Dennis Carroll is the former USAID Director for the Pandemic Influenza and Other Emerging Threats Unit. He currently works with The Global Virome Project, an international initiative that seeks to proactively identify, prepare for, and stop viral threats before they become pandemics.
What We Discuss with Dennis Carroll:
- What’s the difference between an epidemic and a pandemic?
- Why the occurrence of a future flu epidemic is not a matter of if but when.
- Vaccine hesitancy (e.g., “anti-vax” hysteria) is one of the top 10 health threats in the entire world.
- What can we expect from — and how do we prepare for — a worst-case pandemic scenario, and how worried should we be about the current coronavirus threat?
- Why our incursions into wildlife populations expose humanity to greater health risks than ever before.
- And much more…
Like this show? Please leave us a review here — even one sentence helps! Consider including your Twitter handle so we can thank you personally!
Between 1918 to 1919, the H1N1 virus infected about a third of the world’s population and resulted in at least 50 million deaths. So when it’s a hundred years later and the evening news makes us aware of the latest viral outbreak happening somewhere on the planet — whether it’s coronavirus, Ebola, SARS, MERS, Zika, or a new strain of bird flu — it’s natural to wonder if it’s just another media-fueled scare or a genuine cause for alarm.
On this episode we’re joined by Dr. Dennis Carroll, former USAID Director for the Pandemic Influenza and Other Emerging Threats Unit, currently working with The Global Virome Project — an international partnership that aims to identify and halt the spread of the world’s unknown viruses with a proactive, rather than reactive, approach that might just put a cap on the Pandemic Era. Listen, learn, and enjoy!
Please Scroll down for Featured Resources and Transcript!
THANKS, DENNIS CARROLL!
And if you want us to answer your questions on one of our upcoming weekly Feedback Friday episodes, drop us a line at firstname.lastname@example.org.
Resources from This Episode:
- Pandemic: How to Prevent an Outbreak
- The Global Virome Project
- The United States Agency for International Development (USAID)
- PREDICT Project
- Scientists Were Hunting for the Next Ebola. Now the U.S. Has Cut Off Their Funding. The New York Times
- How Does the New Coronavirus Compare with the Flu? Live Science
- Deadly Immune ‘Storm’ Caused by Emergent Flu Infections, Science Daily
- 1918 Pandemic (H1N1 Virus), CDC
- How the Horrific 1918 Flu Spread Across America, Smithsonian Magazine
- Ethical Lessons from the 2009 H1N1 Pandemic, The History of Vaccines
- Historic Congressional Cemetery, Washington, DC
- “Only Thing We Have to Fear Is Fear Itself”: FDR’s First Inaugural Address, History Matters
- Misconceptions about Seasonal Flu and Flu Vaccines, CDC
- Why You May Still Get Sick After a Flu Shot, Verywell Health
- 11 Flu Shot Side Effects You Might Mistake for Being Sick, Men’s Health
- How Anti-Vax Activists Use Conspiracy Theories To Spread Fear Of Vaccines, Forbes
- Autistic People Say Anti-Vax Misinformation Is Only Making Matters Worse, BuzzFeed News
- Vaccine Hesitancy Is a Global Public Health Threat. Are We Doing Enough about It? Elsevier
- Polio Timeline, History of Vaccines
- NIH Begins First-in-Human Trial of a Universal Influenza Vaccine Candidate, NIH
- We Don’t Have Enough Masks: Pandemics Will Require Deciding Who Needs Respirators and Surgical Masks, and Who Doesn’t. The Atlantic
- “Insanity Is Doing the Same Thing Over and Over Again and Expecting Different Results,” Quote Investigator
- What the Plague Can Teach Us About the Coronavirus, The New York Times
- Vaccine Rejection and Hesitancy: A Review and Call to Action, Open Forum Infectious Diseases
Transcript for Dennis Carroll | Planning an End to the Pandemic Era (Episode 320)
Jordan Harbinger: [00:00:03] Welcome to the show. I'm Jordan Harbinger. As always, I'm here with my producer, Jason DeFillippo. On The Jordan Harbinger Show, we decode the stories, secrets, and skills of the world's most brilliant and interesting people and turns their wisdom into practical advice that you can use to impact your own life and those around you. We want to help you see the Matrix when it comes to how these amazing people think and behave. We want you to become a better thinker. If you're new to the show, we've got episodes with spies and CEOs, athletes and authors, thinkers and performers, as well as toolboxes for skills like negotiation, public speaking, body language, persuasion, and more. So if you're smart and you'd like to learn and improve. You'll be right at home here with us.
[00:00:41] Today, a world-renowned expert on infectious disease, Dennis Carroll is here with us. We're talking about influenza, both the seasonal flu and the big deal, new and novel would- be plagues that are mostly plaguing your social media news feeds for now. I'd love to have done this one in person, but this guy chases the flu around the world, so maybe not. We'll discuss why our incursions into wildlife populations expose humanity to greater health risks than ever before. And why something as mundane sounding as the flu is in all likelihood, the next global pandemic that will kill hundreds of millions of people, both at home and abroad. Of course, what we're doing to prepare for this and mitigate the damage -- spoiler alert, not nearly enough -- and what you can do to make sure you're helping do your part to make things better for yourself, your family, and if the whole planet. If you've been watching Pandemic on Netflix or you've been wondering what's up with the coronavirus, Ebola, and all the other headlines, this episode will set you straight.
[00:01:36] If you want to know how I book all these amazing guests, it's all about the network. It's worked in my personal life, my business, and of course, everywhere in between. Check out our Six-Minute Networking course, which is free over at jordanharbinger.com/course. And by the way, most of the guests on the show, they actually subscribe to the course and the newsletter. So come join us and you'll be in great company. Now, here's Dennis Carroll.
[00:01:59] Is it accurate to say that you travel around the world chasing the flu? That's kind of what it seems like.
Dennis Carroll: [00:02:04] Well, not just the flu, but largely emerging viral diseases -- flu, coronaviruses, Ebola, things like that. Usually trying to anticipate the new ones like this COVID 2019 -- where they might emerge -- trying to understand hotspots. There are certain places that are more likely to be places of new emerging diseases. How to bring greater focus onto those areas and try and have a leg up on what it might mean when something like this emerges, and to the extent you can disrupt it.
