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tv   Book Discussion on Pandemic  CSPAN  December 23, 2016 2:16am-3:03am EST

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good evening. i am a bookseller on behalf of politics and prose owners and on behalf of the entire staff welcome it is a pleasure to have you here and to be hosting sonia shah to her book epidemic contagions from cholera to ebola and so on. if you could silence your phones. she will read and talk for about a half an hour and can take as many questions as we can fit into 20 minutes &-and-sign books afterwards. we encourage questions that need you to use the one microphone on my right by the pillar so
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everyone can be involved in the conversation and for the c-span audience. after the event is over, please it would be a great help if you would hold up your chair and placplaced it against a bookshe. the books are for sale up front where you walked in. sonia shah is an investigative journalist, author and lecturer whose work has appeared in "the new york times," wall street journal and scientific american among others. books include the story of oil the body hunters, new drugs on the world's poorest patients and the fever held malaria has ruled in kind for 500,000 years. and tonight the pandemic, sonia shah discusses pandemics from many angles reviewing the history of outbreaks including the cause of them into the personal and civic responses as a reporter going where pandemics stood directly affect people's lives and the sort of future discussing what we now know and how we can use the knowledge to predict and contain the next outbreak. so, please welcome sonia shah. [applause]
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>> thank you all for coming. this is my fourth book and my third time at this bookstore and i think every time i have come here i have some deep-seated understanding that i live closer than i actually do so i'm a little late. when i first started writing this book about six years ago, i certainly didn't expect that we would be living through a pandemic of the novel pathogen right when it came out but that's where we are with this virus kind of washing over the americas, and i just heard the cdc report today that three out of the nine women who were infected with zika via christi and came back to the united states had abnormalities in their babies. so it seems like this might have some not just in brazil. but the zika virus is a good example of what's been going on
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generally over the past decade, and it's the reason why i wrote this book which is over the past 50 years, we have had over 300 infectious pathogens either newly emerged or reemerged into new places they haven't been seen before. zika is the latest. we have had ebola where it has never been seen before, we had influenza coming out of asia including one that last spring caused the biggest outbreak of animal disease in the united states history. we've had viruses like middle east respiratory system and a virus coming out of the middle east. and then of course all of the antibiotic resistant pathogens. and the mosquito borne stuff, we have not just sonia shah but west nile virus and a whole number of things. so, what i wanted to look at as a journalist is how does a
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microbe that is just a tiny little thing that has no independent locomotion, how does it become this kind of pandemic causing so i decided to answer that question into ways. first i looked at the history of pandemics and i picked one to focus on a particular and that is one of the most successful pathogens at all times in this cholera. so it's caused not just one or two, it's caused seven. it kills half the people infected with it and it could matter in a couple of hours unless they are rapidly treated the other is a couple hundred miles off the coast. so i studied the history and went to please his new pathogens are emerging. i went to south china, hong kong, new delhi, port-au-prince and elsewhere to look at how it could shed light on what could
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happen to these other new pathogens. and what i found is the history of cholera is indicative of what is happening globally with all of these other emerging pathogens. cholera came out of the environment like a lot of our new pathogens. it helps recycle nutrients as a kind of helpful inhabitant in that environment and people for
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a long time didn't land in places like this giant slump. it's flooded twice a day. that all changed in the 19th century when the british decided to chop it down and turn them into rice farms. so over the course of this the century 90% of them settled so suddenly people are in close intimate contact with cholera in the environment and that allows the environment to spill over into human bodies and adapt to us. so the first started in 1817 and then it started to spread.
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we are invading wildlife habitat over disrupting wildlife habitat we are allowing animals and people to come into novel intimate kinds of contact and what happens is they can jump over into our bodies have become pathogenic. so from bats leadoff ebola in a number of other viruses. chemicals are probably getting as middle east respiratory syndrome. from monkeys we most likely got zika. we are allowing them to amplify in our cities and crowds and that of course started a 19th century and they took great advantage of that.
