WEBVTT - Ep 4 The Poop Show 0:00:05.320 --> 0:00:08.119 As we passed along the reeking banks of the sewer, 0:00:08.400 --> 0:00:10.800 the sun shone upon a narrow slip of the water. 0:00:11.480 --> 0:00:13.800 In the bright light, it appeared the color of strong 0:00:13.880 --> 0:00:17.840 green tea, and positively looked as solid as black marble 0:00:17.880 --> 0:00:21.600 in the shadow. Indeed, it was more like watery mud 0:00:21.720 --> 0:00:24.840 than muddy water. And yet we were assured that this 0:00:25.040 --> 0:00:28.240 was the only water the wretched inhabitants had to drink. 0:00:29.280 --> 0:00:31.840 As we gazed in horror at it, we saw drains 0:00:31.920 --> 0:00:35.879 and sewers emptying their filthy contents into it. We saw 0:00:35.880 --> 0:00:38.520 a whole tier of doorless privies in the open road, 0:00:39.000 --> 0:00:42.200 common to men and women built over it. We saw 0:00:42.240 --> 0:00:45.080 a little child from one of the galleries opposite lower 0:00:45.120 --> 0:00:47.360 a tin can with a rope to fill a large 0:00:47.360 --> 0:00:51.080 bucket that stood beside her. As the little thing dangled 0:00:51.120 --> 0:00:53.760 her tin cup as gently as possible into the stream, 0:00:54.240 --> 0:00:56.560 a bucket of night soil was poured down from the 0:00:56.560 --> 0:01:10.680 next gallery. 0:01:13.600 --> 0:01:18.520 Well, I want to say two things. Yes, One, I 0:01:18.560 --> 0:01:20.920 support the use of the words privy and night soil. 0:01:21.120 --> 0:01:25.360 Both night soil, by the way, is human feces used 0:01:25.440 --> 0:01:28.840 as compost poop poopy poop poop. 0:01:29.120 --> 0:01:32.360 Also, that's disgusting. That's my second point. 0:01:32.600 --> 0:01:35.199 So I'm going to give you a little context to that. 0:01:35.200 --> 0:01:39.480 That came from an article describing the ground zero of 0:01:40.000 --> 0:01:43.120 eighteen forty nine's cholera outbreak in London. 0:01:43.640 --> 0:01:44.600 That was London. 0:01:44.680 --> 0:01:45.280 It was London. 0:01:45.880 --> 0:01:48.960 That's a city, and it was that just whoop. 0:01:49.000 --> 0:01:51.800 Everywhere there are a lot of cities that continue to 0:01:51.840 --> 0:01:56.320 be very poor sanitation just due to lack of funds 0:01:56.360 --> 0:02:00.400 for public health infrastructure. Oh my god, Welcome to this 0:02:00.440 --> 0:02:01.520 podcast Will Kill You. 0:02:01.640 --> 0:02:07.040 Episode four. Today we're talking about cholera. I'm Aaron and 0:02:07.120 --> 0:02:08.200 I'm also Aaron. 0:02:08.440 --> 0:02:11.680 And before we get into the meet of this week's episode, 0:02:11.760 --> 0:02:15.320 we want to ask you, dear listeners. 0:02:14.919 --> 0:02:17.280 Dearest darling listeners. 0:02:17.400 --> 0:02:20.440 To rate, review and subscribe. 0:02:20.160 --> 0:02:22.480 Because we love you and we want to know how 0:02:22.560 --> 0:02:25.440 much you love us. Just kidding, but not really. Rating, 0:02:25.520 --> 0:02:28.200 reviewing and subscribing is how other people are able to 0:02:28.240 --> 0:02:31.360 find our podcast. So wherever you listen to your podcast, 0:02:31.400 --> 0:02:34.440 please please please take a moment to just you know, 0:02:34.600 --> 0:02:36.480 click five stars or whatever, or. 0:02:36.440 --> 0:02:38.760 You know, anything you want, whatever is in your heart. 0:02:39.280 --> 0:02:42.040 And also we are on all the social media's. We're 0:02:42.040 --> 0:02:45.760 on Twitter, Instagram, Facebook, so you know, if you want 0:02:45.800 --> 0:02:49.079 to keep up to date on little trivia about whatever 0:02:49.440 --> 0:02:50.480 infectious diseases. 0:02:50.800 --> 0:02:53.000 You know where to find us see some growdy photos, 0:02:53.360 --> 0:02:54.800 and also get our drink recipes. 