Hospitals already struggling to provide critical care, doctors say

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With the Quebec health minister warning that hospitals will be stretched to the limit in the coming days, some health workers say those limits have been exceeded long ago.

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For Dr. Amélie Boisclair, an intensive care physician at Pierre-Le Gardeur Hospital in Terrebonne, if care can only be delivered by drastically reorganizing services and forcing health care staff to work during time off, “that means you’ve It’s been a while since we’ve exceeded our hospital capacity.”

“I have a really hard time understanding when they say we have flexibility,” Boisclair said. “If we had flexibility, I would not have exhausted the staff, all the beds would be open, it would not be a puzzle every day to know where to put a patient and if I will still have room for the next ones. There would be no reorganization of services and the postponement of surgeries and treatments”.

On Thursday, hospitalizations for COVID-19 reached 2,994 in Quebec, a record since the pandemic began. The province has reached Level 4 out of 5 on its service reorganization scale, meaning hospitals have been canceling surgeries and treatments for weeks.

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Boisclair said those cancellations mean Quebec has already started evaluating which patients to serve, though he says he hasn’t done so yet.

“It’s less obvious, because people don’t die on the spot,” he said. “There are no surgeries that are done because a person wakes up one day and says ‘what if I have surgery?’ …a surgery is because there is a medical indication to do it. The difference is that you may be in a ‘good enough’ state to plan for that surgery.”

Health Minister Christian Dubé told a news conference Thursday that he sympathizes with such cases and that the solution is to bring in more staff, which is why he has met with health care unions in recent days to find ways to retain and attract more.

At the same conference, Prime Minister François Legault said experts at the Institut national de santé publique du Québec believe the province is approaching a peak in hospitalizations that will hopefully be followed by a rapid decline (the Institut national d ‘excellence en santé et services sociaux, however, announced Thursday that it no longer has enough data on transmission to publish weekly projections of new cases and hospitalizations in Quebec).

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Despite indications that hospitalizations could peak soon, Legault stressed that the peak remains “extremely high.”

Asked about how the province is preparing for triage care, Dubé said that the situation must be analyzed at the provincial level “since the situation may be worse in some hospitals than in others.”

“The first thing we will do before we move to triage or prioritization is ask other hospitals for help,” he said.

Dr. Frederic Dankoff, an emergency physician at the McGill University Health Center, said inter-institutional patient sharing, a pre-pandemic system for ICU beds, is already happening in Quebec.

“We get a call from the ministry and they say ‘look, this area here has too high a number,’ the MUHC will take two, the CHUM will take two, and then we redeploy them to make sure they can all continue to function,” he said.

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The MUHC’s COVID ward is reaching capacity, causing patients to spend more time in the emergency department, Dankoff said. But he believes the hospital will still be able to do what it needs to do in the coming days, thanks in part to a dedicated staff.

“Whatever happens, the MUHC will be like everyone else, doing our own thing and at the same time trying to do our part in the region that we cover for complex care,” he said.

Due to the complex care it provides, it can only take so long at the MUHC.

“If an organ is available to a patient who is actively on a transplant list, that surgery should be done,” Dankoff said. “If a patient requires life-saving heart surgery for (who would otherwise have) another heart attack in the next week, that surgery needs to be done, and those things continue.”

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Dankoff said one lesson from the SARS outbreak in Canada was to avoid creating “more collateral damage than the disease you’re treating.”

Even though the Omicron variant appears less severe than Delta among the general population, Dankoff said the patients who end up in the hospital, which are mostly Omicron cases at the MUHC right now, are still very sick.

“The criteria is the same for hospitalization: need for oxygen, need for care,” he said.

Some of the MUHC patients affected by Omicron are fully vaccinated transplant patients and unvaccinated patients, including some who cannot be vaccinated for medical reasons.

At Pierre-Le Gardeur Hospital, ICU cases are split 50/50 between vaccinated and unvaccinated patients, according to Boisclair. You often don’t know if patients have Delta or Omicron, but Dankoff echoed that there’s little distinction once they get to that point.

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“In intensive care, everyone is very sick,” he said.

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