Hotez says surge is ‘the warm-up act’
The delta variant is running loose and wreaking havoc. Houston-area ERs and ICUs are filling, and hospitals are erecting tents in their parking lots. And all of that is before the Texas school year begins, with unvaccinated children attending in-person classes where masks may not be required.
Peter Hotez, one of the country’s most visible scientists during the pandemic, has been a regular presence in the Chronicle since early March 2020. Hotez codirects the Texas Children’s Hospital Center for Vaccine Development and is dean of the National School of Tropical Medicine at Baylor College of Medicine.
He’s also known for fighting anti-science disinformation on Twitter , cable news networks and elsewhere.
This interview has been lightly edited for length and clarity.
Could you give us an overview of the COVID surge in Houston now?
I was looking back at my comments with you last April. I painted a pretty optimistic picture then: Based on the trajectory of where we were going with vaccinations, and the performance of the vaccines, things were looking really good.
But then things stalled down here. Vaccinations continued in the Northeast, but they abruptly fell off here in the South, and including here in the east
ern half of Texas. That’s one of the reasons why we’re in this situation.
When you look at the pattern of vaccinations, it’s quite distinct. If you look at the level of vaccinations among individuals over the age of 65, the difference between a place like Texas or even Louisiana, which has the lowest vaccination rate, is not too different from the Northeast: It’s around 80 percent versus 95 percent or 99 percent in the Northeast. It’s not a huge disparity.
But with young people, the bottom falls out. In this part of the country 20 or 25 percent of adolescents are vaccinated. Compare that to 70 percent now in Massachusetts and Vermont. And we also have a dramatic disparity among young adults.
And now, the delta variant is so highly transmissible that essentially any young unvaccinated person across the South is getting swept up in this firestorm.
Lots of young people are coming into hospitals. We’re even seeing pediatric hospitalizations. We’ve never seen this many children’s hospitals fill up like they are now. We also hadn’t seen pediatric ICU admissions before. So this is a yet another scary period.
It’s an unforced error. We didn’t have to get here. Had we not had the disinformation campaign, had we had more support from members of Congress and other elected leaders, had they promoted vaccinations instead of tearing them down … and yet here we are.
The children’s hospital admissions and the pediatric ICU admissions are not all COVID. There’s also a component of other respiratory pathogens, including respiratory syncytial virus, RSV. Usually it’s a winter virus. Maybe it’s hitting now because this winter the kids were not interacting with each other very much, so now they didn’t have immunity to RSV.
I don’t have a good rundown yet as to the proportion of hospitalizations of COVID versus RSV versus both — we’re seeing coinfections — but it’s clear that COVID is going up among kids. That really worries me.
And all of this is the warm-up act. Schools are opening now across the South. Louisiana, I think, opened earlier this week with some of the parishes. Houston Independent School District opens Aug. 23. You’re going to have a lot of other young people in close contact with each other and with teachers. I worry that’s going to be a big accelerant. So as tough as things are now, it’s going to be even worse.
Hopefully the peak will start to come down. I can’t tell you when, but I do know that if we had done a better job vaccinating, it would not have risen as high, and it would come down a lot sooner.
The U.K. has already gone through a wave of delta-variant infections. What does that say about how quickly the
U.S. will move through this wave?
In the U.K., the delta variant started accelerating in June, peaked by July, and has started to come down now. But it’s come down and plateaued. It’s not really gone down. It’s just kind of stuck there. I think it went from 5,000 new cases a day in the U.K. to 45,000, and now it’s down to 20,000 new cases a day and kind of staying there.
So I’m wondering if we may see something like that, especially with schools open and not enough kids masked or vaccinated. That’s going to prolong this surge for a good chunk of the fall school year, and how we manage that is going to be really important.
The problem that we face here in Texas is, we’re very heterogeneous in terms of our ability to vaccinate. So I think Fort Bend County is doing among the best in terms of vaccinating adolescents; I think almost half of the adolescents are vaccinated. Even that’s not great compared to the Northeast, but it’s the best in our area.
If you go up to Waller County or San Jacinto County, basically none of the adolescents are vaccinated. It’s really terrible. And not many young adults. Factor in that many of the kids will be unmasked, and I think this is a toxic stew. It’s going to put a lot of young people into the hospital, and I worry about a big surge.
There may not be as many deaths because there’s fewer unvaccinated older people. But can you imagine being a 30-yearold and having an ICU nurse telling you, “Look, Mister Soand-So, it could go either way right now in terms of whether we’re gonna have to intubate you.” I can’t think of anything more terrifying.
That’s going to play out, not tens of times or hundreds of times, but thousands of times across the state of Texas. The state has already lost 53,000 people to COVID. Our nursing staff, physicians and respiratory therapists are exhausted. If there was ever a time we needed a break, it was this summer, and unfortunately that’s just not in the cards. Having surges on top of that exhaustion will contribute to an increased number of deaths.
