'A will of steel': Vera Etches is the face of Ottawa's fight against COVID-19

It's rare for city officials to hold a press conference on a Sunday — and when they do, it's almost never to deliver good news.

The March 15 news conference was no exception.

Only four days after Ottawa's first case of COVID-19 was confirmed, back when the total had just nudged into double digits, Dr. Vera Etches told reporters she believed there were as many as 1,000 cases of coronavirus in the capital.

Ottawa's medical officer of health called for people to stay home from work, cancel events of any size, venture out only for groceries and medical reasons, and take their children out of daycare.

By now, this is all familiar advice. But on the day after Etches issued her plea, the provincial officer of health still wasn't calling for such strict measures. And when asked about Ottawa's projections, he quibbled about Etches relying on "modelling" and not firm data. 

Yet by that afternoon, he too was recommending bars, restaurants and daycares be closed. Early next morning, Ontario declared a state of emergency.

OPH asks residents to strengthen ‘social distancing’ as coronavirus spreads

5 years ago

Duration 1:32

Dr. Vera Etches, with Ottawa Public Health, says local transmission of COVID-19 in Ottawa may mean there are several hundred cases currently in the community. The agency is encouraging residents to strengthen social distancing measures, keeping one to two metres away from others.

That Etches was ahead of the curve surprises no one who knows the 44-year-old doctor. Colleagues, professors, family and friends all describe Etches as smart, collaborative and empathic — and hell-bent on doing the right thing.

"Under that pleasant demeanour is a will of steel," said Dr. Isra Levy, Ottawa's former medical officer of health, who hired Etches back in 2009. 

For her part, Etches puts it bluntly: "You have to say what you need to say when it matters to the health of the public. That's our top concern." 

Face of COVID-19 fight

Etches has been with Ottawa's public health unit for more than a decade, and in the top job for a little less than two years. 

But over the past few weeks, she's become a household name. 

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Public health's unwieldy mandate encompasses everything from providing immunizations and helping people quit smoking to finding ways to improve the health of the city's most vulnerable.

Then along comes a crisis like COVID-19, and suddenly the job shifts from all sorts of worthy stuff to one urgent priority.  

While there are thousands working feverishly behind the scenes to keep COVID-19 at bay, it's Etches — with her almost-daily news conferences, media interviews and council briefings — who is the face of the local fight against the pandemic.

Small-town girl taught to 'promote justice'

Etches was born more than two months premature in 1975 in New Zealand to Duncan and Nora Etches, both young doctors completing medical residencies there.

When their midwife didn't consider the tiny baby "viable," Nora hopped off the delivery table to resuscitate her. She spent weeks in an incubator while her mother finished her residency.

Closing schools, workplaces due to coronavirus not a step to be taken lightly, OPH says

5 years ago

Duration 1:00

Dr. Vera Etches, with Ottawa Public Health, describes what actions the agency would take — and not take — in the event of a COVID-19 case in Ottawa.

Years later, while Etches was a medical student, she wrote her parents a poem about "how it must have felt to us as parents to have a child with the problems that she was seeing in the hospital," Nora told CBC.

By 1977, the Etches family was living in the village of Hazelton, B.C., one of the oldest non-Indigenous settlements in the remote northern part of the province, and her parents both worked at the local hospital.

They lived on a two-hectare property, with a large garden and a flock of sheep. Etches once helped her father deliver a lamb — an event her mother credits as sparking her interest in medicine — and raised her own sheep as part of the 4H Club. Once, while their parents were away, she and her brother had to rescue the flock from a burning barn.

The family was involved in the village's socially active United Church community, which among other things, sponsored a Vietnamese refugee family in the 1980s. When Vera was 13, she visited schools in Thailand.

"We shared our lives with [the children], they knew what we were doing," said Duncan Etches. "We were very aware of the social determinants of health, how poverty has an influence, how housing has an influence, how education has an influence."

Vera Etches said her early life taught her that it's everyone's responsibility to "promote justice" and have a sense of "the way we should do things."

Looking back at her adventurous childhood, she described herself as the "bossy" oldest sister of four siblings — and said to this day she has to work at "leaving room for others' perspectives."

Malawi opened her eyes to public health

At just 16, Etches enrolled at Simon Fraser University and later went onto medical school at the University of British Columbia. Her plan was to go into family practice until a course took her to Africa.

"I didn't know about public health as a career until I did an elective in Malawi," said Etches.

"I saw the work of the public health nurses there, and I really was impressed with how they were facing these big issues of HIV/AIDS and poverty and hunger," she said. "And they weren't despairing. They knew their communities, they were positive, they were influencing people and preventing more negative outcomes."

