Speaker 1: Fang Lind began to feel feverish just as the weather
Speaker 1: was starting to turn dry. Fang made it through that
Speaker 1: day and night, having to pause during his work in
Speaker 1: the chop room to catch his breath, and he took
Speaker 1: frequent cigarette breaks on the back stairs. The next evening,
Speaker 1: when he went up for a cigarette break and sat
Speaker 1: down on the back steps, he couldn't get up. His
Speaker 1: fever had climbed, probably to over one hundred three degrees,
Speaker 1: and he found that no matter how deeply he breathed,
Speaker 1: he felt perpetually winded. His body aggs had reached a
Speaker 1: point where whatever position he stood or sat in, he
Speaker 1: felt as if his muscles were being pulled from his bones.
Speaker 1: The anti febrow medication did nothing to assuage his fever,
Speaker 1: which may have spiked north of one hundred four point
Speaker 1: five twice. He was unable to rouse himself from his
Speaker 1: sleeping palate in time to reach the toilet in the hall,
Speaker 1: each time, soiling his trousers. He found that if he
Speaker 1: moved even slightly to roll over or sit up, he
Speaker 1: would be completely out of breath. The muscle agges were
Speaker 1: so severe he recalls that he found staying still unbearable,
Speaker 1: yet any movement would leave him gasping for breath. What
Speaker 1: was happening to him? Fang knew he was ill, but
Speaker 1: he still assumed he was suffering from another of those
Speaker 1: respiratory infections that regularly burned to the click. Everyone seemed
Speaker 1: to have a hacking cough of some sort. Whether it
Speaker 1: was due to cigarettes, persistent asthma, or air pollution was
Speaker 1: impossible to say, but he had been on his back
Speaker 1: for several days now and wasn't feeling any better. Most
Speaker 1: terrifying for him when he was conscious was the sense that,
Speaker 1: no matter how deeply he breathed, he felt that what
Speaker 1: he was inhaling was not oxygen, but some other odorless,
Speaker 1: tasteless gas with similar properties, but without the life sustaining
Speaker 1: force of simple oxygen. He was running out of air,
Speaker 1: yet he felt he was breathing freely. He now had
Speaker 1: to stay perfectly still. To move was to suffocate. Stay
Speaker 1: still and breathe breathe as deeply as possible. On about
Speaker 1: the sixth day of his illness, he lost all track
Speaker 1: of his environment. From then on, there were only dark
Speaker 1: dreams and the sensation that his life was literally being
Speaker 1: squeezed from him. His muscle aches would come in steady,
Speaker 1: rolling waves, and would peek as gripping cramps around his
Speaker 1: spine and in his neck and upper legs, a dreadful
Speaker 1: tightening that would coincide with a gasping inability to draw
Speaker 1: in enough oxygen. He lay still and struggled to stay
Speaker 1: awake so that he could focus on maintaining his steady,
Speaker 1: ineffectual breathing. He feared that if he fell asleep, he
Speaker 1: might forget to breathe, and that would be it. Perhaps
Speaker 1: that is what dying is. He wondered, your body forgetting
Speaker 1: how to breathe. But he did begin to drift off,
Speaker 1: always remembering even in his unconscious state, that he must
Speaker 1: stay still. Any movement at all, even a wiggling of toes,
Speaker 1: even blinking, used precious oxygen. That was air he didn't have.
Speaker 1: So he lay perfectly still, and in those moments between
Speaker 1: severe cramps and muscle aches, when his bowels were settled,
Speaker 1: he would drift into dark snatches of unconsciousness. But it
Speaker 1: was a cruel sleep, one that never let him forget
Speaker 1: for even a moment his suffering. During those naps, he
Speaker 1: would always feel very far from home and very alone,
Speaker 1: a terrified idea began to glow in the darkness. He
Speaker 1: would die far from home, away from his family. He
Speaker 1: understood finally the importance of that Chinese tradition of rushing
Speaker 1: home when you were ill, even if only to pass away.
Speaker 1: And then he thought of another matter. Who would pay
Speaker 1: for the cost of his funeral arrangements?
Speaker 2: Oof?
Speaker 1: Aaron Oof indeed Erin. That was adapted from chapter seven
Speaker 1: of China Syndrome by Carl Taro Greenfeld, and that description
Speaker 1: was of SARS SARS. Yes. And on this episode of
Speaker 1: this podcast, Will Kill You, we are talking all things coronavirus.
Speaker 2: Because you guys asked for it and we oblige. I'm
Speaker 2: Aaron Welsh and I'm Erin Alman Updike.
Speaker 1: Welcome, Welcome. So this episode we're talking all things coronavirus,
Speaker 1: which means the endemic ones that cause basically like a
Speaker 1: mild cold in humans, SARS mers and then the twenty
Speaker 1: nineteen novel Coronavirus, which doesn't yet have a catchy acronym, right.
Speaker 1: And the reason that we're talking about all of these
Speaker 1: is because, for one thing, they are all related to
Speaker 1: one another. And what we can tell about those twenty
Speaker 1: nineteen novel coronavirus. A lot of that comes from the
Speaker 1: information that we have from these other coronaviruses, so we
Speaker 1: wanted to give you the full picture of all these things.
Speaker 2: We were not planning on covering coronavirus this season, no,
Speaker 2: but yeah, it's making big headlines and for good reason.
Speaker 2: So we want to help everyone to understand what coronaviruses
Speaker 2: are and as much as we can let you know
Speaker 2: about what's going on with the current coronavirus outbreak. A
Speaker 2: few things to keep in mind, we are not experts.
Speaker 1: Once more, for the people in the back, we are
Speaker 1: not experts, so.
Speaker 2: We are not the ones on the ground doing this
Speaker 2: research working on this outbreak. We are going to tell
Speaker 2: you what we know, and because we're not experts, we're
Speaker 2: going to bring in some people who have much more
Speaker 2: expertise than we do to talk about what's going on
Speaker 2: with the current novel coronavirus outbreak. But we will do
Speaker 2: what we do best, which is tell you about the
Speaker 2: biology and the history of coronaviruses in general.
Speaker 1: Yeah. Should we also note that we are recording this
Speaker 1: on oh nine thirty am on February second.
Speaker 2: This is something that's happening so rapidly that by the
Speaker 2: time you listen to it things will be drastically different.
Speaker 1: The earliest you would be hearing this is on February fourth,
Speaker 1: so it's likely that some of the numbers that we
Speaker 1: are reporting about the twenty nineteen novel Coronavirus will have changed,
Speaker 1: but hopefully the broad strokes will still be enough to
Speaker 1: get you the information that you want and will.
Speaker 2: Also point you in the direction of where you can
Speaker 2: find reputable sources to stay abreast on what's going on
Speaker 2: with the current outbreak.
Speaker 1: Yes, I guess though we should start with quarantinies.
Speaker 2: We should because we must.
Speaker 1: This week's quarantini is called the breath Taker, and it's
Speaker 1: called that because that was the colloquial name for Sars
Speaker 1: in China when it first started making the rounds. I
Speaker 1: love it, and Aaron, what's in the Breathtaker?
Speaker 2: Well, it has to start, of course with a Corona.
Speaker 1: And we should also point out that Corona beer has
Speaker 1: nothing to do with coronavirus.
Speaker 2: At all, and this is not sponsored.
Speaker 1: Not sponsored. It also has Ento Ray's chili liqueur and
Speaker 1: some lime juice and some Tomatio salsa.
Speaker 2: A little spicy something or other to get you through
Speaker 2: this episode.
Speaker 1: Yeah, it's basically like immachillada.
Speaker 2: And we will post the full recipe for this quarantini
Speaker 2: as well as our non alcoholic plus e ber rita
Speaker 2: on our website, This podcast will kill you dot com
Speaker 2: and all of our social media channels.
Speaker 1: Okay, I mean I think we should probably just jump
Speaker 1: right it, and people are already chomping at the bit.
Speaker 2: Yeah, they want it. We should just we should stop
Speaker 2: messing around here. Let's take a quick break and then
Speaker 2: we'll talk biology.
Speaker 3: Sounds great.
Speaker 2: Straight off the bat, I want to let y'all know
Speaker 2: that coronaviruses are nothing new. Nope, nothing new. This novel
Speaker 2: coronavirus that's making headlines is a new individual specific virus. Yes. However, coronaviruses,
Speaker 2: like say, influenza viruses, are a large group of RNA
Speaker 2: viruses that we not only have known about for a
Speaker 2: long time, but have been circulating among humans and many
Speaker 2: many other species of animals for a very very long time. Okay,
Speaker 2: fun fact, this is my only fun fact the whole episode.
Speaker 2: Corona means crown, and the reason that coronaviruses are called
Speaker 2: crown viruses is because when you look at them on
Speaker 2: a scanning electron microscope. They have a little halo crown
Speaker 2: of proteins around the outside.
Speaker 1: Oh, cute viral royalty, Yes, royal virus.
Speaker 2: That's the end of my fun fact. Here's how kind
Speaker 2: of this episode biology is going to be structured. All right. First,
Speaker 2: we're going to talk about the most common human coronaviruses
Speaker 2: in general. These are the ones that circulate all the time.
Speaker 2: Almost definitely if you are listening to this podcast, you've
Speaker 2: been infected with a coronavirus at some point in your life.
Speaker 2: And then we'll talk about the three big headline grabbing
Speaker 2: coronaviruses that is stars, Mers and the Newest twenty nineteen
Speaker 2: and Covy.
Speaker 1: Cool gotcha sounds great?
Speaker 2: All right, So coronaviruses in general, there are several different
Speaker 2: large groups of coronaviruses and a lot of them actually
Speaker 2: infect animals, all different kinds of animals, pigs, chickens, cats,
Speaker 2: and in animals they often cause gi illness, so like
Speaker 2: diarrhea and stuff like that, but they can also cause
Speaker 2: respiratory illness. There are four human coronaviruses that are really
Speaker 2: common and they cause the common cold. Yeah, so these
Speaker 2: are upper respiratory tract infections in general. So the question
Speaker 2: first that we like to answer is what exactly do
Speaker 2: they do in your body and how do they make
Speaker 2: you sick? What is their path of physiology? It turns
Speaker 2: out that for the four human coronaviruses, we don't entirely
Speaker 2: know their path of physiology because, like for many viruses,
Speaker 2: we don't have really great animal models to study them.
Speaker 2: But from some really interesting and probably ethically questionable studies
Speaker 2: that they've done in humans where they intentionally infect quote
Speaker 2: unquote volunteers. When were these studies from the eighties and
Speaker 2: early two thousands.
Speaker 1: Uh, okay, that's yeah, that's yeah.
Speaker 2: Anyways, what we do know from these studies is that
Speaker 2: these four human coronaviruses colonize the upper respiratory tract, so
Speaker 2: your nose and throat in general, okay, And we know
Speaker 2: that they invade and replicate in your respiratory epithelium, so
Speaker 2: the sort of first cells lining your respiratory tract. So
Speaker 2: in the case of these four common coronaviruses, that's pretty
Speaker 2: much where they seem to stop. They're not super infectious
Speaker 2: in these human studies, up to like a third of
Speaker 2: people that they inoculated didn't actually even get infected with
Speaker 2: the virus, and most of those that did had very
Speaker 2: mild or maybe moderate colds. So we all know what
Speaker 2: the common cold looks like, right, Aaron, what kinds of
Speaker 2: symptoms do you have?
Speaker 1: Running nose? Hmmm, sneezing, coughing.
Speaker 2: There you go, exactly, yeah, So these are very mild
Speaker 2: upper respiratory symptoms. Cough, runny nose, stuffy nose. Maybe you
Speaker 2: get a headache, maybe rarely you'd spike a fever, but
Speaker 2: in general you're not all that sick. The way that
Speaker 2: common cold viruses like coronavirus are generally transmitted is by
Speaker 2: respiratory droplets. So since they make you cough and sneeze,
Speaker 2: when you cough and sneeze, you cough and sneeze out
Speaker 2: liquid droplets full of virus, and that's how the next
Speaker 2: person gets infected. So it's not like something like measles
Speaker 2: that we talked about that can hang out airborne in
Speaker 2: the room for many, many hours in the air. These
Speaker 2: are viruses that are contained in water droplets that you
Speaker 2: cough and sneeze out. It is also possible that these
Speaker 2: droplets can land on surfaces and the virus can then
Speaker 2: live on these surfaces and be transmitted from say a
Speaker 2: doorknob to your mouth if you touch a doorknob and
Speaker 2: then touch your mouth. That makes sense, yes, Okay, So
Speaker 2: that's the four common coronaviruses. They don't cause a lot
Speaker 2: of morbidity or illness, They don't cause a lot of
Speaker 2: mortality except in very, very very rare cases. And it's
Speaker 2: estimated that anywhere from ten to thirty percent of all
Speaker 2: common colds around the world are caused by one of
Speaker 2: these four coronaviruses. Huh yeah, so there's really common. Yeah,
Speaker 2: And I think that's important to keep in mind because
Speaker 2: even when Stars first came on the scene, while we'll
Speaker 2: see that it was very novel in the type of
Speaker 2: disease and this verity of disease it caused, it wasn't
Speaker 2: a completely unknown alien invasion virus, right, and neither is
Speaker 2: this new novel coronavirus that's circulating today. Okay, So let's
Speaker 2: get into the more serious things, and that starts with SARS.
