Q&A: Dr. Michael Gardam, infectious disease expert and Zika virus skeptic

Q&A: Dr. Michael Gardam, infectious disease expert and Zika virus skeptic

Our Six in the Six interview with the University Health Network's director of infection prevention, who thinks now is a perfect time for a Caribbean getaway

(Image: Courtesy of Michael Gardam)

Flu season got real this month, as Toronto Public Health announced that the city is on the “brink of an epidemic.” But what does that actually mean? And isn’t Zika the bigger worry? Dr. Michael Gardam, director of infection prevention and control at the University Health Network, talked with us about epidemics, the flu shot’s flaws and why non-pregnant people may want to consider a Caribbean getaway.

Assuming that I am not a pregnant person going to the Caribbean, do I need to be worried about the Zika virus?
No, you don’t. And in fact, you can get really good deals on travel to the Caribbean right now. Most people who get infected with it don’t even know they’re infected. Zika causes mild aches and pains, a bit of a rash, a bit of a headache—if that. No one has ever died from it. It’s the whole issue of microcephaly in infants that has made this such a big deal and such a scary thing. I guess one point that I would make is that researchers haven’t proven the link between Zika and microcephaly. They found the virus in some babies, but not all of the babies, so they’re working towards proving that link. Just because the two things happened at the same time doesn’t mean one caused the other.

So if I were a pregnant woman planning a trip to the Caribbean, would you recommend that I cancel?
At this point I think it would be very hard to ignore the Centers for Disease Control recommendation. When the CDC issued a travel warning a couple of weeks ago, my take was that is that it’s important to do these things when there’s a concern. The last thing you want is to find out the CDC had been worried for six months and didn’t say anything. Still, I think it’s important to point out that we still don’t have any idea what the risk is. If you were pregnant and going to Brazil and you asked me what your risks were, I wouldn’t be able to answer. Nobody would. We still don’t know if we’re looking at one in ten, one in a thousand, one in a million. I think a lot of pregnant women are inclined to take precautions regardless of actual risk. A lot of pregnant women don’t take Tylenol, they stop drinking coffee, they do all sorts of things. I would say that right now Zika is in the same ballpark.

Last week Toronto Public Health declared that the city is on the brink of, and I quote, “a flu epidemic,” which sounds like the beginning of an end-of-days movie. Is it time to start stockpiling canned food and placing our homes under protective bubbles?
It does sound like that, doesn’t it? But it’s not. The thing that has been unusual about this year is that we really hadn’t seen any flu until about a week ago, so that’s why we’re hearing about an epidemic now. Aside from that, this is just your regular, garden-variety flu season.

An epidemic is different from a pandemic. A pandemic is when a new strain emerges and it’s spreading around the world and there’s not a lot of pre-existing immunity. The last time we had that was in 2009 with H1N1. I think the problem is that the word epidemic has very different meanings in the public’s mind versus what it means to epidemiologists.

It seems like maybe the point is to freak everyone out a bit.
In public health, we need to be very careful about our messages. If you use scary language or language that people don’t understand, often you’re just creating hype. If you look at when we had cases of measles in Ontario a couple of summers ago, it was seventeen cases out of 13.5 million people—but as a headline it was major and the message was that if you don’t get your kid vaccinated, basically you’re a bad parent and your child could die. That was coming from the media, but also occasionally from public health officials, and it was misleading. The mortality rate of measles in a country like Canada is one per thousand, and seventeen people got it.

Speaking of vaccination. Is there any point in getting a flu shot this late in the game?
Honestly, no. If you’re going to go out and get a flu shot, get it earlier in the season, by the beginning of December, so that you have time for your antibodies to kick in. Even if you were to run out and get it right now, your antibodies don’t kick in for about two weeks, and by then we’ll probably be past the epidemic.

What would you say is the least understood fact about the flu and also the most widely held fiction?
The majority of people who come down with the “classic flu”—the headache, the chills, the aches and pains and cough—don’t have it. They have RRSV, they have Corona viruses, they have any one of these of these other viruses that cause flu-like illnesses and clinically they look the same as influenza. The most notable fiction is around the flu shot. I get it every year, I think that’s the reasonable thing to do, but I don’t rely on it. It’s a meh vaccine.