There are tents outside our hospitals. Every time I see them, I stop startled. Their drab and dirty flaps seems so out of place against the grand facades of world class hospitals. Desperate times, desperate measures. The last time I worked in a tent was West Africa in twenty fourteen, during the able outbreak. In those same tents, I saw too much pain, loneliness, and death, people dying alone. I never thought I'd have to see or experience that ever again. I never wanted to.
Once was painful enough. There's no way to describe what we're seeing. Our new reality is unreal. The people and places we've known so long and so well have been transformed, our ears, our ICUs. Everything looks, sounds, and feels different. Just one week and it's a whole different world. The patients I normally see are nowhere to be found. Every
single patient I see has COVID nineteen. Every single patient working in the er means walking through a corridor of coughing, each a slightly different pitch and different frequency, but all caused by the same exact thing. It's not just the volume of patients that's hitting us, it's the severity respiratory arrest, respiratory arrest. Respiratory arrest. Each takes six to eight professionals, nurses, respiratory texts, er docs, anthesiologists. Each takes an hour or more,
back to back, all shift long. And it's not just the unrelenting severity. We're being asked to do things we've never done before. Run a code as your goggles fog and you can't decipher the vital signs on the monitor. Try to predict which COVID patient will crash if you send them home and which won't. Talk to palliative care, talk to family members, long discussions about likely outcomes. Listen as family members sob. They can't be here when they ask to withdraw care. We face time so they can
say goodbye. We stop, turn off the ventilator and wait. Your hands upon theirs. You think of their family at home, sobbing. Someone starts saying a prayer. You can't help but cry. This isn't what we do. You stand by you wait, This isn't what we do. You stand by you wait. Time of death, seven nineteen pm. I know what my colleagues are feeling. I see it on their faces. We are exhausted. Hours in goggles, gowns, and masks feel like days.
But we are only at the beginning. The mental exhaustion is only starting to set in the things we do, the things we see. This isn't what we do. I worry about my colleagues. Every day someone calls me crying. How long will they hold? How long will I hold? I remember how this anxiety gnawed at me every day in Guinea during abola. Would today be the day I got infected? Won't know for a week. The days add up, the worry adds up. I've never seen my colleagues so afraid,
so unsettled. But I've also never seen them all work so well together. I've never seen us more unified, more focused, more sincere. Yes we worry about Ppe, Yes we worry about lack of medications. Yes we worry about one another. But I've never seen so much sense of purpose, so much honor to do this job. We didn't sign up for this, but we will show up for this. Every day.
I think of this when I finally get home, close in a bag, hot shower, look in the mirror, indentations of goggles still deep in my face, blisters on the bridge of my nose. How long will we hold Jesus? Wow?
Yeah, So that was.
How Long will we Doctors Last? By Craig Spencer, published in The Washington Post on April third of this year. Craig Spencer is the Director of Global Health in Emergency Medicine at New York Presbyterian Columbia University Medical Center. Also, if you want to read this and more from him, he has another really nice thread on his Twitter account describing what day to day life has been like for an er doctor during this pandemic.
That's yeah, it's incredible and so difficult to imagine.
Yeah, it's it's horrific. Erin Yeah, yep.
Well, Hi, I'm Aaron Welsh.
And I'm Erin alman Updyke and this is this podcast will kill you.
Yeah.
So this episode is a continuation of our Anatomy of a Pandemic series, which is our series on COVID nineteen. In each of these episodes, we address different aspects of the pandemic with the help of experts in the field, because hey, we're not experts.
We're not experts.
Our first six episodes covered things like from the virus's biology to clinical disease, from control efforts to do mental health coping strategies.
As you might be able to guess from the title of this episode, we're going to talk today about how spillover events happen and why. We'll talk about what we currently know about where SARS COVID two came from, and how we can use this pandemic to be better prepared to stop another. We were fortunate enough to speak with doctor JOHNA. Mazette, an incredible disease ecologists whose specialty lies in identifying emerging pathogens of public health concern.
But before we get to that, we do have a couple of pieces of business to go over. First. Let's talk first hand accounts. Yes, so, we are working on more episodes of this series covering things like how the pandemic has impacted the economy, or education or marginalized populations, as well as update episodes on topics we've already covered. And for these update episodes, we want to hear from you.
We want to hear how this pandemic has affected your life, your job, your family, your friends, etc. If you are willing to share your story with us for inclusion as a possible first hand account in one of these episodes, please go to our website this podcast willkill you dot com and click on COVID nineteen firsthand at the top of the page, and then that'll take you to a form that you can fill out and then we can get back to you with more details real quick.
Another thing we wanted to say about first hand accounts, it's kind of like what everyone says in their Twitter bio retweets are not endorsements. There are so many people that are having so many different experiences and different perspectives during this pandemic. One of our goals with presenting these first hand accounts is to show just how huge the
diversity is in how this pandemic is affecting people. So we hope that by hearing these stories, it's a way for us all to increase our understanding and empathy during these horrible, stressful times. We recognize that no single experience is going to be universal.
