Pandemic: How to Prevent an Outbreak (2020–…): Season 1, Episode 3 - Seek, Don't Hide - full transcript

[vacuum cleaner whirring]

[reporter 1] Indianola School says
they will be closed tomorrow

because about 20% of their students
are out with the flu.

[reporter 2] Western Heights says they've
had so many student and teacher absences,

canceling school was the best option.

[reporter 3] ...schools in Braggs
right now are closed, 47 were out sick...

[reporter 4] 145 students
called in sick on Monday.

[reporter 5]
After an increase in reported absences,

both Seymour and the Archer City ISD
will be closed tomorrow.

A Muskogee school counselor is dead,

making her one of the hundreds
of Oklahomans



who have now fallen victim
to this year's flu virus.

[Dr. Goracke] All right, so how long
have you been sick?

- [woman] Just today.
- [Dr. Goracke] Just today.

Did it kind of come on you
all of a sudden?

[woman] I went to work this morning.
I was okay.

- Like, my teeth was hurting.
- [Dr. Goracke] Mmm-hmm.

Like, tender and I had a headache,
but nothing else.

[Dr. Goracke] And did you feel body aches
and feel like you were getting a fever...

- [woman] My skin feels like it's burning.
- Oh.

- Eyes are hot?
- My eyes feel like they're burning.

[Dr. Goracke] And then
what are her symptoms?

[woman] She's got
a runny nose and a cough.

[Dr. Goracke] And have you been exposed
to anybody that's had the flu?

[woman] The county that we live in,
they just closed the school



- because of flu.
- [Dr. Goracke] Did they?

I think they get past 20%
and they don't send kids to school.

It does help us stop the flu as well.
It stops the spread.

[woman] When am I going to be able
to go back to work? Tomorrow?

[Dr. Goracke] If you have a temperature
greater than 100.4,

then you really need to be
out of the public.

If those parents
that are in the workforce,

their kids are at home,
they either have to find childcare

so that they can go to work,
or they have to be off work.

All right, it's just a light...

Some of them may have sick days
and some of them may not.

So it expands and we have parents
that are now out of work.

Okay, I'll put together your paperwork
and we'll let you get out of here.

It is a huge struggle,
it's a financial struggle,

it's a mental struggle, physical struggle,
emotional struggle.

[reporter] I know this is hard to believe,

but 3,000 people across
the state of Oklahoma

have gotten so sick, they've actually
had to go to the hospital.

And there's still nine weeks left
in the flu season.

[horns honking]

[cell phone ringing]

[Dr. Vijay] Hello?

[in Hindi] Okay,
the one who was very serious,

and asked me to prescribe the medicine?

Is there some relief?

So you are feeling much better?

My wife is a doctor at Durlabhji as well.

We have an agreement between us:

when she's in the hospital,
I take care of the family.

When I'm in the hospital,
she takes care of the family.

She works only limited hours.

She made this sacrifice for my sake.

So one person could move ahead
while the other takes care of the family.

There were financial difficulties
in paying for my education.

I just had a few clothes
and I borrowed my text books.

Then gradually, after completing my MD,

my life straightened out.

- Manish Ji, are you ready?
- Hmm.

- Should I do your hair?
- Hmm.

I have experienced poverty,

and now, with God's grace,
I have a lot.

So I know the difficulties
faced by the poor.

The poor are at the greatest risk
of the flu.

A doctor alone cannot do
anything in tackling this flu.

The government cannot
tackle it alone.

Neither can the public.

It can be defeated
only if all three work together.

[reporter 1 in English] Rajasthan accounts
for nearly 70% of the swine flu cases

being reported from across the country.

[Singh] This is the failure
of the health department

under the health minister, Raghu Sharma.

Rajasthan has lost 49 lives
due to swine flu.

[Sharma in Hindi] Why is the percentage
of deaths increasing?

People's health is our responsibility.

This means we are shirking our duty.

As soon as someone is found positive,

then your department team
will visit them the next day.

What are you busy doing?

[man] I'm taking notes.

He's the one who is taking notes.

[indistinct]

You should be doing this on your own.

Make me the director, I will do it.

You can come here and be a minister.

If we don't take corrective measures,
then it is our fault, isn't it?

Our attention is elsewhere,

not on this.

That is a sickness in our department.

Have you prepared all the instructions?

What are those?

