Sawbones: Walking Pneumonia

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Hello, everybody, and welcome to Sawbones, a marital tour of misguided medicine.

I'm your co-host, Justin McElroy.

And I'm Sidney McElroy.

Happy holidays.

That's a weird.

I hadn't wished you happy holidays.

That's a weird introduction.

I realized I hadn't wished you happy holidays yet.

Happy holidays, Sid.

Happy holidays, Justin.

Honestly, I hadn't come up with an introduction.

And then I looked at the name of the document you shared with me, and I don't know what I have

got.

You don't know what I mean.

I got nothing.

That's fair.

I got nothing.

I got nothing.

So I said happy holidays and just hope that you would tie it together because I got nothing.

We're a little,

this is timely.

It's just a little behind.

There's been an

I try to keep up with if there's like a new outbreak, infection, something rising, something whatever.

that I feel like would, oh, wait, this is a good opportunity to talk about history and educate on a current thing.

And we're a little, this is, so have you heard about the increasing cases of pneumonia in children?

No, have you?

Well, obviously, I'm doing a podcast about it.

Yes, that is a very fair response.

Also, I'm a physician and also we're parents.

I'm just trying to keep a conversation going, Sydney.

It's a conversational style, okay?

It's called asking questions.

No, I don't know what that is.

Have you heard of that increase?

I will say, yes.

And I will say, I do think there is a little bit of benefit.

It's just another conversation, Cindy.

It's just, I'm just keeping the conversation.

This may be a lesson that COVID taught me.

We tried to jump out, I think, pretty early on when before COVID was COVID, and it was like, there's a coronavirus in China.

And that was all anybody was saying.

We tried to jump out pretty early on that.

And we were not worried.

And we were wrong.

We weren't worried.

And we were being too optimistic.

And we were wrong on that.

And we were wrong.

And so maybe waiting a little bit, gathering some more information is a good idea.

For instance, I am not talking about the new mystery illness in the Democratic Republic of Congo because I don't know what it is.

No one seems to know what it is yet.

There's really not much to say about it yet.

I don't feel like me waiting in a little bit of a picture of it.

We just wanted to raise the specter of worrying about it without any sort of context.

Well, I imagine many of our listeners are paying attention to that as well.

And right now, we don't know anything.

And so I don't think me like theorizing on that would be helpful.

But talking about pneumonia.

I've never heard anything about it.

You didn't even know know that.

How have you not heard about it?

What have I heard about, Sydney?

I don't really hear about things.

Like everybody in my algorithm is talking about it.

Yeah, okay.

Mine's mainly Arby's.

So, okay,

I don't hear about these things, but now I know, I just know that there's a mystery illness, and my wife's not gonna tell you more about it.

So, there is a lot of that concern over this mystery illness.

And all I'm saying is, I think at some point when we know more about it, it would be helpful to talk about that.

Absolutely.

And so, this is a lesson I've learned.

I'm learning from my past mistakes, and I am am growing as a as a person.

I can talk about mycoplasma pneumonia and how it's on the rise,

has been on the rise for the last year, because I think we know more about it, we understand, and I can say something helpful and not just,

you know, cultivate fear around an unknown.

So

if you have been paying attention for any of these reasons, or perhaps if you've been sick or somebody you know has been sick, which is quite possible because it is pretty widespread.

Would Would you say it is fair, a fair assumption for me, if I see a healthcare story to not click on it with the assumption that my wife will know what is happening?

Do you think that's a fair assumption?

I probably do pay a little less attention to medical stuff than your average person

because I assume that my sidgorhythm will bring it to my attention if I need.

Well, and I guess that is, that is bearing out right now.

Yes.

So, Justin, you've probably heard of walking pneumonia.

And the boogie flu.

Most people have heard the term, the colloquial term, walking pneumonia.

I've heard that colloquialism.

Do you know why?

Like, what is that?

I would assume it's because you're like sick, but still good enough to walk.

