Pandemic: How to Prevent an Outbreak (2020) s01e01 Episode Script
It Hunts Us
[car door closes.]
[car door closes.]
[indistinct chatter.]
To walk, I think we'll go on low setting.
We may end up surveying both, but [woman.]
Yeah.
[Dennis.]
This site is a forgotten place.
But it should be a warning to us all.
[man.]
We'll identify the anomalies and mark those out.
So you're trying to narrow the focus of the radar pulse, is that it? [man.]
Yeah, we're looking for a change in the density of the soil.
[machine beeping.]
[man.]
There are some anomalies sort of popping up.
This is a pretty strong one here, there's one there.
At one meter in and then over at three.
[Dennis.]
Each stake represents a probable body.
This is essentially a mass grave.
A hundred years ago, a deadly influenza virus infected hundreds of millions of people around the world.
It overwhelmed hospitals.
It overwhelmed mortuaries.
So towns all over the world needed a quick solution.
We could be standing in any number of towns across the US, or Kenya, India, Vietnam.
This grave site is a reminder of the devastation a flu pandemic can wreak.
This kind of carnage is not relegated to history.
When we talk about another flu pandemic happening, it's not a matter of if, but when.
- [helicopter hovering.]
- [sirens blaring.]
[woman coughing.]
- [man.]
Take the stethoscope, and - [Syra.]
Yes, ensure that the gown covers.
We have received reports of an outbreak of respiratory illness.
Make sure you have a good seal.
Give me a thumbs up once you know you have a good seal.
About eight other countries around the world are also reporting similar outbreaks.
- [woman.]
I can't breathe.
- [man speaking indistinctly.]
[coughing.]
[Syra.]
Unofficial case count is about over 220 with eight deaths.
We don't know what the case definition looks like and we don't know the laboratory analysis of this particular outbreak.
[coughing.]
We know that we are dealing with something novel, we just don't know exactly what we're dealing with, but some of the patients are not testing positive for these normal seasonal flu viruses.
[coughs.]
I don't feel okay.
[Syra.]
Currently, the Emergency Department at Kings County Hospital is operating at 104% and so we have set up a mobile satellite emergency department.
[doctor.]
What's going on? - I'm not doing well.
I can't breathe.
- [doctor.]
Okay.
Okay.
[Syra.]
I need intubation equipment.
There's no intubation equipment.
[machine beeping.]
[Syra.]
Somebody get the ice.
Ashley.
I wouldn't turn it off at this point, I don't think we have time.
Can you check the X-ray on bed one? [buzzing.]
[man.]
Yeah, that's it.
[woman.]
The simulation is ended.
Let's go back to the debriefing room.
- Thank you.
- [man.]
Thank you.
[indistinct chatter.]
[Syra.]
So all who participated, please come to make a circle.
I think one of the things that we tried to bake into the simulation was just healthcare worker safety.
I think that was one of the biggest takeaways in the previous outbreaks.
[woman.]
If I have to take the time out to switch my gown and someone needs to be intubated, I'm gonna pick their life over switching out my garment.
We're talking about a severe respiratory disease.
Really big lesson learned, and we mentioned this over and over, is that healthcare workers were disproportionally affected in MERS and SARS, and it shows us where we need to improve on.
So if you're not protected, if you can't protect yourself, then how are you gonna help others? [Syra.]
My job is to contain the virus here in New York City.
What worries me is that it just takes one person to start an outbreak.
We're basically human incubators, we can host a number of different diseases.
It's just a matter of time where the next pandemic is going to start, we just don't know where or how, but we know it will.
I remember, at a very young age, watching a movie called Outbreak, and in this movie you had a novel virus that started in California that quickly spread.
Healthcare workers get suited up, and I was like, "Oh, my God, working in that high-risk environment, this is amazing.
" That was a formative moment for me, and I have been pursuing a career in infectious disease preparedness ever since.
In even a small outbreak, you have what we call "hoarding.
" We saw this in the H1N1 outbreak where vaccines were not made available in the United States in a timely fashion because countries were hoarding it You know, these infectious disease outbreaks are scarier and more deadly than conventional warfare.
[Syra continues indistinctly.]
So this is something that people should pay attention to, but they forget in their day-to-day lives.
My job is to remind them.
[telephone ringing.]
Hello.
Okay.
Knocked out, okay.
Okay, I'll be there in a second.
Okay.
[man speaking indistinctly.]
Yeah, I can hear it, too.
[Holly.]
I wake up in this building.
I eat in this building.
I put my pajamas on in this building and I sleep in this building.
[Juanita.]
How did I know you'd be the one to make my night? I'm telling you.
[Holly.]
Juanita.
When I came out of medical school in the back of my mind I still had that vision of what it was to be a small-town doctor.
Very old-school, the one doctor in town.
I want you to hold your breath.
Big deep breath in and hold it.
They saw patients in the clinic, they were the ones that were rotating through the ER.
They were the ones seeing the patients in the hospital and delivering babies.
I wanted to be that guy.
I wanted to be that one who took care of the patient when they were well and took care of the patient when they were sick.
- Stick it out and say, "Ah.
" - Ah.
[Holly.]
And took care of the patient when they were hurt and ran into the patient in different social situations outside of the hospital or clinic.
You okay? - I need to see what's under there.
- Yeah.
[Holly.]
I had other physicians that talked to me and I'd say, "What advice do you have for me?" And they'd say, "Reconsider.
" But nobody could dissuade me.
I was gonna do it regardless.
Hi, there.
- So were you diagnosed with the flu? - [woman.]
Yeah.
[Holly.]
They swabbed you? - It was positive? - [woman.]
Yes.
- Do you remember if it was the A or the B? - [woman.]
I think it was the A.
- [Holly.]
A, okay.
- They did both of our noses.
- That was Wednesday.
- [Holly.]
You should be at the end of it, but you're not feeling better [woman.]
Yesterday, my symptoms started getting worse.
[Holly.]
Okay.
Have you been feeling sweats, chills? [woman.]
Chills.
He wakes up in a sweat.
[man groans.]
[Holly.]
She said that you have not been feeling well at all.
That you really haven't been getting over the flu like you ought to.
Big deep breath in.
Well done.
Good.
Do that again.
I don't have every resource that a large hospital has.
I honestly have no idea what I would do in a situation like a pandemic.
We're gonna be lower on the totem pole in terms of getting replenishment of our resources.
Places that have higher populations are gonna be the places that get that lifesaving medication first.
I think that we would be overwhelmed.
We wouldn't be able to manage should a flu pandemic occur in our little county.
[chickens clucking.]
[Dennis.]
We have to follow the virus.
Where is the virus located? Very good.
And the virus is located in birds.
My job takes me all over the world.
My main responsibility is trying to prevent, trying to detect, and respond, and control emerging viral threats.
There is no single, more dangerous influenza virus circulating in this planet today than the avian flu in China right now.
60% of the people who are infected die.
[newscaster 1.]
Chinese and global health authorities are watching a new strain of bird flu.
It's called H7N9.
This is definitely one of the most lethal influenza viruses that we have seen so far.
[newscaster 1.]
Authorities in China are at pains to say they're on top of this potential outbreak.
[newscaster 2.]
At least 108 cases, 22 of those people infected died.
The recent H7N9 virus has a very high mortality rate.
That said, it remains an inefficient virus for infecting people.
So far, this virus has not yet spread beyond China, but it could happen at any time.
- When were these birds last vaccinated? - [woman.]
Seven days ago.
[Dennis.]
So they had a problem with neighboring farms having outbreaks? [in Vietnamese.]
Yes, they did.
Some people bought sick chickens at the market.
[Dennis in English.]
There are almost endless variations of the influenza virus.
They're denoted by different combinations of H's and N's, such as H5N1.
The H's and N's ultimately define the physical characteristics an influenza virus will have and just how deadly that infection might be.
The pandemic flus and the seasonal flus are profoundly different.
A pandemic influenza will likely come from an animal and it will be a new and novel, never-seen-before virus.
When a novel virus emerges from animals, we will not have natural immunity.
Our systems will have no means to fight the infection off, which means it has the potential for being very deadly.
That's why there are researchers around the world committed to developing a universal vaccine that will be effective against any and all influenza viruses.
