Pandemic rch record highs with no signs of slowing down. Researchers are now warning the u. S. Death toll may near 540,000 by april. Today we will speak to one of the worlds leading Infectious Disease doctors, paul farmer, the cofound of partne in health. All of these epidemics find their way to exploit social disparities and inequalities and take their greatest harvest among the pr anvulnerab. E qstion ware aski is does that need to be the case . And of course, the answer is, no, it does not. Amy dr. Paul farmer will talk about the pandemic, health care inequality, and his new book fevers, feuds and diamonds ebola and the ravages of history. All that and more, coming up. Welcome to democracy now , democracynow. Org, the quarantine report. Im amy goodman. The United States has set yet another world record for daily coronavirus cases and hospitalizations and deaths with over 216,000 infections confirmed thursday and more than 2800 deaths. Nearly 101,000 people are hospitalized with covid19 across the u. S. In california, governor gavin newsom has imposed sweeping remainathome orders covering the vast majority of the states population. Just in the last 14 days, close to 1000 californians have tot their lives due covid19. The bottom line is if dont act now, our Hospital System will be overwhelmed. If we dont act now, we will continue to see a death rate climb. Amy governor newsoms order came a day after Los Angeles MayorEric Garcetti warned his city is nearing a devastating tipping point, ordering residents to remain at home and skip social gatherings in order to prevent needless suffering and death. In rhode island, officials have opened two field hospitals with a combined 900 beds to relieve hospitals as covid19 cases hit new record highs. Rhode island Governor Gina Raimondo says the problem now is finding enough medical workers to handle the surge. On thursday, she appealed to retired and unemployed healthcare workers to join the effort. President elect joe biden has nominated vivek murthy to serve as u. S. Surgeon general to help lead the response to the coronavirus crisis. Murthy previously served as Surgeon General for over two years under president obama. On thursday, biden told cnn he ll order new Public Health measures as soon as he takes office. Mr. Biden the first day i am inaugurated, i will ask the public for 100 days to mask. Just 100 days. Not forever, 100 days. And i think we will see a significant reduction and that occurs with masking and vaccination to drive down the numbers considerably. Amy researchers at the university of washington project the u. S. Coronavirus death toll could reach nearly 540,000 by april 1. The same researchers recently protected that if 95 of americans wore masks consistently, over 60,000 lives would be saved by march 1. Italy recorded 993 new covid19 deaths thursday, a daily record. The Italian Government has declared a National Curfew and said thursday it will bar people from traveling between regions over the christmas and new year holidays. Irans official coronavirus cases count topped 1 million on thursday. In october, a member of irans medical association said the true death toll in iran could be four times higher than the official number, which now stands at nearly 50,000. In the gaza strip, officials have ordered schools and mosques to close as part of a partial lockdown as more than 800 new covid19 cases were confirmed thursday. Among those infected are senior members of hamas, including its leader yahya sinwar. At the United Nations, secretary general Antonio Guterres warned thursday the world could be suffering negative effects from the pandemic for decades to come. Lets not full ourselves. A vaccine cannot undo damage that will stretch across years and even decades to come. Extreme poverty is rising. We face the biggest global recession in eight decades. Amy back in the United States, californias farmworkers have contracted covid19 at nearly three times the rate than other residents in the state. This is according to a new study by the university of california, berkeley the first report to explore how farmworkers are disproportionately affected by the pandemic. The report also found farmworkers who only spoke in digenoused which had higher positivity rates than farmworkers who spoke spanish or english. Wisconsin Supreme Court refused thursday to hear the trump campais wsuit seekinto squalifyearly a quartemillion llots inhe stas laest demoatic unties. The ump caaign has losor thdrawn least 2lawsuits seekg to invidate th sults ofhe 2020 ection. Ite houscommunicions direct alyssa rah has signed her post. She rved in e role f just 0 days. Meanwhe, pside trump eeted la thursdahe will veto theassive, 40 billi National Defense authorization act because republican senators refused to include an amendment to strip Legal Protections for social media companies. Trump is demanding the repeal of section 230 of the Communications Decency act to punish twitter and facebook, which he has accused of censoring his false and misleading tweets about the coronavirus and the 2020 election. The u. S. Is pulling dozens of staff from its embassy in baghdad ahead of the anniversary of the trumpordered assassination of iranian general qassem soleimani. Its unclear whether the move will be permanent and comes as tensions are flaring in the region following the killing of irans Top Nuclear Scientist last week. Egypt has freed three human rights workers from prison amid International