Like, you have pneumonia, but you still feel okay enough to go to your job.

That is, that's kind of, yes, that is where the term comes from.

Now, this is obviously not true for everyone who...

who contracts this illness.

There are some people who get quite sick, but yes, a lot of us...

People who were not walking before.

So you wouldn't assume that that would be affected by the pneumonia.

No, not in any way.

So the idea is that for a lot of people who contract this, it will either be a bronchitis, an upper respiratory infection, or a pneumonia that isn't as severe as other pneumonias.

In the medical world, we often call it atypical pneumonia.

And we'll get into the history of the world.

Atypical being one word.

Yes.

Yes.

Atypical, as opposed to typical.

Right.

Yes.

Yes.

Okay.

There is an increase this year.

there is nothing to be alarmed about this isn't a new illness it's a known illness and we know how to treat it and we know how to prevent it and we know how to manage it

and we kind of know why there's an increase and we also kind of saw that coming so i feel like this is all comforting right this is all comforting information when we know things okay so let's talk about walking pneumonia first and to understand why it's a little different than other why do we have a whole other name for this pneumonia?

Why is it different?

Why do we care?

There's a couple reasons.

And I think that it starts off with the difference between a virus and a bacteria.

Okay.

Do you know?

Allow me to

guess.

Yes.

No, not guess.

Can I, I,

wow, that was so mean.

Uh, bacteria is a very small microscopic living organism.

Okay.

A virus is also very small.

These two things, you can't even believe it.

Virus is much smaller than bacteria, though.

Yes, generally, yes.

And virus is not dead and not alive.

Like Nosferatu, it wanders the earth, hovering between twilight and dawn.

Not quite alive, not quite dead.

The virus is a terrifying predator.

This is true.

This is true.

I will give you that.

I think

that was the thing that drew me to

viruses in the beginning, because before I became a family physician, I wanted to study infectious diseases.

And then before I wanted to to go to medical school, I just wanted to do it in a lab and not have to deal with humans, just microscopes.

Got it.

And I think what drew me to it is that viruses exist in this sort of living and non-living space.

And why is it important for us to know?

Well, both can cause a pneumonia.

We treat them differently.

Right.

But and exactly like you said, Justin, bacteria are free-living organisms.

They can live outside of us.

Viruses need us or some host in which to exist.

They cannot just exist.

If you spill a virus on a surface, which I know is a weird visual because they're very tiny, you wouldn't see it.

If there's a virus on a surface, it's not going to exist very long.

It can last there for a determined period of time before it's gone.

It cannot reproduce or

thrive in the way the bacteria can.

Could you get.

Never mind.

I was going to sound really stupid.

Could you get enough virus together that you could see it?

So you can, not without some sort of instrument, not with the naked eye.

Okay, got it.

But they do, they can format.

But we can't get enough viral particles together that we can see them.

I mean, they're so small.

Yeah, but I mean a lot.

I mean, I did not look at how many viral particles would you have to put together before you could see them with the naked eye.

I don't think it's they can form sort of crystal-like structures when you just sort of like stick them all together, which is kind of like some of them.

That's kind of what I'm saying.

They're all different, and

we're finding new ones all the time, by the way.

We are great.

Because like

for a long time, we couldn't tell all this stuff.

All this thing that I'm telling you, like, bacteria is a living, it's a single cell organism, and viruses is like, are like these collections of genetic material inside proteins, and they're kind of alive and kind of not.

We didn't know all that.

We needed a better way to visualize them than we initially had because our original microscopes are just light microscopes.

We're shining light on it.

We're magnifying it.

We're looking very closely.

That's it.

And you can't see a virus that way.

I can't.

Right.

We didn't know all that yet.

We have better microscopes now.

We can figure that out.

But what is cool, I think, is that if you look at the history of microbiology, and especially when you get into like the study of things that are infectious, things that can make us sick, the pathogens, because there's lots of stuff out there that's small that doesn't make you sick.

