During this global pandemic, do you want to hear directly from a medical doctor who specializes in infectious diseases? We did.
While stuck at home inundated with COVID-19 news, we thought it would be nice to learn from and get to know one of the people on the front lines.
Join us for an interview with Dr. Vijai Bhola where we talk about the history of vaccines, the current response to this outbreak and some positive words to help our anxious minds.
Image credit: CDC/ Alissa Eckert, MS; Dan Higgins, MAM
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– [Dr. DeGraaff] Welcome to Spark Science. I’m your host, Regina Barber DeGraaff, an astrophysicist in the Pacific Northwest who, like the rest of you, is spending a lot of time indoors during this global pandemic.
During these certain times, I thought it’d be a good idea to call up an expert in infectious disease, Dr. Vijai Bhola. He joined us remotely to talk about the history of vaccines, this pandemic and COVID-19, and the reality of outbreaks in films.
Because of our ever-changing landscape of this international crisis, this is the fastest turnaround we’ve ever done in Spark Science history. Most of our shows don’t air until months after the interview, which you’ll notice for the rest of the season. But this show was produced within days thanks to our amazing crew! We hope you enjoy our discussion with Dr. Bhola while you’re at home during your part to flatten the curve.
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– [Dr. DeGraaff] You are an infectious disease fellow. Tell us what that entails, what your job entails right now. And then we’ll kinda get into some questions of what our listeners probably have right now.
– [Dr. Bhola] (laughs) Well that’s an interesting question because that’s sort of two different questions—what an infectious disease fellow is and what infectious disease fellows do during the time of the greatest pandemic we’ve had in 100 years are two slightly different things.
– [Dr. DeGraaff] Yeah.
– [Dr. Bhola] I’ll attempt to address them both. So after specializing in internal medicine for example, you can choose a different specialty. So my choice is infectious diseases. It’s usually done as a 2 to 3 year program where you spend most of your time focusing on taking care of patients within your first 2 years.
You can do some research in there, especially 3 year programs. So we’re around in the hospital, we see patients, we take care of patients, we give advice, consulting patients, specifically how to manage patients with infectious disease and issues.
At a time like this we, you know, it’s all hands on deck. And we—the infectious diseases department as a whole is very much involved in figuring out how do we best manage this tremendous challenge that we have to face as a healthcare system.
– [Dr. DeGraaff] I’d like to kind of go over what kind of virus this is.
– [Dr. Bhola] Viruses in general are microscopic (laughs). They sort of basically have types of DNA or RNA. They basically work by injecting their genetic material into the
host and using the host’s cells to generate the viral genetic material. So they sort of use you to take over production of their progeny…
– [Dr. DeGraaff] Right.
– [Dr. Bhola] …which often virus, many viruses they just live with us for life and we would never know. And there are some viruses like this virus that is a very deadly pathogen. So the coronaviruses are a group of RNA viruses. And they particularly call respiratory tract infections.
So there’s some similarity between this particular virus, for example, and SARS which, you know, is a different type of coronavirus. So they’re just one of these groups of viruses which has a propensity to cause respiratory illnesses. And this one just happens to have two skills that are particularly adept at causing human disease which is the ability to spread rapidly and the ability to cause disease and death.
Many of the viruses that we have seen, you know, swine flu, bird flu—terms that they don’t use anymore because it has created a lot of problems in the past. But it does sort of hint at the fact that all of these viruses originate from animals. They are viruses that exist and then it just takes one mutation, human or animal contact to sort of absorb that mutation. If it jumps into a human, it can cause pretty significant disease, as this particular virus does.
It’s absolutely fascinating how these organisms that are with us cause disease outbreaks—just the pathophysiology of it, the biology of it. It’s just absolutely fascinating from a biological point of view. To a great extent more than other diseases, infectious diseases are very much related to social, political, and economic situations.
– [Dr. DeGraaff] Right.
– [Dr. Bhola] So for example, crowded impoverished situations are really ravished by an infectious disease way more than a fairly wealthy type setting where just simply the space between human beings is present. You know, the Plague of Antonine which was somewhere around 164 AD was something that arrived in Rome by Roman legionnaires who were coming back from conquering Mesopotamia which is where Iraq and Iran are.
