UHN News chronicles members of TeamUHN on the frontline of the COVID-19 pandemic.
"Sorry I was on mute."
"We might have to declare an outbreak."
"Have you heard the Singapore Vaccine Song? You have to, its sooo good!"
These are just random bits overheard in a day in the life of UHN Infection Prevention and Control (IPAC) Manager, Carly Rebelo. There is also some talk of snacks, because, after all, 15 months into the COVID-19 pandemic, priorities must still be maintained.
A great big laugh erupts out of her, revealing the sense of humour that is likely keeping Carly afloat, day after endless day. You get the sense the person telling everyone to mask up, stand away from one another and sanitize, sanitize, sanitize is still trying to find the light after all these many months.
"The 'joy' in all this, for lack of a better word, is that I've gotten to know, and collaborated with so many people across this organization," says Carly. "We have such amazing people here.
"And, the hierarchy has really collapsed in so many ways. It's all hands on deck, and when I'm jammed, I can just text (Clinical Vice President) Jan Newton for help…I mean come on!"
No one would be surprised to discover the IPAC team might be jammed on a regular basis. From the very early days of the pandemic, UHN was given the responsibility of supporting more than 14 long-term care centres, five retirement homes, two transitional care centres and 33 congregate care settings.
Virtually none of those sites had hospital-level infection control practices that could have protected them from COVID-19.
"It was intense," says Carly. "We had to learn fast, execute even faster, and just keep moving."
By the time UHN's IPAC team walked into many of these places, outbreaks were active and people were dying.
"There was no time for wringing hands," Carly reflects. "It was crushing to see the impact of the deaths of these patients on their healthcare providers, some of whom had been taking care of them for years."
Looking back more than a year later, Carly feels enormous pride for what her team accomplished. In short order, there were protocols in place, education happening, and healthcare providers feeling more secure about the safety of their patients and each other.
Overall, vaccination rates are increasing and outbreaks are less frequent, smaller in scope, and less clinically severe, giving everyone on the IPAC team a sense that the worst is now over.
However, after more than 15 months of masks, and outbreaks, and repeated lockdowns, Carly and her team are weary. The adrenaline rush of the first wave is long gone, and yet the work to keep everyone safe continues unabated. The fear is gone, but uncertainty remains.
"The constant threat of new variants looms and can throw us back to square one if we aren't careful," Carly says. "How long can this go on? How much can we continue to ask of people? Will we be okay when we're finally 'back to normal'?"
"Normal" is still elusive, and even though rates are going down, and vaccinations are rolling out, people are so mentally and physically tired. Many of Carly's meetings have moments when it's clear someone just needs support, a virtual hand held. Even though most safety practices have been in place for more than a year, Carly is still reinforcing best practices and reassuring people that they are doing a great job.
"The beginning of Wave Three was very, very hard," she says. "I know a lot of people were thinking they just couldn't do it again.
"And saying no all the time is really no fun. I want to say yes to staff parties. I want to say yes to managers who are trying to organize massages for their teams and I really want to say yes to patients who request to have their dogs visit while they are feeling their worst. I want to be the one to say YES, but I can't."
"Saying no all the time, and watching my own little team struggle has been the worst part of all this."
It's clear the IPAC team is like a family. A happy one at that, not the kind that comes to the table crabby. At some point into her fourth call of the day, Carly looks up and Dr. Susy Hota is in the doorway and, standing an appropriately-distanced six feet away, is Alon Vaisman. They are the most visible faces of the IPAC leadership throughout the pandemic. They commiserate with each other over their jam-packed schedules and the decided lack of decent snacks in the office. Then, they share a laugh and carry on.
"Our team is what has got me through this, day-in, day-out," Carly says proudly. "I don't have to ask, they just do, and without complaint."
It's nearing the end of the day and Carly jumps up from her desk and heads off to a unit in outbreak on the fifth floor at Toronto General Hospital. Considering her day is filled with phone calls, texts and MS Teams meetings, she is treating this outing like a long-awaited field trip. She oohs and ahhs over the way the staff have physically and visually divided up the unit between outbreak and non-outbreak. A tour of the staff lounge reveals some need for improved communication, but overall she feels confident the team is handling everything exactly as they should.
Back in her office, it's clear that really connecting with people is the wind she needs in her sails. More calls and questions from all over the organization keep coming in. There's a possible outbreak at one of the facilities UHN supports. It serves those with insecure housing who need to be able to isolate due to COVID-19. Until tests come back, everyone is on heightened alert but Carly will step in if an outbreak is declared. Luckily, most teams know what to do now and it's all a matter of watching and waiting.
During the pandemic, Carly has been able to express some of her personality in her Weekly IPAC COVID Reports to UHN Leadership Forum. A must-read that goes out to a few hundred people across UHN, they feature more than just updates on case counts and Ontario's seven-day rolling averages. There are aspirational elements such as life after two vaccines for everyone – "I can see sports events and concerts in our future!" Urging people to do the right thing – "this will not end if we don't stick to the measures for a few more weeks and get vaccinated!" And humorous, self-deprecating references to her out of control chip eating and confessions, including "I have not started biking to work yet."
Carly says the entertaining aspects of the updates evolved from the weekly UHN-specific information.
"It felt so doom and gloom. I dreaded writing it, let alone sending it out," she says. "I started to add little tidbits of how I was personally managing life in 'lockdown' and what I thought were funny anecdotes.
"Given the enormous positive response, I realized I wasn't the only one who needed a laugh and a little humanity in the craze of the pandemic. Not only is writing the weekly update therapeutic for me, it seems to be helping our colleagues weather this storm."
When asked if there is anything she wished she'd known a year ago, Carly's response is immediate.
"I wish we'd known how long this would last," she says. "Maybe it was overly optimistic thinking but after both Wave One and Wave Two, I thought we were done."
It's one small moment of disappointment in an otherwise positive day. You can forgive Carly for wanting it to be over already. She's not alone. We all want this to be over. And, with COVID rates in decline, some stability slowly returning to the hospitals, and a more robust vaccine rollout, perhaps we are finally coming to an end.
But just as Carly hopes the collaborative, all-hands-on-deck approach to the past 15 months is here to stay at UHN, she also knows our heightened vigilance against infectious disease must also endure.
"We've been able to accomplish some great things, working together, focusing on what's important," she says. "We can't forget that as we move out of this and to the place we so desperately want to be."
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