Houston and Texas appear to be past the peak of coronavirus infections. What does that mean? And what do we need to keep in mind as we try to restart our economy and our lives?

Since early March, we’ve been talking with coronavirus vaccine researcher Peter Hotez.

Based here in Houston, he’s a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, and co-director of the Texas Children’s Hospital Center for Vaccine Development.

Since coronavirus began spreading in the U.S., Hotez’s gift for explaining science has made his bowtie a familiar presence on cable news.

On Monday, he spoke to us from his home office in Montrose.

This interview has been edited for length and clarity.

So where are Houston and Texas in regard to the virus?

We have a little bit of good news coming through. There's two pieces to that.

The first piece is from the models by the Institute for Health Metrics and Evaluation. I tend to favor those models; the White House uses them, and you hear about them on on the cable news networks all the time.

I like those models because they break down by state. And I had a discussion with some colleagues at IHME over the weekend, and they are working furiously on metro models, so there might be one for Houston in a week or two. That would be really helpful.

But in the meantime, for Texas, they just made a major revision Friday. It shows our peak is coming sooner rather than later, and overall, the estimated number of deaths in the state of Texas has gone down considerably.

This has been a trend: Originally IHME forecast around 6,000 deaths by August 4, then 4,000, and now we're down to just under 1,000. It's still a tragedy, of course, but things are looking better.

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A key reason is that we implemented social distancing so early. We avoided the horrors they’re suffering in New York and New Jersey because we social-distanced before the virus had gotten here in a significant way. Early social distancing, before transmission had been going on for a few weeks, really saved parts of Texas, especially Houston.

You might say, “Well, that's just a model.” But we have real-world validation of the model. I’ve been talking to Jim McDeavitt, who's a colleague of mine at Baylor College of Medicine. He’s been working with [Baylor president] Paul Klotman and [Texas Children’s Hospital CEO] Mark Wallace, looking at the ICU admissions.

We're still only around 20-25% of ICU admissions capacity for the Texas Medical Center.

So this was an instance where everybody worked together and did something right to save lives in our city.

Now we have to be careful not to get too complacent. It's too soon to start high-fiving each other. Things could still go wrong.

That brings us to where we are now, as we're trying to figure out how to restart the economy, how to leave our homes. What are your thoughts about what Houston and Texas need to be doing?

We started with good news, but here's where things get a little complicated. The the other part of the IHME model that came out on on Friday predicts we'll start seeing significant declines throughout the month if we keep social distancing.

Then, starting around June 1, we can go back from a mitigation strategy to a containment strategy. Rather than doing damage control as we've been doing, we can actually prevent a resurgence if we continue social distancing all the way to June 1.

Their criterion is less than one new case per million residents per day.

Now imagine that we're going to go tell everybody in Houston, “Well, we have to be at this another 40 days.” That sounds biblical, right? That's gonna be a tough sell. In Austin the governor is chomping at the bit to open up business.

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I get the pressure. This is devastating, particularly for people who are not getting a paycheck and and are heads of households. We've got to get people back to work and start opening things up.

Here’s what the decision comes down to: How do we weigh what the science tells us is needed to protect the public health interest against the economic urgency to start opening up business?

Ultimately those two things have to align. There's no point in opening up the economy prematurely without having everything in place. Then everybody gets sick again, filling up the ICUs, and we wind up looking like New York and New Jersey.

That would set our economy back for a decade. Nobody wants that to happen. Making sure everything goes right will require very carefully orchestrated dance.

Would more and better testing be the top priority?

Full disclosure: I'm not an epidemiologist. I’m a vaccine scientist who's learned a lot about epidemiology by diffusion.

I went on Fox News this morning. They were asking me, “Isn't it great how we've ramped up all the testing and the drugs and what the White House has done?”

I said, “Well, yes, it's great. We're doing 4 million tests. But now it's time to move on to the next piece of this, which is, how do we integrate the testing with the workplace?”

