tv Book Discussion CSPAN November 8, 2014 7:30pm-8:31pm EST
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including a piece just twice -- last week inside the ebola virus. it published a hot zone with the accidental outbreak with a colony of research monkeys and it sold millions of copies and terrified millions of readers. for example, stephen king wrote it is one of the most horrifying things i have ever read. and then it gets worse. [laughter] i am also a surer "the hot zone" inspired many of the readers to consider and pursue that epidemiology that it yules curiosity of what we know today. the most recent massive outbreak occurring for the first time in west africa now "the hot zone" is back onto the national best-seller list 20 years
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after the publication. i always had a particular fascination for the insidious ingenuity have infectious diseases so it is the pleasure to bring this element i am happy we have the opportunity and the foresight to bring richard preston in here today. the book is entitled ebola the breakout from got some. please join me to welcome him. [applause] >> thank you. is the pleasure and the delight to be here even with the context of ebola. i will start by telling you
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a story about ebola not just a virus but a problem. though try to keep my remarks brief so we have some time for q&a afterwards. as rick pointed out my expertise is in english literature and there are people in this room to know more about that epidemiology and molecular biology than i do. but to get into a discussion of the things i would be presenting and i will try dancer whenever questions you have. the ebola virus has been breaking into people's and
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dictatorial africa but it could never establish a firm foothold in the human species. lives somewhere in secretarial africa in the unknown area and then the ticket or a mite that lives in the body of the bat and is the actual carrier. we simply don't know. but in 1976 a small country hospital in the year -- in the democratic republic of conroe it came under notice of the doctors for the first time. they did not know at the time one that was. with his new was a virus.
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and it got into the staff of the hospital. one of the victims' was a belgian nine on raising the by this is the last photograph of the sister. the virus got into the medical staff of the hospital. we don't know who patient zero was or where it came from but it killed a number of people. the gentleman with the beard and the glasses and when the sister lay dying she was weeping at the time. one of the things that happens sometimes you can
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get a tiny pinpoint hemorrhage around the eyelids and apparently she had blood on the eyelids that lee into the tears on her face and she was weeping and he checkout but the handkerchief to wipe the tears from her face then wipe the tears from his face then he was dead 14 days later. at first they had no idea what was going on but it was extremely alarming. the virus experts from around the world but one of the very first people one of the first medical doctors was a belgian physician and was the young doctor and
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this was the first major outbreak. and when they finally got there. printing most of the medical staff was dead. and then walking into the obstetrical ward of the operating room. is devastating for pregnant women because of a spontaneous abortion or miscarriage accompanied by profuse and retreat infant dies in the mother typically guys as well. and then to find pools of blood to use surgical sponges saturated with blood all over the place.
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into the operating room and was even worse so talk about very rudimentary hospitals with the tools and techniques that they were presumably lead in with an unknown virus. nobody knew anything about the characteristics it was assumed to be a virus, not bacteria nobody knew how was transmitted. but it was obvious it was hemorrhaging in some patients and at an extremely high fatality rate. the reported cases is something around 90 percent. one wonders if that figure is at all accurate it is hard to say i don't think
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there was careful epidemiology done but in any event he went to bet in a small bungalow next to the hospital at night and he reported later refers night was called. quiet and silence because people were dead redfin at 5:00 in the morning a woman was brought in in childbirth and terrible distress and shaking with fever and hemorrhaging profusely from her birth canal. the only doctor on the scene could make the decision. that clearly was not the place for this woman so they set up a table on the porch
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and he had a couple of flashlights for elimination and then with nurses around despite the obvious dangers to themselves but at this point the remaining staff understood their lives were in jeopardy by simply being your the patients. he examined the woman in came to some determinations that she was in grave distress at the end of her rope and is likely to die if nothing was done and the baby was breach the woman was hemorrhaging and in order to save their lives he would have to perform a procedure but necessary inspection was completely out of the question she could not be brought into the obstetrical ward and
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there was no anesthetic available just the light of the flashlight. he had a rubber gloves so he made a decision to perform a very old 19th century medical procedure. an alternative way to deliver a baby. he took the scalpel he separated the bones of the pelvis right down in front of the pelvic bone the bones and joining together right here. somewhere below your navel and it is so hard area of if you press hard you can feel the to from bones are joint by a layer of tough
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cartilage it is a joint. while she did not have anesthetic he splits her pelvis through the cartilage in hand and nurses opened her legs and the whole bill this can open and he brought the baby out and it was covered with blood everywhere. and the woman was in distress that is when he discovered the baby was inbreeding arrested without thinking what he was doing he tore off the surgical mask and placed the baby's face up to his and rescued the baby's life and he saved the baby and then he pulled back and suddenly realize what he had done his face and eyes and mouth was
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covered with babies and mothers blood the hands were covered in blood and the nurses were standing there in shock. one said dr. g. realize what you have done? he said i'd do now. i'd tell the story because this is what they have been facing today. it is a situation if you are a trained physician you do what you have to do what you have been trained to do and don't think about your own personal safety. the doctor later reported the only time in his medical career and was not just afraid that lived terror. he survived. as it turned out the woman's fever was from malaria she did not have ebola. and he saved the life of the child and the mother who
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went on to live compute lee -- completely normal existence is. since then ebola virus has made 23 appearances on the planet. 20 of which were outbreaks transmitted from one person to another the key relative number of deaths were less than 2,000 the outbreak tended to be small and after awhile doctors got complacency there was general consensus that the ebola virus was not much of the threat and could be easily controlled. but nature has a way of surprising scientific people if you are a scientist to make an assumption that is
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not based on sufficient data nature has a way to surprise you. now it seems it began in 2013 when it year-old boy a in a small village died now that reno was ebola virus. it type was a little different and later i will talk about the genetics. but this particular strain left the village and it would jump from person to person setting off a chain of infection. when of virus makes a trans species jumped into the human species from another, is attempting to turn the human species into
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a new host. talk about the goal of the virus. this is all little tricky because the organisms do not have the consciousness and it is not intention it does have biological sophistication and is set up to be opportunistic. the goal of the virus to set up endless chain of infection better unbroken and never and. in that sense that virus that makes the jump is making itself immoral. something like 7,000 years ago the smallpox virus did this it was thought to have once lived and probably a
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rodent that lives on grain and 7,000 years ago with a history of our species we would gather in large numbers of the middle east and china with conglomerations of thousands of people at one time. the incubation period for small pox is 14 days. epidemiologists have done the math have concluded that smallpox may have made the jumps to the human species but only with the concentrated populations and river valleys with the explosions of rodent population that the virus
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could become immortal and smallpox maintained its immortality and tallow was declared eradicated by the who in 1979 and now lives only in laboratories in a frozen state. so ebola is summer in the earlier phase of the attempt to make itself immoral in the human species. we have some images. this is from cy year 1976 like what we see today. but the question then is what is ebola anyway? the virus particle was sick a strand of spaghetti and is
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composed of only seven structural proteins. they're only three enzymes that are in the replication and process. incited a container is the story and that contains the genetic code of the virus. the ebola virus one recent sample counted 18,979 strains. that human genome is some them like 3 million and there are orchids that have 10 or 12 billion letters in
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their jeans. it would seem some orchids are more complicated than human beings. [laughter] batik ebola virus is the safety level for aged and for which there is no vaccine and no cure. in the laboratory you have to be wearing a high-level of protective gear to work with quantities of the virus. these are beautiful photographs one that is thought to me that a hiding place and it begins to replicate like mad inside the cell and that replication cycle peaks 18 hours after the first particle. and essentially the virus
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turns that sell into a factory. and it gets a swollen shape and then they begin to grow out like hair and will -- one would produce thousands and thousands of these particles the virus takes its sweet time and they tend to last a lot longer that die once hiv is active. and to have this capability to keep the hose to sell a live longer.
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and in west africa that net effect on human as it multiplies in the body tissues spew out thousands of particles the titres of the virus or the quantity of the particles goes up astronomically. and at the end of the ebola infection the bloodstream is really loaded with these particles. nobody understands how person dies of the ebola virus but clinically we know the blood vessels begin to leak and capillary blood is all to the body they just lose their integrity and
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blood and plasma begin to seep out of the vessels. it also triggers clotting that will continue. you get something that's rose a tiny plots everywhere in the body than eventually that clotting factor is used up then that patients can have hemorrhages to have multiple organ failure than going into shock. and then when they are in shock. think of a droplet of blood
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that covers one-fifth said your pinkie finger and tell and it is infectious and laboratory experiments suggest as you introduced into the human bloodstream. but as the ebola outbreak widens hospitals became overwhelmed with ebola patients. one of them was in sierra leone. but for many years and had a
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laboratory for investigating the virus that was another fever virus that was devastating to be level for agent because there is no vaccine and no reliable care. the number of american researchers who is an assistant professor at harvard university affiliated with to nomex and harvard have been working there for years doing research on this. here they do genetic sequencing of all kinds of organisms. there are two subjects of my recent article about the ebola outbreak.
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but she is quite a remarkable scientist and a singer and songwriter for a big and 1,000 days and they had to put their fourth album on hold due to her involvement with the ebola outbreak. she began working with physicians at the hospital. with their research unit was the chief physician. and early on so it is decided so it is said general sequencing of ebola. is certainly mutating.
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because that genetic code the rna viruses known to make an error when they copy themselves. but as they copied and copy they introduced small changes and as time goes by it changes in this ferocious natural selection that each person affected with the ebola can have multiple genomes by the time it leaks out.
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she was the head nurse at the hospital. she was a small person and a complete dynamo who always wore his starched white uniform except when she was in biohazard gear dealing with -- patients in an ebola patients. in any case may 23 this year a woman arrived in panama and she was having a miscarriage and hemorrhaging. dr. khan suspected that in fact she might have ebola. they tested her blood and they found out that indeed she was positive for ebola. and then dr. khan and his colleagues and the nurse along with others at the hospital ended up collecting blood.
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they collected blood from discarded blood tubes that were going to be incinerated in the biohazard incinerator at the hospital. the reason for doing this is as it considered to be highly unethical to take samples from a patient in a clinical setting for research. that's an in demand -- an anthem. essentially what they had to do was gather up the ina the code of the ebola virus for medical waste. they brought the samples over to the institute and i don't know how many of you are familiar with genome sequencing and how it works. i knew nothing about it before i went there and interview people. steven dire who is the genome guy there, steven guy is an interesting fellow. originally he's apparently a very talented chef and he was
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authored -- offered a chance to compete on the bravo show top shelf and he turned it down and instead went to africa to do research on monkeypox virus which is a cousin of smallpox. but i think the reason he is a good chef is also the reason he's a good molecular biologists. these people tend to be extremely precise with their hands and they tend to have a sense of calmness and control when they are dealing with small quantities of liquid and complex recipes which is what microbiology is essentially all about. so geyer and his colleagues took initially took 14 samples of human blood that were infected with ebola virus from patients. they had a technique whereby they could take -- actually was blood plasma.
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it was blood plasma but have a lot of destroyed red blood blood cells limit because if you take a blood sample from an ebola patient it's going to look different. it's going to look like a mess. it's going to look like blood that is very sick. in fact dead kind of blood with dead blood cells in it. anyway they took as medical waste is horrible looking blood. they purified it and they do things like they add simply ethyl alcohol, essentially purified vodka to this and they can extract the rna. the rna comes out of the solution and they end up with a droplet called a library. the library contained in this case trillions of fragments of rna. the fragments were about 300 letters long. they were shattered rna from a
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much -- from many genomes of ebola and each individual fragment was tagged with the bar code of dna of eight letters of dna that linked that fragment to one of 14 patients, individual human beings who had been infected with ebola virus. this liquid droplet was about the size of a raindrop, no bigger than that and it was in a microtiter tube. steven geyer took it over to the sequencing platform, the machine at the burrow institute, these genomic sequencing machine. each one costs $1 million they are about the size of a chest freezer and there are 54 of them in the sequencing core at the burrow institute. the staff in this place they took that little droplet which is called a library. let's think about the amount of information that droplet of genetic code. the way geyer described this,
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each of these pieces of rna with a bar code on it could be thought of as a book with a cover on it that had an isbn number on it. however this would represent an ungodly number of piles of the library of congress. this is many many libraries of congress in some gigantic pile of books and the books are americanized. they have never been met. nobody knows what's between the covers and they are in a huge pile. they are not lined up on the shelves in proper order. so in the sequencing koritha technician took about a tenth of that raindrop, and amount of liquid something like a drop of moisture that hits your face when you're walking through the fog and put that on a glass slide called a flow cell.