[Jake.]
I don't really get stage fright anymore.
I used to do this thing where if I knew I was about to go on the stage, my heart would start beating and I'd feel like I was gonna pass out, but I knew for the work that I wanted to do, I had to be an effective communicator.
If I wasn't able to communicate my science, then it was almost like the science didn't exist.
Can you get the slides up? That's a different slide there.
All right, good afternoon, New York.
So, yeah, I'm the co-founder, Chief Science Officer, and the Chairman of Distributed Bio, and this afternoon I'm gonna share with you the story of a slow-burning revolution in biologic therapeutic discovery.
I never memorize a specific speech.
I think about the arc of the story I'm gonna tell, and really good storytelling, those rules apply to science.
It's basically the same rules that our ancestors did around the campfire, right? First you have to introduce the terrible monster.
In this case, it's influenza.
The problem is that the virus mutates so quickly that your immune response becomes obsolete by the next year.
We have created these amazing vaccine technologies that are arguably the greatest advances since sanitation and fire, and yet they don't work on rapidly mutating viruses, like the flu, for instance.
And for a while we thought we were just stuck with this.
They're never really gonna be able to solve the problem of having a good single shot that's gonna solve our risk of being exposed to flu.
Then you present the hero.
That there's some new technology that exists, that could potentially create a breakthrough.
We're making a vaccine that could treat all future versions of flu.
So, fundamentally, our approach was different, because we tested against future and past strains.
Under some circumstances, some people end up producing these nice antibodies that hit all the strains or many of the strains of flu, and they enjoy broad protection.
You all might have those friends, right? It's that annoying hippie friend of yours who's like, "I never take the flu shot and I'm fine.
" Right? - Some of them may be right.
[chuckles.]
- [crowd chuckles.]
[Jake.]
But why the hell aren't we all protected all the time? Our approach was able to neutralize viruses all the way back to 1934 as well as protect against future viral variants.
[crowd applauds.]
[Sarah.]
I met Jake Glanville in the fall of 2014.
He offered me a job.
He knew that I had skills that he would need if he wanted to launch this vaccine program.
Okay, so I can add the antibody to this one, then? [woman.]
Yep.
[Sarah.]
Jake just thinks outside the box.
He thinks of these crazy ideas that are completely out of the norm.
Okay, the NHS and EHC are added, so clock's ticking now.
We've done multiple animal studies so we know that this is reproducible.
What we're seeing is real.
I want to prove that my research and Jake's research could change the world.
This vaccine could eradicate influenza as we know it.
[machines beeping.]
This will not work at all.
[man in Hindi.]
Sir, this one is expected H1N1.
So fast? [newscaster in English.]
There has been an alarming rise in the swine flu or H1N1 cases in India this year.
The situation is turning rather serious with the fatalities increasing by the day.
The North Indian State of Rajasthan has been worst hit by the H1N1 virus.
- [man in Hindi.]
Negative.
It's negative.
- [Dinesh.]
But, look.
The shadow is still here.
And there are some light ones here.
Let us see how you feel without oxygen.
[woman.]
Should we continue with Tamiflu? [Dinesh.]
It's day six today, right? Give it for one more day.
[woman in English.]
Tamiflu, stop after seven days.
[in Hindi.]
We will stop it tomorrow.
[Dinesh in English.]
Swine flu is a very rapidly progressing disease.
Very rapidly.
In just a few days, it can affect both of the lungs, and it is a life-threatening disease.
Common flu.
All patients came with throat pain, sneezing, fever, body ache.
But a patient who has nausea, vomiting, along with breathlessness, and he says "troublesome cough," always think "swine flu.
" Always think swine flu.
[Dinesh in Hindi.]
Breathe normally.
[in English.]
If it's not diagnosed properly at an early stage, it is difficult to treat.
[indistinct chatter.]
[Dinesh in Hindi.]
The problem is, when she came here, she had 60%-70% saturation.
If she had been on the road, she would've died.
That is the fact.
[in English.]
We will shift to the ICU.
Then treatment will start.
[in Hindi.]
The later they come, the more laborious it gets to breathe, and it becomes a matter of life or death.
[Dennis.]
Biggest challenge with flu is not being lulled into acceptance of seasonal flu as all we have to worry about.
Because every once in a while, there is a variant of flu that emerges that poses an existential threat to us as a species.
We go back to 1918 and, you know, that flu profoundly impacted this Earth.
It emerged at the very end of World War I.
Soldiers returning home from battle helped spread the virus around the world.
We ended up seeing a global event very rapidly, even at a time when population movements were a fraction of what they are today.
Far more people died in the 18-month period of that flu than died in all of World War I and World War II.
Somewhere in the order of 50 to 100 million deaths.
In 1918, there were 1.
8 billion people on the planet Earth.
Today, there are 7.
8 billion people.
If a similar virus emerged today, the result would be not 50 to 100, but hundreds of millions of people that would likely die.
And it's a guarantee that another version of that killer flu will reappear.
We don't know when, but we should always presume it can be soon.
When it comes to a pandemic, there are many unknowns.
It's about the societal disruption.
The thing that will immediately be threatened is continuity of health services.
But also, you'll have severe issues with normal infrastructure operating.
Electricity is dependent on power plants and power plants are dependent on a work force.
That work force becomes ill, then you have huge vulnerabilities.
What are urban areas going to do after a couple of weeks of disruptive impact on food supplies? You'll not only have people dying from an influenza virus, they'll be dying from what are preventable deaths today.
It will leave its mark.
That's why I do what I do.
If we catch it early enough, we may be able to save millions of lives.
But it's an uphill battle because there are so many opportunities for emergence, and our resources for early detection are limited.
[Syra.]
All right, good morning, everybody.
We'll go ahead and get started with roll call.
As always, one person from each facility can just state that they are on.
We started this weekly system-wide seasonal flu activation call with all hospitals that we have across the system, and the whole purpose of it is really, as we progress with seasonal flu, they let us know any impact that they're having.
Influenza activity is categorized as widespread.
This is the actual first week that widespread activity has been reported.
Last year's flu season was one of the worst that we've had in decades.
A record-breaking number of hospitalizations and deaths.
Bellevue, any changes to your current status? [man 1.]
No changes from the current status.
Great.
Thank you.
Coney Island, any changes? [man 2.]
No changes.
[Syra.]
Great.
Thank you.
We started seeing impacts to staffing.
We started seeing impacts to flu supplies.
There were shortages of Tamiflu, so much so that folks were coming back to the emergency department asking for their children to be admitted, because they couldn't get this medication.
- Queens, any changes? - [man 3.]
No changes.
[Syra.]
Thank you.
So we activated an emergency operation center to really get a bird's-eye view of what's happening system-wide and where we can provide the resources and expertise that's needed.
And Woodhull, any changes? [woman.]
Yes.
We have four patients on droplet precautions as of Monday and seven positive flu tests.
[Syra.]
All right.
Excellent.
Well, thank you all so much for joining.
We appreciate it and we will see you next week.
Take care, everybody.
Part of emergency management is, you know, you're not just at the facilities, but just for me also worldwide.
Sometimes when I wake up in the morning and I see 20 different emails, not just internally but also externally, I'm getting alerts of what's happening.
I just try to stay on top of it.
I'm gonna pull up her info so that On any given day, it's meetings back-to-back.
First, thank you all so much for meeting with us, and then obviously, for this collaboration I typically start, you know, 8:30 or so If this was a real world event, what are some crisis standards and then go on for the duration of the day.
You wanna call the Department of Health.
They will walk you through the case definition and they will This isn't Atlanta.
Anyone email back from CDC yet? [cell phone ringing.]
This is Syra.
A good chunk of my work is actually done at night, so it's not surprising at all if you get an email from me, like, 11:00, 12:00 at night.
- [woman.]
Thank you so much.
- [Syra.]
Thank you for coming.
I'm perfectly fine with it.
I need to meet with these folks, I need to see what's happening.
The threat of special pathogens is constantly on my mind.
Things like MERS, SARS, Ebola, flu.
While these outbreaks are happening remotely in distant areas, we know that they're just one flight away from coming here in the United States and that's exactly why I do what I do.
What did you have for lunch today? [Hassan.]