Outcry over an unprecedented crackdown on activists and journalists. Gasser abdelrazek was arrested at his home last month just days after two other staffers for the Egyptian Initiative for personal rights were also arrested. They had recently hosted foreign diplomats to discuss human rights abuses in egypt. In bangladesh, human rights advocates are condemning the relocation of thousands of Rohingya Refugees to an isolated islandhours away from the mainland. Police thursday escorted refugees, who were put on buses for the long trek from coxs bazar to a port town where theyll be then put on boats en route to bhasan char island, which is prone to flooding and frequent cyclones and only emerged from the ocean two decades ago. The island has never been inhabited. Two aid workers told reuters refugees were pressured to the move by government officials, who threatened them and offered them cash in exchange. Human rights watch called the refugees relocation nothing short of a dangerous mass detention of the rohingya people in violation of International Human rights obligations. In immigration news, nbc news reports attorneys tasked with reuniting children separated from their families at the u. S. Mexico border have finally been given Key Information critical to finding the childrens relatives after months of pleading for the information. Documents filed in federal court in california last week say attorneys have now obtained phone numbers and other data that had not previously been made available by the trump adminiration. This comes as lawyers say theyve found the parents of nearly 40 children among 666 refugee kids whose families they could not track down. The children were taken away from their families between april and june 2018 at the height of trumps zero tolerance family separation policy. In more immigration news, the Arizona Republic reports dozens of Asylum Seekers and allies led a protest wednesday in the border sister cities of nogales, sonora, and nogales, arizona, demanding president elect joe biden restore asylum proceedings. Nearly 80 people marched sidebyside, separated by the massive border wall. Asylum seekers remain stuck on the mexican side as the Trump Administration has used covid19 as a pretext to suspend asylum claims. Asylum seekers are also urging joe biden to kill other trump policies, including the remain in Mexico Program which has forced tens of thousands of Asylum Seekers to stay in mexico while their asylum cases are resolved in u. S. Courts. The u. S. Has banned cotton imports from a Major Chinese producer which it accuses of using the slave labor of recent imprisoned uighur muslims in xinjiang province. China has denied the accusation. Its the latest crackdown on china by the Trump Administration, which could further complicate efforts. In india, demonstrators formed a human chain in the city of bhopal wednesday to commemorate the lives lost and renew calls for justice in the deadliest industrial disaster in history. In 1984, a toxic gas leak from the Union Carbide pesticide factory killed an estimated 20,000 people and poisoned another half million. The u. S. Company and its parent firm, dow chemical, have refused to pay for cleanup. This is activist Rachna Dhingra speaking at the protest. Up until today, people have been fighting for our life of justice and honor and they are finding because both the state and the federal government have closed their eyes and ears. Today. S poisonous water the gas victims have not received proper compsation for the problems they have been pacing for a lifetime. Amy the Trump Administration has announced plans to Sell Oil Drilling Rights in the Arctic National wildlife refuge for the first time. January 6 lease sales could complicate president elect joe bidens pledge to permanently protect the pristine region, which is extremely rich in biodiversity and has been home to Indigenous Peoples for thousands of years. In southern california, two firefighters were injured as a wildfire east of irvine exploded in size thursday, fueled by fierce santa ana winds and bonedry conditions. The bond fire has burned over 6400 acres and is only 10 contained. Over 4 million acres have burned across california so far this year, shattering all previous records. Georgia republican senator david perdue has traded stocks, bonds, and mutual funds nearly 2600 times in the past six years often in companies within his Senate Committees oversight. Thats according to the new york times, which reports perdue has been the senates most prolific stock trader by far, sometimes reporting 20 or more transactions in a single day. Perdue faces democratic challenger jon ossoff in a january 5 Runoff Election in georgia that will determine the balance of power in the senate. In more news from georgia, Florida Attorney bill price faces a felony investigation after he urged fellow republicans to violate the law by registering to vote in georgia. The investigation follows these remarks price made in early november in a sincedeleted Facebook Live video. We have to win on january 5. I want to invite each and everyone of yo to be my roommate in geora. I am moving to georgia. Im changing my Voter Registration right now. I amnviting 2 Million People to become my roommate. Amy under Georgia State law, its a felony punishable by up to 10 years in prison to register to vote as a nonresident without proper qualifications. Price later told reporters in atlanta he was only making humorous