'Miserable and only going to get worse'; Quebec hospitals hit the breaking point
Since March, Quebec's health-care workers have warned that the COVID-19 pandemic could threaten to overwhelm the entire system.
Now, with the province routinely setting records for daily cases of the virus, it appears their fears have been realized.
COVID patients flooding emergency rooms and intensive care units have combined with those suffering normal winter ailments to produce a situation that MUHC emergency room doctor Mitch Shulman called “miserable and only going to get worse.”
“Every year, January, February and March are horrible,” he said.
“Every year, the government says 'Oh my god, it's the flu.' Why should this year be any different? On top of it, you have a tremendous shortage of staff. An excessive number of nurses have left the profession. This has been a recurring problem with orderlies and other people we count on to keep the system going.”
At the Jewish General Hospital, where under normal circumstances there are 24 intensive care beds, capacity has been increased to 30, with 20 of those occupied by COVID-19 patients, according to ICU chief Paul Warshawsky.
"All the ICUs in Montreal in particular are working to increase their capacity," he said. "There are plans to go up to 32 to 34, depending on how we decide to do it. Then we have to open a second ICU, which we did in the first wave in what was the cardiology department. But in the first wave, that was a little easier to do because for reasons we still don't understand, there were less cardiac patients."
Denyse Joseph, a vice-president for nursing union FIQ, warned that life-and-death decisions are on the horizon as finite equipment and manpower are used up.
Hospitals are not just facing influxes of COVID patients, but are still attempting to keep up with other health-care needs, she said -- elective surgeries, tests, appointments. While much of this was cancelled during the pandemic's first wave, that hasn't been the case during the second.
"If the numbers of COVID-19 continue to increase... we will have to look at, again, stopping probably even more surgeries and even more appointments, and at one point in a hospital there's a limit of how many patients you can have on respirators," she said.
"If, even [after] stopping the regular activities, we have too many patients that need these respirators, there are going to be choices that will have to be made."
During the first wave, Warshawsky said staff from other parts of the hospital, such as the cardiac care unit, were re-deployed to work with COVID patients. While that's the plan for the second wave, "right now, those nurses are still doing their usual duties, so they're not re-deployable at this moment in time and that's what's giving us uncertainty and anxiety."
HOSPITAL OCCUPANCY SOARS
Nurse Joanne Scullion said St. Mary's Hospital is already “bursting at the seams.”
“It’s because we’re having, not only with the COVID, but we had a few icy days, so there were a lot of fractures, a lot of broken bones," she said.
"Add that with people coming in with cardiac problems. All the normal things that people come into emergency for. Factor in COVID, and it’s a recipe for disaster.”
As of Tuesday, 1,317 people in Quebec are hospitalized due to COVID-19. Of those, 194 are in ICUs.
A study published last week by the Institut national d'excellence en santé et services sociaux, in collaboration with McGill University, predicted that the situation in Montreal and its surrounding regions would grow increasingly dire in the coming weeks.
“For the first time, an overrun of dedicated capacities withing three weeks is likely (a risk of more than 50 per cent), especially since two-thirds of the designated beds are already occupied,” it read.
Already, on Tuesday, occupancy rates of Quebec emergency rooms stand at 102 per cent, according to indexsante.ca, with rates in Montreal standing at 113 per cent.
Looking at individual hospitals, that number spikes to as high as 157 per cent at Maisonneuve-Rosemont, 155 per cent at the Universite de Montreal Hospital Centre, 147 per cent at Lasalle Hospital and 115 per cent at the Royal Victoria Hospital.
In total, seven of Quebec's region's have ER occupancy rates that are “very high,” four have rates that are “elevated,” and only five are listed as “normal.”
More than beds, there is increasing risk of burnout among hospital support staff, who are facing "tremendous demands," according to Shulman.
“The registration clerks, the nurses, the orderlies are all being forced to work either overtime, being called in for additional shifts or are being asked to work when they are supposed to be off,” he said.
“If it wasn't for them and their extraordinary efforts, the system would be falling apart. As it is, it's strained to the nth degree.... and none of them have been vaccinated yet.”
Quebec Premier Francois Legault is scheduled to make a rare late-afternoon address on Wednesday, in which it is anticipated he will announce more stringent lockdown measures, including potentially a nighttime curfew, which a government source has confirmed the province is considering.
Shulman said that although a lockdown is needed, government action can only go so far.
“A lockdown is only as effective as the people who follow it,” he said. “If we don't do what we need to do as individuals, all of us, no lockdown is going to make a difference.”
Shulman said the issues facing Quebec's hospitals could have been alleviated with better preparation.
“The government should have vaccinated (hospital staff) first, should have made every effort possible to bring in additional staffing first," he said.
"They knew we were having a second wave. They warned us it would be worse than the first and they had time to prepare. The government has failed us horribly and all we can do right now is try to stay out of the emergency rooms.”