May 19, 2020 – Dr. Daniel Kalla, “Pandemics: Then and Now” – VIRTUAL MEETING

Question: What are the lessons from Covid-19 going forward?

Answer: You know, I think we’re learning them by the day, but it’s funny because, first of all, I think we’ve learned so many mistakes. So many governments have mishandled the Covid-19 crisis. Clearly some countries have done better, and some countries have done worse. The WHO which is under attack, as you know, by the Trump Administration and other places, clearly share some of the blame. They arguably didn’t respond quickly enough, but I think the one lesson we can learn is that when we get a warning from the WHO and the CDC that we need to respond quickly through it. I think every country that put social distancing and that put strict measures in place quickly, countries like South Korea which were so good about testing and so good about tracking cases, proved how you could limit the spread of this pandemic and other countries who didn’t are really paying a terrible, terrible price right now.

So, you know, I’m not an expert on these. These are just my opinions, but I think the other thing is that the medical community could have been more prepared as well. I mean, we’ve had a pandemic plan for as long as I’ve worked the emergency department, but no one’s dusted it off in 25 years. Nobody’s looked at it. We should have known this was coming. We should have been prepared. We should have stockpiled PPE and all other things, and I hope forever more will take this lesson. Covid-19, the Spanish Flu, they were not a fluke. A fluke is that we went a hundred years without seeing a terrible pandemic.

Question: Will your next story have a Covid-19 storyline?

Answer: I am so sick of Covid-19. I am so sick of pandemics. So, I hope I don’t break my word to you when I promise you that my next book will not be about Covid-19 or a pandemic. Actually, I know what my next book will be about. It’s about vaccines and the anti-vaccine movement. So, hopefully, you’ll hear a lot more about that if I ever come back and see you guys again.

Question: Why does it appear that law enforcement is unable to shut down the fentanyl labs in Vancouver?

Answer: Well partly because the criminals are so sly and partly because it’s so easy for them. First of all, fentanyl wasn’t even illegal in China until about two years ago. You can order by mail up to a couple of hundred grams of Fentanyl and they won’t even check the mail when it comes in. It’s like dealing with a rat infestation. Every time you stomp out some rats and control one infestation, there’s a hundred to take their place. This is such a profitable business for the criminals. They’re so short-sighted. They don’t care that they kill their clients. All they care about is the huge amount of money they make and it’s so easy for them to set up these crappy little labs and print out their pills.

What has to happen to really stop the criminal side of fentanyl is:
a) decriminalize opioids, I believe, but
b) stop the supply. Prevent it from coming in from China and Mexico and until they do that, they’ll never end the opioid epidemic.

Question:  With Covid-19, is there a concern that overdoses will not be ventilated?

Answer: Well, certainly not in Vancouver. You know, our ICU capacity was so underused thank God during Covid, at one point, only 23% of our ICU beds were filled a couple of weeks ago and that’s for all comers not just Covid patients. We were so lucky in BC to escape the worst of it. So, we’ve had so much capacity to ventilate whoever we need to. Maybe in New York it would have been a concern a month ago, but even they never exceeded their ventilator capacity.

Question: How do you compare the approach of Sweden to the rest of Europe with Covid-19?

Answer: Well today a story came out that the rate of ventilated patients and deaths in Sweden is the highest per capita in Europe this week. As most of you know, in Sweden they decided to take a more permissive approach and keep schools open and limit social distancing to on a personal basis. It’s been the grand experiment, everyone has been wondering how it will turn out. It really hasn’t turned out that well.
If you compare Sweden to Finland, Norway, and Denmark, their nearest neighbors, they have 10 times as many cases per capita and ten times as many deaths so, I would not endorse the Swedish model at all.

Question: With all the mixed messages, should we be using masks when we go out?

Answer: That’s a great question. They think in the US the one thing that stopped a lot of the spread is masks. As probably most people know, masks do more to protect other people from the virus than yourself from the virus. But certainly if I had any medical conditions, if I was concerned, I’d wear a mask. Why not? It’s easy and everybody should be able to get their hands on one. But I think, if somebody points it out, Bonnie Henry says, “it’s a personal choice” and I agree with this.

Question: When did you perceive that the outbreak in Wuhan could spread around the world?

Answer: I didn’t actually. I mean I thought it would spread but I didn’t think it would turn into a pandemic until about February. Interestingly, I was speaking at UBC two months ago when it was just beginning to peak, and I was with an excellent public health epidemiologist who also spoke with me and she didn’t predict it either. No one really did, I don’t think. Even the people truly in the know didn’t see it coming as bad as it came.

Question: There’s evidence that the Spanish Flu might have originated in China.

Answer: There’s a lot of truth to that. It’s certainly possible. It’s also possible that it originated in the US at a military base. Where it didn’t originate was in Spain. There’s a complicated history of why it got called the Spanish Flu. It got to Spain, but it certainly didn’t start there.