comments, but Elections Officials in georgias Paulding County say price did, in fact, register to vote at his brothers address. A debate between senator leffler and rev. Warnock will take place on sunday night. In philadelphia, a black mother who was attacked with her family in october by a horde of Police Officers is speaking out about the harrowing experience. Rickia young was driving an suv with her twoyearold son and teenage nephew when officers descended on the vehicle, busted all its windows, assaulted and arrested young, pulled her 16yearold nephew from the car, and grabbed her child who suffered a bump on his head from the assault. Rickia young says she and young son are physically and emotionally traumatized. He is petried. Hes only t years o. My mom a my nepw askehim, what hapned . Car and [b[ep eep] door. Like the cops were bging on the car. He kt repeatg it. Ke he istill tryg to tel thstory. He bes hisails, pus his hair. Heever did tse this before he is aumatize he is gointhrougsomethin he knows words he ct expres tme howe is fling. Y demrats introdud a solutiono amend clae in th13th amement thabans the enslavemt of peoe with t exceptn of inluntar servude as punishment for being convicted of a crime. Racial justice advocates have for long argued the clause is a loophole thats allowed for new forms of slavery in the u. S. And have likened mass incarceration to slavery as prisoners are forced into harsh labor for the profit of private prison companies. And the ceremony for the right livelihood awards also known as the alternative nobel prize, was held thursday. Four winners share the honor this year indigenous rhts and environmental activist Lottie Cunningham wren of nicaragua, belarusian prodocracy activist ales bialiatski, u. S. Civil rights lawyer bryan evenson, and iranian human rights lawyer Nasrin Sotoudeh who was returned to pris one day before the ceremony after being temporarily released last month due to her worsening alth. Bryan stevenson was presented his award by anthony ray hinton, who spent 30 years on death row for a crime he did not comt and noworks alongside stevenson at the equal Justice Initiative this is stevenn speakingt the ceremony. That has in a country the highest rate of incarceration in t world. I work against a system that treats you better if you are rich and guilty than if you are poor and innocent. We work to overturn this horrific era of mass incarceration in america at has been brought about by the politics of fear and anger in in too many places across the world for being governed byeople who preach beer and anger and those arthe incisnal ingredients of oression and abuse. We need a community of people to stand up against it. That is what human rights work is for me. Challenging these conditions that he been so brutal,o toxic, so critically fair. There are thousands ofnnocent people in jails and prisons and we will continue fighting for them. Speaking intevenson mcgovern, alabama. The exhibition features hundreds of jars of soil collected from various lynching sites around the United States. You can see our interviews with bryan stevenson, anthony ray hinton, as well as watch the entire right livelihood Award Ceremony at democracynow. Org. And those are some of the headlines. This is democracy now , democracynow. Org, the quarantine report. When we come back, dr. Paul farmer on the covid19 pandemic and his new book fevers, feuds, and diamonds ebola and the ravages of history. Stay with us. [music break] amy this is democracy now , democracynow. Org, the quarantine report. Im amy goodman. We turn right now to a Remarkable Book. It is called fevers, feuds and diamonds ebola and the ravages of history. The United States has set yet another world record for daily coronavirus cases and hospitalizations with over 216,000 infections confirm thursday and more than 2800 deaths. Nearly 101,000 people are hospitalized with covid19 across the United States. In califora, governogavin neom has issued sweeping remainathome orders the Navajo Nation s requested a major disaster declaration from the federal government, facing medical supply shortages and surging case numbers. Here in new york city, the positive test rate is the highest its been since may, with officials warning of a second wave. On thursday, president elect joe biden told cnn he would ask americans to wear masks for his first 100 days in office. I amiden my first day inaugurated, im going as the public for 100 days to mask. Just 100 days. Not forever, 100 days. And i think we will see a thatficant reduction occurs with vaccinations and masking to drive down the numbers considerably. Amy president elect biden also announced dr. Anthony fauci, the director of the National Institute of allergy and Infectious Diseases, will play a key role in his administrations response to coronavirus. This comes as the race towards vaccination continues. Earlier this week, the United Kingdom became the first country to approve use of the pfizerbiontech coronavirus vaccine. Authorities said the first 800,000 doses will become available across the u. K. Starting next week. As the u. S. Also prepares to begin issuing vaccinations, starting with healthcare workers and nursing homes, concerns are growing about equitable distribution of the vaccine, especially to the global south. Well, for more on the covid19 crisis, we go to miami, florida, where we are joined by world renowned Infectious Diseases doctor and medical anthropologist paul