WEBVTT - Ep 43 M-m-m-my Coronaviruses 0:00:00.680 --> 0:00:03.440 Fang Lind began to feel feverish just as the weather 0:00:03.520 --> 0:00:06.080 was starting to turn dry. Fang made it through that 0:00:06.200 --> 0:00:08.239 day and night, having to pause during his work in 0:00:08.280 --> 0:00:10.160 the chop room to catch his breath, and he took 0:00:10.240 --> 0:00:13.480 frequent cigarette breaks on the back stairs. The next evening, 0:00:13.560 --> 0:00:15.440 when he went up for a cigarette break and sat 0:00:15.480 --> 0:00:18.119 down on the back steps, he couldn't get up. His 0:00:18.160 --> 0:00:21.280 fever had climbed, probably to over one hundred three degrees, 0:00:21.360 --> 0:00:24.160 and he found that no matter how deeply he breathed, 0:00:24.480 --> 0:00:27.920 he felt perpetually winded. His body aggs had reached a 0:00:27.960 --> 0:00:30.360 point where whatever position he stood or sat in, he 0:00:30.440 --> 0:00:33.519 felt as if his muscles were being pulled from his bones. 0:00:34.479 --> 0:00:37.520 The anti febrow medication did nothing to assuage his fever, 0:00:37.640 --> 0:00:39.880 which may have spiked north of one hundred four point 0:00:39.880 --> 0:00:42.800 five twice. He was unable to rouse himself from his 0:00:42.840 --> 0:00:45.360 sleeping palate in time to reach the toilet in the hall, 0:00:45.600 --> 0:00:48.919 each time, soiling his trousers. He found that if he 0:00:48.960 --> 0:00:51.720 moved even slightly to roll over or sit up, he 0:00:51.760 --> 0:00:54.840 would be completely out of breath. The muscle agges were 0:00:54.880 --> 0:00:58.360 so severe he recalls that he found staying still unbearable, 0:00:58.720 --> 0:01:01.800 yet any movement would leave him gasping for breath. What 0:01:02.080 --> 0:01:05.120 was happening to him? Fang knew he was ill, but 0:01:05.160 --> 0:01:07.320 he still assumed he was suffering from another of those 0:01:07.360 --> 0:01:11.320 respiratory infections that regularly burned to the click. Everyone seemed 0:01:11.360 --> 0:01:13.400 to have a hacking cough of some sort. Whether it 0:01:13.400 --> 0:01:16.360 was due to cigarettes, persistent asthma, or air pollution was 0:01:16.360 --> 0:01:19.160 impossible to say, but he had been on his back 0:01:19.200 --> 0:01:22.560 for several days now and wasn't feeling any better. Most 0:01:22.640 --> 0:01:25.960 terrifying for him when he was conscious was the sense that, 0:01:26.040 --> 0:01:28.880 no matter how deeply he breathed, he felt that what 0:01:28.959 --> 0:01:32.120 he was inhaling was not oxygen, but some other odorless, 0:01:32.200 --> 0:01:35.839 tasteless gas with similar properties, but without the life sustaining 0:01:35.880 --> 0:01:39.119 force of simple oxygen. He was running out of air, 0:01:39.400 --> 0:01:42.800 yet he felt he was breathing freely. He now had 0:01:42.800 --> 0:01:46.679 to stay perfectly still. To move was to suffocate. Stay 0:01:46.720 --> 0:01:50.760 still and breathe breathe as deeply as possible. On about 0:01:50.760 --> 0:01:52.800 the sixth day of his illness, he lost all track 0:01:52.880 --> 0:01:55.760 of his environment. From then on, there were only dark 0:01:55.840 --> 0:01:58.480 dreams and the sensation that his life was literally being 0:01:58.520 --> 0:02:01.600 squeezed from him. His muscle aches would come in steady, 0:02:01.680 --> 0:02:04.440 rolling waves, and would peek as gripping cramps around his 0:02:04.520 --> 0:02:07.560 spine and in his neck and upper legs, a dreadful 0:02:07.560 --> 0:02:10.440 tightening that would coincide with a gasping inability to draw 0:02:10.480 --> 0:02:13.600 in enough oxygen. He lay still and struggled to stay 0:02:13.639 --> 0:02:16.080 awake so that he could focus on maintaining his steady, 0:02:16.120 --> 0:02:19.280 ineffectual breathing. He feared that if he fell asleep, he 0:02:19.360 --> 0:02:22.359 might forget to breathe, and that would be it. Perhaps 0:02:22.400 --> 0:02:25.320 that is what dying is. He wondered, your body forgetting 