COVID-19 research successes, and return to research

Exciting news was announced Thursday this week that three of our CoM researchers and their teams have received funding for work on COVID-19 from the Canadian Institutes of Health Research. Congratulations to Dr. Joyce Wilson, Dr. Kerry Lavender and Dr. Cory Neudorf on their successful applications!

Each is leading, respectively, projects that will: investigate the re-purposing of currently approved drugs to treat COVID-19 patients; rapidly evaluate some highly promising therapeutics against COVID-19; and help prepare for future outbreaks by gathering information on the best interventions public health officers have developed across the country. This last project, led by Dr. Neudorf, is also being funded by the Saskatchewan Health Research Foundation.

You can see the full announcement with more information about each project on our website.

Our Office of the Vice-Dean Research (OVDR) at the CoM has provided support to our researchers, with a total of $120,000 in rapid response funds—half from the OVDR and half from the CoM’s Respiratory Research Centre—to catalyze small-scale, time-sensitive research projects focused on contributing to the response to the COVID-19 pandemic. Congratulations to the recipients of this funding, who are listed on the OVDR website.

We are also working closely with the university on steps to bring some research activities and researchers back to campus. There have certainly been a large number of requests from researchers to return. We continue a very robust review process to ensure we consider applications carefully to maintain the safety of all our people accessing campus facilities.

I know many of our researchers are feeling significant urgency to return to campus. In my role on the university’s Pandemic Response and Recovery Team (PRT), I have been part of work to review these requests against provincial requirements; the return-to-research framework has been developed by the university alongside the Saskatchewan Re-Open plan, of course.

Those who can work remotely will continue to do so. The university needs your co-operation in this regard, so that limited resources can be best used to support necessary and critical on-campus research and teaching and learning work.

More information from the university can be found at:

 

What COVID has taught us about public health capacity

Guest blog by Dr. Cory Neudorf

Dr. Neudorf is a professor in the Department of Community Health and Epidemiology at the USask College of Medicine, and a former chief medical health officer for Saskatoon

The first half of 2020 has proven to be one of huge challenge for the health system and society at large. However, it may yet prove to be a year of huge opportunity born out of tragedy and resiliency. As I write this, COVID-19 has stretched health system capacity in many jurisdictions. Interventions to slow the virus have disrupted the economy, while disproportionately impacting the most vulnerable in society and those working in health care and other sectors deemed essential.

Global pandemics have been overcome in the past, but both the scale of COVID’s impact and the response to date have been unprecedented in most peoples’ lifetimes. However, part of the health system was established and specifically trained to do outbreak prevention and management in the wake of pandemics of cholera and influenza in past centuries. The public health system was expanded and entrusted with learning what causes these outbreaks. Public health was funded to train and hire the staff to deal with outbreaks, and given legislative authority to act in the best interests of public safety, well-being and security through broad measures such as quarantine, mass testing, immunization and contact tracing and prevention. In short, public health is here to ensure we are not left vulnerable through delays in decision making in the critical early stages of a pandemic.

Between large outbreaks, these same approaches are used to manage smaller-scale outbreaks and prevent more common communicable diseases, which together improves population health. In the past 100 years, a legacy of improvements  through public health have followed, including routine childhood immunization, workplace safety laws, health inspection of our food, water, air and soil, family planning, and efforts to improve healthy behaviours and the social determinants of health (see History of Public Health – 12 Great Achievements).

One improvement was the creation of pandemic plans at all levels of government, with the mandate to update them continuously as they are tested over time. These reviews resulted in recommendations to invest in stockpiles of personal protective equipment (PPE), ongoing training of staff in the appropriate use of these supplies, and improvements to institutional infection prevention, control processes and infrastructure. As well, strategic improvements have included strengthening public health and primary care systems with adequate surge capacity, and making the pandemic response lead role of the medical health officer clear through legislation.

