(Quebec) Major turnaround in the examination of the causes of the massacre in CHSLDs during the first wave of COVID-19. There was no directive or initiative from Quebec in January to prepare these establishments for a pandemic, unlike the version of the Legault government presented to coroner Géhane Kamel last week.
This is what reveals the special report of the Ombudsperson Marie Rinfret on the management of the pandemic in the CHLSD during the first wave, a devastating document deposited at the Blue Salon on Tuesday. The Ombudsperson is a watchdog reporting to the National Assembly.
“The facts do not lie,” said Marie Rinfret at a press conference on Tuesday. It was not until mid-April, when it was already “chaos”, for Quebec to “realize the extent of the crisis” and that “actions (be) taken” in the CHSLDs. “It was an incredible amount of failure to take into account, and that is why we conclude that the CHSLDs were not taken into account in any of the pandemic preparation scenarios. ”
It has been said over and over again that the CHSLDs were in the blind spot of the preparations, but Marie Rinfret’s investigation made an eloquent and unprecedented demonstration that plunged the government into embarrassment. CHSLDs “were not taken into account by any scenario” at the start of 2020.
It is only in mid-March, when Quebec decrees confinement, that the CHSLDs are part of a plan. However, they are mainly called upon to welcome patients in order to free up hospital beds, a massive transfer for which they were not at all prepared and which has contributed to the crisis.
“It was not until the second week of April, with the confirmation of the crisis in CHSLDs,” in particular the hecatomb at CHSLD Herron, “that the Minister of Health and Social Services (Danielle McCann, Editor’s note ) and the minister responsible for seniors (Marguerite Blais, editor’s note) presented reinforced measures of protection in living environments, ”writes the Ombudsperson. She denounces an “underestimation by the authorities of the vulnerability to the virus of residents in CHSLDs”.
“During preparations for the pandemic, the Ministry of Health and Social Services did not properly assess the fact that CHSLD staff were unfamiliar with good practices in terms of infection prevention and control during of a major outbreak. Taking the scene by storm, the virus only confirmed this ignorance, aggravated by the lack of personal protective equipment and the dilapidation of the premises, ”she says.
PHOTO JACQUES BOISSINOT, ARCHIVES THE CANADIAN PRESS
The Ombudsperson Marie Rinfret
During a presentation of this report to parliament on Tuesday, it was explained that the Ombudsperson does not do historical revisionism and that she took into account in her investigation the urgency present in the spring of 2020. Her conclusions are d ‘all the more damning in this context.
The government’s version of its preparations for the crisis is contradicted. Thursday, during his visit to Coroner Kamel who is investigating the deaths of COVID-19 in CHSLDs, the former Minister of Health Danielle McCann maintained that he had been asked in January 2020 to the CEOs of the CISSS and of the CIUSSS to prepare their plans to fight the pandemic, including in their CHSLDs, in anticipation of the arrival of COVID-19. The Deputy Minister of Health at the time, Yvan Gendron, also explained that the order to prepare had been sent in January. They added that the CEOs were responsible for preparing the CHSLDs. The national director of public health, Dr Horacio Arruda, had made remarks along the same lines.
However, the Ombudsperson clearly shows that CHSLDs were not at all at the center of concerns at the time. There were no directives and initiatives from Quebec concerning them in January 2020. At that time, the civil security authorities and the MSSS were busy with “preparation focused on screening, PPE research and the capacity of the patient. health network to treat, in its hospitals the affected users ”. Quebec has a “hospital-centric” conception in its preparations and its attention turns to an Italian scenario. Even though outbreaks occur in late February and early March in residential homes for the elderly in Washington State and British Columbia, “this does not seem to have influenced the MSSS’s strategy in its preparation for the pandemic ”. CHSLDs “were not taken into account by any scenario”.
“The MSSS maintains that the urgency to act explains this omission. In the opinion of the Québec Ombudsman, forgetting is also the result of clinical planning in isolation carried out by the various departments, according to their usual operating mode, despite the activation of committees linked to civil security. ”
The General Directorate of the MSSS responsible for CHSLDs was not part of the clinical steering committee, the ” war room From the Ministry, even at the beginning of March. This management was also of the opinion that “living environments were used to dealing with outbreaks of influenza and gastroenteritis”, despite its lack of expertise in the matter. At the same time, in its updated plan against the influenza pandemic, the MSSS had “no specific measures relating to CHSLDs”. In short, “CHSLDs have been placed on the sidelines in terms of deploying measures and tools to strengthen their areas of weakness”.
“There was concern for the elderly in CHSLDs, but the information obtained during the Québec Ombudsman’s investigation does not demonstrate any concrete and specific action to prepare CHSLDs in the field before mid-March 2020.”
At that time, Quebec wanted to free up hospital beds and asked CHSLDs to accommodate patients. Admissions to CHSLDs increased by 31% compared to the normal situation. Some 1,714 people are admitted in a month, including 865 from hospitals. The CHSLDs simply could not accommodate so many people, in particular due to a lack of personnel and equipment. Quebec has not listened to the alarm signals from “certain players in the network”. And “it was only on April 11, when the loss of control in a CHSLD cornered the MSSS to the wall, that the new admissions ceased”, writes the Ombudsperson. Quebec presents to establishments in the second week of April the first protective measures to be applied in CHSLDs. He sets up a committee of experts to guide him. However, “these precautions proved to be late and insufficient for several CHSLDs”.
Worrying fact: “the Québec Ombudsman takes from testimonies (from actors inside and outside the ministry) that expertise external to the MSSS is, in normal times, frequently requested and relevant during the development of health and social services policies or guidelines. However, in an emergency context, this approach did not make it possible to guide crucial decisions in a timely manner, particularly in terms of risk management for CHSLDs when we were talking about the possible emergence of the virus. ”
The lack of expertise was reflected in documents sent to establishments on the subject of infection prevention and control which, “of a general nature, have not made it possible to have a concrete and operational impact on the ground”.
The effects of staff absenteeism due to the spread of the virus were not anticipated. Screening capacities were limited at the end of March, “which explains why the virus was able to enter several” CHSLDs. The lack of protective equipment and the slogan to “minimize” their use, “rather than taking extra precautions”, have contributed to the crisis. The absence of managers in each CHSLD has hampered the implementation of the directives.
“Considering the magnitude of the crisis of the first wave and its dramatic repercussions which marked Quebec”, the Ombudsperson makes 27 recommendations to the ministry to redress the bar.
It also proposes “the establishment of acts of annual commemoration of victims of COVID-19 and of people who worked directly or indirectly with them in order to remember what they went through in CHSLDs during the first wave of the pandemic, recalling the losses and suffering experienced by these hard-hit people ”.
In the spring of 2020, 5,658 people died from COVID-19, including nearly 4,000 in CHSLDs.
The Ombudsperson points out that she had access to important documentation to conduct her investigation. She obtained the famous inspection reports from the MSSS in CHSLDs which are making headlines at the moment and which were at the center of debates at the inquest of Coroner Kamel last week, it was confirmed. So they would not have been destroyed or “overwritten” in the computer system and obviously there were backup copies.