[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:03.74,0:00:05.99,Default,,0000,0000,0000,,I'm going to quickly\Nsketch out a flu
Dialogue: 0,0:00:05.99,0:00:07.91,Default,,0000,0000,0000,,virus for you--\Nsomething like this.
Dialogue: 0,0:00:07.91,0:00:11.01,Default,,0000,0000,0000,,And it has an envelope, so\Nthis is our little envelope.
Dialogue: 0,0:00:11.01,0:00:13.09,Default,,0000,0000,0000,,And on the inside\Nof this envelope
Dialogue: 0,0:00:13.09,0:00:18.17,Default,,0000,0000,0000,,are eight chunks of RNA,\Nso let's draw out the RNA.
Dialogue: 0,0:00:18.17,0:00:19.85,Default,,0000,0000,0000,,This is the genetic material.
Dialogue: 0,0:00:19.85,0:00:22.16,Default,,0000,0000,0000,,And this genetic material,\Namong other things,
Dialogue: 0,0:00:22.16,0:00:23.25,Default,,0000,0000,0000,,codes for protein.
Dialogue: 0,0:00:23.25,0:00:26.68,Default,,0000,0000,0000,,And so one of the proteins\Nhere is sitting on the outside.
Dialogue: 0,0:00:26.68,0:00:29.91,Default,,0000,0000,0000,,I'm drawing it as if it\Nlooks like a little hand.
Dialogue: 0,0:00:29.91,0:00:33.66,Default,,0000,0000,0000,,And the reason I do that is\Nbecause it reminds me that this
Dialogue: 0,0:00:33.66,0:00:38.10,Default,,0000,0000,0000,,H stands for hemagglutinin, but\Nit basically holds onto sialic
Dialogue: 0,0:00:38.10,0:00:38.60,Default,,0000,0000,0000,,acid .
Dialogue: 0,0:00:38.60,0:00:42.30,Default,,0000,0000,0000,,And that's how it gets\Ninside of little cells.
Dialogue: 0,0:00:42.30,0:00:45.24,Default,,0000,0000,0000,,And then there's another\Nprotein over here.
Dialogue: 0,0:00:45.24,0:00:47.12,Default,,0000,0000,0000,,And I draw these as\Na pair of scissors
Dialogue: 0,0:00:47.12,0:00:50.64,Default,,0000,0000,0000,,just to kind of remind me that\Nthis one nicks the sialic acid.
Dialogue: 0,0:00:50.64,0:00:53.69,Default,,0000,0000,0000,,This is called neuraminidase,\Nand it nicks the sialic acid,
Dialogue: 0,0:00:53.69,0:00:56.81,Default,,0000,0000,0000,,and it helps it cut itself\Nloose from the cell.
Dialogue: 0,0:00:56.81,0:00:58.72,Default,,0000,0000,0000,,And so it can move on\Nto other cells- kind of
Dialogue: 0,0:00:58.72,0:00:59.92,Default,,0000,0000,0000,,helps with exiting.
Dialogue: 0,0:00:59.92,0:01:02.60,Default,,0000,0000,0000,,And I haven't actually been\Ndrawing this other protein.
Dialogue: 0,0:01:02.60,0:01:03.64,Default,,0000,0000,0000,,There's another one here.
Dialogue: 0,0:01:03.64,0:01:04.85,Default,,0000,0000,0000,,And I'm going to draw it now.
Dialogue: 0,0:01:04.85,0:01:08.66,Default,,0000,0000,0000,,This is called an M2 protein.
Dialogue: 0,0:01:08.66,0:01:12.74,Default,,0000,0000,0000,,But it's not actually\Nfound on all flu types.
Dialogue: 0,0:01:12.74,0:01:16.18,Default,,0000,0000,0000,,It's actually found\Non flu A, but actually
Dialogue: 0,0:01:16.18,0:01:20.05,Default,,0000,0000,0000,,not found on flu B. So this is\Na really important difference
Dialogue: 0,0:01:20.05,0:01:22.38,Default,,0000,0000,0000,,between flu A and flu B.
Dialogue: 0,0:01:22.38,0:01:26.21,Default,,0000,0000,0000,,And you'll see why, because\None of the medicines that we
Dialogue: 0,0:01:26.21,0:01:30.09,Default,,0000,0000,0000,,use now to treat flu-- and\Nyes, you heard me correctly,
Dialogue: 0,0:01:30.09,0:01:32.64,Default,,0000,0000,0000,,that we do have\Nanti-viral medications.
Dialogue: 0,0:01:32.64,0:01:35.11,Default,,0000,0000,0000,,You probably heard\Nfrom many people
Dialogue: 0,0:01:35.11,0:01:37.04,Default,,0000,0000,0000,,saying antibiotics\Nonly treat bacteria,
Dialogue: 0,0:01:37.04,0:01:38.92,Default,,0000,0000,0000,,not viruses, and that's true.
Dialogue: 0,0:01:38.92,0:01:41.75,Default,,0000,0000,0000,,But we have a special\Nword for these other drugs
Dialogue: 0,0:01:41.75,0:01:43.28,Default,,0000,0000,0000,,that actually do treat viruses.
Dialogue: 0,0:01:43.28,0:01:45.87,Default,,0000,0000,0000,,And we call them\Nanti-viral drugs.
Dialogue: 0,0:01:45.87,0:01:47.08,Default,,0000,0000,0000,,And there are couple of them.
Dialogue: 0,0:01:47.08,0:01:49.17,Default,,0000,0000,0000,,I'm actually going to write\Nout some of the names.