0:02:55.000 --> 0:03:12.000 Oh yeah, that's important. Yeah, okay, Arin, Yeah, I want 0:03:12.040 --> 0:03:14.520 to hear about cholera. Now tell me all about it. 0:03:14.600 --> 0:03:17.920 Let's talk about it as it turns out, which I 0:03:17.960 --> 0:03:21.720 did not know before doing this research. Colera is really complicated. 0:03:21.880 --> 0:03:25.320 It's a complicated little bug. Yeah. So I'm going to 0:03:25.400 --> 0:03:28.760 hit on the real basics of the biology of this disease. 0:03:29.000 --> 0:03:34.000 And I want to encourage y'all to read more. Or heck, 0:03:34.240 --> 0:03:37.200 if you research cholera and I get it wrong, give 0:03:37.280 --> 0:03:39.640 us a shout out. Let me know that we're so 0:03:39.840 --> 0:03:40.840 incorrect about things. 0:03:40.960 --> 0:03:43.400 We are open to being corrected, very open. 0:03:44.520 --> 0:03:48.400 Okay, So cholera. Cholera is a disease that's caused by 0:03:48.440 --> 0:03:52.960 a bacteria called Vibrio cholera, which is a facultative pathogen. 0:03:53.040 --> 0:03:56.320 So that means that in addition to causing disease in humans, 0:03:56.720 --> 0:03:59.400 it also can persist in the environment and reproduce in 0:03:59.400 --> 0:04:04.360 the environment, usually in water, especially brackish water, so like 0:04:04.400 --> 0:04:06.600 at river mouth near the ocean, and things like that 0:04:06.720 --> 0:04:07.640 is where it persists. 0:04:07.840 --> 0:04:13.040 Can you give me an example of an obligate pathogen smallpox? Okay, 0:04:13.040 --> 0:04:16.520 So smallpox, it can exist in the environment, but it 0:04:16.560 --> 0:04:19.880 can only persist if there is a human host for 0:04:19.920 --> 0:04:20.599 it to infect. 0:04:20.760 --> 0:04:24.599 Exactly, it can't reproduce without infecting a host, whereas cholera 0:04:24.680 --> 0:04:28.279 can actually reproduce in the environment. But there are also bacteria, 0:04:28.320 --> 0:04:32.479 maybe leprosy bacteria, which also can't reproduce without being in 0:04:32.520 --> 0:04:34.880 a host. It's also an obligate pathogen. 0:04:35.120 --> 0:04:38.040 Rocky Mountain spotted fever, Yeah, definitely. 0:04:38.200 --> 0:04:44.800 Right, cool, Okay. So generally cholera is transmitted fecally orally, 0:04:44.960 --> 0:04:48.760 which means you have to ingest fecally contaminated water or food, 0:04:49.320 --> 0:04:54.200 especially shellfish which live in water. Really yeah, itcky because 0:04:54.200 --> 0:04:56.720 a lot of shellfish are filter feeders, so they just 0:04:56.760 --> 0:04:59.000 filter all the poop out of the water and then 0:04:59.040 --> 0:05:01.800 you eat it. Yeah, you wanna get some clams after this, 0:05:02.760 --> 0:05:06.480 So that's how you actually get infected. The infectious dose 0:05:06.520 --> 0:05:08.960 of cholera is actually really high, which means that you 0:05:09.040 --> 0:05:11.600 have to ingest a whole bunch of the cholera bacteria 0:05:11.640 --> 0:05:13.960 to actually get infected. And there are a bunch of 0:05:13.960 --> 0:05:17.400 different strains of the Vibrio cholera bacteria, but only two 0:05:17.440 --> 0:05:20.239 of them actually cause the vast majority of the disease. 0:05:20.640 --> 0:05:22.840 And part of the reason that the infectious dose is 0:05:22.880 --> 0:05:26.520 so high for cholera is first because it has to 0:05:26.720 --> 0:05:30.240 survive the super acidic environment of your stomach, because you 0:05:30.440 --> 0:05:31.360 ingest it, right. 0:05:31.640 --> 0:05:35.040 I think I actually read something about how people who 0:05:35.080 --> 0:05:39.520 take anti acids, yeah, have higher chances of getting cholera. Yeah, 0:05:40.160 --> 0:05:41.039 I preempt you. 0:05:41.080 --> 0:05:43.000 No, not at all. I wasn't going to talk about that, 0:05:43.040 --> 0:05:45.360 but I definitely saw that too. So if you lower 0:05:45.400 --> 0:05:47.560 the acidity in your stomach, it makes it easier for 0:05:47.560 --> 0:05:51.760 the cholera to get through that really harsh environment. Super cool. 0:05:51.839 --> 0:05:54.400 I've also heard something about that along the same lines 0:05:54.440 --> 0:05:55.719 with stomach cancer. 