1 00:00:01,320 --> 00:00:04,280 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,400 --> 00:00:11,000 Speaker 1: of iHeartRadio. 3 00:00:11,920 --> 00:00:14,200 Speaker 2: Hello, and welcome to the podcast. I'm Tracy V. 4 00:00:14,320 --> 00:00:16,160 Speaker 1: Wilson, and I'm Holly Frye. 5 00:00:16,360 --> 00:00:21,439 Speaker 2: I am kind of riffing on Holly's beloved theme of 6 00:00:21,480 --> 00:00:26,279 Speaker 2: eponymous foods, but maybe in a less fun direction, which 7 00:00:26,320 --> 00:00:29,360 Speaker 2: is diseases that are named after places. 8 00:00:29,600 --> 00:00:33,000 Speaker 1: I like how you said, maybe like there's someone else 9 00:00:33,040 --> 00:00:34,280 Speaker 1: going Yeah. 10 00:00:34,200 --> 00:00:37,640 Speaker 2: Somebody is excited about learning where disease names came from. 11 00:00:38,000 --> 00:00:40,000 Speaker 2: If you saw the title of today's episode and you 12 00:00:40,000 --> 00:00:42,720 Speaker 2: saw the word eponymous and you were expecting food treats 13 00:00:42,720 --> 00:00:48,680 Speaker 2: and now you're disappointed, I'm very sorry. The word eponymous 14 00:00:48,880 --> 00:00:51,560 Speaker 2: is I think most often used to describe something named 15 00:00:51,640 --> 00:00:55,200 Speaker 2: after a person, but it can also describe something named 16 00:00:55,200 --> 00:00:58,280 Speaker 2: after a place or a thing. And this episode is 17 00:00:58,360 --> 00:01:01,640 Speaker 2: also inspired by an experience I had a few years 18 00:01:01,680 --> 00:01:05,160 Speaker 2: ago when I went to visit family and the big, 19 00:01:05,200 --> 00:01:08,319 Speaker 2: big local news story. While I was there was an 20 00:01:08,360 --> 00:01:13,399 Speaker 2: outbreak of Legionnaire's disease connected to walking past a hot 21 00:01:13,440 --> 00:01:18,600 Speaker 2: tub display at affair. I found all of that horrifying 22 00:01:18,840 --> 00:01:20,679 Speaker 2: from a number of directions, and it made me, then, 23 00:01:20,800 --> 00:01:23,880 Speaker 2: of course, want to do an episode on Legionnaire's disease. 24 00:01:23,959 --> 00:01:27,400 Speaker 2: That's a totally normal response to this whole experience. I 25 00:01:27,440 --> 00:01:29,399 Speaker 2: was not able to work that into a whole episode, 26 00:01:29,400 --> 00:01:31,760 Speaker 2: and it just took me a while to kind of think, hey, 27 00:01:32,000 --> 00:01:35,679 Speaker 2: there's a theme here. We are going to really be 28 00:01:35,720 --> 00:01:39,240 Speaker 2: focused on the outbreak that led to these diseases being 29 00:01:39,360 --> 00:01:42,119 Speaker 2: identified and named, so it won't be like a whole 30 00:01:43,160 --> 00:01:48,240 Speaker 2: history of any of these three diseases. Two of the 31 00:01:48,280 --> 00:01:51,120 Speaker 2: diseases we're talking about today are ones that people can 32 00:01:51,160 --> 00:01:56,400 Speaker 2: contract through incredibly casual exposure, like walking past a hot 33 00:01:56,400 --> 00:02:00,440 Speaker 2: tub display. The third requires a lot more pro longed 34 00:02:00,640 --> 00:02:03,880 Speaker 2: direct contact with somebody who is acutely ill, but it 35 00:02:03,920 --> 00:02:08,320 Speaker 2: can really still spread very rapidly in certain conditions. Although 36 00:02:08,639 --> 00:02:11,960 Speaker 2: there will be some experimentation on animals mentioned in this 37 00:02:12,000 --> 00:02:16,960 Speaker 2: episode and one of the most disgusting human experiments that 38 00:02:17,000 --> 00:02:20,320 Speaker 2: I've ever encountered while working on this show. We're gonna 39 00:02:20,320 --> 00:02:23,440 Speaker 2: talk about that just as delicately as possible, but it 40 00:02:23,480 --> 00:02:29,360 Speaker 2: is gross. So first up, as Tracy alluded to, Legionnaire's disease, 41 00:02:29,680 --> 00:02:34,560 Speaker 2: which is caused by Legionella bacteria. Multiple species of Legionella 42 00:02:34,600 --> 00:02:38,760 Speaker 2: bacteria can cause disease, but most outbreaks are connected to 43 00:02:38,880 --> 00:02:44,919 Speaker 2: Legionella numophila. Legionella numophila can actually cause two different diseases, 44 00:02:45,400 --> 00:02:50,040 Speaker 2: Legionnaire's disease and pontiac fever. Both of these can cause 45 00:02:50,080 --> 00:02:54,400 Speaker 2: flu like respiratory symptoms, but pontiac fever is generally milder 46 00:02:54,440 --> 00:02:58,360 Speaker 2: and typically resolves on its own. Legionnaire's disease, on the 47 00:02:58,360 --> 00:03:02,720 Speaker 2: other hand, can cause pneumonia and lead to hospitalization and death. 48 00:03:03,520 --> 00:03:07,640 Speaker 2: It's not fully understood why the same bacteria causes two 49 00:03:07,680 --> 00:03:11,760 Speaker 2: clinically different syndromes, or why outbreaks tend to cause one 50 00:03:12,000 --> 00:03:16,040 Speaker 2: or the other. Legionnaire's disease is named for the American 51 00:03:16,120 --> 00:03:19,640 Speaker 2: Legion convention that was held at the Bellevue Stratford Hotel 52 00:03:19,760 --> 00:03:24,200 Speaker 2: in Philadelphia, Pennsylvania, in nineteen seventy six. I guess we 53 00:03:24,200 --> 00:03:27,360 Speaker 2: could have a semantic argument about whether a convention is 54 00:03:27,400 --> 00:03:31,680 Speaker 2: a place or not. I think it is, at least temporarily. 55 00:03:32,520 --> 00:03:35,960 Speaker 2: The American Legion is a veterans organization that was chartered 56 00:03:36,000 --> 00:03:40,400 Speaker 2: by Congress in nineteen nineteen, focused on service to veterans 57 00:03:40,480 --> 00:03:44,680 Speaker 2: and to their communities. This nineteen seventy six state meeting 58 00:03:44,760 --> 00:03:49,240 Speaker 2: in Philadelphia also ran alongside the US bi centennial, so 59 00:03:49,280 --> 00:03:52,520 Speaker 2: there were a lot of other celebrations and festivities going 60 00:03:52,560 --> 00:03:56,480 Speaker 2: on as well. The American Legion Convention took place from 61 00:03:56,560 --> 00:03:59,680 Speaker 2: July twenty first through twenty fourth, and then on July 62 00:03:59,720 --> 00:04:02,720 Speaker 2: twenty twenty seven, a retired Air Force captain who had 63 00:04:02,760 --> 00:04:07,880 Speaker 2: attended the convention died of an apparent heart attack. Within days, 64 00:04:08,040 --> 00:04:12,320 Speaker 2: other convention attendees had also died after reporting symptoms that 65 00:04:12,400 --> 00:04:17,800 Speaker 2: included fevers, headaches, chest pain, and chest congestion. On the 66 00:04:17,880 --> 00:04:23,160 Speaker 2: afternoon of Friday, July thirtieth, doctor Ernest Campbell of Bloomsburg, Pennsylvania, 67 00:04:23,640 --> 00:04:27,960 Speaker 2: tried to alert the Pennsylvania State Public Health Department that 68 00:04:28,080 --> 00:04:31,600 Speaker 2: some of his patients had become seriously ill after attending 69 00:04:31,600 --> 00:04:35,560 Speaker 2: the convention, but he was told the office had closed 70 00:04:35,600 --> 00:04:39,520 Speaker 2: for the day. Another doctor tried to report a similar 71 00:04:39,600 --> 00:04:42,720 Speaker 2: pattern of illnesses to the health department on Saturday, which 72 00:04:42,720 --> 00:04:45,919 Speaker 2: of course, was also still closed. By the time the 73 00:04:46,000 --> 00:04:50,520 Speaker 2: office reopened on Monday, eighteen people had already died. 74 00:04:51,360 --> 00:04:54,720 Speaker 1: In addition to this delay in starting an investigation into 75 00:04:54,720 --> 00:04:57,800 Speaker 1: what was going on, there were some specifics that made 76 00:04:57,800 --> 00:05:00,640 Speaker 1: it hard to pinpoint where this illness had come come from. 77 00:05:01,360 --> 00:05:05,400 Speaker 1: Medical staff who saw multiple patients all around Pennsylvania made 78 00:05:05,400 --> 00:05:09,279 Speaker 1: a connection to the convention right away, but there were 79 00:05:09,320 --> 00:05:11,719 Speaker 1: also people who got sick who had not gone to 80 00:05:11,760 --> 00:05:14,919 Speaker 1: the convention or even been inside the hotel where it 81 00:05:15,000 --> 00:05:18,440 Speaker 1: was held. One was a bus driver who had driven 82 00:05:18,480 --> 00:05:21,880 Speaker 1: a marching band to Philadelphia for a parade, who had 83 00:05:21,920 --> 00:05:25,120 Speaker 1: spent almost all of his time in Philadelphia on the bus. 84 00:05:25,839 --> 00:05:28,880 Speaker 1: Another person was local to Philadelphia but had not been 85 00:05:29,000 --> 00:05:33,240 Speaker 1: in the hotel for a while, investigators were classifying this 86 00:05:33,400 --> 00:05:38,680 Speaker 1: as two different diseases, legionnaire's disease for convention attendees and 87 00:05:38,760 --> 00:05:41,200 Speaker 1: broad Street pneumonia for everyone else. 88 00:05:42,320 --> 00:05:46,560 Speaker 2: Health authorities in Pennsylvania, once they had gotten those reports, 89 00:05:46,800 --> 00:05:50,760 Speaker 2: contacted the Centers for Disease Control, and the CDC reported 90 00:05:50,760 --> 00:05:53,760 Speaker 2: on the illness in its Morbidity and Mortality Weekly Report 91 00:05:53,880 --> 00:05:57,120 Speaker 2: on Friday, August sixth, the same week that the illnesses 92 00:05:57,160 --> 00:06:00,760 Speaker 2: had first been reported to the Pennsylvania State Public Health Department. 