Saint Louis University

School of Natural Sciences

Department of Medical Laboratory Sciences

Activity No. 1
Pandemic: How to Survive an Outbreak
Season 1: Episode 1

Group 1
DE GUZMAN, Jezaquiel B.
DIMALANTA, Justine Ace D.
FARRALES, Ara Lea C.
GALICIO, Fiona F.
GUINER, Merry Princess G.
KINGGINGAN, Ruth Joy N.
LAGMAY, Liz Gwyneth S.
MERCEDES, Joielley Nichole C.

0807 8:30 – 9:30 TThS S525

February 29, 2020
 PANDEMIC:
How to Survive an Outbreak
Season 1: Episode 1
“It Hunts Us”
The episode begins with a visit to a forest in Butler County, Pennsylvania,
U.S.A. A forensic analysis was held at the site. Basically, what they do is they look
for density changes in the soil with an instrument of what may be called a
densometer. The anomalies are marked with wooden stakes, the distances of which
range from one to three meters in length. And each stake represents a probable
body, which gave the scientists the conclusion that the site was essentially a mass
grave.
A hundred years ago, a deadly influenza virus infected hundreds of millions of
people around the world. Towns all over the world were running out of hospitals and
immediate health care. And with the high mortality rate, and mortuaries began to
lose space a well. So, the towns needed quick solution for the disposal of the
diseased. Which actually resulted to the mass graves.
People could be standing in towns across the United States, Kenya, India and
Vietnam without knowing that the ground they walk on, was where thousands of
deceased people were buried. The grave sites are a reminder of the devastation a
flu pandemic can wreak. And when the topic of another flu pandemic happening is
brought up, it’s not a matter of IF, but WHEN.

CHAPTER 1
911 won’t be Enough
New York City, New York U.S.A.

The chapter starts with what seems like an emergency department in a panic
because of a reported outbreak in the country. The institution was later introduced
as Kings County Hospital. There was a reported unofficial case count 220 infected
and 8 deaths, but the case definition and laboratory analysis of the particular
disease remains unknown. The medical workers have acknowledged that the
outbreak they are dealing with is novel, meaning that it is new, so they have no clue
how to treat the patients. Some of the patients are testing negative for the normal
seasonal flu viruses. The emergency hospital is currently operating at 104%, so they
had to set up a mobile satellite emergency department to accommodate all
incoming patients. At this point, the emergency room is in a complete frenzy. What
with all the symptoms and pains of all the patients they have to tend to.
A loud and long buzz is heard, which means that the simulation has ended.
All the ruckus was only just a simulation of what could happen in an emergency
outbreak, and what the skilled medical professionals are to do in that particular
situation. The simulation is designed to assess their readiness for a major flu
outbreak. The participants are employees of New York City Health and Hospitals,
which is known to be the nation’s largest municipal health care delivery system.
Dr. Syra Madad is the one who is responsible for preparing New York City’s
municipal hospitals against infectious disease outbreaks. She mentioned that one of
the takeaways in the previous outbreaks is Healthcare worker safety. In MERS and
SARS, healthcare workers were disproportionally affected since they were the first
responders to the disease. Healthcare workers need to improve on prioritizing their
safety first before their patients. Yes, while the patients’ lives are important, and it
is the healthcare worker’s job to ensure their safety, the main priority of the
healthcare workers are their own protection. Because if they [healthcare
workers] can’t protect themselves, how are they going to help others?
Dr. Syra Madad takes the viewers on a brief overview of what her occupation
entails. She said, “My job is to contain the virus here in New York City.” What
worries her is that it only takes one single person to start an outbreak. Humans are
basically incubators, we can host a number of different diseases, if not treated
immediately and effectively. And according to Dr. Syra, it’s just a matter of time
when the next pandemic is going to start, we just don’t know where or how, but we
know that it will.
She mentions the Movie “Outbreak” which was released in 1995 which
showed a novel virus that started in California, that quickly spread. In the movie,
healthcare workers get suited up, and now as a professional, Dr. Syra said, “working
in that high-risk environment, this is amazing!”. This was a formative moment for
Dr. Syra, and she has been pursuing a career in infectious disease control ever
since.
The scene changes to what looks like a conference, where Dr. Syra is a
speaker. She mentions the term “hoarding” during an outbreak. It happened
during the H1N1 virus, when vaccines were not made available in the United States
because countries were hoarding them. Infectious disease outbreaks are scarier and
more deadly that the conventional warfare. This is something that people should
pay attention to and be aware of. But more often than not, people tend to forget,
and it is Dr. Syra’s job to remind them.
Waurika, Oklahoma, U.S.A
 This scene starts with a lady waking up to a phone call. She is introduced as
Holly Goracke, the only doctor at Jefferson County Hospital. In this part of the
chapter, Dr. Holly takes the viewers through a day of what it’s like to be a small-
town doctor, the only doctor in town. She basically lives in the hospital, as she is the
only doctor available. Small-town doctors are the ones that see patients in the
clinic, they are the ones that rotate through the Emergency room, they see the
patients in the hospital, and deliver babies. And Dr. Holly wanted to be that kind of
doctor. The kind of doctor that took care of the patients when they were well, and
took care of the patients when they were sick and hurt, and ran into the patients in
different social situations outside of the medical institution.
She had spoken to different physicians and the one advice that they could
give her was to reconsider the job she took, and the path she chose. But she stood
her ground firmly, because she wasn’t going to be swayed. She was going to be a
small-town doctor, regardless.
The scene shifts to Dr. Holly visiting a couple infected with the Type A Flu.
They said that the symptoms are getting worse, and they wake up with chills and in
sweat. Dr. Holly further explains that she doesn’t have all the resources that a large
hospital usually has, so treatment is very slow and minimal. She has no idea what
she would do if a pandemic would strike their county. It is going to be very difficult
to get replenishment for their resources, since places with higher populations
are going to be those places that get the lifesaving medication first. Should
a flu pandemic occur in their little county, Dr. Holly thinks that their small hospital
would be overwhelmed, and that they wouldn’t be able to manage.
Cao Lộ c District, Vietnam

