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Speaker 1: I want you to close your eyes for a second.

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Picture a warm, humid evening in rural Bangladesh. It's quiet,

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the air smells like, you know, wet earth and vegetation.

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You're standing in a grove of date palm trees. It

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feels peaceful, maybe even a little romantic in that sort

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of rustic way. Right and high up on the trunk

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of one of these trees, somebody has shaved away the

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bark and hung a clay pot.

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Speaker 2: It's a scene that's played out for I mean centuries. Yeah,

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that pot is there to collect the sap.

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Speaker 1: Right. It drips down, drop by sweet drop all night long.

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It's the sugary, refreshing nectar that the locals absolutely love.

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It's a tradition.

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Speaker 2: It is.

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Speaker 1: You wake up in the morning, you walk up to

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the grove, you take the pot down, and you drink

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it fresh. It's raw, it's cool, it's delicious.

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Speaker 2: It sounds like the definition of farm to table or

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a tree to table.

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Speaker 1: It does. But now I want to ruin that image

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for you, okay, because while the village is sleeping, there's

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a visitor. A silhouette glides through the moonlight. It's big,

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a wingspan of maybe four five feet a fruit bat,

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specifically a flying fox, and it is thirsty.

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Speaker 2: And this is where the idyllic scene turns into a well,

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a biological crime scene.

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Speaker 1: That's the perfect way to put it. The bat lambs

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on the tree right above that clay pot. It hangs there,

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maybe upside down, and it starts licking the sap stream.

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Speaker 2: It's just having a drink, just having a drink.

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Speaker 1: But bats are messy eaters. Maybe it dribbles saliva into

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the pot. Maybe because it's perched right there, it urinates

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into the collection jar who then it flies off into the.

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Speaker 2: Dark, leaving absolutely no trace that it was ever there exactly.

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Speaker 1: The sap looks the same, it smells the same. The

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next morning a villager drinks it, and a week later

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that person isn't just sick. They are fighting a pathogen

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that is so aggressive, so efficient at dismantling the human

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central nervous system, that their chance of dying isn't one

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in one hundred like the flu. No, it's somewhere between

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forty percent.

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Speaker 2: And those are numbers that epidemia generally only seeing their nightmares.

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To put that in perspective for everyone listening, COVID nineteen

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had a case fatality rate that was generally speaking, well

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under one percent for the general population.

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Speaker 1: So less than one percent.

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Speaker 2: Right, we are talking about a coin toss with death

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or in some outbreaks, much much worse than a coin toss.

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Speaker 1: Welcome to thrilling Threads. I'm your host, and today we

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are absolutely not talking about the common cold. We are

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unpacking a stack of sources, research papers, who surveillance reports,

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and some really dense epidemiological studies that span from the

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late nineties all the way to the vaccine trials happening

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right now in January twenty twenty six.

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Speaker 2: And it is a stack that tells a very specific

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and I think very terrifying story.

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Speaker 1: We are diving into the Nepa virus nev. Even the

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name sound sharp, doesn't it Nepa.

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Speaker 2: It does sound a bit unassuming, but it's named after

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the village in Malaysia where it was first isolated. Compun

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sing Guy Nepa.

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Speaker 1: The Neper River village exactly.

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Speaker 2: But make nomus. This virus is a beast. It's paramixovirus.

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Speaker 1: Paramixovirus. That's a mouthful. Is that the same family as

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the flu no no.

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Speaker 2: Flu is orthomixivity paramix viruses are a different breed. They

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include things like measles and mumps, things we're familiar with.

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But NEPA is special. It has this dual attack mechanism

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that makes it incredibly dangerous. Most viruses, you know, they

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pick a lane. They either attack your lungs like a

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respiratory virus, or they attack your nervous system. NEPA says, why.

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Speaker 1: Not both, So it's a double agent in a way.

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Speaker 2: Yeah, it causes severe respiratory distress think pneumonia on steroids.

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But it also causes encephalitis.

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Speaker 1: Which is brain swelling.

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Speaker 2: Inflammation of the brain tissues. Yes, your brain essentially swells

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inside your skull. It is on the World Health Organization's

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Priority pathogen list for potential pandemics, and it has been

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for years now.

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Speaker 1: A priority pathogen. That doesn't sound good.

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Speaker 2: No, it means it's on their watch list of things

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that could cause the next big one. And looking at

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the documents we have in front of us, covering the

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initial nineteen ninety eight discovery up to the clinical data

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from twenty twenty five, this is what researchers call a

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paradigmatic challenge.

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Speaker 1: A paradigmatic challenge that sounds like polite scientists speak for,

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we are in big trouble.

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Speaker 2: It basically means it breaks the rules we're used to.

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It doesn't behave like other viruses.

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Speaker 1: Well, let's break down those rules, because this isn't just

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a medical story. As I was reading through these files,

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it felt like a detective story.

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Speaker 2: It really is.

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Speaker 1: It starts with a mystery in Malaysia, moves to a

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tragedy in Bangladesh, and ends with a race against time

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and laboratories happening.

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Speaker 2: Right now, and that race is actually heating up. The

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landscape in twenty twenty six is very different than it

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was even five years ago.

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Speaker 1: So let's rewind the clock. Take us back to the

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origin story. We were in Malaysia. It's nineteen ninety eight.

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The village is Campum Sungey Nipa. What was happening on

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the ground.

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Speaker 2: It was absolute chaos. You have to imagine the confusion.

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Pig farmers started collapsing, and I don't mean just feeling

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a bit under the weather. Yeah, they had high fevers,

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they were deliri, they were having seizures. A cluster of men,

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all with the same job, all coming down with this

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severe neurological illness.

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Speaker 1: And when you see people with seizures and fevers in

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a tropical country like Malaysia, what's the first thing a

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doctor thinks of mosquitos?

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Speaker 2: Always mosquitos. It's just reflex at that point, you think malaria,

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you think danngay or us case. They thought it was

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Japanese encephalitis.

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Speaker 1: Which is a mosquito born disease, right, and it's endemic

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in that region.

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Speaker 2: So the Malaysian health officials and the government did exactly

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what the text books says you should do for a

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mosquito outbreak. They rolled out the fogging trucks.

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Speaker 1: I've seen those.

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Speaker 2: Yeah, they started spraying insecticide everywhere to kill the mosquitos.

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They focused entirely on vector control.

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Speaker 1: But it didn't work.