[man clears throat] Sir, first of all,

there will be a daily monitoring
of house-to-house activities in the city.

- [man continues indistinctly]
- You will do screenings?

You should do continuous screenings.

[man] We will monitor...

Of course, you will be monitoring,
but complete screenings should carry on.

[reporter in English] In an effort to curb
the spread, the Rajasthan health minister

has now ordered
door-to-door screenings of patients.

[indistinct chatter]

[man 1 in Hindi] Yes, sir?

[woman 1] This is
the swine flu control room.

Now, tell me, how is your health?

Madam, there are two patients,

they are positive for swine flu.

Can you tell me your address,
where are you from?

Can you provide any landmark
near your location?

[man 2] So we can confirm a visit
to your place?

Ma'am, the two cases are positive
from the same house for swine flu.

Let me know your ward number,

and our survey team will contact you.

Near the post office. Post office.

[woman 1] The address
is near the post office.

[knocking on door]

[woman 2] Is anyone there?
Can you come out?

[Carroll] The thing about controlling
a deadly virus...

is you need to move from being
reactive to proactive.

We know that viruses move from wildlife
into livestock into people.

And so you don't wait for an outbreak
to infect humans,

you find it and you fight it
before it ever infects a person.

FAO is looking at what's happening
in animals,

broadening our surveillance strategy
to look upstream.

Usually, we would see
the clinical picture in animals

before humans become infected.

And it just bothers me when the report

- first comes out of humans.
- [Carroll] Yeah.

And not picking it up
two or three weeks earlier in livestock.

We have a team that brings information
together from different sources,

including our field teams.

[man] I just received an email
from Russia.

Basically, we asked
about this H5N6, remember?

It seems to come from a gray gull in...

So they actually went to check for a virus
and they couldn't find it?

[man] Yes. It was a result
of active surveillance.

- [woman] Okay.
- Which, it does matter

because apparently the prevalence
was sufficiently high.

Yeah.

So we may, uh, see this virus next winter

- being the main actor on the stage.
- [woman] Yeah, who knows?

[indistinct chatter]

But if we can go ahead
and, uh, get started...

Paul, you have something?

Uh, there is an interesting
detection of H5N6

in the Saratov region
in the Russian Federation.

And this is the first report
of this virus outside Asia.

This is closely related to the viruses
that are circulating in China

and caused several human infections,

and some of them were fatal cases.

[Lubroth] For us, it's quite important,
the triggers and the line of command

within the veterinary system
or a veterinary service.

Once we have that detection,
what happens next?

How it links up to the medical services
and how we react to that detection.

Closing down the markets,
ensuring that consumers are safe,

that there is good communication
between the veterinary arm

- and the public health arm at all times.
- [Carroll] Right.

With the proper risk mitigation measures,

there's no excuse for any outbreak
becoming more than an outbreak.

But it all begins with timely
and effective surveillance.

- [Carter] We're here with the band.
- [man] What's that?

- [Carter laughs] We're here with the band.
- [man] Yeah, well, park right behind Brad.

- [Carter] Behind him?
- [man] Yeah.

[Carter] Okay.

Gear it up.

So much... all right.

So is Paul gonna take two trips?
We'll do two trips?

- One trip...
- One trip with him.

...with the ranger on that trailer

and then the four wheeler on the one
that's hooked up to Brad's truck.

[Carter] Okay.

When I'm in the field with hunters,
it's hard for people who don't understand

to understand the full dynamics.

You can't see it.

The ducks aren't sneezing,
they're not coughing.

But they have the flu.

Wild birds are the ones
that are moving it.

That's how the flu is getting moved.

We're gonna catch these birds in this net.
There's rockets attached to it.

Those rockets are gonna fire
when the birds are ready to be caught,

when they're all balled up.

The net's gonna go over the birds

and groups of people are gonna go out
and take those birds out,

we're gonna put them in keeping cages.

I'm gonna swab them.

And then those swab samples
will go back to the lab,

to see what subtypes of influenza
come through here.

Let's say there's a flu outbreak
at a chicken farm.

The flu didn't start there.

Maybe a hunter went out
and shot something,

and then didn't clean his boots off,

and went into the chicken house,
and, you know, spread all this flu.

Wild birds are the movers of this virus.
That's what they do.

[man] Be ready to go
when you hear the shot.

Get down there as quick as you can.
Grab a crate, and start pulling birds.

