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welcome to a special extended edition of
prognosis daily coronavirus I'm Jason
Gale a senior editor with Bloomberg News
now that the coronavirus has become a
household name we want to take a deeper
look into how pandemics spread if you
want to learn more about what's
happening today today when it comes to
the corona virus be sure to check out
our feed for our daily podcast but on
this episode we're diving deep into the
scary world of pandemics what are they
exactly where do they come from and why
are they occurring more frequently we're
going to meet some of the world's most
experienced pandemic experts the men and
women on the front lines of the battle
to contain covert 19 and other global
scourge 'as dr. Michael Ryan is like the
chief firefighter of global health few
people are busier than this burly
affable Irishman Mike leads the
Emergencies program at the World Health
Organization the United Nations agency
has provided specialist technical advice
and set guidelines and standards on
international health matters since 1948
Mike is also the crisis manager of a
United Nations team to address the
pneumonia causing disease that erupted
in China at the end of last year covered
19 triggered a global health emergency
and made coronavirus the virus that
causes it a household name
over 19 is the latest and possibly most
important outbreak that mike has ever
tried to extinguish for almost 25 years
he's been at the forefront of some of
the most significant disease outbreaks
the jobs taken him across central Africa
for more than a dozen Ebola epidemics
alone but never in his career as he
faced such a rapid spreading novel
disease on a global scale
it's also a job he never expected to be
doing
mic set out in life to become an
orthopedic surgeon but a terrible
motorcycle accident in his 20s
intervened while recuperating from a
broken back he recalled an earlier stint
in Kenya and how he could apply his
skills in public health instead they
chose to throw me into public health but
was my grandmother once said to me
Bonnie a grandmother can say this
probably the best thing that ever
happened to your song you know Mike
wound up working with doctor David
Heyman
he's like them Mick Jagger of disease
detectives before becoming a professor
of infectious disease epidemiology in
London David tackled smallpox polio
Ebola and Legionnaires disease just to
mention a few in the early 2000s David
led the World Health Organization's
response to severe acute respiratory
syndrome or SARS he was working at the
whu-oh in Geneva when he was introduced
to Mike Ryan David had been asked by the
director-general to set up a program in
emerging infectious diseases he was
looking over some epidemiological data
collected in the mid-1970s from Anna
bola outbreak in Kikwit in the
southwestern part of the Democratic
Republic of the Congo Mike recalls being
dragged into an impromptu meeting at the
end of it David recognized Mike as
someone he could use in the field then
he worked out a way to get Mike on his
team I got traded you know like in
baseball when you don't know the coach
just calls you in and says pack your
bags you're going to Minnesota huh
fast-forward 24 years and this imposing
former rugby player now commands an
expanded band of the disease equivalent
of global firefighters on any one day
they're tackling over 30 outbreaks and
natural disasters they're the first
responders to the planets biggest
scariest and often most complex health
crises each year the team is facing
newer and bigger demands they're
happening everywhere and they're
happening all the time mike says we have
an eclectic background of people because
you know we have larger stations we have
communicators we have virologists can
we have epidemiologists we have so many
different people the diversity of team
members reflects the complexity of these
health events the last Ebola outbreak
for example occurred in a conflict zone
that made it often dangerous to
vaccinate people and to trace people
known to have been in contact with an
infected individual navigating the
unique challenges that each outbreak
brings comes down to a cumulative
knowledge and practical know-how there's
no training for crisis response the only
training that really matters in crisis
management is experience and you know
that is where you learn you make the
mistakes and you learn from them that's
the hard thing in crisis when it's just
coming to terms with the fact that you
want always be right you will always
have to make a decision before you have
enough data and it's really easy for the
amateur generals to sit on the side
pitch in because they have no
accountability for the outcome and it's
easy for the retro spectroscopes to be
taken out afterwards to say surely you
wouldn't have done that of course I
wouldn't have done that if I'd known
what I know now but what I knew then was
this and that's the hard part of crisis
men the easy part is all the science
EBIT the hard part is taking
responsibility becoming accountable for
the decisions you make because you're
taking community's health into your
hands you're taking the lives of your
own staff into your hands
we only need to look at the current
covert 19 pandemic to see the political
ramifications of disease outbreaks and
there are hard choices of crisis
management to be made in almost any
public health threat in 2009 a new
strain of h1n1 influenza emerged in
Mexico it was incubated in pigs but
managed to jump across into people it
sparked a large epidemic that quickly
spread globally and what constituted the
first flu pandemic in more than 40 years
and this new swine flu contagion spooked
the world's flu experts
it wasn't what they'd been expecting at
all
virologists had thought the next
pandemic would have come from bird flu
one that had first popped up in a farmed
goose in southern China in 1996 and
spread a decade later across Asia then
