Speaker 1: Also media, Hello everyone, and welcome to It Could Happen
Speaker 1: Here podcast, returning from our holiday break to discuss the
Speaker 1: exciting topic of infectious diseases in Gaza, and for that
Speaker 1: we're joined by an all star cast of experts. We
Speaker 1: have joining us today Saskia Popescu, who's an infectious disease
Speaker 1: epidemiologist and assistant professor at the University of Maryland.
Speaker 2: Welcome Saska, Thank.
Speaker 1: You for joining us.
Speaker 3: Thanks so much for having me.
Speaker 2: Yeah, of course, yeah, you're welcome. It's not just you.
Speaker 1: We've also got Cave carves back, come back baby.
Speaker 4: It's actually my first time. This is Sharene. Also, i'm here.
Speaker 4: This is my first time meeting cave so this is
Speaker 4: a real trick.
Speaker 1: Yeah, sure, I've done you wrong, Sharen, I'm sorry I
Speaker 1: didn't introduce you.
Speaker 4: That's okay, it's probably in the description or something that
Speaker 4: I'm here.
Speaker 1: No one, Yeah, make a valuable contributions. People will know
Speaker 1: you're here.
Speaker 2: But yeah, it's it's all of us.
Speaker 1: And yeah, we talked today because like I think the origin,
Speaker 1: sorry of this particular episode is that, like a few
Speaker 1: weeks ago, there was a very funny thing on the
Speaker 1: internet about people in the i d F getting diarrhea,
Speaker 1: which is funny.
Speaker 4: Object what the d i F stands for?
Speaker 2: Actually, all the kids are saying, but sorry, no, it's funny.
Speaker 5: Don't you ever apologize? Yeah, you do, not apologize for.
Speaker 4: You any opportunity just to ship on them.
Speaker 3: You're good.
Speaker 2: Yeah, expect many. It's half an hour at least of this.
Speaker 1: Don't be driving because you might laugh too much and crash.
Speaker 1: But no, it's very funny. It's the name of our
Speaker 1: group chat it's as Ready Diarrhea Forces. But aside from that,
Speaker 1: like this raises a more important question, right, which is
Speaker 1: that people in Gaza don't have access to very many
Speaker 1: medical supplies to begin with.
Speaker 2: Were things are.
Speaker 1: Embargoed like torny K's which is spoken out in this
Speaker 1: podcast before. They also have obviously a very resource constrained
Speaker 1: environment to begin with, and then a number of their
Speaker 1: hospitals have been bombed since then, which obviously further reduces
Speaker 1: their access to medical care. Also, they have less acklos
Speaker 1: to things like running water now because they're being bombed
Speaker 1: to an incredible degree. And so Saskia has joined us
Speaker 1: today to like explain the risk of the spread of
Speaker 1: infectious disease, maybe give us an update on like what's
Speaker 1: already happening and the risks of what could happen. So
Speaker 1: I guess maybe we should start off with really basic
Speaker 1: stuff and explain what infectious diseases are and like how
Speaker 1: they're different from non communical diseases gets people aren't familiar,
Speaker 1: would one if you like to do that.
Speaker 3: Yeah, I'm happy to. So infectious diseases, you know, when
Speaker 3: we talk about diseases in general, as you mentioned, there
Speaker 3: are chronic diseases, things like diabetes, cancer. When we talk
Speaker 3: about infectious diseases, meaning they're communicable for the most part,
Speaker 3: that means that they are spread through various sources human
Speaker 3: to human, like influenza. There's things like anthrax that you
Speaker 3: can equali Campelobacter that you can get from soil, from food,
Speaker 3: and the zoonotic diseases that they are also spread through animals,
Speaker 3: so things like Ebola mirors which is Middle East respiratory
Speaker 3: syndrome coronavirus. So infectious diseases are viruses, bacteria, fungi, parasites,
Speaker 3: and they really love to take advantage of high stress
Speaker 3: environments for bread and unfortunately this is one of them.
Speaker 3: So this is a very what we see with infectious diseases.
Speaker 3: A lot is that conflict and environments where people are stressed,
Speaker 3: resources are stressed, and the environment is under a continuous bombardment.
Speaker 3: There's densely populated spaces, no access to health, clean food,
Speaker 3: and water, et cetera. I mean, I could probably go
Speaker 3: on for five minutes about what makes an infectious disease spread,
Speaker 3: is going to amplify it. So these are diseases that
Speaker 3: take advantage of these environments.
Speaker 5: I'll add that the situation is just a perfect setup
Speaker 5: for infectious disease to run rampant. There's over one point
Speaker 5: nine million people that have been displaced. Of that, one
Speaker 5: point four million are living in overcrowded shelters at this point.
Speaker 5: And in the best scenario from what I've seen, there's
Speaker 5: one toilet for every two hundred and twenty people. Now,
Speaker 5: if you ever lived in like a house of like
Speaker 5: five people and there's like one case of diarrhea, you'll
Speaker 5: realize how terrible that is. Now you amplify that to
Speaker 5: two hundred and twenty at the minimum, and that's the
Speaker 5: best case scenario. I've heard its highest one per seven
Speaker 5: hundred people in some places. And then you know, people
Speaker 5: have to go in the streets, they have to go
Speaker 5: where there's water supplies, and you're going to be infecting
Speaker 5: those areas. There's one shower for every like four five
Speaker 5: hundred people again in best case scenario. So it's a
Speaker 5: huge number of people getting concentrated into smaller and smaller
Speaker 5: areas and without the infrastructure there to handle that in
Speaker 5: any way. And when that happens, I mean, we are
Speaker 5: going to see I am really worried about seeing in
Speaker 5: the end of this more depth from infectious disease than
Speaker 5: from the bombardments.
Speaker 4: Yeah, well, that's that's like a it almost feels like
Speaker 4: a double another weapon that they're that that they're that
Speaker 4: they've used because they're not letting them have a chance
Speaker 4: to recuperate or have a sanitary place to do surgeries
Speaker 4: or anything. Because if they're doing surgery with unsanitary conditions,
Speaker 4: they can get infect like the wounds can get it affected,
Speaker 4: and that's a whole nother thing, or even just like
Speaker 4: having waste in the street, like making it like having
Speaker 4: it fester. It just it's it's really I think people
Speaker 4: forget that it's not just like a building was destroyed
Speaker 4: or people were killed. It's there's lasting effects that linger
Speaker 4: for probably generations. You know, it's just it's just I
Speaker 4: don't know. It really is infuriating.