93 00:06:01,600 --> 00:06:05,120 Speaker 2: According to this report, one hundred and fifty two people 94 00:06:05,200 --> 00:06:08,880 Speaker 2: associated with the convention had become ill between July twenty 95 00:06:08,920 --> 00:06:12,480 Speaker 2: second and August third, with most of those illnesses starting 96 00:06:12,520 --> 00:06:16,800 Speaker 2: between July twenty fifth and thirty first. Twenty two of 97 00:06:16,800 --> 00:06:19,839 Speaker 2: those one hundred and fifty two people had died, but 98 00:06:19,920 --> 00:06:23,120 Speaker 2: there didn't seem to be an increase in respiratory diseases 99 00:06:23,120 --> 00:06:27,039 Speaker 2: in Philadelphia more generally, and the illnesses didn't seem to 100 00:06:27,080 --> 00:06:30,240 Speaker 2: have spread between these patients and their family members or 101 00:06:30,320 --> 00:06:34,680 Speaker 2: other close contacts. The CDC included weekly updates in the 102 00:06:34,680 --> 00:06:38,960 Speaker 2: Morbidity and Mortality Weekly Report until September third, at which 103 00:06:39,000 --> 00:06:42,799 Speaker 2: point the outbreak was over. As of August thirty first, 104 00:06:42,920 --> 00:06:46,080 Speaker 2: nineteen seventy six, there had been one hundred seventy nine 105 00:06:46,160 --> 00:06:49,680 Speaker 2: cases and twenty eight deaths, including one hundred forty eight 106 00:06:49,720 --> 00:06:52,640 Speaker 2: people who had been at the convention and thirty one 107 00:06:52,640 --> 00:06:55,760 Speaker 2: who had not, but those had been either in or 108 00:06:55,800 --> 00:06:59,240 Speaker 2: near the hotel at some point. The disease had been 109 00:06:59,320 --> 00:07:04,400 Speaker 2: particularly lethal in people who had other conditions like heart disease, diabetes, 110 00:07:04,560 --> 00:07:09,120 Speaker 2: or cancer, but this report did not include what had 111 00:07:09,240 --> 00:07:12,560 Speaker 2: caused the outbreak because at that point they did not know. 112 00:07:13,320 --> 00:07:17,240 Speaker 2: The CDC Epidemic Intelligence Service and the Pennsylvania Department of 113 00:07:17,280 --> 00:07:20,640 Speaker 2: Health had carried out what was at the time the 114 00:07:20,880 --> 00:07:25,920 Speaker 2: largest infectious disease investigation in CDC history. They had more 115 00:07:25,920 --> 00:07:29,720 Speaker 2: than one hundred and fifty investigators and medical professionals involved. 116 00:07:30,240 --> 00:07:34,400 Speaker 2: They looked for evidence of viruses and bacteria, heavy metals, 117 00:07:34,600 --> 00:07:39,440 Speaker 2: environmental toxins, and other potential causes, without any success. They 118 00:07:39,520 --> 00:07:43,880 Speaker 2: checked seemingly every surface and potential source of contamination at 119 00:07:43,920 --> 00:07:47,680 Speaker 2: the hotel. Because there was this clear connection to an 120 00:07:47,680 --> 00:07:51,480 Speaker 2: American Legion convention, there were even concerns that it had 121 00:07:51,520 --> 00:07:55,360 Speaker 2: been an intentional poisoning carried out by anti war protesters, 122 00:07:55,760 --> 00:07:58,800 Speaker 2: or maybe some kind of biological attack connected to the 123 00:07:58,840 --> 00:08:02,880 Speaker 2: Cold War. Meanwhile, this outbreak had gotten a lot of 124 00:08:02,920 --> 00:08:06,200 Speaker 2: press coverage. There had been an outbreak of swine flu 125 00:08:06,280 --> 00:08:09,600 Speaker 2: at Fort Dix in New Jersey the previous winter, believed 126 00:08:09,680 --> 00:08:11,920 Speaker 2: to be very similar to the virus that had caused 127 00:08:11,960 --> 00:08:15,760 Speaker 2: the nineteen eighteen flu pandemic. This had led to fears 128 00:08:15,800 --> 00:08:19,040 Speaker 2: of an impending pandemic and a huge emergency effort to 129 00:08:19,120 --> 00:08:23,720 Speaker 2: vaccinate people. Although a pandemic had not developed, and various 130 00:08:23,760 --> 00:08:26,440 Speaker 2: issues with this vaccine rollout had led the press to 131 00:08:26,480 --> 00:08:30,280 Speaker 2: call it a fiasco. This had led to heightened anxieties 132 00:08:30,280 --> 00:08:35,160 Speaker 2: around the idea of contagious illness. Also, this was an 133 00:08:35,160 --> 00:08:40,200 Speaker 2: illness that had disproportionately sickened and killed veterans, a lot 134 00:08:40,240 --> 00:08:44,600 Speaker 2: of them retirees during the celebration of the US bicentennial, 135 00:08:44,760 --> 00:08:48,360 Speaker 2: so the whole thing had additional layers of emotional impact, 136 00:08:48,559 --> 00:08:51,400 Speaker 2: like this is right on the heels of the Vietnam War, 137 00:08:52,440 --> 00:08:54,400 Speaker 2: but a lot of the people that were that were 138 00:08:54,440 --> 00:08:57,120 Speaker 2: sickened and killed had served in like World War Two 139 00:08:57,440 --> 00:09:00,560 Speaker 2: and the Korean War, and people rea guarded them with 140 00:09:00,640 --> 00:09:04,120 Speaker 2: like a slightly different nuance than how people were viewing 141 00:09:04,120 --> 00:09:06,720 Speaker 2: the Vietnam War at the time. The fact that so 142 00:09:06,800 --> 00:09:11,439 Speaker 2: many people died so quickly also made this outbreak particularly terrifying. 143 00:09:11,760 --> 00:09:16,360 Speaker 2: On August sixteenth, nineteen seventy six, Time Newsweek and US 144 00:09:16,440 --> 00:09:20,120 Speaker 2: News and World Report all had cover stories about the outbreak, 145 00:09:20,360 --> 00:09:22,880 Speaker 2: and all three of them used the word killer in 146 00:09:22,920 --> 00:09:24,199 Speaker 2: the headline. 147 00:09:24,280 --> 00:09:28,000 Speaker 1: By Christmas of nineteen seventy six, the Bellevue Stratford Hotel 148 00:09:28,080 --> 00:09:31,000 Speaker 1: had closed in the aftermath of the outbreak, and the 149 00:09:31,040 --> 00:09:34,920 Speaker 1: CDC had faced intense criticism for not figuring out the cause. 150 00:09:35,760 --> 00:09:40,320 Speaker 1: This included CDC microbiologist Joseph McDade, who got a lecture 151 00:09:40,360 --> 00:09:42,760 Speaker 1: about it at a Christmas party from a random man 152 00:09:42,800 --> 00:09:46,160 Speaker 1: that he had never met before. McDade worked in the 153 00:09:46,240 --> 00:09:48,880 Speaker 1: lab but was not a decision maker at the CDC, 154 00:09:49,559 --> 00:09:52,400 Speaker 1: but over the week between Christmas and New Years, he 155 00:09:52,520 --> 00:09:55,920 Speaker 1: started re examining slides from his initial work on the case. 156 00:09:56,880 --> 00:10:01,120 Speaker 1: This research had involved exposing guinea pigs to pttential pathogens, 157 00:10:01,240 --> 00:10:04,920 Speaker 1: and investigators had figured out that there was something in 158 00:10:05,080 --> 00:10:08,600 Speaker 1: patient's lung tissue that could make the guinea pigs sick, 159 00:10:08,720 --> 00:10:12,240 Speaker 1: but which then couldn't be transmitted from one guinea pig 160 00:10:12,280 --> 00:10:12,880 Speaker 1: to another. 161 00:10:13,600 --> 00:10:15,880 Speaker 2: What they hadn't been able to do was to isolate 162 00:10:15,960 --> 00:10:17,679 Speaker 2: and identify this pathogen. 163 00:10:18,360 --> 00:10:21,520 Speaker 1: A few things were working against them here. One is 164 00:10:21,520 --> 00:10:24,640 Speaker 1: that the bacteria involved didn't respond to some of the 165 00:10:24,679 --> 00:10:28,960 Speaker 1: stains being used to prepare the microscope slides. Another was 166 00:10:28,960 --> 00:10:33,120 Speaker 1: how the CDC was focusing its efforts. Microbiologists had been 167 00:10:33,120 --> 00:10:37,360 Speaker 1: trying to rule out specific pathogens using preparations developed to 168 00:10:37,440 --> 00:10:42,640 Speaker 1: grow those particular pathogens. Some of these preparations used antibiotics 169 00:10:42,679 --> 00:10:47,120 Speaker 1: to prevent contamination by other bacteria, but those antibiotics were 170 00:10:47,120 --> 00:10:51,280 Speaker 1: also killing the bacteria that caused the outbreak. When McDade 171 00:10:51,400 --> 00:10:56,040 Speaker 1: did new cultures without those antibiotics, he immediately saw clusters 172 00:10:56,080 --> 00:11:00,520 Speaker 1: of bacteria under his microscope. Some additional steps can confirmed 173 00:11:00,520 --> 00:11:03,640 Speaker 1: that this bacterium had caused the outbreak, and it was 174 00:11:03,720 --> 00:11:06,520 Speaker 1: ultimately named lee Jionella numophila. 