'No matter how well you've performed, you just have to move on to the next patient. Or the next book.'
VINCENT LAM, DOCTOR AND GILLER WINNER, TALKS TO KATE FILLION ABOUT PANDEMICS, CONTRACEPTIVES, AND HIS SURPRISE VICTORY
Q There were three flu pandemics in the 20th century, the most severe being the one in 1918-19 that killed between 40 million and 100 million people. In The Flu Pandemic and You: A Canadian Guide, you and your co-author, Dr. Colin Lee, write that another pandemic is inevitable, we just don’t know exactly when it will occur. What’s the difference between regular old seasonal flu and a pandemic?
A: Every year, several strains of influenza circulate and cause a relatively low, predictable rate of illness, and they’re typically related to strains that have circulated in human beings in the recent past. Most people have had some previous exposure, if not to those strains, then to similar ones. Pandemics occur when a strain of influenza that previously circulated primarily in animals, mostly in birds, manages to cross into humans and gains the ability to circulate easily. Because most people in the world have not had any previous exposure to strains like it, more people are more prone to be severely affected.
Q: Last year, everyone was clamouring for Tamiflu, but this year the level of hysteria about bird flu has declined. Is that because there’s less risk?
A: Both the panicked type of furor surrounding the topic last year, and the comparative neglect and lack of interest this year, are unjustified. A year ago, people were really going off half-cocked, misinterpreting the
existence of legitimate scientific and health concerns as a likelihood of that phenomenon actually happening next week. It’s true that the issues surrounding PI5N1, the strain of avian influenza people are most concerned about, were evolving last year, but it’s also true that they still exist right now.
Q: Should the average, healthy person get a flu shot?
A: Yes. One, because it reduces their likelihood of missing work; influenza is not like a cold, it involves muscle aches and being incredibly tired and staying in bed for days. Two, to reduce the chance of transmitting the virus to someone more vulnerable, like elderly relatives or very young children. People with ongoing illnesses like heart or lung disease, and people who are frail or elderly, suffer more serious consequences from influenza and are more likely to experience complications and also to die, so it’s quite plain to see that for them, getting a flu shot is a good idea. What’s really interesting is that people can be very fascinated by the prospect of a pandemic, which is serious and dramatic but also unlikely, and yet people cannot appreciate the risk that seasonal influenza causes every year.
Q: Will this year’s flu shot provide any protection in the case of an H5N1 pandemic?
A: It’s very unlikely, and the safe assumption is that it would not. But one of the key stumbling blocks once a pandemic comes will be not only the creation of a vaccine, but the mass production and distribution of it,
which requires a complicated infrastructure. Right now, only a tiny fraction of people in the world get influenza vaccinations—so the network is vastly insufficient to meet the potential demand during a pandemic. By getting a vaccination, part of what you’re doing is building a commercial incentive that will make it easier for companies to mass produce and distribute a vaccine during a pandemic should the need arise.
Q: But some Canadians don’t even believe in vaccinating their kids against measles. How do you convince them to get the flu shot?
A: One thing SARS taught us, and one thing anyone will realize if they visit a country that doesn’t have a good comprehensive vaccination program, is that infectious disease is very real. Most people have never been witness to the effects of rubella, for example, and consequently don’t feel it’s a real phenomenon. But it is, and it causes very serious health problems. I do think it’s worth noting that flu shots are universally available, free of charge. These are times when costs are constrained. If the government is offerg ing something for free, they must have a S good reason for it. Q
Q: What can individual families do to prepare for a flu pandemic? g
A: They should have some kind of plan for > emergencies in general, be they ice storms g or hurricanes, and the preparations are really the same as those for a pandemic. Canadian g families should think about having a stock& pile of food—we suggest a month’s worth. A S
generation ago, it wouldn’t have been unusual at all to have two months of food in the larder, if you could afford it. But now we have a just-in-time delivery society that counts on being able to get things at the last minute. If there’s a disruption in supply chains, and the next pandemic could well cause significant social and economic disruptions, it would be a good idea to have some food in the house.
Q: Your plan in the book is so detailed, right down to the level of suggesting people keep a large supply of contraceptives handy.
A We’re all about detail!
Given everything that might be going on during a pandemic, you might want to think about whether that’s the ideal
time to procreate.
Q: How will medical resources be rationed in a pandemic?
