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The Barbie Hsu case: Influenza and Pneumonia kills · Health Matters

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  Speaker 1: Now,
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  Speaker 2: Health Matters with Daniel Martin. Welcome into Health Matters right
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  Speaker 2: here on CNA 938, everybody. I'm Danielle Martin. Many of
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  Speaker 2: you were shocked by the recent news of the death
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  Speaker 2: of the Taiwanese singer, actress Barbi Sue. She was 48
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  Speaker 2: years old and most known for her role on Meteor Garden.
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  Speaker 2: Reports saying she died from pneumonia.
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  Speaker 2: After contracting influenza and this was during a trip to
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  Speaker 2: Japan in fact what has sadly been trending on social
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  Speaker 2: media in China in particular is the term Japanese flu.
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  Speaker 2: Is this something specific? What do we need to know
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  Speaker 2: about influenza turning into pneumonia and how often does this kill?
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  Speaker 2: If you have any questions about influenza or pneumonia sparked
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  Speaker 2: by this really sad and tragic case, uh, to the
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  Speaker 2: Taiwanese singer actress Barbie Sue, you're welcome to WhatsApp your
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  Speaker 2: questions across at 963-11938 as I speak to Doctor Lo Jiashen,
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  Speaker 2: infectious disease specialist based at Fair Park Hospital. Doctor Lo,
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  Speaker 2: welcome back.
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  Speaker 1: Hello. Hello, hello.
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  Speaker 2: Let's understand the Barbie case a little bit, OK? This
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  Speaker 2: caught a lot of people by surprise. They've been published
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  Speaker 2: reports by her friends saying, oh my gosh, I just
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  Speaker 2: saw her before she left for her trip, that kind
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  Speaker 2: of thing.
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  Speaker 2: This is what a contraction? Was it a specific type
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  Speaker 2: of influenza that became a specific type of pneumonia? What
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  Speaker 2: do we know?
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  Speaker 1: Uh, we know this is seasonal influenza, so this is
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  Speaker 1: the influenza that normal that we catch now and then
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  Speaker 1: that the
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  Speaker 1: The one that we commonly call the flu. Yes, this
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  Speaker 1: is not anything as far as the reports come. We
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  Speaker 1: don't have any new information that this is anything novel
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  Speaker 1: or pandemic strain or avian influenza. We don't have any
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  Speaker 1: reports like that. So it seems like this is just
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  Speaker 1: seasonal influenza.
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  Speaker 2: And why does influenza become pneumonia?
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  Speaker 1: Uh, actually, influenza can become pneumonia, uh, in, in, I mean,
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  Speaker 1: strictly speaking in two different ways. One where the pneumonia
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  Speaker 1: is actually caused by the influenza virus, in which case
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  Speaker 1: it's an influenza pneumonia, or or it's a bacterial pneumonia
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  Speaker 1: that follows the influenza, in which case it's called the
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  Speaker 1: influenza related bacterial pneumonia, right?
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  Speaker 1: Because pneumonia just means infection of the lung, but what
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  Speaker 1: it is caused by is different, whether it's caused by
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  Speaker 1: influenza or a bacterial infection subsequently, it is not so clear,
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  Speaker 1: which is the one that that the actress succumbed to. Yeah,
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  Speaker 1: so it is not that uncommon. Some studies say that
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  Speaker 1: up to 15% of people with influenza have a concomitant
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  Speaker 1: concomitant bacterial superinfection.
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  Speaker 1: But a lot of times it's it's something very mild,
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  Speaker 1: they get over it and then or some sometimes they
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  Speaker 1: get treated antibiotics, they get over it. Um, so it
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  Speaker 1: is not that uncommon to get a bacterial infection after that.
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  Speaker 1: And one of the reasons is because the after the influenza,
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  Speaker 1: the immune system modulates itself in such a way to
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  Speaker 1: combat influenza, sort of making it slightly more susceptible to
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  Speaker 1: a bacterial infection.
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  Speaker 2: So what is the more dangerous of the two here?
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  Speaker 2: It's the pneumonia that could lead to mortality.
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  Speaker 1: Uh, no, I think both are equally dangerous. In, in
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  Speaker 1: large studies, the, the people have stated something like between 4.4%
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  Speaker 1: for influenza-related pneumonias and something like 6.2% in terms of mortality. So,
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  Speaker 1: so people are saying it's in the single digits, mid
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  Speaker 1: single digits number of percentage chance of mortality for influenza
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  Speaker 1: pneumonia and bacteria. So it's about the same.
