Special Episode: David Quammen & Breathless

true origins of epidemiology, dug into fossilized poop. And those were just a few of the episodes. This season, though I'm doing something a little different. We'll still be deep diving into a topic with an expert guest, but that topic will be a book, and that expert guest will

be the author. In each bonus episode this season, I'll be interviewing authors all about their popular science books on topics ranging from smallpox inoculation during the American Revolutionary War to menstrual periods, the history of eugenics, to why sweat matters, and so so much more. I guess you could think of it kind of like this podcast Will Kill You Book Club. In any case, it's going to be super fun and I can't wait to see where these discussions

take us. I am so thrilled to be kicking off this mini series with an interview with one of the all time greatest science writers out there, David Quwaman. Over the course of his career, Quamen has published over a dozen books and has contributed to countless magazines and journals, including National Geographic, The New Yorker, Outside Magazine, and more. His books have explored topics such as island biogeography, the history of evolutionary theory, and the spillover of pathogens from

domestic and wild animals to humans. That last book, Spillover, Animal Infections and the Next Human Pandemic, is actually one of my favorites, as well as one of the most terrifying books I've ever read. I suspect many of you have already read it, but if you haven't, made sure you check it out. Quaman's latest book, Breathless, The Scientific Race to Defeat at Deadly Virus, picks up in a way from where Spillover left off by examining not pathogens that could cause a pay pandemic but a virus that

did indeed cause a pandemic. Of course, I'm talking about SARS covy two and the COVID pandemic. While there may be some quibbling over the finer aspects of the virus's pathophysiology or epidemiology, there's at least one thing that the scientific community can agree on when it comes to SARS

covy two. We saw it coming for decades. Epidemiologists, disease ecologist, virologists, science journalists like David Kwaman, so very many people have warned that a pandemic was on the horizon, that a virus or other pathogen jumping into humans from animals and then being efficiently transmitted human to human was not just possible but likely, especially given the increasing frequency of interactions

among humans, wildlife, and domestic animals. But knowing something is likely to happen is very different than watching your prediction come true before you're very eyes, and the resolution provided by that crystal ball may not be high enough to allow us to turn prediction into prevention, which is part of the reason why three years after the COVID pandemic began, we're still struggling to find answers to questions like what

animal does SARS covy two naturally reside in? What was the sequence of events that led to the spillover event? Was there more than one spillover event? That these questions have yet to be fully answered does not mean that

no progress has been made. On the contrary, we may know more about SARS covy two at this point than we do about any other virus on this planet, but in particular, the lack of clarity on this virus's origins has led to a fierce, controversial, and highly politicized debate that reveals a great deal about attitudes towards science and the disconnect between how science is conducted and how it is presented in popular media. This question of where SARS CoV two came from is just one of many explored

by Kwamen in his book Breathless. In this riveting, fast paced, and slightly terrifying book, Quaman takes a big picture view of the COVID pandemic as seen by those working most closely on the disease, the scientists. How did our scientific understanding of this virus, the disease it causes, and the pandemic it's responsible for evolves since those reports of a pneumonia of unknown cause began circulating in early January twenty twenty.

Tracking down the origins of the COVID pandemic means looking beyond where and when SARS CoV two first emerged. It means examining the influence that past epidemics and pandemics have had on the public health policies shaping this one. It means asking ourselves why prediction and surveillance weren't enough for complete pandemic prevention. It means confronting the growing mistrust in science and spread of myths and disinformation that added fuel

to the pandemic fire. Addressing these elements of COVID is important not just for understanding how we got to where we are today, but also to help us be better prepared if or when this happens again. In Breathless, Kwaman expertly weaves an account of scientific discovery as it relates to SARS covid two, and also stresses that what we haven't yet learned about this virus, where the gaps in our knowledge lie, is just as crucial to the COVID pandemic story as what we have. But before I get

too lost in singing the praises of Breathless. Let's get into the interview itself right after this break. David Qualmyn. What an honor. Thank you so very much for joining me today.