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Speaker 2: It didn't make a dent. Yeah, the cases kept rising,

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people were dying, and critically, the epidemiologist on the ground

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started noticing something that just didn't fit the mosquito narrative.

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Speaker 1: What was the glitch in the matrix?

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Speaker 2: It was the pigs.

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Speaker 1: The pigs.

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Speaker 2: Japanese encephalitis can infect pigs, but it doesn't usually cause

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massive visible illness in the animals. They act as a reservoir,

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a silent one, but they don't drop dead in droves, okay.

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But in Kampung Sunga Nipa, the pigs were sick, very

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very sick, sick.

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Speaker 1: How what were the symptoms.

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Speaker 2: They had this distinctive, loud, barking cough. Farmers called it

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the one mile cough because you could hear it from

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a distance. It was clearly a respiratory infection tearing through

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the pigstyes. And when the investigators looked at the human data,

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they realized that the people getting sick were almost exclusively

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the pig farmers.

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Speaker 1: So not the random villagers down the road, just the

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people handling the pigs.

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Speaker 2: Correct. If it were mosquitoes, everyone would be getting bitten

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mosquitoes don't check your job title before they bite you.

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But here it was the people working the abatoirs, the

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people cleaning the pens. The contact was the key.

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Speaker 1: So it wasn't the insects buzzing in the air. It

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was the animals they were wrestling with every day.

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Speaker 2: That was the breakthrough. They realized this was a zoonotic spillover,

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a disease jumping from animals to humans, but the transmission

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route was specific. In Malaysia, the route was bats to

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pigs to humans.

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Speaker 1: Okay, let's parse that bats to pigs. How does a

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pig catch a virus from a bat? Do they like

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hang out together?

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Speaker 2: Not socially no, But the farms were often planted with

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fruit trees, mangoes, durians to provide shade or extra income.

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Speaker 1: Oh, I see where this is going.

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Speaker 2: Fruit bats love mangoes. So a bat comes in at night,

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eats half a mango, drops the rest into the pig pen.

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That mango is covered in bat's.

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Speaker 1: Saliva, and pigs are basically biological vacuum cleaners.

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Speaker 2: They will eat anything. So the pig eats the contaminated fruit.

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Now here's the crucial concept from our source material. The

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pig acted as an amplifying host.

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Speaker 1: An amplifier like a guitar amp. It makes the signal louder.

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Speaker 2: That's a perfect analogy. The bat is the musician playing

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a very quiet note. The virus in the bat is present,

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but at a low level. When that virus it's into

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the pig, it finds a biological environment that is absolutely

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perfect for replication. It reproduces massively.

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Speaker 1: This goes crazy.

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Speaker 2: The viral load, The amount of virus in the body

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becomes enormous. The pig is a much better host for

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this virus than the bad is in terms of replication.

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Speaker 1: So the pig becomes a virus factory factory.

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Speaker 2: With a cough, a very loud cough. Because pigs in

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these commercial farms are kept in very close quarters, the

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virus tears through the herd like wildfire. The pigs are coughing, sneezing,

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spring respiratory droplets everywhere. Oh man, the farmers are working

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right in this cloud of virus.

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Speaker 1: That is a terrifying image. You're standing in a shed

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with a thousand coughing pigs breathing an air that is

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thick with a deadly pathogen.

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Speaker 2: And once they realize this, once they identified the virus

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of the vector, the solution was brutal. To stop the outbreak,

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they had to destroy the amplifier.

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Speaker 1: I remember reading the numbers on this. It's staggering.

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Speaker 2: They caulled over one million pigs. One million. Imagine the

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logistics of that. The army was brought in. It was

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a massive, desperate operation. It completely devastated the Malaysian pork industry.

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It was an economic catastrophe for those farmers. Many lost

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their livelihoods overnight. But and this is the hard truth

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of epidemiology. It arguably saved countless human lives because it

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broke the chain of transmissions. It stopped the amplifier, it

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pulled the plug. And here is the key difference between

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what happened then and what we see now, which I

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know we're going to get to. In Malaysia, human to

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human transmission was very rare. It was almost entirely animal

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to human. If you didn't work with pigs, you were

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generally safe. The virus wasn't adapted well enough to jump

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from person to person efficiently.

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Speaker 1: Right, So the outbreak thens, the pigs are gone, the

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virus fades away, and for a minute the world thought, Okay,

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that was a freak event, a one off.

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Speaker 2: That's what everyone hoped, a contained zoonotic blip.

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Speaker 1: But the virus didn't disappear. It just moved, or rather

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we found it behaving differently somewhere else. Yes, this brings

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us to the second part of our story, the shift.

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We're moving the map from Malaysia to Bangladesh and India.

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Speaker 2: Specifically West Bengal and the state of Kerala in India.

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Speaker 1: Now, I feel like I've seen Kerala in the news

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a lot regarding this, it keeps popping up.

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Speaker 2: You have it's become a hotspot. There was a major

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outbreak in twenty eighteen, another flare up in twenty twenty one,

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and again just a couple of years ago in twenty

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twenty three. The twenty twenty three outbreak was particularly alarming

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because it happened while the world was still exhausted and

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on edge from COVID nineteen.

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Speaker 1: I remember that there was a tragic case involving a

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young boy, right, yes.

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Speaker 2: A fourteen year old boy. The details are heartbreaking. He

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didn't work on a farm, he wasn't pig farmer. He's

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just a kid.

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Speaker 1: So how did he get it.

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Speaker 2: It's believed he may have eaten fruit that was contaminated

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by a bat. He tested positive and despite the best

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efforts of the doctors, he passed away. It sent shock

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waves through the region because it reminded everyone that this

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threat hadn't gone away. He can just appear out of nowhere.

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Speaker 1: But here's the puzzle that confuses me. In Malaysia, you

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have these massive industrial pig farms, millions of pigs amplifying.

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Speaker 2: The virus right the virus factories in.

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Speaker 1: These villages in Bangladesh and Kerala. There aren't massive pig farms.

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Speaker 2: No, the agricultural landscape is completely different. The cultural context

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is different.

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Speaker 1: So if the amplifier is gone, how is the virus

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getting from the bat to the human.

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Speaker 2: That is the question that kept scientists up at night

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for years. If there are no pigs, what is the bridge.

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Speaker 1: The answer brings us back to that clay pot we

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talked about in the intro, the date palm route, the

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raw sap.

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Speaker 2: It turns out, in these regions the virus doesn't need

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an amplifier, It just needs a vehicle, a sweet, delicious vehicle.

