Lessons learned from the first wave of COVID-19

By Dr. Tim Rutledge


What will the second wave be like? It’s a question we are all asking as we face the coming cold and flu season.

Models can be helpful in predicting short-term scenarios, but with shifting public health policies and people’s behaviours, the next six to-eight months are too big a stretch to forecast with any certainty.

Will the next wave be like the first one, with exponential growth, a peak, then a gradual tapering off? Perhaps it will look more like a series of ripples, with various swells moving across the province at different times.

Layered on top are variables we didn’t face the first time around. Schools, restaurants and bars are reopening. Winter is coming, drawing us indoors, and there will be the re-emergence of seasonal viruses that cause colds and flus.

Despite these uncertainties, we can be sure of a few things. The first wave has provided important lessons that will help us navigate what happens next.

We enter this next phase knowing more about the virus

While fears of airborne transmission fueled anxiety over N95 mask availability in the early days of the pandemic, evidence and experience continue to indicate that the virus is mainly spread by droplets. Aerosol transmission may occur with aerosol-generating medical procedures. This supports our planning as we stock up personal protective equipment in preparation for the coming months.

We also know that a significant proportion of COVID-19 transmission occurs before the onset of symptoms. This highlights why it’s critical to consistently practice the basics of infection prevention and control (IPAC): proper hand hygiene, physical distancing, mandatory masks and face shields for all patient interactions within six feet. Should a COVID-19 outbreak be detected, prompt testing of staff and patients should be carried out broadly, whether symptoms are present or not.

All of these IPAC practices do double-duty during flu season by reducing the spread of influenza and other seasonal viruses. Robust testing capacity and contact tracing will also be key success factors as the pandemic evolves and scientists race toward better treatments and a vaccine.

We must optimize system capacity

When COVID-19 struck, hospitals across Ontario braced for the surge that overwhelmed New York, Italy and China. An estimated 50,000 procedures and treatments were postponed in Ontario as the health care system took an all hands on deck approach to assuring the capacity needed for COVID-19 patients.

As clinical recovery plans continue in the face of this backlog, we must do all that we can to avoid a similar shutdown in the coming months. This will be a significant challenge as many hospitals had capacity pressures pre-COVID, it will not be possible to be as efficient, and we have this new disease to accommodate.

Optimizing acute care capacity will require innovative and system solutions. Exponential increases in the use of virtual care have allowed people to connect with their providers from home avoiding hospital and clinic visits. Integrated models of care involving collaborations among primary care, home and community care and other community providers can help to avoid hospital admissions and shorten lengths of stay.

Vulnerable populations must be a priority

The pandemic put into stark relief some of the cracks in our system. About 80 per cent of recorded deaths linked to COVID-19 in Canada happened in long-term care, including more than 1,800 deaths in Ontario. A number of hospitals, including Unity Health Toronto, are now supporting seniors’ facilities and long term care homes with best practices for IPAC, health human resources and other areas. It will be important to develop lasting solutions to enable the stabilization and recovery of the long term care system.

Similarly, helping those who are experiencing homelessness and lack a safe place to isolate requires a holistic approach. Toronto and other jurisdictions have made use of hotel rooms to care for homeless and under-housed persons with COVID-19 or close contacts. In the coming months, as temperatures dip and indoor space becomes an even greater need, new models like these will be even more important.

Two-way communication is key

The flow of ideas keeps us all safe, and we must remain receptive to new approaches. Staff, physicians, patients and families need to be kept up to date with the latest information, while at the same time, feel encouraged to share their insights, concerns and ideas. At Unity Health, we increased the frequency of all our communications creating new virtual channels while engaging regularly with our Board and regional and provincial partners. We are also conducting an engagement pulse survey to hear from our staff and physicians where we can grow and learn from this unprecedented event together.

To a large extent, the shape and character of COVID-19’s second wave’s will be determined by public health policies and how well society adheres to them. This pandemic has provided the healthcare sector an opportunity to accelerate change at an unprecedented rate. The importance of interdependencies of the sectors in our system have never been more clear. Working together in innovative ways will be key to managing successfully through the next phase of this pandemic and preparing for future challenges.

Dr. Tim Rutledge is the President and CEO of Unity Health Toronto, the Catholic health network consisting of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare