together. I know that sounds Pollyannish, but you know, when I was in ... Before I moved to Texas a decade ago, I was chair of microbiology at George Washington University for 10 years. And I worked with Congress a lot to get legislation passed around neglected tropical diseases. And it was a different Washington then. I mean, I would go to Sam Brownback's prayer breakfast, Sam Brabeck's governor of Kansas before he was Senator from Kansas, very conservative Republican Senator. Walk across the hall and go talk to Senator Leahy's people from Vermont or Sherry Brown's people and you know, far to the left and nobody thought any twice about that. Dr. Hotez: (01:09:54) You know, we all knew we had to go across the aisle to work together and it's just not happening anymore. And it's tearing apart our country. So I hope the other thing that we get out of this is figuring out a way that Republicans start talking to Democrats again, and Democrats talk to Republicans again and figure that out as well. Joe Rogan: (01:10:16) Well, Peter, I appreciate your time and I know you're incredibly busy. Is there anything else that you'd need to say or you think should be said about this before we wrap this up? Dr. Hotez: (01:10:25) Yeah, I thought we talked a lot. I can't tell you how important it is to use your voice to amplify a straight forward discussion about this epidemic. I think you're, and just by doing that, you're making a huge contribution because you have incredible bandwidth and an extraordinary audience. Dr. Hotez: (01:10:45) I mean at the last, I can't tell you the last time I did, talked about your, I was on your show. I think it was last year around this time actually. The response I got about neglected diseases of poverty in the US and vaccines, and you have so much ... It's such a powerful show and powerful guy, and being able to use this time to talk about COVID 19 and what SARS is and why and how we deal with pandemic threats. It's absolutely huge, so I'm very grateful for the opportunity. Joe Rogan: (01:11:16) Well, we're very, very grateful for you, Peter. And let's talk again in person during better times. Dr. Hotez: (01:11:22) Absolutely. Joe Rogan: (01:11:23) Thank you sir. Take care and be safe out there. Dr. Hotez: (01:11:27) All the best. Joe Rogan: (01:11:29) All right, bye.