Pandemic: How to Prevent an Outbreak (2020) s01e06 Episode Script

Don't Stop Now

Well? So, while we were giving the lab tour, I looked down at my phone and noticed that that email had come in.
We're opening the Gates email.
Um No matter what, uh if we don't get it Um If we don't get it The possibilities are we don't get it or we get it but it's different than what we thought or - I think we should just open the email.
- All right, let's just do it.
Tear off the Band-Aid.
Let's see.
"Grand Challenges universal vaccine developments full proposal congratulate you on being selected to move forward.
This is a very competitive process.
We're excited to work with you more closely on your project.
Program officer and program fully funded.
" I've been waiting nine years for this.
We heard back, and it's yes.
Let's do a Champagne toast.
- I'll tell everybody.
- Yeah, sure.
Are you happy? Happy.
Yeah, I am happy.
I'm fucking stoked.
We've won the grant, and that gives me the optimism to be able to move forward without worrying about funding.
To our piggies.
To the piggies.
Right now, I feel confident, but a little antsy.
We need to finish the job with the latest test of our flu vaccine and our pigs in Guatemala.
Take another deep breath.
And again.
So the swab can tell us if it's the flu.
It's pretty accurate but it can You know, we can miss a couple of cases.
They said that you'd been tested last week or that you'd been sick last week.
- But it came back negative - Right.
As the flu season kind of wears on, we're busier and we're having sicker patients.
We get tired and we're really looking forward to the end of flu season.
While I was working, the chills hit and I started feeling worse and then the coughing hit.
And then we did the flu swab and it was negative.
So I'm like, "I'm fine.
I'll just wear a mask.
" And I kept working.
That was on a Monday afternoon.
Draw labs and get an IV and we'll run his urine My shift was Monday through Thursday morning.
So I knew this was early on.
I have to just push.
He'll probably get a chest X-ray, too.
I decided Tuesday afternoon that I would test myself again, and I was positive for the flu.
It shocks me every time I get the flu how much it hurts.
The muscle aches and joint pain and the bad headache and just coughing and feeling so tired, but still feeling too miserable to even sleep.
I get the flu shot because I want to protect myself as much as possible, but with the flu shot, it's not 100%.
I tell my patients that they need good rest and they need to eat healthy.
"You need to make sure you're balancing your life.
Don't work too much.
" And I think that I just don't follow my own advice.
I don't get enough sleep, and I'm very stressed in my position.
It does put me at a place where I'm at risk for having more illness.
Probably, I'm putting myself at risk for having a heart attack and stroke and high blood pressure, but that's the nature of the job.
There has been a rise in swine flu cases across India this winter season, and Rajasthan is where the impact has been felt the most.
Are you seeing an increase in patients this year? Definitely.
There is a huge increase.
Authorities say that the sharpest spike in swine flu cases was seen last week.
The numbers are staggering.
Over 9,000 people are affected, which means that once it reaches that level again, the spread will be that much faster.
So are enough measures being taken to restrict the spread of this disease? So shift number five.
There's an empty bed.
- Don't cough so loudly.
- What else should I do? Cough normally.
If you cough so loudly, it will hurt you.
I am hurting.
We have learned that every year these two months are the most hectic.
We don't even see our own families.
No lunch or anything.
There was no time.
But being a doctor is a passion.
I can work day and night.
Patients who are very, very sick, obviously it's very difficult.
What if the patient does not make it? You follow that patient from day one, when you see that patient arriving in the Emergency.
Majority of the doctors get very attached to their patients, and every time we lose a patient, it really hurts.
When Rajkumar came to us, he was very, very sick.
Take an X-ray for me now and send it to OPD.
When Rajkumar arrived at the hospital, he could hardly breathe.
He was completely deteriorating.
When I attended to him, he was extremely hypoxic.
Hypoxia means there is a lack of oxygen in your body.
His oxygen saturation was around 30-35%.
We had to intubate him immediately and put him on a ventilator.
He was kept unconscious through sedation.
There is a lot of stress, whether he'll make it or not.
Although deep inside, they're very worried, the family has full trust in us.
His children are getting married on the 9th and 10th of March.
But his health is more important now.
If he gets well, it's fine, or else we will try to postpone the wedding.
Let's see.
Get his X-ray sent to me in OPD.
We have to prone him at two o'clock, okay? Proning is a way of placing the patient.
If the patient is not getting sufficient oxygen from the ventilator when lying on his back, then we place him on his stomach, so that even his lower lung will open up with the pressure.
If after proning, his saturation is not improved, then it means his mortality is almost confirmed.
Being a Muslim, it shapes my daily life.
With our busy schedule these days, it's hard to attend various programs, events or prayers, but I always try to make the time to go.