It wasn't halal, but I got - pasta pesto.
- Good job.
Special pathogens don't respect any boundaries.
So I wanna make sure that I'm doing it not just for my children, but for the greater good of humanity, 'cause we wanna make sure people are safe.
[Jake.]
Back in 2012, I was working at Pfizer doing antibody engineering.
I wasn't working on vaccines, but I was learning a lot about how the populations of antibodies respond to their targets.
That technology really opened our eyes to what was really going on when someone gets vaccinated or when we're trying to engineer an antibody as a drug.
I had a BA when I was at Pfizer, and I got promoted every year, so I was a principal scientist with a Bachelor's Degree.
And friends of mine were They thought I was crazy.
Some of them were like, "Why are you leaving a job where normally you need a PhD, and a post doc, and eight years of experience?" But I was worried if I waited another ten years, I might start having children and then I would be too scared to make a big jump.
I definitely was like, "I could be messing up my career right now, but" I came up with this idea and I thought it was too beautiful not to try.
More often than not, startups are looking for the quickest path to funding.
A lot of them have a "fake it till you make it" approach.
[newscaster 1.]
Well, she was a college dropout who became the youngest self-made female billionaire.
[newscaster 2.]
In 2003, then 19-year-old Elizabeth Holmes founded Theranos with the hope of using small amounts of blood to do what normally took numerous tubes.
- Does it work? - Yes.
- You're confident in that? - I am confident in that.
[Jake.]
In order to get funding, they often have to convince investors about ideas that haven't been proven out yet, and sometimes, they do not have sound science to back up their plans.
The company faces new investigations from the Securities and Exchange Commission and a US attorney's office in California.
That's in addition to an ongoing probe by the centers for Medicare and Medicaid services.
[Jake.]
In bio tech, you need time to cultivate your credibility and your science.
on top of those plans.
[newscaster 3.]
Now Elizabeth Holmes is facing some pretty serious prison time.
[newscaster 4.]
Holmes and the company's former president were indicted yesterday on federal wire fraud charges.
So, eventually, some of these companies realize that the hype that they're built on is not enough to support their quest for the almighty dollar.
There are a million reasons why an experiment can fail.
Ultimately, all that matters is what the data says, and so far, our data is very promising.
All righty.
Our goal here is that we want to enable the world to have access to our vaccines.
All the world including people who can't afford it.
That's obviously low on the list for investors.
When you take venture capital, you either lose control of your company or you lose control of your vision.
Right now, we are funding this.
Everything up until this point has been out of our own pockets.
We should not have been able to beat major pharmaceutical companies who have way more money than us and have way more people than us.
But my experience in big pharmas is they typically move very slow and they're risk averse.
And so, there actually aren't that many people as you might think working on new techniques.
So that's worked to our advantage, but eventually, we are going to need to get this vaccine into human trials.
And we are not going to be able to fund that by ourselves.
[in Hindi.]
Goochi, dear son Wake up, it's seven o'clock.
It's been 15 years since I received my MD.
[playing keyboard.]
[Dinesh.]
It was my family's dream to have a doctor in the family.
We are seven sons in the family.
They thought the first one would become a doctor, he didn't.
[in English.]
Second, third, fourth [in Hindi.]
When it came to me, the fifth, they found some hope.
[cell phone ringing.]
Papa, your phone is ringing.
[Dinesh.]
Hello.
Just getting ready.
Okay, okay, bye.
Come on, son.
I don't know why they felt that I could become one.
I used to be poor in studies.
That is the truth.
But they knew that what little I studied, I did it with all my heart.
I'm not in this profession for money.
I am extremely passionate about this cause.
[machines beeping.]
[Dinesh.]
Yes, Nisha, how are you? Tell me this.
When we admitted you to emergency three days back, when you'd came here from Sikar how different are you feeling since then? A little bit.
[man.]
The problem was going on for 15 days.
We admitted her into a hospital in our area.
But it's not a big city, most of the people are from the villages.
They are villagers, so not many people there know about this.
Even the doctors don't know about H1N1.
So they didn't test her for this.
No one realized that it would become such a serious disease.
[coughs.]
[in English.]
The patient is not responding up to the mark which I want.
[imperceptible.]
[in Hindi.]
The problem is there are no facilities in the outlying areas.
When they become seriously ill, they head for the cities.
It is too late by then.
[in English.]
Any patient who had immunity low is a culprit for swine flu in dangerous form.
Child pregnant woman, old age.
A patient with diabetes.
A patient with kidney disease.
[man speaking indistinctly.]
[Dinesh in Hindi.]
What's troubling you? I'm tired.
- [Dinesh.]
What are you tired of? - I'm really tired.
[Dheeraj in English.]
Generally, we Indians think it's a small cough, all you should do is take honey, lemon, turmeric and it goes away.
But seems like it was something very different this time.
Nobody realized it was swine flu.
[Dinesh in Hindi.]
So, now the condition is guarded.
I won't say it's good.
[Dheeraj.]
His kidney and heart have also become weaker [Dinesh.]
Right, right.
We will assume the situation is now serious.
[in English.]
Until and unless he's in ICU, he's critical.
[Dheeraj.]
At this point of time, lungs have infection, kidneys are not working, heart is under constant pressure.
So, if these three vital organs are not working I mean, it's really difficult.
That's why, whatever happens, I'm outside always, so he feels good about it, that there's someone who's taking care.
I have to stay here, there's no one else.
I don't have a brother or a sister.
I'm all alone, so I have to be here.
He's an old kind of man, "I want to go home, I want to take a walk in the garden.
" You know, do stuff like that.
I said, "Yes, you will be able to, but just have some time off.
Just relax and soon you will be able to do all of those.
" As long as it takes, I will be here.
[Amar crying.]
Take if off upstairs.
- Why you have a Band-Aid right here? - [Amar crying.]
- Because I got hurt.
- How'd you get hurt? - I was bleeding.
- In school? - No, at home.
- [Hassan shouting indistinctly.]
Okay, go upstairs.
I'll help you upstairs.
You can't no.
We can't do it over here.
Go upstairs.
Just go upstairs.
I'll put your clothes on upstairs.
Amar, what are you doing? I have a three-year-old and I have a five-year-old.
No hitting.
It never stops.
There are some days that are better than others in terms of just how I can handle it.
- What happened? What happened? - [Amar crying.]
[Syra.]
Why don't you build something? You guys wanna build something? So help me build.
And then there's other days where I'm just super exhausted, 'cause it's just been a really long or a rough day.
Sometimes I actually put the kids down a little earlier than I need to so I can just relax.
- [Amar.]
Mommy.
- [Syra.]
Yes.
What are you doing? - Mommy, look at me.
- Yes.
I actually don't tell them exactly what I do and I try not to also share that with school friends or mommies, 'cause people's fear factor kicks in first before logic.
If they think I had any remote kind of contact with disease, it's like, "Don't touch me, don't come near me.
" I do this because I have a passion for it.
I started to work in the field of bio defense, I did some work with FBI related to bio defense.
My Master's thesis was on Ebola and then the bio threat team that I was part of in 2014 at the Texas Department of State Health Services, was the team that did diagnose the very first patient.
[doctor.]
The patient admitted to this hospital has tested positive for Ebola virus and we're taking every step possible to manage this situation.
No one thought at that time that this would ever reach the shores of the United States, and so, there was no active monitoring or active screening in place.
[newscaster.]
While caring for the first patient to test positive for the Ebola virus in US soil, a Dallas nurse contracted the disease.
And then a number of questions then arose of are all hospitals in the United States equipped and able to identify patients suspected with these types of special pathogens.
Amar, I'm proud of you For me, I wanna make sure from a healthcare delivery standpoint whether this patient's coming in with Ebola virus disease or a pandemic flu, they have the resources to identify these patients.
- [Amar.]
I want to read the night squirrel.
- Okay.
All right, how about I read Hassan's first and then I read yours.
Okay, which one should I read in the superheroes? When I was part of the Ebola response team, we had an appreciation ceremony.
I remember on the card someone wrote that, "When everybody was running away from this, you ran towards it.
Are you crazy?" Like, "Ha, ha, ha.
" But I think for me, it really translates into helping those around me.
He's saying to stop.
This kid is bullying her.
