White Coat, Black Art·Q&A

'We are all in this together': Alberta and Toronto's top doctors face challenges in COVID-19 fight

Dr. Deena Hinshaw and Dr. Eileen de Villa talk to Dr. Brian Goldman about the challenges they face in managing the pandemic amid rising COVID-19 case counts.

'All we have to protect each other is the actions that each of us takes every day,' says Dr. Deena Hinshaw

Alberta's chief medical officer of health Dr. Deena Hinshaw, left, and Toronto's medical officer of health Dr. Eileen de Villa are seeing rising cases of COVID-19 in their regions. (Art Raham/CBC, Michael Wilson/CBC)

Public health officers across this country have been thrust into the spotlight during the pandemic. At daily news conferences, they inform Canadians about the progress of COVID-19 and provide guidance on how to stay safe. 

As case counts rise in Ontario — particularly in Toronto — and in the province of Alberta, White Coat, Black Art host Dr. Brian Goldman spoke with two of the physicians who are tasked with leading the public health response in those regions: Dr. Eileen de Villa, Toronto's medical officer of health, and Dr. Deena Hinshaw, Alberta's chief medical officer of health. 

Here is part of their conversation.

How would you describe the current situation in Alberta right now?

Hinshaw: I think we're really at a turning point. We have seen the number of cases rising over the last several weeks. We know Edmonton in particular has been a hotspot lately. 

We've seen a trend upwards in cases in Calgary. We're watching that closely. 

Of course, I'm concerned about the increasing number of people in hospitals with COVID. And one of the things that we're trying very hard to do ... is minimize the risk of COVID transmission and the risk of severe outcomes, while at the same time wanting to minimize the impact that our restrictions have. 

So we have put in some voluntary public health measures in Edmonton, [and] we have seen a slight reduction in our trajectory of spread. So there are some encouraging examples. 

Alberta's chief medical officer of health Dr. Deena Hinshaw says that the fight against COVID-19 comes down to 'caring for each other the way you would want yourself and your loved ones to be cared for and continuing to be kind.' (Jason Franson/The Canadian Press)

But we can't be complacent. And I think that's one of the things that to me is the most important predictor of our future. How much I can keep the population of Alberta engaged in this ongoing [fight against COVID], striving for balance? Because unfortunately when we start to lose people, that's when the balance might tip and ... if we see that people start to disregard public health measures, or choose to take risks for themselves or others in large numbers that's when we will have a big problem on our hands.

There was a pretty large anti-mask demonstration over the weekend in Toronto. What were your thoughts when you saw that?

De Villa: I think that there will always be a certain segment of society that will not agree with our advice.... the issue is really trying to engage as much of the population as possible.

Dr. Eileen de Villa, Toronto's medical officer of health, says there 'will always be a certain segment of society that will not agree with with our advice.' (CBC)

As a medical officer of health, particularly at the local level, you are trying to establish a relationship with our patient, even if it is three million people — no different than, you know, an individual physician would try to establish a relationship with a singular patient in your typical medical practice. 

And unfortunately, the way it works in medical practice is that sometimes you have to deliver difficult messages or messages that the patient doesn't want to hear. And it's just that much harder when the patient is, in fact, the three million people of a city. 

Dr. Hinshaw, have you found that you've changed your message since the pandemic began based on the feedback that you're getting from the public as to what messages stick and which ones don't?

Hinshaw:  Absolutely. I refine my message all the time. And I really appreciate feedback when I get it. 

There's been some things that have been passed on to me  — one, for example, when I'm speaking about people who have passed away from COVID, and expressing sympathy to the families … people, who are grieving losses from other things, were asking, "Well, does my loved one not count?" … and the importance of acknowledging that … those who die from non-COVID causes leave behind family and friends who can't grieve the same way they would have before and making sure that I'm never inadvertently giving that message that some people's lives matter more than others. But really underlining that kind of back to that point that we are all in this together.

