COVID-19: care in the world after

The unit doors are wide open. In the corridor, caregivers circulate without the usual paraphernalia of a red zone. They wear an N-95 mask and goggles, but no visor or the traditional jacket over the uniform. Here, there is an atmosphere of quasi-normalcy – in a covidian world, of course. However, patients with COVID-19 are hospitalized upstairs, close to uninfected patients.

The Charles-Le Moyne hospital in Longueuil is trying to live with the virus. “It’s a paradigm shift,” says the D^D Chantal Vallée, internist and head of the specialized medicine department. What is considered “red” here is really the interior of the rooms. It’s not the rest of the unit. »

The duty visited two departments of Charles-Le Moyne this week – that of surgery and internal medicine – where positive and negative patients can stay at the same time. Only a corridor separates the “hot” rooms – identified by a red “isolation” sign – from the cold ones. Staff are assigned to each section.

“Unfortunately, patients who have COVID, we keep them inside their room, the door closed”, indicates the D^D Valley. The transmission of the virus must be prevented at all costs. Omicron is spreading like wildfire.

Precisely, aren’t we playing with fire by having positive and negative patients coexist in the same unit? Since the start of the pandemic, patients suffering from COVID-19 have been isolated in red zones in order to avoid further contamination. This is a “good” way to do things, recognizes the D^D Valley. But faced with the tsunami of positive cases during the fifth wave, Charles-Le Moyne decided to change his approach on January 17.

“We too have moved! said the D jokingly^r Jean-François Cloutier, otolaryngologist and head of the surgery department. “I don’t know to what extent,” adds the D^D Vallée, but we’re smarter than we started out. “Like the virus that transforms to survive and continue to spread.

The challenge of avoided trips

Since the fifth wave, many patients with COVID-19 have been hospitalized for other health problems. The hospital is calculating that it is better to leave these positive patients on the floors where they were admitted – in internal medicine or in surgery – rather than transferring them to a red zone.

Omicron being a highly transmissible variant, the movement of patients can be a source of contamination, “despite all precautions”, reports Dr.^r Cloutier.

The new variant entered the establishment in force, and by all possible doors: patients infected without knowing it, visitors vaccinated and declared positive as well as members of staff contaminated by their children or at work. “Between the 1^er and on January 6, almost all the departments were in bloom! » says the D^D Valley.

According to her, the movement of positive patients from one unit to another contributed to this spread. “We were creating a potential exposure chain and looking back, we realized that all employees and patients who had been in contact with an infected patient were testing positive,” says Dr.^D Valley.

By setting up “mixed” units (red and green), the Charles-Le Moyne hospital is betting that positive patients but hospitalized for another health problem will be better served.

“We believe that there is a benefit for the patient to be treated in a unit where the staff has expertise for his pathology,” says Dr.^r Cloutier. The red unit team has developed a specialty in critical care and respiratory issues related to COVID-19, but its members are not necessarily comfortable with, for example, taking care of patients the next day of an operation, explains the D^D Valley.

According to the doctor, this shift also makes it possible to maximize hospital capacity. Creating red units requires moving staff around, which can reduce the number of beds on a floor or cause a unit to close.

The fact remains that this model will “never” apply to immunocompromised patients, such as those on chemotherapy or hemodialysis, who must remain in completely green “sanctuary zones”, she underlines.

Verdun hospital in the red zone

At the Verdun hospital in Montreal, patients with COVID-19 are still hospitalized in a red unit located on floor 2 South. When passing the Duty this week, about twenty patients were staying there, mostly old people.

In the corridor, an old man, frail and with a bent back, was walking painfully with the help of a walker and with the support of a nurse. Employees greeted patients who had just been discharged.

“If the number of hospitalizations continues to go down, the next step would be to return to a green section and a red section at 2 South, but with a temporary wall between the two areas and a circuit dedicated to the red zone,” says the D^D Pascale Dubois, specialist in internal medicine and head of the specialized medicine department of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, of which the Verdun hospital is a part.

Each hospital center manages hospitalizations differently during the pandemic. In Verdun, it’s everyone’s turn: the units receiving infected patients change from one wave to another. This time, the cardiology and pulmonology department has been designated. And the staff were not spared.

“I don’t know about the other people, but I think we may not have enough energy to get through a sixth wave,” says France Massé, head of the unit and nurse.

Catherine, a beneficiary attendant in the 2 South corridor, points out that her manager has “worked very hard” in recent weeks like the rest of the staff. “She stayed until 8 o’clock in the evening, she passed trays, she changed diapers because we had a lack of staff,” she said.

Working conditions are difficult in the red unit. Wearing the N-95 mask remains painful, according to France Massé. “We can’t drink, of course,” she continues. Me, in the morning, I take myself a small glass of juice with a pinch of salt in it to make my morning. Somehow it’s not normal. »

Until recently, employees could not urinate in the red zone. To go to the toilet, they had to leave the unit and pass through an undressing circuit to avoid contamination. Too long a journey for overworked employees. “For the past week, we’ve been very annoyed because we can go to the toilet on the unit! says France Massé.

The team has had its ups and downs. “Last week, we had a lot of deaths, celestial holidays… We certainly find it difficult”, says France Massé.

Now the storm is calming down. But the D^D Dubois remains more convinced than ever that hospitals must continue to refine their strategies to maximize the use of their beds. Patients who do not have COVID-19 need treatment.

At the Verdun hospital, more hip replacements are performed in day surgery. “Normally, we reserved it for people aged 50 and over in good health, says the D^D Dubois. There, we stretched that out to slightly older patients who had good home support and didn’t have any health issues that we were concerned about. These gains that we have made, we will keep them. »

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