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COVID-19: Shaking up the future

“Nothing in life is as painful to the human mind as great and sudden change,” author Mary Shelley once wrote. Certainly, few events in our lifetime have caused as much sudden, profound, and indeed painful, change as COVID-19. However, as we reflect on the past year—a year like no other—it is clear that some of these changes were positive and will have a place in the post-pandemic world. For the Faculty of Medicine and Health Sciences, the experiences gained during COVID-19 will not only improve education, research and clinical care, but make us better prepared for future pandemics.
Image by Jeff Kulak.
Ian Popple | 19 May 2021

The year 2020 began with reports of a mysterious viral pneumonia spreading through the city of Wuhan, China. About a week later, Chinese authorities had determined that the outbreak was caused by a novel coronavirus. By the end of January, just 30 days after the first case came to light, Wuhan and the neighbouring city of Huanggang—a combined population of 18 million—had been placed under quarantine and the World Health Organization (WHO) had declared a global health emergency. On February 11, the disease was given a name: COVID-19.

SĂ©bastien Belliveau, BSc'17, MSc'19—a first year ș«čúÂăÎè med student at the time—had rented a cottage for Reading Week with several classmates. “Quebec’s first COVID-19 case had already been discovered in late February, followed by several more infections in the Montreal area,” he recalls. “But there was still a naive optimism that this would all be over fairly quickly—no one expected the year that was to come.”

By the second day of Reading Week the WHO had declared COVID-19 a global pandemic and by the end of the week Quebec Premier François Legault had mandated the closure of all schools, CEGEPs, universities and daycares in the province. “Things escalated so quickly,” Belliveau says. “Reading Week was the last time we were all together—when classes resumed it was fully online.”

As president of the Medicine Class of 2023, Belliveau was part of a group of students, which included other class presidents and the president of the Medical Students’ Society (MSS), collaborating with the Faculty of Medicine and Health Sciences (FMHS) Faculty Advancement Board to provide feedback from students and, where possible, adapt and improve the educational experience during the pandemic.

“The sudden transition to online learning was a rough experience for students,” says Belliveau. “Most of us had never heard of Zoom before. Transitioning to online learning required discipline and focus and we missed those moments where we could connect with colleagues and educators face-to-face. But we’re a bunch of motivated students and we were able to adapt.” Belliveau felt that he was one of the lucky ones. “The experience was much more stressful for the senior students whose clinical placements had ended at the same time as classes shut down,” he says.

In addition to the cancellation of clinical placements, the Quebec government’s mandate had also interrupted—albeit briefly—in-person training at the Steinberg Centre for Simulation and Interactive Learning—a vital resource, not just for medical students, but for nursing students and those pursuing studies in physical and occupational therapy.

Joella Reev (BSc’21) was about to enter the final year of her undergraduate studies in rehabilitation science at the School of Physical and Occupational Therapy. “Our entire program involves interaction with colleagues, educators and patients,” she explains. “Some things need to be experienced as well as taught in-person, like communication with patients, patient transfers and other physical manipulations—to strip that away from a graduating class is challenging."

These concerns were shared by the FMHS. “It was a priority for us to get students in the health professions back into an in-person learning environment as quickly as possible, so they could gain the clinical skills they need to graduate,” says FMHS Vice Dean, Education, Annette Majnemer, BSc(OT)'80, MSc'85, PhD'90. “Our immediate concern was for the current cohort of students, but it was clear that a potential domino effect could impact multiple cohorts if the situation was not resolved.” The problem, which extended well beyond ș«čúÂăÎè, could even delay the number of trained medical professionals entering the workforce at a very critical time.

The faculty and university leadership worked closely with the provincial government during the spring of 2020 to determine the steps required to get the students back into their hands-on learning of clinical competencies. “We applied the same safety protocols that were being used in hospitals, including hospital-grade personal protective equipment (PPE),” she explains. Labs were reduced in size to optimize spacing between students, and workstations had to be regularly sanitized, including by the students themselves. “It took a lot of hard work, but we succeeded, thanks to the close collaboration, and strong engagement, of many stakeholders,” says Dr. Majnemer. “ș«čúÂăÎè is very resilient, and we often excel in times of crisis.”

At the same time as a route back to hands-on learning was being navigated, an entire system of online education had to be developed and rolled out virtually overnight. “We had to revamp things rapidly and on a dramatic scale,” explains Majnemer. “Our goal was not just to make this learning experience comparable to before the pandemic, but to make it even better.”

Long before the pandemic, the FMHS had formulated a plan to improve and expand online learning. Those plans were now going to have to become a reality quickly, which meant accelerating the establishment of the Office of Education Technology and E-Learning Collaboration for Health (Ed-TECH). The position of inaugural director was posted on March 13, 2020—the very day that in-person teaching was shut down at ș«čúÂăÎè. “I’ll never forget that date—it seemed so symbolic,” says Tamara Carver, PhD'14, who was appointed to lead the office. “As you can imagine, support for online learning was quickly in demand.”

In the past, some people may have been resistant to online learning, but the pandemic changed that. “Everyone recognized the urgency to shift teaching online, so there was buy-in across the board and the Faculty of Medicine and Health Sciences was able to make enormous advances in teaching and learning,” says Dr. Carver. “What could have taken ten years to develop was put in place in ten weeks with the support of the Faculty Development Office and Teaching and Learning Services.”

