SUDBURY - Five years ago this month began one of the most stressful times ever for Public Health Sudbury and Districts (PHSD) when it became apparent that the worst fears of that public health agency became reality.
It was the subject of a breaking news story on the Sudbury.com website at 10:30 in the evening.
"Today, Dr. Penny Sutcliffe, Medical Officer of Health with Public Health Sudbury & Districts confirmed the first positive case of COVID-19 in the Sudbury and Manitoulin districts. The male in his 50s presented himself to the emergency department at Health Sciences North," said the news story.
And so it began, the first days, the first weeks, in the first year of the worldwide coronavirus pandemic had come home to Sudbury after the patient had returned home after attending the annual convention of the Prospectors and Developers Association of Canada (PDAC) in Toronto.
The Sudbury man was one of about 25,000 people from across Canada and around the world who had been at the annual convention.
Public Health Sudbury wasted no time informing the local medical community by posting an online Advisory Alert on Mar. 20, 2020, spelling out in detail the screening and testing procedures for any patients presenting themselves with symptoms of COVID-19.
Dr. Penny Sutcliffe, soon to be officially retired (on March 31), was the Medical Officer of Health at the time. She recalled the day — Monday March 9, 2020 — PHSD held a "tabletop" meeting with local health agencies, the municipalities, the school boards and others to establish lines of communication.
"It was the very next day, we had our first case, and it might have been the first case in Ontario," said Sutcliffe.
She said that was on a Tuesday and it was a few days later that the Ontario government decreed that schools were being shut down. Sutcliffe said things felt different and uncertain.
"And then on the Friday the 13th, (it) was the Friday before March break when everybody had to go home,” she said. “So it felt, even at the very beginning, it felt sort of life altering. You know, there was something really, really big going on that we hadn't seen before, and we had to make sure that we were vigilant, that we used all the tools we had and we're ready to respond to whatever. Because we just didn't know.”
Sutcliffe said the planning meeting PHSD held the day before the pandemic was declared was useful in firming up lines of communication, but she said when the full impact of the pandemic was unfolding, it was clear that it was a massive health emergency.
"We had a pandemic influenza plan that had many of the components. There was good communication with the various sectors, because, of course, public health is kind of at the intersection of health and social services and municipal education, all of those things,” Sutcliffe said.
“I don't know that there is anything really that you could do to fully prepare for something like this. And I also firmly experienced, you know, personal as well as speaking with many others and just seeing the media, etcetera, that we critically forget how much we didn't know at the time and how much fear there was.”
Sutcliffe said there was a sudden demand for information from the highest levels of government, from the province, from other health units, from the hospitals and health-care professionals. At the same time, those agencies were all looking back at public health for relevant information.
"It was like trying to drink from 10 firehoses all at once," said Sutcliffe.
In the early days, Sutcliffe remembered there was a sense of fear in the community because no one — at least no one in the modern era — had experienced a pandemic. Some media outlets ran stories about the Spanish Flu pandemic that swept the world just after the First World War, killing millions. Those stories did not seem to hold relevance for the ordinary citizen.
Sutcliffe said no one knew for sure how serious it would become, especially for children and elders. And a vaccine was still nine months away.
She recalls the urgency of dealing with the fact that people began dying, especially in the long-term care homes.
"What our role then was, what's going on there? Shine a magnifying glass on that with our team. Are they implementing the appropriate infection control measures? Like what actually is happening. And so our role would be to further investigate, to see what else could be done for the future orientation.”
Sutcliffe said public health has the power of law in Ontario, and also throughout Canada, to implement specific orders to do whatever is needed to protect people in whatever situation where people need protection. This could mean temporarily shutting down a place of business or insisting on no visitors to certain nursing homes.
"That's not your first 'go to' but it's so important to make sure that there's teeth behind what it is. These aren't just nice recommendations you could consider; this is what you must do. So be it the closures of certain businesses or facilities and to make sure that was backed up."
Sutcliffe said such actions were part of a larger provincial plan to ensure that infection control was more than just a buzzword.
"It was really based on the parameters that were provided by the province, that then needed local action, and the local medical officer of health to put the teeth behind that, by the way of an order."
One thing that Sutcliffe remembers well is the sense of community caring that arose in many sectors.
"There was tremendous goodwill," said Sutcliffe. "And I think we shouldn't forget that. We should not forget that in, you know, the wake of everything that's happened since then. And you know, we tend to focus on the negative, but people helping people, people bringing groceries to other people, you know, just really acts of huge kindness," she said.
"And I don't think that's sort of Pollyanna-ish to talk about that. I think about how we are capable of that. And I would say that even to the end, and like some 90 per cent of the population that we serve in this area. So be that local citizens, or health-care providers, or those in the various different sectors were really on board and trying to figure out, ask, or figure out themselves, what they could do to help, to assist."
Pandemic taught Sudbury public health to be more flexible
One of the key concerns that arose for public health organizations during the COVID-19 pandemic was misinformation and messages going out in public spaces that clearly were not factual.
This included people on social media questioning authority of the public health agencies, questioning their statements on the need to control possible sources of infection and putting out false information to confuse the public.
