Surviving a marathon and a sprint
What I've learnt working in the heart of our COVID-19 response
I joined our pandemic response in May of last year. I was looking for a new job, and someone I knew said to me “I reckon you could run a vaccination clinic, do you want a job running vaccination clinics?”. I was very flattered, but was a little bit like, “woah, really?” Then I remembered that two years previous, Hamilton had been 80 votes off making me a city councillor and I was like, “yeah, I could do this”.
Back in May 2021, we were riding high in victory over original-recipe COVID-19 with 0 cases in the community. We were working our way through the vaccine rollout as we battled a cyberattack (literally my first week in the job 🥴) and managing vaccine stock as we waited on additional shipments to arrive in the country. I spent two months out at Te Rapa Racecourse with our frontline healthcare workers - learning the ins and outs of vaccination, making friends, and being the crisis control. I was yelled at by people whose booking wasn’t in the system anymore due to the cyberattack. I was yelled at by 55 year-olds who didn’t want to wait a week to become eligible. I was yelled at by people who had come down to the clinic deliberately to be racist and try to cause a scene. I was the “help, there’s someone being abusive in the carpark” person. I was the “I want to talk to the manager” manager.
And yet, this behaviour primarily came from people who were pro-vaccination. They were grumpy and frustrated with our healthcare system - some for valid reasons and some for not (being a racist isn’t btw). Writing this in February 2022, sitting on the other side of a Delta outbreak, entering an Omicron outbreak with nearly 2,000 new cases today, and an ongoing protest in Wellington who are advocating to arrest and execute politicians and healthcare workers - I would give anything to go back to May 2021 and be yelled at by someone who accidentally came a day early for their second vaccination again.
Reflecting on how far we’ve come and all we’ve persevered through this time, I thought I would share some of the things which will be ingrained in me for the rest of my life.
The people who get the most abuse are generally not the people in a position to change the thing making people angry, nor are they responsible for it.
I have an understanding of the working parts of our COVID-19 response because I’ve been inside it. I know what the government and the Ministry of Health is responsible for - the big decisions like the original rollout groups, traffic light settings, mandates, and guidelines for things like how vaccination clinics and testing operates. I know what we as the DHB are responsible for - tangible stuff like where clinics are, how long they’re open, and how we distribute our limited workforce. I also know how things break down inside of that - like how our staff who direct traffic at testing sites (and are the first to meet people after waiting in line) don’t decide when it opens or closes, what days it’s open, or choose to create a long wait. I know that our Kai Manaaki at our vaccination sites (again, often who people first meet) don’t decide what clinics are offering 5-11yo vaccinations nor how many walk-ins the clinic is taking vs how many bookings.
I’m a regular human being, I get grumpy at people, I get annoyed at how things are. That’s not going to change, but I have started doing a check: is this person in front of me, who is the most available person to hear my gripes, the person responsible for this, or in a position to change it? Sometimes people hear COVID-19 or even vaccination and want to talk to me about vaccine mandates and my response is “I hear that you’re frustrated or have some concerns, but if it’s a government mandate, you probably want to talk to the government (start with the Department of the Prime Minister and Cabinet) or the Ministry of Health, or if it’s a mandate your workplace has chosen to set on their own, you need to talk to them”.
We’ve gotta look at the big, biiiiig picture.
There is no better way to become crushingly self-aware of your place in the world and also how your knowledge of things can be pretty limited than working in a pandemic response. I have a lot of conversations with my friends who are like “I don’t understand these changes! It doesn’t make sense!” (which, yep, fair point) or members of the public who are like “But I deserve to have X, Y, Z right now, why can I not have it right now!” (sometimes also, yep, fair). I point them back to a couple of the things I keep in mind:
We are in a pandemic but also everyone worldwide is too. I am pleased when anything I order from overseas doesn’t take three months to get here (and those are fun non-urgent things), let alone when I can access something in-demand (like medical-grade masks), which happens to be already in the country and available locally, right when it becomes apparent to me that I need it.
I want us to live in a world where we have ample resources but oftentimes things are constrained (see above point) and in lieu of having an abundance, we need to acknowledge the limitations we have:
The severity of the outbreak and the duration of that severity - which may not become apparent until we’re past it.
Whether we can create supplies locally vs need to ship them from overseas.
What constraints and inequities we had before the pandemic are only being made worse now?
People with the knowledge and expertise to do certain jobs are also a limited resource, and many are tired and burnt out (see above point).
We also live in a world where not everyone faces the same risks, so we must also ask:
Who is most at risk of serious outcomes from COVID-19?
Whose roles are critical to us functioning as a society - e.g. people will die or be seriously endangered if these roles cannot be done?
