Houston Public Radio Interviews William A. Haseltine

ACCESS Health Chair and President William A. Haseltine recently appeared on Houston Matters: Special Edition with Ernie Manouse. The full interview is available to listen to HERE. A transcript of the conversation is also available, below.

William Haseltine (WH): It is a pleasure to be here.

Ernie Manouse (EM): It is sad that it is under these circumstances, but I am thrilled you accepted our invitation and can join us to talk about this. You have had a lot of experience in what goes on in these global pandemics and understand the way to treat it, the way to look at vaccines and medications. At this point, do you have hope?

WH: We always have hope, and in this case, I have got a lot of hope. This is not a hard problem to solve from a drug point of view. This is a virus. It is not cancer. It is different from your body. It is a foreign invader. Not only that, there are many, many points of vulnerability. We have very powerful tools to find new drugs that target these specifically. We have a lot of drugs that we know work against viruses, not this one, but we are confident that because we have been able to find drug cocktails for HIV, we are able to cure hepatitis B, there are great drugs for herpes virus infections. This is a problem that can be solved. It will not be solved immediately, but I guarantee you we will solve this problem.

As for vaccines. We are hopeful. Vaccines are more complicated. These viruses have developed ways to evade our immune systems in one way or another. That is why they are successful. We certainly will have vaccines. Vaccines will raise immunity, whether it is a perfect shield or not, we do not know yet. And for how long if you are vaccinated, whether protection be long lasting or not, we do not know yet. I am reasonably confident we will also have effective vaccines and that if they do not stop the disease will certainly weaken its impact on the human population.

EM: The problem with vaccines, though, it is going to be a wait before we get them. No matter what we want to do, no matter what we hope for, there is a little lag time there.

WH: There is going to be a lag time for truly effective drugs and there is going to be a lag time for the vaccines.

EM: I was going to say, early on, the President was talking about different drugs we could use and it felt as though they were talking about it like no matter what your illness, just go into a drug store and just pick something up. There has to be more thought when people say what kind of drug can actually show potential to help with this particular virus. This is a little bit in the weeds of a question, I know, but how do you go about deciding where you should even look in the world of drugs that currently exist or even in vaccines that were started to know that they might show hope in this battle?

WH: Let me answer that question in a couple of ways.

First of all, I want to make sure whoever is listening knows there are no drugs that we are currently certain will work to treat this disease. No drugs. You may have heard about of a whole series of drugs. We do not know that any of them work for sure because they have not been done and tested under the proper conditions.

The first place to look for drugs that we might already have approved that could be useful are drugs that are useful for cancer, as well as those that are useful for other viruses. So far those have not proved to work. That does not mean that they will not. It just means it has not been proven yet.

The next place you look for drugs is all of those chemical compounds, drug candidates that were produced to fight SARS and MERS. There were many, as many as twenty possibly thirty, that were shown to be potent in their ability to stop the virus growing in the laboratory. That is different from showing that it is safe in humans and that it will stop it in humans, but at least it is a good start. Why you might ask, don’t we have those available today? Because we stopped all research when we thought SARS or MERS would go away, despite the fact that I, and many, many people who understood how dangerous these viruses were, urged that we bring those to completion. We did not.

The third place to look: We know what this virus needs to grow. There are at least four or five absolutely critical parts the virus cannot do without. I have great confidence that we can find new compounds not yet discovered that will work to stop each one of those. So, we are very confident in the long run. The short run, I would say is still very much open.

EM: When we talk about coronaviruses, we tend to use the term coronavirus to mean what we are talking about today, but as we know it is a whole family of viruses. Are there other drugs out there that are effective against other coronaviruses. Is that somewhere we might look?

WH: There are a lot of coronaviruses.  There are eighty eight different families of coronaviruses and within each family there are many, many variants. There are no known drugs that are shown to stop coronaviruses. There is a short term potential treatment and a way you might even prevent these infections and that is being tested right now, passive immune therapy. Passive immune therapy initially uses convalescent sera. That sera can be used to treat those that are most critically ill. That is being done today.

The next step for passive immune therapy is to prepare hyperimmune IgG from convalescent plasma. Hyperimmune IgG is purified from large pools of convalescent blood. If there is a large enough supply, hyperimmune IgG can be used to treat those who are critically and to protect healthcare workers.  I am pretty sure that will work. I think hyperimmune IgG should be available sometime this summer.

EM:  Why would people consider chloroquine related drugs for treatment of Covid?

WH: The answer is a little bit technical. When the virus enters your cell, it goes into a little compartment within the cell. The virus needs special conditions in that compartment to initiate infection. The chloroquine family of drugs has the potential to change those conditions so that they are unfavorable for the virus. There is some evidence in the laboratory that that happens.

