It’s back to your regularly scheduled programming this week with an episode on schistosomiasis (aka bilharzia), that scourge both ancient and modern. We kick off the episode by walking you through the amazingly complex life cycle of these blood flukes and the myriad of symptoms they and their eggs can cause, including a “check out the reproductive output on this one!” moment.  We then trace its early appearances in mummies (of course) and ancient writings, following that up with an overview of how imperialism drove the field of tropical medicine in its early days. To wrap up this wormy episode, we discuss the current, staggering numbers on schisto around the globe.

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Welcome to Chapter 6 of our Anatomy of a Pandemic series exploring the world of COVID-19. If you have made it this far in the series, you might be feeling a bit overwhelmed by all of the information we’re throwing your way. You’re not alone. We were feeling a bit too deep down the rabbit hole as well. So we reached out to Rosemary Walker and Peter Rosencrans, two psychology doctoral students at the University of Washington to talk to us about the mental health impacts this pandemic has had and walk us through some coping strategies (interview recorded March 20, 2020). Hang in there, everyone. To help you get a better idea of the topics covered in this episode, we have listed the questions below:

1. You are both in Seattle, which has been impacted longer than much of the US, so, how are you? (05:55)
2. This is a brand new situation for all of us that's affecting so much more than our physical health.So what are we seeing in terms of some of the mental health outcomes? (09:21)
3. What are some of the challenges that you, as mental health professionals, have faced so far and that you expect to appear in the future related to COVID-19? (15:59)
4. What are some coping strategies that we could use to deal with some of these issues? (19:15)
5. What are some resources for people who normally see a therapist, but who cannot now because of COVID-19? (31:43)
6. How can we as individuals be good neighbors, community members, in this stressful time while still protecting our mental health? (36:50)
7. Do you have any specific resources that our listeners could seek out? (41:09)

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Chapter 5 of our Anatomy of a Pandemic series covering all things COVID-19 goes through some of the exciting developments in potential vaccines for this new virus. Starting us off is an anonymous account describing the challenges faced by someone in the US trying to get tested for COVID-19. Then we review some of the basics of vaccines - how they work, the different kinds, and some of the challenges in accelerating the vaccine development pipeline during a crisis such as this. We sought the expert knowledge of Dr. M. Elena Bottazzi (interview recorded March 17, 2020), who is part of a group that is currently working on developing a vaccine for SARS-CoV-2. She answers a number of your vaccine- and treatment-related questions and sheds some light on the prospects of vaccine development for this particular disease. We wrap up again by going through 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:

1. What makes this virus a good candidate for a vaccine? (11:05)
2. Why is it more difficult these days to produce completely protective vaccines vs partially protective vaccines? (13:29)
3. How is the vaccine that your group is working on made, what is its target and how does it work? (16:02)
4. What is the timeline of vaccine development, testing, deployment, and how soon might we see an effective vaccine for SARS-CoV-2? (21:19)
5. What steps of this development process can be shortened to get an 'early release' of a vaccine? (25:49)
6. It seems we are better at developing vaccines than we are antivirals; why is this? (28:55)

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The fourth installment of our Anatomy of a Pandemic series takes a look at some of the epidemiological characteristics of the COVID-19 pandemic. But first, we hear about the experience of Katie Burson, who was quarantined along with her family on the infamous Diamond Princess cruise ship in February 2020, when cases of COVID-19 were reported among guests. Then we review some of the disease ecology of the SARS-CoV-2 spillover event and walk through a timeline of the pandemic, which, we have to admit, is pretty chilling to hear. We are joined by Dr. Carlos del Rio (interview recorded March 20, 2020), who chats with us about updated estimates for the R0 of SARS-CoV-2, reasons for regional variation in case fatality rates, and what the deal is with the slow rollout of tests in the US. We wrap up again by going through 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:

