Pandemic: How to Prevent an Outbreak (2020) s01e03 Episode Script
Seek, Don't Hide
Indianola School says they will be closed tomorrow because about 20% of their students are out with the flu.
Western Heights says they've had so many student and teacher absences, canceling school was the best option.
schools in Braggs right now are closed, 47 were out sick 145 students called in sick on Monday.
After an increase in reported absences, both Seymour and the Archer City ISD will be closed tomorrow.
A Muskogee school counselor is dead, making her one of the hundreds of Oklahomans who have now fallen victim to this year's flu virus.
All right, so how long have you been sick? - Just today.
- Just today.
Did it kind of come on you all of a sudden? I went to work this morning.
I was okay.
- Like, my teeth was hurting.
- Mmm-hmm.
Like, tender and I had a headache, but nothing else.
And did you feel body aches and feel like you were getting a fever - My skin feels like it's burning.
- Oh.
- Eyes are hot? - My eyes feel like they're burning.
And then what are her symptoms? She's got a runny nose and a cough.
And have you been exposed to anybody that's had the flu? The county that we live in, they just closed the school - because of flu.
- Did they? I think they get past 20% and they don't send kids to school.
It does help us stop the flu as well.
It stops the spread.
When am I going to be able to go back to work? Tomorrow? If you have a temperature greater than 100.
4, then you really need to be out of the public.
If those parents that are in the workforce, their kids are at home, they either have to find childcare so that they can go to work, or they have to be off work.
All right, it's just a light Some of them may have sick days and some of them may not.
So it expands and we have parents that are now out of work.
Okay, I'll put together your paperwork and we'll let you get out of here.
It is a huge struggle, it's a financial struggle, it's a mental struggle, physical struggle, emotional struggle.
I know this is hard to believe, but 3,000 people across the state of Oklahoma have gotten so sick, they've actually had to go to the hospital.
And there's still nine weeks left in the flu season.
Hello? Okay, the one who was very serious, and asked me to prescribe the medicine? Is there some relief? So you are feeling much better? My wife is a doctor at Durlabhji as well.
We have an agreement between us: when she's in the hospital, I take care of the family.
When I'm in the hospital, she takes care of the family.
She works only limited hours.
She made this sacrifice for my sake.
So one person could move ahead while the other takes care of the family.
There were financial difficulties in paying for my education.
I just had a few clothes and I borrowed my text books.
Then gradually, after completing my MD, my life straightened out.
- Manish Ji, are you ready? - Hmm.
- Should I do your hair? - Hmm.
I have experienced poverty, and now, with God's grace, I have a lot.
So I know the difficulties faced by the poor.
The poor are at the greatest risk of the flu.
A doctor alone cannot do anything in tackling this flu.
The government cannot tackle it alone.
Neither can the public.
It can be defeated only if all three work together.
Rajasthan accounts for nearly 70% of the swine flu cases being reported from across the country.
This is the failure of the health department under the health minister, Raghu Sharma.
Rajasthan has lost 49 lives due to swine flu.
Why is the percentage of deaths increasing? People's health is our responsibility.
This means we are shirking our duty.
As soon as someone is found positive, then your department team will visit them the next day.
What are you busy doing? I'm taking notes.
He's the one who is taking notes.
You should be doing this on your own.
Make me the director, I will do it.
You can come here and be a minister.
If we don't take corrective measures, then it is our fault, isn't it? Our attention is elsewhere, not on this.
That is a sickness in our department.
Have you prepared all the instructions? What are those? Sir, first of all, there will be a daily monitoring of house-to-house activities in the city.
You will do screenings? You should do continuous screenings.
We will monitor Of course, you will be monitoring, but complete screenings should carry on.
In an effort to curb the spread, the Rajasthan health minister has now ordered door-to-door screenings of patients.
Yes, sir? This is the swine flu control room.
Now, tell me, how is your health? Madam, there are two patients, they are positive for swine flu.
Can you tell me your address, where are you from? Can you provide any landmark near your location? So we can confirm a visit to your place? Ma'am, the two cases are positive from the same house for swine flu.
Let me know your ward number, and our survey team will contact you.
Near the post office.
Post office.
The address is near the post office.
Is anyone there? Can you come out? The thing about controlling a deadly virus is you need to move from being reactive to proactive.
We know that viruses move from wildlife into livestock into people.
And so you don't wait for an outbreak to infect humans, you find it and you fight it before it ever infects a person.
FAO is looking at what's happening in animals, broadening our surveillance strategy to look upstream.
Usually, we would see the clinical picture in animals before humans become infected.
And it just bothers me when the report - first comes out of humans.
- Yeah.
And not picking it up two or three weeks earlier in livestock.
We have a team that brings information together from different sources, including our field teams.
I just received an email from Russia.
Basically, we asked about this H5N6, remember? It seems to come from a gray gull in So they actually went to check for a virus and they couldn't find it? Yes.
It was a result of active surveillance.
- Okay.
- Which, it does matter because apparently the prevalence was sufficiently high.
Yeah.
So we may, uh, see this virus next winter - being the main actor on the stage.
- Yeah, who knows? But if we can go ahead and, uh, get started Paul, you have something? Uh, there is an interesting detection of H5N6 in the Saratov region in the Russian Federation.
And this is the first report of this virus outside Asia.
This is closely related to the viruses that are circulating in China and caused several human infections, and some of them were fatal cases.
For us, it's quite important, the triggers and the line of command within the veterinary system or a veterinary service.
Once we have that detection, what happens next? How it links up to the medical services and how we react to that detection.
Closing down the markets, ensuring that consumers are safe, that there is good communication between the veterinary arm - and the public health arm at all times.
- Right.
With the proper risk mitigation measures, there's no excuse for any outbreak becoming more than an outbreak.
But it all begins with timely and effective surveillance.
- We're here with the band.
- What's that? - We're here with the band.
- Yeah, well, park right behind Brad.
- Behind him? - Yeah.
Okay.
Gear it up.
So much all right.
So is Paul gonna take two trips? We'll do two trips? - One trip - One trip with him.
with the ranger on that trailer and then the four wheeler on the one that's hooked up to Brad's truck.
Okay.
