At the end of December 2022, almost three years since the start of the pandemic, I am again on call in the emergency room with the strong impression that we have already played in this bad movie. The scenario repeats itself: between snowstorm and Christmas music, the emergency is overflowing with people who have nowhere else to go.
Respiratory infections – led by COVID-19 (SARS-CoV-2) and influenza – are raging among the most vulnerable. On this New Year’s Eve, they rub shoulders with the distress of a man who has attempted suicide because he can no longer pay his bills, of an elderly person with a loss of autonomy abandoned by deficient home care, of a migrant woman who survived the crossing of the Americas to face the debts imposed by our supposedly universal health care system, and of a man in a situation of homelessness who must be returned to the cold of the street for lack of space in the shelters.
Overcrowded hospitals and overworked staff
By re-reading my “pandemic lessons1 » of the last two years2, it is with sadness and dismay that I see that so little has changed. The health system is still chronically understaffed – even more so than two years ago. The front line is still struggling to meet the needs of the population. The hospital-centric model, focused on technical treatments rather than upstream prevention, still prevails. Waiting lists continue to grow and disruptions in pre-hospital care services mean that in 2022, an Atikamekw baby may die of simple meningitis3.
There are also new elements. The death toll from COVID-19 is no longer reported on the news – yet the highest in 2022 compared to previous years.
Despite the economic crisis which affects the most marginalized, there are no more PCUs, rent deferrals or hotels to accommodate homeless people. Praise for nurses has been traded for a strategy of attrition, far from stemming the problems of TSOs, private agencies, and unsustainable working conditions. We seem to have forgotten the “guardian angels” many of whom paid a high price for the consequences of the pandemic – let us remember Marcelin François4 – in favor of a discourse on “French-speaking economic immigrants” with dehumanizing and xenophobic overtones.
Quebec inertia
While the health system has passed the breaking point, according to our leaders, there would not even be a pandemic anymore. After the inertia and the contradictory discourses that will have served to undermine the population’s confidence in public health, the Quebec government has chosen the policy of denial. After all, if there is no more pandemic, there is no urgency to improve ventilation in schools, living and working environments. Nor is there any imperative to strengthen healthcare infrastructure, speed up the hiring and retention of healthcare personnel and put in place public health protection measures.
In this imaginary scenario, we can settle for half-measures of wishful thinking – a handful of specialist nurse practitioner (NPI) clinics would relieve emergency room congestion – or reforms that run counter to the principles of accessibility. and health equity.
Indeed, Minister Christian Dubé’s plan to overhaul the health system relegates the CLSCs to the status of a relic and wants to increase the share of the private sector – or more specifically the use of public funds to finance privatized care, and this, despite the risks of such an approach5.
This approach is reminiscent of the “overcapacity protocol” recently implemented in hospitals, which moves patients from the emergency room to the second floor, where staffing ratios are just as precarious. Resorting to the private sector as a “solution” follows a similar logic of musical chairs, in this case moving personnel from the public sector… to the private sector. A real magic trick.
I think back to my patients piled up on stretchers in the emergency room. Beyond the care that I provide them today, what would allow them to regain their health has nothing of a magic trick: paying their groceries and their rent for decent housing, having access to medical support and free social security regardless of immigration status, region of residence or income, to live and work in dignified and safe conditions. At the dawn of economic, social and climatic crises, these measures, however obvious to act on the social determinants of health, require much more than a simplistic “anti-inflation shield”, but rather public policies anchored in a vision equity and social justice. If some seem to want to forget the pandemic, let us remember its most precious lesson: solidarity.