175 00:11:07,360 --> 00:11:10,479 Speaker 2: The CDC put out a special issue of the Morbidity 176 00:11:10,520 --> 00:11:14,840 Speaker 2: Immortality Weekly Report on January eighteenth, nineteen seventy seven, to 177 00:11:15,000 --> 00:11:18,720 Speaker 2: announce the discovery of this bacterium, and then a peer 178 00:11:18,760 --> 00:11:21,640 Speaker 2: reviewed paper was published in the New England Journal of 179 00:11:21,760 --> 00:11:25,840 Speaker 2: Medicine in December. McDade was a key part of this, 180 00:11:25,960 --> 00:11:27,760 Speaker 2: but he did not do it all alone. He was 181 00:11:27,800 --> 00:11:31,120 Speaker 2: one of six authors listed on the paper, along with 182 00:11:31,200 --> 00:11:35,880 Speaker 2: the laboratory investigation team. The most likely scenario for how 183 00:11:35,880 --> 00:11:39,280 Speaker 2: this bacterium sickened and killed so many people is that 184 00:11:39,360 --> 00:11:42,280 Speaker 2: it had been growing in the Bellevue Stratford Hotel's air 185 00:11:42,360 --> 00:11:46,160 Speaker 2: conditioning system. When a heat wave moved through Philadelphia in 186 00:11:46,280 --> 00:11:50,240 Speaker 2: July of nineteen seventy six, the air conditioning system started 187 00:11:50,240 --> 00:11:54,520 Speaker 2: working harder, and bacteria laden missed from the cooling towers 188 00:11:54,880 --> 00:11:57,600 Speaker 2: made its way into the hotel and to the street 189 00:11:57,600 --> 00:12:00,600 Speaker 2: and sidewalk below, which is why people who had not 190 00:12:00,720 --> 00:12:05,040 Speaker 2: been in the hotel had also gotten sick. Identifying this 191 00:12:05,200 --> 00:12:09,720 Speaker 2: bacterium also allowed investigators to go back and re examine 192 00:12:09,840 --> 00:12:14,000 Speaker 2: other earlier outbreaks, going back to at least nineteen fifty nine. 193 00:12:14,720 --> 00:12:17,960 Speaker 2: One of these outbreaks had taken place in Pontiac, Michigan, 194 00:12:18,120 --> 00:12:22,120 Speaker 2: in nineteen sixty eight. Ironically, this outbreak took place at 195 00:12:22,240 --> 00:12:24,880 Speaker 2: the health department and more than ninety percent of the 196 00:12:24,920 --> 00:12:28,520 Speaker 2: employees had gotten sick. This included some of the CDC 197 00:12:28,720 --> 00:12:32,599 Speaker 2: investigators who arrived to investigate the outbreak. This was a 198 00:12:32,679 --> 00:12:36,280 Speaker 2: much milder illness, though, and everyone recovered, and that's why 199 00:12:36,360 --> 00:12:39,720 Speaker 2: pontiac fever is given a separate name from Legionnaire's disease. 200 00:12:40,520 --> 00:12:44,080 Speaker 2: These outbreaks led to efforts to better coordinate between the 201 00:12:44,160 --> 00:12:49,359 Speaker 2: CDC and local health authorities and more stringent sanitation standards 202 00:12:49,360 --> 00:12:53,640 Speaker 2: for things like air conditioning systems, swimming pools, and hot tubs. 203 00:12:54,120 --> 00:12:57,840 Speaker 2: But there are still disease outbreaks caused by these bacteria, 204 00:12:58,000 --> 00:13:00,880 Speaker 2: including the one in twenty nineteen at the Mountain State 205 00:13:00,920 --> 00:13:03,760 Speaker 2: Fair in Fletcher, North Carolina that was the one that 206 00:13:03,800 --> 00:13:08,160 Speaker 2: inspired this episode. The final report on that outbreak listed 207 00:13:08,200 --> 00:13:11,640 Speaker 2: one hundred and thirty six cases of Legionnaire's disease with 208 00:13:11,800 --> 00:13:15,560 Speaker 2: ninety six hospitalizations and four deaths, as well as one 209 00:13:15,640 --> 00:13:20,600 Speaker 2: case of pontiac fever. Legionella bacteria occur naturally in soil 210 00:13:20,720 --> 00:13:24,319 Speaker 2: and water. So some cases of Legionnaire's disease and pontiac 211 00:13:24,360 --> 00:13:27,680 Speaker 2: fever have also been traced to things like potting soil. 212 00:13:28,720 --> 00:13:31,320 Speaker 2: Let's take a little sponsor break, and then after that, 213 00:13:31,360 --> 00:13:33,559 Speaker 2: we're going to be talking about an illness that's really 214 00:13:33,600 --> 00:13:36,160 Speaker 2: not for the squeamish, and that also is going to 215 00:13:36,200 --> 00:13:49,240 Speaker 2: include the particularly gross research. Next, we're going to talk 216 00:13:49,280 --> 00:13:53,080 Speaker 2: about something that's not as deadly as Legionnaire's disease, but 217 00:13:53,120 --> 00:13:57,040 Speaker 2: it can still cause serious illnesses and death, especially in 218 00:13:57,200 --> 00:14:02,560 Speaker 2: older people, babies, and people that have other health conditions. However, 219 00:14:02,600 --> 00:14:07,880 Speaker 2: it is miserable. It is neurovirus, also called Norwalk virus, 220 00:14:07,960 --> 00:14:11,520 Speaker 2: and it's probably responsible for more than half of food 221 00:14:11,520 --> 00:14:17,839 Speaker 2: borne illnesses worldwide. Neurovirus causes acute gastroenterritis, which is also 222 00:14:17,960 --> 00:14:21,880 Speaker 2: known as stomach flu, although that is a totally different 223 00:14:22,080 --> 00:14:28,440 Speaker 2: virus from influenza. Neurovirus is a highly infectious RNA virus 224 00:14:28,480 --> 00:14:31,040 Speaker 2: that can live on surfaces for up to two weeks, 225 00:14:31,080 --> 00:14:34,880 Speaker 2: and it's not killed by alcohol based hand sanitizer and 226 00:14:35,040 --> 00:14:39,240 Speaker 2: is resistant to a lot of disinfectants, and that's how 227 00:14:39,240 --> 00:14:41,640 Speaker 2: you wind up with stuff like at least two hundred 228 00:14:41,640 --> 00:14:45,600 Speaker 2: and forty two people getting neurovirus after one player was 229 00:14:45,680 --> 00:14:48,320 Speaker 2: sick court side on the first night of a basketball 230 00:14:48,320 --> 00:14:53,120 Speaker 2: tournament and well meaning attendees did the cleanup without informing 231 00:14:53,120 --> 00:14:56,760 Speaker 2: the custodial staff of what had happened. This virus has 232 00:14:56,840 --> 00:14:59,880 Speaker 2: probably been around for centuries, but the first clear to 233 00:15:00,000 --> 00:15:02,920 Speaker 2: description of the illness was by John Zahorski in nineteen 234 00:15:02,960 --> 00:15:07,400 Speaker 2: twenty nine in a paper titled Hyperemesis higamis, or the 235 00:15:07,440 --> 00:15:11,520 Speaker 2: Winter Vomiting Disease. So Horski was a doctor who described 236 00:15:11,560 --> 00:15:14,560 Speaker 2: a cluster of cases he had seen in Saint Louis. 237 00:15:15,000 --> 00:15:18,680 Speaker 2: He differentiated between respiratory diseases that could also cause gastro 238 00:15:18,760 --> 00:15:22,600 Speaker 2: intestinal symptoms and a disease in which the gastro intestinal 239 00:15:22,640 --> 00:15:26,240 Speaker 2: symptoms were the whole thing. He also noted that this 240 00:15:26,360 --> 00:15:30,480 Speaker 2: disease tended to happen in the winter, although norovirus is 241 00:15:30,520 --> 00:15:33,600 Speaker 2: more common in the colder months, outbreaks can happen at 242 00:15:33,640 --> 00:15:38,800 Speaker 2: any time of the year. Norovirus is named for Norwalk, Ohio, 243 00:15:39,040 --> 00:15:42,200 Speaker 2: where an outbreak struck an elementary school in October of 244 00:15:42,280 --> 00:15:45,760 Speaker 2: nineteen sixty eight. A few people became ill on the 245 00:15:45,840 --> 00:15:49,040 Speaker 2: evening of October twenty ninth, but then a lot more 246 00:15:49,080 --> 00:15:52,520 Speaker 2: people got sick on October thirtieth and thirty first, making 247 00:15:52,560 --> 00:15:56,480 Speaker 2: for a terrible Halloween for all of them. This outbreak 248 00:15:56,600 --> 00:16:00,400 Speaker 2: ultimately sickened half the school that also spread to people's 249 00:16:00,440 --> 00:16:03,320 Speaker 2: family members and their close contacts, with a wave of 250 00:16:03,400 --> 00:16:07,680 Speaker 2: secondary cases from November first through third, and then additional 251 00:16:07,760 --> 00:16:12,720 Speaker 2: illnesses continuing until November seventh. According to the CDC report 252 00:16:12,760 --> 00:16:15,760 Speaker 2: on the outbreak, there were ninety nine primary cases and 253 00:16:15,840 --> 00:16:20,960 Speaker 2: one hundred secondary cases. Everybody recovered, though, and nobody had 254 00:16:21,000 --> 00:16:22,160 Speaker 2: to be hospitalized. 255 00:16:22,760 --> 00:16:27,320 Speaker 1: The CDC investigated this outbreak as well. An obvious possible 256 00:16:27,360 --> 00:16:30,720 Speaker 1: source for an outbreak of gastro intestinal illness is food, 257 00:16:31,240 --> 00:16:33,760 Speaker 1: but students who had brought their lunch from home got 258 00:16:33,800 --> 00:16:36,160 Speaker 1: sick at about the same rate as students who got 259 00:16:36,160 --> 00:16:40,280 Speaker 1: their lunch from the school cafeteria. Tests on the food 260 00:16:40,280 --> 00:16:42,480 Speaker 1: and milk that were still on hand in the cafeteria 261 00:16:43,000 --> 00:16:45,560 Speaker 1: did not show any signs of pathogens. 