How to make pandemics optional not inevitable Sonia Shah

hi everybody hi Whitney hey David how

are you doing I am good and I’m excited

for for this conversation even if it is

about pandemics I mean that that is the

thing to talk about right now and I feel

like some you know we’ll have some

things to share that could really help

us all understand a little bit better

and feel hopefully a little bit better

exactly we can learn from the past so

without further ado I’d like to

introduce Sonia Shah she’s a

award-winning journalist and author who

counts among her many illuminating books

one simply titled pandemic and she’s

here to help us understand what a

pandemic is and what we can learn from

the pandemics of the past thanks for

joining us Sonia nice to be here nice to

see you nice to see you too so I guess

I’ll start with having written a book

about this what does it feel like to

have it kind of come true well it’s very

eerie and surreal but I think that’s how

a lot of people are feeling you know so

I’m sort of experiencing the horror and

tragedy of it with everyone else but

also having a lot of sort of flashbacks

to different historical epidemics and

how they’ve unfolded and the fact that

we’re kind of reliving all of that is

yeah it’s a very eerie feeling yeah

so at least I guess now we know it’s a

virus and not some bad air or whatever

else people believed hundreds of years

ago so what can we learn from past

pandemics I mean it’s it’s interesting

that you say that I think that is sort

of the big difference I see is that we

understand the transmission and sort of

the causative agent of pandemics today

very rapidly like you know in the past

with say cholera or malaria took

hundreds of years to figure it out that

you know oh it’s caused by this like

parasite or this cult of this bacteria

or whatever microbial intruder it is

nowadays we know

really rapidly you know within like

weeks of these things emerging we can

understand what it is that’s actually

causing that but it’s still not clear to

me that that knowledge is you know

helping us contain it any better you

know so so so that’s the trick I mean

one of the things I wrote about in my

last book pandemic was about the

outbreak of cholera in Haiti which was

similar to you know in a small scale to

what we’re seeing today in that this is

a population that had never experienced

this pathogen and then suddenly comes in

and it just like spreads like wildfire

and it’s really this violent

confrontation between a pathogen and a

new population that’s never you know

experienced it before and has no immune

defenses or anything else against it and

in that case you know there was a lot of

knowledge you know there was a lot of

knowledge about what’s causing it and

you know people were collecting cell

phone data and they could see like where

is this Co ain’t going oh it’s going to

hit this village necks gonna hit that

village next and it was really cool so

all these like cool maps that were made

about cholera spreading in Haiti after

the earthquake but it didn’t actually

help anyone here not get cholera you

know so so there’s two separate things

here like we have the knowledge that’s

good but are we able to actually like

act on the knowledge and in a way that

will save lives

yeah so on that point looking at past

pandemics what should we be doing that

we’re not currently doing based on the

past I mean I think the thing that

always interested me about emerging

diseases is that you know they take off

so quickly that you can’t come up with

the wonder drug the magic pill the the

shot the vaccine all of those things

that we have relied upon since you know

the 1940s when we developed antibiotics

that’s has completely revolutionized

medicine and it’s completely changed the

way we deal with contagious diseases

where we don’t have to think about well

maybe we should you know clean up our

water supply or maybe we should separate

our waste from our food or maybe we

should you know all these things that we

used to have to do to avoid contagion in

the

past we don’t have to do that anymore or

not so much because we think oh we’ll

just take a course of antibiotics like

big diello we’ll make a vaccine it’s no

problem

and so you know and I think what’s

interesting about emerging diseases is

when something’s brand new it starts

growing exponentially and of course our

response is linear so there’s a mismatch

there and you cannot have a drug or

vaccine in time for the first wave of

infection in susceptible populations

which is of course the most sort of

disruptive and dangerous wave so we saw

that with Zika just now - right like

Zika came through and it you know

infected a whole load of people we have

a whole generation of babies who are

affected by that and we’ll get some Zika

treatments in Zika vaccines but it’s not

going to be in time for that first wave

so what really you have to do with

emerging diseases brand new diseases is

you have to think about how to change

behavior you know you have to have

collective action and solidarity for

everyone to say okay this is spreading

using you know exploiting this facet of

human behavior because of course that’s

always what they are doing right like a

pathogen is a tiny microbe it can’t move

