Nfld. & Labrador·Q&A

Dr. Janice Fitzgerald talks Omicron, mental health and life after COVID

In a feature interview with CBC News, Janice Fitzgerald sat down with the CBC's Peter Cowan to talk Omicron, what the endemic stage of COVID-19 could look like, and how she's faring through two years in the public eye.
Chief Medical Officer of Health Dr. Janice Fitzgerald spoke with the CBC's Peter Cowan in a CBC News feature interview. (CBC)

The introduction of coronavirus variant Omicron has changed how Newfoundland and Labrador views COVID-19, but the province's chief medical officer of health says it has also provided lessons on how the province will move forward from the pandemic.

In a feature interview with CBC News, Dr. Janice Fitzgerald sat down with the CBC's Peter Cowan to talk Omicron, what the endemic stage of COVID-19 could look like and how she's faring through two years in the public eye.

The discussion has been edited for length and clarity.

Let's go back to Dec. 1. At what point did you realize that Omicron was going to have to change a lot, if not everything, about the way we treated this virus?

Very quickly I think we realized that we were going to have to think differently about Omicron. We didn't have a whole lot of time to get a lot of information about Omicron before it was here, unlike some of the other variants that had surfaced. But I think certainly over the Christmas break, we realized that we would have to change our tactics with regard to contact tracing. And very soon after that, I think we all realized that it was going to have to be something that we dealt with differently than we've dealt with any of the COVID that we had before.

Throughout the pandemic, this province has had very good control of the disease. Tracking down almost every case, finding their contacts, we've been getting them isolated. We've been the envy of the rest of the country. How hard was it to sort of take your hands off the reins and say, 'We can't control it anymore?'

I think it took a fair bit of shifting, really, for us to think about that. But just the sheer numbers alone made us realize that that's the way that it had to be. But it is difficult moving to that place. I think we're seeing, and the evidence is showing and our experience with Omicron is showing, that it's starting to behave more and more like the other respiratory viruses that we see circulating in the winter months. I think it's going to require an approach very similar to that. So right now we're just working through that. This transition period is sort of helping us to figure out how we deal with that and what we have to do.

If we had closed our borders in December and really locked down like in 2020, was there not a world under which we could have kept Omicron from coming in to the province like the other variants?

No. This is just spread so easily that it was going to come in. If we locked down, whenever we opened we were going to see a surge in cases.… This is why we say with influenza that lockdowns don't tend to work as well, because it's very easily contagious. It can spread before anyone even knows that they're sick, of course, so it's much more difficult to keep it out. We can't lock down the province completely. Most of our food is imported, most of our other necessities are imported, so that has to continue to happen. People leave the province for work and have to come back, that has to continue to happen. With what we're seeing elsewhere and the spread we were seeing elsewhere, there was really no way to realistically stop it from coming into the province.

A lot of people I talk to, their emotional tank is kind of empty after two years of dealing with lockdowns and changing measures. I have to imagine that some people in Public Health feel that way too. How much did that play into the decision to the tact we take not only within the team, but the province as a whole?

Well, speaking for the team, I can say that as tired as we all were, we're still going to follow what science tells us we need to do and how we need to approach things. So that's really been our focus: what does the science say? What does the epidemiology happening elsewhere tell us and how do we respond? We understand that people are very tired, and obviously we all want to be able to get back to a more normal way of life than we've all experienced over the past two years. But first and foremost, really, we looked at the science and the science is what has informed our path forward at this point.

Almost every person I've talked to has struggled in some way over the past two years. What's been the biggest struggle for you?

I don't know.… I think just knowing that we had to bring in these measures to be able to control the virus and knowing that the consequences that those measures can have. Nobody in Public Health takes these measures lightly. Nobody wants to do this. But at the same time, we also don't want to see what other jurisdictions have seen; that would be quite tragic and we certainly wanted to avoid that. So I think for all of us in Public Health, besides having to deal with increased workload when it comes to contact tracing at times and things like that, it's just knowing that some of these measures were having impacts that none of us really wanted to see, but really had to happen.