When I'm in the field with hunters, it's hard for people who don't understand to understand the full dynamics.
You can't see it.
The ducks aren't sneezing, they're not coughing.
But they have the flu.
Wild birds are the ones that are moving it.
That's how the flu is getting moved.
We're gonna catch these birds in this net.
There's rockets attached to it.
Those rockets are gonna fire when the birds are ready to be caught, when they're all balled up.
The net's gonna go over the birds and groups of people are gonna go out and take those birds out, we're gonna put them in keeping cages.
I'm gonna swab them.
And then those swab samples will go back to the lab, to see what subtypes of influenza come through here.
Let's say there's a flu outbreak at a chicken farm.
The flu didn't start there.
Maybe a hunter went out and shot something, and then didn't clean his boots off, and went into the chicken house, and, you know, spread all this flu.
Wild birds are the movers of this virus.
That's what they do.
Be ready to go when you hear the shot.
Get down there as quick as you can.
Grab a crate, and start pulling birds.
- Now, we - Yeah.
Okay.
Now, we just wait.
My job is like being a watchman.
A lot of the scary viruses in recent years have been linked to bats.
- Come over here.
- Yeah, yeah.
- Okay? - Yeah, let's go.
There they are.
Ebola, for example.
Coronaviruses, whether SARS or MERS.
When they are in groups you can catch them easily.
You can't catch them one by one.
Okay.
Got it.
Okay.
And we now know that bats can be a reservoir for the flu.
My team and I believe we have discovered a new subtype of influenza in fruit bats in Egypt.
And I want to test these bats in Lebanon to see if this virus is spreading.
The young ones, they might bite.
And you can see the teeth are still clean and still sharp.
Yeah, sharp and clean.
Off you go.
Next.
The more we know about where viruses come from, the better we are prepared.
What we can do is study them before they mutate, try to predict which route they might take.
So it's all about trying to break the transmission cycle from animals to humans.
The most vulnerable populations, or the populations where a pandemic can start, are in caretakers of animals.
We will take a human blood sample.
Human blood? Yeah, I need a worker who works inside the farm.
Okay.
You and your shirt in the street.
Get well soon! You see how I was so soft with you? Yeah, right.
I'm really, really interested in trying to catch that virus as it's causing the infection.
Once we do that, we can look at how transmissible it is.
Can it infect other species? Does it have a pandemic potential? We will add the chicken and human samples collected today to the bat samples and begin our testing.
- So, is this your - Mmm-hmm.
What do you call it? A pig or a sow? - A pig.
- You got a pig.
- Her name is Chessie.
- Chessie? Okay.
I don't think I've ever touched a live pig before.
Ooh, she's sweaty.
Or did you make her wet? Oh, yeah, we put water on her before the big show.
Oh! To make her shine? So, your mom told me that you did not get the flu shot this year.
Next year, you'll get the flu shot, won't you? Probably.
A little shot's not that big of a deal compared to how sick you felt.
And you got Can you imagine if you had the flu this week? - Oh, that'd be horrible.
- That'd be horrible.
I wouldn't have got to show here.
I like showing pigs a lot.
All right, we're ready to let them into the show ring here for our first class the first reveals.
Being a small-town doctor is a unique position.
They're all nice enough to eat.
Oh, yes, a little bit of bacon.
Even if they haven't been my patient, most people know, "She's the doctor.
" That opens up an opportunity to be able to have a really interesting relationship that I don't think a large town, or a city physician, really gets.
Take a big, deep breath in.
And then again.
Just breathe normal.
Good.
Physicians focus outwardly on others and what other people need.
I'm gonna give you some antibiotics in the IV tonight and then I'll give you a prescription for some antibiotics to take for the next ten days.
Do you have insurance? We are expected to be superhuman.
We are expected to do the best that we can for everyone that we come in contact with, with the kind of compassion that they deserve and that's a calling that I've been brought to, and I can do that, I can do my calling.
If I can get the help that I need.
I have a 72-hour shift and so it's important to me that my husband is here with me at times.
Because without Mike, I couldn't do this work.
Oh.
You were out.
Mmm-hmm.
Sleeping good.
- How are you? - I'm here.
So.
So, had two more cases? No, it was old cases that just hadn't gotten over it.
Oh, okay.
- Yeah.
- Okay.
I'm wondering how long I was out.
I'm still feeling tired.
- Half an hour to an hour? - You're as tired as I was because you got disturbed as much as I did last night, and then I got to sleep today and you didn't.
Yeah, I didn't get to sleep, so Okay, well, let me go take care of this patient.
All right, then.
My first marriage didn't do very well.
And my divorce was particularly ugly.
Hello.
I was talking to your wife.
She's really worried about you.
- I've been trying to.
- Okay.
The first year of medical school was really, really difficult for me.
My ex-husband was, uh sent to prison during that time.
I came to school a couple times beat up.
And my faith was shaken during that time.
And then I met Mike and he's a man of extreme faith.
And what I learned throught that was that every experience, good or bad, is building up in me, like this wall of strength and that strength gets me through all of the challenges that I'm confronted with, big and small.
"James, a servant of God and the Lord Jesus Christ to the 12 tribes scattered among the nations.
'Greetings.
Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance.
Perseverance must finish its work so that you may be mature and complete, not lacking in anything.
But blessed is the man who perseveres under trial.
'" Three, two We found that there are different subtypes of virus in these ducks.
These teal are long-distance migrants.
They go from here and they'll go all the way up to Saskatchewan, and then they'll come back again in the fall, and then they'll go all the way down to Argentina.
So that's a huge migration.
Along that flyway, they're either picking something up, or they're dropping something off.
- Whoa! Hello.
- Nice catch.
Doing these surveillance studies helps us to understand trends that are going on with these birds.
In case there's some kind of, let's say, pandemic, or spillover or something, we at least have the information and data to anticipate trends and we're ready.
We're prepared if there was a flu outbreak.
I thought I was gonna be a teacher or a police officer, but the college atmosphere was where I decided to go and start working with students that way.
And for the last 25 years now, I've been in the sciences like this.
Our big main goal is to see what the prevalence of flu is in this area, at this time, right now, with this population of ducks.
You guys are gonna hold the ducks like this.