Speaker 3: I think the crazy part is the World Health Organization.
Speaker 3: So the WHO recently released some data as to what
Speaker 3: is reported to them in terms of disease, and they said,
Speaker 3: so far not keep in mind, these are just reported numbers,
Speaker 3: and that means it's just the tip of the iceberg.
Speaker 3: In most cases, one hundred thousand cases of diarrhea and
Speaker 3: those are in young children. So half of those are
Speaker 3: in young children out of the age of five, which
Speaker 3: means it can be deadly. And this number is just
Speaker 3: twenty five percent higher than what we have seen reported
Speaker 3: pre conflict. And in terms of respiratory infections, the things
Speaker 3: like covid, influenza and pneumonia, one hundred and fifty thousand cases.
Speaker 3: And that's just the numbers that we know about. But
Speaker 3: we're also seeing cases and outbreaks of things like meningitis,
Speaker 3: skin rashes, babies, LCE, chicken pox, which is highly infectious.
Speaker 3: And you know, we worry in those cases about when
Speaker 3: people are in these close quarters and their bodies are
Speaker 3: already strained. Because one thing we do know is that
Speaker 3: when your bodies physiologically under stress, meaning no sleep, malnutrition,
Speaker 3: you know, not access to clean water to wash your hands,
Speaker 3: not dehydrated, et cetera, you're at an increased risk for
Speaker 3: disease and severe disease. So that means that people are
Speaker 3: at higher risk to get it and then to spread
Speaker 3: it in these environments. And that's what's really scary because
Speaker 3: it becomes a hot spot for transmission. And you mentioned
Speaker 3: that this feels like a secondary effect in many ways.
Speaker 3: It's almost like a secondary conflict, if you will, and
Speaker 3: one that will leave lasting implications because what we do
Speaker 3: know is that disease and conflict go hand in hand.
Speaker 3: And when I think about it a lot, and we've
Speaker 3: seen this unfortunately throughout time, is that conflict can bring
Speaker 3: disease and it can amplify disease. When I say bring disease,
Speaker 3: we know that people in these spaces soldiers can bring
Speaker 3: in diseases that are being spread around. But we've also
Speaker 3: seen sexually transmitted diseases in the past being spread through
Speaker 3: sexual assault and sexual violence, and that's one thing I
Speaker 3: definitely worry about, and unfortunately we know that's happening and
Speaker 3: it's not something we're going to see reported for a while,
Speaker 3: but things like that can and do occur, and it's
Speaker 3: a very scary situation.
Speaker 5: If I can tack on a little bit to the
Speaker 5: diarrhea subject here, because I am a GI and liver doc,
Speaker 5: I mean, in a typical month in Gaza, there is
Speaker 5: about two thousand cases of diarrhea and kids under five,
Speaker 5: and in the last month there was over forty thousand cases.
Speaker 5: And for kids that aren't getting water, they're not getting
Speaker 5: the recommended amount of like daily water, like it's like
Speaker 5: seven to eight leaders in refugee situations is what's recommended.
Speaker 5: These people are getting like one to two leaders per
Speaker 5: whole families, so they're not staying hydrated. And these are
Speaker 5: kids that are most vulnerable. That's the part that is
Speaker 5: really hard for me. And I've actually seen people sort
Speaker 5: of downclay it like just like, well, diarrhea, you know,
Speaker 5: that's what you get, but in these situations, it's going
Speaker 5: to be very serious for these kids. And the other
Speaker 5: thing we're seeing is cases of jaundice. They're noting that
Speaker 5: people are becoming that, which to me suggests that there's
Speaker 5: hepatitis A and hepatitis E, which is you know, you
Speaker 5: get through fecal oral contamination and hepatitis E in particular
Speaker 5: is what concerns me because there's pregnant women and when
Speaker 5: pregnant women get hepatitis E, it's worse for them that
Speaker 5: that's a really bad situation. And when that happens, I mean,
Speaker 5: these are these are women who are already not getting support,
Speaker 5: They're already under nourished, They're not able to produce breast milk,
Speaker 5: They're going to be sick, They're not going to be
Speaker 5: able to feed their kids. It's I mean, I can't
Speaker 5: I can't imagine, honestly. I mean, I know it's funny.
Speaker 5: We can say these things, we can talk about the numbers,
Speaker 5: but it is like to actually wrap my brain around
Speaker 5: it breaks my brain. I cannot, like imagine the numbers
Speaker 5: of people that are sick and are in these hospitals,
Speaker 5: not just being treated, but like the NASA Hospital, which
Speaker 5: is one of the two hospitals in Gaza, you know,
Speaker 5: they they are like a three hundred and fifty bed hospital.
Speaker 5: They are already over like a thousand patients and not
Speaker 5: to mention the many thousands, over seventy thousand people just
Speaker 5: staying there, you know, for refuge. It's absolutely a nightmare.
Speaker 5: I can't I can't write my brain around it.
Speaker 1: Yeah, Like often I know when I speak to colleagues
Speaker 1: who are there or at the journalistic they'll go to
Speaker 1: hospitals a in the hope that they'll be safe, which
Speaker 1: hasn't proven to be true sadly, which is pretty messed up.
Speaker 1: But be you know, they have many generators, right, so
Speaker 1: they can charge and and tell the world what's happening,
Speaker 1: or try to. It seems like some of the word
Speaker 1: isn't listening. But yeah it there cost blows are incredibly overgrowded.
Speaker 1: I wonder like if we could go back to diarrhea
Speaker 1: and there's not like a fun topics talk about it.
Speaker 5: Score, Yeah, it's time to shine.
Speaker 2: Yeah, this life's work.
Speaker 1: So like I think it was diarrhea that I read
Speaker 1: kills more people than conflict annually.
Speaker 5: Oh yeah worldwide sure, yeah, yeah, well, I mean Saskia
Speaker 5: probably has better numbers on it than I do, actually,
Speaker 5: but worldwide, yeah, it's probably the number one, number one killer.
