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Toughest Call Ep. 101 - Going into the first pandemic lockdown (with Dr. Robert Strang) - TRANSCRIPT

Robert Strang  00:04

This was going to require essentially shutting everything down and keeping people at home. Because if we didn't, the way this was spreading,  we would get overwhelmed really quickly.


Chaz Thorne  00:20

Welcome back or welcome to Toughest Call, a podcast for organizational leaders where we hear stories from your leadership colleagues about career-defining decisions. I'm your host, Chaz Thorne. In this episode, I'm talking with Dr. Robert Strang about the decision-making that resulted in Nova Scotia entering its first lockdown at the beginning of the COVID pandemic. Rob is the Chief Medical Officer of health for the province of Nova Scotia. The tough calls that our leading health officials have had to make in the face of this pandemic have been staggering. Especially in the early days of the outbreak, these decisions needed to be made quickly. And with incomplete information. Even more challenging, they needed to be implemented within structures that are classically very slow to act. And all of this is taking place in an environment where the stakes are literally life and death. 


What was happening with you and your staff around the time that we started hearing about this potential pandemic, this virus that was going around the world?


Robert Strang  01:40

Yeah, I mean, it really started- I remember it was Dec. 28, 2019, where, you know, I got an email one of these alerts that that would have gone to my colleagues across the country, something interesting is being detected unusual disease activity in western China, from the World Health Organization, and then early in January, you know, more information, we can have everybody coming back for Christmas holidays, you know, the Council of Chief medical officers of health, we have regular teleconferences led by the Public Health Agency of Canada, Canada, Dr. Theresa Tam. So we started to get some more information coming out of fac public health agency. And then we started probably within the second week in January, having regular conference calls, starting with the chief and wages, but it became clear pretty early on that this was, you know, getting becoming bigger. And then the first thing all of us did is we've got, you know, pandemic influenza plans that we'd had prior to, you know, h1 and one 2009. And we'd revisited them and build on them after each one and one. So the very first thing we did with my team is here, okay, we got to pull out that plan. And, and, and let's make sure that we're comfortable with it. And then we alerted the rest of the house system, saying there's something going on that we're not sure about. But let's start on the starting point in Nova Scotia. Let's all look at our pandemic influenza because it's built around a respiratory virus as a starting point for our plan. And we started to have conversations with other, you know, the key leaders in the health system. So they were all up to speed. And so that's where it went from three January into February.


Chaz Thorne  03:37

I can't remember if it was in February or March, but you and I were actually together over a weekend. And at a planning event for a nonprofit that we both sit on the board of. And I remember your phone going off quite a bit. And we also have a mutual colleague that has a background in infectious disease as a scientist, and I remember having some conversations with him about this and when the concept of a lockdown came up. And that just that that just sounded insane to me that that was even possible. Like how do you what, like, you can actually tell everyone to stay home? So when did those conversations start to come up with you and your colleagues across the country?


Robert Strang  04:39

Our thinking started off back in January. I think about, you know, it was a public health issue. Then it became a health system issue. And then as we get into March and go oh, this is even beyond you know the implications of this are even beyond the health system and that we're going to have to think across government across communities and across sectors because this has the potential to overwhelm healthcare systems and that was that's the rationale. So you gotta think Reagan making lockdowns and all those things. Because if you just let the virus, you know, run, you know, even if you try to control it to some extent, but if you don't really have a good lock in it, it will. This is a new virus, no immunity, and you'll have enough people; you're just rapidly overwhelming your healthcare system, which would be what we'd seen what happened in Italy, especially with seniors, etc. So pretty quickly, we went to the point of view, we're going to have to use some very broad tools and very restrictive tools to try to get this under control.


Chaz Thorne  05:49

How did you go about even presenting this as an option? Because what you've just laid out is the unbelievable complexity of the issue of locking, locking down a community, but also all of the different stakeholders, as well as the far-reaching effects. So how did you even sort of position that as a possibility across government and industry?


Robert Strang  06:27

We didn't have to position them that much. Because then, you know, I was directly at the request of premier McNeil. You know, we're starting late February, we're starting to brief him directly. And he was coming to some of these conclusions on his own. He and his staff, you know, really watching the media themselves, watching things unfold, recognize, recognizing the real potential for Nova Scotia to get rapidly overwhelmed. And so he was prepared to make those tough decisions very early on, that this was going to require, essentially, shutting everything down and keeping people at home.


Chaz Thorne  07:12

What was the level of fear, like, given the high degree of uncertainty that we were experiencing early on in the pandemic?