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in the flow cell is put into the business end of one of the sequencing machines and then lasers shine on the flow cell while compounds, liquid compounds are washed over the flow cell. in a period of 24 hours they get the sequence of more than a billion of these little pieces of rna. now they have a huge amount of data all in a computer and it has been put into these giant supercomputing farms were all these little peep pieces of rna are assembled because they are all overlapping. they'll have little bits of code that fit together like a jigsaw puzzle. 24 hours after that they had 12 completed finished genome sequences of ebola virus, 12 varieties of the virus. it had mutated in each of the cases. they could tell because of the
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way the mutations were running and they could tell who had given the virus to him. they were able to reconstruct the chain of infection of these 14 individuals in sierra leone and they were also able to show that the virus that originated as one human being presumably the little boy in million do it could well have been infected but with one particle of the ebola virus. this entire outbreak could have been very started with one particle of ebola and if not just one the even a few. they also found out that ebola in half the cases of ebola moving from one human being to the next there was significant mutation in the code. causing a slight but measurable change in a protein in the vir virus. this has a direct effect on our ability to fight ebola because all of the drugs and vaccines
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and tests that we have for ebola are all keyed into the genetic code of the virus and it's the genetic code of the virus that's changing. it can become less visible to the test. the test won't elicit the virus as successfully. the vaccine might not work as effectively. the vaccines that are now in development. in the drugs are also key to the very genetic code of this organism. meanwhile, while this was going on parties said that he was terrified for dr. khan. dr. kahn above all was a doctor. he was completely committed doctor to his patients and he stopped sleeping and began working in the ebola word at kenema. the work word became distressing and horrible to work in as they filled up with people. some of the staff understandably
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got too frightened to work until finally dr. khan was working alone in wearing protective garb called ppe which is kind of a portable space suit along with the nurse and a few other people. joseph fair and american epidemiologist went to kenema to see how dr. kahn was doing and he was shocked and dismayed to see what was happening. there was one -- there were three wards at kenema that were completely stuffed with ebola patients and the largest was the big plastic tent that had been arrested by relief agency. inside the tent there were about 30 beds of a certain type, and africa known as the column bed. a caller that has a plastic mattress and hold in plastic mattress in the hole than this under the mattress. the patient lies on the mattress and to the whole into a bucket. people who have cholera have
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uncontrollable watery diarrhea. with ebola they can also have uncontrollable diarrhea which is often enough has a lot of blood in it. when joseph fair looked in the window he saw sheik humarr con and their. anything that can come out of the human body was all over the floor and all over the protective garb of dr. kahn. and as i said direct contact may be lethally infectious with one single particle. many of the people who became infected with ebola in this outbreak could remember making any mistakes at all. they thought the decontamination process was precise but they got ebola anyway. in any event, one day sheik humarr con did not come to work and they found that he was keeping himself at home.
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he had isolated himself. he was feeling ill. they noticed for a few days previously dr. khan had been taking himself off a long uncharacteristically and sitting in a plastic chair and smoking a cigarette and looking off into space. he never smoked in the word that he was now. later they thought they knew he was coming down with ebola and he wanted to protect the staff by keeping himself away from them. they sent somebody to his house. they took a blood sample and he was positive for ebola. at that point dr. khan decided that he needed to get himself away from kenema because his presence as a patient in the ebola word be too demoralizing for the remaining staff. so he climbed into an ambulance which took him for four or five hours over these terrible dirt roads to another clinic in a place called thailand where he
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became sicker and sicker in isolation in the ebola ward. there was a freezer and in the freezer there was one human core of an experimental drug that had never been tested in humans called zmapp. this sierra leone and government regarded humarr khan's illnesses a national national crisis may call them international experts asking for help in the experts became aware of the fact that the zmapp drug was there in a freezer 25 feet away from dr. kahn. they debated for three days whether to give him the drug are not. the considerations were very difficult to work their way through. this was an experimental drug. he was an african doctor. he was a national hero. he was given the drug and he died than he would be an african
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doctor who had been killed by an experimental drug administered by doctors from the developed world. the drug might have no effect on him but if he died it would be blamed on the drug. on the other hand the drug might save his life and then it would be -- well if he got the drugs why can't anybody else have the drug? they went back and forth and back and forth and meanwhile dr. kahn didn't seem to be that sick. he seemed to be hanging in there so there was hope that he would at least, that he had a good chance of coming through naturally. the thing about ebola is patients can often look like they are doing all right but then you can suddenly go into what some ebola experts called the crash where you all of a sudden go into a startling decline and it could happen in a matter of hours where you just