- Thank you.
- You're welcome.
Will everyone please come in close? You can move in very close.
People are gonna be joining us.
I try to go to Jumu'ah or Friday prayers at the NYU Islamic Center as much as I can.
Do you want to have the heart that feels and is awakened with what they are going through My faith drives me to do the work I do.
And my desire is to not just help this community, this city, this nation, but the whole world.
But we're only as strong as our weakest link.
And that's why I'm starting a global health center.
To help the health care sector around the world to keep us all safer.
Attention please, this is a boarding call for Amtrak Crescent We have no idea where the next patient zero will present.
So, for this global health center to work, I need to recruit professionals from throughout the health care sector.
The best and the brightest for my leadership board, and I'm starting that process in Washington, DC.
Let's do this.
We're gonna finally learn the results from the third pig study.
Let's take a seat.
Worst-case scenario, which is still a possibility, is that nothing worked, and so we're stuck in the second experiment.
So I'm hoping that we see a real improvement with the Centivax.
So I have data to present from the vaccine study in Guatemala.
This is just showing you that there were 35 pigs in the study.
Five pigs in each category.
This shows that if there is signal, if there is binding, you see a curvature that goes upwards.
- You're killing me.
What's the result? - Tell us.
This is the table that summarizes all of the results.
They're categorized by the groups.
So, as you see, group one was the So I look at the screen.
I'm seeing some green, and here green is good, because green is the amount of response that we're seeing from the pigs.
Seven had MPLA and so forth.
These results are huge for us, because we have a vaccine formulation that takes less shots and gives a stronger response.
So this is very successful.
The pigs are producing antibodies against different strains of flu virus.
All right.
Thanks, Christina.
All right, so good news.
The primary goal of the experiment succeeded.
Obviously, we need some tinkering still because this required three shots, and we want only one shot if possible.
We're excited about those results.
We have new questions.
Scientists look at success and ask, "What's on the other side?" And additional questions.
From an outsider, it's not always obvious that we've achieved a victory.
As for scientists, that's not how we see it.
We see, "Okay, one less thing to worry about and there's new things we're gonna fight towards next," but it's exactly those victories and even more so, the new questions that really drive us.
The foundation of all good science is that the work should work in other people's hands, and so this gives us some winning groups to move forward and we've already gotten better than where we were before so the study was successful.
- Cool.
Thank you very much, Christina.
- Sweet.
All right, magic.
Our success with our vaccine technology on top of the Gates Foundation money means we can begin a pilot study in the UK, where we're gonna further optimize, and then the next step is it creates a flu shot so that people don't get sick.
Our goal here is to create a flu shot so that within a decade, we're looking back and we think of flu as a disease of the past.
I remember each pig and each group that they were in.
I'm like You need to get rid of that information.
I know.
- Just burned into your brain.
- Yeah.
I want to learn new cool stuff.
Yeah, there's other things to put in there.
I don't feel like I can sit down and just rest, because I have these things that are kind of pending.
I have too many balls in the air right now.
Makes me a little anxious.
As a physician, we pour out, and pour out, and pour out, and because we work long hours, and because we lose sleep, fatigue is really, really right there in front of us all the time.
I have a 72-hour shift, and the toll that it takes on my body, and on my emotions, and even on my spirit, is not something that I factored in.
Honestly, as a physician, you begin to sacrifice little things like dinners and church services and baseball games.
- Come in, baby.
- Hi.
- Are you ready to eat? - Yeah.
If you've got it ready.
One little sacrifice at a time, and if we're not careful, we sacrifice our family over it or our marriage.
She did.
I heard her say that.
I wish you'd got some sour cream.
Right there, on the table.
- In a little package.
- Okay.
I didn't see it.
My husband and I have a very strong relationship, but the last probably six months, I haven't been very nice.
- I'm sorry.
I'm in your way.
- No problem.
So our relationship has been suffering.
More arguments.
Not really listening to each other.
I know that what I do is important to me and, of course, my patients, but what am I doing to myself and my family? Is this really right? I don't leave home without praying first.
Even if I spend just a few minutes in my temple, I am content.
Sometimes, I make a request to God, "God, please help me with my patients.
" Sometimes you put in 1,000% and still nothing happens.
Then I sit in my temple and ask for God's help.
I tell God, "I have made every effort.
Nothing is happening.
God, please do something.
Give me ideas.
" And then I see that the patient is gradually improving.
I realized that when I ask God for help, he gives it to me.
This is the patient, Rajkumar.
It seemed like he would pass away in one to two-and-a-half hours.
When we intubate and put on a ventilator, it was the maximum ventilation.
Then we proned the patient.
Three cycles of proning for 16 hours.
It is day ten for him, isn't it? Please call his companions.