On Twitter I’ve joked that I’m known as “the Dark Prince of COVID Doom,” and there you are.
Does the delta variant behave differently than the original COVID-19 virus with infants or young children?
What are we seeing in pediatric hospitals?
I’m frequently asked two questions about kids and delta. One, is COVID selectively targeting kids and adolescents? I don’t think so. I think what’s happened is, this delta variant is highly transmissible. It has the ability to replicate at much higher numbers than the original strain — at least, in the upper airway, where we can test that pretty easily.
So essentially, anyone who’s unvaccinated is getting swept up in this firestorm. That’s partly because we have so few vaccinated individuals. Vermont right now has vaccinated pretty much all the adults and all the adolescents. That has a protective effect for the community. It slows transmission across the community. But we don’t have that buffering here, because we did such a terrible job vaccinating the population.
So delta has crossed the South. It’s a firestorm sweeping up everyone who’s unvaccinated, including the kids and adolescents.
There are reports, but it’s still not well documented, that with delta the severity of illness is worse. And also, anecdotally, we hear that people are getting sicker faster, which makes sense given what we know about delta’s viral load. In the past, when someone came into the hospital, they’d be sick, but there was time for medical staff to watch the trajectory of the virus. Now people are hitting emergency rooms and getting admitted to the hospital already very sick with very high viral load. That’s also quite concerning.
What do you expect as Texas schools reopen?
We’re going to pay the price for not being better advocates for vaccinations and wearing masks.
Everybody talked about how important it is to do in-person classroom learning this fall. I’m the parent of four adult kids. When our kids were little, no one knew the importance of having kids in school better than we did. I get that.
But the problem is, people in positions of power would make these pronouncements about the importance having kids in school, but then it was left there, as though it’s supposed to happen by magic. There was no interest in rolling up sleeves and saying, “OK, if we’re serious about making this happen safely, what do we do?” The pronouncements were never translated into policy.
That’s why I think we’re going to get hit hard, not only in Texas, but in Florida and other states in the South. There wasn’t the situational awareness or the ability to connect the dots — to look at it from the perspective of a systems engineer, to look at the whole entity and say, “OK, what do we need to do to make this successful?”
The answer is, if we want to reopen schools and also keep kids safe, we have to keep community transmission down. We don’t have vaccines approved yet for kids under 12. That means we have to maximize the tools that we have.
That means having everybody masked and having everybody eligible vaccinated. Reopening schools won’t go well if we don’t have all the adolescents vaccinated — the 12- to 17-year-olds — and if we don’t have all the teachers and staff vaccinated.
It’s not a question of ideology. It’s just practical, pragmatic understanding of the virus.
But our leaders weren’t focusing on that. I think people were operating under the assumption that delta is similar to previous virus lineages. But delta’s transmissibility is so different from anything we’ve seen before, you have to throw out all the old rules.
You have to realize that if you want our kids to go back to school, it’s got to be all hands on deck. It’s not fun to talk about mandates. But if you really want to make in-person schooling work, you have to have everybody masked in school, and everybody vaccinated who’s eligible to be vaccinated. That’s just the reality.
To deny it and say, “This interferes with our health freedom” or whatever, is nonsense. We’ve already seen what happened in Mississippi and Arkansas, where people just let it rip. What happened was, so many kids got COVID, they had to shut it down.
Is there still time to make those policies and open schools safely?
Being the eternal optimist, I think yes. But it means all the kids, all the staff, all the bus drivers, and the teachers have to be masked. Everybody over the age of 12 who walks into that school needs to be vaccinated. If we do that, we can give our kids a fighting chance.
But if you fold your arms and stamp your feet and say, “This interferes with my health freedom,” it’s going to be lights out. It’s just not going to work. People have to be adults about it. You can’t simply will a virus away.
When a pandemic is underway, leaders have to pick and choose their victories. You can’t be everything to everybody. You have to ask yourself and your colleagues, “OK, what are the one or two things we want to accomplish?”
If kids’ in-person learning is your top priority, it’s doable. But it takes work. It means talking to virologists and epidemiologists and people who understand air flows in schools, and people who understand the transmissibility of virus pathogens. You put these people together and you say, “OK, if this is our No. 1 priority for the state of Texas, what do we need to do? Help us figure this out.”
And you know what? Texas is really good at that. Our state is built on science and engineering, At the beginning of the pandemic, I said, “I don’t understand. We’ve got all these amazing engineers at the oil and gas companies and the chemical industry. These are the smartest people out there. Why aren’t they in a room figuring out how we’re going to protect our state? Why aren’t we using app-based systems for syndromic surveillance to detect rises in fevers?”
We never did that. Texas has the best and brightest, and we didn’t consult them. But that’s what we should be doing now.