1. Do we know what the R0 is for this virus? (27:44)
2. Is there a risk for a second wave of infection in China or other places where the disease seems to be slowing down? (29:31)
3. What are the stages of an epidemic curve and what does it mean to flatten that curve? (31:03)
4. Are people who get infected able to be re-infected or are they immune? (32:45)
5. What is the relative effect of social distancing vs herd immunity? (33:31)
6. How can we convince people who can stay home to actually stay home? (34:40)
7. What are the differences between populations that contribute to the differences in case fatality rate between China vs Italy vs South Korea, etc? (36:28)
8. What might we see in terms of numbers of infections or how long the outbreak will last? What's the end game? (38:00)
9. Should the measures that have been enacted in some parts of the US be happening even in places with fewer cases so far? (40:55)
10. Is this virus likely to become well established and another 'seasonal' respiratory infection? (42:16)
11. What's the deal with testing in the US? Why was rollout so slow at the beginning? (43:14)
12. When should a person try to get tested if they suspect they're infected? (45:58)
13. What has this outbreak taught us so far about our ability to respond to pandemics, and how can we do better moving forward? (46:36)

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Welcome to the third chapter of our Anatomy of a Pandemic series, in which we cover the many aspects of the COVID-19 pandemic. In this chapter, we discuss how epidemic control can be managed from the individual, state, and national levels, as well as the importance of international collaboration to prevent the uncontrolled spread of disease. We start off with a firsthand account from Dr. Colleen Kraft, featured in COVID-19 Chapter 2, who shares the challenges she faces on a daily basis during this crisis while acting as Associate Chief Medical Officer at Emory University Hospital. Then we review some of the terms you’ve probably seen all over the news lately, such as “flattening the curve” or “social distancing”. Dr. Krutika Kuppalli (interview recorded March 18, 2020) shares with us her expertise from a global health and pandemic preparedness perspective, and she answers some of your questions relating to the steps you can take to protect yourself, your loved ones, and your community. We wrap up again by going through 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:

1. Now that community transmission is established in the US, what can we do to slow it down? (18:05)
2. Do we need to enact these control measures (social distancing, etc.) everywhere, even in places currently have low case numbers? (19:51)
3. Are travel bans effective in slowing disease spread? (21:20)
4. How can we tell if our control measures are working? (22:52)
5. How soon do we expect to see the effect of these control measures? (24:00)
6. There have been a lot of comparisons with seasonal influenza. How does COVID-19 compare to seasonal influenza and why are we taking such extreme measures to reduce the spread of this disease when we don't do so for seasonal influenza? (25:22)
7. How well prepared was the US for this epidemic? (28:25)
8. What have we learned so far to help us stop the spread of this pandemic and prepare for future pandemics? (31:19)
9. What are the risks as this pandemic spreads to less well-resourced areas? (33:39)

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This marks the second installment in our Anatomy of a Pandemic series, in which we discuss the various aspects of the COVID-19 pandemic. In this second chapter, we explore what we currently know about the disease itself, from symptom progression to incubation period and the role that asymptomatic individuals play in the transmission of disease. Our firsthand account, told from the perspective of a respiratory therapist, illustrates the severity of this disease and the frightening, yet very real, prospect of running out of medical equipment, protective gear, and hospital beds. We then discuss what we currently know about COVID-19 from a clinical disease perspective. We are joined by Dr. Colleen Kraft (interview recorded March 19, 2020), whose voice you may recognize from our first episode on coronaviruses. She helps to break down some of the disease-related questions sent in by our listeners. 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:

1. What does "respiratory droplet" transmission mean, and how is this different from something with "airborne" transmission? (15:08)
2. What are the symptoms of COVID-19? (16:48)
3. How long is the disease course, and how does this vary between mild vs severe symptoms? (18:45)
4. What does "supportive care" mean in the context of caring for people who fall severely ill from COVID-19? (19:40)
5. How much does viral load correlate with the severity of symptoms? (20:47)
6. What is the incubation period of this disease, how long do people remain infectious, and are asymptomatic people contributing to the spread of disease? (22:22) 
7. What are the groups that are particularly at risk for severe disease? (24:00)
8. Why do children seem to be more resistant to this infection? What about children who are immunocompromised, are they at risk? (27:40)
9. What is the case fatality rate, and how might we expect it to change throughout the course of this pandemic? (29:09)
10. Are there long term complications associated with COVID-19? (31:58)
11. Is it possible to get re-infected if you get this virus and then recover? (32:54)

