VALÉRIAN MAZATAUD THE DUTY
In 100 days of a health emergency, the pandemic has exposed some of the flaws of the health care network and failures in the management of disasters. Lessons to be learned from the first wave, in order to better prepare for the next.
It all started there : there is a shortage of personal protective equipment (PPE), ration far-off hospitals, contamination of the employees, become sparks in the forest-fragile and arid NURSING homes, responsible for the protection of the most vulnerable patients. “This is the time to rebuild in a massive way our reserves of masks, PPE and medication. In the future, a single agency should manage the stocks, to know in real time the amount of material that is found where, and be able to send it in priority where they are most needed, based on the epidemiological data of the day, ” suggests Dr. François de Champlain, an emergency physician and team leader in trauma at McGill university health Centre (MUHC). At the beginning of the crisis, of acute care hospitals were armored like fortresses, others poorly filled, whereas in NURSING homes, the troops were at the front, without protection.
Addition to the dinosaurs
To fill a patient’s file, Dr. de Champlain has yet to open up to five interfaces on the computer. “In the er, my requests are still going through a fax machine. We are working with an archaic system, and the pandemic has taken advantage of this weak link. “Dilapidated state of some buildings, bureaucracy ankylosant several sections of the vast network of health, centralised decisions and management in closed vessels have put a spoke in the wheel, and bound the hands of several actors. Several NURSING homes, beheaded their directions by the reform Module, was not able to respond tit for tat. “Computerization, it is the sinews of war. We must address that urgently, make it a national priority. This is the key to disaster response “, adds Robert Choinière, demographer and advisor to the Institut national d’excellence en santé et services sociaux (INESSS).
The pandemic is breaking and entering at the most vulnerable, where the door was open. “It is necessary to quickly rethink the environments of life for these people, make them safer, stop the use of agencies, personnel, and stabilize the care teams,” says Dr. Marie-France Raynault, professor emeritus at the School of public health of the University of Montreal. “We wouldn’t have to choose between that would be neat or not to the hospital, but it was done indirectly by neglecting people in NURSING homes,” says Robert Choinière. Should we initiate a dramatic shift towards more home care ? Yes, but this will not be enough, ” adds the latter. “We want to reform NURSING homes, but the population is aging, and the number of seniors seriously ill who cannot be cared for at home also increases. Even with 10 000 employees more, the crisis of the CHSLD is not finished. It’s been 10 years that we have the same number of beds, and we need more. “An investigation by the coroner is in court, and the prime minister François Legault has promised the holding of a scientific and technical commission on the causes of the catastrophes that occurred in NURSING homes.
To increase the surveillance
The ability to hunt down any emerging virus depends on a sentinel network agile. However, the cuts are massive in public health have emasculated the monitoring network. “For the next wave, it is necessary to increase our ability to find cases quickly. This is not the call-by-phone that can only adjust it if you end up with 200 cases in an outbreak, ” says Dr. Karl Weiss, infectious diseases physician at the jewish general Hospital. The professor at the University of Montreal believes that we will be able to completely avoid the technological solutions to tracing. Screen remains the sinews of war, and to speed up case follow-up with a software for search of contacts. “The software must be implemented as soon as possible to avoid that the data are still captured on paper. For the screening, it feels a loosening. There is a need to target work environments, risk, slaughterhouses, agricultural workers. For that, there should be at least 1000 public health inspectors in workplaces, ” adds Dr. Raynault.
