Hotez: With delta variant, Texas ‘still in for a very rough period’
Since 2020, when the word “coronavirus” entered the average American’s vocabulary, bow-tied vaccine researcher Peter Hotez has become one of the country’s — and Houston’s — most visible explainers of science.
He’s dean of the National School of Tropical Medicine at Baylor College of Medicine. And at Texas Children’s Hospital Center for Vaccine Development, he and his team have created a COVID-19 vaccine that can be produced in large quantities for a low cost — a global vaccine for a global pandemic.
Q: Let’s start the way we usually start: What’s the COVID situation in Houston right now?
A: What we’re seeing across Texas is bad. The only possible silver lining is that the number of new cases seems to have hit a bit of a plateau.
That’s actually true in many parts of the South. And in some places, like Florida, it’s even going down now.
But I don’t think we really know what that means. If you remember, the United Kingdom was about a month ahead of us with the delta variant. Their terrible delta wave went from 5,000 new cases a day to 40,000 new cases, then it went down to 20,000 new cases a day.
People thought, “Well, that’s it.” That was what had happened in India: It had a long tail, but it dropped. But then in the U.K. it stuck at 20,000 for quite a long time, and now it’s going back up to 30,000.
So I don’t think we really know. The scientific community
is a bit divided. Some people feel things will now continue to go down in Texas and elsewhere in the South, maybe with a long tail. But a lot of us think it’s not going to go down nearly enough.
That’s because our schools opened. We’re seeing a lot of transmission in the schools, and a lot of kids getting sick — in some cases from each other, in some cases from their parents. We even had that tragic case from the recent Centers for Disease Control and Prevention report: Kids were infected by an unvaccinated teacher.
So I don’t know what’s going to happen here for the next few weeks. I think best case scenario, it slowly goes down. Worst case scenario, the graph forms this small hill, it goes down a little bit, and then it remains almost level for the rest of 2021.
That’s possible because we’re still underachieving in terms of vaccination. If you look at the vaccination rates in Harris County, it’s not so terrible. In Fort Bend, it’s pretty good. But when you get up to Liberty County or Waller County or move into East Texas, it’s terrible.
In Shelby County, only 25 percent of the county’s vaccinated, so what’s to stop this virus from just plowing through it? East Texas is one of the worst affected places in the country right now. That was predicted and predictable.
And preventable! Predicted, predictable and preventable! That’s what’s so tragic.
I think we’re still in for a very rough period here in Texas as we move into the fall.
Q: Are there theories about why it plateaued and then went back up in the U.K.?
A:
I don’t think we really understand it. They did a better job vaccinating the country than we did, but it still wasn’t enough. With this delta variant, the bar has become super high because it is so transmissible — two or three times as transmissible as the original COVID-19 virus.
The more transmissible a virus agent is, the more people you need to vaccinate to stop the virus from spreading. The best example of that is measles, which is so highly transmissible.
The reason we see measles outbreaks in this country now more frequently than we used to is that vaccination coverage went down below 90 percent. That’s all it took.
With delta, we may need to get the 85 percent vaccination coverage in the U.S. to shut it down.
Q: That’s 85 percent of the total population, not just the people who are eligible?
A:
That’s 85 percent of everybody. Since children aren’t eligible, that basically means all the adults and all the adolescents.
You might say that’s not possible. Well, of course it is! We do it for measles. Massachusetts and Vermont are getting there. That’s why COVID transmission is so low there now. That has the collateral benefit of protecting their little kids.
Here, little kids are often getting it from their unvaccinated parents.
Plus, those are also the states that have mandates and even vaccination requirements. All those things work together to protect kids.
Here in Texas, unfortunately, many school districts have no mask mandates, and certainly no COVID vaccine mandates. Having the mandates is not even part of the culture. Now we’re seeing what happens: The schools can’t sustain in-person learning, and they go back to virtual learning.
We talked about this last time: You can’t just stamp your feet and say, “We’ve got to have our kids do in-person classes.” We all get the importance of inperson classes. But then nobody wanted to put the policies in place to make that doable.
