Ologies with Alie Ward - Epidemiology (DISEASES) with 'This Podcast Will Kill You's' Erins Welsh & Allmann-Updyke

Episode Date: July 31, 2018

TWO epidemiologists-named-Erin -- and hosts of the stellar This Podcast Will Kill You -- chat with Alie about historical horror stories, THE plague, cholera cocktails, flu shots, tick bombs, milkmaids, witch trials and more as they share their infectious enthusiasm for disease ecology. How much should you wash your hands? What's the best way to flirt with a stranger on a bus? Why are people scared of vaccines? What conspiracy theory enthralls Alie? So many questions with uncomfy, but fascinating, answers.Listen to This Podcast Will Kill YouFollow TPWKY on TwitterMore episode sources & linksBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray MorrisTheme song by Nick Thorburn

Oh, hello. It's that lady that sells air plants in abalone shells at the farmer's market, Allie Ward. Back with another episode of Allergies. So in this podcast, I usually try to get you to love and appreciate things you think you do not care about because people and subjects are crazy and beautiful with just a little bit of context. But in this episode, it's time to know then enemies. So we're going to discuss disease, dis-ease, the lack of ease, shit that makes you ill,

sometimes actual shit that makes you ill, and breath that can kill a million soldiers. So it's dark. It's fascinating. I'm kind of scared. But as we learned in last week's, selicamorphology episode about sharks. Our brain is programmed to get a little squirt of happy juice when we're scared. Okay. So before we go down an infectious whole of viral wonders, let's just think some quick

little happy thoughts first. Okay. So number one, today is your last day to cash in on theologiesmerch.com July sale with 10% off your entire order using the code CAMPOLOGIES. Go for it. Get a backpack. Get a bikini. So thank you to all the patrons on patreon.com slash oligies.

You guys kick in a dollar or more each a month to submit questions. And honestly, you just, you keep the show running. It wouldn't run without you. So thank you. And thank you to everyone who has rated or reviewed or subscribed. You guys are keeping oligies. One of iTunes top rated science shows that says bad words. It's a distinction that probably dismayed my parents.

Hi Nancy. Hi Larry. This is a science podcast. Go there. The embarrassing places, the gross places, the profane places. Thank you for all the kind reviews. As you guys know, I'm just, just a touch creepy and I read them cause I think it's so nice that you leave them and to prove it, I shout out one each episode as a thank you.

This week, red and black 13 says bees, bees. My friend recommended this to me and I was like, um, okay, you just listen to a podcast episode all about bees and you said it was good. I mean, okay, I will trust your judgment and maybe try this and listen to one that maybe isn't about bees. So I did. And now I've listened to seven episodes in less than seven days and I refer to myself as not much of a podcast listener and that's the level of binge listen I'm at.

Highly recommend. So fun. So informative. You might even take notes and it will be amazing. So thank you everyone who reviews and subscribes and rates and takes the risk of telling your friends about this weird show. Okay. Disease.

Disease. Now, first off, the word epidemiology comes from what else? The Greek. Um, it's cobbled from epi, meaning upon and demos, meaning people. So it's something that is upon the people. So the centers for disease control and prevention says that an epidemiologist can study everything from infectious diseases to natural disasters, terrorism, non infectious diseases, environmental exposures and also injuries.

So if it is upon the people, epidemiologists are there. They're on the scene. They got a clipboard, a notebook, maybe a hazmat suit and they're just figuring that shit out before a cold turns into Armageddon. Now this episode has been months in the making and it's an oligies first. It's two guests and they already have their own damn podcast. It's so exciting. So I was aware of both of them from the worldwide web and I'm proud to say they're mutuals

and their show, this podcast will kill you is just killing it. It was number one on the science charts earlier this year and at the time they were making it, they were also just casually both getting their PhDs, which is quite a feat. I can barely make this podcast and have clean socks. So they're on a little sabbatical right now, but they're coming back with more new episodes this fall. They're based in Illinois and we met up at the hub of just everything cool, the Field Museum.

So special shout out to Kate Golumbeski aka ScienceKate.com who works at the Field Museum for being so kind and you hooked us up with a quiet room to record this in a place where we could talk about open sores privately. So we settled in just one oligies podcaster and two, this podcast will kill you hosts. We scrappily shared two mics between the three of us and we talked about plagues and ticks and cholera and flus and pandemic capitalism and Ebola and hand washing and smallpox and sores and fieldwork and dissertations and some surprising thoughts on the culture of academia. So please be very prepared to become huge giant fans of epidemiologists Dr. Aaron Welch

and Dr. Aaron Alman Uptyke. So now, which one of you is Aaron? It's a great question. Oh God, I might as well be wearing like Oakleys on a lanyard and some crocs. That was such a dad joke question, but yes, both are named Aaron. So I'm Aaron Alman Uptyke and I'm Aaron Welch and Dr. Welch has long straight dark hair. She was wearing a smart black tank top Dr. Alman Uptyke is tall. She was wearing a blue jumpsuit and she has curly hair.

And although I did not see their brains, I would can describe them and they're amazing. Epidemiologists, both of you and doctors, yeah, officially, officially like fresh doctors like how when did you become when did you get your PhDs? I literally deposited on Monday. It's Friday. So five days ago is when it's official official. Oh my God. And then Aaron, I defended a few weeks ago and I'm still waiting to deposit.

I was like, huh, what? But Dr. Alman Uptyke explained that you present all of your research and findings to this PhD approval panel, which I like to imagine consists of Heidi Klum and Simon Cowell and that guy from Maroon 5 and maybe Sporty Spice. And then afterward they can say, OK, well, go make a few tweaks, dog. And then you like air quote, deposit it back to them. And then the deposit and the deposit is when it's like all stamped official done. Oh my God.

Yeah, it's like the library has to check your margins and they're like, please remove this space. And you're like, for real, OK, I'll do that. What did you do when you deposit? Like, do you put it into a draw box and then do you moonwalk away in joy? I wish it was that. That sounds like such a more satisfying experience. I literally emailed a PDF in and then they sent it back and they're like,

one of your titles has a hyphen in the table of contents and not on your page. So you need to delete that. And I was like, OK, so I did that and I sent it back. And then they're like, congratulations. Oh my God. So both errands have PhDs reflective of a certain specific epidemic. Dr. Alman Updike's PhD is an entomology, which is bugs, because she studied Shagas disease, which is contracted from tiny little parasites carried by the kissing bug,

which is also oddly known as an assassin bug. And it's like kissing and having a hit out on me. Like those are just like pick a pick a personal brand. Those are very different activities. Now, also our buddy Darwin, aka the father of evolutionary biology theories, is said to have had Shagas disease. Speaking of evolution, Dr. Welsh just got her PhD in ecology, evolution and conservation biology. And she was studying tick-borne diseases in Panama.

So both have masters in epidemiology and they studied epidemics for their PhDs. They have a podcast all about epidemiology, but they both were not sure if they should call themselves epidemiologists. They were just demuring as many humble brainiacs often do. I was not having that. You have a master's in epidemiologists, but you're not an epidemiologist. It's really hard to call yourself things sometimes when you're like, oh, well, everyone else is. No, I call bullshit on that.

You're an epidemiologist. Okay, so is I. Now, when did you guys realize that you were fascinated with diseases? And also briefly, how'd you meet? That's fun. So I know exactly when I started getting into disease. I was into biology, but I wanted to be a shark biologist. That was what I was going to school to study aquatic biology.

And at the Marine Science Institute at UCSB where I went, they were having this like party for like the 100th or 50th anniversary or something. And there was this professor there who everyone loved. Shout out to Armin Curris. And he taught three classes and I asked him at this party where wine was involved. I was like, of your three classes, which one is the best one? And he said he got very, very serious. The wine was gone and he was like, listen, this is not an exaggeration.

10% of my students' lives are changed by my parasitology class. 10%. 10%. And I was like, okay, I guess I better take it. But I thought he was joking. He wasn't joking. And I literally like, I think it was the second lecture, which was on schistosomiasis. And he calls it the hook.

And he's like, this, this is the one that changes people's lives. And I kid you not, it changed my life. I was like, oh, this is what I have to study. And I went to his office like almost in tears where I was like, it's my senior year and I'm about to graduate and I don't know what to do with my life. And he's like, you'll be fine. And then that's where that's how it happened. So now schistosomiasis, not hookworms, but it is the hooky worm lecture.

And now Erin, when did, when did you know diseases were for you? I actually kind of came at it from a different, slightly different perspective. I, I, when I started university undergrad, I was majoring in nursing. And I thought, okay, I really am interested in sort of this health aspect and the, the concept that every day it's something new and it's really exciting. You can go anywhere. You can see all these different things. And so it was sort of like this way to see my curiosity.

And I did about a year and a half of that until I had to take as part of the nursing curriculum a class in microbiology. It was at 8am, Monday, Wednesday and Friday. Brutal, right? Yeah. And so, but something was different about this particular class, 8am classes. I was, I mean, I slept through an exam that was at 10am. Like I was not an early birth.

It was embarrassing. Yeah, that was music. And so 8am to actually have to get up and get out of bed and go to this class was like at the beginning I was like, oh God, I can't do this. But then I was like, I don't want to miss it actually. I found myself wanting to be there every single morning. And it was like the only class I think maybe in my entire undergrad that I didn't skip once. So that during that semester, I said, okay, this is actually what I need to be doing.

So then I switched into biology started. I joined a lab, microbiology lab, looking at plague. And then I kind of transitioned into epidemiology and then ended up doing disease ecology. That is the most casual use of the word plague I have ever. You just dropped that like so smooth. You know, it's just studying plague. And now how did you guys meet? Well, so I'm from Kentucky originally.

And I, we both go to the University of Illinois. And I started in the PhD program in 2012. And then the next year I got an email from my advisor saying, okay, we have a few new students joining the lab. And one of them is basically you times two. Her name is Erin. She has a master's in epidemiology and she's should be joining the lab. Meanwhile, Dr. Almond Updike, newcomer to the lab, was nervous to meet Dr. Welsh

because she'd done all this cool work in Panama. She seemed like a badass. But one blessed summer afternoon on a Friday. And I like peeked my head around the corner of the office. Yeah. And I was like, hi, are you Erin? Because I'm Erin. And you were the best human ever.

You were like, yeah, hi. And then she like forced me to come to happy hour that same night. And we've been soulmates ever since. Oh my God, double Erin epidemiologist. Now, when did you decide we need to take this relationship to the podcast level? September of last year. My friend hosts a barbecue every year called the Larbecue. His name is Lawrence.

And I forced Erin to come with me last year. And we were sitting around. It's like it's mostly my partner's friends. And so I was like, oh, you know, we'll come and just like to eat delicious food and hang out. And Erin and I were being very antisocial. And we sat in a corner of the yard the whole time. So chatting about parasites and ignoring all the other living humans, they said those fateful words now akin to platonic marriage vows.

We should have a podcast. And the next thing you know, they were dreaming up themed drinks, AKA quarantinies to match their epidemic episodes. We came up with the idea of quarantinies that exact moment. And like started coming up with a list of names, many of which we've actually used. Your quarantinies are so close. They're really fun.

They're really like a nice addition. And you're so funny and passionate about this that it's like, of course, you're the right people to be schooling the earth on plagues. And you make you make influences so accessible. And I really appreciate that. Do you have a favorite quarantine that you've made? Oh, yes. Okay.

My favorite is actually the first one, which was the H1 drink one. Yes, I remember. Yeah, that one, which is technically just a corp survivor number two. That's like the official name for it. It was super delicious. What's your favorite? I think I really enjoyed that one. And then what was in the harmadillo?

Oh, I also have to put a plug in for rice water stool, which sounds horrific, but tastes delicious. Rice water stool. Is that a cholera? Yes, right. I believe. Yes, I remember that episode also. Thank you for taking me back.

Now, what is it about diseases and epidemics that you really love? And like, what is your goal? Like, what's your mission? Do you want to make people more afraid of diseases or less afraid? That's a good question. The thing I love about diseases, and it sucks that you can't say things like, I love disease, like people get offended. But I am really interested by the complexities of disease.

And so that's why we both sort of ended up studying disease ecology, because it's looking at disease from a very wide angle and understanding all of the intricate details between the host and the pathogen and the environment and vectors and multiple hosts and complicated life cycles. And so that's what really hooked me about diseases are these diseases that are very complex and difficult to understand and therefore difficult to treat and deal with.

Especially when they go through so many hosts and they've got to go through this snail to get to this frog, to get to this pelican who like shits on a fisherman, who like makes out with a seal, and then the next thing you know, like a whole village is dead. Exactly, right. And it's so interesting that an organism could evolve a life cycle like that. How did you get there?

How did you come up with that? How did that happen? So that's what really like fascinates me about disease. So I think that our goal is more to just get people thinking about how interesting diseases are. Definitely not to scare them more, but I think that's the end result sometimes. Yeah, I think part of the goal for me is sort of,

it's mostly to inform. And so part of it is if learning about how widespread and unchecked malaria is scares you, that's a good thing because it should scare you. Malaria, other neglected tropical diseases are huge issues. And so I think that it's more of, it's bringing awareness to these problems that still exist and that we don't actually,

most people don't really think about on the day-to-day basis because we're not confronted with it. Because we have vaccines, we have easy access to healthcare. Well, questionable. Lolls. Yeah, we do have the potential for access to healthcare. Whereas in other countries, lack that completely. And so the driving force behind my interest in a lot of this

in disease or in disease ecology is putting it all in context. And so when I think that when I have taken history classes, it all seems so segmented, like bullet pointed. So, and then this war happened and then this invention happened. And instead of putting it all into the perspective, okay, but what else was going on at the time? And so when I was in this lab working on plague, the first thing I did was I ran out and bought a book

on the Black Death. And I was shocked to learn the extent to which it impacted humanity. And still there are like echoes of it today. So understanding how this thing that we think about, we think about these things in little cells. Like, okay, we put disease over there. We put history over there.

We put biology over here. And it's, they don't really all interact together. And so I think sort of putting these things in context is where it really became fascinating for me. And so how much of your work and your research and your science communication deals with kind of domestic epidemics versus global ones that we haven't quite implemented solutions

that we may have implemented in the first world? Dr. Welch says, my research is on tick-borne disease and climate change. And this all takes place in Panama. And so I basically was trying to understand where ticks are, which ticks are infected, and why they are where they are, when they are, and then throwing in the pathogen into that. Okay, let's predict how tick-borne disease

will change in the future. We just have to understand what drives it currently. We talk about how a domestic outbreak can or like a small little outbreak of disease can turn into an epidemic, can turn into a pandemic. And let's address that. Run me through. What is an epidemic versus a pandemic?

Yeah, great question. So an epidemic is essentially just an outbreak of a disease that is outside what is normal for that community. So if you had even a few cases of plague in the US, that might be an epidemic, because plague doesn't happen very commonly in the US. I just got a break in here, because to the gratefully uninitiated.

What is plague? I thought maybe it was just a catch-all term for some bad shit that kills people, but plague is an actual disease caused by a specific bacterium. Yourcinia pestis. Pestis? A little bit on the nose, but okay. So plague is transmitted through fleas that live on rodents,

and there are three styles, if you will. There's septicemic, which infects your blood through a flea bite, and is 100% fatal if left untreated. Just boom, you're out. And then there's bubonic plague, which is responsible for the pandemic in the 1300s, known as the Black Death, or just the plague. I think it's really all an inflection here.

You can't really call the Black Death the plague. I think it's more like the plague, like how Chandler on Friends would say it. Now, the Black Death was responsible for up to 200 million deaths in just over four years. This bubonic plague, FYI, is when the bacteria enter the body through a flea bite, and they infect lymph nodes,

and it causes them to swell and maybe burst. These are called bubos, which sounds so cute, like a term of endearment for your grandma, but they're actually swollen lumpy nodes of infected plague that can kill you and others. But wait, there's more. Now, the third type of plague, pneumonic plague, can also involve bubos, but includes lung infection.

So what I'm trying to say, next time you're having a bad day, there's like not enough ice in your cold brew, or maybe your new jeans stained a whole load of towels, indigo, just think, well, fuck, at least I don't have plague. Epidemiologists also suggest not handling dead animals in areas where plague is common, and for some of us, that warning may be well needed. I've handled the dead thing here and there.

Thankfully, not in plague-torn areas. I'm just going to give a shout-out to Greece, the 1978 musical, which issued this warning about duplicitous, leather-clad John Travolta's being vectors of widespread suffering. Men are rats. Listen to me. They're fleas on rats.

Where's the net? There are meabas on fleas on rats. Meabas, bacteria, and you're close enough. But in Madagascar, there is a cyclical cycle of plague. And so a few cases is normal. But last year, when we were recording like last fall, there was a huge outbreak. There was an epidemic.

And so when you have disease happening in a population that's larger than the norm, that's an epidemic. OK. And then a pandemic just means an epidemic that's gone global. Usually it means global, but it could even just mean it has spread to like many different countries. But yeah, so a pandemic is just an epidemic that's spread globally.

How do epidemiologists feel about people saying like, Snapchat addiction is an epidemic? Like, how do you feel about it being misapplied? That's a good question. I mean, I kind of roll my eyes at it. OK. Like I think like we call everything an epidemic these days. And it's like, OK, yeah, people are using Snapchat

more than they did 10 years ago because it didn't exist. Right. Chill. I roll, yeah. Don't steal the thunder of an epidemic because when I need to talk about ticks on your butt, like I need this word to mean something. Yeah.