0:05:56.200 --> 0:05:59.320 Oh really, just because there's like various bacteria that can 0:05:59.360 --> 0:06:00.720 be associated with stomach cancer. 0:06:00.880 --> 0:06:04.240 No, well, potentially that, but also because acid will kill 0:06:04.240 --> 0:06:07.279 off the more like bad cells basically earlier. 0:06:07.400 --> 0:06:08.600 Oh that's really interesting. 0:06:08.680 --> 0:06:11.880 And so if you don't have that pressure, Yeah, I 0:06:12.200 --> 0:06:14.240 don't know. I mean this is all like me, this 0:06:14.279 --> 0:06:16.880 is what scientists shouldn't do, which is just reading abstracts of. 0:06:16.920 --> 0:06:21.960 Things should happen though, Okay. And the other reason that 0:06:22.160 --> 0:06:25.120 there's a really high infectious dose is that after a 0:06:25.200 --> 0:06:28.400 cholera bacteria survives your stomach, it actually has to swim 0:06:28.480 --> 0:06:30.159 all the way through the rest of your gi tract 0:06:30.200 --> 0:06:33.680 and into your small intestine. So it has a little flagellum, 0:06:33.839 --> 0:06:37.640 which is a tail. So these bacteria actually look like spermes, 0:06:40.240 --> 0:06:42.560 a little sperms that. 0:06:42.520 --> 0:06:45.320 They make giant microbes of cholera. I think that did 0:06:45.480 --> 0:06:46.280 really cute. 0:06:46.400 --> 0:06:49.600 Not probably as cute as Gerardia, because that's the cutest. Oh, 0:06:49.960 --> 0:06:53.680 it's so cute. It looks like a little rostafarian. So 0:06:53.760 --> 0:06:56.880 once the little spermy bacteria get to your small intestine, 0:06:56.960 --> 0:06:59.840 they attach themselves to your intestine wall and they begin 0:07:00.040 --> 0:07:05.080 producing cholera toxin. And this is what actually makes you sick. 0:07:06.040 --> 0:07:09.320 So it's not the bacteria alone, it's the fact that 0:07:09.320 --> 0:07:12.840 the bacteria produces this toxin. And what's super crazy and 0:07:12.920 --> 0:07:16.080 cool about this toxin is that it is actually produced 0:07:16.320 --> 0:07:20.040 by a bacteria phage. A bacteria phage is pretty much 0:07:20.040 --> 0:07:22.520 a virus that infects bacteria. I don't know why we 0:07:22.600 --> 0:07:25.600 have to call bacteria viruses something different, but we do. 0:07:25.880 --> 0:07:27.000 They look really cool. 0:07:27.120 --> 0:07:31.280 They are really amazing. One time in college, we got 0:07:31.320 --> 0:07:34.200 like Hannah paint and we were all painting Hennah and 0:07:34.280 --> 0:07:38.680 my roommate Jocelyn, who's awesome, painted the most beautiful bacteria 0:07:38.720 --> 0:07:40.520 phage on her arm and I was like, that should 0:07:40.640 --> 0:07:42.880 be a I want to it's beautiful. 0:07:43.080 --> 0:07:43.800 Oh that's great. 0:07:43.920 --> 0:07:48.040 Yeah. So anyways, this bacteria phage has basically inserted part 0:07:48.080 --> 0:07:52.400 of its genome into the cholera genome, and that is 0:07:52.440 --> 0:07:55.560 what's actually producing this toxin, which is super interesting to me. 0:07:55.840 --> 0:07:56.720 That's fascinating. 0:07:56.840 --> 0:07:57.280 Yeah. 0:07:57.320 --> 0:08:00.160 And also, are you going to tell me how how 0:08:00.200 --> 0:08:03.000 this toxin works because I need to know. Yeah. 0:08:03.040 --> 0:08:08.560 So, basically, this toxin essentially prevents your body from absorbing 0:08:08.600 --> 0:08:11.320 any water and forces you to push out all of 0:08:11.360 --> 0:08:14.080 the water in your body out of your intestine, which 0:08:14.080 --> 0:08:16.000 means you're basically pooping water. 