However, with pressures mounting to cut taxes and shrink budgets, public health and other community investments in prevention may be at risk. Ironically, neglect in funding prevention and the determinants of health can in turn add to the pressures on the acute care system and the need to respond to other health and social downstream effects. Recommendations to re-invest in public health and other evidence-informed upstream health and social programs have been strong and consistent in the wake of smaller crises like water-born outbreaks in Walkerton and North Battleford, SARS (2002/3) and H1N1 (2009/10), and have resulted in small gains in some cases. However, the most recent rounds of budget cuts and re-organization across the country have reversed these gains in many provinces, leaving us vulnerable once again. (See The Weakening of Public Health)

The net effect is Canada has experienced mixed results in our response to the COVID crisis so far. While some residual legacy products of past crises have stood us well, cutbacks and re-organizations have had unintended negative consequences on our ability to be as prepared as we may have hoped in parts of the country. The Public Health Agency of Canada and the Chief Public Health Officer position created in the wake of SARS have certainly helped us respond to COVID nationally. Investments in Saskatchewan in better information systems for communicable disease surveillance and more inspections and immunizations have been helpful.

Thanks to a good initial response to public health measures, the first wave of COVID-19 has been blunted, giving the system time to prepare for a possible second wave or future stressors. Now is the time to prioritize investment in a strong and unified public health system. In the near future, public health must plan for heightened surveillance for signs of setbacks as we gradually loosen early restrictions, and respond with aggressive testing and contact tracing to contain new clusters and outbreaks. Later, a mass immunization program may be needed on the heels of the seasonal flu immunization campaign, with the spectre of a possible second wave of COVID.

Meanwhile, other essential public health services cannot be put on hold indefinitely, as this leaves us vulnerable to other outbreaks caused by low routine immunization levels, an overburdened outbreak control team, or delayed health inspections. Other gains in health promotion and social determinants of health need to continue. Public health and community partners need to also respond to the unintended consequences of the pandemic, including rising overdoses, increases in family violence and homelessness, setbacks in healthy living strategies, and health inequalities.

Now is the time to invest in prevention and surge capacity. We have been given the gift of time. Let’s not waste it.

Standing together against racism

My May 8 blog was about how the pandemic was hitting people in minority, under-served and disadvantaged groups harder than others, supported by research conducted by members of our own team here at the CoM. The pandemic was very much top-of-mind in that blog, as it has been for nearly three months.

In the past week, racism and its dire impact on the well-being of so many is the top story of our news outlets and top-of-mind for me, as it should be.

I want our Black learners and colleagues to know that their dean, their leaders, their colleagues, and many, many others, recognize the heavy toll in sadness, anger and despair of the way George Floyd died. For our Indigenous learners and colleagues, this is an all-too-familiar and heartbreaking situation.

I know that I do not have all the answers and that we need to do more as a college to eliminate racism from our workplace. But in this moment, I hope it helps in some small way to know that your College of Medicine stands with you.

Plan time off this summer

With warmer days upon us and outdoor activities starting to add a boost to our moods and general wellness, I want to use this blog to remind everyone to plan for some safe, physically distanced downtime for yourself in the coming months. We all need vacations, even if these are staycations this year. (On the plus side, coming from the Maritimes, I highly recommend Saskatchewan in the summer!)

For some, days have been extra-long, as we strive to maintain the many organizational needs supporting education, research and clinical service during COVID-19. This type of schedule is not sustainable, as I’ve experienced firsthand. I realized recently that I was exhausted and needed to take some time away. I made the Victoria Day weekend into a four-day mini-vacation of sorts, complete with many hours of outdoor gardening. This was a significant construction project resulting in raised garden beds. The construction was fun—moving four yards of topsoil less so! But now, between online meetings, I can go outside and check on what seeds have germinated. In the last two days, Swiss chard and beets have started.

Other ways I’m enjoying downtime include doing more cooking for Jane and Marie on the weekends. While I have no races to train for, I continue to enjoy my running. And I frequently watch my grandchildren on FaceTime.

