Every waking hour of Dr. Natalie Bridger’s day is taken up with COVID-19.

As clinical chief of infection prevention and control for Eastern Health, Dr. Bridger has been in meetings from morning until night since the pandemic began.

She likens her days to the movie Groundhog Day.

Like the rest of Memorial University and the entire province, Dr. Bridger and her colleagues at the Faculty of Medicine were thrown into global pandemic mode on March 15. That included moving all staff and faculty to working from home with the necessary support, remote learning for students and a halt to all research until a plan was formulated.

For Dr. Bridger, however, who’s also an assistant professor of pediatrics, preparation began well before a pandemic was declared.

“I think something many people in the public don’t realize is how hard many of us have been working on the COVID-19 response since January,” Dr. Bridger said. “We first started hearing reports of this novel coronavirus coming out of China just after the New Year. My colleagues and I were concerned that this may become a global issue so we started our preparations.”

Simulating the patient journey

The group first focused on educating front line staff.

Dr. Bridger also presented on COVID-19 to specialty groups at sites across the province and was part of teams developing policies and procedures for dealing with the virus, both in and outside health facilities.

The group also conducted patient tracers – something experts do when planning for an emerging infectious disease to test standard operating procedures. Simulating the patient journey can highlight gaps in knowledge, infrastructure and policies.

“For our pediatric tracer, I brought my little boy to the Janeway Emergency Department with a short script: He had a cough and fever and I had just returned from China,” Dr. Bridger explained.

“The staff were aware that it was a simulation, but they were expected to follow the usual procedures for a patient suspected of having COVID-19. My little boy then got “admitted” to a ward on the Janeway, so we literally walked up to the medical unit. This way the team is able to determine the best path for patient transport, how many people are required, what personal protective equipment is required, etc.”

From planning to response

Since the pandemic entered the province in mid-March, the team, in collaboration with the Faculty of Medicine, Eastern Health and the Department of Health, shifted from planning to response mode.

Dr. Bridger says she felt anxious but not surprised when the first case was declared in Newfoundland and Labrador.

“I did take comfort in the fact that we had practised multiple simulated patient encounters.” — Dr. Natalie Bridger

“Given the virus was appearing all over Canada, I knew it was only a matter of time before it reached us,” she said. “I did take comfort in the fact that we had practised multiple simulated patient encounters and the staff who would be looking after patients with COVID-19 were superstars in these simulations.”

For Faculty of Medicine members, many of whom are also physicians like Dr. Bridger, and medical students, who get much of their education in hospitals interacting with patients, the turn of events on March 15 was particularly tricky.

‘Working tirelessly’

Dean Margaret Steele praises faculty and staff for ensuring education and research missions continued during the pandemic.

“Our clinical faculty are also working tirelessly at the front line,” she noted. “I feel very privileged to work with an incredible team of talented, committed and hardworking individuals dedicated to the people and communities we serve.”

Memorial’s Faculty of Medicine is also contributing to other initiatives in response to the COVID-19 pandemic including the following:

• Dean Steele formed a COVID-19 Task Force, chaired by Vice-Dean Cathy Vardy. The task force meets daily to discuss issues related to educational and research programs, national medical school discussions and university and provincial issues.
• Postgraduate residents continue their education while being part of the health-care teams on the front lines in Newfoundland and Labrador, PEI and New Brunswick. The Office of Postgraduate Medical Education developed redeployment principles and is monitoring resident availability week-to-week to ensure resources are available to cover a potential surge in need for physicians.
• As the only medical school in the province, Dean Steele sits on the Eastern Health Regional Health Authorities board as well as the Newfoundland and Labrador Centre for Health Information board, which is chaired by Kris Aubrey-Bassler.
• Dr. Proton Rahman, Eastern Health clinical scientist and professor of medicine, is head of the province’s predictive analytics team, and is responsible for the province’s short-term models.
• Cathy Donovan, associate professor of clinical public health, has been acting medical officer of health for Eastern Health in its COVID-19 response.
• Brenda Wilson, associate dean of the Division of Community Health and Humanities, is a public health physician and working with faculty members to develop research related to COVID-19, responsive to the province’s needs.
• Infectious disease specialists Peter Daley, Faculty of Medicine, along with Dr. Cheryl Foo from the Janeway Pediatric Research Unit, are leading numerous clinical trials and observational studies.
• In collaboration with the Faculty of Medicine as well as with the Janeway’s Primary Health Research Unit, the Newfoundland and Labrador Centre for Applied Health Research produced 5 Quick Response Reports to questions about what’s known and what’s being done on the pandemic.
• Peter Wang received federal funding for research related to COVID-19.
• From the COVID-19 Task Force, a sub-committee focused on well-being and headed by assistant dean of Student Affairs Dr. Greg Radu, is providing well-being communications twice a week to faculty, staff and students as well as partnering with the province’s regional health authorities to promote well-being initiatives to physicians, many of whom are faculty members.
• The Office of Professional and Educational Development developed a website with access to online modules and other educational topics related to COVID-19 for health professionals.
• Faculty at the Centre for Bioethics are supporting the Department of Health and Community Services and the regional health authorities through the Provincial Health Ethics Network of Newfoundland and Labrador by developing a triage protocol for the allocation of ventilators in critical care units if demand outstrips supply; advising on policies and procedures for the triage for personal protective equipment; visitation policies and the potential rationing of blood and blood products, etc.; ethics consultations related to issues driven by the pandemic; and advising on research protocols specific to COVID-19.
• After a provincial call for personal protective equipment (PPE), Dr. Lee Errett (MD’77), generously donated approximately $50,000 of PPE to the Faculty of Medicine, which was given to Eastern Health; the Memorial Medical Laboratories and the Clinical Learning and Simulation Centre donated a significant amount of PPE supplies; and 3D-printing company, PolyUnity, which got its start at the Faculty of Medicine, is fabricating PPE for health-care workers to help with shortages with help from Faculty of Medicine equipment.
• Drs. Bridget Fernandez, Michael Grant, George Zahariadis and Touati Benoukraf are providing input to TaskforceNL, a volunteer group of business and community leaders helping to provide PPE for front line health-care workers.