So yeah, exactly, Okay. Another piece of business alcohol free episodes. So a little bit ago, we posted on our social media about alcohol free episodes now being available and so let me tell you what these are. So some educators reached out to us to ask whether there were versions of episodes that didn't contain the quarantine talk, and if there weren't, whether they could actually edit those portions out
themselves for use in the classroom. And so, instead of having a bunch of people doing the same obnoxious work over and over again editing out the quarantine talk, we thought, you know, it's going to be easier to have them all in one place, available for whoever wants to use
it for whatever reason. And so what we did is we edited out all the quarantiny talks from our past episodes and put these quote alcohol free episodes in a playlist on a page on our website called alcohol Free Episodes, which you can find under the episode tab.
Are regular episodes like the one that you're currently listening to. Even though this is a little irregular for a regular episode that you get from your normal podcast sources, we will still have quarantines and plusy burtas, so you don't
need to worry about losing those. These edited versions of our episodes is just an attempt for us to be more inclusive and accessible, because we recognize that a lot of teachers could get in trouble for sharing a podcast with their students that has a good amount of alcohol talk, and also maybe people who are in recovery or just don't want to listen to might find it difficult to
listen to. This isn't about censorship or being sheltered or anything like that, and there's definitely no need for some of the harsh words that we've seen on social media about this.
No, please, guys, let's just kind be kind, especially during this time. We all need it, right, we do, we do. And as we said, you do not need to worry that we're going to stop doing Quarantiny recipes because we're going to every single episode and we're about to in this one. So nothing is changing about the podcast. We're just providing an additional resource for people who want to
use it. And frankly, we're flattered that some educators want to use our podcast in their classroom, like that's thrilling.
Yes, it really is.
So if you do not wish to hear quarantine Y Talk, you can find the edited quarantine Free versions under the episodes tab of our website, and there's also a disclaimer there at the top of that page that says that there might still be some references to alcohol throughout the episodes that we just haven't found, and so if you find one, of those and you want us to remove it, please send us the timestamp and the context of the mention. And if you do wish to hear quarantiny talk, just keep listening.
Because it's quarantiny time.
It's quarantiney time. What are we drinking this time?
This time we're drinking Quarantini seven.
Such a classic name.
It is one for the ages. Quarantiny seven has rum, orange liquor, lemon juice, and cinnamon simple syrup. Demorros simple syrup also works pretty.
Well too, fabulous.
As always, we'll post the recipe for this quarantini and the non alcoholic plus e burrita on all of our social media pages and on our website. I wanted to say that very clo you.
Enunciated that one that time. Okay, now that that's out of the way, let's go over a few things before we dive into the interview with doctor Mazette. First of all, masks. Oh gosh, if you've been following the news at all, you may have seen that the CDC has now recommended people wear masks under certain circumstances. So let's talk about
that decision. Earlier episode of this series, we went into masks a little bit, and we had repeated the CDC's previous recommendations for masks and why those recommendations were made a quick recap. So previously, wearing a mask was not advised for those who were not sick, and there were a number of reasons stated for this. One that maybe the most important one, masks are in very short supply and should be reserved for healthcare workers who are battling
with this virus on a daily basis. Number two, most masks, especially those that are the most effective, require proper fitting in order to work. Number three, masks can lead to you touching your face more to adjust them or pull them down or to the side, And if that mask has viral particles on it, that's an easy way to become infected yourself, or if you're already infected, you can easily contaminate your hands and then other surfaces that you
touch after adjusting your mask. And number four, it can in some case maybe give people a false sense of security and lead to less hand washing or physical distancing.
So as of.
April third of this year, the CDC is now recommending that people wear masks in certain situations, so kind of more broadly is now their recommendation. So the question is why is that what has changed? Quite honestly great question. According to the CDC website, it's because we know that a good chunk of people, we don't know exactly how many, but a good chunk of people can be infected with the virus, not show any symptoms, but still be able
to transmit the virus asymptomatic transmission. Anyone who's listened to this podcast has known that for quite some time. Right, we've talked about that. Yeah, there's also evidence that people can transmit the virus before they start showing symptoms, even if they do eventually become symptomatic. And of course, if you have a mile infection, you can still transmit the virus.
So none of this is new, brand new information discovered in the past week.
No, not at all.
So these things asymptomatic transmission, infections before showing symptoms, We've known about these things, or at least highly suspected them for a while. And we meaning like the broader scientific community, not just like Aaron and.
Aaron all the deeds.
No, we didn't, We're our experts. Do we need to say it again?
Uh So?
But why has this recommendation changed now, and we don't know exactly because we're not in the room where these policy changes are being discussed and where these decisions are made.
