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Culture At A Crossroads: Corona Edition with Dr. Gillian Kernaghan

Updated: Apr 14, 2020

Dr. Gillian Kernaghan is the President and CEO of St. Joseph's London. She also sits on Premier Ford's Council on Improving Healthcare and Ending Hallway Medicine. Kernaghan is a board member of the Ontario Hospital Association, an associate professor at Western University, on the Academic Hospitals of Ontario Executive and Council, and is the chair of the Catholic Health Associations of Ontario Board of Directors. Not to mention, she was the past co-chair of the Canadian Health Leadership Network, and the past president of Canadian Society of Physician Executives.

It is the continued mission of Culture at A Crossroads to explore issues most prevalent for Canadians. Recently, I interviewed Dr. Kernaghan to gain insight on COVID-19 from a medical, hospital, and executive perspective. Questions are focused on virus concerns, how it spreads, possible treatments, preventative measures, and who is most at risk.

Below is the transcript:

DM: It's great chat with you, a friend and someone who's in the middle of the COVID-19 crisis. Just at the outset, what is your reaction to this crisis?

GK: It's really unprecedented times. I lived through SARS and the H1-N1 pandemic, and this is similar, but way more extensive than this, so it's really requiring much more engagement from the public to really help with this pandemic and is certainly stretching the healthcare system.

DM: Hmm. Talk to me a little bit about some of the response that's happened at St. Joe's. I know London's always been known as a medical care city - a hospital city - and you guys along with LHSC have come out with some pretty good systems, as far as testing goes.

GK: We have, the good thing is we work very closely together between the two hospital systems in London. One of the key areas of focus for us right now is to create the capacity for the increased number of individuals who will need hospital care. So we've been really looking at, London Health Sciences, which is the acute inpatient hospital down in their census, so they have room for people. And then at St Joe's we have four hospital sites and at particularly two of our sites we've opened additional beds to take patients out of London Health Sciences [LHSC] into our other hospital system. This is to create room at LHSC so they can do what they need to do when the wave comes.

DM: And you guys are one of eight sites in the province able to conduct this testing where previously it was taking like five to seven days to turn around and get it back, and now it's happening within 24 hours. How has this sort of data helped catapult you guys going forward to being on top of this crisis?

GK: The lab that we have in London is a joint initiative between the two hospital systems. And yes, we are starting to do testing. We are increasing our capacity and we hope to substantively increase our capacity over the next week. At the moment we're really focusing on people who are sick enough to be admitted to hospital because we know it's covert. It means that we can look at the treatment protocols for people who have this new virus and we're also testing healthcare workers and getting them done quickly so they know if they have this virus and if they don't they can continue serving the public in the healthcare system. And if they do, we can make sure that they're getting the support and the care they need. So those are the two key areas of focus, in addition to anyone in long-term care because they tend to be elderly and they tend to be the people at very high-risk at this time of the pandemics. The lab team looks at what's our capacity, who's our priority, and that's how we're focusing the volume that we have to make sure that we're focusing on the highest priority people

DM: Dr. Kernaghan, down the road the province wants to get to the place where they can have the capacity to test maybe close to 20 000 by mid-April. So when we get to that point, do you think that we'll be able to keep up with the demand in Ontario?

GK: That's a hard one to say, David. I think it will keep up with the need for the people who really need to be tested. If we have mild symptoms and we stay home and make sure we isolate and do good infection control practices. There are people that may not be tested at this point in time. However, I think the important thing will be making sure as this comes into the system, that we're able to test the people that are really getting sick. Healthcare workers, essential workers who are keeping the system going both in healthcare, in our public utilities, making sure that those essential workers are also prioritized.

DM: Yeah, you mentioned the focus on healthcare workers. Those are the front lines and as of March 24th it was shown that more than half of the cases in Canada have been through community transmission as opposed to travel. So just talk to me a little bit about the importance of doubling down on on sanitary means and washing hands and protection in that way.

GK: One of the most important things we're doing to protect our staff is screening everybody that comes into the building, if they've got any symptoms whatsoever, we still ask about travel. We ask what contact with a person who has the virus and obviously if anyone has any of those risk factors, we either don't let them in the building or if we have to, we get them to take precautions to protect other people in the building. And so screening at the door is really important. We screen all our staff and all individuals coming into the building. Really important strategy and then making sure that people have the appropriate personal protective equipment to protect themselves when they are caring for individuals who potentially have this virus or do have this virus is also really important strategy. But I can't stress enough, David, the importance of the public engaging in physical distancing and good hand hygiene to minimize the spread in the community. It protects them, but it also protects our healthcare workers.

DM: Dr. Kernaghan, you mentioned your role in helping with long-term care and some oversight regionally. Talk to me a little bit about the decision making that's gone into that. And you know, some of the tough calls you've had to make, particularly with people, family members that aren't necessarily going to be able to visit loved ones at this point due to preventing them from getting the illness.

GK: It's a hard time for people who are used to visiting their family members who visit every day. And that was the first place that we actually stopped visitors from coming unless their loved one is critically ill. And because they are a vulnerable population, and although it's very hard not to see your loved one, it is a strategy to protect the community in which they live, as well as your loved one. That comes very close to home for me because my husband is in long-term care and since this happened, obviously I've not been able to visit him and so I know what that means as far as having to distance yourself from family. But, it's really important that we protect the vulnerable people in those communities because they are some of the people that are going to be hardest hit if we don't do our best to keep it out of our long-term care facilities and away from the seniors in our population.