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  Speaker 1: Yeah. And
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  Speaker 2: is
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  Speaker 2: it so fast and so quick? Apparently this trip took
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  Speaker 2: place on February 3rd. 0 no, no, the release was
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  Speaker 2: on February 3rd, I beg your pardon, but it was
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  Speaker 2: early in February and apparently it went pretty fast from
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  Speaker 2: the contraction to her passing.
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  Speaker 1: It is, it is possible. Uh, of course, one of
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  Speaker 1: the very well known complications of new, uh, for, for
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  Speaker 1: influenza is actually a heart attack. Uh, I think I
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  Speaker 1: read from some report that she's known to have some
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  Speaker 1: underlying heart condition.
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  Speaker 1: So it is entirely possible that the influenza could, I mean,
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  Speaker 1: I'm just completely postulating here, associated heart attack. So if
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  Speaker 1: it's from a, from a big heart attack, then, then
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  Speaker 1: of course that can be very fast and in itself,
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  Speaker 1: influenza and pneumonia can can deteriorate quite rapidly in days. Yes,
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  Speaker 1: and that we have seen.
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  Speaker 2: I, I was just about to ask that actually. I mean,
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  Speaker 2: in this case, we, we, we don't know, we don't
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  Speaker 2: have the full medical details and things, obviously, but what
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  Speaker 2: could cause something to take such a downward turn? Is
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  Speaker 2: it because of another infection or some underlying unknown cause
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  Speaker 2: that had been there all along that could be triggered
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  Speaker 2: easily by something like an influenza infection potentially, is it?
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  Speaker 1: Ah, yes, say a potentially a poor, poor cardiac reserve
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  Speaker 1: very bad high condition to start with a poor lung reserve,
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  Speaker 1: very bad lung condition.
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  Speaker 1: To start with, uh, elderly, a higher age group, unvaccinated
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  Speaker 1: age group, a late diagnosis, these are all factors that can,
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  Speaker 1: can lead to a rapid downturn.
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  Speaker 2: See, that's what I that's the thing, the rapidity of
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  Speaker 2: it and also the idea, I think not many people
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  Speaker 2: have heard about influenza leading to pneumonia as well, but
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  Speaker 2: like you said, it's not that uncommon.
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  Speaker 1: Yeah.
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  Speaker 2: But, but how come it's not, it's not uncommon, but
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  Speaker 2: how come we never hear about it before?
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  Speaker 1: A lot of times actually, if you were to do
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  Speaker 1: a CT chest on a person with influenza who's admitted
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  Speaker 1: and who's really coughing quite bad, many times the CT chest,
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  Speaker 1: which is a much more detailed like a super chest X-ray.
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  Speaker 1: Uh, you, you actually show some infiltrates on some abnormalities,
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  Speaker 1: but people don't get a CT chest. We just get
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  Speaker 1: a chest X-ray and some people take some antibiotics, sorry,
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  Speaker 1: antiviral antiviral, and they get better on their own. But
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  Speaker 1: that could be a case. So some people, uh, some
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  Speaker 1: data has stated up to 1/3 of hospitalized influenza actually
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  Speaker 1: has some mild or or some some pneumonitis or viral
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  Speaker 1: viral related pneumonia.
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  Speaker 2: It's just there, it's just tagging along for the ride,
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  Speaker 1: is it?
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  Speaker 2: Yeah, yeah. Oh man. So what, what, OK, I want
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  Speaker 2: to talk about prevention later on, but let me just
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  Speaker 2: squeeze that in right here. If you do a pneumococcal vaccine,
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  Speaker 2: does that help?
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  Speaker 1: No, no. It doesn't have influenza because, but it does
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  Speaker 1: prevent uh uh mortality from pneumococcal. So, so pneumococcal vaccine
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  Speaker 1: prevents streptococcal pneumonia, which is one of the most common bacteria.
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  Speaker 1: To follow the heels of influenza, so it helps in
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  Speaker 1: that way, in an indirect
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  Speaker 1: way.
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  Speaker 2: So like if you if you let's say for some
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  Speaker 2: reason you don't like taking influenza vaccine every year, but
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  Speaker 2: at least you took your pneumococcal vaccine, better than nothing, right,
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  Speaker 2: potentially prevents the tag along of the pneumonia developing.
