What the new normal looks like this summer and beyond

It’s summer, and the city is in its first phase of reopening. That’s meant a return to business for street-front shops and, as the warm weather continues, more Torontonians filling the city’s parks and sidewalks.

Twelve weeks into the lockdown—in a city without schools, a summer without camps, and more challenges ahead to flatten the curve—we’re all wondering: what’s next? The answer is cautiously optimistic.

“What I’ve learned from Covid,” says Dr. Erin O’Connor, “Is there is never a time to fully breathe a sigh of relief. But if there’s any relief, it’s knowing that we’ve put protocols in place for a variety of situations. We’ve done a lot of planning to prepare the health care system to cope with the spread of the disease.”

O’Connor is Deputy Medical Director of Emergency Medicine at University Health Network (UHN), the healthcare and research organization that encompasses Toronto General and Toronto Western hospitals, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute and The Michener Institute of Education at UHN. She is a leader in one of the busiest emergency departments in the city, the first line of defense in the battle against the pandemic.

The curve may be somewhat flattening, she says, but there has been a spike in Covid-19 cases recently, presumably the result of gatherings on Mother’s Day. “Covid-19 has not gone away. However, the system is in a better situation to handle the capacity without a big spike.”

In many ways, the city’s reopening means increasing healthcare capacity beyond emergency care. O’Connor and her colleagues at UHN are now deep into planning for how to move forward with urgent surgeries such as transplants performed at Toronto General Hospital—which, this year, was ranked number four on a list of the world’s best hospitals according to Newsweek magazine. One of the important things in O’Connor’s world is to keep the emergency department flowing and to prevent long waits for beds for patients who need to be admitted.

Dr. Beate Sander, Director of Population Health Economics Research, Toronto General Hospital Research Institute, UHN, and the Canada Research Chair in Economics of Infectious Diseases, is a leader in the planning that goes into managing the spread of Covid-19. Sander began her career as an ICU nurse before becoming one of the most respected scientists in the country. She has a wealth of expertise in simulation modeling, population health economics and infectious disease epidemiology.

When the WHO declared Covid-19 a pandemic, Sander and her team gathered quickly to start modeling the impact of the disease on the healthcare system.

“I remember it was the Friday before March Break. We gathered together in my office and started talking about a fast and simple modeling tool to make certain predictions on how to deploy existing resources such as ventilators and ICU beds.” The core group of researchers included Sander’s trainees. “As we expanded, more people joined, including scientists, clinicians as well as government and other stakeholders.” The team became known as Covid-19 ModCollab, and their work on anticipating the need for vital medical equipment, understanding coming surges, and getting accurate information on expected numbers of patients coming to hospital with Covid-19, has been informing public health and government decisions throughout the pandemic.

ModCollab provides a continuous update of data that public-health professionals can use in their decision making. That’s an innovative approach. “It’s an iterative model that is able to respond to a situation that is changing by the day,” says Sander. “Whereas the traditional way of conducting medical research involves longer span of time leading up to publishing the research.”

Another innovation that physicians agree will have lasting impact involves using technology we all have in our homes.

“Our biggest innovation, one that will stay, is our use of virtual care and virtual visits,” says Dr. O’Connor, whose emergency department is piloting virtual follow-up clinics with patients after they return home. “Just as we are all having conversations and meetings on Microsoft teams or FaceTime, we are having the same kinds of interactions with patients at home. Instead of bringing people into the hospital for assessment, we are doing many of these assessments over the phone, to try to make sure that people are getting the appropriate care, at the appropriate time, in the appropriate place.”

The biggest question on the minds of every patient—and, indeed, the city at large—is how their lives and interactions will look in the coming months.

“Basically, until there is an effective vaccine, all we can do is observe physical distancing and wear masks, as medical professionals test, trace and isolate,” says Beate Sander.

“Some of us will return to work. That is, we will no longer work from home, at least part time, as specific sectors of the economy are re-opened. However, work places will look very different,” she says. Only some percentage of employees will return to the office at a time.

“In addition, some kind of child care and summer camp will—hopefully—be available again but limited in some way,” she continues. “I don’t think many of us will be travelling, so we will all probably have staycations. We will also need to prepare for school and university in the fall.”

It’s unlikely that full classes will proceed as they did pre-Covid-19, and instead the city and province will be looking at staggering students, for example alternating days, to facilitate distancing.

Along the way, both Sander and O’Connor stress the importance of our collective empathy.

“Humans are social creatures. We want to be with our family and our friends. And it’s very, very difficult to maintain this kind of distance for a long time,” says O’Connor. “With the weather being nicer, we all just want to be outside and in the sun. But it’s important to realize that, going forward, the pandemic isn’t over. The relaxing of some of the restrictions doesn’t mean that you’re actually now safe. It means that there is some capacity in the system to handle people getting sick. My worry is that we are going to get another increase in cases and that potentially that second wave is going to be bigger than the first wave.”

“We can’t be too hard on each other for wanting to go out and feel a part of the community again,” adds Sander. “At the same time, we have to understand that returning to a normal we all knew is a very gradual, step-by-step process.”

Wash your hands, keep your distance, keep positive. Above all, these experts agree, that is still our best defense to get the city through this.

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