Peter Hotez says his recent COVID case shows just how transmissible subvariant BA 2.12 is

Three weeks ago, Dr. Peter Hotez announced he’d tested positive for COVID-19. 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 — has been among the more public faces providing information over the past two-plus years. Hotez admitted that having been vaccinated and boosted, he started venturing back to public events, and his number finally came up. MORE: Peter Hotez warns of nation’s hidden COVID wave that’s ‘almost like omicron’ So the time seemed right to catch up with Hotez again, as I’d recently attended the opening of the Bob Dylan Center in Tulsa last month, which involved multiple days inside museums and three consecutive nights of live music. A sucker for gift shop T-shirts, I returned to Houston with one extra souvenir. Likely exposed on a Saturday night, I was symptomatic Tuesday night and by Wednesday morning, I rang up positive. Hotez took some time by Zoom to discuss our parallel illnesses, while looking ahead to summer and beyond. Q: Thank you for the time. Since we both rang up COVID positive … A: I’m interested in your album collection there. It looks pretty formidable. Q: Ah, yes. It’s a monolith constructed to honor a lack of restraint. A: (Laughs.) Is there an overall theme? If you had to pick one genre, which would be your favorite? Q: It all changes as I get older. But it pretty much covers everything. These days, I find myself listening to a lot of minimalist, ambient things. A: I drift in and out of things, too. But the one I always go back to is old-school blues. Especially down here in Texas: Freddie King, Albert King, of course Lightnin’ Hopkins. . . . Houston has such a rich blues tradition but you don’t hear much about it outside of Houston. You hear about Delta blues, blues from New Orleans and Kansas City. But the history here is extraordinary. … I could talk to you about music all day. When I was a kid, I grew up in Connecticut. There was this old historic place called the Shaboo Inn. In high school I got to see Johnny Winter, Muddy Waters, the James Cotton Blues Band. The list goes on. It was all standing room only. So I’d just stand up front. This was in the ’70s when everyone was still alive. Q: I try to take my daughter to see anybody left who’s touring. The Bob Dylan show didn’t exactly snare her attention. But she appreciated the act of seeing him. A: That’s interesting. There’s a new museum, right? In Tulsa? Q: There is. In fact, I was just up there, and that’s where I got COVID. Which is as good a segue as we may find from music to the pandemic. A: Ah, yes. Were you at an indoor venue? Q: Indeed. Three nights in a row at the historic Cain’s Ballroom. I’m pretty sure I got it the third night at the Elvis Costello show. A: So let’s get right into it. That’s how people are getting COVID now. What I’m seeing from my own case and other cases is this one-two punch going on with this subvariant, BA 2.12. It is SO transmissible. I joked once that you just need to look at it askance from across the room and you’ll get it. It’s more transmissible than omicron, which was more transmissible than delta which was more transmissible than alpha, which was more transmissible than the original lineage. It’s getting up there where it’s maybe as transmissible as measles, with a reproductive number of 12 or something. And measles is the most transmissible virus agent we know about. An individual in a room can infect 12 other people if unvaccinated. If you’re vaccinated and boosted, it’s unlikely you’ll get seriously ill (with COVID), but you’ll get what I had, which is feeling sick, cold and flu symptoms. So the first punch in the one-two punch is this highly transmissible variant that spreads now that people are going to indoor events. So you had people coming from all over the country to go to Tulsa. Any time you have that many people in a room, there will be somebody with BA 2.12. When you have people in a room, you have these super-spreader events. In my case, I started going to in-person events again. I spoke at events. It’s fun seeing people in three-dimensions again, shaking hands and hugging and having cocktails and laughing. But I paid the price by getting COVID. Q: My timeline, best I can determine, was exposure on a Saturday night. By the next Tuesday night there was a minor sore throat that I thought was allergies. By Wednesday morning, I knew something was wrong. A: Right. One other thing about this virus, one of the reasons it may be more transmissible, it’s a bit controversial, but the amount of virus, the replication is high with this variant. Data from Japan says it multiplies efficiently in nasal mucosal cells. That also may explain why the incubation period is pretty quick. Each successive variant, the incubation period is less. We are now seeing two to four days after exposure, people coming up positive. Before it was more like five to seven days. Q: My illness was contained to 72 hours, 48 of which were just like mid-level flu. But there was a 24-hour spell where I felt like my ear canals were on fire, which isn’t a symptom I’d read much about. A: You can get what’s called vestibulitis, which is inflammation in the vestibula, which helps with balance. The room can feel like it’s spinning. Q: I was walking into walls and doorways a lot. A: Yeah, yeah. That can happen with any upper respiratory virus. In my case, one thing that was interesting, I was preparing for this in the sense that knowing there’s so much transmission, I figured if it was going to happen, it’d happen now, during this wave. So I had a plan in place with my doctor to have access to Paxlovid. I’m older, 64, and maybe have other risk factors. So I wanted to go on Paxlovid right away. The day I started having symptoms, I started the Paxlovid. It was probably a record time from symptomatic to getting on Paxlovid. What happened next was I had a rebound from the Paxlovid, which is really interesting. In other words, during the clinical trials, what happened was 1 to 2 percent of patients on Paxlovid had a rebound after they finished a five-day course. In some cases, they tested themselves, were negative, and a few days later they were sick again and tested positive again. That appears now with the BA 2.12 variant. It’s still anecdotal, but it appears to be happening more frequently than 1 to 2 percent. I go to social media, and it seems like everybody has the rebound. I’ve talked to my colleague Eric Topol a lot, he’s a professor at the Scripps Institute. He thinks it may be related to BA 2.12 — maybe a higher level of virus or efficiency of replication. I don’t think we know. But the thing about my rebound, the symptoms were worse than when I initially had it. More congestion. More feeling tired. And when I did the antigen test, it popped up right away. Q: I read a New York Times story that suggested multiple infections per season could become a new normal. Thoughts? A: Rather than make a broad summary like that, I try to think in different ways. I try to parse out the pieces. Let me give you an example. Right now this BA 2.12, first of all, last time we spoke, I hoped it would be a bump not a wave. Guess what? It’s a wave. But it’s a hidden sort of wave, because most of these cases are being diagnosed at home and not reported to the state or the CDC. If you look at the New York Times COVID tracking numbers, 100,000 cases per day. In the past we considered that an underestimate by a factor of about four. In this case, this wave, which could go as high as omicron, which was extraordinary, it could be underestimated by a factor of 10 or more. It’s not entirely clear, because it’s not homogenously distributed through the country.… But the Memorial Day weekend, the risk of transmission is pretty high. By the Fourth of July, we may be in good shape for a while. But I can’t tell you how long. Late July, August, September we’ve had waves in Texas the past two years. So I think we have to anticipate that is possible again. But rather than make blanket statements, and just say things are fait accompli, I would rather think about how we navigate things when we’re in the middle of a wave. How do we do that? Max out vaccinations. If you’re unvaccinated, you’re playing with fire. Even if you’re fully vaccinated — and I hate that phrase because nobody considers two doses fully vaccinated except the U.S. Centers for Disease Control … but you need that booster. The protection wanes after the first booster. So if you’re eligible for the second booster, get it. Then the question becomes how often do we need to get boosted after that? Here, we’re going back and forth with the leadership in the federal government. Every time we ask the American people to get boosted, the percentage that agrees to do it goes down. Only 100 million people, 30 percent of the population or less, got the first booster. The second booster? I got it, and maybe 10 other people. So what comes next? A third booster? A fifth immunization? I’ll get it. But not many others will. I’ve said to the White House and others, we need to look beyond the mRNA vaccines. …I’ve said we need to look at other technology, with full disclosure that I have a conflict of interest here, because one thing I’d like them to consider is our Corbevax. We’ve seen that the Corbevax protein-based