0:02:25.360 --> 0:02:28.600 how to breathe. But he did begin to drift off, 0:02:28.680 --> 0:02:31.839 always remembering even in his unconscious state, that he must 0:02:31.919 --> 0:02:35.359 stay still. Any movement at all, even a wiggling of toes, 0:02:35.440 --> 0:02:39.480 even blinking, used precious oxygen. That was air he didn't have. 0:02:40.320 --> 0:02:43.440 So he lay perfectly still, and in those moments between 0:02:43.440 --> 0:02:46.240 severe cramps and muscle aches, when his bowels were settled, 0:02:46.639 --> 0:02:49.960 he would drift into dark snatches of unconsciousness. But it 0:02:50.000 --> 0:02:52.560 was a cruel sleep, one that never let him forget 0:02:52.760 --> 0:02:56.080 for even a moment his suffering. During those naps, he 0:02:56.080 --> 0:02:58.800 would always feel very far from home and very alone, 0:02:59.400 --> 0:03:02.680 a terrified idea began to glow in the darkness. He 0:03:02.720 --> 0:03:06.000 would die far from home, away from his family. He 0:03:06.120 --> 0:03:09.600 understood finally the importance of that Chinese tradition of rushing 0:03:09.600 --> 0:03:12.360 home when you were ill, even if only to pass away. 0:03:13.040 --> 0:03:15.800 And then he thought of another matter. Who would pay 0:03:15.840 --> 0:03:17.640 for the cost of his funeral arrangements? 0:04:01.880 --> 0:04:02.480 Oof? 0:04:02.760 --> 0:04:09.240 Aaron Oof indeed Erin. That was adapted from chapter seven 0:04:09.400 --> 0:04:15.200 of China Syndrome by Carl Taro Greenfeld, and that description 0:04:15.880 --> 0:04:23.200 was of SARS SARS. Yes. And on this episode of 0:04:23.440 --> 0:04:28.160 this podcast, Will Kill You, we are talking all things coronavirus. 0:04:27.680 --> 0:04:32.200 Because you guys asked for it and we oblige. I'm 0:04:32.200 --> 0:04:34.440 Aaron Welsh and I'm Erin Alman Updike. 0:04:35.000 --> 0:04:39.679 Welcome, Welcome. So this episode we're talking all things coronavirus, 0:04:39.880 --> 0:04:43.479 which means the endemic ones that cause basically like a 0:04:43.520 --> 0:04:46.960 mild cold in humans, SARS mers and then the twenty 0:04:47.040 --> 0:04:51.760 nineteen novel Coronavirus, which doesn't yet have a catchy acronym, right. 0:04:52.120 --> 0:04:54.479 And the reason that we're talking about all of these 0:04:54.680 --> 0:04:57.919 is because, for one thing, they are all related to 0:04:57.960 --> 0:05:00.760 one another. And what we can tell about those twenty 0:05:00.839 --> 0:05:04.080 nineteen novel coronavirus. A lot of that comes from the 0:05:04.080 --> 0:05:07.440 information that we have from these other coronaviruses, so we 0:05:07.480 --> 0:05:11.120 wanted to give you the full picture of all these things. 0:05:11.400 --> 0:05:15.920 We were not planning on covering coronavirus this season, no, 0:05:17.240 --> 0:05:21.560 but yeah, it's making big headlines and for good reason. 0:05:22.600 --> 0:05:27.839 So we want to help everyone to understand what coronaviruses 0:05:27.880 --> 0:05:31.720 are and as much as we can let you know 0:05:31.760 --> 0:05:35.880 about what's going on with the current coronavirus outbreak. A 0:05:35.920 --> 0:05:41.599 few things to keep in mind, we are not experts. 0:05:42.000 --> 0:05:44.000 Once more, for the people in the back, we are 0:05:44.000 --> 0:05:45.640 not experts, so. 0:05:46.400 --> 0:05:49.720 We are not the ones on the ground doing this 0:05:49.839 --> 0:05:52.760 research working on this outbreak. We are going to tell 0:05:52.839 --> 0:05:56.080 you what we know, and because we're not experts, we're 0:05:56.120 --> 0:05:59.000 going to bring in some people who have much more 0:05:59.000 --> 0:06:01.960 expertise than we do to talk about what's going on 0:06:02.080 --> 0:06:06.320 with the current novel coronavirus outbreak. But we will do 0:06:06.680 --> 0:06:10.000 what we do best, which is tell you about the 0:06:10.000 --> 0:06:14.360 biology and the history of coronaviruses in general. 