Photo: Thomas Coex Agence France-Presse
According to several health workers interviewed, the province has failed in its task adequately protect its medical staff.
One quarter of cases of COVID-19 in Quebec affect the medical staff, a high rate that has left scars — not only physical — on the ground.
According to the ministry of Health and social Services (DHSS), about 13 655 health care workers have been infected by the COVID-19 in Quebec since the beginning of the pandemic, while 54 383 cases have been identified in the whole population. 25 % of reported cases in Quebec, affecting therefore the medical staff. These data relate only to workers in the public network, and exclude staff working in private residences for seniors (RPA) and in the intermediate resources (RI), for which the DHSS said that he did not compile data. The province is further concerned nine deaths among its medical staff.
A heavy balance sheet, which seems to be even heavier than elsewhere. The global average would be 7 %, according to the international Council of nurses (ICN), which brings together 130 national nursing associations around the world. The organization, which has compiled data from some thirty countries, however, emphasises that it is a portrait partial and preliminary, and that the definition of “health care workers” may differ from one country to another.
Attached to Geneva, the director general of the CII, Howard Catton, said put pressure on the world health Organization (WHO) to support this exercise. “It is a scandal that these data are not collected in a standardized manner, and mandatory across the world “, lance-t-il.
The public health Agency of Canada has provided Duty a compilation of the data for all of the canadian provinces. In Ontario, 16.6 % of the cases of COVID-19 affecting the medical staff and in British Columbia, this proportion is 15.9 per cent — the highest rate in the country. The data provided by the Agency indicate that the rate in Quebec is only 12.8 %, a proportion twice as high as this is confirmed by the MSSS. The Agency was unable to provide an explanation to the Duty for several days on this strong disparity.
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How to explain this high rate of infections in Quebec ? The MINISTRY stresses that ” more research is needed to analyse the situation “. Since the health workers — who are more exposed to the virus — are part of the groups prioritized for screening tests, “it is possible that they are over-represented in proportion in the confirmed cases,” says Marie-Claude Lacasse, a spokesperson for the MSSS.
Workers ‘asymptomatic were also infected, one of several” colleagues and residents from various walks of life, to a stage of the pandemic where the knowledge on the COVID did not justify the conclusion that asymptomatic individuals could transmit the disease, ” she adds.
The Duty has tried without success to get the infection rate in Quebec of the staff who worked in the hot zone — which would have helped to have a portrait still more just to the degree of protection of medical personnel ; this, however, is not collected by the DHSS.
It has nevertheless been possible to learn that at CIUSSS of the North-of-the-Island-of-Montreal, 1592 employees have received a positive diagnosis at the COVID-19, whereas 6460 employees have worked in the hot zone (25 %). The CIUSSS du Centre-Sud-de-l’île-de-Montréal, there are 1626 employees positive as 6288 have evolved in hot zone (26 %). The CISSS of the Laurentians, more specifically in NURSING homes, RPA and RI, 259 employees have been reported positive, while 860 were working in the hot zone (30 %).
Both the MSSS that the CIUSSS and the CISSS warn, however, that these data should be interpreted with caution since the health workers have been infected in the community, and not on their places of work.
Loss of confidence
On the ground, the high rate of contamination of the medical staff — which is mainly produced during the early weeks of the pandemic — still leaves traces. According to several health workers interviewed, the province has failed in its task adequately protect its medical staff. Lack of preparation, shortage of medical equipment, guidelines and protocols changing from day to day, even hour-by-hour : the picture drawn is that of a vast improvisation that resulted in a loss of confidence in the national Institute of public health of Quebec (INSPQ).
“The INSPQ, it is no matter what. This is supposedly an independent body. But the rules changed constantly and we really had the feeling that [the guidelines of the INSPQ] evolve according to the stock available, ” growls Françoise Ramel, acting president of the Union of health care professionals of the Centre-South-Island-of-Montreal.
It also speaks clearly of lies. “When you say to a nurse : you have just a coat of protection for the whole day, but this is not serious, you do risk nothing [in thee walking through the room in the room], then we know that this is not possible, that this is not correct…” The nurse believes that the INSPQ would have had to act with transparency and to play an honest game with the medical staff. “If we had explained that we had a big problem, that they no longer had enough shirts and that it was necessary to manage the stock very tightly, the staff would have worked. “
Dr. Joanne Liu also believes that the relationship of trust with the INSPQ has withered. “We were trying to learn at the same time that there was going to act, and to ensure that everyone was included — the people, forgive that you may be in the process of learning. But it is necessary that there is a transparency for it to work, for keep the link of trust with the population, ” stressed the ex-president of Doctors without borders, who has fought the Ebola virus in Africa.