farmer. He is chair of Global Health and social medicine at Harvard Medical School and cofounder of partners in health an International Nonprofit organization that provides direct Healthcare Services to those who are sick and living in poverty. Dr. Farmer cofounded the group in 1987 to deliver healthcare to people in haiti. In 2014, he traveled to west africa to treat ebola patients. Killed 20142016, ebola more than 11,000 people. Leone, newrra guinea, liberia. In his new book just published about the ebola epidemic, he looks not only at the modern day crisis, but at the decades of colonialism and extraction that fueled it. The book is titled fevers, feuds and diamonds ebola and the ravages of history. Dr. Paul farmer, welcome back to democracy now it is great to have you with us. Take you. It is great to be back. And because this is an epic work. Before we go deeply into what we can learn from based on how ebola was dealt with, i wanted to go to the epilogue of your book, which is what we are living in today in this country and around the world. This unprecedented pandemic. As we speak today, paul, all records have been shattered. Not in the poorest countries of the world, but right here in the wealthiest country in the world. Over 2800 people have died. We have less than 5 of the worlds population but nearly 20 of the worlds infections and death. How is this possible . Well, we are facing the consequences of decades and decades of underinvestment in Public Health and of centuries of misallocation of funds away from those who need that help most. All the social pathologies of our nation come to the floor during epidemics and during the pandemic like this one were going to be showing the rest of the world works and all how we have shown the rest of the world how badly we can do. And now we have to rally, use new tools that are coming online. An address some of the older pathologies of haircare of our care and our country. Amy in your epilogue, begin by saying the only means of finding drew, is observes dr. Common decency. And i thought about that in relation to national policy. You president elect joe biden and Vice President elect Kamala Harris yesterday talking about what they will do. Now, he has long known dr. Fauci will play a key role. Vivek murthy was just being named the Surgeon General. He is saying for the first 100 days, they will ask the entire u. S. Population to wear masks, and yet this flies directly counter to what President Trump is doing right now, who will hold scores of holiday parties inside the white house the secretary of state, mike pompeo, has invited nearly 1000 people to the state department for holiday parties. Of course, this is inside, it is winter. We are not just talking about what the future will look like most of President Trump is in office for almost two months. When you have nearly 3000 people dying a day, we are talking about tens of thousands of more needless deaths. What needs to happen right now in the United States . Is arst of all, i think it great tragedy that such matters as masking or social distancing or even shutting down parts of the economy that contribute to shame that has been politicized. These are not political or partisan actions. They are Public Health strategies. Right now they are all we have got. It even when the vaccine is online or begins to come online, we have no history of seeing the vaccine taken up so rapidly that it would alter the fundamental dynamics of a respiratory illness like this. So we are facing,s president elect biden says, along dark winter. If we could make a difference that could spare tens of thousands and perhaps more than 150,000 lives, then we should do that. These arer are not called mass mandates or pleading from the president , need states and local authorities to come together and underline the nine nonpartisan and lifesaving nature of some of these basic protective measures. We need to invest heavily in making sure the vaccine goes to those who need it most and those who have been shut out of previous developments like this or shut out for too long. We have a lot of work ahead of us this winter, but no small amount of it will rely on individual families and communities to take up some of these measures rapidly to make sure the dark winter does not lead to a blighted spring. Amy dr. Farmer, can you comment quickly on these vaccines for people to understand the first what is called mrna commit message or mrna commit what they do in the human body . Do they make you immune or you can get sick and be a carrier but you yourself, i mean, you could be infected but you yourself will the choicek . Explain of who gets the vaccine also the fact that this has not been studied in children, people under 14, so what this means for kids . Well, in general terms, let me just say in the 30 plus years i have been involved in this work, ive never seen such Rapid Development of a novelpreventive for novel vaccine. There is a lot to celebrate in terms of the global effort to come together to develop new vaccines. Again in general terms, the idea is that instead of having a natural infection in this case, breathing in the Novel Coronavirus and getting sick, which leads to the outcomes that itw, death or recovery also means probably to community. That is what it is like with other viral infections in humans, or almost all of them. So what the vaccine as is introduce something that will trick the body into believing that it is being invaded by the