If anyone who's in those rooms wants to come on the podcast and talk to us about it, we would love to hear from you, because this is also a very interesting like, these are difficult things coming up with these policies and recommendation, So it would be fascinating to get to talk to somebody who actually does that. We don't do that, no, nope, So let's talk about what these new recommendations are exactly. On the CDC website as
of April fourth, this is what it says. The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain, for example, grocery stores pharmacies, especially in areas of significant community based transmission. It is critical to emphasize that maintaining six feet social distancing remains important to slowing the spread of the virus.
CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. The cloth face coverings recommended are not surgical masks or N ninety five respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended
by current CDC guidance end quote. So there is they're basically saying, wear a mask if you absolutely have to go out to help prevent transmitting this virus to other people, But masks are no replacement for staying at home. Also washing your hands and never touching your mask with dirty hands, does that make sense?
And also washing your hands after touching your.
Mask, yes, just washing your hands every time your hands go anywhere near your.
Face for sure. Yeah, okay, okay, But this is an ongoing thing, and so there's going to be more information and we'd love to do a deeper dive into it with someone who is working first hand on this.
Knows more than we do.
Yeah yeah, yeah.
All right. Are we ready to talk about spillover events?
Oh?
I sure?
Am okay.
I think the listeners of this podcast maybe don't need a whole lot of setup for this particular topic, because if you've listened to us before, you've heard us talk about spillover events and what they are, and diseasy collegy and what that is. So let's get right to it right after.
This short break.
I'm Jonah Mazette.
I'm a professor of epidemiology and disease ecollege at the University of California Davis in the Veterinary School and the University of California, San Francisco in the Medical School, and I'm the executive director of the UC Davis One Health Institute there. I use one Health in everything I do and that our big team does, and what that means is we're looking at interconnectedness human, animal, plant, and environmental health and bringing together multidisciplinary teams to work on those
really complex problems like this COVID nineteen situation. I've been the principal investigator for the Predict project that's been working in thirty five countries all over the world to identify dangerous, potentially pathogenic viruses that could spill over from animals into people and build the systems that are needed to be able to respond quickly and be ready for just the
scenario that we have. And I've been doing that for ten years leading that team, and we detected and discovered one hundred and sixty novel coronaviruses through PREDICT when just a handful we're known, and as importantly, we learned about their hosts and the interfaces. And more importantly, I think we trained about sixty eight hundred people in this approach so that the world it can be better.
I just wish more of them were here.
Now.
I'm the director of the One Health Workforce Next Generation, which is the logical follow on from PREDICT, meaning that we want this trained workforce to be expanded in the most likely hot spots for spillover, so that academics all over the world.
Can be training.
People to be the workforce for hopefully to prevent anything like this ever happening again.
And finally, I'm also on.
The board of the directors of the new Global Viral Project, which really grew out of the PREDICT project. PREDICT provided the proof of concept that we don't need to wait for the next epidemic or tragically pandemic. We can get in front of the curve, in front of the wave. We can't understand viruses and know where they are sort of lurking and availab ble to spill over into people.
We can know what they are, we can know how to detect them, we can know how to prevent our own risky behaviors that put us in harm's way.
Awesome, so many different things that you're working on.
I'm sorry, No, it doesn't apologue.
It's amazing.
Wow, that's incredible, and it sounds like, I mean, some
of these things sound like really fascinating. And you know you mentioned predict and you mentioned doing surveillance for emerging pathogens, and so can you take us through sort of a step by step of how that's done, Because there's like logistics involved with these working across international borders, and then there's the people in the field doing the sampling to then how do you group all of this information together and then disperse it to the people that need it. How does that work?
Yeah, there's a lot of minutia and not sexy work involved there, and a lot of it also qualifies or for being highlighted on dirty jobs.
We swab a lot.
Of butts on throats and noses. So I can take you through it. But the way that we begin is we begin with math. We begin with looking at the best science and pulling it together mathematically to identify hot spots that might be the places most likely for spillover to occur. And once we identify those countries, if they overlap with our funders for the PREDICT project, USA ID or US Agency for International Development where they want and can work, then we can approach the governments in those
countries and ask if they'd like to participate. And the PREDICT Project was the first time I'd ever started an international effort where every single government that we talked to said absolutely, yes, this is critically important.
We want to get in front of this.
It's not we don't have the resource to do this, but we've loved a partner, so that was really refreshing.
