Your Swine Flu Questions, Answered

Correction Sept. 14, 2009

In response to a question about egg allergy and the flu vaccine, NPR science editor Joe Neel misspoke. Chicken eggs are also used in manufacturing the inhaled flu vaccine, and it is not an alternative to a flu shot for people with egg allergy.

At least one university has already established a quarantine dorm. Meanwhile, a vaccine is still being tested and is not due to be available until mid to late October. Joe Neel, NPR's science editor, answers listener questions about safety measures against swine flu and the vaccines designed to protect us against the virus.

Copyright © 2009 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington. We know it's coming. With words like pandemic, the spread of the H1N1 virus, also known as swine flu, makes a lot of people nervous and many others skeptical. By now, we should know to avoid the spread of germs, wash your hands frequently, stay home at the first signs of fever or cough and smother your coughs and sneezes in your elbow. But until then, there's some confusion about the vaccine that's under development. China says you only need one shot, the U.S. begs to differ, and plenty of people want to know how well it's going to be tested, and how safe it is.

Today, NPR science editor Joe Neel - questions and answers on swine flu. A little later in the program, a new POV documentary on a long collaboration between a British doctor and his Ukrainian colleague to introduce modern neurosurgery to Kiev. But first, a swine flu Q&A. If you have questions about swine flu prevention, myths and how schools, hospitals and the government plan to respond, give us a call, 800-989-8255. The email address is talk@npr.org, and you can join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

NPR science editor Joe Neel is with us here in Studio 3A. Joe, always nice to have you on the program.

JOE NEEL: Glad to be here, Neal.

CONAN: And let's begin with this from Bill(ph). My son got it, then passed it to me this summer. It was really not that bad. I hear from doctors this disease statistically is less deadly than most flus, yet there's a national panic. We've stopped telling people that we got it because they panic. Can you please say something about this?

NEEL: Well, definitely it's - as flu seasons go, as flu outbreaks go, it is a mild epidemic, but I should note that in a normal year, 36,000 people die from regular, seasonal flu. It's too early yet to know exactly how many people will die from this. Some estimates are as many as 90,000 over the next eight to nine months, in which case it would be about twice as deadly as a normal flu season.

I think that someone with a small child like that should think, you know, very carefully about trying to protect the child. Because so far, we're seeing more cases in young children, and more cases in young adults, than we usually do in a regular flu season - where it normally would just be a very small infant or people with immuno-compromised diseases - sorry, with compromised immune systems, like AIDS or the elderly, and that's not happening this time.

CONAN: Well, he says they already had it. If you've had it, are you OK?

NEEL: Should be.

CONAN: Should be. OK. Here's another email question, this…

NEEL: Well, but if they're sure they had it. Because there's very little testing going on specifically for the swine flu strain, the H1N1 flu strain, that's out there right now because the presumption is if you've got flu right now, you've got this because the regular, seasonal flu has not started yet.

CONAN: Here's another one, this from Cindy(ph). No one seems to be talking about how fast this vaccine has been developed and will be used, tested on our children, no less. Does no one remember the swine flu vaccine of the '70s, when several people died and more were paralyzed after the vaccine was rushed to market? I have a 14-year-old daughter, but I'm very concerned about the vaccine's safety, especially since I know someone who became partially paralyzed shortly after having that older vaccine. I've heard only one national news report about this, plus from what I heard on NPR, the current swine flu in South America is going through populations in the matter of a few weeks and for most people, it is still rather mild. So what's a mother to do?

NEEL: Well, certainly the 1976 swine flu vaccine debacle, if you will, where quite a few people got something called Guillain-Barre syndrome, a neurological disorder, which in some cases was paralyzing, is something right at the forefront of public-health officials' minds. It has been ever since that happened. It was an unfortunate outbreak - I mean, an unfortunate consequence of the vaccine, but things are completely different today. The vaccine that's going to be used during this fall's swine flu vaccine campaign is based on the flu vaccine that we get every single year, the seasonal flu vaccine.

What it is, is they're changing out the strain that is in the normal, seasonal flu vaccine and putting in this one. And that's been tested for years, been put into tens of millions, if not hundreds of millions of people in this country without any major side effects other than the normal, very, very low level of side effects that you might see with any vaccine.