We’ve all experienced a high degree of change in how we work, whether working remotely or due to changes in healthcare delivery. There has been stress and change in other ways, including work slowing down or transitioning to a different focus. These realities understandably come with stress and uncertainty. Add to that the changes in our communities and economy, with closures and new requirements for simple things like getting groceries, and this year taking breaks that help us with stress management and escape are especially important.

I encourage our administrative staff and faculty to get away, whether by actually going away from home if you can do so safely, or by ensuring that you find ways to make home purely a place of relaxation for periods of time. Whether this is in the form of some extra, shorter breaks from work, or by stepping away entirely for a few weeks of vacation, we all need this balance.

I encourage everyone to plan for and commit to vacation and breaks from work, and ask supervisors to support their teams in planning for this. It’s all too easy to let the demands of work take over, but we really can’t be at our best when we allow this to happen. We are doing right by our employer, colleagues, families and ourselves when we effectively balance work with time off.

So, another beautiful, sunshine-filled Saskatchewan summer lies ahead. We have had a tough spring and we all deserve some peace and relaxation. For myself this summer, I plan more landscaping projects, including my hobby from back in New Brunswick of growing roses. (Wish me luck!) As well, I am buying new golf clubs and hope to golf more.

What are you doing this summer? I’d love to hear about your plans or ideas for time away from work!

 

Return to clerkship

Our medical doctor Year 3 students return to clerkship on May 25, a date we arrived at working together with the Saskatchewan Health Authority.

That is coming up very quickly and—just as with our shift to learning remotely and stepping away from undergraduate clinical rotations in March—the efforts to coordinate and support this transition again show the dedication and stellar capabilities of our team. Thank you to all those students, staff, faculty and academic leaders, as well as our partners in the health system, who are working to make this happen!

Before we had a date, we had two working groups, one composed of learners, the other of staff and academic leaders, develop proposals for what this return could look like. Their work was exceptional, and positioned us well for the work that’s now been done by our clerkship committee on a clinical rotation plan that will enable our current Year 3 students to complete years 3 and 4 of their degrees for a June 2021 graduation and July 1, 2021, residency start date.

For our clerks and those working in the health system, as you know, much has been done in Saskatchewan’s health system already to address safety in the delivery of care in light of COVID-19, and our college will also be working with our learners, the health authority and other health system partners to align with safety measures for a safe learning environment and an excellent clinical learning experience. As with all areas of life right now, the return to clerkship is not a “return to normal,” but a return to the new normal since the pandemic became part of our daily reality.

As well, our undergraduate and student affairs offices will be working closely with our clerkship students to support their return and help address individual circumstances.

One of our college’s biggest commitments to our learners and our province is this continuous progression of learners through our undergraduate and postgraduate medical doctor programs every year. Keeping these physicians of the future moving through the ranks of undergraduate students, then residents, and ultimately licensed physicians, ensures we can support patient care and the health system today and tomorrow. It is certainly no less important in a COVID-19 world; I think most would agree that it is more important.

With that in mind, I can’t stress enough the need for our medical faculty around the province to be involved as teachers. We need you to take learners into your practices and clinics. Our students today are your physician colleagues of the future.

Finally, I just want to reiterate how impressed I am by our students, staff, academic leaders and faculty in these extraordinary and difficult times. I am thankful for your diligence and responsiveness, and incredibly proud of the resilience and excellence of our team here at the CoM.

 

Pandemic emphasizes equity, diversity and inclusion issues

We are increasingly seeing COVID-19 hitting racialized, socio-economically challenged people and communities harder than other population groups. We are witnessing this in reports from the United States, with the heavier impact of the virus in black communities, and in an article in the New York Times yesterday raising concerns about this disparity within Latino populations, and here in our own province among Indigenous and northern communities.

COVID-19 underlines more than ever why we must face and challenge inequities in our college and beyond. At the College of Medicine, Research Equity & Diversity Specialist Erin Prosser-Loose and researcher Catherine Trask have started a study on how COVID-19 is impacting those already facing challenges related to equity and diversity. They have collected early data through a survey of our broader USask community, with plans to expand the scope to include national data in the coming weeks.

