Community Report: Special COVID-19 Edition

When COVID arrived in Leeds, Grenville and Lanark, its first stop was the long-term care and retirement facilities, home to our area’s most vulnerable populations. It was not long before the same homes in the region faced widespread outbreaks, with many residents dying.

Yves Decoste, worked closely with the area’s long-term care and retirement facilities to manage outbreaks, along with other public health nurses and public health inspectors on the COVID-19 Outbreak Team at the Health Unit.

“It was very sad and some homes were very much in a panic,” he said. “During those early days, I tried to keep calm and empathize when facilities were reporting sick residents or staff, or a death and I did my best to return phone calls promptly even if I didn’t have labs or an answer for them just so they knew they had someone to call and who was working with them to look for answers.”

Decoste’s job was to act as a consultant, providing guidance around Ministry of Health directives, helping develop plans to contain outbreaks, helping manage issues with staffing and staff illnesses and exposures, advising on movement of patients to and from hospitals, acting as a liaison for swab testing and ensuring homes had the supplies needed to suppress the spread of communicable diseases. He was also a friendly voice during a time of crisis.

“I tried to ensure that a plan was in place for follow-up and encourage them with the small gains made like no cases reported today,” he added. “I still get calls from some of those homes that just say I called you because I know you will answer.”

One public health responsibility is managing and controlling communicable diseases and the Health Unit has plenty of knowledge through its work with other transmissible viruses such as influenza, food-borne illnesses and sexually transmitted infections.

“We had a lot of good things in place before COVID through our experience with influenza, and there were a lot of lessons learned from dealing with those that were very transferable,” said Decoste. “COVID was bigger and more intense and the issue was dealing with it on a larger scale because COVID was everywhere in the community. We needed to find efficiency in what we were doing.”

The most important tool to manage the outbreaks was the introduction of the Case and Contact Management Software. Implemented by all Ontario health units, Case and Contact Management allowed staff on the outbreak team to follow the status of positive cases from start to finish, track lab results and send tasks to other heath units. The software was also automatically updated with the most current guidance and government mandates so staff did not have go searching for up-to-date information.

“Before the Case and Contact Management software was released, we were putting information on a white board and manually trying to keep files up to date and input them into IPHIS (Integrated Public Health Information System),” he said. “We had to spend a lot time trying to track down labs, basically trying to gather all the elements we needed.”

Case and Contact Management updated all that information automatically, streamlining the track and trace process.

For Decoste, the introduction of daily meetings with the team and weekly meetings with long-term care partners and the Ministry of Heath ensured all stakeholders, other heath units and the Province were all on the same page, following the same legislation and protocols.

“Ability to work remotely, kept us able to meet the demand and we weren’t all congregated in a small office space,” he said, adding that promoting some staff to managers was also instrumental during the agency’s pandemic response by providing direction so staff could analyze cases and ensure best practices were maintained throughout an outbreak.

“The different cogs of the system all needed a point person to really report to and then have more discussions with the MOH (Medical Officer of Health),” he said. “That’s something that evolved quite a bit, having consultations with the MOH more frequently because of the complexity of the cases and changes that would come up.”

From an outbreak management perspective, the pandemic really solidified partnerships and relationships.

“It brought public health out of the shadows,” said Decoste. “There are retirement homes in the area that had no contact with the Health Unit before the pandemic but since COVID they have reached out for information.“

Another positive for Decoste is that he had the opportunity to spend two months in the summer of 2021 in the Yukon lending a hand with outbreak management throughout the territory.  

This August, the Heath Unit launched its own Diseases of Public Heath Significance dashboard to help monitor and target messaging to health care professionals and inform the public about trends and spikes in communicable diseases. By June 2023, Case and Contact Management Software will update and transition its system (IPHIS) to include these same diseases so public heath can better manage outbreaks in high-risk settings and provide real-time data to the Ministry of Health through an updated system.

Decoste hopes tracking of Diseases of Public Heath Significance spreads awareness of transmissible diseases and the efficacy of vaccines to prevent many of those diseases from spreading, noting that as soon as vaccines were rolled out in long term care homes and other high risk settings, deaths from COVID significantly declined.

“There’s a reason for vaccination and we’re seeing that now,” he said.

As a Public Health Nurse at the Health Unit for the last 15 years, Tanis Brown had worked through a pandemic before. In 2009, Brown was one of the many staff assigned to vaccinate residents of Leeds, Grenville and Lanark against Influenza A, otherwise known as H1N1, as part of a worldwide immunization campaign that lasted less than a year. “That blitz, it was just something that happened over the fall,” Brown recently recounted. “It was short and intense, but not near as intense as COVID. People didn’t fear for their mortality.”

Since then, Brown has held a number of roles at the Health Unit, including working on the communicable diseases team, child and youth development as the Triple P coordinator and, most recently, the Health Equity Coordinator where she works both internally, with colleagues, and externally with community partners to provide evidence based analysis and consultation on the policies and systemic barriers that prevent all residents from “achieving their fullest health potential”.

A week prior to COVID-19 being declared a pandemic in Ontario, Brown was asked by Health Unit management to support the Infectious Diseases Team in answering general questions received by the phone line from the public about a new coronavirus that was sweeping across the world.

“Then a pandemic was declared and it was like a freight train. We were thrust into a forest fire and we didn’t have a hose,” she said referring to the lack of information available for staff to triage questions and find concrete answers about this quickly spreading disease. This was a new virus and there was much still to learn about it.

“As a Health Unit, we were called into action on a dime to meet this level of panic on the phone, with nowhere to send people, just a sheet of paper and we had to find a way to give them a sense of calm and reassurance. We didn’t know if people were going to start dying.”

