Maisonneuve-Rosemont Hospital is seen in Montreal on Saturday, August 23, 2014.The Canadian Press
The second wave of COVID-19 is hitting Quebec hard just as the province’s hospitals are struggling with staff shortage, burnt-out nurses and long waiting lists.
Concerns for the hospitals' ability to handle the resurgence of the novel coronavirus have led the provincial government to declare the regions where most of Quebec’s population lives as “red zones,” the maximum level of alert. Montreal and Quebec City are among the areas under lockdown until Oct. 28.
Even though the spread of the novel coronavirus faded during the summer, there was no respite because the pandemic aggravated long-standing problems in the Quebec hospital network.
François Marquis, the head of intensive care at Maisonneuve-Rosemont Hospital in Montreal, said staff didn’t benefit from a lighter workload during the summer. There was a backlog of cases that had been postponed during the first wave of the pandemic.
“Ailments that were simple to deal with in the spring had now [become] aggravated, there were more complications, the cancers were in more advanced stages,” he said.
Until COVID-19 struck, the hospital addressed the chronic understaffing with a combination of part-time employees, voluntary overtime or standby shifts. That arrangement couldn’t be sustained under the strain created by the pandemic.
“We were papering over the shortage. Everything worked. The hours were done ... now we were seeing the real scale of the lack of personnel,” Dr. Marquis said.
The hardship of dealing with the pandemic also led some nurses to leave the field, he said. Some decided to retire earlier. Others wouldn’t work in intensive care anymore, leaving for less stressful positions in the private sector or to suburban hospitals with lighter caseloads.
In the past two weeks, the tally of COVID-19 hospital cases rose from 217 to 433. “If we are doing nothing we can expect that in two weeks we’ll have 800 hospitalizations and in four weeks we’ll be at 1,600 people hospitalized,” Premier François Legault warned.
At the current pace of transmission, within four weeks, Quebec hospitals will be filled to capacity with coronavirus patients, according to the latest update by the National Institute for Excellence in Health and Social Services. (Know by the French acronym INESSS, the institute evaluates the performance of the health care system for the provincial government.)
The impact of the pandemic is even rippling to hospitals that have no COVID-19 patients. “We are starting to feel it,” said Félix-Olivier Bonneville, a nurse and union official at Sainte-Justine children’s hospital in Montreal.
Hospitals for adults are starting to fill up and are transferring pregnant patients to Sainte-Justine to free up beds, he said. “The birthing unit is overloaded, there is a lot of compulsory on-call work and mandatory overtime to fill the needs.”
In addition, the increase in community transmission has reduced staffing further. In Quebec City, the Heart and Lung Institute, a specialized cardiopulmonary hospital, lost 37 employees who tested positive this fall.
Hospital spokeswoman Valérie Lefrançois said those staffers were infected outside the institute, but their absence forced the closing of two of five operating rooms and the postponement of non-urgent surgeries.
Diane Francoeur, an obstetrician-gynecologist and president of the Federation of Quebec Specialist Doctors, recently worked night shifts at Sainte-Justine. She saw workers who were mentally drained.
“The first wave, there was the intensity of facing the unknown ... now it’s different. People are fed up,” Dr. Francoeur said. “... Even if people are still professional and committed, they are very weary.”
The pandemic also makes the work more solitary, even though it takes place in a crowded setting, she added. It is more complicated to connect with patients and comfort them. During breaks, employees find it harder to get together and bond.
“There are concerns that you can catch COVID in the coffee room or the lunch room, places where people used to be able to get close and encourage each other. Everyone has to be by themselves in a corner,” Dr. Francoeur said.
According to figures from the Quebec Health Department, more than 132,000 Quebeckers are currently on waiting lists for non-urgent operations such as hip replacement, knee replacement or cataract surgery. Nearly 58,000 of those patients have been waiting for more than six months.
On Friday, nine out of 21 Montreal emergency wards were filled beyond capacity, according to the IndexSante.ca website, which tabulates real-time government indicators.
A decree adopted by the province during the spring allowed administrators to override collective agreements to require part-time staffers to work full time and make overtime mandatory.
Mr. Bonneville said this contributed to staff fatigue and resentment. “If you are asked to do overtime, we are not talking about an extra two or three hours. It’s a full shift, so it’s 16 hours in a row.”
Another burden, he said, is standby scheduling, where employees can be summoned on short notice during an off day. “It’s a continuous strain, which is not new in the health sector but which is exacerbated by COVID."
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