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The terrapist bats, the flying foxes love the sugar in

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that sap.

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Speaker 1: So we have evidence of this.

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Speaker 2: It's not just a hunch, Oh, it's definitive. There is

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a brilliant study. Our notes referred to it as the

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Bamfi evidence, named after a lead researcher. They set up

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infrared night vision cameras pointed at these date palm.

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Speaker 1: Pots spy cameras for bats.

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Speaker 2: Essentially, and the footage is undeniable. You see these massive

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bats landing on the cut in the tree, licking the

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sap stream as it flows down. You see them climbing over.

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Speaker 1: The pots, so they're right there at the source.

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Speaker 2: Right there. And bats, to put it delicately, urinate frequently

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to reduce body weight for flight.

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Speaker 1: So they are peeing in the drink.

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Speaker 2: You're peeing in the drink, or their saliva, which is

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loaded with virus, drips into the pot. Now, usually a

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virus outside the body is fragile. Sunlight kills it, heat

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kills it. But sugar nepa is surprisingly stable in sugar

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rich solutions, especially if they are kept cool, like in

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a clay pot overnight. So the bat visits at three am,

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a human drinks the SAP at seven am. The virus

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is still viable. Wow, it has a direct highway into

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the human digestive system.

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Speaker 1: That is incredibly disturbing. You're drinking a viral cocktail. But

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there's something else in the Bangladesh data that scares me

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even more than the SAP. In Malaysia, you said you

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had to touch a pig to get sick. Human to

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human spread was almost nonexistent.

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Speaker 2: Right, It was a dead end for the virus mostly,

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But looking at the.

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Speaker 1: Reports from Bangladesh and India, that rule doesn't seem to

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apply anymore.

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Speaker 2: No, it doesn't. And this is the shift we're talking about.

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This is what puts NIPA on the pandemic potential list.

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In these outbreaks, we see distinct confirmed chains of human

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to human transmission.

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Speaker 1: There is a statistic here in the source deck that

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I circled in reading. It says ninety one percent of

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the index patients the first people to get sick developed

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symptoms during the SAP collection season.

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Speaker 2: Right, that makes sense. That's the bat connection, that's the

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spillover event.

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Speaker 1: But then it says seven percent of patients were responsible

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for infecting fifty percent of secondary cases.

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Speaker 2: That is the classic definition of a super spreader.

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Speaker 1: What makes someone a super spreader is their virus different.

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Speaker 2: It can be a few things. It can be that

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their individual viral load is exceptionally high for whatever biological reason,

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but often it's about their symptoms and their social context.

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The bangladex strain of NEPA causes massive respiratory.

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Speaker 1: Issues, more so than the Malaysian one, much more so.

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Speaker 2: So. If a patient is coughing violently, they are projecting

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aerosols containing the virus. They become a little fog machine

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of death.

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Speaker 1: And who is getting infected.

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Speaker 2: It's tragic. It's the caregivers. It's the family members wiping

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the sweat off their brow. It's the nurses changing their

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ivy lines. It's the people who love them and are

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trying to care for them.

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Speaker 1: That's that's heavy. It targets compassion.

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Speaker 2: It really does. It exploits our most basic human instinct

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to care for the sick. And there is another cultural

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aspect mentioned in the sources too, which is just heartbreaking.

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Corpse to human transmission.

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Speaker 1: Transmission from the deceased.

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Speaker 2: Yes, in many traditions in this region, the family washes

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the body of the deceased before burial. It's a final

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act of intimacy and respect, of course, But if that

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person died of NEPA, their fluids, saliva, respiratory secretions are

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still teeming with live virus. We have verified clusters where

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the virus move from a deceased patient to the warning

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family during these rituals.

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Speaker 1: God, so the funeral becomes the start of the next outbreak.

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Speaker 2: Exactly, and this changes the containment strategy entirely. In Malaysia,

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you could solve the problem with bulldozers and rifles. You

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call the pigs. In Bangladesh, you can't call the humans.

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You have the change behavior. You have to tell a

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mother she can't hug her dying child. You have to

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tell a son he can't wash his father's body in

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the traditional way.

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Speaker 1: Which is infinitely harder than managing livestock.

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Speaker 2: Infinitely is asking people to go against generations of culture

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at the most emotionally devastating moment of their lives.

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Speaker 1: So we have the pigs, we have the sap, and

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we have the heartbreaking human element. But let's look at

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the landlord of this virus, the source segment three, the reservoir.

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Speaker 2: The flying fox, the debis genus.

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Speaker 1: These aren't the little bats that flutter around your porch

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light eating mosquitoes.

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Speaker 2: No, No, these are old world fruit bats. They are big, beautiful,

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magnificent creatures. And I want to be clear, they are

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ecologically essential. They pollen flowers, they disperse seeds. Without them,

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the rainforests basically collapse.

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Speaker 1: But they are also the natural bunker for hennepaviruses, this

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family of viruses.

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Speaker 2: Yes, they are the reservoir host. The virus lives in

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them without causing them any harm.

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Speaker 1: What I don't get is if this virus kills ninety

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percent of the humans it touches, and it kills pigs.

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Why isn't the forest floor littered with dead bats? Why

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are they immune?

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Speaker 2: That is one of the hottest topics in immunology right now.

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The bad immune system is a marvel of evolution. How so, Well,

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think about what a bat does. It flies. Flight is

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incredibly metabolically expensive. It's like running a marathon. Constantly generates

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a huge amount of heat. Okay, when you or I

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get a fever, our body temperature goes up a few

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degrees to help kill a virus. Bats generate that kind

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of heat naturally just by flying.

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Speaker 1: So they are constantly running a low grade fever in

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a sense.

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Speaker 2: In a way, yes, and their immune systems have evolved

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to be in a constant state of high alert but

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dampened inflammation. They tolerate the virus, they keep it suppressed,

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They carry it, but they don't get sick. It's a

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symbiotic relationship that has evolved over millions of years.

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Speaker 1: Okay, so the bat is a carrier, but they don't

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shed the virus all the time. Right, It's not like

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every bat is a flying biological weapon twenty four to seven.

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Speaker 2: No, and that's a crucial point for predicting outbreaks. Viral shedding.

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When the bat actually releases the virus in its urine

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or saliva isn't constant. It pulses, and the evidence suggests

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it correlates with stress.

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Speaker 1: Stress like bad anxiety. Are they worried about their taxes?