Yeah.

But when it gets to the things that affect humans, we knew that things existed and we characterized them and we called them names before we could ever see them.

Like the Roman gods.

Why is that?

What of all

analogies?

I just seemed that.

It seems that, you know, we're looking for ways to explain what's happening in the world around us.

And, you know,

it's a similar thing.

It's a human impulse to want to try to understand things that we don't, right?

So we create narratives.

This narrative happened to be weirdly close to the truth, I guess, right?

No, okay.

See, I think these are two very different, but I mean, I think important

and valuable human impulses.

Yeah.

One, to create a narrative to explain a phenomenon, and two, to scientifically study, to experiment and seek a truth.

Yes.

I think those are both valuable.

Me too.

And they both have their place.

Yes.

One of them in medical science and the other one in lots of media and other things we enjoy, right?

Sure.

So once we kind of understood, because for a long time when we talked about this on the show, we didn't know why disease happened.

So there were the humoral theories, there were miasmas, there's lots of big clouds of disease, free-roaming clouds of disease.

Demons, punishment by Roman gods, perhaps.

The poor.

Just the poor writ large.

Just being poor, being near the poor.

Yes.

Drinking the same water as the poor.

Any of these things.

Yeah.

Being a woman, you know.

So once we knew that germ theory of disease was established.

Thoroughly.

I didn't say yes, yes, out loud, but I was nodding, folks at home, and drinking from my iced coffee.

But I absolutely agree with my wife's sentiment.

And then we established Koch's postulates, meaning like you can take the way we know that an agent, first of all, we know that things cause disease.

They're contagious things, bacteria, viruses, fungus, parasites, whatever, that cause disease.

And in order to figure out is the constellation of symptoms, the thing that's wrong with you, is it because of this tiny thing, we have to find it in you, take it out of you, put it in something else, and see the same thing.

Yeah.

You know, and there's other things.

We have to also find it in everybody who has it, and we have to be able to like grow it and see it.

And so there's a, but anyways, we figured this out.

Well, we using instruments.

But the point is, but with the naked eye.

We figured all that out.

The way we would do this is like sometimes we would take infectious material from people.

So like tissue or spit or something gross, right?

And we would pass it through a filter.

Okay.

Okay.

To look to see if the thing that caused the disease is filterable.

So right now, what we're focused on is size.

We don't really understand.

Like that is.

That's right.

We're trying to figure out.

Right.

It's just the mesh is too big.

Like the colander is too big, right?

We don't have a sieve.

We have a colander.

So we've got a filter and we're passing material through the filter.

And what we started to figure out is that some things were caused by filterable agents

and some things were caused by unfilterable agents, right?

And that was sort of our initial understanding of viruses and bacteria.

Bacteria, generally speaking, are bigger.

Now, the study of virology has evolved and there are bigger viruses than we initially thought.

But the point is, generally speaking, if it passes through the filter, it's a virus.

If it doesn't, it's a bacteria.

Again, this is a massive generalization, but this was our early understanding

of what caused different diseases.

Did it pass through the filter or not?

There was toxins also passed through the filter, so this would cause problems.

But

by the way, initial filters that we used, the first ones were diatomaceous earth.

Do you know what that's made of?

Because I didn't know until I researched this.

What?

Do you know what diatoms are?

No.

They're a kind of like algae.

Yeah.

A very tiny algae.

Yeah.

Diatomaceous earth

is the fossilized remains of diatoms.

Which are.

It has accumulated.

It's kind of algae.

They have accumulated over millions of years.

It's largely, it's almost like glass.

It's largely like silica is what's in this substance, but it is what you can look up, if you want to look up an electron microscope picture of diatomaceous earth, it is, it is a wild thing to see.

Okay, but I just didn't know this.

Diatomaceous Earth is also,

you know, the other thing that's very interesting about that.

What?