I got a call in mid January from an op ed editor at the New York Times saying, hey, Kwamen, it's about time for you to write another op ed on something for us, So why don't you do that, like, for instance, I don't know on this virus in Wuhan, And I said, yes, I do want to write an op ed about this virus in Wuhan because this could be serious, and I can think we can loop back to how I was confident it could be serious at that point mid January, and so I wrote an op

ed for this editor she was based in Hong Kong but working for the New York Times, and it ran on January twenty eighth, saying, people, this could be it. This could be the next pandemic. This virus, it's a coronavirus, et cetera, et cetera. Here's why it could be really a pandemic threat. And then I got on a plane and flew to Tasmania to do research on a book that I was working on for Simon and Schuster about

cancer as an evolutionary phenomenon. And Tasmania was important because the Tasmanian devil, that little marsupial omnivore that's unique to Tasmania, is dying off from an epidemic of genuinely transmissible cancer. A transmissible tumor supposed to be impossible, but it's not impossible, and it says a lot about how cancer can evolve. So I spent my time there crashing around in the bush with Tasmanian devil biologists. I had met them before, I had written about it before, but now I was

back for a book. Except that my email lit up with requests to flap my jaw about the virus in Wuhan, and so I spent half my time doing that, talking about this virus while I was in Tasmania. Flew back from Tasmania on March second, twenty twenty, then did not leave the state of Montana for two years, did not

leave my town here, Bozeman, essentially for two years. And in a late April or so, or maybe it was soon after I got back, I heard through my agent that Simon and Schuster wanted a pandemic book and would David be interested in writing it? Because they knew I had already published Spillover in twenty twelve, so they said, we want a pandemic book, would you write it for us?

And I thought very carefully about this for four or five seconds and then said yes, But then was faced with the difficulty of figuring out how do I write a uniquely useful book about something that a lot of other people were going to be writing books about, and how do I research it without being able to travel, which is usually part of my operating principle. Go there. If you're going to write about ebola killing gorillas in

the Congo forest, go there. We're going to write about viruses in bats and caves in southern China, go there. Couldn't go there, So I spent the rest of twenty twenty trying to figure out how to do this book. But I had committed to it to Simon and Schuster and committed to it on a deadline of delivery by December thirty first of twenty twenty one, so I had to figure it out fast. So that was the beginning of.

So I belong to that, and that means that I and eighty thousand other subscribers get numerous emails virtually every day alerting us to a child has died of a suspicious respiratory disease in Houchimen City, or water buffaloes have shown up with lumpy skin disease in Malaysia, or people are sneezing in Adelaide, Australia. Whatever. So we get emails,

as you know, get emails, bing bing bing. So you get all these emails about all these different kinds of diseases, and most of them you're not interested in, so you delete them. Boom boom, boom, delete delete, delete some of them you read, and then delete some of them you

don't delete. So I went back to January of twenty twenty to see which ProMED emails I had not deleted on this subject, and the earliest one I found was one on January thirteenth, twenty twenty, and for the first time, it used the word coronavirus, at least the first time that I've noticed, And I'm sure that that's the reason I didn't delete it is because I read I looked at ProMED on the Wuhan virus, and I saw the word coronavirus, and that's when I said, boom, this could

be the one. Because the scientists ten years earlier had told me the next one is going to be caused by an RNA virus, an RNA virus with a history of spilling over from animals into humans, So maybe an influenza, maybe a PARAMIXA virus, or maybe a coronavirus.

