- by Anne Fnlay-Stewart, Editor

Are we expecting too much of too few at Grey Bruce Public Health in a pandemic?

“The Grey Bruce Health Unit has eliminated three management positions in response to an anticipated $1.1-million cut to the funding it receives from the provincial government.” Owen Sound Sun Times, January 7, 2020

On that same day, a novel coronavirus was identified and temporarily named “2019-nCoV”.

Exactly three weeks later, the Director-General of the World Health Organization declared the novel coronavirus outbreak a “public health emergency of international concern” (PHEIC), WHO's highest level of alarm.

We dismissed our senior epidemiologist that month. A twenty year veteran of our Health Unit, she is now working full-time for the Middlesex-London Health Unit. We also lost another Public Health Manager, and the Human Resources Manager – a position for which the Health Unit is currently advertising.

"The work previously performed by the three employees will be spread out amongst the remaining eight managers and senior management team, which is comprised of two directors, associate medical officer of health Dr. Linna Li and medical officer of health Dr. Ian Arra”, read that media release last January.

But according to a statement by Board Chair Sue Patterson at Friday's Board of Health meeting, Grey Bruce did not have an Associate Medical Officer of Health (AMOH). That position would have to be appointed by the Board of Health, and approved by the Ministry of Health, and carries all the authority for the legislated responsibilities of the Medical Officer of Health in his absence or delegation.

While staff commonly referred to Dr. Linna Li as their AMOH during her one year contract with Grey Bruce Public Health, she was actually a physician consultant. Ms.Patterson referred to Dr. Arra having this support “from time to time”. In fact Dr. Li worked full-time throughout her contract, which she chose not to renew in July 2020. Dr. Li has a degree in Public Health and Preventive Medicine from Queen’s University and a Master of Public Health from Johns Hopkins, and is currently working for Toronto Public Health.

When we received the first media release from Grey Bruce Public Health about Covid-19 last March 4, it was signed Dr. Linna Li, Acting Associate Medical Officer of Health.

In the summer of 2020, Dr. Donald Cole, Professor Emeritus at the Dalla Lana School of Public Health, responded to our Health Unit's call for assistance. He joined as a part-time physician consultant in mid September 2020, to help out during the COVID pandemic and worked two days per week plus some other hours most weeks until early February 2021 when his colleague, Dr. Rim Zayed, joined full-time. Since then his hours have been much less. At Friday's meeting, the Board of Health welcomed Dr. Rim Zayed who has been working full-time since February, again as a physician consultant.

Is that enough high level support?

It is true that Dr. Arra has no AMOH, and that is not uncommon among smaller health units such as ours. Everyone concurs with Ms. Paterson's report that he has “almost doubled his regular hours, working around the clock at certain critical times and is available 24 hours a day every day”.   But no other MOH in Ontario has clocked anywhere close to the same scale of overtime from the province's special COVID funding for public health.

Is this because of the loss and turnover of experienced staff at Public Health Grey Bruce, and the re-assignment and doubling up of duties for those remaining?

The Covid pandemic is not the only public health emergency senior staff have to address. Back in the summer, CBC quoted Ian Reich, harm reduction manager for the Grey Bruce Health Unit, after six overdoses were reported in five days. "While COVID-19 is a true threat, the opioid epidemic has continued to rage on during the pandemic. We must not forget about this public health crisis in the face of COVID-19, and we must treat it as the same level and rigor as we have the COVID-19 pandemic response," said Reich.

Reich continues to offer strong and professional leadership on this file, focussing on the health and human cost. At the same time, he and others were being thanked by Dr. Arra at Friday's Board meeting for their work in other areas during Covid, and performing “most of these functions after hours”. We often see Reich responding to social media comments on a number of public health issues, on weekends and evenings.

Dr. Arra also thanked Susan Shular, Director of Operations and Programs, who took retirement in February this year.. Another reminder of how much is involved in public health, Arra praised Shular for the stability she brought to her role in continuous operations planning for “everything the Health Unit does other than Covid”.

“Ensuring that all that runs - one director to run all these functions – she did amazing work”, he said.

“Redundancy is key in Public Health,” said Dr. Arra to media, explaining that the arena floor at the Bayshore is still occupied by the field hospital that stands by to accept potential overflow from our regional hospitals.

As we enter the third and possibly largest wave of Covid-19 cases since the virus was first identified, do we have enough redundancy and resilience built in to our human resources at Public Health?

Regardless of how many of the 168 hours of the week Dr. Arra works and for which he is paid over-time, that is all he has available to him. Just like the rest of his staff, he has 24 hours in each day and 7 days in each week, no more. The consequences – health, relationships, staff morale and further attrition - of yet another year at this pace are predictble.

We are in a race between the highly contagious variants and the accessibility of vaccines. At the same time we are facing other growing public health issues including opiates, food insecurity and housing instability.  Praise, thanks and overtime will only take us so far.