This Podcast Will Kill You - COVID-19 Chapter 7: Spillover

Episode Date: April 6, 2020

Coming at ya with our seventh episode in our Anatomy of a Pandemic series on the ongoing COVID-19 situation. So far in the series, we’ve discussed aspects of the virus’s biology, clinical disease, epidemiology, and control efforts. We’ve briefly touched on aspects of the virus’s ecology, including its origins, but we wanted to take a step back and ask, “how do spillover events happen and how do we stop them?” To answer those questions (and many more), we brought on Dr. Jonna Mazet, Professor of Epidemiology and Disease Ecology at the UC Davis School of Veterinary Medicine and Executive Director of the UC Davis One Health Institute, who has spent much of her professional life on the hunt for emerging pathogens (interview recorded April 2, 2020). We pick Dr. Mazet’s brain on how we look for and identify pathogens of possible public health concern, what work disease ecologists are currently doing on SARS-CoV-2, and what we can expect to see in terms of future spillover events. We wrap up the episode by discussing the top five things we learned from our expert. To help you get a better idea of the topics covered in this episode, we have listed the questions below: Can you take us through a step-by-step of how surveillance of novel pathogens is done? From the logistics of international coordination to the sampling to the reporting - what does that look like? What happens when you do identify a potential spillover event? Can you talk about how you decide what a hotspot is? What makes a hotspot a hotspot basically? We've talked a lot on this podcast about spillover events, and obviously they can happen in many different ways, but can you give us a general overview of how one occurs? What are some patterns we see with all spillover events? Over the past 100, 200 years, land use change has increased and the barrier between humans and wildlife has decreased - have we seen a corresponding increase in spillover events during that time? What do we know at this point about how SARS-CoV-2 spilled over into humans? I assume eventually we will get a clearer picture of how that spillover event occurred. How can we use that information in the future? Can you talk about what it means for a pathogen to "jump species"? Do viruses more easily "jump species" compared to bacteria, or is it just that we hear more about the viruses? I'd like to talk about what happens when prevention has to shift to control. What are the first steps taken for disease ecologists studying this outbreak? How is the One Health approach being used to study and slow down the current COVID-19 pandemic? What role do we see wildlife conservation playing in spillover events or preventing them? Can you talk about how there can be a conflict in wildlife conservation for the greater good when people are also just trying to feed their families? How do you determine whether something easily moves between species? Is that a genomic question or is it an experimental question?  What do you think are some of the biggest barriers or challenges in identifying these spillover events in the future? The One Health approach is such a great example of interdisciplinary collaboration. Can you talk about what some of the different fields are that work in One Health? What positive changes do you hope to see come out of this pandemic? Follow Dr. Jonna Mazet (@JonnaMazet), the PREDICT project (@PREDICTproject), and the Global Virome Project (@GlobalVirome). Or check out their websites: One Health Institute (https://ohi.vetmed.ucdavis.edu/), PREDICT (http://data.predict.global/), Global Virome Project (www.globalviromeproject.org).The firsthand account was taken from a piece by Craig Spencer, MD written for the Washington Post titled, “How long will we doctors last?” See omnystudio.com/listener for privacy information.

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Janice Torres here. And I'm Austin Hankwitz. We host the podcast, Mind the Business, Small Business Success Stories, produced by Ruby Studio, in partnership with Intuit QuickBooks. We're back for season four to talk to some incredible small business owners. The big thing about working at tech is that is ever evolving, ever changing. everyone's a rookie. That's how fast the industry is changing. So what I'm really excited about is to be part of that change. So listen on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. There are tents outside our hospitals. Every time I see them, I stop, startled. Their drab and dirty flaps seem so out of place against the grand facades of world-class hospitals. Desperate times, desperate measures.

The last time I worked in a tent was West Africa in 2014 during the Ebola outbreak. In those same tents, I saw too much pain, loneliness, and death, people dying alone. I never thought I'd have to see or experience that ever again. I never wanted to. Once was painful enough. There's no way to describe what we're seeing. Our new reality is unreal. The people and places we've known so long and so well have been transformed. Our ERs, our ICUs. Everything looks, sounds, and feels different. Just one week, and it's a whole different world. The patients I normally see are nowhere to be found. Every single patient I see has COVID-19.

Every single patient. Working in the ER means walking through a corridor of coughing, each a slightly different pitch and different frequency, but all caused by the same exact thing. It's not just the volume of patients that's hitting us. It's the severity. Respiratory arrest. Respiratory arrest.

Respiratory arrest. Each takes six to eight professionals, nurses, respiratory techs, ER docs, anesthesiologists. Each takes an hour or more, back to back, all shift long. And it's not just the unrelenting severity. We're being asked to do things we've never done before. Run a code as your goggles fog and you can't decipher the vital signs on the monitor. Try to predict which COVID patient will crash if you send them home and which won't. Talk to palliative care.

Talk to family members. long discussions about likely outcomes. Listen as family members sob. They can't be here when they ask to withdraw care. We face time so they can say goodbye. We stop the drips. Turn off the ventilator and wait. Your hands upon theirs. You think of their family at home, sobbing. Someone starts saying a prayer. You can't help but cry. This isn't what we do. You stand by. You wait. This isn't what we do. You stand by, you wait. Time of death, 7.19 p.m. I know what my colleagues are feeling.

I see it on their faces. We are exhausted. Hours in goggles, gowns, and masks feel like days, but we're only at the beginning. The mental exhaustion is only starting to set in. The things we do, the things we see. This isn't what we do. I worry about my colleagues.