0:06:14.960 --> 0:06:19.120 Yeah. Should we also note that we are recording this 0:06:19.279 --> 0:06:22.880 on oh nine thirty am on February second. 0:06:23.040 --> 0:06:25.400 This is something that's happening so rapidly that by the 0:06:25.440 --> 0:06:27.880 time you listen to it things will be drastically different. 0:06:28.160 --> 0:06:30.640 The earliest you would be hearing this is on February fourth, 0:06:30.760 --> 0:06:32.440 so it's likely that some of the numbers that we 0:06:32.480 --> 0:06:36.560 are reporting about the twenty nineteen novel Coronavirus will have changed, 0:06:37.000 --> 0:06:40.520 but hopefully the broad strokes will still be enough to 0:06:41.240 --> 0:06:44.400 get you the information that you want and will. 0:06:44.160 --> 0:06:46.120 Also point you in the direction of where you can 0:06:46.120 --> 0:06:49.480 find reputable sources to stay abreast on what's going on 0:06:49.560 --> 0:06:50.440 with the current outbreak. 0:06:50.880 --> 0:06:55.640 Yes, I guess though we should start with quarantinies. 0:06:55.880 --> 0:06:58.880 We should because we must. 0:06:59.320 --> 0:07:03.920 This week's quarantini is called the breath Taker, and it's 0:07:04.000 --> 0:07:06.839 called that because that was the colloquial name for Sars 0:07:07.240 --> 0:07:10.280 in China when it first started making the rounds. I 0:07:10.320 --> 0:07:14.520 love it, and Aaron, what's in the Breathtaker? 0:07:15.040 --> 0:07:18.680 Well, it has to start, of course with a Corona. 0:07:17.960 --> 0:07:21.160 And we should also point out that Corona beer has 0:07:21.280 --> 0:07:23.720 nothing to do with coronavirus. 0:07:23.280 --> 0:07:25.880 At all, and this is not sponsored. 0:07:26.160 --> 0:07:31.560 Not sponsored. It also has Ento Ray's chili liqueur and 0:07:32.080 --> 0:07:36.239 some lime juice and some Tomatio salsa. 0:07:36.080 --> 0:07:38.360 A little spicy something or other to get you through 0:07:38.360 --> 0:07:38.920 this episode. 0:07:39.000 --> 0:07:40.600 Yeah, it's basically like immachillada. 0:07:41.000 --> 0:07:43.840 And we will post the full recipe for this quarantini 0:07:43.880 --> 0:07:46.320 as well as our non alcoholic plus e ber rita 0:07:46.720 --> 0:07:48.920 on our website, This podcast will kill you dot com 0:07:48.960 --> 0:07:50.960 and all of our social media channels. 0:07:51.400 --> 0:07:54.960 Okay, I mean I think we should probably just jump 0:07:55.000 --> 0:07:57.080 right it, and people are already chomping at the bit. 0:07:57.360 --> 0:07:59.640 Yeah, they want it. We should just we should stop 0:07:59.680 --> 0:08:02.960 messing around here. Let's take a quick break and then 0:08:03.000 --> 0:08:04.040 we'll talk biology. 0:08:04.400 --> 0:08:26.440 Sounds great. 0:08:27.400 --> 0:08:29.960 Straight off the bat, I want to let y'all know 0:08:30.640 --> 0:08:36.120 that coronaviruses are nothing new. Nope, nothing new. This novel 0:08:36.160 --> 0:08:46.040 coronavirus that's making headlines is a new individual specific virus. Yes. However, coronaviruses, 0:08:46.800 --> 0:08:51.600 like say, influenza viruses, are a large group of RNA 0:08:51.720 --> 0:08:54.920 viruses that we not only have known about for a 0:08:54.960 --> 0:09:00.520 long time, but have been circulating among humans and many 0:09:00.760 --> 0:09:06.560 many other species of animals for a very very long time. Okay, 0:09:07.600 --> 0:09:12.280 fun fact, this is my only fun fact the whole episode. 0:09:13.240 --> 0:09:19.280 Corona means crown, and the reason that coronaviruses are called 0:09:19.840 --> 0:09:22.880 crown viruses is because when you look at them on 0:09:22.960 --> 0:09:26.400 a scanning electron microscope. They have a little halo crown 0:09:26.679 --> 0:09:29.319 of proteins around the outside. 0:09:29.520 --> 0:09:33.600 Oh, cute viral royalty, Yes, royal virus. 