around on its own it’s completely

immobile unless we carry it around to

each other so they’re exploiting human

behaviors and that’s what we have to

change then so so that’s what really

interested me about emerging diseases

and we’re seeing you know we’re seeing

that play out and tragically right now

yeah I mean obviously Kovan 19 is one of

the worst pandemics in recent memory but

it seems like you mentioned Zika

infectious diseases like this even even

kind of smaller scale pandemics were

we’re already on the rise why why is

that yeah I mean I think what you know

what first sort of got me interested in

emerging diseases also is this idea

about these microbes the pathogens

themselves are not you know new right

they’re newly emerged so for example

cholera lives in it’s a you know it’s a

it’s a bacteria that lives in marine

habitats and it lives there you know

it’s been there for hundreds of

of years or more but we didn’t have

cholera until you know 1817 we

coronaviruses have probably been in bats

for hundreds of years if not longer but

we’re only getting you know a SARS

pandemic and the current virus the Koba

19 pandemic right now so why is that

well we know that over the past 50 or 70

years or so we’ve had the hundreds of

new pathogens either kind of newly

emerged or re-emerge into places where

they have never been seen before

Ebola in West Africa and 2014 s another

example it had never we’ve had lots of

Ebola outbreaks in the past since an you

know the 1970s but never in that part of

the continent in West Africa Zika in the

Americas Zika existed for hundreds of

years - at least you know we knew about

it in in other parts of the world but it

had never been seen in the Americas

before we have new kinds of tick borne

diseases new kinds of mosquito-borne

illnesses new kinds of antibiotic

resistant pathogens and you know the

list goes on and on and so what we do

know about them is that about 60% of

these new pathogens are coming from the

bodies of animals about 70% of those are

coming from the bodies of wild animals

and that’s not strange you know almost

many many of our infectious diseases

come from animals from you know ancient

encounters with animals cows sheep you

know chickens all kinds of animals have

given us the diseases of you know we

accept as sort of normal parts of

childhood influenza measles all of that

so that’s not weird what’s weird is that

it’s happening so fast now that you know

this the scale apace has stepped up and

you know the other part of it is that we

don’t which we don’t talk about enough

is that humans are giving animals a

pandemic causing pathogens also you know

we’ve seen major pandemics and animal

species already white nose syndrome and

that’s kitchen fungus and amphibians

colony collapse disorder in these you

know there’s there’s a number of

different ones so this exchange has been

going on that’s part of you know that’s

part of sort of the human condition

living on a microbial planet is that we

share these microbes and when they come

into a new

habitats they expand to take advantage

of it you know and in that spate that

moment before our bodies can launch any

kind of response they can really take

over but the the underlying driver I

think of the the speed at which we’re

seeing these new pathogens emerge today

is because our expansion has reached

sort of it like a tipping point almost

you know I mean we’ve been industrial

expansion has been going on for you know

the last decades or so since we entered

sort of the fossil fuel era in earnest

and by now we’ve we’ve paved over over

half of the terrestrial surface of the

planet just in the last twenty years or

so we’ve added another twenty two

percent of the planet you know to for

our farms or our mines or cities or

towns or industrial activities and you

know the most obvious impact of that is

of course this the species extinction

crisis the sixth extinction as we call

it with 150 species being lost every day

but for the you know because we’re

destroying where they live but the

species that to hang on they have to

crowd into ever smaller fragments that

we leave for them so and that’s more

often going to be closer to where our

you know our habitations are and that

just increases the probability of

contact between wildlife and humans

whether it’s through you know bushmeat

hunting or a wildlife trade or wet

markets or farming or just casual

contact you know the the Ebola outbreak

of 2014 we know was traced back to a

single spillover event which is a

two-year-old child who’s playing near a

tree where bats were known to roost and

that child was the very first case of

Ebola in that in that epidemic and we

know that from sort of genetic

sequencing he infected his parents and

they infected their healthcare workers

and they infected their family members

and you know on and on and on until

eleven thousand people are dead and you

know and that can that those kinds of

events are you know if they’re

probabilistic right so it’s not like

it’s definitely going to happen but you

know if you cut down the trees where the

bats live in the

farm jungle they don’t just disappear

they come in your garden instead

and so when your kid goes outside and

plays with the picks up a piece of fruit

it might have some fat poo on it or bat

