Chasing Life

You know, I was thinking about this the other day. Like everyone, there are probably aspects of my personality that may seem a bit paradoxical. I have interests and passions that sometimes feel like inherent contradictions. For example, I'm a brain surgeon who loves football. And I have to be honest with you. This is something I wrestle with every fall. I am well aware of the short term risks of concussions and the long term dangers of conditions like chronic traumatic encephalopathy, CTE. There was this study published in 2017 that found 87% of deceased football players whose families were worried about them and they had donated their brains, did show signs of CTE. It included players as young as high school. But here's the thing. I do really love the action and the athleticism of the game. I love the camaraderie of the players in the game and of course, the thrill of watching those players like Tom Brady lead their team down the field to win on a last second touchdown. It's exciting stuff. So yeah, the love of football is a real dilemma for me. Now, one of the ways I've tried to reconcile this over the years as a doctor and a fan and a journalist has been to closely follow the evolution of the game's safety measures, whether it's new equipment, new concussion protocols, new rules. This year, the NFL, the most popular sports league in America, has unveiled the biggest rule change fans may have ever seen, a brand new kickoff. Now, a reminder for my listeners who don't watch a lot of football, the kickoff is the play at the beginning of the game. And after each score where one team kicks the ball down the field to the other team players on the kicking team, then sprint down the field to try and tackle the receiver. As soon as the ball is caught. And that's the issue. It's a high speed, high impact moment. It's an iconic sports image, no doubt. But it also happens to be one of the most dangerous parts of the game. The NFL says that last season, concussions occurred four times more often on a kickoff than any other play.

Just like if you think about a car collision, if you drove your car into a wall, let's say five miles an hour, that risk of injury is obviously very different than if you drive your car into a wall at 40 miles an hour. And so in the same way, when you have collisions between players, the higher the closing velocity, the higher that speed that they come together, the higher the risk of injury. And that was really the problem with the traditional kickoff.

That's Dr. Allen Sills, the NFL's chief medical officer. Last spring, Dr. Sills worked with the league's 32 team owners to develop a new kick off format with new rules and players standing in new formations at the start of the play. Their goal was twofold. First, to restore excitement because the kickoff had recently become essentially a dead play, a boring play. NFL kickers had become so good at kicking the ball into the end zone that it stopped play automatically and set the ball at the 25 yard line. The vast majority of kickoffs ended with no action. The second goal was to increase safety. The old kickoff format, despite being pretty boring, was still really dangerous because of the speed and the space. The new kickoff tries to reduce this by having the players line up close together instead of running clear across the field. The hope is that by reducing space and speed, like in a car crash, it's going to lead to fewer injuries.

The key part of this Sunday is when they start moving again, they're five yards or maybe ten yards at most a pass. So it looks much more like a typical run in pass play, which is what makes the injury rate more in line with those plays than the old traditional kickoff.

I wanted to have Dr. Sills on the show today to talk about this new rule, why the NFL came to adopt it, and how he thinks it'll make the game both safer and more exciting. But I also wanted to talk to Dr. Sills because, full transparency, I've known him for more than 25 years. We are friends, and I know that he, more than anyone, has thought a lot about what it means to be a doctor who loves football. He's literally the sport's top doctor. He's also a professor of neurological surgery. So I wanted to go straight to the source to wrestle with these feelings together and to hear how and if he thinks America's favorite game can ever truly find the balance between exciting and safe. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life. First of all, you know, I read this thing and I guess I didn't realize it when I was watching the Super Bowl last year. Were there no kickoff returns in the Super Bowl?

That's correct. I think and something like 13 kickoffs actually left the field of play. They weren't even in the field of play. They were landing up in the stands. So, you know, the kickoff had really become almost what I say is a ceremonial play where there just there was no action. We were down to an all time low last year, about 21% of kickoffs that were returned. And so really, the play had lost its excitement as a as a part of the game.

So as a doctor, someone who's the doctor for the NFL, was that a good thing or a bad thing?

Well, we always are looking for ways to make the game safer. But I think what you'd like to do is there's a balance there, right? How can we make the game exciting and yet safe at the same time? That's our challenge. And so when we looked at the kickoff play, our football people came to us and said, this seems to be a ceremonial play. It's a dead play. There's no action. We'd like to get some action inserted back into the play, but we don't want to make more injuries if possible. And so that challenged us on the medical side to go back and really take a deep dive at the play and look at what was driving injury and how might we change it to to bring back that excitement and yet make it safe at the same time.