to Europe in Africa that avian flu virus
known as h5n1 killed about two-thirds of
the people who caught it but the virus
never morphed into a form that was
easily transmissible among people
so the pandemic scientists were
expecting never happened and when swine
flu came along world health authorities
were blamed for overreacting Nobel
prize-winning immunologists Peter
Doherty says the h1n1 swine flu was
designated a pandemic because it was a
virus humanity hadn't encountered in
that form before was actually - pig
viruses that got together though some of
the components of that virus went right
back to the 99 18 pandemic virus and it
it was this is part of the problem
people automatically associate with
pandemic shock horror we're all gonna
die which may not be totally
unreasonable with the woo and virus but
a lot of people might die if it really
blows and we don't get a vaccine or
therapeutics quickly but the because it
was called a pandemic people are
expecting a very severe infection and
we'd already had all this discussion
about the h5n1 bird flu which didn't go
anywhere but I think we were right to
try and prepare for it that it didn't
jump and just shows how really how
poorly we still understand these things
even though a lot of efforts gone into
understanding why some viruses crossings
I'm done it's not just chance so so when
I announced was a pandemic of course
everyone said oh we're in for terrible
time but it actually turned out to be
though it was very very infectious it
was no worse than the usual seasonal flu
so then everyone got angry because they
said well WH o has been lying to us and
Korea's pandemic the pandemic strain now
circulates as part of the flu viruses
that cause seasonal epidemics
the h1n1 virus still causes a lot of
hospitalizations and even debts each
year that people by and large don't
react to it with the same level of alarm
that they did when it emerged more than
a decade ago some people have looked
back and said oh you you public health
people sounded a false alarm with h1n1
this is dr. Tom Frieden president and
CEO of resolve to save lives a global
initiative of the NGO vital strategies
he's also a former director of the
United States Centers for Disease
Control and Prevention dr. Frieden was
health commissioner in New York City
during the h1n1 pandemic and it is true
that fewer people died in that pandemic
year than died at an average year that
misses two key points one a lot of kids
died the estimate is 1500 kids in the
u.s. died because of h1n1 that's a
terrible tragedy and to comparing it to
what shouldn't happen every year is kind
of misguided flu is the Rodney
Dangerfield of diseases every year it
hospitalizes millions of people kills
thousands tens of thousands sometimes
hundreds of thousands of people in this
country and around the world and yet we
don't take it as seriously as we should
only half of people in the u.s. get a
flu shot every year and it's very rare
for people to get the kind of treatment
that they that might shorten the
duration of their illness
so with h1n1 there was as there is with
many epidemics a fog of war reality
early on where you're getting reports in
from many places they're inconsistent
it's hard to know who to believe it's
confusing at first and it's only with
really meticulous epidemiology
understanding how it spreads how readily
it spreads how severe the disease is
in-depth studies that you can get a
better sense of what is the real burden
that this is going to cause when public
health experts think of pathogens of
pandemic potential it's typically the
flu that comes to mind
influenza is really unparalleled in its
ability to cause death and destruction
among all microbes
the paradigm is the 1918-1919 flu
pandemic which is estimated to have
killed up to 50 million people around
the world when you look at how bad a
pathogen is you ask two questions how
easily does it spread and how deadly is
it there are diseases like rabies that
are close to 100 percent fatal but don't
spread all that readily and there are
diseases that spread quite readily but
don't cause death often flu is that rare
exception of a disease which spreads
readily and can kill readily also and
what we're concerned about with novel
coronavirus is that it could have that
same deadly combination the temp
pandemic gets used to describe all kinds
of things from hiv/aids to diabetes to
tobacco-related diseases many of these
aren't the rapid spreading contagions
that spring to mind
so i asked tom how does he define a
pandemic generally a pandemic is an
epidemic that's spreading in multiple
parts of the world not necessarily all
parts of the world but multiple parts of
the world and influenza meets that
definition because it predictably causes
widespread disease in one hemisphere
that in another hemisphere and it
circulates around leaving aside their
health impact pandemics have tremendous
political economic and social
consequences health is the biggest
single impact of many disasters and
conflicts more wars have been won and
lost by epidemics than ever by armies
outbreaks provide not just a look into
the workings of the microbial world
they're critical events that shape human
history my name is Laurie Garrett I go
to epidemics Laurie has been observing
and writing about disease outbreaks and
pandemics since the 1970s she is
unrivaled in this specialist field of
journalism in 1996 she won a Pulitzer
Prize for a work chronicling in a
boulder outbreak in what's now the
Democratic Republic of the Congo
I don't think there's anything as
programmed in the human DNA as the
aversion to illness you know it you
think about it it makes sense right when
we're out there as nomads 20,000 years
ago roaming around if someone took ill
and and then another took ill you would
flee right you would just run away and
leave them that's how you survived
didn't you didn't understand why it
happened
could be the gods could be anything but