Keep them down by your chest, um and we're gonna swab them orally and cloacally.
Put it in a media tube.
They're gonna give you a number.
I'm gonna give Put that number on the tube and then you're gonna bring them over to Alindy.
She's gonna bleed them.
She's gonna bleed them through the jugular, 'cause we don't like to wing bleed, 'cause they're migrating.
But remember the number that Lizzy gives you, 'cause that's the number that you and I have to match, and Alindy and I have to match to make sure we have the right sample.
And then once that we find if they have had flu, then we do a lot of serology back off in the lab.
Sound good? Does anyone need this duck? Can I let it go? 'Cause I've been holding it.
Okay.
Sound good? - Do, like Feel like a "break.
" - Let's go.
If they're busy at the table, let it go.
- Who needs a duck? - We do.
Six-six-six.
Oh, come on.
Sorry, Alindy.
Okay, we're gonna try to do this for you.
Ready? That does not seem right.
No, it isn't.
Are you ready? This is gonna seem even worse.
- Are you ready? - Oh! Oh, goodness.
I'm a terrible, horrible person, aren't I? You can let that one go.
Good job.
Yeah, totally let it go.
- Next.
What's your number? - Six-six-seven.
Are you 667? All right.
So I know.
It makes you all That's it.
So I'm gonna just help you, 'cause you're gonna be holding lots of ducks today, okay? Right there with those big pinkies.
Perfect.
Some of my favorite parts is the hunters who have killed them have never held them live, and then they hold them live and there's, like, a new perspective.
It doesn't mean that they're not gonna hunt.
Hunting I love hunting, myself, but that perspective of having this, like, live little creature is They don't get that opportunity.
They get the kill opportunity, but the live opportunity is always my favorite part when they come out in the spring to do it.
I have a role where I can go out in the field, being part of the pulling of the birds and the swabbing of the birds, and then taking those samples and being able to process them, all the way to the end, to see the result.
That one sample you bring back and all the work that went into doing it, all the people involved in doing that, that one sample is so important.
This knowledge gives the scientific community power to predict and prepare.
As the human population grows, we see an increased appetite for animal protein.
And in response, we are raising livestock at unprecedented levels.
The problem with that is that the sheer number of animals in a confined space elevates the risk for a virus to spread and mutate at a rapid pace.
While we can't predict where the next influenza pandemic is gonna come from, there are certain places that need particular attention.
And China is one of those.
It's the place where we've seen the emergence of virtually all of the deadly influenza viruses over the last half century.
And it's right across the border from Vietnam.
And so we set up across five different border markets during the influenza season, a routine monitoring of what in fact was coming across.
We know from recent history the consequences of poorly monitoring the emergence and spread of bird flu.
We at WHO believe that the world is now in the greatest possible danger of a pandemic.
In 2005, a new avian flu, H5N1, had spread out of China and across Southeast Asia.
The Vietnamese government decided that they could not, um, coexist with H5N1.
They had to take draconian steps to really bring it under control.
Vietnam began culling millions of chickens.
The virus began to dramatically spread beyond Southeast Asia, into Europe, and as far as Egypt.
In September, 2005, the World Health Organization estimated that avian influenza pandemic could kill up to 150 million people worldwide.
The national government essentially made a commitment to vaccinate virtually every chicken and duck, um, in Vietnam to try and break the back of the outbreaks.
And within four months, they succeeded.
Every epidemic is an opportunity to learn.
We do this all the time.
We are constantly monitoring, because you never know when something is going to show up in an animal and then make the leap to humans.
Karma? Where is she hiding? Little cat! Come and say hi.
Then let's sit outside in the garden.
Welcome, little cat! This is pretty much home now.
I've been here since 2008.
My wife, Marwa, we've been married for 16 years.
She's, uh, from Egypt.
I was born in Lebanon in 1975.
That's the year that the Lebanese Civil War started in Beirut.
I was born in the city at its worst.
And since then, it never really bounced back and always had trouble.
Lebanese people, we tend to migrate a lot, simply because there are no opportunities.
So for me, I was lucky, because I had the chance to go and get educated out in the West.
The kids have been born here.
Adam who is 14, and Karma, who's gonna be turning five.
What are you going to play at the concert? "Back in Black.
" You didn't learn any Arabic songs whatsoever? Where we are here, it's a little bit quieter than the rest of Cairo.
So, we get to enjoy a little bit of peace, but the hustle and bustle is always accessible.
Cairo's a big city.
It's about 25 million people, so it's quite large.
Very, very extensive.
My work focuses on avian flu and Egypt is a hot spot for that.
2005, 2006, the avian influenza virus started moving out from China to Egypt.
So we have been struggling with it ever since.
It comes back every year.
And this is what motivates us to continue our work in Egypt.
Karma? My kids, they know in general what I do.
But I tend not to bring work back home, because I like to really dedicate most of my time when I'm at home to the family.
He's away a lot, actually.
But, uh, we learn to cope with it.
Shall I tickle you? It's tough on Karma because she's a little girl and she asks a lot about him when he travels.
When she wakes up in the morning and asks, "Where's Daddy?" she's always sad.
I never spend more than two to three weeks here in Cairo.
I spend half of my time in Lebanon and then either the United States, or somewhere in Europe, or somewhere in Africa, depending on what's going on.
It's hard, but that's the nature of the career.
These viruses are circulating all the time.
I'm trying to keep up.
This morning, through a call from the control room I got to know about your two children who are positive.
What happened to the five-year-old child? Only cough and fever.
- Since when he is sick? - Since January, he was sick.
This medicine, Tamiflu, is given to treat swine flu.
You too, from today onwards will start taking medicine with them.
You know how swine flu spreads? When we're sneezing, coughing? Look on his face.
Need to keep this clean.
These are my children, this much I will definitely do.
In the beginning, it was not spreading so much, so the government did not pay much attention.
But now prevention care has increased.
For that, we have implemented this strategy.
Which pregnant lady were you talking about? - Nasira! - Come up.
We'll go down.
- Let's go downstairs.
- Call her.
What's her name? This is a very densely populated area.
Many families.
One germ can multiply into thousands and spread rapidly and continuously, so the whole community is affected.
