Hello and welcome to the How Epidemic Sen Project, which is based at the University of Oxford.
My name is Erica Chartered's and in these videos I'm discussing with experts how they research disease in a variety of ways,
as well as their investigations into how epidemics.
And today I'm here with two professors who together work on biological anthropology in order to understand disease and health.
I have Clark Larsen, who's professor at the Ohio State University, and Fabian Crespo,
who's associate professor in the Department of Anthropology at the University of Louisville.
So, Clarke and Fabian, many people will know that biologists study health and disease,
and anthropologists and archaeologists study the past by looking at material remains very often human skeletons.
So can you explain a little bit more about how biology and archaeology work together?
What do you what do you use as evidence in your research?
Yes, although the biology and archaeology together, it's really a subfield event pathology or field as biological anthropology,
and my speciality within that field is called bio archaeology, which is the study of human remains.
Archaeological Senate. So that's a simple definition.
The larger definition involves the context for living conditions, including health and disease.
And so we study what people age, their population size,
the kind of communities that they lived in size and density communities and all sorts of ability to play into the development of disease,
including infectious disease. So our field, with the much larger context of why archaeology is interested in origins of disease,
impacts on health with regard to epidemics and pandemics.
How long did it last? What are the factors behind the history of those diseases ahead of population?
And do they how do they appear and do they disappear?
Do they do it yet? And so the complexity of our field is to understand all these circumstances of play into health and disease.
And we'll be. It's really interesting to think about the the different types of evidence that you use, so I'm wondering,
can you explain a little bit more about what you look at when you're trying to examine disease in the past?
How what do you look at with human skeletons in order to understand health and well-being?
Yeah. So what what we look at in human skeletons are human skeletons or reservoir of life experiences.
And one of these, of course, is disease. So of course, there are many kinds of diseases.
Even tooth decay is a disease.
Dental caries caused by a pathogen interacting with the gut flora and fauna of the mouth and interacting with the foods we eat.
But other Dutch diseases that have impacted humans over over the millennia include smallpox, which has very little evidence in terms of discount.
But other diseases pertain to our pandemics of epidemics took place, for example, in Europe and Middle Ages.
And unfortunately, there is very little physical evidence for some of these pandemics, some of these epidemics.
But what we're looking at is we can look at the origins of the pathogen by looking at micro
organisms and the record of ancient DNA to determine where and when these diseases occurred.
So we're very interested in the full picture of health and disease in terms of what we can learn from human rage.
One way I know that you've talked about this is thinking about the bio social context of disease,
so I was wondering if one of you can explain exactly what this means.
Bobby, beyond why don't you go first?
Thank you very much for having us and giving us the chance for me is a great honour and as you can imagine,
working with Professor Larson and also working with all colleagues here in this multidisciplinary project.
My background is human immunology. I must clarify that as a biologist.
But then many, many years ago, I decided to study immunology and especially inflammation in the past.
And the only evidence that we can harvest skeletal evidence, of course, the immune system is gone.
But he was having some kind of, as Professor Larson was saying. Skeletal samples.
They do represent this kind of reservoir, not exactly the reservoir for the pathogen, but the reservoir for the whole life experience.
So for me, I try to combine different markers in defining a skeleton kind of bones or skeletal samples to reconstruct inflammation.
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.
I try to embrace a more kind of comprehensive concept that is immune competence.
I know that sounds similar, but for me, the immune competencies allowing me to explain that not only the the genetic information,
the biological information will be useful for us to mount a proper immune response, but also environmental and social factors.
As Professor Larson was explaining by archaeologist reconstructing lifestyles, diet, other diseases, comorbidities.
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,
why we have differential mortality, why more cases here and less cases they are.
Probably it's not only because of the biology of the host pathogenic direction, but also something else from going there.
Can you explain a little bit about when one of the diseases that you've worked on already?
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.
There's still a few cases today, but how does how does this approach?
How does your methodology, how do you study leprosy as an example?
Well, leprosy, well, few diseases as officially single, saying they are living some kind of holding say, oh, theological kind of signatures,
if you want to choose, it would be either leprosy, tuberculosis and syphilis, but they are just very fragmentary and controversial back.
Yes. Just to answer that leprosy has a highly distinctive.
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.
The fingers and toes and atrophy are the face, the facial skeleton and atrophy.
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.
So for the history of the study of the disease, that was primary interest.
Now we're interested in more what Fabiano is talking about in terms of immuno competence
or health of the individual and the circumstances that arise without disease.
So far, we are going to just want to throw that in there.
No, but basically we chose and also also other historian says, you have here Monica, Monica Green,
Laurie Johnson looking phallic but pushing me to work on leprosy in some way because leprosy,
as many of you you know, the clinical outcome of the disease also has something to do with a new competence of the host.
And you have a huge spectrum of different clinical manifestations, as you can study today.
So we got we can tell you if we can do the same in the past, if we can do two different things.
One is to reconstruct as much as possible the inflammatory of immune competence of the host.
Using all these different theological markers lesions that we can use for inflammation,
chronic inflammation on the top that as professor last thing we're saying, can we use other skeletal markers?
