Right Doctor at the Right Time

Dr. Brent Roussin has spent a lifetime getting ready for this pandemic.

by Keir Johnson

Before the pandemic, Dr. Brent Roussin was, among many other things, a student pilot. In his limited spare time, he was learning how to fly a plane.

His training has been grounded these last few months as spare time has become a scarcity in his life. Most of his waking hours since March have been spent leading the charge against COVID-19, a global public health emergency.

That’s a role he hadn’t anticipated when he signed up to be Manitoba’s Chief Provincial Public Health Officer. He was appointed to that position just months before the pandemic was declared.

In fact, without anticipating it, he has spent a lifetime getting ready for this precise job.

Dr. Roussin, 45, grew up in northwest Winnipeg and attended Maples Collegiate. He loved sports, playing football in high school, but he was particularly drawn to science.

“I’ve always been quite interested in science and that really drew me in early on in high school,” recalls Dr. Roussin. “I made the decision to be a physician in high school and I never really looked back. I had some aspirations towards the law back then as well, but I was determined to be a physician.”

“The draw for me was being able to help people”

Drawn to Public Health

After completing a science degree, Dr. Roussin studied medicine at the University of Manitoba, graduating in 2000. Two years later, he completed his residency and started working as a family physician.

It was during this time that he became interested in public health.

“We focus so much on disease,” Dr. Roussin explains about the role of physicians. “We can get caught up in that and we can lose sight of just how important the social determinants of health are. Despite all of the care we provide, you see in front of you that so much of health status is determined well outside of the health care system.”

It was further studies, though, that turned that interest into a professional pursuit. As he prepared to return to university to obtain a law degree – following his other high school aspiration – he took a course on the economics of health care with Professor Robert Chernomas. He was deeply impacted by this experience.

“He really drew me to the importance of the social determinants of health, and that really guided me towards studying public health after law. That’s how I got into public health.” He received his Master’s in Public Health in 2011, just two years after completing his studies in law.

He then took a position with Health Canada’s First Nations and Inuit Health Branch working across northern Manitoba. The time in those communities – and the trust he built with First Nations leaders – has proven important during the pandemic. Many First Nations are geographically isolated and particularly vulnerable to a virus like COVID-19, an experience many communities learned the hard way in 2009 during the H1N1 pandemic.

Calm Before the Storm

After working as the Medical Officer of Health in northern Manitoba, Dr. Roussin was appointed Chief Provincial Public Health Officer last summer. Before COVID-19 was even a blip on the radar, his primary focus was on the growing outbreaks of sexually transmitted and blood-borne infections, such as syphilis.

“I came into the role with those outbreaks occurring, so that was garnering a lot of my time when I first started,” he explains.

With a team of roughly 20 medical officers of health plus dozens of other staff helping with analysis and field work, the public health branch of Manitoba Health, Seniors and Active Living has a diverse focus, including environmental health, vaccines, substance use, and health equity among many others.

Just months after assuming the role and charting a path forward for public health’s work, a novel coronavirus was discovered and he and his colleagues across Canada went on high alert. The first case was identified in Canada in January, 2020. 

Manitobans, meanwhile, had been learning about COVID from Dr. Roussin who was introducing concepts like social distancing. “We wanted to get ahead of things, starting with the distancing messaging early on. It was a stressful time, trying to get those early messages out and getting buy in.”

As outbreaks emerged in more and more countries, Dr. Roussin and other officials braced for impact here in Manitoba. It wasn’t until March 12, 2020 that Manitoba reported its first case, the day after the World Health Organization declared COVID-19 a global pandemic.

Calm During the Storm

Manitoba had descended into what would be the first wave of the pandemic, with public health efforts focused on flattening the curve.

With COVID-19 now in Manitoba, Dr. Roussin’s advice led to early action. The day after the first case was reported, Manitoba announced in- person classes would be suspended for three weeks. Those three weeks turned into the rest of the school year as students and teachers shifted to remote learning.

More restrictions followed, including an order to close all non-critical businesses on April 1, 2020.

