No Cowboy is Safe! Red Dead's Biggest THREAT!/Transcript

[Video starts with the TB counter appearing throughout the video before Austin's voice speaks.]

Let's have a little bit of a real talk for a second. Normally, I'm... a little dramatic; I say things are terrifying when they definitely aren't. Nobody is legitimately scared of Pokémon evolution, Mario's fist, Steve or Alex's biceps, or any other... thing that I've yelled about. Nobody's ever pissed the bed because the water in Fallout is super-radioactive, nobody's gone to therapy because Spider-Man is murdering folk, and nobody's been put on medication because the giants in Skyrim are living bombs; but what I'm talking about today, this is the real stuff! I'm talking about things that affect real people every day across the world. I'm talking about the most deadly threat to human existence, something that's been stalking and killing us ever since our birth as a species; a predator that's been growing alongside us, evolving and killing more of us than any other single cause of death; one that's been able to learn over time how to become immune to our best and strongest weapons against it. It's currently THE most deadly disease on Planet Earth, and it killed Arthur Morgan! I'm talking, of course, of the disease tuberculosis.

So, if you're easily frightened or have a heart condition, now's your warning to turn this video off, because, for the first time ever on this show, it's time for us to step out of the world of video games and into real life, where real people die every single day. Are you ready? Then let's go. [0:00-1:30: TB counter is now 4]

''[Credits: Written by: Austin Hourigan. Edited by: Tanya Metzger, Austin Hourigan. Voice Editor: Yosi Berman. Music by: Nemi, Rouvan. Audio Editor: Austin Hourigan.]''

I decided to do this video because, honestly, the more I read about tuberculosis, the more amazed I was. It's the kind of thing that when you start trailing down the Wikipedia article for a summary, if you live in the United States, your eyes grow wide! Phrases like, "the number one cause of death from an infectious disease," float across your eyes and you wonder, "Can that be right?! What's the source on that?! Oh, the World Health Organization! Holy crap!"

Today is a... bit of a... weird episode for me. I tried to write this section in particular, probably a dozen times, and just could not get it right; but I think, I finally... kinda, sorta have it. We're gonna go over Arthur Morgan's case, piece by piece, and paint a picture of his prognosis, what he could have done to increase his chances of survival, and conclude whether or not his death, a.k.a., his "redemption", was inevitable. [1:30-2:24: TB counter is now 6]

So, first things first: What is tuberculosis? Tuberculosis, known specifically as "mycobacterium tuberculosis", is really, REALLY old! It's not known with any degree of certainty whether it or leprosy is older, but given that they're both from the same Genus mycobacterium and both work somewhat similarly, it doesn't really matter which of them actually came first. Our most accurate estimate suggests that tuberculosis evolved sometime between 50,000 and 70,000 years ago, back when the human population could have been as small as 1,000. So, this is a disease that's been hunting us basically as long as we've existed, and in all likelihood co-evolved alongside us.

You contract tuberculosis when the bacterium reaches the pulmonary alveolus, the endpoint of the branches of your bronchi responsible for gas exchange, where they then begin to replicate immediately. M. tuberculosis replicates slower than most bacteria, but it makes up for this by being incredibly rugged; and as few as ten tuberculosis bacteria can replicate into active infection. People are introduced to the illness exactly like Arthur Morgan is, by being coughed on. Each cough or sneeze can release tens of thousands of droplets of blood and mucus that each carry the disease and breathing them in can spell disaster. And in the time and day of Red Dead Redemption 2, there would have been, like, signs like these that would have been warning people to avoid coughing and spitting to reduce the spread of the disease. Anyway, back to the lungs. [2:25-4:00: TB counter is now 10]

