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Hello and welcome to the How Epidemic Sen Project, which is based at the University of Oxford.

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My name is Erica Chartered's and in these videos I'm discussing with experts how they research disease in a variety of ways,

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as well as their investigations into how epidemics.

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And today I'm here with two professors who together work on biological anthropology in order to understand disease and health.

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I have Clark Larsen, who's professor at the Ohio State University, and Fabian Crespo,

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who's associate professor in the Department of Anthropology at the University of Louisville.

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So, Clarke and Fabian, many people will know that biologists study health and disease,

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and anthropologists and archaeologists study the past by looking at material remains very often human skeletons.

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So can you explain a little bit more about how biology and archaeology work together?

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What do you what do you use as evidence in your research?

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Yes, although the biology and archaeology together, it's really a subfield event pathology or field as biological anthropology,

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and my speciality within that field is called bio archaeology, which is the study of human remains.

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Archaeological Senate. So that's a simple definition.

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The larger definition involves the context for living conditions, including health and disease.

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And so we study what people age, their population size,

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the kind of communities that they lived in size and density communities and all sorts of ability to play into the development of disease,

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including infectious disease. So our field, with the much larger context of why archaeology is interested in origins of disease,

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impacts on health with regard to epidemics and pandemics.

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How long did it last? What are the factors behind the history of those diseases ahead of population?

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And do they how do they appear and do they disappear?

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Do they do it yet? And so the complexity of our field is to understand all these circumstances of play into health and disease.

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And we'll be. It's really interesting to think about the the different types of evidence that you use, so I'm wondering,

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can you explain a little bit more about what you look at when you're trying to examine disease in the past?

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How what do you look at with human skeletons in order to understand health and well-being?

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Yeah. So what what we look at in human skeletons are human skeletons or reservoir of life experiences.

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And one of these, of course, is disease. So of course, there are many kinds of diseases.

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Even tooth decay is a disease.

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Dental caries caused by a pathogen interacting with the gut flora and fauna of the mouth and interacting with the foods we eat.

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But other Dutch diseases that have impacted humans over over the millennia include smallpox, which has very little evidence in terms of discount.

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But other diseases pertain to our pandemics of epidemics took place, for example, in Europe and Middle Ages.

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And unfortunately, there is very little physical evidence for some of these pandemics, some of these epidemics.

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But what we're looking at is we can look at the origins of the pathogen by looking at micro

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organisms and the record of ancient DNA to determine where and when these diseases occurred.

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So we're very interested in the full picture of health and disease in terms of what we can learn from human rage.

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One way I know that you've talked about this is thinking about the bio social context of disease,

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so I was wondering if one of you can explain exactly what this means.

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Bobby, beyond why don't you go first?

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Thank you very much for having us and giving us the chance for me is a great honour and as you can imagine,

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working with Professor Larson and also working with all colleagues here in this multidisciplinary project.

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My background is human immunology. I must clarify that as a biologist.

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But then many, many years ago, I decided to study immunology and especially inflammation in the past.

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And the only evidence that we can harvest skeletal evidence, of course, the immune system is gone.

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But he was having some kind of, as Professor Larson was saying. Skeletal samples.

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They do represent this kind of reservoir, not exactly the reservoir for the pathogen, but the reservoir for the whole life experience.

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So for me, I try to combine different markers in defining a skeleton kind of bones or skeletal samples to reconstruct inflammation.

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And of course, to put that in context, so that by a social component for me as a as I explained more than once is I don't work on it with immunity.

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I try to embrace a more kind of comprehensive concept that is immune competence.

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I know that sounds similar, but for me, the immune competencies allowing me to explain that not only the the genetic information,

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the biological information will be useful for us to mount a proper immune response, but also environmental and social factors.

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As Professor Larson was explaining by archaeologist reconstructing lifestyles, diet, other diseases, comorbidities.

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So we can't build the immunity and immune competence in isolation of the rest, as we are facing now with these with COVID 19,

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why we have differential mortality, why more cases here and less cases they are.