Jordan Harbinger: [00:02:38] Yeah. And we'll get into that. I definitely want to talk all about that. Why did they change the name from coronavirus to COVID 2019? What's the deal there?
Dennis Carroll: [00:02:46] Well, I mean, it's giving them a handle, sort of like MERS or SARS. Coronavirus is just a family name. Think of it as the Kennedy clan. Coronavirus, like influenza, is a family in which you have different varieties of influenza. Every year we have a different influenza flu, and those names are largely denoted by letters and numbers reflective of their architecture. So you have H1N1 or H3N2 influenzas.
[00:03:17] And then coronaviruses, when something new emerges, they try and give it a name that reflects its point of origin. In 2002, it was the SARS virus -- Sudden Acute Respiratory Syndrome -- reflective of its type of clinical manifestation. Then you had the Middle East Respiratory Syndrome -- MERS. And now you have this COVID, which is just Coronavirus Infectious Disease 2019, that's largely what it means.
Jordan Harbinger: [00:03:44] Got it. Okay. I wasn't sure if there was something more specific or maybe even more anecdotal about it. What do the Hs and Ns mean? For us laymen, we kind of blend them all together. Like I've heard of H1N1, but when I see H6N4, it doesn't mean anything to me other than "Have I heard this a lot on the news lately?" Other than that, it doesn't mean anything.
Dennis Carroll: [00:04:06] It's two different structural domains within the virus that speaks to certain of its functions. And so you get different combinations of these different domains -- the H domain, the N domain. And they are constantly what are called reassorting among influenzas. Influenzas are among what you would think of as the most promiscuous of viruses. When you get two different influenza viruses together, they will swap genetic material and that's what makes them so extraordinary because the swapping of genetic material means that they will acquire certain genetic features from other influenza viruses or they'll share certain genetic features with others. So some influenza viruses are very, very well equipped to infect humans. Others are not. When they exchange genetic material, one that previously had not been able to infect the human may now acquire that ability to infect but others may be incredibly lethal.
[00:05:12] So for instance, H5N1 that had everyone's attention 15 years ago, the avian flu virus. And every once in a while, that virus would find an unlucky soul that it would successfully infect. And when it infected someone, there is a 60 to 70-percent chance they die -- very, very, very lethal. But what it had a real problem doing, and still has a problem doing, is efficiently infecting, and one of the things you would be really worried about or we are worried about is that if an H5N1 virus were to commingle with a seasonal flu virus, which is always an efficient infector, and if it was to commingle with that, they may swap genetic material and that H5N1 may end up picking up that part of the genetic domain within the seasonal flu virus. That makes it such an efficient transmitter, then it would have not only efficiency and transmission but very, very lethal in terms of its infection.
Jordan Harbinger: [00:06:15] So it's [when] the highly infectious flu sort of breeds or commingles with the deadly flu, we end up with a massive problem? Because right now it sounds like seasonal flu, often hit or miss, maybe two billion people get infected with it, but they get the flu, they get better, and they're fine. But if one of these super deadly flus that so far just happens to be difficult to kill someone or low morbidity --
Dennis Carroll: [00:06:38] Low transmissibility. So the term morbidity has to do with the severity of the illness, and it can be very severe and deadly. So again, H5N1, 60 to 70 percent of the people who are infected by it die. But it's very rare that someone is infected by it. It sweeps through poultry populations. It's highly infectious within poultry -- chickens, ducks -- but it doesn't have what are called receptors, sort of proteins -- because it's the respiratory virus, they bind to your cells in your upper respiratory tract, that's when you inhale it. They just don't have the efficiency of binding. The seasonal flu is very, very efficient. And so every year, you know, you get a version of the seasonal flu that sweeps around the world infecting people. That's very efficient. So you always worry about something that's incredibly deadly but is just totally inept when it comes to infecting people, acquiring that genetic domain that the seasonal flu has.
[00:07:48] And so if you have a really unlucky person who is infected with the seasonal flu and then becomes exposed to say, H5N1 and gets simultaneous infection with an H5N1, then there's a real risk of in your cells, the H5N1 virus replicating in your cell at the same time there's an H1N1 seasonal flu virus replicating in your cell, and they swap genetic material: Bingo. You're in trouble. "You" on the global sense, not that individual. That individual would have already had a high risk of death because it had the H5N1, but the people around that individual now are vulnerable to being infected, and then we're in deep kimchi.
Jordan Harbinger: [00:08:38] Right. That makes sense. Yeah, we're in deep kimchi. Right. Okay. So I misspoke before. So what we're trying to avoid -- which is impossible -- is the super deadly flu picking up the traits that make it highly contagious. Because right now, in the last few years, we've seen highly contagious flus, which are pain and you know, kill some people, but not nearly the amount that a highly deadly flu would kill. Is it right to say we've just been lucky enough that some of these really, really deadly flus are really, really hard to get and have not as of yet, taken on the characteristics where I shake hands and get it, and then I've got a 70-percent chance of dying?
Dennis Carroll: [00:09:10] Exactly right. And it's a bit like going to Las Vegas -- it's an issue of probability. So if you go to Las Vegas and you have an infinite number of slot machines and an infinite number of quarters, and you throw those quarters in, what's the probability of getting three cherries? Having that infinite number of slot machines doesn't change the probability, but it does change the frequency with which it happens. So what you're concerned about is that the more of these viruses you have circulating, if you start moving from just a handful to thousands or millions or trillions of these viruses, it's like you're moving into an infinite number of slot machines. Because at some point that changing the genetic sequences is a bit like trying to get the three cherries.
[00:09:57] One of the goals we have in the work that we do is trying to keep the overall number of these viruses as low as possible so that the frequency with which they acquire these three cherries is really minimized.
Jordan Harbinger: [00:10:15] That makes sense. So when you're tracking and trying to prevent emerging viral threats, the emerging viral threat is not some new disease that no one's ever seen before and never heard of, and it's totally alien. It's often a mutation on something that we already have that we just don't want to become more deadly/more contagious or both?
