TEXAS ‘COULD BREAK THE 100,000 DEATH MARK’
Hotez calls for second booster shot for health care workers as omicron surges
When we last checked in with Dr. Peter Hotez about the coronavirus pandemic, the omicron variant felt like a creeping menace on the periphery. Hotez — dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Center for Vaccine Development at Texas Children’s Hospital — at the time thought the delta variant was of sufficient concern for a city, state and nation greatly under-vaccinated. Here we are a few weeks later and omicron appears to have stepped in to relieve delta of its duty, with high rates of transmission and varying reports of severity of symptoms. A peak week or two for travel won’t likely halt its progression.
Hotez spoke about the urgency in vaccinating the Southern Hemisphere, where omicron is believed to have originated, and repeated his mantra for our nation, where vaccines remain widely available.
This interview has been lightly edited for length and clarity.
Q: When we talked two weeks ago, I wondered if it was too early to discuss omicron. How would you summarize how we are now in Houston or Texas?
A: In terms of the individual person, we can go through four or five different groups. Group 1 is the unvaccinated, and we have a lot here in Texas since we have only about half the state vaccinated. That’s a huge concern. They will once again get sick and go into hospitals across the state. We’ve now lost 20,000 unvaccinated Texans since June. Those are people who needlessly lost their lives because they were defiant of vaccinations or refused vaccination for some reason. And those numbers could potentially double. We could break the 100,000 death mark in Texas by Q1.
The second concern is that it’s looking like two doses don’t offer that much protection against symptomatic COVID. And only moderate protection against symptomatic illness without a booster. So I’m concerned about those.
The third is those with a booster. They appear to be pretty well protected against severe illness. But we’re still seeing breakthrough symptomatic illness, which is knocking health care providers out of the workforce. And lastly we’re doing a terrible job in our state vaccinating kids. We have really low rates compared to other parts of the country.
Q: There’s a lot of commentary about omicron. Some sounds reactionary; some sounds contradictory. Some sounds like it’s going to change. What are your thoughts about it right now?
A: Well, I think there’s a narrative around omicron that’s not as straightforward as we’re hearing from the major media. I have some concerns, and we can list them. One, there’s the fact that we are hearing happy talk about this being a less severe disease than the previous lineages or variants. And I’m not so sure right now. We’ve noticed in the U.K. and South Africa, their omicron
waves dovetailed with the delta waves. So a lot of their infections were reinfections: first delta, then omicron. There may be some mitigating effects, but I’m not happy with what I’m seeing.
Q: When we talked last, you thought delta was a big enough problem to worry about. Is it safe to say it has been usurped?
A: We’re seeing a different situation in the northern part of the United States, which never got a bigger delta wave like we have down here. But now hospitalizations are up in New York and Washington. That’s my first red flag. My second red flag is that we’re starting to see across the country a lot of health care workers get breakthrough infections because of waning immunity from the second dose or booster. It’s not enough to necessarily hospitalize them. But it could be enough to knock out part of the workforce.
Q: How concerning is omicron’s transmissibility?
A: Yes, very much. It’s almost as transmissible as measles. We’ve never seen vertical rises like this. There’s the fact that we ordinarily get a big wave of a new variant … it usually takes four to six weeks to get from the U.K. to us. Here, it popped up a week or so later. So we know it’s more transmissible. As for the severity issue, that’s one I want to wait and find out more about. I think there’s too much overconfidence.
Q: I think we have a tendency to look at the actual numbers, and maybe we fail to think about how a taxed health care system created its own grim statistics.
A: Right. Our mortality in the last two years has been highest when there’s a surge that affects ICUs and emergency rooms, which get overwhelmed.
Q: So the combination of pandemic fatigue and pandemic disbelief hits the hospitals …
A: It’s normal human psychology considering what we’ve faced. Everybody’s exhausted. I’m exhausted. (Laughs.) And there was this brief holiday glimmer, this time we were starting to enjoy sporting events, music events, being with families.
It’s a bit heartbreaking now. And there’s PTSD for a lot of health care workers; even the average person who isn’t a health care worker.
Q: This is a city with a strong health care core. How do you feel about being in Houston as this variant spreads?