Dialogue: 0,0:01:49.17,0:01:53.20,Default,,0000,0000,0000,,So this is called\NAmantadine or Rimantadine.
Dialogue: 0,0:01:53.20,0:01:55.50,Default,,0000,0000,0000,,And it's kind of\Neasy to remember
Dialogue: 0,0:01:55.50,0:01:57.93,Default,,0000,0000,0000,,that they are in the\Nsame class because they
Dialogue: 0,0:01:57.93,0:02:00.14,Default,,0000,0000,0000,,share a lot of the same letters.
Dialogue: 0,0:02:00.14,0:02:03.29,Default,,0000,0000,0000,,And these two anti-viral\Ndrugs, they actually
Dialogue: 0,0:02:03.29,0:02:08.11,Default,,0000,0000,0000,,work on stopping or blocking\Nthe activity of this enzyme.
Dialogue: 0,0:02:08.11,0:02:10.66,Default,,0000,0000,0000,,And I'm just kind of drawing\Nit like a little negative sign.
Dialogue: 0,0:02:10.66,0:02:13.65,Default,,0000,0000,0000,,But that's just to remind\Nyou that it blocks the M2.
Dialogue: 0,0:02:13.65,0:02:16.79,Default,,0000,0000,0000,,So if you know that\Nflu B doesn't have M2,
Dialogue: 0,0:02:16.79,0:02:18.76,Default,,0000,0000,0000,,then you also know\Nthat these drugs then
Dialogue: 0,0:02:18.76,0:02:20.71,Default,,0000,0000,0000,,don't work against flu B.
Dialogue: 0,0:02:20.71,0:02:24.30,Default,,0000,0000,0000,,These drugs don't even work\Nthat well against flu A,
Dialogue: 0,0:02:24.30,0:02:27.94,Default,,0000,0000,0000,,because flu A has\Nbecome quite resistant.
Dialogue: 0,0:02:27.94,0:02:30.90,Default,,0000,0000,0000,,So remember, resistance\Nhappens because there
Dialogue: 0,0:02:30.90,0:02:32.62,Default,,0000,0000,0000,,are little mutations.
Dialogue: 0,0:02:32.62,0:02:37.51,Default,,0000,0000,0000,,And it turns out that flu A has\Nkind of a mutated form of M2,
Dialogue: 0,0:02:37.51,0:02:40.68,Default,,0000,0000,0000,,so that it actually doesn't\Nget blocked by Amantadine
Dialogue: 0,0:02:40.68,0:02:43.46,Default,,0000,0000,0000,,or Rimantadine quite so easily.
Dialogue: 0,0:02:43.46,0:02:45.30,Default,,0000,0000,0000,,So unfortunately for\Nus, that's bad news.
Dialogue: 0,0:02:45.30,0:02:50.14,Default,,0000,0000,0000,,And the CDC in 2012,\N2013 have recommended
Dialogue: 0,0:02:50.14,0:02:52.43,Default,,0000,0000,0000,,not using these\Ndrugs because there's
Dialogue: 0,0:02:52.43,0:02:55.21,Default,,0000,0000,0000,,so much flu A resistance.
Dialogue: 0,0:02:55.21,0:02:57.62,Default,,0000,0000,0000,,So that's unfortunate,\Nbut the good news
Dialogue: 0,0:02:57.62,0:02:59.93,Default,,0000,0000,0000,,is that we actually have\Na couple of other drugs.
Dialogue: 0,0:02:59.93,0:03:02.69,Default,,0000,0000,0000,,So we have a drug\Ncalled Oseltamivir,
Dialogue: 0,0:03:02.69,0:03:04.62,Default,,0000,0000,0000,,and related to\Nit-- and you'll see
Dialogue: 0,0:03:04.62,0:03:07.86,Default,,0000,0000,0000,,with the spelling--\Nwe have Zanamivir.
Dialogue: 0,0:03:07.86,0:03:11.30,Default,,0000,0000,0000,,And these, of course, share a\Nlot of the same letters again.
Dialogue: 0,0:03:11.30,0:03:15.64,Default,,0000,0000,0000,,And these two actually\Nblock the neuraminidase.
Dialogue: 0,0:03:15.64,0:03:18.88,Default,,0000,0000,0000,,And this is actually\Nin flu A and flu B.
Dialogue: 0,0:03:18.88,0:03:23.00,Default,,0000,0000,0000,,So that's good news, because\Nit blocks both flu A and flu
Dialogue: 0,0:03:23.00,0:03:27.45,Default,,0000,0000,0000,,B. And let me actually just\Nwrite that down, flu A and flu
Dialogue: 0,0:03:27.45,0:03:29.95,Default,,0000,0000,0000,,B. And that's important, right?
Dialogue: 0,0:03:29.95,0:03:33.83,Default,,0000,0000,0000,,So we have these two drugs,\Nand one of them is a pill.
Dialogue: 0,0:03:33.83,0:03:35.34,Default,,0000,0000,0000,,This first one is a pill.
Dialogue: 0,0:03:35.34,0:03:38.66,Default,,0000,0000,0000,,And the second one is\Nkind of an inhaled powder.
Dialogue: 0,0:03:38.66,0:03:40.52,Default,,0000,0000,0000,,So they're taken\Nin different ways.
Dialogue: 0,0:03:40.52,0:03:42.48,Default,,0000,0000,0000,,And another important\Ndifference between them--
Dialogue: 0,0:03:42.48,0:03:45.02,Default,,0000,0000,0000,,this is something that we have\Nto just kind of keep in mind--
Dialogue: 0,0:03:45.02,0:03:47.24,Default,,0000,0000,0000,,is that there are\Nage restrictions.