Speaker 2: SARS stands for severe acute respiratory syndrome. What was novel
Speaker 2: about SARS when it first came on the scene in
Speaker 2: two thousand and two is that it caused a very
Speaker 2: serious illness in people. It caused an illness that was
Speaker 2: so severe, especially compared to what coronaviruses normally cause, which
Speaker 2: was like a cough and runny nose, that we didn't
Speaker 2: recognize it as a coronavirus for a long time. And
Speaker 2: there's a number of reasons for that, many of which
Speaker 2: I'm sure Aaron you'll get into, right, okay, But at
Speaker 2: least in part, it's because we're we didn't expect before
Speaker 2: SARS that coronaviruses could cause the kind of disease we
Speaker 2: saw with SARS, right, So why did we see more
Speaker 2: severe infection? And the answer is that while SARS still
Speaker 2: mostly affects the respiratory tract, unlike the other coronaviruses, SARS
Speaker 2: is able to extend its infection to the lower respiratory tract,
Speaker 2: so not just your nose and throat, but actually colonize
Speaker 2: your lungs and cause disease in your lungs itself.
Speaker 1: What allows the sarskv to do that, Like, what is
Speaker 1: stopping the other four endemic milder coronaviruses from invading your lungs?
Speaker 2: Good question, and This was one of my I put
Speaker 2: a little asterisk next to this because I thought you
Speaker 2: might ask it, so let's talk about it. So, remember
Speaker 2: that viruses can't replicate on their own right. They have
Speaker 2: to enter our cells in order to replicate and then
Speaker 2: use our cellular machinery in order to replicate and make
Speaker 2: new viruses. So in order to do that, they have
Speaker 2: to get into our cells, and the first step in
Speaker 2: doing that is to bind to some receptors on our
Speaker 2: cells and use those receptors to get into our cells.
Speaker 2: Different viruses use different proteins and bind to different proteins
Speaker 2: in our cells. And what proteins they bind to and
Speaker 2: where in our body those proteins are found, like what
Speaker 2: cell types have those proteins determines what's called the tropism
Speaker 2: of the virus, what organs in our body the virus
Speaker 2: tends to invade.
Speaker 1: Oh, like where it goes? Okay, yeah, exactly.
Speaker 2: And so in the case of SARS, we found out
Speaker 2: later we know now that SARS binds to a protein
Speaker 2: called ACE two angiotensin converting enzyme. This protein is expressed
Speaker 2: in very high concentrations in our lungs and also in
Speaker 2: our small intestine and some other organs too, kidneys, et cetera.
Speaker 2: Because this is the protein that SARS uses to bind,
Speaker 2: it was able to then invade our lungs because our
Speaker 2: lung tissue has a lot of ACE on its. I
Speaker 2: didn't look up exactly what proteins the other four coronaviruses
Speaker 2: used to invade, because there's four of them and that
Speaker 2: would be too long of an episode. But it's not
Speaker 2: generally ACE, right, So the other coronaviruses use different receptors
Speaker 2: that they recognize that are located more in the upper
Speaker 2: respiratory tract.
Speaker 1: It seems like knowing the proteins that these viruses bind
Speaker 1: to would be great targets for treatment.
Speaker 2: Absolutely.
Speaker 1: Yeah.
Speaker 2: So there's been some ideas because we have oh, this
Speaker 2: is probably getting too much, Aaron, but we have drugs
Speaker 2: that actually target ACE because it's an important component of
Speaker 2: how your body manages blood pressure.
Speaker 1: Whoa, oh my gosh. Yeah.
Speaker 2: So we have things called ACE inhibitors. So there's this
Speaker 2: thought that like, oh, could maybe you use these to
Speaker 2: treat SARS. We don't, as far as I know, there
Speaker 2: isn't actually good evidence that that works, but it's like, yeah,
Speaker 2: cool idea, Yeah, let's do some research on it, but yeah,
Speaker 2: knowing how viruses get into our body is often a
Speaker 2: good place to try at least try to target for treatments.
Speaker 2: I'll just say we don't have any though at this
Speaker 2: point for SARS, ormers or the novel coronavirus. Just thrown
Speaker 2: that out.
Speaker 1: There, Okay, there we go.
Speaker 2: So, yeah, so SARS gets into your lungs and is
Speaker 2: able to cause a lung infection. Lung infection means pneumonia,
Speaker 2: so this is a virus causing viral pneumonia. So the
Speaker 2: symptoms of SARS, because it's a more extensive disease, tend
Speaker 2: to start more systemically. So fever is the number one
Speaker 2: symptom of SARS. Actually, Okay, fever, chills, mayalgias like you
Speaker 2: described in the first hand account, these muscle aches can
Speaker 2: get really really severe, and then you do still get
Speaker 2: some upper respiratory symptoms, but a lot of the symptoms
Speaker 2: are more lower respiratory, so you'll get a cough, but
Speaker 2: less of the runny nose type symptoms that we see
Speaker 2: with other coronaviruses. And then as this disease progresses and
Speaker 2: more damage is caused to the lungs themselves, you'll get
Speaker 2: other more serious symptoms like shortness of breath to kipnia,
Speaker 2: which means a really fast breathing rate, plurisy, which is
Speaker 2: like pain in your chest and lungs when you breathe,
Speaker 2: and then depending on how late in the course of
Speaker 2: disease people present to the hospital. Because this is a
Speaker 2: very serious illness, most people will present to the hospital
Speaker 2: almost everyone. When you take an X ray of their chest,
Speaker 2: it will look like what we call ground glass opacifications.
Speaker 1: Oh my gosh, that sounds terrible.
Speaker 2: It is terrible. So if you've ever seen an X
Speaker 2: ray of a normal chest, a not ill chest X ray,
Speaker 2: you know that the lungs are filled with air, so
Speaker 2: they're mostly black because air is black on X ray,
Speaker 2: So you can see the outlines of ribs, and then
Speaker 2: you can see sort of black in between the ribs
Speaker 2: with maybe little bits where you can see like blood
Speaker 2: vessels and things like that. That's a normal, not sick
Speaker 2: chest X ray with stars. It looks like you're looking
Speaker 2: through like a bathroom. You know the glass they put
Speaker 2: on bathroom windows. Yeah, I have some of that on
Speaker 2: my bathroom window exactly. So it looks like that. So
Speaker 2: it's not so opaque that you can't still see like
Speaker 2: the shadow of your heart and your ribs. You can
Speaker 2: still see that it's not completely whited out like it
Speaker 2: might be with a bacterial pneumonia, oh.
Speaker 1: Because the bacteria has colonized. Whereas this is just inflammation.
Speaker 2: Well, bacteria still produce a lot of inflammation, but it'll
Speaker 2: be localized to one spot and it'll be so much
Speaker 2: in like one corner of the lung that it's totally
Speaker 2: whited out, okay, Whereas this is bilateral often throughout your
Speaker 2: whole lung fields, top and bottom. Often it's all just
Speaker 2: kind of murky looking.
Speaker 1: That sounds terrible.
Speaker 2: Yeah, it's bad, it's not good. And then this can
Speaker 2: sort of just progress. So about one third of people
Speaker 2: with SARS will get better on their own, but twenty
Speaker 2: to thirty percent end up needing mechanical ventilation because their
Speaker 2: lungs are just so inflamed that they're not able to
Speaker 2: get enough oxygen in on their own. And I want
Speaker 2: to point out that this kind of supportive treatment is
Speaker 2: the only treatment that we have since we don't have
Speaker 2: any antivirals for SARS. And overall, what we saw from
Speaker 2: the SARS outbreak was a case fatality rate of just
Speaker 2: under ten percent, So about ten percent of people who
Speaker 2: were infected with SARS ended up dying from SARS or
Speaker 2: SARS complications.
Speaker 1: That's a very high mortality rate.
Speaker 2: It is, and it varied a lot based on demographic factors.
Speaker 2: So in people older than sixty five, the mortality rate
Speaker 2: was over fifty percent.
Speaker 1: Wow, I didn't realize it was that high.
Speaker 2: Yeah, it was really high. So that's kind of what
Speaker 2: the disease looked like for SARS. We learned a lot
Speaker 2: about it after the outbreak because, as you can probably
Speaker 2: see with what's going on with a new outbreak right now,
Speaker 2: it's really hard to get good information while the outbreak
Speaker 2: is going on right because you're just kind of dealing
Speaker 2: with like trying to keep people alive well.
Speaker 1: And also there's steps to publishing reliable information has to
Speaker 1: have asolute, pure review process, and some of those things
Speaker 1: are are lifted right now and people are getting early
Speaker 1: drafts out. But it's then you know what information is reliable.
Speaker 1: Sample sizes tend to be small, et cetera, et cetera.
Speaker 2: Yeah, But so things that we know now looking back
Speaker 2: at Stars since the outbreak has passed, is we know
Speaker 2: that with SARS, subclinical infection, so like asymptomatic infection, was
Speaker 2: really rare. So in looking at zero prevalent studies of
Speaker 2: people in areas where there were high rates of SARS,
Speaker 2: there's very little evidence of infection in people who didn't
Speaker 2: have symptoms of SARS.
Speaker 1: Interesting, okay, Yeah.
Speaker 2: So we know that in the case of SARS, infection
Speaker 2: almost always led to symptoms, and in general, those symptoms
Speaker 2: were very severe. And the other thing that we learned
Speaker 2: about SARS was that the viral load, so how much
Speaker 2: virus you had in your body, was a really driving
Speaker 2: factor of infectivity, okay. And so in the case of SARS,
Speaker 2: the incubation period, so the time from when you first
Speaker 2: got infected to showed symptoms, was usually about four to
Speaker 2: seven days, and viral load actually increased slowly over that time,
Speaker 2: so people were most infectious about ten days after first
Speaker 2: getting infected. And so that means that people STARS were
Speaker 2: really only infectious if and when they showed symptoms, which
Speaker 2: made SARS relatively easy to screen for and to help contain.
Speaker 2: So that's pretty much SARS, okay, So let's let's move on.
Speaker 2: The next most famous coronavirus was merz Middle East respiratory syndrome.
Speaker 2: So was MURRZ just the same thing as SARS, but
Speaker 2: in a different part of the world. No, not really.
Speaker 2: It was another novel coronavirus that was discovered in twenty
Speaker 2: twelve after an outbreak in I believe Saudi Arabia was
Speaker 2: the first identified cases. Is that right, Aaron?
Speaker 1: So it was first isolated from an outbreak in Saudi Arabia,
Speaker 1: but retrospective testing showed that it actually the first cases
Speaker 1: seemed to be in Jordan earlier that year.
Speaker 2: That's right, That's right.
Speaker 1: Okay.
Speaker 2: So symptomatically, MERHS present very similarly to SARS in a
Speaker 2: lot of ways. It started off with fever, mayalgia's muscle
Speaker 2: pain was really common. Oh, I forgot to mention this,
Speaker 2: but a really common symptom for SARS was actually diarrhea
Speaker 2: and in some cases nausea and vomiting. So you often,
Speaker 2: in addition to this viral pneumonia had pretty extensive GI symptoms.
Speaker 2: You also saw this in MRS, and then like with SARS,
Speaker 2: you would get a really rapidly progressive viral pneumonia. You'd
Speaker 2: have similar findings on chest X ray, those ground glass opacities,
Speaker 2: and it could lead to respiratory failure and potentially death.
Speaker 2: We know that MRS also had a similar incubation period
Speaker 2: a similar time to symptoms as SARS.
Speaker 1: Does it also bind to the ACE two protein?
Speaker 2: Oh, I'm so glad that you asked, Aaron.
Speaker 4: No.
Speaker 2: Really, it turns out MURRHS binds to a different protein
Speaker 2: called DPP four dipeptidl peptidase. This is another protein. It's
Speaker 2: similar to ACE. Okay, but it's expressed in high levels
Speaker 2: in the lungs and the kidney. So can you guess
Speaker 2: another very common symptom of MERS that's different from SARS
Speaker 2: renal failure? Renal failure absolutely, so ACE is also expressed
Speaker 2: in the kidney. So you can still get renal failure
Speaker 2: with SARS, but it's more common in MURRS because I
Speaker 2: think DPP four is expressed at very high levels in
Speaker 2: the kidney.
Speaker 1: Right.
Speaker 2: Oh, how fun? Okay unless you have MERS. So let's
Speaker 2: talk about some of the differences between MRS and SARS.
Speaker 2: First off, MRS way more deadly, yes, okay. So in
Speaker 2: looking at the outbreaks of MURRS, the case fatality rate
Speaker 2: is close to forty percent, about thirty six percent.
Speaker 1: That's very, very, very high.
Speaker 2: It's very high. For SAR, it was just under ten percent, right,
Speaker 2: So a case fatality rate of forty percent sounds very terrifying.
