FACING THE CHALLENGE
The region's top doctor reflects with Taylor Campbell on a stressful, chaotic year, both personally and professionally
Medical officer of health Dr. Wajid Ahmed and his staff at the Windsor-essex County Health Unit have faced plenty of challenges in 2020. But Ahmed says despite the stress that comes with his job, he is up to the task.
“I love my job.”
These are not the words you might expect to hear from a man whose every waking hour the past year has been spent thinking about a deadly and highly contagious virus, and how to keep more than 400,000 people safe from it.
A man whose dreams — and nightmares — are riddled with ideas about infection prevention and control.
A man blamed and criticized for decisions made by elected officials, for the failings of privatized longterm care homes, for federal regulations that allow migrant farm workers to live packed together like sardines — and, yes, for some of his own choices during an unprecedented and highly charged time. The list goes on.
And yet Dr. Wajid Ahmed, the medical officer of health with the Windsor-essex County Health Unit thrust into the spotlight this year, loves what he does.
“What doesn't kill you makes you stronger,” Ahmed told the Star during a video call earlier this month. A serene mountain scape superimposed behind him had a text box that read, “I need a vacation.”
“My personal nature is I like challenges, I like competition. The challenges that public health have dealt with this year, it just made me more attached to my profession and my expertise.”
Ahmed became the local face of the pandemic “out of necessity,” to fill an information gap and address the general public's anxiety about the novel coronavirus. Together with health unit CEO Theresa Marentette, he has appeared live, virtually, on Facebook or Youtube nearly every weekday morning since before the region had its first case of COVID-19, save for a few weeks in the summer when case counts were low and their broadcasts were reduced to three days each week.
The pair has likely answered more than 1,000 questions asked by local media on-camera. The team behind them has no doubt answered even more questions from the general public through email, phone calls, and social media messages.
The 44-year-old doctor believes the COVID-19 pandemic has aged him. Looking back to a recording of the first health unit news conference about the virus held on March 16, it doesn't appear he's gained any more grey hair than he had already. But watching him day after day, it's clear his patience has run thin.
People and citizen groups who vocally doubt the efficacy of public health measures — and Ahmed's leadership — have taken to social media to question the doctor's credentials, even going so far as to say he's not qualified for his job. Ahmed said seeing such comments sometimes frustrates him, and sometimes makes him smile.
He spent more than two decades in school before securing his position as medical officer of health in Windsor-essex. He completed medical school at the University of Karachi in Pakistan and began working as a general practitioner, but became disheartened by issues in that country's health-care system.
Ahmed completed a master's degree in health administration from the same institution, then moved to Canada and completed a master's in population health at the University of Waterloo, a fellowship in addiction medicine at the University of Toronto, and a highly-competitive five-year residency in public health at the University of Ottawa. He now has a faculty position as an adjunct professor at Western University in London, Ont. With a laugh, he asks, “If I'm not qualified, then who else is?”
The pandemic has brought public health into the limelight, Ahmed said, adding it felt like nobody knew what public health did before the pandemic hit.
He's heard criticism from other physicians with other specialties, “but it's not their area of expertise to comment on,” he said, equating it to him commenting on a heart surgery because he's read an article about cardiology.
A Windsor Star freedom of information request earlier this year revealed a tense exchange in April between Ahmed and Windsor Regional Hospital CEO David Musyj, who wanted Ahmed to permit the mass testing of asymptomatic long-term care home residents by Essex-windsor EMS paramedics.
“In a pandemic, when you are dealing with a novel virus, you don't know everything. You have to use all of your expertise to predict, to find a solution about what is needed,” Ahmed said.
“We've been doing that. I think that's the critical piece that we need to recognize. You have to make a decision even in the absence of information, about what tools you can use to guide your decision-making so you end up making the right call.”
Other medical officers of health in Ontario who Ahmed communicates with regularly have received similar criticism, he said, because they are “connected with the community more than ever.” They have become the “bearers of bad news, but we're not causing it.”
Every day, he asks himself what he can do to support his community and prevent COVID-19 from spreading. On the surface, he said he tries to make his Youtube presentations simple and easy to understand.
Time and time again, he and Marentette have nearly begged residents to maintain physical distance from others, wash their hands often with soap and water, stay home if they are sick, wear a face mask when physical distancing can't be maintained — things a vocal minority have called oppressive.
“By following public health measures, it doesn't mean we're trying to control you … or we're trying to shut down everything,” said Ahmed. He and the health unit's staff “are also human beings,” he added. “We are also impacted by everything that you're impacted by. We just need to understand each other better.”
On several occasions, Ahmed has been a trendsetter. He suggested health-care workers stick to one facility to prevent COVID-19 from moving between long-term care homes or hospital settings through staff before the province adopted those measures. He was the second medical officer of health to make face masks mandatory inside commercial establishments, behind Wellington-dufferin- Guelph Public Health.
He also ordered schools to close in-class learning ahead of the holiday break in December when no other region in Ontario did. Conversations from the province about possibly shifting to online learning for students when school resumes in January soon followed.
Before COVID-19, Ahmed said, no medical officer of health in Windsor-essex had issued a Section 22 order under the Health Protection and Promotion Act in decades. He's issued at least three, with updates, including one to agricultural farms that employ temporary foreign workers.
The doctor is quick to credit the work of the entire health unit team, who, short of caring for COVID-19 patients, have been more front and centre during the pandemic than most health-care workers, he said.
The local health unit has approximately 240 staff, though the province has recently loaned them dozens more workers to aid in case and contact management. While health unit programs, like dental clinics, redeployed staff at the beginning of the pandemic to help with Covid-related tasks, most of that work has since resumed.
By following public health measures, it doesn't mean we're trying to control you.… We are also impacted by everything that you're impacted by.
Efforts by the health unit to set up supervised injection services and prevent overdoses in the community quietly continue while the pandemic takes centre stage. Work to prevent a slew of other infectious diseases — tuberculosis, influenza, sexually transmitted infections, etc. — also goes on.
The health unit also consulted heavily with dozens of organizations in the region that needed pandemic plans, including police, municipalities, school boards, and post-secondary institutions. It created detailed, sector-specific COVID-19 fact sheets for numerous kinds of businesses and organizations, made available resources and pandemic safety plan requirements for workplaces, and shared all of it online with regular updates.
Its COVID-19 webpage is updated multiple times daily with the latest available local pandemic statistics.
Meanwhile, protesters have picketed numerous times outside the health unit's main office on Ouellette Avenue, demanding fewer Covid-related restrictions.
It all takes a toll on the people trying to keep the public informed — and safe — during the worst pandemic in a century.
“You cannot imagine how much time and effort we are putting in every day. Even at a baseline level, the level of stress that we have is unbelievable,” Ahmed said.
“There are days you can see that I'm frustrated. There are days you can see that I'm happy. But there is a level of stress that is ongoing since the beginning of this. Unless we get this pandemic under control, that will stay.”
Rewind to May 2019, and the local health unit was worried about Ontario's plans to consolidate its services with four other public health units stretching from Windsor to London. Concerns then were making sure the unique needs of each region's residents were still addressed by a new regional provider's potential onesize-fits-all model.
“That was the sword hanging over our heads at that time,” Ahmed said. “We were trying to figure out … what do we need to do to make a case, and at least help the province understand what we do in Windsor-essex.
“I think the pandemic has made it absolutely clear that Windsor-essex is very different and has very different challenges compared to even the rest of the surrounding communities.”
The health unit reduced its operating budget for 2020 by nearly four per cent from the year before to $22.8 million, though it later sought and received an additional $857,329 to support the recruitment of a 22-person COVID-19 response team.
By comparison, the London-middlesex Health Unit's 2020 budget was roughly $35.3 million — a two per cent increase from 2019.
The local health unit began preparing for COVID-19 in January, before the new virus first detected in China had an official name. They met with Windsor Regional Hospital and Essex-windsor EMS to ensure a system was in place to handle COVID-19 patients ahead of any guidance from the province.
In February, when they had more information about how COVID-19 was spreading, the health unit expanded its consultations to include other primary-care providers, the Erie St. Clair Local Health Integration Network, and Ontario Health.
“Without having formal infrastructure or guidance from the province, we did talk about — if it gets that ( bad) — what are our options? How do we store the bodies?”
The international border was identified locally as a concern before the federal government implemented restrictions on travel, Ahmed said.
Migrant farm workers were identified as a high-risk group back in February, though the health unit has little more input on how farms operate than it does on how the Windsor Assembly Plant runs, Ahmed said. The bunkhouse inspections performed by health unit staff are to ensure the living quarters meet public health and building codes.
Even so, public health staff worked with farms to identify potential risks and show them how to mitigate those risks.
When it came to COVID-19, it was up to municipalities, farm owners and operators, and higher levels of government to do their part, too, he said.
“It's unfortunate that, when the tables are turned, everyone starts to look for someone to blame,” Ahmed said, referring to fingers pointed at the health unit by mayors, hospital officials and other head honchos in the health-care field after COVID-19 spread like wildfire through Essex County's migrant farm worker population.
“We were very clear what our role was, and we acted on it — we did what was needed to contain it.”
Long-term care homes were also identified as high-risk settings, he said. The health unit is responsible for supporting facilities with infection prevention and control measures and managing any outbreaks that happen, “but we do not manage their operations.”
Back in March, the health unit reached out to long-term care and retirement homes to offer support, and to give personal protective equipment (PPE) from its own pandemic stockpile to the homes — “not something we were mandated to do.”
Once various COVID-19 vaccines are distributed throughout the community, later in 2021, and infection rates taper off, Ahmed plans to spend more time with his family. The father of three boys — Adi, 13, Ariz, 10, and Aazil, age three — is looking forward to family road trips.
His eldest son saw first-hand how bullies took to social media to attack those who disagreed with the health unit about COVID-19. The ones that bothered him most attacked his dad. Ahmed used that as an opportunity to teach him to “focus on what is important” and “forget about the background noise.”
Ahmed's middle son sees how busy he is and tends to hold off on reaching out, giving his dad fewer hugs than he normally would to stay out of the way. The three-yearold, however, doesn't care and is happy to interrupt his father's phone calls for attention.
“It's tough on them, too. I try my best — I don't have any other activities. It's work and home and that's it.”
Ahmed plays with them as much as he can, he says, “but generally it's not the same level that I want and they expect.”
His wife, Sana, has remained a source of comfort and support for him. Sharing his thoughts with her, “I even get more ideas (about the pandemic),” he said. “She's always been there, and I'm lucky to have her in my life.”
He's also looking forward to sitting at the feet of his 71-year-old mother, Asiya, and laying his head on her lap again. Although she lives with her son's family, they've tried to maintain physical distance from her out of fear of getting her sick.
Until the large-scale COVID-19 vaccine rollout is complete, “we're still in this mess,” Ahmed said.
And once the mess is over, he intends to once again do his work with his head down, out of the spotlight, but still in love with his job. Maybe then he'll get a few days off and find something else to dream of.
There are days you can see that I'm frustrated. There are days you can see that I'm happy. But there is a level of stress that is ongoing since the beginning of this. Unless we get this pandemic under control, that will stay.