saliva on it and then they touch they

hate you know they get it on a hand they

touch their mouth that’s that’s it

that’s enough yeah yeah so so that’s the

kind of wildlife portion side of it but

then as you were talking about there’s

the the human side of it and obviously

we’re taking big measures in many parts

of the developed world with lockdowns

and and whatever else but what about

places that I mean you mentioned the

Ebola pandemic with the places that

don’t have running water or soap or the

ability to self isolate and still still

feed their family I’m thinking of you

know India going on kind of lockdown but

you know if you’re a slum dweller how do

you even do that is it is it going to be

even harder to contain this virus

because of you know the circumstances

people are living in I mean I think what

we need is a differentiated approach you

know you don’t have one size fits all

for everywhere that this virus is going

to occur you know the demographics are

different the socio-economic conditions

are different so right now like you know

lockdown is something that maybe and we

don’t even know how well it will work

but the idea is that it will work in

places like the United States and Europe

and elsewhere where you know there’s a

good amount of wealth and people can

stay indoors and you do and what you’re

doing is you’re saving your healthcare

system so you have to consider that

there is the health care capacity there

to some extent and so we want to save

that so we’re going to stay home just to

slow down transmission so they’re not

overwhelmed but if you’re looking at a

country where you don’t have that

capacity anyway you know places you know

countries in some parts of Africa that

may not have a lot of ICU beds and they

don’t have ventilators anyway and then

also you know people aren’t able to stay

home and socially distance adequately

because they’re homeless or they’re

migrant laborers or you know whatever

that you know lockdown maybe isn’t the

right approach it doesn’t mean that

there isn’t other things they can do

you know I think about like influenza in

the United States and the most obvious

thing to do because kids are sort of the

main carrier of you know they they shed

more flu virus they spread it more

amongst themselves and they they get to

vouch for that

I have tickets for that yes so they’re

very germy with the flu but the most

obvious thing to do then is okay well

let’s not touch our children during

those six weeks of flu season or let’s

make them wear masks or let’s keep them

home from school you know there’s we

could isolate the kids don’t hug your

kids you know we could make those kinds

of recommendations and it would make

sense but it’s not sensitive to the fact

that these are people in our lives that

we need to be connected to so we think

of other ways to deal with it you know

and so I I think there’s I don’t know

what the answers are in a resource poor

situation like how do you actually stand

that but that doesn’t mean there isn’t

better options we don’t all have to do

it the same way yeah are we so are there

lessons that we can learn from past

pandemics about what works I mean

obviously Europe and let’s say the 1600s

when the plague is is floating around

was was was kind of resource-poor and

certainly understanding poor are there

lessons we can learn from our from our

ancestors or at least mistakes we can

kind of avoid yeah I think I think more

the latter and the stakes we can avoid I

mean I think about sort of color in the

19th century when it came to New York

and it took you know they had evidence

that cholera was coming down the canal

coming down the Erie Canal coming down

the Hudson River into Manhattan they had

they collected all that evidence like

we’ve mapped it out and it’s like so

clear if you look at it today in

retrospect right they knew that the

water was contaminated with human waste

they knew that would make them sick

there was just all these opportunities

to actually solve this problem but they

never did and they had 80 years of

epidemics whereas thousands and

thousands of people

New Yorkers would die and they’re you

know just terrifying panda epidemics

like what we’re seeing today but in the

end you know when they finally did clean

up the water and

Koller disappeared for good it wasn’t

for public health it was because brewers

wanted better tasting water for their

beer and they felt they were at a

competitive disadvantage because

Philadelphia had had Institute had had

you know cleaned up their water supply

so you know it so much is going to

depend on the stories we tell about

these diseases you know to think about

cholera in London also and they you know

because they thought that cholera is a

problem of miasmas which were you know

basically bad smells though they wanted

to get rid of the bad smells so they

installed flush toilets or what they

called water closets but since they only

cared about the smell you know they

installed the flush toilet because they

didn’t want the smell of human waste

around their homes and alleys because

they thought the smell would make them

sick though so they started installing

installing flush toilets get rid of all

this stuff you know get rid of the

smells but since all they cared about