Early in the pandemic you received a lot of praise for how you were handling the situation. You have some of the various arts and crafts that have shown up behind you. But recently some of the public discourse, and I think the key word here is "some," has been much more negative toward Public Health. How much does that affect you?

I mean that's expected, isn't it? We know that these measures are having impacts on people, we know that people are upset by that. We know that there's this fatigue that is happening, that people are tired, that people are frustrated. We understand that, and I think none of us are really immune to that criticism. But you try not to pay attention to it for the most part. There's not much you can do about it, people are entitled to their opinions.

Fitzgerald was thrust into the public spotlight at the beginning of the pandemic as the interim chief medical officer of health, and has been the face of the province's COVID-19 response. (CBC)

But I guess as someone who didn't pick a career in the public spotlight, Public Health has been largely behind the scenes before the pandemic, is that something that was easy to do? Just put up that wall and not have it affect you?

You know, you learn as time goes on. I won't say that you don't get affected when people call you really terrible things on Twitter, but you know, I know it's not true. So that's fine. It's really about having your own internal understanding of your own self-worth. And and that's really important. So I think for the most part, it's just something you learn as you go. 

I want to look ahead and at what the next little bit is going to is going to look like. If everyone is going to end up getting COVID, or a large percentage of the population, have all we done is essentially delayed the inevitable rather than being able to actually prevent it?

That's a difficult question to just answer like that, because I think what we have to consider is that we are dealing with a different variant than we dealt with from the beginning. If we had allowed this to happen from the beginning, I think we would have been in a very different place.… So I think everything we've done up to this point has kept very significant viruses in check, and for us under control. But what we're dealing with now is something that's quite different. Everything we've done that has allowed us to get time to get vaccinated, to get that protection that we need. And so we would not be able to do what we're doing right now if we hadn't done everything that came before. 

It's quite different than what we saw with Alpha and Delta variants.… No. 1, it causes, generally speaking, less severe disease than other variants. But also we have the vaccines that are protective, and certainly the boosters are giving people significant protection from severe disease. And in those first several weeks after you have a vaccine … you're reducing transmission as well. So we know that right now, given our vaccine levels and given what we know about the severity of this, that we can allow, I guess, an easing of restrictions even with the cases that we're seeing. Because we're not seeing the the larger impacts that we would have seen with the other variants that were circulating previously. 

We may not be seeing the larger impacts, but it is still having a very significant impact in terms of the number of people dying because of COVID-19. Can you give us some more information about for whom COVID is not just going to be the sniffles or like the flu, but for whom this is going to be deadly?

What we've seen certainly is in the older population. That's been true all along, and that's true with almost every respiratory virus … especially people who are frail or have other illnesses. So we see that every year. Omicron is behaving more like some of those viruses right now. If we think about deaths, we can't think about it in whole numbers. We can't think just about the number of deaths that we've had. If you think about before Omicron hit … we had less than 20 deaths in about 2,500 cases. And now we've had 16,000 or 17,000 cases and the same number of deaths. So, you know, that speaks to the severity of the illness.

More people are getting sick. And so we're going to see more hospitalizations than before and more people dying than before. But at the same time, there are effects from the measures that we put in place, and that has an effect on health as well.… So we're really trying to balance here. So that's what you have to remember.

As we shift from having more restrictive measures, where the province says, "these are the things you can do, these are the things you can't do," are we essentially shifting to an environment where people have to make their own decisions about their own level of risk that they're willing to accept? 

Yeah, I think that's that is part of where we have to be now moving forward. We have to be able to do that assessment for ourselves, you know?… First of all, am I vaccinated and am I boosted? Then, do I have other health conditions that might put me at higher risk for some of the more severe effects of COVID? And am I in that age group? Am I going somewhere that's going to put me at higher risk? Are there going to be a lot of people there? Are people not going to be wearing their masks? Is there a potential that I could come into contact with that virus? And then, you know, take precautions. It's not to say that you can't go. But if you are going, perhaps you do wear your mask, you make sure you try to keep your distance as much as you can. You make sure you wash your hands carefully and that you pay close attention to any symptoms that you may have.