Speaker 2: So let's calm ourselves down for a minute and not
Speaker 2: freak out too much about MRS. Here's a few reasons why.
Speaker 2: Number one, it turns out that MURS is not nearly
Speaker 2: as infectious as SARS, so person to person transmission is
Speaker 2: not very efficient for MRS.
Speaker 1: Why is that?
Speaker 2: You know, that's a really good question that we don't
Speaker 2: fully understand the answer to. What we do know is
Speaker 2: that when we compare the R NOTS, so the average
Speaker 2: number of cases from a primary case to a secondary
Speaker 2: case for SARS, it was probably around two to three
Speaker 2: I think, is that right?
Speaker 1: Yeah?
Speaker 2: For MRS it's er point seven.
Speaker 1: Okay. Do you think it has something to do with
Speaker 1: the tropism of the virus? Is it in the lungs
Speaker 1: as much? Is the infectious dose different between STARS and MRS.
Speaker 2: It could be the infectious dose, absolutely, I think that
Speaker 2: probably has a lot to do with it.
Speaker 1: It could be the.
Speaker 2: Tropism, although you know DPP four like it causes just
Speaker 2: as bad of a viral pneumonia, if not worse. But
Speaker 2: here's another important part about MRS, and this I think
Speaker 2: helps at least I think this makes more sense as
Speaker 2: to why it maybe doesn't transmit as well. The vast
Speaker 2: majority of cases of MERS, not even just the deaths,
Speaker 2: but the people who were infected with MRS, seventy five
Speaker 2: percent of them had some kind of underlying disease, Okay,
Speaker 2: some kind of comorbidity. So it seems like maybe MURHS
Speaker 2: requires that a person is already a little sick, so
Speaker 2: they have diabetes or some kind of underlying lung disease
Speaker 2: or heart disease, something that makes their immune system not
Speaker 2: work as effectively. That allows for MURZ to colonize, infect
Speaker 2: them and then make them very, very sick, gotcha. Whereas
Speaker 2: with SARS, you know, healthy people got infected, sick people
Speaker 2: got infected. SARS just infected pretty much anyone. Does that
Speaker 2: make sense?
Speaker 1: Yes?
Speaker 2: So overall, that's the good news about MRS. It's a
Speaker 2: lot less transmissible. Almost every outbreak or group of cases
Speaker 2: had at least some documented spillover events, and it's thought
Speaker 2: that there were many many individual spillovers that happened with MRS.
Speaker 2: Whereas SARS, you'll probably talk more about, was one big
Speaker 2: outbreak right right, and MURRS the vast majority of people
Speaker 2: who have been shown to be infected had at least
Speaker 2: some underlying comorbidities. Okay, so that's MURRS and SARS saved
Speaker 2: a special one for last, a special one for last.
Speaker 2: So those two novel coronaviruses, as a recap are different
Speaker 2: than the other four coronaviruses that circulate because they cause
Speaker 2: more serious illness by infecting the lower respiratory tract. So
Speaker 2: that brings us to today, twenty nineteen n Covy, the
Speaker 2: newest coronavirus on the block. I don't have all the
Speaker 2: answers for you about what is this virus and what's
Speaker 2: the fatality rate and et cetera, et cetera, not only
Speaker 2: because we're not the experts on this topic, but because
Speaker 2: this is such a new virus and an ongoing outbreak
Speaker 2: that we can't answer all of these questions. We can
Speaker 2: make estimates based on the fact that we've seen stars
Speaker 2: and merhs in the past. We can guess that in
Speaker 2: a lot of ways, this novel coronavirus likely operates very
Speaker 2: similarly to SARS and MERS and honestly the other coronaviruses.
Speaker 2: So how do we think it's transmitted Most likely respiratory droplets, right,
Speaker 2: That's how all coronaviruses tend to be transmitted. It's certainly
Speaker 2: possible that fomites or surfaces can be an important part
Speaker 2: of transmission. So we don't know how long this particular
Speaker 2: coronavirus can survive on say a door knob or your
Speaker 2: cell phone, but we know it can probably live for
Speaker 2: at least a period of time since other coronaviruses can
Speaker 2: survive for many hours. And what it appears based on
Speaker 2: the number of people who have had severe symptoms, is
Speaker 2: that this novel coronavirus is also able to infect our
Speaker 2: lungs and cause serious viral pneumonia, So this is a
Speaker 2: more severe coronavirus than the four typical coronaviruses.
Speaker 1: We don't know anything about the protein that it binds to.
Speaker 2: So there has been at least one study that has
Speaker 2: shown that it likely actually uses ACE two as well,
Speaker 2: at least potentially, but that study was it's very preliminary,
Speaker 2: and it wasn't you using a live virus. They like
Speaker 2: conjugated it to a herpes virus and it was just
Speaker 2: in cell culture. So no, we don't know for sure
Speaker 2: what protein this novel coronavirus is using. It might be
Speaker 2: the same one as SARS, it might not be. Okay,
Speaker 2: we also don't quite know what the r not is,
Speaker 2: so the basic reproductive value. There have been a lot
Speaker 2: of people trying to make estimates. It seems at this
Speaker 2: point on February second, like it's likely between two and
Speaker 2: two and a half maybe Okay, the estimates that I've
Speaker 2: seen so probably similar to SARS, maybe not quite as infectious,
Speaker 2: although we've seen numbers go up a lot more rapidly
Speaker 2: than with SARS. And one thing that I think is
Speaker 2: really really important is that we cannot estimate a case
Speaker 2: fatality rate until this outbreak is over. Yeah, period. And
Speaker 2: I think that there's a lot of people on the
Speaker 2: internet right now saying, well, the mortality rate is this
Speaker 2: and the case fatality rate is that we can't estimate
Speaker 2: either of those numbers right now at all. We can
Speaker 2: calculate a proportion of you know, total deaths from this
Speaker 2: disease so far, but because so okay, February twod at
Speaker 2: ten am, there are currently fourteen thousand, six hundred total
Speaker 2: cases that we know, about three hundred and forty eight
Speaker 2: of those have recovered, and three hundred and five of
Speaker 2: them have died thus far. Okay, so if you use
Speaker 2: those numbers, then it would look like a proportionate mortality
Speaker 2: of around two percent. But this is not a fixed number.
Speaker 2: Fourteen thousand, two hundred of those fourteen thousand, six hundred
Speaker 2: are still sick, and we don't know how severe their
Speaker 2: illness is going to be and whether they're going to
Speaker 2: end up in the recover group or the death group.
Speaker 2: And there are thousands more tests that haven't been run,
Speaker 2: so we really don't know at all what the case
Speaker 2: fatality rate is going to be at this point, makes sense, yeah,
Speaker 2: but otherwise this likely operates. It seems similarly to SARS.
Speaker 2: So it's estimated that the incubation period is likely no
Speaker 2: more than fourteen days. That's like the max that we've
Speaker 2: seen in both SARS and MERS. So if you're two
Speaker 2: weeks out from being say next to someone with this
Speaker 2: novel coronavirus, and you haven't gotten sick, you're probably not
Speaker 2: gonna get sick. And then there's a lot of other
Speaker 2: questions about like when exactly are you infectious, how many
Speaker 2: asymptomatic or subclinical infections might there be, and at this
Speaker 2: point it's looking like it's more likely than with SARS
Speaker 2: that there might be kind of low level illness rather
Speaker 2: than only serious severe cases.
Speaker 1: Right, which might be part of the reason and why
Speaker 1: the number of infected has surpassed SARS already.
Speaker 2: Exactly right, Yeah, But we don't have a ton of answers,
Speaker 2: and so later in this episode we'll talk more about
Speaker 2: what we know about this outbreak overall and what's being
Speaker 2: done about this outbreak with some experts on the topic,
Speaker 2: people who know a lot more than we do. Yes,
Speaker 2: But first, Aaron, can you help us to understand where
Speaker 2: these coronaviruses came from and how we got through the
Speaker 2: stars and MRS outbreaks and kind of the lay of
Speaker 2: the land.
Speaker 1: I think I can help out with that a little bit.
Speaker 1: Let's take a quick break first. All right, are you
Speaker 1: ready for this?
Speaker 5: Oh?
Speaker 1: I'm so ready. It's a big one, okay, And there's
Speaker 1: a ton of info here, so I try to organize
Speaker 1: it into discrete units just like you did. So I'm
Speaker 1: going to start with talking about the ecology and origins
Speaker 1: of coronaviruses in general, and then I'm going to focus
Speaker 1: on the two thousand and two to two thousand and
Speaker 1: three SARS epidemic, and then I'll talk a little bit
Speaker 1: about MRS. And finally we'll go into what's done on
Speaker 1: everyone's mind, which is the twenty nineteen novel Coronavirus.
Speaker 2: Awesome, all right.
Speaker 1: Let's go As you mentioned Aaron, SARS and MRS and
Speaker 1: this twenty nineteen novel. Coronavirus are all types of coronaviruses,
Speaker 1: and as a subfamily, they're pretty diverse. So, like you said,
Speaker 1: they can be found all over the world different animal species,
Speaker 1: in wildlife, in domestic animals, and humans, and they can
Speaker 1: cause different degrees of illness in all these animals. It's
Speaker 1: difficult to know exactly how long coronaviruses have been infecting humans,
Speaker 1: but it's likely that it goes way back, particularly for
Speaker 1: those mild endemic strains. And it's also possible, of course,
Speaker 1: that there have been historical epidemics of more deadly coronaviruses
Speaker 1: like SARS and MRS and so on. But the first
Speaker 1: one that we are that we were aware of is
Speaker 1: the one from the SARS outbreak two thousand and two
Speaker 1: to two thousand and three, and then MRS popped up
Speaker 1: in twenty twelve, and then finally this one in twenty nineteen.
Speaker 1: The common thread among these more virulent or deadly coronaviruses
Speaker 1: is that they all seem to have their origins in bats.
Speaker 1: So with SARS CoV it was likely a spillover event
Speaker 1: from bats to civets to humans, and with Murrs covy,
Speaker 1: the in between animals were camels. We're not exactly sure
Speaker 1: yet how the twenty nineteen novel coronavirus spilled over into humans,
Speaker 1: but according to two papers, one of which I want
Speaker 1: to point out is not pure reviewed. It's just a
Speaker 1: draft of an early paper. Bats have been implicated as
Speaker 1: the source as well. Makes sense SARS mers twenty nineteen
Speaker 1: novel coronavirus. These viruses are novel to humans, but the
Speaker 1: way that the outbreaks occurred is not. And before I
Speaker 1: get into the nitty gritty on each of these coronavirus outbreaks,
Speaker 1: I wanted to talk more generally about emerging infectious diseases.
Speaker 1: Yeah because yeah, because these coronavirus outbreaks won't be the last.
Speaker 1: And if we want to be able to control or
Speaker 1: predict these spillover events, we have to understand the factors
Speaker 1: driving them. The incidence of emerging infectious disease events has
Speaker 1: risen significantly over time, and the majority of these have
Speaker 1: their origins in wildlife. And the term emerging infectious disease
Speaker 1: can also be used to describe something that has evolved,
Speaker 1: like in antibiotic resistance strained bacteria, or something that's been
Speaker 1: with humans for a long time but has recently increased
Speaker 1: in incidents like lime disease, but it also can mean
Speaker 1: pathogens that are branded to humans and with this last category,
Speaker 1: the so called emerging disease hotspots, so the places around
Speaker 1: the globe where spillover events are most likely to occur
Speaker 1: based on what we've already seen, these tend to be
Speaker 1: concentrated in the tropics, so like in low latitude areas
Speaker 1: and subtropics, that's also happens to be where animal and
Speaker 1: pathogen diversity is high, and also in resource limited countries,
Speaker 1: particularly those with high population densities. As our human population grows,
Speaker 1: as we continue to build and spread into natural areas
Speaker 1: as urbanization increases, as the climate changes, humans and domestic
Speaker 1: animals become more likely to interact with wild life and
Speaker 1: with pathogens from wildlife, and we've seen this time after
Speaker 1: time with Ebola, with Marbourg, with hendra, with Nepa, with
Speaker 1: bird flu, and with many more. Detection or surveillance of
Speaker 1: novel pathogens in these areas is challenging, mostly because the
Speaker 1: funds just aren't there, both nationally and internationally. And if
Speaker 1: we want to reduce the likelihood of another outbreak like this,
Speaker 1: or be better at controlling it from the start, we
Speaker 1: need to channel more resources into early detection and surveillance
Speaker 1: both in humans and wildlife, conservation of natural areas, and
Speaker 1: especially interdisciplinary collaboration like we see in a one health
Speaker 1: approach with ecologists, epidemiologist, physicians, et cetera all working together
Speaker 1: get it arin. There should also be a push towards
Speaker 1: the free and open exchange of information, which is actually
Speaker 1: something great that I've noticed with this twenty nineteen novel coronavirus.