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Speaker 2: Physiological stress Pregnancy is a big one. The strain on

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the body can cause them to shed more virus, but

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increasingly the sources point to nutritional stress starvation.

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Speaker 1: Which brings us to the environmental angle.

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Speaker 2: It does when we cut down the rainforests, when we

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replace wild fruit trees with pummel plantations or cities, the

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bats don't just vanish.

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Speaker 1: They get hungry, and a hungry bat goes looking for food.

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Speaker 2: Exactly, it forces a foraging change. They leave the deep

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forest and come to the orchards. They come to the

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mango trees in our backyards, they come to the date

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palms in the villages. We are destroying their homes, so

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they are moving into ours, and.

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Speaker 1: Because they are stressed and starving, their immune systems are

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a bit weaker and they're shedding more virus.

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Speaker 2: Precisely, it's a feedback loop. We stress the environment, the

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environment stresses the bat. The bat sheds the virus the

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virus hits us. This is the core of the one

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health concept.

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Speaker 1: One health. I've heard that term thrown around.

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Speaker 2: It's the idea that you cannot separate human health from

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animal health or environmental health. They're all interconnected. You can't

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solve NEPA just by looking at the virus in a

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test tube. You have to look at the chainsaw cutting

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down the forest half a world.

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Speaker 1: Away, because they're the same problem.

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Speaker 2: They are the same problem, just with a long and

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complicated fuse.

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Speaker 1: That makes sense. But let's say the chainsaw has done

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its work, the bat has shed the virus, and it's

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inside a human. I want to see men way, let's

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talk about the mechanics of this killer. Segment four virology,

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How the key fits the lock.

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Speaker 2: Where the science gets really elegant in a horrifying way.

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NEPA is an RNA virus. Yeah, but to understand why

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it kills so effectively, you have to look at the

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surface of the virus particle. It has two main weapons,

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two proteins sticking out of his shell, the G protein

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and the F protein. G and F sounds like a

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bad report card. What do they do think of a

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G protein that's for glycoprotein as a grappling hook. Its

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job is to find a specific spot on one of

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your cells and latch on.

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Speaker 1: Does it just grab any cell.

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Speaker 2: No, it's very specific. It's a specialist. It hunts for

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a receptor on your cells called frin B two.

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Speaker 1: F n B two. That's the lock.

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Speaker 2: That's the lock. And this is the AHA moment for

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why NEPA symptoms are so weird and so widespread in

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the body. We have to ask where is fn B

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two located in the human body.

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Speaker 1: I'm guessing not just in one place.

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Speaker 2: No, it's a highly conserved protein, which means it's really important,

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So it's everywhere. Yeah, But it's found in two main

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areas relevant to NEPA. First, it's in the endothelial cells,

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the lining of your blood vessels and arteries, all of

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them pretty much. And second is found in neurons.

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Speaker 1: Blood vessels, and brain cells exactly.

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Speaker 2: And think about your lungs. Your lungs are basically a

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giant sponge of blood vessels for gas exchange. So the

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virus gets breathed in hits, the lungs attacks the blood

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vessels there, causing the respiratory distress, the bleeding. Then it

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enters the bloodstream, rides that highway all over your body,

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and because it targets neurons, it crosses the blood brain barrier.

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Speaker 1: And attacks the brain, hence encephalitis.

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Speaker 2: It's a roadmap written in our own biology. It uses

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our own infrastructure, getst us, but it gets worse. There

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is a secondary receptor. It can also use frin B three.

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Speaker 1: Where is that one?

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Speaker 2: The brain stem?

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Speaker 1: The brainstem, that's the lizard brain, right, the part that

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keeps the lights on.

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Speaker 2: It controls your autonomic functions, breathing, heart rate, swallowing, the

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most basic critical life support systems. If the virus hits

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EFRONB three heavily, it basically unplugs the computer. This is

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why patients can deteriorate so fast.

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Speaker 1: So the G protein hooks on. What does the F

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protein do?

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Speaker 2: F stands for fusion. Once the grappling hook is secure,

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the F protein activates like a spring loaded spike. It

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harpoons the cell membrane and fuses the viral skin to

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your cell skin, opening a door so the virus can

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dump its genetic material inside. Were fine, but the F

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protein is messy. It's really aggressive. It doesn't just fuse

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the virus. To the cell. It's so sticky that it

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causes your infected cell to fuse with its.

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Speaker 1: Neighbors like melting together.

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Speaker 2: Yes, it creates these giant, multinucleated monster cells. We call

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them sincitia sinsidia. It's from the Greek four together. Imagine

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a microscopic horror movie where fifty cells melt into one giant,

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dysfunctional blob. This leads to massive cell death and vasculitis

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inflammation of the blood vessels. The walls of your artery

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start to die and leak.

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Speaker 1: That is visceral and where is our immune system? While

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all this is happening, usually, if a virus enters, we

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send in the swat team. The alarms go off.

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Speaker 2: MIPE has thought of that. It has a suite of proteins.

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They have names like PEVWW and C encoded in its

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genetic script. These are antagonists.

473
00:22:01,640 --> 00:22:02,799
Speaker 1: What are they antagonize?

474
00:22:02,960 --> 00:22:07,440
Speaker 2: Interferon Interferon is your body's air raid siren. When a

475
00:22:07,480 --> 00:22:11,079
cell gets infected, it releases interferon to tell the neighboring

476
00:22:11,079 --> 00:22:14,000
cells shields up, we are under attack.

477
00:22:14,240 --> 00:22:17,079
Speaker 1: Prepared defenses right the alarm system.

478
00:22:16,720 --> 00:22:20,200
Speaker 2: Nepus proteins actively hunt down the signaling molecules that make

479
00:22:20,200 --> 00:22:22,839
the alarm work. They're called STAT one and STET two,

480
00:22:23,279 --> 00:22:25,400
and they block them, they disable them.

481
00:22:25,359 --> 00:22:26,319
Speaker 1: So it cuts the phone lines.

482
00:22:26,400 --> 00:22:28,720
Speaker 2: It cuts the phone lines, kills the guard dog, and

483
00:22:28,759 --> 00:22:31,160
disables the alarm system before it can even make a sound.

484
00:22:31,799 --> 00:22:34,559
By the time the immune systems heavy hitters finally realize

485
00:22:34,559 --> 00:22:37,960
what's happening, the virus has already replicated a billion times.

486
00:22:38,119 --> 00:22:41,000
Speaker 1: That explains the speed, That explains the fatality rate. So

487
00:22:41,079 --> 00:22:43,160
let's talk about what that feels like for the victim.

