Looking back at lessons learned over three years of the pandemic

·8 min read

Covid’s challenge

Looking back at lessons learned over three years of the pandemic

by Ben Powless

When the first cases of Covid-19 were discovered in China in December 2019, it hit the radar of health officials in Eeyou Istchee, who wondered just exactly what kind of threat this new disease represented for the region.

When the World Health Organization (WHO) declared it a public health emergency in January 2020, the Cree Health Board (CHB) began to prepare for infection prevention protocols. By the time the WHO declared it a pandemic on March 11, 2020, the CHB was already coordinating response groups to ensure Cree communities were prepared for the advancing pandemic.

This is the story of how that response unfolded. The Nation talked to key leaders within the health board to look back at the past three years and how the CHB, Cree Nation Government, individual Cree communities, entities and individuals all shaped a generally successful pandemic response – and what lessons were learned.

After it became apparent that Covid was spreading around the globe, the CHB determined that its communities were at high risk because of their isolated locations, limited health resources and infrastructure, overcrowded housing, and their high proportions of people with chronic health issues. There was also a need for accurate information – how the virus was transmitted, how it could be prevented, and how to communicate this to the public.

Bella Petawabano, then-Chairperson of the CHB, remembers clearly the moment the pandemic was declared, followed shortly by Quebec’s declaration of a state of emergency. “I was in Chisasibi, we finished our board meeting and had a presentation on the pandemic by the director of public health,” she recalled.

“I called Grand Chief Abel Bosum, and I asked him what right do the Cree have within the James Bay and Northern Quebec Agreement, and what legal capacity do we have to respond to the pandemic? What can our Cree governance do for us?” she asked.

Petawabano and Bosum did a livestream briefing for the first time to address the population, introducing ideas like social distancing, masking and hand hygiene that would become mainstays for the coming years.

“That’s the only thing we knew about how to protect people at the time,” she said. “There was no manual or protocol to follow in the event of this type of pandemic.”

During this first phase, the CNG, health board, school board, and Cree Nation Council began to meet three times a week and began to issue communiqués. Petawabano also started doing radio broadcasts. “What was important was a good and continuous communication with the population,” she explained.

It was decided to set up strict travel measures, including community gates and coordination with public safety officers, in addition to contact tracing and testing. “We weren’t following what the province was doing,” Petawabano said. “We were doing more.”

One measure limited the number of patients sent south for medical appointments. All commercial flights were cancelled, and the CHB only used charter flights for patients and to bring in supplies, and eventually vaccines.

While Quebec eased restrictions in May 2020, the Cree communities implemented mandatory self-isolation for anyone travelling to areas at risk. The CNG also adopted a deconfinement plan, looking forward to when restrictions could be loosened as cases declined.

By December 2020, Canada approved the Pfizer-BioNTech vaccine and ordered deliveries the same month. Petawabano said that months of discussions with Quebec allowed Eeyou Istchee to receive the vaccines ahead of other regions, owing to its heightened vulnerabilities.

It was after November that Petawabano’s term as Chairperson ended, and Bertie Wapachee took over the role. Looking back at the pandemic response, she said they heard feedback that more cultural values could have been integrated into their response.

“We tried to do that, but things were moving so quickly, you have to move along with the train,” she said. One of the initiatives they were happy to support was pushing people to return to the land, where they would be better protected from transmission. Some communities even offered subsidies to residents who stayed at their camps.

Petawabano is confident the CHB is now more prepared for future health emergencies. “One of the lessons learned is how we all came together: the CNG, the Cree Nation Council, all the different entities like the CHB and Cree School Board,” she said.

“We had one common goal, and that was to protect Eeyou Istchee. That’s one big lesson – that we can unite and be successful in achieving our goal.”

In February 2020, Dr. Colleen Fuller felt she was watching from the sidelines, having just been hired to replace another public health physician. “I called the public health director – I wasn’t supposed to come in for a month – saying I think I need to come earlier. She replied, how early can you come?” Fuller said with a laugh.

