Pandemic lessons learned

Doctors have been on the front lines from Day 1 of this pandemic. How has this experience positioned them to affect change within the health-care system moving forward?

Dr. Wright: The OMA has been working very hard to raise the voice of physicians, who are one of the critical (groups of) health-care workers who bring an enormous breadth of expertise in public health and infectious disease and health-system transformation. It’s demonstrated our credibility and our ability to be effective partners in responding to this crisis.

We really accelerated our involvement and we did it, I hope, in the most constructive, least confusing way, that demonstrated how we can be an effective partnership, not just in this but in every other aspect of health-care transformation.

Of course, we’ve got to deal with the aftermath of the backlog in clinical care, we have to deal with the implications of COVID related to long COVID and the need for probably ongoing vaccination, as well as major challenges to the health-care system, which were there in advance of COVID and they haven’t gone away either. While tragic in many ways, it’s been an opportunity for us to contribute to addressing this crisis for the system.

How is the OMA better positioned now to support our doctors when the next pandemic hits?

Dr. Wright: We’ve positioned ourselves and earned the trust and credibility of our stakeholders, our partners and the public. Not that that wasn’t there before but I think we’ve really demonstrated our role in providing an important constructive, comprehensive and accurate role in addressing the pandemic. That perception, that reality, which is now (that) we can be trusted, will play very well in working with all of our stakeholders, of which the most important is the government. But we have Ontario Health, we have the ministry, we have various branches. We’ve shown that we can work with all of those groups because together we’re much more powerful in addressing the health-care system.

Second, we’ve shown that many of our physicians have been elevated as opinion leaders. This is beyond the OMA, but it’s many of our members who’ve taken a very visible role. You’ve got your science table (and) we’ve got many of our public health and infectious disease experts who, as individuals, have stood up and shown leadership. 

The third thing is we have the collective pride and confidence that we can make a difference. I would say there was a bit of a time period where we felt disenfranchised — and I don’t mean to imply we’ve solved every issue because we’re a long way from that. But I think physicians, again collectively in the OMA, have taken enormous pride and with that pride comes a bit of confidence or a lot of confidence that we will be in a better position.

Our Prescription for Ontario has unfortunately highlighted many of the issues that we’ve been talking about for years. I would say those issues are now front and centre. The challenges of the north and addressing the north, the lack of support for public health, and the need to enhance the integration of health-care systems. These problems have come raging to the forefront and that (also) gives us a mandate to perhaps tackle the mental health issue. The phrase “you don’t want to lose the value of a crisis” sounds trite but it’s brought those issues forward in a way that I think we can hopefully really tackle them in a meaningful way.

“We’ve positioned ourselves and earned the trust and credibility of our stakeholders, our partners and the public . . . I think we’ve really demonstrated our role in providing an important constructive, comprehensive and accurate role in addressing the pandemic.” — Dr. Adam Kassam

Why are associations like ours important during times of crisis?

Dr. Wright: First was in communication. One of the challenges in a crisis like this, people are flooded with information. They are stressed, they’re dealing with their patients, they’re dealing with transitioning to virtual care. They’re trying to figure this all out at the same time. We provided comprehensive, timely and accessible communication.

Second, we advocated for really important steps in responding. One was in the slowdown. We were one of the earliest people to say, “Hey, I think we’re going to need to step back from the less urgent care.” We were able to get health-care workers on the first line of vaccination and, in contrast to SARS, I don’t think there was a single physician on the front line who succumbed to COVID. This is in contrast to Italy and some of the other countries. Getting that early vaccination, getting health-care workers a role in vaccination. The initial thought was that we needed to use only one channel, with a primary focus on pharmacies and public health units. But we played an important role, particularly in reaching those patients who wouldn’t go to pharmacies.

The third thing is we were actively involved. You know, the 500,000 masks. We brought people together — the Ontario health teams, the physician associations, to help co-ordinate the response to COVID.