vaccine may give more durable protection. So a strategy would be to boost with it or the Novavax. Maybe we get more durable protection that lasts four or five years. I think that’s a more sound strategy than just folding all the cards and saying, “I guess I’m just going to get COVID.” We shouldn’t be that complacent. We still don’t know what all of this means. In general, we think it won’t land us in the hospital if we get COVID. But we still don’t fully understand long COVID. I don’t want to endure exercise intolerance or respiratory insufficiency. I don’t want gray matter brain degeneration. I still have other books I’m writing, so I don’t want to deal with cognitive decline. I just signed the contract for my newest book. This has been my newest passion in the decade since arriving in Houston. I still call myself an aspiring writer, rather than a writer. Q: Is it too early to talk about the book? A: No, I’m happy to. It’s called . . . well, let’s finish this train of thought. Q: Sure. Last time we talked, you mentioned the possible value in mixing up vaccine technologies. A: Right. I just think the American people are not buying into this right now. They’re telling us already they’re just not buying it. Q: Do you know what flu shot buy-in looks like typically? A: For some reason, I carry a number around that’s about 40 percent in my mind. I’d have to go back and look. But I get my flu vaccine religiously. Every August or September. And that’s another thing we should be looking at: combining a COVID booster with the flu shot. Since the flu shot seems to have some acceptance, maybe that’s the way to do it — to combine the two. Q: OK, back to the book … A: The book has the working title “Anti-Science Kills.” It’s coming out through Johns Hopkins University Press. I do a deep dive into what happened starting this time last year. The president announced anybody who wanted a vaccine could get one. There were no limits to the vaccines. Yet millions of people refused to get vaccinated. And they deliberately refused in certain parts of the country, particularly Texas and the southern U.S. And people paid for it with their lives. The number I proposed is that 200,000 unvaccinated Americans needlessly lost their lives in the last half of 2021. And my point is that vaccine refusal and defiance didn’t happen for arbitrary reasons. It was a deliberately targeted effort that I call “anti-science aggression.” I identify groups and individuals who promote that agenda and caused people to lose their lives. The people who lost their lives to vaccine defiance are actual victims of this anti-science aggression. And I talk about how it’s extended to target not just science, but scientists, who are portrayed as enemies of the state. Anti-science aggression is part of a political movement, and it’s a killer one. It kills more Americans than global terrorism, nuclear proliferation or cyber attacks. Yet we don’t think about it in those terms. It’s been a tough book to write. It’s a strongly worded book. But I did it to save lives — and I make that point as a vaccine scientist working to save lives by developing new vaccines. Saving lives now also means combating the rise of this movement. Q: This movement has roots with one British doctor whose original published work was retracted, right? Is this movement the worst thing Britain has dropped on us in a few centuries? A: Well, that’s how it started. I go into a deep dive into how it evolved into this movement under a banner of health freedom and medical freedom to become a political movement. It used to be small groups claiming vaccines have toxic ingredients that can change a child’s physiology. Now it’s a full-on monster with PAC money, political backing, political organization and a lot of power, especially in the U.S., but we’re exporting it now to Canada and western Europe. Q: Your book about your daughter and autism sounds like a prelude to this. A: That was version 1.0. This is now a full-on monster. This is 2.0 when it becomes a political monster. andrew.dansby@chron.com | Twitter: @andrewdansby - Memorial Hermann had a pandemic plan, but COVID threw it out the window, CEO says in Q&A - Houston hospitals begin giving Pfizer COVID-19 vaccine boosters to kids ages 5 to 11 - Dr. Peter Hotez warns of nation’s hidden COVID wave that’s ‘almost like omicron’ - Houston’s COVID-19 trends are harder to track after rise in at-home tests, end of public dashboard - Texas Medical Center ending weekly COVID-19 data updates, even as cases rise in Houston

Peter Hotez says his recent COVID case shows just how transmissible subvariant BA 2.12 is

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