Every day someone calls me crying. How long will they hold? How long will I hold? I remember how this anxiety nod at me every day in Guinea during Ebola. Would today be the day I got infected? Won't know for a week. The days add up. The worry adds up.

I've never seen my colleagues so afraid, so unsettled. But I've also never seen them all work so well together. I've never seen us more unified, more focused, more sincere. Yes, we worry about PPE. Yes, we worry about lack of medications. Yes, we worry about one another. But I've never seen so much sense of purpose, so much honor to do this job. We didn't sign up for this, but we will show up for this every day. I think of this when I finally get home, clothes in a bag, hot shower, look in the mirror, indentations of goggles still deep in my face blisters on the bridge of my nose. How long will we hold?

Yeah. So that was, how long will we doctors last by Craig Spencer, published in the Washington Post on April 3rd of this year. Craig Spencer is the director of global health in emergency medicine at New York Presbyterian Columbia University Medical Center. He also, if you want to read this and more from him. He has another really nice thread on his Twitter account, describing what day-to-day life has been like for an ER doctor during this pandemic. That's, yeah, it's incredible and so difficult to imagine. Yeah. It's, it's horrific, Aaron. Yeah. Yep. Well, hi. I'm Aaron Welsh. And I'm Aaron Allman Updike. And this is, this podcast will kill you. kill you. Yeah. So this episode is a continuation of our anatomy of a pandemic series, which is our

series on COVID-19. In each of these episodes, we address different aspects of the pandemic with the help of experts in the field because, hey, we're not experts. We're not experts. Our first six episodes covered things like from the virus's biology to clinical disease, from control efforts to mental health coping strategies. As you might be able to guess from the title of this episode, we're going to talk today about how spillover events happen and why. We'll talk about what we currently know about where SARS-CoV-2 came from and how we can use this pandemic to be better prepared to stop another. We were fortunate enough to speak with Dr. Johna Mazette, an incredible disease ecologist

whose specialty lies in identifying emerging pathogens of public health concern. But before we get to that, we do have a couple of pieces of business to go over. First, let's talk first-hand accounts. Yes. So we are working on more episodes of this series covering things like how the pandemic has impacted the economy or education or marginalized populations, as well as update episodes on topics we've already covered. And for these update episodes, we want to hear from you. We want to hear how this pandemic has affected.

your life, your job, your family, your friends, etc. If you are willing to share your story with us for inclusion as a possible firsthand account in one of these episodes, please go to our website, This Podcast Will Kill You.com, and click on COVID-19 firsthand at the top of the page, and then that'll take you to a form that you can fill out, and then we can get back to you with more details. Real quick, another thing we wanted to say about first-hand accounts, it's kind of like what everyone says in their Twitter bio, retweets are not endorsements. There are so many people that are having so many different experiences and different perspectives during this pandemic. One of our goals with presenting these firsthand accounts is to show just how huge the diversity is in how this pandemic

is affecting people. So we hope that by hearing these stories, it's a way for us all to increase our understanding and empathy during these horrible, stressful times. We recognize that no single experience is going to be universal. So yeah. Yeah, exactly. Okay, another piece of business, alcohol-free episodes. So a little bit ago, we posted on our social media about alcohol-free episodes now being available. And so let me tell you what these are. So some educators reached out to us to ask whether there were versions of episodes that didn't contain the quarantini talk. And if there weren't, whether they could actually edit those portions out themselves for use in the classroom.

And so instead of having a bunch of people doing the same obnoxious work over and over again, editing out the quarantini talk, we thought, you know what, it's going to be easier to have them all in one place available for whoever wants to use it for whatever reason. And so what we did is we edited out all the quarantini talks from our past episodes and put these, quote, alcohol-free episodes in a playlist on a page on our website called Alcohol-Free Episodes, which you can find under the episode tab. Our regular episodes, like the one that you're currently listening to, even though this is a little irregular for a regular episode, that you get from your normal podcast sources,

we will still have quarantinis and placebo-beritas. so you don't need to worry about losing those. These edited versions of our episodes is just an attempt for us to be more inclusive and accessible because we recognize that a lot of teachers could get in trouble for sharing a podcast with their students that has a good amount of alcohol talk. And also maybe people who are in recovery or just don't want to listen to might find it difficult to listen to. This isn't about censorship or being sheltered or anything like that.

And there's definitely no need for some of the harsh words that we've seen on social media about this. No, please, guys. Let's just be kind. Be kind, especially during this time. We all need it, right? We do. We do. And as we said, you do not need to worry that we're going to stop doing quarantine

recipes because we're going to every single episode. And we're about to in this one. So nothing is changing about the podcast. We're just providing an additional resource for people who want to use it. And frankly, we're flattered that some educators want to use. our podcast in their classroom. Like, that's thrilling. Yes, it really is.

So if you do not wish to hear quarantini talk, you can find the edited quarantini-free versions under the episodes tab of our website. And there's also a disclaimer there at the top of that page that says that there might still be some references to alcohol throughout the episodes that we just haven't found. And so if you find one of those and you want us to remove it, Please send us the timestamp and the context of the mention.

And if you do wish to hear Quarantini talk, just keep listening. Because it's Quarantini time. It's Quarantini time. What are we drinking this time? This time we are drinking Quarantini 7. Such a classic name. It is. One for the ages.