A: One of my bosses and mentors, Dr. Mark Wallace, always said the Texas Medical Center has a lot of heft. So the Texas Medical Center will be one of the last medical centers to be overwhelmed. But it could be challenged. And unfortunately the rest of the state doesn’t have a medical center like ours, so I worry about that. I worry about South Africa, where a lot of children have been hospitalized. There’s a lot of instability.
Q: I think we lean on immediate anecdotal data. People we know or read about who are infected despite being vaccinated and/or boosted. As a person who types for a living, I can drop out a few days and recover, but health care workers cannot.
A: We may need a second booster to help keep the health care workforce in play. One step beyond where we are now. I could see a fourth immunization being valuable for those over 60. There are people looking at how to shorten the time of isolation after a known infection. Do we need to wait the full 10 days? Or can people go back sooner with an N95 or negative testing. Now in the U.K., individuals who test positive and stay at home isolating, after seven days and two negative tests they’re coming out of isolation. But the key is to prevent hospitals from being overwhelmed.
This is what we saw down at the border in 2020 and in the panhandle in 2021. When hospitals get overwhelmed, mortality shoots up. You can’t give your best to a patient. And it has the added detriment of demoralizing health care staff. That is a huge emotional toll. Despite their training, nurses, physicians, respiratory therapists, they can’t handle this volume. That’s why we’re seeing so much attrition from the health care profession.
Nationally some estimates have it at 18 percent of health care professionals have left. We need to remember that. When we talk about this virus knocking out the health care workforce, omicron is just on top of a nearly two-year attrition.
Q: I want to ask, “What can we do?” But I feel like you’ve told me that before. The answer hasn’t changed.
A: Yes, it’s the unvaccinated that fill up the emergency rooms in a hurry. It’s a problem in Texas. We’ve done a bad job vaccinating people in this state. There are other concerns. Diagnostic testing has never been fixed. Trying to get a diagnostic test can be really tough. We have to work at it. There’s a particular vulnerability now, especially when people are traveling to see their family over the holidays.
But when you see lines snaking around the block: For everybody you see in that line, multiple it by three. That’s how many people saw the line and said, “To heck with it.” Then at least two of the three monoclonal antibodies don’t seem to be working against omicron. And there are all these spike protein mutations. And we’re not going to have Paxlovid in time for this wave. You go through this list, and tell me if you think things will go well? I’m still quite concerned.
Q: I feel like I’m putting coal lumps into stockings …
A: But the point isn’t to ruin people’s Christmas. The point is to say there are vulnerabilities that we have the ability to fix. I think the biggest vulnerability right now across the state and nationally is keeping health care workers in the health care workforce. I’ve made these recommendations to the White House and others, to do something out of the box, which is to give them a fourth immunization, or a second boost if they’re more than two to three months out of their last boost. We want to boost their antibodies.
Q: A reader asked about quality of masks with regard to omicron. Do you have an opinion?
“We’re seeing a different situation in the northern part of the United States, which never got a bigger delta wave like we have down here. But now hospitalizations are up in New York and Washington. … we’re starting to see across the country a lot of health care workers get breakthrough infections because of waning immunity from the second dose or booster. It’s not enough to necessarily hospitalize them. But it could be enough to knock out part of the workforce.”
A: Most people think the N95 works better. But people complain they’re not very comfortable. But again, here in Texas, we don’t have the same mask culture as in New England. I visited my 92-year-old mother a few weeks back in Boston and everybody indoors had a mask on everywhere. Here, some places you find that. But not many.
Q: What can we talk about for a silver lining? After nearly two years, it can feel like we’ll be cycling through variants for a long time. Or permanently like the flu.
A: Well, more than that, we’re not going to end this pandemic unless we can vaccinate the southern hemisphere. That has to be a bigger priority — our government and the G7 countries doing all we can. Both delta and omicron arose because we refused to vaccinate the southern hemisphere.
Delta came out of an unvaccinated India in 2021. And now we have omicron out of southern Africa. That’s where we have to step up. And that’s what we’re trying to do at Texas Children’s. The Biden administration just announced (Thursday) that we’ve donated 300 million doses. To me, that’s kind of tone deaf. We need 9 billion doses on the African continent. We need a better understanding there.