From then on, Brown supported the Health Unit’s COVID-19 response on the Case and Contact Management Team – calling individuals who had tested positive for COVID-19 to discuss their isolation requirement and identifying their close contacts to inform them of their exposure to COVID-19. She also worked on the Outbreak Management team, specifically working with child care centres; helping them understand as they navigated the provincial guidelines around COVID-19 and instructing them on how to contain outbreaks. 

In her work in case and contact management, Brown needed to understand and apply the provincially-mandated legislation around incubation (period of time a person is contagious before symptoms begin) and isolation (the length of time a person must stay at home). She also had to identify and get in touch with close contacts to advise them of their obligations to isolate and monitor for symptoms. Whereas, in outbreak management Brown helped child care centers interpret the same legislation for congregate settings.

“I needed to help them decide which children needed to stay home and who could reasonably stay (in day care), so parents and families would not lose income and kids didn’t feel a disconnect from being out of school and child care.”

The speed of information and how quickly guidance from the province changed made it difficult to keep track of the rules and know whether she was giving the public the right information. She describes the Brockville office during that time as like a congested “freeway.”

“There wasn’t any other way, I needed to be with my people because there were so many questions to be asked,” she said. “And I needed that emotional support being with my peer group to have the confidence and support to provide that reassurance on the phone. I had a lot of positive experience in just helping people through their own COVID journey. That was a meaningful part of the day.”

Brown quips that during COVID she did “science science verses social science”, a reference she makes to the distinction between her policy work as a Health Unit Health Equity Coordinator and the front-facing infection control work she did on case and contact management. However, her health equity experience trained her for the empathetic and therapeutic communication methods she needed. She was able to act as an advocate for residents pushing for solutions for those who lost income, required access to food, heat and/or a cool environment while they recovered as well as fight for systemic change to the barriers preventing people from equitable access to healthcare and the basic needs of living.

“From the case and contact management view, there’s a lot privilege and a lot of disadvantage,” she said, adding when Omicron spread through the under housed population, there was no place for them to go to isolate or recover and no shelter system in place to ensure they had the basics needs met. It frustrates Brown, as she believes that the root causes of these issues are not adequately addressed in Leeds, Grenville and Lanark through policy and resource solutions.”

As the Health Unit works through recovery, Brown is looking forward to working with partners the community to work on health equity for all people in Leeds, Grenville and Lanark. This includes Health Unit-wide staff education with Rainbow Health, and a Blanket Exercise to learn about the truth of Canada’s history to support our commitment to Truth and Reconciliation.

The term epidemiology, the study of the trends and determinants of health of a population, dates back to Ancient Greece; however, never in history has the public and media been so in tuned to the surveillance and statistics around epidemics as they were with COVID-19.

Nobody knows that more than John Cunningham, the epidemiologist at the Health Unit for the last 15 years. He has worked with the agency through H1N1, SARS, many flu seasons and the ongoing opioid epidemic, and it was COVID-19 that brought his field to the forefront of the public health response to the pandemic.

“The public perception and scrutiny of data was interesting,” he said recently. “We publish a lot of data for the public to see. We don’t tend to get much feedback on it.  However, the public and media were actively engaged in following our daily COVID-19 statistics reporting for LGLDHU. Many were requesting detailed case-level information that we could not provide because of confidentiality; this lead to some folks voicing distrust in our reporting.”

As a public heath epidemiologist, Cunningham and his peers collect data on their population, using real-time monitoring, to assess the health of citizens and identify trends to help inform their health unit on where it should focus its efforts.

Previously, this might mean alerting public heath staff to spikes in drug overdoses or an increase in emergency room visits or a flurry of cases of flu or West Nile Virus in the area, but when COVID-19 hit, Cunningham had to direct all his efforts to the pandemic. 

“We were doing basic epidemiology, but it was just very much focused on COVID,” he said. “There was a huge amount of data coming in and we were reporting at a frequency which we had never done before.”

The Heath Unit began publishing its COVID-19 surveillance daily on March 26, 2020. This data included those who were testing positive, those who were hospitalized and those who died of the disease.

“We also worked with the communications team on responding to public inquiries either directly through email or through social media. Communications Co-ordinator, Susan Healey and I worked directly with the media,” Cunningham said. “With the public and media attention on our local daily COVID-19 statistics, we were challenged at times on the validity of our reporting, which is something we’ve never had to respond to before,” he added “There has never been that much scrutiny on our work before, so we definitely had the spotlight on us from a data perspective. The public’s interest in the data was fascinating to me.”

Our reported case counts and rates often had to be adjusted to reflect changes in a COVID-19 case’s status, and for those who read the COVID Outbreak Status Reports, and later followed the COVID-19 Surveillance Dashboard regularly, sometimes the numbers didn’t add up.

This, explains Cunningham, was often because the dashboard was a live document, so counts were often changed retroactively due to false positives, resolved cases and cases that may have been back-dated.

On December 31, 2021 testing for COVID-19 across Ontario was limited to the most vulnerable and individuals associated with high risk exposure settings, like Long-Term Care. That meant confirmed cases reported by the Health Unit drastically underestimated the actual number of people who are infected with COVID-19.

Prior to studying epidemiology, Cunningham spent 15 years in the Canadian military and was a small business owner. In normal times, he says the behind-the-scenes work of an epidemiologist is usually done at a measured and thoughtful pace, but the frenzy of tabulating all the data coming in and meeting the demands of the pandemic reminded him of his days training for combat.