That's not nice to bully, right? And yes, I may be putting myself in harm's way, but this is something that I have knowledge of and why wouldn't I do that? "Whatever had changed him in that gamma ray accident must have" These threats are never going to stop and we need to do something about it, and that something is now.
So, I have an upwards of ten projects happening at any given time.
I feel like there's so much more that needs to be done.
- [Sarah.]
Shall we cheers? - [woman.]
Yeah, let's cheers.
- [man 1.]
Start off with - [all.]
Cheers.
[woman.]
In the book, I read you're supposed to make eye contact with everyone.
[all laugh.]
- [woman.]
I did, I read the book.
- [man 1.]
What? [Sarah.]
We haven't been eating very much of the food.
You guys need to do a better job.
Sometimes, when I get home from work, I don't wanna follow recipes anymore.
I'm just like, "Fuck it.
I follow protocols all day.
" I just wanna make some stuff up and see what happens.
[man 1.]
This is basically what you've been working on the entire time we've known you, then.
[Sarah.]
Yeah, and we could have a human vaccine ready by 2025.
We just need the money, 'cause the ferret study alone is like over a million dollars.
[man 2.]
Have you thought about crowd funding? [Sarah.]
I have not thought about it.
My understanding was that crowd funding doesn't get you that much money, but maybe I'm wrong.
There's a lot of people in the world that are affected by the flu.
- Yeah.
- [woman 1.]
That's true.
The thing is, for flu, we really haven't seen anything in our lifetimes, or in our parents' lifetimes, or even in our grandparents', but the next flu pandemic is probably on the horizon.
We don't know if it will happen to us or our kids, but it will eventually happen.
It's scary 'cause in 1918, it killed over 50 million people, but we didn't even have planes, and we didn't have people traveling from Asia to North America on a daily basis, we didn't have factory farms with thousands of pigs and thousands of chickens.
But now we do.
So, it could be hundreds of millions of people that would die from the next pandemic if it were as contagious as the H1N1 in 1918.
Anyone want more wine? [all laughing.]
[woman 2.]
No.
You said it was two million dollars.
- That's all you guys need? - Yeah.
[man 1.]
Robyn can send that to you.
- No, I don't.
I'm just saying - [man 1.]
I got my checkbook.
So, my company just announced our Series D yesterday.
- [Sarah.]
Yeah.
- We got a billion dollars.
- [Sarah.]
Holy shit.
- A billion dollars, like, "Okay.
" We wanna maintain full ownership, so we have to get government grants, or like non-profit foundation grants, like through the Gates Foundation.
[woman 2.]
So, you partnered with this foundation, Bill and Melinda Gates Foundation, - and they said yes? - Yeah, well, we We applied for a grant and we've been waiting to hear back.
[crowd applauding.]
Epidemiologists show through their models that a respiratory-spread pathogen would kill more than 30 million people in less than a year.
And there is a reasonable probability of that taking place.
[reporter.]
Research into a universal flu vaccine just got a big boost, thanks to Bill Gates.
The Bill and Melinda Gates Foundation is partnering with the CEO of Alphabet to establish a $12 million fund for research into a universal flu vaccine.
He says the vaccine is needed to help combat possible future pandemics.
The Gates Foundation has an amazing record trying to help global populations and they would enable communities that can't pay for it to be able to be beneficiaries.
I am trying not to sit on pins and needles to wait to hear the results.
It's cool stuff, so I think they're really interested in it.
It's just [sighs.]
It's taking a long time to hear back.
- [Sarah.]
Should we cheers? - [woman 2.]
Yeah, let's cheers again.
[telephone rings.]
[Holly.]
Jefferson County Hospital, how can I help you? I'm just answering the phone 'cause all my girls are They've got their hands busy.
So, Jefferson County Hospital, where I work, is in a rural setting.
We have about eight to nine thousand people in the county.
Their access to healthcare is limited.
The closest other hospital is 35 to 40 minutes away.
Any barrier to care and care gets lessened.
And if you have to travel an hour to get healthcare, people are gonna say, "I'd rather not.
" Do you wanna play the ring toss game with me? - Why not? - [crying.]
They're gonna get me right here.
No, listen, listen, listen.
It's gonna feel just like a little pinch, just like that.
[boy sobbing.]
I don't want a shot! I don't want a shot! [woman.]
I will I will [Holly.]
When October, November come, then I begin to think, "Okay, here we go.
" We're gonna be busier and we're gonna be having sicker patients.
[woman.]
Okay, let's got see what they gotta do.
- [boy.]
I don't want any shot.
- [woman.]
You're not getting any shots or no pinches.
I promise, okay? - You have a seat and wait for Mommy - [boy.]
I don't want to [Holly.]
By the 13th of January last year, we'd already had over 70 Oklahomans that had passed away from the flu.
Seventy people.
That is a lot of folks that died from an illness that could be prevented with a vaccine or that could be prevented with good hand hygiene or if the patient knew to come in earlier and they didn't just say, "Well, I just have the flu.
" And then they die from "just the flu.
" That's just tragic.
- [woman.]
Stop! - [crying.]
I don't wanna get a shot! [imperceptible.]
[sobbing.]
I know.
Do I look somebody that will hurt you? - I really don't want a shot! - I know.
I know.
[woman 1.]
You ready for it, you want us to do it, momma? - [woman 2.]
Thank you, doctor.
- Uh-huh.
Going into the flu season this year, what I have in my mind is, "It's gonna be like last year.
" The CDC is calling this the worst flu outbreak in eight years and if you've had the flu already, guess what, there's a good chance you could get it again.
[male newscaster.]
Can you believe that? We are nearing record breaking numbers in the state of Oklahoma when it comes to flu-related deaths.
[woman speaking indistinctly.]
- On that side? Okay.
- Mmm-hmm.
[Holly.]
Even one death in a tiny town like ours is a pretty big deal.
Take another deep breath.
I don't want to lose a patient to the flu.
[Dinesh speaks indistinctly.]
[in Hindi.]
Sit up, ma'am.
Are you feeling good overall? See, your oxygen requirement - Was this connected last night? - [man.]
No, sir.
It wasn't connected.
The ventilator was not connected all night.
Before, you couldn't stay without it at night.
There was no need for it now.
Oxygen was running at ten liters before, now it is at one liter.
I don't think you have any problem breathing now.
How much less is your coughing than before? - Huh? - [Nisha.]
I only cough at night.
[Dinesh.]
Only at night, just a little, but not as much as before.
Do you want to shift into a ward today? You are getting bored here all by yourself.
In the ward, you will talk to others, converse with them, you will not be bored.
We are shifting her to the ward.
Now, there is no requirement of ICU.
If God will feel so, she will be home in one to two days.
I feel a great joy easing the suffering of others.
If I can save a patient's life, and if I bring tears of joy to their mother, that is the most priceless thing for me.
But these are complicated cases [in English.]
When the body is not responding to any treatment.
[in Hindi.]
Often, in the 15 years of my professional life when a patient of mine did not survive I have wept for them.
The sadness I feel when I lose a patient is more than the happiness of saving ten.
[cell phone ringing.]
[in English.]
Hello.
[speaks indistinctly.]
[in Hindi.]
I never switch off my mobile for even a second in 24 hours.
[in English.]
Never.
[in Hindi.]
Only a person who has lost a patient will understand this.
Even if others don't like it, including my wife, or my kids, I don't care.
[cell phone ringing.]
There is still no respite from swine flu.
[newscaster 1 in English.]
Alarming rise in the number of swine flu cases.
Over 9,000 people have tested positive for swine flu across India with 86 casualties last week.
The death toll has now jumped to 312.
The numbers are staggering, over 9,000 people are affected, which means that once it reaches that level again, the spread will be that much faster.
[newscaster 2.]
According to the CDC, last flu season killed 180 children.
One of the worst flu seasons in recent memory, this new season ushers in one big question.
Are we in for a repeat? [newscaster 3.]
And everything indicates that this upcoming flu season, it's gonna be worse than usual.
[Bill Gates.]
As we've seen various flu scares, we haven't had a super good response.
And it's pretty surprising how little preparedness there is for it.
Fortunately, there's some amazing people who dedicate their life to this.
Like all global problems, it's not easy to solve.
