2020: The year that will reshape healthcare

By Natasha Salt and Dr. Jerome Leis

New Year’s Eve 2019 was an ominous time for us. We were busy tracking the movements of a novel coronavirus in China that at the time appeared concerning but it was difficult then to foretell what kind of global impact this illness would unleash on the rest of the world.

On January 23, 2021, it will have been exactly one year since we admitted the first patient in Canada with COVID-19 to Sunnybrook. In looking back over the past year, it is worth asking ourselves, what have we learned and what has changed? To no one’s surprise, the short answer is, plenty. The pandemic has been stressful and has placed enormous pressure on our hospital, our staff, and the healthcare system at large.  At the same time, it has been a tremendous catalyst for learning and for rapid cycle change. A number of key advances have improved quality within our institution and collectively across the system.

Chief among the most significant changes has been the necessity for hospitals to be better integrated with their community partners.  Prior to the pandemic, our hospital like many others recognized the importance of supporting health outcomes beyond the walls of our facility – but COVID-19 has strengthened this integration at many levels.  For example, we have seen accelerated adoption of virtual care platforms that have enabled our clinical teams to manage patients remotely.  Our Infectious Diseases specialists created a virtual consulting service called COVIDEO, that has managed over 1500 patients with COVID-19 from their homes, while providing ongoing clinical support and home oxygen monitoring.  This system of care has given these patients clinical and social supports in the community and resulted in fewer unplanned visits to the Emergency Department.

Similarly, a cross-Toronto initiative called “Long-Term Care” Plus has provided virtual consultative care to long-term care physicians as needed to help support the management of residents of long-term care.  The partnership between primary care physicians in both long-term care and the community has been strengthened in the process while striving to care for the most vulnerable patients in their home, rather than in hospital, whenever possible.

Hospital infection prevention and control (IPAC) programs have repeatedly demonstrated that they are essential and a pillar in effective response to local infectious disease transmission, epidemics or pandemics.  After SARS in 2003, hospital IPAC teams were strengthened in Ontario.  Significant iterative improvements were made over nearly two decades prior to COVID-19.  Strong surveillance and containment strategies have successfully minimized transmission of COVID-19 in hospital settings and the demand for this expertise has risen exponentially well beyond these walls.  Our hospital as well as many others have formally been supporting long-term care, retirement homes and the broader community, throughout the pandemic in attempts to build IPAC capacity across the continuum of care.  Investment of resources in IPAC will be crucial to making further advances in IPAC across these institutions over years to come.

From planning to practice, we have also learned a significant amount about the allocation and resourcing of personal protective equipment and specifically, the use of masks. In the nascent days of the pandemic last spring, our conversations and decision-making were dominated by the scarcity of personal protective equipment. Our supply chain has responded to these pressures and there has been relatively broad acceptance of the use of masks both inside our organizations and publicly. Enhanced awareness and education about proper mask use and other preventive measures such as hand washing and social distancing have become normalized in our routines and their broad use has helped in managing the pressure on our facilities.

In addition to the day-today management of the virus, the academic curiosity of our teams has also been in full flight during the pandemic. Early in the pandemic, researchers were designing innovative devices to support infection prevention and personal protection when supply chains were threatened.  Our Sunnybrook Research Institute has in excess of 100 different studies taking place to examine every aspect of the pandemic and ensure we are learning from it. We have been a lead hospital in a number of global trials and have conducted research that has isolated the virus and has set the groundwork for what we hope will be the introduction of a vaccine in 2021.

It has been inspiring to see how our teams across the hospital and others throughout the system have responded to the pandemic. The resiliency of our front-line staff has been nothing short of heroic and they continue to set new expectations for high performance. The support we have received from our community including everything from donations to advance research, to thank you cards and letters, have helped buoy our teams and motivate them to continue moving forward.

Looking back on this year, it has clearly been unparalleled and has challenged every aspect of our work and our lives as a whole. It has had pitfalls and occasional triumphs but as we look forward we can say confidently we have learned a substantial amount, and have gained further confidence that we are on the right path and will emerge from this stronger and better informed.

Looking ahead to 2021, like many, we are eagerly anticipating the arrival of a vaccine.  But we must remain extremely cautious to avoid declaring a premature victory. Among the many lessons we have learned is that as soon as you think you are on top of this situation, your perspective changes without much notice and you find yourself slipping underneath it again. COVID-19 is a crafty virus and the biggest mistake we can make is underestimating it.

No one knows exactly when this will end but we do know the pathway to get there is best travelled with the lessons of the past in mind and a vision for the future that is well-informed and rooted in evidence.

New Year’s Eve 2020 will certainly be a different time for all of us but let’s take the opportunity to look back, reflect on what we have experienced, and look forward to the year ahead, when we take what we have learned and use it to our advantage against this virus in 2021.

Natasha Salt is the director of infection prevention and control at Sunnybrook Health Sciences Centre, and Dr. Jerome Leis is the medical director of infection prevention and control at Sunnybrook Health Sciences Centre.