- [Carter] Now, we...
- Yeah.

[Carter] Okay. Now, we just wait.

[water dripping]

[Dr. Kayali] My job is like
being a watchman.

A lot of the scary viruses in recent years
have been linked to bats.

- [man 1] Come over here.
- [man 2] Yeah, yeah.

- [man 1] Okay?
- [man 2] Yeah, let's go.

There they are.

[Dr. Kayali] Ebola, for example.

Coronaviruses, whether SARS or MERS.

[bat screeching]

[man in Lebanese] When they are in groups
you can catch them easily.

You can't catch them one by one.

[in English] Okay.

Got it.

Okay.

[Dr. Kayali] And we now know that bats
can be a reservoir for the flu.

My team and I believe we have discovered

a new subtype of influenza
in fruit bats in Egypt.

And I want to test these bats in Lebanon
to see if this virus is spreading.

The young ones, they might bite.

And you can see the teeth
are still clean and still sharp.

Yeah, sharp and clean.

Off you go.

Next.

The more we know about where viruses
come from, the better we are prepared.

What we can do is study them
before they mutate,

try to predict which route
they might take.

So it's all about trying to break
the transmission cycle

from animals to humans.

[clucking]

[Dr. Kayali] The most
vulnerable populations,

or the populations
where a pandemic can start,

are in caretakers of animals.

[in Lebanese] We will take
a human blood sample.

Human blood?

[Dr. Kayali] Yeah, I need a worker
who works inside the farm.

Okay.

[Dr. Kayali] You and your shirt
in the street.

[woman] Get well soon!

You see how I was so soft with you?

[man] Yeah, right.

[Dr. Kayali] I'm really, really interested
in trying to catch that virus

as it's causing the infection.

Once we do that, we can look at
how transmissible it is.

Can it infect other species?

Does it have a pandemic potential?

We will add the chicken and human samples
collected today

to the bat samples and begin our testing.

[clucking]

[pigs grunting]

- [Dr. Goracke] So, is this your...
- [girl] Mmm-hmm.

[Dr. Goracke] What do you call it?
A pig or a sow?

- [girl] A pig.
- [Dr. Goracke] You got a pig.

- [girl] Her name is Chessie.
- Chessie? Okay.

I don't think I've ever touched
a live pig before.

Ooh, she's sweaty.
Or did you make her wet?

Oh, yeah, we put water on her
before the big show.

[Dr. Goracke] Oh! To make her shine?

So, your mom told me that you did not
get the flu shot this year.

Next year, you'll get the flu shot,
won't you?

Probably.

[Dr. Goracke] A little shot's not that big
of a deal compared to how sick you felt.

And you got... Can you imagine
if you had the flu this week?

- Oh, that'd be horrible.
- That'd be horrible.

I wouldn't have got to show here.
I like showing pigs a lot.

[announcer] All right, we're ready
to let them into the show ring here

for our first class... the first reveals.

[Dr. Goracke] Being a small-town doctor
is a unique position.

[announcer speaking indistinctly]

[woman] They're all nice enough to eat.

Oh, yes, a little bit of bacon.

Even if they haven't been my patient,
most people know, "She's the doctor."

That opens up an opportunity
to be able to have

a really interesting relationship
that I don't think a large town,

or a city physician, really gets.

[announcer continues indistinctly]

[all cheering]

[Dr. Goracke] Take a big, deep breath in.

And then again.

Just breathe normal.

Good.

Physicians focus outwardly on others
and what other people need.

I'm gonna give you some antibiotics
in the IV tonight

and then I'll give you a prescription
for some antibiotics

to take for the next ten days.

Do you have insurance?

We are expected to be superhuman.

We are expected to do the best that we can
for everyone that we come in contact with,

with the kind of compassion
that they deserve

and that's a calling
that I've been brought to,

and I can do that, I can do my calling.

If I can get the help that I need.

I have a 72-hour shift

and so it's important to me
that my husband is here with me at times.

Because without Mike,
I couldn't do this work.

Oh.

You were out.

Mmm-hmm. Sleeping good.

- How are you?
- I'm here.

- [Dr. Goracke chuckles softly]
- So.

So, had two more cases?

[Dr. Goracke] No, it was old cases
that just hadn't gotten over it.

Oh, okay.

- Yeah.
- Okay.