488
00:22:43,400 --> 00:22:45,759
Segment five, the clinical nightmare.

489
00:22:45,920 --> 00:22:49,279
Speaker 2: It is in nightmare, and it's unpredictable. The incubation period,

490
00:22:49,440 --> 00:22:51,759
the time from the drink of SAP to the first symptoms,

491
00:22:52,039 --> 00:22:55,759
is usually four to fourteen days, but there are documented

492
00:22:55,799 --> 00:22:58,480
cases where it has been as long as forty five days.

493
00:22:58,519 --> 00:23:00,960
Speaker 1: Forty five days, so I could go on a to Bangladesh,

494
00:23:01,039 --> 00:23:03,359
come home to New York, go back to work, see

495
00:23:03,400 --> 00:23:06,000
my family, feel perfectly fine for a month and a half,

496
00:23:06,359 --> 00:23:07,119
and then drop.

497
00:23:07,359 --> 00:23:11,960
Speaker 2: Theoretically, yes, and that long silent incubation period is a

498
00:23:12,079 --> 00:23:15,319
huge risk for global spread. Someone could get on a

499
00:23:15,359 --> 00:23:18,079
plane feeling fine and be a ticking time bomb.

500
00:23:18,160 --> 00:23:19,359
Speaker 1: What does the onset look like.

501
00:23:19,480 --> 00:23:23,400
Speaker 2: It starts deceptively. It mimics a dozen other things. Fever, headache,

502
00:23:23,599 --> 00:23:26,240
muscle pain, myyalgia. You think you have a bad flu,

503
00:23:26,759 --> 00:23:27,559
maybe a sore throat.

504
00:23:27,599 --> 00:23:29,559
Speaker 1: Okay, so you take some asper and you go to bed.

505
00:23:29,480 --> 00:23:34,839
Speaker 2: Right, But then fast dizziness we call it altered sensorium.

506
00:23:35,240 --> 00:23:37,519
You get confused, you don't know where you are, Your

507
00:23:37,559 --> 00:23:38,759
personality might change.

508
00:23:38,880 --> 00:23:41,319
Speaker 1: The brain swelling is starting exactly.

509
00:23:40,960 --> 00:23:44,200
Speaker 2: Mean cephalitis is kicking in. Then come the seizures and

510
00:23:44,279 --> 00:23:48,319
eventually coma. In the Bangladesh strain, which we need to remember,

511
00:23:48,359 --> 00:23:52,519
is the more lethal one. Acute respiratory distress syndrome or

512
00:23:52,839 --> 00:23:55,839
ARDS is very common. Sixty to seventy five percent of

513
00:23:55,839 --> 00:23:58,920
patients get it, and ARDS is it's where your lungs

514
00:23:58,960 --> 00:24:01,319
fill with fluid. Drowning in your own flu is while

515
00:24:01,319 --> 00:24:03,720
your brain is shutting down is an absolutely brutal way

516
00:24:03,720 --> 00:24:03,960
to go.

517
00:24:04,279 --> 00:24:07,400
Speaker 1: We mentioned the two strains, Malaysia and Bangladesh. Is there

518
00:24:07,440 --> 00:24:09,440
a big difference in survival rates?

519
00:24:09,480 --> 00:24:13,799
Speaker 2: Significant? The Malaysian strain was predominantly neurological. It had a

520
00:24:13,839 --> 00:24:16,759
mortality rate of about forty percent, still.

521
00:24:16,599 --> 00:24:18,519
Speaker 1: Terrible that the Bangladesh strain.

522
00:24:18,759 --> 00:24:21,960
Speaker 2: It hits the lungs and the brain harder. The mortality

523
00:24:22,039 --> 00:24:25,039
rate hovers around seventy five percent, but in some small

524
00:24:25,039 --> 00:24:29,720
outbreaks it is hit ninety percent or even one. Yes,

525
00:24:29,880 --> 00:24:33,240
small clusters where everyone who got it died, it is

526
00:24:33,400 --> 00:24:34,359
much much deadlier.

527
00:24:34,599 --> 00:24:37,400
Speaker 1: There is one more feature in these notes that sounds

528
00:24:37,480 --> 00:24:42,240
like pure psychological torture, relapsed encephalitis.

529
00:24:42,519 --> 00:24:45,359
Speaker 2: This is the thing that really scares infectious disease doctors.

530
00:24:45,839 --> 00:24:49,039
A patient survives NEPA, they beat the odds, they're one

531
00:24:49,039 --> 00:24:51,960
of the lucky few. They recover, they go home, They

532
00:24:52,000 --> 00:24:54,119
live their life for months, maybe even a year or more.

533
00:24:54,240 --> 00:24:57,039
And then and then the virus, which has been hiding

534
00:24:57,039 --> 00:24:59,799
in a dormant state somewhere in the central nervous system,

535
00:25:00,079 --> 00:25:02,200
maybe in the eye or deep in the brain tissue

536
00:25:02,200 --> 00:25:05,319
where the immune system can't easily see it, reactivates. It

537
00:25:05,359 --> 00:25:08,519
comes back, It comes back, and the patient develops encephalitis

538
00:25:08,559 --> 00:25:11,559
all over again, sometimes with no warning. We call it

539
00:25:11,640 --> 00:25:12,799
late onset NEPA.

540
00:25:12,839 --> 00:25:16,319
Speaker 1: That is incredibly cruel. You think you've won, but the

541
00:25:16,359 --> 00:25:17,079
war isn't over.

542
00:25:17,359 --> 00:25:20,079
Speaker 2: It's rare, but it happens. And even for those who

543
00:25:20,119 --> 00:25:24,200
survive and don't relapse, the cicila, the after effects are harsh.

544
00:25:24,519 --> 00:25:29,640
Survivors often have persistent convulsions, personality changes, cognitive deficits. The

545
00:25:29,720 --> 00:25:32,839
damage the virus does to the neurons doesn't always heal.

546
00:25:33,119 --> 00:25:36,480
Speaker 1: Okay, that is the heavy stuff, that is the monster.

547
00:25:36,680 --> 00:25:39,240
But we are recording this in January twenty twenty six.

548
00:25:39,599 --> 00:25:43,160
Science moves fast. Let's look for the silver lining segment

549
00:25:43,279 --> 00:25:44,839
six countermeasures.

550
00:25:44,880 --> 00:25:47,839
Speaker 2: The landscape is definitely changing. It's much more hopeful now.