0:09:34.080 --> 0:09:37.680 That's the end of my fun fact. Here's how kind 0:09:37.679 --> 0:09:42.199 of this episode biology is going to be structured. All right. First, 0:09:42.240 --> 0:09:46.559 we're going to talk about the most common human coronaviruses 0:09:47.200 --> 0:09:51.040 in general. These are the ones that circulate all the time. 0:09:51.640 --> 0:09:54.559 Almost definitely if you are listening to this podcast, you've 0:09:54.559 --> 0:09:57.360 been infected with a coronavirus at some point in your life. 0:09:58.559 --> 0:10:03.880 And then we'll talk about the three big headline grabbing 0:10:03.920 --> 0:10:10.160 coronaviruses that is stars, Mers and the Newest twenty nineteen 0:10:10.320 --> 0:10:11.720 and Covy. 0:10:11.800 --> 0:10:13.320 Cool gotcha sounds great? 0:10:13.640 --> 0:10:18.600 All right, So coronaviruses in general, there are several different 0:10:18.720 --> 0:10:22.480 large groups of coronaviruses and a lot of them actually 0:10:22.480 --> 0:10:26.440 infect animals, all different kinds of animals, pigs, chickens, cats, 0:10:27.280 --> 0:10:30.680 and in animals they often cause gi illness, so like 0:10:30.800 --> 0:10:34.280 diarrhea and stuff like that, but they can also cause 0:10:34.480 --> 0:10:40.600 respiratory illness. There are four human coronaviruses that are really 0:10:40.640 --> 0:10:46.320 common and they cause the common cold. Yeah, so these 0:10:46.360 --> 0:10:51.320 are upper respiratory tract infections in general. So the question 0:10:51.720 --> 0:10:54.920 first that we like to answer is what exactly do 0:10:55.000 --> 0:10:57.240 they do in your body and how do they make 0:10:57.280 --> 0:11:00.400 you sick? What is their path of physiology? It turns 0:11:00.400 --> 0:11:05.199 out that for the four human coronaviruses, we don't entirely 0:11:05.280 --> 0:11:08.720 know their path of physiology because, like for many viruses, 0:11:08.760 --> 0:11:11.760 we don't have really great animal models to study them. 0:11:12.200 --> 0:11:17.199 But from some really interesting and probably ethically questionable studies 0:11:17.240 --> 0:11:20.120 that they've done in humans where they intentionally infect quote 0:11:20.200 --> 0:11:24.040 unquote volunteers. When were these studies from the eighties and 0:11:24.320 --> 0:11:25.520 early two thousands. 0:11:25.960 --> 0:11:29.559 Uh, okay, that's yeah, that's yeah. 0:11:29.760 --> 0:11:32.960 Anyways, what we do know from these studies is that 0:11:33.559 --> 0:11:38.400 these four human coronaviruses colonize the upper respiratory tract, so 0:11:38.480 --> 0:11:41.880 your nose and throat in general, okay, And we know 0:11:41.960 --> 0:11:46.080 that they invade and replicate in your respiratory epithelium, so 0:11:46.320 --> 0:11:50.520 the sort of first cells lining your respiratory tract. So 0:11:50.800 --> 0:11:54.400 in the case of these four common coronaviruses, that's pretty 0:11:54.440 --> 0:11:59.240 much where they seem to stop. They're not super infectious 0:11:59.240 --> 0:12:01.640 in these human studies, up to like a third of 0:12:01.679 --> 0:12:05.600 people that they inoculated didn't actually even get infected with 0:12:05.640 --> 0:12:08.440 the virus, and most of those that did had very 0:12:08.480 --> 0:12:13.200 mild or maybe moderate colds. So we all know what 0:12:13.280 --> 0:12:15.800 the common cold looks like, right, Aaron, what kinds of 0:12:16.440 --> 0:12:17.400 symptoms do you have? 0:12:18.559 --> 0:12:23.840 Running nose? Hmmm, sneezing, coughing. 0:12:23.800 --> 0:12:28.320 There you go, exactly, yeah, So these are very mild 0:12:28.440 --> 0:12:32.480 upper respiratory symptoms. Cough, runny nose, stuffy nose. Maybe you 0:12:32.520 --> 0:12:36.080 get a headache, maybe rarely you'd spike a fever, but 0:12:36.200 --> 0:12:39.920 in general you're not all that sick. The way that 0:12:40.000 --> 0:12:43.480 common cold viruses like coronavirus are generally transmitted is by 0:12:43.520 --> 0:12:46.520 respiratory droplets. So since they make you cough and sneeze, 0:12:46.720 --> 0:12:49.360 when you cough and sneeze, you cough and sneeze out 0:12:49.679 --> 0:12:53.040 liquid droplets full of virus, and that's how the next 0:12:53.080 --> 0:12:57.400 person gets