I just you and I have always... We're both brain surgeons and we've danced around this topic. And I've got to be honest, I've had a challenge sometimes when I talk to people because I'm a football fan, as you know. I love going to games. And people will say to me, Allen, they'll say, "How can you be a brain surgeon and still love this game?" Because fundamentally these are people who are at higher risk of head injury, preventable head injuries. How do you answer that question?

Yeah the way I look at it is the following. We know that in all sports there can be head contact. I've divided into three different categories. There's what I call intentional head contact, which is really not part of any sport other than boxing or mixed martial arts. But that's not part of the game for most of the games that we all follow and love. Then there's what I'd call unavoidable head contact, where players accidentally collide and players hit the ground with their head. Those are common to all sports. You know, whatever sport you can name, those injuries can happen. I actually saw a professional golfer last year that had a concussion from an errant golf ball that hit him in the head. So, you know, things can happen in any sport. But that leaves us with another big category, which is what I would call avoidable head contact. And that's where I think that we have to make progress, which is there was head contact, but could we play the game in a different way so that head contact did not occur? And that's where our work is focusing in the NFL, is let's get the head out of the game. Let's don't use the head as a weapon. Let's don't use it as part of the game. And I think if we do that, then we're going to see that the safety profile of the game improved dramatically. And so if you look back at how football was played 20 or 30 years ago, you know, using your head was just a routine part of the game. In fact, you and I are of age where we can remember highlight shows showing these hits where people were deliberately hit in the head and there was loud rock music and it was really a celebrated part of the game. We don't see that anymore. Nobody wants to see those hits. So I see the game evolving. I see it changing and I want to be part of that change. And as I said, not just for football but really for all sports, is how do we maintain the the great elements and the excitement of sport and get the head contact out of the game.

If you're in a meeting and you're the doctor or chief medical officer for the NFL and they're coming to you and they're saying, Doctor Sills, we want you to to basically evaluate this part of the game and and tell us what? Tell us how safe it is? Tell us how we could make it safer? I guess what I'm asking is if I'm a if I'm a brain doctor in a meeting like this, probably I'd be saying, look, that's an avoidable head injury. That's an avoidable head injury. That's an avoidable head injury. I'd be saying the same thing over and over again. They're trying to get you to say, look, we understand these are avoidable head injuries, but here's how you can make it safer. Like, what is your role exactly as CMO of the NFL?

Well it's exactly what you describe, which is a really dynamic conversation between our football people, our Rules Committee and our owners and the people that make the policy and our medical side. And it's just along the lines of what you said, which is how can we make the game safer? Where do you, as medical providers see elements of danger that we could remove? And so that conversation is happening all the time. It's a year round conversation. And just before the final vote was taken on this new kickoff rule, you know, all 32 team owners are meeting in a room. And one of the team owners stood up and said, I just want to hear one more time from Doctor Sills what he believes the impact will be on on injury if we make this change. And so, again, that's a great place for us to be to have those conversations. And I think it's obviously a big change from 20 or 30 years ago. But it is it is the exciting time that we're in where sports, medicine, rulemaking and policy are really coming together to try to make our game safer.

So you got a couple sentences probably that you can utter when all of a sudden one of the owners asks you to weigh in at the meeting. I want to hear what Dr. Sills thinks about this rule change. So what did you say?

Well, for this kickoff rule that we adopted, I told them that we've obviously modeled this in the laboratory using artificial intelligence techniques. We've studied other leagues that have had similar kickoffs. It's our belief that the change that was made, the kick off adoption that that that the owners voted for, would indeed restore action to the play, but would not create the kind of concussion levels that we had seen. Part of the challenge with the old kickoff format was it had four times the rate of concussion of any other play that we had. And so we saw that year after year after year. And that was really a function of space and speed, you know, players running at high speed down the field, high speed collisions. So it's not really.

Just going to play for one second. Sorry, because I really want to I really want to talk about the kickoff. You know, just and I really want to explain that for, again, for the audience who who may not know the rules of football as much. Before we talk about the kickoff, you just said to the room, when you talk to all the owners that these rule changes could potentially restore some excitement to the game. I think you said while also reducing the rate of concussions from what they used to be in the past.

That's correct.

How much of each like I guess what I'm asking is how much of this was about restoring the excitement versus trying to decrease concussions?

Well, again, I think it's both. I don't think those are mutually exclusive goals. And what what our modeling looked at, Sanjay, was.