0:08:16.360 --> 0:08:17.080 Oh my gosh. 0:08:17.200 --> 0:08:19.240 Yeah, I'll talk more about it in just a minute. 0:08:19.280 --> 0:08:19.640 Okay. 0:08:20.040 --> 0:08:23.160 So the incubation period, which we've talked about before as 0:08:23.320 --> 0:08:25.600 the period from when you get infected until when you 0:08:25.640 --> 0:08:29.400 show symptoms for cholera, is about one and a half days. 0:08:29.600 --> 0:08:31.040 Wow, that's very fast. 0:08:31.080 --> 0:08:34.640 They're super fast little swimmers and they usually attach themselves 0:08:34.640 --> 0:08:37.120 to your small intestine within twelve to seventy two hours 0:08:37.120 --> 0:08:40.200 of infection, so they're super quick. And another thing that's 0:08:40.240 --> 0:08:42.679 interesting is that there's kind of a range of symptoms. 0:08:42.679 --> 0:08:45.920 So some people who get infected are almost entirely asymptomatic, 0:08:46.080 --> 0:08:48.839 some people have a rather mild infection, and the ones 0:08:48.880 --> 0:08:51.240 that we'll talk about the most today have very very 0:08:51.240 --> 0:08:54.760 severe infections. And the severity of the illness is likely 0:08:54.840 --> 0:08:57.480 based both on prior exposure, so if you got it 0:08:57.520 --> 0:08:59.400 when you were young and then you get it again 0:08:59.400 --> 0:09:01.760 when you're older, you're a little better off, but also 0:09:01.840 --> 0:09:04.400 on infectious dose, since like I said previously, it actually 0:09:04.440 --> 0:09:07.240 takes quite a lot of bacteria to really get you infected. 0:09:07.400 --> 0:09:10.360 But in the severe cases, which let's face it, that's 0:09:10.400 --> 0:09:13.560 what we're here form HM, Basically, what happens is you 0:09:13.800 --> 0:09:17.680 just start pooping your guts out. Oh boy, so really 0:09:17.800 --> 0:09:21.239 like you just poop all of your water out. Adults 0:09:21.240 --> 0:09:25.440 that have severe infections can poop out get this more 0:09:25.480 --> 0:09:29.080 than a leader a fluid per hour. 0:09:29.240 --> 0:09:32.120 Oh my god, are you serious? 0:09:32.160 --> 0:09:33.520 I'm totally serious. 0:09:33.880 --> 0:09:37.200 I have so many questions right now. Yeah, how long 0:09:37.240 --> 0:09:38.760 can you live by pooping out? 0:09:38.800 --> 0:09:39.240 A leader? 0:09:39.320 --> 0:09:40.360 Of fluid an hour. 0:09:40.600 --> 0:09:43.520 I'm so glad you asked, because I did some research. 0:09:45.679 --> 0:09:48.880 So we have four and a half to five liters 0:09:48.880 --> 0:09:51.280 of blood in our body, right, and that's the fluid 0:09:51.320 --> 0:09:54.560 that's the most available for you to get water out of. Oh, 0:09:55.360 --> 0:09:58.280 if you think about that, whoa, right, and then we've 0:09:58.320 --> 0:10:02.439 got another fifteen of fluid or maybe ten liters of 0:10:02.480 --> 0:10:05.440 fluid that's surrounding all of our cells. That's that we 0:10:05.520 --> 0:10:08.679 call it interstitial fluid in between our cells. Right, So 0:10:08.760 --> 0:10:11.960 that's fifteen liters. But that's like all the fluid that 0:10:11.960 --> 0:10:16.360 you have available until you start sucking your actual cells dry. 0:10:16.920 --> 0:10:22.560 Whoa, Oh my god. Yeah, So is this where the 0:10:22.679 --> 0:10:25.680 disease got its characteristic symptom? 0:10:26.080 --> 0:10:26.679 It does? 0:10:27.080 --> 0:10:27.960 And what's that called? 0:10:28.160 --> 0:10:30.800 It's called rice water steol. 0:10:31.120 --> 0:10:32.040 Why is it called that? 0:10:32.280 --> 0:10:37.720 Because the poop that you're pooping out is literally all bacteria. 0:10:38.040 --> 0:10:42.240 It's just like tons of bacteria and water and dead cells. 0:10:41.880 --> 0:10:46.439 And it looks like what murky flaky. 