I do have a question about, I have so many millions of questions. Oh my God. Run me through the different types of epidemics. Like, what is a virus versus a bacterium versus a parasite versus are there fungal epidemics? For sure. What flavors are there?

Yeah. So there's a bunch of different flavors just based on what the pathogen is. So a pathogen is just a microorganism that causes disease. So you can have viruses, you can have bacteria, you could certainly have fungal infections. Fungal infections are less common because generally our immune system is better equipped at dealing with them.

So you're usually most susceptible to fungal infections if you're already immunocompromised. Oh, OK. So, and then you also can have like parasitic infections and usually people distinguish between parasites and pathogens, meaning pathogens are microscopic and parasites are larger. OK.

Is that right? For the most part, I mean, I've also heard people say a protozoa is a parasite. Let's say you're on a date and suddenly you realize, wow, it would really impress this person to know some information about protozoa. Well, I'm here to help. So a protozoa, single-celled organism

that has a nucleus. So bacteria are also single-celled, but they don't have a nucleus. No, I did not know this. Yes, I just had to Google it. You are welcome. I hope this leads to scintillating conversation and maybe smooches provided nobody has the plague.

I was going to say, do they have to have like a mouth and a butt to be full, but even single-celled organisms have that sometimes. OK. So it really depends maybe on who you're asking. Yeah. And can you run me through what exactly is a virus? A virus is, you can't even really call it an organism.

Is it an alien? Is it a tiny space alien? It's not an alien, because they were definitely here before us. OK. That's genetic material. It's genetic material, usually DNA or RNA, surrounded by a protein coat. And that's pretty much it.

It's just like genetic material in a sack of protein, and it can't replicate on its own. So that's why people don't call it a living thing, because it has to infect something else for it to actually make more of itself. Oh, my god. There are some giant viruses that they've discovered recently that are like, I don't know about any of those.

Like the ones that live in the Arctic and stuff that are massively huge compared to other viruses, like in terms of they have way larger genomes than most viruses. And they're like huge, like they're larger than some bacteria in actual physical size. And a virus is essentially like, from what I remember, it's like a hexagon or something like shaped pod with weird legs, like a claw machine

that you would get a stuffed animal out of at Chuck E. Cheese. And it just comes and then it sticks its weird virus dick in you, and then it just puts its DNA in you. Is that am I a doctor now? You're pretty much like, I'm going to give you an honorary PhD. Thank you. So that, what you're thinking of specifically is a type of bacteriophage.

I think it's called T7. I was totally thinking of a bacteriophage, which is a virus that preys on bacteria. Its name, bacteriophage, literally means I eat bacteria. And apparently, they're known informally just as facious. Like, please, please. My father is bacteriophage. Call me Phage.

It has a name, that specific one that one time my roommate drew in Henna on her arm and I was like, we should all get that tattooed, it's so beautiful. But yeah, so that's a bacteriophage. So that's a specific type of virus that infects bacteria. But not all viruses look like that. They can be little squiggles. So the virus that causes Ebola is actually

this little squiggly guy that if you just were looking at it without any context, you might think it's some kind of like spirochete bacteria or something if you don't have a size scale. But yeah, it's just this little squiggly guy. You can have viruses that are just sort of balls. Like influenza virus is like a ball with spikes coming out of it kind of.

Yes, I feel like I've seen that on herbal remedies for flu. Yeah, so there's a lot of different shapes. And all of those shapes are just basically the protein coat. So whatever protein structure it makes, that's what will determine what the virus looks like. And then it injects its little penis probe, is just it pushing its genetic material into whatever cell it's infecting.

Can you not? You know what I mean? Like, do you mind? Did you ask permission? I don't think so. I don't think so. Do you guys feel like there is a certain kind of vector or pathogen that is the worst news?

Like, which of the types of pathogens are you like? Oh, no. Influenza. Yeah. Yeah. Let's talk about it. Because this was your first episode on this podcast. We'll kill you.

You're like, we are going to start with a big one. And also, the questions I got from the Patreon patrons are like, 1918, let's talk about this influenza, this outbreak. So let's get into some flu. Because it seems like you have the flu. You're out for a couple of days. You miss some emails.

You eat some soup. You're fine. But really, it's going to kill us all. Could. OK. I mean, I think the thing about the flu is that we don't really have any very effective treatment for when you actually do get flu.

So if you have a really bad case of flu, it's pretty much just like, OK, let's keep you hydrated. Let's monitor you. And you're probably going to get it. You have a pretty good chance of surviving. But the scary thing is that the things like the 1918 flu, something like that could happen again. And there were a lot of things that went wrong or went right,

depending on your perspective. So flu is publicist. It's like this was a success. Planets are aligning. I'd love to imagine that their little PR team after the epidemic. They're like, guys, this was great. Let's do it just like this every year.

What again? Oh, it failed. 1973. Oh, it failed. So yeah, I mean, something like that could happen again, where it's just sort of everything happens where you have a lot of people gathering together, which we kind of do all the time now.

In a much larger degree than we did in 1918, we have global travel. I guess the recombination with animals and mammal hosts, the bird hosts, and then the viruses inside just sort of intermingling. And can you give me the briefest of rundowns on that 1918 flu? Just tell me, what were we dealing with here?

We were dealing with a flu that started out possibly in Kansas, possibly in France. We don't really know what happened. Same thing. Same, I mean, more or less. And a couple of soldiers who were on leave, probably picked it up, went back to an army base, where it's a ton of young, otherwise healthy dudes

sleeping in a giant tent, all breathing each other's spit, all pooping in holes. Yeah, all pooping. And this allowed for the virus to just sort of boom, boom, boom, boom. And somehow, people started just dropping like flies. People were getting really sick, and they were not recovering, which was really unusual for the flu,

because these were really young men, really healthy. And so I think that specifically about that strain was that it caused something called a cytokine storm. So basically, your immune system went into overdrive, and your whole body essentially just shut down. And I think the most common way that you died is that your lungs sort of filled up with fluid. And that was the end.

But once it got into these army camps, of course, people who were maybe that they were exposed to someone a few days before, got into a bus, were shipped maybe to Philadelphia, a boom, another outbreak there. And then, OK, if someone else went to England, boom, another outbreak there. And it sort of followed this hop, skip, and jump

across the globe. And the reason that a lot of people call it the Spanish flu, or used to call it the Spanish flu, was because Spain was one of the only countries that was not censoring its news reports. And so to keep morale up around, like, in the US, or in England, they were like, oh, no, we're not going to tell everyone how many hundreds of thousands

of people are dying. We're just going to pretend like it's, you know. And Spain was like, real talk. And he was like, oh, guys, everyone's dying. What's going on? Are we the only ones? Oh, my god. Spain is like that person in the party who

would be like, your boyfriend sucks. And you're like, oh, no, you're right. Exactly. So how many people were lost to that? I cannot remember. Is it 50 million? That's right. 1, 5, or 5, 0?

5, 0. Oh, my god. I want to, can I? Can I statue this? Yes. And Google it. So this flu of 1918 infected 500 million people, 10 to 20% of whom died.

So on the low end, that's an estimated 50 million lives lost, maybe up to 100 million. Brutal statistics, nothing to sneeze at. Which, in writing that, made me wonder if the term nothing to sneeze at was born of epidemiology. But it turns out, no. In the 1600s, get this, sneezing became a cool thing to do because people just thought it cleared the brain.

And then, sneezing at will became a way to throw shade at others. So the idiom, nothing to sneeze at, was just invented by snobs, which are maybe even worse than viruses. Because viruses are just trying to make a living and replicate themselves off of your healthy tissues. So influenza is really what should be on our watch list.

Yeah. And so biologically, some of the reasons that most, I would say most epidemiologists probably are most afraid of influenza. One is because, like Erin mentioned already, the rate of recombination is really high. What does that mean? So it means that, OK, so influenza

can infect a lot of different organisms. So it's not specific to humans. It can infect birds. It can infect pigs. It can infect dogs, whatever. And when it infects an organism, if you get two strains that infect the same organism, like say a pig, gets two different versions of flu in it at the same time,

the pieces of the influenza genome can kind of break apart and reassemble in such a way that makes a brand new virus. That's sneaky. Yeah. And so it means that it's really, it mutates rapidly enough. Like it can do those big shifts.

Those are called antigenic shift, where you're basically like big changes. And that can make it really hard for your immune system to identify it and fight it off. It also is an RNA virus, which means its genome is made of RNA. P.S., what is RNA again? OK, I didn't know. So RNA is like DNA.

But instead of that double helix structure, it's a single helix, kind of like a springy curl. Now, DNA stores genetic information. And RNA acts as a messenger between the DNA and the ribosomes to make protein. So it's like DNA's wing woman. Hi, girl. Hey.

