Fact there has never been a time when humans were not affected during his time as a selfdescribed disease detective he has had his own brushes with viruses and wnfectious disease in contagion in 1995 he worked in zaire for the first a bola after 9 11 he was called to washington to prevent the spread of anthrax and in 2003 called to hong kong to help quarantines ours. These are some of the stories he chronicles in the next pandemic as a disease hunter and has been trying to prepare the public for Health Emergencies and he has seen it all. Telling us microbes will always be a problem he also writes that in all all epidemics and pandemics are inevitable in fact most can be mitigated if not prevented. But how do we have enough resources . To help a separate the hype from the facts what poses the greatest risk of what we need to do please join me on a Public Health journey by welcoming doctor kohn to the Carnegie Council this morning. [applause] thank you very much. Good morning everybody. As you have heard i spent a career in the preparedness environment normally means and weeks over time getting ready just in time now in the realtime speaking process. So ive been told put them at ease but there is nothing about my career that has levity but a lot of sex although it is most sex. [laughter] one mosquito sex and trying to give you the idea of what it means to be a disease detective and if you read the papers or the press and from the perspective of somebody doing it every day with other practitioners reading the paper this morning reading about zika virus so it is topical its easy to start a topic of infections so why are we always hearing about these types of diseases . Think of smallpox and measles and it all started around the end of the culturalre revolution when people came to gather and then started spreading from person to person. That is when i start my story of Infectious Disease but thats when the world starts for me the rodents that were caring smallpox moved into somebodys home and that virus made the jump to cause smallpox even including measles now fastforward to the industrialal revolution germ theory we realize Infectious Disease is due to in texas one infectious agents for asthma and around the 20th century the sanitation and revolution and the vaccines and antibiotics. Now we are all done with this Infectious Disease now give him a shot and a pill and they will be better if thats true we wouldnt be having this conversation today right now. So even though we haveen taken care of a lot we have the continued emerging effects there is a lot of factors that drive these diseases. The key factors are microbes they are smart collectively they have multiple generations in ara single day may be a human is a generation and 35 years microbes no problem at all days swab all the time they get smarter from drugresistant microbes because that is what they do. They say this will protect me from the set of antibiotics and then you have the superbug. So microbes evolve and humans change behaviors so nobody had a kidney transplant so we change and the risks to infections change. This should not be surprising talking about ebola or zika virus very quickly the animal connection comeses into play like mosquitoes and ebola it is bats the original cause. Thats a spread the chain of transmission 75 percent of the diseases you hear about they are zoonotic that there is the animal cannot one connection. And that disease has the potential to go person to person and murders is from bats and camels so its not a surprise that they tend to come from africa or south america or Southeast Asia with connection with the animals. And those that are very close to the date on the pigs and birds andd foul. With the global pandemics. So in that subset to lead to these infections. So often Climate Change is framed as an economicco issue. Over the last year or two as a Public Health issue of what is happening with the climate currently. So april with the hottest record on one year on record since 1980 people ask me how do you know 191 1880 . Believe that are not if you are a farmer it is really important to you what the temperature is so there are excellent records about what temperature looks like at least the 100 years the same thing with marine temperatures if you are a captain doing your daily log he would be logging the water temperature. So we have excellent records but april was the hottest year on record and the 12th hottest year in a row. This is not a coincidence what is happening with climate. If you look at Carbon Dioxide not 400 parts per million so the thought to only tap increases at one. 5 degrees is highly unlikely. But you tell this from a different way i got into the Climate Change business 20 years ago this is us mosquito Borne Disease in africa you dont have 401 k but cows and goats that is the 401 k . If a mosquito borne virus comes around and the animals die, that is bad news. It is a biblical disease and what we recognize over the last couple of decades at Subsaharan Africa from Northern Africa and into the middle east actually depends on climate and when this mosquito emerges with these dry periods followed by wet periods. It also causes abortions in humans and brain inflammation in humans. But the farmers dont have the money to vaccinate the animal every years every five or ten or 15 years say this is a bad year if we got vaccinated that would benefit. And so help to protect the farmers and the animals in the community. Thats how i got into Climate Change issues. And what became very clear right now and 2100 but what is happening today. Into the arthropods and mosquitoes it is actually lyme disease. And to live up here in the northeast and then over the