At past COVID-19 briefings, Fitzgerald has compared loosening public health measures to opening a faucet or dam. If things move too quickly, there's a potential for a flood of new cases. (Government of Newfoundland and Labrador)

When I talk to some people who are in that high-risk group, I hear a lot of worry from them that opening up and easing measures, it feels like there's a trade-off, that we're saying we're going to allow this to happen. What do you say to people who are now feeling like they're sort of being left on their own?

I understand an individual's angst when it comes to that kind of decision-making. There's no doubt it is stressful, and we've been able to rely on the measures that we've had in place to be able to protect. But COVID was never going to go away. And COVID is something that's always going to be with us. So this had to happen regardless. We couldn't keep locked down forever. 

I think right now we're in a good place in that we have a milder variant circulating on the air. We are very well vaccinated, and more and more people are getting boosted all the time. So that's really good. Anyone who has those complications, those risks are still there every year when it comes to circulating viruses that can put people in hospital that can give you severe disease.

Tara Moriarty, who's a researcher at the University of Toronto, has done some modelling on what it may mean if most people — in fact the number she used was 90 per cent of the population — gets COVID. She estimates that it could mean between 500 to 600 total deaths if everyone were to get it. That's even with the boosters. Do we just kind of have to accept that that's going to happen? 

I don't know that we have to accept that that's going to happen. I haven't reviewed that study in particular, and so it's difficult for me to comment on it.… We have to accept that people die of all kinds of things, and infections included. You can't prevent everything. So there is going to be some level, you know, of life moving forward that has to have that acceptance. But … we may not see it there. We haven't seen this with other illnesses that are similar at this point. So, you know, it's very hard to to take that information to use it to predict.

I do want to look at what's the sort of near to mid-term might look like for dealing with COVID-19. What are the next measures that you think will be able to start lifting as we move forward, as long as we don't see cases rise and especially as long as we don't see hospitalizations rise?

Those conversations are happening. Where do we go next? What's the next step? But I think overall … the move will be towards capacity increasing. And then, you know, looking at other things further on down the line.… I certainly don't want to take anything I say as hard and fast at this point. 

If we look ahead to the summer, for example, do you see a summer under which we are essentially back to normal? 

I hate to predict in COVID, because every time I've tried to predict something, we've had a new variant that's popped up. Right before Christmas, I was so excited about kids being vaccinated, saying, 'this is the last hurdle'. And then boom.… So we have to be careful. But I think if we are able to open in a graduated fashion and we're able to to keep cases and hospitalizations under control and we see that that's the case, I think we will have a a more normal summer. But I don't want to say that it's going to be just as it was before.

When you say it's not going to be like it was before, in what way? 

We just have Omicron to think about, and we have to think about how we have a new infectious disease on the landscape and how do we deal with that moving forward. What we've gone through, if that doesn't change how we how we approach things in the future, I think that that's probably pretty foolhardy of us. So I think there are going to be some things that will change in the way we manage long-term care and outbreaks in long-term care and outbreak prevention in long-term care. I think we've learned a lot of things that we can do to try to stem some of that.

I think people will be more open to using masks now than they were before. Especially if we start to see that, for example, flu is circulating… If people are traveling more and and people are moving about more, we're probably going to see more respiratory viruses circulating than we have in the past couple of years. So we do have to think about that for the fall. So that's all part of our planning as we go forward in Public Health. 

Do we need to revisit health capacity? If we're seeing all of those cases, plus we're then also seeing the COVID cases, do we need to re-evaluate the capacity that we have in our health care system? 

I think those questions are for certainly a bigger table than my table. I'm sure that [they] are happening at those tables: how we can take some of these lessons learned and make informed decisions going forward?

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