Town Square

Dr. Peter Hotez Discusses Emerging COVID-19 Variant, Pandemic 4th Wave

On Friday’s episode of Town Square, Dr. Peter Hotez, a vaccine and infectious disease expert at Texas Children’s Hospital and Baylor College of Medicine, discussed the recent surge of infections and how it may impact the upcoming school year.

A fourth wave of COVID-19, fueled by the highly transmissible delta variant, has caused hospitalizations to surge in Harris County over the past month — increasing by nearly 286%, according to data from the Southeast Texas Regional Advisory Council.

Dr. Peter Hotez, a vaccine and infectious disease expert at Texas Children’s Hospital and Baylor College of Medicine, joined Town Square on Friday to talk about an emerging COVID-19 variant, as well as the current surge of infections and the impact it may have on the upcoming school year.

This interview has been edited for length and clarity.

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Ernie Manouse: Joining me right now is renowned vaccine expert and a frequent visitor on the show. Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and Co. Director of the Center for Vaccine Development at Texas Children Hospital. Welcome back Dr. Hotez.

Dr. Peter Hotez: Thanks so much for having me.

I need to start with something I heard you say on CNN the other night and I haven’t seen a lot of pick up on this. You were talking about variants. We, of course, are all focused on the delta variant, but you were talking about one that seems to be as contagious as delta, but may appear to be more resistant to vaccines. What are we dealing with here?

Hotez: Yeah, well, right now you know it’s all hands-on deck worrying about delta, but you know we are looking at this variant which doesn’t even have a Greek letter yet. It came out of Colombia, South America. It’s called the B1621 and it’s now a significant percentage of the virus in Florida, where that epidemic is accelerating, and it has a mutation in the 681 position, which is also true of the UK variant and the delta variant — although they have different mutations — so that means it’s pretty transmissible. And it has mutations in the receptor binding domain that will make it less susceptible to the vaccine, not totally resistant, so it’s one that we’re looking at very carefully and hope that it doesn’t accelerate too much more.

For people that hear what we’re both talking about right now and say, "well, then why should we get vaccinated?," and throw their hands up. What would you say?

Hotez: The reason these variants emerge is because we’re not vaccinating. So, what happens is when these viruses exploit unvaccinated populations, and when you allow the virus to circulate, then new variants come in and they can accelerate. So, our only way to prevent new variants from arising and spreading is to vaccinate aggressively. You know we’re not doing terribly here in Texas. We’re not at the bottom, and in Houston, it’s not too terrible compared to other parts of the country in the South, but we’re still underachieving compared to the northeast.

I hear a lot of talk of the delta plus variant. Is that what we were just talking about, or is that something different?

Hotez: I don’t like that name "delta plus" because it makes it seem like it’s delta but revved up more in some way, but it’s not, it’s just a slight variation of delta. For now, we have no evidence that it’s any worse than what we’re dealing with now, and by the way, what we’re dealing with now is pretty awful. I mean, the numbers are really accelerating. Here in Harris County, we just had I think 1,700 cases in a single day. So, we’re looking at numbers, at least in terms of cases and hospitalizations that are starting to rival what we saw last summer and then again in January. So, you know, put your tray table in the upright lock position, your seat forward. This is going to be a tough time.

Is the delta virus is easily spread between people who are fully vaccinated? Or do we not have the research on that yet?

Hotez: This delta virus is multiplying at much higher levels, according to some studies out of southern China — thousand times the amount that we previously saw. And then there have been some studies in breakthrough cases among vaccinated individuals with asymptomatic infections. So, the vaccines are still working pretty well. It’s still working really well against symptomatic illness and serious illness. But there are more breakthrough cases, and those people seem to be shedding almost as much virus as we’ve seen in unvaccinated individuals, which is a lot of virus. But now there’s additional information indicating that they’re not doing this for as many days, so the numbers go down pretty quickly and so therefore, overall, it’s the unvaccinated individuals that are spreading the overwhelming amount of virus in the community.

There is so much talk these days of breakthrough infection and such, but that is not everybody who is vaccinated, correct? Are these are unique cases where they are getting infected? Or is it commonplace for anyone vaccinated could get infected with the virus? What do we know?