But this is the greatest risk, and we're not ready.
[car door closes.]
[indistinct chatter.]
To walk, I think we'll go on low setting.
We may end up surveying both, but [woman.]
Yeah.
[Dennis.]
This site is a forgotten place.
But it should be a warning to us all.
[man.]
We'll identify the anomalies and mark those out.
So you're trying to narrow the focus of the radar pulse, is that it? [man.]
Yeah, we're looking for a change in the density of the soil.
[machine beeping.]
[man.]
There are some anomalies sort of popping up.
This is a pretty strong one here, there's one there.
At one meter in and then over at three.
[Dennis.]
Each stake represents a probable body.
This is essentially a mass grave.
A hundred years ago, a deadly influenza virus infected hundreds of millions of people around the world.
It overwhelmed hospitals.
It overwhelmed mortuaries.
So towns all over the world needed a quick solution.
We could be standing in any number of towns across the US, or Kenya, India, Vietnam.
This grave site is a reminder of the devastation a flu pandemic can wreak.
This kind of carnage is not relegated to history.
When we talk about another flu pandemic happening, it's not a matter of if, but when.
- [helicopter hovering.]
- [sirens blaring.]
[woman coughing.]
- [man.]
Take the stethoscope, and - [Syra.]
Yes, ensure that the gown covers.
We have received reports of an outbreak of respiratory illness.
Make sure you have a good seal.
Give me a thumbs up once you know you have a good seal.
About eight other countries around the world are also reporting similar outbreaks.
- [woman.]
I can't breathe.
- [man speaking indistinctly.]
[coughing.]
[Syra.]
Unofficial case count is about over 220 with eight deaths.
We don't know what the case definition looks like and we don't know the laboratory analysis of this particular outbreak.
[coughing.]
We know that we are dealing with something novel, we just don't know exactly what we're dealing with, but some of the patients are not testing positive for these normal seasonal flu viruses.
[coughs.]
I don't feel okay.
[Syra.]
Currently, the Emergency Department at Kings County Hospital is operating at 104% and so we have set up a mobile satellite emergency department.
[doctor.]
What's going on? - I'm not doing well.
I can't breathe.
- [doctor.]
Okay.
Okay.
[Syra.]
I need intubation equipment.
There's no intubation equipment.
[machine beeping.]
[Syra.]
Somebody get the ice.
Ashley.
I wouldn't turn it off at this point, I don't think we have time.
Can you check the X-ray on bed one? [buzzing.]
[man.]
Yeah, that's it.
[woman.]
The simulation is ended.
Let's go back to the debriefing room.
- Thank you.
- [man.]
Thank you.
[indistinct chatter.]
[Syra.]
So all who participated, please come to make a circle.
I think one of the things that we tried to bake into the simulation was just healthcare worker safety.
I think that was one of the biggest takeaways in the previous outbreaks.
[woman.]
If I have to take the time out to switch my gown and someone needs to be intubated, I'm gonna pick their life over switching out my garment.
We're talking about a severe respiratory disease.
Really big lesson learned, and we mentioned this over and over, is that healthcare workers were disproportionally affected in MERS and SARS, and it shows us where we need to improve on.
So if you're not protected, if you can't protect yourself, then how are you gonna help others? [Syra.]
My job is to contain the virus here in New York City.
What worries me is that it just takes one person to start an outbreak.
We're basically human incubators, we can host a number of different diseases.
It's just a matter of time where the next pandemic is going to start, we just don't know where or how, but we know it will.
I remember, at a very young age, watching a movie called Outbreak, and in this movie you had a novel virus that started in California that quickly spread.
Healthcare workers get suited up, and I was like, "Oh, my God, working in that high-risk environment, this is amazing.
" That was a formative moment for me, and I have been pursuing a career in infectious disease preparedness ever since.
In even a small outbreak, you have what we call "hoarding.
" We saw this in the H1N1 outbreak where vaccines were not made available in the United States in a timely fashion because countries were hoarding it You know, these infectious disease outbreaks are scarier and more deadly than conventional warfare.
[Syra continues indistinctly.]
So this is something that people should pay attention to, but they forget in their day-to-day lives.
My job is to remind them.
[telephone ringing.]
Hello.
Okay.
Knocked out, okay.
Okay, I'll be there in a second.
Okay.
[man speaking indistinctly.]
Yeah, I can hear it, too.
[Holly.]
I wake up in this building.
I eat in this building.
I put my pajamas on in this building and I sleep in this building.
[Juanita.]
How did I know you'd be the one to make my night? I'm telling you.
[Holly.]
Juanita.
When I came out of medical school in the back of my mind I still had that vision of what it was to be a small-town doctor.
Very old-school, the one doctor in town.
I want you to hold your breath.
Big deep breath in and hold it.
They saw patients in the clinic, they were the ones that were rotating through the ER.
They were the ones seeing the patients in the hospital and delivering babies.
I wanted to be that guy.
I wanted to be that one who took care of the patient when they were well and took care of the patient when they were sick.
- Stick it out and say, "Ah.
" - Ah.
[Holly.]
And took care of the patient when they were hurt and ran into the patient in different social situations outside of the hospital or clinic.
You okay? - I need to see what's under there.
- Yeah.
[Holly.]
I had other physicians that talked to me and I'd say, "What advice do you have for me?" And they'd say, "Reconsider.
" But nobody could dissuade me.
I was gonna do it regardless.
Hi, there.
- So were you diagnosed with the flu? - [woman.]
Yeah.
[Holly.]
They swabbed you? - It was positive? - [woman.]
Yes.
- Do you remember if it was the A or the B? - [woman.]
I think it was the A.
- [Holly.]
A, okay.
- They did both of our noses.
- That was Wednesday.
- [Holly.]
You should be at the end of it, but you're not feeling better [woman.]
Yesterday, my symptoms started getting worse.
[Holly.]
Okay.
Have you been feeling sweats, chills? [woman.]
Chills.
He wakes up in a sweat.
[man groans.]
[Holly.]
She said that you have not been feeling well at all.
That you really haven't been getting over the flu like you ought to.
Big deep breath in.
Well done.
Good.
Do that again.
I don't have every resource that a large hospital has.
I honestly have no idea what I would do in a situation like a pandemic.
We're gonna be lower on the totem pole in terms of getting replenishment of our resources.
Places that have higher populations are gonna be the places that get that lifesaving medication first.
I think that we would be overwhelmed.
We wouldn't be able to manage should a flu pandemic occur in our little county.
[chickens clucking.]
[Dennis.]
We have to follow the virus.
Where is the virus located? Very good.
And the virus is located in birds.
My job takes me all over the world.
My main responsibility is trying to prevent, trying to detect, and respond, and control emerging viral threats.
There is no single, more dangerous influenza virus circulating in this planet today than the avian flu in China right now.
60% of the people who are infected die.
[newscaster 1.]
Chinese and global health authorities are watching a new strain of bird flu.
It's called H7N9.
This is definitely one of the most lethal influenza viruses that we have seen so far.
[newscaster 1.]
Authorities in China are at pains to say they're on top of this potential outbreak.
[newscaster 2.]
At least 108 cases, 22 of those people infected died.
The recent H7N9 virus has a very high mortality rate.
That said, it remains an inefficient virus for infecting people.
So far, this virus has not yet spread beyond China, but it could happen at any time.
- When were these birds last vaccinated? - [woman.]
Seven days ago.
[Dennis.]
So they had a problem with neighboring farms having outbreaks? [in Vietnamese.]
Yes, they did.
Some people bought sick chickens at the market.
[Dennis in English.]
There are almost endless variations of the influenza virus.
They're denoted by different combinations of H's and N's, such as H5N1.
The H's and N's ultimately define the physical characteristics an influenza virus will have and just how deadly that infection might be.
The pandemic flus and the seasonal flus are profoundly different.
A pandemic influenza will likely come from an animal and it will be a new and novel, never-seen-before virus.
When a novel virus emerges from animals, we will not have natural immunity.
Our systems will have no means to fight the infection off, which means it has the potential for being very deadly.
That's why there are researchers around the world committed to developing a universal vaccine that will be effective against any and all influenza viruses.
[Jake.]
I don't really get stage fright anymore.