0:10:46.120 --> 0:10:48.280 It looks like. So if you took a bag of 0:10:48.360 --> 0:10:51.719 rice and you soaked it and then you drained the 0:10:51.840 --> 0:10:55.040 rice out. 0:10:54.120 --> 0:10:57.079 And what are we drinking right now? Actually, because we 0:10:57.160 --> 0:11:01.120 forgot to do quarantinies. You're really so right about that. 0:11:03.040 --> 0:11:05.520 Tonight we're drinking rice water stool. 0:11:05.640 --> 0:11:12.199 Oh I can I provide a little correction. We're drinking 0:11:12.440 --> 0:11:18.559 a quarantini that we named rice water stool. It actually 0:11:19.600 --> 0:11:24.559 is composed of cholera bacteria. No, just kidding. It's composed 0:11:24.800 --> 0:11:26.400 of rum chatta. 0:11:26.440 --> 0:11:29.240 About one and a half ounces of rum chatta chai, 0:11:29.679 --> 0:11:33.719 three ounces of chai concentrate or a really strong chai tea, and. 0:11:33.679 --> 0:11:34.960 A half an ounce of whiskey. 0:11:35.200 --> 0:11:38.000 Yep, feel free to add more whiskey. It'll just look 0:11:38.240 --> 0:11:39.800 more realistic. 0:11:39.240 --> 0:11:42.320 Because it will curdle. Yeah, but the most important part 0:11:42.320 --> 0:11:46.640 of this recipe is to gently warm it to body temperature. 0:11:48.920 --> 0:11:50.400 It's actually pretty delicious. 0:11:50.440 --> 0:11:54.360 It's surprisingly good, you guys. I don't like warm drinks 0:11:54.640 --> 0:11:57.720 that are like alcoholic, but this is its taste. 0:11:57.800 --> 0:11:59.120 It's perfect for this time of year. 0:11:59.200 --> 0:12:01.920 It is. It's really oh, happy Thanksgiving. 0:12:01.480 --> 0:12:02.400 Happy Thanksgiving. 0:12:03.800 --> 0:12:11.280 Yeah, rice water stool cheers cheers with our mugs. So 0:12:11.600 --> 0:12:16.360 severely ill patients will have poop that is literally a 0:12:16.679 --> 0:12:24.760 trillion individual bacteria per gram of poop. Whoa, whoa, yeah, 0:12:24.800 --> 0:12:27.280 whoa is right? I did that like one hundred times 0:12:27.280 --> 0:12:29.080 to make sure I was getting the number right. It's 0:12:29.280 --> 0:12:31.240 absolutely ridiculous. 0:12:30.880 --> 0:12:34.600 Which also makes sense why epidemics happen and are so 0:12:34.720 --> 0:12:35.680 easy to spread. 0:12:35.760 --> 0:12:38.040 And the other reason is because, like I said, not 0:12:38.160 --> 0:12:41.040 everyone gets the severe illness, So people who have a 0:12:41.080 --> 0:12:45.640 mild illness are still pooping out about a million bacteria 0:12:45.679 --> 0:12:49.839 program of poop, and even patients who are completely asymptomatic 0:12:50.240 --> 0:12:53.480 can be shedding about ten to one hundred thousand bacteria 0:12:53.520 --> 0:12:54.320 program of poop. 0:12:54.400 --> 0:12:55.560 That's really interesting. 0:12:55.760 --> 0:12:58.360 Yes, the biggest range. I mean, obviously there's a huge 0:12:58.440 --> 0:13:01.600 range in the number of bacteria program of poop. But 0:13:01.800 --> 0:13:05.439 also people who are severely ill are not just shedding 0:13:05.559 --> 0:13:08.720 while they're having massive diarrhea. They're shedding for up to 0:13:08.760 --> 0:13:12.360 one to two weeks after symptoms have alleviated, and people 0:13:12.400 --> 0:13:14.760 who have mild illness are shedding for less time, and 0:13:14.760 --> 0:13:17.040 people who are asymptomatic tend to shed for only about 0:13:17.040 --> 0:13:20.240 a day or two. Okay, so yeah, it's crazy. It's 0:13:20.440 --> 0:13:22.920 they're just tons and tons of this bacteria that are 0:13:22.920 --> 0:13:25.480 getting into the environment. And the other thing is that 0:13:25.520 --> 0:13:28.280 since this is a pathogen that can persist in the environment, 0:13:28.480 --> 0:13:31.880 the types of Vibrio cholera bacteria that you're likely to 0:13:31.920 --> 0:13:35.680 find in the environment, meaning whether they are toxogenic or 0:13:35.840 --> 0:13:40.280 non toxogenic will largely depend on how many severely ill 0:13:40.480 --> 0:13:43.760 people you have in that environment. So it's this vicious cycle. 