“The situation was very similar to what you do in the military except for the military it was a different focus,” he said. “You train, you train and then its full throttle and you don’t stop until the job is done and I found with COVID it was a similar thing for me, which was out of character for my previous everyday role.”

A positive to come from the chaos was technological advancements for Cunningham and his team, which included Health Information Analyst, Hanan Atwy. The adoption of Case and Contact Management software and a new dashboard system, Tableau, now allows data around population health to be seamlessly refreshed and updated on the Heath Unit’s website without information being manually inputted and posted.

“We were slowly adapting our workflows before the pandemic but COVID just accelerated that 100 fold,” said Cunningham. “Instead of having a five year plan, it became a six-month plan, and we did it and a lot of people worked really hard. The dashboards are user-friendly and all the information will be up there for the public to see.”

Cunningham added that the new software has now allowed his team to update 10 years of analysis and reporting that’s currently on the website in just one year.

In August, the Health Unit launched the Diseases of Public Health Significance Dashboard, which will track a number of communicable and vector-borne diseases, including enteric and food-borne illness, vector-borne and zoonotic diseases, sexually transmitted infections, respiratory infections and vaccine-preventable diseases. 

“You can teach an old dog new tricks,” joked Cunningham. “I have always been interested in software; I have always been interested in math and programing. It was a very steep learning curve for me to learn some of it which was not a lot of fun, but I found out I can still learn that stuff and enjoy it.”

While the pandemic may have put a public face on public health, arguably some of the most important work goes on in the background. The Health Unit’s Information Technology team continues to ensure smooth running of day-to-day operations by coordinating the ability of staff to work at home and providing the technology needed to operate over 600 vaccine clinics (and counting).

Within days of declaring a pandemic, Glynn Edgar and the Health Unit’s small IT team got to work helping the five offices and service sites around Leeds, Grenville and Lanark adapt. That meant working with managers to identify what staff could work from home and how to equip them so the transition to working from home would ensure staff has the same capabilities as they did working in the office.

“When we realized that we needed to start getting people working from home, we had to totally adjust our infrastructure and figure out how to make it work,” said Edgar, who has been the computer system specialist at the Health Unit for 15 years.

“It’s always a struggle to make people’s experience at home the same as it is at the office.” Both management and the Health Unit’s Board were immediately supportive of investing in the technology needed to allow more staff to work from home.

Prior to the pandemic, only about 10 to 12 staff were set up to work remotely, and Zoom was a program IT was familiar with but wasn’t widely used. Today, around 100 have the capability to work from home, and between 50 and 60 staff work from home daily.

“The biggest challenge was finding a system that was easy for the end user and easy to set up and support given the time constraints and the pressures that were on us,” explains Edgar. “And the utmost importance was to find something that was secure. Given all the private health information of residents we have in files, the biggest question was: is the data secured that we are transferring from somebody’s home to work?”

Zoom transformed the virtual office experience for staff and IT. Not only can they conduct and attend meetings remotely, it’s also a key tool for IT staff to troubleshoot and fix connection and computer problems for staff working at home.

At the same time, whispers around a vaccine against COVID-19 were beginning to circulate, and the Health Unit knew that even though it hadn’t been developed yet, preparing for mass vaccination clinics would need to start immediately.

“My Manager, Paul Armstrong, came and said we need to start planning for when a vaccine becomes available,” recalled Edgar. “He said ‘we are going to be running mass immunization clinics, we don’t know what they are going to look like, and we should prepare’.”

Both Edgar and Armstrong had experience providing IT support to mass immunization clinics during H1N1, so while they knew COVID-19 vaccine clinics would be much larger in scale and take place over a longer period of time, the had a basic understanding of what needed to be done and how to do it.

First, the IT team accompanied nursing staff to do site visits of all potential buildings around Leeds, Grenville and Lanark that could host a clinic. Together, they had to work out all the logistics, from internet connectivity to accessibility, to how the public would flow in and out of the clinic keeping social distancing and health and safety in mind.

“We needed to figure how many people could be immunized in an hour and we had to ensure we had enough architecture there – laptops and internet connectivity speed – to make sure they could keep the line flowing,” said Edgar. “We ran tests to see how long it takes to check in, how long it takes to enter an individual into COVAX (the Ministry’s vaccine computer database) and how long it takes to get immunized and then wait 15 minutes after the immunization. It took a lot of pre-planning by Paul and the team.”

With the mobile and pop-up clinics, Edgar and team would set up and tear down new clinics each day across the region. Armstrong and Edgar would meet at the office at 5 am, pack vehicles with gear and take off for a new location every day. One member of the team would usually stick around to help if any issues with technology flared up. Then, when the clinic was over, they would pack up all the tech and drive it back to the Brockville office to unload and re-pack again for the next day.

“There were days we were fatigued to the bone but once you get on the road and you get going, you just begin to focus on the layout of the arena, how the clinic will be set up, and remember all the things we need to make sure we do,” says Edgar. “But our team was always really good at checking in on each other. We always made sure each other was okay. Everybody came together and I saw the kindness that exists in this organization”

As the agency slowly emerges out of its full-scale COVID response, Edgar hopes to continue to improve the Health Unit’s technological infrastructure, and the quality and efficiency of remote work for staff, whether that’s chairing a meeting with partners or a glitch-free experience for staff to work from the office or home.

With a smile Edgar said: “I have learned that no matter what the world throws at us, from an IT standpoint, we are going to be able to provide the necessary equipment and support to our staff.”

When the Health Unit’s COVID-19 response forced the partial, and in many cases total, stoppage of Health Unit programs and services, Language Express, the Health Unit-sponsored preschool speech and language program, was one of the few programs that continued to operate, an opportunity about which Language Express manager Catherine Robinson feels grateful.