I was in Australias, in Tasmania. I took when I flew there on February sixth I took masks with me, shoved him in my briefcase. I shoved in some N ninety fives, thinking I may need these to get on an airplane by the time I come back. But I didn't. I thought they will have real time airport diagnostic testing by the time I come back if this thing goes big. But we did not, not because it's technologically impossible, but

just because nobody was willing to pay for it. Nobody was willing to spend either the financial or the political capital to be ready. I asked the same question you just asked me. I asked Ali Khan. Ali Khan is a great disease scientist I've known for a long time time. He's now Dean of the School of Public Health at the University of Nebraska. Formerly he was in special Pathogens at the CDC. I asked him, Ali, what happened? Why? Why were we so poorly prepared? And he said, failure

of imagination. Wasn't a failure of science, wasn't a failure of public health. It was a failure of imagination. And I'm pretty sure what he meant was failure of political leadership to realize a that although the scientists can predict a pandemic, they can't tell you whether it's going to

happen between now and the November twenty twenty election. And they can tell you that it would cost tens of billions of dollars to be adequately prepared, and also political capital instituting measures that would be unpopular and would hurt economies. And then it takes the imagination of the political leader to say, Okay, well, they can't guarantee, but it could

happen between now and the next election. And although it would cost tens of billions of dollars to be out of ely prepared, it'll cost tens of trillions of dollars not to be adequately prepared. And that's what happened, and I think Oli was right about that this.

National Geographics. So I spent two days going up and down the corridor talking to people about Ebola, and you know, rabies and Marburg and Nepa and Hendra and Avian influenzas and all sorts of things. And then Alie took me to lunch, and he is he's a very serious man, and he has been in all of the difficult outbreak situations, and he has great empathy for the human victims. But he's also kind of a jaunty guy with a very

candid sense of humor. So we sit down at lunch and he says to me, all right, colmen, so you've interviewed all my people about these emerging diseases. Which one of them is your favorite? I gave the entry level answer. I said Ebola. Ebola is pretty dramatic. Ebola is a very dramatic disease. And Ali said, yeah, I like Ebola as much as the next person. But for me, it was Sars and he likes Ebola. You know Gallo's humor he was at he was at the kickwit Ebola outbreak.

I think he was he was risking his life to save lives during that. So that's the way Ali talks. But for me it was Sars. I said, really, Sars, really, SARS, he said, yeah, and then he told me why SARS. It's coronavirus, single stranded rnavirus, respiratory transmission, high case fatality rate,

did not burn out. We stopped it because of good public health measures and the luck that it spread to cities with strong governance and strong healthcare systems who stopped eight thousand cases, eight hundred fatalities, ten percent case fatality rate. And Ali said to me, literally, we dodged a bullet. Next time it could be a lot worse. How could it be a lot worse? Well, for instance, the coronavirus with that kind of case fatality rate plus transmission from asymptomatic cases.

learned the lesson of SARS, absorbed it. He was in Singapore, as I say, but there were few, if any cases in the US, and I think no fatalities in the US, So the the lesson of SARS did not register nearly strongly enough on American public health and political preparedness for public health emergencies, just didn't register the way it registered in Singapore, in South Korea, in a few other places who were far better prepared and who took this virus

very seriously in consequence, and who did not have big first waves Singapore, South Korea, although eventually they got hit, they got their waves because this is a virus that's so enterprising you can't keep it out forever.

of global trade, so there was an advantage. If you were the smart Prime Minister of New Zealand, you had an advantage. She had an advantage, and she put her advantage to good use and protected her country. So those things are relatively easy to explain. And as I said, Singapore eventually and South Korea eventually got their turns to be hard hit. But then there are other mysteries, like most of Sub Saharan Africa, Central Africa, and yet apart from South Africa, Africa has not been very hard hit

at all. The democratic public of the Congo last time I checked, has not been very hard hit at all, and it's been a mystery that people have tried to explain. One of the possible explanations is that the demographics is different. The population is much younger than other places. I could be part of it. People speculate that maybe a coronavirus burned its way through Africa within the memory frame of immune systems, but nobody knows. I would love to know.