Well, I mean, it would be it would be easiest to just say don't do the kickoffs. Right. Of course, because if that is the most dangerous part of the game. So any rule changes at this point are to restore excitement and then have an acceptable level of risk.

That's right. We were trying to create an injury rate or anticipate an injury rate that would be somewhere in line with a typical run or pass play. In other words, in all the other plays of the game, we have an injury rate. And we said, can we find an injury rate on a kickoff play? Can we design a play that would have a rate about at that same level? Because that's a level that we've all accepted as sort of part of our game. So that was really the calculation is can we get the injury rate somewhere in line of what we would expect? Because obviously in any sport, any play, there's there's some risk of injury, right? And so for the kickoff, again, concussion was the one that really jumped out. We were trying to get that concussion rate down to what we see on any other play in any other part of the.

Got it. Why is the kickoff such a potentially dangerous play?

'Space and speed. You've got players running downfield at high rates of speed and when you --

Kick off's the play, a team kicks, and then everyone's running towards each other sort of or at least the kicking team is running straight at the the receiving team and they they generate a fair amount of speed by the time they actually get there to the right of the field.

Just like if you think about a car collision, if you drove your car into a wall at, say, five miles an hour, that risk of injury is obviously very different than if you drive your car into a wall at 40 miles an hour. And so in the same way when you have collisions between players, the higher the closing velocity, the higher that speed that they come together, the higher the risk of injury. And that was really the problem with the traditional kickoff is just as you said, players running 50 or 60 yards down field colliding with other players and producing injury.

I do want to jump in here and give a quick bit of context. What you should know is that this season isn't the first time the NFL has tried to adjust the kickoff. Over the years, the league has incrementally made small tweaks to kickoff rules, and it made a difference by lowering concussion rates during the play. But that was largely because the kickoff no longer led to any returns, meaning the ball never went into action. Here's some numbers. Last season, only 22% of kickoffs were actually returned. That was the lowest in league history. And that's what Dr. Sills means when he says the kickoff lost its excitement. And it's also why the league has decided to go with a more radical change to the kickoff this year. They want to see if they can continue to make it safer while also bringing back that excitement. Who who's complaining about the lack of excitement? Where where are you hearing that from?

I think we hear that from everywhere. We hear it from from fans, but we also hear from players. And we hear.

There were fans that were saying, hey, man, we really miss the guys banging their heads into each other as hard as they could?

It's not that they're missing that, it's that they're missing a play that that there's some chance of of excitement on that there's some chance of advancing the ball. Players themselves were not happy with the play because you basically have taken physicians out of the game like kick returner. If you paid attention to the recent Hall of Fame induction that was playing in Devin Hester, he made his career as a kick returner, essentially. There would be no job for anybody like that in the NFL under the old rule because there was just no value in having someone with that skill set. So I think coaches, I think players, I think fans, I think the NFL community as a whole said, you know, we've got a part of the game that's just not very exciting and is not fun to watch. And so again, can we do something about that while continuing to make gains on the injury front? That was really the challenge.

Yeah, I hear you. And, you know, I ask these questions in part because I think out of all the interviews I do, this is one of those... And I think in part because of our shared love for the brain, this is one of those ones where I've struggled with it, Doc. I mean, I think the game of football is perfectly exciting. I love college football. I didn't really miss the kickoff return as much as a fan. I'm not saying I speak for everybody. And I also felt better about it because I thought, look, I heard that was the most dangerous part of the game. And these guys really they addressed that in a way that made the game a lot safer. It brought the kickoff sort of return in line with the rest of the game in terms of injuries. And I thought that was a really good thing.

Yeah, but I think that this new rule, the dynamic kickoff rule that we've passed, has just to do exactly that same thing while creating a little bit more excitement. So if you look at them at the modeling and again what's happened in other leagues, you reduce the space and speed with this new kickoff because players are not running down the field at full speed. Yet you give the return team a chance to return it and in many cases to advance and have better field position and break the break to return for a touchdown, which again are very exciting parts of the game.

What what was your biggest concern about this? Again, you're the CMO of the NFL. Nothing is a slam dunk decision, right? There's always pluses and minuses to everything, I imagine. What was your biggest negative?