When did you learn about the pregnancy? A couple of months ago.
He is her husband, explain to him.
She is his second wife.
As you are staying with her, your two children with your other wife are sick.
Keep her away from those kids.
Because Yes.
Because of their illness, she might have to suffer.
She'll be at a high risk and there may be a threat to her and the child We told them that a positive case was reported here.
So some were alarmed, some were concerned.
What will happen to us? There is no problem, come out.
There is no problem.
We are from the hospital.
You have to take Tamiflu, because you are close to a swine flu case.
We send a team to conduct surveys within a radius of one kilometer.
This is good work.
It's a good step from the government.
Even if we miss one case, we still find 100 cases.
And we stopped 500 from happening.
Is anyone sick in your house? Cough, cold, fever The problem is, everyone should be vaccinated.
But it is a costly vaccine.
And our population is very high.
It is hard for health care workers to reach every corner.
That's why in India, there is higher activity of flu during epidemics.
So, we just have three.
These two are stable.
I've seen everybody today.
She came in yesterday, had had the flu, got a little bit better and then suddenly got really bad.
Had a fever of over 103, has bilateral pneumonia.
So we may have to watch that a little bit.
Okay, sounds good.
Bye, Lizzie.
Bye.
See you later, Dr.
Goracke.
When I begin my 72-hour shift, I'm kind of in this high-energy mode.
About 12 to 15 hours before the end of the shift, that's when I begin to feel that fatigue sets in.
Probably at least three to four times a month, I think, "Ugh.
I can't do this anymore.
I'm done.
It's just too hard.
" And then I get some sleep and I feel better.
Or something really great happens, or, you know Something happens that changes my mind and I do better.
Father in Heaven, we thank you so much.
Thank you for the time to be able to come together in your presence with friends.
Lord, thank you for this meal.
We always wanna give you praise and glory.
In Christ Jesus' name.
Amen.
- Great.
- Holly, I brought out your good napkins.
Oh, good.
Do you want We love entertaining people at our home and we have some incredibly great friends.
Yeah.
And one of the main focuses of our private time has been prayer with our friends.
All right, Lord, thank you so much.
Lord Heavenly Father, we come before you tonight Just pray that you would guide the doctors' hands and let them see everything, uncover everything.
That you would keep them safe as much as they travel Lord, I thank you for this prayer right now.
Are we good? When I dedicated my life to Jesus, I said, "I'm not going to be like the world anymore.
I'm gonna be like Jesus," and Jesus was loving and he was kind and he laid down his life for others.
I have my own little place in the community.
But from my tiny little place, it ripples outward and I know that there are hundreds, maybe thousands of lives that are different because they came in contact with me.
And there's still a lot of time left of this year's flu season, so I have to just be in prayer that God has it in His hands and I can continue to do what I'm supposed to do in His will.
Coffee.
Coffee, coffee, coffee.
I have a pretty full day, every day.
But coffee Starts in the morning with coffee.
I was born here and it's still my favorite city, my favorite place to be.
Every time I come back, it just brings me back to my childhood, early days.
So the samples that we have been collecting over the last three days, we're gonna run some molecular analyses on them and that will tell us if we have the virus itself.
Do we have influenza or not? All of my staff are graduate students.
So as they're working on the project, they're also learning.
I did my PhD at the University of Iowa in the United States.
So for me, having graduate students start developing their careers while they're working on a problem that's relevant to their countries and doing it in their countries, it's incredibly important.
Science has always been my passion since I was a child.
I've always wanted to be like Do you know how Einstein looked while he was working, with his scruffy hair? I really liked that, I wanted to be the same.
Without the scruffy hair.
Dr.
Ghazi is my mentor and everything I learned is coming from him.
He doesn't approach science in a conventional way.
Actually, we're supposed to be interested in what we do.
To do something that we love.
Chief! Let's take this.
What do we have here? It looks like we have some activity.
So we do have a finding.
We have to have a certain number in order to call something positive.
We use a cutoff point of 80.
- So H was what again? - Human.
- Where was his origin? Backyard? - Yeah.
Thirty-two, which we call the negative.
Not high enough to call him positive, so it's below the limit that we detect.
Second human, another backyard.
He's at 64.
We would still call that a negative.
And the third human, I think we sampled at the farm.
That's another negative.
For the bats, they're below 40.
None of them make the cut, so we're gonna call them negative.
But then we have a chicken that's 256.
So that's definitely a positive for avian influenza H9N2.
That was on the farm.
On the farm, the virus is what we call endemic, which means it's always around.
Either the chickens were vaccinated, or during their growing period, they had an infection.
This is very, very expected.
Nothing of concern, but this is the nature of surveillance.
Regardless, this is a good learning experience for my students.
We have some antibodies.
Why don't we have virus? It might be because of vaccination.
Could be.
One more.
Distance.
Is the distance between Distance between, all right.
But it's not what I'm thinking of, so one more.
What do we know about an infection or an activity of Anomalies or something? - The - Anomalies.
The cold weather.
Seasonality.
We're a little bit out of the influenza season, that's why we don't see it much.
Um, influenza season picks up its activity during the warmer months, so if April, May, then you We expect to see more.
- Okay.
- Good job, everyone.
Let's eat.
I'm going to be the president of the table? Yeah.
Tomorrow, we need to return to Egypt.
A new avian influenza has been detected.
And it's essential that we begin surveillance.
We work under what we call the "One Health" perspective, so we strongly believe that the health of humans, of animals, of environments, of ecosystems, are all interconnected and influenza is a great example.
The bird migration patterns, as well as travel routes for commercial airlines and people So anything can affect any country and any country can affect other countries.
If something happens, the problem is that it spreads rapidly between countries before we're prepared.
2,000 years ago, it's hard to imagine, but this was a robust, dynamic community.
The Roman forum was the seat of power, both political and economic power, and never would they have imagined, 2,000 years later, we'd be standing here looking over their ruins.
The very idea that their civilization wasn't a permanent civilization, just was something they would never have grasped.
Two thousand years later, we're in exactly the same situation.
We think the world we live in is permanent.
This is the eternal city and if nothing else, the eternal city tells us nothing is eternal, right? All things must pass.