Dialogue: 0,0:03:47.24,0:03:49.39,Default,,0000,0000,0000,,So you have to be\Na certain age to be
Dialogue: 0,0:03:49.39,0:03:51.08,Default,,0000,0000,0000,,able to take these medications.
Dialogue: 0,0:03:51.08,0:03:53.22,Default,,0000,0000,0000,,And they differ\Nbetween the two drugs,
Dialogue: 0,0:03:53.22,0:03:55.56,Default,,0000,0000,0000,,and whether you're\Nusing it to treat,
Dialogue: 0,0:03:55.56,0:03:58.75,Default,,0000,0000,0000,,or if you're using it to prevent\Ngetting sick from the flu.
Dialogue: 0,0:03:58.75,0:04:00.34,Default,,0000,0000,0000,,There's a difference there too.
Dialogue: 0,0:04:00.34,0:04:02.39,Default,,0000,0000,0000,,So there are age\Nrestrictions that we just
Dialogue: 0,0:04:02.39,0:04:03.28,Default,,0000,0000,0000,,have to keep in mind.
Dialogue: 0,0:04:03.28,0:04:05.91,Default,,0000,0000,0000,,But overall, I'm pretty\Nhappy with the fact
Dialogue: 0,0:04:05.91,0:04:08.13,Default,,0000,0000,0000,,that at least we\Nhave these options
Dialogue: 0,0:04:08.13,0:04:12.25,Default,,0000,0000,0000,,if we need to treat someone\Nthat's very sick from the flu.
Dialogue: 0,0:04:12.25,0:04:14.24,Default,,0000,0000,0000,,So let's talk about\Nthat treatment then.
Dialogue: 0,0:04:14.24,0:04:17.23,Default,,0000,0000,0000,,So what if you have someone--\Nand this happens to me all
Dialogue: 0,0:04:17.23,0:04:19.71,Default,,0000,0000,0000,,the time where someone comes\Nin kind of frowny faced
Dialogue: 0,0:04:19.71,0:04:22.00,Default,,0000,0000,0000,,because they're sick with\Nthe flu, and you're thinking,
Dialogue: 0,0:04:22.00,0:04:23.98,Default,,0000,0000,0000,,OK well, this person\Nobviously needs treatment.
Dialogue: 0,0:04:23.98,0:04:25.56,Default,,0000,0000,0000,,So I'm going to write\Nthat at the top.
Dialogue: 0,0:04:25.56,0:04:27.55,Default,,0000,0000,0000,,They need some\Nsort of treatment.
Dialogue: 0,0:04:27.55,0:04:29.74,Default,,0000,0000,0000,,And I guess the\Nfirst question is,
Dialogue: 0,0:04:29.74,0:04:31.31,Default,,0000,0000,0000,,why would I treat this person?
Dialogue: 0,0:04:31.31,0:04:33.38,Default,,0000,0000,0000,,Of course, everyone's\Ngoing to be frowny faced
Dialogue: 0,0:04:33.38,0:04:34.38,Default,,0000,0000,0000,,if they get the flu.
Dialogue: 0,0:04:34.38,0:04:36.08,Default,,0000,0000,0000,,So why am I treating\Nthis person?
Dialogue: 0,0:04:36.08,0:04:37.71,Default,,0000,0000,0000,,What makes them so special?
Dialogue: 0,0:04:37.71,0:04:40.03,Default,,0000,0000,0000,,Well, one thing that\Ncould make them special
Dialogue: 0,0:04:40.03,0:04:42.44,Default,,0000,0000,0000,,is-- let's say that\Nthey're high risk.
Dialogue: 0,0:04:42.44,0:04:46.95,Default,,0000,0000,0000,,Remember high risk groups in\Nour society, in our community,
Dialogue: 0,0:04:46.95,0:04:49.01,Default,,0000,0000,0000,,include real young\Nkids-- so let's
Dialogue: 0,0:04:49.01,0:04:52.22,Default,,0000,0000,0000,,say under two years\Nold-- or older folks--
Dialogue: 0,0:04:52.22,0:04:54.68,Default,,0000,0000,0000,,let's say people\Nover 65 years old.
Dialogue: 0,0:04:54.68,0:04:57.53,Default,,0000,0000,0000,,It could be someone\Nthat's pregnant.
Dialogue: 0,0:04:57.53,0:04:59.47,Default,,0000,0000,0000,,That's another high risk group.
Dialogue: 0,0:04:59.47,0:05:02.70,Default,,0000,0000,0000,,Or it could be someone that has\Nsome sort of chronic disease.
Dialogue: 0,0:05:02.70,0:05:06.10,Default,,0000,0000,0000,,And that could be like a\Nlung disease or asthma,
Dialogue: 0,0:05:06.10,0:05:08.88,Default,,0000,0000,0000,,any sort of chronic disease\Nthat makes them ill.
Dialogue: 0,0:05:08.88,0:05:11.03,Default,,0000,0000,0000,,Maybe their immune\Nsystem isn't working.
Dialogue: 0,0:05:11.03,0:05:13.45,Default,,0000,0000,0000,,And that would be a\Ngroup I would definitely
Dialogue: 0,0:05:13.45,0:05:15.13,Default,,0000,0000,0000,,consider treatment for.