And you know many scholars sort of say that this was the beginning of the end of the Roman Empire as we know it. This was the end of Pax Romana which was 200 years of Roman peace. And basically this plague just wiped out maybe 5 million people—25 percent of the population which led to the decline of the Roman Empire.
– [Dr. DeGraaff] Wow.
– [Dr. Bhola] We don’t of this, you know, now. Even we live in the continent of America from you know Alaska all the way down to Chile. What we don’t understand is part of
the reason this part of the world was conquered so effectively was that there was a fairly advanced civilization at the time. But probably 90 percent of the indigenous population all the way from Inca-Aztec territory to the Mississippi Valley was just wiped out by disease before even European settlers came to conflict with them. This was part of the reason why this conquest of this continent was so simple. And so the historical understandings are just absolutely fascinating.
And what is interesting when we see something like coronavirus happen is that we realize as much as we are modern, powerful, etcetera, we are connected. We are human beings and our actions interact with each other. It’s not okay to say this is a segment of the population that’s poor; we don’t need to care about them. Things like Ebola, things like coronavirus make us realize that we need to all cooperate.
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– [Dr. DeGraaff] I’m assuming you were interested in medicine when you were growing up. Like were you thinking of plagues wiping out a civilization?
– [Dr. Bhola] Me doing medicine was a complete accident. I just like biology in general. In Trinidad, there is—where I’m from, if you choose a field that goes straight into the straight sciences, there aren’t necessarily as many opportunities to do research as, for example, if you do medicine. So I had the opportunity to do medicine. But I turned out to like it quite a lot (laughs).
– [Dr. DeGraaff] (laughs) Well and, I mean studying infectious disease, I feel like it is very much of a researcher kind of—I feel like you’re still kind of studying biology, right? Like you’re still kind of in that world.
– [Dr. Bhola] It definitely is. It definitely is very biologically. You need to understand biology. But what’s interesting is that you can take infectious disease and go straight into a bench type sciences. Or you can be a clinical person who sees patients. Or you can be a public health person who’s out there in the field with Ebola research and, you know, emergencies and outbreaks, and managing finances for health-related concerns. So the opportunities are really really endless. It’s really—it gives you amazing opportunity, breadth and depth of scope.
– [Dr. DeGraaff] So, I mean, you had said this earlier, this idea of—people kind of don’t realize what infectious diseases have done to populations over time, and like how that’s actually shaped our history. Can you share with our listeners any other like, you know, really impactful story that maybe you tell a lot related to infectious disease? If people don’t really relate to their lives now or the history they know of now, you know?
– [Dr. Bhola] Right. I, you know, I like to think of us as being this human species as being sort of a latecomer. So bacteria have been around for like 3 billion years. Viruses have been around for like, you know, 1 billion—very, very rough numbers because it changes.
– [Dr. DeGraaff] I’m an astronomer. I go like, 5 billion, 2 billion. They’re the same.
– [Dr. Bhola] Right. Billions. Let’s just say billions!
– [Dr. DeGraaff] Right, right, right!
– [Dr. Bhola] Human beings as we know have been around for no more than 300,000 years. Like, and that’s being generous. You know, we learned to speak 50,000 years ago. So we came and we’ve evolved with bacteria and viruses in us. And they change. They are part of our biology. They’re on our skin. They’re in our guts. And they change based on our mood. It’s really impactful.
And they have limited human populations for a vast majority of time. We, you know, we lived as hunter-gatherers. We lived as bands of places where diseases can destroy us. And as we started to get in groups, you know, the larger the groups, the more susceptible you are to bands of diseases.
At this point, you know, within the last 100 to 200 years we’ve been able to control these things a bit more. And if we did not, our world and our life would be very different.
If polio and smallpox were still real possibilities as they were in, you know, and generation or two ago, we would have people who looked different, people who walked different. Many more people are cripples, pock-marked, disfigured individuals. You get a bad pneumonia. You could have a fistular with just draining puss out of your chest. You could have bones that drain puss because you already have a deep-seeded infection. We would physically look different as a species.
You know, we complain about acne which is related to infectious disease. It’s related to propionic bacteria which causes pimples.
– [Dr. DeGraaff] (laughs)
– [Dr. Bhola] We would not more problems with infectious diseases than just…
And you know, we need to understand that. We would be like a much more disfigured population without some of these tools that we have such as vaccination, for example, to keep diseases under control.