I would love to know why South Africa got hit badly, and Democratic Republic of the Congo has been relatively spared. Italy got hit so badly, especially the north of Italy

at the beginning. I think that was bad luck. I think they got heavily seated very early on, because there are three international airports around Milan, and there are travelers coming in for business from Wuhan, among other places, and the population is older and their multi generation households, and there's air pollution and there's smoking, all those things, and then New York City got hammered and a few other

places got hammered. We still don't know how much of that was determined by differences in public health response, how much was determined by differences in the nature of the population, and how much was determined by bad luck.

We certainly did not dodge a bullet with COVID. In what ways do you think we might be better off with the next pandemic because of our initial mishandling of COVID.

of work to do on the rest of it. I mean, science denial has just gotten worse and more toxically obdurate in the last two and a half years. We've got to fix that. I don't know how you fix that, but we've got to fix that. We've got to get the general public back on the side of science so that they trusted, they accept its guidance, and they readily pay for it. You know, education of kids is a really important part of that. I don't know if we can afford to say that it starts with educating kids,

because we've got to do it now. We've got to do it fast. We can't wait for the fifth grader who's got a great science teacher to go up and become an epidemiologist. We can't wait that long. But that has to happen, and we need more surveillance. We need more what some people call smart surveillance so that we're not waiting for outbreaks to hit us and then try to respond to outbreaks where you know, suddenly forty one people are sick from a new virus in a city

or in a village somewhere. We got to get there before we've got those forty one cases of people with human transmission. We've got to get there when it's one or two cases, or maybe nobody symptomatic at all. But a virus that looks like a dangerous virus is detected in a poultry work in Arkansas who feels fine, but the poultry worker is routinely screened for new viruses because he or she is working with two hundred thousand chickens and twice a day some wild ducks land in the

pond where they get their water. So danger of avian flu among other things, or some other version of that. We need to screen the person who is driving a truck that delivers farm raised raccoon dogs and bamboo rats from southern China to the city of Wuhan, to the markets in the city of Wuhan. We need to be screening that truck driver, and the results of that screening have to be flowing at the speed of electricity around the world to labs all over who are connected, who

are coordinated to help interpret and respond. We need a lot of that, among other things.

which creates conflict between the two. Can you talk a bit about the different sides of this conflict and how you think the COVID pandemic has affected the discussion of where funding should be concentrated.

it as discovery and prediction versus surveillance and response. So discovery and prediction implies sampling animals all over the world, all kinds of animals, looking for viruses, new viruses that might potentially be zoonotic, be transmissible to humans, in particular, looking at mammals and birds, because the viruses that take hold in us generally, almost without exception, come from mammals

and birds. One estimate there's maybe one point seven million viruses unknown viruses in mammals and words capable of infecting humans.

These are at best orders of magnitude estimates. There was a program that was funded for years through USAID called the PREDICT Program, was an acronym PREDICT they gave away two hundred million dollars over the course of ten years for this kind of work, sampling, looking for new viruses, characterizing new viruses, looking at them to see which ones look the most dangerous that we could predict might spill

over into humans. So discovery and prediction, and Dennis Carroll, who has been the lead initiator of what is now the Global Virum Project, is I think it's fair to say a spokesperson for this point of view discovery and prediction. And that's the idea of the Global Virum Project. Let's really learn about all the viruses that are out there that have any potential to be human pathogens and try

and predict. But there is overlap between these views. On the other side is surveill and response, which says, let's don't worry about every virus in every mammal and every bird. Let's worry about the viruses that exist in animals at the points where there is ecological disruption and human animal interaction,

the interfaces. Let's look at the interfaces rather than going into the deep forests and finding really really really wild animals that nobody ever messes with and see what viruses they care So let's look at the interfaces in the ways that I was just describing. Let's do zerological sampling for antibodies in people who work with wildlife but who still feel fine, and let's see what viruses are turning

up in their bodies. Viruses therefore, that have already showed the capacity to infect a human, whether or not they make that human sick, and whether or not they transmit. That's the warning bell to this school of thought. Surveillance

and then response. When we find like there are three poultry workers in Arkansas who have PCR positive tests for a new coronavirus that we haven't seen, not this one and not stars Won, but a different one, and it's in three people but they feel fine, then let's flood

that situation with resources to contain that situation. Find out where it's coming from, how it's getting into those people, whether they are showing any symptoms whatsoever, even if they're not reporting them, what their viral loads are, whether the virus is replicating within them, or maybe it's just you know, they've just gotten a big nose full but it hasn't

been replicating. Let's find that out. So that's surveillance and response the idea being that catch the tiny fires, catch the tiny spot fires before they grow, and do that in the areas where there's a lot of dry tinder, rather than walking through the entire rainforest to make sure that there are no fires.