“None of our staff were redeployed, and we were very thankful that we were able to keep up with our preschool speech and language work because there was a huge need, and we’re seeing now especially, two years plus later how the pandemic had a big effect on young children and their development,” said Robinson, a certified speech-language pathologist.

Language Express is a provincially funded service providing assessment and therapy for children with speech, language and social communication delays and disorders from birth to age five.  Education and coaching for parents to help their kids improve their communication skills is a big part of the service.

Prior to the pandemic, Language Express staff all met children and their parents at clinic locations, at childcare centres, in kindergarten classes and sometimes at the family’s home. Face-to-face consultations are important for speech and language assessment and therapy for young children, so when provincially-mandated shutdowns halted in-person services across the province, including at Language Express, Robinson and her colleagues were challenged to adapt their methods to meet their clients’ and their family’s needs.

“That was a huge learning curve for everyone,” said Robinson. “Not just learning how to use the technology, but learning how to do therapy virtually and how to engage young kids and their parents through a screen instead of through directly interacting and playing with those kids, which is a lot of how we would usually assess a child.”

Robinson and the rest of the Language Express staff quickly shifted their therapy strategies to telepractice (providing therapy sessions via Zoom and telephone) and scrambled to find new ways to make the material engaging for kids. They had to learn how to use green screens, PowerPoint, games and apps and create lesson plans and tools that she says “don’t necessarily just exist and are easily found. You have to make up a lot of stuff.”

For some kids and their families, the shift worked well. For instance, Language Express staff started conducting parent classes by Zoom for the program’s youngest clients so that parents could learn strategies to use at home with their children. Parents could participate at home and not have to travel to an in-person session. “So that was a big win,” said Robinson.

Robinson said she also found that appointments online allowed her and Language Express staff to observe young children at home with their parents and they were able to coach parents to help their children in their home environment. “We don’t need those kids to engage with us over the screen, we really  just want to see them at home and coach their parents and give them some things to try, so that has worked really well,” she said.

However, for some older kids virtual sessions proved extremely tough for both the clients and staff. “With the older kids, we actually need to work with the children directly, and make it fun and engaging and have activities. It works for some kids and some families but for others, they just don’t have the attention span or the ability to focus on screen,” said Robinson. “And for some of our populations like the hearing-impaired kids it’s a lot harder because the sound quality is not good, and some kids have severe motor-speech disorders and you can’t really hear them well. It’s hard enough for them already and then for them to do it over Zoom, it’s even harder.”

Computer and internet access also added another layer of challenges and meant that some families were underserved by the program. “For those families we tried to do what we could. We did a lot of phone consultation and counseling and tried to make arrangements for families to go somewhere and access a computer and an internet connection so they could participate in one of our parent classes from somewhere else,” said Robinson, who added that the inability to have face-to-face contact with the clients and families with whom they’ve built relationships also took a toll on staff. “A lot of speech-language pathologists that work with a pediatric population have chosen that work because they really love working with kids and a lot of people really missed that and struggled with the switch. Overall, I’m very impressed with our team; it was a huge change in the way we work.”

Moving forward, Robinson sees continuing the telepractice service, especially for parent classes and coaching sessions as one way of expanding Language Express’s reach and improving accessibility to classes, and found many families are open to a hybrid model of consultation (virtual and in-person).

At present, Language Express services 800-1000 families and receives about 400 referrals every year. Anecdotally, Robinson said the program has seen an increased number of referrals since the pandemic for clients whose needs are notably more complex, showing that the pandemic has significantly affected the neurodevelopment of young children.

“And the research backs that observation,” explained Robinson. “There’s been some good research on the effect of the pandemic on little kids, and not surprisingly, the biggest effect is on families that face socio-economic barriers. And kids whose moms have had mental health concerns.”

Robinson says that the last two years have given her a heightened awareness of the role of mental health in families, and of how children are doing, as well as how our staff is doing. “It’s something we talk about a lot more and I’m thinking about it a lot more,” she said.

A positive outcome of the pandemic for the speech and language program is strengthened relationships with Leeds, Grenville and Lanark children’s services community partners: “Everyone pulled together and wanted to share ideas and figure out how we can make this work for families,” said Robinson. “And the families were involved as well. The pandemic was a strange new thing for everybody, but families were trying the best they could, they were willing to give virtual consultations and coaching a go. And kids, if they have the support they need, are amazingly adaptable and resilient.”

Now more than ever, Robinson recognizes her program’s role goes beyond speech and language therapy; it’s to navigate the system on behalf of clients and be aware of all the barriers they are facing, and most importantly, and be a friendly and helpful advocate to families in the tri-county.

At the height of the Health Unit’s COVID-19 response, Senior Public Health Inspector Kim McCann’s friends would joke with her that every time they turned on the radio, it was frequently her they were hearing.

McCann was one of the most public-facing staff during the pandemic (with the exception of MOH, Dr. Paula Stewart), regularly called on to speak with the media and sit on local committees formed to help the community figure out how to move forward amid constantly-changing directives.

That’s all when she wasn’t working with businesses, local government and law enforcement to ensure businesses and organizations were complying with the rules and developing communication tools to provide information to both the general public and local establishments. 

“I was firing off fact sheets and guidance documents so fast you wouldn’t believe,” she laughed.

Normally, under the Health Promotion and Protection Act, (HPPA) and its regulations Public Health Inspection is limited to specific types of businesses: restaurants, personal services settings like hair salons and tattoo parlours, public pools, child care centers. Under the HPPA, public health is the sole enforcer of the legislation; police and bylaw are rarely involved.

