By JON VAN DER VEEN
To further understand the challenges and changes resulting from the pandemic, The Jewish Post & News has reached out to different members of the community to see how their lives have been impacted.
We contacted Dr. Lorne Brandes, who has had a long career as an oncologist, but who, upon retiring from that specialty, has been working as a practicing internist at Eaton Place Medical Centre. We wanted to know how Dr. Brandes has adapted to the restrictions imposed upon doctors such as him.
Lorne Brandes received his M.D. from the University of Western Ontario in 1968, followed by a Fellowship in Internal Medicine from the Royal College of Physicians and Surgeons of Canada. He became a professor at the University of Manitoba in 1975, where he conducted cancer research and was a tenured professor in the Faculty of Medicine, while also being an oncologist at CancerCare Manitoba.
I asked Dr. Brandes how Covid-19 has affected his work.
He said that he is now primarily working from home, but that the Eaton Place clinic remains open with several of his colleagues choosing to go into the office a couple times a week. Dr. Brandes said, “It’s an interesting transition but one that has worked out well.”
He went on to say that it’s been very easy to work from home since he has the same clinical programs on his computer that are at the office.
“I can do consults with other doctors from home, order x-rays, CT scans, MRIs, new prescriptions, old prescriptions, and blood work, I can do it all,” he explained. The only thing Dr. Brandes said he couldn’t conduct from his house were in-house examinations, but even that isn’t too much of a problem, he said, because most of his patients are follow-ups, so it’s quite easy to do appointments over the phone.
I asked him how then he was handling patient examinations, and if he was just treating the phone consultations as pre-screenings?
Dr. Brandes answered that since most people nowadays have a cellphone, they can take a picture of any physical findings like a rash or lump and send that to him. He could then assess the image and make the proper referrals or order any tests.
He offered the following example how a phone screening could work: “If I’m managing a patient with diabetes, I can send them to the lab to get their bloodwork done a couple of days before the phone call and then I have it to go over with them. I can make any changes to their medication that way. A very high percentage of patients have their own blood pressure gauge at home and to several of them I have recommended that if they are willing to go buy one, they’re only $70 now. They can therefore measure their blood pressure at home, take several readings, and then we can discuss it over the phone, and I know how their blood pressure is doing and if their medication is working well.”
Dr. Brandes also noted that it’s much easier for people to consult online rather than in person at the clinic because patients don’t need to drive downtown and wait in a lobby for him. As a result, he added, almost everyone keeps their appointments over the phone and they are much less likely to reschedule or cancel, especially since many people are staying at home for a large portion of the day during the pandemic.
At that point in the interview we began to talk about the virus itself, and the possibility of a vaccine being introduced in the near future. Dr Brandes suggested that we’ll be very lucky to have a vaccine by halfway through next year, but that he remains optimistic because there are multiple high-tech vaccines currently in the works. Yet, he also issued a warning that “There are a lot of unknowns… no vaccine is 100% effective, and that vaccines are less effective in older people.”
However, he also said that, similar to a flu vaccine - which is by no means 100% protective, a coronavirus vaccine doesn’t necessarily need to protect you from getting infected - it just needs to stop you from getting deadly sick. Moreover, whether a vaccine “will give long term protection, or if we’ll have to take it every year we just don’t know yet.”
I mentioned that I had read an Oxford study about the effect of the virus on twins. According to that study fraternal twins showed a greater variation in infections, whereas identical twins were likely either both be to be immune to the virus or both identically susceptible to the coronavirus, which suggested a genetic predisposition to becoming infected.
Dr. Brandes agreed, saying: “That makes a lot of sense. We know that you do inherit your genes and they do determine your immune response to a significant degree and that variations in the immune response may well be genetically determined.”
Dr. Brandes then offered this observation about susceptibility to the virus: Apparently studies show that people with Type A blood have a higher chance of getting a severe case of COVID-19. However, Dr. Brandes added the caveat that the blood type itself may not be responsible.
“Is it the blood type itself?” he wondered. “Not necessarily,” he continued, “because the blood type gene is intimately linked with what we call the HLA gene. Those are the tissue genes that are linked to the immune system. So, there’s no question, it’s very clear that there are huge differences in how people react to this virus, that are very likely, in a major part at least, linked to their immune system, and how they’ve inherited their immunity.”
I then asked about “pre-existing conditions” and which conditions specifically pose the greatest dangers.
Dr Brandes replied, “There is a clear link between worse outcomes in patients who have hyper-tension, high blood pressure, diabetes and so on. The high blood pressure link is very interesting because the receptor on the cells to which the virus links is called the ACE2 receptor and many of the drugs that are used to treat blood pressure bind to that receptor. So, whether having high blood pressure itself is causing a severe interaction with the virus and that receptor, or being on drugs which interact with that receptor, may modulate in a good way or bad way… these are the things we are learning.”
He went on to say that “We also know some young people have died from the virus with no apparent pre-existing conditions so that maybe takes it back to something in their immune system being wonky.”