What do you think of for diatomaceous earth these days?

What are you using your diatomaceous earth for

around the house?

I don't use it for anything, but there are some people in the shelter who try to use it to keep bugs away.

You know what you actually do use it for every day to put your dishes on.

We use a diet to make

it drying

for and for like for dishes.

I put dishes on it because it's extremely hydrophobic.

It's the fossilized remains of algae.

That's so cool.

And now

I put my Disney on ice cups on it and it helps them dry.

Amazing.

Thank you, Algae.

I just stepped out of you from the shower to the floor and didn't slip, slide around.

Even millions of years later, you're still doing me a solid.

Thanks, Thanks, Algie.

I mean, I think it's pretty cool.

I didn't know this.

And maybe everybody listening already knew this about diatomaceous service.

But eventually we switched to porcelain filters.

Porcelain filters worked better.

So, in case you're curious, those are the kind of filters.

And then we have other ways of separating it out now.

But this is our early understanding.

And what was confusing about this bacteria is that it's really tiny.

It's a very tiny, filterable bacteria.

And so it was originally thought to be a virus, probably.

We couldn't see it.

We couldn't find it, but it passed through a filter.

What is it?

And so it took us a while to find out about mycoplasma.

It took longer, for instance, than like streptococcus can cause pneumonia.

A certain kind of strep bacteria can cause pneumonia.

We figured that out earlier.

Right.

It took us longer to discover mycoplasma because it's just this little teeny, it's like the smallest living, free-living thing that are in the mycoplasma world of bacteria.

And the way that we initially encountered it, there were other kinds of mycoplasma that caused diseases in other creatures, but in humans in the 1930s in the US, there were these cases of an atypical pneumonia.

And the way they distinguished it at the time, the way they would call it either typical or atypical, was based on its responsiveness to a certain kind of antibiotic.

At the time, we didn't have,

this is pre-penicillin.

So all we have are the sulfonamides.

Penicillin would come along within the next 10 years or so.

But we could treat a lot of pneumonia patients with sulfonamides.

We couldn't treat this kind of pneumonia with this antibiotic.

So we called it an atypical pneumonia.

It's atypical.

All the other pneumonias respond to this.

This one doesn't seem to.

It's different.

It looked pretty.

Why are we so sure that, like, why is it still a pneumonia?

You know what I mean?

Like, why are we so sure that it was the same thing that we, that it wasn't something else?

Infection of the lungs.

Pneumonia just means infection of the lungs.

And so you can get a viral pneumonia, bacterial pneumonia, fungal pneumonia.

Right.

And you can do, by this point, we have x-rays.

So you can see that.

You got the clinical picture.

So you've got cough, fever, chills.

You're weak.

You're tired.

You're sore throat, headache.

You know, the whole thing.

You look like you have pneumonia.

Your lungs sound like you have pneumonia.

The x-ray looks like pneumonia, but you're not getting better the way we expect you to.

So we know there's something else.

It's small.

We think it's a virus at first in the 30s and 40s because it passes through what was the best filter at the time.

The SEATS filter was was the best one to remove bacteria, and it wasn't removing this, so we didn't think it was bacteria at first.

And then eventually, Eaton was the scientist who was able to take whatever was growing, whatever they were taking out of people with this illness, and put it in cotton rats and then hamsters and then chicken embryos.

And all of those things got sick, or he grew more of it, but he still hadn't proved it in humans.

So for a while, actually, it was called the Eaton agent.

Mycoplasma was known as the Eaton agent because Eaton was the closest to figuring out what this thing was.

But the final thing we needed to do in order to prove that mycoplasma was causing these different cases of pneumonia was to put it in some humans and see them get sick.

Okay,

ethically dicey, right?

A little bit.

We're gonna do it anyway.

Oh, you and me?

Well, not us, but humans.

Okay.

But first, we got to go to the billing department.

Okay, let's go.

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No, you would be wrong.

