Local health officials should have tailored government COVID-19 directives to their own regional needs rather than apply them in a rigid, detrimental way, Quebec’s senior health civil servant during the first months of the pandemic told a coroner’s inquest Wednesday.
Yvan Gendron, who was deputy minister until June, 2020, said the health ministry started preparing for the pandemic in mid-January of 2020 and considered the impact on seniors.
However, on March 9, after seeing forecasts that hospital admissions could surge to 35,000 weekly if the virus was left unchecked, the department opted to prioritize hospitals rather than long-term care facilities.
Coroner Géhane Kamel’s inquest, which is looking into the death toll in Quebec nursing homes during the first wave of the pandemic, has heard that two-thirds of the thousands of elderly people who died during the first wave were nursing home residents.
The inquest is focusing on provincial directives, which barred family caregivers from visiting nursing homes and made it harder to hospitalize ailing residents during the initial weeks after COVID-19 first struck.
In a March 19 letter, Mr. Gendron told nursing home administrators that transfers of residents to hospital centres “have to be avoided and be an exceptional step.”
The inquest has heard that the directives were applied to the letter in understaffed, poorly equipped elder-care facilities, depriving their residents of basic care and contributing to the chaos that left thousands dead.
Mr. Gendron said local health authorities and nursing homes needed to make the directives suitable to their own context. He said the health ministry had to take steps to protect the health care system and to contain the spread of the novel coronavirus.
“Should we have changed some words? Perhaps. But we had to get things moving,” he said.
In opening remarks, he praised the fortitude of front-line health workers who faced a new, unpredictable illness “and had to take decisions and also to adjust when the remedies changed.”
Ms. Kamel told Mr. Gendron that, despite his remarks that the directive had to be adapted to local situations, his words were “taken as gospel” by health administrators.
The inquest heard previously that ailing long-term care residents died after being denied a transfer to a hospital where they could have received intravenous rehydration or oxygen masks, which were lacking in nursing homes.
It also came up in the case of Résidence Herron, the private care home in Montreal’s West Island that was taken over by the local health authority on March 29 after most of its staff deserted and residents were left in squalor.
In a March 30 letter justifying the takeover, the local health authority’s chief executive officer, Lynne McVey, criticized Herron, not just for failing to provide proper care but also for transferring several residents to hospital, “going against Quebec’s ministerial directives and pandemic plan.”
Another government decision, in mid-March, to ban visitors from nursing homes, was meant to curb viral transmission. However, it ended up keeping out family caregivers, who lent a hand to overworked employees.
Mr. Gendron said it was clear that if a resident was withering away, a caregiver should have been called to help since humanitarian visits were still allowed.
The inquest heard however that some elderly people died after they were left on their own and no one made sure they were properly fed and hydrated.
Ms. Kamel has often noted the gap between elaborate plans and under-resourced front-line workers.
After hearing Mr. Gendron outline the lengthy workdays senior civil servants faced during the crisis, Ms. Kamel asked, “What happened after your directives, your meetings, your 18-hour days? When the message got to nursing homes, those people went to war with no weapons, no ammunition.”
Mr. Gendron said it was up to the local health authorities to implement the directives. ”The organization on the ground is theirs.”
Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.