We expect an increase of the pressure on emergency departments, intensive care units and hospital beds, hospitals with the déconfinement announced.
April 30, 2020 4: 00
Déconfinement: the health system will take place the kick?
The health system is ready to cope with a foreseeable increase in the event of a COVID-19 in the population with the déconfinement announced by the government Legault? The Association of emergency physicians (AMUQ) and the Society of intensivists du Québec (SIQ) do not hide their concerns, but the minister of Health and the national director of public health wants to be reassuring.
“Is-what one is prepared to face an increase in cases? At this time, it’s not going well in the east of Montreal, the hospitals are crowded, emergency room overflow. I’m in the hospital [Maisonneuve-Rosemont] today, and I have a patient who is on a stretcher for 110 hours with a COVID positive […]. This is not supposed to, it, patients COVID must be able to climb on the floors and have care in isolation. To the emergency, it is supposed to do evaluations, not admissions,” recalls in the interview, the president of the AMUQ, Dr. Bernard Mathieu.
The problem, he explains, is that “the hospital beds are full because the residences do not want to take back the patients [who no longer need acute care] or that intermediate resources do not have enough staff to monitor patients who are wandering and who are COVID positive”.
The president of the AMUQ points out that, in addition, it wants to “reopen machine” and start to make surgery less urgent. “For that, it takes beds. And if it reopens the industries, there is a risk of having an accident and people who will need care. But we are full already.”
Among the intensivists, it is also expected to increase the pressure on emergency departments, intensive care units and hospital beds, hospitals with the déconfinement announced. “The recovery in several economic sectors, the re-opening of the construction sites, the increased traffic on roads will make them a lot of injured patients. If it does not have room to receive them, it’s going to be a problem,” explains the president of the SIQ, the Dr Germain Poirier.
Up to now, the intensive care units have not been put to the test with the COVID-19, notes Dr. Poirier. Normal, the population is confined for a month and a half.
Intensive care: the challenges
“Currently the capacity of intensive care is far from being reached. This is far from the predictions. The intensive care unit in Quebec were ready to receive easily double, or even triple, of the patients that what they see now, so it was still a good zone buffer, it can still take, of patients. But once we take these patients, it is necessary that they can mount to the floors, and currently, the problem [in Montreal] is not in the icu, but on the upper floors. The floors [of some montreal hospitals, including Maisonneuve-Rosemont and Sacred Heart] are overwhelmed by the amount of patients COVID,” notes Dr. Germain Poirier.
Another challenge for the intensive care units of hospitals, it is to keep areas where patients are not contaminated by the COVID, ” says Dr. Poirier.
“Currently, what we fear, what are the asymptomatic carriers. There are people who come to the hospital for something other than the COVID and who are asymptomatic carriers. We got one yesterday who was admitted to the hospital [Charles-LeMoyne] for a problem of intestinal obstruction, surgery urgent, and that was the fever. Six months ago, it would not have been detected, it would be said : he has a fever because he has a bite. But we put a rod in the nose, and finally, it was COVID. If we are not careful, these are patients who could easily infect other patients and even hospital staff. It is a challenge, that. How screener all in? Should it be screener, the whole population, all the patients?”
The regions not protected
If the National Capital and the regions have been relatively spared by the new coronavirus in the past few weeks, the scenario could change with the re-opening of schools, day-care services and certain economic activities, and with the increase of traffic on the interregional that will allow the lifting of roadblocks.
“It is certain that the déconfinement can lead to a second wave, and the risk, it could be see fill intensive care units and hospital beds. The first wave was less important than what we had planned for the intensive care unit, probably because of the containment and the measures of socio-sanitary. But if one is struck by a second wave, and if we want in addition to a recovery of the operating theatres, to go forward with the case of cancers, the surgeries, it could bottleneck the system so important,” says Dr. Poirier, who also emphasizes that people have avoided visit to the hospital recently for fear of contracting the COVID-19. “When they finally arrive at the hospital, one realizes that they have waited too long, and they end up in the icu…”
Dr. Bernard Mathieu also stresses the importance of keeping the place in our hospitals for the patients “non-COVID”. “The prime minister told us that there were 6000 hospital beds in Quebec, they are where these 6000 people there? […] Is that it is well balanced in the network? Clearly not, because there is the east end of Montreal which is overflowing, and everywhere else, it does not overflow. There is no regional distribution of cases, it seems, and that is problematic,” laments the president of the AMUQ.
Lack of staff
The development of alternative sites, such as Hotel Place Dupuis Montreal, can be a solution to free hospitals, but it is difficult to give proper care, the beds and the bathrooms are not adapted. And, anyway, “there is the wait for these places-here, too, and if there is waiting everywhere, to the hospital, it is going to overflow,” insists Dr. Mathieu, for which it must find a way to return the patients in their living environment.
Except that the staff in the residential environments for seniors are overwhelmed with the outbreak of COVID-19. In the beginning of the week, it was missing more than 10 000 employees in the health network.
“If we reopen the industries, there is a risk of having an accident and people who will need care. But we are full already ”
The president of the Association of emergency physicians, Dr. Bernard Mathieu
The other concern for Dr Mathieu : the hardware protection. “We still have problems of management of material. Every day, we wonder if we will run out of covers, gloves, masks,” he said.
In the regions, the hospitals will be able, according to him, to cope with the increased number of cases of COVID that will come with the déconfinement? “If the patients in the region are not too ill, the local hospitals should in principle be able to treat, but severe cases intensive care, it will be more difficult […] To the intensive care light, it can go, but if the patient needs a respirator and everything, it’s going to be complicated,” said Dr. Mathieu.
More serious cases may end up to Quebec or Montreal, and that, “it is not that there is too much”, warns the president of the AMUQ, which includes, however, that the children should return to school and that the industries must re-open. “But it should not be that the situation will become anywhere in the network as it is in Montreal,” he said.
Preserve the regions
According to Dr. Matthew, it must be kept isolated from the regions least affected by the COVID “for it to remain like that”. “We should not start to make the movements of population, that the people of Montreal to go to contaminate the people of the Gaspé and Îles-de-la-Madeleine, for example. It is necessary to continue to restrict” as long as one has not seen a significant decrease in cases of COVID-19, believes Dr. Mathieu.
On Wednesday, the minister of public Safety, Geneviève Guilbeault, announced at a press conference that, if all goes well, the police controls will be removed from the may 4, for the regions of Laurentians, Lanaudière, Chaudière-Appalaches, and the city of Rouyn, on 11 may for the Ottawa (excluding Gatineau), Abitibi, La Tuque and Saguenay—Lac-Saint-Jean, and may 18, for the regions of Bas-Saint-Laurent, in the Gaspésie-Îles-de-la-Madeleine, Charlevoix and Côte-Nord.
ARRUDA AND MCCANN CONFIDENT
The minister of Health, Danielle McCann, agreed Wednesday that Montreal remained a “hot area” and that it was necessary “to really further stabilize our schools, our NURSING homes”.
“It is what it is doing”, including “thanks to everyone who came to lend us a hand”, said the minister, according to that, you will also see more of mutual assistance between hospitals to relieve those who are in trouble. Already, she said, patients from hospitals in montreal have been transferred in the Suroît region, at Charles-LeMoyne and Pierre-Boucher.
Danielle McCann does not believe, however, that the opening up of areas will put at risk the health system.
“We are following day by day the famous curve, hospitalizations in general, and intensive care. And we see that there is a stabilization in the level of hospitalization and intensive care. The numbers they give you, it includes people who have the COVID-19, but who no longer have need of the technical platform of the hospital. And two-thirds of the people who have been hospitalized and who have had intensive care are in the greater Montreal area. Then, it is not concerned as much for other regions and for the region of Montreal currently, but we still made preparations in the other regions of Quebec,” assured the minister McCann.
For the Dr. Horacio Arruda, “if there is a spot where the valves can leak a little water, currently, it is in the more peripheral regions than those of the Communauté métropolitaine de Montréal”. The national director of public health has argued Wednesday that the regions had smaller populations that have less probability of great contacts”. “And they are in the process of preparing, in terms of human resources, to not have the problems that we had [in Montreal],” said Dr. Arruda.
As there have been few cases in the regions “cold”, “it means that the virus is likely to be present”, has analysed the national director of public health. “There, the question is : if it is reintroduced, how one is able to investigate and then control it? If, in the Bas-Saint-Laurent, there is an outbreak or a case, we are going to intervene very, very quickly to stifle it here […]. As the majority of people have not necessarily complications, as we are going to ask people, to the elderly to protect themselves as, well, the health impact, the hospital is expected to be less, but still you need to predict it”, he said.
The minister of Health, emphasized : “The advantage for the regions that we déconfine, is that they have learned from Montreal and the greater Montreal area, who were taken by surprise, with the break, the density of the population… We have reviewed all of our protocols in the network of health and social services. Thus, the areas that were less affected have learned, have implemented these protocols, […] and it has a planned capacity. But actually, we count on the population to follow the same instructions, because if we saw that there was a significant increase, one would be forced to close the tap.”