But maybe she gets a little sloppy drunk sometimes. I mean, hello. Which means it doesn't have a fact-checking mechanism. So it makes more mistakes. And sometimes those mistakes mean it does something better, like it replicates faster, or it's more virulent, meaning it makes you sicker, or things like that. So the fact that it changes so rapidly

is something that makes it difficult to combat. And that's why we have a new flu shot every year, is because it's always a slightly different strain. And the other thing is that it's spread by respiratory droplets. And so it's unlike something like Ebola, which you have to have close personal contact with bodily fluids to actually get the infection. In this room, if I breathe, I can get you infected.

Oh, OK. Yeah. And so those are the kind of components, I guess, that make a disease what we call a disease of pandemic potential. OK. So. So OK. Is it a DPP or no?

Let's call it a DPP. So you got yourself a little DPP. A little DPP. Disease of pandemic potential. I always think about exponential growth curves in populations, how you look at deer populations, human populations. It's like boo-boo-boo-boo-boo-boo,

and then sharp increase exponential growth. And then there's always something that picks you off. Either it's famine because there's lack of resources, because the population can't be sustained, or it's close quarters overpopulation causes a quick drop. And you're like, if you look at human populations, like I feel like we're due for that. People say that, yeah, for sure.

I mean, in terms of epidemiology, do you look at populations and say, oh, no, there's so many of you that you're going to spread things quickly? It definitely. So the globalization has definitely led to things having the potential to become pandemics much more easily than in the past.

So that's why it was 2003 when SARS was a thing. And everyone was like, that's going to be it. This is it. This is our next pandemic. Everyone gear up. Can I just say, I have one of my best friends. His name's Sarah. And we've called her SARS as a nickname since we were like 12.

And so she's in my phone as SARS. Oh, man. She's been in my phone since before 2003, as SARS. And I can't change it. But anyway, I'm sorry, SARS. I know you're listening, SARS. And I'm sorry.

As long as it's not in all caps, it should be fine. OK, good. No, it's not. So you're fine. We're fine. Don't worry about it. Contextually, totally unclear. But yeah, so with something like that,

that was a disease that made people really sick. It was transmitted by respiratory. And at first, we didn't know at all what it was. And so the fact that we have globalization and people living in close quarters and cities where people are living right on top of each other, it definitely makes it a lot easier for certain diseases to spread, for sure.

It doesn't, I think, necessarily mean that we're going to, you know, that there's going to be something that kills the entire human population. But it's possible. How much do you guys wash your hands? Oh, not enough. I don't. This is horrible, because I'm legitimately

going to become a doctor. So I've been washing my hands. I know, right? Sorry, patients. I do wash my hands a lot more now that I'm doing doctorly clinic things. And I'm always pumping that hand sanitizer. But before the clinical things, I don't know.

You weren't obsessive about it. No. I've never been obsessive about it, which is bad, maybe. But I also kind of, like, every time I would be in the field in Panama, and I would be setting out camera traps or something, and I would have just climbed through mud and trees, and my hands would be filthy.

And I'd be like, well, I guess I forgot any soap again, and I'm going to have to eat the sandwich. And I would just kind of sing to myself like, microbiome. Two questions about that. Number one, when will Purell stop working? And do we go live in bunkers at that point? And number two, there are certain theories of too much sanitation, screws you up,

sets you up for allergies. What is it called in Sweden? The hygiene hypothesis. Yes, the hygiene. So where is the in-between there? I like to think, because this is how I live my life, that the in-between is, if you're, like, picking up your dog's poop, yeah,

you should wash your hands after. Good idea. But if you're just, like, hanging out on the beach and you're in the sand, whatever, dude. There's some microbes. If you're camping, you don't probably have soap. It's fine. It's fine.

But you might have Giardia. Oh, right. Right. You have a water filter. That's what's important. Right. Yeah. I think it's just managing reasonable risks.

It's like, OK, well, when I take public transportation, I know that people are coughing all over poles. And in certain times, in the winter, I'm, like, a little more paranoid. Like, OK, time to wash my hands now. Oh, I just went and taught this class. Definitely going to wash my hands after hearing, you know, 1,300 kids cough all over the place.

Right. But yeah, I think, I mean, and we're also not saying, don't wash your hands. Right. So, right. But you're saying that even as epidemiologists, like, you haven't reached, like, compulsive levels of, like, oh, my gosh, you haven't reached a state of paranoia.

Well, and I think also washing your hands, like, it's a very conscious act. You're saying, OK, my hands are going to be clean now. But we touch our faces so much throughout the day that when our hands are not clean, that we don't think about it. So it's like, our eyes, you know, you can definitely infect yourself

with dirty hands and the eyes. And it's, I mean, and the number of ways that we can get sick is not just because we clean our hands. If someone's on the bus and I, you know, I'm holding onto the railing and then I go home and wash my hands, that doesn't matter if someone coughed directly into my mouth, but we're on the bus.

Lucky you. I know, right? Coughing directly into a stranger's mouth is how I flirt on the bus. OK, so influenza is definitely on their shit list. And this is a poorly phrased question to ask because it kills people. But do either of you have, like, a favorite disease

or any stories of triumph or you're like, wow, this could have really wiped us out, but we figured this shit out. I feel like, I mean, one of the stories that brings me great joy is the smallpox. Just like her eyes when she says it brings me great joy. Just to be clear, it's not smallpox that brings her great joy.

It's the eradication. So please do refrain from getting it twisted. Something to celebrate for sure. Yes. How did we? What was smallpox and how did we get rid of it? Smallpox was a virus, a pox virus, and we got rid of it through vaccination. And this was it's one of the it actually was

the smallpox vaccine was the first vaccine developed. And it was developed in a very unethical way. So this guy named Edward Jenner basically grabbed a like a village boy and James, I can't remember his last name. Dang it. And James Phipps, just in case anyone's taking notes. Edward Jenner had noticed that milkmaids

would get this like version of a pox that was very mild and then they would never get any sort of smallpox. So side note, since the CDC announced the global eradication of smallpox in 1980, it's no wonder that most of us have no idea what this sometimes fatal,

oft called speckled monster looks like. I thought maybe like it looked like zits or something. OK, I just googled it and y'all it's horrific. So imagine raised weeping pustules all clustered together like rush hour subway style. Like your whole body is the texture of an oozing, painful, infectious Nestle's crunch bar. Whole lot of no thank you.

And you know, there's always this like romantic idea of like, oh, a milkmaid's skin is so pure and clean and smooth. Oh, yeah. And it's because I never got smallpox because they were exposing themselves to cowpox. So cowpox, on the other hand, rarely fatal. It looks like some sores usually on the hands and arms, but they resemble bullet hole Halloween makeup.

Seriously, I just looked it up. I may put a side by side on Instagram or Twitter because it's identical. And for some backstory, Dr. Jenner was this young science loving orphan who was taken in by some families and in his teens, he became an apprentice to a surgeon because like back then, I don't know,

being a teen was like middle aged or something was like 13. Yeah, sure. You can cut some people open. You're like over the hill. Now, there are two theories. Either Jenner had heard reports from other local doctors that farmers who had had cowpox never got smallpox. Or there's another kind of more beloved story that as a lad, Dr. Jenner overheard a milkmaid bragging,

saying, I shall never have smallpox for I have had cowpox. I shall never be ugly. So essentially, her milk face brought all the boys to the yard. And so he thought, OK, well, what happens if we inject or if we expose somebody intentionally to cowpox? So he just chose it, you know, a boy who had no ability to say, no, I don't think this is going to be great for me. No, I wonder what that boy's deal was.

So I had to look into this. I was thinking maybe James Phipps, this tiny eight year old human guinea pig, was like the neighborhood rapscallion. Maybe it was just a wicked bratty boy that Jenner pulled aside and stuck with a virus out of spite like poisoning Dennis the menace. But no, little British Jimmy Phipps was simply nearby and available.

He was the son of a poor, landless laborer who tended the Jenner's garden. So the doctor was like, I'll do part in me, man who clips the roses, might I borrow your fine young lad? I'm just going to put a disease on him. Brilliant. Cheers. So then he he gave this poor James Phipps cowpox and this boy recovered.

And so then Edward Jenner was like, OK, that was pretty good. That's a good sign that that's not enough. Let's expose him to smallpox. So then he took smallpox from someone who was infected and gave it basically tried to give it to him and it was a success. And because it came from cowpox or vaca for cow, Dr. Jenner called it a vaccination. So he never really tried to profit off of his vaccines,

which in 2018 I find that very impressive. But he was eventually awarded money from the government for his contributions to science and like saving humanity. And little James Phipps lived quite a long life. I am happy to report. And Dr. Edward Jenner gave him and his wife and his two children a free lease on a cottage, which later went on to become the Edward Jenner Museum. I also found out in researching this that on the property,

there's a small, thatched hut known as the Temple of Vaccinia. And it was originally built to be like Dr. Jenner's man cave for like writing or just chilling or I don't know what. I don't know if they just like smoked opium casually in it. But he actually ended up using it as a place where he would administer vaccinations for free to the poor. And while reading these follow up facts, I totally cried on my keyboard. Vaccination has not always been or has always been a controversial issue, I should say.