Dialogue: 0,0:05:15.13,0:05:17.21,Default,,0000,0000,0000,,Now another group-- I'm\Ngoing to put it just right
Dialogue: 0,0:05:17.21,0:05:19.33,Default,,0000,0000,0000,,below-- is let's say\Nyou have someone that's
Dialogue: 0,0:05:19.33,0:05:23.78,Default,,0000,0000,0000,,completely healthy-- young,\Nhealthy person, not pregnant.
Dialogue: 0,0:05:23.78,0:05:28.28,Default,,0000,0000,0000,,They still might get\Ntreatment if there's maybe
Dialogue: 0,0:05:28.28,0:05:29.85,Default,,0000,0000,0000,,severe disease.
Dialogue: 0,0:05:29.85,0:05:32.35,Default,,0000,0000,0000,,Let's say they get\Nreally, really sick.
Dialogue: 0,0:05:32.35,0:05:35.86,Default,,0000,0000,0000,,They're just feeling awful,\Nand I'm worried about them,
Dialogue: 0,0:05:35.86,0:05:38.20,Default,,0000,0000,0000,,and they might need\Nto be hospitalized.
Dialogue: 0,0:05:38.20,0:05:40.62,Default,,0000,0000,0000,,If they're very,\Nvery sick, or they
Dialogue: 0,0:05:40.62,0:05:43.27,Default,,0000,0000,0000,,get some sort of\Ncomplication, or they're
Dialogue: 0,0:05:43.27,0:05:45.52,Default,,0000,0000,0000,,going to get hospitalization,\Nanything like that,
Dialogue: 0,0:05:45.52,0:05:48.49,Default,,0000,0000,0000,,then this is a person, again,\NI would be careful with.
Dialogue: 0,0:05:48.49,0:05:50.58,Default,,0000,0000,0000,,And I would consider treatment.
Dialogue: 0,0:05:50.58,0:05:52.60,Default,,0000,0000,0000,,Let me bring up a\Nlittle bit of space.
Dialogue: 0,0:05:52.60,0:05:54.77,Default,,0000,0000,0000,,So this is the kind of group\Nthat I would definitely
Dialogue: 0,0:05:54.77,0:05:56.00,Default,,0000,0000,0000,,consider treatment in.
Dialogue: 0,0:05:56.00,0:05:57.96,Default,,0000,0000,0000,,So what else should we\Nthink about or consider?
Dialogue: 0,0:05:57.96,0:06:01.19,Default,,0000,0000,0000,,Well, the next question,\Noften, that comes up
Dialogue: 0,0:06:01.19,0:06:04.74,Default,,0000,0000,0000,,is how soon do you need\Nto start treatment?
Dialogue: 0,0:06:04.74,0:06:07.49,Default,,0000,0000,0000,,When do you need\Nto begin treatment?
Dialogue: 0,0:06:07.49,0:06:09.31,Default,,0000,0000,0000,,Or when do you start?
Dialogue: 0,0:06:09.31,0:06:10.68,Default,,0000,0000,0000,,And of course that\Nanswer's going
Dialogue: 0,0:06:10.68,0:06:11.84,Default,,0000,0000,0000,,to be as soon as possible.
Dialogue: 0,0:06:11.84,0:06:15.92,Default,,0000,0000,0000,,But a bigger range on that\Nwould be within two days.
Dialogue: 0,0:06:15.92,0:06:21.25,Default,,0000,0000,0000,,So really, if they've started\Ngetting symptoms a week ago,
Dialogue: 0,0:06:21.25,0:06:23.30,Default,,0000,0000,0000,,I might still be\Ninclined to treat them.
Dialogue: 0,0:06:23.30,0:06:26.82,Default,,0000,0000,0000,,But I'd be more inclined\Nif it had just started.
Dialogue: 0,0:06:26.82,0:06:28.59,Default,,0000,0000,0000,,What other questions\Nor considerations
Dialogue: 0,0:06:28.59,0:06:30.01,Default,,0000,0000,0000,,should we just\Nkind of go through?
Dialogue: 0,0:06:30.01,0:06:31.78,Default,,0000,0000,0000,,What about treatment?
Dialogue: 0,0:06:31.78,0:06:34.35,Default,,0000,0000,0000,,So how long do you\Ntreat them for?
Dialogue: 0,0:06:34.35,0:06:37.32,Default,,0000,0000,0000,,And generally speaking,\Nit's about five days.
Dialogue: 0,0:06:37.32,0:06:41.99,Default,,0000,0000,0000,,So five days of either\NOseltamivir or Zanamivir.
Dialogue: 0,0:06:41.99,0:06:43.97,Default,,0000,0000,0000,,And sometimes it goes\Na little bit longer,
Dialogue: 0,0:06:43.97,0:06:45.36,Default,,0000,0000,0000,,but usually it's just five days.
Dialogue: 0,0:06:45.36,0:06:46.89,Default,,0000,0000,0000,,That's kind of a normal course.
Dialogue: 0,0:06:46.89,0:06:48.52,Default,,0000,0000,0000,,So this is how I\Nwould manage someone
Dialogue: 0,0:06:48.52,0:06:51.46,Default,,0000,0000,0000,,that's being treated for flu.
Dialogue: 0,0:06:51.46,0:06:54.42,Default,,0000,0000,0000,,But of course, what if they're\Nnot being treated for it?
Dialogue: 0,0:06:54.42,0:06:57.26,Default,,0000,0000,0000,,What if they come in,\Nand they're feeling fine?
Dialogue: 0,0:06:57.26,0:07:00.62,Default,,0000,0000,0000,,And we have to draw\Nanother face here.