0:13:44.080 --> 0:13:46.480 Once you have people who are ill in a certain area, 0:13:46.559 --> 0:13:51.800 they're shedding so forking much virus, I mean bacteria. Oh shoot, 0:13:51.960 --> 0:13:54.880 that's embarrassing. How many times do you think I've said virus? 0:13:55.120 --> 0:13:57.800 I don't think you have, Okay, So once you have 0:13:57.920 --> 0:14:01.240 people who are ill in a specific they are shedding 0:14:01.360 --> 0:14:05.719 so forking much bacteria that if you don't have proper sanitation. 0:14:06.160 --> 0:14:09.959 For example, if you're living in London in eighteen fifty. 0:14:09.960 --> 0:14:12.440 Or many places today, right, if. 0:14:12.280 --> 0:14:15.520 You're say, pooping in a river and then drinking from 0:14:15.520 --> 0:14:19.000 that river downstream, or even if you you know, have 0:14:19.320 --> 0:14:22.880 like an outhouse or something, but that hole is near 0:14:22.920 --> 0:14:26.080 a well or upstream of a river, you're just spreading 0:14:26.080 --> 0:14:28.880 that infection like wildfire. What else do you want to know? 0:14:29.000 --> 0:14:32.240 So treatment for cholera, well, the good news is that 0:14:32.360 --> 0:14:35.720 treatment for cholera color is a very treatable disease. So 0:14:35.800 --> 0:14:40.440 the World Health Organization basically calls for oral rehydration solution, 0:14:40.560 --> 0:14:44.840 which is just like salty, sugary water gatorid kind of. Yeah, 0:14:44.880 --> 0:14:47.440 pretty much, they have like a proprietary blend. I'm sure 0:14:47.600 --> 0:14:51.840 i v iv if for severe infections definitely need treatment 0:14:51.920 --> 0:14:54.520 up to like six liters in the first day. Severe 0:14:54.520 --> 0:14:57.480 cases might need more than that, so it's quite a 0:14:57.480 --> 0:15:00.000 lot of liquid that you need. Generally, they don't reckon 0:15:00.200 --> 0:15:04.920 antibiotics except in super severe cases, primarily because a antibiotics 0:15:04.960 --> 0:15:07.400 are wiping out all of the good bacteria in your gut, 0:15:07.880 --> 0:15:10.120 which can make it so that you're very susceptible to 0:15:10.240 --> 0:15:12.680 other potentially more serious diseases. 0:15:12.840 --> 0:15:15.080 Well, and cholera has kind of done that, Like if 0:15:15.120 --> 0:15:17.320 you have a severe infection of cholera, it pretty much 0:15:17.400 --> 0:15:20.040 has taken over your entire intestine right way. 0:15:20.120 --> 0:15:22.120 Yeah, And the other thing is that because this is 0:15:22.160 --> 0:15:25.200 a bacteria that can persist in the environment, antibiotic resistance 0:15:25.280 --> 0:15:26.479 is a real concern. 0:15:26.240 --> 0:15:29.440 And it's really kind of cool that it can be 0:15:29.600 --> 0:15:31.800 treated with just rehydration there, right. 0:15:31.960 --> 0:15:35.520 Yeah, it's generally like a fairly short course of disease. 0:15:35.720 --> 0:15:39.840 The severe cases without treatment, fatality rate is about fifty percent. 0:15:40.760 --> 0:15:42.720 With treatment it can be as low as one percent, 0:15:42.920 --> 0:15:44.000 which is amazing. 0:15:44.440 --> 0:15:45.560 What about a vaccine? 0:15:45.880 --> 0:15:49.240 So there is an oral cholera vaccine. There are actually 0:15:49.240 --> 0:15:53.000 three different types of ocvs, and who does have a 0:15:53.000 --> 0:15:55.920 stockpile of these in case of severe outbreaks and emergencies, 0:15:56.320 --> 0:15:58.280 which we'll probably talk more about when we talk about 0:15:58.280 --> 0:15:59.520 what's happening with cholera today. 0:16:00.160 --> 0:16:01.360 That's good that there's a vaccine. 0:16:01.440 --> 0:16:02.240 Yeah, it's great. 