At the beginning, people were like, absolutely not. You're going to turn us into cows. This is a this is horrible. What's wrong with you? This is unnatural. Turn us into cows by giving us cowpox. That's like all of the political cartoons around that were like anti vaccination back then, or like people as cows or other animals. Oh, man. It's really.

I mean, but a nice rack of udders would be like kind of hot in the summer. Milk all the time. Yeah, all the time. Butter, I can poo wherever I want. Yes, I love this. I have four stomachs, like bring it on. So people were ethically like, we're not an animal. How dare you put animal things in us?

And then they continue eating milk and cheese. But OK, yeah. And so and what do you think about like moving on to vaccine research? Like that that must be a real big, real big itch in your trap. I don't know what the thing. What do you say when something said not an itch in your trousers? That sounds disgusting. Yeah, is that not it?

Thorn in your side. There you go. OK, there you go. That's got to be a real thorn in your side. Oh, yeah. Two choice story. A real itch in your snake. So it's got to be a real a real pain in the old neck. Yeah, to come up against so much resistance to vaccines.

How do you deal with that? And and like what's the nitty gritty there? I do a lot of screaming into my pillow to deal with it, which helps. Moderately. But no, it is really it's really problematic because you you literally have children in the United States today dying from measles because they were too young to get vaccinated or they are immunocompromised to the can't get vaccinated.

And some kid whose mom listens to Jenny McCarthy didn't vaccinate her kids. And now there's a measles outbreak at Disneyland or whatever. Right. Which happened? Yeah, it happened. I mean, it continues to happen every year. It's like getting worse because the more kids you have not vaccinated, the greater the risk of it is. It's really frustrating. And it's something that actually has been one of the

the best feelings about starting our podcast is when we have people email us to be like, hey, I got my flu shot for the first time ever because of you. And then we just cry tears of joy because that's like kind of what it's all about is like when you look at the vaccination schedules from CDC, they do look intense. And I totally understand like my niece is like not even two years old. And like there's pictures of her after her vaccines. And she's got like a million band-aids and you're like, oh, my poor baby.

And so I get it that it's a lot of vaccines. But it's it's very easy to ignore the fact that these diseases literally killed people for decades for hundreds of years before we came up with these vaccines. And because we aren't faced with those deaths or with paralysis from polio on a daily basis anymore, it's really easy to just ignore it and say, this is my personal right to make a choice and to not vaccinate my children. When reality is you're putting everyone's children at risk of

death by not doing it. So. And what do you think about the risks that seem to keep people up at night, like the risks, the risks of autism or mercury poisoning or setting off some kind of wildfire of an autoimmune response? Yeah. So the autism thing is 100% false. Like there's not even a millionth of a risk there that there was one paper by Andrew. We're not going to mention his name.

He's not worth mentioning Voldemort. Got it. Voldemort. He must not be named who wrote that paper, got like fired from the medical society and had to retract his paper because it was completely falsified. Like it wasn't just that they were like, we don't like your data. It was completely false. So that entire association with autism, which is one of the main things that sort of started this anti-vax movement, at least in the States

and also in the UK, because that's where he was from. That it's it's based on a completely false statement, a false paper that it is not to real 100%. So if you had to debunk some flimflam, that would be this. Yeah, it's the easiest thing to debunk because it's 100% false. There are very small risks of other like adverse reactions. There are certain vaccines that you should not get that you're contraindicated to get if you have certain allergies.

And that's something that you and your doctor should talk about, obviously. But all of the other risks are orders of magnitude less than the risk of dying if you get this like measles or something like that. And all of those like adverse reactions, like if someone cannot have a vaccine for that reason, that's like that's there's something called herd immunity. And so that's fine. And so the small proportion of the population that is not vaccinated, I feel like should be reserved for the people who actually cannot for health reasons,

not for personal choice, not because, oh, I'm scared that my child will have autism because that is not true. Like your child may develop autism or maybe diagnosis autism, but that's not because of the vaccine. And that has been shown for decades now. And so I think that it's sort of debunking some of these things. And I think that our podcast in a way is sort of, I think we have responsibility as just as every disease ecologist, epidemiologist or science communicator

has to to inform and say, OK, let's actually talk about what's going on here. And so by saying we're doing two things by saying, OK, the flu vaccine is actually really important, even though every year there are people who go, oh, well, it's not effective this year. So why do I even get it? And you still get it. They just just get it. Right. But we also, I think in talking about in the ways

that these diseases have impacted people in the past. And, you know, it's I think also bringing awareness to the fact that, yes, a lot of these a lot of these diseases we can talk about within the past tense. But for so many that's only because we are privileged with where we are. And so for so many other people who don't have a back who can't get a vaccine for something like think about what's going on there and be aware that this is still a huge problem. So there have been theories about correlations between autoimmune diseases

where your body's immune system just loses shit and attacks its own tissues like MS and rheumatoid arthritis and lupus and any possible links to vaccine use. But a lot of experts say that it's just as likely, if not more, that wild infections can trigger the body's immune response in people predisposed to autoimmune diseases. So I don't have much for you there. But as soon as I have an immunologist on, I'm going to ask about autoimmune diseases since they run heavily in my family and I'm just very selfishly curious.

OK, let's ask more just super smart, hard hitting and really complicated questions. Do you guys have any favorite movies about diseases? Oh, Contagion. Oh, really? What is it about Contagion versus outbreak versus, I mean, like so many other disease movies like late on me. I so I haven't seen outbreak, OK, which I know I should. I know a gas from the other area. Yeah, I know it's atrocious, but it doesn't matter

because Contagion is I know so much better. OK, so between outbreak and Contagion, two out of two epidemiologists named Aaron prefer the 2011 film Contagion. Which one is Contagion? Contagion is the one with Kate Winslet, my hero. Don't talk to anyone. Don't touch anyone. Stay away from other people. So that movie came out while I was doing my masters and I told my mom,

oh, mom, if you were wondering why I'm doing my masters and why I'm applying to MD PhD programs, watch this movie. This is who I want to be. And after the movie, she was like, oh, and that's just so great. You're going to be the one who saves the day and finds the cure. I'm like, Nabra, I want to be Kate Winslet. See, yeah, be sure. Spoiler redacted, kiddos, because I care. I care.

And she got really upset about it. But that movie is they worked with CDC and they worked with public health professionals and they did such an awesome job of keeping it very true to life. I think it is the scariest movie that you can watch because it's it's so weirdly accurate. It's not perfect. You know, there are science things that aren't absolutely perfect. We actually, in a class that our advisor teaches, he has the kids watch the movie and critique it.

Like what did they what is true to life and what things are not true to life? So that's a fun little exercise into it. Also, it must be noted that Kate Winslet plays an epidemiologist named Aaron. Oh, my God, I forgot that. Get out of town. She's a me, you guys, for real. Oh, my gosh. We need to help us out. I would die. OK. OK, are you listening?

Hi. Is that Aaron? Is that also your favorite? I think it is. I think it is the most unsettling and definitely like after I washed that or after I washed that, see, I'm already I'm already thinking about it. After I watched that, I was washing my hands a lot more because. Yeah, you were like, but it is. I mean, it's really scary. It shows at the very beginning, you see.

Oh, no, it's not even at the beginning. It's a very end where you see how the the virus that has caused this pandemic has jumped from animal to animal to human. And it's just sort of all of it's it's so I just got goosebumps. It's so real. Like it's so that is how it has happened for for SARS, I think, was a very similar series of events in terms of like wildlife to then an outdoor market to the domestic animal to then humans.

And so this like SARS actually was a pretty good shot at it for a while. And then it for for various reasons, it didn't become like a full fledged pandemic, thank goodness. But was that because we controlled it or because it just died out? This is so fun. OK, the reason that I get really excited about the SARS one, but one of the main reasons why SARS didn't become as big of a pandemic as it could have been. And as people were afraid that it would is because we were able to catch it early

and they did a lot of really intense quarantines at airports. But the reason you could quarantine at an airport is because SARS with when you get infected with SARS, you actually begin to show symptoms before you're infectious. Oh, so if you're coughing on a plane like during 2003, SARS outbreak, if you were on a plane from any of the areas where SARS had been a problem and you were coughing, they were going to quarantine you. Oh, well, that worked as a quarantine method because people were not yet infectious with something like influenza.