fear of contagion I think is programmed
Laurie cut her teeth on outbreaks in
1976 back then she was a scientist
moonlighting in public radio in San
Francisco that year she was confronted
with a swine flu virus an outbreak of
Legionnaires disease and toxic shock
syndrome linked to tampons three big
ones all in one 12-month period and it
was so extreme that Gerald Ford insisted
that the head of the CDC resign he was
essentially fired on camera on NBC and
it was at a moment when Nixon had just
what five years earlier created the war
on cancer and the whole country was
riveted by the prospect of eliminating
cancer and heart disease and nobody was
talking about infectious anything it was
all history it was all some something
other people had problems with not us
and then we have this year boom I was in
grad school and I was studying
immunology I was working in the lab at
Berkeley and Stanford and on the side as
a hobby I was working in a local radio
station doing science news you know
every now and then the wire machines one
of the three or four would start banging
and you'd run over and to see you know
who just died or where was there a coup
or who just won the World Series and
that would be about someplace I never
heard of having an outbreak of something
I never heard
and nobody knowing what to do and
descriptions of terror and fear and
befuddlement and I thought this was
completely in contradiction to
everything I was learning in grad school
how could this be and so slowly but
surely I got hooked Laurie has written
several books about outbreaks in public
health her first was the coming plague
published in 1994 over 750 pages Laurie
takes readers on a 50-year journey
through the world's battles with
microbes she's found that most of the
time the real risks have nothing to do
with the pathogens the danger is people
specifically how they react to the
threat anxiety politics greed are just a
few recurrent themes I see it everywhere
all the time I mean every single
epidemic and outbreak I've ever been in
there are inappropriate political
statements made that are based on
manipulating public fear there are
opportunistic politicians that say the
wrong things do horrible things
every epidemic there's religious people
who say and do the wrong things or
declare that it's God's will or that if
you can pray away your illness every
epidemic there's scoundrels making money
off it by selling bogus cures every
single epidemic you have hoarding of
goods anything that somebody thinks will
protect them they hoard the supplies and
suddenly you have a mixture of organized
crime and the response so that you know
the person trying to kill you just might
be a mobster who's ticked off because
you discovered his stockpile of syringes
or masks the current kovat 19 pandemic
is a glaring example of the Khaosan
economic cost these outbreaks cause
we've seen spurious treatments run on
face masks and toilet paper travel bans
and conspiracy theories about the
disease's origins there is baffling as
they are frustrating but weird
our brakes come from how do they start
and why are they occurring more
frequently almost 2/3 of human
infectious diseases are caused by
pathogens shared with wild or domestic
animals in recent decades more and more
of these microbes have jumped this
species barrier in many instances these
have gone on to spread internationally
some globally most of these have been
viruses jumping from wildlife to humans
take HIV which cross the species barrier
from great apes possibly as early as the
1920s in more recent decades Nipah virus
which can cause acute respiratory
infection and fatal and careful itis
jumped from bats to pigs and then to
people in the late 1990s then a few
years later size emerged starting first
in bats moving to civets a small lean
mostly nocturnal mammal then jumped to
humans in 2012 Mercer Middle Eastern
respiratory syndrome made the jump from
camels to humans we think the current
coronavirus came from bats via some
other intermediary hosts but what
precipitates the cross species jump and
what can be done to prevent or mitigate
it I suppose the bottom line is that man
is just another animal and as far as the
virus is concerned and so there is
nothing particularly special about
viruses that infect humans are supposed
to those it that infect animals this is
Professor Trevor drew he's the director
of the Australian Animal Health
Laboratory at Geelong just outside of
Melbourne it's the Australian equivalent
of the US government's Animal Disease
Research Center on Plum Island located
off the coast of New York
the Australian lab has one of the
largest I bio containment facilities in
the world
it's been at the forefront of research
on emerging viral threats since the mid
1980s
according to Trevor changing
environments are driving a big change in
viruses certainly something that we have
seen time and again in the raising of
animals domestic animals is that if you
intensify production in other words if
you put lots of animals together in a
very closed space the viruses tend to
get more pathogenic so they create more
disease because they are able to
multiply to a higher level and it
doesn't matter if they kill their hosts
because the next host is right next door
and particularly where you get animals
all of the same age all of the same
genetics that can actually act as a
environmental driver towards higher
pathogenicity we see this in animals
time and again from Trevor's perspective
the intensive way livestock and seafood
are being farmed is contributing to the
proliferation of dangerous pathogens we
find that if we put large numbers of
fish together or crustaceans together we
find that diseases which are really
quite minor and only seen occasionally
in the wild suddenly become a big
problem and again this is this this
reinforces that hypothesis that that if
you cram loads of animals together you
will get increased pathogenicity the
same goes for humans crowded living