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Well, it sounds like we're in store for another one of humanity's classic cut-ups.

Sid, I'm so excited.

What do we get into this time?

So as I was reading through the history of the discovery of mycoplasma, and at first, Justin, I got to be honest, I'm researching this because I feel like it's an important thing for us to talk about, and I'm not finding something fascinating to latch onto or like something weird.

Right.

And then I started reading about when we finally, and we have done this, there is an ethical way to go about actually taking something that we believe causes disease and intentionally inoculating, making people sick with it.

There is an ethical way to go about that.

We have established that in society.

Obviously, we have also done it in many unethical ways.

Super duper.

But there is a there is a path for that.

And so this is not unprecedented.

But that's what I was looking for were what I what I kept finding referenced in different articles as the Pinehurst trials.

What were the Pinehurst trials?

I wanted to know because this was the moment where we actually got volunteer subjects to put

this

eaten agent in and see if they got sick and prove definitively that this was the cause of this atypical pneumonia.

So back during 1944 and 1945,

which there may be some other major world events you might remember, well, not remember personally, but probably have learned about.

World War II.

Exactly.

During World War II,

specifically, atypical pneumonia was actually causing quite a problem

for the U.S.

Army and probably a lot of other people, but specifically for the U.S.

Army.

A lot of people were getting sick.

And again, even though for most people who get walking pneumonia, they're not going to die, you're sick for a while.

I had it back back in college, and it was like two miserable weeks.

I was still able to go to class and do the stuff I had to do, but I felt awful.

And if you're in the military, I imagine that's a much bigger deal that you feel that bad.

So, they were trying, they wanted to do a study through the military to figure out what is causing this pneumonia definitively, and can we do something about it?

So, they created the Commission on Acute Respiratory Diseases as a way to study this.

And then, during the summers of of 44 and 45, they got four groups of 40 men to come to the Holly Inn.

This is in the this is near Fort Bragg in North Carolina

to do this study.

Now, how did they find this?

Is where I finally pieced together, where did they get these guys?

Justin, they were conscientious objectors.

What?

These were people who were conscientious objectors to the war

and had been jailed

because you can't do that.

Right.

Yes.

And so

instead of going to jail, they were sent to be

subjects in this experiment.

Now, they volunteered.

I'm not suggesting that they were coerced, except in the sense that...

They definitely were.

What does that mean?

I don't mean, well, no, I mean, they were coerced, but I mean, I'm not saying like they did, they did agree to it.

Yeah.

I mean, yeah, I understand.

I think we all understand the distinction that you're.

Well, I just, I want to, I want to paint the right picture.

I don't want to paint a picture of people being forced, you know.

I mean, because you're going to give somebody a bacteria.

You're going to put an infectious agent in somebody's body.

I don't, I think, I just want to paint the right picture of this, right?

So, anyway.

This is one of many bad outcomes that was available to them, but there were other bad outcomes that they could also have experienced had they not chosen this bad outcome.

And the reason they were called the Pinehurst trials is because they were all in the Pinehurst area around Fort Bragg because there were so many people there because, you know, World War II was happening.

Yes.

So anyway.

Yeah.

So basically they

took these guys

to this hotel.

and put them there and then they would take material, infectious material from patients who had this pneumonia.

So take washings of their airways, of their throat, swabs from the back of their throat, take material and then put it in these.

It ended up being 12 subjects and wait and see if they got pneumonia.

And they would hang out in this hotel, waiting to see if they got pneumonia and then to monitor the course of their disease.

And of course, they were provided with medical services and support, they weren't just observed, but they were very intentionally given pneumonia.

they did, by the way, did not receive any pay for this,

and they did have to sign a waiver that said, and if anything goes wrong, we're not, yeah, the U.S.

Army is not responsible for any of this.

Um,

so I, there's a fascinating story to this, I found.

Sorry, go ahead.

I would like to hear your fascinating story.

And if

a question will be

answered later, let me know.