And to avoid the worst consequences of change, we're going to have to change the way we live on this planet.
If we don't, then we are gonna pay a severe price.
Western Heights says they've had so many student and teacher absences, canceling school was the best option.
schools in Braggs right now are closed, 47 were out sick 145 students called in sick on Monday.
After an increase in reported absences, both Seymour and the Archer City ISD will be closed tomorrow.
A Muskogee school counselor is dead, making her one of the hundreds of Oklahomans who have now fallen victim to this year's flu virus.
All right, so how long have you been sick? - Just today.
- Just today.
Did it kind of come on you all of a sudden? I went to work this morning.
I was okay.
- Like, my teeth was hurting.
- Mmm-hmm.
Like, tender and I had a headache, but nothing else.
And did you feel body aches and feel like you were getting a fever - My skin feels like it's burning.
- Oh.
- Eyes are hot? - My eyes feel like they're burning.
And then what are her symptoms? She's got a runny nose and a cough.
And have you been exposed to anybody that's had the flu? The county that we live in, they just closed the school - because of flu.
- Did they? I think they get past 20% and they don't send kids to school.
It does help us stop the flu as well.
It stops the spread.
When am I going to be able to go back to work? Tomorrow? If you have a temperature greater than 100.
4, then you really need to be out of the public.
If those parents that are in the workforce, their kids are at home, they either have to find childcare so that they can go to work, or they have to be off work.
All right, it's just a light Some of them may have sick days and some of them may not.
So it expands and we have parents that are now out of work.
Okay, I'll put together your paperwork and we'll let you get out of here.
It is a huge struggle, it's a financial struggle, it's a mental struggle, physical struggle, emotional struggle.
I know this is hard to believe, but 3,000 people across the state of Oklahoma have gotten so sick, they've actually had to go to the hospital.
And there's still nine weeks left in the flu season.
Hello? Okay, the one who was very serious, and asked me to prescribe the medicine? Is there some relief? So you are feeling much better? My wife is a doctor at Durlabhji as well.
We have an agreement between us: when she's in the hospital, I take care of the family.
When I'm in the hospital, she takes care of the family.
She works only limited hours.
She made this sacrifice for my sake.
So one person could move ahead while the other takes care of the family.
There were financial difficulties in paying for my education.
I just had a few clothes and I borrowed my text books.
Then gradually, after completing my MD, my life straightened out.
- Manish Ji, are you ready? - Hmm.
- Should I do your hair? - Hmm.
I have experienced poverty, and now, with God's grace, I have a lot.
So I know the difficulties faced by the poor.
The poor are at the greatest risk of the flu.
A doctor alone cannot do anything in tackling this flu.
The government cannot tackle it alone.
Neither can the public.
It can be defeated only if all three work together.
Rajasthan accounts for nearly 70% of the swine flu cases being reported from across the country.
This is the failure of the health department under the health minister, Raghu Sharma.
Rajasthan has lost 49 lives due to swine flu.
Why is the percentage of deaths increasing? People's health is our responsibility.
This means we are shirking our duty.
As soon as someone is found positive, then your department team will visit them the next day.
What are you busy doing? I'm taking notes.
He's the one who is taking notes.
You should be doing this on your own.
Make me the director, I will do it.
You can come here and be a minister.
If we don't take corrective measures, then it is our fault, isn't it? Our attention is elsewhere, not on this.
That is a sickness in our department.
Have you prepared all the instructions? What are those? Sir, first of all, there will be a daily monitoring of house-to-house activities in the city.
You will do screenings? You should do continuous screenings.
We will monitor Of course, you will be monitoring, but complete screenings should carry on.
In an effort to curb the spread, the Rajasthan health minister has now ordered door-to-door screenings of patients.
Yes, sir? This is the swine flu control room.
Now, tell me, how is your health? Madam, there are two patients, they are positive for swine flu.
Can you tell me your address, where are you from? Can you provide any landmark near your location? So we can confirm a visit to your place? Ma'am, the two cases are positive from the same house for swine flu.
Let me know your ward number, and our survey team will contact you.
Near the post office.
Post office.
The address is near the post office.
Is anyone there? Can you come out? The thing about controlling a deadly virus is you need to move from being reactive to proactive.
We know that viruses move from wildlife into livestock into people.
And so you don't wait for an outbreak to infect humans, you find it and you fight it before it ever infects a person.
FAO is looking at what's happening in animals, broadening our surveillance strategy to look upstream.
Usually, we would see the clinical picture in animals before humans become infected.
And it just bothers me when the report - first comes out of humans.
- Yeah.
And not picking it up two or three weeks earlier in livestock.
We have a team that brings information together from different sources, including our field teams.
I just received an email from Russia.
Basically, we asked about this H5N6, remember? It seems to come from a gray gull in So they actually went to check for a virus and they couldn't find it? Yes.
It was a result of active surveillance.
- Okay.
- Which, it does matter because apparently the prevalence was sufficiently high.
Yeah.
So we may, uh, see this virus next winter - being the main actor on the stage.
- Yeah, who knows? But if we can go ahead and, uh, get started Paul, you have something? Uh, there is an interesting detection of H5N6 in the Saratov region in the Russian Federation.
And this is the first report of this virus outside Asia.
This is closely related to the viruses that are circulating in China and caused several human infections, and some of them were fatal cases.
For us, it's quite important, the triggers and the line of command within the veterinary system or a veterinary service.
Once we have that detection, what happens next? How it links up to the medical services and how we react to that detection.
Closing down the markets, ensuring that consumers are safe, that there is good communication between the veterinary arm - and the public health arm at all times.
- Right.
With the proper risk mitigation measures, there's no excuse for any outbreak becoming more than an outbreak.
But it all begins with timely and effective surveillance.
- We're here with the band.
- What's that? - We're here with the band.
- Yeah, well, park right behind Brad.
- Behind him? - Yeah.
Okay.
Gear it up.
So much all right.
So is Paul gonna take two trips? We'll do two trips? - One trip - One trip with him.
with the ranger on that trailer and then the four wheeler on the one that's hooked up to Brad's truck.
Okay.
When I'm in the field with hunters, it's hard for people who don't understand to understand the full dynamics.
You can't see it.