The top masks
The mask ? No, yes, maybe. The greater Toronto area has just the place in the metro. Otherwise, stay a metre, a metre and a half, to two meters of distance ? Humans are neither accurate nor malleable as a gallon measure. The shilly-shallying of the government Legault and the hair-splitting on the actual usefulness of the mask have greatly inhibited its adoption by the population, consider the experts of public health. Science changes, but the public has lost its latin. “It will have to be more precise in the communication, as in public health, the message, it is the prescription. The prevention is based in large part on adherence to the guidelines, ” adds Dr. Raynault. “It is very important since the distancing is reduced, and the business allowed,” according to Michel Camus, a former epidemiologist with Health Canada. “If 80 % of people wear it, it would have the effect of a vaccine, without the vaccine. 140 countries have done [mandatory] Why do we compromise ?’, raises the Dr of Champlain. Without punishing anyone else, the mask should be distributed and promoted, think Dr. Weiss. Widely worn in Vietnam and Korea, the cover face has allowed these countries to be spared by the COVID-19. “Before the next wave, use all the tools possible, including the mask. Because there, there is nothing, says Dr. Weiss. No vaccine, no treatment. “
Heal, always heal
One of the mistakes of the last few months has been to put all the eggs in the same basket, and put on the ice almost all of the hospital operations, say several observers. A judgment that took its toll on the health of patients who are already ill, become indirect victims of the pandemic. Stroke, advanced cancer, cerebral hemorrhage : all conditions favored by neutral medical follow-up, which he will one day raise the death toll. “It must be able to deal with an epidemic, while continuing to care for people who need it,” says Dr. Karl Weiss. “It was déconfiné the company before déconfiner hospitals. It is not true that telemedicine can solve the whole problem, ” said Dr. de Champlain. “Monopolize hospitals hyperspécialisés, particularly in trauma or cardiac surgery, to make of the centres priority of processing of the COVID-19, has had a strong impact on their mission and infected some of the staff. “We must have the humility to change plans, to rethink the roles of each for our intensive care units are not mobilized or by patients COVID. With the déconfinement, already there are more accidents and injuries. And it must be able to provide this care-there quickly. “
Keep an eye on the deprived neighbourhoods
One of the findings that emerge from the crisis of the COVID-19, is that the coronavirus strikes stronger in disadvantaged neighborhoods. Thus, cases of contamination are two and a half times more numerous in poor neighbourhoods and in areas more affluent of the metropolis, observed the public health Directorate. In this chapter, Montréal-Nord and Mercier–Hochelaga-Maisonneuve are at the top of the list.
If a second wave occurs, the municipal and health authorities should be prompt to act in these neighborhoods more vulnerable, writes Sasha Dyck, a nurse by profession and active citizen in Parc-Extension, a neighbourhood where the poverty index is high. “We sacrificed a bit of the seniors and health care workers during the first wave. I fear that we sacrifice of precarious workers in the second, ” he says.
According to him, the authorities must act in matters of housing and early detection, with particular attention to the working conditions of precariously employed people, such as refugees, particularly those of the agri-food sector, where inspections are insufficient, ” he said.
The mayor of Montréal-Nord, Christine Black, believes that it is important, in the case of a second wave, to rapidly deploy screening clinics and mobile to advertise the presence. The pandemic has also demonstrated that it was necessary to adapt the communication with the citizens : “there are people who do not have access to the Internet or the television. It takes other measures, such as the bodies on the ground and the trucks criers. “
But according to it, actions in the medium and long term will be also required : “we need to invest now in projects that may have an impact on employment, education and access to doctors. “
A clear message, and obligations of result
The prime minister François Legault addressed to the québec population on a daily basis from the room Evelyn-Dumas of the hill. On more than one occasion, the government machine was unable to follow the pace of its announcements. And she has sometimes contradicted.
Thousands of applications from volunteers is lost in the meanders of the Web site I contribute to. Family caregivers have found themselves in front of closed doors despite the will of Quebec to allow them to regain their own. Employees of the health network have found themselves exposed to an infection to the COVID-19 after receiving instructions from managers that contrasted with the demands of Quebec. School principals and teachers have had to navigate to a view, because the instructions of the ministry of Education proceeded, but did not look.
Were the messages clear enough ? Or the paths that they have borrowed in the State apparatus have they distorted ? “Me, I think, in every establishment, there should be a boss or a boss “, has already ruled, François Legault. The head of government will follow to the eye the patrons of the CISSS and CIUSSS, to which he has set of ” obligations of result “. What to avoid repeat calls to the help to doctors, specialists, and soldiers of the canadian army, or even the use of mps and ministers so that they have masks and visors to lend a hand in a CHSLD.