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lose blood pressure and you have multiple organ failure and you die very fast. in the end that is what happened to dr. kahn. the zmapp drug eventually ended up with the two people working for a christian medical organization called samaritan's purse. dr. kent brantly and an aide. both survived. they split that those of zmapp and dr. brantly in particular seemed, his symptoms -- he seem to be at the point of death when the drug was administered to him and he turned around in the period of three or four hours on the night of july 31 this year. when i was researching the article i discovered that at the very moment that kent brantly was apparently being saved by
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the zmapp drug was the moment that the burial detail finished digging graves and burying dr. humarr khan in kenema sierra leone. now i'm thinking of the words william t. close. dr. william t. close it died a couple of years ago was the father of the actress glenn close. he was an expert in ebola virus. he was the head of the hospital in the, in 1976 and he was involved first-hand in that first outbreak of the ebola virus. he said to me once if there are lessons to be learned here they are human lessons. this is about people doing their duty. it's about doctors doing what has to be done right now without a whole lot of heroics. have you ever been petrified with fear for you have no hope
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of control over your shades? if you are a medical worker when the dye is cast in the face of bolla the fear goes away and you do what you have to do, you get to work. this is what dr. humarr khan did. i'm sure in times to come there will be bronze statues of him and to nurse them follow funny and the people who died in kenema. i think what we have here is medical people who sacrificed their lives for their patience and not only that also sacrificed their lives for science itself. when the said betty geyer off -- article was published favored people who died in kenema and one of the authors was dr. kahn and another was the nurse.
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i'm going to leave it there. i have more but i see we are running a little short on time. i thought it would be wonderful to just open up the room to questions and during the course of that i might be able to tell you a little bit more about the results as we now see them in terms of the mutation rate of ebola in what ebola is doing right now in west africa. thank you very much. [applause] [applause] >> questions, please. please see them -- use the microphone for your questions. any thoughts? any questions?
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yes. >> there was an interesting spread in the sunday "new york times" about photographs of workers in africa including an american steven hatch from massachusetts. my question is, i gather one or two people have survived in america and telling american medicine and they have all the bells and whistles and they have a lot of transfusions, however one of the people in the photographs in "the new york times" a young african man, a survivor of ebola -- to some people because of their unique whatever they have got, genetically, to some people just make it through with the type of ebola they have or are at the bells and whistles absolutely necessary? >> this is a very good question and i don't think at this point
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we really know the answer fully. we don't actually know why some people survive the ebola infection and some do not. it seems pretty evident that there's a genetic component that some people just have a lucky roll of the dice in their genes. >> there were people who had tons of contact with hiv and never got it. no one really knew why. i never got an answer as to what made them have no problem with it. >> i can tell you one thing. if you want to survive an infection of ebola, this comes from unpublished oral data that parties so that they told me about. you need to be young. if you are infected with ebola here this is statistics to this outbreak.
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if you are as old as 35 or 40 case fatality rate goes up to 84%. you are already too old. if you are 43 to 45 the case fatality rate is around 93% rate if you are in your 50's or 60s you might as well kiss yourself goodbye. the case fatality rate is probably going to be close to 90 something%. young people are surviving ebo ebola. yes. >> thanks so much for your talk. you started off by speaking about how you were going to talk about the human aspect in the human story behind ebola. i think you have done that so well and i also wanted to see if you could speak for a moment about the human animal stories behind diseases like ebola. i'm thinking in particular of course these diseases aren't
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created equal. they are very different in their effects and how they are transmitted. did you share this human animal leap and i'm thinking about culture we, question about the culture in a particular ebola rather than the science thinking of diseases like sars and the ways that we talk about those diseases in the human animal connection there. we have tend to think a lot more about what are the chinese eating and what are the wrong things that they are eating that they are getting diseases coming into the human world from? we don't hear as much about ebola in some other reporting that we see. we don't talk about it as much and i'm curious if you have thought about that difference in the human animal story they're? >> that's really interesting. i think actually that's correct. we don't talk very much about the human animal connection with ebola except they're the strictures don't eat push me.
