Q&A: Dr. Alex Summers, London-Middlesex MOH, reflects on 2 years of COVID-19 pandemic

It was two years ago Friday that the World Health Organization declared COVID-19 a global pandemic, changing the world overnight and marking the start of what would become one of the deadliest pandemics in world history.

London had already seen one confirmed case of the virus by the time the WHO declared COVID-19 a pandemic on March 11, 2020, while the province had recorded at least 42 cases, along with its first death. (The death wouldn’t be officially confirmed as COVID-19-related until the following week.)

Two years later, the London-Middlesex region has seen more than 32,500 lab-confirmed cases of COVID-19 — an undercount due to testing eligibility changes — and has recorded more than 350 deaths, while across Ontario, more than 1.12 million people have tested positive and 12,227 have died during the pandemic.

Globally, more than 454 million people have tested positive for COVID-19 while more than six million people have died, according to figures released by the Center for Systems Science and Engineering at John Hopkins University.

To mark the two-year anniversary of the pandemic, 980 CFPL’s Mike Stubbs sat down with Dr. Alex Summers, the newly named medical officer of health for London and Middlesex, to reflect on the pandemic so far, the lessons learned, the unknowns moving forward, and the lifting of pandemic measures as health indicators improve and as more people get vaccinated.

Mike Stubbs: Dr. Summers, the last two years, how long have they felt for someone who has been in public health? Can you put those in context at all?

Dr. Alex Summers: On one hand, Mike, it’s felt like a lifetime. On the other hand, it’s felt like 30 seconds, and I think maybe people will understand what it’s like when you go through intense life experiences like the pandemic has been for all of us, but certainly for public health staff. It has been a transformative experience, and to think that we are two years out now from the declaration of a global pandemic by the World Health Organization is remarkable, it’s humbling, and it’s a reminder of just how much work this has been for so many people.

Stubbs: Prior to this day, two years ago, we had heard about Wuhan, China … you had heard even that we had a COVID patient in London. We had all of those things that had already taken place. This was that declaration. It was, incidentally, the same day that we saw Tom Hanks and his wife diagnosed with COVID-19…. We saw Rudy Gobert in the sports world, and someone had said, ‘Hey, nothing’s going to happen until a celebrity gets this.’ When you were watching all of this play out, (and) lead up to the global declaration … how do you remember feeling?

Summers: I remember feeling, through January and February of 2020, anxious, obviously. Dedicated, anxious, focused for sure. But there was this sense that we and the public health world knew that something wasn’t right and that something big seemed to be happening, and we knew that we were a bit ahead of the curve in terms of knowing that, as is our job. So it was a sense of feeling as though, although the rest of the world was functioning as though nothing was changing, that everything was changing.

When it all started to happen, I remember feeling as though it happened very quickly. Like, I remember watching it and being like, ‘Oh my goodness, the world is catching up to where my head has been for the last little while.’ … It felt like we went from the beginning of March to mid-March, and the world had just completely transformed with regards to how we understood the risk…. In some ways, it was a relief that I wasn’t, and my colleagues, we weren’t the only ones worried about this anymore, even though it also meant we were now in the thick of it.

Stubbs: What was it like being in public health … saying, ‘Here’s what we have to do, here’s how serious this really is,’ and then instead of people saying, ‘Gotcha, OK, let me know what I need to do’ — which many people did — you had some serious pushback?

Summers: It wasn’t a surprise. It was always clear to me, and certainly to my colleagues, just how much we were asking, right? We were asking people to cancel plans, to cancel vacations, to completely change their very day. We were asking people to stay at home. We’d never asked people to do something so profound before, and so I was not surprised that there was a variety of responses to that.

What I recall most of all was just how quickly people got on board. How quickly people said, ‘Yep, let’s go.’ Especially at the beginning, there was a recognition … and I think seeing, as you noted, some people that were familiar names to us getting it, as well as the implications in northern Italy or New York City, watching that unfold really brought home the severity of the situation. At the time, I really remember, certainly for our region, just a tremendous amount of coalescence around the importance of taking what were drastic steps.

0:34 COVID-19: Ford encourages those concerned with lifting of mask mandate to continue wearing them

Stubbs: You can play with a lot of hindsight, and we’ll do that for decades. There will be university final exams written, and this will be talked about from a historical perspective, from a medical perspective, (but) looking back, 20/20 hindsight, is there anything that you point to and say, ‘Huh, I really wish we would have taken that left turn at Albuquerque right there?’

Summers: I wish that we — and I think this isn’t going to be a surprise to anybody — I wish we had instituted masking earlier, particularly in long-term care homes and congregate settings. I wish we’d done that earlier. At the time, the data around masking with previous respiratory illnesses, like influenza, was not convincing that it would have made a difference at the time. Two years later, it’s clear it made a difference and it would have made a difference, so I wish we’d done that earlier. But, at the time, we also had supply challenges, and that made a mark with regards to how we had to prioritize (a) finite resource. It’s one of those things where, yeah, I wish we did it earlier, but I also remember why we didn’t.

Stubbs: When we look forward, how are you feeling now? Because a lot of people are hoping that we’re coming out of this, that we’re not going to have to go back. But there is still that voice in the back of our heads that says, ‘Yeah, but we’re not sure.’ How are you feeling?

Summers: One week at a time, I think, is how I’m taking things. When we look at the metrics that we’re seeing, obviously it’s been a dramatic decline. But they’ve stopped declining, they’ve really plateaued, and I foresee an increase in cases. That increase in case count may not actually manifest in increased hospitalization or mortality, and that is going to be something that’s unique about this pandemic.

One thing that’s changed with the high vaccination coverage that we have now is the severity of outcome. There’s this metric called case fatality rate, which is the proportion of people who get infected who end up dying. Amongst people who lived in long-term care homes during the first wave of the pandemic — so back in March, April and May of 2020 — 30 per cent of those people ended up dying, which is an unbelievably high case fatality rate, and it was amongst, obviously, medically vulnerable people.

This past Omicron wave, where we had substantial cases, that case fatality rate was less than five per cent. So it’s just a very different pandemic, and that’s because of the vaccine, and it’s because of the vaccine that there’s a bit of uncertainty about exactly where we’re going to go from here, because the severity of illness, particularly amongst people with a booster dose, is just so much better than it would be without it.

So one week at a time. I do anticipate cases will go up. I hope that we don’t have to backtrack on public health protections, but it’s one of the reasons why I’m still saying to folks, ‘Let’s be cautious. Get your vaccine, get your booster, wear your mask, wash your hands, stay at home if you’re sick, still function as though you want to recognize that this pandemic isn’t over yet.

Stubbs: One final thing, and that is the recommendation from the provincial government that if you want to wear a mask, you continue to wear a mask…. We’re seeing school boards now making decisions on how they want to do it. Thames Valley (District School Board) has decided that they will have the recommendation, and it will be up to the student or their parents to have made that decision. How about when it comes to city council or city hall or municipal buildings? Do you have any plans to give them any kind of recommendation on how to proceed?

Summers: Our message is going to be consistent across all sectors, that given the high rate of Omicron transmission that we continue to see in our province and in our region, we continue to recommend masking in indoor environments through March and into April. We’ll continue to reassess the risk as we get through into April, but generally speaking, we continue to recommend masks in all indoor settings. For organizations and businesses, for their employees and patrons, requiring masking is an option, so as an employer, the Middlesex-London Health Unit is going to continue to require masking for our office spaces for March and for April. And that’s still an option, as this is a simple and effective way to reduce risk, in addition to other things like vaccination.

— This interview has been edited lightly for clarity.