I know that for testing that we do now, there is a board that has to, right?

Like appro that there's like standards that people have to adhere to, and there's like approvals and like a process that you have to go through, right?

This is,

do I have this correct?

Yeah, I don't know the name.

The institutional review board, right?

Okay.

Do you know the extent to which that sort of process exists within the military?

Like, is the military adhere to those standards?

Are they super military or are they, you know, like we have things like the Geneva Convention, right?

That

ostensibly people adhere to because there are tenets that we uphold.

Is there a similar thing for, obviously, for research?

This is a good, in terms of timing, this is a good question.

Well, first of all,

the Institutional Review Board, the IRB guidelines around any kind of

human research

apply to everybody now, now, in this time period.

So, military or otherwise, you can't do this without IRB approval, period.

In 2024.

In 2024.

That was not established until 1974.

Okay.

So at this time, we're in 1944 and 1945.

The precursor, by the way, to

the IRB, and I don't mean direct precursor, I mean the set of guidelines that we were supposed to follow prior to the IRB IRB in 1974 were actually established in 1945.

It's the Nuremberg Code.

And it was in response to a lot of unethical, of course, you know, I don't even want to use the word research that was being done during World War II.

And it was certainly not in response to this Pinehurst trial.

But I think you could point to this as...

another example of

while it's hard.

Definitely they were coerced in the sense they had two bad options, and they were choosing the lesser of two evils.

They did,

it was very brave that they signed up to become infected with something.

Sure,

contribute to.

So, I don't want to say, I mean, I don't want to undermine the significance of their contribution.

I mean, that's why we're as, I mean, they're people, and their stories deserve to be told, and they did this, and they got sick, and they did get better.

I mean, I also don't think, Sid, that it's I, you know, I think that sometimes something that I have been guilty of, I think that it's okay for us to just say what happened.

You know, like, like, we don't need to, I think I feel an instinct to try to, like,

a lot of times on stop bones, try to, like, pass judgment on something that's pretty complicated and that I don't fully understand.

So, but I think it's okay to not

say, you know what I mean?

Like, I don't know.

Right.

There's a lot.

It's a very complicated thing, and it's hard to just do kind of a drive-by judgment on everybody involved in the, in the situation.

I know.

And I think that this is beyond the scope of our show to discuss all of the different kind of ethics people were personal ethics people were following throughout this whole story.

I mean, because we are talking about World War II.

Yes.

And so I think a conscientious objector in the setting of World War II is a.

It's hugely complex.

That's a hugely right.

Like, I'm not going to sit here and tell you definitively, this is where history has weighed in on any of this.

I mean, certainly not me.

I don't have that moral authority.

It did happen.

It did happen.

No, but I read,

it was really hard to find a good history of this exact event.

The Pinehurst trials are mentioned multiple times in different articles about the history of mycoplasma.

So it's not hard to find that they existed.

But to get into like, who were these men and how were they chosen as subjects?

Well, they, this is how, and how did this come to be?

That was actually kind of hard to find.

I finally found this article

that was in the

News and Record in Greensboro, and it was called Lonely Valor.

Some Objectors Served as Medical Pigs.

And this is from 1995.

Guinea pigs, right?

Guinea pigs is what they mean.

They mean guinea pigs.

But it's an article.

Right.

It is an article about the history of the conscience objectors who

were coerced into participating in this experiment and

the sacrifice that they made in terms of allowing themselves to be sick was something that we didn't have all the tools to know how to treat at the time.

We didn't know how to cure it.

And

there's a whole history of that.

They wrote poems while they were stuck there looking out the window at people outside enjoying the summer weather and they're in isolation for two months waiting to see if they get pneumonia.

Anyway, it was a definitive moment in proving that this was the causative agent.

The poems also,

nothing rhymes with pneumonia.

So you can imagine it's like, it's a tough.

After, after we figured that out in the 40s, by the 50s, we started to be able to figure out how to grow this thing.

