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The new normal

Introduction by Dr. David Walker, MD, FRCPC
Special adviser to the principal, COVID planning and preparation
As we approach day 250 of this projected 1000-day pandemic voyage at Queen’s and in Kingston, much – but not all – has changed.

In March, COVID-19 caused the university to move most programs to online  delivery of teaching and exams. Students in residence were encouraged to move home and our community went into lock-down mode.

Coincidently, planning for and management of the effects of the pandemic moved into high gear, where they have remained since. Academic and Operations oversight committees have been engaged on all fronts in collaboration with students, faculty, staff, Public Health, the City of Kingston, and our academic and community partners.

Decisions were made early that most fall academic programs would be delivered virtually. Exceptions were made for some programs where in-person education was essential, such as in the health professions and a few other areas. Some research and laboratory-based graduate programs satisfying significant safety criteria have been maintained. A significantly reduced number of students have been admitted to residence, again based on a variety of criteria, all to single rooms with private bathrooms. Residence space is available for isolation of students who are required to do so.

The university requested that those students returning to campus consider testing pre-arrival and observe quarantine for two weeks after arrival. Extensive education and support for students living on and off-campus have been developed.

The university community is now guided by an array of federal, provincial, health unit, and municipal legislation, directives, and guidelines. We have all become educated in “IPAC” (infection prevention and control) procedures such as handwashing and sanitizing, masking, physical distancing, working from home when possible, and completing our daily screening requirements for building entry. All of our buildings have been assessed for safe capacity levels, entry, and egress.

The university has worked hard to protect the health of our academic and broader community. A campus COVID assessment and testing site has been established for students and steps have been taken to ensure that contact tracing can be facilitated when necessary.

In the late summer, anticipating the inevitability of outbreaks over the fall and winter, the university activated its COVID Incident Command structure, chaired by Provost Mark Green, and undertook desktop simulation exercises (in-person, all adequately protecting and protective) with our Medical Officers of Health. Much was learned that has been useful in the weeks that have followed.

As I began, I mentioned that not all has changed. Many upper-year and some first-year students not in residence have chosen to undertake their virtual programs after moving to Kingston. This large migration of young people to Kingston has required significant educational and other interventions to prevent or reduce the potential for COVID transmission. To date, Kingston has proven very effective at managing the pandemic and the evidence that transmission across the continent is currently ���˴�Ƭ in this age group is naturally concerning.

Looking forward, we all hope for the panacea of a widely available, safe, and effective vaccine but realistically, we must prepare for a somewhat more sanguine result more in line with influenza control. In conjunction, and perhaps more likely, advances in antiviral and other therapies will reduce the lethality of this virus so that we can achieve a stalemate that allows our society and its institutions to move onwards.

Pandemics change society. Doubtless our future will be different in both predictable and unpredictable ways. Principal Deane is leading the process of creativity and thinking that will prepare this academy to play a leading role in that future.

Here are just a few stories from “the new normal” at Queen’s.

Drew Davies (Physical Plant Services) works 6 am to 2 pm every weekday in Chernoff Hall and the Rideau Building. He cleans 18 bathrooms in the two buildings, about 28,000 square feet of surfaces.

In late March, while Queen’s moved most campus activities off-site, some staff, like Drew and his colleagues, kept right on working (almost) as normal. Queen’s campus, though, felt  strangely empty for on-site staff. Fall has not been too much busier.

“I used to work in the BioSciences building where I was surrounded by thousands of kids every day. I’d work around the rushes of students entering and leaving classrooms,” says Davies. “Now I might see 20 people in an eight-hour day between the two buildings.”

While the “new normal” took a lot of people by surprise, Davies says that PPS was prepared early on. “We got out in front of this thing really quickly. PPS started planning in January and February. We got new training and a lot of support.”

Custodians got new equipment, too, including aqueous ozone machines, which change water to ozone. Davies uses this machine to clean the surfaces – including floors and walls – in each of those 18 bathrooms. Hydrogen peroxide-based cleaners are used on high-touch points in each building, like doorknobs, railings, and elevator buttons.

“We are cleaning for disinfection. The best thing I’ve learned is to slow down and take my time and think about what I’m walking into. It’s about making sure your areas of responsibilities are disinfected, clean, and safe.

Three Nursing students arrive at the Cataraqui Building for their lab to practise epidural procedures. With an instructor, they review the components of the epidural pump and practise reading the standard orders for patients: what type of infusion they receive for pain relief, the infusion rate and history. Then they do patient assessments, first with written scenarios, and then with each student taking turns as the patient and the clinician. They check the patient’s pain levels at rest and in motion. They review how to assess the range of sensory and motor blocks, which will tell them how well an epidural infusion has worked on the patient.