Speaker 1: So like let's just break that because I most of
Speaker 1: like by the very hus being a podcast, right best,
Speaker 1: so people listening in the in the kind of the
Speaker 1: in the neoliberal core or the global north, whatever you
Speaker 1: want to call it. Right, Like, they have a smartphone
Speaker 1: and they've downloaded this, and it might be difficult to
Speaker 1: understand how you die from diarrhea, which is like an
Speaker 1: inconvenience in a lot of places. So can you just
Speaker 1: explain that for people so they can they can understand
Speaker 1: and how the conditions that we see in Gaza would compound.
Speaker 5: That Saska, Do you want me to go first?
Speaker 1: Oh?
Speaker 3: All you, I'll talk about spreads, you can talk, okay.
Speaker 5: So, I mean, the there's a couple of issues that
Speaker 5: can happen. There's a lot, but I mean dehydration is
Speaker 5: going to be a major one, and loss of electrolytes.
Speaker 5: I mean, these people can get so badly dehydrated that
Speaker 5: the circulatory system isn't working properly, or they can lose
Speaker 5: the amount of electrolytes that they need and they're not
Speaker 5: replacing and that can cause cardiovascular issues as well. So
Speaker 5: it's a terrible way to die. I mean, you know,
Speaker 5: cholerara and these terrible like diarrheal epidemics that you know
Speaker 5: we think of of mostly in the past. They're terrible.
Speaker 5: They're terrible ways to go, and especially if you don't
Speaker 5: have the I mean it's treatable. Usually it's treatable. You know,
Speaker 5: you get fluid rehydration, you get electrolyte management. It's it's
Speaker 5: pretty manageable in the right situation. But if you don't
Speaker 5: have that, it's gonna be a devastating thing to the
Speaker 5: body over time, and for young kids, sooner rather than later.
Speaker 2: Yeah, so maybe we should explain how it spread.
Speaker 3: Yeah, I mean the scary parts. So there's multiple pathogens
Speaker 3: that can cause diarrheal illness, and for the most part,
Speaker 3: we see bacteria and viruses. If you've had neurovirus, which
Speaker 3: is the cruise ship bug, that is highly transmissible, meaning
Speaker 3: it just goes through households and environments very very quick.
Speaker 3: During outbreaks. You can't just use hand sanitizer and a
Speaker 3: simple disinfectant. You need bleach. And if you're if we're
Speaker 3: thinking about the best case scenario, and I've seen you know, diarre,
Speaker 3: real illnesses go through schools, hospitals, you name it. We
Speaker 3: still struggle to contain those. Now, put yourself in an
Speaker 3: environment with this level of stress, and you know, the
Speaker 3: thirty six hospitals in Gazda Gaza twenty six have been damaged,
Speaker 3: twenty one are not functional at all, thirteen are partially functioning,
Speaker 3: and two are barely functioning. So we know that access
Speaker 3: to care is a challenge. Resources I can't even imagine.
Speaker 3: So that means the capacity to treat patients with antibiotics,
Speaker 3: with fluids, everything, and now contain it, which is the
Speaker 3: disinfection you know, all the infection prevention essentially, And I
Speaker 3: don't even want to think about contact tracing in public
Speaker 3: health interventions because it doesn't exist. It's an entirely collapsed system.
Speaker 3: You know, this is a humanitarian crisis. So when you know,
Speaker 3: when you have people in close quarters and there's a
Speaker 3: lot of high touch items because a lot of direal
Speaker 3: illness is spread through touch. It's you know, contaminated hands
Speaker 3: and objects, and then you know, you touch your mouth,
Speaker 3: you eat with your hands, et cetera. That's how these
Speaker 3: things are spread. So between the bathroom not having access,
Speaker 3: you know, not having access to restrooms. You know, we
Speaker 3: mentioned the toilet situation, there's also one shower for every
Speaker 3: forty five hundred people, so we know that people are
Speaker 3: not able to clean themselves effectively. And this is a
Speaker 3: ripe condition for direal illness to spread, and they it
Speaker 3: spreads very quickly, very efficiently, and it is exceedingly hard
Speaker 3: to get rid of. And it worries me because a
Speaker 3: lot of these diseases, it's not just like you get
Speaker 3: it one time and you have immunity to it. It
Speaker 3: can keep going around and if you have a situation
Speaker 3: like that where you cannot clean effectively, you can't treat effectively,
Speaker 3: then we're just going to see it continuously compound. And
Speaker 3: that's absolutely terrifying because you know, we were talking about
Speaker 3: pregnant women earlier. There's fifty thousand pregnant women right now
Speaker 3: in Gaza and they are malnourished. That's just the tip
Speaker 3: of the iceberg. And we see that so many children
Speaker 3: there are malnourished, and these are very dangerous infections for
Speaker 3: vulnerable people. And on the best of days, we struggle
Speaker 3: to contain diarreal illness. So my big concern is this
Speaker 3: and respiratory viruses. To be honest with you, because when
Speaker 3: you have this many people in close quarters and ignore
Speaker 3: the fact that they're extremely you know, physically strained and
Speaker 3: stressed right now, which is when your immune system struggles,
Speaker 3: it's going to spread and it's going to be exceedingly
Speaker 3: hard to contain it. So this is an environment where
Speaker 3: we're going to see diarreal illness spread and it's going
Speaker 3: to unfortunately kill a lot more people then we will
Speaker 3: even realize. It's going to take years to understand implications
Speaker 3: of this, you know, if we even consider that access
Speaker 3: to clean water and food. We've been talking a lot
Speaker 3: about malnourishment, which is huge, but I'm also concerned to
Speaker 3: the quality of food that they're getting too, and the water,
Speaker 3: all of it. Everything about the situation is going to
Speaker 3: spread disease. It's you know, I know that sounds quite dramatic,
Speaker 3: but it's entirely true.
Speaker 4: No, I mean, I'm glad you're emphasizing that, because I
Speaker 4: don't think people realize the gravity of of like a
Speaker 4: second wave of death like that that happens like not
Speaker 4: even not with weapons. Uh, but no, I'm glad you
Speaker 4: emphasize that. Let's uh, let's take our first break. We'll
Speaker 4: be right back.
Speaker 3: And it reminds me too of when we saw U
Speaker 3: N peacekeepers in Haiti and they introduced polera, and you know,
Speaker 3: and that's it's an unfortunate reality when you are bringing
Speaker 3: in groups of people to and this you know, for
Speaker 3: in Haiti, they were trying to help the situation. In
Speaker 3: this case, it's not surprising. I mean, there's there's a
Speaker 3: really good book called Contagions and Chaos that actually talks
Speaker 3: about how infectious diseases can amplify conflict or create it.