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that's ridiculous. the problem is that we don't know very much about the anima animal -- the connection to the animal world. we know that ebola is coming out of an animal host but in these outbreaks in all of them the early patience, patience zero and the ones that follow patient zero are dead or even the epidemiologist comes around to find out what were you doing, did you e a back? fruit that are supposed to taste delicious. they are supposed to taste not bad at all. did you kill a bad or did you kill something else? did you get a tick that was on the back? where was the back? or was it actually a rodent that you ate or what was it? the epidemiologist simply run into darkness because all of the early cases were dead and they
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can't talk anymore. they can't tell you what they i do want to dress address us a little bit which is the great confusion. there has been a huge amount of confusion in the public discourse about what airborne means and whether the ebola virus can mutate and get into the air and turn into some kind of andromeda strain that's going to wipe us all out. eric lander, the head of the road -- brode institute. the ebola book virus is mutating. the longer the ebola virus goes on the more chances this virus has to develop a mutation that would be really dangerous for all of us that it doesn't necessarily have to go into the air in order to travel more effectively from one human being to the next. the way eric lander put it was
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ken sieber is learn how to fly? he said that's really not the right question to ask a direct question to ask is can zebras learn how to run three times faster? ebola can certainly do that. there are unpublished results showing that in some ebola patients of this type of ebola we are seeing there getting up to 10 times the number of virus particles in the blood stream that has been seen typically in previous outbreaks. so the virus is growing into tremendous perfusion in the human body. it doesn't necessarily make you sicker but it might make you more infectious because you are just producing that many more particles coming out of your body so that could be as favorable adaptation or a favorable mutation for ebola. we just don't know this point in terms of airborne there were two
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kinds of airborne with viruses. there's one called droplet infection which is where, here we are. we have a picture. this is somebody sneezing and you can see the droplets coming out of this guy's mouth. these are liquid droplets and bayard of the size that causes most of them to fall to the ground at a distance of a meter and maybe two meters at most. the rule of thumb is when you're around ebola patients they could be throwing liquid droplets into the air. 40% of the patients in this outbreak or coughing. coughing is apparently a major feature of the ebola virus disease seen in west africa today. people can easily be causing small droplets of blood. they are not going to go that far through the air. the other way that a virus can move is the way the measles virus moves.
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here is measles. measles is part of a -- virus family. in this case the virus can travel through the air and dry form. the virus survives drying and it can essentially end up as a small dried dust particle that can travel 150 yards from one person to the next person and then get embedded deep into the lungs where the virus can then activate and it patch itself to lung and replicating the new post the new host. his true aerosol transmission like this. this is the measles and viruses from the measles are far more dangerous than ebola because it's almost impossible in an outbreak to really trace the cases of contacts. you can have somebody 100 yards away and gets it to somebody else. and that's something that really alarms a lot of people. the question about the animal kingdom.
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there argues marbella viruses and animals and they have the potential of moving into humans and they have done so in the recent past. yes. >> i was wondering if professional writer struggling on the story from the scientific experts to the general public what do you think it's been the role of the american media in conveying the story of the bolla? has it been effective or beneficial and can you describe this relationship? >> i think the media coverage in the united states has been terrific. "the new york times" and the "washington post" in particular have done a really good job covering the ebola outbreak. they have had reporters on the ground really detailing the human suffering, getting into the questions of science. i think the print media has done a wonderful job. i never know about the video
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media. it's always hard. the video media depends heavily on the print media for stories in the united states. they don't seem to have a whole lot of time to really get into things. in some instances i've seen very good reporting. "cnn" has done an excellent job in terms of video media. in general the media coverage of this outbreak has been quite good, very good, yeah. >> thank you for your topic is wondering if you could talk about your research method when you were gathering information about "the new yorker" article. did you go to west africa and how did you get this information? >> this is a great question. i'm a writer and i love talking about writing. i'm supposed to to be an area expert in the ebola but actually
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what i am as is an expert at writing. i love to talk about teaching classes here. it's been a lot of fun. in this particular instance, this is nonfiction writing. this is what we would call narrative nonfiction and i typically spend huge amounts of time with my subjects. i get to know them as individuals. very often people i've written about over the years become lifelong friends. it's one of those things that happens but when you spend a lot of time with somebody taking a lot of notes you end up learning a whole lot more about the human being that ever ends up in print. all the skeletons in the closet come out. you find out all the medical problems they have. typically i never write about a person's issues unless it's part of the story itself. i also get the case of their voice in my head until i can hear them in my sleep. i wake u
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