Now the problem. This approach has never worked well for other viruses that rely on a similar strategy to initiate infection. What works in the lab does not always work in real life. The issue may be the amount of the drug needed to change the conditions enough. That level of drug may be toxic. We already know enough to know that, at best, the chloroquine family of drugs may have only a weak effect. They might be mildly effective, but they will not the cure all. It simply will not be. What will eventually be the cure is either the hyperimmune IgG or very specific combinations of antiviral drugs.

What is happening now reminds me of the early days of HIV/AIDS when people were desperate to try any kind of drug. We learned a very powerful lesson. Be careful of what you try. Suramin as a treatment for HIV was tried in France and other countries. It did not work and was toxic. Curiously the enthusiasm for chloroquine drugs also started in France, by a doctor with a controversial reputation. There was Compound Q, a drug from the traditional Chinese pharmacopeia. A community of gay activists tested Compound Q outside of government control. A lot of people ended up dying sooner than they had to. After that failure I was part of a dialogue with the leaders of that community. They learned an important lesson and became partners rather than critics in drug testing by the NIH. Curiously, I was working very closely with Tony Fauci in those days, the same Tony Fauci, and this is thirty years later, who is leading the fight against Covid-19. When Tony issues cautious statements about the drugs some are touting, be sure that he has very good reasons to urge caution.

EM: Wendy, one of our listeners asked, “Why  weren’t vaccine and antiviral drug efforts continued after the SARS and MERS epidemic waned?”


WH: The belief that disaster won’t strike again seems to be an integral part of human nature. People put out the fires of today but generally not those of tomorrow.

One lesson we should all take away from the Covid pandemic is that nature is mounting a sustained attack on humans beings. Each organism is in a fight for its own survival. Each must adapt to its immediate ecosystem. For many viruses, we humans are part of their ecosystems. Each day, nature throws up trillions of random mutations in viruses that may infect us. Usually they don’t help the virus. Sometimes they do. The viruses, by massive parallel mutation, are out there trying to crack your protective code, whether it is our immune system, our healthcare systems, our social systems. Nature is experimenting with ways to find the chinks in our armor and no matter what we do nature will succeed. Nature is a far more dangerous and persistent foe than any ideologic terrorist. Think of all of the living world as a giant AI machine capable of learning. What is it learning? How to replicate in this delicious environment of billions of humans closely networked and closely interacting.

The lesson? Know that we are and always will be under assault and prepared to defend ourselves for the inevitable.

EM: How do we know where to put our resources?

WH: We’ve known for at least seventeen years that  coronaviruses are dangerous. Nature warned us once with SARS. Nature reminded us once again with MERS. It seems we did not heed the lesson. Now that we are in the midst of the third assault we rue the day we dropped our shield. But will we remember tomorrow?

What else is coming our way. We know antibiotic resistant TB is out there and coming to get us. We know that antibiotic resistant microbes, specifically flesh eating staphylococcus is out there and is coming to get us. We know that global warming is changing the environment, so tropical diseases like malaria, dengue, zika, and yellow fever is coming our way. We know a new, highly transmissible and deadly influenza strain, one far more deadly the SARS-CoV-2, is on its way. We just do not know when, but we are certain it will come. Up to one billion people or more may die if we are not prepared.

Can we protect ourselves? Forewarned should be forearmed. Just after 9/11 and the anthrax attacks that followed closely on the heels of that tragedy, we ramped up our defense against bioterrorism. The Department of Homeland Security working with the Defense Department, the Centers for Disease Control and the National Institutes of Health created a matrix. Down one axis were potential organisms that might be weaponized. On the other axis were extant defenses. Where there was match the box was checked. Where there was an open square, the government promised to buy and stockpile vaccines, drugs and other effective countermeasures should some company develop one.  I know the process well because at the time I was CEO of a company that filled in one of the boxes. We were in fact awarded a contract to supply a strategic stockpile.

We need to be far more prepared for what we know is coming our way. That means research. It means development, and if a drug company will not pay for it, the government should pay for it just as we do to protect ourselves from bioterrorists. When I worked with Tony Fauci on that legislation, we made sure that the wording covered “new and emerging infectious disease of man made or natural origin.” We have the legislation, we have the tools, we just did not use them. Frustrating then and even more so now. You bet!

EM: One listener asked us to discuss testing people for antibodies to the virus. They are beginning to do that in England.

WH: There are two types of tests. One measures the presence of the virus itself. I call this genomic tests. They detect the actual virus. The early versions were slow and cumbersome. After a swab was taken, it was sent to a specialized lab for analysis. The results are slow, many hours at best, many days at worst.

Recently a new type of genomic test has been developed and approved for use. This test also measures the presence of the virus itself. The test is called a point of care test. A positive answer shows up within 5 minutes, negative in 15 minutes. That will be a game changer. But the supplies of this test are very, very limited.

