Three lessons learned from COVID-19

The COVID-19 pandemic was a worldwide crisis. Decisions were often made with incomplete information. While there will be much to reconsider in retrospect, one of the pandemic’s silver linings is how it unified stakeholders around a single aim of responding collectively to an unprecedented threat. This article is written from the perspective of the OMA as one of the major stakeholders involved.

Lesson 1: Recognize the role played by stakeholders

The pandemic’s first lesson is that professional organizations should be recognized for the individual roles they played during the health-care crisis and should be called upon to play a bigger role in future crises. During COVID-19, these organizations have supported their members and the broader health-care system. The OMA was one of many organizations that played a prominent role in tackling the pandemic; other organizations included nurses, pharmacists and private-sector bodies such as Ontario Chamber of Commerce.

The OMA made at least six different types of contributions:

1. Through white papers and the media, the OMA publicly advocated for specific policies to respond to the pandemic and the vaccination campaign.
2. The OMA worked behind the scenes with ministries and ministers’ offices to influence or modify policy. For example, the early decision to ramp down non-essential care was a result of strong advocacy from members.
3. The OMA used its negotiating position to link appropriate compensation to necessary policy. For example, K codes were approved for the expanded use of virtual care—minimizing the need for in-person care—and Q codes were negotiated to enable primary care to administer COVID-19 vaccinations.
4. To influence policy, the OMA supported the expertise of individual physicians and many Sections, such as public health, infectious disease and long-term care.
5. The OMA directly supported community-based practices with advice on how to manage care during the pandemic and by distributing more than 500,000 pieces of personal protective equipment to doctors.
6. Finally, like all health-care workers, Ontario’s doctors cared for patients with COVID-19 and continued to care for them during the several waves of the pandemic.

Lesson 2: Share the workload with key stakeholders

The pandemic’s second lesson is that government should formally assign duties to professional organizations and stakeholders to share the burden of executing all the required tasks. The government clearly needed to be in charge, as decisions required to address the pandemic encompassed all aspects of society. To address health-care issues, the government appropriately turned to community health experts, our public health colleagues and medical officers of health, who had and must continue to have a formal role in responding to public health crises, be they contaminated water, environmental catastrophes or infectious disease. 

However, in retrospect, the number and scope of the tasks were overwhelming. While the government should determine what needs to be done, many tasks cannot and should not be executed exclusively by the government. For example, addressing vaccine hesitancy is a critical step in achieving sufficient herd immunity. Dealing with this issue required two separate streams: developing content and communicating that information. The task was also complex because different communities required strategies, customized to address their concerns. Culturally sensitive vaccine hesitancy can only be addressed by the cultural groups themselves. While fabulous initiatives came from such organizations as the South Asian COVID Task Force, there was no coordinated or comprehensive effort to meet this challenge. In the future, the government should assemble task forces on specific issues, ensure they are comprehensive in scope and assign tasks to professional organizations and stakeholders.

Lesson 3: Be transparent

The pandemic’s third lesson for the future is the need for transparency. During COVID-19, stakeholders have struggled to understand where to best apply their expertise and what to tell their constituents about how decisions were made. Transparency with stakeholders and the public builds the trust that is so crucial during uncertain times. Transparency means communicating what you do know and admitting what you don’t know. A key part of the message is to set expectations by pointing out that missteps will happen and recommendations will change, but that everyone is doing the best they can with incomplete information. 

Sometimes, tough decisions needed to be made. The key to building trust is understanding who makes those decisions and how. This information helps the experts understand who to talk to and the type of information needed to assist in decision-making. An unclear decision-making process impairs better decisions and also creates the impression that certain groups have undue influence.

Competing priorities have existed throughout the pandemic and stakeholders have placed a different value on each one, depending on their situation. For example, many stakeholders held conflicting views on the impact of lockdowns. While lockdowns reduced transmission of the virus and saved lives, they exacerbated the frequency and severity of mental illness and had a devastating impact on small businesses. While science has a role to play, the value placed on competing priorities is often closely tied to one’s personal circumstances, for example, a person over the age of 80 compared to a small business owner. These competing priorities need to be acknowledged and the trade-offs made explicit. In short, transparency leads to improved trust and also to better decision-making.

The pandemic taught us three key lessons: The important role played by stakeholders, the need to share the workload and the value of transparency. During future crises, government needs to acknowledge stakeholders’ expertise, rely on their assistance and be open and transparent at all stages.

Dr. Jim Wright is chief of OMA Economics, Policy and Research.