Speaker 1: So there are several scientific journals that are saying, we're
Speaker 1: putting all of these articles, We're taking these from behind
Speaker 1: the paywall, We're making them free to the public, open access,
Speaker 1: publish early with like you know. Note that it was
Speaker 1: a draft or whatever, But there are still so many
Speaker 1: journals and journal articles that are behind a paywall, and
Speaker 1: this current outbreak of twenty nineteen novel Coronavirus. It's probably
Speaker 1: not going to be the thing to wipe out the
Speaker 1: human race, but the next one could be unless we
Speaker 1: make certain changes and we work really hard on the
Speaker 1: prevention and surveillance aspect of this. Okay, now, are you
Speaker 1: all scared? Stars. The earliest signs of the SARS epidemic
Speaker 1: began in November two thousand and two in Guangdong Province
Speaker 1: in China. In Guangdong Province, as well as many other
Speaker 1: places throughout the country, open air markets and restaurants featured
Speaker 1: animals of all different species, often held in tiny enclosures,
Speaker 1: with their poop and breath and blood all mingling constantly.
Speaker 2: Poop and breath yea.
Speaker 1: There were many restaurants that offered any part of any
Speaker 1: species you could possibly want, and to ensure that the
Speaker 1: meat was fresh, the animals on the menu were often
Speaker 1: held in cages in alleys behind the restaurant. It was
Speaker 1: at these restaurants and markets that the first cases of
Speaker 1: SARS would emerge. On November sixteenth, two thousand and two,
Speaker 1: an official on the village committee was admitted to a
Speaker 1: hospital in Foshan, Guangdong Province, complaining of respiratory symptoms. His
Speaker 1: family also came down with the illness. Over the course
Speaker 1: of the next month, case numbers of this mysterious atypical
Speaker 1: pneumonia steadily rose. By December twenty fifth, two thousand and two,
Speaker 1: thirty five people were infected and eight had died. And
Speaker 1: this is important to note it was a retrospective count
Speaker 1: for they but deaths were apparent. And so with these
Speaker 1: number of deaths from a mysterious respiratory ailment, some public
Speaker 1: health officials were growing suspicious and a little bit concerned.
Speaker 1: Rumors started to circulate of an influenza epidemic, possibly avian influenza,
Speaker 1: and since the outbreak of avian influenza in Hong Kong
Speaker 1: in nineteen ninety seven, there was constant vigilance for the
Speaker 1: virus because it is extremely deadly and if person a
Speaker 1: person transmission was established that could be a real problem.
Speaker 1: But other people doubted that it was avian influenza. This was,
Speaker 1: after all, the winter season when it seemed like everyone
Speaker 1: had a respiratory complaint of one kind or another, and
Speaker 1: rumors circulated every year about a mysterious hemorrhagic fever or
Speaker 1: a wild skin disease. These rumors were different though. For
Speaker 1: one these rumors all focused on the respiratory ailment and
Speaker 1: were pretty consistent, at least as far as rumors go.
Speaker 1: Cloudy chest exs rays, burning fevers, and high prevalence owning
Speaker 1: medical personnel. The first official public statement about the SARS
Speaker 1: epidemic was released on January third, two thousand and three,
Speaker 1: a little over a month since the beginning of the outbreak.
Speaker 1: At this point, there were forty eight people infected and
Speaker 1: nine dead another retrospective count. This statement was published on
Speaker 1: the front page of the Heywan Daily. It read, quote,
Speaker 1: there is no epidemic in Haywan. There is no need
Speaker 1: for people to panic. Regarding the rumor of ongoing epidemic
Speaker 1: in the city, Health department officials announced at one thirty
Speaker 1: am this morning, there is no epidemic in Haywan. The
Speaker 1: official pointed out that people don't need to panic and
Speaker 1: there is no need to buy preventative drugs end quote.
Speaker 1: Despite this incredibly reassuring statement, people panicked. They rushed to
Speaker 1: the pharmacy, buying all the accedo, minifin and antibiotics that
Speaker 1: they could get their hands on. Because antibiotics are available
Speaker 1: over the counter without a prescription.
Speaker 2: There and they're very useful viruses.
Speaker 1: Not they're They're not useful at all.
Speaker 2: They are not, they're not.
Speaker 1: Public health officials were dispatched to the Hewan Number one
Speaker 1: Hospital to conduct an investigation into the mysterious pneumonia. Some
Speaker 1: suspected a species of chlamydia, which can cause pneumonia, but
Speaker 1: the infection didn't respond to broad spectrum antibiotics. Others thought
Speaker 1: maybe it was caused by a virus, possibly influenza, or
Speaker 1: possibly a virus not yet described. They also interviewed patients
Speaker 1: and medical staff about their experiences. Disturbingly, they found that
Speaker 1: several patients had been to multiple hospitals, moving either by
Speaker 1: their own choice or being transferred. Oh yeah. By the
Speaker 1: end of January, rumors were soon swirling yet again, this
Speaker 1: time in Jangshan about the atypical pneumonia, which was now
Speaker 1: circulating in multiple hospitals in the city, as well as
Speaker 1: popping up outside of hospitals. By this time, it had
Speaker 1: earned the nickname breathtaker or breath stalker, which is where
Speaker 1: we got our quarantine name. And whereas in Hewuan the
Speaker 1: disease was largely confined to one hospital. What was going
Speaker 1: on in Jiangshan appeared to be the first community outbreak
Speaker 1: of the mysterious disease, and it would later be determined
Speaker 1: that the first known super spreader of SARS, nicknamed the
Speaker 1: Poison King, was transferred from Jiangshan, where he had infected
Speaker 1: six medical personnel, to Guangzhou, where he would continue to
Speaker 1: infect people. And these super spreaders, it's no fault of
Speaker 1: their own. People didn't know how to control the infection
Speaker 1: at this point or how infectious it was, but these
Speaker 1: super spreaders would be a hallmark of the SARS outbreak
Speaker 1: where a lot of the infections originated from one source
Speaker 1: like that. Okay, So by late January, medical officials were
Speaker 1: pretty certain that it was caused by an extremely infectious
Speaker 1: virus transmitted through respiratory droplets. But getting that information out
Speaker 1: there was a different story, because it was standard practice
Speaker 1: among the Chinese government to keep this information top secret
Speaker 1: and classified, to not share it among anyone less than
Speaker 1: the top most ranking public health officials, not the public,
Speaker 1: and certainly not to the outside world. So the rest
Speaker 1: of the world finally caught wind of a mysterious and
Speaker 1: deadly outbreak in China on February tenth, two thousand and three,
Speaker 1: at which point an estimated three hundred and ninety three
Speaker 1: people were infected and forty had died retrospective count somebody
Speaker 1: posted a report on ProMED ProMED all right, you ready
Speaker 1: quote there's like also there's this is like a quote
Speaker 1: within a quote, So just keep that in mind as
Speaker 1: I'm trying to say it. Okay, this morning I received
Speaker 1: this email and then searched your archives and found nothing
Speaker 1: that pertained to it. Does anyone know about this problem?
Speaker 1: And then here's the email another quote, have you heard
Speaker 1: of an epidemic in Guangzhao? An acquaintance of mind from
Speaker 1: a teacher's chat room lives there and reports that the
Speaker 1: hospitals have been closed and people are dying and double quotes.
Speaker 1: So around this time, the WHO got an email describing
Speaker 1: panic in Guangdong as the death toll from a mysterious
Speaker 1: pneumonia was climbing, but official word from the Chinese government
Speaker 1: was still lacking. But once other countries started reporting on
Speaker 1: this disease, speculating with what little information they had, panic
Speaker 1: and anxieties set in anyway, and the Chinese government was
Speaker 1: forced to hold a press conference on the disease in Guangdong,
Speaker 1: and this press conference, held on February eleventh, which was
Speaker 1: one day after the ProMED announcement, was full of assurances
Speaker 1: that this disease wasn't anything to be concerned about. They
Speaker 1: said there were only three hundred and five people infected
Speaker 1: and it was already under control. Meanwhile, in Hong Kong,
Speaker 1: a doctor from Guangzhou arrived at a hotel where he
Speaker 1: was staying for a wedding. This would be the next
Speaker 1: super spreader. He started to feel worse and worse and
Speaker 1: eventually sought medical care, but it was too late to
Speaker 1: stop the spread of the virus. Also at this hotel
Speaker 1: was a woman from Toronto, a Chinese American businessman, and
Speaker 1: a Hong Kong local who went to the hotel to
Speaker 1: visit a friend. All of these left the hotel to
Speaker 1: continue on their travels or to return home, unknowingly bringing
Speaker 1: with them this hitchhiking virus. And this marked the start
Speaker 1: the real start of the global spread of the virus.
Speaker 1: Hong Kong, Toronto, Hanoi, Singapore, Beijing, These would be the
Speaker 1: next hotspots of infection. On February twenty eight, two thousand
Speaker 1: and three, parasitologist Carlo Urbani, based in Vietnam, alerted the
Speaker 1: WHO about a highly contagious, atypical pneumonia after treating the
Speaker 1: Chinese American businessman who had stayed in that Hot Zone
Speaker 1: hotel in Hong Kong and several healthcare workers who had
Speaker 1: also come down with this pneumonia. After treating this person
Speaker 1: back in Toronto, a similar scene was unfolding. So the
Speaker 1: woman who was infected in Hong Kong died in a
Speaker 1: hospital back in Toronto, and five of her family members
Speaker 1: were found to be infected as well. On March fifteenth,
Speaker 1: the WHO was notified of a possible SARS infected doctor
Speaker 1: traveling from New York back home to Singapore with a
Speaker 1: stopover in Frankfurt. Mid flight, the doctor, his wife, and
Speaker 1: his mother in law were all cordoned off and then
Speaker 1: as soon as the plane landed in Frankfurt, they were
Speaker 1: placed in isolation.
Speaker 2: That's one of the few moments that I really do
Speaker 2: remember from the SARS outbreak.
Speaker 1: When it was like there's a person traveling in.
Speaker 2: The yeah, and like on the plane and then they
Speaker 2: like quarantined them when they landed in Germany. Like I
Speaker 2: don't know why that's one of the moments. I wasn't
Speaker 2: that into disease at the time. I was in high school,
Speaker 2: but I remember that.
Speaker 1: You should read his account. It's really interesting because he
Speaker 1: talks about the depression of isolation and how much insight
Speaker 1: it gave him as a physician to know what his
Speaker 1: patients had been going through. So this doctor, his wife,
Speaker 1: and his mother in law, all three of them developed SARS.
Speaker 1: I don't know if they infected anyone else, actually I
Speaker 1: don't remember, but regardless, these signs of a global spread
Speaker 1: or potential global spread prompted the WHO to declare a
Speaker 1: travel advisory and to come up with a name. And
Speaker 1: as we said, locations were out, but acronyms can be catchy,
Speaker 1: so someone suggested SARS, and it's stuck. But what no
Speaker 1: one realized at the time was that SARS was very
Speaker 1: similar to what China called Hong Kong Special Administrative Region
Speaker 1: sar OH. In a way, it was it placed a
Speaker 1: lot of stigma on Hong Kong as like who had
Speaker 1: already experienced stigma about the Avian influenza outbreak in nineteen
Speaker 1: ninety seven and subsequent outbreaks, and then it sort of
Speaker 1: further stigmatized Hong Kong, Okay. At the hospitals where the
Speaker 1: people with atypical pneumonia were being treated, the pattern that
Speaker 1: emerged was that healthcare workers were becoming infected by the dozens.
Speaker 1: There weren't enough beds to put all of the sick people,
Speaker 1: and there were too few people left to help care
Speaker 1: for them, so hospitals were beginning to crash. Some emergency
Speaker 1: hospitals were being built, and one practice that developed was
Speaker 1: to form dirty teams, which were composed of medical staff
Speaker 1: that had volunteered to treat the infected people, and they
Speaker 1: would live at the hospital in isolation, and those who
Speaker 1: were not on the dirty team would not be permitted
Speaker 1: to go near the patients, and so this would reduce
Speaker 1: the number of medical staff that was potentially exposed. And
Speaker 1: filling out the dirty team was never a problem. More
Speaker 1: people volunteered than there were places. Wow. Always yeah and
Speaker 1: the Star's epidemic, like this coronavirus epidemic and other epidemics,
Speaker 1: is filled with these stories of selfless people, especially healthcare workers,
Speaker 1: many of whom lost their lives to the illness. And
Speaker 1: one of these was the parasitologists that I mentioned earlier.
Speaker 1: Carlo Orbani, who just before he died, asked to have
Speaker 1: his lung tissue sent to the CDC so they could
Speaker 1: use it for research.
Speaker 2: That's who in the movie Contagion. That's who Kate Win's
Speaker 2: it's character is based off of.
Speaker 1: I didn't realize that. That's cool.
Speaker 2: Yep.