You're infectious for several days before you show symptoms. So quarantine is much less effective. And what about Ebola? The reason that it became as big as it did was in part because of miscommunication between like World Health Organization and CDC and like people on the ground. It was in part because it made it into a larger city that it didn't usually. Usually Ebola outbreaks happen at sort of more rural areas because that is a disease that tends to happen as what we call spillover.

So from animal populations spilling over into human populations. Bats, right? Bats. In this case, yeah, they they are pretty sure in the big 2014 Ebola outbreak, they traced it back to a kid playing in a tree with a bat. This is sad for the humans and also for the bats. And I hate that because bats are like just getting on the up and up or people like, don't worry about bats, you guys, they're good, they're cool. They got we should save them.

They're really important. Yeah. And they are, but they also are great at diseases. And so many diseases are in bats. I have no idea. I think it's part of it is because they're mammals and they can disperse long distances also that for a lot of bats, there's this communal living. Like it's a lot of bats in one population. Yeah. Yeah.

And so you have the opportunity for something to spread very rapidly. And so with with Ebola, what's the latest on like a vaccine for that? How are we? Let's check in on. Let's knock on Ebola's door and do a little visit. Yeah, yeah. From what I know, there is a vaccine that they tested right towards the end of that outbreak in 2014, and it is effective.

And so I think now they have been using it in current outbreaks that are happening in things. OK, so that's a week. It's easier. Yeah. And the thing is that here in the U.S., there really was never a reason to not sleep easy because since the way that Ebola is transmitted is is through close physical contact with blood or other bodily fluids, you living in Chicago or LA, you're not at risk, right? That's not the disease that's going to become the next pandemic,

just because mostly because of the mode of transmission. OK, so what is the medical community stance on illnesses that some would argue are behavioral or lifestyle influenced, like smoking related lung cancer or obesity or heart disease? Do those fall under the same epidemiological protocol in terms of response to them? Yeah, so I know the CDC, I think just a couple of years ago, actually classified obesity as a disease.

So it's officially classified. I have personal feelings about that. But yeah, because it's I feel like it's not we say we say that certain behaviors are a choice, but I feel like they're so we're we're marketed to in a way that is that is a pathology in and of itself. Exactly. It's so hard to say it's a choice when you're like, oh, there's billions of dollars at making our brains make these choices. Yeah, free. Are we to make these choices?

Like, I don't think that a huge swath of the population would suddenly become obese of their own doing. Right. Exactly. And that's not. Yeah. And that's not sort of how this has come to pass. But it is definitely something that more and more the CDC and public health agencies like state public health agencies are focusing on more. It's it's then therefore very easy to ignore infectious diseases in this country because chronic illnesses and things tend to take the forefront,

which makes sense because those in some ways, because that's sort of the what what costs the most in terms of health care dollars in this country. But yeah, so they I would say most public health professionals do call those things epidemics or pandemics because that's the way that they view them. I'd have a lot of just personal feelings about it. So. But yeah, I mean, I feel like we we talk about pathogens and we talk about viruses, bacteria, you know, parasites and OK, that's that's who that's what we're up against. Yeah.

But with things like heart disease, you know, a pulmonary disease from smoking obesity, the pathogen is like capitalism. Like what do we do exactly what it is, you know, and it's also it's. Well, I just as a as a little side note to bring pathogen to bring microbes into this question of obesity and so on. Right. There is a lot of recent research that suggests that the way our gut microbiome is sure organized might actually contribute to a lot of these things that we consider behavioral epidemics. Exactly.

And so that's I think a really interesting facet that we're only beginning to grasp sort of the enormity of how how the microbes in our gut are actually making our choices for us in some ways. And so there's a really interesting book called Your Brain on Parasites. Side note, full title quote, this is your brain on parasites. How tiny creatures manipulate our behavior and shape society by Kathleen McCullough and call me crazy. Seems like a good beach read.

She deals a lot of this like the question of of being what choices are our own. And so exactly. And so yeah, but but in addition, you know, these. It's a behavioral these chronic disease epidemiology is really difficult to kind of get a grasp of the risk factors for because it's very easy to say, OK, well, this person ate that or this person smoked or X, Y and Z. But assessing those data like getting going out and collecting the surveys. I mean, asking someone what they ate for lunch three days ago. Like, I have no idea what I ate.

Yeah. And so it's just in general, very difficult data to get. But I'm thankful that in our med school, we talk a lot about this. It's also a problem of health literacy, where we have huge health disparities in this country that are a result of wealth disparities and education disparities. And these result in health literacy disparities so that if people if they do have access to a health care provider, they might not actually be getting all the information that they need from that. And if they do get information, it might not be in a language that they can

understand or in terms that they can understand or they might not know what to do with that information. Chronic diseases in general are a very much more complicated in very different ways. Right. Some of the same ways, too, especially in terms of wealth. But anyways, they're complicated. From what I understand, in med school, you have like a four hour course on nutrition. Our nutrition and our gut biome aren't necessarily super addressed in Western No, definitely not. And then we're like, oh, we have this epidemic.

Everyone's own personal fault. And you're like, excuse me, like if you only had four hours on infectious diseases in your entire, you know, in your entire med school, you probably wouldn't be very good at solving that. I don't even think I am actually now remembering that as part of my biochemistry class, we had a nutrition component, but it was this online thing. And I just straight up clicked because I was like, I don't have time for this. I'm trying to write dissertation. I'm trying to do fieldwork, you know.

And so, yeah, it's definitely not. There's a lot of things that I think don't get addressed as well as they could. A lot of the problems that we put on individual people sort of stem from these systemic issues that we have in the country. We wouldn't see we wouldn't see it such a huge spike if there weren't something systemic underneath it. It's weird that in a first world nation that the big sweeping dangers that we're up against are so ingrained.

It's not nature we're fighting against. It's money, which is like, oh, like, yeah, so awful. Oh, man. OK. We have so many Patreon questions and very limited time. But shoot. OK. Shoot. Just one more first. But I do want to ask Lyme disease. What's the deal? Dang it. I was hoping not to get this question.

No. So I so my I am I have to admit that I am not a Lyme disease expert in any way, shape, or form. So I am like a panamottic tropical tick lady and tropical tick lady. And there's like these on. But that being said, Lyme disease. So we've been seeing a lot lately in the news, you know, reports. I get I get forwards from, you know, family members and friends like, oh, I just saw this about ticks and tickborne disease is incredibly on the rise.

Like we've seen doubling of cases over the past couple of decades. And part of that has to do with more reporting. Part of that has to do with the fact that it is actually increasing both in terms of incidents, so the number of cases a year, but also in terms of geography, so where people are actually getting infected. And Lyme disease is one of these where it is spreading and spreading and spreading. And part of what is driving the increase in cases is development, basically. And so by changing the structure of forest, you're changing the animals

that live in the forest. And some air, some animals are better at transmitting Lyme to ticks than other animals. So if you imagine a tiny little baby tick just emerged and it does not have Lyme. So when it is born, it does not have any Lyme disease in it, even if it's mother had Lyme. And it's the size of a poppy seed. It's yes, it's teeny tiny.

Yes, I remember CDC issued like an apology for ruining poppy seed muffins. Dude, this is just absolutely one Twitter for me. So a few months ago, the CDC published this photo to illustrate just how tiny nymph ticks can be by placing a few of them on a poppy seed muffin with a caption, can you spot all five ticks in this photo? Plus a link to learn how to prevent tick bites. This tweet had everything, food porn, a hidden twist. There was science communication outreach, a puzzle and a link to save lives.

But nevertheless, Big Muffin got in the way and as a USA Today headline woefully reported the next day, quote, CDC apologizes for hiding ticks on a poppy seed muffin to warn of Lyme disease threats. The CDC followed up with a tweet, quote, sorry, we ticked some of you off. Oh, I loved it. It was amazing. It was so good. Yeah. Oh, I would constantly in Panama, when I would come across

a tick bomb of larval ticks, I would play freckle or tick like all the time. Wait, tick bomb. Oh, I should have brought pictures. Yes, or a video, actually. Oh, my God. And you do have freckles. Oh, that's a nightmare. So the most ticks that I have ever counted in one over 6,800 ticks in one tick bomb.

So a female tick lays a clutch of eggs after she's fed. And then they all hatch at once, roughly. And then they all do something called questing, which sounds very like, you know, Arthurian legend, but just going to the end of a piece of vegetation where they wait for an unsuspecting host to walk by. And it's a writhing mass of ticks. Oh, God. And so I would I would that's how you collect is you just drag

you drag a piece of cloth through vegetation and you count them. And so I would they would crawl up on the cloth onto my arms or I would just brush up against it when I was doing camera trapping and they'd be all over. So I'm having a full body crunch. I'm so sorry. And I love bugs. Like I love bugs, except for ticks. Ticks are pretty gross.