"I thought, 'These were the kind of people I'd like to work with.'"

That led her to the University of Toronto, where she completed her residency in public health. Her friends there said she embraced all of city life — from the indie theatre scene to growing vegetables in the front yard of her downtown home to volunteering in a men's shelter.

H1N1 pandemic 1st test of leadership

Etches always thought she'd practice in a rural area, and had spent a chunk of her residency in Labrador. That rural focus, and her deep interest in Indigenous health issues, led her to the public health office in Sudbury in 2005.

That's when Levy, then Ottawa's associate medical officer of health, met her through a provincial public health research organization.

She made an impression. 

"Under that pleasant demeanour," he said, "there's a consummate professional, a caring person, a person who perseveres with a will of steel to influence for the betterment of people the decisions that get made."

So when Levy was promoted to chief medical officer of health for Ottawa Public Health (OPH) and needed a new associate, he made sure Etches knew about the opening.

She aced the interview.

Etches started the new job in February 2009. That April, H1N1 broke out in Mexico, and the deadly influenza strain was declared a pandemic in June.

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In Ontario, 128 people died, including a 10-year-old girl at CHEO in late October, mere days after Health Canada approved a vaccine. 

The H1N1 outbreak was the first time that Etches' leadership style was felt at OPH, according to Levy. She excelled at collaborating with other community partners, forging strong relationships that continue to this day. 

Etches said H1N1 underscored the importance of using social media to push out information. The 2009 pandemic was the first time the department used Twitter, which is now standard practice, and today they use Facebook and Instagram too.

But H1N1 also taught Etches something deeper about the way a community reacts to a crisis.

"I remember the fear and concern and anxiety," she said. "There was a young person who died, and I think that it hit home for people that this could be a deadly act. So I'm trying to keep that in mind in terms of the way anxiety can build."

Burden of decisions

The unprecedented scale of the COVID-19 pandemic requires hard decisions based on rapidly changing information. For many, the measures being imposed are inconvenient. For some, they entail severe economic and social hardship.

So how does the public medical officer, whose job it is to consider the community as a whole, make the right calls? Etches says she pulls out her "ethical decision-making framework."

She oversaw the creation of the framework in 2012 after 7,000 patients at a private endoscopy clinic had been potentially exposed to infection.

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"It sounds kind of academic, but I'm really proud of it," said Etches. 

The framework helps guide her through the difficult decisions demanded by COVID-19, including the implications of keeping people apart. 

"I could see what was happening in other countries around these social distancing measures," said Etches. "And I was worried about children, especially children who have no choice or autonomy to choose a different environment, worried about them being isolated or missing out on the support they need and being safe in their homes and being hungry."

She says social distancing isn't perfect, but there's evidence it can mitigate COVID-19 fatalities.

She also has some ideas how the vulnerable might be allowed to re-enter society in a targeted way earlier than others, but that possibility is still off in the future.

Making it personal

When it comes to her own mental and physical well-being, Etches aims for work-life balance — relatively speaking. Even during the pandemic, she been out for early morning runs a few times a week, and encourages others to go outdoors daily if they're allowed.

She even took a few days off, after noticing she had been "less patient" with people.

"No one is indispensable," she said. "If we don't look after ourselves, we can't look after others."

Etches says she couldn't do her job without her supportive partner, who's taken on most of the child-care responsibilities for their two young boys. She sees them around supper time most evenings before going back to answer emails, although she admits to falling asleep a few times while putting her four-year-old to bed.

Lately, she's being kept awake by questions she's being asked on Twitter.

"I feel really bad that I can't answer them all, because I see a lot of misinformation or misinterpretations," said Etches."It's just too hard. I can't get into engaging with every individual."

Resisting that instinct is hard for a public official whose strength is empathizing on a personal level. Recently, when she was urging social distancing for the umpteenth time, she recently told reporters about how she'd decided to cancel her parents' planned Easter visit. 

"I'd like to see my parents too," she said. "But they're over 70, and it's not safe."

'Focus on what we can do'

This week, she will again be delivering what will unavoidably be bad news on her daily conference call with journalists. There were more than 50 new COVID-19 cases confirmed in Ottawa over the weekend, as well as the city's fourth death from the respiratory illness.

Provincial modelling, meanwhile, suggests that anywhere from 3,000 to 15,000 Ontarians could eventually die from COVID-19.

"It's not a good picture," she admitted, " and it's not something that's going to change."

Etches says she's not willing to let the grim reality have the last word, however. She takes strength from stories of people "stepping up" to help their neighbours, and wants to thank people for doing their part.

"For me," she said, "I always try to focus on what we can do, what's working."