Pandemic: How to Prevent an Outbreak (2020) s01e05 Episode Script

Prayers Might Work

1 Your Grace is sufficient To cover my past Your love is more than enough More than enough Your love is more than enough More than enough Your love is more than enough More than enough For me Thank you for your grace.
Thank you for your forgiveness.
Hallelujah, Hallelujah, Hallelujah.
The one thing about medicine and faith that is unique is that when you meet someone who is on their darkest day, they're in their worst health.
Most people in that situation are pretty much open to faith.
They're open to prayer.
So I think that medicine creates kind of a different environment for faith.
I will rejoice.
I often attribute the fact that I'm still standing to God, because why am I not just shaking and not able to be successful in anything I do based on the trauma that we went through as a family? I have two children, my son, Jay, and my daughter, Shaylee.
They live up in Oklahoma City and visit about once a month.
My divorce was not easy on my children, particularly since I was in medical school at that time.
First year of medical school, you would have been 14.
I purposefully would pick.
I have a test to study for tomorrow, my daughter has a game.
But there were times when I had to say, "I have to study or I'm gonna fail, and then this whole thing will be for nothing, so" I don't look back and think, "I wish you would've spent more time with us.
" 'Cause you were able to balance, you know, school and work and family time really well.
- That's something that I really aspire to.
- Thank you.
- I don't feel that way.
- You don't - You feel like I just left you? - You should tell the truth, Shay.
Not "left," you obviously were doing something that is fruitful now, but, yeah, I wish that we had more time with you.
I did kinda feel like I was Jay's mom at some points.
I would make food for us and hang out with us and I would pretend to be his teacher.
Yeah, home school.
I guess we didn't realize at the beginning how hard and how much time it was gonna take, so Becoming a doctor and being a doctor has definitely come with sacrifices.
My daughter doesn't believe in God.
Had I known that the result of me becoming a physician was going to result in her not having faith, then to me that decision is easy, and in a heartbeat, I would have dropped my pursuit of my career.
I started questioning when I was 11, so it's been a long time.
And then kind of just went in and out of it and then just don't believe, so And you're at peace with that? - Mmm-hmm.
- Yeah.
I'm not.
- Right.
- 'Cause I'm going to hell.
- Well - Is But I don't I'm not trying to convert anybody, like, "No, there is no God, Mom.
Stop believing what you believe.
" But I also want the same, you know, respect.
Yeah, but I'm your mother.
Knowing that Shaylee doesn't believe like me doesn't make me love her less.
In fact, it makes me more compassionate for her, like, I want her to have what I have.
- Do you have everything? - Mmm-hmm.
As a parent, at some point, you say, "Okay, I've trained, I've given, I hope," and then, ultimately, they're another person that makes their own choices.
In medicine, it is a sacrifice.
It just is.
We sacrifice all kinds of things to be doctors.
The time will come when we'll harvest what's for Jesus.
What's the preacher trying to say? The preacher is saying this Get hold of your bread.
Get hold of your bread.
- Throw it into the sea.
- Throw it into the sea.
After sometime, you will see, that loaf will return to you.
And that loaf will return to you.
I read from my Bible in the Book of Hosea, my people get misled, because of lacking knowledge.
Yesterday, I got news about one of our brothers, who had his in-law, who died from Ebola in Butembo.
I know there are others who take it lightly.
Others don't know that Ebola is real, but Ebola is real.
And we need to be guided and trained about it.
We serve with these brothers, to fight these diseases like Ebola.
I will invite them one by one to speak.
I came here this morning to this house of the Lord because I am also a Christian.
We came here to talk about Ebola.
If we mobilize together, we can avoid bringing this disease to Goma.
It's a disease that has unfortunately killed over 600 people since the epidemic started in North Kivu.
It's a disease that has made families here disappear.
I would like to know where it comes from.
Let us ask.
Unfortunately, Ebola was discovered in Congo and Sudan.
Unfortunately, some consider us their enemy.
According to them, we brought the disease into the community.
Maybe they see a kind of invasion coming from others to implement the Ebola response.
So the starting point is that we have to initiate community dialogue.
You have to convince them to trust you.
What are the quarantine measures for people who come from contaminated places? We do not recommend quarantine for Ebola.
When we impose quarantine, people hide and flee.
When someone touches a positive person and flees, that person will die, but before they die, they will contaminate other people.
With this kind of outbreak, we can count on science, we can count on medicine, but we cannot count on human behavior.
