‘Let’s learn from our mistakes’, coroner tells Arruda during CHSLD investigation

“What bothers me a bit about Quebec is that we can go from hero to zero in a fraction of a second,” said coroner Géhane Kamel.

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Quebec long-term care homes received COVID-19 planning guides the day before the province closed in mid-March 2020, public health director Dr. Horacio Arruda stated Monday in the coroner’s investigation. about deaths in those institutions.


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Arruda’s long-awaited testimony during the provincial component of the investigation began last week, when he said that a labor shortage, a fragile health care network, and many employees who fell ill resulted in a perfect storm of negative circumstances when beginning of the pandemic.

On Monday, Arruda said that in mid-February 2020 health institutions were asked to run simulations of the province’s 2006 pandemic plan to prepare for COVID-19, and by the end of the month, they were asked to include a COVID-19 annex. in those plans.

When asked why the province’s pandemic plan had not been updated more recently, Arruda replied: “We must understand that pandemics are relatively rare.”

With much still unknown about COVID-19 in January and February 2020, Arruda said his department kept an eye on the situation and began preparing for a possible community transmission scenario. The government’s decision to close the province on March 13 was a swift response, he said, allowing them to ban visits to long-term care homes.


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Patrick Martin-Ménard, the attorney representing the families of the deceased residents, asked Arruda if he considered, when preparing for possible scenarios, the possibility of the virus being transmitted to CHSLD residents.

“We knew we had to protect them,” Arruda said, noting that residents of long-term care homes are among the most vulnerable in society.

The coroner Géhane Kamel, who presides over the hearings, said that he was upset to hear that the CHSLDs were included in the scenarios from January and February, considering that other testimonies have shown that “the preparation was nil”.

“It’s like one of the first times that I realize this, that these discussions took place even before March 13,” he said. “It’s a bit disturbing.”


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Martin-Ménard asked Arruda if he thought the CHSLDs were a “blind spot” as the province prepared to handle the pandemic.

“It depends on what you mean by ‘blind spot,'” Arruda replied. “We knew that older people, wherever they were, were at risk.”

Arruda said the chaos described during various testimonies in recent months has raised questions about organizing in long-term care homes.

Several attorneys questioned Arruda on Monday, asking questions about the first directives to isolate healthcare workers, the decision to ban caregivers from CHSLDs, and the initial decision not to enforce the use of N-95 masks, all which appear to have played a role in the impact of the pandemic on households.

He was also asked to respond to a question on Thursday that he was unable to answer at the time: whether or not to recommend stopping the movement of personnel between long-term care homes at the start of the pandemic (which testimonies have shown contributed to the spread of the virus).


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After checking over the weekend, Arruda told the investigation that he did not make that recommendation.

“It was discussed online with management,” he said, “but I did not issue a recommendation.”

Monday’s questioning marked the end of Arruda’s testimony. Thanking him for his time, Kamel said that he would not have wanted to be in Arruda’s place at the beginning of the pandemic and that he would not want to be in it today either.

“I want to tell you that what bothers me a little bit about Quebec is that we can go from hero to zero in a fraction of a second, and that really bothers me,” Kamel said. “I wish you to continue your work. … I want to thank you, on behalf of the coroner’s office, for helping to try to save lives. “

Arruda responded that saving as many lives as possible has always been his motive and he was aware of the difficulties families went through during the pandemic.


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“I hope that the coroner’s investigation process allows families to have their questions answered so that they can experience a more normal form of grief, because grief was not very normal in these situations and I am very aware of that,” he said. .

“Let’s learn from our mistakes,” Kamel replied.

The coroner’s investigation is scheduled to continue through Thursday.

The Canadian press contributed to this report.

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