551
00:25:48,359 --> 00:25:51,039
Speaker 1: If I am in Kerala today and I get diagnosed

552
00:25:51,039 --> 00:25:53,319
with NEPA, what is the treatment? Is there a pill?

553
00:25:53,359 --> 00:25:54,440
Is there something they can give me?

554
00:25:55,000 --> 00:25:58,599
Speaker 2: If you walk into a hospital today, the reality is stark.

555
00:25:59,279 --> 00:26:02,559
The standard of care supportive, which means we keep you hydrated,

556
00:26:02,640 --> 00:26:04,559
we put you on a ventilator. If you can't breathe,

557
00:26:04,680 --> 00:26:06,920
we give you anti seizure meds. We try to keep

558
00:26:06,920 --> 00:26:09,039
your body alive long enough for your immunes system to

559
00:26:09,039 --> 00:26:12,160
hopefully figure it out. There are no fully licensed, globally

560
00:26:12,200 --> 00:26:15,160
available drugs specifically approved for NEPA yet yet.

561
00:26:15,240 --> 00:26:17,720
Speaker 1: But I know there are trials. I've seen the reports.

562
00:26:17,920 --> 00:26:21,680
Speaker 2: There is a lot of movement in the experimental space. Historically,

563
00:26:21,759 --> 00:26:26,200
they tried drug called ribevierin during the Malaysia outbreak. It's

564
00:26:26,319 --> 00:26:29,599
a broad spectrum anti viral. Did it work The data

565
00:26:29,920 --> 00:26:33,240
is a messy. One study suggested it reduced mortality by

566
00:26:33,279 --> 00:26:36,640
thirty six percent, which sounds great, but later studies in

567
00:26:36,680 --> 00:26:40,480
animal models couldn't replicate that success. The consensus now is

568
00:26:40,519 --> 00:26:42,000
that it's probably not very effective.

569
00:26:42,200 --> 00:26:45,640
Speaker 1: What about antibodies. We heard so much about monoclonal antibodies

570
00:26:45,680 --> 00:26:47,599
during COVID Yes, there.

571
00:26:47,480 --> 00:26:50,200
Speaker 2: Is a specific one called M one O two point four.

572
00:26:50,480 --> 00:26:53,319
Speaker 1: M one O two point four, catchy name. How does

573
00:26:53,319 --> 00:26:53,759
it work?

574
00:26:54,039 --> 00:26:56,960
Speaker 2: Remember the G protein the grappling hook.

575
00:26:56,920 --> 00:26:58,799
Speaker 1: Right, the one that grabs onto ourselves.

576
00:26:58,880 --> 00:27:01,119
Speaker 2: This antibody is designed to stick to the G protein.

577
00:27:01,160 --> 00:27:03,640
It basically covers the hook and glue. If the hook

578
00:27:03,720 --> 00:27:06,400
is covered, it can't grab the Effrin B two receptor.

579
00:27:06,680 --> 00:27:09,079
The virus just bounces off the cell. It's a shield,

580
00:27:09,200 --> 00:27:12,400
it's a neutralizer. It is completed phase one safety trials

581
00:27:12,400 --> 00:27:14,480
in humans, and it has been used on a compassionate

582
00:27:14,519 --> 00:27:17,279
use basis in a few cases. It shows real promise

583
00:27:17,319 --> 00:27:19,640
if you give it early. But once the virus is

584
00:27:19,680 --> 00:27:23,039
inside the brain, it's harder for big antibody molecules to

585
00:27:23,039 --> 00:27:24,480
get across the blood brain barrier.

586
00:27:24,759 --> 00:27:28,079
Speaker 1: So timing is everything. What about simple anti virals? I

587
00:27:28,119 --> 00:27:29,519
seem desivere.

588
00:27:29,319 --> 00:27:30,440
Speaker 2: Ah rem de sivere.

589
00:27:30,599 --> 00:27:30,839
Speaker 1: Yeah.

590
00:27:30,960 --> 00:27:33,400
Speaker 2: The African green monkey study, this was a very compelling

591
00:27:33,440 --> 00:27:36,279
piece of research from a few years back. They exposed

592
00:27:36,319 --> 00:27:39,880
monkeys to a lethal dose of NEPA, then gave them

593
00:27:40,039 --> 00:27:42,359
rims survival.

594
00:27:42,400 --> 00:27:43,000
Speaker 1: Wow.

595
00:27:43,319 --> 00:27:45,640
Speaker 2: But and there is always a butt. It was given

596
00:27:45,680 --> 00:27:49,079
as post exposure prophylaxis. That means they gave the drug

597
00:27:49,200 --> 00:27:52,599
very shortly after infection, before symptoms got severe. So it

598
00:27:52,640 --> 00:27:56,079
proves the drug works mechanically against the virus, but whether

599
00:27:56,119 --> 00:27:58,279
it saves a patient who is already in a coma

600
00:27:58,480 --> 00:28:00,400
is a different and much harder question.

601
00:28:00,720 --> 00:28:03,680
Speaker 1: And then there's a holy grail vaccines. I see notes

602
00:28:03,720 --> 00:28:06,119
here about Oxford University. This is the big news right now.

603
00:28:06,160 --> 00:28:07,960
Speaker 2: Yes, this is the big news for twenty twenty five

604
00:28:07,960 --> 00:28:11,960
and twenty twenty six. The vaccine race has finally, finally accelerated.

605
00:28:12,279 --> 00:28:15,039
Oxford launched the world's first Phase two trial for their

606
00:28:15,119 --> 00:28:18,640
NEPA vaccine chad ox one neve ChAdOx one.

607
00:28:18,880 --> 00:28:22,200
Speaker 1: I know that code. That's the astrazenica COVID vaccine technology,

608
00:28:22,240 --> 00:28:24,440
isn't it? The chimpanzee adenovirus spector.

609
00:28:24,720 --> 00:28:27,720
Speaker 2: It is the exact same platform. It's a viral vector.

610
00:28:28,119 --> 00:28:32,319
They take a harmless chimp cold virus, strip out its insides,

611
00:28:32,680 --> 00:28:35,160
and put in the genetic code for the neperg protein.

612
00:28:35,359 --> 00:28:38,359
Speaker 1: So they use a harmless virus to deliver a picture

613
00:28:38,400 --> 00:28:40,200
of the bad virus to your immune system.

614
00:28:40,279 --> 00:28:43,559
Speaker 2: Exactly. It trains your immune system to recognize the grappling

615
00:28:43,559 --> 00:28:47,720
hook without ever exposing you to the actual dangerous NEPA virus.