CONAN: Let's get a caller on the line, and this is Daniel(ph), Daniel with us from Tucson.

DANIEL (Caller): Hello, thank you for having me on the air.

CONAN: Go ahead, please.

DANIEL: Yes. I'm in the marching band at the University of Arizona, and a few of our students in the band have been - contracted swine flu already. Since we're so close to the Southern Hemisphere, we tended to have a bad swine flu epidemic already going on, close to 50 students already infected. What precautions can I take extra?

CONAN: Anything he can do now?

NEEL: Try to stay away from people who are sick. The people who are sick should try to stay away from other people. Social - it's called social distancing, and the idea is to keep people apart so that they're not spreading because, as most of us know, flu is spread through coughs and touching surfaces where people's droplets from their coughs have landed. So if you stay apart, you're not going to get it. You know, definitely don't share any kind of food utensils or drinking cups or anything and, you know, try to - if someone's - if people are sick, they should be staying with each other in their own rooms, and the well people should be not going in to see them.

CONAN: And does the fact that he's in Tucson, relatively close to the border with Mexico, does that make him any more susceptible than somebody in northern Minnesota?

NEEL: Well, I don't think so. The statistics so far show that H1N1 is - the prevalence is highest in the Southeast and in the Northwestern United States, with some cases down along the border where you're talking about, in Southern Arizona. But there's really no connection there between the Southern Hemisphere and what's happening here.

CONAN: OK, Daniel. So it sounds like you can continue to play.

DANIEL: All right, thank you very much.

CONAN: Bye-bye. Here's another email question, this from Sneads, Florida, from David(ph): I'm wondering if the segregation that they're planning at schools, sick dorms, etc., is anything like what was carried out during the pandemic of 1957. I lived through that one and had the flu and know how we were treated then.

NEEL: No, I think that we've learned a lot about how to stop the spread of all kinds of diseases, flu being one of them. The idea of social distancing is relatively new - and implementing it on such a widespread scale. And it should work.

CONAN: Let's go next to Scottie(ph), Scottie with us from Charlotte.

SCOTTIE (Caller): Yes, thank you for taking my call. My question is, I've read reports that the H1N1 swine flu virus is mutating. So what - if that's true, if those reports are true - what good would a vaccination made today, you know, be tomorrow if it is, indeed, mutating?

CONAN: Joe?

NEEL: Well, they're definitely worried about that, except that it hasn't really started mutating yet. All flu strains mutate constantly. So it wouldn't be surprising if it mutated. In the thousands of cases that have been tested in the last few weeks, there's no sign that it's moving on, that it's mutating. But you're absolutely right. If it mutated enough, the vaccine wouldn't do any good. But for the moment, the vaccine that they're developing looks like it pretty much will work for this.

SCOTTIE: Thank you.

CONAN: Thank you, Scottie. Let's get another email question, this from Fair Oaks in California. And Joe: Why not have everyone who has a cough wear a mask?

NEEL: Good idea. Masks are somewhat effective, probably more to keep the people coughing from spreading than for a healthy person from getting it, and I'll explain that. When you - when someone's coughing, like I said earlier, the droplets spray everywhere, and surfaces become contaminated, or you cough onto someone else, and that's how it spreads. So if you have something, some barrier on your face, you're going to protect other people. This would be particularly appropriate for people at home, where one person is trying to stay well and the other one isn't.

For people who are healthy - I'm starting to get a sore throat. I hope I'm still one of the healthy ones, but…

(Soundbite of laughter)

NEEL: For healthy people, the mask may prevent these small droplets from getting through into your nose and your mouth, but you're just as likely to have touched a surface, then touch your eye. Or when you have the mask off, you will touch your mouth or your nose. And masks, the proper mask - which is called an N95 respirator, it's something you can buy at a hardware store, the kind you would wear when you're painting or doing sawing and raising up a lot of dust - those are very effective. But they are really hot, and we had one of our producers downstairs - earlier this spring, we did a story on this.

He tried to wear it all day, and people can't hear you. They definitely stay away from you because they think you've got something. But it's so uncomfortable that you do tend to shift, and you're touching your face. So you start to - there have been no studies. The bottom line here is there have been no studies to show that masks do much good.