Her role involved leading much of the health board’s Covid response. Fuller’s background included using data methods to understand aggregate health outcomes, a focus on infectious diseases and understanding how outbreaks have been controlled.

At the beginning, this meant integrating the quickly evolving science of the virus into everyday practice. “That led to giving and putting into place a certain recommendation one week, then five days later finding new evidence needing to be integrated and adapted,” she explained.

Early recommendations came from the SARS outbreak in 2003, when hospitals enforced masking and isolation. Still, they had to train staff to properly wear masks and conduct contact-tracing investigations.

Community clinics needed infrastructure upgrades to improve ventilation and implement “red” and “green” zones, with Covid cases isolated to avoid infecting those who needed other medical interventions. Telemedicine was introduced, allowing consultations by telephone and video calls.

Still, there were challenges, particularly when it came to government regulations that restricted people without specific qualifications from doing testing. “In Eeyou Istchee, it’s not the local reality that we’d have these types of professionals available. But some people who were able to train and intervene were first responders who don’t necessarily have the same credentials as in the south,” Fuller explained.

They also had to push the Quebec government to adapt their vaccine program to local realities. While the province wanted to allocate vaccines by age group, Cree health officials urged the government to allow broader vaccinations, owing to intergenerational households, and the limited resources and staff available to conduction the program.

Within Eeyou Istchee, Fuller was encouraged by how all levels of officials took the pandemic seriously. “I was very impressed with the willingness of people to come together and listen; to set aside politics – this agency does this or that – but to listen to each other and adapt and revise, to look at needs that might be unanticipated by some agencies.”

She is also confident that Eeyou Istchee is in a better place today to respond as a society – from how to do testing, to how infections spread, to hygiene measures.

Fuller encouraged people to continue getting booster vaccinations, as the virus is still circulating. “The waves aren’t peaking and chopping like they were in the past. Think of it as a river and bay being violently out of control, but it’s now just fast moving. It’s still dangerous, even if not as visible. It’s still not time to go swimming – Covid is still there,” she implored.

Jason Coonishish, Coordinator of Pre-Hospital and Emergency Measures for the CHB, remembered the first days of closely following the WHO’s recommendations, while also studying the plans put forward by New Zealand, Australia and Quebec.

The priority at the time was to set up protocols to follow and to organize departments to ensure that essential services could continue. This also meant working with public safety officers (PSOs) to carry out enforcement of community-protection measures.

These measures ensured the CHB knew when people left and returned to the communities, and where and with whom they travelled. All this to help conduct contact tracing and enforce isolation measures. “We were in a good position because we were isolated, so we could protect points of entries,” Coonishish explained.

The officers had to resist pressure coming from political leaders to reveal information about infection status. “That’s the hard part the PSOs have – that’s their bosses – but they still maintained that confidentiality,” he added.

He said this built trust being between doctors and the PSOs, and among all frontline workers, including nurses, police and ambulance drivers. Coonishish was proud of the work by all the frontline workers. “Hats off to all of them for their sacrifices to protect our communities.”

Still, there were challenges. Coonishish said the hardest part were measures surrounding funerals, which prohibited open coffins and enforcing social distancing. “It was sad for the family – they didn’t see the body. I’m sure they’re still dealing with grief from that,” he added.

Coonishish praised the vaccine rollout. “Each clinic did very well, they were all ready for it. They had vaccinations. We also did well with the first two boosters,” he said.

One episode that stuck out was that, after vaccines arrived in Mistissini, there was an outbreak in Ouje-Bougoumou. Authorities in Mistissini gave half of their vaccines to Ouje-Bougoumou to ensure Elders and the immunocompromised could be protected.

“I’m happy with the work that was done by all the communities and all the frontlines,” Coonishish emphasized.

Benjamin Powless, Local Journalism Initiative Reporter, The Nation