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Probably it's not only because of the biology of the host pathogenic direction, but also something else from going there.

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Can you explain a little bit about when one of the diseases that you've worked on already?

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I know you've worked on a range of diseases, but leprosy especially, I think, is one that people probably associate with the Middle Ages in Europe.

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There's still a few cases today, but how does how does this approach?

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How does your methodology, how do you study leprosy as an example?

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Well, leprosy, well, few diseases as officially single, saying they are living some kind of holding say, oh, theological kind of signatures,

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if you want to choose, it would be either leprosy, tuberculosis and syphilis, but they are just very fragmentary and controversial back.

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Yes. Just to answer that leprosy has a highly distinctive.

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Visible pathology of the skeleton. And so it's it's I wouldn't say it's unique, but it's pretty close to it.

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The fingers and toes and atrophy are the face, the facial skeleton and atrophy.

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And so there is a distinctive disprove and like some infectious diseases, that a distinctive morphology of the of the of the impact of disease.

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So for the history of the study of the disease, that was primary interest.

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Now we're interested in more what Fabiano is talking about in terms of immuno competence

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or health of the individual and the circumstances that arise without disease.

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So far, we are going to just want to throw that in there.

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No, but basically we chose and also also other historian says, you have here Monica, Monica Green,

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Laurie Johnson looking phallic but pushing me to work on leprosy in some way because leprosy,

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as many of you you know, the clinical outcome of the disease also has something to do with a new competence of the host.

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And you have a huge spectrum of different clinical manifestations, as you can study today.

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So we got we can tell you if we can do the same in the past, if we can do two different things.

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One is to reconstruct as much as possible the inflammatory of immune competence of the host.

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Using all these different theological markers lesions that we can use for inflammation,

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chronic inflammation on the top that as professor last thing we're saying, can we use other skeletal markers?

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Reconstruct lifestyle makes sense. Dilute other comorbidities.

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And then on the other side is, can we see some kind of life?

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He's very connected with leprosy. Can you see while mostly comatose leprosy,

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as most of the body archaeologist probably paying attention to this kind of interview will

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recognise that most of the lesions are associated with one specific side of the spectrum.

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But, but clearly the ending of these kind of endemic leprosy mediaeval Europe, as you know all very well,

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has something to do with probably the immune competence of the cold changing.

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And not only because biological factors, probably biological factors were playing a role, perhaps a pathogen,

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but perhaps also the new competence what he calls was changing many different factors these five social and perhaps moving into this endemic idea.

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For us, this pandemic theory that we are using today, many scholars is very powerful for us to explain this by your social context in the past.

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So I would describe to review that's a very important part of the discussion is send back what you might explain was the different one.

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Some damage is and how is that different epidemic? I think that the viewers will want to want to know more about that.

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That would be great, because I think it's true most people won't have heard of this endemic theory.

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Well, to start, I must be honest, I must clarify in that mix theory was very well developed by many different scholars.

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Marilyn Zinger is one of the top ones. So basically at the beginning was, allow me to say, a more biomedical term,

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trying to understand the interaction of two different infectious diseases happening at the same time in a single host.

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And the idea in that mix, if you can just separate, will be synergistic epidemics.

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And then you remove some letters and you will get seeing them. So at the beginning was the interaction of, for example, HIV and tuberculosis.

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I'm talking about now contemporary kind of infectious diseases.

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The same goes with hepatitis C and HIV, but not it didn't take too long for other scholars,

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especially, I would say, medical anthropologists to start adding other factors in patients.

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So these synergism making things worse makes sense to accelerate or exacerbate wasn't only

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the interaction of two pathogens was the interaction of two infectious diseases last.

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For example, malnutrition, stress, lifestyles, other comorbidities.

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So the equation, as you can imagine, is getting longer to understand the outcome.

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As you can explain now with age that the outcome of COVID 19 probably will have different clinical manifestations.

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Social policy. So you have all these different layers.

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Mary Singer put it very clearly that in some ways, trying to create a more social scientific approach to reframe and rethink public health.

