WEBVTT - Ep 7 Hit Me With Your Best (Polio) Shot 0:00:02.759 --> 0:00:05.000 In nineteen ninety two. In February, I was born in 0:00:05.000 --> 0:00:08.560 India in a town talk called Napour. It's basically in 0:00:08.600 --> 0:00:11.000 the dead center of India if you're trying to find it. 0:00:11.480 --> 0:00:15.720 In April of nineteen ninety three, I was brought over 0:00:15.760 --> 0:00:20.200 to the States by airplane and was adapted into a 0:00:20.200 --> 0:00:22.640 family in Saint Louis, Missouri, and I was raised there 0:00:22.840 --> 0:00:27.680 until I was nineteen, and then in twenty eleven I 0:00:27.800 --> 0:00:33.400 moved to Springfield, Illinois for college. So somewhere between four 0:00:33.400 --> 0:00:37.000 and nine months of age one in India, I had polio. 0:00:37.680 --> 0:00:41.239 I also had tuberculosis as well. I was there, so 0:00:41.479 --> 0:00:44.360 we're not sure which one of those came first, but 0:00:44.479 --> 0:00:48.120 very likely one of them weakened my immune system and 0:00:48.440 --> 0:00:52.000 made it so when I had the polio vaccine. 0:00:51.440 --> 0:00:53.520 My body was possibly not able to fight it off. 0:00:53.960 --> 0:00:57.440 Because the records do show that I did get the vaccine. 0:00:57.560 --> 0:01:01.000 The orphanage also has a true of not having the 0:01:01.000 --> 0:01:04.000 best medical records, so there is a chance that maybe 0:01:04.000 --> 0:01:06.080 I was, you know, out getting my diaper changed or 0:01:06.120 --> 0:01:08.280 getting fed, and you know, when they came down the 0:01:08.319 --> 0:01:11.440 row and inoculated every child that I, you know, just 0:01:11.560 --> 0:01:13.880 wasn't there, so I could have just not gotten it either, 0:01:14.080 --> 0:01:16.920 But no other children in the orphans got polio, which 0:01:17.319 --> 0:01:19.800 leads us to think that I possibly got it from 0:01:19.800 --> 0:01:23.520 the vaccine. Growing up with polio. I don't remember having 0:01:23.520 --> 0:01:26.720 it as a child, like as a baby per se, 0:01:26.920 --> 0:01:29.440 but I remember growing up. I remember learning how to walk. 0:01:29.480 --> 0:01:32.000 When I was younger, I had a walker. I went 0:01:32.040 --> 0:01:34.640 to Shiner's Hospitals for Children in Saint Louis, which is 0:01:34.640 --> 0:01:37.080 where I got my leg brace made, and my mom 0:01:37.160 --> 0:01:40.120 can tell you exactly what tiles I took my first 0:01:40.120 --> 0:01:43.280 steps on as a child, and since then I've pretty 0:01:43.319 --> 0:01:47.400 much just been having preventive care, whether that be different braces, 0:01:47.960 --> 0:01:50.120 a couple times I've broken my leg because my lucky 0:01:50.160 --> 0:01:53.960 leg is weaker, or just different surgeries to help correct 0:01:54.120 --> 0:01:56.960 or prevent certain problems from occurring related. 0:01:56.600 --> 0:01:57.200 To the polio. 0:01:57.480 --> 0:01:59.640 And the main one as an adult that I've really 0:01:59.720 --> 0:02:03.880 run into is my official paralysis line is that T 0:02:04.000 --> 0:02:07.960 and I in my spine, and luckily it makes it 0:02:08.040 --> 0:02:12.720 just so my abdomen is weaker, but the actual paralysis. 0:02:12.080 --> 0:02:14.120 Is where my hip is in down. 0:02:14.480 --> 0:02:18.040 So as an adult, I've had issues with chronic UTIs 0:02:18.080 --> 0:02:21.720 a kidney infections secondary to the polio, and I've also 0:02:21.720 --> 0:02:26.120 had issues with arthritis and my joints, but otherwise not 0:02:26.560 --> 0:02:29.480 too terrible, at least for me. When you grow up 0:02:29.600 --> 0:02:32.120 as disabled and it's the only thing that you know 0:02:32.520 --> 0:02:35.560 that's your normal, so it's not anything like there was 0:02:35.600 --> 0:02:38.960 an accident, and I knew what being able bodied was 0:02:39.200 --> 0:02:42.200 versus being disabled, so I never had that, I guess 0:02:42.320 --> 0:02:45.680 annoyance factor there. I just was like, oh, this is 0:02:45.720 --> 0:02:47.520 how I walk, this is how I do things. I 0:02:47.600 --> 0:02:48.959 just do things a little differently. 