Dennis Carroll: [00:10:33] No, it's really both. I mean, for the influenza family, we know that there are different combinations of influenzas out there that potentially become very deadly, but they have the deadly feature, but they don't have the transmissibility feature. So you're concerned about those features changing, getting highly transmissible and being deadly. But then we also have literally tens, if not hundreds of thousands of viruses circulating in their natural habitat. And their natural habitat is, in fact, wildlife animals, and they're circulating largely without consequence in wildlife animals. Wildlife animals have learned to adapt to those viruses by and large, and they circulate and they don't pose any issue to us because they're in wildlife. But every once in a while, wildlife animals will become proximal to people or to livestock and the virus that's in that wildlife animal has an opportunity to -- what we call -- spill over from the wildlife.
[00:11:41] The thing about viruses is that they're always -- sort of a Darwinian directive for all life, including humans, is diversify your ecosystems because if you have only one ecosystem that you're dependent on, and that ecosystem gets wiped out, then you go extinct. And what you're always trying to do is to hedge your bets and be adaptive to as many ecosystems as possible. So humans, Homo sapiens, originally we were limited to parts of Africa, and then we began to migrate out and we diversified our habitats rather remarkably. We're all over the planet and Jeff Bezos and all that are looking to get us out to Mars and beyond, you know, they're also trying to diversify our habitats. Viruses do the same thing. If they only exist in a particular wildlife species, and that species moves towards extinction, then they're gone, and they're always trying to move from one animal species to another. And so when these wildlife reservoirs for viruses bump up against another species, that virus will test its luck and see whether or not it can further expand its ecologic niche.
[00:12:59] Humans are within that domain. And so whenever there's a chance for a virus to jump to livestock or jump to humans, they'll give it a try. And if it successfully adapts and is able to circulate and thrive in that ecosystem, so be it, but there is not infrequently the consequence to that species that just got infected, the risk of severe illness and death.
Jordan Harbinger: [00:13:24] That makes sense. Okay, if that wasn't scary enough, it gets a little scary even from here. And you said in one of your talks, it took humanity 400,000 years to get to a population of one billion, and then it took another hundred years or so to get to seven billion. And I'm paraphrasing, so I could have the numbers a little bit off.
Dennis Carroll: [00:13:42] No, I mean, as a species, it took us somewhere 300,000 or 400,000 years to hit the billion mark. A hundred years ago, there were 1.8 billion people. So in one century, 100 years, we added another six billion. So even if it took us 300,000 years to hit the billion mark, we've been able to add six billion years in just 10 decades.
Jordan Harbinger: [00:14:04] That's six billion people.
Dennis Carroll: [00:14:05] Yeah, so we're at 7.8 billion, and by the time we get to the end of this century. We're going to be right on the edge of 12 billion.
Jordan Harbinger: [00:14:15]. Oh, my God.
Dennis Carroll: [00:14:16] And so this is where that footprint that we have on this planet has become incredibly disruptive because as we have more people populating the earth, we're moving further and further into ecologic domains that largely had been free of human populations, but they are been rich in wildlife. And we're now moving into areas and we're starting to interact with wildlife species, or our domestic animals are interacting with those wildlife species with increasing frequency.
[00:14:53] And so what we've documented quite well is that over the last several decades, as this population pressure and expansion into wildlife domains for settlements, for establishing outposts, for extracting natural resources, for agricultural purposes, that more in more spillover of these long existent, but unknown viruses in animal populations -- wildlife -- are making their way into domestic and human populations, and we know that that is accelerating and intensifying. So the events of this coronavirus, which previously existed in wildlife spilled over into people. We're not sure what the wildlife reservoir is at this point. Retrospectively, we'll find it. We found very similar genetically, very similar viruses in China in bat. So it could be that bats were the primary reservoir for this, but that said, as we move further into the century, these kinds of events -- what we're seeing play itself out in China right now -- happened with greater frequency.
[00:16:09] So as I've said, there are hundreds of thousands of these viruses circulating in wildlife that had the potential to infect people. We're going to become increasingly more familiar with what those viruses look like because spillover will happen, little intensifying, and sometimes there'll be no consequence whatsoever -- not all viruses make you ill -- but there's a subset that will prove to be highly lethal, such as this coronavirus. So it's part of our future. The 21st century is unprecedented in terms of the frequency and the intensity with which we're going to have to struggle with these issues.
Jordan Harbinger: [00:16:48] You'd said we can't have this type of population growth without seeing impact at the epidemic and pandemic level, but what is an epidemic/pandemic? How are these different? What is the difference between a pandemic and epidemic and a global epidemic?
Dennis Carroll: [00:17:02] Sure. Well, a global epidemic would be, by definition, a pandemic. So an epidemic largely means it's a disease outbreak that is geographically limited. Think of the Ebola epidemic in West Africa, that was largely limited to the three primary countries, Liberia, Sierra Leone, and Guinea. Even as it made its way to Dallas, it never established itself for further transmission. So it was largely, the transmission was limited in a geographic area, and it's the nature of some of these viruses that they can't transmit that easily. So that they're always going to be viruses that will have epidemic events, but never really pose a pandemic risk.
[00:17:50] Respiratory viruses such as influenza and coronaviruses, however, are much more readily transmissible. These are the two viral families that we are particularly concerned about as being the source of future pandemics. That is it will spread around the world and pose a global risk. The strict definition of pandemic that the World Health Organization uses is when a virus spreads and is having sustained transmission in at least two continents on the planet.
Jordan Harbinger: [00:18:24] Got it. Okay. Yeah, that was a little confusing and I thought it makes sense to clear that up because I feel like the words are used interchangeably and that's not quite correct.
Dennis Carroll: [00:18:31] A lot of people use them interchangeably, so an epidemic is sustained transmission in a limited geographic area. Pandemic is when a microbe -- it may be a virus or it may be a bacteria -- has sustained transmission in at least two continents.
Jason DeFillippo: [00:18:52] You're listening to the Jordan Harbinger Show. We'll be right back.
Jordan Harbinger: [00:18:56] This episode is sponsored in part by Oura Ring. I love this thing. I can't even believe they fit all this into a ring. It's a ring that looks like a regular ring, but it's actually a fitness and sleep tracker. And what I like about this, yes, I have my sleep tracker watches and my fitness watches and all that stuff, but the Oura Ring is by far the most accurate. My watch thinks I'm asleep whenever I'm not moving or whenever I'm lying down. The ordering is really good at getting different phases of sleep. It can tell you when you're in REM sleep when you're in deep sleep. It's just so much more accurate as far as activity is concerned and amazingly, it can give you cool recommendations like, "Hey, you didn't have this much REM sleep. Did you have caffeine later in the day? You're falling asleep at this time. When you go to bed at this hour, your sleep quality is a little bit lower. Try going to bed earlier or try waking up at this hour." It's been really good with the recommendation. So long time use of this Oura Ring is working out well for me. And the next chapter of my life here at parenthood, the sleep pattern is totally changed, so it's not just like, "Hey, sleep more." I need to be able to kind of tweak stuff here. So if you're into the sleep tracking, if you're really interested in this, I would recommend the Oura Ring. Jason, I know you've got one of these too.