[indistinct]

[Mike] I'm wondering how long I was out.
I'm still feeling tired.

- Half an hour to an hour?
- You're as tired as I was

because you got disturbed
as much as I did last night,

and then I got to sleep today
and you didn't.

Yeah, I didn't get to sleep, so...

Okay, well, let me go
take care of this patient.

[Mike] All right, then.

[Dr. Goracke] My first marriage
didn't do very well.

And my divorce was particularly ugly.

[Dr. Goracke] Hello.

I was talking to your wife.
She's really worried about you.

- [man] I've been trying to.
- [Dr. Goracke] Okay.

The first year of medical school was
really, really difficult for me.

My ex-husband was, uh...
sent to prison during that time.

I came to school a couple times beat up.

And my faith was shaken during that time.

And then I met Mike
and he's a man of extreme faith.

And what I learned throught that was
that every experience, good or bad,

is building up in me,
like this wall of strength

and that strength gets me through
all of the challenges

that I'm confronted with, big and small.

"James, a servant of God
and the Lord Jesus Christ

to the 12 tribes
scattered among the nations.

'Greetings.

Consider it pure joy, my brothers,
whenever you face trials of many kinds,

because you know that the testing
of your faith develops perseverance.

Perseverance must finish its work
so that you may be mature and complete,

not lacking in anything.

But blessed is the man
who perseveres under trial.'"

[birds chirping]

[squawking]

Three, two...

[rockets fire]

[Carter] We found that there are different
subtypes of virus in these ducks.

These teal are long-distance migrants.

They go from here and they'll go
all the way up to Saskatchewan,

and then they'll come back again
in the fall,

and then they'll go all the way down
to Argentina.

So that's a huge migration.

Along that flyway,
they're either picking something up,

or they're dropping something off.

- Whoa! Hello.
- Nice catch. [chuckles]

[Carter] Doing these surveillance studies
helps us to understand trends

that are going on with these birds.

In case there's some kind of, let's say,
pandemic, or spillover or something,

we at least have the information and data
to anticipate trends and we're ready.

We're prepared
if there was a flu outbreak.

[ducks squawking]

[engine rumbling]

[Carter] I thought I was gonna be
a teacher or a police officer,

but the college atmosphere
was where I decided

to go and start working
with students that way.

And for the last 25 years now,
I've been in the sciences like this.

Our big main goal is to see
what the prevalence of flu is

in this area, at this time, right now,
with this population of ducks.

You guys are gonna
hold the ducks like this.

Keep them down by your chest, um...

and we're gonna swab them
orally and cloacally.

Put it in a media tube.

They're gonna give you a number.
I'm gonna give...

Put that number on the tube and then
you're gonna bring them over to Alindy.

She's gonna bleed them.

She's gonna bleed them
through the jugular,

'cause we don't like to wing bleed,
'cause they're migrating.

But remember the number
that Lizzy gives you,

'cause that's the number
that you and I have to match,

and Alindy and I have to match
to make sure we have the right sample.

And then once that we find
if they have had flu,

then we do a lot of serology back off
in the lab.

Sound good?

- Does anyone need this duck?
- [woman laughs]

[Carter] Can I let it go?
'Cause I've been holding it.

Okay. Sound good?

- Do, like... Feel like a "break." [laughs]
- Let's go.

[Carter] If they're busy at the table,
let it go.

- Who needs a duck?
- [woman] We do.

Six-six-six.

Oh, come on.

Sorry, Alindy.

Okay, we're gonna try to do this for you.
Ready?

[boy] That does not seem right.

[chuckles] No, it isn't. Are you ready?

This is gonna seem even worse.

- Are you ready?
- [boy] Oh!

[Carter] Oh, goodness.
I'm a terrible, horrible person, aren't I?

[chuckles] You can let that one go.
Good job.

Yeah, totally let it go.

- Next. What's your number?
- [woman] Six-six-seven.

[Carter] Are you 667?

All right. So... I know.
It makes you all... That's it.

So I'm gonna just help you,

'cause you're gonna be holding
lots of ducks today, okay?

Right there with those big pinkies.
Perfect.

Some of my favorite parts is
the hunters who have killed them

have never held them live,

and then they hold them live
and there's, like, a new perspective.

It doesn't mean
that they're not gonna hunt.

Hunting... I love hunting, myself,

but that perspective of having this,
like, live little creature is...

They don't get that opportunity.