Speaker 3: And ultimately, I think we're just going to see this
Speaker 3: as a rolling in health issue until there's a ceasefire
Speaker 3: and until there's really substantial work in there to resource
Speaker 3: and to take care of people.
Speaker 4: I mean, it's scared any Kave. You mentioned that you
Speaker 4: had a question for Saskia I.
Speaker 5: Do you know you've written and you talked a lot
Speaker 5: about the intersections of science and policy, particularly in terms
Speaker 5: of COVID nineteen. We've seen that global threats elsewhere can
Speaker 5: affect Americans, and I'm wondering, is there a way to
Speaker 5: try and appeal to Westerners who aren't that interested yet
Speaker 5: and why they should care about infectious diseases that are
Speaker 5: rising or become rampant in other places. Is there an
Speaker 5: argument you can make to these people who may not
Speaker 5: care that much about the Palestinian people per se.
Speaker 3: Oh, there's the political answer. I should give you. And
Speaker 3: then there's the real answer, which is political answer saying
Speaker 3: that you know people do care and you know we're
Speaker 3: just having the console in your mind them. But the
Speaker 3: real answer is, look, we just came out of three
Speaker 3: and a half years of a pandemic and at this point,
Speaker 3: if people don't give a shit, they're not going to.
Speaker 3: And I know that's crude for me to say, but
Speaker 3: it's I've been working in this and we've seen it
Speaker 3: from Ebola to mers too, empocs, and in now coming
Speaker 3: out of COVID. I think we can safely say that,
Speaker 3: you know, it's not a matter of if, but when.
Speaker 3: But people really like the saying that is infectious disease
Speaker 3: knows no borders, and to a certain extent that is true.
Speaker 3: Infectious diseases they don't know that, but it ignores the
Speaker 3: fact that some countries are more equipped to handle them,
Speaker 3: and that borders are a pores concept. So in this case,
Speaker 3: I think from an American perspective, where it is a
Speaker 3: very complicated relationship Americans have and I'm not getting into
Speaker 3: that when it comes to Israel. The reality is that
Speaker 3: it shouldn't matter if it's a conflict. If you see
Speaker 3: an outbreak somewhere. You should be worried for those people,
Speaker 3: and it shouldn't matter if it's going to impact you.
Speaker 3: But now that we have lived through a pandemic, a
Speaker 3: historical event, I would like to think people would see
Speaker 3: this and realize any one of these diseases can come
Speaker 3: to the States, it can strain global resources. And I'm
Speaker 3: hopeful that with the amount of attention that's coming to
Speaker 3: this and that the work that the WHO and the
Speaker 3: UN have been drawing attention to it, that will change.
Speaker 3: But I get a little nervous every time we talk
Speaker 3: about infectious diseases and conflict areas because I find that
Speaker 3: Americans and it's not just us, that people in high
Speaker 3: income countries disassociate because that is a conflict related issue,
Speaker 3: but it's not Conflict can mean many different things, and
Speaker 3: it's essentially saying, this is an issue that's going to
Speaker 3: bubble out of control. And if we were in a
Speaker 3: situation where there was no clean food and water, we
Speaker 3: had no access to health services, in medicine, well was
Speaker 3: an issue in power, no communication and I just read
Speaker 3: that three Palestinian internet providers went down, so they have
Speaker 3: no way to contact outside world. They have housing, safe passes,
Speaker 3: et cetera. Any one of those impacted US, we would
Speaker 3: be experiencing it. And I will leave that question with
Speaker 3: one comment. That's to say we are a very well
Speaker 3: resourced country. The US invests so many resources into health,
Speaker 3: global health, security, biopreparedness, all of the above, and we
Speaker 3: were one of the worst performers when it came to
Speaker 3: COVID response. And I say that having worked in health
Speaker 3: care during that and doing epidemiology, and I think this
Speaker 3: should be a continuous wake up call that it's we're
Speaker 3: one disease away from an international crisis, and when we
Speaker 3: see this, it should really speak to the fact that
Speaker 3: it is global health. It's not national health, not local health,
Speaker 3: it is global health. That's my ted talk.
Speaker 2: The good tech.
Speaker 1: I guess if I could piggyback on that, there is
Speaker 1: not a single war that I have covered, either remotely
Speaker 1: or in person, where I have not then seen those
Speaker 1: people arrive our border where I live, Like I was
Speaker 1: in Syrian Kurdistan in October. I am seeing people leaving
Speaker 1: Turkey more and more Turkish Kurdistan, but also Syrian Kurdistan,
Speaker 1: or people who went to Syria went back to Turkey
Speaker 1: at our southern border right now. I am seeing people
Speaker 1: from conflicts all over the world at our southern border
Speaker 1: right now, and every single conflict, because we tend to
Speaker 1: stick our nose into every single conflict, it ends up here,
Speaker 1: right because we tell people we support them and then
Speaker 1: we abandon them, and they come here thinking that we
Speaker 1: were going to support them. I'll also add that every
Speaker 1: time there is an infectious disease outbreak going forward, it
Speaker 1: will be used in the same way that COVID was
Speaker 1: to prevent asylum. The title forty two that was used
Speaker 1: to like quote unquote catch and release migrants at the
Speaker 1: southern border allowed border patrol to reject people without processing
Speaker 1: their asylum came. That's a public health floor, it's migration law.
Speaker 1: Biden's already indicated that he would love to do the
Speaker 1: same thing again, and like, you don't even need an
Speaker 1: excuse with this infocused disease stuff, right the laws are
Speaker 1: already there, and it was already in place for several years,
Speaker 1: so it's kind of stood the test of the courts.
Speaker 1: And this will impact even if you don't give a
Speaker 1: shit about people in Palestine, and maybe you should examine
Speaker 1: what's up with your morality if you do, like, this
Speaker 1: will impact you because people will come here, and it
Speaker 1: will impact you because people who should come here won't
Speaker 1: be able to and that will mean that people who
Speaker 1: have done nothing wrong, you who trusted us when we
Speaker 1: lie to them. You know, people Americans seem to care
Speaker 1: about Afghanisa more than other people. Like I've spoken to
Speaker 1: hundreds of Afghan women our border and like they were
Speaker 1: stuck under Title forty two in very dangerous situations in
Speaker 1: places like Mexico. So even if you only care about
Speaker 1: those people, you should still care about this. I guess
Speaker 1: can I add something to I think, please.