We cannot predict how people will react.
If the community collaborates, Ebola will be over.
And in order to realize that, we need you.
Help yourselves and your families.
We're counting on you.
The wind is helping.
Ado, grab the pot and remove the lid.
Ghazi travels a lot, and since he's Lebanese, he doesn't have a lot of friends in Egypt.
The people coming today are his co-workers.
- Did Neama finish? - Ibrahim, Give me that plate to fill it.
How about some salad, Yousef? So you cook a blend of Egyptian and Lebanese food, right? Yes, that's right.
The food is very good.
My co-workers in Egypt, we're like family.
We've known each other for more than ten years now.
We have a shared common goal, which is to save lives and one of our recent tests shows signs that there is a potential influenza case back here in Cairo.
What happened with Ahmed with the H5N2? There's a strong outbreak in Gharbiya.
- Of what? - In Gharbiya.
They don't know, but the situation is very bad.
- In poultry? - In poultry.
It's full of farms there.
Can't we get samples from there? No, we have them.
In our surveillance, the positivity is very high.
Positive in what? H5 and H9.
We're talking about almost 20%.
20%? This is too high! - What happened, Mukhtar? - I don't know.
Go get some water from the cooler.
In 2005, we had the first detection of the first bird flu as it's commonly called The avian influenza virus.
It started moving out from China and going elsewhere in the world through wild bird migration.
Soon after that, the virus started crossing from the migratory birds to domestic poultry.
Infected birds have been culled.
The virus has shown up in almost half of Egypt's 26 provinces.
Workers in the Egyptian health ministry's central lab are checking throat swabs from people who may have been exposed.
And very soon after, we started getting human infections.
Since the disease was so new to us, there were no protocols in place to fight it.
It was never really controlled, and if you look at the data, Egypt had the most human infections with H5N1.
So Egypt became what is known as a hot spot.
The H5N1 outbreak in Egypt was a game changer for surveillance.
It's our job to make sure it doesn't happen again.
Did we determine a sequence from the sample yet or not? We're at the end of flu season.
Why is our surveillance so high? There's something happening.
The main purpose of this trip is to administer the vaccine to pigs and over the course of a few months, determine the most effective dose.
I just have a way that I want to do it.
I think this'll work, we basically We know Centivax works in pigs.
Getting it to work in fewer shots will be a big deal.
But getting it to work in just one shot will be a massive success.
We have seven groups of pigs.
One group is a negative control that receives salt water.
One group is a positive control that contains a seasonal vaccine that pigs would normally receive.
It's 58.
Just put it in.
Five groups are getting different doses of Centivax.
- Good? Okay.
- Yeah.
This group of pigs holds the biggest promise for us.
Let's proceed.
I'll go start this thing up at the lab.
We inject them with a flu virus that we've created in the lab that is inactive and won't make them sick, but their immune systems will respond to it just like it is the flu.
I make that I will help you, right? While we're anticipating the results of this test, we're still nervous about our funding going forward.
We expected to hear back from the Gates Foundation this month so that we can move on to human clinical trials.
We haven't heard anything so we're certainly getting anxious.
Whether or not we get that money, right now, we need to focus on this project.
- Good morning.
- Good morning.
Can I see a doctor, please? Are you experiencing any fever, rash? Yeah, I'm having a fever, some abdominal pain, and I've just been vomiting, slight cough.
I'm gonna need you to put these gloves on, place the mask over your face and the plastic in your pocket.
Have you traveled outside of the country within the last 30 days? Yeah, three days ago, I went to the Democratic Republic of Congo.
- Okay.
Melinda? - Yes.
Please come.
I have a patient who's traveled to DRC.
- Sent to us? - Yeah.
- Give him the sheet.
- Okay.
Also, could you step out between the double doors there and place this sheet around you? Everything's okay? Yeah, we're just gonna ask you to wait between the doors, okay? - I'll come talk to you in a minute.
- Thank you.
Okay? My gown and my mask.
Attention all staff, attention all staff.
Code E.
Attention all staff, Code E.
We are in an environment where we're surrounded by these outbreaks, and it's imperative that we maintain readiness for all these types of diseases that are gonna come knocking at our doors.
So what we're practicing today is on Ebola virus disease.
We are in currently the second-biggest outbreak of Ebola virus disease in the Democratic Republic of the Congo.
This is This is real life.
So what's going on is we're just gonna ask you to stay a few feet apart, okay? At least six feet.
