If Quebec still has to come to terms with the limits imposed by an ugly curfew, it is not because it is avant-garde nor either because its epidemiological portrait or its vaccine performance are lamentable – quite the contrary, in in both cases, it does not position itself in a worse way than the others. No, if the use of draconian measures is in force here, it is because our health system is like a real house of cards.
A fatal combination is about to give it the final blow over the next few days, if the projections are true: a staggering rate of absenteeism of the nursing staff combined with an insufficient availability of the number of hospital beds will place us soon faced with difficult, if not tragic, choices. Correction: we are already faced with difficult choices. Even if they do not make the headlines, major changes in the delivery of health services are already underway: postponements of diagnostic tests, surgeries, cancellation of appointments in the crucial area of mental health. , transfers of pregnant patients to other establishments for childbirth, etc.
While attention is naturally on all the statistics surrounding the fifth wave of COVID-19, more statistics are brewing behind the scenes. They will not be less gloomy, alas, when the time to take stock comes. The load shedding operation which is underway throughout Quebec and Canada will have negative effects on the treatment of patients followed in oncology, but also in mental health, to name just these two crucial areas. Recall that at the end of the first year of the pandemic, family physicians whose offices had been deserted during the first waves due to the invasion caused by the coronavirus then noted the damaging consequences of several months of non-consultation. on diseases like diabetes, hypertension and cancer.
During his last press briefing, the Minister of Health, Christian Dubé, spoke very clearly of the cul-de-sac in which Quebec finds itself: 50,000 caregivers are missing – out of a total of approximately 275,000 – including 20,000 due to COVID-19. This level of severe absenteeism comes at the worst time as hospital admissions are on the rise. The latest projections from the National Institute of Excellence in Health and Social Services predict an unprecedented rate of 3,000 hospitalizations per day in mid-January, including 400 intensive care beds. If nothing is done urgently, we will not get there. Over the next few days, 1,000 beds are due to be reopened, along with associated nursing staff. Even if the vast majority of hospitals will imminently practice level 4 in the stages of load shedding planned for such a level of emergency, “it will not be enough to treat all the patients”, dropped the sub. -minister Lucie Opatrny last week.
Something is wrong with our systems. The Organization for Economic Co-operation and Development recently demonstrated that Canada ranks among the countries that spend the most per capita on health care while having one of the lowest number of beds per 1,000 inhabitants in the world (2 , 5). Not enough to talk about! Across the globe, the limits of health care systems have been tested, but it is unfortunate to conclude that Canada and its provinces, although cited as an example in terms of universality of care, do poorly.
In an emergency, Quebec turned to the unions, because the whole concept of bed availability is based on human numbers. But the creative solutions are starting to run out, as are the staff. The idea of asking for more from those who remain has made it possible to keep the network going – with a pinch – for two years, and it is a solution that pulls down, because the employees in place are exhausted at the task and risk leaving for exhaustion.
The easy solution will always consist in injecting more and more money to keep the house of cards going, and it is moreover with a unanimous voice that the provinces are claiming from Ottawa a greater share of their due by the through the Canada Health Transfer. In its 2021 budget, Quebec has earmarked $ 52.3 billion for health, or 42.9% of the total budget. In the space of about 15 years, these expenses have literally doubled.
The more complex solution will be a complete review of our practices, because the dead end we are currently navigating is as incomprehensible as it is unacceptable. For a few hundred beds in the hospital system, Quebec is completely paralyzed, despite spectacular vaccination rates. It is simply mind-boggling.