So we immediately had a collaborative process. But we in those initial government meetings, we brought together the ministries of Environment, Health, and Agriculture where the veterinary sector usually lives, so that we could apply the one health approach in those countries to really identify on the ground the best hotspots to target our work and then really get out there and collaboratively look at it from the animal side, the environmental side, as well as the human side. So we brought those
teams together. I can talk to you more if you like about how that went. But once we found those hot spots to investigate, then we needed to train folks to be really safe biosafety and biosecurity number one, even including how to pack and ship samples. And before anybody could go out in the field, they needed to have a clearances for working with people and animals so that we knew that we could conduct the work in the
most appropriate way. Then you have to get with the communities, because most communities, if you show up in white suits, even my house, if someone showed up in my front yard in a white suit trying to sample the birds in my yard, or in some of the communities where we work their food in the market, that would be
horrifying to anyone. So we work with the communities and talk to them about what we're going to do, have them help us target exactly what kind of high risk interfaces they're seeing in their areas, and they become the
really great informational partner and operational partners for us. Finally, then you can do the more sexy stuff, the stuff people like to film on the Discovery Channel of sampling the bats, sampling the non human primates, and getting sort of down into the mud, getting with the rodents and the shrews people's houses and trying to find the virus safely.
Those samples didn't have to go to the laboratory. And we had to strengthen the capabilities for molecular virology in almost every place we work, because we were working in the least resource countries of the world most times, and most of them did not have the technology, they had the will to do this work, especially for wildlife. They
didn't have places to do the wildlife virology. So we had to help build that up, and our teams at Davis and Columbia University were amazing and coming up with a low cost platform to really discover many, many, you know, more.
Than thousand viruses.
So once you get that done and you get in the lab and you safely do that, then you have to figure out what you do with that information.
And there's two important things.
One, it needs to get back to those governments and all of those across the platforms, those different ministries so that they can take action or at least have that information in their repository so that they know what to
look for when something strange happens. And you have to get that information back into the hands of people like me, people like our team at Eco Health Alliance the mathematical modeling to really help inform on what should be done from a public health perspective globally and to figure out how to better target surveillance going forward. So it's kind of circular, and we do it better iteratively over time.
Gotcha.
Yeah, it sounds like a huge effort in just coordinating everyone's movements and activities and permits and all of that. So yeah, yeah, it's amazing. And so you know, hypothetically, let's say that you do or clearly you have found pathogens that have been a potential concern for public health health safety, and so what happens when you do identify let's say, a potential spillover event. What happens in that case?
Well, I mean there are multiple scenarios. In the predict project.
We assisted governments with forty five now forty six unfortunately counting this one outbreak investigations, many of which stayed really small, I think, testament to being prepared, some of which, like this one, the project was actually finished in the countries where we were working at that time, where were reactivated now thankfully, but those teams reactivated and helped identify the first cases of SARS Kobe two coming into their countries
using the predict platform as well. But you know, when we do have a very concerning finding, we again have to be very careful. We go to the ministries and these viruses, we consider them sovereign to their property of their sovereign nation, so we always bring it back to the governments first and talk to them about how to
release the information to the public. Certainly, we write publications, and we've gotten into a very interesting ethical dilemma sometimes about whether or not we should talk to the communities at risk or get our paper out. I think most all of us on the team feel like it's the right thing to do to put information out, even if
it's not published. Now that's becoming more commonplace with pre prints and with this current again COVID nineteen situation, we're seeing that becoming more the norm, which I think is fantastic.
Public health should be first.
And foremost on all of our minds, and so that's a positive change that's coming out of this horrible tragedy. And I think there will be others.
But yeah, we inform the ministry.
I can give you an example, we identified a novel of bolavirus when we were working in Sierra Leone and we found it in bats that were living in people's homes.
There aren't that many ebola viruses in the world, so we were immediately concerned about that, and we took that to the government and we worked with them to develop an outreach platform, even developed a illustrated guided book that could go out with the narrators picture book to all of the communities where we were working to start to give them the information but also the tools and the skills to be able to protect themselves in the communities,
and then press releases and papers and all of those other things come as well. But at first and foremost, it's about letting the governments know so that they can prepare their plan and then working with the communities so they can protect themselves.
Gotcha that makes sense. Yeah, So you talked about identifying hot spots where emerging infectious diseases or spillover events are more likely to occur. Can you talk about how you decide what a hot spot is and whether you know sort of what makes a hot spot a hot spot?
Basically?
Okay, Yeah, so hotspots for us uh, you know involve you know, a map with colors, and of course the hotter the spot, the redder the place on the map,
but what what are the underpinnings of that map. So we've done a lot of research throughout well many of us before predicts started, but throughout the decade of predict to really figure that out and improve those models is kind of what I was saying about bringing that data back into the models and the things that make a hot spot a hot spot so far are places where there's wildlife, so biodiversity is critical. Places where people are interacting with that wildlife, and so we call those high
risk in our faces. So we identify those higher risk in our faces. Those often come together where human population growth is high, biodiversity is high, and landscape change is high or evolving. So in the more pristine areas we often have a little bit lower risk. In the more urban areas, we have high risk for amplification and spread, but a little bit lower risk for spillover. It's kind of those intermediate areas where things are changing, you're chopping
down for us to make farmland. Those kinds of areas where we really see the systems of the animals and the people being stressed and the ecosystems being stressed, and that makes for a perfect recipe for spillover.