"That comes very close to home for me because my husband is in long-term care and since this happened, obviously I've not been able to visit him and so I know what that means as far as having to distance yourself from family."

DM: Wow, very challenging to make those calls. I know you also are very close working with the province. What has it been like to be on this board for big decisions like improving healthcare and ending hallway medicine. Have you been in dialogue with people like Dr. David Williams [Ontario's Chief Medical Officer of Health] at this time?

GK: No. The Premier's Council really is focusing on looking at what advice we can give to the ministry about the future of healthcare. At the moment, this is crisis management and there is a command table centrally. And really that command table is looking at directing the healthcare system in the province at the time. This is not a time for really that work, the previous council's taken a bit of a pause while this is happening. And really at the moment there's a singular focus on how do we serve the community best in this crisis and how do we protect our healthcare workers as they serve the community best.

DM: What can you say about the job that the chief medical officer, Dr. Williams has done during this time as Ontario? It's been said, its [Ontario has] been kind of leading the way in Canada as far as just being on top of regulations and preventions as far as like school and all sorts of things.

GK: This is a really difficult time for Medical Officers of Health across the country. And this situation has evolved so rapidly and I know that every one of them across the country is doing their best to make the wisest decisions with the information they've got at the time. It's always easy for people to be critical. However, having been in these circumstances as a leader, you do your best to make the very best decision with the information you have that day. Sometimes that means you reverse your decision the next day. And that's just the way life is in this evolving crisis. So I have great admiration for the people in the province who are doing their best to guide us. And getting information out as quickly as they can and listening to a lot of voices, including the experts around this to make sure that we are doing the best we can with the resources we've got to serve the public. So recognize this is a tough place to be.

DM: And just the virus itself, you mentioned SARS earlier and how this is far greater than SARS, it past SARS in Canada as far as deaths. What are some of the differences that make this more malignant?

GK: I'm not a microbiologist David, so I would not suggest that I would have the subtleties of this. The important thing about this virus is it appears to be quite infectious and that's why physical distancing is really important because it appears to be fairly easily transmitted through droplets. So if we cough and when we talk, there is a certain amount of saliva that is secreted into the your immediate environment. And so it's making sure that we keep that physical distance to minimize the spread. It appears to spread fairly easily through droplets. And so that's why it seems to be different from some of the other viruses that we've seen.

DM: Wow. And as to the future of Coronavirus, there's some speculation that this could become a seasonal virus. What's the latest on maybe vaccines going forward? Or is that something that you're not really considering at the moment? Because like you said before, this is kind of a crisis that you're trying to avert...

GK: Certainly vaccines are the most effective strategy against viral illnesses. Just like influenza vaccine and a number of other effects scenes. There are many places around the world working very hard, scientists working to see if we can develop a vaccine, but the vaccine is not likely to be ready for this particular outbreak of the Coronavirus, this new Coronavirus. And so lots of people working hard, but the emphasis, we shouldn't wait for the vaccine. We need to listen to Public Health and do what we're asked to do are in physical distancing, hand hygiene and good infection control. That's the strategy that will flatten the curve and minimize the risk to our vulnerable people in our society.

DM: Dr. Kernaghan, as of March 29th there's been over 350 people that have recovered from the virus in Canada. What sorts of characteristics have been sort of across the board for these people to get over this?

GK: For the vast majority of people, this will not be a serious illness. If you look at the data around the world, most people who get this, it will be a relatively mild illness where you need to stay home, look after yourself. The hardest part is that for a smaller percentage of the population, this is a devastating illness. When you look at the death rates around the world. And an age appears to be the most significant factor, that puts people at risk. So if you are over 60 and have other significant health concerns, you are at high risk. And so part of the reason for everybody paying attention to this virus is that you may get a mild illness, but you could give it to somebody for whom this could be life-limiting. So that's the importance of every one of us owning this virus, not just the people who are high-risk.

DM: What are some ways that our bodies are able to fight it off and to keep it in mild form, if it does come into contact? How could we apply, you know, health strategies at this time kind of well in lockdown

GK: As far as our own immune system, there are many people that have a very healthy immune system and we know that the good lifestyle helps with our immune system, you know, getting exercise, good nutrition, etc. It helps boost our immune system and paying attention to the basics that you hear about as far as a healthy lifestyle helps with her immune system. There are people whose immune system isn't as strong because of other illnesses they might have or other medications they might be on. And so we need to be very aware of that and be careful with individuals who may not be able to fight this virus as well as others there. As far as I know, again, I'm not a researcher in this area, but as far as I know, there are not medications you can take to boost your immune system to protect you against this particular virus. And the most important thing is really good lifestyle and good infection control practices.

DM: Hmm. Just to speak to the optimism that you have for this. As we've seen that numbers are starting to decline in places like BC and Ontario and even, you know, hearing in China things have been kind of at a stand still there for people who have been diagnosed with this disease, do you remain hopeful that we could have this stopped within the next few months?

GK: I am hopeful that we will get this under control. I look at places around the world like China who are now starting to open up. They had absolute discipline around the infection control practices. Once they got going in managing this disease, people were quarantined at home and people listened. And that's the important message, we can flatten this curve or reduce the number of cases if we are all owning this and practicing it. But if there's a segment of the population that feels that these rules don't apply to them, they will be putting their neighbours, their family members, and the public at risk.

DM: Well, that's, that's great. Dr Gillian Kernaghan. Thank you so much for answering these rapid fire questions on covert 19

GK: You are so welcome, David. I'm delighted to get any messages out that stress the importance of this [Coronavirus].

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