They get the kill opportunity,

but the live opportunity
is always my favorite part

when they come out in the spring to do it.

I have a role
where I can go out in the field,

being part of the pulling of the birds
and the swabbing of the birds,

and then taking those samples
and being able to process them,

all the way to the end, to see the result.

That one sample you bring back
and all the work that went into doing it,

all the people involved in doing that,
that one sample is so important.

This knowledge gives
the scientific community

power to predict and prepare.

[Carroll] As the human population grows,

we see an increased appetite
for animal protein.

And in response, we are raising livestock
at unprecedented levels.

The problem with that is that the sheer
number of animals in a confined space

elevates the risk for a virus
to spread and mutate at a rapid pace.

While we can't predict where the next
influenza pandemic is gonna come from,

there are certain places
that need particular attention.

And China is one of those.

It's the place
where we've seen the emergence

of virtually
all of the deadly influenza viruses

over the last half century.

And it's right across the border
from Vietnam.

And so we set up
across five different border markets

during the influenza season,

a routine monitoring of what in fact
was coming across.

We know from recent history

the consequences of poorly monitoring
the emergence and spread of bird flu.

We at WHO believe that the world is now

in the greatest possible danger
of a pandemic.

[Carroll] In 2005, a new avian flu, H5N1,

had spread out of China
and across Southeast Asia.

The Vietnamese government decided that

they could not, um, coexist with H5N1.

They had to take draconian steps
to really bring it under control.

Vietnam began culling
millions of chickens.

The virus began to dramatically spread

beyond Southeast Asia,
into Europe, and as far as Egypt.

In September, 2005,
the World Health Organization

estimated that avian influenza pandemic

could kill up to
150 million people worldwide.

The national government
essentially made a commitment

to vaccinate virtually
every chicken and duck, um, in Vietnam

to try and break the back
of the outbreaks.

And within four months, they succeeded.

Every epidemic is an opportunity to learn.

We do this all the time.

We are constantly monitoring,

because you never know when something
is going to show up in an animal

and then make the leap to humans.

[Dr. Kayali] Karma?

[in Egyptian] Where is she hiding?

[exclaims] Little cat!

Come and say hi.

[Karma whines]

Then let's sit outside in the garden.

[grunts and exclaims]

[speaks indistinctly]

[Dr. Kayali singing]

Welcome, little cat!

[in English] This is pretty much home now.

I've been here since 2008.

My wife, Marwa,
we've been married for 16 years.

She's, uh, from Egypt.

I was born in Lebanon in 1975.

That's the year that
the Lebanese Civil War started in Beirut.

I was born in the city at its worst.

And since then, it never really
bounced back and always had trouble.

Lebanese people, we tend to migrate a lot,

simply because there are no opportunities.

So for me, I was lucky,

because I had the chance to go
and get educated out in the West.

The kids have been born here.

Adam who is 14, and Karma,
who's gonna be turning five.

[in Egyptian] What are you going to play
at the concert?

[in English] "Back in Black."

[in Egyptian] You didn't learn
any Arabic songs whatsoever?

[in English] Where we are here,

it's a little bit quieter
than the rest of Cairo.

So, we get to enjoy a little bit of peace,

but the hustle and bustle
is always accessible.

Cairo's a big city.

It's about 25 million people,
so it's quite large.

Very, very extensive.

My work focuses on avian flu
and Egypt is a hot spot for that.

2005, 2006, the avian influenza virus
started moving out from China to Egypt.

So we have been struggling
with it ever since.

It comes back every year.

And this is what motivates us
to continue our work in Egypt.

Karma?

My kids, they know in general what I do.

But I tend not to bring work back home,
because I like to really dedicate

most of my time when I'm at home
to the family.

[Marwa] He's away a lot, actually.

But, uh, we learn to cope with it.

[in Egyptian] Shall I tickle you?

[Marwa] It's tough on Karma
because she's a little girl

and she asks a lot about him
when he travels.

When she wakes up in the morning and asks,
"Where's Daddy?" she's always sad.

[Dr. Kayali] I never spend more
than two to three weeks here in Cairo.

I spend half of my time in Lebanon

and then either the United States,
or somewhere in Europe,

or somewhere in Africa,
depending on what's going on.

It's hard,
but that's the nature of the career.

These viruses are circulating
all the time.

I'm trying to keep up.