Speaker 1: Wow. On March twenty first, researchers at Hong Kong University
Speaker 1: announced they had found that the pathogen causing this atypical
Speaker 1: pneumonia was a coronavirus, beating the CDC by a couple
Speaker 1: of days. And up to this point, a coronavirus, as
Speaker 1: we have said, had never been known to cause such
Speaker 1: severe disease, and it was kind of low on the
Speaker 1: list of potential agents because of that, right, and also
Speaker 1: there was a couple cases of H five N one
Speaker 1: avian influenza that had shown up in Hong Kong, and
Speaker 1: so it was kind of thought, maybe this is just
Speaker 1: a mutated strain and for some reason, we're not detecting
Speaker 1: it in these samples, and so on. Anyway, on March
Speaker 1: twenty first, there it was coronavirus, and that allowed people
Speaker 1: to test whether people were infected or not, which was
Speaker 1: a great help in terms of understanding the extent of
Speaker 1: the epidemic. At this time, though, the Chinese government was
Speaker 1: still refusing to give up any information on the disease
Speaker 1: holding firm with its February eleventh totals of three hundred
Speaker 1: and five people sick, the real numbers as of March eighteenth,
Speaker 1: two thousand and three, another retrospective count were around fourteen
Speaker 1: hundred infected and one hundred and thirty seven dead. Wow.
Speaker 1: Those are global totals, okay, and those numbers would continue
Speaker 1: to climb as the nature of transmission changed a bit.
Speaker 1: Earlier in the epidemic, transmission mostly seemed to be happening
Speaker 1: within hospitals, which is why there was such a high
Speaker 1: proportion of those infected being healthcare workers. But then there
Speaker 1: was a bit of a shift to community outbreaks, notably
Speaker 1: in Hong Kong. At the end of March, several people
Speaker 1: showed up to the Prince of Wales Hospital in Hong
Speaker 1: Kong with symptoms of stars. But they had no obvious
Speaker 1: connection to or contact with other infected people. So what
Speaker 1: was making them sick? Turns out they all happened to
Speaker 1: be residents of a housing complex called Amoy Gardens. Pretty
Speaker 1: soon After this discovery, the housing complex was put under
Speaker 1: strict isolation, no one in, no one out, and this
Speaker 1: went on for weeks. But what if that wasn't enough?
Speaker 1: They had to find out how this had spread in
Speaker 1: the housing complex before it started doing the same in
Speaker 1: other parts of the city. Elevators, Eh, maybe, but air
Speaker 1: and water were both tested and found to be clean.
Speaker 1: Rats may have contributed, but they alone couldn't account for
Speaker 1: the infection pattern that had been observed. And around this
Speaker 1: time researchers realized that the virus could be spread in
Speaker 1: fecal matter from infected people, and so their new hypothesis
Speaker 1: became that fecal matter containing viruses was being aerosolized. Every
Speaker 1: time a toilet was flushed. The contaminated droplets were spread
Speaker 1: to other apartments via a dried up U trap, which
Speaker 1: is that thing under the sink, and so when they're
Speaker 1: standing water, that water acts as a barrier. But a
Speaker 1: lot of the U traps had dried up, and so
Speaker 1: it was effectively spraying poopy virus particles. Dude, Yeah, And
Speaker 1: it is like it's important to note that that is
Speaker 1: still a little bit debated whether it was that or
Speaker 1: the rats or some combination of multiple things, but regardless,
Speaker 1: it was like a sequence of really unfortunate events. The
Speaker 1: isolation seemed to work though of a moi gardens. Those
Speaker 1: cases there seemed to mark the peak of the epidemic
Speaker 1: in Hong Kong, and by April it was largely over there.
Speaker 1: Part of this was because in crease precautions at hospitals
Speaker 1: in terms of personal protective equipment, the formation of these
Speaker 1: dirty teams. Part of it was because contact tracing an
Speaker 1: esar's database were proving effective at identifying potentially exposed people
Speaker 1: and isolating them. And part was that community outbreaks died
Speaker 1: out as people changed their daily routine. Hong Kong became
Speaker 1: a virtual ghost town during the epidemic, as people who
Speaker 1: could leave did so and others stockpiled food and dared
Speaker 1: not go outside. Okay April, moving on to April.
Speaker 6: Okay April first, two thousand and three and estimated twenty
Speaker 6: three hundred people infected, two hundred and fifty five dead globally.
Speaker 2: Globally Okay.
Speaker 1: Even though the epidemic in Hong Kong seemed to be waning,
Speaker 1: it spread in other places. Was a concern to the
Speaker 1: who who was still getting the same numbers from government
Speaker 1: officials in China on changed for about two months, so
Speaker 1: the WHO resorted to making surprise visits to hospitals in Beijing,
Speaker 1: where the official numbers were twelve infected, three dead. At
Speaker 1: at least one of these hospitals, minutes before the WHO
Speaker 1: were due to arrive, a fleet of ambulances pulled up
Speaker 1: and the hospital director ordered all thirty one stars infected
Speaker 1: healthcare workers to get into the ambulances, where they were
Speaker 1: driven around until the WHO left. The WHO showed up
Speaker 1: to the hospital to the promising site of an outbreak
Speaker 1: nearly over. Regardless, they still amended their estimates of those
Speaker 1: infected in Beijing to like one to two hundred people.
Speaker 1: In reality, it was much higher than that. And I
Speaker 1: want to note that among healthcare workers and among people
Speaker 1: in the community, there was ample communication. People were trying
Speaker 1: to get the word from one hospital to another, from
Speaker 1: one city to another, to get some sort of idea
Speaker 1: of the scope of the outbreak, how to protect your self,
Speaker 1: what was being done, et cetera. But communicating that info
Speaker 1: to press outside of China could have serious repercussions because
Speaker 1: it was sharing. It would be the sharing of state secrets.
Speaker 1: What was needed was a whistleblower, and what we got
Speaker 1: was a whistleblower. And this whistleblower was named doctor Jiang
Speaker 1: Yan Yung, and Jiang, who had treated many of the
Speaker 1: students injured in the Tanneman Square massacre, became aware of
Speaker 1: the extent of the SARS crisis in Beijing when he
Speaker 1: called a hospital to check on a friend of his
Speaker 1: who had lung cancer, and the doctors that he had
Speaker 1: talked to, who were respiratory specialists, sounded panicked as they
Speaker 1: described how at least sixty people were infected with SARS,
Speaker 1: many of them healthcare workers, and that this was happening
Speaker 1: in hospitals all over the city. Remember the official numbers
Speaker 1: were still twelve total infected in Beijing at this point.
Speaker 2: Oh yeah.
Speaker 1: Jiong did a bit more calling around and made tallies
Speaker 1: of the number of estimated SARS cases in different hospitals
Speaker 1: across Beijing, and he sent those numbers in a note
Speaker 1: to a couple of Chinese TV stations, But unfortunately his
Speaker 1: note was ignored, but it was eventually picked up by
Speaker 1: Time magazine, which made it into international news. That there
Speaker 1: was an epidemic could no longer be denied, and on
Speaker 1: April sixteenth, an official announcement was made by the Chinese
Speaker 1: government saying that the tsar's situation is quote extremely grave.
Speaker 1: The numbers were revised from twelve to three hundred and
Speaker 1: thirty nine infected in Beijing, with hundreds more suspected. And
Speaker 1: it wasn't just three hundred and five people infected in
Speaker 1: all of China, which is the number that the government
Speaker 1: had been sticking to since early February. It was over
Speaker 1: twenty two hundred, wow, with again many more suspected. And
Speaker 1: then the government did a remarkable thing. They canceled the
Speaker 1: week long Spring holiday and admitted that they were wrong.
Speaker 1: After the announcement, the number of cases went up tremendously
Speaker 1: and continued to grow. But was that because people now
Speaker 1: felt they could report accurate numbers. Was the epidemic actually growing?
Speaker 1: But with this sudden shift to finally acknowledging that SARS
Speaker 1: was a big freaking deal, the propaganda around it changed.
Speaker 1: There was now twenty four hour coverage of the epidemic,
Speaker 1: whereas previously there had been almost none in China specifically.
Speaker 1: And then, whereas before sharing information about SARS meant betraying
Speaker 1: state secrets, the government now threatened the death penalty to
Speaker 1: anyone spreading misinformation or hiding aspects of infection.
Speaker 2: Ooh yes, oh, swing one pendulum to the other. Yes.
Speaker 1: The Chinese Ministry of Health finally put into place some
Speaker 1: preventative measures, foremost among them being thermal scanning for fevers.
Speaker 1: So these scanners were put into place at train stations,
Speaker 1: bank's office buildings, everywhere, and if you were found to
Speaker 1: have a fever, you would be rushed off in an
Speaker 1: ambulance and placed under quarantine for up to twenty one days.
Speaker 7: Wow.
Speaker 1: And even though this method was perhaps crude, it was
Speaker 1: probably pretty effective because a person was found to be
Speaker 1: most infectious, as you mentioned, between ten and twenty one
Speaker 1: days after infection, and during that period they would almost
Speaker 1: certainly have a fever. This quality of stars made it
Speaker 1: easier to control, as we've talked about. And the authoritarian
Speaker 1: aspect of China was a double edged sword because on
Speaker 1: one hand it restricted the flow of information that would
Speaker 1: end up fueling the outbreak, but on the other hand,
Speaker 1: once the epidemic had been acknowledged, it could mobilize people
Speaker 1: and put into effect practices some that are questionable in
Speaker 1: terms of civil liberties, that might have been more delay
Speaker 1: in a more democratic society.
Speaker 2: This is where public health becomes difficult, man.
Speaker 1: This is where public health becomes difficult because these are
Speaker 1: civil liberties that are being trampled on. But that's why
Speaker 1: I say, you know, it's been called this double edged sword.
Speaker 1: All Right, We're almost done with the SARS outbreak. Okay.
Speaker 1: Throughout May and into June, the epidemic began to wind
Speaker 1: down as Vietnam, Singapore, Hong Kong, and Beijing are all
Speaker 1: declared free of SARS. First case was in November. Now
Speaker 1: it's May.
Speaker 2: Okay, it's like half a year. Okay.
Speaker 3: Yeah.
Speaker 1: In July, Toronto and Taiwan see no new cases, and
Speaker 1: it's been announced by the WHO that SARS has been
Speaker 1: contained worldwide.
Speaker 2: Awesome.
Speaker 1: The final tally of infected and dead is eight ninety
Speaker 1: eight people infected, seven hundred and seventy four people dead.
Speaker 1: The economic costs of an outbreak like stars are extreme.
Speaker 1: People lost jobs, personal bankruptcies went through the roof. Tourism
Speaker 1: and travel revenue fell tremendously. The economies crashed in many
Speaker 1: of the affected areas. But I think what is often
Speaker 1: not as highly considered is the personal impact. Many people
Speaker 1: lost their lives, and those lucky enough to survive the
Speaker 1: infection often experience long term health consequences, and many also
Speaker 1: experienced PTSD or depression and were highly stigmatized for a
Speaker 1: period after. So the cost of an epidemic like this
Speaker 1: are far ranging, and some costs are more easily quantified
Speaker 1: than others, and I think that's important to keep in
Speaker 1: mind as we talk about the twenty nineteen novel coronavirus outbreak,
Speaker 1: and as we'll get into also a little bit of
Speaker 1: the issue of stigma and xenophobia that are surrounding things
Speaker 1: like this, and and how travel bans restricting people from
Speaker 1: entering certain countries does not seem to be effective and
Speaker 1: is actually a way of disguising xenophobia and racism.
Speaker 2: Yeah, we can. We can look back at times when
Speaker 2: we've instituted travel bands in past outbreaks and see that
Speaker 2: they in general cause a lot more harm than good.
Speaker 2: So I think that's really important to keep in mind,
Speaker 2: considering that they've already been put in place supposedly during
Speaker 2: this outbreak.
Speaker 1: Yep, So okay, let's move on to Merz. What all right?
Speaker 1: This is going to be really fast, I.
Speaker 2: Promise, cool, cool, cool, cool, cool all right.
Speaker 1: So MRS most cases have an association with dromedary camels.
Speaker 1: An analysis of past samples show that the virus may
Speaker 1: have been circulating in camels at least since the early
Speaker 1: nineteen eighties, which is thirty years before the first known
Speaker 1: human case. And this also suggests a long history association
Speaker 1: between camels and the virus. And I also want to
Speaker 1: note though that MURRS related viruses have been found in
Speaker 1: bat species on five continents, so it suggested, Yeah, there
Speaker 1: are like clusters of you know, MURZ related coronaviruses, SARS
Speaker 1: related coronaviruses that are found in bat populations or animal
Speaker 1: populations that don't have the ability to infect humans or
Speaker 1: don't appear to. But it does show that this is
Speaker 1: a very diverse and wide ranging group of viruses.
Speaker 2: Yeah, yeah, yeah, Okay.
Speaker 1: So Murr's covey was first isolated in June twenty twelve
Speaker 1: from a sixty year old man from Saudi Arabia who
Speaker 1: died of pneumonia and renal failure. And as I mentioned earlier,
Speaker 1: this wasn't the first case of MERS. So retrospective testing
Speaker 1: show that there was a cluster of cases in a
Speaker 1: family in Jordan a few months earlier to this, with
Speaker 1: likely human to human transmission occurring. Since then, there have
Speaker 1: been a handful of murr's outbreaks as large as SARS
Speaker 1: or as the twenty nineteen coronavirus is turning out to be.
