Life After the Pandemic — Dr. Vivek Goel

Alex Maheux:

As the COVID-19 pandemic is rapidly evolving, the circumstances may have changed from the time this podcast was recorded and may not reflect the current environment.

Hi, and welcome to the CHIP, the Canadian Health Information Podcast. I’m your host, Alex Maheux. This show from the Canadian Institute for Health Information will give you an in-depth look at Canada’s health systems and talk to experts you can trust. If you’re interested in health policy, our health care systems and the work being done to keep Canadians healthy, this podcast is for you.

Today on our season finale, we’re joined by a very special guest, Dr. Vivek Goel, a renowned physician and a public health researcher who is also the chair of CIHI’s Board of Directors. Dr. Goel is a professor in the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health at the University of Toronto. On July 1 of this year he became the President and Vice Chancellor of the University of Waterloo. 

He’s made tremendous contributions to advance the health of Canadians. He is a member of the COVID-19 Immunity Task Force, the Chair of the Expert Advisory Group on the Development of a Pan-Canadian Health Data Strategy, and he’s a Scientific Advisor for CanCOVID, the national research platform for COVID-19 research. If that wasn’t enough, he is a Fellow of the Canadian Academy of Health Sciences and a member of the Order of Canada. Dr. Goel is here to chat with us about what life post COVID will look like for Canadians, and what we can expect our new normal to be like. Let’s get to it.

Hi, Vivek. Welcome to the CHIP. How are you doing?

Dr. Vivek Goel:

Great, how are you, Alex?

Alex Maheux:

I’m good, thanks. It’s been a long, challenging pandemic year. There have been many changes in how we live our lives. What are some things that have surprised you?

Dr. Vivek Goel:

Well, there’s so many things that have surprised I think everyone. You know I think probably the most impressive thing is to see how resilient people actually have been, right. It’s been 16, 17 whatever the right number of long months, and you know I think back in the beginning of March 2020, I don’t think any of us would have imagined we would spend more than a year working from home and be able to do the kinds of things that we’re doing online. 

You know at the university we’ve delivered entire programs virtually. People have moved their shopping. People have been doing their exercise classes over Zoom. And it’s amazing to see how fast people actually did adapt to all of that. It’s not been easy and there have been lots of challenges and lots of impact on people’s mental health, and so we have to be cognizant of that. But for me, that is certainly a major lesson, just how adaptable humans can actually be when the pressure is on.

Alex Maheux:

Mm-hmm, people have certainly been resilient. There have certainly been a lot of learnings in the past year and a half. From your perspective, what have been the most important lessons we’ve learned about Canada’s health systems?

Dr. Vivek Goel:

So, we’ve obviously learned a lot about the ongoing challenges that we have in many parts of our health care system, and 2 very important areas that CIHI has done very significant work; long-term care and, more generally, how we support older adults, right. How we treat them. How we regard them. This was an issue for decades, right, and so it’s not anything new. But the pandemic really opened it up for everyone. I think in the early days we certainly saw the impact on long-term care. And unfortunately, in many parts of the country we saw it again in the second wave, even though there was clarity on what needed to be done.

And the second big area is around the important contribution of the social determinants of health. And again, with the pandemic there were people I think very early on who started to talk about the communities that were being impacted and so on. But it took a little bit a while and it took the data being generated to really demonstrate the impact of housing, occupation, ethnicity, and the intersection of those factors into the people that were least protected, who were not able to safely work from home. And so, we have seen the impact that has on health and on our health care system. We also saw the impact that the public health measures, the restrictions, also had on many of the same populations. And with all of these things, we’ve also seen the importance of really good, timely data to inform decision-making.

Alex Maheux:

Well, you’re leading me to my next question which one of the things I think COVID has highlighted is the importance and the power of data. And in a time where information is constantly evolving and changing and being updated, there is an obvious need for timely data that people can trust. What has the pandemic taught us about Canada’s health analytics and data tracking?

Dr. Vivek Goel:

So, we clearly have some great systems in place for tracking health data, but we also know we have challenges, right. In particular, we have challenges in the timeliness of the data that we have, and we have challenges in the coverage across the country. And with COVID, very early on it became clear that, at a national level, we did not have timely, complete data on COVID cases. And if we wanted to drill into things like symptom history or place of an outbreak, the employment of someone who’s infected, that data had been and continues to be, across the country, challenging to have. 