Dialogue: 0,0:07:00.62,0:07:02.99,Default,,0000,0000,0000,,This is a smiley face,\Nsomething like that.
Dialogue: 0,0:07:02.99,0:07:04.70,Default,,0000,0000,0000,,And I'm going to draw two.
Dialogue: 0,0:07:04.70,0:07:05.74,Default,,0000,0000,0000,,So let's say there's two.
Dialogue: 0,0:07:05.74,0:07:07.62,Default,,0000,0000,0000,,And we're going to deal\Nwith them separately.
Dialogue: 0,0:07:07.62,0:07:09.59,Default,,0000,0000,0000,,So let me actually draw\Na line between them,
Dialogue: 0,0:07:09.59,0:07:11.20,Default,,0000,0000,0000,,something like this.
Dialogue: 0,0:07:11.20,0:07:12.98,Default,,0000,0000,0000,,So we've got two more cases.
Dialogue: 0,0:07:12.98,0:07:18.84,Default,,0000,0000,0000,,Both are feeling fine, but\Nthey might need prevention.
Dialogue: 0,0:07:18.84,0:07:22.37,Default,,0000,0000,0000,,Another thing these drugs\Ncan do is prevent you
Dialogue: 0,0:07:22.37,0:07:24.11,Default,,0000,0000,0000,,from getting sick.
Dialogue: 0,0:07:24.11,0:07:26.82,Default,,0000,0000,0000,,So prevention is\Nimportant as well.
Dialogue: 0,0:07:26.82,0:07:29.83,Default,,0000,0000,0000,,And let's say these folks\Nare living in a home.
Dialogue: 0,0:07:29.83,0:07:32.11,Default,,0000,0000,0000,,Let me actually build\Na little nice house
Dialogue: 0,0:07:32.11,0:07:34.85,Default,,0000,0000,0000,,around my first\Nsmiley face person.
Dialogue: 0,0:07:34.85,0:07:38.92,Default,,0000,0000,0000,,And I'll do the same around\Nthis second smiley face person.
Dialogue: 0,0:07:38.92,0:07:40.79,Default,,0000,0000,0000,,And let's say this\Nfirst person--
Dialogue: 0,0:07:40.79,0:07:42.41,Default,,0000,0000,0000,,this person gets a\Nvisit from someone
Dialogue: 0,0:07:42.41,0:07:44.93,Default,,0000,0000,0000,,who's feeling flu symptoms.
Dialogue: 0,0:07:44.93,0:07:48.80,Default,,0000,0000,0000,,So this person comes to\Nvisit, and our friend,
Dialogue: 0,0:07:48.80,0:07:51.13,Default,,0000,0000,0000,,our smiley friend, is worried.
Dialogue: 0,0:07:51.13,0:07:53.56,Default,,0000,0000,0000,,They think, oh my gosh,\Nnow I'm going to get sick.
Dialogue: 0,0:07:53.56,0:07:55.87,Default,,0000,0000,0000,,So if they're high\Nrisk-- and we went
Dialogue: 0,0:07:55.87,0:07:57.64,Default,,0000,0000,0000,,through some of the\Ncategories-- actually,
Dialogue: 0,0:07:57.64,0:08:01.17,Default,,0000,0000,0000,,I should mention there are\Nother categories, not just these
Dialogue: 0,0:08:01.17,0:08:01.76,Default,,0000,0000,0000,,that I listed.
Dialogue: 0,0:08:01.76,0:08:03.52,Default,,0000,0000,0000,,There are some others as well.
Dialogue: 0,0:08:03.52,0:08:06.27,Default,,0000,0000,0000,,But if they're high\Nrisk in some way,
Dialogue: 0,0:08:06.27,0:08:09.60,Default,,0000,0000,0000,,then I would\Nconsider giving them
Dialogue: 0,0:08:09.60,0:08:13.22,Default,,0000,0000,0000,,a medication like\NOseltamivir or Zanamivir
Dialogue: 0,0:08:13.22,0:08:16.16,Default,,0000,0000,0000,,to prevent them\Nfrom getting sick.
Dialogue: 0,0:08:16.16,0:08:19.47,Default,,0000,0000,0000,,Now this whole bit about severe\Ndisease or hospitalization--
Dialogue: 0,0:08:19.47,0:08:22.14,Default,,0000,0000,0000,,this doesn't really apply\Nbecause they're not sick.
Dialogue: 0,0:08:22.14,0:08:24.22,Default,,0000,0000,0000,,They're obviously not going\Nto have severe disease
Dialogue: 0,0:08:24.22,0:08:26.19,Default,,0000,0000,0000,,or hospitalization already.
Dialogue: 0,0:08:26.19,0:08:29.07,Default,,0000,0000,0000,,What about this question of\Nwhen would I start treatment.
Dialogue: 0,0:08:29.07,0:08:32.40,Default,,0000,0000,0000,,Well ideally, again, it's\Ngoing to be within two days.
Dialogue: 0,0:08:32.40,0:08:36.03,Default,,0000,0000,0000,,So within two days\Nof their exposure.
Dialogue: 0,0:08:36.03,0:08:38.55,Default,,0000,0000,0000,,We call the visit,\Nor whoever kind of
Dialogue: 0,0:08:38.55,0:08:40.79,Default,,0000,0000,0000,,made them worry that\Nthey might get the flu,
Dialogue: 0,0:08:40.79,0:08:42.70,Default,,0000,0000,0000,,we call that the exposure.