Erin is leading the study and recently walked our dean’s executive team through early findings.

The data showcases both positive and negative experiences. On the positive side, people have indicated they’ve felt well-supported with regard to information technology needs, and that mental health supports have been well-communicated. Teams are making excellent efforts among themselves to support one another, including through social connections like virtual coffee breaks.

Race-related issues included that some have found working from home has reduced their exposure to racism. While this was expressed as a positive outcome due to COVID-19 adjustments, it points to change we know is needed in our work environment. Also, racialized people expressed being disadvantaged in COVID-19-related changes impacting employment contracts and research opportunities. Some identified having witnessed racism against Asian people.

A gender-related issue identified by many was that primary caregivers, mostly women, are experiencing greater pressure managing childcare, homeschooling and work productivity.

A variety of work, career and financial impacts were brought forward. Pre-tenure faculty are concerned about research progress. It was expressed that tuition for online learning shouldn’t be as high as for face-to-face learning. International students are uncertain about their degree progress and are facing financial hardships. Rural and low-income students are disadvantaged due to internet access issues.

Generally, it was expressed that EDI and Indigenization are being sidelined because of COVID-19, with more conventional issues getting priority. Given how I opened this blog, this is clearly the opposite of what is needed now (and at all times).

Survey participants indicated that the causes of inequities being experienced were based most on power differentials, followed by race, then gender. Participants suggested solutions, including denouncing racism, acknowledging primary caregivers, placing health and wellness ahead of productivity, and extending promotion timeframes. From my own perspective, in particular we do need to denounce racism and continue work towards eliminating it; we must think about how we support and acknowledge primary caregivers, most often women; and our leadership team needs to further explore as a college how we can address issues highlighted by this survey.

Again, I do want to reiterate that information I’m sharing is preliminary. The survey is ongoing and different issues are likely to come up as the situation with the pandemic continues to change.

For our staff, students and faculty (and anyone at USask), if you haven’t already, please take the survey.

Some other information related to this blog topic:

 

Mental health during COVID-19

As the changes we are all experiencing with COVID-19 have now stretched into weeks, stress and anxiety are becoming an increasing challenge for some. Coping with staying at home, managing work and family together in that setting, and the many other restrictions associated with physical distancing are the reality for many. For others on our CoM team, going to work in our hospitals and medical clinics comes with a different set of challenges and causes for stress and anxiety.

This week, the university announced its workforce strategy due to COVID-19 and our college has begun working with supervisors and administrative employees on next steps. This is a stressful time and I remind you that university-supported services including the Employee and Family Assistance Program are available to all employees.

In light of all this, mental health is top of mind right now for many. I want to share some thoughts and resources (see end of this blog) that I hope you find helpful. Of course, I encourage you to focus on the things most useful to you in staying well and welcome you sharing those here, if you would like. Monitoring your moods, thoughts and feelings is especially important, and help is available should you need it through university and college resources, and through our health system.

In many basic day-to-day ways, our mental health is supported by work teams and colleagues maintaining contact and supporting one another virtually. Making time during video meetings for some lighter conversation and humour is helping with social connections and friendships. It certainly helps to see one another, laugh together, and share anecdotes from our lives. As one example, our dean’s office team shares information, humour, pet pictures, grandchildren pictures (I may have posted a few!), and messages of encouragement and support in our MS Teams group every day. This has been a valuable means of keeping us together as a team, along with virtual monthly meetings.

Some teams are having quick daily remote huddles, and colleagues and friends are including online coffee breaks in their schedules to ensure opportunities for the social connections we all value in the workplace. We are reminding one another to get outside for breaks, fresh air and sunshine; the weather has finally co-operated these last few weeks! Making time for exercise and relaxation is a big help in staying upbeat, and mentally and physically well.

