Canadians often see hockey as a metaphor for life. Hockey’s cliché littered locker room may offer some wisdom as we collectively deal with the early days of the COVID-19 pandemic in Canada. Let’s take a few of hockey’s time worn aphorisms and apply them to our situation. In Canada’s COVID-19 outbreak we are in the first period and its 2-0 for the virus. Think of COVID-19 as the fictional Team Iceland (in Mighty Ducks 2). Team Iceland is big, strong and fast and engenders fear. So how do we change the situation and ensure the game ends in 4-3 in favour of Team Canada? The first step is overcoming fear by building a sense of team-(apologies it's Team USA)!
1: The best offense is a good defense: We are using social distancing and cancelling of mass gatherings, and elective healthcare services to ensure we don’t all get sick at the same time. This flattening of the epidemic’s curve (below) is designed to slow the spread of a virus, against which we have no immunity, so that the numbers of infected people will be distributed over a longer period. This makes the care of the sick much more manageable. This is a good defensive strategy and until we get approved treatments and an effective vaccine it is the best defence we have.
2: There is no “I” in TEAM: We will defeat COVID-19 as a TEAM. There is no credit for being the first or most prolific source of email communique’s or interviews. In fact if you are communicating, it should follow the chain of command, to avoid confusion. TEAM Medicine, which includes the Department and the Hospital Program, has a Head office (Mike McDonald, Michelle Matthews), a head coach (Stephen Archer), assistant coaches for offense and defense (Chris Smith, Gerald Evans), a manager (Anita Ng) and captains (the Division Chairs). There are rules to be followed. We exist in a league (the Faculty of Health Sciences, FHS and Kingston Health Sciences Centre, KHSC). We rely on each of you to do your part. Please participate, giving your all to the game; but don’t freelance and shoot (email) when you’re supposed to pass (act upon communicated instructions).
3: Move to where the puck will be: Advice from Wayne Gretzky, of Edmonton Oilers fame, can be applied to COVID-19. The question is not where we are now (there are no cases thus far at KHSC and only 3 in the SELHIN). We can see where the outbreak is today but we want to know how to flatten the curve and slow the spread. The question is where are we going? What will the epidemic look like in the third period? How can we shape it to ensure we are victorious?
COVID 19 cases in Canada as a of March 18th in the am
Skating to where the puck will be will require KFL&A Public Health (our scouts) to track the epidemiology of the epidemic and apply lessons learned from other provinces and countries. These scouting reports are helpful because the natural history of the spread of COVID-19 varies substantially from country to country.
Dr. Kieran Moore, medical officer of health for KFL&A Public Health, announced Tuesday there are three cases of the novel coronavirus in the Kingston region.
We can take some comfort in knowing that we are prepared and that <5% of cases will be life threatening. For most (80%) of people, including almost all who are young and healthy, this will be a self-limited infection, managed by staying home and recovering with symptomatic care, good nutrition, fluids and OTC medications. We have planned for outpatient and in-patient screening (although its slow to start due to a national dearth of the swabs required to acquire the specimens for the COVID-19 PCR assay). We should also be encouraged by victories that have occurred in other countries. After 3 very difficult months, things have stabilized in China, indeed cases peaked a month ago. Some well-prepared countries managed to avoid high mortality rates, such as South Korea and Germany (see graph below).
4) Play your position: There is not a position on the team that trumps the others in terms of importance. Our victory will reflect the efforts of frontline nurses, doctors, trainees and those in our lab, pharmacy, and support services, from housekeeping to our information technology team. There will not be a 3-star selection when we beat COVID-19; you will all be stars!
5) Thank the team members: A typical hockey interview, given by the star player almost always follows a rambling, self-deprecating script. I’d like to thank the coach, my goalie was amazing, the wingers were passing the puck tape to tape, and our fans were great! Here’s an example of how hockey players describe their roles in the game. It’s never self-congratulatory.
Likewise, in the hospital and beyond, a virtual pat on the back to a colleague or team member is always appreciated and goes a huge way to reassure them. Small acts of kindness to support each other are always appreciated. The bolstering effect of praise and acknowledgement is particularly felt as healthcare workers struggle with day care and school closures and worry about aging parents, all while caring for patients. Queen's medical students are offering a tangible example of support to our physicians during this difficult time. They are offering services such as childcare, pickups/drop-offs, errands, etc. You can sign up using the Online Staff Form and they will do their best to connect you with an available student in a timely manner.
5) Keep your head up: In hockey this admonition is a reminder to be aware of what is happening around you so you are not blind-sided (i.e. run over by an opponent). In the COVID-19 pandemic we can keep our head up by paying attention to high quality, reliable information about our city, province and country. There is lots of information that is dark and false on the internet, so follow the information feed from the DOM and KHSC and use only trusted news agencies like the CBC and CTV.
Gordie Howe, Mr. Hockey-demonstrating heads up hockey
6) Envision success: Believing that you will succeed is a precondition for success, whether in hockey or Medicine. In hockey you cannot let your mind go to that easily reached, dark place of defeat. When its 2-0 in the 1st period all thoughts should be focused on turning the tide. Stop further goals, score 1 goal, repeat as necessary! In the case of COVID-19 we are doing much the same, slowing spread through social distancing, hand hygiene, and suspension of elective services, buttressed by ramping up COVID-19 testing in symptomatic people. I am envisioning success and a resumption of normal life, much as is already beginning to occur in China.
7) Thank the fans: We are not in this alone. The impact of COVID-19 (even before cases emerge locally) is being felt by students, families, and regular people working in restaurants, retail outlets, utilities and more. We stand with the people in our community and need to be mindful that they share our concerns but have even less information and support. We can “thank the fans” in this analogy not only through the health care we provide but by listening to and allaying their concerns, providing accurate information and role-modeling calm.
Habs fans in act of social distancing?
So let me offer a few final aphorisms, keep your stick on the ice (be prepared), skate to the paint (stay engaged with your Department) and together we will put the puck in the net.
Postscript: In the Toronto vs Chicago game from March 2019, Chicago was victorious!