Dialogue: 0,0:08:42.70,0:08:46.40,Default,,0000,0000,0000,,And so really you want to start\Ntreatment within two days.
Dialogue: 0,0:08:46.40,0:08:49.82,Default,,0000,0000,0000,,And you also want to start\Nprevention within two days.
Dialogue: 0,0:08:49.82,0:08:52.69,Default,,0000,0000,0000,,So how long would you actually\Ngive them the medications for,
Dialogue: 0,0:08:52.69,0:08:54.34,Default,,0000,0000,0000,,to prevent them\Nfrom getting sick?
Dialogue: 0,0:08:54.34,0:08:57.43,Default,,0000,0000,0000,,Well it really depends\Non whether or not
Dialogue: 0,0:08:57.43,0:08:58.97,Default,,0000,0000,0000,,they've had the vaccine.
Dialogue: 0,0:08:58.97,0:09:01.97,Default,,0000,0000,0000,,So let's say they've had the\Nvaccine, the flu vaccine.
Dialogue: 0,0:09:01.97,0:09:03.23,Default,,0000,0000,0000,,And they were high risk.
Dialogue: 0,0:09:03.23,0:09:06.20,Default,,0000,0000,0000,,They got visited by\Nsomeone, or had an exposure.
Dialogue: 0,0:09:06.20,0:09:08.68,Default,,0000,0000,0000,,For this person,\NI'm thinking I want
Dialogue: 0,0:09:08.68,0:09:10.62,Default,,0000,0000,0000,,to treat them for two weeks.
Dialogue: 0,0:09:10.62,0:09:13.74,Default,,0000,0000,0000,,Or give them two\Nweeks of medications.
Dialogue: 0,0:09:13.74,0:09:16.94,Default,,0000,0000,0000,,And the logic is that if\NI kept them two weeks,
Dialogue: 0,0:09:16.94,0:09:19.17,Default,,0000,0000,0000,,then that basically covers them.
Dialogue: 0,0:09:19.17,0:09:20.95,Default,,0000,0000,0000,,And then after\Nthat, I would assume
Dialogue: 0,0:09:20.95,0:09:23.56,Default,,0000,0000,0000,,that the vaccine would\Nkind of take hold.
Dialogue: 0,0:09:23.56,0:09:25.58,Default,,0000,0000,0000,,Because remember, the\Nvaccine takes two weeks
Dialogue: 0,0:09:25.58,0:09:27.31,Default,,0000,0000,0000,,to really take full effect.
Dialogue: 0,0:09:27.31,0:09:29.73,Default,,0000,0000,0000,,So basically, I give\Nthem a medication
Dialogue: 0,0:09:29.73,0:09:33.11,Default,,0000,0000,0000,,during that period of time when\Nthe vaccine isn't completely
Dialogue: 0,0:09:33.11,0:09:34.26,Default,,0000,0000,0000,,protecting them.
Dialogue: 0,0:09:34.26,0:09:37.05,Default,,0000,0000,0000,,And then I expect their\Nvaccine to kind of take over,
Dialogue: 0,0:09:37.05,0:09:39.58,Default,,0000,0000,0000,,and for the rest\Nof the flu season,
Dialogue: 0,0:09:39.58,0:09:42.30,Default,,0000,0000,0000,,presumably, they should\Nhave good protection.
Dialogue: 0,0:09:42.30,0:09:43.86,Default,,0000,0000,0000,,So that would be my strategy.
Dialogue: 0,0:09:43.86,0:09:47.29,Default,,0000,0000,0000,,Now let's say that they can\Nnot take the vaccine, so
Dialogue: 0,0:09:47.29,0:09:48.71,Default,,0000,0000,0000,,no vaccine.
Dialogue: 0,0:09:48.71,0:09:52.44,Default,,0000,0000,0000,,And maybe this person\Nhas a severe allergy,
Dialogue: 0,0:09:52.44,0:09:54.80,Default,,0000,0000,0000,,or had a horrible\Nreaction to the vaccine.
Dialogue: 0,0:09:54.80,0:09:58.18,Default,,0000,0000,0000,,For whatever reason, they\Ncannot take the vaccine.
Dialogue: 0,0:09:58.18,0:10:00.63,Default,,0000,0000,0000,,Well in this person, if\Nthey can't take the vaccine,
Dialogue: 0,0:10:00.63,0:10:03.93,Default,,0000,0000,0000,,or don't have the vaccine,\Nthen for this person
Dialogue: 0,0:10:03.93,0:10:07.13,Default,,0000,0000,0000,,I would actually treat\Nthem for just one week.
Dialogue: 0,0:10:07.13,0:10:10.53,Default,,0000,0000,0000,,One week after exposure.
Dialogue: 0,0:10:10.53,0:10:14.32,Default,,0000,0000,0000,,So if the exposure\Nhappened, let's say today,
Dialogue: 0,0:10:14.32,0:10:15.74,Default,,0000,0000,0000,,I would basically--\Nand then let's
Dialogue: 0,0:10:15.74,0:10:17.85,Default,,0000,0000,0000,,assume it's not going\Nto keep happening--
Dialogue: 0,0:10:17.85,0:10:22.26,Default,,0000,0000,0000,,so one week after exposure\Nwould then make it next week,
Dialogue: 0,0:10:22.26,0:10:24.42,Default,,0000,0000,0000,,is when I would\Nstop the medication.