Quarantine 7 has rum, orange liqueur, lemon juice, and cinnamon simple syrup. Demerara simple syrup also works pretty well, too. Fabulous. As always, we'll post the recipe for this quarantini and the non-alcoholic placebo-rida on all of our social media pages and on our website. I wanted to say that very clearly. Glad you enunciated that one that time. Okay, now that's out of the way, let's go over a few things before we dive into the interview with Dr. Mizzette. First of all, masks. Oh, gosh. If you've been following the news at all, you may have seen that the CDC has now recommended people wear masks under certain circumstances. So let's talk about that decision. In an earlier episode of this series, we went into masks a little bit,

and we had repeated the CDC's previous recommendations for masks and why those recommendations were made. A quick recap. So previously, wearing a mask was not a mask was not a advised for those who were not sick, and there were a number of reasons stated for this. One, maybe the most important one, masks are in very short supply and should be reserved for healthcare workers who are battling with this virus on a daily basis. Number two, most masks, especially those that are the most effective, require proper fitting in order to work. Number three, masks can lead to you touching your face more to adjust them or pull them down

or to the side, and if that mask has viral particles on it, that's an easy way to become infected yourself, or if you're already infected, you can easily contaminate your hands and then other surfaces that you touch after adjusting your mask. And number four, it can in some cases maybe give people a false sense of security and lead to less handwashing or physical distancing. So as of April 3rd of this year, the CDC. is now recommending that people wear masks in certain situations. So kind of more broadly is now their recommendation. So the question is why is that? What has changed? Quite honestly, great question. According to the CDC website, it's because we know that a good chunk of people,

we don't know exactly how many, but a good chunk of people can be infected with the virus, not show any symptoms but still be able to transmit the virus, asymptomatic transmission. Anyone who's listened to this podcast has known that for quite some time, right? We've talked about that. Yeah. There's also evidence that people can transmit the virus before they start showing symptoms, even if they do eventually become symptomatic. And of course, if you have a mild infection, you can still transmit the virus.

So none of this is new, brand new information discovered in the past week. No, not at all. So these things, asymptomatic transmission, infectious before showing symptoms, we've known about these things, or at least highly suspected them for a while. And we meaning like the broader scientific community, not just like Aaron and Aaron. Aaron and Aaron, no, all the deets. No, we don't. We're not experts, so we need to say it again. So, but why has this recommendation changed now?

And we don't know exactly because we're not in the room where these policy changes are being discussed and where these decisions are made. If anyone who's in those rooms wants to come on the podcast and talk to us about it, we would love to hear from you. Because this is also a very interesting, like these are difficult things coming up with these policies and recommendations. So it would be fascinating to get to talk to somebody who actually does that. We don't do that. No, no, we don't do that. Nope. So let's talk about what these new recommendations are exactly.

On the CDC website, as of April 4th, this is what it says. The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain, for example, grocery stores, pharmacies, especially in areas of significant community-based transmission. It is critical to emphasize that maintaining six feet social distancing remains important to slowing the spread of the virus. CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.

The cloth face coverings recommended are not surgical masks or N95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders as recommended by current CDC guidance. End quote. So they're basically saying wear a mask if you absolutely have to go out to help prevent transmitting this virus to other people. But masks are no replacement for staying at home. Also washing your hands and never touching your mask with dirty hands. Does that make sense?

And also washing your hands after touching your mask. Yes. Just washing your hands every time. Your hands go anywhere near your face for sure. Okay. Okay. But this is an ongoing thing, and so there's going to be more information, and we'd love to do a deeper dive into it with someone who is working first hand on this. Knows more than we do.

Yeah. Yeah. Yeah. All right. Are we ready to talk about spillover events? Oh, I sure am. Okay. I think the listeners of this podcast maybe don't need a whole lot of setup for this particular topic.

Because if you've listened to us before, you've heard. us talk about spillover events and what they are in disease ecology and what that is. So let's get right to it. Right after this short break. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook, dish by Blue Apron meals are fully prepared. Just heat them in the oven or microwave,

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I'm John Mazzette. I'm a professor of epidemiology and disease ecology at the University of California, Davis in the veterinary school, and the University of California, San Francisco, in the medical school. And I'm the executive director of the UC Davis One Health Institute. There, I use One Health in everything I do and that our big team does. And what that means is we're looking at interconnect. among human, animal plant, and environmental help and bringing together multidisciplinary

teams to work on those really complex problems like this COVID-19 situation. I've been the principal investigator for the Predict Project that's been working in 35 countries all over the world to identify dangerous, potentially pathogenic viruses that could spill over from animals into people and build the systems that are needed to be able to respond quickly and be ready for just the scenario that we have. And I've been doing that for 10 years, leading that team. And we detected and discovered 160 novel coronaviruses through Predict when just a handful were known. And as importantly, we learned about their hosts and the interfaces. And more importantly, I think we trained about 6,800 people in this approach so that the world can be better.

I just wish more of them were here. Now I'm the director of the One Health Workforce Next Generation, which is the logical follow-on from predict, meaning that we want this trained workforce to be expanded in the most likely hotspots for spillover so that academics all over the world can be training people to be the workforce for hopefully to prevent anything like this ever happening again. And finally, I'm also on the board of the directors of the new Global Virome Project, which really grew out of the Predict Project, provided the proof of concept that we don't need to wait for the next epidemic

or tragically pandemic. We can get in front of the curve, in front of the wave. We can't understand viruses and know where they are sort of lurking and available to spill over into people. We can know what they are. We can know how to detect them. We can know how to prevent our own risky behaviors that put us in harm's way. Awesome.