There’s challenges with collecting that data to begin with, right. You have to go and talk with people to find out what their occupation is. And if public health is being overwhelmed, there’s challenges. But there’s challenges with how it gets coded, whether it gets coded consistently across the jurisdictions, or even across different health units or health departments. And then there’s challenges with getting it transmitted.

So, while we have some good information, we were able to have, for example, some pretty good reporting on mortality in long-term care. I think CIHI’s report on that came out in June of 2020, right. And so, as I said earlier, we had some good information about that that may not have been acted on as we got to the second wave. But we also have challenges in a lot of other areas in terms of being able to have timely data.

Alex Maheux:

Absolutely. We know that data can help inform decision-makers. You know this more than anyone. You are the Chair of the Expert Advisory Group on the Development of a Pan-Canadian Health Data Strategy. Why does a comprehensive data strategy matter for Canadians?

Dr. Vivek Goel:

So, if we want to ensure that we’re giving Canadians, first of all at an individual level, the best possible health care that they can get, and also ensuring that we’re protecting public health, promoting population health, and then enabling the kind of research, the development of new technologies and processes that they deserve, we need to harness the power of data. And we need to make it easier for them, first of all, to get their own data. 

Right now, I don’t think there’s anyone in Canada who can get access to their own health information in a timely way. And if they can get access to it, it involves logging into multiple different portals, right: lab tests over here, diagnostic imaging over there, their medical records over here. And there may be a few jurisdictions, a few places where it’s getting better, but it’s far from ideal. 

If you’re a provider and you have a patient in front of you and you want to know what their imaging results from a year ago, it’s not necessarily easy to get that, right. So, we know we’re not delivering services, we’re not supporting providers in an efficient way in giving the best possible service [unintelligible 00:08:58]. So that’s the first level, right. I'd start with what Canadians need. 

And then we can think about our First Nations Inuit and Métis communities. They don’t have the information they need and they’re increasingly responsible and want to be in charge of their own services. They should be able to manage and follow their own approaches. Other communities, as I mentioned earlier, the ones that were most affected, whether it’s black community, immigrant communities, what we call the hot spots, they don’t have timely data. And then, if you think of it from a policy perspective, from a health administration management perspective, do we have timely data in each of those settings?

So, in this work that our expert group is doing, we’re going through each of these different communities and looking at what are the challenges that they have. And unfortunately, the limitations that they have in access to data are not new, right. In our first report released on June 17, you know we actually start with quotes from the inquiry into SARS chaired by Dr. David Naylor. And I have a quote from the 1991 Wilk Commission Report. For listeners of the podcast, go look up the report from the expert group. Read the quote from the Wilk Commission. And if you didn’t know it was written in ’91, you’d be thinking it’s describing what we’re seeing right now with health information in Canada. And so that’s the sad part, right. 

So, we sort of turned all of these things up and they’re in the public eye during COVID. But these challenges for the flows of information, the root causes have been around for a long time. So, in our first report we described those root causes and we really are looking at how we can overcome those root causes. And the challenges are not about simply building better systems, using better technology and methods. We certainly have to do that, but the challenges are around engaging the public and engaging providers. And ensuring they understand why the flows of data are important, how they benefit from the sharing of data, how providers can benefit, that when you’re seeing a patient, if you want to have timely access to the past procedures, we need the flow of information to happen. 

We need to look at our policies and our privacy frameworks. Most importantly, we need to modernize that for the digital age, because the models that we have are based essentially only paper records. So, even a concept like health information custodian is the custodian of the paper records. When you have to go to the basement of the hospital or go to the medical records room, there was a custodian of the record. But what does that mean in a digital age where you don’t have to have a paper record? But even with digital technologies, again, as many of our listeners will be familiar with, digitization actually still involves the digital movement of the images of what are essentially paper records, PDF forms. And during COVID we had stories of faxes still moving around.

Another component is accountable alliances, because there are many different players in the health system: federal government, provinces, territories. But then we have the providers, we have the health system organizations, and we have individuals out there. And everyone has to hold each other to account. And then the final component that we’ve identified is interoperability, like common definitions. And it does not mean single big-box systems, right. With modern technologies we can have interoperable systems, but everyone has their own system. 

And so, that’s our first report. We’re going to continue to work over the summer and drill into each of these areas. And our second report will try and lay out a path forward to overcome these root causes that we know have been with us for many, many decades.

Alex Maheux:

Absolutely. And that is just one of your roles. Vivek, you wear a lot of hats. You’re a public health researcher, health services evaluation expert, CIHI’s Board chair, a professor. I would imagine that having this many roles in and of itself is a huge challenge and would be accompanied by a lot of pressure and stress. Have you found that some of these roles have been more challenging than others during the pandemic?