So it's just safety precautions for you and for everyone around you, okay? Just to make sure everything is okay.
We're gonna go around the building.
There'll be some nurses and doctors in there.
They're gonna be wearing some big old plastic suits that might look a little scary.
Don't be scared.
Attention please, Code E.
All the nurses, please come inside.
To the isolation areas we have to be ready for the team to arrive.
Donning team is getting prepared.
Once the donning team's prepared, we'll say, "Ready to proceed.
" We can say, "Prepared now.
" So what we'll do is per the protocol, we'll just leave the bridge open.
If you need anything from us, we've got the team here and we'll get you the resources.
Thumbs up.
We're ready.
Donning team is prepared to receive the patient.
Shift over into the room? Nice deep breaths.
So with these symptoms and your travel makes you very high risk.
The worry is that you may have contracted Ebola virus.
We're going to try to stop any kind of epidemic from starting.
As such, the safest way of doing this is to transfer you in a special unit that will be coming here wearing protective gear, and transport you to Bellevue.
We're gonna dress out in all the normal PPE for Ebola transports, okay? All right.
If you guys are comfortable and ready to accept the patient, I'll let Coney Island know and the patient will be out momentarily.
They're coming out.
These types of cases require a very large response.
Let's pull you across.
This is really one patient.
If it was a pandemic flu, you would most likely have a much higher patient care count and you would need more hands on deck.
- All right.
- You're in good hands.
The funds that we use for maintaining readiness will stop by 2020 if funding is not reissued.
We may have to cut some of the programs and activities that we do if we don't have that money.
And if we can't keep up with this training and maintaining readiness in general, then we're risking more lives.
All right, so it doesn't seem to be an infection.
The one thing that I can't do that I think you need is an ultrasound.
Like, if you were to have a blood clot in your leg, the test of choice is that ultrasound.
Is there any way I could stay here? Probably not but I can talk to And the reason is that we don't do dialysis.
- Right.
- So if we got If you were here for more than two days, you're gonna need dialysis.
- We - Well, let's get to the end - of what we're doing, okay? - Okay.
Let's just figure out what's going on.
I love my patients.
So it's really hard to sometimes not have all the resources that they need.
You need a hug? Aww.
- Morning, good morning.
- Morning.
I've never ran a hospital before.
When I interviewed with the board, the hospital wasn't in good shape.
Knew it was going to be a challenge.
We had a physician, Dr.
Lensman, who was here for a long time.
His saying was, "All I've got is an EKG machine, a stethoscope and a Bible.
" Hi, this is Richard from the hospital.
How are you? Good.
Is Mr.
Simmons available? Thank you.
We had $2.
2 million in debt and we did not have the money to service that debt.
Simmons, Richard from the hospital.
How are you? We'd been receiving a one-cent sales tax from this county, but this sales tax is due to expire this year.
And that money went to support the operations of the hospital.
Would it be out of line for me to ask for a public service announcement to remind the teachers and the now-professional staff to go vote? And so there was a concerted effort to mount a county-wide vote to extend or renew the sales tax.
Eleven hospitals in Oklahoma have closed in the last two years.
That is a trend nationally, that rural hospitals are closing.
The doors are shut at the Paul's Valley Regional Medical Centre.
A Norman hospital is closing down, giving employees almost no notice.
In the wake of a state-wide healthcare budget crisis, another hospital closes its doors.
The pace of the closures has only escalated in recent years and the National Rural Health Association says more than 280 hospitals, with 700,000 patient visits, are at risk of shutting down.
Debbie, Richard, how are you doing today? 2015, Jefferson County was the most unhealthy county in the state of Oklahoma.
So if the hospital were to close, there'd be a huge impact.
I was just calling to remind you to get out there and vote.
Hopefully, it all turns out positive.
Violence and mistrust are seriously hampering efforts to contain this outbreak.
Ebola treatment centers like this one are often attacked by militia groups and people are either too scared or too suspicious to seek medical help.
The longer this outbreak rages on, the higher the risk of it spreading globally.
This weekend was marked by an acceleration of incidents related to community reluctance, with unfortunate violence.
Most of my colleagues, including myself, we are quite determined.
We want to stop this virus.
Concerning the operational zone, we observed 11 incidents, but this time, including violence.
Just yesterday, a team was ambushed.
Two vehicles were battered with rocks.
So long as we don't control the big hotspots, we cannot regain control of other zones that were previously under control.
We continue to find cases.