In previous years, NURS403 students would have met as a lab group of up to 20 students. A few times during the term, they would work, during this lab, with volunteers acting as patients on different scenarios. This year, students are put into groups of three or four. Each small group arrives at an appointed time; each enters a separate room and works with a separate instructor. As much as possible, these students will remain with the same group of classmates in all their in-person lab sessions this year.

Instead of teaching POLS110 in Dunning Auditorium, Dr. Jonathan Rose is teaching the class from his home study. This week’s topic is the state in modern democracies. He’s seen here answering a question on the role of the state around protests addressing anti-Black racism.

“Teaching in a pandemic has meant lots of surprises, some pleasant and others, not so,” he says. “I’ve been shocked at how much extra time it takes to craft a lecture and produce it into a coherent narrative. My lectures are shorter, which I thought might be easier. Early in the term I spent 10 hours or more to produce a 15-minute lecture video. I’m getting more efficient but still never expected ‘digital producer’ to be part of my job description.”

"I also miss the feedback that I receive from students, both in class and in the moments when I bump into them on campus. Those brief interactions often provide lots of helpful advice
about what’s working and what’s not working. One pleasant surprise is that I am heartened to know how eager students are to engage inmeeting live online (if you’ll excuse the oxymoron!). My one-hour class almost always goes beyond that time and I get a sense that my first-year students are eager and hungry to devour the course material. I’ve also been very impressed at how quickly students have adapted and flourished in a very different learning environment.”

Dr. Stephen Montague is on a video call with a fellow internal medicine physician. From an office in KGH, Dr. Montague is demonstrating how to incorporate Point of Care Ultrasound (POCUS) on a patient to diagnose – quickly and accurately – heart and lung problems. He moves his pocus transducer, the size of a cellphone, on his simulation manikin, as his colleague observes from her laptop at home.

“You’re looking for the ribs. Here’s one…” A white line moves into view on the ultrasound screen on both their computers. “And there’s the second. Now we’re going to look at the pleura between them. If – right here – you see pneumothorax [air in the pleural cavity], then you’ll know it’s pneumonia.”

With Dr. Amer Johri (Cardiology), Dr. Montague has launched a trial tele-mentoring project to teach colleagues how to incorporate POCUS into their practices. They provide the equipment and the training, as well as live coaching during POCUS exams. For two weeks, the physicians who have signed up for this mentoring will practise using a POCUS transducer on volunteers within their household or COVID bubble, scanning them for heart and lung issues. This will prepare them to incorporate POCUS into their medical practice with real patients.

“POCUS is the stethoscope of the 21st century,” says Dr. Montague. Having an accessible diagnostic tool is particularly relevant during a pandemic. If a physician suspects covid-19 in a patient, a POCUS exam of the heart and lungs can confirm the diagnosis on-site, without moving the patient. And while the training is currently limited to interested physicians at Queen’s, Drs. Johri and Montague hope that they can expand the project, getting both the technology and the tele-mentoring to physicians across Canada, including in remote and rural areas.

"The COVID-19 pandemic has dramatically changed the landscape of education," says Dr. Johri. "How can we ensure hands-on acquisition of clinical skills, especially for health-care personnel in a safe manner in this challenging era of social distancing?  This has become a critical question for the teaching of medical students, staff physicians, nurses, and any care provider. The ARCTICA team (Accelerated Remote Tele-POCUS in Cardiopulmonary Assessment) was awarded a seed fund from a national competition held by the Canadian Cardiovascular Society to meet this challenge using novel technologic innovation - the use of live-streaming of imaging by an expert to support learners and provide a Virtual Learning Lab."

At QCPU – Queen’s CardioPulmonary Unit – Dr. Patricia Lima and Dr. Elahe Alizadeh are working together in the Physiology and Experimental Therapeutics lab. They were among the first researchers to get clearance to return to campus in April. It was then that they, and several of their QCPU colleagues, pivoted their research to address COVID-19.

Researchers at QCPU study heart, lung, blood, and vascular diseases. With the discovery that the COVID-19 virus disables the mitochondrial function in lung cells, Dr. Stephen Archer(Meds’81), QCPU’s scientific director, and his colleagues have been working all summer on how they can create therapeutics that block mitochondrial damage in lung cells to stave off COVID-related pneumonia.

Dr. Alizadeh is an imaging and radiation physics specialist. Dr. Lima is a molecular imaging and cytology specialist. In basic terms, for their current research, Dr. Alizadeh looks inside the body to see how the lung vasculature and airways are affected by COVID-19 infection and Dr. Lima explores why it is happening.

The how and the why of COVID-19’s attack on the lung cells will bring them to the next step of this research problem, how to treat the issue. This concept has already brought together more specialists: chemists, virologists, and infectious disease experts. This type of translational research is at the heart of the work at QCPU. Its researchers work with colleagues across 24 departments at Queen’s.