However, in July 2020, four months after declaring the pandemic, the province enacted the Reopening Ontario Act (ROA), an extensive piece of legislation that outlined a staggered approach for businesses to re-open amid COVID-19.

McCann explained that the ROA transformed the role of public health inspectors. Inspectors were now designated along with other provincial offences officers the responsibility to ensure all business in Leeds, Grenville and Lanark, including businesses (office settings, retail stores, and construction sites) that are not normally under inspector’s purview, were following the rules.

“At public health, while we train for emergency response, our regular job is doing proactive work: we have a list of places we go and inspect and we provide a lot of education. We spend a lot of time with operators consulting on standards and best practices to ensure their businesses are safe environments for the public, but with COVID, our role became less about education, and more enforcing of the regulations. That was a huge change for us.”

The inspection team was still required to perform other parts of their job, such as responding to demand calls including adverse water reports, complaints, follow up on cases of infectious diseases. McCann says the “COVID puppy” phenomenon also meant inspectors were seeing an increase in animal bites in the region.

Expanded responsibility to solely carry out the Reopening Ontario Act would have stretched the team too thin. Fortunately, the Act allowed various levels of law enforcement – local police, Ontario Provincial Police, municipal by-law – to also be involved in carrying out the legislation.

For McCann, not only did that collaboration take some of the load off the already maxed-out department, but it forged invaluable partnerships between the Health Unit and branches of law enforcement.

“That was a great thing,” said McCann. “Moving forward with regular public health work, we have those partnerships established to help with different things.

“We still had that authority and we were lucky, during COVID, that people in the area were generally cooperative. So we when businesses did have to shut down, they shut down. We had a few businesses that refused and tried to stay open and we were able to lean on our partners to help with that,” she added.

The new partnerships, which include a newly-formed United Counties Business Development Committee and a sports league network, were also instrumental in disseminating up-to-date information, posting signage and acting as liaison between the Health Unit and the community.

“Personally for me, the partnerships were the most valuable thing to come out of COVID,” said McCann.

For McCann, the willingness of the businesses in the area to comply with the rules, knowing scaling back operations or shutting down completely was going to have a long lasting impact was a testament to the commitment of the businesses to protecting the health of the community, and positive rapport with the public health unit amongst the community.

“The biggest thing that I learned is that community trusts us, they trust public health. The vaccination rates are a big indicator. The other indicator is the willingness to comply with the legislation. It was very hard for them; it’s still very hard for them. The restaurants, for example, my heart goes out to them, they laid people off, they had no other income but they did it and they did it because they trusted the messages coming from us.”

As the Health Unit’s School Health Coordinator for the last 15 years, Public Health Nurse Tawnya Boileau has spent the majority of her career at the Health Unit working with school boards and principals to ensure schools in Leeds, Grenville and Lanark are healthy and inviting spaces for students. But for Boileau, when the pandemic hit, making schools safe and positive places felt in some ways like “starting from scratch” as the province, and public health units hurried to develop protocols and resources tailored to the school setting for kids to go back to school in September of 2020.

“It was definitely a more intense version of my job,” recalls Boileau. “Everything was new, because students hadn’t been in school since March 2020, so what was this going to look like for them? It was stressful for the school boards; they felt like they had a lot of responsibility and parents were concerned, students were concerned, staff was concerned.”

Because schools in the Upper Canada District School Board and the Catholic District School Board of Eastern Ontario’s jurisdiction straddles both the Leeds, Grenville and Lanark District Health Unit and Eastern Ontario Health Unit, this meant Boileau, alongside a team of school health nurses, liaised with the 87 schools in the Health Unit’s region. She also coordinated infection control processes and communications and policies with another Health Unit. She recalls being glad when the province developed some important resources such as an Infection Prevention and Control Checklist to guide schools on how to set up classrooms and school environments to minimize the spread of infection and the COVID-19 screening tool for parents to fill out prior to their child attending school.

“We took the initiative and developed a lot of procedures and tools and factsheets for our schools,” said Boileau, adding that these resources included guidance on how schools would manage outbreaks, how communication would be disseminated in partnership with the boards and how letters would be distributed to parents.

On top of that, she worked with the School Transportation of Eastern Ontario to develop processes for bussing students to and from school, and to provide advice around masking and seating arrangements to ensure social distancing guidelines were met. 

“There were just so many pieces and COVID was a comprehensive approach. And overall, we worked really well together and I think of it as a model for the future and I think we are continuing to do that now. And our school boards really appreciate that. They (UCDSB & CDSBEO) work with two health units and they would rather have one message and one approach from us.” And while there were some bumpy patches as COVID swept through the province and rules were ever changing, overall, Boileau believes the experience of working through the pandemic strengthened relationships with her partners.

“All of my school health coordinator career I was striving to work with the boards at the level we got to during COVID and here we are,” she said. “While it was very stressful, and I wouldn’t want to go through another pandemic anytime soon, it was a really good opportunity to build those partnerships and learn more about the workings of the board and what processes they have to do and what leadership teams they have to pass decisions by.”

The COVID experience reinforced for Boileau how passionate she is about school health, and building strong relationships with her partners she found herself in awe of just how much school boards and school staff care about the health and safety of the students. It was not uncommon, she said, for principals to call or text her on weekends or late at night about things they were concerned about.

“They just wanted to make sure they were doing the right thing,” she said. “And we just supported each other. With (Upper Canada School Board Superintendent) Marsha McNair, we knew we could call each other any time, we would figure a situation out together. It was a true partnership because while the school boards were looking to us for expertise, they really are people who are on the ground, know our audience, and they are our in to the school population.”