infected. So it's not like something like measles 0:12:57.400 --> 0:13:00.240 that we talked about that can hang out airborne in 0:13:00.320 --> 0:13:04.080 the room for many, many hours in the air. These 0:13:04.120 --> 0:13:07.880 are viruses that are contained in water droplets that you 0:13:07.960 --> 0:13:11.679 cough and sneeze out. It is also possible that these 0:13:11.760 --> 0:13:14.679 droplets can land on surfaces and the virus can then 0:13:14.760 --> 0:13:17.560 live on these surfaces and be transmitted from say a 0:13:17.640 --> 0:13:20.800 doorknob to your mouth if you touch a doorknob and 0:13:20.840 --> 0:13:25.240 then touch your mouth. That makes sense, yes, Okay, So 0:13:25.760 --> 0:13:30.000 that's the four common coronaviruses. They don't cause a lot 0:13:30.040 --> 0:13:33.640 of morbidity or illness, They don't cause a lot of 0:13:33.800 --> 0:13:38.360 mortality except in very, very very rare cases. And it's 0:13:38.480 --> 0:13:41.280 estimated that anywhere from ten to thirty percent of all 0:13:41.360 --> 0:13:43.920 common colds around the world are caused by one of 0:13:43.960 --> 0:13:50.040 these four coronaviruses. Huh yeah, so there's really common. Yeah, 0:13:50.080 --> 0:13:52.439 And I think that's important to keep in mind because 0:13:52.640 --> 0:13:56.280 even when Stars first came on the scene, while we'll 0:13:56.320 --> 0:13:59.080 see that it was very novel in the type of 0:13:59.160 --> 0:14:02.920 disease and this verity of disease it caused, it wasn't 0:14:02.920 --> 0:14:08.360 a completely unknown alien invasion virus, right, and neither is 0:14:08.400 --> 0:14:13.920 this new novel coronavirus that's circulating today. Okay, So let's 0:14:13.920 --> 0:14:17.040 get into the more serious things, and that starts with SARS. 0:14:18.480 --> 0:14:23.960 SARS stands for severe acute respiratory syndrome. What was novel 0:14:24.000 --> 0:14:26.080 about SARS when it first came on the scene in 0:14:26.120 --> 0:14:29.320 two thousand and two is that it caused a very 0:14:29.360 --> 0:14:33.080 serious illness in people. It caused an illness that was 0:14:33.120 --> 0:14:37.480 so severe, especially compared to what coronaviruses normally cause, which 0:14:37.520 --> 0:14:41.640 was like a cough and runny nose, that we didn't 0:14:41.680 --> 0:14:44.320 recognize it as a coronavirus for a long time. And 0:14:44.360 --> 0:14:46.320 there's a number of reasons for that, many of which 0:14:46.320 --> 0:14:50.320 I'm sure Aaron you'll get into, right, okay, But at 0:14:50.400 --> 0:14:53.760 least in part, it's because we're we didn't expect before 0:14:53.880 --> 0:14:56.880 SARS that coronaviruses could cause the kind of disease we 0:14:56.920 --> 0:15:02.160 saw with SARS, right, So why did we see more 0:15:02.200 --> 0:15:08.120 severe infection? And the answer is that while SARS still 0:15:08.320 --> 0:15:13.360 mostly affects the respiratory tract, unlike the other coronaviruses, SARS 0:15:13.440 --> 0:15:17.200 is able to extend its infection to the lower respiratory tract, 0:15:17.880 --> 0:15:21.280 so not just your nose and throat, but actually colonize 0:15:21.320 --> 0:15:24.560 your lungs and cause disease in your lungs itself. 0:15:25.240 --> 0:15:28.160 What allows the sarskv to do that, Like, what is 0:15:28.160 --> 0:15:33.040 stopping the other four endemic milder coronaviruses from invading your lungs? 0:15:33.400 --> 0:15:35.960 Good question, and This was one of my I put 0:15:36.000 --> 0:15:38.120 a little asterisk next to this because I thought you 0:15:38.200 --> 0:15:43.960 might ask it, so let's talk about it. So, remember 0:15:44.000 --> 0:15:46.800 that viruses can't replicate on their own right. They have 0:15:46.840 --> 0:15:49.880 to enter our cells in order to replicate and then 0:15:50.000 --> 0:15:53.320 use our cellular machinery in order to replicate and make 0:15:53.360 --> 0:15:56.280 new viruses. So in order to do that, they have 0:15:56.320 --> 0:15:58.480 to get into our cells, and the first step in 0:15:58.560 --> 0:16:01.400 doing that is to bind to some receptors on our 0:16:01.480 --> 0:16:05.640 cells and use those receptors to get into our cells. 