have made a difference. I mean, if we were doing surveillance of the commercial trade in wildlife species for food, both caught from the wild and farm raised, if they were sampling those truck drivers and sampling those raccoon dogs that were coming up out of Yunnan Province, and sampling those bamboo rats, they might have spotted this virus before it got into forty one people reporting to hospitals in

the city of Wuhan. And at the same time, I mean you can argue that EcoHealth Alliance, the organization based in New York. I don't know whether they at this point would say we're in the business of discovery and prediction, or whether they'd say, well, no, we're more targeted than that, where we're more in the business of surveillance and response. But they were doing this kind of work at one scale,

not at the scale that we need. They were supporting jangle She and her laboratory at the Wuhan Institute of Virology. Jangly She and EcoHealth Alliance and a number of other colleagues for fifteen years have been publishing papers saying, hey, there are dangerous coronaviruses in bats in the caves of Yunan Province and in botanical gardens flying around in botanical gardens.

People are in their vicinity. This is dangerous. They've been publishing papers on that for fifteen years, and now it's sort of a blame the messenger situation because they've done

that work. They're being accused of having had this virus in a lab and let it leak, despite the fact that there is no evidence whatsoever that they ever had this virus, and there is counter evidence to suggest that if they had had this virus, first thing they would have done would have been published a paper in Nature or Science saying hey, here's a really really dangerous coronavirus. We found it. We're getting the publication in Nature. That's

what we do for a living. That helps our career, and you need to be aware of it didn't happen.

measures extremely difficult, if not impossible. And I think the ongoing struggle to understand the emergence of SARS kobe two reflects this. Can you bring us up to speed on what is currently known about the origin of this virus, I.

of thought. This is a natural spillover of a wild virus from a bat, possibly by way of an intermediate animal, and possibly with recombination, creating a hybrid genome when two coronaviruses were replicating inside the same animal, inside the same cell. That's the natural origins hypothesis school of thought. And then there is what I call the nefarious origins school of thought. And the nefarious origins school of thought is a basket

that contains a couple of different hypotheses. One, this is an engineered virus that was specifically designed in a laboratory by evil scientists trying to create a virus and succeeding to be released intentionally to cause harm to people. That's

the most extreme form of nefariousness. Second gradation on the spectrum is well, this is a virus that was manipulated in a laboratory, maybe originated as a wild virus, was manipulated in a laboratory with gain of function research of some sort for supposedly good scientific purposes, but that was reckless and should never have been done. And this was made more dangerous and more adaptable to humans, and then

somehow it leaked from a laboratory. And the third version is the sort of the mild Lablique hypothesis, which is, this is a virus, one way or another, was taken into a laboratory, was cultured, not just a genomic sequence in a sample, but it was grown live. And a lot of people don't appreciate the huge difference there, that the importance of that distinction. Lots of sequences are messed around with in laboratories and that doesn't mean you have

live virus. So this was a virus that was in a laboratory, a wild virus, but a dangerous virus, and it was allowed to leak. So those are the nefarious origins hypotheses. And I don't consider myself an advocate really for any of those, or at least I didn't start out as an advocate for any of those different hypotheses.

I don't consider myself a prosecutor. Some people seem to perceive their roles as prosecutors in this discussion, particularly on the lab Leak side, because they have made a lot of prosecutorial accusations based on circumstantial evidence, coincidence and absence of evidence, a lot of accusations against Peter Dashak of Eco Health Alliance, against Jangle Shehi at the Wuhan instant accusation. Whether they're right or not, they are assuming a prosecutorial role.