last 20 or 30 years continuing to spread across theve United Statesy so were seeing that already today and then to cause infections in humans and animals that does not belong in vancouver but in the itropics we are getting infected oysters from the northwest. So we all know if any oyster eaters are here like me to listen to all the good Health Messages about oysters. [laughter] eat oysters in the cold month eat them with a month of our to protect yourself from the infected oyster. But it shouldnt be a problem if you are getting them from the northwest United States were alaska with nice cold waters but we have not have these outbreaks reported because they are not as cold anymore so these contemporary examples already working from the us to europe. And encephalitis. And we give it back to as a medical term. And then my head hurts you yave encephalitis you are so smart. [laughter] its called brain inflammation. But that this has been spreading over the last couple of decades there are some factors of where that is spreading the climate is one. Respiratory those that have kids or grandchildren and then we see those seasons in europe are becoming shorter and shorter so those contemporary examples so what is happening in india 128 degrees heat wave and yes less people die from coal but proportionally more will die from heat and then heart and lung disease from all the air pollution with all this Infectious Disease anything that has to do with mosquitoes or checks and then the foodborne illnesses. That is an issue as we get flooding. I want to make a quick shout out to Climate Change think about emerging infections the biggest factor of what is happening to microbes and in the environment if you look at the outbreaks these will continue to emerge. But we play a role to keep them from becoming epidemics like f the recent outbreak of ebola and west africa. And know about the science and i had the opportunity in the mid 19 nineties working with the Ebola Outbreak in zaire. You are infected probably from a bat if you are in the bush you died 95 percent of the people die unfortunately a Family Member or two but then you change that dynamic and its in a hospital. And those that do not have infection control. So then you are a virus magnet and then to increase until you die so when you have the most possible virus in your body . As you go to the hospital because you are sick you dont have more than when you die. And then if the immune system then you increase the virus you produce so when you have the most possible virus in your body . As you go to the hospital and you dont have more than when you die. I could give you a ten with a lot of big numbers so here you are sick and dying in the hospital and somebody doesnt wash their hands going from patient to patient what will happen you spread ebola. We have known this for many years as a reservoir that spreads and then a Family Member taking care of them and we know that. And then they die unfortunately and then you wash the body and kiss the body and hug the body what are the practices we saw and then the sainted person that just died. This is not a good idea. [laughter] but that is the science. That is in the issue. So this is the 24th on outbreak and then you think this just like east africa we see these all the time then we shut them down. But they dont even need International Teams anymore they know exactly what to do they follow everybody who is potentially sick. But nobody had ever seen the disease before and it verym quickly spread to urban areas. And the thinking was more of the same then the outbreak will go away. What happened that is not what happened 11000 death each and every one of inadequate response so politics and the Public Health system play the biggest role in whether or not this goes from a handful of cases are small outbreak and with these cases across the world for what happened here in the United States. And i want to ask because the answer is yes how many have read around the world in 80 days . How quaint. Eighty days to get around the world. For 20 years or where the Public Health uniform and on that it looks very much like the navy uniform. Thats because we started as the merchant marines. So now that is the purpose is to fly quarantine but if it takes 80 days to go from point a to point b we knew if you had smallpox or yellow fever because the incubation period to manifest your symptoms is always shorter than the time it would take to go from point a to pointg b but now we have turned that upside down. You could go to your mothers funeral in liberia and engage in the usual ask around the funeral you are distraught you are kissing and hugging and then the next day you get on the plane go to amsterdam to new york city 1824 hours maybe 48 out incubation. Three days after you show back up in new york now i have a headache and a fever im not feeling quite well you show up at a hospital the number one diagnosis will be malaria and if it is not an they missed it and its easy to see him get hospitalizedit and then you spread disease in the community we saw this in texas with the exact same scenario and then infected to local nurses i have spent a lot of time in places across the world to let you know our Healthcare System is not better than what you see in toronto and they had sars or singapore when they had sars or hong kong i just spent some time in seoul korea they had an outbreak. And again Excellent Health ours. Ystem like but they are not ready for the patients coming in. So travel has played a big role how these diseases emerge. So now i have given youou a sense why you hear about this and what we can do around social and political aspects. I do want to spend a couple of minutes to talk