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So basically, the idea that we are doing is basically taking these complex theory into the past.

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Can we also explore the interaction, for example, leprosy and tuberculosis in the past, or perhaps leprosy and plague, but not anything there?

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You understand that we need to explain and explore other factors playing.

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Probably it would be an oversimplification to think that mediaeval leprosy was more or less the same in the whole of Europe.

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That would be to us. All historians would be jumping at me and say, no, do not create a homogeneous makes sense European history.

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The same goes with the same kind of scene that mixes open access.

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Our picture to this adding different factors that perhaps at the same time, they're totally different in different places.

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Now, with the COVID 19 that we're talking about, I don't know if you saw in the news that we should be calling pandemic.

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No one should be calling us endemic, but perhaps it's not a single thing that makes you understand is perhaps we have multiples in that mix,

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depending on the continent, the region that we are facing. I think that's endemic is very powerful, keeping us these open mind.

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The only issue with that is we understand what syndromic is.

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But I think that that it's a term unfamiliar to your average citizen, the average person.

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What is the difference between epidemic and sentiment?

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I think it's the overall understanding that those epidemics pandemics have a number of influences and a number of different sort of histories.

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Or, as you were saying that that allow us to get into the deeper meaning of health disease in the past and the present.

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It's complex, but we're we're attempting to sort out that complexity.

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And my sense is also, as you're saying, that we need to have multiple perspectives and multiple insights,

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so as an example of different disciplinary work.

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Having a biologist and having an archaeologist in anthropology all together, I think is one way of doing this.

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But my other senses, you're saying that we need to have a long term perspective as well.

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One of the things I'd I'd love if one of you can just maybe explain and conclude by by

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explaining what this means for how we should think about epidemics and doing so did leprosy.

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And with the with the decline of the disease, how should we take your findings of thinking about endemic theories about multiple disease,

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about by a social context, an immune competency? How does that change your understanding of the ending of an epidemic?

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I think that and I would like that also at the end, Professor Larson would make a comment about it.

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We think that there is an ending of epidemics or pandemics, but from a multidisciplinary perspective,

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if I would do this research from a multidisciplinary perspective, it would be a great mistake.

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If I would think that it would have a single ending for each discipline will bring or will find different endings.

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Epidemiologists will be just analysing cases makes sense and the prevalence.

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But perhaps historians, economist other kind of sociology psychologists, they would find these findings.

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And that's the kind of complexity of seeing them mix. For us to understand how the epidemic was happening makes sense.

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It has that same complexity how the epidemic will end. You will be, in my understanding, perhaps some misunderstandings in dynamics.

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You've seen them. It will help us to reconstruct, make sense and understand the whole epidemic or pandemic is equally complex to

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understand the ending and the ending shouldn't be happening in a single day.

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Mixes in a single moment or a snapshot, probably where facing that and don't have these copies would be ending, but it would be ending in a long time.

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And so it's not a single month. Maybe we were counting cases, but that's a case.

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Just to add to that, that part of the perspective on never ending is that the the whole global perspective on population health,

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population size where we're now at a billion amount.

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And so those epidemics and pandemics, part of their continuation is supported by that population increase the.

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The world health context. For example, while most of diet for the majority of the world population is based on the the superfood rice and corn wheat,

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which are carbohydrate, which is supporting the world population.

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And so that in itself, in terms of understanding disease epidemics is an issue just in terms of quality of life, global or going forward.

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So one reason why why are epidemics?

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Pandemics have a very buzzy ending, if at all, is owing to these conditions, it will continue to mount and grow as as I did in the past.

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Population was increasing and concentrating and now.

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So the past record is so important for understanding laying the groundwork for what's happening today.

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And I think that's another message of what we do in this field is what what we are today.

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Contrary to what most of the public thinks is not new.

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The groundwork for it was laid with the transition from farming the border to farming and living in permanent communities.

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And so it's a longer term context that helps us understand what's what's happening today.

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Thank you both very much, Clarke and Fabian, for reminding us of this long term context and also for sharing your expertise with us.

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