So many different things that you're working on. Yeah, sorry. No, don't apologize. It's amazing. Wow. That's incredible. And it sounds like, I mean, some of these things sound like really fascinating. And, you know, you mentioned predict and you mentioned doing surveillance for emerging pathogens.

And so can you take us through sort of a step by step of how that's done? Because there's like logistics involved with these working across international borders. And then there's the people in the field doing the sampling to then how do you group all of this information together and then disperse it to the people that need it? How does that work? Yeah, there's a lot of minutia and not sexy work involved there. And a lot of it also qualifies for being highlighted on dirty jobs. We swab a lot of butts, hand throats and noses. So I can take you through it. But the way that we begin is we begin with math. We begin with looking at the best science and pulling it together mathematically to identify hotspots that might.

be the places most likely for spillover to occur. And once we identify those countries, if they overlap with our funders for the Predict Project, USAID or U.S. Agency for International Development, where they want and can work, then we can approach the governments in those countries and ask if they'd like to participate. And the Predict Project was the first time I'd ever started an international effort where every single government that we talked to said absolutely, yes, this is critically important. We want to get in front of this. It's not, we don't have the resources to do this, but we've loved to partner.

So that was really refreshing. So we immediately had a collaborative process. But we, in those initial government meetings, we brought together the ministries of environment, health, and agriculture where the veterinary sector, usually. lives so that we could apply the one health approach in those countries to really identify on the ground the best hotspots to target our work and then really get out there and collaboratively look at it from the animal side, the environmental side, as well as the human side. So we brought those teams together. I can talk to you more if you like about how that went, but once we

found those those hotspots to investigate, then we needed to train for. folks to be really safe, biosafety and biosecurity, number one, even including how to pack and ship samples. And before anybody could go out in the field, they needed to have ethical clearances for working with people and animals so that we knew that we could conduct the work in the most appropriate way. Then you have to get with the communities, because most communities, if you show up in white suits, even my house, if someone showed up in my front yard in a white suit trying to sample the birds in my yard or in some of the communities where we work, their food in the market, that would be horrifying to anyone.

So we work with the communities and talk to them about what we're going to do, have them help us target exactly what kind of high-risk interfaces they're seeing in their areas. And they become the really great informational partner and operational partners for us. Finally, then you can do the more sexy stuff, the stuff people like to film on the Discovery Channel of sampling the bats, sampling the non-human primates, and getting sort of down into the mud, getting with the rodents and the shrews in people's houses, and trying to find the virus safely. Those samples then have to go to the laboratory, and we had to strengthen the capabilities for molecular virology in almost every place we work.

because we were working in the least resource countries of the world most times. And most of them did not have the technology. They had the will to do this work, especially for wildlife. They didn't have places to do the wildlife virology. So we had to help build that up. And our teams at Davis and Columbia University were amazing in coming up with a low-cost platform to really discover many, many. you know, more than 1,000 viruses.

So once you get that done and you get in the lab and you safely do that, then you have to figure out what you do with that information. And there's two important things. One, it needs to get back to those governments and all of those across the platforms, those different ministries so that they can take action or at least have that information in their repository so that they know what to look for when something strange happens. And you have to get that information. back into the hands of people like me, people like our team at EcoHealth Alliance, the mathematical

modeling to really help inform on what should be done from a public health perspective globally and to figure out how to better target surveillance going forward. So it's kind of circular and we do it better iteratively over time. Gotcha. Yeah, it sounds like a huge effort in just coordinating everyone's movements and activities and, you know, permits and all of that. Yeah, yeah. That's amazing. And so, you know, hypothetically, let's say that you do, or clearly you have found pathogens that have been a potential concern for public health safety.

And so what happens when you do identify, let's say, a potential spillover event? What happens in that case? Well, I mean, there are multiple scenarios. in the Predict project, we assisted governments with 45, now 46, unfortunately, counting this one, outbreak investigations, many of which stayed really small, I think, testament to being prepared, some of which, like this one, the project was actually finished in the countries where we were working at that time, we're reactivated now, thankfully, but those teams reactivated and helped identify the first cases of,

SARS-CoV-2 coming into their countries using the Pridic platform as well. But, you know, when we do have a very concerning finding, we, again, have to be very careful. We go to the ministries, and these viruses, we consider them sovereign to their property of their sovereign nation. So we always bring it back to the governments first and talk to them about how to release the information to the public. But certainly we write publications and we've gotten into a very interesting ethical dilemma sometimes about whether or not we should talk to the communities at risk or get our paper out. I think most all of us on the team feel like it's the right thing to do to put information out even if it's not published.

Now that's becoming more commonplace with preprints and with this current, again, COVID-19 situation. we're seeing that becoming more the norm, which I think is fantastic. Public Health should be first and foremost on all of our minds. And so that's a positive change that's coming out of this horrible tragedy, and I think there will be others. But yeah, we inform the ministry. I can give you an example. We identified a novel Ebola virus when we were working in Sierra Leone,

and we found it in bats that were living in people's homes. There aren't that many Ebola viruses in the world, so we were immediately concerned about that. And we took that to the government, and we worked with them to develop an outreach platform, even developed a illustrated, guided book that could go out with the narrator's picture book to all of the communities where we were working to start to give them the information, but also the tools and the skills to be able to protect themselves in the communities. And then press releases and papers and all of those other things come as well. But first and foremost, it's about letting the governments know so that they can prepare their plan and then working with the communities so they can protect themselves.