Sutcliffe, who was the medical officer of health for the Sudbury health unit back in 2020 when the pandemic was growing, recalled that PHSD had to limit public input on social media.
"We did have to shut down our messaging, our responses on social media because of some of the vitriol from a small number of people," Sutcliffe said.
Acting PHSD medical officer of health Dr. Mustafa Hirji, was working in public health in Southern Ontario at the time. He said the spread of misinformation became malicious over time, throughout Ontario.
"I think the more interesting question was the uncertainty about what is the actual truth, because we were dealing with a brand new virus, which we had not studied up close," said Hirji.
The best knowledge at the time was that the virus had originated in China, but there was not a lot of information being shared with the West.
"We were getting very limited information coming out of the Chinese government to inform our planning. We were trying to, you know, sort of figure out what this virus is, from a distance, and sort of what our plans would be, and put up the best information that we had," said Hirji.
He said a key tenet of public health is to provide good information to people at times of uncertainty, to calm their fears.
"And I think in some cases, we maybe spoke about things that we didn't actually have as much certainty on with a lot more certainty than we did, in hopes of, I think, the very right goal of trying to calm the public down, give them some reassurance and give them some hope," said Hirji.
"And unfortunately, I think we had some of those, over time, turned out to maybe not be quite as correct as we hoped."
Hirji said the direction to encourage people to use face masks was an example.
"All of our previous research around respiratory viruses show that masking didn't really work, except maybe in a health-care setting where people have a high degree of training and know how to use them well," he said.
A news release from Public Health Ontario in 2020 actually stated: "Masking to protect the wearer is unlikely to be effective in non-health-care settings." By the same token, the release stated there was nothing to show that masking was causing actual harm.
But then something happened. While the clinical opinion was that masking was not that helpful, after some months health agencies noticed that in areas and regions where masking was enforced, the infection rate was changing. Masking was working.
Hirji said it was a problem for the public to get one message from public health and then a short time later, to be hearing a different message from public health.
Looking forward, Hirji said one of the lessons learned is the importance of pinning down the correct information before sharing with the public. Hirji said it was the effort to be absolutely transparent with all bits of information that may have caused confusion for the public.
Nastassia McNair, manager of Effective Public Health Practice at PHSD, said it was difficult for public health at times when bits of conflicting new health information came down from higher levels of government.
"I will echo that 100 per cent there were times where we would have one set of directives in the morning, and by the end of the day, we would have new information or new messaging to communicate,” McNair said. “And so for us to keep on top of that and to maintain transparency with our community. It was a very quick turnaround. And so as a community member, I can appreciate that it was very challenging to also stay on top of the messaging.”
On the other hand, said Hirji, the virus itself was changing and developing in unexpected ways.
"We were learning new things all the time, so that had an impact. Another is that this was a very fast-moving virus, and so the conditions on the ground would literally change in a day or two,” he said. “Sometimes we’d go from a very controlled situation to something where now the virus was spiking up very quickly, which meant we would have to change our advice on what people should do.”
Also, as more people became infected and continued to spread the virus, the virus itself changed, mutating as it spread to new people in the population, said Health Canada. These "variants" of the original COVID-19 virus would cause spikes in the number of infections.
"Sometimes we'd go from a very controlled situation to something where now the virus was spiking up very quickly, which means we would have to change our, you know, advice on what people should do. So that was a challenge," said Hirji.
There were many good lessons learned, McNair said. One of the things PHSD did was learn to adapt to the many changing situations and to be flexible and able to pivot when the need arose, she said..
“One of the examples of that would be as we continued along through our vaccine rollout, we saw that we needed to be able to increase numbers," said McNair. She said that's when PHSD set aside the usual clinic model and set up shop in local hockey arenas.
"This is where we could have over 3,000 people through a clinic in a day, in one venue. So, you know, we saw there was a need for it. We saw that there was a long time people were waiting to book appointments. We really needed to maintain that flexibility and look at new and creative and innovative ways to be able to action our response," said McNair.
Another approach was to work with local committees in different parts of the health unit's very large service area, taking in such areas of Sudbury East, Manitoulin Island and Chapleau. McNair said this approach continues today.
Another development was working with community paramedics in different areas to provide vaccinations to people who were unable to leave their homes.
McNair said that approach also continues today.
"Now, community engagement continues to be very important in what we're doing in our public health planning," she said.
Another example of doing things differently said Hirji was the decision to create a vaccine bus, a vehicle that could travel to different areas and set up a walk-in clinic to make it more convenient for people to get vaccinated.
Hirji said another example of flexibility is that PHSD can now adjust its schedules if necessary to respond when the need arises. Instead of being a nine-to-five Monday-to-Friday operation, it was demonstrated that workers could respond at any time if there was a critical need.
"Now, for example, we will do weekend vaccination clinics, which is not something that was happening before the pandemic. Obviously there's, you know, complexities around collective bargaining agreements that come into play when we're doing flexible work,” Hirji said. “But having more flexible work is something that I think the pandemic set us up, as a precedent, that we're now following through on doing more, and that's something that we will hopefully see continue to evolve.”.
Len Gillis covers health care and mining for Sudbury.com.