616
00:28:48,319 --> 00:28:51,279
It's a proven platform. We know it worked for other diseases,

617
00:28:51,440 --> 00:28:53,319
and early data is very promising.

618
00:28:53,359 --> 00:28:54,599
Speaker 1: And there's an m RNA one two.

619
00:28:54,880 --> 00:28:57,720
Speaker 2: Oh of course, yeah, Medorna have a candidate mRNA twelve

620
00:28:57,759 --> 00:29:01,480
fifteen in clinical trials. Concept of the covid shots. You

621
00:29:01,519 --> 00:29:04,480
inject the instruction manual, your body builds the G protein,

622
00:29:04,680 --> 00:29:06,119
your immune system learns to fight it.

623
00:29:06,319 --> 00:29:08,519
Speaker 1: So why has it taken so long? NPA was found

624
00:29:08,519 --> 00:29:11,119
in nineteen ninety eight, it's twenty twenty six. That's nearly

625
00:29:11,200 --> 00:29:14,359
thirty years. Why are we just doing phase two trials now?

626
00:29:14,519 --> 00:29:16,799
Speaker 2: That is the tragedy of economics. It's what we call

627
00:29:16,839 --> 00:29:20,920
a market failure. NEPA outbreaks are sporadic, they're unpredictable. They

628
00:29:20,920 --> 00:29:23,680
happen in poor rural areas of Bangladesh.

629
00:29:23,160 --> 00:29:24,799
Speaker 1: In India, so not a big market.

630
00:29:24,839 --> 00:29:28,000
Speaker 2: There isn't a billion dollar market for a NIPA vaccine

631
00:29:28,039 --> 00:29:30,039
like there is for the flu, or for a global

632
00:29:30,039 --> 00:29:33,680
pandemic that's already started. Big pharma didn't prioritize it because

633
00:29:33,680 --> 00:29:35,000
it wasn't profitable.

634
00:29:34,559 --> 00:29:36,880
Speaker 1: Until they realized it could become a global pandemic.

635
00:29:37,000 --> 00:29:40,519
Speaker 2: Right. That's why groups like CEPI, the Coalition for Empidemic

636
00:29:40,559 --> 00:29:45,319
Preparedness Innovations, stepped in. They were formed after Ebola to

637
00:29:45,400 --> 00:29:49,400
address this very problem. They use donor money to fund

638
00:29:49,440 --> 00:29:52,319
these trials because they know it's not about profit, it's

639
00:29:52,319 --> 00:29:53,200
about insurance.

640
00:29:53,240 --> 00:29:55,240
Speaker 1: They're buying us insurance against the apocalypse.

641
00:29:55,279 --> 00:29:56,599
Speaker 2: That's a dramatic way to put it.

642
00:29:56,640 --> 00:29:59,279
Speaker 1: But yes, so until we have that shot in every arm,

643
00:29:59,319 --> 00:30:02,440
which could still be years away, we are left with

644
00:30:02,599 --> 00:30:08,799
prevention segment seven the future, and weirdly, the best prevention

645
00:30:09,000 --> 00:30:09,920
might be low tech.

646
00:30:10,160 --> 00:30:14,000
Speaker 2: Surprisingly, so we could talk about mRNA and monoclonals all day,

647
00:30:14,200 --> 00:30:17,480
but in Bangladesh, the most effective tool they found costs pennies.

648
00:30:17,759 --> 00:30:18,960
It's a bamboo skirt.

649
00:30:18,759 --> 00:30:20,759
Speaker 1: A bamboo skirt for the tree.

650
00:30:20,599 --> 00:30:23,119
Speaker 2: For the tree you weave a barrier of bamboo strips,

651
00:30:23,200 --> 00:30:25,599
or even use a polyepolene sheet and you wrap it

652
00:30:25,640 --> 00:30:27,160
around the shaved part of the tree where.

653
00:30:26,960 --> 00:30:28,599
Speaker 1: The pot hangs like a lambshade.

654
00:30:28,759 --> 00:30:32,240
Speaker 2: Basically, it physically stops the bat from getting to the

655
00:30:32,240 --> 00:30:35,279
flowing sap. If the bat can't lick the stream, the

656
00:30:35,359 --> 00:30:38,240
virus doesn't get in the pot. It's that simple scarecrow.

657
00:30:38,480 --> 00:30:39,839
It's a physical firewall.

658
00:30:39,960 --> 00:30:40,200
Speaker 1: Yeah.

659
00:30:40,200 --> 00:30:44,079
Speaker 2: And another simple solution boil the sap. If you boil

660
00:30:44,119 --> 00:30:47,559
it to make molasses, which they call gurr, the heat

661
00:30:47,880 --> 00:30:51,000
kills the virus instantly. It becomes completely safe to eat.

662
00:30:51,119 --> 00:30:53,799
Speaker 1: But people like it raw. It's a delicacy you do.

663
00:30:53,880 --> 00:30:56,599
Speaker 2: It's like telling a Frenchman he can't have unpasteurized cheese

664
00:30:56,960 --> 00:30:59,240
or Japanese poosts and they can't have sushi. Yeah, it's

665
00:30:59,240 --> 00:31:00,000
a cultural practic.

666
00:31:00,400 --> 00:31:03,720
Speaker 1: So it's a classic clash between tradition and biosecurity.

667
00:31:03,799 --> 00:31:05,920
Speaker 2: It is, and that is the hardest battle to win.

668
00:31:06,400 --> 00:31:09,079
Public health isn't just about science. It's about anthropology. It's

669
00:31:09,079 --> 00:31:10,200
about communication.

670
00:31:10,720 --> 00:31:12,680
Speaker 1: On the high tech side, what are we doing to

671
00:31:12,680 --> 00:31:15,160
stop the big one? To see it coming?

672
00:31:15,440 --> 00:31:20,279
Speaker 2: Surveillance, genomic surveillance specifically We are sequencing the virus from

673
00:31:20,279 --> 00:31:23,440
every outbreak. We are watching its genetic code like a hawk.

674
00:31:23,480 --> 00:31:24,160
Speaker 1: What are you looking for?

675
00:31:24,319 --> 00:31:27,200
Speaker 2: We know, for example, that the Bangladesh strain is six

676
00:31:27,279 --> 00:31:30,400
nucleotides longer than the Malaysian one. That helps us track

677
00:31:30,440 --> 00:31:35,400
the lineage. But mostly we are watching for mutations. NEPA

678
00:31:35,480 --> 00:31:39,079
is an RNA virus. It mutates, It makes mistakes when

679
00:31:39,079 --> 00:31:40,119
it copies itself, and.