For Boileau the pandemic also highlighted the importance of the role of the school nurse. Surveys conducted with schools emphasized the importance of having a school nurse available throughout the COVID response and showed a need for this important resource to continue beyond COVID.

Moving forward, Boileau hopes her heightened relationship with the school boards will serve her and the team of school-focused nurses for upcoming work around vaping, mental health, healthy growth and development and sexual health in schools, topics which have been identified as Ontario Public Health Standard priorities. For her, the experience of COVID should act as a model for all that can be accomplished through collective impact.

“Think about if we could put all of that same energy into any other topic, like injury prevention or opioids, and everyone at the Health Unit is working together with the community on the same goal,” she said.  “When everyone is working towards a common agenda, common goal – good things come of it.”

Danielle Shewfelt has worked at the Health Unit for 24 years. As both a resident of Lanark Highlands and the municipal public health nurse for Lanark County, Carleton Place, Mississippi Mills and Lanark Highlands, she knows many residents and community partners and she knows the importance of relationships and clear, effective and evidence-based communications in public health.

After a brief stint on working the COVID-19 phone lines early on in the pandemic, Shewfelt was redeployed to the Communications Team where she has, for the last two years, responded to thousands of webmail queries from the public, drafted updates for the website when guidance or rules changed, created social media posts and answered public and private messages coming in on our social media platforms.

In addition to her municipal public health nurse role, Shewfelt is the Heath Unit’s team lead for physical activity promotion across the tri-county. Communications when working with municipalities is an art Shewfelt has learned that requires collaboration, open and responsive communication and delicacy whether she’s writing an email, letters of support, collaborating on a fact sheet or doing presentations to council or the community.

“The work that I do with municipalities, there are a lot of communication skills required,” she said. “There’s a skill around articulating messages that make health information more interesting, receptive and clear for the public.”

While many questions from the public were about how to interpret regulations and measures they should be following, Shewfelt was often providing additional education around the protective measures to help people and organizations make a well informed decision to protect and improve their health and wellbeing. 

As the scientific community continued to publish more information around how the public could best protect themselves, and as the pandemic lingered on, guidance from the province was updated. It then became particularly nuanced when communicating these changes to the public.

“There was a lot of clarifying of the different effective measures in different situations, particularly as the evidence evolved and grew from early on in the pandemic when we knew very little to later with the new variants as we learned more about the differences in their transmission and protection,” said Shewfelt

There are challenges to creating the messaging around COVID, and making sure the message is clear and consistent while also adjusting for changes happening in the community and with the COVID-19 viruses that were circulating. We also have to be knowledgeable of the trigger points: what misinformation is circulating and where it’s coming from and respond in a way that is compassionate, informative and respectful that will hopefully guide people to more reliable sources of information,” she added.

COVID-19 heightened our community’s awareness of the role of public health as residents sought out credible, up-to-date, evidence and science-based information. That was evident in the number of emails Shewfelt and staff responded to on a daily basis, by traffic to our website, the increased social media following and engagement and the frequency in which staff were in the media. However, the pandemic also stirred up a vast amount of conspiracy theories, misinterpreting scientific information and individuals spreading bunk science, more commonly known as misinformation and disinformation.

“Misinformation has popped up fairly frequently; particularly during the pandemic so it was important for me to read through the concerns, understand the fears and worries and share the best health information and evidence to allow them to make the most informed decision they can,” said Shewfelt.

“I would also often share some fact checking on the misinformation itself and share ways they can identify misinformation, fact check in the future and included places to go for reliable answers.”

The Heath Unit has stepped up its efforts to stop the spread of misinformation. First and foremost, the agency ensures that information it shares is the most current, up-to-date and backed by scientific evidence. The Health Unit has also developed processes internally to prevent abusive behaviour towards staff and misinformation on social media. “We don’t want to be a platform that individuals and groups can use to spread harmful misinformation,” says Shewfelt.

For Shewfelt, improved internal communications really helped all staff stay up-to-date on the most recent guidance.

“Considering the complexity of our agency, the number of cogs in the wheel and all the activities happening at the same time that are changing by the minute, it’s seemed impossible to know everything that was happening all the time, but it’s surprising to me how well we did at keeping people up to speed on what was happening,” she said. “When information is coming in so quickly and changing so often, taking time to read through regulations and guidance documents and understand how it applies in various situations is a tough thing to do.”

With one foot still on the communications team and another back on her municipal health nurse file, Shewfelt feels the experience of COVID has not only strengthened her communication skills but has fostered stronger collaboration between the Communication Team and the Health Unit’s programs and services.

“I’ve developed a really positive relationship with the Communications Team. We’ve connected on a different level now, so that’s going to make the work that we do together later that much better,” she said.

Moving forward, Shewfelt wants to continue working with communications on misinformation whether it’s around climate change, Healthy Bodies Healthy Minds or other health topics, and help to develop strategies to continue to educate and inform residents on critical thinking and media literacy skills so they can identify and avoid sharing misinformation/disinformation online.

As an Administrative Assistant in charge of vaccine supply, Christine Karasiuk’s job is to oversee the inventory and distribution of all publicly funded vaccine in Leeds, Grenville and Lanark. In her everyday work, she ensures health care providers including the Health Unit and long-term care homes are stocked with enough vaccine and supplies to carry them through influenza seasons and school clinics. 

“I kept the same role, just COVID was added on to it,” Karasiuk said. “So taking on COVID vaccine inventory meant taking on all the supplies needed for a clinic, doing all the requisitions to get all the fixed sites up and running, from pens and paper, to chairs, to privacy screens to fridges, anything and everything.”