M. tuberculosis is covered in a thin, waxy coating on its cell surface that's made up of mycolic acid chains, and it's these acid chains that are the key to its resilience. And, horrifyingly, its dependence on our immune system to multiply. Like HIV, tuberculosis turns our own body's defenses against us. [cue the Yu-Gi-Oh! Reverse Trap card] As soon as our body detects the presence of M. tuberculosis in our system, it sends what's known as macrophages out to destroy them. Macrophages are the shock troops of the immune system, [cue Star Wars Shock Trooper head on macrophage] and they basically eat stuff that's not supposed to be in our body; however, when macrophages attempt to eat tuberculosis in a process known as "phagocytosis"---from the Greek phagein, meaning "to devour", and kytos, meaning "presence in blood"-- [cue AHAD head looking unamused] Wait... okay, no, that's the wrong show, and the wrong translation... kytos just means "cell", so, literally, "Cell that eats". Anyway, what happens is, the macrophage envelops M. tuberculosis, throws it in a bag filled with oxygen and acid in an attempt to basically melt it to death, but the waxy mycolic acid chains protect the tuberculosis bacteria from disintegration like its own personal Darth Vader; [cue Darth Vader going, "No disintegration!"] and it's here that things start to get out of control, because the bacterium just lives inside the macrophage and replicates over and over and over until it literally punches its way out like an alien chestburster, spreading hundreds of new tuberculosis cells throughout your body. It's here that we cross the point of no return. Once the bacteria has entered your pulmonary alveoli and bursts out of a macrophage, your chance of dying skyrockets to 66%. You now have an active infection and the clock is ticking!

But believe it or not, while you may think Arthur Morgan was doomed the instant he got coughed on by Mr. Downes, that's not actually true! You see, before tuberculosis progresses to an active stage, it has a latency period, where it can stay for years! A ton of people have tuberculosis and are asymptomatic, because the bacteria never gets to the alveolar air sacs. Up to 90% of people who get infected with tuberculosis never progress through active state. So, what made Arthur Morgan so lucky... or, I guess, unlucky? His life. [4:00-6:18: TB counter is now 15 (and-a-half)]

Everything he chose to do with his life was a risk factor for disease, and pretty much guaranteed that the instant he was exposed to the bacteria, he was going to not only get infected but die. The mortality rate for untreated active tuberculosis is at least 50%, but can be as high as two-thirds of patients; but there are a lot of things that increase your risk factors. People who smoke, for example, double their risk of tuberculosis infection, and Arthur is an avid smoker. A lot of it is up to player choice, but it's shown multiple times that he smokes on his own.

Arthur also drinks quite a bit, with an entire mission, easily the best part of the game, being dedicated to getting blackout drunk. This isn't an anomaly, and it in fact would be much more surprising if Arthur Morgan wasn't a bon vivant. In the 1800s, the average man [caption says, "Hi Jim!"] consumed seven gallons of ethanol (pure ethanol amounts, mind you!) per year, which translates into over four-and-a-half beers per day, or over 1,659 bottles of beer per year: over 155 gallons of beer per year! And you wonder why prohibition has existed! [6:19-7:32: TB counter is now 18]

Cigarettes and alcoholism both increase the risk of progression by a huge amount, because, well, cigarettes cause direct damage to your lungs, and alcohol can weaken your immune system and cause dehydration. In fact, all sorts of immuno-compromising conditions can increase your chances of tuberculosis progression (HIV is a major factor, but this wasn't a problem in America at the time of Red Dead Redemption 2, and probably wasn't a thing at all until the early 20th century); however, there's one big fat event that happens in Arthur Morgan's life that utterly and completely dooms him, and it's when he is shot, kidnapped, and tortured by the O'Driscoll gang in Chapter 3. Being shot with a gun and not being properly fed for days means he's going to be suffering from physical trauma and malnutrition, both of which increase the likelihood that his tuberculosis will progress. [ Rouvan's cover of "I Will Follow You Into the Dark" by Death Cab for Cutie plays in the background] Malnutrition suppresses the immune system, and physical trauma, even medical trauma from surgery, greatly increases your chance of getting all kinds of secondary infections, what's known as the "two-hit response". It's here, at this moment, that Arthur Morgan's fate is solidified; and it's telling that the first real cough that you see from him is after this point in the game. [7:32-8:48: TB counter is now 21]