The full article our firsthand account came from can be found here: https://www.propublica.org/article/a-medical-worker-describes--terrifying-lung-failure-from-covid19-even-in-his-young-patients

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To discuss the ongoing COVID-19 pandemic, we are introducing Anatomy of a Pandemic, a series in which each episode tackles a particular aspect of COVID-19, from virus biology to clinical disease, from control efforts to epidemiological patterns, from vaccine development to mental health coping strategies during this uncertain time. And we’ve got a quarantini (and placeborita) recipe for each installment! In the first episode of this series, we tackle some of your questions about SARS-CoV-2, the virus that is responsible for COVID-19 (aka COronaVIrus Disease-2019). Our episode begins with a firsthand account from Tiziano, a schoolteacher in northeastern Italy who has been living under the strict movement restrictions imposed by the Italian government in an attempt to limit the spread of the disease. Then, we review some of the basics about SARS-CoV-2 and RNA viruses in general. To help us discern fact from fiction, we seek the expertise of a virologist, Dr. Angela Rasmussen (interview recorded March 15, 2020), who answers some of the listener-submitted questions about the virus itself. 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:

1. What are the origins of this virus? Where did it come from?
2. How can we tell whether this virus originated from one spillover event or multiple?
3. What do we know about the mechanism of how this virus causes disease in humans?
4. Are there multiple strains of SARS-CoV-2, and how do different strains of virus affect disease severity? 
5. Is there a risk of SARS-CoV-2 mutating into something more deadly? 
6. What is Remdesivir and how does it work? 
7. How does handwashing work to reduce transmission risk?
8. How long can SARS-CoV-2 live on surfaces? 
9. What is the minimum infective dose of SARS-CoV-2?

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Everyone loves a good poop story, don’t they? We certainly hope so, because our good friend Katie shares a fantastic one to kick off our episode on lactose intolerance. In this episode, we explore what lactose is and the symptoms that lactose non-digesters experience when they eat some sneaky cheese or ice cream. Then we explain that this episode is actually flipped - turns out that not being able to digest lactose is the normal state, and those of us who can are actually the mutants! We trace the origins of this mutant allele and how the persistence of pastoralism spread milk drinking far and wide. Where do we stand with lactose intolerance today? Tune in for that answer and for an abundance of milk facts to arm yourself with for the next pub trivia night.

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From its discovery only 30 years ago to the recent development of an effective treatment, the short life of the Hepatitis C virus certainly has been action-packed. This week, we take you through the biology of this deadly virus by exploring its cancer-causing qualities and pondering the plural of hepatitis. Then we take a stroll through the often bizarre and disturbing history of blood technology, discussing how a lack of sterilization and screening allowed for the proliferation of the Hepatitis C virus around the world. Finally we ask, “what’s going on in the world of Hepatitis C today?” Spoilers: it’s not all bad! As long as you can afford the treatment of course...

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[TRIGGER WARNING: see below] Whooping cough, that terrible childhood scourge, has been making an alarming comeback due to lapses in vaccination coverage across the globe. And in this episode, we’ll tell you why exactly its return is a cause for concern. From the devastation it wreaks on the body to the untold tragedy of past epidemics, pertussis is a dreaded disease that was nearly relegated to the past thanks to the amazing efforts of three incredible researchers, Pearl Kendrick, Grace Eldering, and Loney Gordon. But as the provider of our firsthand account illustrates, pertussis is still very much present today. We are joined by the incredible Catherine Hughes, who does us the honor of sharing her story about her son Riley and her efforts to raise awareness about the importance of childhood vaccinations.

 

Read more about the Light for Riley campaign and the Immunisation Foundation of Australia to see the hugely important work being done.

 

Trigger Warning: The firsthand account of this episode features the death of an infant. If you do not wish to hear this, skip to 5:10.

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