This scene takes place in a chicken farm in Vietnam. Dr. Dennis Carroll serves
as the Director of the U.S. Agency for International Development’s (USAID)
Emerging Threats Unit. His main responsibility is trying to prevent, detect, control,
and respond to emerging viral threats. Hence, his job takes him in different places
all around the world. Why is this scene located in a chicken farm? Because the virus
is located in birds. The most dangerous influenza virus circulating on Earth is
the Avian Flu, located in China, as 60% of the people who are infected die.
In China (2013), a new strain of Bird Flu emerges, the H7N9 virus, discovered
by Taiwan’s Center for Disease Control. Shots from newscasts are portrayed in this
film, showing the absolute devastation that the strain of Influenza virus has caused.
Keiji Fukuda, an official with the World Health Organization (WHO) said that the
H7N9 is “definitely one of the most lethal influenza viruses that we have seen so
far.” During that time, there were at least 108 people infected, and 22 of those
people died, since the first confirmed case in late March 2013.
Dr. Dennis further elaborates that the recent H7N9 virus has a very high
mortality rate. That being said, it remains an inefficient virus for infecting people.
Thankfully, up until now, this virus has not left the borders of China. But it is not
impossible, it could happen any time.
 The outbreak starts from chicken farms and public markets. If the chickens
are not vaccinated, the chances of an outbreak are higher. People can buy infected
chickens without knowing that they’re infected, and eventually acquire the disease.
Dr. Dennis explains that there are almost endless variations of the influenza virus,
denoted by different combinations of H’s and N’s, such as the H1N1 and the H5N1
viruses. The H’s and N’s ultimately define the physical characteristics an influenza
virus will have, and just how deadly that infection might be.
Pandemic flus and seasonal flus should not a subject for confusion, as they
are profoundly different. A pandemic influenza will most likely emerge from an
animal, and it will be a new, and novel, never-before-seen virus. It will have new
and unusual signs and symptoms. One thing to take note from Dr. Dennis is that
when a novel virus comes from animals, we as humans will not have natural
immunity, which means that our body systems will have absolutely no means to
fight off the infection, which implies that it will have the potential of being very
deadly. This is essentially why there are thousands of researchers around the world
who are committed to developing a universal vaccine that will be effective against
any and all new and old influenza viruses.
- MERCEDES, Joielley Nichole C.