Gotcha. That makes sense, yeah. So you talked about identifying hotspots where emerging infectious diseases or spillover events are more likely to occur. Can you talk about how you decide what a hot spot is and whether, you know, sort of what makes a hotspot a hotspot, basically? Okay. Yeah, so hotspots for us, you know, involve, you know, a map with colors and of course the hotter, the spot, the redder, the place on the map. But what's, what are the underpinnings of that map? So we've done a lot of research throughout, well, many of us before PREDIC started, but throughout the the decade of predict to really figure that out and improve those models is kind of what I was

saying about bringing that data back into the models. And the things that make a hotspot, a hotspot so far are places where there's wildlife. So biodiversity is critical. Places where people are interacting with that wildlife. And so we call those high risk interfaces. So we identify those high risk interfaces. Those often come together where human population growth is high, biodiversity is high, and landscape change is high or evolving. So in the more pristine areas, we often have a little bit lower risk in the more urban areas. We have high risk for amplification and spread, but a little bit lower risk for spillover. It's kind of those intermediate areas where things are changing.

You're chopping down forests to make farmland. those kinds of areas where we really see the systems of the animals and the people being stressed and the ecosystems being stressed. And that makes for a perfect recipe for spillover. Yeah, that makes sense. So on the podcast, we've talked a lot about spillover events in general, but could you kind of give us like a step by step and maybe whether there are any patterns that we can see in all spillover events? Sure. Well, I'm, I'm sure your listeners are quite a bit better verse now about the human food value chain, including all the way from hunting or farming food, especially wildlife,

or species that aren't used to being farmed or are coming into often contact with humans or throughout evolutionary history haven't been living in close contact with humans. So all the way through that wildlife, human food value chain, we have concerns. And certainly we'd been raising the flag about our concerns, especially at the market level where you have a lot of wildlife species mixing together that don't normally live together. So again, really big ecosystem disturbance, even if the ecosystem is the market, because you're housing these animals together. And then all the way through to restaurants, restaurants that keep live animals, but restaurants that buy the animals at those markets. So that's one that

that people are now aware of, that we've been kind of concerned about, warning about, conservation organizations also been warning about for a long time. Other ones are really things that people necessarily aren't thinking about here. There's a huge bat guano industry all the way from going into caves and collecting guano from natural caves. That, just the humans in their digging is a big ego system disturbance. or setting up actual attractants for vats to collect their guano so that they preferentially, you know, roost in palm fronds right at the farm, then you can take that guano and put it right onto the

fields for fertilizer. So these are really other important interfaces. And then the, there are ones that just take us into the wilds. For example, we need elements and minerals for our cell phones to make them faster, thinner, sexier, better. And we often need those minerals from rare places for human populations to go, like deep into caves. So all these things are interfaces that I think you can think of, but they do all have something in common. And that is that people are sort of treading heavily into systems or effectively changing the evolutionary patterns that have been at work for hundreds of years. So when we disrupt those patterns, we put ourselves at risk, both because we may be out of our element, but most especially because we're putting pressure on the systems, including the

wildlife in those systems. So we may expose ourselves to things that we're susceptible to because we're evolutionarily naive. Absolutely. And so, you know, in talking about land use change and that interface or that barrier between humans and wildlife seems to have kind of decreased. Well, the barrier has decreased. The land use change has increased over the past, say, 100, 200 years. And so do we see a corresponding increase in spillover events? Unfortunately, we certainly have. Our projections and those of other great scientists show that we can expect about three recognized emerging infectious diseases

each year. And I think that our projections will be updated to even show more. Our predict data is showing that spillovers are happening actually quite frequently, even of things as scary as Ebola viruses, and that they don't always, in fact, don't often take off and cause a recognized outbreak. They might only make one person sick and then for whatever reason that person doesn't infect someone else. Again, as we look at how humans, animals, and the environment interact, sometimes all of the perfect scenarios come together for tragedy, and sometimes they don't, and just one person gets sick, and no physician anywhere would pick that up and think of testing for something new. In that scenario, the person either gets better or they unfortunately don't, and it ends. So those spillovers are

happening a lot. I think if you look throughout history, initially there wasn't great evidence of germ theory or people didn't believe in it. So we don't have a lot of data for, you know, hundreds of years ago. And then those pathogens that were noticed and picked up were the ones we were sharing with domestic animals, which make total sense because we're living in close contact with them, especially the ones that we eat. So we were sharing pathogens with them and we recognized that, and we now documented that. We know how to control that. Over time, I think we got a little complacent, and especially as the human population has grown, you know, 8 billion people on the earth, we're living in more frequent contact with wildlife pushing out into wild lands, and we need to

figure it out. Yeah, I guess it's kind of, when you think about it that way, too, it's hard to know how many close calls we've had in terms of pandemics, how many just was a dead end host kind of a situation. And so, you know, going now specifically into SARS-CoV-2, which is, of course, as you know, the virus that causes COVID-19. What do we know at this point as to how it spilled over into humans? What those steps were? We don't know much at all. Well, first of all, my soapbox, if we had been doing this work more broadly earlier and people were beyond sort of the same people that all collaborate, have, if we have been paying more attention, we would have been able to know a lot more. But unfortunately, this kind of work will probably not be done or known until after the pandemic

at least begins to wane. Because right now, the best minds to do this work have to be focused on the human to human spread. We have to get that under control. We do believe with quite a bit of confidence that the virus is bat origin and that the evolutionary host is bats. Whether or not it spilled over into an intermediate host is a good question, but it didn't need to. We know from our other work and receptor binding work that these SARS-related and SARS-2 related viruses can have quite broad host plasticity or a host range, and they can infect numerous species. So there's a lot of talk about what that species might have been, and it could have been anything that people were exposing themselves to in markets or other things, or it could have been a bat flying through.

