As COVID-19 cases pile up in regions of Quebec, some hospitals could approach a tipping point

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The hospital in Maria, Quebec, built in 1954, is one of at least four civic institutions in the city of 2,500 people currently struggling with a COVID-19 epidemic.The 82-bed hospital serves a population of approximately 33,000 in an area that has some of the highest per capita COVID-19 infection rates in the province.

The way the second wave of coronavirus swept through the Gaspé region illustrates how quickly things can turn out badly in the outlying regions of Quebec.

In the Gaspé, as in other remote regions of the province, the spread of the community is rooted in populations that are solidly united and socially active.

Health infrastructure is crumbling. There is a shortage of health workers – and those working in facilities like Maria Hospital say they are exhausted.

The cramped building has been renovated over the years, but even Prime Minister Francois Legault called his emergency service “dysfunctional and dilapidated” when he drove through town in July.

The main admission service is a corridor only about three meters wide. Hospital beds line one of the walls; some are separated from the traffic passing by a curtain.

A union representing paramedics in the region has expressed concern that asymptomatic COVID-19 patients could spread the virus in this part of the hospital.

“Everyone goes through the same place,” said André Tremblay-Roy, vice-president of the union and himself an ambulance driver who transported patients to the hospital last weekend. “The emergency department is really dated.

A nurse consults a computer in the COVID-19 unit of the Sacré-Coeur hospital in Montreal. Some healthcare worker unions say resources are depleted in all regions of Quebec as staff members resign and others are diagnosed with COVID-19. (Ivanoh Demers / CBC)

Brick and mortar buildings are a concern, but the main problem in the Gaspé, as everywhere else, is people.

“The challenge is human resources… but we had a challenge before COVID,” said Connie Jacques, vice-president and general manager of CISSS Gaspésie, the local health authority.

With staff resigning, sick with COVID-19, resources are exhausted

During the first wave of the pandemic, 13,500 healthcare workers across the province were infected, according to a study conducted by the provincial public health research agency. This represented a quarter of all cases.

Nursing aides and nursing assistants accounted for 70% of cases among health workers, in part because almost half of the cases were in long-term care facilities. Almost a third of these 13,500 workers worked in hospitals.

In the Gaspé, the local federation of nurses and the union representing nursing assistants, maintenance workers and cooks both declared that they were resigning in clusters. Others are sick with COVID-19.

Because the figures in the regions are all smaller – the main COVID-19 hospital in Gaspé has 10 beds reserved for coronavirus patients – every absence or empty post has an impact.

“When a person goes out, it makes a big difference,” Jacques said.

The result is having to move staff, and sometimes patients, through the system. This is one of the ways in which the pandemic spread through the CHSLD network in and around Montreal last spring.

Union leaders say it is happening again – this time in the regions.

“We are at the stage now that the large centers were last spring,” said Pierre-Luc Boulay, president of a union that represents nursing aides and support workers in the Gaspé.

The health authority says workers are only moved when “absolutely necessary”.

The big city bottleneck

Eastern Quebec has a kind of safety net: if a person becomes seriously ill, they are usually sent first to Rimouski and, in severe cases, to the Quebec Heart and Lung Institute or to Hôtel-Dieu hospital in Lévis.

But Rimouski, Quebec and Lévis are all seeing an increase in their cases, including among healthcare workers.

Maria’s hospital, in Baie-des-Chaleurs, is at the center of a COVID-19 outbreak in Gaspésie. A union representing paramedics in the region has expressed concern that asymptomatic COVID-19 patients could spread the virus in the hospital’s admission corridor. (Radio Canada)

The Hôtel-Dieu de Lévis is the treatment center for acute cases in Chaudière-Appalaches, one of the regions most early and hardest hit by the second wave. He also deals with epidemics among staff and patients.

One of those patients, a former health region nurse named Raphaël Blouin-Durand, provided a bewildering account of his COVID-19 ordeal to Radio-Canada last week.

When Blouin-Durand started to feel unwell, he first went to his local hospital in Saint-Georges-de-Beauce, where he says he found a situation similar to what Maria’s paramedics describe: non-COVID patients in relative proximity to a suspected COVID -19 cases, and staff walking from area to area.

“Yes, they were changing and there is a door, but the point is that when the minister says that people do not move from red zones to green zones on the same day, that is not true,” he said. declared to Radio-Canada.

When Blouin-Durand’s symptoms worsened a few days later, he was taken to Lévis, where he said harassed workers were also moving from area to area. He said he had also been left unattended in some places and could have easily moved to the hospital despite being diagnosed with COVID-19.

Displacement of patients recovering from COVID-19

Then there is the issue of what to do with recovering patients. Some CHSLDs and residences for the elderly only allow residents to return to their room after having been symptom-free for two weeks.

But in some small regional hospitals with few beds, recovered patients are being moved out of COVID-19 ward long before 14 days have passed.

An elderly COVID-19 positive patient in Maria, who suffered from dementia, was turned away by his retirement home after leaving the hospital. Regional health officials found him a bed in the city’s CHSLD, where he died a few days later. In this case, family members made their anger public.

Several regions have attempted to resolve these types of problems.

The CIUSS Chaudière-Appalaches has opened a “non-traditional” convalescence service opposite the hospital, which has 60 beds, of which about a third are occupied.

A similar establishment has been set up in Saint-Georges, and almost all of its 19 beds are occupied.

Central Quebec struggling with similar issues

In the Mauricie-Center-du-Québec region, halfway between Montreal and Quebec City, the main COVID-19 intake center is the Center hospitalier affilié universitaire régional de Trois-Rivières, where 21 of 40 beds are occupied.

16 additional beds can be made available in Drummondville, 70 kilometers away, said a spokesperson for the CISSS.

The concern in Trois-Rivières is that the establishment is fighting a major epidemic in its neurological unit, with 46 positive cases. Of these, 27 were detected among staff members.

If one looks for good news in the regional image, it can be found by looking north. The Abitibi-Témiscamingue COVID-19 center is at 10% occupancy. There are no COVID-19 patients in intensive care and no outbreaks are currently under investigation.

Decreased morale of health workers

Additional beds and recovery services – like other COVID-19 resources in Quebec City, Gaspé, Saguenay, Trois-Rivières and elsewhere in the regions – did not exist six months ago. In addition, they are mainly staffed with people who theoretically have other jobs.

“It’s very, very hard. Morale is very low, ”Boulay said of the Gaspé attendants’ union. “There are more resources going out than going in… people are tired. They are exhausted.

The Chaudière-Appalaches situation is described in similar terms.

“We had a lot of resignations, people decided to leave for the private sector because of overwork,” said Sonya Leboeuf, vice-president of the union of professional and administrative workers of Chaudière-Appalaches. “Morale is not good. “

The Hôtel-Dieu Hospital in Lévis is the main COVID-19 treatment center in the Chaudière-Appalaches region, which is experiencing a sharp increase in cases. A “non-traditional” convalescent service opposite the hospital. (Raymond Routhier / Radio-Canada)

In Saguenay, which continues to climb the scale of the color-coded alert map of the province, the region’s nurses’ union is sounding the alarm. He maintains that more and more employees are resigning. The health region reports that it is facing 23 separate outbreaks.

Local health officials have declared outbreaks in three retirement homes in recent days, and the Saguenay Police Department is ravaged by the disease; about a fifth of the force is currently either infected or in quarantine pending test results.

“In two days, we had 11 hospitalizations,” said Julie Bouchard from the Saguenay section of the Fédération interprofessionelle de la santé du Québec. “We are worried about whether our network here in Saguenay-Lac-Saint-Jean will be able to cope.

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