Seems to me I view my role as a juror. I'm listening to all this and I'm saying, what's persuasive,

what convincing to me? And after two and a half years, what is very convincing to me is the natural origins hypothesis as supported by a lot of very specific work and evidence gathered and assembled by people like Eddie Holmes and Michael Warby and Marian Koopman's in the Netherlands and other people that I respect, you know, disease scientists of various different sorts, molecular evolutionary virologists, veterinary virologists, epidemiologists, professionals,

more professionals on that side and more amateurs on the other side. Because a lot of people have decided that there are full time researchers on the Internet. Therefore they are knowledgeable about molecular evolutionary virology. I've been following this stuff for twenty years, and I know I'm still an amateur, and I will always be an amateur, so anyway, so

I perceive myself as a juror. But the preponderance of the actual evidence is strongly, strongly, strongly on the side of natural origins in peer reviewed scientific papers by Michael Warby and Christian Anderson and Eddie Holmes and Marian Kopman's and angel Erasmus and a number of others. Is a lablique still a theoretical possibility. Yeah, it's hard to prove a negative. Should we still think about, talk about, and in some way investigate the lableek hypothesis? Yeah, yep. Does

that mean equal time, equal resources, equal probability. No, I think natural origins is much more probable. But it's still important not to close our minds to the possibility that this other thing might have happened. But we need to see some evidence, We need to see some data. If it happened, and this virus sars kov two cannot have leaked out of a laboratory unless it was in a laboratory, and we have zero evidence that this virus was ever in a laboratory.

of wild animals, especially in the chain of supply. If you think that this virus came from gain of function work or just growing it in a laboratory, and that's crazy and dangerous, than what you're essentially saying is we need less science so more science or less science. And the other difference is that it's the difference between did

we do this or did they do this? If it's natural origins, then it leads to an understanding that all of the things that all of us do as humans consumers on this planet put pressure on highly diverse natural ecosystems and lead to the contact between humans and mild animals and their viruses and cause spillovers. If it's a lab leak, then it's easy we say they did it. Those idiots, those reckless idiots over there, they did it. So that's a big difference. There are stakes in figuring

this out. And so why do those people embrace the Lablique hypothesis with such passion and they do. It's partly that it's partly being able to say they did it, those idiots over there, and it's partly that conspiracies and dark movements of evil activity are more dramatic, and they've always been more dramatic.

evidence on their side. They could be right, but as so far, there's no evidence that they are right.

out of the natural world into our ambit. So use another metaphor, and as long as that keeps happening, there will be viruses infecting a human here there, and a couple of people here and there. There will be spillovers. Michael Warribee I think has said, you know, spillovers are common, but pandemics are rare, and we have to keep it that way, and we have to make it even more true.

We have to make pandemics more rare. You know, we've had three pandemics three million, million, million killing pandemics in the last one hundred years, the nineteen eighteen influence a little bit more than one hundred, the nineteen eighteen influenza, AIDS and COVID, and they are all almost certainly zoonotic events. So we need to do that surveillance and response that

I was talking about. It needs to be one of the highest geopolitical scientific priorities on the planet, surveillance and response so that we catch the next spillovers before they become outbreaks. Of two dozen, three dozen people dying horrible deaths in an African village, or in a city in central China, or in a town in the American Southwest. We have to catch those early, early, early, and if we do, if we really saddle up and invest, I think we can prevent pandemics.

Breathless and Don't Forget. You can check out our website for all sorts of other cool things, including but not limited to, transcripts, Quarantini and Placibrita, recipes, show notes and references for all of our episodes, links to merch our bookshop dot org, affiliate account, our Goodreads list, a first hand account, form, and music by Bloodmobile. Speaking of which, thank you to Bloodmobile for providing the music for this

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