was the smell and not the contents they

dumped all that into the River Thames

which was of course their drinking water

supply and so after every outbreak of

cholera they installed more flush

toilets to dump more of their waste into

the drinking water and made it you know

progressively worse so so much depends

on how we sort of characterize this

disease like if we did characterizes

this disease as as you know some

political leaders have done a Chinese

virus you know then then what becomes

our response our response is then okay

well we should like close our borders

and trade you know or do we or you know

do we think of it as a problem of well

too many people are travelling let’s cut

let’s shut that down or do we think of

it as you know people are invading

wildlife habitat let’s start conserving

wildlife habitat so that doesn’t happen

you know there’s there’s all of these

things all of these epidemics are

multifactorial there’s more than one you

know there’s a lot of pieces that come

together so ultimately the stories we

tell are going to be really influential

in the actions we’ll take after this

pandemic ends it’s that cultural piece

where we just need to get the Brewers

involved and that America will take

action but it looks like Whitney has a

question

now this is this is so fascinating and

we have some questions coming in from

the audience one of them is about you

know in your point about this being

multifactorial thinking about the

climate crisis and how and why might

that make infectious disease outbreaks

more common yeah so I mean the thing

about the climate change is it’s gonna

have a diverse effect on infectious

disease epidemiology in some places

there’ll be more opportunities for

pathogens to spread certain pathogens to

spread in other places there might be

less so malaria is a good example of

that where malaria is carried by

mosquitoes of course if you had say

climate change means more precipitation

in a place maybe that would mean that

there’ll be more puddles around so

there’ll be more breeding areas from

mosquitoes and so that could mean that

there will be more malaria or there

could be more malaria but it also could

mean that there’d be more flooding and

if there’s more flooding then that would

wash more mosquito eggs away and so

you’d have less mosquitoes and so then

you might have less malaria around so

the the impact is going to vary but I

think the main thing is that the

opportunities for transmission are going

to change

so when disease happens in new places

that’s that’s what we’re gonna see is

disease happening in new places

meaning populations that haven’t had

those experiences before going to be

having diseases and that’s we know

because of immunity you know when

something’s new to you you’ll get more

sick - overall I think the impact will

be a higher burden of disease from

infectious from infectious pathogens

even as like in some places there might

be less you know less of this one

disease and more more of it somewhere

else but the other factor is just

wildlife is moving you know climate

change is already scrambling migration

patterns of people and also wildlife

about 80% of the species that have been

checked are actually moving they’re

shifting their ranges to you know

maintain their what they’re used to in

terms of the climate and that’s really

good that’s like what we want that

that’s going to help them survive but it

also means that wildlife and human

populations are going to come into new

kinds of contact in those areas too

and so we don’t know how that’s going to

kind of play out in terms of infectious

disease risks but certainly that will

that will also play a role thank you

I’ll be back from there questions and

I’d love to remind our audience online

that you can lead questions in the chat

function which is that little talk

bubble on the upper right-hand side of

your window I’ll be back shortly

so it sounds like we got a bring an end

to the wildlife trade for one thing but

let’s let’s turn to maybe a more more

hopeful subject how does this how does a

pandemic end based on you know examples

from the past and how will we even know

when the pandemic is is ending what

would you point to what will be the

initial signs and what are the quickest

things to to end I mean I think here in

the in the US it’ll be you know we’ll

have once our hospitals can manage the

number of cases that become severe on a

on a sort of steady basis then we’ll be

able to relax some of our social

distancing and we’ll probably have to

have intermittent you know social

distancing a little bit here and there

kind of coming and going but the way the

way I see it is like you know we’re in

the Steep first wave and it’s the most

sort of violent and difficult part of

this process of sort of a new pathogen

kind of tearing through a susceptible

population but as it proceeds more and

more of us are going to become you know

immune because we’ll have had it or you

know MIT some of us will perish from it

of course we’re going to lose people but

most of us are going to be able to have

it and recover or wait until there is a

vaccine and then have exposure so you

know we look at measles coming into

North America I think about that a lot

and how violent that was you know that