0:16:02.320 --> 0:16:05.520 Do you know anything about whether it provides long term? 0:16:05.920 --> 0:16:08.560 As far as I know, it's not long term, but 0:16:08.640 --> 0:16:10.720 it is short term, and so that's why it's generally 0:16:10.840 --> 0:16:12.760 used in case of outbreaks. 0:16:13.520 --> 0:16:13.800 Yeah. 0:16:13.840 --> 0:16:15.920 So, I mean I feel like that's pretty much the 0:16:15.960 --> 0:16:17.600 biology of cholera? Am I right? 0:16:18.000 --> 0:16:18.520 You better be? 0:16:19.280 --> 0:16:36.040 I hope, I am. 0:16:36.120 --> 0:16:37.720 So can I tell you about the history? Then? 0:16:37.840 --> 0:16:38.000 Oh? 0:16:38.040 --> 0:16:39.400 I cannot forking? 0:16:39.480 --> 0:16:42.200 Wait, Okay, it's a good one. Good. I mean they're 0:16:42.200 --> 0:16:44.440 all good. Well, yeah, but this is a good one. 0:16:44.880 --> 0:16:47.760 It's a I think, as we are both epidemiologists, this 0:16:47.880 --> 0:16:49.800 is especially close to our heart. Am I right? 0:16:50.080 --> 0:16:52.320 Yeah, because you can't really talk about the history of 0:16:52.400 --> 0:16:56.280 cholera without talking about the birth of epidemiology as a field. 0:16:57.200 --> 0:17:01.520 The struggle for germ theory to prevail over my asthmatism, 0:17:01.800 --> 0:17:07.000 which is Okay, this word is miasmatim. I'm not saying 0:17:07.240 --> 0:17:12.480 my asthma. Just fyi, it's not my asthma. Yeah. And 0:17:13.359 --> 0:17:17.800 also the role that modern sanitation practices have played and 0:17:17.880 --> 0:17:20.200 continue to play in reducing disease burdens. 0:17:20.280 --> 0:17:21.680 Yeah, definitely huge. 0:17:22.320 --> 0:17:24.800 But let's start a little more simply than that. Let's 0:17:24.800 --> 0:17:26.800 start with what we know about the origins of the 0:17:26.840 --> 0:17:30.800 bacterium itself. Since cholera doesn't leave any physical mark on 0:17:30.840 --> 0:17:34.119 the body that would remain after death, you can't really 0:17:34.359 --> 0:17:37.240 detect it and skeletal remains the way that researchers have 0:17:37.280 --> 0:17:40.120 been able to with like leprosy and smallpox, what else 0:17:40.240 --> 0:17:40.880 we've mentioned. 0:17:40.960 --> 0:17:44.639 I had never thought about that. Yeah, that is so interesting. 0:17:44.880 --> 0:17:47.600 It's really cool to look at how you can trace 0:17:47.760 --> 0:17:51.240 the physical evidence of certain bacteria, because this means that 0:17:51.240 --> 0:17:54.359 we have to rely more on ancient texts and writings 0:17:54.400 --> 0:17:56.880 which may or may not refer to the same disease 0:17:57.440 --> 0:17:58.639 that we call coller today. 0:17:58.800 --> 0:18:00.160 Oh that's so interesting. 0:18:00.359 --> 0:18:03.840 Yeah, it makes the history of cholera a little murky. 0:18:04.080 --> 0:18:05.119 Oh, just like. 0:18:09.400 --> 0:18:12.439 The first mention of cholera comes from the father of 0:18:12.480 --> 0:18:18.159 western medicine himself, Hippocrates, in around five hundred BC, he 0:18:18.320 --> 0:18:21.879 uses the word cholera to describe an intestinal illness that 0:18:21.960 --> 0:18:25.280 causes diarrhea. In fact, it's thought that the word cholera 0:18:25.600 --> 0:18:30.800 itself comes from the Greek word for gutter kalidra. Yeah. Yeah, yeah, 0:18:30.800 --> 0:18:33.840 that's so cool. So he may have chosen this word 0:18:34.119 --> 0:18:38.680 cholera to describe the way poop water gushes out of 0:18:38.720 --> 0:18:41.679 you if you have cholera, Oh my god, like the 0:18:41.720 --> 0:18:45.880 way water gush is out of a gutter. Wow. There 0:18:45.920 --> 0:18:49.359 are some other loose mentions of cholera prior to the 0:18:49.359 --> 0:18:54.399 eighteen hundred. Your puns are killing me right now, But 0:18:54.560 --> 0:18:57.639 any that were written outside of India were probably just 0:18:57.760 --> 0:19:01.160 using the term cholera to refer to any die real disease. Okay. 0:19:01.520 --> 0:19:04.000 It would be like saying, oh, man, I ate taco 0:19:04.040 --> 0:19:07.280 bell last night, and I've had cholera all day. 0:19:07.040 --> 0:19:10.879 To day, every time, every time. 0:19:12.240 --> 0:19:15.080 So it wasn't until the early eighteen hundreds that the 0:19:15.119 --> 0:19:19.200 word cholera was directly linked to one disease caused by 0:19:19.240 --> 0:19:24.760 one organism, the cholera bacterium. Cool. Yeah, eighteen hundreds, eighteen hundred. 