CONAN: Let's go next to Amy(ph), Amy with us from Hubbard in Nebraska.

AMY (Caller): Hi. On Friday's show, I heard one of your experts saying that they weren't testing when patients come in to the doctor, that they were just diagnosing, telling them that they had it or not, but they weren't testing. So my question is, what criteria do they use to differentiate the difference between swine flu and regular flu? And if they're not testing, how do they get their numbers? And I can take my call off the air.

CONAN: OK, Amy, thank you.

AMY: Those are all excellent questions. The way that - at this point, the CDC is always conducting small tests at specially selected hospitals and doctors' offices - they're called sentinel sites - where they do actually test people who come in and determine whether they've got this strain of the flu or that strain of the flu, or something else. And based on these small samples of, you know, relatively - 1,000 or - I actually don't know the precise number - they're able to tell how prevalent the flu is across the country. These sites are spread all across the country.

So from that, they know right now that the - virtually the only strain of flu that's spreading is this new H1N1. So if someone comes in with the symptoms of flu, you can say, well, you've probably got it. You've got swine flu. The symptoms that you're looking for are really very simple. It's a fever of 100 or more and either a cough or a sore throat, and then, of course, all the other symptoms of flu. But those are the three things that people are looking for that you are then suspected of having influenza and of having H1N1, and that you should either get treated with one of the antiviral drugs or take a fever reducer like acetaminophen, Tylenol, ibuprofen.

If you're a teenager or a young person, you should definitely not take aspirin because that causes Reye syndrome. So that's basically how they're handling it right now.

If we were to test every single person for swine flu, it would be very expensive, and it wouldn't tell us any more than this smaller study is telling us.

CONAN: We're speaking today with NPR science editor Joe Neel. If you have questions about swine flu, prevention, myths and responses, give us a call, 800-989-8255. Email us, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. No, you can't get it from eating pork; this is not the first outbreak of swine flu in U.S. history; and your usual flu shot will not protect you. When it comes to swine flu, the misinformation is spreading as fast as the virus.

Today, we've called in NPR science editor Joe Neel to give us the facts and take your calls. If you have questions about swine flu prevention, myths and how schools, hospitals and the government plan to respond, 800-989-8255. Email talk@npr.org. You can also join the conversation on our Web site at npr.org. Click on TALK OF THE NATION.

And here's an email from Patricia(ph) in Iowa City: Why do you continue to call H1N1 swine flu? The hog farmers in Iowa are suffering enough simply because the press called it swine flu in the beginning and, of course, people stopped buying pork, thinking they could get flu from eating it. Every time you call it swine flu, you send the income for hog farmers right down the tubes.

NEEL: Well, I looked at the data last week and looked at the prices during April and May when swine flu first was in the media, and then again in the last couple of weeks. Pork prices started going down last December; beef prices did, too. All meat prices are generally on a downward trajectory because of the recession. People are not eating as much meat.

It is a swine flu virus. It is a virus that originated there, and it's scientifically accurate to call it that. The other reason that we tend to say swine flu, then say H1N1, is because normally, in every season, there is an H1N1 that circulates, and to distinguish the two, it is accurate and scientifically accurate to call it a swine flu virus. And we will continue to do that.

CONAN: And also, people tend to know what you're talking about when you call it that.

NEEL: That's right. And I should stress, like you just did, there's no risk from eating pork of getting swine flu, and that's what we're going to continue to call it.

CONAN: All right. Let's go next to Heather(ph), Heather with us from Reno in Nevada.

HEATHER (Caller): Hi. I was calling because I have a 17-year-old daughter with asthma, who always gets a seasonal flu shot. And my only question, or one of my questions I'm having this year, is I also had her vaccinated for Gardasil, and now all of these reports are coming out, and I'm questioning my judgment to vaccinate her with Gardasil. Should I still go ahead? Is this vaccination going to be safe for our kids and especially one with asthma?

CONAN: So Gardasil and asthma - remind us what Gardasil is for, Joe.

NEEL: Gardasil is for the human papillomavirus, or HPV, which causes cervical cancer, and it's recommended for girls from age 11 on up. It's - the two are different questions. Gardasil has its - is considered to be a very safe vaccine. There have been some reports lately where they've gathered reports that show some serious side effects, and a couple of deaths are being investigated. However, there's absolutely no evidence that we've seen so far or that the CDC is talking to us about, and I don't think they see any link, between those deaths and the vaccine. So as far as that vaccine goes, it's safe.

