Two weeks after Heidi Wagner was promoted to head of operations for UHN Biospeciman Services at the University Health Network in Toronto, business as usual came to an abrupt stop. On March 11, 2020, the World Health Organization declared the novel coronavirus a pandemic and Wagner was charged with repurposing the McCain GU BioBank and the UHN BioBank. Within a matter of days, the facility would transition from collecting cancer specimens to joining the worldwide effort to comprehend and control COVID-19.

"This has been one of the most challenging experiences in my professional life," the 2006 Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences pathologists' assistant alumna said. "So much of this has been new territory - the highest level of PPE to protect staff, safety requirements for social distancing in the lab, backordered supplies. At one point we couldn't get the necessary types of tube; Canada was completely out of stock. And three weeks in, we had a COVID-19 outbreak in one of our emergency departments, leading to a 5 a.m. notification to cancel shifts, rapid testing, self-isolation and a search for a higher level of PPE in a short amount of time."

Thankfully, nobody on Wagner's team tested positive.

Pre-pandemic, the McCain GU BioBank's program was based on collecting biospecimens at certain time points, allowing for serial collections throughout the patient's course of disease. To date, more than 600,000 biospecimens had been stored from over 16,000 participants to enhance future cancer research capabilities in the areas of genomics, proteomics and epidemiology. The UHN Biospecimen Services is the umbrella program that offers services to various biobanks, including the Princess Margaret Oncology biobank and the McCain GU BioBank.

These days, two-person teams conduct targeted collections from consenting patients, beginning when they first present with suspected COVID-19 in the emergency department throughout their time in the ICU or ward. Those collected specimens keep their colleagues in the lab busy with processing seven days a week.

And the entire process keeps Wagner on call 24/7, often managing her 50-person team remotely while parenting and home-schooling 4 ½-year-old son Eshaan with her husband, Amar.

"I never imagined I'd be in the middle of a pandemic, sending my team to the front lines," Wagner said. "The uncertainty of the situation is significant. I've made every effort to respect and accommodate everyone's needs and personal situations."

Over time, she's realized that transparent and supportive communication helps alleviate an already high anxiety level. "It's been imperative to have Monday business calls and have less formal Zoom calls on Fridays," she said. "We keep it casual and light, trading recipes and checking in with each other emotionally."

Balanced perspective

After earning a degree in law and security from Fanshawe College in Ontario, Wagner intended to join the police force as a forensic scientist. Then she heard about Wayne State's Pathologists' Assistant program and found her niche in Detroit. She especially appreciated the hands-on nature of her WSU education.

"Clinical rotations at 10 different facilities rather than just one allowed me to come into the profession as a mature student," Wagner said. "I learned to deal with multiple surgeons, pathologists, lab personnel and hierarchies, giving me the balanced perspective I needed to handle high-pressure situations."

Wagner took that perspective and went on to work in pathology and laboratory medicine departments at the University of Texas MD Anderson Cancer Center in Houston and Roswell Park Cancer Institute in Buffalo, New York. She then landed back to Ontario, where in 2018 she was named manager of clinical research for McCain GU BioBank, which is housed in the Princess Margaret Cancer Centre as part of the University Health Network. Two years later, she was promoted to the title she holds today.

"I never could have anticipated where my career would take me, but it goes to show that PAs can facilitate clinical research by bringing the mindset of pathology to the team," Wagner said. "Historically, clinical operations and research have stayed in their own silos, so being able to bridge those groups by speaking the same language and sitting on both sides has been crucial."

A year ago at this time, Wagner was making news as a member of the research team launching the McCain Centre for Urological Innovation and Education following a major donation. Now she's helping to lead a COVID-19 trial that has brought her full-circle to the days she dreamed of joining the police force. Last month, UHN launched a vaccine study with more than 3,500 Toronto police officers, firefighters and paramedics.

First responders often work under circumstances where social distancing is difficult and therefore may be at higher risk than the general public of becoming infected with COVID-19. Because of this, they were invited to participate in a voluntary study to examine whether a novel version of the common vaccine Bacille Calmette Guerin (BCG) - already used globally for prevention of tuberculosis - may work to reduce the incidence and severity of COVID-19.

In addition to the COVID BCG Relief Assessment (COBRA) trial and other pandemic work, UHN Biospecimen Services is currently in the midst of a multiphase restart to resume previous cancer-focused operations under new safety guidelines.

"I'm not complaining, but I've never worked so hard in my life than in the past five months," Wager said. "I am incredibly thankful to be in a position to be able to contribute in this capacity."