Dialogue: 0,0:10:24.42,0:10:26.99,Default,,0000,0000,0000,,So in this scenario,\NI'm protecting them
Dialogue: 0,0:10:26.99,0:10:28.89,Default,,0000,0000,0000,,with the medication\Nagainst getting sick
Dialogue: 0,0:10:28.89,0:10:30.59,Default,,0000,0000,0000,,from this exposure.
Dialogue: 0,0:10:30.59,0:10:32.40,Default,,0000,0000,0000,,But because they've\Nhad no vaccine,
Dialogue: 0,0:10:32.40,0:10:34.59,Default,,0000,0000,0000,,if they have ongoing\Nexposures-- let's
Dialogue: 0,0:10:34.59,0:10:38.98,Default,,0000,0000,0000,,say they get exposed again\Nto flu in three weeks-- then
Dialogue: 0,0:10:38.98,0:10:40.52,Default,,0000,0000,0000,,again they'd have\Nto come back to me,
Dialogue: 0,0:10:40.52,0:10:42.19,Default,,0000,0000,0000,,and we'd have to do\Nthis all over again.
Dialogue: 0,0:10:42.19,0:10:45.87,Default,,0000,0000,0000,,So it really is ideal to have\Nthat vaccine in your system
Dialogue: 0,0:10:45.87,0:10:47.76,Default,,0000,0000,0000,,to keep protecting\Nyou and preventing you
Dialogue: 0,0:10:47.76,0:10:48.72,Default,,0000,0000,0000,,from getting ill.
Dialogue: 0,0:10:48.72,0:10:50.37,Default,,0000,0000,0000,,Now in this second\Nscenario, let's say
Dialogue: 0,0:10:50.37,0:10:52.59,Default,,0000,0000,0000,,instead of having a\Nvisitor who's sick,
Dialogue: 0,0:10:52.59,0:10:55.53,Default,,0000,0000,0000,,let's say you've got people\Naround you that are sick,
Dialogue: 0,0:10:55.53,0:10:58.38,Default,,0000,0000,0000,,living in the same place as you.
Dialogue: 0,0:10:58.38,0:11:02.97,Default,,0000,0000,0000,,Now this person is obviously in\Nthe home with a group of folks.
Dialogue: 0,0:11:02.97,0:11:04.39,Default,,0000,0000,0000,,So let's call that a group home.
Dialogue: 0,0:11:04.39,0:11:08.71,Default,,0000,0000,0000,,And what we call this scenario\Nis basically an outbreak.
Dialogue: 0,0:11:08.71,0:11:12.02,Default,,0000,0000,0000,,So this person is living\Nin an outbreak setting.
Dialogue: 0,0:11:12.02,0:11:15.74,Default,,0000,0000,0000,,And many, many people with\Nflu are living together
Dialogue: 0,0:11:15.74,0:11:18.07,Default,,0000,0000,0000,,causing an outbreak to happen.
Dialogue: 0,0:11:18.07,0:11:21.22,Default,,0000,0000,0000,,We really are worried\Nabout other healthy people
Dialogue: 0,0:11:21.22,0:11:24.44,Default,,0000,0000,0000,,like our smiley faced friend\Nfrom getting sick with the flu
Dialogue: 0,0:11:24.44,0:11:25.02,Default,,0000,0000,0000,,as well.
Dialogue: 0,0:11:25.02,0:11:26.81,Default,,0000,0000,0000,,So in this setting,\Nwho am I worried about?
Dialogue: 0,0:11:26.81,0:11:30.68,Default,,0000,0000,0000,,Who do I want to make sure gets\Nmedications to prevent them
Dialogue: 0,0:11:30.68,0:11:31.65,Default,,0000,0000,0000,,from getting sick?
Dialogue: 0,0:11:31.65,0:11:35.56,Default,,0000,0000,0000,,Well, we've got high risk\Npeople, again, living together.
Dialogue: 0,0:11:35.56,0:11:37.13,Default,,0000,0000,0000,,So if people are\Nliving together--
Dialogue: 0,0:11:37.13,0:11:39.38,Default,,0000,0000,0000,,and this could be\Nsenior citizens,
Dialogue: 0,0:11:39.38,0:11:43.29,Default,,0000,0000,0000,,or could be a chronic care\Nfacility, or nursing home--
Dialogue: 0,0:11:43.29,0:11:46.12,Default,,0000,0000,0000,,and really any kind\Nof group setting
Dialogue: 0,0:11:46.12,0:11:48.16,Default,,0000,0000,0000,,where people are\Ninstitutionalized
Dialogue: 0,0:11:48.16,0:11:50.44,Default,,0000,0000,0000,,and they're high risk,\NI'm going to be worried.
Dialogue: 0,0:11:50.44,0:11:53.92,Default,,0000,0000,0000,,And I want to make sure\Nthat we consider prevention
Dialogue: 0,0:11:53.92,0:11:58.45,Default,,0000,0000,0000,,with one of these medications,\Nthe Oseltamivir or Zanamivir.
Dialogue: 0,0:11:58.45,0:12:00.49,Default,,0000,0000,0000,,And do I have to worry\Nabout severe disease
Dialogue: 0,0:12:00.49,0:12:01.29,Default,,0000,0000,0000,,or hospitalization?
Dialogue: 0,0:12:01.29,0:12:03.39,Default,,0000,0000,0000,,Well, no, again because\Nhere specifically
Dialogue: 0,0:12:03.39,0:12:05.86,Default,,0000,0000,0000,,I'm talking about\Nthe healthy person
Dialogue: 0,0:12:05.86,0:12:07.61,Default,,0000,0000,0000,,who happens to be\Nin an outbreak.