[Dr. Ahuja in Hindi] This morning,
through a call from the control room...

I got to know about your two children
who are positive.

What happened to the five-year-old child?

[woman] Only cough and fever.

- [Dr. Ahuja] Since when he is sick?
- Since January, he was sick.

This medicine, Tamiflu,
is given to treat swine flu.

You too, from today onwards
will start taking medicine with them.

[woman] You know how swine flu spreads?

When we're sneezing, coughing?

Look on his face. Need to keep this clean.

These are my children,
this much I will definitely do.

[Dr. Ahuja] In the beginning,
it was not spreading so much,

so the government did not pay
much attention.

But now prevention care has increased.

For that, we have
implemented this strategy.

Which pregnant lady
were you talking about?

- [woman 1] Nasira!
- Come up.

[woman 1] We'll go down.

- [woman 2] Let's go downstairs.
- [woman 1] Call her. What's her name?

[Dr. Ahuja] This is a very
densely populated area. Many families.

One germ can multiply into thousands

and spread rapidly and continuously,
so the whole community is affected.

When did you learn about the pregnancy?

A couple of months ago.

[woman] He is her husband, explain to him.
She is his second wife.

[Dr. Ahuja] As you are staying with her,

your two children
with your other wife are sick.

Keep her away from those kids.

Because... Yes.

Because of their illness,
she might have to suffer.

She'll be at a high risk and there may be
a threat to her and the child...

We told them that a positive case
was reported here.

So some were alarmed, some were concerned.

[woman] What will happen to us?

There is no problem, come out.
There is no problem.

We are from the hospital.

You have to take Tamiflu,
because you are close to a swine flu case.

We send a team to conduct surveys
within a radius of one kilometer.

[doctor] This is good work.

It's a good step from the government.

Even if we miss one case,
we still find 100 cases.

And we stopped 500 from happening.

[Dr. Ahuja] Is anyone sick in your house?

Cough, cold, fever...

[doctor] The problem is,
everyone should be vaccinated.

[in English] But it is a costly vaccine.

[in Hindi] And our population
is very high.

It is hard for health care workers
to reach every corner.

That's why in India, there is
higher activity of flu during epidemics.

[Dr. Goracke] So, we just have three.

These two are stable.
I've seen everybody today.

She came in yesterday, had had the flu,

got a little bit better
and then suddenly got really bad.

Had a fever of over 103,
has bilateral pneumonia.

So we may have to watch that a little bit.

Okay, sounds good.

[woman chuckles]

Bye, Lizzie.

Bye. See you later, Dr. Goracke.

[Dr. Goracke] When I begin
my 72-hour shift,

I'm kind of in this high-energy mode.

[Dr. Goracke] About 12 to 15 hours
before the end of the shift,

that's when I begin to feel
that fatigue sets in.

Probably at least
three to four times a month,

I think, "Ugh. I can't do this anymore.
I'm done. It's just too hard."

And then I get some sleep
and I feel better.

Or something really great happens,
or, you know...

Something happens that changes my mind
and I do better.

Father in Heaven, we thank you so much.

Thank you for the time to be able to come
together in your presence with friends.

Lord, thank you for this meal.

We always wanna give you praise and glory.
In Christ Jesus' name. Amen.

- [man] Great.
- Holly, I brought out your good napkins.

Oh, good. Do you want...

We love entertaining people at our home
and we have some incredibly great friends.

Yeah.

And one of the main focuses
of our private time

has been prayer with our friends.

All right, Lord, thank you so much.

[all] Lord Heavenly Father,
we come before you tonight...

[all continue praying]

Just pray that you would
guide the doctors' hands

and let them see everything,
uncover everything.

[Mike] That you would keep them safe
as much as they travel...

[Dr. Goracke] Lord, I thank you
for this prayer right now.

[all continue indistinctly]

Are we good?

[all laughing]

[Dr. Goracke]
When I dedicated my life to Jesus,

I said, "I'm not going to be
like the world anymore.

I'm gonna be like Jesus,"

and Jesus was loving and he was kind
and he laid down his life for others.

I have my own little place
in the community.

But from my tiny little place,
it ripples outward

and I know that there are hundreds,
maybe thousands of lives

that are different
because they came in contact with me.

And there's still a lot of time left
of this year's flu season,

so I have to just be in prayer that God
has it in His hands

and I can continue to do
what I'm supposed to do in His will.