- How are you related to him? - Brother-in-law.
- Mr.
Rajkumar, look at him.
- You okay? You recognize him? I am telling Mr.
Rajkumar, if he can be brave and is willing to cooperate, then all these machines will be removed.
Cooperate with the doctors.
Don't be tense.
Now, your arms are weak because you were on a ventilator for ten days.
You don't have strength in your limbs like normal people do.
You have to bring that strength back, and you have to show me how much power is in your breathing muscles.
Now, you grasp my finger with your fist.
Grasp it.
Bravo! Use more force.
He has the strength.
Now, listen to me.
I want to try taking him off the ventilator.
We reduced it from 100% to 30%.
But now the question is, can he live without the ventilator? We are trying that out today for the first time.
This will stay outside.
Breathe calmly.
Breathe calmly.
You have to breathe on your own now.
We have turned the ventilator off.
It is not connected now.
Now, we can see your power by the saturation over there, which shows how well you are breathing.
Pull his bed up at an angle of 90 degree.
We'll see for two, four, six, eight hours.
How long he can remain like this? If I see that there's no problem for 12 to 13 hours, then starting tomorrow, he will stay off the ventilator.
What is the saturation? 92, 93.
Wow, that is great! Do like this.
You have to use your strength continuously.
Okay? I will send you home walking.
You will walk out of here.
Okay? Show us your courage for six hours like this.
Okay? Don't you want to go home? There's a wedding to attend.
Now, you have to dance in the wedding, okay? When I say things like, "You have to dance in the wedding," then the patient feels it's not a doctor who's treating him, but someone dear to him.
And his confidence in me increases.
We were very scared for ten days when he was unconscious.
We felt a bit relieved when he became conscious.
We finally had some hope.
But until he is shifted from the ICU to the regular ward, we can't say anything yet.
We have to go to the Dirksen entrance, so we're gonna have to maybe walk around.
We're in DC to meet with some high-profile individuals in the field of public health.
We have a meeting at APAJ.
Our purpose of meeting with these individuals is to tell them that we've launched this new global health center.
- Welcome.
Glad you're here.
- Thank you.
And then also to have them as board members, to really help leverage some of their network and connections.
- How are you? It's great seeing you.
- How are you? Nice to see you.
And also get their advice and recommendations as we are looking to develop our strategic plan moving forward.
We want to talk to you about some of the things that we're doing in terms of bio-defense, our new global health center.
There's infectious disease outbreaks every second, every day.
So it's constantly all around us and we just need to make sure that we have the structure in place to manage these types of cases.
Our focus really is on the front line whether it is an H7N9, or seasonal flu, or Ebola.
And in a pandemic situation, in a health care delivery system, we don't have the luxury of having a week or two months to come out with the clinical guidance or some sort of program.
And so based on some of our findings, we actually have launched a global health center.
It is geared towards preparedness to special pathogens and pandemics.
We are looking to assist, you know, health care delivery systems outside the United States in terms of preparing for special pathogens based on a lot of tools, resources and experience that we have here.
To turn back to you with a question, as you are sharing your learnings and your recommendations, what is your, um way forward? Have you got to a point where you have a game plan? For example, the flu on call, when we talked to CDC, that's something we are very interested in and partnering and piloting, given our significant impacts.
Other tools that we can also come up with are, like, flu forecasts and knowing when flu season's gonna peak or knowing when there'll be a more severe flu season, so we can get the three S's, more staffing, making sure we have more space, making sure we have adequate supplies.
So tools that can come from a health care delivery standpoint.
Probably the biggest scare is that if funding does not continue, that the system that we've built in place may not exist next year.
You're on point, because our history with this as a country is we have one of these incidents, we invest very heavily in this sort of stuff, and then we slack it.
We spend, you know, the equivalent of a half of an aircraft carrier on bio-defense when issues involving bio-defense have been responsible for far more deaths than all the wars put together in the last century.
And we are looking at putting an advisory group together on this global center, and we would love to have you be a part of it, if you are interested.
I would love to be.
I'd be honored to be a part of it.
Obviously, I'd be happy to help in whatever way you think I can.
This is an issue I care deeply about.
- It's an urgent need.
- Yeah.
And we obviously saw how close to the edge we have been.
- One time we're not gonna be that lucky.
- Absolutely.
To the future! - To Centivax! - To Centivax! The victories that you get, they're important to celebrate.
That's what fuels us.
I had a career in the first world in the pharmaceutical industry, where there's a focus on markets that have a lot of money.
But if we really are serious about creating cures, and vaccines can be cures, unlike many other types of medicine, then we need to finish the job, and the way to do that is to subsidize its release globally.
I always wanted to be a scientist.
I like the idea of science, but I think I never really knew what that could mean.
I feel like I'm really able to make a difference and maybe surmount a problem that was previously insurmountable.
Our success has been because I've a lot of brilliant people like Sarah, who are willing to go tackle these new classes of problems and not be afraid of the past.
There are many scientists who said, "Hey, you're never gonna get to the Moon.
No one's done it before.
" And, luckily, there are always voices in humanity who ignore voices from the past because, ultimately, those voices will always be wrong because humans are moving towards a greater future.
That's it.
In order to maintain my health, in order to find a lifestyle that I can balance, I have to leave Jefferson County.
- No? All right.
- I don't think so.
I know that someone will come up behind me and continue the work.
I just decided it can't be me.
Nothing spectacular here, but you may work a little bit.
Um Miss Reynolds is in 2C.
She's a hip fracture.
She is The bottom line is I can't continue to work 24, 36, 72-hour shifts and be healthy.
I think their plans are to bring in two doctors to do what I was doing, 'cause the model's not working.
- Love ya.
- Love you, too.
But truly, this is a great hospital.
It's a beacon for the community.
So that was really a difficult decision to make, to leave Jefferson County Hospital.
My husband and I are going to work really hard on our relationship and reconnecting with each other.
Place is so pretty.
She's beautiful.
I wanted to be "the guy.
" I had the attitude that I could do it all, and I enjoyed doing it all for a while.
Now, that's come to an end for me.
Can you give that to him? And I fear that if other physicians in rural areas are experiencing the same sorts of stresses and the same sorts of fatigue, that rural medicine as a whole is going to be depleted.
It's gonna take a plan to be in place and, now, I don't think we have that plan.
Good morning, everybody.
We'll go ahead and get started.
The CDC estimates that flu has caused as many as 29.
3 million illnesses, 394,000 hospitalizations, and over 35,000 deaths just this season.
It has been a mild season, luckily for us, this year, and from a city, state, and national perspective, with flu activity decreasing generally all around, we've opted to deactivate our system seasonal flu activation calls.
So, with that, I would like to first express my thanks to everybody that has been with us on a weekly basis for this protracted and long seasonal flu activation.
Thank you all for your time, and we will see you next year in the next activation meeting.
Take care, everybody.
Open your mouth.
Good job.
Just like that.
- Go pick out his book.
- Mommy, turn the lights off.
No, Omar's using his toothbrush right now.
Why are you sitting in the sink like that? When I think about my two boys and my little girl that's now on the way, and the future that they'll have 10 to 15 years from now, I want my children to grow up in a world where they don't have to think about this as constantly as I do.
Failure to take this as a global crisis will have dire consequences.
We're all in it together, and the greater our complacency, the greater the crisis will be.
How are you, Mr.
Rajkumar? Okay, he's not getting a fever, right? - He had fever yesterday.
- About 99.
99 is It never went above 99.
Rajkumar, it was a very gradual journey.
It was a very challenging case, very challenging case, because he had come in a very bad state.
Our patient is much better after coming here.
I think he needs a little family support.
He's been alone for so long I'll move him into the ward today.
He will be with you all in the ward.
Keep pen and paper handy, so he can say what's on his mind.
He can write it out.
Because, look - He escaped from the jaws of death.
- Yes.
Then, what's the problem? If it's not destined, even if you keep him within the ICU walls, you can't do anything.
If it wasn't his destiny, then would he come this far? So he'll stay in the ward for a couple of days.
- Okay.
- Okay? On Sunday, I didn't come to the hospital, but I tend to follow patients, so I called him I called the resident on duty, and he told me that he's gone home and he was very happy.
So it was very, very satisfying.
He was so happy that he'll be able to attend his daughter's wedding.
Rajkumar basically stayed in the hospital for 22 days.
In my opinion, they should go all out.
He has a new lease of life.
Vijay is a true doctor.
He's excellent.
Vijay is more than a doctor.
He is God's incarnation.
For us, he is that.
I try to save every case of swine flu.
But when you step into the battlefield, you cannot win every battle.
There is still a lot to be done regarding the swine flu.
The government is trying, the doctors are trying, but considering the doctor-to-population ratio, we still have a lot of things to be done.
- Peter, hey.
- Oh, hi, Dennis.
I thought maybe we could talk a few minutes about our visit to China.
And in particular, the graphic that At some point in time, there will be an event where an emergent virus, like the 1918 virus, will emerge and will spread around the world.
And we're talking about the wellbeing of seven-plus billion people.
Policy makers and planners, global health leaders, they should be thinking about this in serious terms.
We have to be prepared.
We have to be vigilant.
So a little bit about core structure and what to expect, so this morning I am not one to back down.
Flu will be back again next year.
We will fight against it again.

Previous Episode