The Health Unit’s roll-out of COVID vaccinations began in January 2021 in long-term care facilities, as the province deemed residents and health care workers as a high-priority to receive vaccine to prevent deaths and stop the spread of COVID-19 in congregate settings. As eligibility for the vaccine opened up, demand increased exponentially, and Karasiuk’s workload also intensified.

“We were sending out supplies to the fixed sites (Almonte, Kemptville, Brockville and Smiths Falls) on a weekly basis, sometimes it was every other day, depending on volume,” said Karasiuk, adding that during the busiest times, clinics required 10,000 needles and syringes per week.

Pallets of supplies from the Ministry of Health would be delivered in the main lobby of the Brockville office. They had to be broken down and moved; the items needed to be distributed to one of the four fixed site clinics happening across Leeds, Grenville and Lanark. Karasiuk was also in charge of requesting items that the Ministry was not supplying health units such as hand sanitizer, wipes, stethoscopes and blood pressure cuffs.

“It was very labour intensive, and a lot of hours. We were going from 5 in-house clinics with 10 or 15 immunizers to 100s of people (including fixed site, mobile and pop-up clinics and health care providers) that needed this stuff and sometimes everything would be on backorder,” said Karasiuk. “(Purchaser) Claudette (Boivin) and I did a really good job. We worked great together. If the supplies were available, we got them and it was within a quick turnaround time and I had great support from all of my managers.”

It was not uncommon for Karasiuk to be at work for 7am and stay until 9pm at night, and for the community, the long days and hard work from all staff paid off. Leeds, Grenville and Lanark continue to lead the province in vaccination rates.

“But the hours have taken their toll on staff,” Karasiuk says, herself included. “I think our staff really felt depleted and we can see that now. As we have gone through the waves of the pandemic, staff are tired, exhausted.

I did do the work and I stepped up and got it done, but I also realize that I need a better balance. I missed a lot in my personal life. My son went off to university, and he was gone most of that summer, my husband retired, and we didn’t celebrate those milestones because I just didn’t have it in me to do it.”

As part of its COVID response, the Health Unit has made commitments to supporting employee mental health and well-being by creating a Mental Health at Work Steering Committee with management and staff champions. The agency is providing training for staff and management on mental health, debriefing sessions with councillors, enhancements to mental health benefits, and switching to a new Employee and Family Assistance Program provider are all examples of how the Health Unit is putting things in place to support employees.

Karasiuk sits on the Mental Health at Work Steering Committee. “The Health Unit promotes mental health and health equity to the public but I think we need to focus on the mental health of our staff and health equity within the Health Unit,” she said. “We talk the talk; we need to walk the walk.”

Through her COVID journey, Karasiuk has also found her own “avenues to de-stress” through yoga and meditative breathing practices, as well as recognizing when it’s time to shut work off for the day. 

“I realized I can’t be everything to everyone and that’s okay,” she said.

Finding moments to celebrate during a pandemic can be few and far between. However January 15, 2021 is a day to remember. That’s when the first COVID-19 vaccinations were administered in Leeds, Grenville and Lanark, marking the beginning of the region’s vaccination journey.

Aynsley Polson is a registered practical nurse at the Heath Unit and was part of the first COVID-19 immunization clinics held in long-term care homes. Polson, who says her “first love” is geriatric care, worked at the first COVID-19 vaccine clinic at Stoneridge Manor Long-Term Care in Carleton Place. She describes the experience as a ‘privilege.’

“As a Health Unit, we had some jitters,” she recalls. “We know how to run immunization clinics and have such a good team, who has done this through H1N1, through many flu seasons, but it was such a new vaccine that had such specific requirements. We got such positive response going into the long-term cares, it was really uplifting.”

The earliest versions of the Pfizer-BioNTech COVID-19 vaccine, which was the first of the approved vaccines to reach Leeds, Grenville and Lanark, required its vials to be refrigerated at – 60oC to -80oC, much colder than other vaccines.

In the first months, before hospitals in Leeds, Grenville and Lanark were able to acquire a -80o freezer, Polson and mobile clinic lead nurse, Lucia Taggart would travel to Kingston Heath Science Centres every morning to pick up enough vaccine to get the team through the day.

Because long-term care residences in Leeds, Grenville and Lanark were hit so hard by COVID outbreaks, and the population already faces challenges with mobility and transportation, it was not feasible to bring residents and staff to mass immunization clinics.

“We had to be mobile with this,” said Polson. “I had personally only ever been in a clinic where they come to you, whereas we were on their floors, so we had all the residents remain in their rooms because there were still isolation policies. I learned how to run clinics in 50 to 250-bed homes where we needed to get everyone immunized.”

While launching the local vaccine program was a signal of happier and healthier days ahead, it was important for Polson and the team to remember the trauma many of the long-term care homes went through to get to that point.

“We saw some of the struggles many of the long-term care homes had gone through,” recalled Polson.  “It’s forever ingrained in my head the residences that were operating at half-capacity because many of their residents had passed away. We had to be really respectful of that, empathetic to the staff and remember that the person who passed away was someone’s mom or dad, grandmother or grandpa.”

As eligibility for COVID-19 vaccines opened up to age groups outside of long-term care, the Heath Unit expanded its mass vaccination operations to four fixed site locations (Brockville, Kemptville, Smiths Falls and Almonte) Polson joined the mobile clinic team, a small “rodeo” of immunizers and support staff who ran pop-up clinics in legions, recreation halls and Lions Clubs and even from an RV in villages and hamlets across LGL.