was just such a such a violent

confrontation and you know changed

history entirely but then you know after

those first waves that are so deadly

measles then becomes a disease of

childhood and we see that with malaria

too which is you know an ongoing

catastrophe that malaria killed so many

people every year this is something

we’ve known how to prevent

entirely and cure with drugs for

hundreds of years and still you know

thousands and thousands of babies die of

malaria every day every year and you

know and this has been going on year

after year after year but in places

where there is a lot of malaria malaria

is a disease of childhood so if you can

survive those first and episodes of

malaria

you know before you’re 2 years old then

you’ll you can live in a malaria society

and malaria kill you that’s you know

it’s much less likely to be able to kill

you because you’ve acquired some

immunity so it’s it’s I sort of see it

as a process of slowly getting you know

sunburn that turns into a tan you know

you have to have to go through this the

pain of that and sort of get to this

level where like okay you can kind of

withstand it and that’ll be supplemented

hopefully with vaccines so that not you

know so not so many of us have to

experience the actual like hardship of

having to survive this pathogen yeah

what but what does it look like so you

talked about the cholera epidemic in

Haiti what does it look like when when

life returns to normal or does it does

it ever return to normal are we

typically kind of transformed as a

society post pandemic well I think

that’s what’s been so frustrating about

writing about infectious diseases for

all these years is that things don’t

change enough after we have these you

know the I mean that’s sort of the the

deep lesson I’ve learned his like people

society to undergo these horrible

epidemics that are so disruptive and so

deadly and we turn against each other

and you know corrupt governments kind of

take advantage of it and there’s secrecy

all these things happen and it’s it’s

very negative in a lot of ways but we

come out of it we just bounce right back

right back to business as usual and

that’s why pathogens are so successful

you know in the end it’s because we

don’t change our behavior we keep doing

the same things and therefore they

keeping there they’re able to continue

to exploit our our behaviors you know I

think we’re getting to a point now

though that you know with this pandemic

in particular where business as usual

has been so disruptive

that I think there’s going to be a lot

more political will to actually get to

the root causes of you know why were at

why we’re being why we’re so vulnerable

to these new pathogens and what we can

what can we do to prevent them and there

is a lot of things we can do to minimize

the risk of pandemics so that’s a

beautiful segue what are what are the

things we can do to minimize the risk

well so one of the things I talk about

in my book is that you know what I tried

to what I tried to do is show how a

microbe turns into a pandemic causing

pathogen so you know starting from its

environmental reservoir happy beneficial

and it’s known environment not causing

any disease for anyone and then slowly

adapt to the human body and becomes this

very disruptive pathogen so so I wanted

to look at that whole story and what I

learned is that you we really know how

that process unfolds we know a lot about

how that process unfolds so what that

means is while we can’t tell which

microbe is going to cause the next

pandemic since we know how it happens we

can predict where it’s most likely to

happen so you know infectious disease

modelers have come up with hotspot mats

you know basically a map of the world

where places where there’s a lot of

invasion of wildlife habitat there’s a

lot of intensification of like factory

farming a lot of slums a lot of flight

connections you know these are the

drivers of microbes turning into

pandemic housing pathogens and so

there’s hotspots around the world and in

those places we can actively surveil

from microbes you know don’t wait until

a bunch of people start getting sick

because that’s when the pathogens

already adapted to the human body it’s

already starting to spread it’s already

starting to spread exponentially and our

response is linear you it’s not gonna

you know we’re not gonna be able to

catch up but you can actively look for

microbes that might be changing you know

might be evolving in certain ways and

they do that through you know various

sampling techniques looking at blood

samples or scat from wild animals or you

know taking blood from farmers bush meat

hunters like people kind of on the front

lines of interacting with microbes in

this way and really look and see like

which ones are changing and they

you can just kind of tinker with the

local situations so that it doesn’t have

those opportunities anymore and you know

we were the USAID was funding that

program was called predict it was like a

ten year old program and over the course

of ten years that scientists who are

involved in that program fingered about

nine hundred microbes that might be

changing in ways that could cause

pandemics and so that’s the kind of like

you know background invisible Public