Online education has several important advantages that became immediately apparent in the context of the pandemic, such as the ability to work remotely and at the students’ own pace. But while online learning has its benefits, it is not a panacea. “We need that in-person component as well—that connection with our peers. This is what we call blended learning,” explains Carver. “This will likely become the default model, providing an assortment of teaching and learning methodologies that can be tailored to the needs of learners, geographies, learning styles and, most importantly, the program requirements and objectives.” Majnemer agrees and references a quote by education specialist George Couros, which resonates with her: “Technology will not replace great teachers but technology in the hands of great teachers can be transformational.”

Another faculty member who was rapidly thrust into the spotlight during the pandemic was the founder and director of the ș«čúÂăÎè Interdisciplinary Initiative in Infection and Immunity (MI4), Dr. Don Sheppard, PGME’99. MI4 was established in 2018 to leverage research for the prevention, cure and elimination of infectious disease threats. Who would have believed that the very next year, the appearance of a new pathogen would trigger a global pandemic and provide the initiative with its first major test?

"While the university was shutting down, MI4 was ramping up," says Sheppard. "We secured philanthropic support through the ș«čúÂăÎè Health Centre Foundation and established the Emergency COVID-19 Research Fund to give investigators the support and resources they needed to pivot to COVID-19 research." The initial financial support, totalling over $4 million, came from the Hewitt family, the Trottier family and the Doggone Foundation, founded by the late Elspeth McConnell and under the stewardship of Paul Marchand, BCL'66, LLM'85. Together, these gifts enabled MI4 to support 67 new projects, ranging from real-time tracking of vaccine development to the mental health effects of COVID-19.

The Doggone Foundation, which has also provided gifts to the Ingram School of Nursing at ș«čúÂăÎè and the Steinberg Centre for Simulation and Interactive Learning in recent years, was responsible for providing the initial $15 million needed to establish MI4 prior to the pandemic. “Dr. Sheppard explained to me, back in 2017, that doctors in his field were very worried about pandemics, infectious diseases, antibiotics and mutations, and that we're going to be in bad shape if we don’t do something about it,” explains Marchand. “It was clear we needed to be prepared and through the Doggone Foundation we were in the position to do something about this.”

Sheppard explains that MI4 has received a total of 173 applications since the pandemic started: “In a normal year that number might be closer to 30 or 40.” Every step along the way, MI4 researchers were looking for the next big issue to tackle. Vaccine hesitancy was raised as a potential problem in November 2020. “Less than one month from conception we had five projects set up to look at this,” recalls Sheppard. “We were quick, nimble and strategic, which allowed us to stay ahead of the game.”

The COVID-19 pandemic was the first real test for MI4 and it passed with flying colours. “I’m incredibly proud of the team,” says Sheppard. “Through their hard work, we have gained international recognition for our research. It’s been an exhausting year and there is still a lot more to do after the pandemic ends. We can’t let our guard down and let COVID-fatigue affect our preparation for future pandemics.”

This is a sentiment shared by Dr. Timothy Evans, inaugural Director and Associate Dean of ș«čúÂăÎè’s new School of Population and Global Health, and Executive Director of Canada’s COVID-19 Immunity Task Force (CITF). “Historically, there’s a concerning behaviour of panic and neglect when it comes to pandemic responses,” Evans explains. “During the crisis there’s panic, and afterwards there’s exhaustion, and a tendency to think that this will never happen again.” Evans references several other recent pathogens where a similar process of ‘crisis and crash’ has played out. “Recommendations were made after H1N1, SARS, MERS, Ebola and Zika,” he explains. “But I don’t think anybody would say we did all we could in the aftermath of one outbreak to prepare adequately for the next one. There has to be an appetite to engage in planning and to build back better with some urgency, otherwise we risk repeating mistakes of the past.”

Planning for the future may also involve reconstructive surgery on our national public health agency, which would require serious political will and patience. “We’re not going to fix those issues in the middle of a pandemic, but I think we need a serious and sober audit of all critical institutions, including universities, to determine whether we are fit for purpose,” explains Evans.

There are also many things that Canada did right however. Evans is quick to praise the attitude of the general public. “We are fortunate in Canada to have a population that largely heeds public health recommendations and takes precautions,” he says. The benefits of good leadership and strong public adherence to public health guidelines are visible in CITF data on population infection, which indicate that less than 1 per cent of the Canadian population has been infected, compared to nearly 20 per cent in the United States.

But the data also point to areas for improvement, particularly in testing, vaccine roll-out and the needs of vulnerable communities. CITF studies reveal the epidemic grew fastest amongst those living in poorer neighbourhoods and in racialized communities. “As a university, we should advocate for more research in communities of the greatest need such as longterm care facilities and poorer neighbourhoods,” says Evans. “For ș«čúÂăÎè’s School of Population and Global Health there’s an opportunity to become the vanguard of this action through both research and training.”

COVID-19 has shaken up our world, and we will feel the impacts for years to come. But there is reason to believe that we will be stronger and smarter on the other side of this pandemic, and that the experiences gained can make us more resilient.

“Our world has changed, yet we have persevered to continue to offer world-class education and conduct leading research. Many members of our community, learners included, have served on the front lines and contributed to the global research effort. While it may be too soon to appreciate what we have learned over the past 15 months as a result of this health crisis, I believe the knowledge we are gaining will help to make us stronger for the future,” says David Eidelman, MDCM’79, Vice-Principal (Health Affairs) and Dean, FMHS.

As Belliveau puts it, “COVID-19 was a great lesson in adaptability, flexibility and resilience, which are all instrumental skills required for a career in medicine. I have no doubt that going through this pandemic will make us better healthcare professionals.”

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