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so everyone had to live near work or the possibility of work. so places like new york city had about 77,000 people per square kilometer. so they were reading more, touching each other more, their waiswaste with contaminating thr food and water. they had outhouses -- 77,000 people per square kilometer that wouldn't have been before it actually rained into the streets were overflowed into people's wells.
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>> spin accident passes and of course it started in the 19th century and it's only reaching its peak now. since just a few years ago i think that half of the humankind now lives in the cities that happened a few years ago. there'lthere will be cities like mumbai, ad hoc, poor infrastructure at 2 billion people live in slums that's the prediction. we had the outbreak since the 1970s but it never infected a place of more than a few hundred
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thousand inhabitants. it infected the combined population of nearly 3 million. it was taking advantage of urbanization so it was since the 1940s or before that. so it was mostly in asia and africa and it is carried by a force of mosquito and bad mostly dead animals. it didn't bite people that much. people didn't really get a lot of the virus. but right now, in the v. america as it is being carried by the a mosquito that specializes in living in human habitations. it can actually breathe in a
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drop of water in a bottle cap. so all of the plastic garbage that we leave around in our urban areas are perfect environments for the mosquito to breed and individually bite humans, so as soon as it got in, it started to explode and its expanded rapidly. then of course we carry these things around. * in the 19th century. it's where we startethat's wherg steamships and the atlantic and then of course we connected all of those waterways by using steam engines to build the canal so 1825 the canal had opened. just in time to come over from london and paris into canada into new york city and the
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entire interior in north america and that happened again and again. we did much better today. we have hundreds of airports and tens of thousands of connections between all the airports. this is a map i have in the book you can make a map of all the cities in the world connected by direct flight and if you run a simulated flu pandemic on a map like that it basically is just expanding outwards. you can predict where and when it will strike simply by measuring the number of direct flights so that's how influential the flight network is. on the way they spread today. so those are some of the ways i talk about in the book how
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modern life increases the risk of the epidemics in the rising pathogens in the human population. but the other part of the book is what we do about it. we have political differences, medical defenses, all kind of things that we can do to fight back to contain these pathogens. it's interesting to look at what happened and i spent a lot of time trying to kind of dissect that outbreak in particular. now in 1832, it came to canada and the governor of new york sent one of his top doctors to upstate new york and canada to the reconnaissance to see what's happening. is this going to threaten new york and he collected this data that had been mapped and it shows a very clear picture of the cases all around the hudson river all around the canal and
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you can see it coming down heading straight for new york city, very clear picture but nobody wanted to quarantine the rivers or the canal. it turned new york city into kind of a backwater port. so this is the huge part of the economy nobody wanted to close the waterway which would have been the obvious thing to do to protect the city at this time and so he said it might look like it's coming out of the waterways were contagious but actually, it is caused by -- and of course this is a 2000-year-old medical theory that diseases like cholera and other contagions are spared for a bathrough bad smell. that's what they thought. so they decided to blame the bad
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smells on the drunks, the poor and immigrants. especially the irish in 1832. and this wasn't just the bad mouth them in the press. there were massacres of irish workers to the cholera epidemi epidemics. i lost my train of thought where i was going with this. i think i'm having a senior moment. oh my god. [laughter] excuse me i'm going to look at my notes. okay, right. the doctors. yes. it's funny that's where my mind quite because this is my favorite part of the story.