262 00:16:46,000 --> 00:16:49,840 Speaker 2: Another obvious possibility is water. The school had its own 263 00:16:49,880 --> 00:16:53,160 Speaker 2: well rather than being on a municipal water system, and 264 00:16:53,240 --> 00:16:57,359 Speaker 2: that well was routinely chlorinated. It was checked for coliform 265 00:16:57,440 --> 00:17:01,600 Speaker 2: bacteria that did not reveal anything. A miss but it 266 00:17:01,640 --> 00:17:04,439 Speaker 2: also wasn't enough to totally rule it out as a 267 00:17:04,480 --> 00:17:08,040 Speaker 2: possible source of illness, so the school just used bottled 268 00:17:08,080 --> 00:17:10,719 Speaker 2: water until the well was determined to be safe. 269 00:17:11,280 --> 00:17:13,920 Speaker 1: When the CDC issued a report on this outbreak in 270 00:17:14,000 --> 00:17:17,680 Speaker 1: the Morbidity and Mortality Weekly Report on November twenty third, 271 00:17:18,320 --> 00:17:22,320 Speaker 1: no specific cause had been identified, but the overall conclusion 272 00:17:22,480 --> 00:17:25,280 Speaker 1: was that the primary cases had all come from a 273 00:17:25,320 --> 00:17:29,119 Speaker 1: single source, while the secondary cases had spread from person 274 00:17:29,160 --> 00:17:33,639 Speaker 1: to person starting with those primary cases, and the suspected 275 00:17:33,720 --> 00:17:35,520 Speaker 1: cause was a virus. 276 00:17:35,880 --> 00:17:39,840 Speaker 2: The CDC's write up also reflects some expectations around gender 277 00:17:40,080 --> 00:17:44,440 Speaker 2: and parenting. Quote person to person spread was probably responsible 278 00:17:44,440 --> 00:17:48,199 Speaker 2: for the secondary cases, and consequently one might expect a 279 00:17:48,280 --> 00:17:52,360 Speaker 2: significantly higher attack rate in mothers, who have more intimate 280 00:17:52,440 --> 00:17:56,320 Speaker 2: contact with sick children than in fathers, and a higher 281 00:17:56,359 --> 00:17:59,600 Speaker 2: attack rate in larger families five or more members than 282 00:17:59,640 --> 00:18:03,240 Speaker 2: in small doller families. Although the attack rate in mothers 283 00:18:03,359 --> 00:18:07,240 Speaker 2: thirty seven percent was higher than in father's twenty two percent, 284 00:18:07,640 --> 00:18:12,560 Speaker 2: this difference was not statistically significant. Furthermore, attack rates in 285 00:18:12,680 --> 00:18:16,879 Speaker 2: large and small families were similar. Although researchers could not 286 00:18:17,119 --> 00:18:20,600 Speaker 2: identify the pathogen right away, they did want to confirm 287 00:18:20,640 --> 00:18:23,399 Speaker 2: whether there was an infectious agent at work that was 288 00:18:23,480 --> 00:18:27,800 Speaker 2: shed by sick people and could infect others. This involved 289 00:18:27,800 --> 00:18:30,120 Speaker 2: collecting and preparing what we are just going to call 290 00:18:30,240 --> 00:18:34,040 Speaker 2: the inoculum, which was then given to volunteer test subjects. 291 00:18:34,920 --> 00:18:37,440 Speaker 1: This was not a new idea. The nineteen seventy one 292 00:18:37,480 --> 00:18:41,320 Speaker 1: paper detailing this research cited three prior studies from the 293 00:18:41,400 --> 00:18:44,719 Speaker 1: nineteen forties and fifties that had similarly showed that it 294 00:18:44,760 --> 00:18:50,639 Speaker 1: was possible to transmit non bacterial gastroenteritis this way. Different 295 00:18:50,760 --> 00:18:54,320 Speaker 1: versions of the inoculum were made from samples collected during 296 00:18:54,480 --> 00:18:59,240 Speaker 1: four outbreaks of gastro intestinal illness at the elementary school 297 00:18:59,320 --> 00:19:03,240 Speaker 1: in Norwalco, Ohio, aboard the US Navy ship Shenandoah while 298 00:19:03,240 --> 00:19:06,320 Speaker 1: it was in the Caribbean, and in New Britain, Connecticut, 299 00:19:06,359 --> 00:19:11,840 Speaker 1: and Bethesda, Maryland. The inoculum was presumed to contain something 300 00:19:12,040 --> 00:19:16,520 Speaker 1: non bacterial that was going to cause gastrointestinal illnesses, but 301 00:19:16,640 --> 00:19:19,880 Speaker 1: it also went through a bunch of cultures and safety 302 00:19:19,920 --> 00:19:22,040 Speaker 1: tests to try to make sure that it did not 303 00:19:22,240 --> 00:19:26,320 Speaker 1: contain any other known pathogen that could cause problems or 304 00:19:26,359 --> 00:19:30,720 Speaker 1: other illnesses. Two groups of participants were part of this study. 305 00:19:31,440 --> 00:19:34,480 Speaker 1: Some were men who were incarcerated at the Maryland House 306 00:19:34,520 --> 00:19:37,600 Speaker 1: of Correction in Jessup, Maryland, and others were from the 307 00:19:37,600 --> 00:19:41,600 Speaker 1: Clinical center of the National Institutes of Health. The paper 308 00:19:41,640 --> 00:19:45,520 Speaker 1: detailing this work described all of these participants as volunteers 309 00:19:45,880 --> 00:19:50,280 Speaker 1: who all gave informed consent before participating, but there are 310 00:19:50,560 --> 00:19:53,720 Speaker 1: a lot of caveats around the idea of volunteering for 311 00:19:53,800 --> 00:19:58,560 Speaker 1: medical research in the context of being incarcerated. The Maryland 312 00:19:58,600 --> 00:20:01,919 Speaker 1: House of Correction was also vote notorious for violence and 313 00:20:01,960 --> 00:20:04,720 Speaker 1: harsh treatment of the people incarcerated there. 314 00:20:05,640 --> 00:20:09,359 Speaker 2: Participants were given a complete physical exam, including lots of 315 00:20:09,560 --> 00:20:12,320 Speaker 2: lab work and chest X rays, to confirm that they 316 00:20:12,320 --> 00:20:16,080 Speaker 2: were in good health before being given the inoculum. They 317 00:20:16,080 --> 00:20:20,000 Speaker 2: were also treated with gamma globulin injections to protect them 318 00:20:20,320 --> 00:20:24,199 Speaker 2: in case there was some kind of hepatitis contamination in 319 00:20:24,320 --> 00:20:27,280 Speaker 2: the inoculum that would not have shown up on tests. 320 00:20:27,880 --> 00:20:31,359 Speaker 2: Participants at the prison were isolated in the prison's hospital ward, 321 00:20:31,680 --> 00:20:34,399 Speaker 2: and participants in the clinical center of the nih were 322 00:20:34,440 --> 00:20:36,240 Speaker 2: placed in isolation rooms there. 323 00:20:36,960 --> 00:20:40,399 Speaker 1: The only inoculum that produced illness in this experiment was 324 00:20:40,400 --> 00:20:43,280 Speaker 1: the one that had been prepared from samples collected in 325 00:20:43,359 --> 00:20:48,000 Speaker 1: Norwalk Ohio. Of the three volunteers who received this inoculum, 326 00:20:48,160 --> 00:20:52,040 Speaker 1: two became ill. Then their samples were used to prepare 327 00:20:52,080 --> 00:20:57,480 Speaker 1: additional inoculum, which was administered to additional test subjects. Seven 328 00:20:57,600 --> 00:21:01,680 Speaker 1: of those nine people also became ill. When another round 329 00:21:01,720 --> 00:21:05,159 Speaker 1: of innoculum was prepared from these patients, only one of 330 00:21:05,200 --> 00:21:07,320 Speaker 1: the fore men who received it became ill. 331 00:21:08,280 --> 00:21:11,280 Speaker 2: A paper detailing this research has been described as a 332 00:21:11,400 --> 00:21:15,760 Speaker 2: landmark article in the study of viral gastroenteritis, and it 333 00:21:15,840 --> 00:21:19,080 Speaker 2: created a pretty thorough picture of how this disease could 334 00:21:19,080 --> 00:21:22,800 Speaker 2: spread and what symptoms it could cause, but it still 335 00:21:23,000 --> 00:21:26,879 Speaker 2: was not clear what the actual pathogen was. The paper 336 00:21:27,000 --> 00:21:30,600 Speaker 2: uses the term non bacterial, and some researchers thought the 337 00:21:30,640 --> 00:21:34,520 Speaker 2: illness must be caused by a virus, but others thought 338 00:21:34,520 --> 00:21:38,360 Speaker 2: a virus was unlikely because so many other acute gastro 339 00:21:38,440 --> 00:21:43,360 Speaker 2: intestinal illnesses were caused by known bacteria, including E. Coli 340 00:21:43,520 --> 00:21:47,440 Speaker 2: and salmonilla. The only thing that had been mostly ruled 341 00:21:47,440 --> 00:21:50,920 Speaker 2: out was toxins, because it seemed unlikely that a toxin 342 00:21:51,119 --> 00:21:56,040 Speaker 2: could progressively pass through multiple people's digestive systems to then 343 00:21:56,200 --> 00:22:01,280 Speaker 2: sicken other people. Researchers using immuno electronic roscopy finally got 344 00:22:01,280 --> 00:22:04,760 Speaker 2: a look at a particle measuring twenty seven nanometers in 345 00:22:04,840 --> 00:22:09,359 Speaker 2: samples collected in Norwalk in nineteen seventy two. This made 346 00:22:09,400 --> 00:22:14,840 Speaker 2: neurovirus the first viral gastroenteritis to be conclusively identified, and 347 00:22:14,880 --> 00:22:17,119 Speaker 2: within a few years it was being connected to a 348 00:22:17,160 --> 00:22:21,080 Speaker 2: lot of illnesses. One paper published in nineteen seventy