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  Speaker 2: Interesting. OK. So obviously the the the the case here
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  Speaker 2: is don't get the influenza in the first place. That's
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  Speaker 2: very challenging with high travel rates, Lunar New Year festive period,
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  Speaker 2: global rise in respiratory illnesses are expected as well, and
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  Speaker 2: this doesn't have to be a novel strait, it's just
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  Speaker 2: a regular seasonal influenza. Correct.
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  Speaker 2: So what do we talk about? Why doesn't medical intervention
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  Speaker 2: solve this? Again, the big problem is a lot of
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  Speaker 2: people think it's just the flu, just the flu, just
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  Speaker 2: the flu. This one can
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  Speaker 2: easily be solved.
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  Speaker 1: Actually, medical intervention has done a big way to solve this. Uh,
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  Speaker 1: I was just looking at the mortality rates by different countries,
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  Speaker 1: and you can see that the countries with more well-developed
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  Speaker 1: healthcare systems doing much, much, much, much better.
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  Speaker 1: than countries with more broken healthcare systems, you know. So
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  Speaker 1: that means that uh I, for example, in Singapore, there's
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  Speaker 1: a parliamentary statement, uh, 2023, in the first four months,
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  Speaker 1: there were only seven deaths, so extrapolated through the whole year,
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  Speaker 1: there will be something like 20 deaths in a year.
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  Speaker 1: Um, and some estimates as high as 20% of the
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  Speaker 1: population haven't gotten influenza in a year. So 2020% and only,
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  Speaker 1: only 20 deaths, that's that's really remarkable. Yeah, and poorer
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  Speaker 1: countries will do much, much worse in some, most of
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  Speaker 1: these countries.
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  Speaker 2: So again to high quality good medical intervention makes a difference.
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  Speaker 2: What is done if somebody turns up with influenza which
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  Speaker 2: has concomitant.
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  Speaker 2: Uh, pneumonia.
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  Speaker 1: Earlier testing, earlier delivery of antivirals, uh, supportive care. If
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  Speaker 1: a person can't breathe, they get oxygen. If they can't,
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  Speaker 1: if their lungs deteriorate, they get uh supportive care in
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  Speaker 1: the ICU. The machine can breathe for them. And in
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  Speaker 1: the most extreme case, uh, it's a situation called ACMO
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  Speaker 1: where a machine takes out the blood, oxygenates it, and
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  Speaker 1: puts it back in the patient, uh, and, and a
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  Speaker 1: lot of rich countries and countries good healthcare system has
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  Speaker 1: a whole range at your disposal.
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  Speaker 1: So medical intervention has actually played a big part in
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  Speaker 1: bringing down the influenza mortality, you know.
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  Speaker 2: Unfortunately, in some cases, as we're seeing here, it doesn't
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  Speaker 2: always work.
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  Speaker 1: Yeah, there will be one or two cases that fall
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  Speaker 1: through the cracks.
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  Speaker 2: Yeah. And like you said, what if there was some
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  Speaker 2: underlying situation, for example, heart issue that's just gonna complicate
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  Speaker 2: the recovery.
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  Speaker 1: Exactly, exactly.
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  Speaker 2: OK, I want to talk about prevention. Yeah. Why are we,
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  Speaker 2: are we taking influenza vaccine or not? Like why are
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  Speaker 2: we not? The
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  Speaker 1: last, I think the last census in 2022, the national survey,
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  Speaker 1: a self-reported influenza vaccine rate has gone up to 40%.
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  Speaker 1: So, uh, well done because it's better than the previous
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  Speaker 1: years of 30 something. I think some years we haven't
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  Speaker 1: hit 20, so 2022, 240, so maybe this is spurred
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  Speaker 1: on by greater vaccine consciousness with the COVID vaccine, yeah, so, uh.
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  Speaker 1: Uh, maybe we can go past 50% and this year
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  Speaker 1: we don't know that the numbers are not available to me.
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  Speaker 1: But
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  Speaker 2: that's
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  Speaker 2: miles above where we
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  Speaker 2: were before.
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  Speaker 1: Yeah, I think we have improved 10 10% or more
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  Speaker 1: over the last few
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  Speaker 1: years.
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  Speaker 2: OK, I know what you are thinking. The first question
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  Speaker 2: always with you, Daniel, you will.