Ticks and roaches are like, sorry, no, 86. Oh, yeah, roaches for sure. But in but from what I understand, Lyme disease is there's like 300,000 cases a year. So I just looked at a CDC map comparing the rates and distribution of Lyme from 2001 to 2016. And dude, it looks like someone broke a pen near Connecticut and the ink is just steadily hemorrhaging into New England. And the rest of the United States, just for funsies.

I'm just going to just going to mention if you're into conspiracy theories, say you might want to look up Lyme and Plum Island Animal Disease Center, which was a government military testing facility that employed re-homed Nazi doctors to do trials on animal born bio warfare. Now, fun fact, Plum Island sits eight miles off the coast of old Lyme, Connecticut, where Lyme disease was first identified. Now, am I saying that this conspiracy theory is true? No. Am I telling you that it's super interesting?

Yes. Am I a doctor? No. But anyway, 300,000 cases a year of Lyme disease in the United States alone. Now, Dr. Welch, who likely does not believe in conspiracy theories, explains some other reasons why Lyme might be spreading. Yeah. That's a lot. It's a lot. And so this is it's sort of it's one of these things where it's these ticks are now infected, like where the disease is present, like all the ticks are infected.

And yeah. And so it's because we have these suburbia, basically, where we have in these in these areas, we have deer can still live amongst neighborhoods and stuff like that. And so that doesn't really hurt deer populations. Mice can also live amongst these neighborhoods, doesn't hurt mice populations. Mice are really, really good at infecting ticks with Lyme disease. Right. And deer are really good at feeding ticks and making more ticks. And so with a combination of these two things, you just have this explosive boom.

So when we deforest an area, we reduce the number of species around. Right. And then we then get this huge increase in tick-borne disease because we have the hosts that are left that amplify the ticks and amplify the pathogen. So that's part of what's going on. In addition to just this general geographic spread, you know, we could throw in some some climate change up in there and talk about the overwintering survival of a tick. And it's a very, I mean, vector-borne disease is super complicated.

And what about chronic Lyme? Chronic Lyme is a really interesting thing. I think, you know, the the definition or the the treatment with in public health and regarding public Lyme has really changed over the past couple of decades, because it first became if first started out as being this like, oh, it's all in your head. Oh, it's all right. And now it's becoming increasingly apparent that it's actually not in your head. And these are people for whatever reason are having some having symptoms

that last long beyond the active infection stage. And so whether it is something where your body recognizes the Lyme bacterium and then just like and then that that Lyme bacterium is very similar to a cell that you already have in your body and it elicits this huge autoimmune reaction. Right. How much is like how much is like severe autoimmune reactions to some kind of infection? Yeah, you know, it's interesting. And there's other vector-borne diseases that can cause weirdly long lasting like joint pains and things.

If you get infected with something like chicken, guña or dengue chicken, guña, it sounds like a lunch special. Yeah, it's another like vector-borne. It's transmitted by the same mosquitoes that transmit dengue and Zika. And it also invaded like in the same way as Zika did, like started in the Caribbean and then sort of spread to South America. And it just sort of as all these diseases do, they get press and then they fade from the public eye.

But yeah, there's are they fading because the disease is fading? Are they fading because no one cares anymore? A little bit of both, a little bit of both. I think that because so when you talked earlier about the exponential growth of populations, you see the same thing in epidemics. So you have what's called an epidemic curve where when a disease invades a susceptible population, a whole bunch of people get sick really fast. But then you hit some sort of peak and what causes that peak is maybe like

there's no more susceptible people left in the population or something. And so then that disease will decline and it's literally like a hump, like a mountain shape. Right. And that's what's called an epidemic curve. And every single outbreak follows this exact pattern. How big the curve is or how wide it is depends on the disease. And so when you have that waning phase of a disease, it's very easy to just stop talking about it because, well, people aren't getting sick anymore.

It's also, you know, you get funding for a certain amount of time. So it's in the news and then the next news cycle comes around and people stop talking about it. And Chikungunya is hard to pronounce. So people don't talk about it. It really does sound like a curry. I wonder, I wonder how much of it too is like, Oh, well, Zika, Zika was huge. People were like, Oh, no, we're in the U.S.

Can it happen here? And then once that answer slowly could be kind of became no, it became less of an interesting right or like, you know, press hot issue. As soon as pregnant women started being like, Oh, go to Mexico. You know what I mean? Then it was like, yeah, yeah, you came. Are you guys ready for rapid fire? So ready. OK, I'm we're going to blaze through these.

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Sarah Nichelle wants to know, what does it deal with the dancing plague of 1518? Great question. OK. I've looked into it the tiniest bit, and it seems like it's still unclear. But I really want to do that as a future episode. So what happened tuned? It was just a bunch of people started dancing to the point of exhaustion, like they dropped dead from dancing so much.

It sounds like a Buffy the Vampire Slayer episode, because it was fact checked. And yes, this epidemic was said to have inspired the dancing demon of Buffy's musical episode titled Once More with Feeling. Are you serious? Now, what do they think caused this? I don't know. Like, I don't I don't remember what the different hypotheses were in the Wikipedia article that I've glanced through once. Top contenders, famine-induced psychological distress

and or possible wheat fungus. More on that in a minute. Oh, my God. It sounds like just Chardonnay at a wedding disease. Might have been. Open Bar a wedding is, a.k.a. a dancing plague. OK, Greg, Hannah Silverman, Alison Bray and Brittany Bell all asked, essentially, as global warming continues to expose more and more diseases

and we generally work to destroy ourselves through our own short-sightedness. Are we as humans destined for a sudden massive population crash? And like, essentially, how is climate change affecting things like mosquitoes, vector-borne diseases? Like, how is climate change affecting epidemics and how much are we going to die? Yeah, that's a good question. It's definitely the one thing that people can say for sure is that climate change is going to affect infectious disease, whether that means it's going to change

the distribution of diseases or whether that's so meaning that diseases will happen in places that they didn't happen before or whether it means that you're going to have more diseases than we had before. It's a little bit hard to say at this point. OK, it's still sort of a crapshoot and it's who you talk to and also where you live. So it could be that as climates warm in more temperate regions and it's warmer for longer, yeah, maybe diseases might shift, but then that also might mean that in some areas it becomes too hot for certain diseases, like in some areas

of the tropics, right, perhaps, it definitely can shift the placement of vectors. So you might have mosquitoes moving into new areas or ticks wintering better or like their populations lasting longer. You actually study climate. I don't know. Well, I think no, I think that you you answered it perfectly. I think the other thing, though, is that climate change. Yes, will impact disease, infectious diseases and the direction and the

strength, etc., is always very dependent upon where you are, what disease you're talking about. But I also think that having studied climate change and tick-borne disease, that the way that climate change is actually going to probably impact humanity is not as much through vector-borne disease as it is through, you know, actually like farming and crops and just famine worldwide. I think that those are the more pressing of water, water availability. I mean, water is clean water is not accessible for so many people now.

It's only going to get worse and worse and worse. And so it's diseases is not the least of our problems, but it is, I think, trumped by a couple of other big, big names, trumped by big names. So, you know, don't worry about diseases that much because other problems are probably going to get us first. And while that seems very depressing, if you've listened to the show before, you know, I always like to reflect on mortality or the upcoming apocalypse as an excuse today to say, fuck it, text your crush, cut bangs,

eat a quesadilla, we're all going to die. Anna Thompson wants to know where the Salem Witch Trial is a mass delusion brought on by Ergo Ergot. I can't remember. I know it's a wheat rust, but I can't remember how it's pronounced. So as promised, more on this. This is a grain fungus that contains all kinds of toxic alkaloids and in some cases precursors to LSD.

So symptoms of contamination can include muscle spasms, fever and hallucinations, mania, feeling dazed. You can have tremors, distorted perceptions, according to Wikipedia. Now, in terms of its pronunciation, I found out it's. This is a Ergot fungus. So Ergot or claviceps, if you're nasty. And I learned this because I accidentally watched way too much of a YouTube video by a guy called Basic Survival.

And it's just the visual image of his hand palming an infected blade of grass as his very, very oddly sensual, like beyond ASMR voice, just drones for an astounding six minutes about the history of Ergot fungus. I feel like I just, I need to know his life story. And I'm sorry, I just have to play you like 10 more seconds because it's just so bizarrely soothing. It destroys the nerves underneath the skin there and it also bothers the capillaries and causes intense burning feeling and big bad sores crop up

and it'll even destroy your brain. Anyway, grain fungus. Just making people silly since witch burning times. I have heard that before. I've also heard that. So there's this, there's this new Netflix movie called Brain on Fire based on a book by a journalist who I can't remember with the name of the.

