Special Episode: Understanding Pandemics

What are they exactly, where did 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 COVID nineteen and other global scourges. Dr Michael Ryan is like the chief firefighter of global health. If you people are busier than this barely affable Irishman. Mike leads

the Emergency's 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 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. COVID nineteen triggered a global health emergency and made coronavirus, the virus that causes it, a

household name. COVID nineteen is the latest and possibly most important outbreak that Mike has ever tried to extinguish. For almost twenty five years, he's been at the forefront of some of the most significant disease outbreaks. The job has 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.

Mike said out in life to become an orthopedic surgeon, but a terrible motorcycle accident in his twenties 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. Fit chose to throw me into public health. But as my grandmother once said to me, only a grandmother can say this probably the best thing that ever

happened to your son, you know. Mike wound up working with Dr David Hayman, who's like them, Mick Jagger of Disease Detectives. Before becoming a professor of infectious disease epidemiology in London, David tackled smallpox, polio, a bowler and legionnaire's disease, just to mention a few. In the early two thousand's, David led the World Health Organization's response to severe acute respiratory syndrome or STARS. He was working at the w h O in Geneva and 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 nineties seventies from an a bowler outbreak and kick with in the southwestern part of the Democratic Republic of the Congo microcall is being dragged into an impromptu meeting. At the end of it, David recognized Mike as somebody could use in the field. Then he worked out a way to get

Mike on his team. I got traded. You're not like in baseball when you don't know the coach just called you in and says, back your bags, you're going to Minnesota. That's what happened to me. Fast forward twenty four 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 thirty outbreaks and natural disasters. They are the first responders to the planet's biggest, scariest,

and off 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 stitions. We have communicators, we have viologous clinicians, we have epidemiologies, we have so many different people. The diversity of team

members reflects the complexity of these health events. The last a Bowler 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 accumulative knowledge and practical know how. There's

no training for a crisis response. The only training that really matters and crisis management is experienced and you know that is where you learn, when you make the mistakes and you learn from them. And that's the hard thing in crisis managers, just coming to terms with the fact that you won't always be right. You will always have to make a decision before you have enough data. And it's really easy for the armitude generals to sit on the side and pitching because they have no accountability for

the outcome. And it's easy for the retrospector scopes to be taken out afterwards and say, surely you wouldn't have done that. Of course I wouldn't have done that if I had known what I know now. But what I knew then was this. And that's the hard part of crisis manage The easy part is all the science a bit.

The hard part is taking responsibility, becoming accountable for the decisions you make, because you're taking communities health into your hands, you're taking the lives of your own staff into your hands. We only need to look at the current COVID nine team 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 two thousand and nine, a new strain of H one N one

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 in what constituted the first flu pandemic in more than forty years. And this new swine flu contagion spooked the world's flu experts. It wasn't

what they had 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 and southern China, and spread a decade later across Asia than

to Europe and Africa. That avian flu virus, known as Age five in one, 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 pandemics scientists were expecting never happened, and when swine flu came along, world health authorities were blamed for overreacting. Nobel Prize winning immunologist Peter Doherty says the H one N one swine flu was designated a pandemic because it was

a virus humanity hadn't encountered in that form before. It was actually two pig viruses that got together, though some of the components of that virus went right back to the ninety name pandemic virus and it was This is part of the problem people automatically associate with pandemic shock horror, We're all going to die, which may not be totally unreasonable with the wou and virus, but a lot of people may 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 H five in one bird flu, which didn't go anywhere. But I think we were right to try and prepare for it, but it didn't jump. It just shows how really out poorly we still understand these things. Even though a lot of efforts gone into understanding why some viruses crossing some done.

It's not just a chance. So um so when they announced was a pandemic. Of course, everyone said, oh, we're in for a terrible time, but it actually turned out to be that it was very, very infectious. It was no worse than the usual seasonal flu. So then everyone got angry because they said, well, w h O has been lying to us and calling a pandemic. The pandemic strain now circulates as part of the flu viruses that

cause seasonal epidemics. The H one N one virus still causes a lot of hospitalizations and even debts each year, but 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 healthy will sounded a false alarm with H one N one. This is Ductor's Home. Freedom, President and CEO of Resolved to Save Lives,

a global initiative of the NGO vital Strategies. He's also a former director of the United States Sentence for Disease Control and Prevention. Dr Freedom was Health Commissioner in New York City during the H one and one pandemic, and it is true that fewer people died in that pandemic year than die in an average year that misses two key points. One, a lot of kids died. The estimate is dred kids in the US died because of H

one N one. That's a terrible tragedy, and to comparing it to what shouldn't happen every year is kind of misguided. Flu is the Rodney Danger field 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 US 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 H one N one, 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 nineteen flu pandemic, which is estimated to have killed up to fifty 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 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 the novel coronavirus here is that it could have that same deadly combination. The term pandemic gets used to describe all kinds of things, from HIV, AIDS two 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 the world. 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 seventies.