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– [Dr. DeGraaff] you’re listening to Spark Science with our guest, Dr. Vijai Bhola, and we’re talking about what makes a “successful virus.”
– [Dr. Bhola] What’s fascinating is that you can dig into history and vaccination goes way beyond, you know, Edward Jenner who’s considered the founder of modern vaccination.
And you have to understand, these times people thought diseases were a plague from God and this dark death that you literally had to be afraid of, the way we are afraid of war or crime now.
Their practice, what they noticed was that if they took the scab of someone who healed from smallpox, ground it up, and basically blew it into the nostril of well person, they did not seem to get smallpox. They did not seem to die of smallpox. So that had been practiced for a very, very long time, some years in China, maybe some in India. We don’t even know when it really, really started. I don’t think there’s evidence.
– [Dr. DeGraaff] Wow.
– [Dr. Bhola] Modern vaccination, however, started in 1796. So Edward Jenner, who’s considered the founder of modern vaccinology, he was an interesting individual. He was actually invited to go with Sir Cook’s second expedition, but he declined because he was sort of a biologist type person first. So he’s someone who really thought outside the box.
And what he noticed was that the milkmaids who worked with cows (laughs), cause that’s where milk comes from—they would get these pock-marks from cows. So it would be called cowpox.
– [Dr. DeGraaff] Right!
– [Dr. Bhola] Now what he noticed is they had these pock marks, but the milkmaids did not seem to suffer from smallpox.
– [Dr. DeGraaff] Hmm.
– [Dr. Bhola] Maybe other people suffer from smallpox. So he began to think, does exposure to cowpox protect you from exposure to human disease that would cause smallpox? So what he did is he got a 13-year-old boy…
– [Dr. DeGraaff] Yeah…
– [Dr. Bhola] (laughs)
– [Dr. DeGraaff] Cause that’s what you do! They didn’t have any of the ethical regulations that we have now (laughs).
– [Dr. Bhola] He would go to jail in like (snaps) in a heartbeat if he did this now. And he basically took a needle and pricked the pocks of one of the milkmaids, and inoculated that by sticking that same needle into the skin of the boy who developed some cowpox-looking symptoms. And then later, he inoculated him with actual smallpox and noticed that he did not develop the full blown disease of smallpox. And he repeated
that experiment a few times.
And that’s basically the founding principle of modern vaccinology and how science works. You need to just do something once. If it works, you know it works. That’s an anchor. You figure out the principles around what makes it work. And then you can build around that principle. So it started with cowpox and smallpox, and now we have, you know, protection against—vaccines against malaria, etcetera.
And we sort of take it for granted that when there’s an Ebola outbreak, we’re like, “Okay we need a vaccine!” This is because we understand intuitively that these things are very, very important.
– [Dr. DeGraaff] Yeah.
– [Dr. Bhola] But at the same time, there is a bit of this, you know, flare vaccines that seems to be very unfounded. Firstly, if your children are not vaccinated, you probably would not have all of them survive an (inaudible) to begin with. That’s just the reality. Vaccination is single-greatest accomplishment of medicine. And you know, there just isn’t solid anti-vaccination literature.
Probably the kids who have autism, what is believed in many scientific circles is that the timeframe that autism is noticed just happens to coincide with some of the schedules of big vaccines. So they just happen at the same time, but there’s not a cause and effect relationship.
– [Dr. DeGraaff] Because it’s a developmental scale.
– [Dr. Bhola] Exactly. It has to be something that has to be in utero. Something that we don’t understand. By focusing on blaming vaccines for other problems, we don’t put the resources into figuring out what actually causes those problems.
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– [Dr. DeGraaff] Our history is filled with like us trying to tackle these big things. It’s just we haven’t done it in these quick moments, right? They’ve been like decades of work. But as a medical professional, how close is what we’re dealing with right now to any movies that exist? I’m just gonna go into pop culture! I’m gonna do it (laughs)!
– [Dr. Bhola] (laughs) It’s really not close to movies. Cause what people like in movies are like, you know, that big movie where you just see someone with the disease and you drop dead. That is stuff that, you know (laughs)—someone walks into a room and you drop dead. A virus that does that is actually an unsuccessful virus.
– [Dr. DeGraaff] Right.