Beyond that, at the individual level, more than ever before, our rule of thumb needs to be when we think of someone we know, we call or better yet, video call, to say hi and see how that person is doing. We can all play a role in reaching out to anyone we notice seems down or not themselves. Some of our team members are more isolated than others, and we need to keep this in mind and reach out and include one another in virtual group activities, meetings and through direct connections.

I hope everyone is benefiting from and extending support to colleagues, family and friends. I also share a variety of college, university and other resources here:

As always, I welcome your feedback, including ways you are finding to stay well.

 

Early steps in reopening medical education clerkship

I have a few messages for this week’s blog.

First, as a Maritimer my thoughts have been with those in Nova Scotia since news broke Sunday of the tragedy there. We at the CoM and in Saskatchewan have tremendous compassion and understanding for what Nova Scotians and the Maritimes are going through, with the terrible toll of the Humboldt Broncos bus crash still deeply felt here after two years. And we have a number of people on our CoM team who are from the Maritimes, as well. So our thoughts are very much with our fellow healthcare learners and workers and first responders in Nova Scotia.

On behalf of everyone at our college, I extend heartfelt condolences to all who are suffering from this incredibly painful loss.

I want to also provide a brief update on our undergraduate medical education clerkship program and where we are at in planning for “reopening” clerkship.

In this vein, as you know, earlier today Premier Scott Moe shared details of a careful, gradual approach to reopening Saskatchewan services and businesses that was developed with Dr. Saqib Shahab, chief medical health officer. Important context from this plan for us all: even as some businesses and services begin to reopen, requirements for physical distancing, personal hygiene and cleanliness, and appropriate use of protective equipment remain in place for at least many more weeks. I encourage you to visit the plan website and read the plan document.

The province’s plan will certainly inform all of our own planning, including for clerkship. In that regard, a significant amount of work has already taken place. Earlier today we had a meeting where proposals developed by two working groups—one composed of our clerkship students, the other of the educators and directors leading clerkship curriculum—were shared with our medical education leaders and will be used to develop a plan for how and when undergraduate clinical education resumes.

Of course, the pandemic is expected to be with us for the foreseeable future and any plans we make must be flexible, as changes with changing circumstances must be expected. More information on our clerkship plan will be shared as it unfolds.

The good news is, as our premier said, we have reason to be cautiously optimistic about the spread of COVID-19 in our province. Continued diligence and thoughtful planning will enable us to make some progress on returning to some aspects of our previous approach to clerkship and other areas of learning and working. It’s important for us to recognize that what we are planning for is a new normal and we need to adjust our expectations with that in mind. This is true for our plans for clerkship, and all our plans for our work of the future.

As always, I welcome your thoughts.

COVID-19 impact on research

Many adjustments have been made to where and how we are working in the past month. With this blog, I draw attention to the difficult circumstances of our researchers—our faculty researchers, graduate students and postdoctoral fellows.

For this group, our campus and other facilities are critical to the progress of their work. So, similar to learners who can’t be physically present in clinical settings, most or all work for our researchers is stopped at this time. Their projects, some of which may have been on the cusp of a significant breakthrough, are halted. For our graduate students, as I mentioned in my earlier blog on learners, this stop to projects comes also with delays in graduation for some and managing difficult financial realities for many.

Processes are underway for determining facility access for projects related to COVID-19, and of course some access has been ongoing for some COVID-19 work at VIDO-Intervac and with testing in some of our laboratory facilities, and for projects involving care of animals. But for the majority of our researchers, projects are halted and they won’t gain access to facilities until that time when we begin our return to campuses and other facilities.

We have  a number of our researchers involved in the critically important COVID-19 efforts at USask, like Scott Napper, professor of biochemistry and senior scientist at VIDO-Intervac. Maureen Anderson, assistant professor in community health and epidemiology, worked with the dynamic modelling team providing evidence to inform Saskatchewan’s pandemic decision-making in real-time, a collaboration with USask’s Department of Computer Science. Gary Groot, associate professor in community health and epidemiology and surgery, is working with Jim Barton, associate dean of continuing medical education, and a team that’s been gathering and vetting information on the science of the COVID-19 virus to inform provincial leaders in their planning and decision-making. I know you join me in thanking these members of our team for their work.

