EDITOR'S NOTE: The World Health Organization declared a global pandemic March 11 - six months ago. To mark the milestone, we will be publishing a series of stories over the next few days about how COVID-19 has changed our world. Today, we talk to the region's top doctor about dealing with a pandemic.
If you’ve heard the term “physical distancing” any number of times this year, it’s because of your local public health unit.
The arrows on the grocery store floor and the homemade face coverings you pack every time you leave the house are there because the health unit requires them.
“Normally, what we do is really important and not very visible to the public,” said Dr. Charles Gardner, medical officer of health for Simcoe Muskoka District Health Unit. “But when you have a crisis like this, it becomes very visible to the public.”
At the peak of the pandemic, Dr. Gardner was doing live press conferences five days a week. He and his management team were working seven days a week, for 10 to 12 hours per day.
“In those early weeks with the rapid increase … and the profound change the province led, there was a lot of news. There was just a lot of information that needed to get out,” said Gardner. “It was a tremendous amount of work and it was absolutely an essential amount of work.”
In March and April, the health unit fielded thousands of emails and phone calls from mayors, CAOs, business owners, and members of the public looking for guidance.
“The very earliest days of this was just … an ongoing demand for information and guidance,” said Gardner. “Now it’s very much about schools. With every change, we’ve had to be on top of what’s the guidance from the province? What’s the latest evidence? The latest paper on the topic? What’s been the experience of other countries?”
The doctor also sits on a provincial public health measures table helping to inform the decisions of the province’s medical officer of health.
“It’s been demanding to keep up,” said Gardner.
In normal times, Dr. Gardner has a variety of tasks in his day related to several different public health issues.
Since March, his role as top doctor in the region has been dominated by one thing: COVID-19.
“It’s not the first pandemic in my career, but it’s the first pandemic that’s really of substantial magnitude,” said Gardner, who stepped into his role as medical officer of health in 2005.
He was leading the health unit when H1N1 was declared a pandemic in 2009 and 2010.
“But it really didn’t have anywhere the same impact that we’ve had with COVID-19,” said Gardner. “It was new territory for me in my career. I think it’s a new experience in living memory. To have this magnitude of an impact, you really need to go back to the Spanish Flu pandemic of 1918 through to 1920.”
He knew the coronavirus was going to be a pandemic after he watched cases increase 500-fold from January to February.
“Quite a time before its formal declaration, it was clear to me it was going to be declared a pandemic,” said Gardner. “The nature of it – based on the history of previous pandemics – meant that we’d be with it for definitely more than a year. The rapid pace of its growth was an indicator to me that it was something that would become very big.”
The World Health Organization officially declared COVID-19 a pandemic on March 11, 2020. Simcoe-Muskoka confirmed its first case on March 13, nearly six months ago to the day.
At the height of the pandemic, 150 of the health unit’s 280 full-time staff had been totally redeployed for COVID-19 response. There was a team of 50 case and contact workers, which has now been reduced to 20 staff for the same task.
From January to July, health unit staff have devoted 125,000 hours to COVID-19, amounting to $6 million worth of staff time.
Some health unit staff have been repatriated to their pre-COVID jobs, but their work is all impacted by COVID. For example, food safety staff are dealing with complaints about restaurants not following COVID safety protocols.
“We’ve got quite a few people just getting some vacation time … in recovery mode,” said Gardner. “That reduces our ability to be able to take people back to their work.”
But the recovery time is a necessary preparation in case there is another wave of the virus.
If there’s a case resurgence, staff that were repatriated would be redeployed to COVID response once again.
“The task of responding to the pandemic is still overwhelming, it is still greatly dominating what we do,” said Gardner. “We’ve found the nature of the work has continued but shifted … Each stage where new businesses and venues have opened up has been a new draw for us to respond and to help everybody adapt and know what to do and follow up on complaints as well.”
And since COVID-19 is a public health threat, it is the job of Gardner and the health unit’s staff to communicate, promote, and require control measures.
There are the usual suspects – physical distancing, handwashing, self-isolating when you’re sick, and getting tested when you’re symptomatic.
And among those controls, perhaps the most contested, is wearing a face-covering indoors in public spaces. An order from Dr. Gardner put in place in July requires businesses and organizations to ask their customers, clients and patrons to wear masks.
“I fully expected there would be some degree of opposition, that people would question it with regards to fundamental human rights and be scrutinizing the evidence,” said Gardner. “It’s not new to public health to have a range of views on things. The matters we deal with impact on everybody and often the solutions require some restrictions on people’s freedoms.”
Gardner said as long as there have been public health measures, there have been those who oppose them.
The smallpox vaccine of the 19th century drew criticism. A requirement for milk to be pasteurized did not get unilateral support, nor did mandatory seatbelts.
“To me, all of that is necessary,” said Gardner. “It’s an important part of the change process. It’s certainly important we be held accountable to provide evidence for what we require or what we advise. I think that’s healthy.”
The opposition, and there has been a lot directed at Gardner and his staff, has not changed his mind when it comes to any of the prevention controls he has been urging.
“I do think it’s important … we continue to state our case for what people need to do,” he said. “If we aren’t successful in convincing most people to comply with mask use … or with physical distancing … or with handwashing or isolation and testing … then we end up with another wave of COVID-19.”
The pandemic, and the “overwhelming” work of the health unit since March, said Gardner, is a good reminder of the necessity of public health units.
Prior to COVID-19, Premier Doug Ford was promising a change to the public health system with several amalgamations planned.
“It’s an opportunity for the public to fully appreciate the critical value of public health as a function in our society, as an institution. And, therefore, appreciate that any change you make to it has to be done extremely carefully. With a lot of help,” said Gardner. “I believe there is room for improvement in public health, like there is in everything.”
He noted the nature of public health work aligns with school boards and municipalities more often than the healthcare system.
“I think it’s very important that whatever changes happen to public health be done softly and carefully … and, of course, we need sufficient resources to do our jobs,” he said.
