Editor’s Note: One of the things the Neurohacker Collective is considering doing is summarizing some of the media we are listening to, reading or watching about COVID-19. If you’d like us to do more of this, please let us know in comments, social media, or by emailing us.
We listened to two hour-long episodes of The Peter Attia Drive Podcast in which COVID-19 and the coronavirus that causes it, SARS-CoV-2, were discussed. Dr. Peter Attia and his guests, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, and Dr. Paul Grewal, M.D., discussed the characteristics, transmissibility, risk, and possible treatments and vaccines for COVID-19. They also discussed what can be done individually and collectively to slow COVID-19 transmission, as well as the challenges we face when there are still so many uncertainties around this outbreak and changes come at such a fast pace.
We think it’s worth listening to these episodes and following Dr. Attia if you’re looking for a balanced and informative discussion on the coronavirus outbreak, and other topics related to healthy aging. Dr. Attia’s podcast is a favorite of a member of our Science team—Greg Kelly, ND.
The two episodes are: (1) #97 - Peter Hotez, M.D., Ph.D.: COVID-19: transmissibility, vaccines, risk reduction, and treatment; and (2) #98 – Peter Attia, M.D. and Paul Grewal, M.D.: Coronavirus (COVID-19) FAQ.
In the episode with Dr. Peter Hotez, an expert on viral diseases, they started by discussing the differences and similarities between SARS-CoV-2—the coronavirus that causes the disease called COVID-19—and other coronaviruses that caused disease outbreaks in recent years: the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak and the 2012 Middle East Respiratory Syndrome (MERS).
SARS-CoV-2 may not be as lethal as SARS or MERS, nor as transmissible as other viruses (e.g., measles), but it is high in both categories, which is a reason for concern. Also, whereas SARS and MERS affected everyone similarly, COVID-19 is serious only for specific groups of people.
COVID-19 is particularly lethal for older individuals, individuals with cardiometabolic conditions (heart disease, hypertension, diabetes), and immunosuppressed individuals. Also, there are several cases of healthcare workers that become seriously sick despite being young and previously healthy and it's still not clear why. On the other hand, children and adolescents don’t seem to get sick, but are transmitters of the disease. It’s a complex setting with many unanswered questions.
Dr. Peter Hotez presented Convalescent Plasma Therapy as a possible intervention for coronavirus while a vaccine or effective antiviral drugs are not available. The idea, supported by Dr. Arturo Casadevall, MD, PhD, and Professor at Johns Hopkins, is using antibodies from the blood plasma of individuals that have been infected and have already recovered. It’s a low-cost intervention that is already being tested and that has been helpful in previous epidemic outbreaks. They discussed the procedure, logistics, and scalability of this intervention.
Dr. Hotez then talked about the potential of antiviral medication to treat COVID-19 and what can be expected in the short-term. He also talked about the challenges associated with vaccine development, an intervention that is particularly demanding in terms of testing and safety assessments because it is meant for healthy individuals. He talked about the particular challenges of developing a vaccine for a coronavirus, based on experience with similar coronaviruses, and about vaccines that are in development.
Regarding the disease mechanisms of COVID-19, Dr. Hotez, explained that the virus that causes COVID-19 uses Angiotensin‐converting enzyme 2 (ACE2) as a receptor to gain access to cells, i.e., it infects cells that have this molecule at their surface. An important target of the coronavirus is a type of lung cell that has high levels of ACE2 called type II pneumocytes. This is why COVID-19 causes respiratory symptoms. ACE2 is also found on cells in the kidney, intestinal wall, blood vessels, and heart. This distribution may be one of the reasons why severe cases of COVID-19 are associated not only with respiratory complications, but also with gastrointestinal and cardiovascular problems.
The reasons why this coronavirus is so transmissible were also discussed. Unlike other viruses, SARS-CoV-2 can survive on different surfaces for up to 3 days and can therefore be transferred via surfaces.* This is one of the reasons why this virus has a high reproductive number (i.e., the number of people that will get infected by a single person that has this virus), 2-3 times higher than the seasonal flu. Furthermore, there are many individuals who do not have symptoms but unknowingly spread the virus, which also increases transmission.
As we mentioned in Neurohacker’s Guide to Hand Washing as an Antiviral Strategy, the preliminary research suggests the SARS-CoV-2 can survive on surfaces; surviving for longer on steel and plastic surfaces (up to 2-3 days) compared to copper or cardboard (less than 1 day).
Dr. Attia and Dr. Hotez then discussed what can be expected in the US, how the disease may spread, and the most concerning aspects of the outbreak. Finally, they talked about what can be done to reduce the spread of the disease. You can also read about those recommendations on our website.
In the episode with Dr. Paul Grewal, Dr. Attia builds on the discussion of the previous episode. They started by talking about how, based on what is happening in other countries, it’s not the mortality rate of COVID-19 that’s the most concerning problem. Mortality in countries that were prepared, responded quickly, and took adequate preventive measures was not very high. The real problem with COVID-19 may be morbidity—the percentage of individuals with serious illness who require hospitalization and an elevated level of care. Because of the high morbidity of COVID-19, there can be a very high demand for ICU beds and an inability to meet that demand. This is something to worry about as it may mean that many patients may not receive adequate care, which may increase mortality.
Although this is still being pieced together, Dr. Grewal and Dr. Attia walked us through the general steps between coming in contact with the virus and reaching a state of respiratory failure. As previously mentioned, the virus uses the ACE2 receptor for entry into type II pneumocytes in the lungs. In the process of replicating within the cells, the virus damages them. When damage is extensive, it can lead to lung fluid accumulation or lung collapse. That’s why many people that contract COVID-19 need respiratory support.
Treatment options were also discussed and the challenges of developing or repurposing medication at a time when data regarding the characteristics of the disease is still insufficient. Given the time constraints and how quickly the disease is spreading, repurposed medication may be the best option in the short-term.
The importance of decreasing the spread of COVID-19—flattening the curve—was again highlighted. Prevention is still the most effective approach. It will allow us to buy time to build capacity to face the challenge: scale up ICU capacity, develop vaccines, develop effective treatments, and build knowledge about the disease so that informed decisions can be made.
Dr. Attia and Dr. Grewal and give some advice on how to do so. You can also check out Neurohacker’s Guide to Hand Washing as an Antiviral Strategy.