A health system “at the end of the line” and a plan to provide “B care instead of A+”. The situation of Quebec hospitals is more critical than in France, Italy or the United States, which nevertheless have as many hospitalized patients. It is our low number of hospital beds that is thought to be the cause: 21% of these are currently occupied by COVID patients – which could be a peak among G7 countries.
Posted at 5:00 a.m.
COVID-19 weighs heavily on the Quebec health system
So much so that the Minister of Health, Christian Dubé, said Tuesday of this system that he was “at the end of the line” and that the Deputy Minister of Health, the DD Lucie Opatrny, warned that hospitals should offer level “B” care instead of A+” in the face of the influx of patients. Increasingly, load shedding is commonplace.
In the G7 countries, Quebec is one of the places where COVID-19 weighs the most heavily on the health system.
Currently, COVID patients occupy 21% of available hospital beds in Quebec (see note 1), compared to 13% in Ontario, 12% in the United Kingdom, 16% in the United States and 23% in the State of New York. All of these jurisdictions count their COVID patients in much the same way (they count both patients in hospital due to COVID-19 and patients in hospital for another reason, but who test positive for COVID-19; see note 2).
As of January 17, of the 10 countries and U.S. provinces/states surveyed by The Press, it is in Quebec and New York State that COVID patients would weigh most heavily on the hospital system. In France, COVID patients occupy 7% of beds. In Germany, 4%. (There is, however, a caveat to certain international comparisons: some countries could use a more restrictive definition of a COVID patient, which could reduce their ratios.)
What seems to be one of the main problems in Quebec? There are fewer – sometimes much fewer – hospital beds than elsewhere.
“When you have just enough beds to meet the usual needs, if you have a crisis like COVID, you are forced to offload. If you have a reserve, you will not have a load shedding as seen [au Québec] “says the D.r Réjean Hébert, professor of public health at the University of Montreal and former Minister of Health of Quebec in the Marois government (2012-2014).
In France, COVID is hitting hard, but they have a hospital capacity three times greater than ours.
The Dr Réjean Hébert, professor of public health at the University of Montreal and former Minister of Health of Quebec
“We have the health system that we have, which has lived through five waves,” said Christian Dubé, Minister of Health and Social Services of Quebec, on Tuesday in a press briefing, about the health system in general.
16,093
Number of hospital beds available in Quebec as of January 13, including 1,145 intensive care beds
More COVID patients in Europe and the United States, but more hospital beds
There are a lot of COVID patients in Quebec hospitals right now. But in proportion to the population, no more than in France, Italy or the United States.
Except that Canada is one of the OECD countries with the lowest hospital capacity. And among the four largest Canadian provinces, Quebec is the one with the fewest hospital beds in proportion to its population. It’s simple: at first glance, no major region of a G7 country seems to have fewer hospital beds than Quebec.
“It shows that we have no room for manoeuvre. We can’t let it run [le virus] like in other countries,” says epidemiologist Benoît Mâsse, professor at the University of Montreal.
For 25 years, Quebec has wanted to reduce hospital stays as much as possible. This was the Bouchard government’s “ambulatory shift” in the 1990s, followed by the “Toyota method” with the Charest government. This philosophy may have good sides, but today we see its perverse effects in times of crisis.
“The Toyota method is good for making tanks, when you are able to predict the demand for the product, says the Dr Réjean Hébert, professor of public health at the University of Montreal. But in a health network where there are crises, we quickly see the limits of this philosophy which puts us in a situation of great vulnerability. This is a lesson that we will have to learn from this pandemic: we must have reservations. »
Note 1: For our calculations, we used for Quebec the number of beds available on January 13, 2022, i.e. 16,093 hospital beds available, including 1,145 intensive care beds. This is the same criterion as for the data from the OECD and the Canadian Institute for Health Information (their latest data is for the year 2019). The available beds are the beds where there are nursing staff to serve them. In addition to the beds available, we can measure the hospital capacity of Quebec in set-up beds – beds physically installed (there are currently 18,192 set-up beds in Quebec) – and the theoretical hospital capacity of Quebec (number of beds allowed, i.e. 20 042 beds). In Quebec, COVID patients currently occupy 21% of available beds (the criterion used in our calculations), 19% of set-up beds and 17% of theoretical hospital capacity.
Note 2: For hospitalizations related to COVID-19, Ontario, New York State and the United Kingdom count both patients in hospital due to COVID-19 and patients in hospital. hospital for a reason other than COVID-19, but who are declared positive for COVID-19 (this second category of patients is much more difficult for the system to manage than a non-COVID patient). The Ministries of Health in Ontario, New York State and the United Kingdom have confirmed this important detail of their calculation method to The Press. For the whole of the United States, the New York Times explained that the United States also used this way of calculating COVID patients. However, certain details in the calculation method may vary by province, state or country.