However, it is not uncommon to see an infection rate of medical personnel is higher in the beginning of the outbreak, notes Dr. Liu. “It remains a tragedy that it is absolutely necessary to emphasize […], but the trend in the epidemic, it is that at the beginning there are more infections [among the staff], and then it improves. “A trend that has been observed in Quebec.
This lack of transparency — combined with the fact that the authorities have more than once made to wear the blame for health-care workers to explain the high contamination of medical personnel is also fulminate Natalie Stake-Doucet. The nurse went to lend a hand in a CHSLD in mid-April. Three weeks later, she received a positive diagnosis at the COVID-19. “At the beginning, we were as angels, then of the warriors, and then we become incompetent who does not know how to put on their personal protective equipment correctly “, quips she.
The waltz of the recommendations was yet stunning, this spring, to the point of losing the foot. “We received conflicting direction on the same day. “The issue of wearing a mask was particularly revealing. “In the beginning, colleagues were threatened by their managers because they dared to wear a mask [at the risk of frighten the residents]. Two weeks later, we would be forced to wear one. However, nobody apologized. And after, we are told that it is our fault if it has been infected “, is indignant-she.
The INSPQ has refused our interview requests. The recommendations in force in order to protect the medical personnel would be ” modulated in order to adapt them to new knowledge “, we had mentioned.
On the side of the standards Commission, equity, health and safety in the workplace (CNESST), the organization is said to have made more out of 289 interventions related to the COVID in the health sector after having received 126 complaints and 6 exercises the right of refusal of work from march 13 to June 10, under the Law on health and safety in the workplace (OHSA).
Audréane Lafrenière, a spokesman for the CNESST, recalls that ” the employer must take all measures necessary to protect the health and ensure the safety and the physical integrity of the worker, as provided for in article 51 of the OHSA “, which includes the reduction and control of the risk associated with the COVID-19.
Hierarchy of measures
The contamination of the medical staff, however, is not dependent on the protective equipment, said Dr. Yves Longtin, chief of the Unit of infection prevention and control jewish general Hospital — an establishment which is first class has managed to contain the contamination to its medical staff since the beginning of the pandemic. “In the minds of the people, the personal protective equipment (PPE), it is the most important way [to limit the contamination], but rather, it is the last line of protection,” he explains. The “hierarchy of infection control measures” includes three levels, details there. The first level is composed of the engineering measures, for example, the quality of ventilation and the presence of private rooms. The second includes the protection of the source, such as isolation of infectious patients. Finally, the third level relates to the PPE.
“In the centers of long-term care, often the ventilation is deficient and the infected patients were not always confined to their rooms. So the first two lines were not respected, ” analysis Dr. Longtin, who adds that the health care workers in residences for seniors spend about eight hours a day in a contaminated environment, so that the duration of exposure in the hospitals is far lower. All these factors, combined with shortcomings in the management of PPE, may explain the high rate of contamination of staff, particularly in residences for seniors.
A broad analysis will inevitably be made to dissect the drama which played out in NURSING homes — and in which the contamination of the medical personnel played a key role. The crisis of the C. difficile — a bacterium that has infected approximately 14 000 patients in Quebec between 2002 and 2005 — has had the effect to greatly improve the prevention of infections in the hospitals of the province, said Dr. Longtin. “The report Aucoin [written in the aftermath of the crisis] would not decide on the long-term care. I have the impression that the crisis of the COVID will be equivalent to the long-term care. “A bond that is so hotly anticipated and which will have the effect of preventing a set of hospital-acquired infections each year, spreading death in seniors.
The good student
The jewish general Hospital of Montreal is a good student, he who deplores the fact “only” 135 positive cases in the COVID-19 among its nursing staff. Although it is difficult to isolate with precision the factor that allowed the school to protect more acutely its employees, Dr. Yves Longtin, chief of the Unit of infection prevention and control at the jewish general Hospital, sketch some elements of response.
“We were very strong on both measures,” he explains. First, the mask-wearing has been made compulsory very soon in the hospital. “There is not a single person who walks in the hospital without a mask. Security guards give input, ” says Dr. Longtin. Secondly, the separation physical is respected at all times within the walls of the establishment (except for care of close). In many care settings, the COVID-19 spread between the employees during breaks or lunch hours, often taken in small closed rooms. “Here, we are assured that at all times the detachment was maintained. “
For eye protection of workers, the INSPQ recommends the wearing of goggles or visors. “We had only shields. “And in addition to gowns, gloves and masks recommended, the jewish general Hospital also makes available to its employees caps hair protection and uniforms. A choice motivated by the precautionary principle, ” explains Dr. Longtin. “It is not gone against the recommendations, but it has made some additional equipment available. “