I used to do this thing where if I knew I was about to go on the stage, my heart would start beating and I'd feel like I was gonna pass out, but I knew for the work that I wanted to do, I had to be an effective communicator.
If I wasn't able to communicate my science, then it was almost like the science didn't exist.
Can you get the slides up? That's a different slide there.
All right, good afternoon, New York.
So, yeah, I'm the co-founder, Chief Science Officer, and the Chairman of Distributed Bio, and this afternoon I'm gonna share with you the story of a slow-burning revolution in biologic therapeutic discovery.
I never memorize a specific speech.
I think about the arc of the story I'm gonna tell, and really good storytelling, those rules apply to science.
It's basically the same rules that our ancestors did around the campfire, right? First you have to introduce the terrible monster.
In this case, it's influenza.
The problem is that the virus mutates so quickly that your immune response becomes obsolete by the next year.
We have created these amazing vaccine technologies that are arguably the greatest advances since sanitation and fire, and yet they don't work on rapidly mutating viruses, like the flu, for instance.
And for a while we thought we were just stuck with this.
They're never really gonna be able to solve the problem of having a good single shot that's gonna solve our risk of being exposed to flu.
Then you present the hero.
That there's some new technology that exists, that could potentially create a breakthrough.
We're making a vaccine that could treat all future versions of flu.
So, fundamentally, our approach was different, because we tested against future and past strains.
Under some circumstances, some people end up producing these nice antibodies that hit all the strains or many of the strains of flu, and they enjoy broad protection.
You all might have those friends, right? It's that annoying hippie friend of yours who's like, "I never take the flu shot and I'm fine.
" Right? - Some of them may be right.
[chuckles.]
- [crowd chuckles.]
[Jake.]
But why the hell aren't we all protected all the time? Our approach was able to neutralize viruses all the way back to 1934 as well as protect against future viral variants.
[crowd applauds.]
[Sarah.]
I met Jake Glanville in the fall of 2014.
He offered me a job.
He knew that I had skills that he would need if he wanted to launch this vaccine program.
Okay, so I can add the antibody to this one, then? [woman.]
Yep.
[Sarah.]
Jake just thinks outside the box.
He thinks of these crazy ideas that are completely out of the norm.
Okay, the NHS and EHC are added, so clock's ticking now.
We've done multiple animal studies so we know that this is reproducible.
What we're seeing is real.
I want to prove that my research and Jake's research could change the world.
This vaccine could eradicate influenza as we know it.
[machines beeping.]
This will not work at all.
[man in Hindi.]
Sir, this one is expected H1N1.
So fast? [newscaster in English.]
There has been an alarming rise in the swine flu or H1N1 cases in India this year.
The situation is turning rather serious with the fatalities increasing by the day.
The North Indian State of Rajasthan has been worst hit by the H1N1 virus.
- [man in Hindi.]
Negative.
It's negative.
- [Dinesh.]
But, look.
The shadow is still here.
And there are some light ones here.
Let us see how you feel without oxygen.
[woman.]
Should we continue with Tamiflu? [Dinesh.]
It's day six today, right? Give it for one more day.
[woman in English.]
Tamiflu, stop after seven days.
[in Hindi.]
We will stop it tomorrow.
[Dinesh in English.]
Swine flu is a very rapidly progressing disease.
Very rapidly.
In just a few days, it can affect both of the lungs, and it is a life-threatening disease.
Common flu.
All patients came with throat pain, sneezing, fever, body ache.
But a patient who has nausea, vomiting, along with breathlessness, and he says "troublesome cough," always think "swine flu.
" Always think swine flu.
[Dinesh in Hindi.]
Breathe normally.
[in English.]
If it's not diagnosed properly at an early stage, it is difficult to treat.
[indistinct chatter.]
[Dinesh in Hindi.]
The problem is, when she came here, she had 60%-70% saturation.
If she had been on the road, she would've died.
That is the fact.
[in English.]
We will shift to the ICU.
Then treatment will start.
[in Hindi.]
The later they come, the more laborious it gets to breathe, and it becomes a matter of life or death.
[Dennis.]
Biggest challenge with flu is not being lulled into acceptance of seasonal flu as all we have to worry about.
Because every once in a while, there is a variant of flu that emerges that poses an existential threat to us as a species.
We go back to 1918 and, you know, that flu profoundly impacted this Earth.
It emerged at the very end of World War I.
Soldiers returning home from battle helped spread the virus around the world.
We ended up seeing a global event very rapidly, even at a time when population movements were a fraction of what they are today.
Far more people died in the 18-month period of that flu than died in all of World War I and World War II.
Somewhere in the order of 50 to 100 million deaths.
In 1918, there were 1.
8 billion people on the planet Earth.
Today, there are 7.
8 billion people.
If a similar virus emerged today, the result would be not 50 to 100, but hundreds of millions of people that would likely die.
And it's a guarantee that another version of that killer flu will reappear.
We don't know when, but we should always presume it can be soon.
When it comes to a pandemic, there are many unknowns.
It's about the societal disruption.
The thing that will immediately be threatened is continuity of health services.
But also, you'll have severe issues with normal infrastructure operating.
Electricity is dependent on power plants and power plants are dependent on a work force.
That work force becomes ill, then you have huge vulnerabilities.
What are urban areas going to do after a couple of weeks of disruptive impact on food supplies? You'll not only have people dying from an influenza virus, they'll be dying from what are preventable deaths today.
It will leave its mark.
That's why I do what I do.
If we catch it early enough, we may be able to save millions of lives.
But it's an uphill battle because there are so many opportunities for emergence, and our resources for early detection are limited.
[Syra.]
All right, good morning, everybody.
We'll go ahead and get started with roll call.
As always, one person from each facility can just state that they are on.
We started this weekly system-wide seasonal flu activation call with all hospitals that we have across the system, and the whole purpose of it is really, as we progress with seasonal flu, they let us know any impact that they're having.
Influenza activity is categorized as widespread.
This is the actual first week that widespread activity has been reported.
Last year's flu season was one of the worst that we've had in decades.
A record-breaking number of hospitalizations and deaths.
Bellevue, any changes to your current status? [man 1.]
No changes from the current status.
Great.
Thank you.
Coney Island, any changes? [man 2.]
No changes.
[Syra.]
Great.
Thank you.
We started seeing impacts to staffing.
We started seeing impacts to flu supplies.
There were shortages of Tamiflu, so much so that folks were coming back to the emergency department asking for their children to be admitted, because they couldn't get this medication.
- Queens, any changes? - [man 3.]
No changes.
[Syra.]
Thank you.
So we activated an emergency operation center to really get a bird's-eye view of what's happening system-wide and where we can provide the resources and expertise that's needed.
And Woodhull, any changes? [woman.]
Yes.
We have four patients on droplet precautions as of Monday and seven positive flu tests.
[Syra.]
All right.
Excellent.
Well, thank you all so much for joining.
We appreciate it and we will see you next week.
Take care, everybody.
Part of emergency management is, you know, you're not just at the facilities, but just for me also worldwide.
Sometimes when I wake up in the morning and I see 20 different emails, not just internally but also externally, I'm getting alerts of what's happening.
I just try to stay on top of it.
I'm gonna pull up her info so that On any given day, it's meetings back-to-back.
First, thank you all so much for meeting with us, and then obviously, for this collaboration I typically start, you know, 8:30 or so If this was a real world event, what are some crisis standards and then go on for the duration of the day.
You wanna call the Department of Health.
They will walk you through the case definition and they will This isn't Atlanta.
Anyone email back from CDC yet? [cell phone ringing.]
This is Syra.
A good chunk of my work is actually done at night, so it's not surprising at all if you get an email from me, like, 11:00, 12:00 at night.
- [woman.]
Thank you so much.
- [Syra.]
Thank you for coming.
I'm perfectly fine with it.
I need to meet with these folks, I need to see what's happening.
The threat of special pathogens is constantly on my mind.
Things like MERS, SARS, Ebola, flu.
While these outbreaks are happening remotely in distant areas, we know that they're just one flight away from coming here in the United States and that's exactly why I do what I do.
What did you have for lunch today? [Hassan.]
It wasn't halal, but I got - pasta pesto.
- Good job.