Manitoba is fortunate to have a Chief Public Health Officer who is both a medical doctor and a juris doctor, as orders are issued under The Public Health Act to help slow the spread of the virus. “I was always interested in the intersection of medicine and the law,” Dr. Roussin says as he recognizes how both degrees have prepared him for this moment.

“I don’t think The Public Health Act has ever been utilized like this in Manitoba,” he adds.

Demands on his time quickly took off in March, though he is often described by officials and the media as remaining levelheaded and unflappable.

“Usually I’m in the office around 7am and brief the Minister early in the morning,” he explains. Sometimes he would brief the full cabinet and Premier. Deputy Ministers and other officials were briefed too in what quickly evolved into a cross- departmental response. Soon, every industry and sector of the economy needed his guidance.

Dr. Roussin continued to see patients in his family medicine practice in the early days of the pandemic, but that soon changed: “When we started doing incident command seven days a week,” he explained, “I had to give up my clinical work for that period.”

As he was forced to suspend his clinical work, other physicians were reporting a very significant decrease in their own patient visits as many patients delayed seeking care. Serious concerns emerged about a secondary curve, with complications arising from health issues that go untreated.

“What concerned me most during the first wave was the lack of utilization of the health care system,” Dr. Roussin notes. “There is much more to health than this virus. We know what happens in places where you don’t address it. We’ve seen it.”

Frequently, he reminds Manitobans to stay on top of their medical conditions to help stay as healthy as possible. Doctors Manitoba has reinforced this message with a public awareness campaign, reminding Manitobans not to put their health on hold.

During this time, Dr. Roussin became a familiar face, providing public briefings seven days per week. Those briefings have become infamous, even being parodied using Lego in a viral video.

Many have praised Dr. Roussin’s straightforward answers and calm, steady advice as helping to instill confidence in Manitoba’s response to the pandemic. His reaction to those comments, however, is to quickly pivot to recognizing how others contribute. “There’s a whole group of people working so hard with me,” he acknowledges, adding “they don’t get the accolades I receive, but they should.”

As he reflects on our experience so far, Dr. Roussin is very cognizant of the effects his orders have on society. “These orders have huge implications on Manitobans and their health, so we don’t take them lightly.”

“We receive feedback from a wide variety of individuals – including physicians – on both sides, with some wanting stringent lockdowns and other people thinking lock downs are too aggressive. It’s a real balance and a changing landscape.”

That balance means real-time analysis of dozens of indicators to constantly help reconcile the imperative to contain COVID-19 with the impacts of the restrictions designed to do just that.

Another consideration is timing. Dr. Roussin points out that “compliance fatigue is a real thing, sticking with those fundamentals is really challenging.” He adds: “Every restriction has the risk of decreasing adherence.

Looking Ahead

With Manitoba now firmly in a second wave of COVID-19, Dr. Roussin is focused on what is in front of him and what may come next.

“We’re going to see a lot of peaks and valleys for the next year,” he explains. “The pandemic will only end with a viable vaccine or treatment. But even with a vaccine, it will take months to be distributed and get into people’s arms. We are still a long way until we have effective community coverage for COVID.”

This helps to understand one of the phrases Manitobans hear so often from Dr. Roussin: “We have to learn to live with this virus.”

For the more immediate future, he cautions that this respiratory virus season is going to be unlike any other. “As physicians, we have all gone to work ill, or sent our kids to school ill. But this year, we really have to all focus on not returning ill people to work or school, even when we have what we think is an alternate diagnosis. We have to have a high degree of suspicion for COVID this year.”

While he emphasizes that staying home when ill is vital to slowing the spread of COVID-19, he also acknowledges this will have an impact on workplaces, notably hospitals and physician practices. “We are going to be faced with rates of absenteeism rates that we have never experienced before.”

Through all the challenges, the ambiguity and the unending uncertainty, there has been a constant source of hope for Dr. Roussin: his colleagues. “I have a lot of pride for our profession. Period. Manitobans can really lean on doctors and look to doctors for help and advice at a time like this.” 

With that pride helping to fuel him, Dr. Roussin continues to pilot Manitoba on this pandemic journey, through uncharted territory.