0:16:06.520 --> 0:16:10.360 Different viruses use different proteins and bind to different proteins 0:16:10.400 --> 0:16:14.600 in our cells. And what proteins they bind to and 0:16:14.760 --> 0:16:17.520 where in our body those proteins are found, like what 0:16:17.680 --> 0:16:22.720 cell types have those proteins determines what's called the tropism 0:16:23.080 --> 0:16:26.560 of the virus, what organs in our body the virus 0:16:26.600 --> 0:16:27.920 tends to invade. 0:16:27.880 --> 0:16:30.720 Oh, like where it goes? Okay, yeah, exactly. 0:16:31.400 --> 0:16:34.920 And so in the case of SARS, we found out 0:16:35.160 --> 0:16:37.960 later we know now that SARS binds to a protein 0:16:38.000 --> 0:16:43.720 called ACE two angiotensin converting enzyme. This protein is expressed 0:16:44.000 --> 0:16:47.560 in very high concentrations in our lungs and also in 0:16:47.600 --> 0:16:50.960 our small intestine and some other organs too, kidneys, et cetera. 0:16:51.600 --> 0:16:54.240 Because this is the protein that SARS uses to bind, 0:16:54.280 --> 0:16:56.960 it was able to then invade our lungs because our 0:16:57.080 --> 0:17:02.120 lung tissue has a lot of ACE on its. I 0:17:02.160 --> 0:17:06.240 didn't look up exactly what proteins the other four coronaviruses 0:17:06.359 --> 0:17:09.119 used to invade, because there's four of them and that 0:17:09.200 --> 0:17:11.760 would be too long of an episode. But it's not 0:17:11.960 --> 0:17:16.920 generally ACE, right, So the other coronaviruses use different receptors 0:17:16.920 --> 0:17:20.240 that they recognize that are located more in the upper 0:17:20.280 --> 0:17:21.119 respiratory tract. 0:17:21.560 --> 0:17:25.919 It seems like knowing the proteins that these viruses bind 0:17:25.960 --> 0:17:28.920 to would be great targets for treatment. 0:17:29.440 --> 0:17:30.120 Absolutely. 0:17:30.200 --> 0:17:30.440 Yeah. 0:17:30.480 --> 0:17:33.439 So there's been some ideas because we have oh, this 0:17:33.560 --> 0:17:37.959 is probably getting too much, Aaron, but we have drugs 0:17:37.960 --> 0:17:42.560 that actually target ACE because it's an important component of 0:17:42.920 --> 0:17:44.920 how your body manages blood pressure. 0:17:45.520 --> 0:17:48.399 Whoa, oh my gosh. Yeah. 0:17:48.440 --> 0:17:50.960 So we have things called ACE inhibitors. So there's this 0:17:51.080 --> 0:17:53.480 thought that like, oh, could maybe you use these to 0:17:53.560 --> 0:17:56.360 treat SARS. We don't, as far as I know, there 0:17:56.400 --> 0:17:59.440 isn't actually good evidence that that works, but it's like, yeah, 0:17:59.480 --> 0:18:02.160 cool idea, Yeah, let's do some research on it, but yeah, 0:18:03.040 --> 0:18:05.760 knowing how viruses get into our body is often a 0:18:05.800 --> 0:18:10.760 good place to try at least try to target for treatments. 0:18:12.080 --> 0:18:13.920 I'll just say we don't have any though at this 0:18:14.000 --> 0:18:18.040 point for SARS, ormers or the novel coronavirus. Just thrown 0:18:18.119 --> 0:18:18.560 that out. 0:18:18.400 --> 0:18:20.000 There, Okay, there we go. 0:18:20.920 --> 0:18:23.399 So, yeah, so SARS gets into your lungs and is 0:18:23.440 --> 0:18:27.399 able to cause a lung infection. Lung infection means pneumonia, 0:18:27.680 --> 0:18:31.679 so this is a virus causing viral pneumonia. So the 0:18:31.720 --> 0:18:35.880 symptoms of SARS, because it's a more extensive disease, tend 0:18:35.960 --> 0:18:40.160 to start more systemically. So fever is the number one 0:18:40.240 --> 0:18:47.199 symptom of SARS. Actually, Okay, fever, chills, mayalgias like you 0:18:47.280 --> 0:18:49.879 described in the first hand account, these muscle aches can 0:18:49.920 --> 0:18:53.720 get really really severe, and then you do still get 0:18:53.760 --> 0:18:56.960 some upper respiratory symptoms, but a lot of the symptoms 