Dialogue: 0,0:12:07.61,0:12:08.92,Default,,0000,0000,0000,,So they're still healthy.
Dialogue: 0,0:12:08.92,0:12:09.96,Default,,0000,0000,0000,,They're not hospitalized.
Dialogue: 0,0:12:09.96,0:12:11.65,Default,,0000,0000,0000,,They don't have\Nsevere disease yet.
Dialogue: 0,0:12:11.65,0:12:13.23,Default,,0000,0000,0000,,So the whole idea\Nis to make sure they
Dialogue: 0,0:12:13.23,0:12:15.36,Default,,0000,0000,0000,,don't get those things, right?
Dialogue: 0,0:12:15.36,0:12:17.27,Default,,0000,0000,0000,,And when would I\Nwant to treat them?
Dialogue: 0,0:12:17.27,0:12:20.64,Default,,0000,0000,0000,,Well, it's hard to really\Nsay within two days
Dialogue: 0,0:12:20.64,0:12:22.90,Default,,0000,0000,0000,,because that implies that\Nsomething specific is
Dialogue: 0,0:12:22.90,0:12:23.86,Default,,0000,0000,0000,,happening.
Dialogue: 0,0:12:23.86,0:12:26.15,Default,,0000,0000,0000,,When in fact,\Nduring an outbreak,
Dialogue: 0,0:12:26.15,0:12:28.53,Default,,0000,0000,0000,,you just have constant\Nexposure, right?
Dialogue: 0,0:12:28.53,0:12:30.85,Default,,0000,0000,0000,,I mean, everyone\Naround you is sick.
Dialogue: 0,0:12:30.85,0:12:32.86,Default,,0000,0000,0000,,Let's say you go down\Nto eat in the cafeteria.
Dialogue: 0,0:12:32.86,0:12:33.98,Default,,0000,0000,0000,,Everyone is sick.
Dialogue: 0,0:12:33.98,0:12:36.05,Default,,0000,0000,0000,,So when you're having\Nconstant exposure,
Dialogue: 0,0:12:36.05,0:12:38.86,Default,,0000,0000,0000,,we don't really think\Nabout within two days.
Dialogue: 0,0:12:38.86,0:12:40.28,Default,,0000,0000,0000,,It doesn't really\Nmake sense here.
Dialogue: 0,0:12:40.28,0:12:42.07,Default,,0000,0000,0000,,So here I would just\Nkind of be worried
Dialogue: 0,0:12:42.07,0:12:43.77,Default,,0000,0000,0000,,in general about this person.
Dialogue: 0,0:12:43.77,0:12:45.56,Default,,0000,0000,0000,,And as far as\Ntreatment, you really
Dialogue: 0,0:12:45.56,0:12:47.54,Default,,0000,0000,0000,,end up just treating everybody.
Dialogue: 0,0:12:47.54,0:12:51.41,Default,,0000,0000,0000,,Vaccine or no vaccine,\Nyou treat everybody
Dialogue: 0,0:12:51.41,0:12:55.69,Default,,0000,0000,0000,,throughout the outbreak\Nbecause the whole goal here
Dialogue: 0,0:12:55.69,0:12:58.08,Default,,0000,0000,0000,,is really to minimize\Nthe outbreak.
Dialogue: 0,0:12:58.08,0:13:01.94,Default,,0000,0000,0000,,You don't want people to have\Nall the horrible consequences
Dialogue: 0,0:13:01.94,0:13:02.46,Default,,0000,0000,0000,,of flu.
Dialogue: 0,0:13:02.46,0:13:07.49,Default,,0000,0000,0000,,Remember, flu can kill people,\Nand can cause hospitalizations.
Dialogue: 0,0:13:07.49,0:13:10.16,Default,,0000,0000,0000,,So to prevent all that,\Nbecause it's a high risk
Dialogue: 0,0:13:10.16,0:13:12.62,Default,,0000,0000,0000,,group of people living\Ntogether, you would really just
Dialogue: 0,0:13:12.62,0:13:14.43,Default,,0000,0000,0000,,treat throughout the outbreak.
Dialogue: 0,0:13:14.43,0:13:22.00,Default,,0000,0000,0000,,And even one week after the\Nlast case of flu is found.
Dialogue: 0,0:13:24.52,0:13:28.56,Default,,0000,0000,0000,,So here, unlike\Nthe scenario where
Dialogue: 0,0:13:28.56,0:13:30.95,Default,,0000,0000,0000,,you have just a single\Nexposure, because you
Dialogue: 0,0:13:30.95,0:13:33.46,Default,,0000,0000,0000,,have so many people in\Nan outbreak that are sick
Dialogue: 0,0:13:33.46,0:13:36.40,Default,,0000,0000,0000,,and kind of exposing\Neach other, you basically
Dialogue: 0,0:13:36.40,0:13:40.79,Default,,0000,0000,0000,,just treat everybody with\NOseltamivir or Zanamivir.
Dialogue: 0,0:13:40.79,0:13:43.39,Default,,0000,0000,0000,,So now you see we have a\Ncouple of anti-viral drugs,
Dialogue: 0,0:13:43.39,0:13:45.72,Default,,0000,0000,0000,,and you see when we can\Nuse them to treat folks,
Dialogue: 0,0:13:45.72,0:13:47.64,Default,,0000,0000,0000,,and also when we can use\Nthem to prevent folks
Dialogue: 0,0:13:47.64,0:13:49.54,Default,,0000,0000,0000,,from getting sick.