CHAPTER 2
Every Goliath needs a David
New York City, New York U.S.A.

Jake Glanville a Co-Founder, Chief Science Officer, and Chairman of

Distributed Bio works to create the world’s first universal flu vaccine. He is an
effective communicator of science that narrates the story of slow-burning revolution
in biologic therapeutic discovery. As a matter of fact, he was invited to be a speaker
in the Conference for Therapeutic Discovery in particular. He emphasized that first,
you have to introduce the terrible monster, the Influenza in particular. He
discussed how virus can make the immune response of an individual become
obsolete by the year/s to come. Although, there are vaccine technologies
introduced, however, it does not work on rapidly mutating viruses, making it
somehow ineffective. But this time, you present the hero, that there is an
existing technology that could potentially make a breakthrough. In a way that, a
vaccine is being formulated universally, a means to eradicate all versions of flu. He
also discussed that some of us has broad protection from flu, and some of us do not
have.
San Francisco, California, U.S.A

On the other hand, there is a woman named Sarah Ives who works in Jake
Glanville’s facility, as she was offered by him a job as he knew that she has the
skills and capacity that Jake Glanville need if he already wanted to launch a vaccine
program. She is a Principal Scientist spearheading the development of a universal
flu vaccine. One of the reasons why she unhesitatingly submits herself to the job, it
is because she observed that the man, she is working with has the passion in the
medicine field. She described Jake Glanville as a critical thinker, who have ideas
that is out of the norm. In connection to that, she confidently mentioned that the
research they are working on can possibly eradicate Influenza, as she said that they
have done reproducible multiple animal studies, proving that they are on the right
track.
Jaipur, Rajasthan India

In Jaipur, India, Dr. Dinesh Vijay, a Pulmonologist who is battling the rising
number of seasonal flu cases such as the H1N1 Virus or the Swine Flu in the people
who live in the rural areas of the state of Rajasthan, who don’t get proper treatment
locally and often come to the city for treatment when patients feels near-fatal
levels. Like Nisha Devi who came from hospital in Chomu, after she was diagnosed
of having the said flu. Dr. Dinesh Vijay described the swine flu as " A very rapidly
progressing disease, that can affect both of the lungs in just few days."
He also stated that, "All patient came with throat pain, sneezing, nausea,
vomiting along with the breathlessness and troublesome cough always think of
swine flu." And if not diagnose early it is difficult to treat, because later they come
the more laborious it gets to breathe and it becomes a matter of death and life.
Cao Lộ c District, Vietnam

Dr. Dennis Carroll, director of USAID’s Emerging Threats Unit, says that
"Biggest challenge with flu is not being lulled into acceptance of seasonal flu as all
we have to worry about, because every once in a while, there is a variant of flu that
emerges that also poses as an existential threat to us as a species." He also
discusses the H1N1 outbreak in 1918. That pandemic overwhelmed the healthcare
system back then and killed 50-100 million people, on a planet that had 1.8 billion
people. And now, with the almost 8 billion people on Earth and if a similar virus
emerges today, the result will not be the same in 1918, it could be a hundred of
millions of people who will die. And it seems that such a pandemic’s arrival is not a
matter of when, not if.
- GALICIO, Fiona F. and KINGGINGAN, Ruth Joy N.

CHAPTER 3
The Answer Lies in the Young and Bold
New York City, New York, U. S. A.

In the first part of this chapter, Dr. Syra and her group did a roll call with all
the hospitals across their system. The purpose of the weekly system-wide seasonal
flu activation call is, as the progress with seasonal flu, they let them know any
impact that they are having.
While on a roll call, one person in a facility will be asked if there’s any
change, the last one reported that influenza activity is being categorized as
widespread in the first week that has been reported. As they go over checking
current status of hospitals, they also started seeing impacts in which there is a
shortage of Tamiflu making folks to go back in emergency department for their
children to be admitted and receive the needed medication.
Dr. Syra is always alert when she receives an email, because she always
wants to know what is happening and to be on top of it. Her meetings are back-to-
back, she checks her email every night. For her, pathogens are threats like MERS,
SARS, Ebola and flu. That is precisely why she wants to make sure that not only her
children are safe, but also the humanity.
San Francisco, California, U. S. A.