Let's say we're now opening up segments of the economy. And let’s say, before June 1, the word comes down that people can go back to work at Target or Walmart or a restaurant — whatever your workplace. How can we be certain that people feel safe? How can workers look across at the next cubicle not be terrified that the person is carrying COVID-19 but is asymptomatic?

Here's where we need guidance. A lot of it has to come from the CDC. They're going to have to be more granular than they've been.

We need very specific information: How do you set up workplace testing? What do you do with the testing information? How do you bring in all the contact tracing that needs to be done?

The governor said he's got this great economic task force that's going to reopen the economy, but that's only half of it. The other half is integrating the reopening with all of the people doing the modeling, the testing, the contact tracing — to come up with a road map and a plan.

That's what's not happening in most states in the country right now. And this is frustrating.

A lot of people are very hopeful about therapies such as remdesivir that will help people who have the virus. Could you talk about some of those?

We're starting to see a number of new technologies roll out. I pushed very hard on the convalescent antibody therapy, and now here in Houston, that's underway at Baylor, St. Luke's and Houston Methodist, and maybe elsewhere. That's going to be life-saving.

We're doing a lot of clinical trials now at Baylor and the other hospitals at the TMC around new antiviral drugs. Preliminary evidence suggests that one of these drugs, remdesivir, looks promising. And there's another one, favipiravir.

Those are going to be for sick patients — patients who may be in the hospital, where doctors are trying to decide whether to put them on a ventilator.

We also still don't have anything for prophylaxis. That would be using some of those same antiviral drugs and same immune therapies, but giving them to well individuals for short periods of time — for instance, to make first responders and healthcare providers feel comfortable that they're not going to get sick.

It's not really a vaccine. It's a treatment that circulates in your body for a while. It doesn't keep you protected over the long term.

Let me give an example of a prophylactic: PrEP prevents AIDS if you take it daily.

For COVID, there are clinical trials underway to look at the same antivirals they're using to treat sick people to see whether they can be used as a prophylactic, a COVID version of PrEP.

And then, of course, we're trying to roll out a whole bunch of vaccines into clinical development, including one at my lab. We’re ramping up now to get at least a dozen new vaccines into clinical trials.

With a vaccine, you're immunizing well people to prevent them from ever getting sick. That's the Holy Grail. That's what everybody wants. Then you can fully open things up.

The problem is, creating a vaccine has a long time horizon. Dr. Fauci says a year to 18 months, but some of us think that’s optimistic.

We've been hearing a lot about people who had recovered from the virus but then show symptoms a second time. We’re not sure whether they've caught it again or if it’s resurged. Could you talk a little about that and what it would mean?

It’s common for viruses to resurge. When someone is infected with a virus, they oftentimes develop a waxing and waning course — meaning they initially get sick, and they feel better, then they get sick again. It's not necessarily because they're getting reinfected. We see this with influenza, and we see that with other respiratory virus infections. So the same thing may be happening with COVID.

We can point to the example of another coronavirus, the original SARS virus. (This new COVID-19 is also called SARS-2.)

Back in 2003, with SARS-1, there was evidence that if you got SARS, you got sick and you recovered, you had an antibody response that could keep you protected from getting reinfected for a period of time. Some say it’s two years, some say up to 12 years, but for maybe even longer than that for a period of time.

The question is whether that's also true for SARS-2, the COVID that causes COVID-19. There's some evidence to suggest that yes, it's going by the same playbook.

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However, we also have a large number of infected people who never show symptoms. Will they mount the same level of antibody responses to protect them from getting sick again? That's Problem No.1.

Problem No. 2: Could the loss of immunity also occur in people who have had all the symptoms? There's some evidence from rhesus macaques (monkeys). There's one study of five rhesus macaques that were infected with the COVID-19 virus. They got sick, they had an antibody response, and then they could not be reinfected.

Maybe that's the case for people too. But we don't know that for sure — especially among people with low-grade symptoms or no symptoms.