0:03:02.520 --> 0:03:06.760 So that was an interview that we conducted with a 0:03:06.800 --> 0:03:10.760 girl named Grace, who, as you heard, came down with 0:03:10.800 --> 0:03:14.680 polio as a small child, and so we wanted to 0:03:14.680 --> 0:03:18.000 actually have something unusual, which was an actual first hand 0:03:18.040 --> 0:03:21.280 account instead of me just reading from a piece of paper, 0:03:21.360 --> 0:03:23.000 which is the norm. 0:03:22.840 --> 0:03:27.519 Which is also great, but we like that too, yeah, 0:03:27.520 --> 0:03:29.799 but even better when we can actually hear firsthand from 0:03:29.800 --> 0:03:31.160 somebody who experienced it. 0:03:31.320 --> 0:03:33.680 Yeah. So that was really fascinating and also thank you 0:03:33.760 --> 0:03:35.200 again so much Grace for that. 0:03:35.400 --> 0:03:36.800 Yes, we really appreciate it. 0:03:37.280 --> 0:03:39.840 And if you're just tuning in, this is this podcast 0:03:39.880 --> 0:03:40.480 will kill you. 0:03:40.720 --> 0:03:44.520 Welcome. I'm Aaron Welsh and I'm Erin Olman Updike. It's 0:03:44.520 --> 0:03:45.360 great to have you here. 0:03:45.440 --> 0:03:49.440 Yeah. Thanks, And in case you haven't gathered, this week, 0:03:49.480 --> 0:03:53.440 we are doing polio and let's jump right in. 0:03:53.680 --> 0:03:58.120 Yeah, let's do it. Oh wait, oh wait, it's quarantiney time. 0:03:58.400 --> 0:04:02.080 Yes, my favorite time, mine too. What are we drink 0:04:02.080 --> 0:04:02.560 in this week? 0:04:02.720 --> 0:04:10.160 This week we're drinking the sulk shot salk shot And say, okay, sounds. 0:04:09.880 --> 0:04:13.840 Like so I don't pronounce things. Well, what's in the 0:04:13.840 --> 0:04:14.480 salk shot? 0:04:14.680 --> 0:04:21.279 It is rum, orange liqueur, and lime juice rimmed with 0:04:21.360 --> 0:04:23.320 tahen yep, and we rimed the glass with tahen. 0:04:23.680 --> 0:04:26.120 We're gonna post the full recipe on all the social 0:04:26.160 --> 0:04:30.160 media so you can gather get it there. But I 0:04:30.200 --> 0:04:33.560 do have to note that this was not a true 0:04:33.640 --> 0:04:34.680 quarantini for us. 0:04:34.839 --> 0:04:39.000 We we something weird happened this week, you guys. First 0:04:39.000 --> 0:04:42.599 of all, we don't drink rum very often. No, why 0:04:42.640 --> 0:04:44.520 did we choose to use rum for this? 0:04:44.640 --> 0:04:47.960 Okay? So the reason that I was pushing for rum 0:04:48.120 --> 0:04:53.320 is because FDR, the most famous person with polio, was 0:04:53.880 --> 0:04:59.040 possibly the United States biggest drinker of all of the presidents. 0:04:59.200 --> 0:05:01.960 He was a drinking resident, he truly was. 0:05:01.880 --> 0:05:04.719 And he loved to make cocktails, and rum was one 0:05:04.760 --> 0:05:08.200 of his favorite liquors to mix. But also he made 0:05:08.520 --> 0:05:12.320 the worst cocktails of all time. It has there like 0:05:12.360 --> 0:05:14.880 there are people on record saying the President made the 0:05:14.880 --> 0:05:16.679 worst martini I have ever tasted. 0:05:17.839 --> 0:05:22.479 So our selk shot is not that bad. Actually, no, 0:05:22.720 --> 0:05:25.279 except we don't know that for sure because when we 0:05:25.400 --> 0:05:28.159 tried to make it, it turned out that my bottle of 0:05:28.240 --> 0:05:29.760 rum was water. 0:05:30.320 --> 0:05:31.440 Yeah, that was bizarre. 0:05:31.720 --> 0:05:34.080 And I don't have a sixteen year old living with me, 0:05:34.400 --> 0:05:36.080 so I don't know what's going on. 0:05:37.880 --> 0:05:41.720 So yeah, if you make this, actually make it, because 0:05:41.720 --> 0:05:44.760 we have no realm, we haven't actually tried it, let 0:05:44.839 --> 0:05:46.679 us know how it tastes. 