Speaker 3: You know, to avoid fueling isolationism, because I think that
Speaker 3: happens all the time when we talk about these global
Speaker 3: health issues. Every resource that has to be put to
Speaker 3: helping this health crisis that is bubbling out of a
Speaker 3: humanitarian crisis is a resource that's not back where it's
Speaker 3: supposed to be addressing global health issues. Meaning so for example,
Speaker 3: when we saw the people outbreak in West Africa in twenty fourteen,
Speaker 3: after there were you know, we started to actually realize
Speaker 3: the implications to malaria controlled tuberculosis HIV. So when we
Speaker 3: have to throw a bunch of emergency resources at a crisis,
Speaker 3: those are coming out of somewhere else. And I worry
Speaker 3: too that people don't realize that we're, you know, as
Speaker 3: the who, the un everywhere, MSS is having to help
Speaker 3: this situation because there's no access to care and again
Speaker 3: is a health crisis. That means we're going to start
Speaker 3: to see other things pop up elsewhere, and that really
Speaker 3: worries me because we are already very strained when it
Speaker 3: comes to global health resources. We just again came out
Speaker 3: of a pandemic, so everyone's tired, everyone's burnt out. We've
Speaker 3: got health systems and a lot of and we're seeing
Speaker 3: even in the US where a lot of funding for
Speaker 3: like the CDC is being pulled in NIH. So now
Speaker 3: that we're out of kind of coming back into this
Speaker 3: panic neglect cycle, I worry that a lot of the
Speaker 3: resources that we're having to pull to address this crisis
Speaker 3: are going to then ultimately leave a lot of other
Speaker 3: places at risk or infectious diseases for long term health implications.
Speaker 3: So it is a lot bigger than one area or
Speaker 3: people you know, having to flee to the US. It's
Speaker 3: it's all of these things, and too often we approach
Speaker 3: this with a very short sighted this and we have
Speaker 3: we don't you know, we have finite resources when it
Speaker 3: comes to global health response, and when we have to
Speaker 3: use them because you know we're not you know, approaching
Speaker 3: this effectively or appropriately, then we're going to see larger implications.
Speaker 1: Yeah, even like we can just keep building off each
Speaker 1: other stuff and it's not here from the other two.
Speaker 1: Even recently, I was trying to buy some humanitarian daily
Speaker 1: rations for the border, which are people aren't familiar. They're
Speaker 1: like MRIs for refugees, and make sure we eat one
Speaker 1: on our.
Speaker 2: Live show once.
Speaker 1: Yeah it's very salty, Yeah, very salty. That it's good
Speaker 1: for the electrolytes, but like that is a state department.
Speaker 1: It's buying the back of surplus retailers at the minute,
Speaker 1: which means that there's obviously like a critical lack of
Speaker 1: supply of these things. Same with UNHCR shelters, and like
Speaker 1: that means that someone else doesn't get to eat, right,
Speaker 1: because we've just massively increased the burden of people who
Speaker 1: desperately need to eat. Like it's not like these things
Speaker 1: were chilling before, like there were you know, hunger is
Speaker 1: still a massive problem in the world, despite us having
Speaker 1: so much food here and so like they say, yeah,
Speaker 1: the same as true of medical supplies. Like you said,
Speaker 1: right that that means that somebody else doesn't get them,
Speaker 1: that money doesn't go to something else very important, that
Speaker 1: it could be going to.
Speaker 4: Can I ask about something I just learned about the
Speaker 4: past couple of days. So on December twenty fifth, the
Speaker 4: Jerusalem Post reported that an IDF soldier died of a
Speaker 4: fungal infection, and apparently he was hospitalized and eventually he died,
Speaker 4: and at least ten other soldiers have been diagnosed with
Speaker 4: infections of some sort. I think what kind of made
Speaker 4: me annoyed is that there is a headline from the
Speaker 4: Times of Israel that said, as a soldier with fungal
Speaker 4: infection dies, fears grow of Gaza diseases spreading into Israel,
Speaker 4: and apparently they're examining whether the infections originated from the
Speaker 4: Hammas tunnels and all this stuff. I think, while Iel,
Speaker 4: it really bothered me because I looked at all of
Speaker 4: these articles. I mean, most of them are obviously Israeli sourced,
Speaker 4: but it still was the same rhetoric of there's diseases
Speaker 4: in God and our soldiers are getting them, And honestly,
Speaker 4: the takeaway in all of these was we have to
Speaker 4: worry about Israeli public health and the Israeli citizens. It
Speaker 4: wasn't about anything about the gosins or anything like that.
Speaker 4: And I was just I guess I wanted to ask,
Speaker 4: is there any truth at all to the idea that
Speaker 4: there can be certain infections localized to that degree even
Speaker 4: though it's like a very small country in general. And
Speaker 4: I guess it's really I feel like it's a just
Speaker 4: fear mongering tactic using health as a weapon. But I
Speaker 4: don't know. I'd love to hear your thoughts.
Speaker 5: Even the fungus has gone woke. I can't believe it.
Speaker 5: They've weaponized fungus, sasky. I'll let you address it, but
Speaker 5: I would say this, I mean, I think the fear
Speaker 5: I just did an episode of my podcast on funguses
Speaker 5: and talking about the last of us and seeing like
Speaker 5: the truth that there's really a concern, especially with global
Speaker 5: climate change, and it is I mean, the thought of
Speaker 5: a fungus affecting humans in that way who were not
Speaker 5: in some way under their body understress or immuno suppressed,
Speaker 5: it's it's not that likely. And I definitely agree from
Speaker 5: what I'm hearing that like this is just another way
Speaker 5: to be like, look at these dirty people, we should
Speaker 5: bomb them to them.
Speaker 4: Everything related to Palestinians is oh, it's all the plague.