I think there's always just that element of of the unknown. You know what what what could happen that we haven't accounted for? Are there things that the modeling did suggest or things that you didn't see in other leagues just because of the size and the speed and the skill of NFL athletes? So I think you never know about the ultimate package until you put it in place. And so that's where we will continue to monitor this very carefully. But one other thing about this that I would tell you that I think fans would find interesting is everything we've discussed today wasn't just me and my team sitting around. This actually came out of the special teams coaches, all 32 special teams coaches got together with us. We shared our data. We shared our concerns. We shared what we had learned from other leagues. And we said, you know, these are our concerns. This is where we think the play is, is going off the rails in terms of high injury risk. And those coaches were actually who got together and really put the elements of design. So it was a very interactive process. And and I think they're excited about it as well. But they expressed the same reservation that I just mentioned that you just sort of don't know until people are are actually putting it in place and using different schemes. And so that's something we'll just have to track very carefully.

If you look at the models, it's likely that the kickoff return part of the game will be similar, as you're saying, to other parts of the game in terms of potential injuries. When you look at the current rules, meaning going back to 2022, 2023, versus these new rules, what do you expect? Do you expect concussions to go up as a result of this compared to what it is now?

Sure. If you have a play where there's no return, obviously there's a low risk of injuries, not zero. We actually did have injuries on those plays where kickoffs were not returned. You'd have hamstring pulls, you'd have ankle, you have ACL when people are changing direction, things like that. So it wasn't as if the injury rate was zero on the old kick off, if you will, the 2023 kickoff. The goal hopefully will be to have, as I said, this new kick off with a lot more excitement, but again, with a comparable injury rate. And so that's that's what we'll have to monitor, what we'll have to look at, and then we'll we'll make changes. That's obviously what we've always done is kind of adapt to that based on what the data is telling us.

Yeah. And look, I'm not trying to pin you down here. I'm just saying that you're right, it would be very low if not zero, at least with regard to head injuries if you were returning far fewer kicks. So you have to accept with this new rule change that the concussion rate is likely to go up, go up on par with the rest of the game. But still go up.

We have to accept the fact that every play that happens during the game carry some risk of injury. That's absolutely right. And so to to your point, could injuries go up overall? That's just something we'll have to track very carefully. But as I said, if we're seeing that this play did not achieve what we thought it would, if the injury rate is spiking back up and going up and is what we consider unacceptably high, then we'll have to make changes again.

After the break, we're going to discuss the future of football, the possibility of the NFL abandoning the kick off altogether, and this small high school league in New York that has done just that. That's coming up. Okay, we're back. So before I get to my conversation with Doctor Sills, I want to tell you about a reporting trip I took recently because I think it makes this whole new kick off discussion relevant to more of us, especially if you have a child who plays or wants to play football. The trip was to a high school football practice at Riverdale Country School in the Bronx.

I sort of jokingly said to him, like, I want to change football in America. Like, we need to figure this out.

I want to change football in America. It's pretty audacious.

Yeah, I don't know if I actually realize what I was saying at the time.

That's John Pizzi, the school's athletic director.

So in 2018, we we had 18 players left for the last game of our season. We had a bunch of concussions and a bunch of season ending injuries. So we made a decision to cancel our last game. But when that season ended, we had to figure out how we were going to manage the next football season.

After that season, Pizzi teamed up with the Concussion Legacy Foundation, and they ended up proposing something pretty radical. No more kickoffs. Now play just simply starts from the 35 yard line. And so far, Pizzi says they have seen a 33% decrease in concussions across the league and importantly, an 18% increase in participation. It's no surprise, perhaps, that parents are happy that their kids are safer. But what I think is the most surprising aspect of this: Players didn't seem to miss the kickoff either. In fact, they said they now appreciate the change.

I've talked to people when I told them that my school doesn't do kickoffs. They they're like, my gosh, that's one of the biggest parts of the game. How can you not do that? But then I see all these injuries that happen from kickoffs. So the fact that we don't have that probably allowed us to keep healthy and play throughout the entire season. It hasn't really changed the aspect of my football journey and my path. I just get more time on offense.

What they said basically with no kickoff is that the players just get more time on the field doing what they love. So when I sat down with Dr. Sills, I asked him what he might say to those kids.

Listen, I think that we are always in favor of innovation and in people looking at the game through the lens of how they make it safer, full stop. I mean, I think that's what as I said earlier in our episode here, that's what we should be doing with all sports at all levels. How do we make the game as safe as possible? And I think that is an opportunity, again, to learn and be informed by their data. Certainly there have been discussions, Sanjay, about getting rid of the kick off completely in the NFL. Absolutely. There have been those discussions.

What do you hink of that?