This means that Arthur 100% caused his own death. No, he didn't know that smoking would make things worse and everybody at the time was drinking like a fish, but it was his life that put him in this position in the first place. His life, his choices... those put him in harm's way, and made his death inevitable. This is the core thesis of the Red Dead Redemption series: that choices have consequences, and a life of murder, violence, and crime has a price tag that can't be avoided; attention must be paid. And if he wasn't an outlaw enforcer for a loan shark, he wouldn't have been exposed to tuberculosis. If he wasn't living a risky life of constant violence with no time to rest at all, it's possible he could have recovered from his infection, or possibly not even progressed into active tuberculosis at all. Choices have consequences. And it's this realization that a life lived in a certain way has a price that drives Arthur's decisions and motivations after his diagnosis: to try to leave a legacy behind, to try to lift up other people out of this life. He knows his fate; he knows that the life he leads, one that doesn't allow for rest or peace, does not put him in the 34% survival bracket. From his diagnosis on, he knows what's gonna happen to him, and he accepts it. That's his redemption. [end of "I Will Follow You Into the Dark", and another song, "Can't Get Through to You" by Nemi, plays] [8:48-10:18: TB counter is now 25]

It's fitting that they used to call tuberculosis "the romantic disease", and it's a fitting end for an outlaw who led a kinda gray life. What's less romantic is that, right now, every single day, people on earth, our real world, die horrifically from tuberculosis. It's the single most deadly disease on our planet. It kills more people than HIV every single year! Throughout history, it's killed an estimated 10.7 billion people total, more than every war ever fought, HIV, ebola, the Black Death, car crashes, snake bites, and falling deaths combined! Right now, 25% of the entire human population is infected, and over 1.3 million of them will die.

Let me put this into a real number that you'll understand, at a glance. You see that counter that's been on the screen for this whole video? That's how many people have died from tuberculosis while you've been watching this. 27... people. Real... people! Because while tuberculosis has largely been eradicated in the United States with only 9,093 new cases in 2017 due to vaccines and antibiotics, most of the world does not have access to these treatments. In large sections of the world, if you get tuberculosis, you have no choice but to deal with it. And in some cases, even medication won't help, because tuberculosis has many antibiotic-resistant strains now, meaning our one tool for combating it has become obsolete! This revelation blew my mind! 1.3 million (MILLION!) deaths every year (!), mostly children and the elderly and those infected with HIV. That is absolutely horrible! And I honestly haven't been aware of how lucky I am to live in the United States in a long time than by learning this fact alone: Tuberculosis is one of THE #1 causes of human death, and is THE #1 cause depending upon how you count, and is absolutely the #1 cause in our entire human history; and I don't hear about it! Ever!

This is likely the first time you have heard about it. People get infected and can suffer in waves, for months, as their body heals a bit, recovers, and relapses, until eventually their lungs just stop working because they're too damaged and they suffocate! [10:19-12:47: TB counter is now 31 (and two-thirds)]

BUT, there actually is hope! Every day, people like TB Alliance are fighting to find more effective treatments for tuberculosis to hopefully undo the damage its growing immunity to antibiotics is causing, while charities like TB Alert and the Bill &amp; Melinda Gates Foundation try to bring existing treatments to people in need on the ground. Links to all three of these charities that I personally have added myself are in the description, and if you can give money, I definitely recommend that you do so. Even as little as a dollar can save a life, either today by getting treatment to those who need it, or ten years from now when a new treatment is discovered; because, we're all humans, on this planet together. We should do what we can to help those of us who are in need; like Arthur Morgan trying to forge a future for his adopted family, we should do what we can to help those of us who are in need! [caption says, "I literally noticed just now that I repeated myself. Imma leave it. I'm only human."] It doesn't take a lot! A little bit from a lot of people goes a long, long way to making a better world, not just a better world for us, but for those who are gonna come after we're gone.

Just something to think about.

Sincerely, Austin.

''[12:28-14:00: TB counter is now 35. Video shows a clip of one of the game's High Honor endings that depicts the protagonist, Arthur Morgan, gasping for breath as his head is turned toward the sunrise on the mountaintop, then letting out his final breath as his eyes close for the last time, his body becoming still and motionless, followed by a shot of a stag looking up from eating the grass and gazing toward the camera. Video ends at 14:29 with a total number of 36 deaths on the counter as the scene fades to black.]''