0:05:46.680 --> 0:05:48.960 I'm very curious. So if you guys could make it 0:05:49.040 --> 0:05:51.600 and send us a picture and let us know, that 0:05:51.600 --> 0:05:52.720 would be great. That'd be great. 0:06:05.279 --> 0:06:09.320 Aaron, Yes, Aaron, I want to know about the biology 0:06:09.360 --> 0:06:09.800 of polio. 0:06:10.000 --> 0:06:11.919 I want I tell you all about it. Are you 0:06:11.960 --> 0:06:12.440 ready for this? 0:06:12.760 --> 0:06:14.880 I'd better be so. 0:06:15.120 --> 0:06:19.840 Poliomyelitis, or polio for short, is a disease that is 0:06:19.880 --> 0:06:23.280 caused by the poliovirus. That's the first thing you might 0:06:23.279 --> 0:06:23.680 have learned. 0:06:23.760 --> 0:06:25.920 Okay, check check, it's a virus. 0:06:27.400 --> 0:06:30.400 Poliovirus is an RNA virus. So if you remember that 0:06:30.520 --> 0:06:34.279 viruses are basically just genetic material surrounded by protein. Polio's 0:06:34.360 --> 0:06:37.600 genetic materials RNA and it's surrounded by a protein capsid. 0:06:38.560 --> 0:06:42.880 Polioviruses are related to enteroviruses, which are super common viruses 0:06:42.960 --> 0:06:46.480 that often cause stomach illnesses like vomiting, sort of stomach 0:06:46.520 --> 0:06:49.720 flu type illnesses, and also can cause upper respiratory illnesses. 0:06:50.320 --> 0:06:52.640 And they're also in the same family as the virus 0:06:52.760 --> 0:06:55.440 that causes the common cold, rhinoviruses. 0:06:55.760 --> 0:06:56.240 Interesting. 0:06:56.640 --> 0:07:01.440 Yeah, polioviruses are physically capable of an affecting other primates, 0:07:02.160 --> 0:07:06.720 but they are really a human specific virus in general. Okay, 0:07:06.760 --> 0:07:08.080 poliovirus itself. 0:07:08.440 --> 0:07:13.120 So, for instance, would you find another primate in the 0:07:13.160 --> 0:07:16.080 wild that has poliovirus or just humans? Right? 0:07:16.200 --> 0:07:19.040 No, you wouldn't. You only find humans naturally infected. We 0:07:19.080 --> 0:07:22.160 can infect animals in the lab that are other primates, 0:07:22.240 --> 0:07:25.760 and also certain lines of mice that we've mutated. Okay, anyways, 0:07:25.800 --> 0:07:31.160 there are three distinct zero types of the poliovirus poliovirus one, two, 0:07:31.160 --> 0:07:31.520 and three. 0:07:31.600 --> 0:07:32.680 Oh, that's easy to remember. 0:07:32.720 --> 0:07:35.920 I love it, love it when it's easy, keep it simple. 0:07:36.160 --> 0:07:42.000 These three zerotypes are antigenically distinct. So antigens again are 0:07:42.040 --> 0:07:44.880 the outside proteins that are on the surface of the 0:07:44.960 --> 0:07:49.120 virus that our bodies use to find them. So these 0:07:49.280 --> 0:07:53.240 three zerotypes are different enough that infection with one zero 0:07:53.280 --> 0:07:57.760 type of polio does not confer immunity to the other zerotypes, and. 0:07:57.640 --> 0:08:02.080 That's important in terms of vaccine developing vaccine. 0:08:01.800 --> 0:08:04.440 Definitely, big time, big time. Yeah, So the vaccines that 0:08:04.480 --> 0:08:07.520 are used are trivalent vaccines, so they cover all three 0:08:07.600 --> 0:08:11.760 zero types like try yeah, try valent, try harder. Just kidding. 0:08:14.040 --> 0:08:18.440 So poliovirus one is the most common. And something that's 0:08:18.480 --> 0:08:20.840 kind of cool is that poliovirus two has actually been 0:08:20.880 --> 0:08:24.960 declared eradicated, so there's no wild circulating poliovirus two. 0:08:25.160 --> 0:08:26.200 Whoa, that's super cool. 0:08:26.280 --> 0:08:27.240 Yeah, it's pretty exciting. 0:08:27.360 --> 0:08:29.560 And do these guys, Sorry from jumping the gun, but 0:08:29.640 --> 0:08:33.439 do these guys differ in their virulence or infectivity? 0:08:33.520 --> 0:08:35.679 Great question. I actually couldn't find a lot of good 0:08:35.720 --> 0:08:37.480 information on that. Do you know the answer? 0:08:37.880 --> 0:08:39.640 Well, I know that they do, but I don't know 0:08:39.679 --> 0:08:41.760 which is more virulent or infectious. 