I think those discussions have to continue based on the results of what we see, because, again, if we have any part of the game where we see an unacceptably high injury rate, then I think we have to look at that and we have to address it. And so let's just say, for example, in a worst case scenario that this new kick off rule dramatically increases injuries. We're going to be back at the table, changing it and doing something very different. But but I think the prevailing spirit, the overwhelming desire, again, from players and coaches and certainly the NFL community was can we keep the foot in the game? You know, football obviously starts with the return foot. Is there a way to maintain that part of the game, which implies that the skill and all of the techniques that the kicking teams use, whether it be punting or kick? Can we keep that part of the game and yet keep the injury risk down? If the answer is no, then I think we'll all have to confront that. And maybe this league in New York is leading the way on that. But I think what we're trying to do with this approach is to say we're not accepting what's happened in the past. The injury rate was too high and the play was not exciting. I mean, if we didn't play at all, we wouldn't have any risk. And that's true for every game. So where is that balance point? That's where we live.

Yeah, it is. I can appreciate the point. I guess I'm just sort of saying, look, you even talk to high school students and they're thinking, you know, we found that part of the game dangerous. We don't have it anymore. We don't miss it. The game is just as exciting. And by the way, we really care that our league cared about us to actually get rid of that part of the game. You know, I there's no question that, again, we're both football fans. But if you said, hey, look, we've identified the most dangerous part of the game, we identified it now based on all the modeling and we did something about it, got rid of it, and now we're sort of bringing it back a little bit. It just I it's it's hard for me to get my head around it completely. I hear what you're saying. I'm just saying you want the excitement. I get it. You have plenty of excitement in football. I mean, that's why we watch, you know, And without that, I think.

If you asked the 32 guys whose living depends on kicking the football, you know, they'd say they'd like to try to have a part of the game. If you talk to the 32 special team coaches, it's been an essential part of the game. And and again, we've realized that those special teams plays and again here, whether we're talking about kickoffs or whether we're talking about punts, they've carried higher risk of injury. Okay, let's acknowledge that. And before we just say let's wipe them out of the game, let's really work at them, that's would let them, let's engineer them. Let's try to see if we can get them into a place of of being safer. And so I don't agree that this kickoff change with the NFL that we're taking a step backwards in health and safety. I didn't feel that way at all. I actually felt like this is another step forward. And again, I just go back to something we talked about before. 20 years ago, nobody was sitting down saying, let's hear from the health and safety people, what they think about this. That just didn't happen. And so now, as I told you, that's front and center. That's the number one conversation. And so, as I told you earlier, all options are on the table. But I don't look at this as a retreat at all. I don't look at this as as throwing caution to the wind. I think what we're trying to do, as I said, is put some excitement in the game and yet keep it safe. And if we if we succeeded, then that will be a great thing. And I think it will spread to other levels of the game. But if we failed and if if we made the wrong set of moves, then we'll acknowledge that and we'll make corrections. I mean, that's been the history of what we've tried to do, at least over the time that I've been in the league, is honestly look at our data and really come back and try to make those changes that make sense to to to reduce the risk of injuries.

Put on your your your fortune teller hat for a second and tell me what you think football will look like in ten years.

Well, that's a that's an interesting one. I think equipment will continue to evolve. I think you're going to see a whole nother generation of of helmets and shoulder pads and protective equipment. I think that you'll have likely sensors that will detect head contact and will will allow people to monitor that and train specifically about it. I think the rules of the game will continue to evolve to get the head out of the game. And as we talked about at the very start of this episode, I think the only head contact you'll see is players inadvertently hitting the ground or accidentally colliding with each other. I think the heads out of the game and I think you'll continue to see, you know, bigger, faster, stronger players who who have these incredible skill sets. And you'll see the game played with a much higher degree of sort of finesse and speed. Maybe, you know, if we think back to football 50 or 60 years ago, it was three yards and a cloud of dust, right? You know, this big collision of people. I think you'll see these schemes in space and speed continue to evolve. But I'm excited about where we are. As I said, I think we're in sort of a golden era of sports medicine where we have all this data and this knowledge and now that's really blending together with coaches and with rule makers to to make the game safer. And so I anticipate in ten years we'll have an even lower injury rate than than what we have today. If we haven't done that, then I failed at my job. But that's the challenge we have in front of us.

The name of the podcast is Chasing Life, and I think I know the answer to this question, but Doctor Allen Sills, how do you chase life?

You know, I try to chase life in a lot of ways, Sanjay. Just being grateful for every day that I have, grateful for the opportunity to do the work that we do and staying as active as I can because I think we all know and you've been a great advocate for this too. We have to keep our lives active in every way, whether it's mentally, physically, relationally. And so I'm getting up there in years. And as we do, that's our challenge, is to make our life keep growing and keep forming new memories and new bonds. And so that's what I'm trying to spend my time doing and making those relationships and memories that that really are the fabric of life.