The second part of this chapter focuses on the creation of vaccines. Jake
Glanville was working at Pfizer back in 2012 doing antibody engineering, not on
vaccines, but on how the populations of antibodies respond to their targets. He had
a Bachelor of Arts at Pfizer and got promoted every year, and eventually, he
became a Principal Scientist with a bachelor’s degree. For Mr. Jake, technology is an
eye opener on what is happening to those who receive a vaccine or when they are
trying to engineer an antibody as a drug.
More often than not, startups are looking for the quickest path to funding.
One of them is Elizabeth Holmes who founded Theranos in 2003 at the age of 19
using a small amount of blood. She was a college drop-out but then became the
youngest self-made female billionaire. In order for them to get funding they
convince investors about ideas that are not yet proven. There’s no even science
back-up for their plans. Theranos would’ve been the “next big thing” had it not been
fake.
CNN news about new investigation into Theranos blood testing startup from
the Security and Exchange Commission and a US Attorney’s Office in California.
Holmes and former president of the company were indicted on federal wire fraud
charges.
Experiments fail for many reasons. All that matters now, is the knowledge
that the data, as well as Mr. Jake’s data are very promising. They want to enable
the world to have access to their vaccine, inclusive in a sense, which
means that it also includes the people who can’t afford it. While it is
acknowledged that this can’t beat the major pharmaceutical companies, but its
technique would come to be their advantage. All that’s left is the vaccine to be
tested on humans.
- DIMALANTA, Justine Ace D. and GUINER, Merry Princess G.
 Chapter 4
You Have to Breathe
Jaipur Rajasthan, India

Dr. Dinesh Vijay, received his MD last 15 years ago. He pursued being a
doctor because his family’s dream is to have a doctor in the family. They thought
the first son would become a doctor but didn’t. They hoped that the second, third
and fourth would also become a doctor but didn’t. So then, Dr. Dinesh Vijay, the
fifth, found some hope to become a doctor. Little did they know that Dr. Dinesh
could become one, who has poor academic performance but did everything he
could. He didn’t apply this profession for money but passionate about this cause.
SDMH, as the best-equipped hospital in Rajasthan, have been overrun with
critical flu patients from smaller towns of the state. Nisha Devi, a patient diagnosed
with a severe case of flu was admitted to emergency three days back. The flu was
going on for 15 days. She was admitted into a hospital in their area but it not as big
as this. Doctors doesn’t even know about H1N1 so she wasn’t tested for this.
Because of lack of information, no one even realized that this flu was a serious
disease. The problem is there are no facilities in the distant areas. When people
become ill, they head to the cities but it is too late for them. The culprits for
swine flu are those patients who have low immunity; child, pregnant woman,
elders, a patient diagnosed with diabetes, a patient with kidney disease.
- LAGMAY, Liz Gwyneth S.
Devraj Manghnani, a patient positive in H1N1 with chronic kidney disease and
has been in the ICU for four days. Feeling tired and can’t even breathe well. Indians
thinks it’s just a small cough that can be cured by honey, lemon, turmeric and the
cough goes away but it was the opposite this time. Nobody realized it was a swine
flu, even Devraj’s son, Dheeraj Manghnani. He is the only child and always willing to
take care of his father. So that his father is reassured that someone is looking out
for him and taking care of him.

CHAPTER 5
It Can’t be for the Money
New York City, New York, U. S. A.

The first part of the fifth chapter started with Dr. Syra, a mom of two young
boys who is also working in the field of defense, does not tell people what she does
because as she stated, “People’s fear factor kicks in first before logic.”, or in other
words, if people think that Dr. Syra had any remote kind of contact with disease,
people would respond like, “Don’t touch me, don’t come near me.” But despite
those things, she still does her job because she has a passion for it. According to
her, she started working in the field of bio-defense and she also did some work with
FBI related to bio defense. Dr. Syra’s master’s thesis was on Ebola and the bio
threat team that she was part of in 2014 at the Texas Department of State Health
Services, was the team that diagnosed the very first patient with Ebola. There was
no active monitoring or screening in the United States because no one thought at
that time that the virus would ever reach the shores of the United States. A number
of questions then arose of are all hospitals in the United States equipped and able
to identify patients suspected with these types of special pathogens.
For Dr. Syra, she wants to make sure from a healthcare delivery standpoint
whether the patient is coming in with Ebola virus disease or a pandemic flu, would
they have the resources to identify these patients. Yes, Dr. Syra may be putting
herself in harm’s way, but that is something that she has knowledge of. She has an
upwards of ten projects happening at any given time because they need to do
something about the threats that are never going to stop.
San Francisco, California, U. S. A.