Dr. Vivek Goel:

So, you know certainly in the early part of the pandemic, part of my role at the University of Toronto was helping to lead the university’s own response. And the University of Toronto is a community of about 100,000 people operating across multiple campuses, we have residences, we have food services, we have day cares, we’re a little town, right, or a large town if you think about it. So, we had to deal with everything. 

So that was certainly a very stressful period, as it was for many, many people. And we were faced with a lot of uncertainty, rapidly evolving information, and you know, juggling things was obviously challenging. But in terms of the multiple roles you highlighted, one thing, as you can hear from my answer to the earlier questions, is that I've always been involved in working with data. 

Alex Maheux:

Well, I think I can confidently say on behalf of CIHI, we’re very grateful for that. I want to pivot a little bit and look ahead through the final waves of the pandemic. I know we’re all wondering when life will start to feel normal again. Can you walk us through what you think we can maybe expect?

Dr. Vivek Goel:

You know I wish I had a crystal ball that would let me tell you exactly what to expect. I think there’s still a significant amount of uncertainty, although we’re in a much, much better place than we were even a few months ago or a month ago. So, in the next few months I think we’re in for a pretty good summer in most parts of the country. The vaccination program has really picked up steam. We’re leading the world in doses per day. 

Probably some time in early July we will pass the United States in the proportion of population that has had first and second doses. So, back in March/April, I don’t think anyone would have imagined that would be possible. And probably by the end of summer we will be leading pretty well every major OECD country. You know there’s a few really small island countries that got, they had 100,000 people to do and they got them all done early on, and so the list of countries will be down there. But if you think of major economies in the world, countries with more than a million population, we’ll be up there. And right, across most of the country the case counts are trending downwards. And so, there are some variants that we have to keep an eye on, but I think we’ll have things manageable.

Now the big risk is what kind of potential fall wave comes about. People now, for most parts of Canada, would refer to it as a potential fourth wave. And I think the thing that I would say is we have to understand there is going to be a fourth wave of disease. The question is when it comes and how big it is. Is it going to be something that’s going to be manageable, not cause a surge on health system capacity? We have to acknowledge that this is not going away any time soon. And there will be places in the world that are going to have COVID because the vaccination program is not rolling out evenly around the world. Canada’s going to be leading the world, but there’s going to be many parts of the world that will have not had the vaccine. 

So that has implications for us in terms of our ability to travel, to have family members who might be living abroad visit us. I think we will start to have travel but there will probably be requirements for testing. We’ll see the lifting of quarantine requirements for vaccinated travellers. And that will happen slowly. So, we’re not going back to exactly the way we were. I think it’ll be a new normal. And I think we’re going to have sporadic outbreaks, but as long as we can detect them quickly, so that means having regular surveillance testing, we have the public health capacity to do contact tracing and support people in isolation, we’ll be able to manage those sporadic outbreaks that will come up across the country. 

So, the bottom line is, I don’t see any time soon that it’ll be completely back to normal. But I think in most parts of society we will start to be able to go about our business. And it may take a little bit longer in some of the provinces and territories across the country, but we will see the lifting of social distancing requirements, the lifting of mask requirements start to happen. 

Alex Maheux:

Mm-hmm. You’ve already spoken to a few of these, but I'm hoping to get to your quick rapid-fire thoughts on a few specific elements of society and how you might envision those changing post COVID. Let’s start with large-event gatherings like sports and concerts.

Dr. Vivek Goel:

It’s going to vary over the coming months. So, certainly in the next few months, because it’s going to be done separately for every province and territory. We’ve seen now in several provinces, when we had more teams in the NHL playoffs, they were starting to allow vaccinated health care workers with masks, in small numbers, you know, 10% capacity or so, for the events. And I think we’ll continue to see that gradually ramp up. At some point, I would say as we have a critical portion of the population fully vaccinated, disease transmission rates are right down, I think we will start to see events starting to get back pretty close to the way they were. 

Alex Maheux:

Mm-hmm. I'm sure that’ll be fantastic news for a lot of people listening. 

Masks, will these become a more permanent part of how we live our lives, even past COVID?