Speaker 4: Like they're scary, they're barbaric, and also they're going to
Speaker 4: make you sick. It's it's really infuriating. They're just going
Speaker 4: at every angle. I just I found the quote that
Speaker 4: made me mad. Can I read it? Okay, I'm going
Speaker 4: to read it. Basically, it says the war between Israel
Speaker 4: and Hamas has led to the destruction of large swaths
Speaker 4: of Gaza and internal displacement of the vast majority of
Speaker 4: its population, resulting in what is called humanitarian crisis for
Speaker 4: the Palestinians. It is called that because it is that
Speaker 4: body what law. These conditions have led to the outbreaks
Speaker 4: of various diseases, which can potentially threaten the well being
Speaker 4: of hundreds of thousands of IDF groups fighting in Gaza.
Speaker 4: They can also ultimately spell trouble for public health in Israel.
Speaker 4: I just can't believe that's the takeaway.
Speaker 5: All at Saskia, do you want to address the spread
Speaker 5: of fungal infection in a situation like this.
Speaker 3: Yeah, I mean, look again, this is a situation where
Speaker 3: disease is going to be spread and that includes idea soldiers.
Speaker 3: They are at risk because guess what, they all have
Speaker 3: to go back to their bunks and sleep at night
Speaker 3: in close quarters. Do we see diseases spread easily in militaries,
Speaker 3: of course, I mean it would be insane not to
Speaker 3: think that. But trying to, you know, source it in
Speaker 3: Palestinians and Gazas is slightly ridiculous because there's no epidemiological
Speaker 3: evidence of that. But it's also kind of weird to
Speaker 3: me that they're saying a fungal infection. That's a very
Speaker 3: specific thing, and bungle infections aren't fast infections for the
Speaker 3: most part. You know, when we do see them, I
Speaker 3: think from a regional perspective. If you live in Southwest
Speaker 3: like I do, Valley fever is a fungal infection. It's
Speaker 3: in the dirt though, it's a spore in the dirt,
Speaker 3: and it's not spread between people though that's that's the
Speaker 3: key part. It is you inhale it and you get it,
Speaker 3: and it takes months in a lot of cases. But
Speaker 3: you know, can you can you see fungal infections yeah,
Speaker 3: that could be contaminated water, you know, inhalation, through showers,
Speaker 3: things like that. I mean, there's ways for that to happen,
Speaker 3: but we really just for the most part see those
Speaker 3: infections spread from an individual source, not an individual person.
Speaker 3: They tend to really not be they're environmentally spread, you know.
Speaker 3: And I'm not a fungal expert. I can just speak
Speaker 3: to the ones that I've seen, and really we don't
Speaker 3: see them spread between people, and so I think that
Speaker 3: it's it's a weird choice to say, and I worry
Speaker 3: a little bit that they're just again to your point,
Speaker 3: trying to say like, oh, look, our soldiers are getting sick.
Speaker 3: You know, the sacrifice that we're making right is so much.
Speaker 3: And here's the thing. Conflict is where we're going to
Speaker 3: see disease spread no matter what. And I if you're
Speaker 3: so worried about soldiers getting fungal infections from Gaza, then
Speaker 3: maybe keep the people in Gauza safe and then they're
Speaker 3: you know, either way you paint this, if you're trying
Speaker 3: to blame it on them, they keep them safe and
Speaker 3: they won't be able to spread disease. Very simple.
Speaker 4: Yeah, they did. They did. Cite contaminated soil.
Speaker 3: Okay, that's a contamination thing like environmental.
Speaker 4: Yeah, this one epdibiologist said that these soldiers have come
Speaker 4: back with serious anti microbial resistant infections that they've picked
Speaker 4: up through contact with contaminated soil, among other factors. Like one,
Speaker 4: I feel like it's like a very direct statement.
Speaker 3: There's a lot of there's a lot to unpack there.
Speaker 1: Yeah.
Speaker 3: Again though if it's in the soil, it's an environmental exposure.
Speaker 3: That is like, that's not anyone's fault from an anti
Speaker 3: microbial perspective that I'm having a hard time believing that
Speaker 3: value fever, as I mentioned, is really hard to treat,
Speaker 3: so sometimes it's not responsive to some of the medications
Speaker 3: you give. But you know you're gonna get anti microbial
Speaker 3: infections more so from people and contaminated objects, because that
Speaker 3: means that it has to have been exposed to antibiotics
Speaker 3: and become resistant to the infections. But there's that feels
Speaker 3: like very messy, uh, you know, reporting on their part
Speaker 3: or communications, because not a lot of that makes sense
Speaker 3: to me. And either way, if they're saying it's from
Speaker 3: the environment, congratulations, you've just proven you're not getting it
Speaker 3: from people.
Speaker 4: Yeah, thank you for getting into that. I just the
Speaker 4: the Hamas tunnels, the Hamas terror tunnels, sorry in their words,
Speaker 4: their terror tunnels. They're going to investigate whether infections have
Speaker 4: originated from there. It just it's also just that doesn't
Speaker 4: make any sense. So I'm glad to have two doctors
Speaker 4: here agree, and that's all I wanted.
Speaker 5: I mean, I will say this Coxidium micosis is value fever,
Speaker 5: and we like, you know, she just mentioned it's we
Speaker 5: see it here in California. It's the reason why we
Speaker 5: used to say, if you're driving down Central Valley, California,
Speaker 5: down the Eye five, you should roll up your window
Speaker 5: and not breathe in the air because there's a possibility
Speaker 5: of getting it from that. So okay, they say that, Well,
Speaker 5: I don't think they do so much anymore.
Speaker 2: There's a whole number of reasons why you don't want
Speaker 2: to be breathing in.
Speaker 5: Yeah, there's a lot of cow farms out there too.
Speaker 5: It gets a little bit nasty out there in the
Speaker 5: I five. But but I mean, that's what is an
Speaker 5: endemic thing. It's like, if they don't want to be
Speaker 5: exposed to it, stay out of that area.
Speaker 3: Yeah, but you're not going to get it from other people.
Speaker 3: That's the kicker. It's not spread from people.
Speaker 1: It is very common to attribute infect your diseases that
Speaker 1: come from conflict to your enemy. It's like if you
Speaker 1: look at like the nineteen eighteen pandemic flu, right, and
Speaker 1: all the different things that people call that flu and
Speaker 1: the people to whom they attributed it, like, you can
Speaker 1: see that we've been doing that for more than one
Speaker 1: hundred years. It's it's part of the process of dehumanizing
Speaker 1: people who you're trying to kill.
