Our neighborhood expert worried about ‘third peak’ in fall
For many people, both across the country and here in Houston, bow-tied researcher Dr. Peter Hotez has served as one of the pandemic’s most reliable guides.
Hotez is co-director of the Texas Children’s Hospital Center for Vaccine Development, where his team is working on coronavirus vaccines. He’s also a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.
We’ve talked with him periodically since early March , when the disease had surfaced in Seattle but not yet in Houston. At the time, he said Houstonians didn’t need to disrupt their daily lives yet, but urged people to keep an eye on the growing threat.
Six grim months later, he said Wednesday that he is worried the U.S. and Houston may be heading for the biggest surge in cases yet.
This interview has been edited for length and clarity.
Q: What’s on your mind now as you look at COVID-19 stats across the country and here in Houston?
A: The big issue is where we’re headed this fall. I’m concerned because we’re seeing an uptick in the numbers again. After that big summer surge in July and into August, the numbers were starting to go down as we moved into September. We’d hit a low of around 30,000 new cases nationally.
Now we’re over 40,000.
I’m worried that we’re starting to see the third peak. A number of people have predicted a rise this fall. And I’m especially worried about that third peak because, even more than the first two, we’ll be starting it from a much higher place.
With the first peak, we went from zero new cases per day up to around 30,000. That was that terrible surge in New York with all the deaths.
We went down to about 18,000 after that, and then up to 66,000 new cases a day: That was the second peak.
Now we’re back down to 30,000 — starting from the height of our first peak — and are seeing a rise. I worry it’s going to crescendo even more. The graph of new cases per day would be a triple hump, with successively bigger humps.
That’s scary. I’m worried about what will happen in the fall.
If it is happening, I can identify several reasons, and there may be others. One is the K-12 surge because we’re opening up schools in areas where there’s transmission. Second is the college-associated surge.
The last is just this general malaise. Some people will call it COVID burnout. Others will call it lack of national leadership because we don’t have any role models. When I walk around Montrose, in my neighborhood, no
one’s got masks on. They’re out in the cafes, and it’s looking more and more like business as usual.
And I worry about voting in places where they’re not allowing mail-in ballots. That could cause a surge.
The combination of all those things portends something very ominous this fall.
Q: Could you expand on that? Why is it so scary to have a peak that starts from a high number of transmissions? What does that mean?
A: It could mean we get to those terrible numbers that Dr. Fauci predicted way back when he said we can get to 100,000 new cases a day.
If that happens, a surge in deaths surely follows. And then we’d realize the IHME University of Washington predictions of 300,000 deaths before the end of the year, and maybe as many as 400,000 deaths by the time the inauguration rolls around.
We’re already at 200,000, which is a terrible number. But 400,000?! That’s the number of American GIs is killed in World War II. That’s going to continue to destabilize the nation.
Q: Could you tell us more about each of the places where you’re worrying about surges? Let’s start with K-12 schools. What would it look like if outbreaks were beginning there?
A: Remember, the K-12 schools have just opened. The Houston Chronicle reported last week that the numbers are not as bad as some principals and school teachers thought it might be. But I think it was too soon to say. I think it’s just starting now.
We have to remember that when we have seen peaks and rises with this disease, it’s never linear, and it’s never contemporaneous with the new thing that may have triggered the rise.
We’ve always seen the same graph. It’s flat, it’s flat, it’s flat — and then when it goes up, it really goes up. It’s too late to put it back in the bottle then.
We have to be really careful about any sense of complacency. We can’t be self-congratulatory after that the first week or two of school have gone well. If it’s going to go bad, it’s going to go bad very quickly, and it’s going to happen in a few weeks.
I’m worried about Texas schools. And I’m worried about schools across the southern part of the United States, where we never really brought the rates down. Everyone is being very self-congratulatory about Florida, but the panhandle of Florida still has one of the highest rates in the nation.
