More than half of the hospital beds occupied in Quebec are used for patients who have COVID-19. To make room, many regions have triggered the maximum load shedding level, which allows up to 80% of elective surgeries to be postponed.
Hospitals are not designed to handle pandemics, believes Cyril Stein, who has worked as a manager of emergency humanitarian operations in many countries. In particular, he set up a treatment center during the cholera epidemic in Haiti in 2011.
The consultant proposes to set up regional care centers for patients with COVID-19. These infrastructures, which could be deployed near highways or airports, would bring together under one roof the human and material resources needed to treat mild, moderate or severe forms of the disease.
The Canadian Armed Forces would be responsible for logistics and medical support, with support from civilian medical personnel.
Disease care centers are generally deployed in international humanitarian operations during epidemics. At the start of the pandemic, the World Health Organization proposed to set up specialized centers if the capacity of the health system was exceeded.
Examples elsewhere in the world
Countries have bet on this strategy at different times of the pandemic.
In the United Kingdom, the government ordered at the end of December the setting up of eight temporary hospitals which will be able to accommodate 100 patients each given the resurgence of declared cases.
At the very start of the pandemic, China rushed to build hospitals for COVID-19 patients.
Tents housing field hospitals popped up in New York at the height of the first wave, including on the grounds of Downstate Medical Center in Brooklyn.
It happened in very special circumstances., nuance however the Franco-American neurologist who worked there, Julien Cavanagh.
The temporary facilities were opposite a normal hospital, which made it possible to quickly direct patients according to their pathology. And during the first wave, patients who had health problems other than COVID-19 did not show up at the hospital, which is no longer the case.
” What do we do when patients come for scheduled hospitalization and we have a chance discovery of COVID-19 infection? All of this, in the end, makes things very complicated. “
Not in the plans
Moreover, the Ministry of Health and Social Services of Quebec (MSSS) does not currently plan to set up regional centers for COVID.
We arrive at the hospital. We have a diagnosis of COVID in the first days. We have difficulty breathing. All of a sudden, we need intensive care and a ventilator. Do you think that a place in the region set up quickly enough will have the manpower, the equipment or the skill to do the treatment? I do not think so, he argues.
The various players in the health network agree: the shortage of caregivers is making things worse. They are more than 20,000 employees to be absent due to COVID-19. In a press briefing, Prime Minister François Legault admitted to needing 1,000 more people in hospitals to get through the next few weeks.
The help of army medical personnel would remain insufficient, believes the medical chief of the critical care program for the CIUSSS du Nord-de-l’Île-de-Montréal, Patrick Bellemare.
We will not be able to control the two clienteles, then to provide completely separate support that would allow some form of economy of scale, he believes.
Convalescent centers as a solution?
Transitional resources that would support patients once acute care is over could help reduce pressure on hospitals, believes Dr. Bellemare. Similar centers exist in Laval, Lévis and Québec in particular.
theMSSS encourages establishments to put in place the necessary measures, such as the use of non-traditional places of care to free up hospital capacity. Human resources issues, however, make this approach more difficult in certain regions, admits the ministry.
Caregivers could be brought in to provide services at these facilities, adds former health manager David Levine.
They come, they have a little training, all the necessary equipment for protection, and provide assistance as they do for their loved one at home or in long-term care centers, he opines.