Yeah, that makes sense. So on the podcast we've talked a lot about spillover events in general, but could you kind of give us like a step by step and maybe whether there are any patterns that we can see in all spillover events.
Well, I'm sure your listeners are quite a bit better verse now about the human food value chain, including all the way from hunting or farming food, especially wildlife or species that aren't used to being farmed or are coming in too often contact with humans, or throughout evolutionary history haven't been living in close contact with humans.
So all the way through that wildlife human food.
Value chain, we have concerns, and certainly we've been raising the flag about our concerns, especially at the market level where you have a lot of wildlife species mixing together that don't normally live together. So again, really big ecosystem disturbance, even if the ecosystem is the market, because you're housing these animals together, and then all the way through to restaurants, restaurants that keep live animals, but restaurants that buy the
animals at those markets. So that's one that people are now aware of that we've been kind of concerned about warning about. Conservation organizations also been warning about for a long time. Other ones are really things that people didn't necessarily aren't thinking about.
Here, there's a huge bat guano.
Industry all the way from going into caves and collecting guano from natural caves that just the humans in their digging is a big at us system disturbance, or setting up actual attractants for bats to collect their guano so that they preferentially, you know, roost in palm fronds right at the farm and then you can take that guano and put it right onto the fields for fertilizer. So these are really other important in our faces. And then there were ones that just take us into the wilds.
For example, we need elements and minerals for our cell phones to make them faster, thinner, sexier, better, and we often need need those minerals for rare places for human populations to go, like deep into caves. So all these things are our interfaces that I think you can think of, but they do all have something in common, and that is that people are sort of treading heavily into systems or effectively changing the evolutionary patterns that have been at
work for hundreds of years. So when we disrupt those patterns, we put ourselves at risk, both because we may be out of our element, but most especially because we're putting pressure on the systems, including the wildlife in those systems. So we may expose ourselves to things that we're susceptible to because we're evolutionarily naive.
Absolutely, And so you know, in talking about land use change and that interface or that barrier between humans and wildlife seems to have kind of decreased. Well, the barrier has decreased, the land you change has increased over the past, say, one hundred two hundred years, And so do we see a corresponding increase in spillover events?
Unfortunately, we certainly have.
Our projections and those of other great scientists show that we can expect about three recognized emerging infectious diseases each year. And I think that our projections will be updated to even show more. Our predictata is showing that spillovers are happening actually quite frequently, even of things as scary as avlaviruses, and that they don't always, in fact, don't often take
off and cause a recognized outbreak. They might only make one person sick and then, for whatever reason, that person doesn't infect someone else again.
As we look at how.
Humans, animals, and the environment interact, sometimes all of the perfect scenarios come together for tragedy, and sometimes they don't, and just one person gets sick and no physician anywhere would pick that up and think of.
Testing for something new. In that scenario, the person either gets better or they unfortunately don't, and it ends. So those spillovers are happening a lot. I think if you look throughout history, initially there wasn't great evidence of germ theory or people didn't believe in it, so we don't have a lot of data for you know, hundreds of years ago. And then those pathogens that.
Were noticed and picked up were the ones we were sharing with domestic animals, which make total sense because we're living in close contact with them, especially the ones that we eat, so we were sharing pathogens with them, and we recognize that, and we now documented that we know
how to control that. Over time, I think we got a little complacent, and especially as the human population has grown, you know, eight billion people on the Earth were living in more frequent contact with wildlife pushing out into wild lands.
And we need to figure it out.
Yeah, I guess it's kind of when you think about it that way too. It's hard to know how many close calls we've had in terms of pandemics, how many just was a dead end host kind of a situation. So and so, you know, going now specifically into Star's CoV two, which is of course, as you know, the virus that causes COVID nineteen, what do we know at this point as to how it's spilled over into humans, what those steps were.
We don't know much at all.
Well, first of all, my soapbox, if we had been doing this work more broadly earlier.
And people were beyond.
Sort of the same people that all collaborate had, if we had been paying more attention, we would have been able to know a lot more. But unfortunately this kind of work will probably not be done or known until after the pandemic at Lease begins to wane, because right now, the best minds to do this work have to be focused on the human to human spread.
We have to get that under control.
We do believe with quite a bit of confidence that the virus is bat origin and that the evolutionary host is vats. Whether or not it's spilled over into an intermediate host is a good question, but it didn't need to. We know from our other work and receptor binding work that these Stars related and Stars too related viruses can have quite broad host plasticity or a host range, and they can infect numerous species. So there's a lot of
talk about what that species might have been. And it could have been anything that people were exposing themselves to in markets or other things, or it could have been a bat flying through. So it will take some time to figure that out.
