The Drive with Peter Attia — Peter Hotez (2)

On: COVID-19 (Continued)

Episode: 99

Date: March 2020

Background: Scientist, pediatrician, and advocate in the fields of global health, vaccinology, and neglected tropical disease control.

Key Subjects:

  • No real sense of actual number of cases (% of population infected).
    • Geographical distribution of cases (density) probably more important than absolute number of nationwide cases.
  • Multiple of actual to confirmed cases could be about 10-20x (estimate as of March 20).
    • Based on estimated days to mortality and mortality rate.
    • Means there could be about 100-200k cases in the US, spread over various centers.
  • US hospitals starting to become overwhelmed.
    • Lack of state/federal coordination.
    • Healthcare professionals are getting sick.
    • Shortage of equipment.
  • Inconsistency in age range of infections across countries.
    • About 1/3 of US hospital cases is 20-40 year age range, about 50% under 54.
    • Different from China.
    • Fatality rate not as high in lower age group, but still fairly severe symptoms and perhaps long-term implications.
    • Reasons not clear: vaping? [or, as per Comments below, high blood sugar may be a relevant underlying symptom that is more prevalent in the US?]
  • Potential treatment options.
    • Plasma from recovered patients.
    • Repurposed drugs, such as:
      • Chloroquine (cheap malaria drug).
      • Remdesvir (ebola).
      • ARBs (angiotensin-receptor blockers).
    • Vaccine: takes time.
  • Toxic mix ensures rapid transmission and high number of fatalities.
    • Rate of transmission (fairly high).
    • Rate of fatality (fairly high).
    • Asymptomatic individuals (not all cases are immediately symptomatic).


  • Excellent video explanation of ACE-2 receptors, Ace-inhibitors and ARBs here.
  • Some related points from a Twitter thread by David Sinclair, biologist, genetics professor:
  • SARS-CoV2 attacks pneumocytes in the lungs, intestine, heart and the cells lining blood vessels.
  • In the lungs, CoV2:
    • Prevents cells from making biological detergents to keep lung passages open.
    • Acute respiratory distress follows.
    • Oxygen levels fall.
  • There may be a dangerous underlying process.
    • COVID-19 may also involve abnormal blood production.
    • CoV genes may interfere with heme, the red compound in blood, by kicking out the iron.
  • This would explain why chloroquine seems effective as a treatment.
    • Chloroquine prevents the attack on heme.
  • This may also explain why diabetics and elderly are more susceptible.
    • Blood sugar levels usually increase as we get older.
    • This increases the amount of glycated hemoglobin (HbA1c).
    • The virus may more easily disrupt the heme in red blood cells.
  • If so, the virus:
    • Destroys the lung so patients can’t take up oxygen, AND
    • Reduces the body’s ability to carry oxygen.

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