Speaker 1: Most of these outbreaks or clusters seem to be regional,
Speaker 1: with limited spread outside of the hospital setting, and with
Speaker 1: most infected people being close contexts of the index case.
Speaker 1: Since its first appearance in twenty twelve, it has caused
Speaker 1: outbreaks in Saudi Arabia, the United Arab Emirates, South Korea,
Speaker 1: and many many other countries have had isolated cases or
Speaker 1: very small outbreaks clusters. Some outbreaks have been larger than others,
Speaker 1: and as of December twenty ninth, twenty nineteen, there have
Speaker 1: been two four hundred and ninety nine lab diagnosed cases
Speaker 1: and eight hundred and sixty one deaths, and eighty four
Speaker 1: percent of these cases were reported from Saudi Arabia. Yep
Speaker 1: okay novel coronavirus twenty nineteen novel coronavirus.
Speaker 2: This is that everyone had to wait an hour and
Speaker 2: a half to get to this point.
Speaker 1: We're sorry, not sorry.
Speaker 2: These are important things to understand the context of this outbreak,
Speaker 2: absolutely I agree.
Speaker 1: I mean, I think that there's a really important lessons
Speaker 1: to be learned from SARS in particular, but just from
Speaker 1: the way that these outbreaks occur and how they progress,
Speaker 1: and you know, we learn something new every single time,
Speaker 1: so as I as I you know, hammered on over
Speaker 1: and over again in the SARS history, the Chinese government
Speaker 1: seemed very reticent in keeping the rest of the world
Speaker 1: updated on how the outbreak was progressing, and that does
Speaker 1: not seem to be the case so far with the
Speaker 1: twenty nineteen novel Coronavirus, and I think that's a really
Speaker 1: important thing to consider. There's been a huge push towards
Speaker 1: the free and open exchange of information, as we mentioned,
Speaker 1: with these early articles being published in certain journals. The
Speaker 1: sequence of the virus has already been published like this
Speaker 1: is pretty incredible and very encouraging.
Speaker 2: I think we are getting information so incredibly rapidly in
Speaker 2: this outbreak, more than we ever could have seen in
Speaker 2: the past, which is incredible. But I think also in
Speaker 2: some ways people are now freaking out about it because
Speaker 2: there's a lot of triple exclamation mark all caps going
Speaker 2: on that maybe isn't always valid, and so I think
Speaker 2: trying to understand this outbreak what's really going on in context,
Speaker 2: is really important.
Speaker 1: Yes, absolutely, so what is going on? Yeah, Well, in
Speaker 1: December twenty nineteen, a bunch of people became sick with
Speaker 1: atypical pneumonia after visiting the Wuhan Juanan seafood wholesale market,
Speaker 1: which also sells non aquatic animals such as birds and rabbits.
Speaker 1: This cluster of twenty seven pneumonia cases, seven of them severe,
Speaker 1: was reported by the Wuhan Municipal Health Commission on December
Speaker 1: thirty first, twenty nineteen. On January ninth, it was an
Speaker 1: that a novel beta coronavirus, which is just a subtype
Speaker 1: of coronavirus.
Speaker 2: That's the same subtype as SARS and mers.
Speaker 1: Yes. The next day, January tenth, the genome sequence of
Speaker 1: the virus was announced was published. This is incredible.
Speaker 2: We're talking in less than like two weeks.
Speaker 1: Yes, first cases, It's incredible. Yeah. So genomic analysis suggests
Speaker 1: that the virus likely originated from a bat, as I
Speaker 1: mentioned before, and then maybe jumped into an animal that
Speaker 1: was at that market. This is yet to be determined.
Speaker 1: I'm sure that in the upcoming months more will be
Speaker 1: discovered about the origins and the exact nature of that
Speaker 1: initial spillover event. The numbers of infected and dead have
Speaker 1: continued to grow since that first cluster was announced. So Aaron,
Speaker 1: how about we check in on how the current epidemic
Speaker 1: is progressing.
Speaker 2: Let's would you want to take a break first?
Speaker 1: Let's take a break, all right?
Speaker 2: Erin. It is ten fifty one am now on February
Speaker 2: TEWOD twenty twenty.
Speaker 1: This is a long episode.
Speaker 2: We're sorry, it's fine. Listen. I am on the Johns
Speaker 2: Hopkins map that they've created. We'll put a link to
Speaker 2: this on our website and in the show notes. That
Speaker 2: is updating very rapidly with confirmed cases, so as of
Speaker 2: right now, this will change by the time you listen.
Speaker 2: There have been fourteen thousand, six hundred and twenty eight
Speaker 2: confirmed cases of novel coronavirus. The vast majority of these
Speaker 2: fourteen thousand, four hundred and fifty one have been in
Speaker 2: mainland China. The rest have been in a number of
Speaker 2: countries across the globe. There have been three hundred and
Speaker 2: five total deaths confirmed from this novel coronavirus, only one
Speaker 2: of which has taken place outside of China, and that
Speaker 2: was in the Philippines. There have been three hundred and
Speaker 2: forty eight people that are confirmed to have recovered from
Speaker 2: this infection thus far.
Speaker 1: Cool. Cool, cool.
Speaker 2: So that's the details that we have. That's about it, Aaron.
Speaker 2: There's a lot of questions that remain right and like
Speaker 2: we've hopefully informed you all, we are not experts on
Speaker 2: this topic. So to give you guys a better sense
Speaker 2: of what is being done, what can be done, and
Speaker 2: kind of what the differences are that we've seen so
Speaker 2: far between stars and mehrs and this novel coronavirus. We
Speaker 2: had the fortune of interviewing four people who are much
Speaker 2: better experienced in outbreaks and infectious disease and coronaviruses than
Speaker 2: we are. So let's talk to them about what's going on,
Speaker 2: shall we.
Speaker 1: Let's do that.
Speaker 5: Hello, my name is de Niche Meta. I am an
Speaker 5: infectious disease physician at Emory University. I specialize in infectious
Speaker 5: disease care of oncology so cancer patients and solid organ
Speaker 5: transplant patients. And I am also a member of the
Speaker 5: Emory Serious Communical Diseases Unit, which is our biocontainment unit
Speaker 5: at Emory University Hospital.
Speaker 8: My name is Colin Kraft. I'm an infectious disease physician
Speaker 8: at Emory University Hospital. I'm also trained in medical microbiology,
Speaker 8: and so I sort of enjoy my role in bridging
Speaker 8: those two worlds between diagnostics and also seeing patients. I
Speaker 8: love being on both sides of that of the computer screen,
Speaker 8: if you will. I've been at Emory Hospital since twenty ten.
Speaker 9: So my name is Carlos del Rio.
Speaker 7: I am a professor of Medicine and Global Health a
Speaker 7: federal university. I have been involved in infectial disease for many,
Speaker 7: many years. Say it's almost finished. My fellowship in nineteen
Speaker 7: eighty eight.
Speaker 9: Eighty nine, so I've been doing this for thirty plus years.
Speaker 7: Most of my work is around at HIV, but I've
Speaker 7: been involved also in effectious ease and generally and particularly
Speaker 7: in global aspects of effect disease. I was very involved
Speaker 7: with Mexico during the two thousand and nine a swine
Speaker 7: flu pandemic, and I worked closely with CDC and with
Speaker 7: Mexico in working on that outbreak and in controlling that outbreak. Also,
Speaker 7: I am a COPI of the recently funded Emory Vaccine
Speaker 7: Treatment and Evaluation unit, so I work a lot also
Speaker 7: in vaccinology and in the user vaccines to prevent infection diseases.
Speaker 4: My name is Marshall Lyon. I am an MD, and
Speaker 4: I am an infectious disease physician at Emory University Hospital
Speaker 4: in Atlanta, Georgia. My day job, if there is such
Speaker 4: a thing, is the Director of Transplant Infectious Diseases, and
Speaker 4: that is the bulk of my clinical care is taking
Speaker 4: care of patients who have had a transplant or are
Speaker 4: being considered for transplant and get an infection. So we
Speaker 4: deal a lot with viruses, both latent viruses and community
Speaker 4: acquired viruses. One of my other roles is as a
Speaker 4: physician in Emory's Serious Communicable Diseases in it as one
Speaker 4: of the high level biocontainment units.
Speaker 9: In the States.
Speaker 4: When novel coronavirus broken wu on and started to become
Speaker 4: more of an issue, you know, we started to pay
Speaker 4: attention and started thinking that potentially a case might come
Speaker 4: our way. And so we've certainly been paying attention to
Speaker 4: the outbreak of it's unfolded in China and what and
Speaker 4: the measures that the Public Health US is putting in
Speaker 4: place to try to keep the public safe.
Speaker 2: So we'd love for you to talk about this new
Speaker 2: coronavirus that's been making headlines. This isn't the first time
Speaker 2: that we've seen a coronavirus causing a disease outbreak, but
Speaker 2: this virus is new, So can you tell us a
Speaker 2: little bit about this twenty nineteen En Covey.
Speaker 5: So, the first sort of novel coronavirus we saw was STARS,
Speaker 5: and then more recently we saw the Middle Eastern respiratory
Speaker 5: syndrome coronavirus or otherwise called mrs kV. And we've learned
Speaker 5: a lot a lot from those novel viruses that have developed,
Speaker 5: which I think have us a little bit better prepared
Speaker 5: now for what we're seeing, and that's this novel twenty
Speaker 5: nineteen coronavirus.
Speaker 4: So this is actually an interesting outbreak because when it
Speaker 4: first started, the majority of patients seem to have had
Speaker 4: contact with this wet market or the seafood market in Wulan,
Speaker 4: and so it looked like it was more a point
Speaker 4: source outbreak or a zoonautic outbreak. And so when we
Speaker 4: think of those, we think that people who get sick
Speaker 4: all had a common exposure and that if you weren't
Speaker 4: exposed to whatever that agent is or that location, in
Speaker 4: this case the market, then you probably didn't have risk
Speaker 4: of getting infected or getting disease. It was only later
Speaker 4: when it appeared so that when the second wave of
Speaker 4: facial and began to come in, but it became evident
Speaker 4: that there was now person to person transmission of what
Speaker 4: we now know is novel coronavirus twenty nineteen. And so
Speaker 4: now it starts to take the epidemic or the outbreak
Speaker 4: takes on a different characteristic where you have to think
Speaker 4: about how do we limit contact with sick individuals?
Speaker 1: Right? Quick question about viral or about pneumonia caused by viruses,
Speaker 1: What is the mechanism by which that occurs? Why does
Speaker 1: that look different than one caused by bacteria.
Speaker 8: One of the things we should think about is when
Speaker 8: viruses caused pneumonia, that is when we become fearful sort
Speaker 8: of as clinicians. And so that's a lot of what happened.
Speaker 8: We think in nineteen eighteen is that we believe that
Speaker 8: some of those deaths that were so dramatic probably came
Speaker 8: from influenza virus pneumonia, which I think is a lot
Speaker 8: different than how we think about pneumonia's today, which are
Speaker 8: typically bacterial, and so I think for me when this started,
Speaker 8: when it was kind of announced in December thirty first,
Speaker 8: our first question is how frequently does this cause a
Speaker 8: viral pneumonia versus you know, kind of a bronchitis or
Speaker 8: even an upper respiratory tract, which is what we usually
Speaker 8: think about coronaviruses.
Speaker 5: The things that really worry me about a viral pneumonia
Speaker 5: as opposed to a typical bacterial pneumonia is that when
Speaker 5: we have a bacterial pneumonia, we generally, though not universally,
Speaker 5: see that pneumonia in one region of the lung. One
Speaker 5: of the things that often concerns me about patients with
Speaker 5: a viral pneumonia, it's usually affecting multiple regions of the lung,
Speaker 5: potentially all of the regions of the lung, and in
Speaker 5: that situation, there's so much inflammation produced that the ability
Speaker 5: for the lungs to extract oxygen out of the air
Speaker 5: gets minimized very rapidly, and you see patients develop something
Speaker 5: we call acute respiratory distress syndrome where they can not
Speaker 5: exchange oxygen and require a lot of ventillary and oxygen
Speaker 5: support to keep all the systems of the body running,
Speaker 5: and also in that inflammatory condition that you can develop
Speaker 5: a bacterial pneumonia on top of the viral pneumonia's inflammation,
Speaker 5: and that can compound the issue and further cause not
Speaker 5: only damage to the lung, but further developed problems in
Speaker 5: oxygenating the body. And finally, the other concerning issue that
Speaker 5: goes on with viral pneumonias is the fact that we
Speaker 5: have very limited therapies, unlike bacterial pneumonias and antibiotics to
Speaker 5: address these. There are some anti virals that are out there,
Speaker 5: but most of them do not have any ability to
Speaker 5: treat the viral pneumonias that we are seeing nowadays.
Speaker 1: I know that it's sort of early stages in this outbreak,
Speaker 1: and there's still a lot that we don't know about
Speaker 1: this virus and how it behaves. Particularly I was trying
Speaker 1: to get a handle on the infectious period and how
Speaker 1: that overlaps with a period during which symptoms are apparent,
Speaker 1: and so I know that that's sort of now more
Speaker 1: in the gray zone. But correct me if I'm wrong
Speaker 1: about that. But based on how we've seen this virus
Speaker 1: spread so far, and what also we have seen in
Speaker 1: past coronavirus outbreaks. What do you think we might be
Speaker 1: able to expect in the next few weeks or months
Speaker 1: as this outbreak progresses.
