In the 20 years since Vincent Lam became a physician, he has experienced two widespread viral outbreaks: first SARS, which hit Toronto in 2003; and now the COVID-19 pandemic, which has left the city in a state of total shutdown since mid-March.

Lam is the co-author of the book The Flu Pandemic and You, and the medical director of the Coderix Medical Clinic, an addictions medicine centre in Toronto. He is also an accomplished fiction writer — his book Bloodletting and Miraculous Cures won the 2006 Scotiabank Giller Prize. 

We spoke with him about what it’s like to work on the frontlines, how to manage the fear and anxiety surrounding pandemics, and the subtle ways that racism functions and flourishes during a crisis. 

Sejla Rizvic: I wanted to discuss your previous experience working as an emergency room doctor during the SARS outbreak and now as a medical director during the COVID-19 pandemic. How do those two experiences compare?
Vincent Lam: It’s interesting because actually, as a physician, it isn’t that different. Many of the things that we were doing as precautionary measures are in fact the same things that we’re doing now. So in terms of screening, in terms of using personal protective equipment, that is all exactly the same. I think the biggest difference is just that the COVID-19 situation has had more of an impact. There have been more cases in the health-care system itself, and in the community at large things have been seriously affected. 

During SARS, I remember feeling like we were in a bit of a parallel world, in the sense that in health-care we were taking care of people who were potentially sick and we were taking all these precautions and everything was really different. But in the city itself everything was pretty much business as usual. I mean, there were news stories, but there weren’t the same kinds of widespread public health interventions. The work was really the same, but the big difference was just the sense that we were in our own little bubble doing all this stuff. And now we’re all impacted.

I want to discuss your book The Flu Pandemic and You and some of the insights you offer about the anxiety that tends to surround pandemic events. How does anxiety affect our experience of this time?The principles that my co-author, Colin Lee, and I discuss in that book are almost entirely parallel between an influenza pandemic and the novel coronavirus pandemic. I think what we really need to understand as a society is that anxiety is normal. And the function of anxiety, as human beings, is to get our attention and to alert us to threats. 

So it’s actually an incredibly useful role. Once we understand this is the role of anxiety, then we have to think “Okay, anxiety is supposed to function as this warning system so that I do something. What should I now do?” If people are able to formulate useful actions and figure out what they can do to help to protect those around them, to keep themselves and their families safe, then that’s really, really useful. If people have less productive reactions to anxiety, and of course we see some of that, then that’s not going to be helpful. 

In an article for the Globe and Mail that you wrote in January, you state that: “Our minds are biased toward overestimating the significance of novel risks and nonchalantly accept familiar ones.” But what happens when the novel risk becomes the familiar risk, and governments and people begin to loosen lockdown restrictions prematurely?
One of the things that we can do with risk is to come to terms with it and still understand that it’s there, without it being the only thing that we’re paying attention to. But at the same time, we should modify our behaviour. 

I remember getting into cars that didn’t have seatbelts in the back when I was a child. Now we think that’s really bizarre. Now our reflex is to put on a seatbelt when we get into a car. There’s a reason for that: if the car is going to crash, then we’re less likely to be injured or killed. But it’s not as if everytime we get into a car we sit there for ten seconds and imagine a horrific crash, right? We just get in, put the seatbelt on, and drive. 

I think that’s really what we have to figure out if we reopen after the pandemic and before there’s a vaccine. It’s this question of what patterns can we change; figuring out what can we do that will allow life to continue while still modifying our behaviour in a way that reduces risk. 

Coming back to the question of anxiety, I think the danger is that if people have this kind of defiant response, it’s really a response to anxiety. People don’t enjoy feeling anxious — it makes them feel vulnerable, it makes them feel like they have less agency, perhaps. So, in order to get away from that emotional state, some people will seek a way to feel better through an expression of defiance. Which is that, “You know what, I don’t have to be scared of whatever it is. Don’t tell me what to do.” There’s a sense in which that feels good, because it feels like I’m taking back my control, I’m asserting my agency, I’m acting in a powerful way by doing whatever it is that I want. 