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Jordan Harbinger: [00:22:49] Now we've had flu epidemics before, and you said in the Netflix special -- where I found you -- Pandemic that there will be another flu epidemic. It's not a matter of if, but when, and this is more scary than conventional warfare. I know that we were talking about the flu before and how it takes just one person to cause an outbreak simply because one person can incubate the super contagious with the super deadly and then spread it from there. Why will there, for sure, be another flu epidemic? What is it about the flu that makes it spectacularly dangerous compared to other types of diseases, or is that just what we're seeing in the news now?
Dennis Carroll: [00:23:28] First off, influenza virus is very easily transmittable. One, it has a human-to-human transmission. We know that for every individual that gets infected, they will infect between two and three individuals. It's self-sustaining. It's a rock rolling down a hill because all you have to do is sneeze, cough, and people sitting around you have a high vulnerability of being exposed and infected. So when you get an influenza virus that has the kind of genetic profile that makes it highly transmissible, it will move very quickly.
[00:24:03] Secondly, influenza viruses, as I said, they are incredibly promiscuous and are constantly changing their genetic profile, which means that they evolve and are able to emerge with a whole new set of physical characteristics, which could make it lethal and transmissible. And our body has never seen it before, has never seen, doesn't recognize it in terms of past exposure. Even though we get influenza every year, our natural immunity is very much dependent on responding to things that are familiar. So when we get infected by a particular virus -- if that virus comes back and infects in the future, our immune system is prime. That's why you use vaccines. Vaccines are intended to prime your immune system to be able to ward off. Any future infection from that disease. For instance, measles, you get a measle vaccination. Your body is now armed that anytime you see or exposed to a measle virus, your body recognizes it and essentially protects you against it.
[00:25:19] Influenza viruses are constantly changing those -- their signature, if you will -- so you're body doesn't recognize, but the last virus was or the next. The new virus is always a little different than the last virus. So because of that, your immune system, influenzas are always infecting you and you are what to call an immunologically naïve. You are vulnerable to an infection and when a pandemic virus -- what's different about a pandemic virus from a seasonal flu virus? Seasonal flu viruses are ones that we've been exposed to. They've already had past record of infecting people and they will continue to circulate in the ecosystem and come back every season. And there are ones we called H3N1, H1N1 that every year they come back in some combination to cause seasonal flu. And that's what you get the vaccine against as a slight variation. And each of those every year that you need to get vaccinated against, but we recognize it and you can build up a vaccine -- vaccinated population to protect against the worst consequences.
[00:26:30] A pandemic virus is one that now is totally new. It's not circulated among humans before. We get exposed to it and it's the first time our body has ever seen it. We don't have natural immunity of any kind, and we don't have a vaccine against it because we've never seen this particular virus. So we weren't able to be forewarned and as a consequence forearmed. So a new influenza virus that is transmissible and is deadly, that is what will then sweep around the world as a pandemic.
[00:27:06] And there's another difference between pandemic viruses and seasonal that it the people that are most vulnerable. Seasonal flu, it's elderly and the very, very young that is people whose natural immune system is underdeveloped as they are in very young children or diminished capacity as we find with elderly. Those people aren't able to mount a sufficient immune response, even against a somewhat familiar seasonal influenza. A brand new pandemic influenza, one we've never seen before -- combinations of these H's and N's -- our immune system doesn't recognize it and isn't able to mount an appropriate immune response.
[00:27:54] In fact, one of the problems with the pandemic virus is that it frequently over activates the immune response. And so when you look at the people who die from a pandemic virus, it's less the very old and the very, very young, and it's the middle-aged, healthy people. Someone like you, Jordan, that I presume is a healthy guy. You have a healthy immune system. What would happen if you were infected with a pandemic virus is that your immune system would get hyperactivated and would go nuts. And when it gets hyperactivated, it starts essentially destroying your own organs and cells and starts attacking everything and it just goes crazy. There's a term for it. It's called a cytokine storm, and we frequently see that the major cause of death for pandemic viruses are young, healthy people who've unleashed this hyperactive immune response that is just as unregulatable.
Jordan Harbinger: [00:28:56] Wow. So that's terrifying because I think a lot of people go, "Ah, well, you know, this is going to happen in China or India, and there's going to be -- it's all dirty and they're poor and they're unhealthy, so it doesn't matter." But no, it actually is going to affect people like us here in the Western world just as much, if not more, because it's using our own defense mechanisms against us.
Dennis Carroll: [00:29:16] Yeah. So the big difference between pandemic and seasonal influenza viruses is the healthy middle age are the most vulnerable for a pandemic virus. So when you talk about 50 or a hundred million, it's people who might die. It's 50 or a hundred million people in their 20s, 30s, 40s. The societal impact above and beyond is just sheer mortality associated with it. The societal impact is just devastating.
Jordan Harbinger: [00:29:47] Some people think all we have to worry about is the seasonal flu. We've kind of established that that's not true, but people will say things like, "Ah, massive pandemic. What are the odds? It's never happened before," but it has happened before. For example, the 1918 flu, at the end of World War I, soldiers were spreading the virus and we had -- was it 50 to a hundred million deaths back then?
Dennis Carroll: [00:30:06] It was 50 to a hundred million deaths when the world's population was 1.8 billion, so think about it today.
Jordan Harbinger: [00:30:13] Right, and now we have population movement that's much more frequent. So special pathogens and outbreaks in remote areas are like a hop, skip, and a jump, one flight away from London Heathrow to Chicago O'Hare.
Dennis Carroll: [00:30:25] Absolutely.
Jordan Harbinger: [00:30:26] There's like -- what was it -- 3,000 commercial flights pass through New York City alone every day. So one person with an avian flu could spread it to somebody and then suddenly it's in New York within 24, 48 hours.
