Vaccine expert lays out how to reopen nation by October
Since the pandemic began, bow-tied vaccine researcher Dr. Peter Hotez has emerged as one of the country’s most visible explainers of science. Based here in Houston, he’s a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, and co-director of the Texas Children’s Hospital Center for Vaccine Development.
This week, we discuss his plan to reopen the U.S. by Oct. 1.
Q: Last week in the journal “Microbes and Infection,” you published a commentary titled “COVID-19 in America: An October Plan.” You wrote, “Within a few weeks, we will reach the awful milestone of 100,000 new COVID-19 cases per day, then 225,000 deaths by Oct. 30, and possibly 300,000 deaths by the end of 2020. However, it is not too late to chart a different course. By Oct. 1, we could safely reopen our schools, colleges and businesses. Potentially we could even launch a college football season or the NFL.”
What are you proposing? How could we get our lives back to that degree?
A: The first piece is to recognize that we’re not in a good position right now nationally. We’ve had this massive resurgence across the southern United States. The southern U.S. alone accounts for about 25 percent of the world’s daily cases of COVID-19. That’s not good.
And and even though some of the numbers are starting to plateau in places like Houston, we’ve plateaued at a very high level; we’re still going at 100 miles an hour. We’ve got thousands of new cases per day in Harris County; each confirmed case usually means about five times more actual cases.
Even though people are now starting to get it with face masks and social distancing, we still have a raging COVID epidemic. We’re not in a position to open schools. The number of deaths continues to accelerate — more than 1,000 deaths per day in the
U.S.
In some parts of Texas, including in South Texas and maybe even in Houston, COVID-19 is the single leading cause of death on a daily basis. That’s probably true in Florida and Arizona; now you’re starting to see it really ramp up in Louisiana and Mississippi. It’s going up the Mississippi River. We’re starting to see it now in St. Louis, and Deborah Birx points out that Ohio and Indiana are getting hit very hard.
We are in a terrible situation in the U.S., and people are starting to feel insecure. On that basis I think it’s affecting homeland security. So the idea of doing (a) national reset is to realize that our quality of life in the United States is a fraction of what it could be and to enact a plan to get us back to some semblance of normality by Oct. 1.
My Oct. 1 plan essentially says, figure out what we need to do for each state in the country to bring us down to something resembling containment.
There are different definitions of containment. Some people use one new case per million residents per day. We may not have to go to that extremely low level, but at least make it possible that we could bring the whole nation back down to that level. Some states, like those in New England, don’t have to do anything. Vermont, Maine and others are already there. Here in Texas, and in Florida, we have a lot of work to do.
But if we could bring it that back down to that level of containment by Oct. 1, then things will start to work again. Then you can really do contact tracing. You can’t do contact tracing if you’ve got 1,200 confirmed new cases a day in Houston — which is really like 5,000 to 6,000 actual cases — contact tracing stops working. The same goes for Florida.
Then if you bring it back down to containment, you can safely open schools. You cannot open schools right now in most parts of Texas because teachers and staff and bus drivers will start to get sick.
You can have a life again, but we have to have a national plan to get there starting now, not the muddling along like we’ve done for the last six to seven months.
Q: What should that national plan do?
A: The closest thing we have to a national plan right now is to say, we’re going to let the individual states take the lead. They make the decisions on what needs to be done. Then the U.S. government provides some of the backup support — for FEMA, supply-chain management, and making ventilators and healthcare professionals available on an emergency basis.
That’s not working. No. 1, the states just don’t have the epidemiological horsepower. They don’t know how to manage this epidemic.
No. 2, the states need the political cover of the CDC. They need the political cover of the federal government. They’re being buffeted by all these forces that are telling them to just open up. They need to be able to say, “Look, I hear what you’re saying. I know why you’re not happy with this. But the CDC is saying if we don’t do x, y and z, this many Texans are going to die.”
Those conversations just aren’t happening. Leaving it to the governors in the states has clearly failed. My evidence that it’s failed is that we are the epicenter of the global COVID pandemic.
We don’t have to be this way. We can fix this. It’s not even that hard. We just need political will and leadership to take it on.
