When COVID-19 hit Canada last March, Dr. Amy Salmon was working frantically with colleagues to deal with two big research projects that were suddenly halted — one on overdoses in rural isolated areas and another on long-term care — and juggle the needs of 600 UBC medical students who were in various stages of their Flexible and Enhanced Learning (FLEX) course. As a Scientist and Program Head for Knowledge Translation at the Centre for Health Evaluation and Outcome Sciences (CHÉOS), plus the FLEX Site Co-Director for the Vancouver-Fraser Medical Program, Salmon was dealing with the pandemic on all levels at work.
And then she got COVID-19.
“I was locked down with my then 17-year-old daughter, my partner moved in so we could be in a bubble, three dogs, and a cat…all in a 1,000 square foot apartment,” Salmon laughs. Her symptoms were manageable — fever, cough, some aches — and aside from a few days off, she continued to work from home.
First lesson: Be flexible
Hundreds of FLEX students no longer had a supervisor for their projects; many of those supervisors were clinicians who now had to work overtime on the front lines of the pandemic response and no longer had time to support the FLEX program. But Salmon says the first thing she learned in this new world was how to be flexible and adaptable, and she was inspired by seeing others do the same. “Many retired physicians came to work with the students, and they were delighted to step in. There were some fantastic collaborations that never would have happened otherwise.”
As Salmon recovered, she assumed her personal battle with COVID-19 was behind her. But six weeks after she first got sick, she started having trouble breathing and issues with her heart rate. After many investigations, she was told she very likely has long COVID, or post–COVID-19 syndrome. Since then, Salmon has had several flare-ups with a wide range of symptoms — coughing fits, sudden drops in oxygen levels, swelling of her legs, some frightening heart problems, and more.
“It was an interesting time to be a sick scientist,” says Salmon. “I’d say to colleagues, ‘This would be fascinating…if it wasn’t happening to me.’”
Second lesson: Social determinants of health more pronounced in a pandemic
The second lesson she learned was how one of the very issues she tries to address in her research — social determinants of health — impacted her personally. “As a member of the scientific community, that privilege benefits me as a patient. I have access to information and people to help me make sense of what is happening to me. Most people don’t, and that needs to change,” explains Salmon. “Many people who talk about their experience with long COVID publicly share experiences of being ignored, belittled, or just plain abandoned by health care providers. There was never a time that I wasn’t taken seriously or supported in my recovery. Those are protections and supports that everyone dealing with this illness needs and deserves.”
Salmon has made connections with other ‘long-haulers’, as those who are dealing with post–COVID-19 symptoms are known. She says many of them can’t get the treatment they need, or information that could make a difference for their recovery. Some have lost jobs and relationships as a result. “I think there is a great deal the scientific community could be doing to pay attention. We need to recognize how inequities continue, especially when you are in the context of an emerging crisis that is not well understood.”
Connecting COVID-19 life lessons to research
Recently appointed the new CHÉOS Associate Director of Academic, Community, and Systems Engagement, Salmon is now fully immersed in connecting her research with the learnings that have come from the past year. With the overdose study, for example, one of the main focuses was examining why people use alone. After all this time of social isolation, Salmon explains, “We are now, as a society, even more aware of the different ways that we come to be alone, or feel isolated and disconnected. We are even more aware of how this leads to huge challenges with mental health and substance use as people struggle to do the best they can with what they’ve got.”
Her work on the “village” model is also timely. One of the key components of this model is small groups of 10 to 20 people living together based upon common interests, culture, or language, and care teams assigned to specific households. Now, Salmon’s team is looking at the benefits of this setting in relation to the pandemic response.
“In a pandemic, we know people will have to be together for a long time,” she explains. “When compared to many current long-term care sites, even just the physical setup of the ‘village’ model provides a much better mechanism for helping people who live and work in long term care be well physically, mentally and socially, while also being able to control infections.”
As Salmon continues to navigate the long-lasting effects of COVID-19 on her own health, she is appreciative of the unique perspective it has brought to her work. “I really hope people start to see the importance of all of the different types of research that are needed to get through this pandemic. It’s not just about numbers, statistics, death rates, and new drugs,” she says. “Those are critically important. But we need to be able to do so much more than focus on making sure people don’t die. It will take us a long time to truly understand all the ways our health and our health systems are being impacted. We at CHÉOS have to continue with our commitment to put people and their well-being at the centre of the work we do.”