The ducks aren't sneezing, they're not coughing.
But they have the flu.
Wild birds are the ones that are moving it.
That's how the flu is getting moved.
We're gonna catch these birds in this net.
There's rockets attached to it.
Those rockets are gonna fire when the birds are ready to be caught, when they're all balled up.
The net's gonna go over the birds and groups of people are gonna go out and take those birds out, we're gonna put them in keeping cages.
I'm gonna swab them.
And then those swab samples will go back to the lab, to see what subtypes of influenza come through here.
Let's say there's a flu outbreak at a chicken farm.
The flu didn't start there.
Maybe a hunter went out and shot something, and then didn't clean his boots off, and went into the chicken house, and, you know, spread all this flu.
Wild birds are the movers of this virus.
That's what they do.
Be ready to go when you hear the shot.
Get down there as quick as you can.
Grab a crate, and start pulling birds.
- Now, we - Yeah.
Okay.
Now, we just wait.
My job is like being a watchman.
A lot of the scary viruses in recent years have been linked to bats.
- Come over here.
- Yeah, yeah.
- Okay? - Yeah, let's go.
There they are.
Ebola, for example.
Coronaviruses, whether SARS or MERS.
When they are in groups you can catch them easily.
You can't catch them one by one.
Okay.
Got it.
Okay.
And we now know that bats can be a reservoir for the flu.
My team and I believe we have discovered a new subtype of influenza in fruit bats in Egypt.
And I want to test these bats in Lebanon to see if this virus is spreading.
The young ones, they might bite.
And you can see the teeth are still clean and still sharp.
Yeah, sharp and clean.
Off you go.
Next.
The more we know about where viruses come from, the better we are prepared.
What we can do is study them before they mutate, try to predict which route they might take.
So it's all about trying to break the transmission cycle from animals to humans.
The most vulnerable populations, or the populations where a pandemic can start, are in caretakers of animals.
We will take a human blood sample.
Human blood? Yeah, I need a worker who works inside the farm.
Okay.
You and your shirt in the street.
Get well soon! You see how I was so soft with you? Yeah, right.
I'm really, really interested in trying to catch that virus as it's causing the infection.
Once we do that, we can look at how transmissible it is.
Can it infect other species? Does it have a pandemic potential? We will add the chicken and human samples collected today to the bat samples and begin our testing.
- So, is this your - Mmm-hmm.
What do you call it? A pig or a sow? - A pig.
- You got a pig.
- Her name is Chessie.
- Chessie? Okay.
I don't think I've ever touched a live pig before.
Ooh, she's sweaty.
Or did you make her wet? Oh, yeah, we put water on her before the big show.
Oh! To make her shine? So, your mom told me that you did not get the flu shot this year.
Next year, you'll get the flu shot, won't you? Probably.
A little shot's not that big of a deal compared to how sick you felt.
And you got Can you imagine if you had the flu this week? - Oh, that'd be horrible.
- That'd be horrible.
I wouldn't have got to show here.
I like showing pigs a lot.
All right, we're ready to let them into the show ring here for our first class the first reveals.
Being a small-town doctor is a unique position.
They're all nice enough to eat.
Oh, yes, a little bit of bacon.
Even if they haven't been my patient, most people know, "She's the doctor.
" That opens up an opportunity to be able to have a really interesting relationship that I don't think a large town, or a city physician, really gets.
Take a big, deep breath in.
And then again.
Just breathe normal.
Good.
Physicians focus outwardly on others and what other people need.
I'm gonna give you some antibiotics in the IV tonight and then I'll give you a prescription for some antibiotics to take for the next ten days.
Do you have insurance? We are expected to be superhuman.
We are expected to do the best that we can for everyone that we come in contact with, with the kind of compassion that they deserve and that's a calling that I've been brought to, and I can do that, I can do my calling.
If I can get the help that I need.
I have a 72-hour shift and so it's important to me that my husband is here with me at times.
Because without Mike, I couldn't do this work.
Oh.
You were out.
Mmm-hmm.
Sleeping good.
- How are you? - I'm here.
So.
So, had two more cases? No, it was old cases that just hadn't gotten over it.
Oh, okay.
- Yeah.
- Okay.
I'm wondering how long I was out.
I'm still feeling tired.
- Half an hour to an hour? - You're as tired as I was because you got disturbed as much as I did last night, and then I got to sleep today and you didn't.
Yeah, I didn't get to sleep, so Okay, well, let me go take care of this patient.
All right, then.
My first marriage didn't do very well.
And my divorce was particularly ugly.
Hello.
I was talking to your wife.
She's really worried about you.
- I've been trying to.
- Okay.
The first year of medical school was really, really difficult for me.
My ex-husband was, uh sent to prison during that time.
I came to school a couple times beat up.
And my faith was shaken during that time.
And then I met Mike and he's a man of extreme faith.
And what I learned throught that was that every experience, good or bad, is building up in me, like this wall of strength and that strength gets me through all of the challenges that I'm confronted with, big and small.
"James, a servant of God and the Lord Jesus Christ to the 12 tribes scattered among the nations.
'Greetings.
Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance.
Perseverance must finish its work so that you may be mature and complete, not lacking in anything.
But blessed is the man who perseveres under trial.
'" Three, two We found that there are different subtypes of virus in these ducks.
These teal are long-distance migrants.
They go from here and they'll go all the way up to Saskatchewan, and then they'll come back again in the fall, and then they'll go all the way down to Argentina.
So that's a huge migration.
Along that flyway, they're either picking something up, or they're dropping something off.
- Whoa! Hello.
- Nice catch.
Doing these surveillance studies helps us to understand trends that are going on with these birds.
In case there's some kind of, let's say, pandemic, or spillover or something, we at least have the information and data to anticipate trends and we're ready.
We're prepared if there was a flu outbreak.
I thought I was gonna be a teacher or a police officer, but the college atmosphere was where I decided to go and start working with students that way.
And for the last 25 years now, I've been in the sciences like this.
Our big main goal is to see what the prevalence of flu is in this area, at this time, right now, with this population of ducks.
You guys are gonna hold the ducks like this.
Keep them down by your chest, um and we're gonna swab them orally and cloacally.
Put it in a media tube.