Speaker 4: It happened with COVID too, No, it's.
Speaker 2: Yeah, yeah, I mean, yeah, that was a whole different situation.
Speaker 4: I guess humans just don't learn. I suppose.
Speaker 1: So I wonder Saskia like we obviously this is a
Speaker 1: terrible situation, and it's one that's like super easy to
Speaker 1: feel very disempowered with because you know, as much as
Speaker 1: you march around and do things, it doesn't seem to
Speaker 1: be stopping. There is there anything that like people can do,
Speaker 1: advocate for, like take action on, that could make this
Speaker 1: slightly less bad.
Speaker 3: I mean, a ceasefire. I encourage people to donate to
Speaker 3: UNISF and obviously you know MSF A lot of the
Speaker 3: wonderful organizations doing work there, and probably my my biggest
Speaker 3: one right now, especially since we're around the holidays and
Speaker 3: people are spending a lot of time with family and
Speaker 3: likely getting into some heavy conversations around the dinner tables.
Speaker 3: Make sure you're well informed and you're not spreading misinformation
Speaker 3: and disinformation online because that's been a huge aspect of this.
Speaker 3: You know, we saw with the humanitarian crisis in Ukraine.
Speaker 3: You know, Russia took direct action to spread misinformation and disinformation,
Speaker 3: and we're struggling with that in the United States right
Speaker 3: now with this. So I encourage people to stay informed
Speaker 3: of this, to really utilize good resources and not pull
Speaker 3: things from social media. If you're going to share something,
Speaker 3: you know, do so from an accurate source. I really,
Speaker 3: you know, the who un have been really good at
Speaker 3: doing continuous updates and sharing that information. Human Rights Watch
Speaker 3: at all of the above, and on top of again,
Speaker 3: donating and really being an advocate for a ceasefire, to
Speaker 3: me is the biggest thing because also reminding people, hey,
Speaker 3: this is currently a localized crisis, but infectious diseases and
Speaker 3: a humanitarian crises, excuse me, rarely stay that way.
Speaker 5: I would also plug the Palestinian Medical Relief Society the PMRS.
Speaker 5: They're the on the ground people. They've been there since
Speaker 5: nineteen seventy nine. They are founded by Palestinian doctors. It's
Speaker 5: mostly a Palestinian run and they're doing I think, really
Speaker 5: good work down there as best they can. And they're
Speaker 5: where actually the who gets most of their information or
Speaker 5: a lot of it at least it's coming from their
Speaker 5: updates from the PMRS people on the ground, So that's
Speaker 5: another local source to look at if people are interested
Speaker 5: in getting involved.
Speaker 2: Perfect, you got to do.
Speaker 4: Sure, I'm not going to wrap it up yet. I
Speaker 4: was just thinking how unfortunate it is that people don't
Speaker 4: care enough. So you have to be like, it's not
Speaker 4: only going to stay localized, Like it's not just that
Speaker 4: probably you know what I mean. I hate that we
Speaker 4: have to go there because, especially after going through a
Speaker 4: pandemic yourself, if that is still not enough for you
Speaker 4: to have any kind of empathy, that's that's just insane
Speaker 4: to me. That's uh.
Speaker 3: The one consistent thing I've seen is a lot of
Speaker 3: people say, oh, this conflict is you know, very There's
Speaker 3: a lot of history and I don't really want to
Speaker 3: get involved and yeah, and you know, to us, I
Speaker 3: do understand that there is a long, complicated history that
Speaker 3: not a lot of people are well informed of. But
Speaker 3: inform yourself. And that doesn't mean you can't have empathy.
Speaker 3: You can you know, denounce the Moss and also denounced
Speaker 3: anti Semitism. These things are not really intrusive. And it's
Speaker 3: it's impressive to me that we're still after you know,
Speaker 3: it's not even been three months and we've lost twenty
Speaker 3: thousand people that we know of a this. We're seeing
Speaker 3: journalists held left and right as well. It's it's impressive
Speaker 3: to me that people are still saying, oh, I don't
Speaker 3: I don't really want to comment on that, or you know,
Speaker 3: it's it's it's very messy.
Speaker 5: It is, and it's not though in the medical I'm sorry, James.
Speaker 5: In the medical world, i've seen doctors complain about more
Speaker 5: about the word provider and how it's used. Then the
Speaker 5: fact that three hundred medical professionals have been killed, some
Speaker 5: of them while doing their duty in the hospital, Like,
Speaker 5: that's a part that kind of surprised me from a
Speaker 5: medical perspective. And you know, I think I mentioned it
Speaker 5: to you before. I'm grateful for coming on your show,
Speaker 5: because I think a lot of the overlap between doctors
Speaker 5: who listen to our show and they listen to yours,
Speaker 5: and they're very vocal and they're online, and they are
Speaker 5: the ones who are really giving me hope in these
Speaker 5: situations because and there's a lot of people in medicine,
Speaker 5: this is a medical issue. I mean, I'm not even
Speaker 5: talking about any of the history. That's nothing. That's not
Speaker 5: what I'm that's not what it's important to me right now.
Speaker 5: It's about this healthcare crisis that is worsening and progressively worsening,
Speaker 5: and it is a bit of a bummer that I'm
Speaker 5: not seeing a little bit more interest in addressing it.
Speaker 1: Yeah, I would hope also that most people, like insider
Speaker 1: outside of medical community could maybe agree that like the
Speaker 1: correct number of hospitals to bomb is zero hospitals, and
Speaker 1: that yeah, there isn't a reason why you bomb a hospitalities, shouldn't.
Speaker 4: Anthony Blincoln said like a year or about Ukraine and Russia.
Speaker 4: Russia bombed hospitals and schools. There's no way that's normal.
Speaker 4: And then like there's a video where it's like cross
Speaker 4: sectioning into like right now, how it's like we're always
Speaker 4: going to support Israel. So it's like, no, it's not normal.
Speaker 4: Bombing hospitals and schools is never normal or okay, it's
Speaker 4: crazy that Israel went from being like we would never
Speaker 4: bomb a hospital to bombing dozens of them and nothing happening.
Speaker 2: Yeah, but like yeah.
Speaker 1: I guess just felt like like completion. Again, it's not
Speaker 1: okay when Turkey bomb's hospitals in Northeast area either, like
Speaker 1: I was there when they bombed one, they bombed another one.
