By Michelle Read
Writer
The round-the-clock work of medical residents at Ottawa Public Health (OPH) has proven their value as public health professionals, forming part of the team easing pressure on the city’s hospitals and keeping COVID-19 case counts under control.
For years, OPH has partnered with the Faculty of Medicine as one of its training sites. Since COVID-19 hit the city earlier this year, 12 residents in Public Health and Preventive Medicine (PHPM) at the Faculty of Medicine have stepped in to lead and staff key initiatives at OPH and other residency rotation sites at the local, provincial and federal levels to help curb the spread of COVID-19.
Fifth-year resident Dr. Austin Zygmunt was working at OPH for the leadership and management component of his PHPM specialization when the first wave hit. He seized the opportunity to move forward as a leader within the organization.
“We all took leadership roles as residents,” says Dr. Zygmunt. “We devised new ways to help with the COVID response, and that has continued to this day.”
Residents lead two critical teams
Two teams at OPH have been led by the Faculty’s residents throughout the pandemic.
The Case and Outbreak Management Team reviews incoming positive cases to learn about the individuals and determine who they were in contact with. What the team learns allows them to make recommendations for testing and potentially isolation of those contacts, and to manage large outbreaks in long-term care homes and workplaces.
“In one instance, I noted that several cases all worked in the same location. That evening I recommended closing the building, isolation and testing for employees, and having a public health inspector go into the building to do an inspection to assess their adherence to public health guidance,” says Dr. Zygmunt. “This was one of our first workplace outbreaks and I'm confident that our action to close the workplace and quickly put contacts into isolation prevented further transmission at the workplace and into the community.”
The Technical Team reviews the evidence on COVID-19 to provide scientific guidance for OPH recommendations and to answer questions from city councillors, businesses, physicians and the general public. The team also reviews guidance from the provincial government and recommends how to implement that guidance at the local level.
When OPH needed all hands on deck during Ottawa’s first wave, they reached out to resident Dr. Ellen Snyder. On maternity leave at the time, she resolutely joined forces with her peers. She was soon approached by Dr. Zygmunt to lead the technical team.
“Every single one of our residents has been working flat-out since the beginning of the pandemic,” says Dr. Snyder, now chief resident. “We’ve been just floored by the amazing work of our resident and OPH colleagues.”
MD students join the effort
With infections on the rise in the city in April, case management became critical in understanding the origin of positive cases and preventing the virus from spreading to those in contact with those cases. More help was needed—triggering OPH to reach out to medical students for their help.
Tavis Hayes was nearing the end of his MD training and was awaiting the results of his residency match. At a loose end due to a delay in his exams, Hayes was invited to join the Case Management team before he was officially matched as a resident.
“I’m grateful to OPH for not only this great learning opportunity, but the chance to contribute to the need to control this crisis,” says Dr. Hayes. In the same boat was his colleague Yipeng Ge, and the two joined OPH at the same time in April of this year.
Paying it forward
Drs. Snyder and Zygmunt have since completed their rotation at OPH. Now with Nova Scotia Public Health, Dr. Zygmunt has shared his knowledge gained at OPH in his current role and others.
“There is a lot of information-sharing across different organizations,” says Dr. Zygmunt. “I’m bringing a lot of knowledge from Ontario and my work federally, provincially and locally to the work here in managing cases and clusters of COVID-19, as well as developing a testing strategy for the province.”
Dr. Snyder, who has now moved on to a research-based rotation, feels satisfaction in having played a big part in this historic time, a sentiment she shares with her colleagues.
“It’s been very rewarding to work on the COVID-19 response with OPH,” says Dr. Snyder. “As residents, we are very lucky to have the incredible mentorship and support from our supervisors, public health colleagues and co-residents.”
“We’re very much on the front lines, before cases show up in the emergency room,” she reflects. “Everyone was afraid a big crashing wave would overrun our emergency departments.
“But the work of our residents and our public health colleagues, as well as the cooperation of the general public with public health recommendations, are what have prevented us from running out of ventilators.”
Main photo: Dr. Ellen Snyder in front of Ottawa Public Health. Credit: Kate Jaimet
Realizing the staggering amount of time and effort the residents had invested in the first 100 days of the pandemic, Dr. Zygmunt highlighted the scope of the residents’ work in a report for Ottawa Public Health. Dr. Snyder used that text as a basis for a summary shared with the Faculty of Medicine outlining the team’s hard work and dedication.
The full text of that summary appears below.
Reprinted from the School of Epidemiology and Public Health newsletter, September 2020:
Austin Zygmunt, MD CCFP, PGY5 Public Health & Preventive Medicine, University of Ottawa
Ellen Snyder, MD CCFP, PGY4 Public Health & Preventive Medicine, Chief Resident June 28, 2020–January 11, 2021, University of Ottawa
At Ottawa Public Health (OPH), PHPM residents have been critical in leading the Case and Outbreak management team. Residents created the first line list of cases in Ottawa which led to improved communication and served as the main data source for the epidemiology team’s daily reports. PHPM residents played leadership roles during the numerous institutional outbreaks and community clusters during the first wave. Early in the epidemic PHPM residents developed outbreak definitions used in acute care facilities and drafted the strategy to guide the regional response in mass surveillance testing of Long-Term Care (LTC) homes.
OPH’s technical team, led and staffed mainly by PHPM residents, answers technical questions received from stakeholders and assists in the development and review of guidance documents. The residents collaborated with internal and external stakeholders. The residents prepared responses to over 500 individual technical consultations, created over 50 documents for the public (e.g. public website content, community handouts, isolation handouts used at the Brewer Assessment Centre), and summarized Ministry of Health guidance on case and contact management for the organization.
PHPM residents have been instrumental in OPH’s engagement with physicians and other health care professional during the pandemic. Residents have written most public health alerts sent to all physicians in Ottawa, updated content on the physician and health care professional website, and provided webinars through the University of Ottawa Office of Continuing Professional Development.
Recognizing that the COVID-19 pandemic disproportionately affects certain populations due to underlying health and social disparities, PHPM residents were dedicated to address the needs of priority populations. They developed a COVID-19 process map for managing cases within the Ottawa shelter system, authored a document on lessons learned in shelter outbreaks, contributed to an urban Indigenous specific pandemic response plan, and conducted an assessment of personal support workers with confirmed COVID-19 working during their period of communicability.
PHPM residents collaborate with the IT team to embrace digital solutions for managing COVID including developing an online physician COVID-19 reporting tool, developing an online case management tool, and supporting the COVID-19 Ottawa Database (COD) digital solutions team in developing outbreak detection functionality.
In addition to this work at the local level within Ottawa, PHPM residents also assisted in the response to COVID-19 within other rotation sites including the Eastern Ontario Health Unit, the First Nations and Inuit Health Branch of Health Canada, the Public Health Agency of Canada and Public Health Ontario.
Every resident in our program has gone above and beyond both in terms of supporting and even leading COVID-19 response operations and in supporting each other through unprecedented personal and professional strain.