“We set up, we’d vaccinate 200 to 400 people and then we would tear it down in the evening and do it all again the next day. We kept a really positive morale because there was a lot of angst, stress and excessive work hours but we all had a positive outlook and we enjoyed each other’s company.”

In March 2022, the Health Unit rented a motorhome and Polson and the mobile clinic team drove across Leeds, Grenville and Lanark stopping in even smaller corners of the region. A first for the Health Unit, the week-long campaign sought to reach some of the more remote pockets of the region, where residents had trouble accessing vaccines.

Overall, the Vaxi-RV was a success, 146 people at 18 stops across Leeds, Grenville and Lanark received their first, second or booster dose.

“It was taking everything we need for a mass immunization clinic and putting it in a vehicle and taking it to the community clinics,” said Polson, who estimates that she has given more than 10,000 COVID-19 vaccines to date and says others working the clinics would have a higher count.

“It was really fun and we had decent numbers and got to see new areas of LGL. I now know the area so well, I no longer need a GPS,” laughed Polson.

Now that infants are eligible for COVID vaccines and with an Omicron-specific vaccine on the horizon, it’s important for Polson and the immunization team to keep the positivity rolling. 

“We want everyone at the clinics to have a good experience,” she said. “I have learned through the Health Unit that at the end of the day, whether you are pro-vaccine or anti-vaccine or unsure, we just want you to have an OK experience at a vaccine clinic. That brings families out. If a mom and dad had a good experience, they feel more comfortable about bringing their teenager out; if the teenager had a good experience they will bring their five year old sibling out. That’s a testament to how good we are doing at the clinics, it’s bringing out generations.”

As a registered dietitian and one of the Health Unit’s public health nutritionists, Danielle Labonté’s work during the agency’s COVID-19 response resembled nothing like her day-to-day work, focusing on promoting healthy eating in schools to youth, and consulting with municipalities on projects like community gardens and community kitchens.

From the beginning of the Health Unit’s COVID response, Labonté’s work quickly shifted from nutrition to supporting staff as the Health Unit built and operationalized a phone-line system to support our public response to COVID-19.

In the early days of the pandemic, a small handful of Health Unit nurses were assigned to the Health Unit’s phone line to answer questions from residents looking for information about this rapidly spreading virus that had yet to wreak havoc on our community. As COVID-19 emerged in Leeds, Grenville and Lanark, it became clear that the organization needed to ratchet up ways for residents to reach us; the most integral means was by phone.

“The volume of calls from the public started to become overwhelming and we started to realize, as a Health Unit, we need to have a more sustainable plan to respond, all of us are going to need to be involved and that’s when we started to put more staff on the phone lines, staffing weekends and extended hours,” said Labonté.

To start, the Health Unit used a single phone line extension (extension 2499) to triage general questions about COVID: ‘should people wear a mask? How can their family member get a COVID test?’, ‘how many people can gather at a time?’ This line was managed by a variety of staff including registered nurses, dietitians, family home visitors, dental hygienists and dental assistants. In August 2020, as local students were about to start school, the Health Unit added a phone line for queries from parents, guardians and educators related to COVID safety in schools. There was also an infectious diseases line that was answered directly by a nurse.

Labonte’s job was to ensure staff had what they needed to best respond to residents.

“I was basically figuring out processes to get these things in place and supporting the phone lines to make sure they had all the up-to-date resources, providing updates at meetings. The information was coming in so fast and there was so much,” recalls Labonté.

“There were days when my phone would ring about 40 times with questions like ‘what’s the answer to this?’, ‘who do I send to this to?’ because staff didn’t have time to catch up on the new guidance all the time especially for people working on weekends,” said Labonté.

“A lot of the times the guidelines were up to us to interpret, so questions would be like ‘how to read this’, and a lot of times I would be reaching out to Health Promotion Consultant Joseph Reid or Danielle Shewfelt, a Public Health Nurse and Senior Public Health Inspector, Kim McCann.

In addition to ensuring staff answering the phones had the latest provincial legislation in front of them; Labonté was a responsible for tracking all statistics, as part of an evaluation of the Health Unit’s performance during its COVID-19 response. She oversaw the implementation of Humanity, a staff scheduling software and helped set up and operate the global COVID-19 vaccine distribution app, COVAX, at the Health Unit.

“I had a lot of different roles during COVID,” said Labonté. She also completed her Master’s Degree and got married during the pandemic. “The adrenaline kept me going.”

As vaccine arrived in LGL and the Health Unit opened up mass immunization clinics across the region, the original phone line extensions faced being clogged to meet the demand and an official call centre was created using a cloud-based phone line system that allowed staff to work in office or remotely. Our community partners, United Counties of Leeds Grenville and Lanark County, also deployed their own staff to lend a hand fielding calls from residents looking to book or cancel a vaccine appointment, find their proof of vaccine, obtain transportation to a clinic or looking for information about clinics. The Health Unit also hired some summer students to help answer the phone lines.

“It was just amazing, to be able to see them do that to help us without a second thought,” said Labonté. “It was really, really awesome.”

At the height of our COVID response, Labonté supported a group of 25 to 30 staff and at its peak in March 2021; the Health Unit phone lines were receiving 1600 calls a week – the highest week being May 10 with 3633 calls.

Today, the Heath Unit has three call centre representatives operating the Leeds, Grenville and Lanark Vaccine Call Centre, and while Labonté is now back to her work as a public heath nutritionist, a role she loves, she says she gained meaningful professional development through coordinating the phone lines.

“I like being a public health nutritionist, being a dietitian, but I really like that broader public health work, which is why I did my masters of public health; so having the opportunity to do that confirmed that I could see myself really enjoying looking at programs and services as a whole and meeting community needs as a whole.”