As far as the two different vaccines being used together, that's not a problem. Vaccines are used together all the time. There wouldn't be any reason to - I haven't heard this question before, but there wouldn't be any reason to think that…

HEATHER: I was just second-guessing because here I thought it was the best thing to get the Gardasil, and I felt safe, and all these reports are coming out, and then this H1N1 vaccine is, you know, relatively new…

NEEL: Well, but it…

HEATHER: …reports in a year or two that I shouldn't have done it.

NEEL: Yeah, it's new in that it will be a new kind of - a new strain this year, but it's still the same old flu vaccine that has been given every year. And as far as we know, it's very safe. There's the flu mist that's inhaled that children can take from 6 months up, and then there's the regular shot that you can get. And there's no reason to think that there would be any interaction or anything.

And you mentioned that your child had asthma. That's one reason you might particularly want to get both the seasonal flu and the H1N1 when it becomes available in mid-October. Because people who have chronic diseases, especially respiratory diseases like asthma, are vulnerable to having more serious consequences, like pneumonia. So you want to do what you can to protect your child.

HEATHER: OK, great. Thank you very much.

CONAN: Thanks, Heather. Let's go next to - this is Joel(ph), Joel calling us from Mainz in Germany.

JOEL (Caller): Hello, my name is Joel. Yeah, sorry. Thank you for taking my call.

CONAN: Sure.

JOEL: My question is about the - which companies are producing this immunization and - yeah, who's going to be profiting from this drug that is being promoted here?

NEEL: Well, there are five companies that the U.S. has bought the vaccine from already. And studies are under way on each one of the vaccines that they produce to see whether they're safe and effective. I don't have the number in front of me, but for the U.S., it's 600 million doses of vaccine. That's quite a lot of money. It's enough to make the manufacturers consider it worth their time to make vaccines.

You may remember a situation - I think it was 2004 or '05 - where we had a shortage of regular flu vaccine in this country because there was only one flu vaccine maker at the time, and they had some contamination problems. And there were some severe shortages for about six weeks to eight weeks. So what the government is trying to do is to give incentives to make this - and other vaccines, I might add. And yes, there is profit involved, that's for sure.

JOEL: For a cat in a sack, yeah.

CONAN: OK, Joel, thanks very much.

JOEL: Bye.

CONAN: Bye-bye. Let's go next to Christine(ph), Christine with us from Chicago.

CHRISTINE: Hello.

CONAN: Hi.

CHRISTINE: One little point: If you're allergic to eggs, I assume this vaccine is still produced using eggs.

NEEL: The shot is, but you could get the flu mist, which is inhaled. [POST-BROADCAST CORRECTION: Chicken eggs are also used in manufacturing the inhaled flu vaccine. It is not an alternative to a flu shot for people with egg allergy.]

CHRISTINE: Ah, OK, good - just a little, tiny detail.

CONAN: Thanks for mentioning it.

CHRISTINE: I came off the plane on July 1st from London. By the 3rd, I had the cough. And I went to the doctor saying, you know, I think I might need a nebulizer. And I went to the hospital in the ambulance with pneumonia. So it's not always - you know, people say oh, it's not so bad. The American government - in England and a lot of other countries, it is very bad. It's considered an epidemic.

I spent a lot of time in the hospital, and they put every antibiotic in me. And after the fact, they decided - they did the swab test up the nose. Oh, you don't have that. After the fact, they said well, yes, I guess you did have swine flu.

Now, it's been over a month, almost two months later. I still have terrible breathing. I am very, very exhausted. And I can't find any research anywhere on the long-term effects of, I mean, pneumonia, OK, fine, but the long-term effects of the - well, I don't know what you'd call it, the triggering effects of swine - originally, it was called Mexican flu. Call it what you will, but can you give me any - can you direct me to any information? What should I expect?

NEEL: Christine, the best thing I think I could tell you would be to go see your doctor.

CHRISTINE: I have…

NEEL: I haven't heard or seen anything like that, either. We don't have a lot of experience with swine flu because it only started in April. So…

CHRISTINE: I know. They don't have anything - they're, like, well, you know, stay at home if you have to rest. I'm still sleeping more than 12 hours a day, you know.