0:08:41.840 --> 0:08:44.640 Yeah, so I know that poliovirus type one is by 0:08:44.880 --> 0:08:48.480 far the most common, and then type two I think 0:08:48.559 --> 0:08:50.200 was the least common, So that's the one that has 0:08:50.200 --> 0:08:51.120 now been eradicated. 0:08:51.200 --> 0:08:54.360 Okay, and these are geographically distinct, like that is why 0:08:54.360 --> 0:08:55.559 they're geah Type one, two and three. 0:08:55.640 --> 0:08:58.040 Yeah, they tend to be in different geographic areas, but 0:08:58.080 --> 0:09:00.680 poliovirus one was overall like a cross the globe. Most 0:09:00.679 --> 0:09:05.320 common poliovirus is transmitted fecal oral just like cholera, so 0:09:05.440 --> 0:09:09.800 you have to actually ingest poopiness to get infected. There's 0:09:09.840 --> 0:09:12.560 a small chance that you can transmit it by coughing 0:09:12.600 --> 0:09:15.559 if you have an infection in your upper gastro intestinal tract, 0:09:15.559 --> 0:09:19.280 but it's pretty not very common, so you can imagine that, 0:09:19.360 --> 0:09:23.600 similar to cholera, the burden was historically and still tends 0:09:23.600 --> 0:09:27.280 to be heaviest in countries that have poor sanitation. But 0:09:27.400 --> 0:09:30.280 another important thing about polio that makes it very different 0:09:30.320 --> 0:09:32.920 from something like cholera is that it's considered a disease 0:09:32.960 --> 0:09:35.480 of childhood, so it tends to affect children that are 0:09:35.600 --> 0:09:38.199 under the age of five. And the reason for this, 0:09:38.440 --> 0:09:41.880 besides the fact that children are constantly shoving poop covered 0:09:41.880 --> 0:09:46.040 stuff in their mouths. Is that infection with poliovirus provides 0:09:46.080 --> 0:09:49.280 a lifetime immunity only to the strain that you're infected with, 0:09:49.480 --> 0:09:52.480 but unlike some other diseases, immunity to polio is very 0:09:52.480 --> 0:09:53.120 long lasting. 0:09:53.559 --> 0:09:57.240 And so when you talk about the infection prevalence being 0:09:57.320 --> 0:09:59.640 highest in children under the age of five, that is 0:10:00.360 --> 0:10:04.319 or recent polio infection prevalences. 0:10:03.720 --> 0:10:07.320 Or historically as well historically as yeah, okay, yeah, So 0:10:07.360 --> 0:10:09.800 it was always considered a disease of childhood, so people 0:10:09.840 --> 0:10:11.800 who were not that you couldn't get it when you 0:10:11.880 --> 0:10:14.920 were older, but you were probably exposed when you were 0:10:15.000 --> 0:10:17.520 very young, and then once you got infected, you had 0:10:17.520 --> 0:10:20.360 lifetime immunity. Right, So you could in theory be infected 0:10:20.400 --> 0:10:22.520 with other zero types, but if you lived in the 0:10:22.559 --> 0:10:26.280 same geographic region, there's probably in most regions, aren't multiple 0:10:26.320 --> 0:10:30.160 strains circulating. Okay, So about seventy five percent of people 0:10:30.160 --> 0:10:34.600 who get infected with poliovirus are totally asymptomatic. Seventy five 0:10:34.679 --> 0:10:37.400 seventy five percent. I saw estimates as high as ninety five, 0:10:37.440 --> 0:10:40.520 but I don't believe them. I believe the WHO and 0:10:40.559 --> 0:10:45.160 the CDC fair enough. Similar to cholera, though these asymptomatic 0:10:45.240 --> 0:10:47.800 people can still shed virus in their stool, so they 0:10:47.840 --> 0:10:51.480 still could be infecting others. The incubation period is around 0:10:51.520 --> 0:10:54.559 seven to ten days, but actually can vary from four 0:10:55.000 --> 0:10:58.640 to as long as thirty five, which is crazy to me. 0:10:59.080 --> 0:11:00.559 That's such a huge Well. 0:11:00.760 --> 0:11:02.600 I read that it had something to do with the 0:11:02.640 --> 0:11:04.920 amount of time that it takes to make it up 0:11:05.000 --> 0:11:07.880 to the central nervous system, and so for very tall people, 0:11:08.000 --> 0:11:10.400 your incubation period would be longer. Oh my god, are 0:11:10.440 --> 0:11:13.319 you serious, that's what I read something. Oh that's funny. Yeah, 0:11:13.320 --> 0:11:15.560 I never I guess I didn't think about that because 0:11:15.840 --> 0:11:20.679 this is only for symptomatic cases. Obviously, the incubation period, right, 0:11:20.720 --> 0:11:22.880 because incubation period again is the time from when you're 0:11:22.880 --> 0:11:25.520 infected to when you show symptoms, So most people don't 0:11:25.559 --> 0:11:26.120 really have an. 0:11:26.000 --> 0:11:28.920 Incubation period because they don't have symptoms. 0:11:29.280 --> 0:11:32.400 Yeah, seventy five percent, right, interesting. 0:11:31.960 --> 0:11:35.040 That is interesting. So also similar to what we saw 0:11:35.040 --> 0:11:37.520 in colera, people start shedding virus in their poop a 0:11:37.559 --> 0:11:41.000 few days before symptoms start, and they continue to shed 0:11:41.040 --> 0:11:42.920 for at least one to two weeks, though I saw 0:11:42.960 --> 0:11:45.880 some estimates that they can shed for up to four 0:11:45.920 --> 0:11:49.240 to six weeks, which is a really long time. So 0:11:49.360 --> 0:11:53.079 undoubtedly that's something that has made polio more difficult to control, 0:11:53.160 --> 0:11:55.719 is how long you are shedding. And this very high 0:11:55.800 --> 0:11:59.680 rate of asymptomatic cases as well, So seventy five percent 0:11:59.720 --> 0:12:02.120 of people are asymptomatic, and then the other twenty five 0:12:02.160 --> 0:12:04.720 percent of people who get infected, most of them end 0:12:04.800 --> 0:12:09.240 up with a relatively mild illness, fever, headaches, sore throat, 0:12:09.520 --> 0:12:13.080 maybe some nausea, stomach ache, vomiting since this does infect 0:12:13.080 --> 0:12:19.640 your gastrointestinal tract right fecal oral. But you're here aaron, yeah, 0:12:19.679 --> 0:12:25.960 and listeners to hear about poliomyelitis, Oh yes, aka polio. 0:12:26.960 --> 0:12:27.040 So. 0:12:27.360 --> 0:12:31.760 Poliomyelitis is the disease that happens in less than one 0:12:31.840 --> 0:12:34.960 percent of people who get infected with the poliovirus, about 0:12:34.960 --> 0:12:38.559 one in two hundred cases. This happens when the poliovirus 0:12:38.679 --> 0:12:42.520 exits your gut and travels to your central nervous system, 0:12:42.960 --> 0:12:45.000 where it attacks your motor neurons. 0:12:45.520 --> 0:12:49.600 Can I just throw something in here right now? Please 0:12:49.640 --> 0:12:54.079 do the etymology of poliomyelitis. Well, I'm gonna what are 0:12:54.080 --> 0:12:56.760 you gonna say it? Okay? Sorry, no, you go go 0:12:57.600 --> 0:12:58.240 give it to me. 0:12:58.360 --> 0:12:58.760 I love it. 0:12:58.840 --> 0:13:04.520 Okay. It's from the Greek polios meaning gray and muelos 0:13:04.679 --> 0:13:10.360 i guess, meaning marrow, and itis meaning inflammation, and so 0:13:11.000 --> 0:13:14.120 it refers to the inflammation in the gray matter of 0:13:14.160 --> 0:13:16.880 the spinal cord yiches causes the paralysis. 0:13:16.960 --> 0:13:20.880 Yeah, exactly. So myelitis is essentially an infection of the 0:13:20.920 --> 0:13:24.200 central nervous system, so you can get myelitis from other 0:13:24.240 --> 0:13:28.719 things as well, But poleomyelitis is myolitis caused by the poliovirus. 0:13:30.040 --> 0:13:35.400 Thanks for that. Sorry, No, don't be sorry. So sometimes 0:13:35.480 --> 0:13:39.880 the paralysis can be reversible, but often it is not. 0:13:40.880 --> 0:13:43.679 And of these paralytic cases, about five to ten percent 0:13:43.720 --> 0:13:47.040 of them are fatal because the paralysis affects the diaphragm 0:13:47.120 --> 0:13:50.280 or intercostal muscles, which are the muscles in between your 0:13:50.320 --> 0:13:53.360 ribs that are responsible for respiration, so you can't breathe. 0:13:53.679 --> 0:13:57.880 And was there a treatment for those cases? Eventually? 