They're gonna give you a number.
I'm gonna give Put that number on the tube and then you're gonna bring them over to Alindy.
She's gonna bleed them.
She's gonna bleed them through the jugular, 'cause we don't like to wing bleed, 'cause they're migrating.
But remember the number that Lizzy gives you, 'cause that's the number that you and I have to match, and Alindy and I have to match to make sure we have the right sample.
And then once that we find if they have had flu, then we do a lot of serology back off in the lab.
Sound good? Does anyone need this duck? Can I let it go? 'Cause I've been holding it.
Okay.
Sound good? - Do, like Feel like a "break.
" - Let's go.
If they're busy at the table, let it go.
- Who needs a duck? - We do.
Six-six-six.
Oh, come on.
Sorry, Alindy.
Okay, we're gonna try to do this for you.
Ready? That does not seem right.
No, it isn't.
Are you ready? This is gonna seem even worse.
- Are you ready? - Oh! Oh, goodness.
I'm a terrible, horrible person, aren't I? You can let that one go.
Good job.
Yeah, totally let it go.
- Next.
What's your number? - Six-six-seven.
Are you 667? All right.
So I know.
It makes you all That's it.
So I'm gonna just help you, 'cause you're gonna be holding lots of ducks today, okay? Right there with those big pinkies.
Perfect.
Some of my favorite parts is the hunters who have killed them have never held them live, and then they hold them live and there's, like, a new perspective.
It doesn't mean that they're not gonna hunt.
Hunting I love hunting, myself, but that perspective of having this, like, live little creature is They don't get that opportunity.
They get the kill opportunity, but the live opportunity is always my favorite part when they come out in the spring to do it.
I have a role where I can go out in the field, being part of the pulling of the birds and the swabbing of the birds, and then taking those samples and being able to process them, all the way to the end, to see the result.
That one sample you bring back and all the work that went into doing it, all the people involved in doing that, that one sample is so important.
This knowledge gives the scientific community power to predict and prepare.
As the human population grows, we see an increased appetite for animal protein.
And in response, we are raising livestock at unprecedented levels.
The problem with that is that the sheer number of animals in a confined space elevates the risk for a virus to spread and mutate at a rapid pace.
While we can't predict where the next influenza pandemic is gonna come from, there are certain places that need particular attention.
And China is one of those.
It's the place where we've seen the emergence of virtually all of the deadly influenza viruses over the last half century.
And it's right across the border from Vietnam.
And so we set up across five different border markets during the influenza season, a routine monitoring of what in fact was coming across.
We know from recent history the consequences of poorly monitoring the emergence and spread of bird flu.
We at WHO believe that the world is now in the greatest possible danger of a pandemic.
In 2005, a new avian flu, H5N1, had spread out of China and across Southeast Asia.
The Vietnamese government decided that they could not, um, coexist with H5N1.
They had to take draconian steps to really bring it under control.
Vietnam began culling millions of chickens.
The virus began to dramatically spread beyond Southeast Asia, into Europe, and as far as Egypt.
In September, 2005, the World Health Organization estimated that avian influenza pandemic could kill up to 150 million people worldwide.
The national government essentially made a commitment to vaccinate virtually every chicken and duck, um, in Vietnam to try and break the back of the outbreaks.
And within four months, they succeeded.
Every epidemic is an opportunity to learn.
We do this all the time.
We are constantly monitoring, because you never know when something is going to show up in an animal and then make the leap to humans.
Karma? Where is she hiding? Little cat! Come and say hi.
Then let's sit outside in the garden.
Welcome, little cat! This is pretty much home now.
I've been here since 2008.
My wife, Marwa, we've been married for 16 years.
She's, uh, from Egypt.
I was born in Lebanon in 1975.
That's the year that the Lebanese Civil War started in Beirut.
I was born in the city at its worst.
And since then, it never really bounced back and always had trouble.
Lebanese people, we tend to migrate a lot, simply because there are no opportunities.
So for me, I was lucky, because I had the chance to go and get educated out in the West.
The kids have been born here.
Adam who is 14, and Karma, who's gonna be turning five.
What are you going to play at the concert? "Back in Black.
" You didn't learn any Arabic songs whatsoever? Where we are here, it's a little bit quieter than the rest of Cairo.
So, we get to enjoy a little bit of peace, but the hustle and bustle is always accessible.
Cairo's a big city.
It's about 25 million people, so it's quite large.
Very, very extensive.
My work focuses on avian flu and Egypt is a hot spot for that.
2005, 2006, the avian influenza virus started moving out from China to Egypt.
So we have been struggling with it ever since.
It comes back every year.
And this is what motivates us to continue our work in Egypt.
Karma? My kids, they know in general what I do.
But I tend not to bring work back home, because I like to really dedicate most of my time when I'm at home to the family.
He's away a lot, actually.
But, uh, we learn to cope with it.
Shall I tickle you? It's tough on Karma because she's a little girl and she asks a lot about him when he travels.
When she wakes up in the morning and asks, "Where's Daddy?" she's always sad.
I never spend more than two to three weeks here in Cairo.
I spend half of my time in Lebanon and then either the United States, or somewhere in Europe, or somewhere in Africa, depending on what's going on.
It's hard, but that's the nature of the career.
These viruses are circulating all the time.
I'm trying to keep up.
This morning, through a call from the control room I got to know about your two children who are positive.
What happened to the five-year-old child? Only cough and fever.
- Since when he is sick? - Since January, he was sick.
This medicine, Tamiflu, is given to treat swine flu.
You too, from today onwards will start taking medicine with them.
You know how swine flu spreads? When we're sneezing, coughing? Look on his face.
Need to keep this clean.
These are my children, this much I will definitely do.
In the beginning, it was not spreading so much, so the government did not pay much attention.
But now prevention care has increased.
For that, we have implemented this strategy.
Which pregnant lady were you talking about? - Nasira! - Come up.
We'll go down.
- Let's go downstairs.
- Call her.
What's her name? This is a very densely populated area.
Many families.
One germ can multiply into thousands and spread rapidly and continuously, so the whole community is affected.
When did you learn about the pregnancy? A couple of months ago.
He is her husband, explain to him.
She is his second wife.