nine 349 00:22:21,200 --> 00:22:25,000 Speaker 2: suggested that a third of the acute gastroenteritis outbreaks that 350 00:22:25,200 --> 00:22:28,280 Speaker 2: didn't have a known cause had likely been caused by 351 00:22:28,320 --> 00:22:33,520 Speaker 2: Norwalk like viruses. Technological developments later in the nineteen seventies 352 00:22:33,560 --> 00:22:36,760 Speaker 2: and into the nineteen eighties allowed researchers to study the 353 00:22:36,840 --> 00:22:40,399 Speaker 2: virus further and some more easily detect and identify it 354 00:22:40,480 --> 00:22:44,240 Speaker 2: in samples during outbreaks, and this also led to efforts 355 00:22:44,240 --> 00:22:49,360 Speaker 2: to identify other viruses that could cause similar illnesses, including rotavirus, 356 00:22:49,680 --> 00:22:55,399 Speaker 2: enteric dentovirus, and astrovirus. Neurovirus's whole genome was sequenced in 357 00:22:55,440 --> 00:22:58,520 Speaker 2: the nineteen nineties, and today it is described as part 358 00:22:58,520 --> 00:23:03,600 Speaker 2: of the Calisaveridae family of viruses. Studying neurovirus continues to 359 00:23:03,640 --> 00:23:06,600 Speaker 2: be challenging, though it's only been within the last few 360 00:23:06,680 --> 00:23:10,160 Speaker 2: years that researchers have found animal species that could potentially 361 00:23:10,200 --> 00:23:13,920 Speaker 2: work as a model for human beings in terms of neurovirus, 362 00:23:14,119 --> 00:23:17,159 Speaker 2: and it has also only been recently that researchers have 363 00:23:17,200 --> 00:23:21,720 Speaker 2: figured out how to cultivate the virus in vitro. These 364 00:23:21,760 --> 00:23:24,240 Speaker 2: are also some of the reasons why there's not yet 365 00:23:24,280 --> 00:23:28,560 Speaker 2: a vaccine for neurovirus. As we said earlier, it can 366 00:23:28,640 --> 00:23:31,960 Speaker 2: be deadly in some people, but for most people it's 367 00:23:32,040 --> 00:23:36,080 Speaker 2: just an extremely unpleasant inconvenience that would be really nice 368 00:23:36,080 --> 00:23:39,480 Speaker 2: to avoid. According to a paper published in the Journal 369 00:23:39,520 --> 00:23:43,720 Speaker 2: of Infectious Diseases in twenty twenty, neurovirus outbreaks in the 370 00:23:43,880 --> 00:23:48,240 Speaker 2: United States costs an estimated seven point six million dollars 371 00:23:48,280 --> 00:23:51,960 Speaker 2: in direct medical costs annually, and then another one hundred 372 00:23:51,960 --> 00:23:56,399 Speaker 2: and sixty five million dollars in loss productivity. Also just 373 00:23:56,440 --> 00:23:59,280 Speaker 2: it's real unpleasant thing to have to go through beyond 374 00:23:59,320 --> 00:24:03,399 Speaker 2: those economic numbers. In addition to all the difficulties in 375 00:24:03,440 --> 00:24:06,760 Speaker 2: studying the virus itself, there are also multiple strains of 376 00:24:06,760 --> 00:24:09,679 Speaker 2: it that shift very rapidly, and that makes the effort 377 00:24:09,720 --> 00:24:11,920 Speaker 2: to create a vaccine even more complicated. 378 00:24:12,480 --> 00:24:16,000 Speaker 1: So there are going to continue to be neurovirus outbreaks 379 00:24:16,080 --> 00:24:20,040 Speaker 1: all around the world for the foreseeable future. They're particularly 380 00:24:20,119 --> 00:24:25,960 Speaker 1: common in places like hospitals, schools, and restaurants. Gastro Intestinal illnesses, 381 00:24:25,960 --> 00:24:29,520 Speaker 1: including neurovirus, are so common on cruise ships that the 382 00:24:29,560 --> 00:24:33,600 Speaker 1: Centers for Disease Control has a whole vessel sanitation program 383 00:24:33,880 --> 00:24:37,720 Speaker 1: to try to prevent and track outbreaks on board. Some 384 00:24:37,760 --> 00:24:41,200 Speaker 1: outbreaks are almost counterintuitive, like there have been a number 385 00:24:41,200 --> 00:24:44,600 Speaker 1: of outbreaks on long distance hiking trails like the Pacific 386 00:24:44,720 --> 00:24:48,320 Speaker 1: Crest Trail and the Appalachian Trail, which are exacerbated by 387 00:24:48,320 --> 00:24:52,240 Speaker 1: people using common latrines and shelters and often relying on 388 00:24:52,359 --> 00:24:56,840 Speaker 1: hand sanitizer rather than soap and water. Let's take a 389 00:24:56,880 --> 00:24:59,360 Speaker 1: quick sponsor break and then talk about on illness that's 390 00:24:59,359 --> 00:25:02,800 Speaker 1: a lot dead than neurovirus, but also not nearly as 391 00:25:02,840 --> 00:25:03,680 Speaker 1: easy to spread. 392 00:25:13,600 --> 00:25:16,040 Speaker 2: The last disease we're going to talk about is one 393 00:25:16,040 --> 00:25:19,560 Speaker 2: that is surrounded by a lot of stigma and fear, 394 00:25:20,000 --> 00:25:24,439 Speaker 2: which is ebola virus disease. Ebolavirus disease is a hemorrhagic 395 00:25:24,600 --> 00:25:28,600 Speaker 2: disease with a high mortality rate. The World Health Organization 396 00:25:28,960 --> 00:25:33,520 Speaker 2: estimates the average at fifty percent, although different species of 397 00:25:33,760 --> 00:25:37,280 Speaker 2: ebolavirus can have very different mortality rates, some of them 398 00:25:37,400 --> 00:25:41,880 Speaker 2: much higher than that. People who survive ebola infection can 399 00:25:41,960 --> 00:25:46,119 Speaker 2: also have long term physical and mental health effects afterward. 400 00:25:46,960 --> 00:25:50,560 Speaker 2: All of this is genuinely scary, which has really contributed 401 00:25:50,640 --> 00:25:53,880 Speaker 2: to that stigma in places that are affected by this disease. 402 00:25:54,560 --> 00:25:58,200 Speaker 2: This includes people who have survived ebola who can continue 403 00:25:58,240 --> 00:26:02,879 Speaker 2: to face stigma and ostrasis after recovering. Since Ibola is 404 00:26:03,000 --> 00:26:07,680 Speaker 2: also found almost entirely in Central and Western Africa, there's 405 00:26:07,720 --> 00:26:10,479 Speaker 2: also a lot of stigma and misinformation about it in 406 00:26:10,640 --> 00:26:14,199 Speaker 2: other parts of the world, based on people's preconceptions and 407 00:26:14,280 --> 00:26:18,880 Speaker 2: biases rather than any actual experience or knowledge about the disease. 408 00:26:19,960 --> 00:26:23,320 Speaker 1: There were two concurrent outbreaks of a Bowla virus disease 409 00:26:23,359 --> 00:26:26,800 Speaker 1: in nineteen seventy six, although at the time it was 410 00:26:26,840 --> 00:26:29,480 Speaker 1: not known that these were caused by two different species 411 00:26:29,480 --> 00:26:32,840 Speaker 1: of the virus, and it seemed like they were probably related. 412 00:26:33,680 --> 00:26:37,240 Speaker 1: One started in the Southern Sudan Autonomous Region, which was 413 00:26:37,320 --> 00:26:40,880 Speaker 1: then part of Sudan but is South Sudan's today. The 414 00:26:40,920 --> 00:26:44,080 Speaker 1: other was in what's now the Democratic Republic of the Congo, 415 00:26:44,280 --> 00:26:45,720 Speaker 1: which was then known as Zaire. 416 00:26:46,480 --> 00:26:50,160 Speaker 2: The first cases in the first known outbreak of ebola 417 00:26:50,320 --> 00:26:54,360 Speaker 2: were reported in workers at a cotton factory in Nzara, 418 00:26:54,520 --> 00:26:57,600 Speaker 2: which is in what's now South Sudan. This is a 419 00:26:57,640 --> 00:27:00,639 Speaker 2: town roughly twenty five kilometers nor the east of the 420 00:27:00,680 --> 00:27:04,520 Speaker 2: border with the DRC. The cotton factory was part of 421 00:27:04,560 --> 00:27:09,240 Speaker 2: a large agricultural cooperative, which was in Zara's primary employer. 422 00:27:09,920 --> 00:27:13,120 Speaker 2: About four hundred and fifty people worked at the cotton factory, 423 00:27:13,440 --> 00:27:18,080 Speaker 2: with about two thousand people employed at the agricultural collective overall. 