NEEL: There could be something else going on there. You should talk to your doctor, I think.

CONAN: But she does remind us that this can be serious. I mean, again, most of the cases are mild, but some are not.

NEEL: Well, exactly. And with the expectation that 150 million people will get sick, you can be sure that a lot of people will be seriously ill, and some worst-case scenarios say there could be 2 million people in the hospital. So it's not something to just blow off. There are two perceptions here. You know, from a public health point of view, you stand back and you say oh, it could have been a lot worse. It could have been the 1918 flu pandemic that killed millions and millions. This isn't going to be that bad. But of course, we don't know if it'll be that bad. Like our earlier caller said, it is mutating. It could get stronger, more deadly. We just have to wait and see. It's more prudent to be cautious, I would say.

CONAN: This an email from Veronica(ph): I am a pregnant woman trying to weigh the risks and benefits of getting the H1N1 shot. Although I know it's recommended that I do get the shot, no one has adequately answered for me what are the odds that something serious will happen if I decide not to get the shot. Can you help me weigh the odds?

NEEL: Well, we've seen so far that pregnant women have a much - that pregnant women have a significantly higher risk of being hospitalized when they get H1N1, and dying. Now, the numbers are very small. I don't want to scare anyone, but compared with the rest of the population, pregnant women do have some risks.

There have not been enough cases for us to know whether it actually increases the risk of miscarriage, and the rate of miscarriage in this country is pretty high already. There are 2,500 miscarriages a day. So it'll be pretty hard to decide if a particular miscarriage was due to a vaccine.

We do know that pregnant women have gotten the seasonal flu shot in the past and have had no problem. So we would expect the same thing, and the risks of getting something that could either put you at risk or potentially your baby at risk for not getting it, that the flu would do the damage, I think public health people would say that outweighs the risk of going without it.

CONAN: Let's go next to Gail(ph), Gail with us from Ann Arbor in Michigan.

GAIL (Caller): Well, hi there. I'm glad to be on your show.

CONAN: Thank you.

GAIL: My question is this. I've read that the percentage of people over 55 who will contract H1N1 is, it would appear to be, at this point, 1 percent or lower. I'm just wondering if public health-wise, we might not try to discourage people who are in their 50s and in good health from taking the shot so that my 23-year-old son can get one and all of his friends.

CONAN: You oldsters, back of the line.

(Soundbite of laughter)

NEEL: Well, that's the plan. Actually, the CDC and other federal agencies have a quite elaborate plan in place to prioritize this vaccine. Some might call it rationing. But the first people in line for this would be health-care workers, then pregnant women - or they're treated more or less equivalently so health-care workers can stay on the job.

And then - let me look at my list here - it's people between the ages of 6 months and 24 years, because there has been a higher death rate among young people in those age groups. And then people 25 to 50 - 64, excuse me. And that's because right, the death rate in the older population has been significantly lower. It's unlike what we see in a normal season.

CONAN: And that's because those older people have been exposed to previous examples of swine flu?

NEEL: That's what people think, but there are studies going on right now to definitely determine what the reason is. But the thinking is that this strain was similar enough to the pandemic of 1957 that anyone born before - at that time or before then has been exposed to it and has some immunity. But that's - it's still not out there. It's still not conclusive yet.

CONAN: Gail?

GAIL: I'm glad to know that. My son would appear to be in the third group.

NEEL: Right.

GAIL: And I'll be pushing him through the door.

(Soundbite of laughter)

NEEL: Well, the other thing is, so many people don't get flu shots and even with the government encouraging them. I think there won't be - it won't be that they're checking to see if you meet certain criteria when you show up for a shot that, in many cases, people will just go ahead and get it. But if there are severe shortages, you may see them fall back on this plan and do some enforcement to the degree that they can.

GAIL: Well, my son is a food health worker and I think that it would be…

CONAN: He should be at the front of the line then.

GAIL: …he should be at the front of the line.

CONAN: Gail, thanks very much.

GAIL: Well, let's hope everybody stays well. Thank you, doctor.

CONAN: Let's hope.

GAIL: Bye-bye.