So it will take some time to figure that out. When we do, which I assume hopefully we will get at a clearer picture of how that spillover event occurred. How can we use that information in the future? What does that tell us? So always in retrospect, we can learn more about how to control our risk. That said, I want to live in a world where we're not doing it retrospectively. I think we can learn more now. And we were learning, again, as I mentioned with the Predict Project, we knew that these markets where animals were sort of housed and really high density kind of crushed together, stacked on top of each other, and multiple species were mixing, that might have been occurring in the market that at least amplified, if not started this pandemic. We know that's dangerous.

We knew it before. Hopefully we will see solid policy change. There's some great movement towards that and some concerning events, reopening markets and things that point to us really having a hard time changing our behavior. Humans are the issue here. We have to get more comfortable with change and that's evolutionary to us. We're not comfortable with that. So that's going to be tough. But so we can learn from this one. We can also, because we have lots of samples and lots of people interested. We can learn as we're responding to this one about our transmission risk and those intermediate hosts. We just have to do the work. And there's so much more attention now. I think the time is here. We can have a lot of positivity and hope that this horrible, horrible tragedy

will help us to do things differently to keep anything like this from happening again, but also to allow us to strengthen our governmental and public health systems so that we're much more nimble and ready and able to respond to anything that comes our way. Yeah. So going back again quickly, just to spillover events in general, can you talk about what it means for a pathogen to jump species? And also, you know, I feel like I hear mostly or read mostly or for some reason just associate mostly viruses as.

jumping species more than bacteria. Is that a known characteristic or is it just that we hear more about the viruses? Well, Erin, I mean, I think the reason you're hearing about it now is because we're paying attention to viruses. Frankly, I would say other than a few really important viruses like influenza and HIV, we haven't been in our medical history been paying very much attention to viruses. Frankly, you know, we know a lot, lot more about bacteria because we've been paying attention to them. They're easier to work with without molecular tools. And now we have the tools, so we have no excuses. We need to do this for viruses and know as much about them as we've known about bacteria.

Gotcha. So, you know, I want to talk now a bit about what happens when prevention, so identifying these pathogens before they spillover or right at a spillover event, when that has to shift to control efforts. So what are the first steps taken for disease ecologists that are studying this outbreak in particular? And how is the one health approach being used to study and slow down the current pandemic? Well, we have to get together and make sure that we're, again, working in that sort of one health approach where we're collaboratively bringing the disciplines together. Everybody has their area of expertise and can work on their own specific part,

but we need to communicate and collaborate to really get a handle on things. So in really good One Health responses, we see the governments and entities, regulatory entities that are in charge, pulling together those platforms for communication, collaboration, and assignments of everybody's different role, and then coming back together. In Uganda, for example, they have a zoonotic disease task force that over the years of the Predict Project, we saw it going from just, you know, being sort of ad hoc and stood up often way too late when an outbreak started to being a constant permanent committee that was ready and available and would be activated within hours of a first case being identified.

And then you could see that the environmental team would go out and start sampling in the environment, understanding the environmental exposures, figuring out how to clean those up and protect people. You saw the animal side trying to find the hosts, making sure additional spillovers don't happen or things don't get amplified in animal hosts, while the really important work for human-to-human spread, contact tracing, control, go into place. Unfortunately, at least here in our country, that didn't happen this time. And I'm, you know, disappointed about that. But the only thing that we can do now is say we have the opportunity to fix. that for the future. Yeah, absolutely. I wanted to talk a bit about conservation and how wildlife conservation fits into this and what role we see wildlife conservation playing in spillover events or

preventing them. And then also maybe a little bit of the conflict in terms of how wildlife conservation is sort of a public greater good thing when people are struggling to feed their families. and I know if you wanted to chat a little bit about that. Absolutely. So especially in this one, I think there's a moment here that we shouldn't lose from a wildlife conservation perspective. People are aware that wildlife in markets now presents a risk. And it's really the heavily trafficked wildlife that presents the biggest challenge from a

conservation perspective. And even for the most heavily trafficked wildlife, were seeing that they're likely susceptible hosts or at least could be infected with closely related, if not this SARS-2 coronavirus. So first and foremost, wildlife that is moving around the planet, sometimes legally, sometimes not legally, and into our value chains for medicines, foods, and things. Those are targets of surveillance and control. and for wildlife that's trafficked or hunted, captured, transferred illegally,

we can really do a greater good for the wildlife while also doing an amazing risk reduction effort for humans. So I think the time is now to look at that. And frankly, a lot of that traffic wildlife is moved by the same bad actors that move drugs and traffic humans. And we want to see that stopped. Certainly there are places where we look at the tradeoffs of protein availability and nutrition and what's available to people. So certainly we can think about better ways to get protein into diets than eating wildlife. But really, frankly, in my last decade of work and going to these markets, most of the wildlife is more expensive.

We have papers on this. Most of the wildlife is more expensive than chickens and even pork. which is sometimes a very highly valued meat. And it's really tradition and sort of the, you know, everybody at Thanksgiving has the thing they like the best. Some people want to make sure there's turkey or macaroni and cheese. And families all over the world have those preferences and traditional dishes that make events special.