424 00:27:18,760 --> 00:27:21,960 Speaker 2: The first illnesses were reported in June and July of 425 00:27:22,080 --> 00:27:25,600 Speaker 2: nineteen seventy six in men who worked as storekeepers at 426 00:27:25,600 --> 00:27:29,440 Speaker 2: the cotton factory. These men were connected only through their 427 00:27:29,520 --> 00:27:33,000 Speaker 2: jobs and didn't have any common contacts outside of work. 428 00:27:33,720 --> 00:27:36,600 Speaker 2: The first to become ill eventually went to the hospital 429 00:27:36,640 --> 00:27:40,399 Speaker 2: and died there on July sixth. His brother had taken 430 00:27:40,440 --> 00:27:42,440 Speaker 2: care of him at home and got sick as well, 431 00:27:42,480 --> 00:27:46,159 Speaker 2: but he recovered. The second man to get sick also 432 00:27:46,280 --> 00:27:49,920 Speaker 2: died in the hospital on July fourteenth. His wife had 433 00:27:49,960 --> 00:27:52,320 Speaker 2: taken care of him at the beginning of his illness, 434 00:27:52,680 --> 00:27:56,480 Speaker 2: and she died at their home on July nineteenth. The 435 00:27:56,520 --> 00:27:59,159 Speaker 2: third reported illness was in a man who worked in 436 00:27:59,240 --> 00:28:03,160 Speaker 2: a cloth roam adjacent to the store who got sick 437 00:28:03,280 --> 00:28:06,520 Speaker 2: in mid July, and he also had no other contacts 438 00:28:06,520 --> 00:28:09,320 Speaker 2: with these other two men outside of work, but he 439 00:28:09,440 --> 00:28:12,639 Speaker 2: had a much more active social life than either of 440 00:28:12,680 --> 00:28:16,160 Speaker 2: them did. He had lots of friends, and his friends 441 00:28:16,240 --> 00:28:19,720 Speaker 2: also had lots of friends, and this illness really quickly 442 00:28:19,760 --> 00:28:23,520 Speaker 2: spread among all these friends and acquaintances as people looked 443 00:28:23,520 --> 00:28:26,399 Speaker 2: after each other when they were sick and also just 444 00:28:26,640 --> 00:28:30,520 Speaker 2: visited and checked in on one another. This included the 445 00:28:30,600 --> 00:28:35,280 Speaker 2: virus being introduced into other areas when people traveled, often 446 00:28:35,359 --> 00:28:37,320 Speaker 2: before they realized that they were sick. 447 00:28:38,120 --> 00:28:42,120 Speaker 1: Emola spreads through contact with blood and other bodily fluids, 448 00:28:42,160 --> 00:28:46,240 Speaker 1: and it also causes things like vomiting and hemorrhaging, so 449 00:28:46,280 --> 00:28:49,440 Speaker 1: it can spread easily between patients and the people taking 450 00:28:49,480 --> 00:28:53,080 Speaker 1: care of them, especially if those caregivers don't have access 451 00:28:53,120 --> 00:28:57,800 Speaker 1: to things like protective equipment and disinfectants. This pattern of 452 00:28:57,880 --> 00:29:01,480 Speaker 1: spread also meant that the outbreak in them Tizara eventually 453 00:29:01,600 --> 00:29:04,440 Speaker 1: ended as people started avoiding one another out of fear 454 00:29:04,440 --> 00:29:07,880 Speaker 1: of the illness, and the remaining patients and their caregivers 455 00:29:07,920 --> 00:29:13,440 Speaker 1: either recovered or died. The last reported infection in Nazara 456 00:29:13,480 --> 00:29:16,840 Speaker 1: was on October twenty seventh, nineteen seventy six, and there 457 00:29:16,880 --> 00:29:20,240 Speaker 1: were sixty seven total cases there. By the end of 458 00:29:20,280 --> 00:29:23,800 Speaker 1: this outbreak there thirty seven percent of the workers in 459 00:29:23,840 --> 00:29:27,800 Speaker 1: the cloth factory had been infected. It's likely that the 460 00:29:27,840 --> 00:29:31,360 Speaker 1: initial source of the infection was bats that were living 461 00:29:31,440 --> 00:29:35,120 Speaker 1: in the roof space of the factory, or possibly rats 462 00:29:35,160 --> 00:29:39,280 Speaker 1: that had contracted it from the bats. But on August seventh, 463 00:29:39,360 --> 00:29:42,160 Speaker 1: abola had also been introduced to the town of Meridi, 464 00:29:42,320 --> 00:29:45,360 Speaker 1: about one hundred and fifty kilometers away, when a patient 465 00:29:45,440 --> 00:29:49,000 Speaker 1: was admitted to the hospital there. This patient had been 466 00:29:49,040 --> 00:29:52,240 Speaker 1: close friends with the third worker from the Nazara cotton 467 00:29:52,280 --> 00:29:56,320 Speaker 1: factory who became ill. A second patient from Nazara, who 468 00:29:56,400 --> 00:29:59,600 Speaker 1: was a nurse, was also admitted to the Meridi hospital 469 00:29:59,640 --> 00:30:01,320 Speaker 1: on Allfae August twenty ninth. 470 00:30:01,720 --> 00:30:05,440 Speaker 2: And as this illness started to spread at the hospital, 471 00:30:06,120 --> 00:30:10,960 Speaker 2: conditions there quickly broke down. This was a teaching hospital 472 00:30:11,120 --> 00:30:12,960 Speaker 2: and a lot of the people who got sick were 473 00:30:13,040 --> 00:30:16,480 Speaker 2: nurses and nursing students. By the end of the outbreak 474 00:30:16,520 --> 00:30:20,160 Speaker 2: in Mariti, ninety three of two hundred and thirteen cases 475 00:30:20,200 --> 00:30:24,160 Speaker 2: had been contracted at the hospital. With seventy two of 476 00:30:24,200 --> 00:30:28,920 Speaker 2: those cases, or about seventy seven percent, being among hospital staff. 477 00:30:29,480 --> 00:30:32,719 Speaker 2: This included the doctor in charge and about forty percent 478 00:30:32,800 --> 00:30:37,680 Speaker 2: of the nursing staff, about half of whom died. Understandably, 479 00:30:37,840 --> 00:30:40,840 Speaker 2: patients and staff alike started to be afraid to go 480 00:30:40,880 --> 00:30:43,880 Speaker 2: to the hospital, and that meant the disease continued to 481 00:30:43,920 --> 00:30:47,520 Speaker 2: spread out in the community as people were cared for 482 00:30:47,600 --> 00:30:50,840 Speaker 2: by friends or relatives instead, as they became more and 483 00:30:50,920 --> 00:30:54,720 Speaker 2: more ill, and people with other illnesses and conditions weren't 484 00:30:54,760 --> 00:30:56,880 Speaker 2: able to get the care that they needed because of 485 00:30:56,920 --> 00:31:00,680 Speaker 2: what was happening at the hospital. This disease he also 486 00:31:00,800 --> 00:31:04,000 Speaker 2: spread in the community as people prepared their loved ones 487 00:31:04,120 --> 00:31:05,680 Speaker 2: bodies for their funerals. 488 00:31:06,800 --> 00:31:09,400 Speaker 1: As the disease was starting to spread in the hospital 489 00:31:09,440 --> 00:31:13,800 Speaker 1: at Meridi, another outbreak began in the Yambuku Mission Hospital 490 00:31:14,040 --> 00:31:17,400 Speaker 1: in what's now the Democratic Republic of the Congo. The 491 00:31:17,480 --> 00:31:20,480 Speaker 1: headmaster of the Yumbuku Mission School was admitted to the 492 00:31:20,480 --> 00:31:24,080 Speaker 1: hospital on August twenty sixth with what was believed to 493 00:31:24,120 --> 00:31:27,680 Speaker 1: be a relapse of malaria. He had just returned from 494 00:31:27,680 --> 00:31:30,120 Speaker 1: a two week trip to the area near the border 495 00:31:30,160 --> 00:31:34,920 Speaker 1: with Sudan. He was treated with anti malarial medications by injection, 496 00:31:35,360 --> 00:31:38,920 Speaker 1: and he was discharged on September first, but he returned 497 00:31:38,920 --> 00:31:42,920 Speaker 1: on September fifth after developing a hemorrhagic illness, and he 498 00:31:42,960 --> 00:31:47,800 Speaker 1: died the following day. Another man, whose identity is not known, 499 00:31:48,160 --> 00:31:51,520 Speaker 1: had also been admitted to the hospital on August twenty eighth. 500 00:31:52,000 --> 00:31:56,720 Speaker 1: He was experiencing nosebleeds, dysentery, and fever. He left the 501 00:31:56,760 --> 00:32:00,480 Speaker 1: hospital two days later, even though he was serious ill 502 00:32:00,840 --> 00:32:03,480 Speaker 1: and what happened to him after that is not known. 503 00:32:04,320 --> 00:32:07,800 Speaker 1: Some sources conclude that the headmaster was the index patient 504 00:32:07,880 --> 00:32:10,840 Speaker 1: in this outbreak, while others conclude that it was that 505 00:32:11,080 --> 00:32:15,520 Speaker 1: unknown other patient. It is possible that the headmaster contracted 506 00:32:15,520 --> 00:32:18,720 Speaker 1: abola during his treatment for malaria through a needle or 507 00:32:18,760 --> 00:32:21,200 Speaker 1: a syringe that had been used on the other patient. 508 00:32:22,320 --> 00:32:27,000 Speaker 2: Injections using contaminated needles and syringes became a major source 509 00:32:27,080 --> 00:32:31,120 Speaker 2: of the spread of illness in this outbreak. At the time, 510 00:32:31,360 --> 00:32:34,040 Speaker 2: it was a common practice at the hospital to administer 511 00:32:34,240 --> 00:32:38,200 Speaker 2: a lot of medicines and supplements by injection, including things 512 00:32:38,240 --> 00:32:42,520 Speaker 2: like prenatal vitamins. Some of this was cultural. People generally 513 00:32:42,560 --> 00:32:46,640 Speaker 2: believed that medicines delivered by injection were more powerful and 514 00:32:46,720 --> 00:32:50,480 Speaker 2: worked better than ones that were taken orally, so nurses 515 00:32:50,600 --> 00:32:54,720 Speaker 2: administered more injections than they would have in other contexts. 