Photo: Renaud Philippe The Duty
The CIUSSS must deal with the deployment of mobile clinics on their territory, recommends that the internal submitted to the minister of Health, Christian Dubé, June 23. But it must be done “in close collaboration” with the regional Direction of public health of Montreal, says it in the document.
Guillaume Lepage and
July 30, 2020
More than 28 656 cases, 3434 death : the COVID-19 was hit hard in Montreal, much more than elsewhere in Quebec. Why ? In a recent internal report in which The Duty has obtained a copy, the new deputy minister of Health and social Services system is state of the many gaps in the management of the crisis. Dominique Savoie made 24 recommendations, in anticipation of a possible second wave.
The report, submitted to the minister of Health, Christian Dubé, June 23, shows a variety of coordination problems as well as tensions between the CIUSSS of the montreal region, the regional Directorate of Montreal public health, and the ministry of Health and social Services (MSSS).
Dominique Savoie states that ” most of the p.-d. g. [of CIUSSS Montreal] have argued that some decisions were taken by the authorities, without anyone who is assured beforehand of the feasibility of their application on the montreal territory, and especially of their impacts “.
“Several difficulties in docking” between the CIUSSS and public Health have also been identified on the ground, out in the document, titled” Diagnostic of the coordination of public health activities and the prevention and control of infections during the first wave of the pandemic of the COVID-19 in Montreal.
“The questions of the screening strategies, management of public health resources distributed within CIUSSS, the operationalization of mobile clinics for screening, as well as the sharing of swabs according to the needs, have been particularly thorny, and have generated losses of energy and time “, says one.
Nearly forty stakeholders have been consulted in the preparation of this report. Among them, the presidents, general directors (ceos) of CIUSSS and establishments that are not merged on the island of Montreal, Dr. Mylène Drouin, regional director of public health of Montreal, and the assistant deputy ministers of Health and social Services, including the Dr. Horacio Arruda, national director of the public health.
Decide on the responsibilities
All agree on one thing : the responsibilities between the CIUSSS and public Health need to be clarified. The subject gives rise to ” heated discussions “, according to the author of the document.
With the current administrative structure, the regional Directorate of Montreal public health reports to the CIUSSS du Centre-Sud-de-l’île-de-Montréal, but serves the five CIUSSS of the territory. Dr. Mylène Drouin directs, therefore, not all staff in public health of the metropolis, which complicates the coordination of the screening, among others.
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The doctor is also ” little involvement in the decisions relating to the activities of the screening centres of the CIUSSS and other testing activities under their responsibility “, says the report.
The p.-d. g. of CIUSSS feel they “have the expertise to deploy a massive and coordinated in their respective territories of screening activities, immunization and other direct services to citizens,” said Dominique Savoie. “They denounce a certain lack of coordination of their operations with those of the public Health, such as the mobile clinics screening “, she adds.
The dearth of labour is also at the heart of the concerns. At the height of the crisis, 6450 employees were absent on the health network on the island of Montreal, because of the COVID-19. However, the CIUSSS have had to deploy surge teams in CHSLD-private and private residences for seniors (RPPS), struggling with outbreaks.
In the light of its discussions with stakeholders, Dominique Savoie concludes that there is a “strong consensus” on the fact that the regions least affected by the COVID have not sufficiently contributed to support the attack on montreal.” “The aid came too late and the resources [were] by far insufficient,” she adds.
The CIUSSS de Montréal must however develop a better understanding of the private circles for elders in their territory, in order to facilitate operations during a situation out of control, she said. Their links with them prior to the pandemic, ” were very limited for the most part “.
Asked to react to the conclusions of the report, the minister of Health and social Services, Christian Dubé, has indicated that it ” is not a question of putting your head in the sand “. “The first highlight is the need to better align and coordinate the communication, coordination, and the strike force of all the actors involved within the network of the health in the metropolis,” he said.
To each his strengths and his skills, ” said minister Christian Dubé. “We must leave to the public Health governance and decision-making science, as they are the experts in public health, and we must leave it to the CISSS and the CIUSSS support operations, as they are the experts in logistics. “
The minister emphasized that regular meetings, or even daily, is already taking place between the national authority and the stakeholders in the Montreal region.
Examples of recommendations
The report contains 24 recommendations, including :
The CIUSSS should exclude personnel in public health from the load shedding, in particular to NURSING homes. The regional Directorate of Montreal public health must prepare a plan to mobilize employees, from outside of the network of health, for epidemiological surveys. It could make use of the polling firms or insurance companies.
The CIUSSS must have a plan to govern the sending of resources in NURSING homes and private residences private seniors struggling with outbreaks. Same thing in the case of exchange of resources between the regions. Institutions must also provide a list of volunteers willing to lend a hand in their facilities. The canadian army, called in reinforcement in the spring, can also be a source of inspiration. The military personnel have been deployed within” multidisciplinary teams, ” a model that should be fostered in a possible second wave, the report said.
Private circles for seniors
The CIUSSS need to exchange regularly with seniors homes and NURSING homes private present on their territory. They must accompany them in the development of a contingency plan in the event of an outbreak.
In the event of a second wave, the ministry of Health may need to ration the personal protective equipment, such as surgical masks and N95 masks. According to the report, the minister of Health and social Services should refine its model of rationing taking into account the operating budget and the number of cases of COVID-19, among others.