0:13:57.960 --> 0:14:00.719 Oh, I believe you may have heard of it, the 0:14:00.760 --> 0:14:04.440 iron lung. Are you gonna tell us a bit about 0:14:04.440 --> 0:14:05.800 the iron lung later? No? 0:14:06.080 --> 0:14:09.560 Oh, dang, I mean there's so much that polio has 0:14:09.600 --> 0:14:12.079 such a rich history that it is. I mean, it's 0:14:12.080 --> 0:14:12.920 a very important part. 0:14:13.000 --> 0:14:14.319 It's hard to pick and choose, right. 0:14:14.360 --> 0:14:18.920 Basically, the iron lung was a huge machine that was 0:14:19.160 --> 0:14:22.280 used to treat the patients whose diaphragm who could no 0:14:22.320 --> 0:14:26.040 longer breathe because their muscles had become paralyzed, and so 0:14:26.120 --> 0:14:30.600 it breathes for them using like a pressurized and depressurized rhythm. 0:14:31.000 --> 0:14:33.880 And there are still people that are in iron lungs today. 0:14:33.960 --> 0:14:36.840 Yeah, there's actually a video that's been making the rounds 0:14:36.880 --> 0:14:39.400 on social media, and we'll post it to our social 0:14:39.440 --> 0:14:41.480 media account as well in case you haven't seen it yet. 0:14:41.520 --> 0:14:43.560 That's about some of the last people that are still 0:14:43.600 --> 0:14:47.440 living today in an iron lung, because that's pretty interesting. So, 0:14:47.640 --> 0:14:51.880 most of the time in paralytic poleomyolitis, it's some part 0:14:51.920 --> 0:14:54.640 of the spinal cord that's attacked, so you might lose 0:14:54.680 --> 0:14:57.440 function of a limb, or you might lose function entirely 0:14:57.480 --> 0:15:00.000 in a region inferior to where the motor neurons were damaged. 0:15:00.200 --> 0:15:03.920 But the fatal cases are often because the virus infects 0:15:03.920 --> 0:15:06.400 the brain stem, and when you infect the brain stem, 0:15:06.680 --> 0:15:11.600 you can affect the cranial nerves, which again can affect breathing, swallowing, speaking, 0:15:11.920 --> 0:15:14.720 So yeah, Basically, the virus infiltrates and just destroys your 0:15:14.760 --> 0:15:17.440 motor neurons. So it's really sad. 0:15:17.560 --> 0:15:18.240 That's horrible. 0:15:18.720 --> 0:15:21.800 And if that's not horrible enough, oh great, the idea 0:15:21.840 --> 0:15:25.760 of tiny babies losing function in their limbs. And there's 0:15:25.800 --> 0:15:29.160 also post polio syndrome, which is a combination of symptoms 0:15:29.160 --> 0:15:33.240 that include progressive muscle weakness, fatigue, and pain from joint 0:15:33.240 --> 0:15:36.000 degeneration that can happen in about twenty five to forty 0:15:36.040 --> 0:15:40.720 percent of poleomyelitis cases, and this happens fifteen to forty 0:15:41.040 --> 0:15:42.800 years after infection. 0:15:43.360 --> 0:15:46.360 So just to go back to relate this back to 0:15:46.480 --> 0:15:51.320 polio infection, overall of the cases that are actually symptomatic 0:15:51.600 --> 0:15:54.800 of polio, there are a very small proportion of them 0:15:54.800 --> 0:15:58.480 that actually get poliomyelitis correct, and of those, it's the 0:15:58.520 --> 0:15:59.840 twenty five to forty percent that you're. 0:15:59.760 --> 0:16:02.680 Talking exactly, So twenty five to forty percent of people 0:16:02.720 --> 0:16:08.280 who end up with poliomyelitis that neuron involvement can go 0:16:08.360 --> 0:16:11.760 on to have post polio syndrome, and this happens fifteen 0:16:11.760 --> 0:16:14.480 to forty years after infection. So if you imagine you 0:16:14.520 --> 0:16:18.200 get polio as a baby, fifteen to forty years later, 0:16:18.240 --> 0:16:21.160 you can end up with these very in some cases, 0:16:21.240 --> 0:16:25.320 very severe and debilitating muscle symptoms, and there isn't really 0:16:25.360 --> 0:16:27.640 anything to do to prevent it, and there's not much 0:16:27.680 --> 0:16:30.080 that you can do to cure it. And from what 0:16:30.160 --> 0:16:33.920 I understand, it's not like the poliovirus