Beautiful. I got to say for the audience, you know, you're not seeing Dr. Allen Sills. I've actually known Dr. Sills for a quarter century now. And you look the same, doc. Really. You are. You. You're one of those guys. You have nine grandchildren. I never believe that when you tell me this because you look fantastic. You look really youthful, healthy, and you are practicing what you preach.

Well, you're kind to say that, and same goes for you. But I appreciate the chance to chat with you. Always appreciate the advocacy. Look, I love talking about these topics and I appreciate your interest in it. And I think as as neurosurgeons, you and I both take our job seriously. You're trying to to help spread information that that can make things safer for people that are out there staying active. So thanks for having me and for the chance to have this conversation today.

Listen, I know football's never going to be 100% safe. I get it. And it bothers me because it is a game where people will almost assuredly get hurt. But I also think Dr. Sills is right when he says that conversations about how to make the game safer are at an all time high. And I think he's also right that we're going to continue to see new efforts and innovations to make the game safer, coming from all levels of the sport, from doctor sills and professional leagues to youth and high school leagues. There are a lot of people out there who are working hard to make the game safer, to make the game have an acceptable level of risk. And that gives me hope. Because love it or hate it. Football is America's most popular sport, and it's not going away anytime soon. We owe that to the players from the youngest kids to the seasoned pros to continue pushing forward with these efforts. It's about finding that balance between safety and excitement. It's a tough task, but if we keep having conversations like this, if we keep investing in research, if we keep implementing changes, we just might move closer to achieving that goal. Now, before we go, I want to answer one of your questions for our new segment, On Call. This one is about several reports on mosquito borne illnesses like triple E and West Nile virus. We'll be right back. And now it's time to reach into the mailbag for this week's On Call.

Hi, Sanjay and team. My name's Casey, and I'd like to propose a topic for your new Ask Dr. Gupta segment. I would really love a segment about encephalitis. It's been in the news recently with outbreaks of equine encephalitis. I've read a lot, but I have more questions than answers.

Well, I bet she does, because Casey also told us that three years ago she spent a week in the neuro intensive care unit for what was later diagnosed as idiopathic encephalitis. Encephalitis is an inflammation of the brain. Any time a word ends with itis, that means inflammation. And encephalo in this case means brain. Now, encephalitis can be caused by an autoimmune response where the body mistakenly attacks itself. Or it can be caused by a bacteria or virus. Those viruses can be spread by insects like mosquitoes. Idiopathic, incidentally, means we don't know what the causes like in Casey's case. Now, Casey mentioned eastern equine Encephalitis or Triple E, which despite making headlines, is pretty rare. As of early September, there were fewer than ten human cases reported in five states, including one death. All of the reported cases, however, were what we call neuroinvasive. That means they affect the central nervous system, making them obviously very serious. About 30% of people who develop the severe cases end up dying. Now, the good news is most people who get infected don't develop any symptoms at all. In fact, it's hard to get infected because this virus is maintained between one type of mosquito and birds. Transmission to people then requires another mosquito species to create a bridge between those infected birds and uninfected mammals. There are other mosquito borne diseases which are much more common than triple E, such as West Nile virus, malaria and dengue. In the case of dengue and malaria, most of those cases are travel acquired, according to the CDC. But there is plenty of West Nile virus here in the United States, more than 300 cases in at least 38 states. One recent patient was Dr. Anthony Fauci, who was actually hospitalized for a week due to West Nile. Health officials estimate that in areas where mosquitoes carry the virus, one out of five mosquitoes are infected with West Nile virus. But if you happen to be bitten by just one of them, you can become infected. So no one wants to play the odds if they can help it. And prevention is the best way to protect yourself. Use an insect repellent with Deet or picaridin wear loose fitting long sleeved shirts and pants. Check for standing water outdoors because that's where mosquitoes like to lay their eggs. And avoid being outdoors as much as possible from dusk to dawn. Mosquitoes really don't like the sunlight, so that's why they're most active early in the day or later in the day. I hope that answers some of your questions, Casey.

And shout out to the UC San Diego team that pretty much saved my life.

Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Matthewson, Jennifer Lai, Grace Walker and Jesse Remedios. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Sealy is our showrunner. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Licteig. With support from Jamus Andrest, John Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nichole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker and Nadia Kounang of CNN Health and Katie Hinman.