about you at the Carnegie Council and the observation which i guess i recognize my whole life if you think of hiv and who was infected it is marginalized populations. But as i started to write the book it dawned on me how almost every chapter it was increased risk the disease due to rodents in the southwestern United States people get infected with the original outbreak occurred was with native americans some of you will remember when it occurred in the early 19 nineties there was a group of young navajo kids who came to dc for the capital tour and were denied aib tour because you came from the southwest you could potentially be infected so theres nothing that anything that we knew that said they were at our risk. But often they affect marginalized populations i already talked about hiv i talked about ebola and the poor marginalized populations in west africa and in todays day and age we talk about sica there are poor pregnant women in brazil that has one. 1 million cases think thats what they are calculating now in over 1500 infected and the babies have congenital zika virus illness with small brains other Developmental Disabilities including hearing loss and vision problems it is a laser guided missile for neurons it kills the neuron sales one cells and not just a with babies when first described was 20 percent of people will get sick then a little headache with some itching and red eyes and they will get better than very quickly it became clear this was a problem for pregnant women but now we knowh even adults because of the laser focus we have the is a one a disease that is neurological causing weakness and even in a healthy virus to cause brain inflammation of the coverings aroundto your brain even what you think is a normal healthy adult this virus is a problem. It should not be aes problem. It is spread by a certain type of mosquito it is not new to us it is the exact thing that spreads yellow fever causing 30000 deaths per year. The exact same mosquito that spreads dengue outbreak that causes about 30000 deaths per year. The same exact mosquito that has chicken gonyea virus that was in the news a couple years ago. That doesnt seem to cause any death but the cause of the failure since the seventies with the efforts to decrease mosquitoes and not Pay Attention to the people dying from yellow fever, people dying from dengue are now all up in arms we have the disease that is affecting pregnant women so there is a lack of action over the last 40 or 50 years against a known threat that has put us in the current position so i heard yesterday that zika virus didnt only move through the americas now in cape verde knocking on africa to say you are next so think when it sweeps through to pregnant women there in africa. The head of who a brilliant woman k doing amazing work admitted a major policy failure over the last 40 years to address this mosquito. Also talked about a major policy failure this is a big issue in brazil and other places where they dont have the same contraceptive rights that you take for granted here in the United States or other parts of the western world. So why did it take all this time people dying of yellow fever and dengue to say we need to Pay Attention because now in north america women may have this disease . We will see zika virus. Hopefully not a lot of cases but we will likely see it. Ethics of a delayed response goes back to what you talk about amongst your audience , think about these marginalized populations why we see these delayed responses and we see it today with the conversation there are better terms so lets protect the United States against zika virus and how much they want to pay for it and i often get asked should be 500 million that Congress Wants to give or one. One the senate wants to give . I dont care. Pick a number where we having this conversation six months later . Me know what will happen. We also know Mosquito Control in the United States is not a federal function. Is not even a state function by the city and county and district function and you need to get the money out to these people so they couldld be doing what they should be doing to eliminate mosquitoes and then think about a longterm strategy to protect pregnant women and then have a vaccine strategy why are we still having this conversation six months later . Why are we robbing peter to pay paul so this was essentially for keeping america safe from all Public Health threats no matter their nature whether a mak pandemic, terrorism and as part of that my passion was for the Public HealthPreparedness Program to putut money into state and local Health Departments and then we pulled back some of that money to support those cases. So why are we take in my analogy so if this is a preparedness infrastructure why are we taking money out of that but we should be putting that into preparedness i will leave you with a number because im all about observable measures. Six. Seven. In the last three years the foundation has been doing great work looking at how prepared the United States is for Public Health emergencies. Every year it gets a little bit better six. Seven out of ten just is not good enough if we want to make sure americans are protected. As far as i am a concerned the responsibility is to protect us against threats and that includes Public Health and Health Threats and how do we make sure im old enough to realize you cant completely pull the politics out but maybe we need to strip politics to think the health needs of the population. Thank you. [applause] that was fascinating you seem so calm. S [laughter] i am call because i decided 20 years ago that fear is not a Public Health strategy i know it makes for great press the sky is falling and g