virus. In this case, focused on a particular protein on the outer surface of the virus. In generate that immune response, which is often robust and enduring, at least with other viruses. Novel case of any pathogen, we dont know for sure how long that immunity last. How could you . It is not been studied for long. But we know about other viruses and can take some lessons from those. In the case of this new vaccine or new type of vaccine, the mrna vaccine, we are also dealing with a new kind of vaccination, new approach. It is very exciting in part because it seems to confer that immunity without significant adverse effects. Again, on the side of development of a novel technology, these vaccines, whether mrna vaccines or others, our great news and maybe they will influence a new generation of vaccine to other pathogens, particularly viral pathogens, which tend to be the worst was among humans. That is where we are with the development of new technology. Unfortunately, as i have said any of underline many times, the old pathologies of our society make it unlikely that the role that will be smooth and evenly taken up across various communities, some of them with wellfounded fears and mistrust of any kind of Public Health campaign. Pickle. E in a bit of a i am optimistic about what will happen in this country, but as you pointed out in opening up the hour, a lot of us are concerned with what will happen in the global south and among those who might as well be considered living in the global south and it wealthy countries like the United States and parts of europe. It will be a rocky winter with some highs and lows. I hope there are more highs and lows. I hope there is more reason for celebration and for grief, but i think it is going to be a very difficult winter. Amy on thursday, the United Nations secretarygeneral criticized couries that rejected covid 19 facts in the World Health Organizations recommendations. From the start, the World Health Organization provided scientific guidance that should have been the basis for a coordinated global response. Unfortunately, many of these recommendations were not followed. In some situations, there was a and ignoranceacts of the guidance. When countries go in their own direction, the virus goes in every direction. The social and Economic Impact of the pandemic is enormous and growing. Amy that is the u. N. Secretarygeneral. It is interesting the United States, the most horrific record ,n the world now in covid19 and then trumps allies in the bolsonaro,azil, j or Narendra Modi in india, worse johnson who was in intensive care himself and then switched his kind of herd immunity approach, one that President Trump this country. Not true vaccines, but essentially through leaving the population and letting covid19 rip through our country. Denying the science leaders a number of them authoritarian, and the effects in those countries. And also, though, places like the United States buying up the vaccines in the world. If you, dr. Farmer, kentucky about trump pulling out of can talk about trump pulling out of the World Health Organization and what that means when the wealthiest countries than buy up the available vaccis . All,ealthy countries buying up the available vaccines is nothing new. And that is why there have been a number of efforts to make sure that doesnt happen with these new crop of vaccines to prevent covid19. And that is going to be among the tasks i mentioned for the coming months. Again, it will happen within countries in addition to between countries. Another thing i would say as a sort of pushback is that vaccines do not require cognitive change to be effective. Covidther you attribute or polio or measles to, lets that soundsry like a stretch but it is something of hurt again and again once the vaccine is in you, it seems to work the same within those who understand the nature of the disease and its origins and those who dont. That basic point i think is important because we do have to address vaccine hesitancy, but we dont have to convince people , for example, this is an rna virus that comes in to the respiratory route and you can develop immunity. Those are parallel activities, if yes, to an effort to make sure we have an equity Platform Global equity platform for distributing the vaccine. And then back to the point you made, which is about sciencedeniers who are in leadership positions. That makes not only Vaccine Distribution difcult, it makes makesch difficult, it common and shared understandings of how diseases work difficult. It is something we should inlore and try to get rid of our public discourse, but we still have to proceed with the Vaccine Distribution and knowing it will not engender a lot of culture and cognitive changes in the shortterm. That is something i saw in west africa during the ebola crisis, where very often, as you read in the book, very often people did attribute their illness or their family members illness to events and processes that had nothing to do with an infectious pathogen. I have seen that all over the world. But when there were rules applied around social distancing around ppe, around how burials were to be conducted, when those rules were appli and when there was better care provided for those afflicted, that is when we started to see some decline in the incidence of ebola and it west africa. I just want to underline that stuff we dont have to make everybody who gets this vaccine or vax in virology analogy, but need to