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so in fact, there were companies at the time distributing cholera contaminated water and they were making money doing that. so there is a slum in the middle of manhattan, if anyone has seen gangs of new york it was about five points and that's where all of the worst parts of the epidemic was affected because it was really crowded and really filthy. and they have actually been built on what was a pawn. it is the only source of fresh water for a long time. it had been over the course of f the sentries filled up with garbage and on top of that, garbage filled landfill. so the ground underneath was low lighting and unstable like the rest of it was that rock. so, the grand water was
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contaminated in the slum of coors because there is no sewer system and all the material is sinking down into the groundwater. well, the state of new york tried to a company to deliver drinking water to the people of new york and that company instead of testing the upstream sources of water at the time was fresh and what tastes better for sure, they thought that would cost too much money so they made a decision on what happened in flint michigan they decided not to tap the good water. they decided instead that they would sink the well in the middle of the slum and they distributed the water to one third of the people in new york and this is through the repeated epidemics. this is the good part, the person that maneuvered all this was alexander hamilton's nemesis and murder. on top of that, the company that
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did this was called at the manhattan company and the reason they wanted to save all this money is because they wanted to start a bank which they did, the bank of the manhattan company. the bank still exists to this day. do you know who it is, j.p. morgan chase, biggest bank in america. that is their earliest history. so -- and i tell that story in the book because i think we don't really look at the political and social drivers of contagion in a and i think that's an interesting kind of turnaround from the past. my last book was on malaria. we had no area from the 16 hundreds through the mid-19 hundreds, and we got rid of it before we had solid biomedical solutions by changing our land-use policy basically.
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we started building dams of course but we had engineers and scientists who were on the board of the dams to make sure that when we build them, we wouldn't extend the mosquito habitat. we changed housing practices, people started putting screens on their doors and windows. we uplifted people out of poverty in rural areas, give them electricity and mechanization in the farm and it ended through the malaria of life that built out. this is well before we had ddt or any specific drugs to deal with malaria. but then in the 1940s we started developing these specific chemical cures. it created a biomedical establishment that became powerful and potent advocacy is very effectively i and he sort f gave over public health to the
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biomedical establishment. so what happens now when we have outbreaks of contagious disease, we don't look for the social and political roots, we wait for them to erupt, people get sick and then we hope that we can throw sufficient drugs and vaccines add it to make it go away and that can work in some cases but wha when i tried to sn the book it isn't sufficient for new diseases because when the pathogens come up, we don't have the vaccines all made up. yet these things can spread exponentially. so we talk about exponential growth of untreatable disease. one example of this is the outbreak in florida in 2009.
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it was really centered in key weskeykeywest but it was in soua generally in 2009. hadn't beehaven't been here in s and was immediately attacked as a biomedical problems. attack the insect, attack the virus, that's what we did. but of course the mosquitoes that carry that had been present in florida for a long time. florida has been surrounded by countries where there is dainty around. that's not true. therthere hasn't been an invasif mosquitoes or virus that needed to be attacked with a chemical onslaught. what happened in 2008 as we had the foreclosure crisis. the foreclosure crisis meant we had a lot of abandoned homes and in florida, the themes of swimming pools. when the rains came, they filled up with water and became a giant mosquito hatcheries.
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and behold a year later we have this unprecedented outbreak of mosquito virus in florida so i don't know if it would have helped contain the dangue outbreak in florida because nobody tried that. but i do know arguably is the biomedical model failed. we are continuing to have outbreaks in florida it is considered a permanent part of the landscape. it's great as the biomedical solutions are if we can start to prevent pandemics if we engage in the root causes of them which are more often political and social in which case it isn't a question of waiting for the perfect cure but our own political will. thank you for listening. i will take questions, too.
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[applause] >> i have a question about the virus because i think that came probably right after with your thoughts about the political, economic and every kind of treatment in terms of the olympics and what given the theories in the book but what you suggest? >> i think it is a difficult situation, because the arguments that they are putting forward in brazil of why they should have the olympics and why people should come anyway is because it's winter and it's true when it's dry and cold, these mosquitoes eater will hatch not as readily because you need standing water for at least a week or even if they do, you won't survive for long enough to transmit the virus because that takes seven to ten days. and it actually slows down if it
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is cool. so, it is quite possible that that is a good -- that's true. there's going to be less virus around. ..
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>> >> and 15 of those asked transmitted. so there is many many more cases. it will be here. and any more detectable way. foretold years i was one of the leaders of infectious disease.
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under clinton and bush with the national security council to have white house control you have nothing and that wipes it out. order the top 11 properties. and under bush there is amazing efforts. and what they were very well designed. in the explanation is that what we heard and therefore
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we don't. >> that has been widely quoted. and how this possible that 1 billion people could die. if this roughly the same. he did have quarantine or panic. >> you have said it all led don't think you had a question so much as a comment. ferried have. but even more than that.