As you are staying with her, your two children with your other wife are sick.
Keep her away from those kids.
Because Yes.
Because of their illness, she might have to suffer.
She'll be at a high risk and there may be a threat to her and the child We told them that a positive case was reported here.
So some were alarmed, some were concerned.
What will happen to us? There is no problem, come out.
There is no problem.
We are from the hospital.
You have to take Tamiflu, because you are close to a swine flu case.
We send a team to conduct surveys within a radius of one kilometer.
This is good work.
It's a good step from the government.
Even if we miss one case, we still find 100 cases.
And we stopped 500 from happening.
Is anyone sick in your house? Cough, cold, fever The problem is, everyone should be vaccinated.
But it is a costly vaccine.
And our population is very high.
It is hard for health care workers to reach every corner.
That's why in India, there is higher activity of flu during epidemics.
So, we just have three.
These two are stable.
I've seen everybody today.
She came in yesterday, had had the flu, got a little bit better and then suddenly got really bad.
Had a fever of over 103, has bilateral pneumonia.
So we may have to watch that a little bit.
Okay, sounds good.
Bye, Lizzie.
Bye.
See you later, Dr.
Goracke.
When I begin my 72-hour shift, I'm kind of in this high-energy mode.
About 12 to 15 hours before the end of the shift, that's when I begin to feel that fatigue sets in.
Probably at least three to four times a month, I think, "Ugh.
I can't do this anymore.
I'm done.
It's just too hard.
" And then I get some sleep and I feel better.
Or something really great happens, or, you know Something happens that changes my mind and I do better.
Father in Heaven, we thank you so much.
Thank you for the time to be able to come together in your presence with friends.
Lord, thank you for this meal.
We always wanna give you praise and glory.
In Christ Jesus' name.
Amen.
- Great.
- Holly, I brought out your good napkins.
Oh, good.
Do you want We love entertaining people at our home and we have some incredibly great friends.
Yeah.
And one of the main focuses of our private time has been prayer with our friends.
All right, Lord, thank you so much.
Lord Heavenly Father, we come before you tonight Just pray that you would guide the doctors' hands and let them see everything, uncover everything.
That you would keep them safe as much as they travel Lord, I thank you for this prayer right now.
Are we good? When I dedicated my life to Jesus, I said, "I'm not going to be like the world anymore.
I'm gonna be like Jesus," and Jesus was loving and he was kind and he laid down his life for others.
I have my own little place in the community.
But from my tiny little place, it ripples outward and I know that there are hundreds, maybe thousands of lives that are different because they came in contact with me.
And there's still a lot of time left of this year's flu season, so I have to just be in prayer that God has it in His hands and I can continue to do what I'm supposed to do in His will.
Coffee.
Coffee, coffee, coffee.
I have a pretty full day, every day.
But coffee Starts in the morning with coffee.
I was born here and it's still my favorite city, my favorite place to be.
Every time I come back, it just brings me back to my childhood, early days.
So the samples that we have been collecting over the last three days, we're gonna run some molecular analyses on them and that will tell us if we have the virus itself.
Do we have influenza or not? All of my staff are graduate students.
So as they're working on the project, they're also learning.
I did my PhD at the University of Iowa in the United States.
So for me, having graduate students start developing their careers while they're working on a problem that's relevant to their countries and doing it in their countries, it's incredibly important.
Science has always been my passion since I was a child.
I've always wanted to be like Do you know how Einstein looked while he was working, with his scruffy hair? I really liked that, I wanted to be the same.
Without the scruffy hair.
Dr.
Ghazi is my mentor and everything I learned is coming from him.
He doesn't approach science in a conventional way.
Actually, we're supposed to be interested in what we do.
To do something that we love.
Chief! Let's take this.
What do we have here? It looks like we have some activity.
So we do have a finding.
We have to have a certain number in order to call something positive.
We use a cutoff point of 80.
- So H was what again? - Human.
- Where was his origin? Backyard? - Yeah.
Thirty-two, which we call the negative.
Not high enough to call him positive, so it's below the limit that we detect.
Second human, another backyard.
He's at 64.
We would still call that a negative.
And the third human, I think we sampled at the farm.
That's another negative.
For the bats, they're below 40.
None of them make the cut, so we're gonna call them negative.
But then we have a chicken that's 256.
So that's definitely a positive for avian influenza H9N2.
That was on the farm.
On the farm, the virus is what we call endemic, which means it's always around.
Either the chickens were vaccinated, or during their growing period, they had an infection.
This is very, very expected.
Nothing of concern, but this is the nature of surveillance.
Regardless, this is a good learning experience for my students.
We have some antibodies.
Why don't we have virus? It might be because of vaccination.
Could be.
One more.
Distance.
Is the distance between Distance between, all right.
But it's not what I'm thinking of, so one more.
What do we know about an infection or an activity of Anomalies or something? - The - Anomalies.
The cold weather.
Seasonality.
We're a little bit out of the influenza season, that's why we don't see it much.
Um, influenza season picks up its activity during the warmer months, so if April, May, then you We expect to see more.
- Okay.
- Good job, everyone.
Let's eat.
I'm going to be the president of the table? Yeah.
Tomorrow, we need to return to Egypt.
A new avian influenza has been detected.
And it's essential that we begin surveillance.
We work under what we call the "One Health" perspective, so we strongly believe that the health of humans, of animals, of environments, of ecosystems, are all interconnected and influenza is a great example.
The bird migration patterns, as well as travel routes for commercial airlines and people So anything can affect any country and any country can affect other countries.
If something happens, the problem is that it spreads rapidly between countries before we're prepared.
2,000 years ago, it's hard to imagine, but this was a robust, dynamic community.
The Roman forum was the seat of power, both political and economic power, and never would they have imagined, 2,000 years later, we'd be standing here looking over their ruins.
The very idea that their civilization wasn't a permanent civilization, just was something they would never have grasped.
Two thousand years later, we're in exactly the same situation.
We think the world we live in is permanent.
This is the eternal city and if nothing else, the eternal city tells us nothing is eternal, right? All things must pass.
And to avoid the worst consequences of change, we're going to have to change the way we live on this planet.
If we don't, then we are gonna pay a severe price.