The fourth thing is around alignment. One of the problems was we have 34 autonomous public health units, we have a chief medical officer of health, we have Ontario Health, we have the ministries. Behind the scenes, we were working really hard to bring all of those people together, complementing what the government was doing.

The final thing is there were and are ongoing issues. In a time of crisis, that doesn’t mean these other issues go away. For example, we issued a major report on burnout, which we knew was there pre-pandemic and has only been worsened by the pandemic. We developed a model for independent ambulatory centres to help us deal with the backlog. We’ve worked on health human resources and in recognizing that there are overall and geographic issues that need to be addressed urgently.

Then of course we negotiated on behalf of physicians — for example, the virtual codes which basically came into reality overnight so that physicians were able to transition to a modality of care so they could continue to look after their patients.

These are just some of the ways in which we and the physicians played a role and it just shows the power of the 43,000 physicians and of the OMA.

What mistakes did we make as a system that impacted our response to the COVID health emergency?

Dr. Wright: One is we perhaps didn’t learn as much from SARS as we thought we had. And how did that play out? Well, it meant that the command structure — who’s in charge, who’s making those initial decisions — that seemed to take a longer period of time than probably it should have.

The second thing was getting our public health system up and running quickly, pivoting to this, I hope, once-in-a-lifetime threat. We recognized that there could be a major genetic shift in an infectious disease. People have been expecting flu. It wasn’t flu, but it could have been any number of other viruses. The public health system did not have the kind of co-ordination and perhaps support that it needed to rise to the challenge.

The third thing — and this is one of the lessons that’s particularly important for the OMA — is the alignment of all the various stakeholders. We look to the government to be in charge, but there’s enormous experience, engagement of the nurses and the doctors and the other health-care professionals and figuring out how to bring them into the mix.

We kind of forced our way into the tent, I think successfully. In fact, in many ways, it elevated the role of the OMA and showed what an effective partner we could be. But I wouldn’t say that that came off early. How do we bring all those players together, the physicians, the nurses and the other health-care professionals?

In Ontario, in Canada and, unfortunately, I think worldwide we didn’t really recognize the extreme vulnerability of our long-term-care sector and, of course, that had horrific consequences for the most vulnerable of our population. There was a lot of confusion about movement, who was going to do what, infection control, and that really demonstrated that the long-term-care (sector) was very ill prepared to deal with this. Unfortunately, that’s where much of our mortality came from and we could have done collectively a much better job.

Are we done with COVID-19 and the pandemic?

Dr. Wright: We’re done with, likely, the massive waves of infection, with large spikes in hospitalization and possibly the public health measures such as widespread lockdowns, recognizing that ‘lockdowns’ is a broad term that encompasses many restrictions on movement and physical interaction and masking.

COVID-19 has shown its ability to mutate, which means that it continues to circulate. And at some point, what is called a pandemic becomes an endemic, so it shifts from a massive wave of infection to a much more grumbling, ongoing infection. We live with colds and we live with flus — these are endemic diseases. It certainly appears like COVID-19 is going to become endemic and likely will be with us into the permanent future.

This is barring a major genetic shift, such that those who have been immunized or those who have immunity through infection, that a major mutation would evade all of that natural immunity, which would take us back to the beginning. That remains always a possibility. It just seems less likely.

The worst part, I believe, I am hoping, I am reasonably confident, is over. But is COVID gone? No.

It’s been two years of highs and lows and many learnings. What would you say is our biggest takeaway from this pandemic?

Dr. Wright: I am confident that the OMA and the physicians, working with everyone, can make a substantial impact on the health-care system and hopefully fundamentally change it in a way that prepares us for future challenges, of which there will no doubt be many. We have our Prescription for Ontario, with a clear plan to fundamentally transform the system including a pandemic plan updated every five years. This experience with COVID will not be forgotten. It has cost us all too much.

This interview has been edited for length.