A: There will be very tough medical decisions as well as ethical decisions. Antivirals such as Tamiflu pose a particular problem. Most of the evidence points to the conclusion that if they’re useful at all, they may be more useful in terms of prevention than treatment. If you have a limited supply in a public system, does it make more sense to provide preventative treatment for essential services workers—health care workers, police, electrical and utility system workers— or to use antivirals to treat illness?
Q: You don’t advise laying in a personal stockpile.
A: Absolutely not. For one thing, it’s expensive.
Q: And if it turns out to work best as a preventative, you’d need a lot of it, right?
A: You would need enough to last until you can reasonably expect a vaccine to be developed, which is to say, a minimum of eight to 10 months.
Q: How would a flu pandemic stack up against SARS?
A: SARS was a logistical nightmare, and threw us for a loop as a system. But it actually affected relatively few people in terms of the final number of illnesses and deaths. An influenza pandemic would affect a much larger percentage of the population. One of the big differences is that with influenza, in the day before a person has any symptoms at all, they may already be highly infectious. With SARS, people were shedding the most virus and were most infectious about 10 days into the illness, when they were already quite ill. That’s one reason it could be more easily contained, you could see that they were sick. There are some things which people expect in a pandemic, and in a scary way, almost fantasize about, like enforced quarantines and signs nailed on the front door telling
people not to go in or out. The reality is that we probably won’t see those, because the success rate of enforced, individually directed quarantine and isolation in the past pandemics simply has not been borne outinfluenza is too infectious, and people shed virus before they know they’re sick. Once an influenza strain hits the general community, it’s almost impossible to completely stop its progress. What will likely be possible is to slow down and limit its progression by asking people to stay home, voluntarily.
Q: How do you shed the virus, exactly?
A: It comes from your mucous membranes, typically: your nose, or mouth or perhaps from rubbing your eyes. A person coughs or sneezes, and a virus-containing droplet flies out and lands on another person, or an object like a table or an elevator button. It only travels about a metre, but the droplet, depending on temperature and humidity, could survive a maximum of about 48 hours. A lot of people can touch an elevator button in the meantime, but the thing to understand is that you don’t get influenza from touching the button—you get it from touching the button, then touching one of your mucous membranes, scratching your nose or rubbing your eyes. This is why handwashing is so important, you can prevent that indirect transmission.
Q: You published two books this year, including Bloodletting & Miraculous Cures, which won the Giller Prize, and you’re currently finishing a novel. You’re a practising emergency physician. And you have a two-year-old. Do you have any hobbies?
A: The short answer is no.
Q: In your fiction, you’re very interested in relationships. But emergency medicine seems kind of like a one-night stand.
A: Well, literally, because we’re there at night. I love being thrust into a new situation 30 times a day. There’s something upfront and kind of wild about emergency medicine that makes it both tiring and, frankly, kind of addictive. I certainly do miss the ongoing sense of follow-up and knowing what happens with patients. But it’s okay. I have a vivid imagination.
Q: Has your medical training helped you as a writer, beyond providing subject matter?
A: Medicine has taught me that it really doesn’t matter how well you’ve performed. Someone will always be dissatisfied or unhappy, either for a reason you couldn’t do much about, or for a reason that’s simply untrue. And you just have to move on to the next patient. Or the next book.
Q: What did you think of the other books on the Giller shortlist?
A: I had a moment reading each of the books when I thought each one should win.
Q: Come on. That’s your safe media answer.
A: No, I’m serious. Anyway, I didn’t think I would win. First collections of short stories don’t win the Giller. I’ve really been struck by lightning in terms of good fortune.
Q: Did your parents encourageyou to write, or did they want you to become a doctor?
A: My parents very strongly encouraged me to be a writer—after I became a doctor. I come from an immigrant family but I was rarely, counter to stereotype, directed this way or that way. I was more, nudged. I do remember being advised that first I should work on some way of putting food on the table, then I could do what I wanted. Also at 14 or 15,1 won a short story competition, and the prize was attending a writing course. The teacher was [fiction writer] Jane Urquhart, and much to my amazement, at the end of the course, she sat me down and said, “You know, you have talent, and you could prob-
'During a pandemic, you might want to think whether that’s the ideal time to procreate’
ably do this, but I strongly encourage you to go out and get a job.”
Q: Why do you think she said that?
A: I don’t know, maybe she was having a tough year. It just made me think more about p writing, though. ^
Q: Does being a writer help your doctoring? > A: Actually it does, because being a writer § makes me listen for story. And if you can do u> that, you can get the diagnosis about 95 per ^ cent of the time. But I’m probably more JJj gifted as a writer. Being a diagnostician just ^ requires a lot of work. M Z
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