680
00:31:40,079 --> 00:31:42,519
Speaker 1: One of those mistakes could be a terrible.

681
00:31:42,240 --> 00:31:46,480
Speaker 2: Upgrade, exactly the nightmare scenario. The next pandemic risk that

682
00:31:46,559 --> 00:31:48,920
keeps the WHO up at night is that it picks

683
00:31:48,960 --> 00:31:51,400
up a mutation that allows it to spread more easily

684
00:31:51,440 --> 00:31:54,480
through the air more efficiently from person to person.

685
00:31:54,359 --> 00:31:55,839
Speaker 1: Like COVID or measles.

686
00:31:56,000 --> 00:31:59,000
Speaker 2: If NEPA evolved to spread as efficiently as measles but

687
00:31:59,160 --> 00:32:01,119
kept its seventy percent mortality.

688
00:32:00,759 --> 00:32:03,279
Speaker 1: Rate, that's civilization ending stuff. I don't even want to

689
00:32:03,279 --> 00:32:03,839
think about that.

690
00:32:03,960 --> 00:32:06,680
Speaker 2: It would be catastrophic. That is why the WHO is

691
00:32:06,720 --> 00:32:09,000
so worried. That is why we are tracking it. We're

692
00:32:09,039 --> 00:32:14,119
also developing better faster diagnostics. ELIZA tests r TPCR. So yeah,

693
00:32:14,119 --> 00:32:17,359
when a case appears, we can know instantly if it's NEPA.

694
00:32:17,400 --> 00:32:20,880
And not Japanese encephalaitis or malaria. Speed is everything.

695
00:32:20,920 --> 00:32:22,880
Speaker 1: So what does this all mean. We've gone from the

696
00:32:22,920 --> 00:32:26,039
pig farms of Malaysia to the date palms of Bangladesh.

697
00:32:26,279 --> 00:32:29,160
We've looked at the molecular grappling hooks, the zombie cells,

698
00:32:29,200 --> 00:32:30,319
and the bamboo skirts.

699
00:32:30,720 --> 00:32:33,319
Speaker 2: I think the summary is that NEPA is a thrilling

700
00:32:33,440 --> 00:32:37,359
thread because it exposes the fragility of our relationship with nature.

701
00:32:38,079 --> 00:32:40,599
We have a virus that is perfectly happy in a bat.

702
00:32:40,759 --> 00:32:43,640
It does no harm there. But when we force that

703
00:32:43,720 --> 00:32:46,559
bat into our world, when we push into its world,

704
00:32:46,880 --> 00:32:49,839
that virus becomes a weapon of mass destruction.

705
00:32:49,640 --> 00:32:51,920
Speaker 1: And the trigger is almost always us.

706
00:32:52,440 --> 00:32:54,160
Speaker 2: That is the final thought I want to leave you with.

707
00:32:54,839 --> 00:32:57,720
We often talk about fighting the virus, we use war metaphors,

708
00:32:58,119 --> 00:33:01,000
but the recurrence of NIFA isn't an act exodent of nature.

709
00:33:01,200 --> 00:33:04,920
It's a symptom of human encroachment. Right as we cut

710
00:33:04,960 --> 00:33:08,119
down forests, as we change the climate, we aren't just

711
00:33:08,200 --> 00:33:11,119
losing trees. We are removing the buffer zone between us

712
00:33:11,119 --> 00:33:14,200
and the animal kingdom. We are inviting the reservoir hosts

713
00:33:14,200 --> 00:33:15,200
into our living rooms.

714
00:33:15,319 --> 00:33:17,519
Speaker 1: We are tearing down the fence and then acting surprise

715
00:33:17,559 --> 00:33:18,319
when the wolf comes in.

716
00:33:18,480 --> 00:33:21,279
Speaker 2: Exactly, The question isn't just how do we treat Nepa?

717
00:33:21,480 --> 00:33:23,640
The real question is how do we restore the ecological

718
00:33:23,680 --> 00:33:25,799
balance so the bats stay in the forest where they belong.

719
00:33:26,640 --> 00:33:29,720
Because if we don't solve the ecological spillover problem, we

720
00:33:29,799 --> 00:33:31,839
will just be fighting the next virus and the next

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00:33:31,880 --> 00:33:33,319
one after that forever.

722
00:33:33,640 --> 00:33:38,000
Speaker 1: That is a heavy but necessary perspective. It's not just biology,

723
00:33:38,240 --> 00:33:40,880
it's ecology, and I want to turn that to you,

724
00:33:41,000 --> 00:33:44,000
the listener. We talked about the bamboo skirts. We know

725
00:33:44,079 --> 00:33:47,000
that a simple piece of bamboo can stop a ugly outbreak,

726
00:33:47,240 --> 00:33:50,319
but it requires people to change a tradition that goes

727
00:33:50,440 --> 00:33:53,799
back centuries, drinking that raw morning sap.

728
00:33:53,880 --> 00:33:56,839
Speaker 2: It asks a community to give up a piece of

729
00:33:56,880 --> 00:33:58,920
their joy, their culture for safety.

730
00:33:59,079 --> 00:34:02,160
Speaker 1: Exactly. So where do you stand on that? How much

731
00:34:02,200 --> 00:34:05,440
should we or the global health community interfere with local

732
00:34:05,440 --> 00:34:08,559
traditions to prevent a global threat. Is it ethical to

733
00:34:08,639 --> 00:34:11,000
demand that culture change to stop a virus.

734
00:34:11,159 --> 00:34:13,599
Speaker 2: It's a question with no easy answer. There's no right answer.

735
00:34:13,760 --> 00:34:15,639
Speaker 1: We'd love to hear your take, leave a comment on

736
00:34:15,639 --> 00:34:18,360
whatever platform you're listening on, and let us know your thoughts.

737
00:34:18,119 --> 00:34:20,639
Speaker 2: And if you see a bat, maybe appreciated from a distance.

738
00:34:20,679 --> 00:34:24,239
Speaker 1: They're important, very safe distance. This has been thrilling Threads.

739
00:34:24,320 --> 00:34:26,480
Thanks for diving in with us, Stay curious, d S.

740
00:34:26,840 --> 00:34:27,360
Speaker 2: Goodbye,