What Dr. Vera Etches learned from 15 years at Ottawa Public Health

During the challenging early years of the COVID-19 pandemic, Dr. Vera Etches, the city’s medical officer of health, became a familiar face delivering information about how the pandemic was affecting the health of the population. Part of her role was to mandate and manage often unpopular measures to try to limit harms. After 15 years at Ottawa Public Health, nearly seven of them serving as the city’s first female medical officer of health, Etches is stepping down at the end of January to take up a new role as president and CEO of CHEO. Etches spoke with Elizabeth Payne about the challenges of navigating the pandemic, including facing verbal abuse, as well as the work still being done that is making a difference to the health of Ottawa residents. She leaves the job, she said, feeling both thankful and hopeful.

Q:  How are you feeling as your final day approaches?

A: Really thankful, obviously, for the team. When you work in a workplace for 15 years, there’s a lot of personal growth and personal support that comes along with that, in terms of the relationships through change in life. But also I’m feeling really appreciative for how the public health team has continued to adapt. When I think back 15 years, I think every single team, whether we’re doing chronic disease or supporting parents or infectious disease, their work has changed. It’s quite striking to me.

Q: I want to ask you about the highs and lows of your time at OPH. I suspect both happened during the COVID-19 pandemic.

A:  I think the early days of the pandemic were some of the most challenging, as we saw what was happening (in China and Italy and New York) and were thinking about what might need to happen to slow down transmission in an evolving environment with not enough information and supplies. I’m proud of the team because they were trying to get as much information as they could from all around the world, and they were being evidence-based when they made a conclusion. We worked through it to understand if there’s community spread and the community needs to know about that, how do we tell them? I’m proud of how we shared information with the community, always trying to give people the data so that they could make informed decisions. I think we were always ahead with trying to depict what was happening with dashboards, with infographics, and using social media.

Q: What were some of the hardest parts?

A: The harder parts certainly were that as we were taking these measures to protect people and we could see the harms that were resulting — with people’s employment affected, with social connections affected. And you know, this is part of what society is having to recover from still. We are now in the rebuilding phase. There are many (in public health) who are playing a role in trying to do that.

Q  Can we go back to March 2020 and the day the global pandemic was declared? I’m just wondering if you can recall what you were thinking and what you were looking at on that day?

A: We had been watching things, actually, since the beginning of January. So when we were seeing some of the more drastic measures being taken (in other parts of the world such as asking people to stay home) we were looking at what that would mean in Ottawa. And so the things going through my head were what would the impact be on the community? I was particularly concerned about children and youth as well as families where getting out to school is pretty important. We did an ethical analysis. It came down to loss of life versus harms (from isolation and stay-at-home orders) and we felt we had to protect lives and try to work with partners to mitigate the harms.

Q: Just so I am clear: The ethical analysis determined there would be harm done by pandemic measures such as staying home but on the other hand you have loss of life that public health orders would reduce? That is a pretty tough choice to have to make.

A: It wasn’t comfortable to sit there and see that this is something that could cause harm and we needed to mitigate it. I remember meeting with CHEO leadership and the Children’s Aid Society and the school boards (to look at) how can we get kids the things they need, how can we make sure we stay in touch with kids? It wasn’t enough. People still struggled.

Q: What else stands out about those early days of the pandemic?

A: As public health medicine trainees we do pandemic planning and these (public health measures to reduce spread during a pandemic) have been theoretical measures. It was the first time that this kind of thing had been done.

Q: The first time this kind of thing had been done across Canada?

A: Yes. It was also the first time in my lifetime that infectious disease became a leading cause of death in Ottawa and Canada. You know, people thought infectious diseases were a thing of the past — not a major cause of death, that it’s all chronic disease now. That changed during those first two years of the pandemic.

Q You quickly became a familiar face during the pandemic. What was the physical and emotional impact on you?

A: I want to reference my role model in this, Dr. Sheela Basrur (Toronto’s then medical officer of health during SARS). In public health medicine, we are taught that you need to have a consistent spokesperson, someone that people get to know and can trust. And so I really entered into it as ‘This is my job to do,’ and focused on that. Hopefully what people saw was, ‘We have information we hope will help the population, we’re going to share it with you, we’re going to tell you when information changes.’ We tried to be as transparent as we could and explain the rationale for shifts and direction. So I think that sense of responsibility really carried me through.

Q: Were you either threatened implicitly or explicitly in a way that you felt unsafe during that time?

A: There were nasty comments, certainly, on social media and things that were directed at me that were misogynistic, you know. I didn’t feel that was a personal threat to my safety, but I did decide some of those things I didn’t need to be exposed to so I could focus on my work. And I did have people come to my house and express their dissatisfaction.

Q: With signs and things or knocking on the door?

A: Shouting outside. Again, I didn’t feel personally, physically threatened. I felt sad because people were feeling harmed.

Q: What do you remember about when the initial vaccines were available?

A: The joy and sense of relief that we would have some protection. But (public health) was watching from the sidelines, in a way. We were not initially tasked to deliver the first vaccine. It was our team that reached out to (retired) general Rick Hillier (who headed Ontario’s vaccine distribution task force) and said, ‘You know, public health has experience in mass vaccination.’ There wasn’t a public health person on the task force. And so we were able to introduce our expertise and really demonstrate here in Ottawa what can happen when the city, the hospitals and public health work together along with Indigenous partners. (Ottawa Public Health would eventually help write the playbook for mass distribution of COVID-19 vaccines across the province).

Q: What stands out about the way vaccines were distributed in Ottawa early in the pandemic?

A: We had the data about who was dying from COVID by neighbourhood and by population. I am proud of Ottawa Public Health. We were one of the first to set up a database for case and contact management that included race-based information, and to do that analysis by postal code so we could see (COVID infections and deaths) within lower-income neighbourhoods and neighbourhoods with more racialized populations and newcomers. We took that information about who’s at greatest risk, and that’s where we wanted the vaccine to go first. And so in March, we distributed vaccines to the lowest income neighbourhoods, for people over 80, and we actually had equity emerging at that time. Before there were mass vaccination clinics, we were disproportionately protecting where the burden was greatest. (The province eventually followed that model).

Q: What inspired you to go into public health as a profession?

A: I have been very privileged to have two parents who are family doctors and they are my main role models. But I hadn’t heard of public health, really, until I was in the middle of medical school and I worked with some public health nurses in Malawi. I saw there were huge challenges the nurses were tackling and they were really not daunted. They were inspiring.

Q: How will your public health experience inform your work at CHEO?

A: We have similar goals to try to promote and protect health, which is often about prevention. There is also the opportunity for early intervention which can last a lifetime. I think the public health way of using data, looking at information to understand where the needs are to target interventions is all relevant to CHEO’s work as they try to create a more integrated health system for children and youth.

Q: Is there anything else you would like to say?

A: I want to say what a privilege it’s been to be in this role. There are a lot of things that are affecting the health of our community. That there are so many people that are trying to make things better and working together and collaborating, I just have a lot of hope when I see that.