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but to get those root causes with the health care infrastructure with the enough primary health services to those who are vulnerable holarctic be regulating? and there is a lot of reasons not to do that. so we need the all of the above approach and to be multifaceted. >> as you probably know the highest rate of hiv in the indebted states.
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and what some lessons could be learned. >> because there is the epicenter of hiv so how does that translate? to mexico what can you learn from disease clinic. >> we see this in history of contagions. and this is an interesting aspect.
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even with ebola is a great example very special interventions could control that but we have nothing on the ground. and that is the history of contagion. >> up working for global health care organization to strengthen develop the world's. it is not ridiculously hard like people in kenya it is
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not ridiculously hard to figure out to have the greatest impact but that it gets harder if you don't know what the disease is. and that question of priority is important because we will never have all of resources that we want so we need to set those priorities. and there is a ton of things we can do to prove it the pandemic. >> to have an easy answer. and even those poor people in the remote places.
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and traveling 15 miles from the capital but it took eight hours because it is so caught off. it was so caught off they cannot have cholera but they were cut off enough they had no resources to help them and that struck me where they have one pipe of water coming down from the hills from 20 years ago and never gave any support so when i came there to be upon us class in -- a cliff so --
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slowly has fallen down to sea level. really their richest using cloth to wraparound. and then to the only add a bucket of water pdf you give up washing as much. some of those simple things like clean water that is sustainable over time. those are vague things. but i am looking at how these spread. and that is a huge lesson of all.
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muddy think we should do? they say we would like better water into the town or whatever it is. >> and although from a different part of that because of the tremendous poverty. and with that sanitation issue and medical issues but having said that the if from
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europe and the united states of america to place them in the tropics with potentially the appendix. in this with that context of this zika virus. it is just a of a matter of time. of those consequences so potentially that is the consequences.
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that is the problem that they are talking about. and if those pesticides and these other elements i would like to hear from you. thank you. >> en this rash of microsoft's lead -- microsoft elite in brazil some say that is definitely not happening but to me there is a lot of evidence. could it have then used differently or because of cultural reasons today have
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gotten a higher dose? i think it is a mistake of conspiracy theories i think that is the conventional response of the global health the establishment but there is a reason why it is useful to look at that coming about with a lack of trust where does that come from? if we trace this back some of this happened during the cholera epidemic even the
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burn down quarantine hospitals. and if you walk it back there have been transgressions between the establishment and the local people may be with the best of intentions but it is still there is real and with the underlying feeling that they don't trust this part of the public health messages. they see you are stupid and ignorant. manet said there socs stupid and ignorant? and with those industrial contaminants all of these things with corporate control and that is worth
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the dressing to trust these messages and we need to do that work now all because we really do need to trust our authority all to be on the same page we are not there yet with conspiracy theories that come up with the gm macedo and monsanto there are all kinds of theories. >> i am studying public health phnom my concentration is policy. so how do you work towards creating policy that would be effective but also a direct cause like social
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issues? >> this day huge issue what does this mean with be interventions? that was the topic of my last book. and they did not match up with their own priorities. that was the ada was cheap and easy to be in the most pour and deprived settings okay so we did that. and bill lot of good attention and then they were
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not used right away. and then they scented the anthropologist. did don't consider malaria a killer disease the nets are square but they live in a round have. and the people on the ground is totally different they have community if is the first two years of life than malaria comes and goes.
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and all you need to do is go to school and work for six weeks out of the year for flu season. many rauscher hands during floozies in. >> i have a question of us contracts between this book and the statements so what are your personal actions that you have done to prepare or would you do in your daily life to avoid epidemic diseases quick. >> and to live-in the microbial world this part of
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nature and increase the idea to live in nature free environment if you think of the of long history of the of battle with microsoft sphere -- the microbe so all of these patterns sell a period time when i grew up with that feeling it is simple. this will not be a part of my life. and to adjust to this new reality.
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