To make in-person classes safe, you’d have to require that everybody who walks into a school, whether it’s a bus driver or teacher or student, has a mask on. The possible exception would be the special needs kids who can’t do it.
And also, everybody would have to be vaccinated.
If we had done that, we wouldn’t have so many kids getting sick. This weekend, Texas set a record for pediatric hospitalizations. We had over 300 hospitalized kids in Texas every day this week.
The policy makers operated as though this is the old-fashioned COVID that that we did pretty well with over the last year. Despite warnings from the scientific community, they were not able to adjust their thinking to the delta variant.
Q: Do scientists still believe that delta is not targeting kids relative to grownups? They think that so many kids are getting sick simply because there’s so much virus loose in the state?
A: It may turn out to be that kids are disproportionately infected, but it doesn’t look that way so far. I think it’s just that delta is so highly transmissible, and it’s sweeping through unvaccinated populations.
What’s interesting is the effect of vaccination rates on pediatric hospitalizations and pediatric cases: Pediatric hospitalizations are much lower in areas with this high vaccine coverage. It’s a collateral benefit of the vaccine. Even though the little kids aren’t vaccinated, if you’re a little kid in Vermont or Massachusetts, you have a far lower risk of getting sick or being hospitalized.
Q: Does the high transmission rate that we’re seeing in Texas mean that we could be a breeding ground for new variants?
A:
It could. But look, right now, delta is pretty much your nightmare variant already. It is so highly transmissible, and now it looks like it’s spreading in the face of waning immunity. There may be some partial resistance to the vaccine in terms of lower virus neutralizing antibodies, but I think the combination of delta and waning immunity is why we’re in this really difficult situation.
Addressing that waning immunity requires another dose. Now, to be fully vaccinated, we’re talking three doses of the Pfizer BioNTech vaccine, or three doses of the Moderna vaccine, or two doses of the J&J vaccine.
That was also predicted: We’ve spoken about this before.
When we rolled the vaccines out in December and January, we did it with a three- to fourweek interval between doses — three weeks for Pfizer BioNTech, four weeks for Moderna. We did that because we were in a hurry to fully vaccinate the American people — especially that first round, to protect nursing home residents, who were being picked off by the virus, and our health care providers. That was a good decision and saved a lot of lives.
But if you were designing a vaccine schedule to give longlasting, durable protection, you would never think about a threeto four-week interval between doses. The interval would be longer. So that pretty much guaranteed it was going to be a three-dose vaccine, with a third dose given six months to a year later.
There’s a lot of precedent for that.
If you look at the pediatric vaccines our kids get — like diphtheria, pertussis, tetanus, influenza type B or the inactivated polio vaccine — we give three or four immunizations in quick succession. That’s our primary immunization. Then we wait.
Six months to a year later, we give the boost. That’s what gives you the durable protection.
The mRNA vaccine is going by the same playbook — as predicted. Its effectiveness appears to wane. There’s new data from Israel showing that with the Pfizer vaccine, the decline in protection went from over 90 percent down to 40 or 50 percent, primarily with breakthrough infections being mild or asymptomatic. It looks like boosting restored that protection.
The other piece of that argument is, we’re getting vaccinated not just because we want to stay out of the hospital or not lose our lives. We also want to interrupt transmission in the community. That’s an important reason.
Q: What else is on your mind these days?
A:
The big piece that I’m thinking about is our lab’s vaccine, trying to do something by the end of 2021 so we can stop all the loss of life globally. That’s a big priority.
Q: Actually getting it into people’s arms by the end of the year?
A:
Yeah, that’s the aspirational goal. We think we can do that.
The other thing on my mind is, how do we convince more people in the U.S. to get vaccinated? We’ve just got to do a better job at that if we hope to end our epidemic. The only way I see ending it is to vaccinate our way through it.
It’s a high bar, but it’s doable. Somehow we have to bring the country together for that purpose.