– [Dr. Bhola] That virus fails at life because it kills you before you can spread its progeny
to infect other people.
– [Dr. DeGraaff] This is good, this is good! This is very helpful, okay.
– [Dr. Bhola] Sort of the worse case scenario for human beings is that combination of something that spreads well and then kills you later on. So HIV, for example, was one of those viruses that if you were think of virus in terms of how it, you know, as a plotting enemy, it was brilliant.
– [Dr. DeGraaff] Mm.
– [Dr. Bhola] HIV had the ability to lie dormant in a human being for years, you know, many years before it really went into gear to cause disease. That means you are perfectly healthy individual walking around for up to 10 years before something happened to prove that you…
So there was this 10-year spread that people would have where they’d go around just infecting other people. And so that’s the sort of, you know—a virus that has that stealth capacity.
– [Dr. DeGraaff] Mmhm.
– [Dr. Bhola] And then kills—and HIV killed, prior to the medications that we have now, HIV was considered 100 percent fatality.
– [Dr. DeGraaff] It’s one of the pandemics. I looked up all the pandemics that have happened in the last hundreds of years, yeah.
– [Dr. Bhola] Yep. It really affected—like countries in sub-Saharan Africa could have completely collapsed because of HIV because it primarily infected the young, working, productive individuals. So it had a selective socioeconomic toll that was incredibly impactful.
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– [Dr. DeGraaff] This is Spark Science and we’re talking to Dr. Vijai Bhola about the world’s response to the COVID-19 pandemic. But we try to end on a positive note.
– [Dr. Bhola] We need to respect this as a very potent adversary that we have to manage in a certain way. If we look from country to country, we can see how different nations have…
– [Dr. DeGraaff] Handled it.
– [Dr. Bhola] …dealt with this.
– [Dr. DeGraaff] Yeah (laughs).
– [Dr. Bhola] And I think what really seems to be—if we have a public health infrastructure, we have a leadership that takes things seriously, the impact is not that bad. So when it began in China, one of the first physicians, for example, he was shut down. He had to retract the fact that he brought this to light. He later died of this virus. That was an opportunity to sort of keep this under control.
Then there are many leaders across the world who sort of ignored, and still do, who sort of ignore this problem. The truth is we have so many resources to mitigate. We can’t just make this not a problem. But we have resources to mitigate these things.
Germany has done, compared to other countries, a fairly good job of keeping mortality down, of tracking the contacts, and keeping things under control.
– [Dr. DeGraaff] And Taiwan too. Taiwan’s been pretty…
– [Dr. Bhola] Taiwan has been good. Japan so far has been good. Lots of other Asian countries have done a pretty good job. But countries that have been way too relaxed too long have been hit very hard.
This is sort of the enemy we’ve been expected.
– [Dr. DeGraaff] Mm.
– [Dr. Bhola] We’re had SARS, we’ve had MERS. We know that respiratory viruses spread fairly easily because there’s something that—you know, if you have a virus in your airway, by coughing you expel that virus; you share that virus around.
– [Dr. DeGraaff] Right.
– [Dr. Bhola] One of the things that seems to be tricky with this one is that it seems that before you’re sick and after you recover, you can still—we’re not clear on it yet. You can spread the virus.
So it’s not okay to say, “I’m not coughing. I can’t spread it.” And that’s sort of the term they use, that the media uses is sort of “stealth spreader,” someone who feels well but is able to spread the virus.
– [Dr. DeGraaff] Right.
– [Dr. Bhola] And the majority of people who contract it, do not become hospitalized, right? So we need to understand that to take the hysteria out of the disease.
– [Dr. DeGraaff] We’re not dying. We’re not getting sick. We’re not like the high risk people, but it’s pretty hard being in a global pandemic and being super anxious, you
know, all the time. So like, how do we help people like that?
– [Dr. Bhola] One, dying of coronavirus is not pleasant. So the alternative of just staying in your house is actually a very very mild issue compared to dying of coronavirus. And I think that there’s a lot, especially in America, there’s a lot to be thankful for.
A friend said they’ve been putting on weight cause they’re just home eating. Pandemics and afflictions of infectious disease usually leads to like starvation, death. We don’t have that here.
– [Dr. DeGraaff] Right.
– [Dr. Bhola] In this country for the most part, quarantine, it’s like—it’s annoying. Many of these lower income countries, you know, massive slums, etcetera. They don’t have the financial reserve to simply stay home.
