Transfers of patients from hospitals to CHSLDs did increase significantly during the first wave of the pandemic, but they did not lead to a marked increase in mortality in these settings, noted researchers commissioned by the Health and Welfare Commissioner (CSBE).
From there to affirming that “there is no one who has suffered the negative consequences of these transfers”, as Prime Minister François Legault had argued in April 2020, there is however a step. In fact, “we estimate that approximately 3% of patients transferred during this period developed an infection within 14 days of admission,” noted doctors Quoc Dinh Nguyen, Robert Goulden and Sophie Zhang in their epidemiological report in support for the work of the CSBE.
The commissioner mandated these three experts to identify, among other things, the explanatory factors for deaths in CHSLDs. Result: “transfers from hospitals to accommodation facilities have not been observed as a factor having contributed to the spread of the virus”, summarized CSBE, Joanne Castonguay on Wednesday.
In interview at Duty, Dr. Nguyen explained that the researchers tried to determine whether the CHSLDs that received the highest number of patients transferred from hospitals had “more mortality” than those that received fewer. All this while controlling a series of variables such as density, community transmission and size. “Because obviously, the larger CHSLDs receive more transfers, but also have more employees, and therefore more deaths eventually,” said the epidemiologist of the Center hospitalier de l’Université de Montréal.
“When we control for all of these variables, we cannot find a strong association between transfers and the number of residents who eventually die,” he summarized. “The most predominant factors to explain the death are probably community transmission, density, tests, mask, protective equipment, etc. All of these variables are more preponderant than the transfer of residents,” he continued.
Stress “on already limited resources”
Transfers from hospitals to CHSLDs have not been smooth sailing, however. Dr. Nguyen and his team determined that these movements had increased by 18% between March 11 and April 7, 2020. This percentage is consistent with that advanced by the former Minister of Health Danielle McCann at the coroner’s inquest. on deaths in CHSLDs.
However, the increase in transfers has “increased the vulnerability and the burden of these environments less endowed with staff and material resources as the epidemic spread there”, noted the researchers. “It was still a choice to favor hospitals, to empty hospitals,” recalled Dr. Nguyen. “And that is putting additional stress on already limited resources in CHSLDs. So, even if it does not have a direct impact on mortality, it still has an impact on the basic care that can be received, the shortage of personnel, etc. »
In his opinion, it would be risky to compare the situation prevailing during the first wave to the current one. Over the past few days, overwhelmed hospitals have started to transfer some of their patients back to CHSLDs.
“What is very different from the discussion that is taking place right now in Quebec is that at that time [lors de la première vague], the hospitals were not overflowing. […] We should not make the mistake of considering the current situation as the first wave, ”warned the epidemiologist.