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  Speaker 2: Yes, I took it last month. Sorry. I always take
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  Speaker 2: it twice a year, at the end of the year
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  Speaker 2: and around my birthday, um, as well. So it just
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  Speaker 2: spaces it out. There are 2 that come out in
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  Speaker 2: every year. Do we need to
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  Speaker 2: take both?
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  Speaker 1: It depends on whether it's a strain. Uh, so if
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  Speaker 1: there's a strain, yes. And if there's no strain, usually
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  Speaker 1: no need.
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  Speaker 1: OK.
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  Speaker 2: Let's talk about the pneumococcal vaccine. Do we need to
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  Speaker 2: take that?
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  Speaker 1: Yeah, for sure. Uh, up to 65, I mean, it,
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  Speaker 1: it's two jabs, PCV 30 followed by 23, and now
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  Speaker 1: there's a new new version called a PCB 20.
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  Speaker 1: Um, that's available in, in quite a few private centers
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  Speaker 1: and so that, um, above 65 in those people with
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  Speaker 1: chronic lung disease earlier than that, that prevents mortality from
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  Speaker 1: invasive streptococcal disease. So it's absolutely.
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  Speaker 2: But as we sadly found out in this recent case,
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  Speaker 2: she was only 48 years old. She would not even
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  Speaker 2: be thinking about taking the pneumococcal vaccine. Can a younger
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  Speaker 2: person take it as well if they want to?
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  Speaker 1: Uh, in this case, she's less than 65, but she
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  Speaker 1: has a heart disease, so she actually qualifies.
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  Speaker 2: So you need to qualify. I cannot just walk into a,
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  Speaker 1: a, some kind of medical qualification, I need to cross threshold. Oh,
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  Speaker 2: like me, if I have no preexisting conditions, I'm 44
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  Speaker 2: years old. I can't just go to my doctor and say,
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  Speaker 2: can you give me pneumococcal vaccine?
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  Speaker 1: For you, yeah, yeah, no, you're not vindicated, but influenza, yes,
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  Speaker 1: everybody universal every year best practice
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  Speaker 2: peasy last month I took both, OK, like pneumococcal was
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  Speaker 2: in my left arm, COVID was in my right arm. Uh,
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  Speaker 2: so it's all good. Just a reminder as we wrap up,
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  Speaker 2: pneumonia is one of the top global killers of older people,
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  Speaker 2: isn't it?
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  Speaker 1: Correct.
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  Speaker 1: Yes.
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  Speaker 2: Why is it? I mean, but most people hear about
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  Speaker 2: it in terms of hospital acquired pneumonia.
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  Speaker 1: Oh, no, uh, when they say pneumonia as a as
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  Speaker 1: a top cause what it actually means is it's usually
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  Speaker 1: um community community acquired and the hospital acquired pneumonia has
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  Speaker 1: a very strict definition, and it is not of course
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  Speaker 1: not as common as acquiring in the community and community
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  Speaker 1: acquired pneumonia, pneumonia just means an infection of the lungs.
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  Speaker 1: Sometimes it's hard to tease out whether it's a viral
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  Speaker 1: pneumonia or bacterial pneumonia.
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  Speaker 1: They kill all just the same in the elderly, right?
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  Speaker 1: So if we can prevent it, why not, you know.
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  Speaker 2: And is it likely, I wonder whether this has happened
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  Speaker 2: regularly in the medical world. Somebody has turned up with
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  Speaker 2: pneumonia and it's after investigations that most likely this started
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  Speaker 2: with a recent bout of influenza. I'm sure that happens
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  Speaker 2: for a lot of health issues, right? Even heart issues.
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  Speaker 1: Yeah, we, we have detected that. We have detected.
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  Speaker 1: cases where there's influenza and then uh maybe a few
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  Speaker 1: days ago and then there's a pneumonia and sometimes if
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  Speaker 1: people come with bacterial pneumonia, we can still catch some
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  Speaker 1: traces of, of, of influenza on the PCR test kits.
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  Speaker 2: So the issue is like that's a very strong trigger
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  Speaker 2: for something else as well. So don't get the influenza
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  Speaker 2: in the first place. That's right. That's the key point.
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  Speaker 2: Doctor Law, thank you for helping us understand that. We
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  Speaker 2: really appreciate your time today. Thank you. He's Doctor Liu Jiahe,
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  Speaker 2: infectious diseases specialist out of Fair Park Hospital. This has
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  Speaker 2: been Health Matters.
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  Speaker 2: Before making any decisions based on the information in our program,
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  Speaker 2: please consult a medical professional.