Reconstruct lifestyle makes sense. Dilute other comorbidities.
And then on the other side is, can we see some kind of life?
He's very connected with leprosy. Can you see while mostly comatose leprosy,
as most of the body archaeologist probably paying attention to this kind of interview will
recognise that most of the lesions are associated with one specific side of the spectrum.
But, but clearly the ending of these kind of endemic leprosy mediaeval Europe, as you know all very well,
has something to do with probably the immune competence of the cold changing.
And not only because biological factors, probably biological factors were playing a role, perhaps a pathogen,
but perhaps also the new competence what he calls was changing many different factors these five social and perhaps moving into this endemic idea.
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.
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.
Some damage is and how is that different epidemic? I think that the viewers will want to want to know more about that.
That would be great, because I think it's true most people won't have heard of this endemic theory.
Well, to start, I must be honest, I must clarify in that mix theory was very well developed by many different scholars.
Marilyn Zinger is one of the top ones. So basically at the beginning was, allow me to say, a more biomedical term,
trying to understand the interaction of two different infectious diseases happening at the same time in a single host.
And the idea in that mix, if you can just separate, will be synergistic epidemics.
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.
I'm talking about now contemporary kind of infectious diseases.
The same goes with hepatitis C and HIV, but not it didn't take too long for other scholars,
especially, I would say, medical anthropologists to start adding other factors in patients.
So these synergism making things worse makes sense to accelerate or exacerbate wasn't only
the interaction of two pathogens was the interaction of two infectious diseases last.
For example, malnutrition, stress, lifestyles, other comorbidities.
So the equation, as you can imagine, is getting longer to understand the outcome.
As you can explain now with age that the outcome of COVID 19 probably will have different clinical manifestations.
Social policy. So you have all these different layers.
Mary Singer put it very clearly that in some ways, trying to create a more social scientific approach to reframe and rethink public health.
So basically, the idea that we are doing is basically taking these complex theory into the past.
Can we also explore the interaction, for example, leprosy and tuberculosis in the past, or perhaps leprosy and plague, but not anything there?
You understand that we need to explain and explore other factors playing.
Probably it would be an oversimplification to think that mediaeval leprosy was more or less the same in the whole of Europe.
That would be to us. All historians would be jumping at me and say, no, do not create a homogeneous makes sense European history.
The same goes with the same kind of scene that mixes open access.
Our picture to this adding different factors that perhaps at the same time, they're totally different in different places.
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.
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,
depending on the continent, the region that we are facing. I think that's endemic is very powerful, keeping us these open mind.
The only issue with that is we understand what syndromic is.
But I think that that it's a term unfamiliar to your average citizen, the average person.
What is the difference between epidemic and sentiment?
I think it's the overall understanding that those epidemics pandemics have a number of influences and a number of different sort of histories.
Or, as you were saying that that allow us to get into the deeper meaning of health disease in the past and the present.
It's complex, but we're we're attempting to sort out that complexity.
And my sense is also, as you're saying, that we need to have multiple perspectives and multiple insights,
so as an example of different disciplinary work.
Having a biologist and having an archaeologist in anthropology all together, I think is one way of doing this.
But my other senses, you're saying that we need to have a long term perspective as well.
One of the things I'd I'd love if one of you can just maybe explain and conclude by by
explaining what this means for how we should think about epidemics and doing so did leprosy.
And with the with the decline of the disease, how should we take your findings of thinking about endemic theories about multiple disease,
about by a social context, an immune competency? How does that change your understanding of the ending of an epidemic?
I think that and I would like that also at the end, Professor Larson would make a comment about it.
We think that there is an ending of epidemics or pandemics, but from a multidisciplinary perspective,
if I would do this research from a multidisciplinary perspective, it would be a great mistake.
If I would think that it would have a single ending for each discipline will bring or will find different endings.
Epidemiologists will be just analysing cases makes sense and the prevalence.
But perhaps historians, economist other kind of sociology psychologists, they would find these findings.
And that's the kind of complexity of seeing them mix. For us to understand how the epidemic was happening makes sense.
It has that same complexity how the epidemic will end. You will be, in my understanding, perhaps some misunderstandings in dynamics.
You've seen them. It will help us to reconstruct, make sense and understand the whole epidemic or pandemic is equally complex to
understand the ending and the ending shouldn't be happening in a single day.
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.
And so it's not a single month. Maybe we were counting cases, but that's a case.
Just to add to that, that part of the perspective on never ending is that the the whole global perspective on population health,
population size where we're now at a billion amount.
And so those epidemics and pandemics, part of their continuation is supported by that population increase the.
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,
which are carbohydrate, which is supporting the world population.
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.
So one reason why why are epidemics?
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.
Population was increasing and concentrating and now.
So the past record is so important for understanding laying the groundwork for what's happening today.
And I think that's another message of what we do in this field is what what we are today.
Contrary to what most of the public thinks is not new.
The groundwork for it was laid with the transition from farming the border to farming and living in permanent communities.
And so it's a longer term context that helps us understand what's what's happening today.
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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