(Quebec) “Quebec was not ready” to face the pandemic, slice the commissioner for health and well-being, Joanne Castonguay, who unveiled her expected report on the management of the first wave on Wednesday. She deplores “a confused division of roles and responsibilities”, the absence of an updated crisis management plan and insufficient reserves of protective equipment. Mme Castonguay emphasizes the “paternalistic attitude” of the health system towards seniors. She recommends reviewing the role of the national director of public health.
Posted at 10:12 a.m.
The Health and Welfare Commissioner unveiled her investigative report on Wednesday into “the performance of care and services for the elderly” during the first wave of the pandemic, in the spring of 2020, which led to the death of 4,836 people seniors in seniors housing. Joanne Castonguay’s conclusion is unequivocal: she concludes that it is “a collective failure”.
“The review of the events that occurred in the spring of 2020 and the interviews conducted with stakeholders clearly show that Quebec was not ready to face the pandemic due to the virus causing COVID-19,” writes Ms.me Castonguay in his report entitled “ The duty to do otherwise ».
Quebec “did not have an up-to-date crisis management plan. IPC measures were largely deficient and PPE in short supply. The division of roles and responsibilities was confused. The consequences for the elderly and caregivers have been dramatic. Several situations, sometimes inhuman, have been reported, ”she underlines.
Why did the carnage occur in CHSLDs and seniors’ residences during the first wave in Quebec? Joanne Castonguay makes four main observations.
- The management of the health system in the context of a crisis, indicating that Quebec was ill-prepared to deal with a pandemic.
- State of the care and services system for the elderly at the time of the pandemic (lack of manpower, insufficient staff supervision, lack of expertise in infection prevention and control).
- Poor governance of care and services for the elderly.
- General governance of the health and social services system.
Shortcomings at all levels
Mme Castonguay notes several shortcomings in the management of the health system in the face of a public health crisis such as “under-representation of the reality of living environments and the needs of seniors resulting from the absence of experts in decision-making committees. She even notes a “paternalistic attitude towards seniors”. The consideration of seniors in preparing for the pandemic has been making headlines for a few weeks when members of the government contradicted themselves before coroner Géhane Kamel, who is investigating the first wave in certain accommodation settings.
In his report, Mr.me Castonguay does not make a chronology of events, but rather a statement of facts according to the testimonies collected and the scientific literature. In her report, the Commissioner states that “the findings and recommendations made […] do not seek to attribute responsibility for the consequences of the crisis to any particular organization or official. The responsibility for the crisis we have experienced is collective. »
The organization of care for the elderly was problematic before the arrival of the pandemic, which accentuated the effects of the crisis on the care settings, according to the commissioner. There were “several shortcomings at the time of entering the pandemic: financial resources, manpower, staff supervision, lack of expertise in infection prevention and control, deficiencies in the organization of medical care in the living environment , deficiency in monitoring and quality assurance systems, deficiency at the informational level”, she quotes.
Review the role of the national director of public health
Among her recommendations, the commissioner recommends “give explicit power to the national director of public health to inform the public independently”. After study and analysis, she notes “no ideal model for organizing public health leadership has been identified” elsewhere.
“However, ensuring the independence of the National Director’s scientific advice from political decisions is important to improve public buy-in and trust. The transparent public communication by the national director of public health of his opinions and recommendations as well as the justifications in support of them would testify to this independence, ”she writes.
The independence of the national director of public health, the Dr Horacio Arruda, has been questioned on several occasions during the pandemic. Quebec has not closed the door to reviewing the role of the national director of public health with the arrival in office of Dr Luc Boileau, last week.
Shortly after the first wave of the pandemic, in August 2020, Quebec had entrusted the commissioner for health and well-being, Joanne Castonguay, with the mandate to examine the performance of the health network, in particular care for the elderly. , during the first wave of the COVID-19 pandemic. The study period is from February 25 to July 11, 2020. During this period, there were 5,718 deaths related to COVID-19, of which 4,836 occurred in various residential settings for seniors.
Its preliminary report, unveiled last September, set the tone: the disorganization of services, a poor evaluation of the quality of care and the lack of reliable data “contributed to the sad results of the first wave of the COVID-19 pandemic. for seniors residing in Quebec,” concluded the commissioner. It pointed to “gaps in governance” which explain, at least in part, the high number of deaths during the first wave.
Joanne Castonguay’s investigation is in addition to those conducted by the Ombudsperson, who examined the management of the pandemic by the Legault government during the first wave, and by the coroner, Géhane Kamel, who is continuing her public inquiry into the death of elderly or vulnerable people occurring in residential settings also during the first wave.