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Since the beginning of the COVID-19 pandemic, Ontario has been gathering medical experts to advise on how the province’s healthcare system can best meet the challenges created by this global pandemic. Chris Simpson, Vice-Dean (Clinical) in the Queen’s School of Medicine and Professor in the Department of Medicine and School of Policy Studies, has been selected as one of these experts. Currently, Dr. Simpson is serving as the clinical science lead on Ontario Health’s COVID-19 Health System Response Oversight Table. As part of his work at this table, he also serves as the chair of committees addressing personal protective equipment (PPE) and surgical and procedural work in the COVID-19 era.

The Gazette connected with Dr. Simpson to learn more about his work for the province and to hear his insights on the health care system’s response so far and what may be next for medicine and physical distancing as Ontario continues to deal with the pandemic.

What is the function of the Ontario Health COVID-19 Health System Response Oversight Table? And how would you describe your role as the clinical science lead?

Simpson: With the onset of the COVID-19 pandemic, Ontario Health set up this table to oversee the work being done across the agency to address the situation. Several tables report up to the Oversight Table, including human resources, supply chain, data and analytics, communications, primary care, and emergency care. And then there is a clinical science table that is designed to rapidly respond to new and emerging evidence to help inform Ontario Health’s recommendations to the system. I am the lead of that table. And in that role, I assemble experts to rapidly evaluate new evidence to advise on issues such as the use of personal protective equipment (PPE) and how we can continue to do surgical and procedural work at a time when we need to create tremendous capacity to deal with COVID surges.

What is the current state of PPE in the Province? And what recommendations has the committee put forward?

Simpson: PPE is in limited supply almost everywhere in the world right now. And so, there has been a lot of very important work done by supply chain experts on securing the kind of PPE needed by the health care sector and other frontline workers in our society.

The picture for PPE seems to be gradually improving. The security of the supply chain seems to be on its way to stabilizing. But there is still a tremendous amount of work to be done. Our Ontario Health committee on PPE has taken an evidence-based approach to the use of PPE. We want to conserve PPE whenever possible and be good stewards of the resource. In times like this, fear can play a large factor in how people might consume PPE. And we find that when we look closely at the evidence, it’s quite clear what kinds of PPE are required for various sets of circumstances. And so, by laying that out very clearly, the committee has encouraged people to use PPE in a way that keeps them very safe without overusing it or using it inappropriately. Those conservation strategies can make a huge difference. Simple things like extending your mask use between patients can help turn an eight or ten-mask shift into a two-mask shift – all the while remaining safe.

We have looked at the possibility of reprocessing or sterilizing masks so that they can be used again, which is something many people around the world have been investigating. We agreed that this would be a step we would take only if all the conventional supplies were exhausted. It’s a matter of preparing for the worse, and hoping for the best. It’s always better to plan for worst-case scenarios. If people say, in hindsight, that we over-prepared, I’m ok with that.

You also chair a committee to help determine when elective surgical and procedural work can start being performed again. What have been the effects of these procedures being put on hold due to COVID-19? And how is the committee going about finding ways to resume these activities?

Simpson: At the beginning of the pandemic, there was a recognition that we needed to create capacity in the healthcare system. We knew we needed to free up patient beds and ventilators and other resources to ensure that there would be enough PPE and ICU and ward bed capacity in the hospitals in the event that we got a huge influx of COVID patients. Part of the strategy to create capacity was to delay so-called elective procedures and surgeries and other types of care that could be temporarily put on hold.

That plan works well if the time period is three or four weeks, but if we’re looking at months, that kind of delay creates a tremendous backlog of surgeries and procedures that may be less urgent, but are no less important. For all these procedures, there is a period of time beyond which it is no longer reasonable to wait, or even safe to wait. Today’s bowel polyp snaring is tomorrow’s bowel resection. Today’s stable angina is tomorrow’s emergency bypass surgery. Today’s breast lumpectomy is tomorrow’s mastectomy. We can’t be lulled into a sense that “elective” care can be delayed for very long.

As we’re starting to think we may be seeing the peak of the first wave in Ontario, this committee is exploring options for resuming normal healthcare activity as much as is reasonable. We are very aware, though, that we must make sure that we are prepared for a second wave of COVID-19 in Ontario. That means ensuring that we have enough PPE, ventilators, and other supplies to address another outbreak. We would also need to consider the other support that’s required for surgeries and procedures, including rehabilitation therapy, imaging, and home care. There would have to be capacity in these areas. Ramping up surgical and procedural work will require a system-wide approach. And that’s what the committee is preparing for.

Our goal is to make sure that the healthcare system is looking after all patients: those with COVID-19 and those who need all the usual medical care. But we need to do so in a thoughtful way that doesn’t create unintended consequences in other parts of the system.

What do you think the future of the pandemic will look like in the province? What should people in Ontario expect in the next few months?

Simpson: We’re learning more about how the virus behaves every day. And what has become abundantly clear is that the public health measures that have been put in place are working highly effectively, particularly physical distancing. At the same time, we have to recognize that low rates of infection keep us vulnerable. As we start to plan for a gradual re-opening of society, we can’t fall into a sense of complacency. This is far from over.

When we get past this first wave, there will need to be some reopening of society, but it’s going to have to be done in a very staged way. It can’t be a complete return to normal, with large crowds gathering at concerts and sporting events. We will have to continue physical distancing to the maximum extent that we can, while finding ways to get the economy going again and enabling people to return to work. How we go about opening society again will determine what the next waves of COVID-19 will look like in Ontario. We need to keep the waves manageable so that the health care system is not overwhelmed the way it was in Italy or New York.

In the next few weeks, I think people can expect there to be discussions around opening things back up in a very measured and gradual way. When society first opens back up, it won’t look like it did before the pandemic, but it will look less restrictive than it does right now. 

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To learn more about how Queen's experts are helping guide Ontario's response to COVID-19, read the Gazette Q&A with Troy Day, who serves on the Provincial COVID-19 Modelling Table.