It took a while.

It was the 50s and 60s before we were able to fully grow it.

Some things are harder to grow than others.

And that's why we can test, we were able to test for some things a lot earlier than we were able to test for others.

And it was another like 20 years before we finally said, like, yep, the eaten agent is mycoplasma.

It is a bacteria.

It is this small.

And it led to this whole, in the 70s, this whole like field of mycoplasmology arose from this because this was kind of a whole little subset of bacteria that nobody had really understood yet because they were so small, they had all been mis kind of identified as viruses.

And so it led to the International Organization of Mycoplasmology and the first International International Congress of Mycoplasmology in the 70s.

There's some great pictures from this of a lot of, they're all guys, I think, in like fancy robes and hats at their first mycoplasmology conference, which, and by the way, it still exists today.

I think the next one is in Poland in 2026 will be the next Congress of Mycoplasmology because it is a very unique subset of living organisms.

It's going to be a killer one this year.

I heard Chapel Rohn's closing it out.

It's going to be to be like two days of just like madness.

Yeah.

They call them, they used to call everything in this group mycoplasma.

Now they've expanded it to other names, other genuses.

You get a better hotel rate if you expand the conference a lot more.

But they're all called molecutes.

That is molecules.

They're molecutes.

They're molecutes.

Anyway,

so

what do you need to know about walking pneumonia after all this strange and challenging history that we've covered?

So for most of us, you are going to get like a, what we call like a tracheobronchitis, meaning an infection in your airways, but not necessarily in the lung tissue itself.

Once it gets to lung tissue, that's when you have a pneumonia.

And some people will develop a pneumonia.

So some people get like a bad bronchitis.

That's mycoplasma.

Other people get sick enough, it continues on and they actually have pneumonia.

Cough, fevers, chills, body aches, sore throat, headache, the usual stuff.

There are some severe complications that are more rare that can happen to some people, but for the most part, this is what we're talking about.

And again, for most of us, you can, quote, walk around with it.

So it is walking pneumonia.

What has been interesting, oh, and treatment.

The treatment is something you may be very familiar with.

For most of us, we will receive azithromycin or what you may call a Z-PAC.

A Z-PAC.

Yes.

A Z-PAC is dosed to treat walking pneumonia or atypical pneumonia or mycoplasma pneumonia, whatever you prefer to call it.

there are some backups if you're allergic to that or for some reason you can't take it you can take a fluoroquinolone like levaquin you can take doxycycline my favorite antibiotic depending on age and pregnancy and all other factors that we all the things we consider with antibiotics so it is something that we know how to treat now that explains why initially it didn't respond to uh it doesn't have a cell wall so it didn't respond to the old antibiotics or not old the older as in they came along first antibiotics that we used to use for pneumonia wouldn't work on this So that's why we had to wait till we had macrolides, which that's what azithromycin, that's what, what class it is in.

So what's different this year is,

one,

we're seeing more cases than last year.

And two, we're seeing it in younger children than usual.

Anybody can get it, but the peak is usually school age, adolescent, moving kind of up into young adult.

It's all those years where you're crammed in schools together, right?

I got mine when I was living in a college dorm.

Makes total sense.

But this year we're seeing it in kids younger than five.

So pre-school, not preschool, you know what I mean, prior to school age children.

And that is a little more unique.

Now, why would that be happening?

Well, there are several reasons.

And I actually, as I was researching why is there a rise now, I found an article from last year sort of predicting that this was going to happen.

Why?

For one, we saw a suppression in rates of all respiratory viruses during COVID.

Right.

Why?

Masking, social distancing, etc.

All the mitigation

techniques we used.

The mitigation mitigated.

The mitigation mitigated everything.

And so we saw lower rates of a lot of other respiratory illnesses.

That's why in many countries they take those precautions and keep people from getting sick.

And so it was natural that we saw that.