I’m also worried about what’s going on in the Midwest. If you look at where the largest rise in cases is, it’s a big block in the center of the country. It’s the central Southwest: Texas, Arkansas, Oklahoma and Missouri are looking bad. And then it’s North Dakota, South Dakota and Iowa. Those seem to be the big hotspot areas for now.
And if it really takes hold later in the fall, then we might see it come back to the Northeast. So that’s the K-12 story. Q: What about colleges?
A: The New York Times reported that Texas has the largest number of college students affected of any state. We opened up colleges in areas of high transmission. The things that worry me about K-12 also worry me about colleges, even in the schools where things are going okay. We’re just at the beginning of this, and I don’t know how it’s gonna go.
What’s interesting is when you look at what’s happening up in Iowa, the Dakotas, and in some of the Midwest parts of the country where the numbers are high. When I first saw that rise in the Dakotas, Iowa and Wisconsin, I thought, “Oh, that’s post-Sturgis.” I thought it was a consequence of the Sturgis bike rally.
But when I started looking closer at the places where the numbers were high, a lot of them were college towns — Ames, Iowa, and Grand Forks, where University of North Dakota is. So there may be something different going on.
It’s easier to spot college transmission in college towns in the Midwest than it is elsewhere. Those land grant institutions there, they’re in little tiny towns. They concentrate people in places with a lot of flat prairie all around. In a place like that, a rise in college cases stands out a lot more.
In a place like Houston, if a rise in cases is happening because the colleges are opening, it’s hard to discern it right away. We have big universities, like University of Houston and Rice, but we also have a lot of people not connected to universities here, so looking at our stats, it would be much more difficult to spot college transmission. Q: What worries you about voting?
A: Voting is still tough. Some places are making a lot of accommodations, like drive-by voting or mail voting. But other places are sort of drawing a line. It seems to be that way in Texas.
If my wife and I are going to vote, it seems as though we’re going to have to go to the polling place and mask up, wear our face shields and everything else, and hope for the best. We shouldn’t have to make those kinds of choices.
We’ll have to wait and see how well voting is set up — especially when you get inside the polling booth. Voting in person will cause a lot of people contact that wasn’t really necessary. Some polling places will be better regulated and more efficient than others in terms of taking precautions. But I’ve noticed that in the southern part of the United States, people are often not as attentive to those details. So we’ll see how it goes.
I’m worried that we could see spikes afterward. When we see a spike, it’s going to be hard to ascribe it to any one thing. A laundry list of things are happening at the same time — K-12 reopening, colleges, complacency. Voting is definitely going to be on that list.
But much bigger than voting is going to be is this attitude, this complacency, that we’re seeing. Especially in this part of the country, a lot of people are going out without masks. Some people do it out of defiance, or they see it as part of their political allegiance not to wear masks. More commonly, I think, it’s just carelessness and not really understanding. We still need to get the word out.
When I take a walk with my wife, Ann, in our Montrose neighborhood, we’ll often walk down Westheimer past all the cafes. People are outdoors, having a good time, drinking their wine, and though they’re in pretty crowded areas, they just don’t mask. And even though the bars are supposed to be closed, there are still funny things going on.
I won’t give you the name of my favorite Houston dive bar — I don’t want them run out of business — but it a bar. I mean, before the pandemic, Ann and I would often go there for a drink. If you asked the proprietor nicely, they had a little carton of Goldfish — those little orange snacks — and they would pour some in a bowl for you, and you’d give them an extra dollar for a tip. That was the extent of the culinary options.
Now, to stay open, the bar has refashioned itself as a restaurant. I’ve noticed a large sign there advertising hotdogs. I haven’t gone in, but I don’t doubt that somebody is back there with a little tiny grill and a toaster and a couple rolls of Saran Wrap. They have the capability of making hotdogs, so suddenly it’s classified as a restaurant, and therefore can stay open.
So yeah: I’m quite concerned that things are really going to go badly this fall — not just in Houston but across the country. All the places that have been hit hard over the summer are going to go way back up because we never really brought it down.