It’s an understandable way to try to get rid of feelings of anxiety. It’s just that it actually is not very helpful. People are going to try and achieve that really short-term sense of feeling powerful, of feeling good, of feeling defiant, and trade away sensible precautions for the sake of that short-term emotional benefit.

There has also been rampant anti-Asian racism and discrimination surrounding the novel coronavirus. Have you personally experienced this kind of discrimination?
I’ve been pretty fortunate, and I think Canada is still relatively fortunate, in that I don’t think we’ve had as much anti-Asian racism as a lot of places in the world. But we have had some unfortunate incidents. 

I think there is a sense of wanting to take back some measure of personal power. If I’m feeling vulnerable, if there’s a situation that I don’t like, it feels satisfying in some ways to be able to point a finger, to be able to blame someone even if there’s no actual substantive truth to it. It does kind of give this sense of satisfaction in some way. So I think it comes from that place.

I don’t want to say too much about my patients because, ultimately, I’m their care provider and I have a duty of confidentiality toward what they say to me. But I can say that I’ve experienced flavours of comments that I think do come from a place of fear. 

If someone is a person of Chinese descent and considers themself to be part of Canadian society — and especially if one is in a position of respect, a position of authority — it’s hard to know what to do with comments that may have some sort of racist implication. You’ve probably seen the whole Derek Sloan debacle with respect to his comments about Theresa Tam. 

I think the incident you’re referring to is when Conservative MP Derek Sloan who, in a video posted to Facebook and Twitter last month, criticized Chief Public Health Officer of Canada Theresa Tam, and questioned whether she worked “for Canada or for China.”
It’s really quite difficult to know what to do as a person of Chinese descent in response to one of these incidents. I think Theresa Tam handled it perfectly — she made it clear that her role is that of a professional who is deeply engaged in doing the best possible job in a difficult time, and therefore she is not going to engage in what she called “noise.”

I’m sure it must be very hurtful for her, as Canada’s top public health official, to receive comments which may have a racist tone to them from an elected member of Parliament in the House of Commons. I can imagine that the personal dilemma for her might be — and I’m speculating because I don’t know for sure — that she feels the best way to really demonstrate her solidarity (not that she should have to) and demonstrate the value that she has as a member of Canadian society is to simply do the best job possible and to not allow herself to be drawn in and distracted by these really unsavoury comments. 

I very much feel the same way. I do experience comments that are maybe tinged with something, but I feel that I’m here as a professional and what I should do is what I do best. And in the larger picture, that in itself should demonstrate who I am and what I stand for. But it doesn’t mean that those comments are not hurtful. It doesn’t mean that those comments are acceptable. 

It’s just quite difficult, when one is in a professional capacity, to always respond to those comments in a way that is both effective as a professional and will address them directly. So sometimes one makes the decision simply to prioritize professionalism and to forgo any kind of direct confrontation. At the end of the day, I don’t really know whether that’s the best response in terms of confronting racism, but I think it’s often the decision that ends up being made, which I myself have made.

Sloan has since refused to apologize for those comments and claims that his statement was simply “rhetorical.” What do you make of that explanation?
In modern culture, we’ve learned that racism is wrong — and I think lots of people who are racist will even quite happily say that racism is wrong. It creates this tendency to couch comments in some sort of justification or some sort of double-speak. Sloan’s comment was called out by Canadian media; he responded to it and didn’t apologize. He just said that he didn’t refer to Tam’s ethnicity or country of origin. It felt very much like he was double-speaking his way out of a very embarrassing political situation.

I think because we live in a culture where, for the most part, we have all agreed that it is wrong to be racist. And what that means is that comments which are based on race or ethnicity, or that have some kind of underlying edge to them, are usually not stated in a way that is overtly racist. I think some of that is happening during this pandemic, and it’s a tricky thing to know how to deal with.