Marie-Michele Sioui and Marco Bélair-Cirino
A turn techno on the horizon
In the intimate atmosphere of the Cinquième Salle of Place des Arts, the minister Jean-François Roberge was attended by the who’s who of education network, this week, for his announcement on the return to school in the fall. The managers all had the same concern : prepare for the second wave of infections with the coronavirus.
The back-to-school will be good to do as much as possible in the classroom, from preschool up to the university, the watchword is to be prepared to offer distance education. Anytime. Without notice. It seems clear that blended learning is taking hold, if only in part, with or without a pandemic.
The example of Ontario, and other States, who have turned away towards the distance education in the month of march, showed cruelly the delay of the province of Quebec for the ” technopédagogie “.
An important part of the faculty is wary of the enthusiasm for the technology. These teachers remind us that the online education is an easy way to offer low-cost and very profitable, especially to students (local or foreign) of the network college or university. The majority of the profs went out of their way to provide follow-up teaching to their students during the pandemic, but some privately admit that they fear they will have demonstrated to their patrons the virtues of online education.
Some teachers, overwhelmed by the technological turn, were ahead of their retirement. Those who remain prepare to meet the challenge of the post-COVID : take advantage of technological advances without sacrificing the inestimable value of the teaching presence.
“We have been too far in the process of globalization”
This health crisis has demonstrated the rapid response capacity of the governments, of the central bank and of the companies with an exceptional situation and not planned. It has also laid bare the limits of globalization.
“In this globalization of 10 to 12 years, the pendulum has gone a little too far. The crisis shows us that it is not healthy to see all of these supply chains are completely delocalized ” retains Gaétan Morin, president and chief executive officer of the Fonds de solidarité FTQ.
The pandemic has brought us back to our ability to meet our own basic needs. “We had some very fine examples of rehabilitation rapid assembly lines, and creativity of our québec entrepreneurs,” continues Gaétan Morin. The question to ask is : am I too built around the world ? “
François Dupuis agrees. “Without falling into the protectionism, it is clear from this crisis a need for greater autonomy and protection of key sectors. “The vice-president and chief economist Desjardins group adds that the health crisis has demonstrated the importance of having public finances in order. Ottawa had a sustainable level of debt before facing the pandemic, while Quebec, in spite of a high debt ratio, could capitalize on a margin of budgetary manoeuvre.
François Dupuis also said he was surprised by the ability of actors to make quickly the transition to digital. And this crisis has highlighted the telework. “We’re headed probably to a hybrid model, which will be the case of a number of companies. Workers will be less likely to want to work five days per week in the office. “
New models more marked than ever
The pandemic has cruelly highlighted the disaster of the social distancing in an environment that carbide in the exchange and communion. A second wave will do nothing to change this essence, even with the emergence of new models, more modest, more marked than ever, which is cautiously put in place. As the crisis has taught us that even if the imaginary is on the side of the artists, there comes a time when the phrase “re-inventing” no longer passes. That the living arts are NOT digital arts. It is time, in the matter, the GAFAM pay their share. The financial model is in a shambles, that it is necessary to rethink the support. A budget of 400 million dollars, it includes a lot of old money. It was also understood that a live concert on Facebook Live, it’s nice, but as 107 concerts on Facebook Live, it’s alienating. There is nothing like browsing in a bookstore. That we should never take for granted the action of strolling, by the way. Olivier Kemeid has a hell of a beautiful feather. That make-up artists and hairdressers are the creators of the utmost importance. That even the prime minister waits for the end of District 31. That nothing will ever replace an outing to the theatre. Emissions before an audience, without an audience, it is good also. That CAMILO is a hero. That Ricardo has a superfibre of youtubeur. That even a vile breeder of tigers in the cup Longueuil can become a planetary star. But, fundamentally, it was understood that without culture, this containment would have been a damn sight more painful.