What are you seeing in other countries? What what are you watching there?

I've written an article for the Public Library of Science, “Will COVID-19 become a neglected tropical disease?” I'm very worried that it will.

Some respiratory viruses peak in the Northern Hemisphere in the winter, then wane as we move into the warmer months. In the southern hemisphere, they peak during our summer — their cold months.

So I'm very worried about South America. I'm worried about India and Bangladesh, and I'm worried about sub-Saharan Africa. There are signs this virus is now tearing through those countries, especially the crowded urban slums of places like Dar es Salaam, Lagos, or you name it — Mumbai, Delhi, Dhaka, or Sao Paolo. In Ecuador, we're hearing stories of the bodies piling up. I'm really worried.

I make it a point not to openly disagree with the White House, but I'm distancing myself on the president’s cutting off funding for the World Health Organization. That's a terrible move.

Who else looks out for these countries? This is why we have the World Health Organization. The U.S. and Europe don’t need help from the WHO, but all of these other places we're talking certainly do. Now's not the time to be threatening to cut off funding.

Is there anything else that you think Houston and Texas ought to know? What’s on your mind right now?

We are doing better than expected. And I think we're doing better because of good leadership in the city in the county, and the Texas Medical Center. That's a good feeling. But we’re not out of the woods yet.

And, and it's going to be a question of how we balance the need for social distancing for a few more weeks versus the urgency to open up the economy. And then being really smart on how we do that and getting a little more input from the Centers for Disease Control.

Assuming that we figure out how to open back up — and that’s a big unknown — we need to get ready for possible next waves of the virus. The Harvard models say we might get another peak January and February 2021, and in 2022.

Those are the things I think about. They’re among the 3,020 reasons I don't sleep in at night.

You're still not sleeping at night?

I do, actually. It's just a very stressful time because we're trying to (move) my lab’s vaccines into clinical trials, and then in parallel, I'm raising money for it still.

It’s also difficult threading the needle. I’m speaking to the nation on Fox News and MSNBC and CNN — and trying to maintain the respect of all three networks. Things are very polarized politically, and they want to get you to say bad things about the other side. On one network you can't say anything nice about the president. On the other network you have to say something nice.

Threading that needle is in itself stressful. It's also a great lesson in science communication — how to keep the science above the politics as much as possible.

I think it'd be a fun exercise to take all my clips — to put them all together in the Fox News bucket, the CNN bucket and MSNBC bucket, then see how I made some modifications to the language I used on each of the three networks but still stayed stayed true to the science.

Maybe there’ll be a lesson learned there.

Can you be specific? What’s an example of something you’d say differently for different networks?

Well, it's not that I say it differently. The content is ultimately the same because the science is the same. It's nuance and how you say it in a way that's not going to seem offensive either to the anchor or to the audience.

Can you talk about your new haircut?

[Laughs.] Yeah, the new haircut’s not going well. I was getting really pretty bushy. Usually when I go to the to the barber, the barber takes the No. 5 blade and goes up and down.

I thought I was looking a little too rough for the cable news networks. So Ann, my wife, ordered a razor. She gave it to me without telling me that it did not have the number five blade attached to it.

So I wound up making some big divots on the side of my head, and only finding out after the fact.

The good thing about doing Skype or Zoom is that the picture is a little grainy and fuzzy. That’s working to my advantage.

Hopefully they'll just notice the bowtie.

How else is social distancing going?

There’s no sports! We should be right in the middle of the NBA playoffs, and baseball season should be up and running.

It's sad not being able to fight with my wife over watching the ballgame every night when she wants to watch something else.

We have this thing: I'm a big Jose Altuve fan because he's about my height.

For all the time we've been in Houston, Ann falls asleep in front of the game. Then every time Altuve gets up, I say, “No, no, you’ve got to watch this!”

I miss that. I miss seeing my guys on TV.

lisa.gray@chron.com

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