[indistinct chatter]

[Dr. Kayali in English] Coffee.

Coffee, coffee, coffee.

I have a pretty full day, every day.

[laughs] But coffee...

Starts in the morning with coffee.

I was born here
and it's still my favorite city,

my favorite place to be.

Every time I come back, it just brings
me back to my childhood, early days.

So the samples that we have been
collecting over the last three days,

we're gonna run
some molecular analyses on them

and that will tell us
if we have the virus itself.

Do we have influenza or not?

All of my staff are graduate students.

So as they're working on the project,
they're also learning.

I did my PhD at the University of Iowa
in the United States.

So for me, having graduate students
start developing their careers

while they're working on a problem
that's relevant to their countries

and doing it in their countries,

it's incredibly important.

[Moatasim in Egyptian]
Science has

always been my passion
since I was a child.

I've always wanted to be like...

Do you know how Einstein looked while
he was working, with his scruffy hair?

I really liked that,
I wanted to be the same.

Without the scruffy hair.

Dr. Ghazi is my mentor and everything
I learned is coming from him.

He doesn't approach science
in a conventional way.

Actually, we're supposed to be
interested in what we do.

To do something that we love.

[Dr. Kayali] Chief!

Let's take this.

[Dr. Kayali in English]
What do we have here?

- [Moatasim speaks indistinctly]
- It looks like we have some activity.

So we do have a finding.

We have to have a certain number
in order to call something positive.

We use a cutoff point of 80.

- So H was what again?
- [man] Human.

- Where was his origin? Backyard?
- [man] Yeah.

[Dr. Kayali] Thirty-two,
which we call the negative.

Not high enough to call him positive,
so it's below the limit that we detect.

Second human, another backyard.
He's at 64.

We would still call that a negative.

And the third human,
I think we sampled at the farm.

That's another negative.

For the bats, they're below 40.

None of them make the cut,
so we're gonna call them negative.

But then we have a chicken that's 256.

So that's definitely a positive
for avian influenza H9N2.

That was on the farm.

On the farm, the virus
is what we call endemic,

which means it's always around.

Either the chickens were vaccinated,

or during their growing period,
they had an infection.

This is very, very expected.

Nothing of concern,
but this is the nature of surveillance.

Regardless, this is a good
learning experience for my students.

We have some antibodies.
Why don't we have virus?

[Moatasim] It might be
because of vaccination.

[Dr. Kayali] Could be. One more.

Distance. Is the distance between...

[Dr. Kayali in Egyptian]
Distance between, all right.

But it's not what I'm thinking of,
so one more.

[in English] What do we know
about an infection or an activity of...

[woman in Egyptian]
Anomalies or something?

- The...
- Anomalies.

The cold weather.

[in English] Seasonality.

We're a little bit out of
the influenza season,

that's why we don't see it much.

Um, influenza season picks up its activity
during the warmer months,

so if April, May, then you...
We expect to see more.

- [woman] Okay.
- [Dr. Kayali] Good job, everyone.

Let's eat.

[Moatasim] I'm going to be
the president of the table?

[Dr. Kayali] Yeah.

[indistinct chatter]

Tomorrow, we need to return to Egypt.

A new avian influenza has been detected.

And it's essential
that we begin surveillance.

We work under what we call
the "One Health" perspective,

so we strongly believe that the health
of humans, of animals,

of environments, of ecosystems,

are all interconnected
and influenza is a great example.

[Moatasim in Egyptian]
The bird migration patterns,

as well as travel routes for
commercial airlines and people...

So anything can affect any country and
any country can affect other countries.

If something happens, the problem is that
it spreads rapidly between countries...

before we're prepared.

[Carroll] 2,000 years ago,
it's hard to imagine,

but this was a robust, dynamic community.

The Roman forum was the seat of power,

both political and economic power,

and never would they have imagined,
2,000 years later,

we'd be standing here
looking over their ruins.

The very idea that their civilization
wasn't a permanent civilization,

just was something
they would never have grasped.

Two thousand years later,
we're in exactly the same situation.

We think the world we live in
is permanent.

This is the eternal city
and if nothing else,

the eternal city tells us
nothing is eternal, right?

All things must pass.

And to avoid the worst
consequences of change,

we're going to have to change
the way we live on this planet.

If we don't, then we are gonna pay
a severe price.

[dramatic music playing]