The second part of this chapter showed how Bill Gates actually contributed to
research into a universal flu vaccine. It also showed that the Bill and Melinda Gates
Foundation partnered with the CEO of Alphabet to establish a $12 Million fund for
the said research. Bill Gates stated that the vaccine is needed to help combat
possible future pandemics.
The Gates Foundation has an amazing record trying to help global
populations and they would enable communities that cannot pay for it to be able to
be beneficiaries.
- DE GUZMAN, Jezaquiel B.

CHAPTER 6
You Get One Shot
Waurika, Oklahoma, U. S. A.

In Waurika, Oklahoma, five new people were admitted to Jefferson County

Hospital with flu-like symptoms. Dr. Holly said that the people living in the county
has poor access to health care and can take up to 35-45 to get to the hospital that
is why people chose not to get themselves checked anyway. When October and
November are coming which is the flu season the medical team expects them to be
busier and have sicker patients because they just had 70 patients who died from
the flu. Additionally, Dr. Holly said that if the patients only had good hand hygiene,
had been vaccinated and did not just let the “flu” aside, then the illness would have
been prevented. Her mindset was clear that the flu season that they are about to
face will be like the last time.
Jaipur, Rajasthan, India

On the next scene, Dr. Dinesh Vijay’s patient Nisha Devi has been sick with
the flu for three weeks and after checking on her, he told the patient’s son that her
mother was not responding to the treatment. She died on February 8 due to
complications from influenza. The news reported that there are 9,367 cases of H1N1
across India. Bill Gates then implied that people who are willing to risk everything in
facing the flu scare which is not an easy task and that we are not prepared for it.
- FARRALES, Ara Lea C.
 RELEVANCE
1. There are many countries and places that are vulnerable when an outbreak
happens. Small countries get less resources, while big countries “hoard” the
resources. Therefore, it is important that the constituents of a certain
municipality are well-informed with the proper hygiene and care, for the
prevention, and intervention of disease. And also, to lessen the occurrence of
“hoarding” medical resources and goods due to panic buying.
2. As future medical professionals, it is our duty to ensure our safety and
protection not only when an outbreak happens, but every day, anywhere, and
anytime. Our duty as medical professionals does not stop at the work place.
3. The importance of prevention and intervention of an illness during flu season.
Despite the unpredictable nature of pandemic emergence, there are lessons
to be learned from the 1918 flu pandemic lessons that may offer clues as to
how future infectious disease outbreaks and pandemics may be prevented.
4. Always visit your physician no matter how mild your illness is. Because it is
possible that a simple cold may be a symptom of a worse disease. As the
saying goes, “It is better to be safe than sorry.”
5. The significance of the continuous researches done in order to provide a
universal vaccine for influenza that is effective and inexpensive.
6. The people need to be prepared for the high probability of the occurrence of
an outbreak. This can be accomplished through various programs to
disseminate the proper information, and ensure the knowledge of skilled
workers are somewhat imparted to local communities.
7. Monitoring the public’s health is important to know the status of the
community not only to prevent the disease but also to cure those who are
infected. When it comes to creating vaccines or medicines, it is not just only a
single snap for it needs a long process to produce one, trial-and-error will
always be present.
8. As medical technology science students, we must apply the things we
learned from this episode because by the time when already have our
licenses as registered medical technologists, it will be our responsibility to
contribute in the community by helping in maintaining the health of other
people. Therefore, we must work by heart, and not by the title we hold and
the money we earn.
9. Science communication with the help of scientists and researchers breaks
down the walls of scientific research and makes it possible for everyday
people to understand its relevance and how it can affect the society. If we
want to solve problems, make improvements and bring about change, we
need to make information available. At the end of the day, it is a collective
effort.
“Sciences and humanities are actually interdependent ways of getting to
know the world”.