Who can do critical roles while still working from home, who can do them in an environment with limited risks, and who can only do them in high-risk environments?
Who already has access to resources and support to weather these risks and who needs further support to ensure equity?
Many decisions don’t make sense if you can’t see the big, biiiiig picture - sometimes the information we need for it to make sense isn’t always provided in the headline or in the soundbite. Sometimes a limited piece of information is just repeated enough times it makes finding the full context harder. I spend a lot of my time in my new role as a senior advisor making sure that the information I’m working with is correct and up to date - because I’ve never been so cognisant I might not be aware of something or it may have changed between yesterday and today.
Humility is the name of the game.
There are a couple of questions I use as a baseline for keeping myself in check:
If I requested a resource - like wanting a testing site in my suburb when there are already 14 testing sites in Hamilton, would it limit our ability to distribute it equitably to people who do not have the same access - like in more rural parts of our region who only have pop-up testing sites?
If I complained about not having access to a resource - like not having N95s when I work in healthcare but I work from home, knowing the significantly bigger risk other people face - like healthcare workers at the hospital - would distributing resources to me over them sit within my values?
Am I being asked to go without a resource (like RATs) or am I being asked to be patient while the resource becomes available and is distributed?
Am I basing the information I have from a verified source (e.g. Ministry of Health, Healthpoint, Unite Against COVID-19) or from a source I trust but who could be wrong (e.g. a friend, someone in a Facebook group, etc)?
If I’m making an assumption - like few locations of interest being published means we’ve given up on contact tracing - am I indulging my own fears or am I missing information - like only publishing locations when not everyone can be identified, or there are new criteria for what a high-risk environment is? Am I sharing misinformation if I publicise my assumptions and they’re wrong?
How can I acknowledge the anxiety and fear that I feel for myself, my loved ones, my community - while also acknowledging that I might not need the same support from the government or our healthcare system that others will and that my anxiety doesn’t trump their need?
We can still be frustrated or upset that we don’t have more resources, that other countries’ COVID responses affect how we manage ours, and that we cannot implement all public health measures we might want to - like not everyone having access to fit-tested N95s, or that we’re not providing more support for people or organisations who may take a hit from what we do to keep the worst outcomes at bay. Those are valid feelings for us to have and for some things, we can hold people accountable for them.
Sometimes you can ask all those questions and end up at “maybe it was more politically palatable to make this decision over that”. There are a lot of valid reasons to make that your first choice but I try to keep it as my backup. I try to give the intelligent, caring people that I work with the benefit of the doubt first.
Lots of really intelligent, caring people work in our response. Lots of them are not doing okay right now.
The two catchphrases of our workplace are “it’s both a marathon and a sprint” and “we’re building the plane as we fly it”. The first refers to how we have to be swift and responsive as things happen in real-time, while also looking after ourselves because it’s a loooong slog. The second is to be gentle with each other because we don’t always have the time to build the process before the process needs to be being used out in the real world.
Remember how I said I would give anything to be back in May 2021? It’s hard to explain how much worse things have gotten between now and then. Not just because we had an outbreak, now we have a worse outbreak - but the complaints we’re facing now include violence and death threats from people who question the very basis of our reality and society.
Often I wonder how to best survive the coming months. Not from an Omicron-preparedness perspective, but from a how-to-roll-with-the-punches perspective. How do we help our communities not just medically do okay - but also mentally and emotionally, as we have to change our course, maybe multiple times? How do we make sure that our frontline workforce survives the barrage of criticism aimed their way? How do we become resilient to pandemic conditions, rather than less empathetic, less accommodating, less understanding? How do we undo the harm of disinformation and those who are actively trying to make us more fearful and more distrustful? How can we be better at fact-checking ourselves and making sure our emotional response doesn’t lead us to spread misinformation?
I don’t have those answers yet, I’m sure I’ll have more reflections before my time in the COVID programme is over. Maybe the lowest hanging fruit is aggressively refusing to give into narratives of hopelessness and surrender - ask questions instead of making assumptions and starting misinformation, be generous to those you see on the frontline, and use humility to remember what resources you already have. Lots of us have good reasons to be pessimistic of the healthcare system (myself included) and even more so in a pandemic, but lots of us are also working very hard to ensure those able to help themselves can prepare and plan, and those who are at highest risk and in highest need have a system who will be there for them.
Note: Opinions expressed are my own, not that of my employer.
I joined the COVID-19 Directorate at the Waikato DHB and was the Service Delivery Manager of Te Rapa Racecourse, Ryburn at Waikato Hospital, Morrinsville Community Clinic, aged residential care, and mental health & disability. I am now a Senior Advisor in the Strategy team.