Special pathogens don't respect any boundaries.
So I wanna make sure that I'm doing it not just for my children, but for the greater good of humanity, 'cause we wanna make sure people are safe.
[Jake.]
Back in 2012, I was working at Pfizer doing antibody engineering.
I wasn't working on vaccines, but I was learning a lot about how the populations of antibodies respond to their targets.
That technology really opened our eyes to what was really going on when someone gets vaccinated or when we're trying to engineer an antibody as a drug.
I had a BA when I was at Pfizer, and I got promoted every year, so I was a principal scientist with a Bachelor's Degree.
And friends of mine were They thought I was crazy.
Some of them were like, "Why are you leaving a job where normally you need a PhD, and a post doc, and eight years of experience?" But I was worried if I waited another ten years, I might start having children and then I would be too scared to make a big jump.
I definitely was like, "I could be messing up my career right now, but" I came up with this idea and I thought it was too beautiful not to try.
More often than not, startups are looking for the quickest path to funding.
A lot of them have a "fake it till you make it" approach.
[newscaster 1.]
Well, she was a college dropout who became the youngest self-made female billionaire.
[newscaster 2.]
In 2003, then 19-year-old Elizabeth Holmes founded Theranos with the hope of using small amounts of blood to do what normally took numerous tubes.
- Does it work? - Yes.
- You're confident in that? - I am confident in that.
[Jake.]
In order to get funding, they often have to convince investors about ideas that haven't been proven out yet, and sometimes, they do not have sound science to back up their plans.
The company faces new investigations from the Securities and Exchange Commission and a US attorney's office in California.
That's in addition to an ongoing probe by the centers for Medicare and Medicaid services.
[Jake.]
In bio tech, you need time to cultivate your credibility and your science.
on top of those plans.
[newscaster 3.]
Now Elizabeth Holmes is facing some pretty serious prison time.
[newscaster 4.]
Holmes and the company's former president were indicted yesterday on federal wire fraud charges.
So, eventually, some of these companies realize that the hype that they're built on is not enough to support their quest for the almighty dollar.
There are a million reasons why an experiment can fail.
Ultimately, all that matters is what the data says, and so far, our data is very promising.
All righty.
Our goal here is that we want to enable the world to have access to our vaccines.
All the world including people who can't afford it.
That's obviously low on the list for investors.
When you take venture capital, you either lose control of your company or you lose control of your vision.
Right now, we are funding this.
Everything up until this point has been out of our own pockets.
We should not have been able to beat major pharmaceutical companies who have way more money than us and have way more people than us.
But my experience in big pharmas is they typically move very slow and they're risk averse.
And so, there actually aren't that many people as you might think working on new techniques.
So that's worked to our advantage, but eventually, we are going to need to get this vaccine into human trials.
And we are not going to be able to fund that by ourselves.
[in Hindi.]
Goochi, dear son Wake up, it's seven o'clock.
It's been 15 years since I received my MD.
[playing keyboard.]
[Dinesh.]
It was my family's dream to have a doctor in the family.
We are seven sons in the family.
They thought the first one would become a doctor, he didn't.
[in English.]
Second, third, fourth [in Hindi.]
When it came to me, the fifth, they found some hope.
[cell phone ringing.]
Papa, your phone is ringing.
[Dinesh.]
Hello.
Just getting ready.
Okay, okay, bye.
Come on, son.
I don't know why they felt that I could become one.
I used to be poor in studies.
That is the truth.
But they knew that what little I studied, I did it with all my heart.
I'm not in this profession for money.
I am extremely passionate about this cause.
[machines beeping.]
[Dinesh.]
Yes, Nisha, how are you? Tell me this.
When we admitted you to emergency three days back, when you'd came here from Sikar how different are you feeling since then? A little bit.
[man.]
The problem was going on for 15 days.
We admitted her into a hospital in our area.
But it's not a big city, most of the people are from the villages.
They are villagers, so not many people there know about this.
Even the doctors don't know about H1N1.
So they didn't test her for this.
No one realized that it would become such a serious disease.
[coughs.]
[in English.]
The patient is not responding up to the mark which I want.
[imperceptible.]
[in Hindi.]
The problem is there are no facilities in the outlying areas.
When they become seriously ill, they head for the cities.
It is too late by then.
[in English.]
Any patient who had immunity low is a culprit for swine flu in dangerous form.
Child pregnant woman, old age.
A patient with diabetes.
A patient with kidney disease.
[man speaking indistinctly.]
[Dinesh in Hindi.]
What's troubling you? I'm tired.
- [Dinesh.]
What are you tired of? - I'm really tired.
[Dheeraj in English.]
Generally, we Indians think it's a small cough, all you should do is take honey, lemon, turmeric and it goes away.
But seems like it was something very different this time.
Nobody realized it was swine flu.
[Dinesh in Hindi.]
So, now the condition is guarded.
I won't say it's good.
[Dheeraj.]
His kidney and heart have also become weaker [Dinesh.]
Right, right.
We will assume the situation is now serious.
[in English.]
Until and unless he's in ICU, he's critical.
[Dheeraj.]
At this point of time, lungs have infection, kidneys are not working, heart is under constant pressure.
So, if these three vital organs are not working I mean, it's really difficult.
That's why, whatever happens, I'm outside always, so he feels good about it, that there's someone who's taking care.
I have to stay here, there's no one else.
I don't have a brother or a sister.
I'm all alone, so I have to be here.
He's an old kind of man, "I want to go home, I want to take a walk in the garden.
" You know, do stuff like that.
I said, "Yes, you will be able to, but just have some time off.
Just relax and soon you will be able to do all of those.
" As long as it takes, I will be here.
[Amar crying.]
Take if off upstairs.
- Why you have a Band-Aid right here? - [Amar crying.]
- Because I got hurt.
- How'd you get hurt? - I was bleeding.
- In school? - No, at home.
- [Hassan shouting indistinctly.]
Okay, go upstairs.
I'll help you upstairs.
You can't no.
We can't do it over here.
Go upstairs.
Just go upstairs.
I'll put your clothes on upstairs.
Amar, what are you doing? I have a three-year-old and I have a five-year-old.
No hitting.
It never stops.
There are some days that are better than others in terms of just how I can handle it.
- What happened? What happened? - [Amar crying.]
[Syra.]
Why don't you build something? You guys wanna build something? So help me build.
And then there's other days where I'm just super exhausted, 'cause it's just been a really long or a rough day.
Sometimes I actually put the kids down a little earlier than I need to so I can just relax.
- [Amar.]
Mommy.
- [Syra.]
Yes.
What are you doing? - Mommy, look at me.
- Yes.
I actually don't tell them exactly what I do and I try not to also share that with school friends or mommies, 'cause people's fear factor kicks in first before logic.
If they think I had any remote kind of contact with disease, it's like, "Don't touch me, don't come near me.
" I do this because I have a passion for it.
I started to work in the field of bio defense, I did some work with FBI related to bio defense.
My Master's thesis was on Ebola and then the bio threat team that I was part of in 2014 at the Texas Department of State Health Services, was the team that did diagnose the very first patient.
[doctor.]
The patient admitted to this hospital has tested positive for Ebola virus and we're taking every step possible to manage this situation.
No one thought at that time that this would ever reach the shores of the United States, and so, there was no active monitoring or active screening in place.
[newscaster.]
While caring for the first patient to test positive for the Ebola virus in US soil, a Dallas nurse contracted the disease.
And then a number of questions then arose of are all hospitals in the United States equipped and able to identify patients suspected with these types of special pathogens.
Amar, I'm proud of you For me, I wanna make sure from a healthcare delivery standpoint whether this patient's coming in with Ebola virus disease or a pandemic flu, they have the resources to identify these patients.
- [Amar.]
I want to read the night squirrel.
- Okay.
All right, how about I read Hassan's first and then I read yours.
Okay, which one should I read in the superheroes? When I was part of the Ebola response team, we had an appreciation ceremony.
I remember on the card someone wrote that, "When everybody was running away from this, you ran towards it.
Are you crazy?" Like, "Ha, ha, ha.
" But I think for me, it really translates into helping those around me.
He's saying to stop.
This kid is bullying her.