And that is a lot of what we see in the legal wildlife trade. And so, again, it's human behavior and what will tolerate and what will change to protect ourselves as well as the planet. Absolutely. It's, I mean, it's hard because I think this is, again, where something like a one-health approach or a more interdisciplinary approach is really crucial in trying to get messages, not only from the people studying these pathogens to people maybe expose to these pathogens, but also vice versa.

What are the things that they're? concerned about what are the tradeoffs that they view and how do we come to a compromise while also making everyone healthy? Yeah, absolutely. So so far, in this pandemic, what do you think we have learned from a one health or maybe a disease ecology perspective that you think could help us prepare for or hopefully stop the next one? Well, certainly we need to be ready earlier. So what we did with the Predict project provided a proof of concept that we need to go even further. And we need to have a One Health approach to be able to prepare. That's why, you know, I've joined the Global Viran Project and we really want to understand the host,

the interfaces, the geographical locations, not just identify the viruses early, but understand what will make them a jumper and how to target therapeutics and diagnostics. And that takes more than just finding the virus once. Really, you know, we've been working on a risk ranking for all the new viruses that we've found and others have found in a tool that we call spillover that will help us rank those viruses. We've used experts from around the world, the best in the field, to help us rank about 40 different factors epidemiologically, ecologically, virologically, to help us collect that information and rank new viruses as they're found. The key thing to that is having enough detections to

understand if they're single host viruses or if they're easily moving between species. And if they're easily moving between species, that certainly moves them way up high on our risk ranking. How do you determine whether something easily moves between species. Is that something like that's a genomic question or is it an experimental question? We can do it multiple ways. So certainly we can do it genomically looking at both the viruses' ability to bind to receptors and then the host receptors' ability to receive that virus. That's happening with coronavirus. We've been doing that for quite a few years and working with some of the best folks out there like at North Carolina University to do that work. But you can also do it

in a low-tech way. And frankly, if you go out and sample the wildlife and you find the viruses, then they're getting into those wildlife. So you don't necessarily, for every single virus, need to do heavy-duty laboratory investigations because that's very expensive and time-consuming. You can start by identifying those viruses. And if you're doing heavy sampling, you can say, okay, this one is only ever being found in this one species. It's much less likely to jump, let's look at its spike protein and in the host, the ACE two receptors to see what makes that one different than all these coronaviruses that seem to be able to jump and we find in dozens of hosts.

Mm-hmm. Mm-hmm. You know, I think the Predict Project with its one health approach is such a perfect example of how you can have expertise in one field and bring so many different people together with all so many different expertise together to still work on one common goal. And so, you know, you mentioned mathematicians, field ecologists, veterinarians, physicians. Like, what are some other examples of people? Because I know that people after this are going to want to get involved and maybe this is

something that speaks to them. So what can they do? I mean, a big one that we need more of, that we have some great social scientists working with us, both in the behavior realm and the economics on the Predict project and the Global Viran project. those areas of expertise are underrepresented in health work. And frankly, because they're underrepresented in health work in academia, we've undertrained people to help us with this.

And we're going to feel that, especially from the behavior change perspective. We really need those medical and cultural anthropologists that are willing and able to innovate in behavior change if we're going to get in front of these things. Awesome. So what do you think are some of the biggest barriers or challenges in identifying these spillover events in the future? And maybe, you know, even though we've learned so much from this, what do you think in the future is going to make it more difficult to prevent something like this from happening again?

Well, for me, the future is bright. And I have a lot of hope that this tragedy will allow us to not have to live with the barriers anymore. I think the barriers have always been there, and we can break them down now. The barriers are really human nature barriers. We deal with what we were worried about because it just happened instead of looking forward. It's hard to prioritize resources to things that only might happen instead of definitely will happen. And when the resources are limited, of course we're going to take care of what's affecting our population right now. but in some of the better resourced countries like our own,

we need to contribute to and take care of what we know will come, even if we don't know when. So I think those barriers are lowered right now. We have to take advantage of that lowering to really stop chasing the last epidemic and start preparing for the next one. And we can prepare sort of agnosticly to the pathogen to be ready to bring in

the right people. So if the next one happens to be a paramexovirus like measles in that family, we can have all the contingency plans and bring in the best labs that work on those every day for that emergency early phase response so that while our government gets ready and makes its test kits and everything, we aren't just waiting. We're testing and we're using that very willing an able workforce that can be pre-approved on a contingency basis. So I really think those barriers are down right now, but we need to take advantage of this opportunity

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This is Bethany Frankel from Just Be with Bethany Frankel. listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these, quote-unquote, fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies, 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat, not that the babies would ever share. Food for Dogs is the number one bet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner. They run to the bowl, tags wagging,

pause tapping, full Broadway performance every single night. So I do care about the food I feed big and smalls. So go to just food for dogs.com for 50% off your first box. No code, no gimmicks, just real fresh food. Janice Torres here. And I'm Austin Hankwitz. We host the podcast, Mind the Business, Small Business Success Stories, produced by Ruby Studio in partnership with Intuit QuickBooks. And we are back for season four. We're talking to small business owners who are doing incredible things in their industries, achieving their dreams, being their own bosses, putting in the work, and enjoying all the benefits that come with it. This is our most exciting season yet. We're talking to more entrepreneurs about how they launched their vision, and more importantly,

how QuickBooks on the Intuit platform helps them do more in line. less time. Working in QuickBooks just makes it easier to run the business, right? There's so much that you need to do when it comes to running a business, building products, setting up marketing campaigns. And to run a business, you have to make sure that your finances are in order. So it removes my anxiety from one side of it so that I can focus on everything else. Whether you're a long time listener or just getting started, tune in and join us. You'll be so glad you did. Listen on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. That was awesome.