0:19:24.840 --> 0:19:27.320 From Hippocrates to the eighteen hundreds. 0:19:26.960 --> 0:19:30.879 It was just in the Indian subcontinent. Interesting in fact, 0:19:31.200 --> 0:19:35.679 until eighteen seventeen, cholera was confined entirely to India. 0:19:35.880 --> 0:19:36.760 Wow, when it. 0:19:36.680 --> 0:19:41.280 Would pop up occasionally and cause an epidemic, particularly during 0:19:41.280 --> 0:19:42.400 religious pilgrimages. 0:19:43.680 --> 0:19:44.640 Wonder why I wonder? 0:19:44.640 --> 0:19:47.800 Oh, I'm about to tell you, because during these pilgrimages 0:19:48.119 --> 0:19:50.000 there would usually be a lot of people in a 0:19:50.080 --> 0:19:53.160 very small place, and so a disease like cholera, which 0:19:53.200 --> 0:19:56.840 relies on high population density, can really take hold and 0:19:56.960 --> 0:19:58.119 tear through a population. 0:19:58.440 --> 0:20:03.440 Just thousands of people shedding trillions at bacteria and they drinking. 0:20:03.800 --> 0:20:04.600 Water per gram. 0:20:04.720 --> 0:20:06.520 Yeah, per gram. Isn't that crazy. 0:20:06.640 --> 0:20:08.240 That's a lot of that's a lot of poop. It 0:20:08.280 --> 0:20:12.040 explains why it spread so rapidly. Really, the world in 0:20:12.080 --> 0:20:15.399 eighteen seventeen was pretty perfect in terms of opportunities for 0:20:15.680 --> 0:20:16.720 color pandemics. 0:20:16.840 --> 0:20:18.320 So you were just going to leave it at perfect. 0:20:18.400 --> 0:20:19.560 I was like pretty perfect. 0:20:19.720 --> 0:20:23.080 I mean, yeah, women had the right to vote everywhere, 0:20:24.480 --> 0:20:28.200 Global population density was higher than it had ever been 0:20:28.359 --> 0:20:32.600 in eighteen seventeen, and trade routes were really well established. 0:20:33.040 --> 0:20:36.840 So basically bringing the furthest reaches of the world to 0:20:37.440 --> 0:20:40.440 the doorstep. You know, you could go anywhere, much more 0:20:40.520 --> 0:20:42.920 rapidly than you ever had before or ever could before. 0:20:43.200 --> 0:20:46.480 But something happened in eighteen seventeen to tip the scales 0:20:46.560 --> 0:20:50.520 from colera epidemic to color a pandemic. Maybe one or 0:20:50.560 --> 0:20:53.520 two colera victims hitched a ride on a ship or 0:20:53.520 --> 0:20:56.840 a caravan heading east. Who knows, and they continue to 0:20:56.920 --> 0:21:00.679 shed the collar of bacteria even if they felt okay. 0:21:00.800 --> 0:21:03.000 Can you remind us the difference between an epidemic and 0:21:03.040 --> 0:21:06.000 pandemic for those people who maybe haven't listened to every 0:21:06.040 --> 0:21:06.920 one of our episodes. 0:21:07.320 --> 0:21:10.439 Basically all the difference between epidemic and pandemic has to 0:21:10.480 --> 0:21:13.720 do with spatial scale, So epidemic is a lot smaller 0:21:13.840 --> 0:21:18.800 regional outbreak, and epidemiologists tend to define pandemic as being 0:21:18.800 --> 0:21:24.000 either countrywide or global multiple countries. Yeah. In any case, 0:21:24.200 --> 0:21:28.840 Cholera raged for the next seven years in India, China, 0:21:29.000 --> 0:21:33.040 the Philippines, Mediterranean countries, et cetera, all of which had 0:21:33.080 --> 0:21:36.119 probably except for India, had never seen the disease before. 0:21:36.240 --> 0:21:38.800