She had encephalitis, right? Yes. And so they don't know the exact source of what it was, but that's another hypothesis is that some of these like witch trials were based on people who had this encephalitis that caused them to have these psychotic like delusions and be basically labeled as like a psychotic person instead of, okay, well, let's actually find out what's going on. Especially in children, there's that there's pandas,

which is a brain encephalitis caused by strep that is children are susceptible to which can cause like immediate behavioral changes, right? I wonder if there was something like a strep outbreak. I think it was just fragile masculinity, but. Quite possibly just a pandemic fear of witches. Exactly. Aki wants to know, is antibiotic resistance a critical issue? Heck yes.

Oh, I can say hell. Hell yes. Like you can say fuck yes. We don't cuss on our podcast. So this is new with the microphone. Fuck yes. It's a huge problem. Oh my God.

It is it is one of the scariest problems for sure. Like antibiotic resistant strep in or staff in hospitals is massively huge. Antibiotic resistant. My dad got sepsis from antibiotic resistant UTI infection. It was awful. Antibiotic resistant tuberculosis is terrifying. XDR TB. That's what they call it.

And what about MRSA? MRSA exactly. That's staphococcus aureus. And so now the the fix to that is stop taking antibiotics when you have viruses. Yeah. So there's definitely like the doctors shouldn't be prescribing antibiotics for things that they don't know are bacterial, but a large part of the problem too is like the agricultural industry and they're they use antibiotics profil, profilactically.

So we're just going to give all of our cows antibiotics so they don't get sick. And so prophylactic antibiotic use is a huge issue. Oh wow. That is help driving it. So it's not it's kind of the same thing when you talk about like how can we solve climate change or stop putting trash everywhere? Like yes, we have personal responsibilities, but there's also this systemic responsibility that is not being addressed as much.

Right. So on the personal side of things, if you are prescribed an antibiotic for something, take the entire course of it. Right. Don't save a few pills for your own case. Next time I have a sore throat. Don't do that. Don't do that.

People will do that all the time. Don't do that. Take every single pill because that what that does is that basically when you take, let's say three quarters of your antibiotics, you're going to kill. This is very basic, but three quarters of the bacteria in your body and your your your body will probably fight off the rest of it. But those or or it might just be selecting the ones that are resistant. Strongest ones are like oh yeah.

Oh my god. It's like the people who are left at your party at like two in the morning. They're the worst people. You're like go home. Go home. Yeah, exactly. How? She should have left forever ago.

Yeah. Yeah. So okay, so keep kicking them out. It's funny in our healthcare system is such a beautiful thing that I have friends who are like actors who don't have health insurance who are like oh if I get strepsord, I just order fish antibiotics online and you're like oh America. Wow. They're like yeah you just use them in fish tanks, but you can also take them for stretch.

Like yes, people do that. Like there are whole reddit subreddit like subreddits about like. This is such a good learning experience. Like veterinary antibiotics that you can get for your dogs and cats that are cheaper. Buy them online. Yep. And don't do it. Wow.

Okay. John Worcester and Stephanie Hancock both wanted to know is there any cure for the Lone Star tick bite that makes you allergic to meat? And do you think there's a possibility that the Lone Star tick is evolution's way of helping with global warming by moving us to a red meat reduced society? That's a fun thing to think about, but it's that's just not how evolution works. But you can answer this tick one. I actually do love every time it's always brought up as like oh every time that

someone says oh the red meat allergy from Lone Star tick they're like maybe that's a good and I'm like well yeah it's kind of a good thing. I mean it could be a good thing. Yeah. The almost dying part and not a good not a plus. I have I have some anecdotal evidence not not personally but so what it seems that the strength of the allergy varies depending on who you are and it might depend on what tick bit you.

But some people it seems to be last decades or even a lifetime and anytime they re-expose themselves to red meat it's a really bad reaction like anaphylaxis etc. On the other hand I have known people because there seems to be an outbreaks like a high frequency of cases in Panama for some reason where we worked like I had a lot of friends who would be like yeah now I have this red meat allergy what do I do which is really strange so it's on every continent except for Antarctica I think it first popped up in Australia. Anyway some of these people would come back to me and say yeah actually I've tried out different meats and I tried out different kinds of meats like okay so a steak still a no go

pepperoni yeah that's actually okay if I eat it weird and then another person said I tried lamb I tried you know veal I tried deer and a few years after they had first gotten the allergy it kind of just went away. Okay so as far as I know there's no treatment for it but I think it is just really depends on who you are. I just looked this up on some health sites and even they were like I don't know man benadryl epinephrine fucking sucks dude there's always chicken I guess cut to chickens in a lab engineering the next tick-borne pathogens.

Last questions what about your job sucks so bad what is the worst thing about your job? Dr. Alman Updike started off I guess our jobs right now are grad school so I just finished half of my grad school but I still have three more years left and I think the worst part for me is how small academia can feel so it's like am I glad I did it mostly yeah it's done now but you're also shaking it up by doing your own psychom which is kind of cool right yeah doing it your way yeah which is neat Aaron what about you I think I mean I think my answer is probably going to be fairly similar the culture of academia that the fact that we're doing so we're doing disease ecology work we're doing work that can be applied to public

health that can be applied to wildlife conservation but it doesn't feel that way and it also feels very frustrating to kind of sort of like I'm just I look around and I think we're disease ecologists why aren't we actually helping people like why it feels like that the the data that I'm collecting the results that I'm writing up are just going to sit in an academic journal where they're going to be accessed by people who have subscriptions who have the privilege to be able to read these journals and that's it and that feels so disappointing and it feels so unfulfilling in so many ways because it is more than that like the reason that I am interested in doing this research is so that I can actually help people like we're we're the world is on fire

around us and we're just kind of like dawdling like oh but you know this p-value isn't quite significant so I don't know I guess I can't publish this like that feels it feels so we get to in our own heads it's funny that your work deals with assassin bugs tick bombs like probably not the best toilets and you're like the worst thing is the culture of academia like that says a lot that the needs there needs to maybe some change there culturally if you're like the 6000 ticks on my body is not the worst thing about my life no yeah it's like it's it while you're slogging through it you're like this day is the worst but like realistically it's fun those are the funnest times of grad school is doing fieldwork and and being miserable while

you're doing fieldwork but also having fun what is the best thing about epidemiology or your work or what are you looking forward to the most in your career I think for me the best thing about I would say the best thing about grad school in general and when I am able to take a step back and look at it from this perspective it makes things a lot better is that I have for the last five actually seven years I get paid to learn yeah which is so cool and like what an awesome opportunity and and I love the things that I'm learning and I I do love the program that I'm in and I'm so happy that even though I have three years left and I'm gonna be in champagne which isn't like the most exciting town I'm champagne problems though yeah right I am but it's I'm

thrilled about the next three years of doing more clinical work and being able to actually like do things with everything that I've learned but getting being able to be paid to learn cool stuff is awesome it's legit yeah pretty pretty dope it's pretty great what about you aren't I mean honestly I think my favorite thing is the field work which was horrible at times but also I got to basically spend years in Panama being outside collecting data and then being able to like analyze those data and say okay but what actually is going on here so the excitement of finding out the answer to your problem or the answer to your questions is really thrilling and also sort of the satisfaction which sounds very selfish of being like oh you know what this

can actually help people I just have to make that leap to do it but it is I mean I do there were so many times when I would be in Panama and I would look around and I would say I can't believe that this is my life yeah I get to do this why didn't anyone tell me this when I was a kid that I could actually have a life like this well I'm glad you guys are doing it thanks for fixing the world I'm such a big fan thank you guys so much for being on and I hope I never catch any of these diseases me too yay thank you guys so ask smart doctors stupid questions because without them we'd all just be festering skin bags full of bacteria jk we are already that and it's fine but that's a topic for a microbiologist now to find out more about the doctors Aaron check out this podcast

will kill you wherever you get podcasts they are this podcast will kill you on instagram and tpwky on twitter we are oligies on twitter and instagram and i'm ali ward with one l on both so do follow along now the oligies podcast group is just a a wonderful collection of very cool curious humans on facebook and thank you to hannah lipo and erin talbert for moderating that group which contains at present count zero assholes you can cover your body in oligies merch at oligiesmerch.com and you can find my merch queens shannon feltas and bonnie dutch tagged on the oligies instagram you can follow them because they make very pretty pictures they're both artists and they're wonderful uh nick thorvern wrote and performed the music and big big thanks as always

to steven remorris for editing this all together and for pulling last week's all nighter to get sharks up in time for shark week steven you are a glimmering treasure from the sea so if you listen to the end of the episode you know i tell secret and this week's secret is more of a life hack i'm trying to use to help myself have like some life work balance it's called time blocking it's where you say okay from this time to this time i answer emails from this time this time all right from this time this time i'll eat so far my secret is it's helped me get this episode turned around two days faster so boom there you go you're welcome we're gonna see if this sticks i don't know check in next week i'll let you know if i'm still doing it but so far this week so far so good okay

go cut those bangs and wash your hands baby hack a dermatology homeology cryptozoology litology meteorology i got to see it