Dennis Carroll: [00:30:37] Absolutely. Absolutely. So not only are there six billion more people on this planet than there were in 1918, the speed with which people move around the world is staggering. It was the pandemic of 2009 that was a novel H1N1 virus that emerged in Mexico and then swept around the world. And you can look, there are these nice maps that show the speed with which the virus moved out of Mexico and largely by air, swept around the world. It was first identified in April. By the end of June, it was virtually on every continent on the planet.
Jordan Harbinger: [00:31:23] Wow, that's incredibly --
Dennis Carroll: [00:31:25] Fast.
Jordan Harbinger: [00:31:25] -- terrifying, yeah, fast.
Dennis Carroll: [00:31:27] It is fast. So the speed with which an influenza virus can move is staggering, far faster than we can respond. And that's the issue is that we know that these viruses will emerge. We know that it is inevitable. Our preparedness is really woefully lacking. And if a 1918 virus were to emerge today, we would see the impact on numbers far greater than what we saw at 1918 even in 1918 when they didn't have the benefits of vaccines. We didn't have mass production of vaccines. We didn't have vaccinations at all. We didn't have antibiotics. Many of the deaths associated with pandemic influenza are also associated with secondary infections from bacteria. So as you're struggling with the influenza virus, your whole system begins to collapse and then bacterial infections will further amplify your clinical situation. And you'll see that maybe half of the deaths ultimately were due to bacterial infections. Where a virus to emerge today, let's say April of 2020, similar is it emerged in 2009 within one year, a year later, two billion people would likely be infected, and if it were as lethal as the 1918 which had a mortality rate of three percent that is for every 100 people that were infected, three people of those would have died. When you've got two billion people better infected, three percent mortality, you're talking about hundreds of millions of people.
Jordan Harbinger: [00:33:12] Oh my God.
Dennis Carroll: [00:33:12] And that virus spreads far faster than our ability to produce a vaccine. So if people say, "Well, this virus will emerge. It'll spread, but we'll just vaccinate and we'll be fine." We saw that even though it emerged in April of 2009 despite the very best efforts of the global community to produce and mass manufacturer an effective H1N1 vaccine, we didn't have production of that vaccine largely until late September, early October and the United States, we didn't get our 58 millionth dose until December of 2009 when already more than a quarter of the population was infected and it was well into the fall wave. By the time it spreads around the world, we're going to just begin to get enough vaccines to protect only a quarter of the world's population.
Jordan Harbinger: [00:34:12] That's terrifying. And so of course, the death toll will be much, much higher, as you mentioned that in the hundreds of millions. And that's with three percent morbidity, right? So if we have something that's like --
Dennis Carroll: [00:34:21] Mortality.
Jordan Harbinger: [00:34:22] Oh, is that different? Okay.
Dennis Carroll: [00:34:23] Mortality says you're dead. Morbidity says you're sick.
Jordan Harbinger: [00:34:28] Okay. I did not know that. That's good to clarify. So if we have something that is much deadlier than we're talking about -- I mean, look, I don't need to exaggerate this. Hundreds of millions are already bad enough. I guess I can move on. I don't really need to like -- no need to put a cherry on that one. In addition, you'd mentioned that we'll have economic and societal disruption, so if everybody's sick and everybody's massively infectious, we're not going to have people going to the power plant. We're not going to have people at the wastewater treatment plant. A lot of infrastructure is going to go down. So people will start to die from other very preventable things like violence, sanitation issues, heat, cold, things like that.
Dennis Carroll: [00:35:05] Well, and they're also going to die from all the other health issues that you're struggling with before the pandemic don't suddenly disappear. People are still going to be struggling with normal health issues. People with chronic illnesses that may have cardiovascular diseases or diabetes who may be say infected with HIV and required routine with antiretrovirals. There's a real vulnerability that the health system will collapse because the health workers are going to be sick. And so people's ability to get access to medical care for the routine things -- women who were going to be giving birth. Where is the maternity ward going to be? This is going to be a real issue.
[00:35:46] It's worth noting though that when you talk about a pandemic virus weeping into a community, you're talking largely what's thought of in terms of waves, that if you're in Los Angeles right now and if there was a pandemic happening, it doesn't happen everywhere at the same time, and there are waves of influenza virus that will sweep across the community. And there's typically about a two to four-week period when this massive event is playing itself out, and then it's over.
[00:36:19] Just while I was working on the Netflix piece, I went to a local cemetery here in Washington up on Capitol Hill -- it's called, it's the Capitol Hill Cemetery. And I went back into their records. They had burial records for 1918 and I was curious as to what that looked like. And what you saw -- and when I looked in June, July, August, early September -- people were dying from tuberculosis. They were dying from dementia and whatever. And then by the end of September, you started seeing flu deaths. By the middle of October, everything was a flu death, and the numbers were staggering. And by the beginning of November, the flu desk began to dramatically diminish and normal causes of deaths were being registered as the primary cause of death. So there's this one month period when you're, it's hell. And that's where it gets really intense because it's an intense period when health systems are incredibly overwhelmed and the workforce in that period -- as you just mentioned -- is going to be really challenged because of illness. So critical life-saving, life-needed services from hospitals to police two, the electric grid, telecommunications, food transport -- all of that is going to be incredibly challenged and we know that. And then once that wave passes, you have to build all of that up again.
[00:37:52] So when you talk about how do you prepare for a pandemic, it's not just how you mobilize the health system to be able to properly treat infections, but also how you protect the health workers to be able to ensure sustained health systems for other critical issues. We also need to say, what's our plan B for how we're going to ensure the power grid stay on, how are we going to ensure there's food, how are we going to ensure that their safety and security. And we have to have that thought out beforehand. You can't make that up on the fly in the midst of a crisis of this magnitude.
Jordan Harbinger: [00:38:31] Yeah. That seems like something we should have planned out ahead of time. I know a lot of people are saying, "Eh, this is overblown. It's fearmongering. This is fake news. It's social media causing a panic." What are these people right about and what are they wrong about?