Health work that nobody hears about you

know because when Public Health is

really really successful like nothing

happens you know students sort of you

know that the the paradox of it all is

like the great victory of Public Health

is that oh nothing happened you know so

the optics aren’t great for public

health but it’s really important work so

you know that’s and that that’s the kind

of thing we could do if we had the

political will and then of course

protecting wildlife habitat

you know conserving more wildlife

habitat and thinking about the public

health impact of development you know we

know we think about sort of the

environmental impact okay is this gonna

you know cause runoff or you know

whatever you know we’ll look at sort of

the environmental impact before we say

yes okay you can build that house or

that mine or expand that mall or

whatever but we don’t look at well what

is the public health impact and maybe

that’s something we can add on you know

and I think if we did that and we had a

really holistic way of looking at how

pathogens emerge like it would have a

constraining effect on our expanding

footprint on the landscape and that’s

ultimately really the the kind of deep

driver of all this so Public Health is

kind of the you know boy who didn’t cry

wolf and therefore it’s very easy to

forget about those programs right and

but they’re the only thing predict

predict protecting us is is predict

still still around or were we so foolish

as to stop it the Trump administration

cut it last year I think but I believe

they had some anonymous donor who gave

them a couple million dollars so they’re

doing a little bit more but this is

something that obviously we’re gonna

need to beef up in the

you know if we you know make some new

prices in November and you know get a

government and political leaders in

place who understand the value of that

kind of work and then of course we need

to have our you know uplift our primary

health care the people have more access

to care and paid sick leave and you know

all of those things so that when

outbreaks do occur that we you know we

don’t have we don’t have this kind of

disruption and try to do that we’re

seeing right now and looks like Whitney

is back with another question I have

many more though Whitney if you if you

are struggling no no no no there’s

there’s a couple of interesting ones

here in fact one that sort of takes

things in a little bit of a different

direction one person wrote in about how

you wrote recently about another type of

pandemic that of xenophobia and

scapegoating and it’s really interested

to hear you talk more about that and

sort of how we can combat that pattern

of harassment yeah I mean this has been

sort of a hallmark of outbreaks of new

disease you know since like hundreds of

years ago as at least in the history

that I’ve been writing about that you

know a new disease comes out and nowhere

people don’t know why is it coming you

know why is it spreading who why some

people getting white other people aren’t

getting in and they start pointing their

fingers at each other during the days of

cholera it was you know the Irish

immigrants who were blamed before the

cholera after you know after they were

blamed then it was the Muslims were

blamed and then it was the Eastern

Europeans who are blamed and so today we

see people blaming the Chinese or maybe

Asians writ large and of course there is

a geography to where pathogens emerge

but once they once they erupt their

global you know as we clearly see today

this thing is everywhere then as much as

you know coronavirus might have

originated in parts of China again this

goes back to like what are the stories

we tell about epidemics and contagions

when we see a pathogen emerge somewhere

else you know outside of our society we

talk about it in a certain way when it’s

something that emerges right on our own

soil in our own

we talked about it in a totally

different way do you look at for example

antibiotic resistant bacteria this is a

huge problem in the United States and

it’s directly linked to our completely

irrational use of antibiotics not just

in human medicine but in agriculture and

you know we’re already rapidly

approaching the point where we’ll have

like unstoppable infections but we don’t

talk about it that way you know we don’t

talk about it as this like scary thing

that’s like growing and encroaching on

us because it doesn’t match this

paradigm of invasion and encroachment

that others are the ones they’re the you

know the the other people are the

polluted polluted intruders who are

contaminating us and we need to kind of

close our borders and keep our pristine

you know pure a pure societies intact

and keep all this contamination outside

of us and I think that’s sort of the

general way we talk about pathogens and

disease processes as a process of

invasion really lends itself to

scapegoating even if you don’t have a

political leader like we do in the

United States who actually actively

calls you know the virus a Chinese virus

or you know it you know actively kind of

engages and encourages scapegoating but

I think the general way we even talk

about diseases has to change you know we

don’t talk about HIV as the New York

City virus even though it explored