get the protected. Amy just before we go through this Remarkable Book about dealing with ebola and what it meant, i would ask about Property Rights come about patents, about countries like in south africa and india pushing for a temporary suspension bridge in lecture property covid19d patents and vaccines and medications become more accessible, particularly in the global south. Want to say something, we have had a previously, when you look at what happened around hiv 19951996, those in the Infectious Disease world understood that this would be a lifesaving suppressive therapy, like as with diabetes requiring insulin you would have to keep taking it, but this went safe millions of livesnd maybe prevent transmission from mother to child. The same debates about intellectual properties came up then. The average wholesale price for three drug regimen in that years immediately after the discovery 15,000e new agents was dollars, sometimes 20,000 per person per year. If you split your time between harvard and haiti as i had and he you would imagine if could not have any imagination beyond conventional Property Rights discussion, that the majority of the world would be shut out of access to this therapy. Of course, that made the most difference on a continent level in africa where the majority of People Living with hiv and dying with hiv were at the time. And what happened later was the production of generic versions of these drugs, often in india or china or even south africa, so that a much lower cost could be tied to the same agents when i say much lower, i mean a reduction really even within the early years from 15,000o 20,000 to about 300 per person per year. With groups like the Clinton Foundation getting involved, those prices dropped even further. Right now you can get a really eventhree drug regimen with some pediatric formulations for children for about 60 per patient per year. You could say that took a long time, but he did notake a long time in terms of the impacit could have dish millions and millions of lives, maybe even 16 million to 20 million lives are being saved by these drugs. But in some places like rwanda where i have spent 10 years, so the virtual eradication of aids among children. Because if mom is on therapy, the transmiion to babies in utero or through breastfeeding probably really does not occur. This is not a hypothetical development. This has already happened in rwanda, which is a very poor country with a very robust Public Health and care delivery system. Amy were going to go to break. When we come back, we will talk about fevers, feuds and diamonds ebola and the ravages of history. Our guest for the hour, dr. All former. Dr. Paul farmer. Stay with us. [music break] amy this is democracy now , democracynow. Org, the quarantine report. Im amy goodman. Our guest for the hour, dr. Paul farmer, Infectious Disease doctor, renowned medical anthropologist. Numerous books. Mearried his book with around haiti. His latest book is fevers, feuds and diamonds ebola and the ravages of history. Dr. Farmer is chair of Global Health and social medicine at Harvard Medical School and cofounder and chief strategist of partners in health. Which works in countries around the world. Fevers, feuds and diamonds ebola and the ravages of history. Journey you took, paul, as you wrote this book. A lotl, i wrote the book of it in sierra leone. As chance would have i and i think we talked about this in 2014, i was in sierra leone in june 2014 but for an unrelated matter. I was there for a. Partly ins involved organizing. I remember folks coming to the conference saying there is already ebola and neighboring countries, should we really have it is it a safe venue . My response was, you don get ebola look at medical conferences but through caregiving. That is nursing the sick, bearing the dead, and we would be ok. Shortly after i left and went back on to rwanda. As you will recall, my colleague , sierra leones leading Infectious Disease doctor, died of the disease on july 29. I began lobbying my own friends and coworkers to join in on the fight. And so i will add, amy, we were tardy to get there in my view and arrived in october. What i saw that in both liberia and sierra leone was just terrifying. It is not like there is a terror with respiratory virus that is invisible. The terror comes from someone who is sick and falls ill. But in the midst of this clinical desert, there were times when we saw people collapsed in the street and knew it was likely or possibly from ebola. And with some shame, waited for those fully masked and downed to come and help people. That was not during the time which would follow in a couple of weeks under the ebola treatment units and Community Care centers and abated public hospitals, we are still doing a lot of that work today, but the reason i wte the book was i got to know a number of patients quite well. As they recovered, we became often, friends. That initial group i met in october and some that i met in ebola treatment units in the course of the worst weeks of the epidemic. And one of them, a young man named abraham, on the night i met him told me he lost more than 20 members of his family to ebola and asked me to interview him. Even though as you point out i am an anthropologist as well as a physician, that was aunusual experience to have someone who experienced such loss and still recovering to make such a request. That kind of convinced me that these stories from west africa and