Dennis Carroll: [00:38:46] Well, I mean, the big issue is that there is an element of fearmongering in there, which is unfortunate. The truth is that these are deadly events. So let's talk about this coronavirus circulating in China right now and potentially on the verge of breaking out around the world. The biggest problem you have with an event like this coronavirus and it's the same thing that happens during the early stages of an influenza pandemic, is that there are more questions we don't know than we do have answers for. And in that space of known versus unknown, people start making up answers. And so there's a lot -- as you called it fake news -- there is an enormous amount of misinformation which is likely to play itself out. And there's a tendency that when misinformation is spread, it tends to be the worst kind of messaging, either provoking fear or telling people this is just not a real threat. So you have both extremes at work. Professional communicators have a responsibility -- people like yourself -- and the newspaper is making sure that accurate and informed information is what dominates the airwaves, the newspapers, television, everything. And that's a challenge how to get the right information out. Franklin D. Roosevelt really summed it up very nicely when he was talking about the depression, you could have just as easily have been talking about a pandemic event, which is that you have nothing to fear but fear itself. Fear itself can be the most damning consequence of a pandemic.
Jordan Harbinger: [00:40:19] A lot of people say things like, "Oh, I don't get the flu shot because it causes the flu," or, "I'm afraid I'm going to get the flu because of that." Is it just confirmation bias where people think they're getting the flu from the flu shot because they remember it happening once, somewhat in the same timeframe.
Dennis Carroll: [00:40:33] Well, you know, again, what's the flu shot? The flu shot is essentially trying to prime your immune system to be able to react strongly and appropriately against a future infection from the influenza virus. So when you get the flu shot, you get a momentary period where your immune system may start acting up a bit. So people may feel a little uncomfortable, but it's incredibly transitory and it's an inconsequential thing. You don't get the flu. You just may feel a bit uncomfortable, but it's a small price to pay when that does happen, and again, some people have that adverse effect.
[00:41:12] Every vaccine has some kind of adverse effect, but the reason you're using a vaccine is that the thing you're vaccinating against, whatever the adverse effect is, it's incredibly negligible compared to the risk of what it is that you're vaccinating yourself against. So when people refuse to let their children get measles vaccine -- I mean, it's stunning because they have the perception that there's adverse effects associated with the measles vaccine. The whole issue about autism is just an absolute falsehood for people to believe that. And then to put their children at risk for an infection as serious as measles is truly criminal behavior. You're really putting the lives of young children at incredible risk of severe illness and lifelong consequences. And it's just frightening when you see that happening.
Jason DeFillippo: [00:42:13] you're listening to the Jordan harbinger show. We'll be right back after
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Jordan Harbinger: [00:47:13] Speaking of anti-vaccine lunacy. Why can't we eradicate influenza? Like we had mostly done with the measles up until, of course, people decided they were going to rub peppermint oil on their kid's forehead, whatever the hell, you know? I know vaccine hesitancy is one of the top 10 health threats in the entire world, according to the UN, which should be scary to everyone. Like this thing where somebody watches YouTube and then creates one of the top 10 threats to humanity in the entire planet. That's really one of the dumbest things, I think is our generation.
Dennis Carroll: [00:47:46] Yeah, and it's really unfortunate because the dream of all of these revolutions in the information technologies was that the opportunity to not only unite people but to make people better informed. And little did people anticipate just how much a double-edged sword all of these extraordinary advances in information technologies we're going to be and how they can be taken over by people who basically are committed to misinforming and creating mistrust and fear for things that we should be thankful for. We live in a time where the power of vaccination has made life a far less dangerous experience. It's really hard to remember, in the United States, when the fear of diseases like polio swept across the country because polio was such a damning disease. I grew up in a family -- my oldest brother had polio and he was crippled for his entire life. He's still alive, but he's in his very late 70s now, and he's paying this lingering consequence for polio survivors that he's still struggling with. And that was for the want of a vaccine. And when the vaccine became available in the 1950s absolutely extraordinary, revolutionary public health breakthrough, and that anti-vaxxers would throw us back into the days of polio sweeping across this country because of their absolute belief in lies and misinformation. It's just stunning to me.
Jordan Harbinger: [00:49:31] Why can't we eradicate influenza like measles?
Dennis Carroll: [00:49:37] One of the things I said about influenza is that they're constantly mutating, which means that developing one vaccine to deal with all influenza is incredibly difficult, and we have not been able to develop what's called a universal vaccine. Measles, on the other hand, genetically is very, very, very stable. And so the measles virus that circulates today is basically the same one 50 years ago. So you develop one vaccine, it's incredibly efficacious. So it's that issue about how changeable, how much mutations there are in the virus really determines how stable your vaccine efficacy might be. That's one of the reasons, for instance, it's been so, so difficult to develop a vaccine against HIV. Because it is constantly changing the makeup of its protein receptors that they have on the outside of the virus that a vaccine would recognize. Today it's red, tomorrow it's green. The next day it's yellow. That just constant shifting of its genetic signature. Changing structural properties of the virus itself makes vaccination incredibly, incredibly challenging. Some viruses mutate routinely, vaccines are really difficult. Others are incredibly stable. Rabies virus, remarkably stable. Yellow fever virus, remarkably stable, but things like influenzas are very, very, very mutagenic.
Jordan Harbinger: [00:51:18] People in California are worried about things like earthquakes, but how could we prepare for a pandemic? Do we need food? Do we need water? Do we need those breathing masks that we see people wear on airplanes? What do we do?
Dennis Carroll: [00:51:29] I mean, first off, the best prevention against infection is good hygiene, handwashing. If and when let's say this coronavirus makes its way to the United States, if it is not able to be contained in China, then handwashing and social distancing -- not finding yourself going to large gatherings with people. And then wearing an appropriate facemask makes a lot of sense, not so much that the face mask protects you. If the virus is circulating in the air, the face mask is largely porous to a virus. It's much smaller than the webbing of the face mask. But if you are infected or if someone next to you is infected, when they're sneezing and coughing and likely to expel the virus, they're going to expel the virus in droplets of spittle or mucus. And that right there is captured by the inside of the face mask. So, someone who's infected, they will protect against infecting other people. If they have a face mask on. So if everyone wears a face mask -- those who are not infected and those who are infected -- then the probability of you are getting infected by the person next to you, if they cough or sneeze will be zero or not zero, but it's going to be greatly, greatly reduced. And if you coupled that too, very good personal hygiene, washing hands, using sanitizers. Being careful about shaking hands and exchanging interactions with people, then you'll greatly reduce your risk of exposure and infection. And if you do get infected, you're going to greatly reduce the risk of your acting as a further spreader of the virus.