0:18:56.960 --> 0:19:00.640 are more lower respiratory, so you'll get a cough, but 0:19:00.760 --> 0:19:03.640 less of the runny nose type symptoms that we see 0:19:03.680 --> 0:19:08.520 with other coronaviruses. And then as this disease progresses and 0:19:08.600 --> 0:19:11.880 more damage is caused to the lungs themselves, you'll get 0:19:11.920 --> 0:19:15.840 other more serious symptoms like shortness of breath to kipnia, 0:19:15.920 --> 0:19:20.320 which means a really fast breathing rate, plurisy, which is 0:19:20.560 --> 0:19:23.600 like pain in your chest and lungs when you breathe, 0:19:25.400 --> 0:19:28.199 and then depending on how late in the course of 0:19:28.240 --> 0:19:31.840 disease people present to the hospital. Because this is a 0:19:31.920 --> 0:19:34.800 very serious illness, most people will present to the hospital 0:19:35.680 --> 0:19:38.600 almost everyone. When you take an X ray of their chest, 0:19:39.160 --> 0:19:42.960 it will look like what we call ground glass opacifications. 0:19:43.400 --> 0:19:45.280 Oh my gosh, that sounds terrible. 0:19:45.480 --> 0:19:47.919 It is terrible. So if you've ever seen an X 0:19:48.000 --> 0:19:52.880 ray of a normal chest, a not ill chest X ray, 0:19:53.359 --> 0:19:55.679 you know that the lungs are filled with air, so 0:19:55.680 --> 0:19:58.560 they're mostly black because air is black on X ray, 0:19:59.400 --> 0:20:01.679 So you can see the outlines of ribs, and then 0:20:01.680 --> 0:20:04.159 you can see sort of black in between the ribs 0:20:04.400 --> 0:20:07.800 with maybe little bits where you can see like blood 0:20:07.880 --> 0:20:11.200 vessels and things like that. That's a normal, not sick 0:20:11.600 --> 0:20:15.720 chest X ray with stars. It looks like you're looking 0:20:15.760 --> 0:20:18.520 through like a bathroom. You know the glass they put 0:20:18.520 --> 0:20:20.560 on bathroom windows. Yeah, I have some of that on 0:20:20.560 --> 0:20:23.399 my bathroom window exactly. So it looks like that. So 0:20:23.560 --> 0:20:27.919 it's not so opaque that you can't still see like 0:20:28.080 --> 0:20:30.919 the shadow of your heart and your ribs. You can 0:20:30.960 --> 0:20:34.280 still see that it's not completely whited out like it 0:20:34.400 --> 0:20:38.120 might be with a bacterial pneumonia, oh. 0:20:37.720 --> 0:20:40.959 Because the bacteria has colonized. Whereas this is just inflammation. 0:20:41.359 --> 0:20:44.440 Well, bacteria still produce a lot of inflammation, but it'll 0:20:44.480 --> 0:20:47.200 be localized to one spot and it'll be so much 0:20:47.359 --> 0:20:50.560 in like one corner of the lung that it's totally 0:20:50.560 --> 0:20:55.760 whited out, okay, Whereas this is bilateral often throughout your 0:20:55.840 --> 0:21:00.320 whole lung fields, top and bottom. Often it's all just 0:21:00.440 --> 0:21:01.879 kind of murky looking. 0:21:02.480 --> 0:21:03.880 That sounds terrible. 0:21:04.280 --> 0:21:07.040 Yeah, it's bad, it's not good. And then this can 0:21:07.080 --> 0:21:11.920 sort of just progress. So about one third of people 0:21:12.359 --> 0:21:16.520 with SARS will get better on their own, but twenty 0:21:16.600 --> 0:21:20.200 to thirty percent end up needing mechanical ventilation because their 0:21:20.280 --> 0:21:22.959 lungs are just so inflamed that they're not able to 0:21:23.520 --> 0:21:28.440 get enough oxygen in on their own. And I want 0:21:28.480 --> 0:21:31.000 to point out that this kind of supportive treatment is 0:21:31.040 --> 0:21:33.320 the only treatment that we have since we don't have 0:21:33.359 --> 0:21:40.320 any antivirals for SARS. And overall, what we saw from 0:21:40.359 --> 0:21:43.879 the SARS outbreak was a case fatality rate of just 0:21:44.000 --> 0:21:47.360 under ten percent, So about ten percent of people who 0:21:47.400 --> 0:21:51.119 were infected with SARS ended up dying from SARS or 0:21:51.160 --> 0:21:52.359 SARS complications. 0:21:52.640 --> 0:21:54.920 That's a very high mortality rate. 0:21:55.040 --> 0:21:59.200 It is, and it varied a lot based on demographic factors. 