exploded in New York City we don’t talk

about methicillin-resistant

staphylococcus aureus MRSA as you know

the Boston plague even though that’s

where it exploded you know because we we

named things as other and foreign when

they’re outside of us and I think that’s

part of trying to make us feel better

about it and also I mean you know like

externalizing the threat when really

it’s so much about our own behaviors and

I’ll I’ll come back to join you guys at

the very end

that I think is a very important point

point in that we’re kind of an info

demmick of sorts there’s as much kind of

missing misinformation with this

pandemic as well as any I’ve ever seen

are there examples from the past where

we’re kind of the rumors and the bad

Intel

kind of raced ahead of the pandemic or

is that truly a feature of our kind of

modern age oh no I don’t think it’s a

feature of our modern age at all like

that you know that was not there was

rumors and like secrecy and all of that

was is definitely very much a part of

epidemics of the past I mean I was just

I think a lot about an epidemic of

cholera that happened in Italy in 1911

or so and that it was on the eve of the

I think was a 50th anniversary of the

country of the state of Italy and so

there’s these big you know big

celebrations planned and then cholera

erupted in Naples and the government

basically just decided to keep it a

secret I mean it was still spreading and

you know people are getting sick and

people are dying but they kind of paid

off newspaper reporters not to mention

it and they intercepted telegrams that

had the word collaring in the you know

censored those they it was in cahoots

with other international leaders you

know in the United States and in France

they knew and they said okay we’re just

not gonna you know let’s just not

mention it you know and you know in the

absence of sort of authoritative

accurate information from the top the

all kinds of rumors spread

you know oh it’s people are dying from

eating watermelons people are dying from

eating strawberries people are dying too

all different because it cuz you don’t

know you don’t know there’s just this

vacuum but you know something is

happening and I think right now because

there you know there are some mixed

messaging there is some Mis mixed

messaging coming from our political

leaders where some are saying oh it’s a

oh it’s very serious is kind of the fog

of war you know there’s a lot of

uncertainty right now and so it’s

understandable but that definitely lends

itself to the rumors and misinformation

you know just like in you

eight 19th century when people blame

diseases on Irish immigrants you know

that that was that was basically a

made-up idea also right well we we

certainly saw that early on in this

pandemic you know China was not exactly

transparent in the early days and that’s

a feature you know going back to the

Spanish flu which is only called the

Spanish flu because as I understand that

Spain was the only one to kind of openly

talk about it but it’s thought that it

actually originated in the US right yeah

I’m not sure where it actually

originated somewhere in the Americas but

but yeah it’s vanished blue became sort

of you know the Spain got blamed for the

whole thing even though it didn’t even

originate there so that is a recurring

feature are there kind of common

responses that we have to these

pandemics that kind of repeat themselves

over and over again that we could maybe

avoid next time around because it seems

like end mxr are going are are a feature

of human existence I mean I think they

are in a way but you know they are also

manufactured by our political choices so

I think we can we can’t get rid of

infectious diseases

we’ll always have those will always have

outbreaks and epidemics here and there

but we don’t have to spread them around

the world rapidly in a pandemic I don’t

think so you know Larry brilliant

epidemiologists had this great quote

which I used a lot but he said

infectious diseases are inevitable but

pandemics are optional and I think that

is right you know we don’t have to

spread these around so rapidly and we

don’t have to create that basically

built we’re building highways for these

microbes to enter the human body and

then we’re distributing them around the

globe you know in the most efficient way

possible and yet you know and for me

like the spread you know the Travel

Network is also part of the solution

right because yes that spreads disease

but it also spreads cures it also

spreads knowledge and innovation

so to me there’s all of these risk

factors are theirs costs and benefits

and you have to weigh those so to me

movement is is it’s so beneficial also

that you know I think that maybe

outweighs the cost but there’s a lot of

other things we can do you know in terms

of being prepared for the next epidemic

but also just minimizing the risk that’s

going to happen at all you know I mean

Quran the coronavirus family is obvious

candidate like this this virus is the

same species of the SARS virus that came

out in 2002 so you know once we can

better understand where these things are

coming from and what is the exact sort

of pathway we can we can start to

rearrange those so that it becomes less

likely that you know these pathogens