When we do, which I assume hopefully, we will get at least a clearer picture of how that spillover event occurred. How can we use that information in the future, like what does that tell us?
So always in retrospect we can learn more about how to control our risk. That said, I want to live in a world where we're not doing it retrospectively. I think we can learn more now. And we were learning again, as I mentioned, with the predict project. We knew that these markets where animals were sort of housed and really high density kind of crushed together, stacked on top of each other, and multiple species we're mixing that might have been occurring in the market that at least amplified, if
not started, this pandemic. We know that's dangerous, we knew it before. Hopefully we will see solid policy change. There's some great movement towards that, and some concerning event reopening markets and things that point to us really having a hard time changing our behavior. Humans are the issue here. We have to get more comfortable with change and that's evolutionary to us. We're not comfortable with that, so that's going to be tough. So we can learn from this one.
We can also because we have lots of samples and lots of people interested, we can learn as we're responding to this one about our transmission risk and those intermediate hosts. We just have to do the work, and there's so much more attention now. I think the time is here.
We can have a lot of positivity and hope that this horrible, horrible tragedy will help us to do things differently to keep anything like this from happening again, but also to allow us to strengthen our governmental and public health systems so that we're much more nimble and ready and able to respond to anything that comes our way.
Yeah, So going back again quickly, just to spill over events in general, can you talk about what it means for a pathogen to jump species? And also, you know, I feel like I hear mostly or read mostly or for some reason just associate mostly viruses as jumping species more than bacteria. Is that a known characteristic or is it just that we hear more about the viruses?
Well, Aaron, I mean, I think the reason you're hearing about it now is because we're paying attention to viruses. Frankly, I would say, other than a few really important viruses like influenza and HIV, we haven't been in our medical history been paying very much attention to viruses. Frankly, you know, we know a lot lot more about bacteria because we've been paying attention to them. They're easier to work with without molecular tools, and now we have the tools, so
we have no excuses. We need to do that for viruses and know as much about them as we've known about bacteria.
Gotcha.
So you know, I want to talk now a bit about what happens when prevention, So identifying these pathogens before they spill over or write at a spillover event when that has to shift to control efforts. So what are the first steps taken for disease ecologists that are studying this outbreak in particular, and how is the one health approach being used to study and slow down the current pandemic.
Well, we have to get together and make sure that we're again working in that sort of one health approach where we're collaboratively bringing the disciplines together.
Everybody has their.
Area of expertise and can work on their own specific part, but we need to communicate and collaborate to really get a handle on things. So in really good one health responses, we see the governments and entities regulatory entities that are in charge pulling together those platforms for communication, collaboration and assignments of everybody's different role and then coming back together.
In Uganda, for example, they have a Zonautic Disease Task Force that over the years of the predict project, we saw it going from just you know, being sort of ad hoc and stood up often way too late when an outbreak started, to being a constant, permanent committee that was ready and available and would be activated within hours of a first case being identified, and then you could see that the environmental team would go out and start
sampling in the environment, understanding the environmental exposures, figuring out how to clean those up and protect people. You saw the animal side trying to find the hosts, making sure additional spillovers don't happen or things don't get amplified in animal hosts while the really important work for human to human spread contact tracing control go into place. Unfortunately, at least here in our country, that didn't happen this time, and I'm you know, disappointed about that.
But the only thing that.
We can do now is say we have the opportunity to fix that for the future.
Yeah.
Absolutely, I wanted to talk a bit about conservation and how wildlife conservation fits into this and what role we see wildlife conservation playing in spillover events or preventing them, and then also maybe a little bit of the conflict in terms of how wildlife conservation is sort of a you know, public greater good thing when people are struggling to feed their families. I don't know if you wanted to chat a little bit about that.
Absolutely, so, especially in this one, I think there's a moment here that we shouldn't lose. From a wildlife conservation perspective, people are aware that wildlife in markets now presents a risk, and it's really the heavily trafficked wildlife that presents the
biggest challenge from a conservation perspective. And even for the most heavily trafficked wildlife penguins, we're seeing that they're likely susceptible hosts or at least could be infected with closely related if not this Stars two coronavirus.
So first and foremost.
Wildlife that is moving around the planet, sometimes legally, sometimes not legally, and into our value chains for medicines, foods, and things, those are targets of surveillance and control. And for wildlife that's trafficked or hunted, captured, transferred illegally, we can really do a greater good for the wildlife while also doing an amazing risk reduction effort for humans. So I think that the time is now to look at that.
And frankly, a lot of that traffic wildlife is moved by the same bad actors that move drugs and traffic humans, and we want to see that stopped. Certainly, there are places where we look at the tradeoffs of protein availability and nutrition and what's available to people. So certainly we can think about better ways to get protein into diets than eating wildlife. But really, frankly, in my last decade of work and going to these markets, most of the wildlife is more expensive.