Yesterday, we found seven cases.
We have to adjust our leadership in terms of Butembo.
So I will go to Butembo and take over coordination there.
While my team are taking a lot of risks in a dangerous place, I have to be there with them.
If our situation worsens, it could be the case that we totally have to move out.
Oui, hello? But it would be really the last option.
Because moving out means leaving Ebola.
The only objective is to save the population from Ebola.
At the end of the day, we have an absolute ethical and moral imperative to make sure that we do that.
And inevitably, that requires people going to areas that are not safe.
It's like a soldier where you can lose your friends but you have to move towards the victory.
And we have no option but moving toward this victory.
- Those are the big ones.
- Yeah.
This is one of our most important experiments yet because it will determine whether our vaccine can be delivered in fewer doses to pigs.
We know how easily things can get messed up, especially if we're doing it in multiple languages and it's loud and the pigs are kind of grunting and crying.
There's a thousand ways that we could achieve a negative result or a poor result and it's nerve-wracking.
That's why we have this methodical way where either Diego or Juan will hold the pig, or both of them, and then Corina will wipe the dirt off the ear tag and she will read it, verbally say the number, and then I will read it and then I will say the number.
And we'll look in each other's eyes and make sure that we both said the same number.
And then usually I'll go tell Jake, "Hey, it's number 52," and he'll say, "52?" And I say, "Yes, 52.
" Then he goes and grabs number 52, I look at it and I read "52," I take the cap off and I hand it to Corina.
For all 35 pigs.
- And we're done.
- Done.
That was awesome.
Whoo! You can go and hang out with the piggies a little bit now.
- Oh, yeah? - Yeah.
We just injected all these pigs with our new round of Centivax.
I'm very confident we're gonna see some improvement.
I think the question is, are we gonna see total improvement in fewer doses? And I think that's what we have to wait and see.
So, our work here in Guatemala is basically over and we are going to fly back to San Francisco.
So, the next step is we wait.
I will be back here in three weeks.
We will begin pulling blood out of the animals, sending it back to the lab, and beginning to determine how their bodies are responding to the vaccine.
We might get lucky and see the kind of response that we need after one shot.
And if we achieve this in pigs, it will be a huge step towards our goal of a post-pathogen humanity.
Every now and then, we get surprised by the nature of a new bug or a new virus in our region.
- That positive control? - Positive control.
Where are the two samples? And now we have confirmed the presence of an avian influenza virus here in Cairo.
Is that the first time you'll try it on this? Yes.
We don't know how severe it is, how pathogenic it can be and so we're really interested in trying to understand as much as possible about it.
Can we tell if these came from one farm or not? Yes, I was just telling Hisham to check on this.
All right.
The outcome could be a novel virus that we do not know about in the animal population.
And so we do not know how severe it would be in the human population.
To me, it becomes a little bit personal when it's in your own backyard.
What do you want to eat, Besah? Do you want falafel? No? Try it, you'll like it.
A city like Cairo, with a big population, with this close and intimate interaction between its people means that the virus is going to be spreading rapidly.
What worries me about my family is when these viruses are out in the community and my family would be part of that community.
Another influenza pandemic.
If you ask any influenza scientist, they tell you it's coming.
We don't know which virus is going to cause it.
We don't know when it's gonna happen.
So the only thing we can do is just keep an eye on things.
You have to do your surveillance, you have to be prepared, and you have to do the science.
Jefferson County will soon decide whether they wanna continue a 1% sales tax that goes toward the Jefferson County Hospital.
A few years ago, the hospital in Jefferson County nearly closed after going around $2.
2 million in debt.
This is coming up for a vote when five rural hospitals in Oklahoma had to close their doors due to financial problems over the past nine years.
- That's for you.
- There you go.
- Thank you.
- Y'all want a sticker? Today, this county is having a vote to extend the tax that supports this hospital.
In my mind, if it doesn't pass, everything would completely just fall apart.
Of course, nobody likes to pay taxes.
When the initial straw poll was taken, there was 151 were "yes," 41 were "undecided" and nine were "no.
" We have limited resources, but you have to invest in this facility.
We provide health care services within the county and the communities.
I took an oath.
And the oath was to protect and serve the people of Jefferson County.
The average person in Jefferson County is probably making about $18,000 a year.
We're an agricultural community.
There's not a lot of money in that.
The sales tax is what drives everything for this community and it's just not enough.
Everything's divvied up according to necessity and need.