is still sitting 0:16:33.960 --> 0:16:37.480 there alive in your nervous system or anything like that. 0:16:37.600 --> 0:16:41.280 It's not like herpes virus, for example, like with chicken pox, 0:16:41.280 --> 0:16:45.040 where it can re emerge as shingles. The best explanation 0:16:45.160 --> 0:16:49.960 that I've seen is that when polio attacks your motor neurons, 0:16:50.040 --> 0:16:52.760 it might not destroy all of your motor neurons, so 0:16:52.800 --> 0:16:56.000 you're left with a subset of functioning neurons and then 0:16:56.080 --> 0:16:59.560 these neuronal cell bodies, because your neurons are basically a 0:16:59.600 --> 0:17:03.240 cell body with fibers sticking out of it, then the 0:17:03.280 --> 0:17:06.280 cell bodies that are left will sprout new fibers to 0:17:06.440 --> 0:17:09.960 reinnervate the muscles that have previously lost function. But then 0:17:10.040 --> 0:17:13.600 over time, these cell bodies are essentially working way harder 0:17:13.640 --> 0:17:16.480 than a cell body would otherwise have to work, and 0:17:16.520 --> 0:17:19.920 so over time they may weaken or end up dying themselves. 0:17:20.080 --> 0:17:23.040 Right, So it's like rapid aging of your. 0:17:23.960 --> 0:17:26.680 Yeah, and so that's why you have this very late 0:17:26.760 --> 0:17:30.400 onset and it's a very progressive weakening of your muscles. 0:17:31.440 --> 0:17:33.640 From what I understand, it's not one hundred percent sure 0:17:33.640 --> 0:17:36.119 that that's the explanation, but that's the best that people 0:17:36.160 --> 0:17:38.719 have been able to come up with. Yeah, things like 0:17:38.760 --> 0:17:41.880 the severity of the initial infection, the age at which 0:17:41.920 --> 0:17:45.119 you were infected. And the thing I found really interesting 0:17:45.200 --> 0:17:48.280 is how well you recovered all affect whether or not 0:17:48.320 --> 0:17:52.440 you end up getting post polio syndrome. The better your recovery, 0:17:52.760 --> 0:17:55.399 the more likely you end up with post polio syndrome. 0:17:55.560 --> 0:17:56.080 Interesting. 0:17:56.240 --> 0:17:57.639 Yeah, and I think that's one of the things that 0:17:57.680 --> 0:18:00.879 helps support this hypothesis that if you covered really well, 0:18:01.240 --> 0:18:04.160 then your neurons regenerated a lot and then they're really 0:18:04.200 --> 0:18:07.280 working over time. Is that interesting? Yeah? That that was 0:18:07.480 --> 0:18:10.520 very very cool, I mean not cool, very it's a 0:18:10.600 --> 0:18:14.840 very interesting side effect of an infection with a virus like. 0:18:14.800 --> 0:18:18.720 This, particularly when it's no longer in your system rightaculating. 0:18:19.080 --> 0:18:21.960 Yeah. So I think that's everything about the biology. Any 0:18:22.040 --> 0:18:25.520 questions not yet good, but. 0:18:27.040 --> 0:18:38.720 We'll see. So I guess then that means that it's 0:18:38.760 --> 0:18:44.639 time for me right. Yes, it seems like I always 0:18:44.760 --> 0:18:48.000 start off the history part by saying, oh, well, the 0:18:48.000 --> 0:18:53.000 first recorded instance of whatever disease was in Egypt, and 0:18:53.200 --> 0:18:58.040 today is going to be no difference. Yeah. Yeah. There 0:18:58.080 --> 0:19:02.480 are illustrations dating from Egypt in fourteen hundred BC that 0:19:02.560 --> 0:19:05.320 show people with withered limbs and a dropped foot, which 0:19:05.359 --> 0:19:07.399 is particularly characteristic of polio. 0:19:07.680 --> 0:19:08.240 Wow. 0:19:08.560 --> 0:19:13.520 So it's been around for millennia. But it's interesting because 0:19:13.600 --> 0:19:17.560 it really didn't start to re emerge or be noted 0:19:17.640 --> 0:19:22.000 in literature or in historical accounts of the day until 0:19:22.119 --> 0:19:25.760 the seventeenth century. Then it was more just like case 0:19:25.800 --> 0:19:29.399 by case or describing a disease overall. It wasn't really 0:19:29.440 --> 0:19:31.200 in reference to epidemics. 