516 00:32:55,680 --> 00:32:58,880 Speaker 2: This was an impoverished area without a lot of resources, 517 00:32:58,920 --> 00:33:03,960 Speaker 2: including a limited supply of needles and syringes. These were 518 00:33:04,080 --> 00:33:07,360 Speaker 2: rinsed with sterile water between patients, and they were boiled 519 00:33:07,400 --> 00:33:09,560 Speaker 2: at the end of the day, but neither of those 520 00:33:09,600 --> 00:33:14,040 Speaker 2: steps was enough to effectively sterilize them. Roughly a quarter 521 00:33:14,160 --> 00:33:17,440 Speaker 2: of the ebola patients at this hospital had no risk 522 00:33:17,560 --> 00:33:20,880 Speaker 2: factors for the disease other than the injections that they 523 00:33:20,920 --> 00:33:25,000 Speaker 2: received there. As had happened in Mariti, the disease also 524 00:33:25,080 --> 00:33:30,240 Speaker 2: spread from patients to their direct caregivers at the hospital. Ultimately, 525 00:33:30,400 --> 00:33:34,880 Speaker 2: thirteen of the seventeen staff at Yambuku Mission Hospital became ill, 526 00:33:35,320 --> 00:33:39,560 Speaker 2: and eleven of them died. People in Yambuku also contracted 527 00:33:39,560 --> 00:33:43,400 Speaker 2: the illness while preparing people's bodies for their funerals. This 528 00:33:43,440 --> 00:33:48,080 Speaker 2: included the headmaster's mother, wife, mother in law, sister in law, 529 00:33:48,200 --> 00:33:52,080 Speaker 2: and other loved ones. The disease also spread from Yambuku 530 00:33:52,200 --> 00:33:57,000 Speaker 2: to the capital city of Kinshasa. In September of nineteen 531 00:33:57,080 --> 00:34:01,080 Speaker 2: seventy six, doctor Gooi Mishola, who was the district's chief 532 00:34:01,120 --> 00:34:06,320 Speaker 2: medical officer, visited Yambuku and wrote the first clinical description 533 00:34:06,480 --> 00:34:09,319 Speaker 2: of this disease that with description was sent to health 534 00:34:09,360 --> 00:34:14,160 Speaker 2: officials in Kinshase. On September twenty eighth, Belgian physician Jacques 535 00:34:14,160 --> 00:34:17,000 Speaker 2: Corteat took a blood sample from a nun at a 536 00:34:17,040 --> 00:34:21,560 Speaker 2: hospital in Kinshase. He sent this sample to the Institute 537 00:34:21,600 --> 00:34:25,279 Speaker 2: of Tropical Medicine and Antwerp, Belgium, where it was analyzed 538 00:34:25,320 --> 00:34:30,040 Speaker 2: in the microbiology department electron Micross because Vin Jakub spotted 539 00:34:30,080 --> 00:34:33,400 Speaker 2: a Marburg like virus in this sample, and then the 540 00:34:33,440 --> 00:34:38,600 Speaker 2: institute notified the World Health Organization. Marburg virus is named 541 00:34:38,600 --> 00:34:41,760 Speaker 2: for Marburg, Germany, which was the site of an outbreak 542 00:34:41,800 --> 00:34:46,280 Speaker 2: of another hemorrhagic fever in nineteen sixty seven. That nineteen 543 00:34:46,360 --> 00:34:50,880 Speaker 2: sixty seven outbreak also involved Frankfurt, Germany in Belgrade, Serbia, 544 00:34:51,040 --> 00:34:54,080 Speaker 2: and it was connected to contact with monkeys that were 545 00:34:54,200 --> 00:34:55,720 Speaker 2: used in laboratory research. 546 00:34:56,760 --> 00:35:00,279 Speaker 1: Officials from the World Health Organization arrived in Zayu on 547 00:35:00,320 --> 00:35:04,440 Speaker 1: October nineteenth and in Sudan on October twenty ninth, and 548 00:35:04,480 --> 00:35:07,319 Speaker 1: in both places went through similar efforts to work with 549 00:35:07,360 --> 00:35:11,239 Speaker 1: local health officials and medical and nursing staff to investigate 550 00:35:11,280 --> 00:35:16,200 Speaker 1: and contain these outbreaks. This included distributing personal protective equipment 551 00:35:16,320 --> 00:35:19,960 Speaker 1: like gowns, masks, and gloves, and teaching staff how to 552 00:35:20,040 --> 00:35:23,640 Speaker 1: use them Safely. Donning and doffing this kind of protective 553 00:35:23,640 --> 00:35:28,600 Speaker 1: equipment without contaminating anything is a whole process. They also 554 00:35:28,719 --> 00:35:32,799 Speaker 1: taught nursing staff how to thoroughly sterilize needles and other instruments, 555 00:35:33,160 --> 00:35:36,840 Speaker 1: and worked with local leaders and chieftains to identify cases and, 556 00:35:36,960 --> 00:35:41,279 Speaker 1: whenever possible, bring patients to isolation units at a hospital. 557 00:35:41,920 --> 00:35:45,080 Speaker 1: An isolation bard had been built in Mariti just before 558 00:35:45,160 --> 00:35:49,520 Speaker 1: the World Health Organization arrived. Since there was no known 559 00:35:49,680 --> 00:35:53,560 Speaker 1: treatment for this illness, the World Health Organization also collected 560 00:35:53,640 --> 00:35:56,840 Speaker 1: plasma from people who had recovered to see if it 561 00:35:56,840 --> 00:36:01,680 Speaker 1: could be used for therapeutic purposes. This process took time, though, 562 00:36:01,760 --> 00:36:05,000 Speaker 1: since they also needed to develop tests to confirm that 563 00:36:05,040 --> 00:36:10,160 Speaker 1: this plasma didn't contain any active virus. Direct patient care 564 00:36:10,320 --> 00:36:13,719 Speaker 1: was handled by healthcare workers from the local area, while 565 00:36:13,760 --> 00:36:17,360 Speaker 1: the World Health Organization managed things like disease surveillance, tracking, 566 00:36:17,560 --> 00:36:21,840 Speaker 1: education and support. Samples were also sent to facilities that 567 00:36:21,920 --> 00:36:25,920 Speaker 1: had the ability to contain such a dangerous pathogen, including 568 00:36:26,000 --> 00:36:29,279 Speaker 1: the Centers for Disease Control in Atlanta and Porting Down 569 00:36:29,320 --> 00:36:32,920 Speaker 1: in the UK. The virus was eventually determined to be 570 00:36:32,960 --> 00:36:36,640 Speaker 1: in the same family as Marbourg virus. The species of 571 00:36:36,640 --> 00:36:39,560 Speaker 1: a bolovirus that were involved in these two outbreaks are 572 00:36:39,640 --> 00:36:43,960 Speaker 1: now known as Sudan a bolavirus and Zayre a bolavirus. 573 00:36:44,320 --> 00:36:47,160 Speaker 2: By the end of these outbreaks, three hundred eighty one 574 00:36:47,239 --> 00:36:50,680 Speaker 2: people had contracted the disease in what's now the Democratic 575 00:36:50,680 --> 00:36:53,200 Speaker 2: Republic of the Congo, and two hundred and eighty of 576 00:36:53,239 --> 00:36:56,400 Speaker 2: them had died. In Sudan, there were two hundred and 577 00:36:56,480 --> 00:36:59,440 Speaker 2: eighty four cases and one hundred and fifty one deaths. 578 00:37:00,320 --> 00:37:03,879 Speaker 2: There was also one smaller outbreak in this same part 579 00:37:03,960 --> 00:37:06,960 Speaker 2: of South Sudan in nineteen seventy nine, but then after 580 00:37:07,000 --> 00:37:10,920 Speaker 2: that there was really no known ebola activity until nineteen 581 00:37:11,040 --> 00:37:14,480 Speaker 2: ninety four. The nineteen ninety four outbreak kind of revived 582 00:37:14,560 --> 00:37:18,920 Speaker 2: scientific and medical interest in studying the disease. The largest 583 00:37:18,960 --> 00:37:22,600 Speaker 2: ebola epidemic in history took place between twenty fourteen and 584 00:37:22,680 --> 00:37:26,400 Speaker 2: twenty sixteen, when the disease was introduced into more densely 585 00:37:26,480 --> 00:37:30,759 Speaker 2: populated areas in western Africa that had no prior experience 586 00:37:30,880 --> 00:37:31,200 Speaker 2: with it. 587 00:37:32,120 --> 00:37:35,400 Speaker 1: There were more than twenty eight thousand suspected and probable 588 00:37:35,440 --> 00:37:39,680 Speaker 1: cases and more than eleven thousand deaths during this outbreak. 589 00:37:39,719 --> 00:37:42,520 Speaker 1: It was confirmed that a Bola virus can be transmitted 590 00:37:42,560 --> 00:37:45,799 Speaker 1: sexually as well as through direct contact with blood and 591 00:37:45,880 --> 00:37:47,640 Speaker 1: other bodily fluids. 592 00:37:48,040 --> 00:37:53,080 Speaker 2: It's suspected that bats are the natural carrier of this virus, 593 00:37:53,120 --> 00:37:56,640 Speaker 2: although other animals can carry it as well, and in 594 00:37:56,680 --> 00:37:58,960 Speaker 2: addition to the types of transmission that we've talked about 595 00:37:59,000 --> 00:38:02,360 Speaker 2: in this episode, it can also be transmitted when people 596 00:38:02,400 --> 00:38:06,440 Speaker 2: have contact with animals, including when hunting and when butchering 597 00:38:06,480 --> 00:38:11,440 Speaker 2: animals for their meat. Today, a bolavirus disease is treated 598 00:38:11,480 --> 00:38:15,279 Speaker 2: with monoclonal antibodies and supportive care, and there are two 599 00:38:15,719 --> 00:38:21,200 Speaker 2: licensed vaccines for zayre ebolavirus. Carl Johnson, who was part 600 00:38:21,239 --> 00:38:24,600 Speaker 2: of the international commission that formed to investigate and worked 601 00:38:24,600 --> 00:38:27,960 Speaker 2: to control this outbreak, suggested the name of Bolah for 602 00:38:28,000 --> 00:38:32,560 Speaker 2: a river in the Northern Democratic Republic of the Congo. Locally, 603 00:38:32,680 --> 00:38:35,759 Speaker 2: this river is more commonly known by its Bondi name 604 00:38:35,880 --> 00:38:39,400 Speaker 2: of Lake Bala. This name was accepted in nineteen seventy 605 00:38:39,480 --> 00:38:44,480 Speaker 2: seven Johnson reportedly suggested this name because he wanted to 606 00:38:44,560 --> 00:38:49,160 Speaker 2: avoid bringing additional stigma to any of the villages, towns, 607 00:38:49,239 --> 00:38:52,960 Speaker 2: or cities where this outbreak had taken place, and this 608 00:38:53,120 --> 