Fewer COVID-19 in intensive care, but patients with more advanced diseases

In one year, the daily life of intensive care units in Quebec has changed completely. The number of patients admitted for COVID-19 is plummeting, but the collateral damage of the pandemic is well and truly felt and filling the beds of patients with increasingly advanced diseases.

“Despite the figures, we have not returned to the pre-COVID situation. We can say that what we are experiencing now is a whole new normal, ”underlines the D^r Joseph Dahine, director of the intensive care unit (ICU), met last week during the passage of the Duty at the Cité-de-la-Santé in Laval.

A little over a year ago, in the middle of the fourth wave, this floor of the Cité-de-la-Santé showed a continuous flow of intubated patients due to COVID-19. N95 masks screwed to the face, in a heavy silence, nurses and caregivers were busy constantly turning patients placed on ventilators in negative pressure rooms. The tension was palpable. On February 8, 2022, 2,348 patients were hospitalized in Quebec with or for COVID, including 171 in intensive care.

A year later, there are less than 1,400 patients infected with COVID hospitalized (most for a reason other than COVID) in all of Quebec, and only 32 patients in intensive care. In the Laval hospital, only one COVID patient was admitted to the ICU last week. The only one for two months, says the D^r Dahin. “For COVID, we are almost experiencing a lull,” he rejoices.

You would think you were dreaming. The storm passed. And yet. It’s far from dead calm on this February Wednesday in Laval. The 22-bed unit is full to bursting with patients affected by pathologies more serious than each other. “What we’re seeing more and more are patients coming in with later presentations of disease,” he says.

“It’s sad, it pains us, because these people come for something that has bothered them for a while, and end up with metastatic cancers, or advanced cardiovascular or neurological diseases,” explains the head of intensive care.

This is the case of one of the patients, bedridden and intubated before us that day, quite young, admitted to this critical care unit for advanced cancer. “These people could not be taken care of or were afraid of overcrowding the emergency room. This now has an impact on the demographic burden of certain diseases, and we see this every day in our unit. It is no longer anecdotal, ”laments the D^r Dahin.

It’s sad, it hurts us, because these people come for something that has bothered them for a while, and end up with metastatic cancers, or advanced cardiovascular or neurological diseases.

Fellow oncologists, cardiologists and surgeons are also seeing this trend, he says.

In several patients, the disease progressed silently during the pandemic. Social problems have also increased in certain sections of the population, left more to their own devices.

Further on, three patients, all struggling with complex medical records, are in intensive care for problems of intoxication or street drug use.

“Without the pandemic, these people would not have arrived in such a state. This reality will put a strain on our healthcare system for years to come. And this kind of case can never be treated by a private health system, to help the public network. This is why we need to maintain a strong public health network,” says Dr.^r Dahin.

In place of COVID, outbreaks of influenza and respiratory syncytial virus (RSV) have helped fill intensive care beds with patients struggling with complications. This is the case of one of the patients of D^r Dahine, intubated and plunged into a coma at the beginning of January, who is still struggling to recover from this infection and the tracheotomy performed to help him breathe.

“Another normality”

At the Cité-de-la-Santé intensive care unit in Laval, as in most ICUs in Quebec, this is the first winter since 2020 where COVID does not dictate the flow of admissions. In the rest of the hospital, there are only 18 patients hospitalized with or for COVID out of 500 beds, while it was 60 to 70 in the winter 2022 peak. because these patients must be isolated and the rooms disinfected after their discharge. But we are still in another world, ”explains Sébastien Rocheleau, deputy director of nursing at Cité-de-la-Santé.

In short, we breathe a sigh of relief, knowing that the backlash of the pandemic will be felt for a long time to come. Both in patients and in staff.

“We will never complain about being too busy, that’s our job. Sometimes it feels like it’s not as bad as it was at the height of COVID, because not all of our patients are intubated. But with these heavier cases, we never returned to the pre-pandemic situation. We are in another normality, ”notes the D^r Dahin.

A reality confirmed by the D^r Hoang Duong, internist at Pierre-Le Gardeur Hospital and president of the Association of Internal Medicine Specialists of Quebec. “We are experiencing the same thing at home. Fortunately, with vaccines, there are fewer severe COVID cases. But normal, will we return to it one day? What is very different is the state of the troops. Nurses specializing in intensive care have reoriented their practice, or left the profession. We never managed to replace them and regain our pre-pandemic workforce, ”he laments.

At the Cité-de-la-Santé ICU, no one has left the fort, but retaining staff requires constant effort. “To perform, it takes connections. It doesn’t happen by magic. You have to do caucuses, social activities, group retreats so that bonds are created and that it works, explains the D^r Dahine, greeting in passing his colleague Joanie Bolduc-Dionne, head of critical care in the unit. Many think that it’s “flafla”, clouds, but it’s the basis of everything. Individuals must feel confident in order to work better together. If there is a lesson to be learned from the past few years, it is to value our world in the health network. »

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