Thank you so much, Dr. Mazette. I just had the greatest time talking with you. I'm just so jealous, Erin. I'm at home with a baby currently. Who doesn't like to nap for long enough for me to get to do these interviews. Listen, your presence was missed. Yep. Someday I'd like to meet you, Dr. Mazzette. Anyways. What did we learn from that interview?

We learned a lot of things, a lot of things. Let's talk about the five, just as we have for other episodes in the series. So the first thing that we learned isn't that new, and we've said it before, but I think it bears repeating. Spillover events have been on the rise for a very long time, and there's a very long time. is no slowing down in sight. Researchers estimate that we'll see three recognized emerging infectious diseases every year. Three, those are just the ones that we recognize. And so that means that there are a good deal of spillover events or emerging infectious diseases that we may not even realize are there simply because the person got better or they died and no one else got infected and we didn't know what to look for or even that we should be looking for something.

So, the more we look, the more likely we are to catch something early and stop a potential pandemic in its tracks. Dang. Three a year. Three a year. My gracious. All right. Number two. There is a usual sequence of events that emerging infectious disease researchers

follow when they collect and present their data. Normally, it goes like this. Collect data, present the data to governments of the countries where you're working, and then begin the lengthy process of publishing the data in peer-reviewed articles. An ethical dilemma can arise about whether the data you've collected should be shared with the communities at risk before being published. And the reason for that dilemma is not because you're worried about being scooped, but because the peer-review process is an important way of double-checking your work with people

who don't have any horse in the race. By and large, though, there seems to be consensus that getting that information to the communities at risk as soon as possible is the right thing to do, even if the data aren't published yet. And this is something that we've seen a lot in this current pandemic and will hopefully cause us to re-examine the way we get public health information out there in the future.

Number three, we know how spillover events happen and we can estimate where they're most likely to occur. Spillover events are caused by humans invading wild spaces and wild animal habitats, changing the natural environment. When people do this, we stress the systems and the wildlife, and that leads to us exposing ourselves to things to which we are immunologically naive, something we've never, our bodies have never seen before. And so the places that tend to be hotspots for spillover events are high in biodiversity and have increasing or evolving land. landscape change. And this is because in those places, the barriers between humans and wildlife are lowered. And the wildlife trade in particular poses a pretty huge threat not only to the conservation of some of the most trafficked animals, but also to public health because that's where a lot of these

spillover events happen. And conservation efforts would go a long way towards reducing the likelihood of spillover events, but policies also need to be sensitive and keep in mind cultural traditions and the basic needs of people living in these hotspots. Number four. How many times can we say this? We need to stop chasing the last pandemic and spend more resources on stopping the next one. What what?

By doing that, we can enable an entire willing and skilled workforce that can give us a leg up on preventing another devastating pandemic. We've said before that when these emerging infections occur, we're not starting from scratch, but let's make sure we can do all we can to start as far away from scratch as possible. Invest in global health. Yeah. Okay, number five, we got to work together. We got to work together. So working together, this is what the one health approach is all about. And so by recognizing that the health of humans, animals, plants, and the environment is interconnected. It makes it so that a lot of disciplines have to work together to understand the drivers of disease. And people

who work in One Health have done a great job of collaborating across disciplines that are very different, but there is also a need for more social scientists in health care and especially health research fields. Because we can do all of this super cool ecology or microbiology or mapping research, but if we want this research to make an impact on people, we need to communicate these things to communities and get them involved. Yes, absolutely. Okay. What a fun episode.

It was so great. I mean, honestly, like, I was very nervous. I felt like completely starstruck, and it was really fun to talk with her. So. And also, thank you so much to Brooke for putting us in touch with Dr. Mazette. It was very appreciated. Fantastic guest to have. And also a huge thank you to my very good friend, Zewen Spiegelman, for all of your help with our first-hand account form. Reminder, if you'd like to share your firsthand account with us, please go to our website. This podcast will kill you.com and click on COVID firsthand.

hand. Let's do sources real quick. Yeah, let's. Okay. Once again, that first-hand account was by Dr. Craig Spencer and the article appeared in the Washington Post. We will also post a link to the new recommendations on the CDC website regarding the use of cloth face coverings. Excellent. Thank you to Bloodmobile for providing the music for this and all of our episodes. Did you know that you can find Bloodmobiles music. If you click on our website and then you click on music, you can find it. You can, you sure can. And thank you to you, listeners, for listening. We know that these are very trying times. And so we hope that you find, I don't know, those of you who find comfort in more information, which is obviously the kind of people that we are. Hopefully you're getting

something out of these episodes. And we hope you're staying safe. well mentally and physically. Yeah, we do. And if there's an aspect of this pandemic that you want us to cover in more depth or more detail, we're open to hearing suggestions. Yeah. Well, until next time, wash your hands. You filthy animals. This is Bethany Frankel from Just Be with Bethany Frankel.

Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these, quote-unquote, fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat. Not that the babies would ever share. Just food for dogs is the number one bet recommended fresh dog food back by over a decade of research.

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