Robert Strang  07:21

This is where some of the anxiety, actually, I think helped, because everybody was very, very anxious about this. And I think by large, people saw the potential invocations, and there wasn't really any pushback, at least in those early days around just having to, you know, shut down schools. I mean, it was just before we cancel March Break; when kids were coming back from March Break, you know, no travel, when March Back comes back, schools are closed down for two weeks, you know, we essentially basically shut down for the rest of March, not knowing, really, how long it was going to be before we could open up. And maybe we're a little bit naive thinking that we could do this in just a matter of few weeks. But you know, what, that early decision actually wasn't that hard. It's just, we knew we had to act quickly and act very firmly. And certainly having the trust and the confidence between myself and the premier made that I think much smoother and in prep some other jurisdictions when there was not necessarily the same political buying, if you will, to take the tough measures.


Chaz Thorne  08:34

This is very early days, and there's still a lot of question marks about the virus, a lot of things that are known, there was a lot of back and forth on masks, and so on. Once that was decision was made and communicated to the public that we were going to enter this lockdown, what happened next?


Robert Strang  09:02

I mean, it really was, it's the reverse of, if you will, of often how, you know, decisions are made, we can do the policy analysis, you reach out to stakeholders, and ultimately you make a decision and implement, we made the decision and implemented and then I spent a lot of time in those first few weeks, on, you know, zoom calls and team calls virtually, with business sectors, with restaurants, you know, with colleagues across government, helping them understand the virus, the situation we were in and what why what we're doing was necessary. And I think, by and large, everybody understood that because they were watching themselves, with their own emotions and their own feelings about themselves and their families. As well and that same level of anxiety. So there was, I think, we used the word trust a lot. But I think the way we're able to set up from the very beginning that, that we were setting clear direction, we think we had a good, you know, a strong rationale for why we're doing what we're doing. And, and, and the premier and I've been very much visibly on the same page, I think that did feed a lot into uncomfortable it was and the challenges that businesses were facing, there was my large buy-in, and an acceptance of this is just what we need to do.


Chaz Thorne  10:36

There was a fair bit of, you know, really agreement and compliance in when that the first lockdown started. And there certainly, you know, there was this, as it went on, there was some fatigue that set in. But we also had some really significant events happen in this province that challenged our resolve; there were, you know, some local protests that were in reaction to the murder of George George Floyd in the US. And even more specific to us, there was the porter peak massacre, which was the largest mass shooting in our country's history. And this all of these things sort of challenged, I think, our, our resolve of staying apart. So how did you and the premier and the rest of your colleagues handle these events when you started to see the population starting to fray around being kept apart, either that or also even just the individual impacts of not being able to gather with others?


Robert Strang  12:07

I think some of the other events that we had to come together around actually helped because they tapped into this common sense that we're all together, that we can make their way through this, whether it's COVID or whether it's the mass shootings or other tragic, you know, deaths that impacted Nova Scotia, that we need your support each other. And so in a way that helped all these other events help amplify, and I think to bring that caring about each other, and that putting the common good first, actually maybe strengthened that.


Chaz Thorne  12:48

What was the most difficult point for you during those first few months?


Robert Strang  12:58

I mean, there's no doubt that the- two things I mean, in the middle of April with Porter peak and everything else it was, it was almost overwhelming. That- I wasn't directly involved in any of those. But the impact and just seeing the impact on families and communities on top of how people were already stretched with COVID was- but knowing we had to continue with the COVID response- you can't give up. And then have we had to deal with, you know, how do you support families with grieving and mourning. But knowing that, you know, we didn't, we weren't allowing funerals, and we weren't allowing, you know, mass gatherings for, for people to get together in the morning. And so, that was challenging. And we did work, you know, we made some little accommodations to help support some families with that, but we many times having to say no, I'm sorry, you can't have a community celebration of life for somebody or those are really hard. And because those are as part of the healing for people for these tragic events. Those are so critical, and we couldn't have them.


Chaz Thorne  14:08

Were you ever challenged or called out personally around some of the decisions that you were involved with making in our pandemic response?


Robert Strang  14:23

I think we started to get it was it wasn't the shutting down. That was it was when we finally got to where we were starting to open up. You know, we got into May, and people- there was this growing kind of people wanting us to go faster. And that was where we started getting some criticism from that perspective that but, you know, we continue to say and is we need to open up slowly and cautiously and again, I credit the premier for being fully supportive of that, despite all the pressures. People just wanted to open up again, and we didn't really open up until July when we finally opened up the Atlantic bubble. And even through summer there, you know, people weren't fully opened up. But it took us probably a number of weeks behind, if you will, other provinces before we took some of the steps to open up. When we were, as we were doing that, and we were slow and cautious, we were seeing the resurgence already and, and the impact in other parts of the country, I'm opening up too quickly, before you have the disease well under control. So again, those kinds of being in a place where looking around ourselves compare- comparing ourselves and observing what's happening, and learning, if you will, from others that, you know, going too quickly, too fast as it doesn't help you out, that a slow, cautious approach- it's kind of like, you know, it's a marathon. And, you know, if you go racing ahead, you're gonna burn yourself out or have, you know, significant setback and so, but it was challenging because there was a lot of pressure to just open up.