CONAN: And Joe Neel is not a doctor.

NEEL: And I should say, I'm not a doctor.

(Soundbite of laughter)

CONAN: But he's our science editor. And you're listening to TALK OF THE NATION from NPR News.

And Joe, this email from Gregory - and we've gotten a lot along these lines. This flu vaccine contains dangerous adjutants(ph) such as squalene. Why are these chemicals in the vaccine? What is squalene, and what is an adjutant in this context?

NEEL: Well, it's adjuvant. It's a V.

CONAN: OK.

NEEL: And adjuvants are used in vaccines to give the immune system a boost. It's a chemical that - once your immune system is exposed to it, you get a lot of antibodies to that. And that primes the pump for the -whatever bug it is you're trying to - whatever strain or segment of virus that you're trying to get an immune response. And in the early tests of this particular virus, the vaccines without an adjuvant, without this added agreement, showed that the vaccine wasn't as effective as a seasonal flu vaccine. And that's why we're talking about getting two doses this fall.

The second question is squalene. There is - GlaxoSmithKline, GSK, has a product, and it's an H1N1 vaccine that does have squalene in it. Squalene is an adjuvant that attempts to boost the immune system. And that's -that research is ongoing. And that vaccine is - it's very unlikely that vaccine would be licensed in time for this outbreak and for this fall's vaccination campaign because it's a new kind of vaccine, and the FDArequires a lot more study of it.

So what we're going with is this - is the regular seasonal flu - is a vaccine modeled on the regular seasonal flu vaccine with just the strain change. And that vaccine has no adjuvant. And in many cases, there will be a vaccine available - it doesn't have thimerosal, which is a preservative that many people are concerned about. Pregnant women and children will be able to get a vaccine that doesn't have that ingredient.

Now, there's never been any study showing that ingredient causes harm, but some people have linked it, and think that it's linked to the rise in autism cases and other diseases. So that's…

CONAN: You mentioned two shots. How far apart, and why is it the Chinese seem to think they're going to only need one?

NEEL: Well, how far apart is yet to be determined. And whether we will need two shots is yet to be determined because the - we should know the results of the studies within the next few days, maybe this week, maybe next. And they're hoping to have it licensed by the first week of October or perhaps sooner - or actually, it is sooner - so that they can start ramping up the manufacturing.

The - it's unclear if the Chinese study that came out last week, saying that one shot was all that was needed, whether that vaccine actually had an adjuvant or not. We don't have enough information about that. Some of the data suggest it must or it wouldn't be quite as effective. But be that as it may, if it doesn't, then they will go with one shot. And perhaps our vaccines will show the same thing.

CONAN: Let's talk with Angela in Oklahoma City.

ANGELA (Caller): Hi there. I have a question. I was wondering, since we're all in the - we all come across the flu every year and we all - a lot of us get flu shots, etc., does it stand to reason that in five years or whatever, we will have come across this virus and we'll be immune from that anyway? Does that make sense?

NEEL: Yeah. I mean, flus rarely cycle that quickly. So, like we were speaking - we were talking about earlier, some of us may be immune because we were exposed back in 1957 - I can say that, giving away my age.

(Soundbite of laughter)

NEEL: But it's - no. There probably isn't immunity that quick. I mean, for 10, 20, 30 years from now, you may have some immunity to this particular strain.

ANGELA: OK, thank you.

CONAN: And thank you very much, Angela.

Finally, this email from Mark(ph) in Philadelphia. Any greater risk traveling to Mexico than traveling in the U.S.? You've mentioned that it originated in Mexico.

NEEL: I don't think there'd be any reason. I mean, we haven't seen any numbers out of Mexico that would suggest it's any more prevalent than it is here. I mean, in this country, we're way over a million cases.

And they - we're right now, I was looking at the graphs this morning, we're back to about where we were in the middle of May in terms of the number of projected cases. And this should peak in the tens of millions of cases by late September, if everything goes according to the current projection. So it's right here.

CONAN: Joe, take care of that cough.

NEEL: Thank you.

CONAN: Joe Neel is NPR's science editor. He joined us here in Studio 3A.

Coming up, the brain surgeon who's bringing modern neurosurgery and hope to Ukraine, "The English Surgeon." Stay with us.

I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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