0:19:31.560 --> 0:19:32.000 Huh. 0:19:32.000 --> 0:19:36.640 Interesting, So descriptions of matching clinical signs of polio show 0:19:36.680 --> 0:19:39.840 up in the seventeenth century. This is in contrast with 0:19:39.920 --> 0:19:42.560 many of the other diseases that we've talked about so far, 0:19:43.160 --> 0:19:45.639 all of which have kind of popped up in epidemic 0:19:45.760 --> 0:19:49.879 form at some point or another or multiple times, or 0:19:49.920 --> 0:19:52.920 at least, like leprosy, have left enough of an impact 0:19:53.080 --> 0:19:56.520 that they're written about throughout history. One of the thoughts 0:19:56.640 --> 0:20:01.000 as to why polio wasn't an epidemic disease has to 0:20:01.040 --> 0:20:05.800 do with sanitation. Prior to wide scale water treatment and 0:20:05.840 --> 0:20:09.720 sanitation measures, children were probably exposed to polio at a 0:20:09.840 --> 0:20:14.440 very young age, experienced a minor infection, or the vast 0:20:14.480 --> 0:20:18.119 majority of them did, and then it also recovered and 0:20:18.160 --> 0:20:21.399 had lifetime immunity. Obviously, there was a proportion of these 0:20:21.440 --> 0:20:25.160 individuals who became partially paralyzed as a result of infection 0:20:25.480 --> 0:20:29.360 or died or died, but studies done in the twentieth 0:20:29.400 --> 0:20:32.480 century prior to the introduction of the vaccine showed that 0:20:32.520 --> 0:20:37.320 the case fatality rate and case paralysis rate was highest 0:20:37.359 --> 0:20:40.600 in the very young, so like under a year, and 0:20:40.640 --> 0:20:43.120 then it dropped in young children like under the age 0:20:43.119 --> 0:20:46.200 of five, and then it rose in adolescents and adults 0:20:46.800 --> 0:20:51.240 like a checkmark. Which is really interesting. And this seems 0:20:51.280 --> 0:20:53.600 to suggest that the older you are when you first 0:20:53.680 --> 0:20:56.320 encounter polio, the more devastating it could be. 0:20:56.280 --> 0:20:58.400 And the more likely you were to get post polio syndromes. 0:20:58.480 --> 0:21:02.479 So that makes sense. Probably I actually know why that 0:21:02.640 --> 0:21:07.080 is because as a child, your nerves are really good 0:21:07.080 --> 0:21:10.680 at regenerating and so the older you get, the less 0:21:10.720 --> 0:21:13.240 good they are at regenerating. That makes sense, and except 0:21:13.280 --> 0:21:15.080 that when you're a tiny baby infant, you have no 0:21:15.119 --> 0:21:17.840 immune system and so you can't fight anything off. So 0:21:18.040 --> 0:21:20.439 tiny babies are going to die. Little kids are going 0:21:20.520 --> 0:21:22.840 to be okay for the most part, and then as 0:21:22.840 --> 0:21:24.639 you get older, you're not going to be able to recover. 0:21:25.640 --> 0:21:29.600 Got that medical degree for something, Hey, working on it. 0:21:29.640 --> 0:21:37.680 That's real interesting. It's only a matter of years. Yeah, So, 0:21:37.680 --> 0:21:41.879 so these epidemics were probably able to occur in the 0:21:41.880 --> 0:21:46.119 twentieth century as sanitation measures increased, the interesting and the 0:21:46.160 --> 0:21:51.000 population of already exposed people decreased, so that polio could 0:21:51.080 --> 0:21:52.800 tear through an unexposed community. 0:21:52.840 --> 0:21:54.960 That is so fascinating. 0:21:56.000 --> 0:21:59.080 It's kind of like a disease of sanitation, right, unlike 0:21:59.119 --> 0:22:02.400 a disease that we see like with cholera, where the 0:22:02.440 --> 0:22:04.280 lower the sanitation measures. 0:22:03.880 --> 0:22:06.359 And it kind of goes It's a middle ground, right, 0:22:06.400 --> 0:22:09.960 because you have to have good sanitation so that you're clean. 0:22:10.040 --> 0:22:13.320 If you have really really great sanitation, then you're not 0:22:13.400 --> 0:22:17.200 going to have fecal oral contact very often. But then 0:22:17.320 --> 0:22:19.560