And mycoplasma was among the respiratory illnesses that we saw decreased numbers of.

It was one of the last to come back.

It was one of the, in terms of as we saw the rise of all these other viruses, I think you remember RSV, we were having the same conversation about last year.

So this was one of the last ones to sort of rebound, but that's part of it.

We kind of figured it would rebound as everybody finally,

you know, stopped engaging in those mitigation techniques.

Not that everybody has.

There are still some people doing that, but I think

in a mass sense.

Not in the scale needed to mitigate

public health-wise, not personally.

And the other thing is that there is a three- to five-year cycle naturally with mycoplasma, where we see bigger surges and then years where there's less.

And so we have fewer people exposed for a few years, then now all of a sudden more people get it.

And we've got younger people who had not been exposed previously and are now getting exposed.

It all kind of makes sense as to why this is happening.

There's also some testing differences that are interesting.

Mycoplasma used to be a lot harder to test for.

Now I know at all the facilities facilities I work at, it's on the standard respiratory virus panel.

So it's not a virus, but it is on a respiratory virus panel, which I always think is interesting.

Yeah.

When you,

and, and initially, a lot of us were ordering.

I did too, since it is interesting.

Yeah.

Initially, when COVID started, we were all ordering a COVID test, and then COVID got added to our respiratory viral panel.

So instead of ordering a COVID test, if someone suspected COVID, they would just order the panel.

And we can all debate whether economically that's a good idea or not.

But the point is, it's happening.

I wonder if that's also why we're picking up more mycoplasma.

Because we're catching it more, because we're testing it.

So we're testing more.

That could be it too.

But all of these things contribute to the fact that we are seeing an increase in cases.

We kind of knew this would happen.

So I don't think it's something to worry about in that sense.

What I would do is engage in the same sort of strategies that help us prevent illness of any kind of respiratory droplet illness.

So it is, it is transmitted that way.

Respiratory droplets, coughing, sneezing, not washing your hands, getting that infectious material on other people.

So

washing your hands, covering your mouth, staying home when you're sick, not sharing, you know, beverages with people who are ill,

wearing a mask if you're going out in public if you're sick, or if you are somebody who's particularly concerned about getting a respiratory illness, keeping your kids home when they're sick, staying home from work when you're sick.

I mean, staying home when you're sick is a really big part of all of this.

And then it is a time of year where, especially if you're somebody who is especially vulnerable to these kinds of illnesses, to avoiding crowds whenever you possibly can.

Obviously, that is something we can only do to whatever extent we can.

Yeah.

But that is, that is what's going on.

If you do contract, and I'm not suggesting that if you get a cough and a fever, you should immediately run to the doctor every time.

Certainly not everybody always needs to do that.

You know your own health history better.

Maybe you do, but you know, not everybody always needs to.

But if you are sicker than, you know, you'd expect with a common cold, right?

Than you'd expect with a runny nose cough kind of thing, certainly go get checked out.

If your young child is ill, certainly go get checked out.

If you, again, have some sort of other coexisting condition that makes you more vulnerable, go get checked out.

If something is lasting longer than you expect it to, we usually expect a virus to last like seven to 10 days and then you're pretty much better.

If you're still sick, I always tell people, if it's going on a week and you're just as sick as you were in the beginning, you need to get checked out or certainly if you're getting worse.

And you might see that your doctor is a little quicker to prescribe something like a ZPAC because we know there are increased rates of this right now.

So if you're concerned, go get checked out.

There is a test for it.

And also a lot of it is clinical picture.

We can just tell, you know, based on your exam and your history.

Yeah.

Thank you so much for listening to our podcast.

We hope you have enjoyed yourself.

Thanks to the taxpayers for for use of their song Medicines as the intro and outro of our program.

Thanks to you for listening.

That's going to do it for us.

Until next time, my name is Justin McElroy.

I'm Sydney McElroy.

And as always, don't drill a hole in your head.

All right.

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