0:21:59.280 --> 0:22:02.680 So in people older than sixty five, the mortality rate 0:22:02.760 --> 0:22:04.159 was over fifty percent. 0:22:04.800 --> 0:22:07.080 Wow, I didn't realize it was that high. 0:22:07.320 --> 0:22:12.399 Yeah, it was really high. So that's kind of what 0:22:12.440 --> 0:22:15.680 the disease looked like for SARS. We learned a lot 0:22:15.760 --> 0:22:18.960 about it after the outbreak because, as you can probably 0:22:19.000 --> 0:22:21.400 see with what's going on with a new outbreak right now, 0:22:21.480 --> 0:22:24.960 it's really hard to get good information while the outbreak 0:22:25.000 --> 0:22:27.520 is going on right because you're just kind of dealing 0:22:27.560 --> 0:22:30.800 with like trying to keep people alive well. 0:22:30.840 --> 0:22:35.840 And also there's steps to publishing reliable information has to 0:22:35.880 --> 0:22:39.359 have asolute, pure review process, and some of those things 0:22:39.359 --> 0:22:43.160 are are lifted right now and people are getting early 0:22:43.240 --> 0:22:47.879 drafts out. But it's then you know what information is reliable. 0:22:48.040 --> 0:22:50.640 Sample sizes tend to be small, et cetera, et cetera. 0:22:50.800 --> 0:22:54.160 Yeah, But so things that we know now looking back 0:22:54.160 --> 0:22:56.879 at Stars since the outbreak has passed, is we know 0:22:57.000 --> 0:23:02.240 that with SARS, subclinical infection, so like asymptomatic infection, was 0:23:02.359 --> 0:23:05.960 really rare. So in looking at zero prevalent studies of 0:23:06.040 --> 0:23:08.640 people in areas where there were high rates of SARS, 0:23:09.080 --> 0:23:12.840 there's very little evidence of infection in people who didn't 0:23:12.880 --> 0:23:14.560 have symptoms of SARS. 0:23:14.560 --> 0:23:16.800 Interesting, okay, Yeah. 0:23:16.640 --> 0:23:19.360 So we know that in the case of SARS, infection 0:23:19.560 --> 0:23:22.680 almost always led to symptoms, and in general, those symptoms 0:23:22.720 --> 0:23:26.720 were very severe. And the other thing that we learned 0:23:26.800 --> 0:23:30.240 about SARS was that the viral load, so how much 0:23:30.359 --> 0:23:34.160 virus you had in your body, was a really driving 0:23:34.320 --> 0:23:39.840 factor of infectivity, okay. And so in the case of SARS, 0:23:40.320 --> 0:23:42.760 the incubation period, so the time from when you first 0:23:42.760 --> 0:23:45.800 got infected to showed symptoms, was usually about four to 0:23:45.920 --> 0:23:51.040 seven days, and viral load actually increased slowly over that time, 0:23:51.119 --> 0:23:56.280 so people were most infectious about ten days after first 0:23:56.320 --> 0:24:00.760 getting infected. And so that means that people STARS were 0:24:00.800 --> 0:24:04.639 really only infectious if and when they showed symptoms, which 0:24:04.680 --> 0:24:08.080 made SARS relatively easy to screen for and to help contain. 0:24:09.400 --> 0:24:13.359 So that's pretty much SARS, okay, So let's let's move on. 0:24:15.280 --> 0:24:20.920 The next most famous coronavirus was merz Middle East respiratory syndrome. 0:24:21.600 --> 0:24:24.320 So was MURRZ just the same thing as SARS, but 0:24:24.359 --> 0:24:28.160 in a different part of the world. No, not really. 0:24:29.960 --> 0:24:34.719 It was another novel coronavirus that was discovered in twenty 0:24:34.800 --> 0:24:38.680 twelve after an outbreak in I believe Saudi Arabia was 0:24:38.720 --> 0:24:41.800 the first identified cases. Is that right, Aaron? 0:24:42.480 --> 0:24:47.840 So it was first isolated from an outbreak in Saudi Arabia, 0:24:48.000 --> 0:24:51.679 but retrospective testing showed that it actually the first cases 0:24:51.720 --> 0:24:54.160 seemed to be in Jordan earlier that year. 0:24:54.400 --> 0:24:55.320 That's right, That's right. 0:24:55.440 --> 0:24:55.800 Okay. 0:24:56.040 --> 0:25:02.320 So symptomatically, MERHS present very similarly to SARS in a 0:25:02.400 --> 0:25:06.480