There is a different type of test altogether. These tests determine whether or not you were infected by the virus. They measure the immune response to the virus. Within the first two weeks of infection the body makes an initial antibody response. These are called IgM antibodies. Several weeks later the body begins to make more effective and longer lasting antibodies called IgG antibodies.  Tests for such antibodies are fast and cheap. I recently described, in the New England Journal of Medicine, the use of one such rapid test to screen the entire population 12 and over for evidence of infection with hepatitis C. It required one drop of blood from a finger stick and took five minutes to get the answer, and cost 50 cents each!! The test is made by a US company. We can do the same for SARS-CoV-2, and we should.

Serologic tests that cost $1 or less are available from China, Singapore and an increasing number of sources.  I just learned that Andorra is going to test everybody, all 70,000 people.

EM: We have been very fortunate here in Texas. Our numbers are still relatively small.  Can you actually control this virus, this outbreak, by opening some areas and closing others? Keeping some people on stay at home orders and other areas can be open and relaxed?

WH: You probably cannot do that in the United States. In China they were relatively successful with a modified version. It is important to understand exactly what they did. In China, if somebody is infected, they contact trace. They do a very rigorous interrogation to make sure they know all the people that person has been in contact with.  Each and every contact is put in what they called controlled quarantine for fourteen day post exposure. Controlled quarantine is isolation in a single occupancy hotel room. Leaving the room is not allowed. I emphasize everyone no matter their test result. That is how China controlled the infection. That is how Singapore is controlling the infection. That is how South Korea is controlling the infection. It is not what we are doing.

I am sitting here in the middle of New York, in the middle of our rampant epidemic. We are not doing contact tracing to any extent. We are not putting people in mandatory isolation as single individuals. We know this virus can be controlled without any medical intervention. You can stop this epidemic. We are not doing what is needed to stop it. We are doing what is needed to slow it.

I have a thought experiment for you. All of us know by now what flattening the curve looks like. That means reducing the number of new cases at the peak and stretching out the timeline of the epidemic. I am interested in the area under the curve. That tells us how many people will be infected in total. Flattening the curve helps prevent hospital overload. As the curve moves down, flattening the curve does not mean reducing the total number of people infected. It could mean that, that might be the case for South Korea, Singapore, Hong Kong and Taiwan, but it does not necessarily mean that. A word of advice from Houston. Don’t believe you will be spared. It is simply a dangerous assumption.

EM:  What can an individual do tom protect themselves and their family?

WH: The most important thing to do is to remain at home and as isolated as you can be. And when you leave the house for needed supplies, leave for the shortest time possible. Only have one person go. Wear gloves. Wear a mask that protects others if you happen to be infected. Limit your exposure to as short a time as possible. Wash your hands when returning home. I wear gloves when I go out and wash my hands when I return. Be careful of how you handle the gloves as you do not want to touch what those gloves have touched. Do not go out and mix with other people. Do not have friends over. Do not take any public transportation unless absolutely necessary. If you must be in public, wear a mask and cover your hands. Be aware. Be vigilant. Be in the moment and do not let your mind wander.

EM: Will the virus mutate to become airborne?

WH: It does not have to mutate. It is already airborne. Maybe not as airborne as some other viruses, but it is also airborne.

EM: What does that mean so people understand?

WH: It means that you can get it from breathing the air that somebody exhaled. SARS-CoV-2 is not as infectious as tuberculosis, for example. It seems to be airborne to some limited extent.

EM: What should we do with the cruise ship in the Caribbean now looking to dock?

WH: Well, you are getting beyond my area of expertise.  That is a very tricky question.  I just feel for all of those people who are on those ships. I do have a word of advice. Stay off cruise ships for a long time to come.

EM: If tomorrow you were handed the keys to the kingdom, what would you do? How would you start to fix this problem?

WH: The first thing I would do is institute mandatory contact tracing and fourteen day isolation for all those in contact with a person known to be infected. I would do population based genome and serology screening. I would do everything in my power to make sure healthcare workers had the equipment they needed to keep themselves safe. We only have so many healthcare workers and we are losing them. In other countries they are losing them pretty fast. It’s a real tragedy. Every life is a tragedy, but a life that can save other lives is a special kind of tragedy.

In the United States I would activate all of our research efforts. I would order the pharmaceutical companies to drop almost all other projects to concentrate their full power to finding drugs, vaccines and monoclonal antibodies to prevent and cure this infection. I would put a full court press on our efforts to create protective hyperimmune IgG so that we can we can protect our healthcare workers.

That is off the top of my head but give me more time and there is much more I would do.

EM: Thank you for your time.

WH: You are welcome. Fare thee well Houston!

END

Note: This transcript has been lightly edited