That's not nice to bully, right? And yes, I may be putting myself in harm's way, but this is something that I have knowledge of and why wouldn't I do that? "Whatever had changed him in that gamma ray accident must have" These threats are never going to stop and we need to do something about it, and that something is now.
So, I have an upwards of ten projects happening at any given time.
I feel like there's so much more that needs to be done.
- [Sarah.]
Shall we cheers? - [woman.]
Yeah, let's cheers.
- [man 1.]
Start off with - [all.]
Cheers.
[woman.]
In the book, I read you're supposed to make eye contact with everyone.
[all laugh.]
- [woman.]
I did, I read the book.
- [man 1.]
What? [Sarah.]
We haven't been eating very much of the food.
You guys need to do a better job.
Sometimes, when I get home from work, I don't wanna follow recipes anymore.
I'm just like, "Fuck it.
I follow protocols all day.
" I just wanna make some stuff up and see what happens.
[man 1.]
This is basically what you've been working on the entire time we've known you, then.
[Sarah.]
Yeah, and we could have a human vaccine ready by 2025.
We just need the money, 'cause the ferret study alone is like over a million dollars.
[man 2.]
Have you thought about crowd funding? [Sarah.]
I have not thought about it.
My understanding was that crowd funding doesn't get you that much money, but maybe I'm wrong.
There's a lot of people in the world that are affected by the flu.
- Yeah.
- [woman 1.]
That's true.
The thing is, for flu, we really haven't seen anything in our lifetimes, or in our parents' lifetimes, or even in our grandparents', but the next flu pandemic is probably on the horizon.
We don't know if it will happen to us or our kids, but it will eventually happen.
It's scary 'cause in 1918, it killed over 50 million people, but we didn't even have planes, and we didn't have people traveling from Asia to North America on a daily basis, we didn't have factory farms with thousands of pigs and thousands of chickens.
But now we do.
So, it could be hundreds of millions of people that would die from the next pandemic if it were as contagious as the H1N1 in 1918.
Anyone want more wine? [all laughing.]
[woman 2.]
No.
You said it was two million dollars.
- That's all you guys need? - Yeah.
[man 1.]
Robyn can send that to you.
- No, I don't.
I'm just saying - [man 1.]
I got my checkbook.
So, my company just announced our Series D yesterday.
- [Sarah.]
Yeah.
- We got a billion dollars.
- [Sarah.]
Holy shit.
- A billion dollars, like, "Okay.
" We wanna maintain full ownership, so we have to get government grants, or like non-profit foundation grants, like through the Gates Foundation.
[woman 2.]
So, you partnered with this foundation, Bill and Melinda Gates Foundation, - and they said yes? - Yeah, well, we We applied for a grant and we've been waiting to hear back.
[crowd applauding.]
Epidemiologists show through their models that a respiratory-spread pathogen would kill more than 30 million people in less than a year.
And there is a reasonable probability of that taking place.
[reporter.]
Research into a universal flu vaccine just got a big boost, thanks to Bill Gates.
The Bill and Melinda Gates Foundation is partnering with the CEO of Alphabet to establish a $12 million fund for research into a universal flu vaccine.
He says the vaccine is needed to help combat possible future pandemics.
The Gates Foundation has an amazing record trying to help global populations and they would enable communities that can't pay for it to be able to be beneficiaries.
I am trying not to sit on pins and needles to wait to hear the results.
It's cool stuff, so I think they're really interested in it.
It's just [sighs.]
It's taking a long time to hear back.
- [Sarah.]
Should we cheers? - [woman 2.]
Yeah, let's cheers again.
[telephone rings.]
[Holly.]
Jefferson County Hospital, how can I help you? I'm just answering the phone 'cause all my girls are They've got their hands busy.
So, Jefferson County Hospital, where I work, is in a rural setting.
We have about eight to nine thousand people in the county.
Their access to healthcare is limited.
The closest other hospital is 35 to 40 minutes away.
Any barrier to care and care gets lessened.
And if you have to travel an hour to get healthcare, people are gonna say, "I'd rather not.
" Do you wanna play the ring toss game with me? - Why not? - [crying.]
They're gonna get me right here.
No, listen, listen, listen.
It's gonna feel just like a little pinch, just like that.
[boy sobbing.]
I don't want a shot! I don't want a shot! [woman.]
I will I will [Holly.]
When October, November come, then I begin to think, "Okay, here we go.
" We're gonna be busier and we're gonna be having sicker patients.
[woman.]
Okay, let's got see what they gotta do.
- [boy.]
I don't want any shot.
- [woman.]
You're not getting any shots or no pinches.
I promise, okay? - You have a seat and wait for Mommy - [boy.]
I don't want to [Holly.]
By the 13th of January last year, we'd already had over 70 Oklahomans that had passed away from the flu.
Seventy people.
That is a lot of folks that died from an illness that could be prevented with a vaccine or that could be prevented with good hand hygiene or if the patient knew to come in earlier and they didn't just say, "Well, I just have the flu.
" And then they die from "just the flu.
" That's just tragic.
- [woman.]
Stop! - [crying.]
I don't wanna get a shot! [imperceptible.]
[sobbing.]
I know.
Do I look somebody that will hurt you? - I really don't want a shot! - I know.
I know.
[woman 1.]
You ready for it, you want us to do it, momma? - [woman 2.]
Thank you, doctor.
- Uh-huh.
Going into the flu season this year, what I have in my mind is, "It's gonna be like last year.
" The CDC is calling this the worst flu outbreak in eight years and if you've had the flu already, guess what, there's a good chance you could get it again.
[male newscaster.]
Can you believe that? We are nearing record breaking numbers in the state of Oklahoma when it comes to flu-related deaths.
[woman speaking indistinctly.]
- On that side? Okay.
- Mmm-hmm.
[Holly.]
Even one death in a tiny town like ours is a pretty big deal.
Take another deep breath.
I don't want to lose a patient to the flu.
[Dinesh speaks indistinctly.]
[in Hindi.]
Sit up, ma'am.
Are you feeling good overall? See, your oxygen requirement - Was this connected last night? - [man.]
No, sir.
It wasn't connected.
The ventilator was not connected all night.
Before, you couldn't stay without it at night.
There was no need for it now.
Oxygen was running at ten liters before, now it is at one liter.
I don't think you have any problem breathing now.
How much less is your coughing than before? - Huh? - [Nisha.]
I only cough at night.
[Dinesh.]
Only at night, just a little, but not as much as before.
Do you want to shift into a ward today? You are getting bored here all by yourself.
In the ward, you will talk to others, converse with them, you will not be bored.
We are shifting her to the ward.
Now, there is no requirement of ICU.
If God will feel so, she will be home in one to two days.
I feel a great joy easing the suffering of others.
If I can save a patient's life, and if I bring tears of joy to their mother, that is the most priceless thing for me.
But these are complicated cases [in English.]
When the body is not responding to any treatment.
[in Hindi.]
Often, in the 15 years of my professional life when a patient of mine did not survive I have wept for them.
The sadness I feel when I lose a patient is more than the happiness of saving ten.
[cell phone ringing.]
[in English.]
Hello.
[speaks indistinctly.]
[in Hindi.]
I never switch off my mobile for even a second in 24 hours.
[in English.]
Never.
[in Hindi.]
Only a person who has lost a patient will understand this.
Even if others don't like it, including my wife, or my kids, I don't care.
[cell phone ringing.]
There is still no respite from swine flu.
[newscaster 1 in English.]
Alarming rise in the number of swine flu cases.
Over 9,000 people have tested positive for swine flu across India with 86 casualties last week.
The death toll has now jumped to 312.
The numbers are staggering, over 9,000 people are affected, which means that once it reaches that level again, the spread will be that much faster.
[newscaster 2.]
According to the CDC, last flu season killed 180 children.
One of the worst flu seasons in recent memory, this new season ushers in one big question.
Are we in for a repeat? [newscaster 3.]
And everything indicates that this upcoming flu season, it's gonna be worse than usual.
[Bill Gates.]
As we've seen various flu scares, we haven't had a super good response.
And it's pretty surprising how little preparedness there is for it.
Fortunately, there's some amazing people who dedicate their life to this.
Like all global problems, it's not easy to solve.
But this is the greatest risk, and we're not ready.