– [Dr. DeGraaff] Yeah.
– [Dr. Bhola] So they can’t do those things. They have to go out there to make ends meet day by day. The nations don’t have the resources to take care of people for months on end if they keep falling sick and coming to the hospital. So one, think about the context. Think about what’s going on in other parts of the world. And just feel grateful and thankful that we have internet. We can speak with friends on the phone. It’s an opportunity to spend time with friends and family.
– [Dr. DeGraaff] Yeah.
– [Dr. Bhola] Now I don’t want to be blithe about this, because there are issues with people concerned about losing their job. The issue of the economy is very very brutal. This is gonna affect the economy.
– [Dr. DeGraaff] Yeah.
– [Dr. Bhola] But if we’re alive, we can (inaudible) economy.
– [Dr. DeGraaff] Yeah.
– [Dr. Bhola] So if one person has a disease and they go out 10 people and give it to 10 people. Those 10 people spread the disease. It multiplies. That’s where the thought of exponential stuff comes from.
If people are in pockets and they stay at home, they can’t give it to people if they have it. And it’s kind of hard to get it if you don’t come in contact with someone.
– [Dr. DeGraaff] Right.
– [Dr. Bhola] And so the idea of flattening the curve is, we’re basically saying, let’s just assume many people are going to get it. But if we distance ourselves, maybe we’ll get it slower. And therefore, if the hospital is not overwhelmed and you get in the hospital and you’re very sick, you’ll get a bed. You’ll get a ventilator.
Versus if we all go to the hospital needing ventilators at the same time, we basically all die ‘cause there’s no ventilators left to take care of us. So that’s where the idea of flattening the curve comes from.
The problem and the reason why we don’t wanna do that is that the economy starts shutting down. The economy’s not about money; it’s about our ability to get goods and services.
And if, for example, you’re at home but there’s no infrastructure for you to get food at home because there still needs to be people working to have (inaudible) and get food. Then that doesn’t work. And so that’s the stuff that we need to balance. How do we self-quarantine yet the have the economy working, not from the point of view of one, not even one strong economy, but to support the idea that people quarantining need to be taken care of.
Just think of what happened to the Roman Empire in that story we just saw. Basically one disease is thought to be responsible for the end of the Roman Empire in Rome as we thought, leading to them migrating to Constantinople (laughs).
And then about 500 years later, another plague—the Plague of Justinian came and is thought to be responsible for the end, the decline of the Roman Empire there.
So the impact of disease could be so much worse that what we need to do is say, look, we need to be thankful that we have so many remedies, we have so many things. There’s something we know we can do to really help ourselves get through this alive. Let’s just do it.
– [Dr. DeGraaff] Yeah I agree.
– [Dr. Bhola] I think to some extent, the projections, they are grim projections. We have to be honest. Both for the economy and the estimated mortality from this disease. We knew this was coming. We just didn’t take it seriously. This is not something to be hysterical about, but something for us to think very carefully about how to respond to this in the future. We need to have good infrastructure in place, leaders who listen and act early.
This can go on anywhere from 6 months to a year. If we get a cure very quickly, if we get a vaccine very quickly, it may bring that time back and get us back on our feet. We just have to go through it. We have to bite the bullet because there’s gonna be tough times. But after this, just like the financial crash of 2008, the world rebounded. Listen
to, you know, the wise advice we’re getting, and we’ll get through this.
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– [Dr. DeGraaff] We’d like to thank Dr. Vijai Bhola for taking the time to talk to us and for being on the frontlines of this crisis.
To learn more about COVID-19 and the response, please visit the World Health Organization at WHO.int, and the Centers for Disease Control and Prevention at CDC.gov.
Spark Science is produced in collaboration with KMRE and Western Washington University. Today’s episode was recorded in Bellingham, Washington in my house on my computer during the 2020 statewide homestay. Our producers are Suzanne Blais, Robert Clark, and myself, Regina Barber DeGraaff. Our audio engineers are Zerach Coakley, Julia Thorpe, and Ariel Shiley.
If you missed any of this show, go to our website: SparkScienceNow.com.
If there’s a science idea you’re curious about, send us a message on Twitter or Facebook: SparkScienceNow. Thank you for listening to Spark Science.