Chaz Thorne  16:17

What do you feel you and your staff, and I guess to even everyone across government, learned from the experience of that first lockdown?


Robert Strang  16:31

The first lockdown was like a heavy hammer, just shut down everything. And I think as we've seen, what it takes, and what really works and what's not what you don't need to shut down. In the second wave in the fall, you've seen we've had a bunch more- most of the economy's been able to stay open. And we've focused appropriately, so much more on parts of the economy that are built around socialization, people getting together, restaurant, entertainment, because that's how this virus is spread. So I think what we've learned is being able to be much more surgical in our approach to get the same control of the virus, therefore minimizing those impacts. 


Chaz Thorne  17:15

What do you feel we can take away from- and it's not over. But what do you feel we can take away from what has happened thus far to inform how we deal with similar events when they happen in the future.


Robert Strang  17:36

A couple of things that that I've focused on. One is that an event like this requires across government's response, that it's even though it's a health issue, led by public health, everybody's got to be at the table, across government, and even across our society, because of the impacts are so broad-reaching, and then the tools that you need to use to control that are so far-reaching as well. So it has to be a kind of an all-hands-on-deck approach. And that's been a hallmark of our success, that normally bureaucratic organizational barrier that we that are hard to break down. Everybody's got their own turf and their own budget and their own this and that. All disappeared. I've got so many examples of how the people have just come together and go- How do we make this happen? that most of the public isn't aware of, but the incredible work across government, even by every department doing what's necessary, and the same in the health system. So that's one thing about we learned, and maybe that's something that we can actually tackle other issues by saying it's urgent, it's a priority. Let's all get around the table and work and solve it. Another big thing I think is that I'd love to get, you know, capture is that the pandemic has identified substandard vulnerabilities in our communities. There are parts of our communities that are at much greater risk, and much- getting have been impacted, significantly impacted by the next pandemic. And also, day to day, they bear an unnecessary- unequal burden of a whole range of health issues. So whether it's our senior care and there's a whole conversation in this country about how we care for the elderly, it's about people who are homeless, marginalized, or vulnerable communities. The pandemic has highlighted those, and so what are we going to do about those two? And even if we want to say how do, how do we be better prepared? How do we make all those different communities less vulnerable for the next pandemic? And the third thing is, and I love to how do we and I think it's been a hallmark again, Nova Scotia success, we have come together and said, we're going to do things too, that are for our collective good first. And we're going to do things no matter how challenging they may be for me, my family, my business. I'm doing that because I know it's for the greater good. And so how do we hold on to that piece as well, that we are maybe a stronger sense of community, a stronger sense of equity and sharing and looking after each other? And we've been able to give up, you know, less about ourselves and more about our community and putting that fist- Then how do we hang on to that piece as well?


Chaz Thorne  20:42

So in closing, Rob, what would you most want for Nova Scotians to hear from you about the months to come?


Robert Strang  20:53

In the short term, we have a lot of hard work still to remain safe while we get our vaccine rolled out because that is a very important tool that doesn't solve everything, but it provides a substantive level of safety. For the longer term, we are going to have to live with COVID. You know, as we get into the summer and fall, nobody really knows for sure what that exactly means how much of what we're doing, we have to hang on to, or once we have a well-vaccinated population, then a lot of the tight restrictions and all that real significant limitations I think we can back away from, and it's more about all of us be more cautious in, in how we, you know how we get together in large numbers. And maybe we still hang on to things like masking because that prevents influenza and other diseases, especially during the winter, better handwashing, and just paying more attention to the risk of infectious diseases in general.


Chaz Thorne  21:54

Well, Rob, I have said this to you before, and I know you've heard it for many, but I will say it again, as a way for us to wrap this conversation that as a fellow citizen of this province, I have been just blown away by the leadership that you've shown. And it's not just about the decisions that you've made, but the empathy and understanding within how you've communicated those decisions. And dare I say the love that you've shown for your fellow Nova Scotians throughout this process? I am unendingly grateful to you.


Robert Strang  22:49

Oh, jazz, thank you. And maybe we shouldn't be embarrassed to say we love each other. And that's why we do this stuff is because ultimately we're putting our love for each other first, and how do we look after each other and we shouldn't be ashamed or embarrassed to say that that's what's driving this. So, but I appreciate it. And I always have to say, because of my position. I'm kind of like the front person of this, and I'm the most visible, but there are hundreds and hundreds of very talented people in across government across the health system who have worked endlessly and tirelessly for the last year to do keep Nova Scotians safe, so I have to recognize all of them.


Chaz Thorne  23:31

Well said. Thanks so much, Rob. If you'd like to learn more about Rob, you can check out his Wikipedia page for a brief background on his life and career. And if you'd like some assistance with your own tough calls, we've compiled a collection of free tools just for you. Go to toughest to check them out. If you're not yet a subscriber to Toughest Call, please add us wherever you listen to your podcasts. Thanks for listening. I hope this conversation helps you when faced with your next tough call.

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