Hotez: So what we know is that the vaccines are doing really well. It’s still against protecting against symptomatic illness and, even better, it’s serious illness and hospitalization. So, there’s almost everybody hospitalized is an unvaccinated individual, but we are seeing more and more breakthrough cases with asymptomatic or people with low grade symptoms, and that’s because the level of virus neutralizing antibody against the delta variant is not as high as the previous lineages, and so on that basis we’re hearing a lot about booster shots. And I think those are coming, meaning a third immunization with either the Pfizer biotech or Moderna vaccine and a second with the J&J vaccine. I think that may come the soonest with those people around immunosuppressive therapy, either monoclonal antibody therapy or bone marrow transplant, solid organ transplants — I think we’re going to hear something pretty soon about that, and then we’ll see if older populations are next in line because they’re doing that in Israel. And that will build in better resilience. Against the variants and the delta variant, and then, there’s some thought that maybe we might not need to give annual boosters after that, so we shouldn’t think of this like an annual flu vaccination that may be kind of one and done. But don’t be surprised if in the coming days and weeks we start hearing first about people on immunosuppressive therapy and then older individuals. And who knows, we might even do a third immunization for the general population that’s eligible for vaccines. But then I don’t think we’re going to need a lot more after that.

As somebody who would be designing the vaccines or even the booster shots, would they be altered from the formula we’re already using to encompass these other variants, or is what we have just needing to be stronger?

Hotez: I think it’s the latter. I don’t think there’s enough time to do all the bridging studies needed to bring in one that’s more specific for the delta variant. And there’s some disagreement or debate within the scientific community whether we even really need to do that. So, the Pfizer CEO in a shareholders meeting, put up a slide showing really good virus neutralizing antibodies with people who got a third dose of the same vaccine. But the fact that I had to say it that way is in itself concerning. The way the data is coming out — you do not want to get your information from a shareholders meeting from a Pfizer executive, right? We’ve got to do better at getting the data out there.

Is the Delta variant creating more illness in younger people, or is it simply the population that’s available to get sick now because the more susceptible have already been vaccinated?

Hotez: We don’t know for sure, but I don’t think this virus is selectively targeting kids, but what’s happening is this variant is so contagious — as contagious as chicken pox, which is one of the more contagious childhood viral illnesses. It means that this virus is going to be sweeping through an unvaccinated populations, so if you’ve been lucky enough to escape COVID so far, I think there’s a high likelihood in the next few weeks you’ll be exposed to the virus and kids are getting swept up in that. I don’t think it’s selectively targeting kids, but what I do worry about is what we’re seeing in Louisiana and other states in the South where even before the school year starts, we’re already seeing hospitalizations, even pediatric ICU admissions. So, I am holding my breath as the school year opens to be certain that we don’t see that kind of thing. And that’s why I’ve been pushing so hard. This is not a time to hold back, just based on the little we’ve seen so far in Louisiana and elsewhere.

A message you would have to parents who are rightfully petrified at what’s going on in the news and how it’s being reported. What would you tell them as they gear up for going back to school?

Hotez: Well, first of all, if you have an adolescent child over the age of 12, absolutely get them vaccinated. You still have until August 23 to see if you can get those two doses into them and that’ll make a big difference. The single most impactful thing you can do. Don’t wait anymore, this this is your last chance. I think second, it’s going to be really important to make certain that your child is masked when they go into class, even if they’re vaccinated. But especially the younger kids who are not yet eligible. That’s the only other backstop that we have at this point.

Do you expect to see numbers continuing to grow like they’ve been going, or do you think there would be a point relatively soon where it will stall?

Hotez: Again, there’s disagreement in the scientific community. Some people have pointed to the UK where you started to see the spontaneous decline in the number of cases. The problem that I’m worried about is our epidemic with delta is peaking at about the time when kids are going back to schools so that schools could really act as an accelerant and really help expand the epidemic. In Houston, we’re not doing so badly in terms of vaccination, but if you look at some of the counties in East Texas, none of the young people are vaccinated practically. Same in Central Texas and parts of the Panhandle. So, there’s this huge vulnerability there, so I think we’re going to be in for a very difficult time.

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