Eight months ago, I wrote in these columns the “scenario” that we live in today: “With the current doctrine, what will happen if the vaccines do not work as much as hoped, if an outbreak? large number of cases occurs or if a new virus barely twice as lethal than COVID-19 appears in 2022? Since there is no room for maneuver, it will unfortunately be exactly the same scenario of the flooding of regular hospital capacities which will lead to the reduction in the supply of diagnostics and medical care, deprivation of liberty and death. ‘economic activity. “
Cancer is twenty times more lethal than COVID. However, cancer diagnoses have been reduced by 30% in 2020. If there had been three times as many COVID patients, would we have reduced cancer diagnoses by 90% and multiplied the shedding and cancellation of surgeries by three ? Are we going to passively wait for our hospitals to gradually transform into COVID care centers to the detriment of other pathologies? From what threshold will there be a change of strategy? It is inconsistent to restrict the freedom of the population without doing the maximum in parallel to increase the capacity to treat as many patients as possible. The freedom of the population cannot be the only adjustment variable to face this pandemic. The current strategy is to hope for the best without preparing for the worst. But hope is definitely not a good strategy. A good strategy is to prepare for the worst and hope for the best.
Cannibalized resources
The pandemic does not present a high case fatality rate, but an irregular fluctuation in the number of patients which overloads the current capacities of hospitals, the vast majority for non-intensive care. We run the “hospital program faster” when it would be necessary to change the program, because the hospital is not designed to manage a pandemic. The load shedding consists in fact of cannibalizing ordinary hospital resources to the detriment of patients suffering from many other pathologies as much or even more lethal than COVID. A WHO report from March 2020 explains that “the construction of a treatment center for severe acute respiratory infections is indicated when the number of cases exceeds the capacity of the health system […] “.
We have been there for many months since, at the slightest increase in the number of hospitalizations, the government offloads and restricts the freedom of the population, paradoxically having serious consequences on their physical and mental health, of all ages. Disease care centers are nothing new and are standard practice in international humanitarian operations in the event of an epidemic or pandemic. The aim is to avoid harming as much as possible the normal healthcare offer in hospitals.
The shortage of medical personnel is a reality which all the more justifies the need to maximize the effectiveness of the medical management of the pandemic. These regional COVID care centers would improve this efficiency. They could be managed by the Canadian medical and logistics armed forces, with the support of civilian medical personnel from the public and the private sector. And a significant proportion of these caregivers should be proactively trained to manage COVID patients. If that became necessary, they would be a strike force, already operational, to lend a hand to their colleagues on the front line.
Room for maneuver
These regional COVID care centers with several hundred beds each would create this real leeway that is lacking. And, even when the number of cases drops, it will be important to keep these infrastructures on standby, ready to be reactivated very quickly if necessary. Several countries, such as China, the United States, Morocco, the Philippines or Thailand, have opened treatment centers for COVID.
This change in strategy would give the government leeway to: suffer less from fluctuations in the number of cases and hospitalizations; minimize the load shedding which cannibalizes the normal healthcare supply of hospitals; fully and sustainably offer cancer diagnoses and surgeries; sustainably reduce restrictions on freedom and economic activity; improve in real time the strategy and tactics to manage outbreaks.
It’s about accepting the presence of COVID, living with it while fighting it, for as long as this pandemic lasts. We must learn from this pandemic and come out of it better prepared and equipped to face possible more lethal variants or a new pandemic.