These efforts focused now on COVID-19 are a reminder that under normal circumstances, on a daily basis, our researchers are engaged in knowledge creation and discoveries that the world needs—important work that our researchers are passionate about, and to which they are passionately committed.

I am not suggesting that the physical distancing measures and changes in access to our facilities are not the right things to do—we know they are and that the safety of our people is paramount and comes before other considerations. But I do want to bring attention to the significance of this change for our researchers, this loss of momentum, this stop to incredibly important work.

As you can appreciate, it is particularly ironic to have, at the very same time, public recognition broadening for just how important science, knowledge creation and discovery are to our collective safety and wellbeing. That said, we know this public awareness is a good thing ultimately for science, and certainly has brought the incredibly valuable work of our population health experts and biomedical scientists to the forefront.

Similar to many, my own awareness and understanding of population health, immunology and the nature of viruses is expanding. I’ve become quite immersed, while working out, in This Week in Virology podcasts. Perhaps it’s my inner nerd speaking; I find them fascinating. I expect many of you are accessing new sources of information related to the pandemic; I welcome you to share here information you are turning to and finding helpful.

So with this message, I ask you to join me in acknowledging and recognizing our researchers at the CoM for their valuable contributions—those engaged directly in work now on the virus, but equally those who are removed for the time being from their work on underlying causes, treatments and cures for so many areas of health: cancer, heart disease and stroke, HIV-AIDS, multiple sclerosis, mental illness, cystic fibrosis, and so many more.

Coming days at the CoM

I wanted to share some current thoughts for how our college is operating today in light of the pandemic, and what we expect in the coming days and weeks.

Increasingly we are seeing the need to continue with our critical actions of physical distancing, practicing proper hygiene, staying at home as much as possible, and self-isolation when required. The Government of Saskatchewan’s release of COVID-19 modelling for Saskatchewan yesterday as the basis for health system planning (it is not a prediction), underlines this need to continue with current measures.

In short, we are in a holding pattern for now. I am sure you will appreciate that we cannot plan with great certainty, especially farther out. We do know that for the moment and likely until at least July, we are continuing with learning, teaching and working remotely.

Our physicians too are delivering more care virtually, but of course our residents, medical faculty and some of our staff are attending our hospitals and other healthcare facilities, looking after patients, while learning and adjusting to new realities, approaches and safety measures. To this group: you are our colleagues and our learners, and we are keenly aware of the challenges and difficulties you are facing. Alongside everyone in Saskatchewan, we are thinking of and thanking you each and every day.

We are committed to supporting your efforts on the frontline by doing our part to stay home, practice appropriate hygiene, and do all in our power to stay well.

For all who are learning and working remotely, our new methods of staying connected will continue for the near future. With our learners, we will continue to update you with communications from your program offices, as well as with virtual meetings including town halls, small group work, and meetings with student and resident leaders. And we continue with online teaching and learning, and meetings, and various virtual administrative meetings, as our college moves forward in its mandate as much as possible apart from our physical facilities at our campuses and sites around the province.

So I offer words of encouragement to everyone at the CoM. Maintain a strong commitment to the necessary processes and approaches we’ve adopted. Use the virtual tools we have at our disposal to stay connected and stay positive and healthy. Help is available to all—our learners, faculty and staff—if you are struggling personally, through our USask resources and within our college, and via your supervisors. Do not hesitate to reach out if you need support.

Finally, on a separate note, I want to congratulate Dr. Melissa Just, who the university named this week our incoming interim provost and vice-president academic. She joined USask as dean of the University Library in February 2017 and has provided exceptional leadership in that role, and brings a strong background with extensive experience in academic and research libraries, including within a medical school, at a variety of major American universities. I am looking forward to working with Melissa in the days ahead.

As always, I welcome your feedback. Stay well.

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