Speaker 1: Since it's not okay when the Hunter and Meanmile bombs
Speaker 1: hospitals and at this one hospital left standing in the
Speaker 1: whole of Kerny State right now, and like this is
Speaker 1: happening there too, not like not caring about those people
Speaker 1: because it's just a topic of the day or whatever.
Speaker 3: Like it's also not okay to use white phosphorus on
Speaker 3: armed civilians across the board were Yeah, like in general,
Speaker 3: it's horrific, and I just I think it's it's you know,
Speaker 3: and there was there were a couple of reports and
Speaker 3: I think that there's still data coming out about it
Speaker 3: that bodies had organs stolen from them, Yeah, which is
Speaker 3: just horrific.
Speaker 4: And yeah, it doesn't really practice what Israel has done
Speaker 4: for a while though. Israel's uh, they said they stopped
Speaker 4: it and then they're continue to do it. But it's
Speaker 4: like they're notorious for bringing to returning bodies that have
Speaker 4: been like autopsied or having all their organs removed. And
Speaker 4: I want to just point out that for Muslim burials,
Speaker 4: the body is like it's very important that the body
Speaker 4: is whole, and the same for Jewish burials. But it's
Speaker 4: just really disgusting, just point blank and then also really disrespectful. Yeah,
Speaker 4: sorry interrupted, No, no, I mean it's and again, you know,
Speaker 4: I think there's still a lot of information coming out
Speaker 4: about that and how many that cret etc. Because I,
Speaker 4: like I mentioned before, I think information right now is
Speaker 4: really challenging. Accurate information, of course, is exceedingly difficult, so
Speaker 4: I'm always very careful, you know what we say. But
Speaker 4: to me, you know, the Washington Post just released a
Speaker 4: really good article and in death analysis of the attacks
Speaker 4: on the Al Shifa hospital, because that's the biggest hospital
Speaker 4: in Gaza. And for a while, you know, IDF was saying, well,
Speaker 4: this is where Hamas has been operating. They have a
Speaker 4: tunnel networks and there was there was a good breakdown
Speaker 4: of why this is int accurate and at the end
Speaker 4: of the day, now there's no acceptable reason to bomb
Speaker 4: a hospital, and drawing attention to the fact that this
Speaker 4: was occurring and misinformation is being shared is huge. So
Speaker 4: I'm hopeful that you know and very grateful to be
Speaker 4: on this podcast and talk with you all because the
Speaker 4: more information we can communicate about this situation, but also
Speaker 4: about the fact that there are much larger consequences of
Speaker 4: this from just even an infectious disease perspective is so
Speaker 4: critical because I don't think people realize that, and again
Speaker 4: they disassociate when they hear it's the conflict, it's a
Speaker 4: result of conflicts. It is so much larger than that.
Speaker 4: It will you know, we will see it in the States,
Speaker 4: we will see the ramifications of this and if nothing
Speaker 4: else again coming out as COVID, I'd like to think
Speaker 4: that we realize that we are part of a much larger,
Speaker 4: interconnected world and infectious diseases are simply a plane flight away.
Speaker 1: Yeah, very true.
Speaker 4: Thank you both so much for your brains and your
Speaker 4: knowledge of we're coming on the show.
Speaker 5: It's thanks for having us.
Speaker 1: Yeah, thank you so much for having us, of course,
Speaker 1: and before we go, I'd like to ask you guys
Speaker 1: if you have anything you'd like to plug, like white
Speaker 1: people can find you good. You've mentioned a couple of
Speaker 1: good resources, but other information resources, that kind of thing
Speaker 1: that you'd like to share.
Speaker 5: So in terms of the resources, I I am following
Speaker 5: a couple members of the pm RS. They have a
Speaker 5: Twitter feed but it's not very active, but the who
Speaker 5: gets a lot of the same information and they do
Speaker 5: a good job of updating in terms of where you
Speaker 5: could learn more. I just did an episode on the
Speaker 5: healthcare crisis in Gaza on my podcast, The House of Pod,
Speaker 5: which James has been on and stream. I'm trying to
Speaker 5: get you to come on so I'm down. I'm going
Speaker 5: to keep working on you in Saskia too. I mean
Speaker 5: you're all invited.
Speaker 3: I'm recording this.
Speaker 5: I'm just gonna release it on my podcast as well,
Speaker 5: and uh yeah, so listen to us there. I'll be
Speaker 5: doing more episodes on this topic as well in the
Speaker 5: in the coming months.
Speaker 4: Cool.
Speaker 2: Perfect, How about.
Speaker 3: All of those resources I really been looking to of course,
Speaker 3: on the public health parents so w h O and
Speaker 3: writes watch and my big go tos as you know
Speaker 3: again as all the sources we've already mentioned, and I
Speaker 3: really I want to give a shout out to a
Speaker 3: colleague of mine, Jessica Alti Rivera, who is really really
Speaker 3: wonderful in this space and has been doing a lot
Speaker 3: of science communication on her Instagram. I tend to be
Speaker 3: a little bit more on the cesspool that is formally Twitter,
Speaker 3: but you know, I'm I think there's some really wonderful
Speaker 3: people out there, this entire group included, that are actively
Speaker 3: working to share information but also how people can get
Speaker 3: engaged and involved. So shout out to her and just
Speaker 3: all of the hard work that a lot of key
Speaker 3: journalists are doing in this space, because again, if you
Speaker 3: have no communication out it's really hard to get accurate information.
Speaker 4: Well, thanks guys for listening. Why are you laughing? James?
Speaker 4: Can I wrap this out? Or is this too monotone?
Speaker 4: Send it now? That's the show again, Thanks again for
Speaker 4: both of you being so outspoken, and I think especially
Speaker 4: reminding everyone that it's actually not complicated, because it's also
Speaker 4: like a medical issue. It's not exactly when you just
Speaker 4: look at the numbers, look at BodyCount, look at families.
Speaker 4: That's I think what our main focus should be and
Speaker 4: I appreciate you both because I know it's a tricky
Speaker 4: out there to be outspoken.
Speaker 5: So thank you, thank you guys, thank you so much.
Speaker 6: It could Happen here as a production of cool Zone Media.
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Speaker 4: Thanks for listening,