Question: What are the benefits of Health Care experienced from Covid-19?

Answer: That’s a good question. I think we’ve learned a lot. We learned to be facile and quick on our toes. Like in my emergency department, you wouldn’t believe how quickly we created hot and cold zones, how quickly we separated spaces between patients. We really rejigged our entire emergency system in a couple of days and that happened all over the world. You know, human resourcefulness and innovativeness when we’re facing an existential threat is really quite impressive and I think if we could apply that flexibility and not be so set in our ways we could improve a lot of things about the Healthcare System.

Question: How could the virus survive if we hypothetically have completely locked down for 2 months? It can’t exist outside live tissue.

Answer: That’s true. Viruses do not live on their own; they need a human host or whatever animals they live in, but in this case a human host to keep living. But the point is as much as we did social distancing, we never truly quarantined all of society. You would have had to shut down society, not cared for the people who needed it in long-term care homes and prisons, not provided food or gas or anything. The idea of completely quarantining the world for two weeks to stop it from spreading is too extreme. Too many people would die of too many other things. So, the truth is, all we’ve done is social distance, we haven’t quarantined society. When an outbreak is spreading silently and you don’t know exactly where it is, it will keep spreading in spite of social distancing. Social distancing just flattens the curve. It doesn’t stop it all together.

Question: Should we have moved seniors in care homes to hospital as soon as they tested positive? So many have died in the care homes.

Answer: Well, the truth is they would have died just as quickly in hospital.  For those patients, once they have the Covid virus, with all their comorbidities, all their other sicknesses, they would have died. Quebec is a disaster because almost all caretakers worked part-time in a nursing home and then moved from one nursing home to another, and they’re just vectors of the disease spreading it around. We should have had much better standards where people aren’t allowed to work in multiple care homes. The patients in the care homes are separated better. There’s tons of learning. It’s tragic what’s happened to residential care for seniors in the world. They are by far the biggest victims of this virus.

Question: Is the US approach referred to as “just taking the punch”?

Answer: Well, there’s some people in the US I’d like to give a punch too, but I don’t know if that’s the term. The US truly has never been as extreme as Sweden or as lax as Sweden about their approach, but I think it’s the inconsistency and the slowness of their response, and the misinformation that comes out of the White House, and the confusion that’s led to so much of the issues in the US.

Question: What surprised you about Covid-19 relative to what you knew when you wrote Pandemic?

Answer: You know, with all my soapbox espousing I shouldn’t have been surprised by this at all, right? I said another Spanish Flu is coming several times in Pandemic and other books and yet I was as surprised as anybody when this showed up. I can’t believe how insidious this virus has been, how its incubation period can be for days to weeks, how many different forms it takes, how many hosts it can hide in… It’s just a perfectly awful virus for causing the economic, social, and health crisis that it has.

Question: Do we need a Trump to have the wisdom to close the border to China and Mexico?

Answer:  You know, obviously, I have a different viewpoint on Trump. The truth is, in New York, for example, they’ve done genetic testing, and most of those cases did not come from China, they came from Europe. So, shutting the border to China, and none of the cases came from Mexico, so, shutting the borders to China was not what would have prevented the virus, and it’s why the US has the worst outbreak anywhere in the world. It was European cases that caused the crisis in the US.

Oh, I’m sorry! Jan corrected that she was talking about the opioids from Mexico and China. Yeah, I don’t know how you close the border. Half of our products, half of our manufactured and bought goods come from China. It’s not so much tourists and people bringing it in, as it’s shipped in containers and other things. So, I don’t know how you can stop the opioids that way. I mean, what you do is with better border control, with stricter measures in China for stopping the factories that produce it. I don’t think you can just stop the flights and hope to stop it.

Question: What’s the greater risk – airborne transmission or Covid-contaminated surfaces?

Answer: Well, technically Covid isn’t airborne. It’s what’s called droplet. Airborne is something like TB or Measles where the virus is so small that it can get in the ventilations system and spread around the building. Covid can only spread about six feet when it’s in the air, but it’s very contagious. It is spread through sneezes and coughs. Apparently sneezes are worse than coughs for spreading Covid. I just heard today, coincidentally, that it’s much more contagious when it’s spread through the respiratory or on people’s hands. I mean the truth is that most viruses are spread from hand-to-hand touching, but it is apparently more contagious from human-to-human than it is on any contaminated surface.

Question: Is it true that in Israel, 75% of people survived on a ventilator compared to 15-20% here?

Answer: That’s not true at all. The survival rate in Vancouver on ventilators was 93%. So, 9 out of 10 people who’ve been on ventilators have gotten off the ventilator. Vancouver has done a terrific job. And in Canada, it’s upwards of 80%. In Italy, at its worst, the survival rate was 50% but they’ve learned so much more about how to better decide which patients to ventilate and how to manage them better. So, we’ve made huge strides. Israel has done very well fighting the pandemic but so has Canada, particularly on the ICU Critical Care side. The survival rate is very impressive. Most of the people you hear about dying in Canada, are what we call the DNR, the no code status, where they’re not to be put on a ventilator in the first place.