Jordan Harbinger: [00:53:14] Ah, that makes sense. Do you have a personal stash of emergency stuff? Do you have like a mask -- a hazmat suit in your garage and drugs or something like that?
Dennis Carroll: [00:53:22] I do have a face mask. So for instance, as you know, I just flew back from Southeast Asia, everyone on the airplane when I flew out when I went from the Hanoi over to Bangkok and then Bangkok out, everyone on the airplane was wearing a face mask.
Jordan Harbinger: [00:53:37] Yeah. I was the only person on the plane from San Francisco to Los Angeles wearing a mask, unfortunately.
Dennis Carroll: [00:53:43] Yeah, I mean, think about it, if the person next to you was infected and they didn't have a mask, not only they're sick, they are acting as spreaders. If they had a mask on, they're infected, but they don't become the source of further spreading of that disease. So it takes a community shared effort to be able to reduce the spreading of this virus. And so we always have to act in a way that not only is in our self-interest, but it's in the interest of the people next to us. Wearing masks, proper hygiene, it's a community good as well as an individual good.
Jordan Harbinger: [00:54:22] Now we're totally unprepared for this, and thankfully there are people like you who are working hard to one, generate awareness and two, help find a real solution. I think that you probably would agree -- you're underappreciated, but I think history will look kindly upon you for this. How can we prevent things like this? I mean, controlling a deadly virus and you said this in one of your talks requires moving from reactive to proactive because we know the virus moves from livestock into people and caretakers of animals are usually, I guess, patient zero is a, as you hear about in graphic novels or dramas, does that mean that we should be preventing this from transmitting from the animal to the person, like attack it when it's in the animal population before it gets into the human population?
Dennis Carroll: [00:55:04] Jordan, I'm going to hire you. You're right on top of it. That's exactly right. I mean, again, as I said whatever we've seen so far in terms of emerging viral threats, it will pale compared to what we'll see over the course of this century. Because as I mentioned, increasing population and encroachment in wildlife is accelerating the rate at which new emergent viruses will spill over into people. So it's going to be more and more part of our landscape. And so I'm part of a group that's called the Global Virome Project which is really trying to anticipate what the future is going to be. Looking at how these new viruses will emerge, and rather than do what we've been doing which is largely waiting for a new virus such as this COVID 2019 then react to it. We know that these viruses already exist and they're circulating the wildlife. So part of a proactive stance is to go out and begin developing a comprehensive catalog of what is circulating in wildlife. Understand where these viruses are, what's their geography, what animals they're in, and understand their proximity to livestock into people, and begin ranking of all these viruses in which have genetic properties or genetic pedigree that makes them potentials for future epidemic or pandemic risks and use that information.
[00:56:42] Think about this viral dark matter that's circulating out there and shine a light on it and use this information to better inform first and foremost, our ability to disrupt the spillover. It's not inevitable that these viruses move from wildlife into livestock or wildlife into people. It's a consequence of our bringing that heightened interaction as we expand our footprint. Let's pay attention to that. Use this information to identify where there may be hotspots, where these viruses are circulating in abundance in wildlife, and we see that the potential interactive dynamics between wildlife and livestock and people is consistent with enhancing spillover. Then let's get in there and disrupt that interactive dynamic. Lower the risk of spillover. But also bring heightened surveillance to these places so that if there is spillover, we pick it up at its very earliest moment and we stop its spread. Not once it's reached the point where it becomes a headline in the New York Times, we stop it when it's still circulating in a market, on a farm, or in only one or two people.
[00:58:00] So again, Albert Einstein famously said, keep doing the same thing over and over again, and you expect a different result is the definition of madness. As we look towards the future for future viral epidemics and pandemics -- if we keep doing what we've done in the past, which is sitting and waiting for these events to happen and then react, we're doing a disservice. We have an opportunity to change the dynamics. We have an opportunity to take advantage of what we know we can do, which is to document and characterize what that viral dark matter looks like, and use that information to better prepare, prevent, and respond to future events. You know, it also has the added feature of possibly totally transforming how we very much think about vaccines, how we think about drugs for future viral agents.
[00:58:54] Right now we develop a vaccine against an individual virus. There's this coronavirus emergence. There'll be a mad rush to create a vaccine against it at the cost of hundreds of millions if not billions of dollars. And whatever the next coronavirus emerges, that vaccine will not be effective, so we'll scramble to develop a vaccine against the next coronavirus if we've documented and characterized virtually all of the coronaviruses circulating in wildlife before they move into people. How can we use that big data, the genetic profiles that we've developed for every one of these viruses? Does it transform the kinds of questions researchers and scientists are asking about these viruses? Can we be thinking about broad-spectrum vaccines that are not simply effective against one virus, but maybe effective against multiple members of a viral family, or as we are trying to do with the influenza virus, a universal coronavirus vaccine?
[01:00:01] It's an opportunity. Big data can be transformative and allow us to do things that we've never done before. So I would say the way to respond to the future is to get ahead of the future. And I think the Global Virome Project, a global partnership to really develop this insight, build the capacities in countries around the world to do this surveillance and better prepare countries around the world to disrupt spillover and respond to it as rapidly as possible. And then use the big data that you would capture in this monitoring to transform the sciences around emerging viral disease. That to me is the future.
Jordan Harbinger: [01:00:42] This was all fascinating and there are so many interesting developments in this area that I think are probably underrated and hopefully we'll get famous, not because we needed them and they saved the planet, but because we thought we didn't need them and they saved the planet. Does that make sense?
Dennis Carroll: [01:00:57] Yeah, yeah, yeah.
Jordan Harbinger: [01:00:58] You said something really interesting in Pandemic that I think is a great way to close the interview which is that, "Rome was the center of the world 2000 years ago and now they're in ruins." Can you go over that? I think that was actually a great way to kind of wrap this in a bow.