spaces can create opportunities for
viruses to evolve into a higher
pathogenicity and increase the chances
of spreading among human populations
now if you then take the fact that
humans are increasingly encroaching into
spaces where they previously haven't
gone it's inevitable that they will more
often encounter novel viruses in a
wildlife reservoir that has an
opportunity to jump into the human if we
take the case of Ebola the virus has had
been around in the in Western and
Central Africa for quite some time it
caused outbreaks and then it seemed to
attenuate itself it became less virulent
and disappeared because every outbreak
before the big West African outbreak was
in a rural environment however when the
virus emerged in in Sierra Leone it
caused a big problem in cities and this
is again because the the the humans are
close together there there's a an easy
opportunity for the Ebola virus to jump
from host to host an additional
challenge is how interconnected the
world has become global travel is an
everyday reality a person can be
exploring a cave in Africa one day and
bring home a lethal disease the next we
saw an example in 2008 when a body one
year old woman died in the Netherlands
from Marburg hemorrhagic fever a viral
infection similar to Ebola the Dutch
woman had visited a bat infested cave in
Uganda a couple of weeks earlier her
case highlighted the role globalization
is playing in the rapid spread of
pathogens as Trevor drew mentioned we
got an even more dramatic example of
that six years later when a toddler from
a small village in Guinea was infected
with Ebola probably by a bat that was
carrying the virus within months the
disease spread to Ginny's capital
Conakry and then to neighboring Liberia
and Sierra Leone the epidemic in West
Africa was unprecedented because it
ripped through densely populated urban
centres like wildfire from 2014 to 2016
Ebola virus disease spread to seven more
country
including Italy Nigeria Spain the United
Kingdom and the United States all love
almost 29,000 people were infected and
over 11,000 died it demonstrated yet
again the risk that international
mobility and air travel posed to
infection control especially the panic
that sets in when infected people cross
international borders here's the World
Health Organization's Mike Ryan again I
can argue to you whether globalization
is a good thing or a bad thing let's
accept it's a good thing that's accept
that creating a global architecture or
global movement of people global
movement of goods and services has been
a good thing it's driven economic growth
if you like that kind of thing but with
that we've added risk huge risks into
the global system and we're not doing
anything to mitigate them so if we're
going to accept that globalization is
good then we need to accept what is the
risks that have come with that and how
are those risk mitigators how are they
managed reduced and mitigated and
preparedness represents has to be seen
as one of those we've seen the others
climate stress all of these things that
are emerging and and I think we have to
put a price on that
the nature of how we're disrupting our
environment is constantly changing and
worsening habitats are being altered and
often diminished putting humans and farm
animals in close contact with wildlife
Laurie Garrett says it's providing an
advantage for microbes resulting in
diseases that really weren't an issue 20
or 30 years ago you know I always get
asked why do we see all these
hemorrhagic viruses and these you know
new corona viruses so I have like people
the pollinators of the rainforests are
bats gentle nocturnal fruit bats and
their niche in our global ecology is
being destroyed they are starving they
are flying in flocks in search of the
fruit that they their particular species
is adapted to and when they can't find
it they're getting closer to human
orchards and human activities even
though very few bat species in the world
want to be anywhere near as human being
they are very shy animals you know we
have disrupted that ecological niche so
completely that there's thousands of bat
borne diseases that one way or another
we're probably going to get exposed to
over the next few decades it's not just
people who are exposed in 1994 race
horses stabled in Hendra an outer suburb
of Brisbane Australia began falling ill
and dying rapidly the disease spread to
seven people killing most of them
scientists identified the cause and
named it
Hendra virus after much searching they
found Hendra viruses natural source or
reservoir it was a type of large fruit
bat known as a flying fox turns out it
was an important finding the discovery
of Hendra virus and bats prompted
scientists to study how these ancient
flying mammals are capable of carrying
viruses without actually getting sick
but what makes them such rich reservoirs
of viral pathogens how do these viruses
spill over to humans and what can we
learn from
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coming up next week bats
I'll look at how the discovery of
enterovirus and flying foxes profoundly
change scientific understanding of the
origins of some of our most feared
viruses I'll explain how it led to
greater awareness of the interaction
microbes have with their hosts knowledge
that might help us better anticipate and
respond to current and future viral
threats that's it for this episode of
prognosis thanks so much for listening
we'll be back with a new episode soon
but until then you can see when our
health team is up - by going to
www.onproperty.com.au/plus heads if
you're a fan of this episode please take
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new listeners find the show this episode
was produced by Laura Coulson a special
assistance from John Wellman historia de
de was Rick Shire special thanks to Drew
Armstrong health team leader and
Francesca levy and of Bloomberg podcasts
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