Speaker 4: Yeah, so you're right, we are in a gray zone
Speaker 4: about our understanding of this, but I think there are
Speaker 4: a few things that we do know. So the incubation
Speaker 4: period seems to be somewhere around five days as sort
Speaker 4: of the median or the mode of the incubation period,
Speaker 4: and there is variation probably anywhere from two to the
Speaker 4: longest being fourteen days. We're pretty comfortable, bullet fourteen days
Speaker 4: is kind of the outside limit. And what we are
Speaker 4: starting to learn from what's happening in China is there
Speaker 4: may be an infectious prodrum before someone gets sick. And
Speaker 4: so a prodram is a period of time where someone
Speaker 4: can actually transmit the virus to somebody else, but they
Speaker 4: don't have any symptoms of illness and they don't know
Speaker 4: that they're about to get sick. They feel normal, and
Speaker 4: so unfortunately, what that means is identifying people once they're
Speaker 4: sick won't absolutely terminate this epidemic. And this is slightly
Speaker 4: different than SARS because SARS was really transmitted by sick individuals,
Speaker 4: and that most of the outbreaks could all be traced
Speaker 4: back to someone who had developed illness but was not
Speaker 4: in medical isolation.
Speaker 2: So, in terms of the looking at this outbreak so far,
Speaker 2: how does it seem that this virus might differ from say,
Speaker 2: the Stars coronavirus or the Mers coronavirus, both in terms
Speaker 2: of the disease that it seems to cause and also
Speaker 2: how the outbreak is actually progressing.
Speaker 8: So I'm currently at an ASM Biothreats meeting where I
Speaker 8: got to hear Tony Fauci this morning from NIAID talk
Speaker 8: about this virus, and I think one of the things
Speaker 8: that he really talked about that we're noticing is the
Speaker 8: total number of cases from Stars. You know, we've almost
Speaker 8: succeeded and we're only like, you know, a couple of
Speaker 8: weeks in. So I think the main question that remains
Speaker 8: to be answered is really how severe is this?
Speaker 5: Yeah, I believe what we're seeing with this current novel
Speaker 5: Corona outbreak is quite concerning as far as the tenor
Speaker 5: of infection and spread goes. Initially I thought it was
Speaker 5: similar to Sarus, which is quite concerning in itself, but
Speaker 5: the number of cases that we've just had in the
Speaker 5: past week alone and now exceeding the total number of
Speaker 5: cases of STARS that we had previously. Is concerning not
Speaker 5: only for China and the population there, but given them
Speaker 5: out of travel that occurs from China to China, the
Speaker 5: ability for this virus to spread. The other concerning thing
Speaker 5: that I think is out there is lessons that we
Speaker 5: learned from STARS was that hospitals and healthcare systems clinics
Speaker 5: can sort of be incubators for the spread of these
Speaker 5: type of coronaviruses, and that's something that really was harkened
Speaker 5: by SARS, and we've learned a lot of lessons from that.
Speaker 5: But I think still there's a lot of vulnerability in
Speaker 5: our healthcare systems or the virus to spread within healthcare
Speaker 5: systems and therefore create broader outbreaks that can spread throughout
Speaker 5: the community.
Speaker 1: So as with SARS, it seems that there's a decent
Speaker 1: proportion of cases with this novel coronavirus that are healthcare
Speaker 1: workers who are likely exposed while treating someone who is infected.
Speaker 1: Does there seem to be any other pattern in the
Speaker 1: people who develop maybe severe disease or more negative outcomes.
Speaker 4: So certainly, like with many respiratory viruses, you know, it
Speaker 4: seems that people were older or have other chronic illnesses
Speaker 4: are more likely to have severe disease and have worse outcome.
Speaker 4: So the first seventy some odd cases that were reported
Speaker 4: out of China, of the patients that died, I think
Speaker 4: the average age was seventy five years old, and so
Speaker 4: that it's a similar pattern to what we see with
Speaker 4: the viruses that we're familiar with.
Speaker 1: Could you elaborate a bit on the first steps that
Speaker 1: are normally taken when an outbreak like this occurs and
Speaker 1: you think, okay, we might need to be prepared if
Speaker 1: somebody happens to be infected and comes to the US.
Speaker 4: What US Public Health has done is first, for over
Speaker 4: a week now, they've been screening passengers who are coming
Speaker 4: in from China looking for anyone who might be ill
Speaker 4: or might have fever, so that if they are sick,
Speaker 4: they're can be identified quickly and then contact tracing could
Speaker 4: be done of everyone who was on the airplane with them.
Speaker 4: So early identification is one of the keys in terms
Speaker 4: of limiting then subsequent contact to that sick individual. So
Speaker 4: the other sort of measure that is then put in
Speaker 4: place is social distancing. So if you have something that's
Speaker 4: passed from person to person, especially a coronavirus which uses
Speaker 4: the droplet method of transmission, if you can distance the
Speaker 4: infected individual more than two meters from anyone else, then
Speaker 4: in theory, they would not be passing that virus on
Speaker 4: to someone else. And so if you cover your mouth,
Speaker 4: wear a mask, et cetera, all those things can sort
Speaker 4: of decrease the amount of drop of production that a
Speaker 4: sick individual will make and therefore reduce the amount of
Speaker 4: droplets that are in the environment which someone else could
Speaker 4: be exposed to. So those are sort of the early
Speaker 4: measures that the public health is using right now to
Speaker 4: try to prevent an outbreak in the United States.
Speaker 1: The interconnectedness of everything and sort of this decreasing barrier
Speaker 1: between humans and wildlife has really seemed to be the
Speaker 1: pattern that's emerged behind all of these recent outbreaks of
Speaker 1: novel diseases. So what do you think in terms of
Speaker 1: prevention that can be done to prevent the spillover from
Speaker 1: these animal hosts to humans.
Speaker 7: The first thing is we need to invest more more
Speaker 7: in global health security, and we haven't done enough in
Speaker 7: investing in global health security at the level we should
Speaker 7: And I quote and Dolly Parton when you said, you know,
Speaker 7: you have no idea how expensive it is to look
Speaker 7: this cheap. You know, if you think it's the cost
Speaker 7: of investing in global security is high, wait until you
Speaker 7: get the bill for what is this outbreak is going
Speaker 7: to cost us? So non investing in global security is
Speaker 7: going to make you spend more money at the end
Speaker 7: of the day. With climate change, with connectivity like flights
Speaker 7: that we talked about, with growing population, all those things
Speaker 7: together are essentially a recipe for more and more outbreaks.
Speaker 7: They're not going to end, They're just going to be.
Speaker 7: The question I always have is what's next? Not will
Speaker 7: we have something?
Speaker 1: In speaking more broadly, not just about the twenty nineteen coronavirus,
Speaker 1: but in any sort of novel outbreak or emerging infectious disease.
Speaker 1: What are some of the logistical issues in infection control,
Speaker 1: both maybe at a hospital level and then also with
Speaker 1: multiple countries working together.
Speaker 7: Well, you know, I mean that's where who fits in, right,
Speaker 7: That's when you need to have international collaboration. You need
Speaker 7: to have international cooperation. An outbreak in China should be
Speaker 7: a concern to the US, to England, to know every
Speaker 7: other country in the world, so we all need to
Speaker 7: work together. We need to also get away from saying, oh,
Speaker 7: this is a problem of China. Let China deal with that.
Speaker 7: This is not our problem, because at the end of
Speaker 7: the day, that's not true. So the nationalism has to disappear.
Speaker 7: Microbes are do not recognize borders, they travel without passports,
Speaker 7: and therefore we should get away from thinking about countries
Speaker 7: and think more about the globe.
Speaker 1: So one of the I guess challenging things about an
Speaker 1: outbreak like this today is the role of media and
Speaker 1: social media and the rapid spread of information, which is
Speaker 1: sort of this double edged sort. What role do you
Speaker 1: see social media in particular playing in the spread of
Speaker 1: information during an outbreak such as this.
Speaker 4: Well, I think it's important that all media, whether it's
Speaker 4: traditional media or social media, presents the facts that surrounds
Speaker 4: any sort of an outbreak. And I think that because
Speaker 4: social media and our global information age does allow us
Speaker 4: to get information so quickly it almost feels as if
Speaker 4: China is next door, when it's actually halfway around the world.
Speaker 4: By the same token, then it also enables people like
Speaker 4: yourself who are putting together podcasts to reach the masses
Speaker 4: to put the truth out there and to help people
Speaker 4: see things in perspective. As of today, which is January thirtieth,
Speaker 4: China is reporting that they have around seven to eight
Speaker 4: thousand confirmed cases. This isn't a country of one point
Speaker 4: five billion people. That's a lot of people, and it
Speaker 4: still is a very tiny minority of their population, which
Speaker 4: has so far been effective. In the United States, we've
Speaker 4: had five confirmed imported cases, and that's you know, again,
Speaker 4: in a country of three hundred and thirty million, is
Speaker 4: a very small n compared to the larger population. And
Speaker 4: so I think that social media should be trying to
Speaker 4: put forth the truth and to try to keep the
Speaker 4: perspective of things that are going on. But by the
Speaker 4: same token, I think that social media should continue to
Speaker 4: examine this and look at it. And I think I'm
Speaker 4: not sure how big of a part social media played
Speaker 4: in this, or the fact that social media exists now
Speaker 4: where it didn't really exist to this extent in two
Speaker 4: thousand and three. I think that the Chinese government has
Speaker 4: actually been fairly transparent with this outbreak and with what
Speaker 4: they're doing as compared to the stars outbreak in two
Speaker 4: thousand and three. I think Social media has been good
Speaker 4: because to some extent has kept governments honest.
Speaker 7: Some of the media has been great, some of the
Speaker 7: media not so much. I mean, I think that newspapers
Speaker 7: sell headlines, right, so talking about the end of the
Speaker 7: world and is going to kill us all is against
Speaker 7: people attention. But the reality is we tend to forget
Speaker 7: about the common things. I mean, for example, right now,
Speaker 7: CDC estimates that over success and people in the US
Speaker 7: have died of influence at this epidemic.
Speaker 9: And yet we're more concerned about the coronavirus.
Speaker 7: And we should be telling people, you know, pet your
Speaker 7: flu shot and wash your hands and your resptory etiquette
Speaker 7: because that's going to be more important. That's going to
Speaker 7: save you from influenza, but it's also probably going to
Speaker 7: help you with with preventing some other restory viruses.
Speaker 9: So I think that the media needs.
Speaker 7: To needs to inform, needs to communicate, and more importantly,
Speaker 7: I think the media needs to rely on reliable sources.
Speaker 7: I cringe a little bit when you know, meia to
Speaker 7: start scoring an expert in nutrition as an expert in
Speaker 7: the diseases. We need to we need to talk to
Speaker 7: people that know what they're talking about and there are
Speaker 7: plenty of experts out there.
Speaker 1: While I was doing the research for this episode, I
Speaker 1: came across a bunch of articles that compared this current
Speaker 1: outbreak of the twenty nineteen coronavirus to things like the
Speaker 1: nineteen eighteen influenza pandemic and of course SARS, and in
Speaker 1: many ways, so kind of feels like a bit of
Speaker 1: a bullet dodged because the control measures that we used,
Speaker 1: contact tracing and quarantine, these things worked really well. What
Speaker 1: do you think that says about the current outbreak?
Speaker 8: I really liked what you said about the bullet being
Speaker 8: dodged because I think if you think about us having
Speaker 8: the most population on Earth that has ever been of
Speaker 8: human population, some of that is really because we have
Speaker 8: learned how to do things to prevent ourselves from dying
Speaker 8: from infectious diseases. So in nineteen eighteen, I cannot only
Speaker 8: imagine it was so scary to think about you didn't
Speaker 8: have really anything, I mean, supportive care really was like nothing.
Speaker 8: And so when you think about having mechanical ventilations and
Speaker 8: whole specialties of subspecialties of pulmonary critical care that are
Speaker 8: dedicated to super sick people with bad lungs. I just
Speaker 8: think we have made a lot of advancements. And what
Speaker 8: Anisha and I have said since even Bola virus five
Speaker 8: years ago and Stars and Mers is this rapid development
Speaker 8: of bringing in therapeutics into clinical use a lot sooner
Speaker 8: than we've ever seen before. And that's because we're getting
Speaker 8: used to saying, you know, the longer we wait, the
Speaker 8: less information we have, the less knowledge we have. Even
Speaker 8: the fact that we've had the sequence of this virus
Speaker 8: so quickly, it's pretty it's pretty amazing, even from five
Speaker 8: years ago. And so I really like your dodging the bullet.
Speaker 8: But I think it's pretty cool to think about all
Speaker 8: the kind of advancements that we have even in the
Speaker 8: last decade, not not even since you know, one hundred years.