label to take it to exploit these

pathways we’ve created for them right

and and looking at history is it that

pandemics kind of follow these waves of

the globalization or is it more

complicated than that yeah I think that

is true I mean you look at you know

cholera is the one I wrote about the

most because it’s one of our most

successful pandemic causing pathogens

it’s caused famine global pandemics and

I think there’s an eighth one sort of

brewing most likely but yeah it

definitely took advantage of you know

19th century travel patterns of the new

canals and steamships and you know the

Industrial Age was really something that

cholera took advantage of and you know

we see with like stars for example in

2002 would never have gotten out of

South China and Hong Kong if it weren’t

you know it reached Hong Kong which like

critical because that was that’s an

international flight hub and then from

there was able to be carried out in

flights to like dozens of other

countries and same with Zika you know

Zika you know wouldn’t have made it over

to the Americas except for international

sporting events and things like that so

everyone kind of come in suddenly coming

together creates these great

opportunities for pathogens to spread

but at the same time you know you can

actually predict like where and this has

been mapped out in really beautiful maps

where if you have like a map of the

world and you do

flu you simulate a flu pandemic on it

you know the you know they’ll be like a

little red dot in one place where is

infection and then it kind of just

spreads kind of seemingly randomly

around the globe until it’s everyone’s

gotten it if you take that same map and

you map out all the cities in terms of

their direct flight connections and then

run that same stimulated flu pandemic on

that kind of map it resolves into this

like beautiful perfect series of waves

because you can literally predict which

Divi will be infected next just based on

the number of direct flights between

uninfected and infected cities so you

know the way we travel is hugely

influential in sort of the shape of

these pandemics and how they unfold so

it looks like we we have to wrap up but

I want to I want to ask one final

question which is you know you’ve

studied all these past pandemics what

gives you what gives you hope from from

what you’ve learned what you’ve seen

two things one is maybe a little darker

than the second one so I’ll I’ll start

with the dark :

what is that pathogens have to balance

their transmissibility and their

virulence you know if you have a

pathogen and this is just from the

pathogens point of view you know to

survive they have to spread from one

host to the next and they have to

replicate within that host so that they

you know their populations get stronger

and bigger so they need to do both of

those things and that’s the tension for

them because if they’re too virulent if

they replicate too fast then their host

is gonna get so sick and maybe even die

and then they’re not gonna be able to

carry them to the next person you know a

dead host or a sick host is isolated

they’re not interacting with other

people as much so there’s much fewer

transmission opportunities to sort of in

the pathogens interest to not be so

virulent that you can’t get carried on

you know that you end up in sort of a

dead end host essentially so they have

to balance those two things out so

that’s just a way I cope with had the

fact that we live in a world of

pathogens around us you know is is it’s

not really in their interest

evolutionarily speaking to be like

really really deadly that’s that’s why I

saw it the first stars died out that

that virus is extinct now it basically

just burnt itself out because it was it

wasn’t very it wasn’t transmissible

enough it was too deadly so that’s

something that I always kind of keep in

mind is it just in terms of like

perspective it helps me but the other

thing is I think what we’re seeing today

is you know people really coming

together because we don’t have

technology you know when we have a tool

when we have a product then we can more

easily say well I’m just gonna get my

piece of it I’m going to get my

prescription and my pill and my vaccine

in my shot and then you know I don’t

need to mind what other people are doing

it’s not going to matter as much to me

it becomes a very individual response

and I think what we’re seeing today is

the need for collective action and

solidarity and we’re seeing that across

societies you know with you know

governments sharing information

scientists and collaborating and whole

new ways that we haven’t seen before you

know global populations collaborating

and connecting and all these

new ways and sort of having this common

experience this shared experience it’s a

tragic experience it’s going to be so

traumatic for so many of us but we’re

all going through it together and I and

I’m hopeful that out of that something

good will come for all of us

me too well thank you so much for

joining us and sharing your insights and

wisdom Sonya I’m gonna say goodbye

because I think we’re out of time is

that right Whitney yeah that’s right

thank you so much Sonya it was really

great to have you and to hear your

conversation but David here be well by

Sonya

they say it’s