I refer to it as “the before times.” I was at a birthday celebration, hanging out with other adults, leaning in close to talk, sharing food from communal platters, and we were all enjoying ourselves as if there wasn’t a care in the world.
Then my phone buzzed and I glanced down and saw, as I have hundreds of other times, an alert from Pro-Med, an email service that sends notices on important emerging infectious diseases issues from around the world.
I get multiple alerts, every day, related to infections in humans and animals, but this one almost instantly felt different. There was a cluster of undiagnosed pneumonia cases in Wuhan, China, and it automatically gave me a sense of foreboding. In my world, we know that a cluster of acute respiratory illness could represent “THE Event,” a possible pandemic. However, most alerts turn out to be nothing, so I parked it in the back of my brain. I made a mental note to send a heads up to our Emergency Departments in the morning, to remind them of the importance of asking about travel history at triage.
Truthfully, there was no “Oh my God” moment. Reports kept coming but there were no details, so the pit of discomfort just grew in my stomach. There were lags in information dissemination and the whole, terrifying picture did not emerge until it was almost too late for Wuhan in China, and some European countries such as Italy and Spain. COVID-19 was on our doorstep, ravaging New York before we really understood what we were facing.
Because of our previous experiences and understanding of the importance of monitoring global infectious diseases threats, we were fortunate at UHN to be ahead of the curve in our preparations for the pandemic. UHN has dealt with SARS, the H1N1 influenza pandemic, and intense Ebola planning, so we do this stuff really well. However, and I do not say this lightly, I have never experienced anything quite like this. Nothing compares to what we have lived through this past year.
Even before the pandemic, the world of infection prevention and control (IPAC) was changing. Our patients today are sicker than ever, medical procedures are increasing in complexity, and there are deadly antibiotic resistance organisms on the rise, threatening the safety of our patients. The challenges to infection prevention are too numerous to recount here.
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It was in this context that the pandemic upended the world as we knew it. Every single day there was something new and potentially overwhelming to the system. When faced with a new infectious disease threat, the first priority is to ensure we can rapidly and efficiently identify and contain any possible cases before they spread too far. We did that pretty well.
Despite all the unknowns and some hiccups, our early pandemic response was effective in Canada and we seem to have avoided the worst-case scenario. But things have not always gone smoothly since. And, it would be untrue to claim there has not been a toll since that very first day.
So many different things have kept me up at night through this pandemic. I worry about the enormous strain on my team, who are working night and day to manage COVID exposures and outbreaks while continuing with their other IPAC tasks. I have worried about Ontario’s elderly and long-term care centres, with their terribly vulnerable residents.
I agonize about providing the best scientific guidance in a rapidly shifting environment, and communicating it effectively to my colleagues and the public. Outbreaks permeate my dreams, even when they are contained in the hospital. But I cannot let these thoughts consume me. I have to focus on acting, because anything less is not an option.
A year in, and there is some good news. The rate and success of vaccine development, clinical trials and manufacturing has been breathtaking, and hopefully we will see lots of people vaccinated sooner than we had initially projected. I have seen incredible teams roll up their sleeves to do everything in their power to administer vaccines to our most vulnerable.
And yet, COVID variants continue to cause concern and we cannot take our eyes off the road now. It is not easy to keep urging people to wear their masks, be diligent in the use of personal protective equipment, and maintain a safe physical distance from others. Though we must strive to do our best, the weariness of this unnatural level of caution and for many, isolation, is understandable.
I think of my own children who have not seen enough of their mom. When I am working from home, they will sometimes slide me notes of encouragement or something to make me laugh. I am so lucky they seem to be weathering this with a healthy degree of resilience.
We will likely never entirely go back to the way things were in “the before times.” Eventually, we will have to learn to live with this virus, like we do with so many others. Until then, I will keep wearing my mask and washing my hands, fantasizing about the day when I can eat and drink in a crowded room, full of the people I love.
Dr. Susy Hota is the medical director of infection prevention and control at the University Health Network and an associate professor at the University of Toronto.
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