Dennis Carroll: [01:01:12] You know, the hardest thing we have is the perspective of it. We don't really understand that the world we're living in now, one is very different than the world that was, and the world that will exist in the future is very different than the one we live in now. We tend to get trapped and think that what we're living in is always was and always will be, and we just don't appreciate that nothing is forever. And a lot of people's resistance to doing something different is because they're comfortable doing with what they're doing and no matter how comfortable they get, the fact of the matter is time marches on whatever we look at around us and think is the norm that will not be the case 10 years from now, 20 years from now, much less a hundred or a thousand years from now. The societies we live in today that we take for granted, well, be a footnote in history 500 years from now. The architecture that we surround ourselves with, they will be in ruins or forgotten a thousand years from now. When you look at ancient civilization, they looked at the world exactly the same way we do. They thought what they saw is exactly what always was and always will be. And you know, the irony of being in Rome and looking out over the Roman Forum, Rome was known as the eternal city, and you look at the Forum and you look at it today, and it's hard to imagine that it was the equivalent of Wall Street today.
Jordan Harbinger: [01:02:49] Right. We look at a bunch of rocks on the ground and we say, someone stood here thousands of years ago and said, "This will never be a giant pile of stones with moss and grass rolling over in it. This is the center of the universe right now."
Dennis Carroll: [01:03:02] That's right. So diseases are a reminder just how vulnerable we are to losing everything. Just imagine what the world's going to be like if 500 million people in the space of six months die. There are populations around the world that will never recover from that loss. The world will change dramatically. And we've seen this before. The plagues of the 14th century, 25 to 40 percent of all Europeans were wiped out. Cities and towns were decimated and abandoned. We don't realize just how catastrophic the black plague was in terms of putting Europe on the brink of extinction, and that was because of an infectious disease. We've remained as vulnerable today as Europe was 700 years ago, and we should pay attention to those events to understand our vulnerability and to learn from those events to figure out how we can maximize our opportunity for survival and recovery.
Jordan Harbinger: [01:04:14] Dennis, thank you very much. This is fascinating, and I think people should be paying more attention to this and maybe -- this is the kind of thing we don't need to dramatize it because it is so important and it's being diluted with a lot of fearmongering, but it's not that we shouldn't be afraid, it's just that we should be afraid of the right things in order to take action in the right ways.
Dennis Carroll: [01:04:33] Yeah, fear is a good thing. There's an advantage to fear sometimes. It elevates our response to things, but mindless fear is the most damning situation you can put yourself in. And yes, we do say very clearly that epidemics and pandemics, it's not a question of if, there will be epidemics, there will be pandemics. It is a question of when. But that inevitability should strike a measure of fear into our hearts. But if we stop at being fearful, then we've missed the point. The fear should then trigger us to act. We should take measures, anticipate what the meaning of a future epidemic and pandemic might be, and put in place the kind of preparations that minimize the consequences. So fear can be the greatest trigger towards our getting our act together. But it also, for many people, immobilizes them into inaction. And we really have to drive the equation forward, a world prepared as a world that will thrive and live for a long time.
Jordan Harbinger: [01:05:47] Dennis, thank you so, so much. This has been fascinating and I'm so glad we got a chance to do this.
Dennis Carroll: [01:05:52] Great, Jordan, thank you. I appreciate it.
Jordan Harbinger: [01:05:57] Great. Big thank you to Dennis Carroll. We will be linking to his stuff on the website in the show notes at jordanharbinger.com. Also in the show notes, there are worksheets for each episode, so you can review what you've learned here from Dennis, and we have transcripts for each episode, and those can be found in the show notes as well.
[01:06:12] Super interesting show today, and I hope you agree, it's worth noting that the hospitals in cities like New York City, almost always running it over 100-percent capacity. That means if something catastrophic occurs, they will not be able to take in all the sick and the injured, especially in a special pathogens situation. Special pathogens, by the way, are those that are high morbidity, high mortality, are hard to treat, very contagious, and cause public panic. Been a few of those in the media lately, if you haven't noticed. And it's not just us humans spreading things around the world that we've caught from animals, wild birds, one of the most common carriers of the flu, especially, of course, the avian flu migrate from North America to South America and as far South as Argentina down from Canada, that can spread things fast. When there are outbreaks, countries tend to hoard vaccines, and big pharma is not only slow to produce new and novel treatments but not that many folks are even working on these new treatments. Since in the past, many epidemics have mostly affected those who can't afford to pay handsomely for treatment.
[01:07:12] Rural hospitals are also under-resourced and often the last in line to get help in case of a pandemic or outbreak. I think it goes without saying that the poor are often the slowest to get healthcare anywhere. So in poor areas, poor countries, these things tend to spread even faster, and further people can't afford to miss work. So we're going to the office contagious. But are we just overreacting? I mean, what about Ebola that was contained, right? Well, it was a mess, and we got through it by the skin of our teeth, from what I understand, and it's still a work in progress, but yeah, that was contained. Something like coronavirus, much, much more contagious. It can affect billions of people in the same time. It took Ebola to infect just 30,000 to 50,000. We all have shared risk with this one. So the solution is shared action. We can't bomb, ban, or explain our way out of this one. We need to get serious here, folks, and I hope this episode has helped generate some awareness here today.
[01:08:07] Thanks again for Dennis here and I met him through my network. If you want to create a great network for business, personal, whatever it is you want to do, I'm teaching you how to do it for free at jordanharbinger.com/course. Dig the well before you get thirsty. Don't try to make relationships after you need them. The drills take a few minutes a day. I wish I knew this stuff decades ago. It is not fluff. It is crucial and you can find it all for free at jordanharbinger.com/course. And by the way, most of the guests on the show actually subscribed to the course and the newsletter, so come join us and you'll be in smart company. Speaking of building relationships, you can always reach out and/or follow me on social on at @JordanHarbinger on both Twitter and Instagram.
[01:08:46] This show is created in association with PodcastOne. This episode was produced by Jen Harbinger and Jason DeFillippo, engineered by Jase Sanderson, show notes and worksheets by Robert Fogarty, music by Evan Viola, and I'm your host Jordan Harbinger. Our advice and opinions, and those of our guests are their own, and yeah, I'm a lawyer, but I'm not your lawyer. And I'm sure as heck not a doctor or a therapist. So do your own research before implementing anything you hear on the show. And remember, we rise by lifting others. The fee for the show is that you share it with friends when you find something useful or interesting -- anybody interested in infectious disease, somebody who's maybe panicking too much or not enough, they're a great person to share this with. Hopefully, you find something useful in every episode of the show. So please share the show with those you love, and even those you don't. In the meantime, do your best to apply what you hear on the show, so you can live what you listen, and we'll see you next time.
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