Why COVID-19 represents such a threat to Quebecs hospital system this winter

Quebec has passed a sobering landmark as the holiday season approaches, with more than 1,000 people in hospital for COVID-19 for the first time since the spring.

Mounting hospitalizations have been cited by Premier François Legault as a reason for the lockdown measures imposed over the break. But those numbers only tell part of the story.

New research from Quebec’s public health research institute, the INSPQ, adds detail and definition to the challenging picture that is treating COVID-19.

Not only is the disease deadly, it also has a way of draining human and other resources at an alarming pace.

According to an INSPQ study, the average stay for the 5,863 hospital admissions for COVID-19 during the spring wave was 17 days.

The average hospital stay for seasonal influenza is six days according to the study, which analyzed 26,154 hospitalizations over the past eight flu seasons (2011-2019). 

On average over that period, there were 3,200 hospital admissions for influenza each year in Quebec.

(The study also found that those hospitalized with COVID-19 are six times more likely to die than those hospitalized with the flu).

There are also a growing number of outbreaks in hospitals, in Montreal and beyond, putting further pressure on the network.

In its update this week, Montreal public health reported more than 30 outbreaks. Verdun Hospital, in particular, is struggling to contain the virus, with outbreaks in four units.

“We have a problem of manpower, but we also have a problem that there’s more and more patients being infected,” said Dr. Gilbert Boucher, head of Quebec’s association of emergency medicine specialists.

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“The situation in the emergencies in Montreal is very congested. Almost every hospital in Montreal has been hit with outbreaks and they’ve had to close beds here and there — sometimes it’s 10 beds, sometimes it’s 40 beds.”

Beyond the numbers

At the peak of the first wave, there were more than 1,800 people in hospital with COVID-19. Health Minister Christian Dubé has said the province can handle 2,000 this time around.

But in a year-end interview with Radio-Canada this week, Legault sketched out another aspect of the challenge posed by COVID-19: hospital beds aren’t evenly distributed across the province, and neither are coronavirus cases.

“It’s not the overall number,” he said. “You have to look at it region by region.”

Legault was clear on another point, chiefly that the COVID-19 hospital caseload is chewing up the capacity the system has to deal with other health problems, some of them severe.

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Already, hospitals have been forced to once again scale back surgeries and other services to free up resources for COVID-19 patients.

Dr. François Marquis, the head of intensive care at Maisonneuve-Rosemont Hospital, said there’s a limit to what can be done.

Even if there are beds available, he told Radio-Canada, there are a limited number of personnel available and, while he said there is no shortage of ventilators, other medical equipment can be harder to come by.

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More than 7,000 health-workers are now off work because of the virus, and some regional health authorities have refused to grant nurses vacation.

The CHU de Québec-Université Laval hospital sent out an email to staff, offering to buy back their time off to help address the shortage.

In Sept-Îles, hospital officials transferred 15 non-critical patients into a temporary “non-traditional site” adjacent to a retirement home this week, in order to open beds for coronavirus patients.

At 43, the number of active infections in the health region might appear modest, and there is just one person currently hospitalized with COVID-19. But case numbers have doubled since Dec. 8, and resources are thin.

According to a government document listing second-wave resources, the hospital has five COVID-specific beds.

What’s to come in 2021

The latest modelling from the province’s INESSS health research group, made public last Friday, indicates some regions outside Montreal could find themselves blowing through their maximum capacity in as little as three weeks’ time.

Researchers noted 60 per cent of regular beds designated for COVID-19 patients in outlying regions are already occupied and breaking the planned occupancy limits “cannot be ruled out.”

Sonia Bélanger, head of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, at a news conference earlier this week, warned of rising hospitalizations in the city. (Ivanoh Demers/Radio-Canada)

They also noted their forecast may underestimate the situation slightly.

The INESSS is set to update its projections again today, but given the developments this week it’s unlikely things will improve.

January and February are traditionally the worst months in terms of emergency capacity, according to data provided by the province’s Health Ministry.

And in fact, based on the averages, many of the people admitted to hospital in the coming days will still be there when the calendar switches to 2021.

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