history of the place would be an important thing for me to learn about. That was the genesis of the book. Amy so talk about ebola. The outbreak and then how it was contained. You talk about it as the caregivers disease. Well, ebola, like the coronavirus, is an rna virus. Both come from other species, animal species, and then leap into humans. If you stand back and look, a lot of the diseases that cause the highest numbers of deaths among humans have these zoonotic roots, and ebola is onof those. Its natural host is still disputed. It may be a bat. That seems plausible. In the midst of that, its species it came from, was not the task at hand. The task at hand was stopping transmission from persontoperson. Because once introduced into the human family, ebola spreads easily through contact. And the two main sources of exposure are caregiving. First, nursing the sick, cleaning up after them. Second, the last active caregiving and in most parts of the world and most religious traditions, is marrying the dead. Those were causing the transmission. The problem there, unlike the United States, is that there were not professional caregivers and there were not professional undertakers or morticians. So of course, family members and traditional healers had to fill in the gap. That is why so many people got sick 70 traditional healers got sick. Then, of course, the professional caregivers also experienced enormous risk. It was not just dr. Collin. It was thousands and thousands of nurses, laboratory technicians, ambulance drivers, and doctors. In the thousand or so they got sick during that time, probably more than have died. Loss fornother huge any country. But if youre living in the medical desert and dont have a lot of physicians and nurses and ambulance drivers and lab techs, it is really something going back to the u. N. Secretarygenerals comments about covid, the effects of that will be felt for years and decades if we dont step in and work to build those Health Systems again. Amy certainly as we have learned, dealing with health with epidemics, with pandemics, if people have any questions about whether altruism is the motivation, we just understand we are all connected. You, dr. Farmer, talk in your book about colonization come the slave trade, the catastrophic consequences on african nations. Talk about though this is not usually talked about in health terms, you put the two together. Let me just start by saying during the epidemic, the great majority of our attention, certainly mine, was on the clinical response. Thatis trying to make sure ebola treatment units at least the ones with which we were affiliated were not only places for isolation, but places for care. Care for a bola is not rocket science. Even without what are called specific therapies like an antiviral, like remdisiver for example for covid, even without specific therapies, the interventions that are required to save the lives of the majority of ebola patients are to replace the fluids that they have lost through nausea, vomiting, diarrhea, sweating, the toward heat of the area. All of those losses of fluids and electrolytes are what imperil the lives of those sickened with ebola in the short term. And we have therapies for that. They have been around for 100 years. They have improved over time. Salts are rehydration important. For those who cannot take oral medications because theyre nauseated or vomiting or in a coma,here are iv solutions that can save lives in that manner. Even that was not happening across the region. There were reasons for that. People were frightened. Anything that involved a sharp the needle to put in an iv or blood draw poses some risk to health care workers. But it would have been better st to say, hey, were frightened because anyone in the right mind would be frightened. But instead, we started having arguments about what kind of care would be appropriate. The arguments i mean, especially actorsthe international which does not meet academy awarwinning actress, but the ngos and humanitarian groups that it flooded the region after the civil war that afflicted it returnedtime, and then obviously sometimes a different cast of characters, including once we know well, came back just a decade after this colict ended to be involved in the ebola response. I made the argument in the book that the response was hpered by the fact the attention was togely to containment, not care. Of course, this generated. Painful echoes from colonial rule which in that part of the world was largely 20thcentury phenomenon. This is not remote history, as you know. In order to improve the quality of containment efforts, we should have focused more on the quality of care. We are going to face that when the next epidemic of ebola comes along. People,r description of the life histories of the ebola survivors come is deeply moving. , someu talk about abraham of the people you dedicate this it is not always easy to talk about them because they endured such losses and they were not easy to hear about. Having been invoed in their care, i thought i knew something about their losses. It turns out, there were many more. I had an at tiffany, which i am embarrassed to share, but it wasnt long before we understood every adult patient that we cared for who survived ebola or didnt had also survived a brutal civil war. When i started talking with ibrahim, the very man i mentned earlier, the person really in a way who inspired me to write this blog, i could not