Speaker 1: Ago, less of dodging the bullet and more building the shield.
Speaker 2: I guess yeah, I agree.
Speaker 5: I like that analogy of building the shield. And you know,
Speaker 5: one of the great lessons we learned from Stars and
Speaker 5: Colleen and I really witnessed this during the Bola outbreak
Speaker 5: was how important it was to keep unicate information about
Speaker 5: what's going on with patients, what's going on in the
Speaker 5: public health setting, what's going on immunologically and with the
Speaker 5: virus very rapidly to healthcare environments and scientists and public
Speaker 5: health officials around the world, and with this outbreak, we're
Speaker 5: seeing exactly the same thing. As soon as there were
Speaker 5: reports coming up, the sort of the infectious disease community,
Speaker 5: the public health community, the emergency medicine community throughout the
Speaker 5: United States was coming together. We're having conference calls, we're
Speaker 5: having rapid communication, and importantly, our colleagues in China were
Speaker 5: putting out all this information about what they were seeing.
Speaker 5: They put out immediately the sequence of the virus that
Speaker 5: people could work on diagnostic testing and learn more very rapidly,
Speaker 5: and I think those are the lessons that we've learned
Speaker 5: as a global public health community on how to really
Speaker 5: address these new challenges.
Speaker 2: One of the questions that many of our listeners are
Speaker 2: very concerned with is basically how scared should we be
Speaker 2: of this? Which is a pretty big and loaded question.
Speaker 2: So could you maybe talk about something about this virus
Speaker 2: or this outbreak in particular that is quite concerning to you,
Speaker 2: and then maybe something that also is reassuring that maybe
Speaker 2: you know, this isn't the end of the world.
Speaker 8: We hope, yes, so I'm pretty sure it's not the
Speaker 8: end of the world, but one never knows. I would
Speaker 8: say that that there's always this initial panic about something new,
Speaker 8: and without being glib, I want to say that this
Speaker 8: isn't like an alien invasion of something we've never seen.
Speaker 8: We have dealt with things that are similar, and so
Speaker 8: it falls within our paradigm to be able to figure out.
Speaker 8: You know, yes, it may be more severe, but we
Speaker 8: understand how these things are transmitted. We also understand how
Speaker 8: to protect ourselves in terms of what.
Speaker 1: Makes me nervous.
Speaker 8: I think is the surface aspect of virus transit mission?
Speaker 8: And so what does that mean? It's kind of what
Speaker 8: I've already been saying. But if somebody coughs on like
Speaker 8: a seat that I now sit in, or a surface
Speaker 8: that I now touch because I'm getting, you know, like
Speaker 8: a fast food takeout or something, how long does it
Speaker 8: stay on that surface and how much of that has
Speaker 8: to be transmitted to me to make me really sick?
Speaker 5: And maybe maybe I'll add something, but before I do,
Speaker 5: I just have to say doctor craft has really taught
Speaker 5: me to fear my cell phone and make sure I
Speaker 5: clean it all all the time.
Speaker 8: It really like it literally has poot bugs on it.
Speaker 8: I don't let my children touch my phone, and I
Speaker 8: lends wipe clean it every day.
Speaker 2: I know, I looked down at my cell phone and
Speaker 2: I was like, oh, dear, I just.
Speaker 1: Like kicked it out of the way.
Speaker 5: I was like, no, I you know, I every time
Speaker 5: I talk to doctor Craft, I make sure I don't
Speaker 5: have my cell phone in my hand. I think every
Speaker 5: reporter I've talked to in the past seventy two ours
Speaker 5: is the first question is should we panic? And my
Speaker 5: answer is there's no reason to panic. There are things
Speaker 5: that are worrisome. The thing that I think is worrisome
Speaker 5: to me is how quickly it's spread and how quickly
Speaker 5: we found cases in other countries, which means that we
Speaker 5: really need to institute good controls and screenings to make
Speaker 5: sure that we don't have continuous spread. I think, just
Speaker 5: like any novel infection, early on, one of the greatest
Speaker 5: fears is what we don't know about it. I think
Speaker 5: we will learn more about the virus in the coming
Speaker 5: weeks that will be reassuring to us, but there's still
Speaker 5: some that's unknown, and how it's transmitted, how severe the
Speaker 5: disease can get, and who's most susceptible for. But as
Speaker 5: my colleague doctor Craft mentioned, there are a lot of
Speaker 5: things that are reassuring about this. I think, going back
Speaker 5: to their experience with SARS, what we learned from both
Speaker 5: the experience in China and our experience with our colleagues
Speaker 5: in Canada and here in the United States is that
Speaker 5: once we were able to identify the infection and the
Speaker 5: signs of the infection, we're actually able to do really
Speaker 5: good epidem and logic contact tracing and appropriately isolate people,
Speaker 5: put people who were at risk in appropriate monitoring, and
Speaker 5: suddenly the cases started to get to go down very rapidly,
Speaker 5: and the morbidity and the mortality from SoRs started to
Speaker 5: go down rapidly. And so I think we have the
Speaker 5: tools in place to understand how to control infections like this,
Speaker 5: And it has worked with STARS, it has worked with
Speaker 5: mers CoV and preventing the spread around the world of
Speaker 5: mers CoV, and I think it will continue to work.
Speaker 5: Those lessons will work here with the novel coronavirus.
Speaker 7: What scares me, I mean, I'm more scared about driving
Speaker 7: home this evening and getting killed in an accident that
Speaker 7: I'm about this virus. But honestly, so you know, I
Speaker 7: think we all need to put into perspective risk and
Speaker 7: realize what the risks are.
Speaker 9: I think what concerns.
Speaker 7: Me is that is that yes, this virus can can
Speaker 7: continue to is read and can reach places like for example,
Speaker 7: Africa and other places that are not going to be
Speaker 7: able to control it as quickly as as as China has.
Speaker 9: Been able to.
Speaker 7: And again it makes me worry about about the lack
Speaker 7: of support for international and global health security and the
Speaker 7: need that we need to have to talk to Congress
Speaker 7: and talk to others and say, hey, and we have
Speaker 7: to invest in global health security. We have support WHO
Speaker 7: and other agencies, and we really need to think about
Speaker 7: how to make global health security a priority for all
Speaker 7: of us, because the reality is right now that we're
Speaker 7: all worried about this, it's the right time to do that.
Speaker 1: What do you think our listeners can do on an
Speaker 1: individual level to try to push that cause forward a
Speaker 1: bit more, having more investment in global or national health security.
Speaker 7: I think you send an email or call it Environment
Speaker 7: Frontment and say, hey, you know, with this outbreak, I
Speaker 7: worried that we're not investing enough in global health security
Speaker 7: and we need to do that, I think we need
Speaker 7: to have the attention of the people that have the
Speaker 7: that are the funders, right.
Speaker 1: That was so fantastic. Thank you again so much to
Speaker 1: doctor aniche Metta, doctor Colling Kraft, doctor Carlos Delria, and
Speaker 1: doctor Marshall Lyon. Those interviews were so wonderful and we
Speaker 1: really appreciate you taking the time to come and talk
Speaker 1: to us.
Speaker 2: And a huge thank you to Sonia Bell from Emory
Speaker 2: University who hooked us up for these interviews. We never
Speaker 2: would have gotten to talk to such experts without you.
Speaker 2: Thank you so much.
Speaker 1: Thank you, Sonya. Before we dive into sources and stuff
Speaker 1: like that, I feel like there's a couple things that
Speaker 1: we wanted to say.
Speaker 2: Yeah, hugely important things.
Speaker 1: One is influenza.
Speaker 2: Yeah, okay, listen. Like doctor Kraft especially mentioned in her interview,
Speaker 2: the ways that we can protect ourselves against this novel
Speaker 2: coronavirus will also protect us against things that really you
Speaker 2: should be more concerned about than this novel coronavirus at
Speaker 2: this point, because you're far more likely to be infected
Speaker 2: with influenza than you are with this novel coronavirus, even
Speaker 2: in China, across the entire world. Let's talk about what
Speaker 2: a toll influenza has taken thus far.
Speaker 1: Now, you're not just more likely to be infected, you're
Speaker 1: also more likely to be hospitalized or die from influenza
Speaker 1: than you are from the twenty nineteen novel coronavirus. Have
Speaker 1: you gotten your flu shot this year?
Speaker 2: Have you be? Because thus far in the United States alone,
Speaker 2: it's estimated that there have been in this flu season
Speaker 2: between one hundred and eighty and three hundred thousand hospitalizations
Speaker 2: from influenza and upwards of ten thousand deaths do to
Speaker 2: influenza in the US alone. Just in these few weeks
Speaker 2: where we have seen fourteen thousand confirmed cases of novel coronavirus,
Speaker 2: there have been over forty thousand confirmed cases worldwide of influenza.
Speaker 2: And that's just the confirmed cases. The vast majority of
Speaker 2: influenza cases are not reported.
Speaker 1: Get your flu shot. If you haven't, protect yourself, protect
Speaker 1: others please. I think that one of the lessons that
Speaker 1: we can take away from this outbreak, as with past
Speaker 1: coronavirus outbreaks and other types of spillover events, is that
Speaker 1: these epidemics reveal these international wealth disparities o YAH, it
Speaker 1: can decide who will get the vaccines, who will get
Speaker 1: the treatments, Who has the financial support for control or
Speaker 1: importantly prevention and emergency preparedness. Yeah, as several of our
Speaker 1: interviewees said, microbes don't know country boundaries, They don't acknowledge them,
Speaker 1: recognize them. These are not national concerns. This is a
Speaker 1: call for international concern. An epidemic in one place is
Speaker 1: an epidemic globally with the interconnectedness that we have, and
Speaker 1: I think that, you know, some of the ugly sides
Speaker 1: of these epidemics are this, you know, pointing fingers and saying, oh,
Speaker 1: it's it's this country's problem, not mine.
Speaker 2: And that's not effective. Right when we have something that's
Speaker 2: of international concern, what we need is international collaboration and
Speaker 2: working together. And I think what's great is that we
Speaker 2: have seen a lot of that in this novel Corona
Speaker 2: virus outbreak. We see people exchanging information and talking with
Speaker 2: each other in order to do our best to prevent
Speaker 2: this outbreak from getting worse.
Speaker 1: Exactly, Okay, sources, sources, I have oodles of sources, but
Speaker 1: I want to shout out a few of them. A
Speaker 1: couple books that I read that focused on SARS. One
Speaker 1: is called twenty first Century Plague by Thomas Abraham. Another
Speaker 1: is called China Syndrome. The True Story of the twenty
Speaker 1: first centuries First Great Epidemic by Carl Tarol Greenfeld. That's
Speaker 1: where our first hand account was drawn from. And then
Speaker 1: I have a few other articles. A couple I want
Speaker 1: to shout out are by Qui at All in twenty
Speaker 1: nineteen Origin and Evolution of Pathogenic Coronaviruses, and by Jones
Speaker 1: at All in two thousand and eight Global Trends of
Speaker 1: Emerging Infectious Diseases, and then also by Lee at All
Speaker 1: two thousand and five. Bats are natural reds of stars,
Speaker 1: like coronaviruses.
Speaker 2: Excellent. I read a great chapter in the book Viral
Speaker 2: Infections of Humans all about coronaviruses in general, if you're
Speaker 2: interested in that. Two articles I loved, one was the
Speaker 2: Severe Acute Respiratory Syndrome in the New England Journal Medicine
Speaker 2: about SARS, and one called Middle East Respiratory Syndrome in
Speaker 2: the Lancet. And then if you'd like the most up
Speaker 2: to date information about the novel coronavirus, which I know
Speaker 2: that's what you all are here for. Our experts recommended
Speaker 2: a few sources that we also have been relying upon.
Speaker 2: That is the World Health Organization Situation Report. They are
Speaker 2: updating this daily. Every single day there's a new situation
Speaker 2: report that's released, so you can get the most up
Speaker 2: to date information on the number of cases. Oh look,
Speaker 2: they just updated it. Let's see what it says. Yep,
Speaker 2: it's a little less up to date than the other
Speaker 2: up to date source, which is the Johns Hopkins website
Speaker 2: of a app that's continuously updating. And finally, the CDC
Speaker 2: has a great sight on the novel coronavirus. If you're
Speaker 2: interested in specific things that you can do to help
Speaker 2: prevent yourself from getting infected, wash your hands and cover
Speaker 2: your mouth, and we'll post the links to all of
Speaker 2: these in the show notes and on our website.
Speaker 1: Awesome. Thank you again so much to our wonderful, wonderful guests.
Speaker 1: We really appreciate it.
Speaker 2: And thank you to Bloodmobile for providing the music for
Speaker 2: this episode in all of our episodes.
Speaker 1: And thank you to you listeners for allowing us to
Speaker 1: keep making this podcast. It is our absolute favorite thing
Speaker 1: to do. And with that, wash, wash, wash your hands.
Speaker 2: Our experts had something else to say about this don't panic.
Speaker 4: Just wash your hands and wash your.
Speaker 2: Cell phone, you filthy animals on um
Speaker 7: U oh