She is unrivaled in this specialist field of journalism. She won a Bullet Surprise for a word chronicling in a bolda outbreak and 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, you think about it makes sense right when we're out there as Nomad's twenty thousand years ago, roaming around, if someone took ill and then another took ill, you would flee, right,

you would just run away and leave them. And 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 is programmed. Laurie cut her teeth on outbreaks in 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 legion as disease, and toxic shock syndrome linked to tampons through read big ones, all in one twelve month period, and it was so extreme that um 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 on a local radio station doing science news. You 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 of, and uh, nobody knowing what to do, and descriptions of terror and fear and um 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 and public health. Her first was The Coming Plague, published in The Seven Fifty Pages, Laurie takes readers on a fifty 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 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 you can prey 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 um 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 COVID nineteen pandemic is a glaring example of the chaos and economic

cost these outbreaks cause. We've seen spurious treatments, run on face masks and toilet paper, travel bands, and conspiracy theories about the diseases origins. That is baffling as they are frustrating, But where do outbreaks come from, how do they start? And why are they occurring more frequently? Almost two thirds 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 to nationally, some globally. Most of these have been viruses jumping from wildlife to humans. Take HIV, which crossed the species barrier from great apes, possibly as early as the nine twenties. In more recent decades, neber virus, which can cause acute respiratory infection and fatal and capelitas jumped from bats to pigs and then to

people in the late nines. Then a few years later stars emerged, starting first in bats, moving to civets, a small, lean, mostly nocturnal mammal, then jumped to humans in two thousand and twelve. Mirce or Middle Eastern respiratory syndrome made the jump from camels to humans. We think the current coronavirus came from bats via some other intermediary host. 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 has just to 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 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 high bio containment facilities in the world. It's been at the forefront of research on emerging viral threats since the mid nine 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 close 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 host, 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 an 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 cross staceans 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 if you cram loads of animals to other 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 a bowler, 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 it became less virulent and disappeared because every outbreak before the big West African heartbreak was in a rural environment. However, when the virus emerged in Sierra Leone, it caused a big problem in cities. And this is again because the humans are close together, there's an easy opportunity for the abolavirus to

jump from host to host. An additional challenge is how interconnected the world has become global travelers in 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 two thousand and eight when a forty one year old woman died in the Netherlands from marburg hamorrhagic fever, a viral infection similar to a bowler. 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've 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 Guinea'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 centers like wildfire. From two thousand and fourteen to two thousand and sixteen, a bowl of virus disease spread to seven more countries, including Italy, Nigeria, Spain, the United Kingdom, and the United States. All up, almost twenty nine thousand people

were infected and over eleven thousand 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 organizations Mike Ryan Again, I can argue to you whether globalization is a good thing or a bad Let's accept it's

a good thing. Let's accept that creating a global architecture, 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, and don't all of that. But with that, we've added risk, huge risks into the global system. Um uh. And we're not doing anything to mitigate. So if we're going to accept the globalization is good and we need to accept, what is the risks that

have come with that? And how are those risks mitigated? How are they managed, reduced and mitigated? And preparedness reprodemics has to be seen as one of those. We've seen the other's climate stress, all of these things that are emerging, um 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 in farm animal enclosed contact

with wildlife. Laurie Garrett says it's providing an advantage for microbes, resulting in diseases that really went an issue twenty or thirty years ago. You know, I always get asked, why do we see all these uh hemorrhagic viruses and these uh you know, new coronaviruses, and so it's 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 are 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 a

human being. They are very shy animals. You know. We have disrupted that ecological niche so completely that there's thousands of bat born 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. 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 hendrovirus is natural source or reservoir. It was a type of large fruit bat known as a flying fox. Turns out he was an important finding. The discovery of hendra virus in bats prompted scientists to study how these ancient flying mammals are capable of caring 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 them? Coming up next week, Bats, I'll look at how the discovery of hendra virus 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 what our health team is up to by going to www dot bloomberg dot com, forward slash prognosis. Do you have a story about life during COVID nineteen, We want to hear from you. We're on Twitter at j W Gale or at Fay Cortez. If you're a fan of this episode, please take a moment to rate and

review us. It helps new listeners find the show. This episode was produced by Laura Coulson with special assistance from John Lawerman. Our story editor was Rick Shine. Special thanks to Drew Armstrong Health Team leader and Francesco Levy, head of Bloomberg Podcasts,