how an east toronto hospital got ahead of covid-19

sarah downey first heard about covid-19 (back when it was still just a ‘mysterious new virus’) on january 15 from dr. jeff powis, michael garron hospital’s medical director of infection prevention and control (ipac) — she remembers because he’ll often remind everyone of this.the ipac team had been following the situation in wuhan closely. downey, president and ceo of michael garron, says the team is often the first to know and understand outbreaks. but for everyone else, the novel coronavirus felt a bit like an abstract.so when powis started saying this would be “the one we have to react to,” downey and her team tuned in. by late january, the hospital had already started a high-level response.since then, michael garron hospital — formerly known as toronto east general hospital — has run one of the most visible personal protective equipment (ppe) drives (more than 400 people have dropped off enough enough ppe to fill a meeting room) and a massively successful campaign for 1,000 hand-sewn masks a week (where they received 40,000 homemade masks). an incredible feat more comparable to a flashy downtown academic health centre than a community hospital tucked away in a residential neighbourhood.“the amazing thrill is the resilience of these toronto communities and how that helps lift our spirits in here,” says downey. “they make us want to be even better fighters of covid-19.”

lessons from sars

having worked at the helm of many hospitals in her career, including princess margaret cancer centre during the sars outbreak in 2003, downey is familiar with pandemic plans. the staff who had been around at michael garron hospital back then still have what are known as “sars scars.”it’s thanks to sars that canadian hospitals today are able to respond to covid-19. after five months, much more is known about the virus than was known about sars — from how to test for it to how to isolate it. as vice-president at princess margaret, downey didn’t understand who worked on the infection and control team at the hospital and she had never heard of an n95 mask before. today, she’s fit-tested for a respirator mask every two years — as is everyone else in the hospital.“it occurred to me that everything we do now is through the lens of infection prevention and control. every decision you make, you have to think through the potential impact on your staff and on the patients you treat,” she says. “this time is far more natural and i understand it so much better. we have pandemic supplies right in our hospital for the eventuality of a pandemic — that was not the case with sars. we have a pandemic plan which we never would have had in the time sars. we’ve developed a whole lot of sophistication.”

a week in the life of a hospital ceo during a pandemic

every day starts with a half hour executive team meeting at 8 a.m. with the heads of infection control discussing what issues are on the radar. they all meet again at 3 p.m. to talk about what needs to be accomplished. downey also has a larger hospital command centre that meets three times a week as well as a twice weekly managers meeting to talk through management issues and messages to staff.for downey, it’s vital to get information out as quickly as possible to staff. she finds out what’s going on and contextualizes that for the hospital. whether it’s through daily emails, enhanced rounding, or going around units and talking to people face-to-face. she also hosts a five-question series with experts every week, some of which are shared publicly if they’re relevant for the general public.“we get out and speak to people about what it means here so they have information and hopefully make them feel more confident in our own organization’s response to covid and that their role in it is clearer,” she says.at home, downey says she’s been watching more netflix than ever. her home is close to the hospital, but typically, she would be out three nights a week for work-related events. nowadays she’s able to be home most nights for dinner.“my family is safe and that gives me great security,” says downey. “my kids are 12 and 14, so the impact on their lives and on their extracurricular activities is deep. it’s amazing how much time i’m able to spend with them. i try to stay connected with my kids and my husband, and call my parents, who are older and living in waterloo, and deliver them meals and flowers and make sure they’re okay.”“it’s not always easy but i figure if we can keep it together, it will help me be a better employee.”

hospitals have not seen a surge, other health systems have

every week has been slightly different since covid-19 began. the first few weeks were focused on preparing to identify, treat, and not spread the virus. the hospital set up screening doors, assessment centres, and zones in the emergency department. as new york, italy, and spain were quickly becoming overwhelmed, it was clear that the hospital needed to figure out how to double the size of the intensive care unit and open a hundred more acute care beds.“we really spent a lot of time preparing ourselves and our hospital to respond to a surge which, mercifully, has not happened to the degree of overwhelming us,” says downey.to date, michael garron hospital has diagnosed about 300 patients with covid-19 and at the time of this interview, there were 21 patients in the hospital, which she says is manageable.in the last few weeks, the focus has shifted to covid’s impact on shelters, congregate living, and long-term care homes and how michael garron can help minimize the spread amongst seniors and staff in those facilities. hospitals have the expertise to provide mass infection control expertise and staffing for the places that don’t have enough staff, physicians for medical supervision and guidance, and palliative care when it’s needed for residents.there are 10 long-term care homes in east toronto and michael garron hospital has reached out to all 10.“we’ve figured out internally what to do and we’re not seeing the crisis we thought might happen yet. so we’re spending a lot of time in our community helping others in their response,” says downey. “we bring a hospital lens to it, which forms a great partnership to go in and help others who are overwhelmed. and some places have been in trouble.”some of the places they’ve been called into include st. clair o’connor community a few weeks ago and ina grafton gage home last week.“what’s occurred to me during this pandemic is the whole system is not as prepared as hospitals are,” says downey. “the big thing that came out of the sars era was this high quality infection prevention and control in hospitals. we are now relatively well prepared to fight this kind of a thing. we need to bring that degree of expertise and resource to other parts of the system where it’s required. that’s my hope and why we’re spending a lot of time outside our walls trying to help.”downey says this is inherent to the approach of michael garron. at 91 years old, the hospital was born into the community and has long served the community.it was the ipac team that first told downey, ‘we’ve got to get out there and help them. we’re pretty well set up in here.’although the government has just passed orders to be able to more easily allocate hospital staff to those settings, downey says that’s never been a problem for michael garron.“people have always said ‘i’ll go help!’ and that’s what i so admire about the culture here,” she says. “people just feel like it’s their duty to help. there’s a sense that this is our community too.”

the importance of gifts for morale

since the beginning, downey has seen her hospital move from a place of fear to one of learning.“i don’t think it’s going to go away soon and so we’re going to have to learn to live with covid in our environment. i’m not sure exactly what that will look like yet, but the growth part is getting out and being in our community to help others,” she says. “it’s accepting that you always live with some risk and to be alert to it. don’t be consumed by it, but be alert to it. understand that personal protective equipment is part of your approach and what you need to do to protect yourself and protect others from covid.”the staff at michael garron hospital all have the same fears and worries that many others do. they worry about coming to work and getting covid and bringing it home to their families.“that’s everybody’s fear and if they’re not resilient and strong, we can’t mount this kind of response,” says downey. “it takes time, it takes education, it takes communication, it takes trust and of course, you can’t just build those things overnight.”one critical part of this is being able to thank the staff.“you can thank them physically — i was here for three hours yesterday walking around talking to people who were working on the weekend — but what’s amazing too are the gifts we’ve gotten,” she says. “we’re able to say thank you in many ways every week. as i was leaving on sunday afternoon, there were lush soap gift bags for people. there were frozen meals for them to take home for dinner for their family.”other gifts michael garron has been able to give healthcare workers include meals from oliver & bonacini, covered by rbc, hand sanitizer, potted plants, and soon, dove soap.being able to thank staff in person is one reason why downey continues to go into work every day. “i think there are some who can work more easily from home, but i actually think that leaders need to stand beside the people on the frontlines and be able to look them in the eyes and thank them personally,” she says.“i spend every day here. there’s nothing more important than our teams, our staff, our patients, and our community than for me to be here most of the time. i’ve chosen to come to work every day to stand with the teams of people who are making those sacrifices.”diana duong is a writer and editor at healthing. find her on twitter @dianaduo.dduong@postmedia.com