Question: I appreciate your criticism of the Swedish approach, don’t we have to wait a year to decide if it was or wasn’t the right thing to do?

Answer: You could well be right. I don’t know. I think it’s already proving that it’ll be the wrong thing to do. The thing about this virus is that it grows exponentially. I do not believe that Sweden is going to establish herd immunity and protect everybody. When they looked at studies of New York in the worst hit areas of New York and did blood testing for antibodies, only 20% of the people in the hardest-hit epicenter of the epidemic were positive for Covid antibodies. That meant that 80% were still vulnerable. That’s nowhere near herd immunity. You need to get to 80% or 90% of people who have had it and developed antibodies before you get herd immunity. And the way to herd immunity ultimately will be a vaccine, we hope and pray. So, I don’t think the Swedish model is going to accomplish that

Question: What’s the best way to spread the message about film options?

Answer: Well, if any of you know, Steven Spielberg or others that would help! The truth is that I’ve had my books optioned several times, a few of them, the Shanghai Trilogy, which some of you may or may not have read, is now under serious option to try to be developed in an extended tv series, but I’ve been disappointed so many times by the film business. I’m like always the bridesmaid when it comes to film and TV, so I don’t count on anything. But you know, I won’t give up hope. I’ll keep you posted, I promise.

Question: Could Covid have developed randomly by nature or careless biological experimentation in Wuhan labs?

Answer: So, again I’m not an expert, but everything I’ve read suggests that first of all, it’s very hard to genetically engineer what’s called an RNA virus. It’s never really been done before and there’s tons of evidence that that the virus emerged in the wet markets in Wuhan which are under terrible control with all the cross-contamination of species, but there’s not a lot of suggestion that it emerged from a laboratory. Some people think it might be a naturally occurring virus that was contained in a lab and leaked out. Even that I don’t actually believe. I think there’s a ton of conspiracy theories around this. I think these viruses emerge naturally all the time. There’s something like a thousand coronaviruses in various animals that have never made the jump to humans at any given time. So, I don’t believe that that you need a laboratory to create this. They use bats in a Wuhan lab that may be true, but they also have bats in the wet markets of China. It’s my belief, and I don’t pretend to make myself or to represent myself as an expert on this subject, but I don’t I believe that occurred naturally.

Question: Is the number we can rely on for the deaths real, because we don’t know who is being tested and how many are not tested?

Answer: That’s such a good point. When you looked at that slide that said there were 4 million cases and 300,000 deaths, don’t for one second think that 8% or 10% of people who get this virus die. I think we’ll find out that there’s 10 times as many people with this virus as we know. We haven’t tested everyone. And death is the one accurate measure. Death, ICU admissions, and hospital admissions. We capture all of those people. So, I think we capture those people accurately, but I honestly think that there’s way more cases than we know about. So it means the mortality rate is much lower than they suggest, probably 1% or 2%, but it doesn’t help the 400,000 people who are going to die from this virus and it doesn’t help the most vulnerable people to this virus.

Question: What happened to the non-Covid volume in the ER?

Answer: Our volumes plummeted in the ER. Everybody stopped coming to the Emergency. In Vancouver, we were down about 50% and we were actually quite worried. I mean, we knew people weren’t going outside and getting injured, but we thought people were having strokes, and infections, and other things at home and were too terrified to come into the hospital. I think we’ll find out that a lot more people died at home during this Covid. It’s not just the opioid crisis. I told you about that collateral damage already, but this has caused so much collateral damage. All the people with cancer and other issues, and hip replacements, and heart disease waiting for urgent surgeries that have been put off, the economy, the mental health crisis this is going to cause… The collateral damage has been enormous from this virus and I think sadly we’re just seeing the tip of the iceberg with that.

Question: Have you seen a Kamikaze case?

Answer: I’m not sure I’ve heard that term. I haven’t seen anything like that with Covid.

Question: Can you touch on Kawasaki disease that kids get?

Answer: Kawasaki disease – some kids get this what’s called a vasculitis or inflammation of the blood vessels. No, we haven’t seen many kids at all with Covid in the hospital. Kawasaki’s disease is incredibly rare. I don’t think even at Children’s Hospital they have, I go to regional meetings and I haven’t heard about any. The only reason they picked it up in the US is because they had five or ten cases in New York, which is five or ten as many as they were expecting. It’s not like they had an epidemic of Kawasaki’s disease. The truth is that kids can carry this virus and they can die of it, but for the most part they do better than the rest of us with this virus. This virus is very age-specific. The older we are, the worse it targets us.