Q: In places like Houston and South Texas, where the virus is raging out of control, do we have to shut down again?
A: Clearly in South Texas, that’s necessary now. In places like Stark County and Hidalgo County, you have a dire public health crisis. There’s even talk about rationing ventilators. Things are bad, too, in Corpus Christi.
So yes, I think for those areas we do have to shut down.
As for Houston, we may have to also, even though the number of cases has plateaued. But it’s plateaued at a very high level. The car has stopped accelerating, but it’s still going 100 miles an hour.
Now that we’re wearing masks and mandating some level of social distancing, we’re preventing the further acceleration, but that’s not even close to satisfactory. So we might have to do a full shutdown in Texas. Maybe not for long — but at least to get it to the point where we can do contact tracing and all the things that will prevent the resurgence.
The answer is probably same in Louisiana, Mississippi and Florida right now. It’s probably the same in Arizona. But other states may not have to take those extreme measures.
The point is, you have to do it across the nation. Different states might take different measures, depending on how bad things are in each of them right now. But the point is to bring us all back down to the same level.
Then you can safely start opening up the nation.
Q: What is the timeline on that? Could we really get there by Oct. 1?
A: I think so. I need help with the modeling to to confirm it all, but I think it takes about six to eight weeks to do it. Others have said maybe a little bit longer, but that’s roughly the timeframe.
Of course, every week that we delay, we push back that date.
I’ve sent the plan to some colleagues at the White House. Maybe my plan is not the ultimate answer. But we need to implement some national strategy and recognize that business as usual is not working for the nation.
It’s become very destabilizing. Nobody’s happy. Everybody’s worried and stressed.
School teachers and staff are in a panic about having to return under the current circumstances, and I think they’re absolutely right. They shouldn’t have be forced to return to work. They’re going to get sick.
We’re setting up our teachers to fail. We’re setting up our health care professionals to fail. We just can’t do this anymore.
Q: What else is on your mind these days?
A: Well, our lab — run by myself and Maria Elena Bottazzi, who’s co-director — is working hard to accelerate our vaccine. We’re also working on a path for the U.S. That’s exciting. That’s a huge effort.
Q: When you say “a path for the U.S.,” what do you mean?
A: We’re developing a global health vaccine, but we also want to look at the strategy for the United States and North America, because we think our vaccine is going to find use in multiple areas. So we’re moving forward on that.
I’m excited about the results that we’re getting in in the lab and moving that into clinical trial. It’s all hands on deck for that.
I’m also continuing to talk to the nation on the cable news networks. But explaining to the country every day why we’re headed in the wrong direction, why we’re slowly inching toward the apocalypse, is not very satisfying. It’s taking an emotional toll on me.
So finally, I thought it was important to put something out there and say, “Okay, here’s this thing we need to do” — to turn it into something positive and get the White House to do something.
Maybe they will. We’ll see how this goes. If they’re going to do something, they need to do it soon, because things are spiraling out of control in states across the southern U.S.
This comes back to who’s getting hit the hardest. Nursing homes, yes, are taking a lot of it, but also the essential workers living in low-income neighborhoods — people who physically have to be in the workplace to support their families. It’s people on construction sites; people in family-owned businesses, like dry cleaners and restaurants; people in transportation, like Metro bus drivers; people who work in churches. All these people are getting hammered.
Now I see Hispanic neighborhoods getting hit really hard. Houston Health Department puts out a daily death list from COVID-19. They don’t print the names because that’s kept confidential, but they put out age and race and ethnicity. You’ve seen this, Lisa: Every day, it’s “Hispanic, Hispanic, Hispanic, Hispanic, Black, Black, Hispanic, Hispanic, Black, Black, Hispanic, Hispanic.”
We don’t have the real tally yet, but it’s all those people in low-income neighborhoods that are getting hit really hard. This is not only true for Houston. I’m confident this is true down in the Rio Grande Valley. I’m sure it’s showing in all the other metro areas of Texas and probably across the southern U.S. We’re refusing to take care of our most vulnerable populations.
And now we’re starting to put it onto school teachers. This is not what we do in America. So I felt it was really important to come out with a statement on what needs to be done.