believe the details and spent in someny months, and cases, years, learning about them. Of course this happens over time. But the other mans story was different, if i could go back and say you are him was probably 26 ebert he was 26 probably when he came down with the ball and did not have children of his own, is most grievous losses were his mother, siblings, family members, grandparents, aunts and uncles. The other man, the other hand, was 39 and she lost in addition to her husband some of her children, her mother, and other family members. What i learned about these two was they moved between villages and the capital city during the war, after the war, and even during the epidemic because he often they were called to perform those Caregiving Services for afflicted members of their family. And in the case of those who perished, who was going to bury them at the time they fell ill. This was in august of 2014. They faced these impossible choices. Another reason it was difficult and painful to write about them, choices that i have never face li do we respect our mothers dying wish to be buried in her home village . Of course that was also against the recommendation of Public Health authorities. But there was not enough in the way of assistance with caregiving or with respectful burial of the dead until later in the epidemic. So theirompassion led to their ownnfections and to infections among other members of their families. I will add, amy, of course i still am friends with these people and they have recovered to varying extent. Lost her almost eyesight. As we discussed when we were together in august of 20 a talk about ebola, one of the complications is a blinding inflammation that can be readily treated with steroids and eyedrops that cost pennies or a dollar to save someones vision. So there were lots of complications to say nothing of grief and psychological d emotional publications. Complications. Amy dr. Farmer, you write that every american must europeans who fell ill with people in west africa survived. Different mortality outcomes emerged from the same strain of ebola. Depending on care that was or was not available, depending on your country of origin. If you can explain this and then expand that to what were seeing today in this country, for example, also on the issue of racial differentials and disparities . This is something that i encourage my students to grapple with or our trainings in clinical medicine, which is case totality rate. Case fertility rate is a report card on the quality of medical system. And there are many parts to that. Clinical facility, able to manage complication and we are to be facing the same challenge in the coming weeks if hospitals become saturated, if we dont flatten the curve that they become overwhelmed. Not only do they perform more poorly in terms of caring for those sickened by the pandemic or in the case of ebola the epidemic, they fair to failed to prode services for other illnesses and injuries. We saw a lot of that during ebola but weave also seen it in the United States once our hospitals in new england and new york became overwhelmed. That is exactly what happened and it west africa as well. It just happened earlier and more devastatingly. But that is just the first part of the equation. Case fertility rate is report card on what happens after you get infected. We also have Racial Disparities and other social disparities, as you have noted, any risk of infection. So all along that noxious path, we have to make interventions that lessen the risk for infection but also lessen the risk for a bad outcome once infected. I think that is the goal before us with covid19, just as it was a goal during ebola. Why am i bringing this up . Because if the report card is only about Disease Control that is stopping in epidemic and not about survival once infected, why is it that people would go to an ebola treatment unit to be isolated if they fear they will not receive care . The answer is, they wont. This was not new. Treatment centers and units that were really isolation and quarantine facilities proliferated across the continent of africa during colonial rule and remained a feature there even after the end of colonial rule. And that pathology of focusing on Disease Control over care i think really weakened the epidemic. With coronavirus in the u. S. On the other hand, we have to look carefully at case fatality rate. It has been all over the map. I believe it will be better during this current surge because people are more experienced. But we dont have a control over care. Amy we have 10 seconds. Plus we dont have a control over care system here. We have containment and nihilism giving up on containment too early. Amy we want to thank you for being with us. There is so much more to discuss. I encourage people to read dr. Paul farmers book fevers, feuds and diamonds ebola and the ravages of history. He is an Infectious Disease doctor and medical anthropologist. He is chair of Global Health and social medicine at Harvard Medical School and cofounder and chief strategist of partners in health. Sami jakarta was just the first taste of what was to come. Karinding attacks heavy bamboo sound drag me deeper into the diverse music scene of indonesia. I had to have some more. I needed to find something new. I wanted to get inside wt it means to be indonesian, a country with hundreds of languages, myriad religions, and a million points of view on music making and the meaning of it all