Dr. Vivek Goel:

You know I think that’s going to be an interesting question, probably more for sociologists to start to explore what the cultural practices will be. You know masks were a cultural practice in many parts of the world, in Asia. And we saw how that they were able to better deal with the first wave because of some of those attitudes, and you know, they have other attitudes towards hygiene. So, whether we will accept that and stick with some of those practices on a voluntary basis or not, I think that’s going to be a sociological question. Like again, if you look in the United States, people are ripping off their masks and saying we’re not going back. Canadians have been sort of in between on that. And my own prediction is there will probably will be some types of settings where some people will want to continue to wear a mask.

Alex Maheux:

My last rapid-fire keyword for you, vaccinations. How do they play a role in managing post-COVID life?

Dr. Vivek Goel:

Yeah, so right now the immediate thing is just getting enough vaccinations – 

Alex Maheux:

I'm jumping the gun here.

Dr. Vivek Goel:

– post COVID and getting it around the world. The data is still emerging around whether boosters are going to be required. And so there’s 2 sort of paths to whether we will need boosters. One is, if the immunity induced by vaccination starts to wane over time. And the second way in which we may have a need for further vaccinations is if the variants continue to evolve. And we have a variant that the existing vaccines are not providing protection for. So far, all of the major variants, there is a good degree of protection from the vaccines, so those are going to be complex issues. And again, that goes back to it’s not going away. The risk will be with us and we’re going to be living with it in a new normal sort of way. 

Alex Maheux:

Mm-hmm. That’s great insight. Many Canadians have expressed feelings of stress, anxiety about returning to a new normal, what it will look like, how to make that transition, and the social expectations, undoubtedly, that will take place along with that. Do you have any advice for how to manage those concerns?

Dr. Vivek Goel:

You know first of all, I think we have to acknowledge the concerns. You know it really is about having dialogues with people, understanding why they might have concerns. Maybe they have a family member that’s immunocompromised. Maybe they had a family member that got COVID and they had to follow their hospitalization and maybe their death. People will have different reasons how COVID has affected them and have different expectations about what might happen to them as they get back out into society. And so, there’s not a single message to give.

And so, we have to support people in acknowledging their concerns, giving them access to information, giving them access to the resources that can help them get the answers to the questions that they have. And then we have to work to ensure that they have the information and that the place that they’re going to is following good practices, has engaged in ensuring promoting vaccination in their employees, is practising regular hygiene, improve their ventilation, all those sorts of things. 

And you know one of the things that businesses are looking to do is how can they portray that. How can they present in a clear way that we’re practicing all of the safe practices? And governments are working with businesses and employers to try to find ways to really reassure people that all those kinds of practices are being followed. 

Alex Maheux:

Mm-hmm. That’ll be incredibly important. I'd like to end on a more hopeful note. What is something you personally are looking forward to? And what’s something we can all look forward to?

Dr. Vivek Goel:

Well today, I've got a reservation on a patio this afternoon with my wife and we’re going to get out there. It’s a sunny day here in Toronto. So, I'm certainly looking forward to getting back out and engaging in those kinds of activities, visiting with family and friends. I'm also looking forward – your listeners know that on July 1 I start a new job at the University of Waterloo and I'm looking forward to getting into that.

You know, to just tie this back, part of why I got interested in taking that is part of the vision there is to create a post-pandemic university that will look at a lot of these issues. The Waterloo region has been a hub of manufacturing in Canada for well over a century. And as we think about how we repatriate some of our manufacturing capacity through critical supplies, they’re a centre for excellence in data science, engineering, artificial intelligence, so a lot of things that we talked about. So, I am looking forward to tying a lot of those threads in my career together in that role in creating new education programs, new research programs and new [unintelligible 00:25:29] society that help build back a better Canada.

Alex Maheux:

That sounds wonderful. Vivek, thank you so much for your wisdom and your perspective today and such a thoughtful conversation. This has been the best way to help us wrap up our first season of the CHIP. Thanks again.

Dr. Vivek Goel:

Thank you for having me. 

Alex Maheux:

Thanks for listening. We hope you enjoyed this episode. Check in next time when we bring you more valuable health perspectives and continue to chip away at health care topics that matter to you.

If you want to learn more about CIHI, visit our website: cihi.ca. That’s C-I-H-I-dot-C-A. If you like what you heard, subscribe where you find your podcasts and leave us a review and give us a follow on social media.

This episode was produced by Jonathan Kuehlein, with research from Amie Chant, Marissa Duncan, Shraddha Sankhe and Ramon Syyap. I’m Alex Maheux. Thanks for tuning in to the Canadian Health Information Podcast. Talk to you next time.

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