00:38:55,759 Speaker 2: is part of the thought process for how diseases are 609 00:38:55,840 --> 00:38:59,840 Speaker 2: named today. In twenty fifteen, the World Health Organization released 610 00:39:00,080 --> 00:39:05,279 Speaker 2: updated best practices for naming diseases and they specifically discouraged 611 00:39:05,320 --> 00:39:10,759 Speaker 2: the use of geographic locations as well as people's names, industries, foods, 612 00:39:10,800 --> 00:39:14,000 Speaker 2: and animals. And this is because these kinds of names 613 00:39:14,000 --> 00:39:17,080 Speaker 2: for diseases can contribute to a lot of stigma and 614 00:39:17,200 --> 00:39:23,560 Speaker 2: other unnecessary negative effects, including misinformation like monkey pox, which 615 00:39:23,560 --> 00:39:27,640 Speaker 2: has been renamed empos doesn't have anything to do with 616 00:39:27,760 --> 00:39:31,280 Speaker 2: monkeys other than that it had been identified in work 617 00:39:31,360 --> 00:39:35,239 Speaker 2: that involved lab monkeys. The word monkey is connected to 618 00:39:35,360 --> 00:39:39,480 Speaker 2: racist stigma, and then people were sort of folding that 619 00:39:39,600 --> 00:39:43,480 Speaker 2: into their discussions of the disease. And we also all 620 00:39:43,560 --> 00:39:46,200 Speaker 2: just lived through something like this at the start of 621 00:39:46,239 --> 00:39:49,840 Speaker 2: the COVID nineteen pandemic, when people, mostly outside of the 622 00:39:49,880 --> 00:39:53,320 Speaker 2: medical field, used the fact that it was first reported 623 00:39:53,440 --> 00:39:56,920 Speaker 2: in China to stoke a lot of anti Asian racism. 624 00:39:57,400 --> 00:39:58,920 Speaker 2: So there are a lot of these names that are 625 00:39:58,960 --> 00:40:02,439 Speaker 2: still in use, but the best practice now is to 626 00:40:02,480 --> 00:40:07,439 Speaker 2: just name things descriptions of what the illness is, rather 627 00:40:07,480 --> 00:40:09,960 Speaker 2: than connecting it to like a place or a person, 628 00:40:10,680 --> 00:40:12,879 Speaker 2: or an industry or anything like that. 629 00:40:13,400 --> 00:40:14,840 Speaker 1: I have thoughts on this. We'll discuss that. 630 00:40:15,000 --> 00:40:18,400 Speaker 2: Sure, Sure we may have another one of these episodes 631 00:40:18,440 --> 00:40:22,080 Speaker 2: at some point in the future, because I found it interesting. 632 00:40:23,040 --> 00:40:24,439 Speaker 1: Do you have listener mail for us? 633 00:40:24,840 --> 00:40:25,080 Speaker 2: Yes? 634 00:40:25,120 --> 00:40:25,760 Speaker 1: I have email. 635 00:40:25,800 --> 00:40:30,399 Speaker 2: This email is from Carolyn, who wrote about Icelandic volcanoes 636 00:40:30,920 --> 00:40:35,440 Speaker 2: and Norwegian corvids. Carolyn wrote, Hello, Tracy and Holly. Huge 637 00:40:35,480 --> 00:40:38,640 Speaker 2: fan and second time emailer. I finished John Ben and 638 00:40:38,680 --> 00:40:41,960 Speaker 2: the Lucky Fisher episodes yesterday on my commute and had 639 00:40:41,960 --> 00:40:47,200 Speaker 2: to write in again. No pronunciation corrections this time. Carolyn 640 00:40:47,280 --> 00:40:49,080 Speaker 2: is one of the folks who wrote in about how 641 00:40:49,120 --> 00:40:50,960 Speaker 2: to say decalb. 642 00:40:52,200 --> 00:40:53,319 Speaker 1: It's so hard to see it. 643 00:40:53,600 --> 00:40:58,520 Speaker 2: I can't. Yeah, I have a hard time for me too. First, 644 00:40:58,800 --> 00:41:02,040 Speaker 2: I also love and have already visited this year, so 645 00:41:02,120 --> 00:41:05,320 Speaker 2: I won't be joining you. I do have a suggestion 646 00:41:05,480 --> 00:41:07,759 Speaker 2: for another country for a future stuff you miss in 647 00:41:07,840 --> 00:41:10,680 Speaker 2: history class road trip, But more of that in a minute. 648 00:41:10,880 --> 00:41:15,200 Speaker 2: If you haven't already been to the Snifelessness Peninsula in Iceland. 649 00:41:15,360 --> 00:41:17,319 Speaker 2: You may want to go there. I've attached two of 650 00:41:17,320 --> 00:41:20,879 Speaker 2: my favorite seal pictures from our trip there earlier this year. 651 00:41:21,480 --> 00:41:23,320 Speaker 2: I was so excited to hear you talk about the 652 00:41:23,400 --> 00:41:26,719 Speaker 2: Locky Fissure because that was my very first introduction to 653 00:41:26,800 --> 00:41:29,240 Speaker 2: Iceland before my husband and I went for the first 654 00:41:29,239 --> 00:41:32,200 Speaker 2: time just before shut down in March twenty twenty. I 655 00:41:32,280 --> 00:41:36,840 Speaker 2: read Island on Fire by Alexandra Vitz to do some 656 00:41:37,080 --> 00:41:42,120 Speaker 2: quote light geology reading, history reading before arriving. I don't 657 00:41:42,120 --> 00:41:44,440 Speaker 2: know if you use this book in your research for 658 00:41:44,480 --> 00:41:47,920 Speaker 2: the episode, but I highly recommend it. I was fortunate 659 00:41:47,920 --> 00:41:51,840 Speaker 2: to see the chapel dedicated to Jan Steinerson on another trip. 660 00:41:52,120 --> 00:41:55,080 Speaker 2: It's small but cool, but it wasn't open when we stopped. 661 00:41:55,880 --> 00:41:58,160 Speaker 2: I was also so grateful to meet you both in 662 00:41:58,200 --> 00:42:00,920 Speaker 2: person at the recent live episode of and Indie, and 663 00:42:00,960 --> 00:42:03,959 Speaker 2: Holly's mention of crow love reminded me that I hadn't 664 00:42:04,040 --> 00:42:07,919 Speaker 2: yet sent the pictures of Norwegian hooded crows. I think 665 00:42:08,040 --> 00:42:10,759 Speaker 2: they look like they're wearing fluffy vests. My husband is 666 00:42:10,800 --> 00:42:13,560 Speaker 2: Norwegian and I have a lot of topic suggestions for you, 667 00:42:13,600 --> 00:42:16,239 Speaker 2: and wonder if you've considered doing a trip there. It's 668 00:42:16,280 --> 00:42:18,520 Speaker 2: really beautiful and full of history that definitely has not 669 00:42:18,600 --> 00:42:22,280 Speaker 2: made it into many American history books. Carolyn then follows 670 00:42:22,280 --> 00:42:27,520 Speaker 2: with some topic suggestions and says, since I sent pictures 671 00:42:27,520 --> 00:42:30,000 Speaker 2: of my dog Penny, she loves kisses Holly and my 672 00:42:30,040 --> 00:42:33,000 Speaker 2: granddog and kitties last time, my pet taxes some pictures 673 00:42:33,040 --> 00:42:36,200 Speaker 2: of the beautiful hooded crows and icelandic seals, I hope 674 00:42:36,200 --> 00:42:39,280 Speaker 2: you enjoy best. Carolyn, thank you so much for this email. 675 00:42:39,320 --> 00:42:39,680 Speaker 1: Carolyn. 676 00:42:39,760 --> 00:42:42,480 Speaker 2: I did not use that book as part of the 677 00:42:42,560 --> 00:42:45,840 Speaker 2: research for the Locky Fissier eruption episode, but I did 678 00:42:45,920 --> 00:42:49,239 Speaker 2: have a paper by that author that was part of it. 679 00:42:50,360 --> 00:42:55,799 Speaker 2: There were just too many possible resources to use to 680 00:42:55,840 --> 00:42:57,479 Speaker 2: be able to go through all of them. And man, 681 00:42:57,520 --> 00:43:02,080 Speaker 2: these birds are definitely beautiful, and you're right they look 682 00:43:02,160 --> 00:43:05,279 Speaker 2: like they have little white vests on this is I 683 00:43:05,400 --> 00:43:07,920 Speaker 2: don't think this is a place that we visited when 684 00:43:07,960 --> 00:43:10,840 Speaker 2: we were in Iceland last time, and I have not 685 00:43:10,920 --> 00:43:12,759 Speaker 2: looked at a map to see if it is in 686 00:43:12,800 --> 00:43:16,239 Speaker 2: the vicinity of where we will be in November. We 687 00:43:16,360 --> 00:43:18,960 Speaker 2: have mentioned the trip we're taking to Iceland in November 688 00:43:19,000 --> 00:43:21,600 Speaker 2: a couple of times recently. At last check that was 689 00:43:21,640 --> 00:43:24,000 Speaker 2: sold out, but there is a waiting list, and if 690 00:43:24,040 --> 00:43:25,640 Speaker 2: you're curious and maybe you want to see if you 691 00:43:25,640 --> 00:43:28,560 Speaker 2: can get on that waiting list, it is at Defined 692 00:43:28,800 --> 00:43:34,799 Speaker 2: Destinations dot com. So thank you again for sending these 693 00:43:34,840 --> 00:43:37,840 Speaker 2: great pictures in this email, Carolyn. If you would like 694 00:43:37,880 --> 00:43:41,360 Speaker 2: to write to us about this or any other podcast, 695 00:43:41,520 --> 00:43:44,440 Speaker 2: or at History Podcast at iHeartRadio dot com, and you 696 00:43:44,520 --> 00:43:48,239 Speaker 2: can subscribe to the show on the iHeartRadio app or 697 00:43:48,280 --> 00:43:56,480 Speaker 2: wherever else you would like to get your podcasts. Stuff 698 00:43:56,520 --> 00:43:59,280 Speaker 2: you Missed in History Class is a production of iHeartRadio. 699 00:43:59,600 --> 00:44:04,239 Speaker 2: For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, 700 00:44:04,360 --> 00:44:06,400 Speaker 2: or wherever you listen to your favorite shows.