We have papers on this. Most of the wildlife is more expensive.
Than chickens and even pork, which is sometimes a very highly valued meat.
And it's really.
Tradition and sort of the everybody at Thanksgiving has the thing they like the best. Some people want to make sure there's turkey or macaroni and cheese, and families all over the world have those preferences and traditional dishes.
That make events special.
And that is a lot of what we see in the legal wildlife trade. And so again it's human behavior and what will tolerate and what will change to protect ourselves as well as the planet.
Mm hmm, absolutely, I mean, and it's hard because I think this is again where something like a one health approach or a more interdisciplinary approach is really crucial in trying to get messages not only from the people studying these pathogens to people maybe expose these pathogens, but also vice versa. What are the things that they're concerned about, what are the trade offs that they view, and how do we come to a compromise while also making everyone healthy?
Yeah?
Absolutely so so far in this pandemic. What do you think we have learned from a one health or maybe a disease ecology perspective that you think could help us prepare for or hopefully stop the next one.
Well, certainly need to be ready earlier.
So what we did with the predict project provided a proof of concept that we need to go even further, and we need to have a one health approach to be able to prepare.
That's why you know, I've.
Joined the Global Virum Project, and we really want to understand the host, the interfaces, the geographical locations, not just identify the viruses early, but understand what will make them a jumper and how to target therapeutics and diagnostics. And that takes more than just finding the virus once. Really, you know, we've been working on a risk ranking for all the new viruses that we've found and others have found, and a tool that we call spillover that that will
help us rank those viruses. We've used experts from around the world the best in the field to help us rank about forty different factors epidemiological, ecologically, viralogically, to help us collect that information and rank new viruses as they're found. The key thing to that is is having enough detections to understand if they're single host viruses or if they're
easily moving between species. And if they're easily moving between species, that certainly moves them way up high on our risk ranking.
How do you determine whether something easily moves between species? Is that something like that's a genomic question or is it an experimental question.
We can do it multiple ways.
So certainly we can do it genomically, looking at both the virus' ability to bind to receptors and then the host receptors' ability to receive that virus.
That's happening with coronaviruses.
We've been doing that for quite a few years and working with some of the best folks out there, like at North Carolina University to do that work.
But you can also do it in a low tech way.
And frankly, if you go out and sample the wildlife and you find the viruses, then they're getting into those wildlife, so you don't necessarily for every single virus need to do heavy duty laboratory investigations because that's very expensive and time consuming. You can start by identifying those viruses and if you're doing heavy sampling, you can say, okay, this one is only ever being found in this one species.
It's much less likely to jump.
Let's look at it spike protein and in the host that is two receptors. To see what makes that one different than all these coronaviruses that seem to be able to jump.
And we find in dozens of posts.
Mm hmmmm. You know, I think the predict project with its one health approach is such a perfect example of how you can have expertise in one field and bring so many different people together with all so many different expertise together to still work on one common goal. And so you know you mentioned mathematician AND's field, ecologists, veterinarians, physicians, Like,
what are some other examples of people? Because I know that people after this are going to want to get involved and maybe this is something that speaks to them. So what can they do?
I mean a big one that we need more of that.
We have some great social scientists working with us, both in the behavior realm and the in economics on the Predict Project and the Global viron Project, those areas of expertise are underrepresented in health work, and frankly, because they're underrepresented in health work in academia, we've undertrained people to help us with this, and we're going to feel that, especially from the behavior change perspective, we really need those
medical and cultural anthropologists that are willing and able to innovate in behavior change if we're going to get in front.
Of these things.
Awesome. So what do you think are some of the biggest barriers or es in identifying these spillover events in the future? And maybe you know, even though we've learned so much from this, what do you think in the future is going to make it more difficult to prevent something like this from happening again.
Well, for me, the future is right and I have a lot of hope that this tragedy will allow us to not have to live with the barriers anymore. I think the barriers have always been there and we can break them down now. The barriers are really human nature barriers. We deal with what we were worried about because it just happened, instead of looking forward. It's hard to prioritize resources to things that might only might happen instead of
definitely will happen. And when the resources are limited, of course we're going to take care of what's affecting our population right now, but in some of the better resource countries like our own, we need to contribute to and take care of what we know will come, even if we don't know when. So I think those barriers are lowered right now. We have to take advantage of that lowering to really stop chasing the last eponemic and start
preparing for the next one. And we can prepare sort of agnostically to the pathogen to be ready to bring in the right people. So if the next one happens to be a paramixa virus like measles in that family, we can have all the contingency plans and bring in the best labs that work on those every day for that emergency early phase response, so that while our government gets ready and makes its test kits and everything, we
aren't just waiting. We're testing, and we're using that very willing and able workforce that can be pre approved on a contingency basis. So I really think those barriers are down right now, but we need to take advantage of this, this opportunity that's presented itself out of chaos and tragedy.
