Analysis: Quebec's health-care system has already reached the point of no return

The situation is so dire that many Quebecers haven't seemed to notice that emergency-room overcrowding has returned with a vengeance.

Aaron Derfel 4 minute read January 21, 2022

As Quebec posted 98 COVID-19 deaths on Thursday — the highest to date during the Omicron-fuelled fifth wave — it’s clear the pandemic has laid bare the severe shortcomings of the province’s health-care system — a ticking time bomb that was at least two decades in the making.

Consider how the Health Ministry has responded to this fifth wave of infections. First, in late December, the provincial government confirmed that authorities would stop testing everyone for the SARS-CoV-2 virus, and Dr. Horacio Arruda (chief of public health at the time) recommended “autogestion” — or self-administration of rapid tests by Quebecers at home.

Health Minister Christian Dubé then announced that some infected workers would have to return to hospitals and nursing homes while still carrying the coronavirus — an acknowledgement that staffing levels were no longer sufficient.

Soon after, the surreal started to occur. So many patients were infected with COVID on one of the floors of the Maimonides Geriatric Centre in Côte-St-Luc that it made more sense to isolate in their rooms those residents testing negative than the positives. The Jewish General Hospital launched a pilot project allowing some COVID patients to remain home with oxygen tanks in what has been dubbed a virtual care ward. (Radio-Canada reported Thursday that the government wants to expand home oxygen therapy for COVID patients across the whole network.)

Hospitals across Quebec have resumed délestage — a euphemistic term in French that means purposely ramping down clinical activities in an overwhelmed hospital system. For the first time since the pandemic began two years ago, cancer and heart patients are being told that their scheduled surgeries are being postponed.

The situation is so dire that many Quebecers haven’t seemed to notice that emergency-room overcrowding had returned with a vengeance in Montreal and other regions of Quebec, with some hospital ERs reporting occupancy rates as high as 183 per cent.

All this culminated with the unveiling on Tuesday of a proposed guide prioritizing health care in the fifth wave which Dr. Lucie Opatrny, an assistant deputy health minister, described as providing “B” level care to patients instead of “A+.” That plan — yet to be fully activated — calls for family members and caregivers to provide assistance in hospitals.

On Jan. 11, amid rising COVID hospitalizations and deaths, Dubé warned that Quebec hospitals were “very close to the point of no return.” Two days later, however, Premier François Legault declared seeing the “light at the end of the tunnel.” And on Thursday, Legault repeated that phrase despite the 98 new COVID deaths.

The latest wave of COVID casualties in Quebec has surpassed the one last January. What’s more, in the span of a week, Quebec went from ranking third among industrialized jurisdictions around the world in its seven-day average of COVID deaths per million population to first, according to the Institut nationale de santé publique.

(Rather than discuss the latest mortality figures — and what this might signify — Legault went into detail instead about deaths that occurred in the pandemic from 2020 to four months ago. He also discussed an arcane term — “surmortalité” or excess deaths — that few Quebecers save epidemiologists truly understand.)

The accumulation of health-care measures, taken together, suggest strongly that Quebec’s system has already reached the point of no return.

There have been times when that system has been sorely tested. In 1999, the government bused cancer patients to Plattsburgh for radiotherapy because of a shortage of oncology resources. In 2003-2004, the C. difficile superbug killed more than 1,400 Quebecers, underscoring the lack of proper infection control in underfunded hospitals.

But nothing compares to the situation today. More than 12,600 Quebecers have so far died in the pandemic — the highest mortality rate per capita of any province, by far.

Legault suggested COVID hospitalizations may well have peaked in this wave, pointing out that the total number dipped by 14 on Thursday to 3,411. Whether this is indeed a peak will have to be borne out by tallies taken in the coming days. In the meantime, even as other provinces and countries have moved to relax public health restrictions, Legault said it’s too soon for Quebec to consider doing the same.

The reason? “We’re at the limit of the limit of our hospitals,” he explained.

Dubé pledged Thursday to carry out a health-care reform (or “refondation” in French) — a tacit acknowledgement that the system has collapsed.

This pandemic will one day end. But perhaps it’s time for Quebec and countries around the world to consider something even bolder — not merely a reform — but an international Marshall Plan to rebuild health systems and prevent another pandemic in the future. Among other things, this would involve massive investments in better ventilation in buildings and air transportation to guard against COVID and every other respiratory virus, including the flu.