Dr. Hinshaw, you're not only dealing with a pandemic, but you're also dealing with some severe provincial health budget constraints.  Last week, the Alberta government announced it is planning to cut up to 11,000 jobs in health services with an emphasis on not cutting the jobs of front-line staff dealing with the pandemic.  What was your reaction to that announcement? 

Hinshaw: Well, you know, my job really is to provide advice on public health issues. And so issues of health system structure and alignment aren't things that are a part of my portfolio. Of course, with the downturn in oil and gas prices and the way that our economy is structured right now, there are a lot of people who are out of work, and that has an impact on our provincial budget … but of course, it does impact the resilience of our entire population.

If we did let COVID go out of control, that would have a huge impact on the economy.- Dr. Deena Hinshaw

People are tired, they're feeling these impacts of not just COVID, but of the economic downturn…. With respect to the COVID response, there's been assurance that the resources for the response to COVID will be there. I think there's a recognition that this is a critical issue that we need to resolve. 

And when it comes to COVID, sometimes there's a false dichotomy that is articulated of economy versus health.

And it's actually both … not an either/or, because if we did let COVID go out of control, that would have a huge impact on the economy.

Another vulnerable population, as we discovered during the first wave, involves racialized populations and low-income groups. Given these very severe times in Alberta, how can you better protect these vulnerable populations during a second wave?

Hinshaw:  That's an incredibly important question. And we absolutely have seen that those in the first wave, who didn't have the privilege of having a job where they could do that job from home, were of course disproportionately [impacted] — those who were, say, newcomers or those who were in lower-income job.

And one of the things that has been really important and that we've been working on for a long time, but with more attention over the past couple of weeks, is that question about people's ability to get financial support, if they need to stay home ... and that's something we've been working on to make sure that there's as few barriers as possible to accessing financial support. 

I think it's also critical that we consider the impact of living conditions in the spread [of COVID-19], and we have been making available isolation and quarantine hotel options for those who live in crowded housing. The things I'm mentioning are short-term solutions, but of course, longer-term solutions are things that really involve going back to those social determinants of health and thinking about how can we support people ... to have secure income and to have appropriate living conditions.

Dr. de Villa, during the first wave, we didn't do so well at protecting our elderly. What have you learned from that that might help us now?

De Villa: I think that learning has occurred not only within public health but … across many sectors. And I'm pleased to say that I do see much more collaboration … whether it's hospitals, long-term care, public health, and the other agencies that exist here within this province that provides support to those in long-term care in particular, where some of the most horrific outcomes were experienced in the first wave of the pandemic.

But we know that ultimately, resilience within our systems, resilience within long- term care will require a much more future-looking perspective, and will require investments down the road that will allow our entire community to be more resilient.

Toronto's top doctor urges caution to keep COVID-19 from 'catching fire'

Toronto

1 month agoVideo
1:53
Individual actions are all that stand to keep COVID-19 cases from surging further upward as they are in Europe, Dr. Eileen de Villa says. 1:53

I'd like to talk a little bit about the job of a medical officer of health. It's a tough job made even tougher by the attacks and criticism that both of you have received on social media. How do you cope with that side of the job?

De Villa: I admit it is a challenge. It's never nice to be the object of criticism, particularly when you know that we are trying to do our very best to take the best available evidence and apply it in the spirit of advancing and improving health status of the population and reducing disparities, and in this case, responding to a major outbreak in an emergency… and, you know, do you have a strong network of colleagues and friends and supports, who actually understand, so that you have that opportunity to discuss, vent as necessary and then pick up and and take on the next day. 

Because this is the job. It's a wonderful job. There's so many opportunities to really make a huge difference. So I think you take the feedback. You learn what you can from it … and you continue to resolve to do the best you can each and every day.

Dr. Hinshaw … knowing that it's a difficult job that you do being a voice of authority (yet not knowing everything at all times), what's your advice to the people of Alberta at this time?

Hinshaw:  I think it comes down to caring for each other the way you would want yourself and your loved ones to be cared for and continuing to be kind and remember that COVID isn't over. It will be with us for a while and all we have are each other. That's all we have to protect each other is the actions that each of us takes every day.


Q&A edited for length and clarity. 

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