That was awesome. Thank you so much, doctor Mazette. I just had the greatest time talking with you.
I'm just so jealous, Aaron.
I'm at home with a baby currently who doesn't like to nap for long enough for me to get to do these interviews.
Listen, your presence was missed, and.
Yep, someday I'd like to meet you, doctor Mazette. Anyways, what did we learn from that interview?
We learned a lot of things, a lot of things. Let's talk about the five just as we have for other episodes in the series. So the first thing that we learned isn't that new, and we've said it before, but I think it bears repeating. Spillover events have been on the rise for a very long time, and there is no slowing down. In sight. Researchers estimate that we'll
see three recognized emerging infectious diseases every year. Three Those are just the ones that we recognize, and so that means that there are a good deal of spillover events or emerging infectious diseases that we may not even realize are there simply because the person got better or they died and no one else got infected, and we didn't know what to look for, or even that we should
be looking for something. So the more we look, the more likely we are to catch something early and stop a potential pandemic in its tracks.
Dang three A year, three a year, my gracious all right?
Number two.
There is a usual sequence of events that emerging infectious disease researchers follow when they collect and present their data. Normally, it goes like this, collect data, present the data to governments of the countries where you're working, and then begin the lengthy process of publishing the data in peer reviewed articles.
An ethical dilemma can arise about whether the data you've collected should be shared with the communities at risk before being published, And the reason for that dilemma is not because you're worried about being scooped, but because the peer review process is an important way of double checking your work with people who don't have any horse in the race.
By and large, though, there seems to be consensus that getting that information to the communities at risk as soon as possible is the right thing to do, even if the data aren't published yet. And this is something that we've seen a lot in this current pandemic and will hopefully cause us to re examine the way we get public health information out there in the future.
Number Three, we know how spillover events happen and we can estimate where they are most likely to occur. Spillover events are caused by humans invading wild spaces and wild animal habitats, changing the natural environment. When people do this, we stress the systems and the wildlife, and that leads to us exposing ourselves to things to which we are immunologically naive, something we've never our bodies have never seen before.
And so the places that tend to be hot spots for spillover events are high in biodiversity and have increasing
or evolving landscape change. And this is because in those places the barriers between humans and wildlife are lowered, and the wildlife trade in particular poses a pretty huge threat not only to the conservation of some of them most trafficked animals, but also to public health because that's where a lot of these spillover events happen, and conservation efforts would go a long way towards reducing the likelihood of spillover events, but policies also need to be sensitive and
keep in mind cultural traditions and the basic needs of people living in these hotspots.
Number four, how many times can we say this, We need to stop chasing the last pandemic and spend more resources on stopping the next one. What by doing that we can enable an entire, willing and skilled workforce that can give us a leg up on preventing another devastating pandemic. We've said before that when these emerging infections occur, we're not starting from scratch, but let's make sure we can do all we can to start as far away from scratch as possible. Invest in global heal.
Yeah, oh okay. Number five, we gotta work together. We got to work together. So working together this is what the one Health approach is all about. And so by recognizing that the health of humans, animals, plants, and the environment is interconnected, it makes it so that a lot of disciplines have to work together to understand the drivers of disease, and people who work in one Health have done a great job of collaborating across disciplines that are
very different. But there is also a need for more social scientists in healthcare and especially health research fields, because we can do all of this super cool ecology or microbiology or mapping research, but if we want this research to make an impact on people, we need to communicate these things to communities and get them involved.
Yes.
Absolutely, Okay, what a fun episode.
It was so great. I mean honestly, like, I was very nervous. I felt like completely starstruck, and it was really fun to talk with her. So and also thank you so much to Brooke for putting us in touch with doctor Rosette. It was very appreciated.
Fantastic guest to have. And also a huge thank you to my very good friend Zuwen Spiegelman for all of your help with our first hand account form. Reminder, if you'd like to share your first hand account with us, please go to our website this podcast will Kill You dot com and click on COVID firsthand.
Ah, let's do sources real quick.
Yeah, let's okay.
Once again, that first hand account was by doctor Craig Spencer and the article appeared in the Washington Post. We will also post a link to the new recommendations on the CDC website regarding the use of cloth face coverings excellent.
Thank you to Bloodmobile for providing the music for this and all of our episodes.
Did you know that you can find blood ba Bill's music if you click on our website and then you click on music, you can find it. You can, Dan, and thank you to you listeners for listening. We know that these are very trying times and so.
We hope that you find I don't know those of you who find comfort in more information, which is obviously the kind of people that we are. Hopefully you're getting something out of these episodes, and we hope you're staying safe and well mentally and physically.
Yeah, we do. And if there's an aspect of this pandemic that you want us to cover in more depth or more detail, we're open to hearing suggestions.
Yeah.
Well, until next time, wash your hands.
You feel the animals. Bum bum bum