Every department struggles.
Every area of county government is trying.
It is a challenge.
It's There are days that you wonder and say, "How are we gonna make it?" The average person in our community, they don't understand that there's times that I pay out of my pocket for fuel in our vehicles.
They just know that when they call, we come.
A vote was presented to continue paying on a debt we had for our county hospital.
It's a good thing that we're supporting our hospital and taking care of it, but we also need We need fire service, we need ambulance service, we need law enforcement.
We even need my dog, Joe, to help with our mission.
There's so many avenues that finances can help in a rural community that What takes priority? And that's quite a challenge.
These votes are very important.
They affect more than people realize.
How are you doing, Robert? I know we've been dealing with medical stuff with you.
Your blood pressure's been high.
Our problem is, as you know, - I'm only budgeted so much money.
- Yeah.
We don't have a way to get you the medication you need.
Robert, I don't want you to have the issues you're having, but also, my hands are tied on how I can help you.
- Yeah.
- Anything you wanna tell me or talk to me about? - No, I just need to get that medication.
- I know you do.
- And I don't have the money to do it.
- I know.
I wish that the state would give us something to take care of you guys better.
Didn't mean to get you upset, bubba.
He has no plan.
He has no insurance.
He has nothing.
But we have $38 in our medical account.
And it's not easy.
Okay, did we figure anything out on Grant's appointment? Yes, we did.
Talked to Dr.
They're just gonna call in his prescriptions until we can They can get him on some emergency aid.
- Okay, thank you.
- Yes, sir.
We need a hospital.
This is Dr.
If you start taking things away from a rural community like this, before long it dries up and blows away.
With that being said, we're maxed out on our tax base, but it's still not enough, and that is hard, because there's nothing else to pull from.
It's an issue that needs to be addressed state-wide, and I'm hoping that we see some changes.
- Sheriff, how are you? - How are you doing? Doing well.
Thank you.
Yes, sir.
The final tally was 664 to 45.
- Okay.
- 93.
65% to - 6.
35% no.
- Okay.
There you go.
You can hang that on your wall.
All right.
Thank you.
- Right.
Y'all have a good evening.
- All right.
See you later.
It shows that it was a 664 and 45.
664 "for" and 45 "nay.
" Basically, if you round up, a 94% approval.
So that's pretty good.
In fact, that's really good.
Yeah, it's very humbling, actually.
This vote shows that our county supports our hospital.
In terms of our hospital, I just don't see it operating for very long without the support of its people.
We still face so many difficulties here, but this small win is still a victory to celebrate for our community.
I had two new calls this morning, one with an Atlas guy.
They're interested in six projects with us.
- They're all - Six? - Six projects.
- All right.
And the Gates Foundation is probably going to email.
I don't know.
I've been checking regularly and I have not received it yet.
If you do receive it - I won't read it.
- don't open it.
Yeah, I'm not gonna open it.
I'll let everybody know.
We'll get together and we'll read it together.
'Cause I could use some buddies if the answer's like - "No"? - Yeah.
If the answer's "no," - then I could use a tequila shot.
- Yeah.
And we have extra champagne if the answer's "yes," - so we're prepared for all eventualities.
- That's true But, yeah, we'll read it together.
So, while we are waiting for the results of the Gates grant, the show must go on, so we're meeting with other companies, looking for potential areas of collaboration.
Our technology relies on the ability to see lots of versions.
So what we did is we took a snapshot of evolutionary history.
We used hyper-geometric triangulation, which is just a fancy way of saying, "Find one flu and then find one that's the most distant, then another most distant from those two, then from those three, until" If we get the grant tomorrow and if those experiments went well this year, then you could probably go off the shelf by 2025 or earlier to receive this vaccine.
We have two different TC rooms.
Over on this side, it's just big decks of PCR machines, 'cause we use lots of PCR The Gates grant is for $1.
95 million.
That's enough for two years of research and an additional set of scientists that are gonna come join our team.
So what we're looking at here is the data that we generated actually just yesterday.
So, it took about two months of testing every day on these live flu viruses to finally narrow it down and optimize all the conditions exactly to get it just right.
I had an email come in we should take a look at in a little bit.
- Okay.
- Yeah.
- Well, thanks a lot for coming out.
- Thank you.
Very nice to meet you.
- Thank you for coming.
- Thank you.
- Thanks.
- And let's be in touch about that.
- All right, excellent.
- Okay.
- Take care.
- Safe travels.

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