The health and well-being commissioner, Joanne Castonguay, delivered a rigorous and implacable observation on the shortcomings that led to the carnage in CHSLDs during the first wave of COVID-19, in the spring of 2020. But above all , it proposes that the Government of Quebec thoroughly review the goals and governance of the health care system.
While we marched in front of coroner Géhane Kamel to affirm that the health network had a plan to face the pandemic, Joanne Castonguay rather reveals that the health network was ill-prepared, that its plan was not up to date. and that the watch he exercised on the progression of COVID-19 was deficient. The authorities therefore did not take into account, from the week of March 22, 2020, one week after the outbreak of the state of health emergency, the “early signal” which showed that in CHSLDs as well as in private residences for elders (RPA), the situation was rapidly deteriorating. Both the Public Health Department and the Ministry should therefore have reviewed their strategy, which was to focus on hospitals. The “living environments”, as they are called, do not appear in the priorities of the ministry, underlines the commissioner.
His report, which has two parts and runs to almost 300 pages, contains statistics that damningly illustrate the consequences of this indifference. During the first wave in Quebec, which ran from February 25 to July 11, 2020, nearly two-thirds of the 5,718 deaths took place in CHSLDs, RPAs and intermediate resources. Excess mortality, the appropriate measure to denote the severity of the wave, was 34% in CHSLDs and 15% for all of Quebec. This rate is the highest among all Canadian provinces.
The report establishes a ” timeline » significant events that occurred at the start of the pandemic, in particular the major developments in scientific knowledge of the virus here and abroad. The commissioner notes the “late consideration” of the evidence, reported in the first studies, relating to the risks incurred by the elderly, the transmission of the virus by asymptomatic people and the effectiveness of the mask.
Within the plethoric organization chart of the Quebec health system, Public Health is at the bottom of the list, a function whose capital nature we realize today. At the back of the pack in Canada, Quebec is one of the states in the developed world that spends the least per capita on public health, notes the report. It’s time for that to change, in a context where the world must prepare for the appearance of other harmful viruses.
As we wrote, the national director of public health must enjoy greater independence from political power. This is the Commissioner’s opinion. The public must be able to distinguish scientific advice from political decisions.
It is immediately necessary to implement the Commissioner’s recommendations concerning the short-term deployment of an integrated national strategy for preparing for health risks and the annual testing of a crisis management plan. This strategy includes a supply plan for protective equipment, which was outrageously lacking during the first wave.
But it is his longer-term recommendations that the government must consider. The commissioner is not the daughter of Claude Castonguay for nothing. She recalls that most of the shortcomings of our health system are known, but that “decisions have not followed”. Reports piled up on the shelves, including his father’s report commissioned by the Charest government and that of the Clair commission. The recommendation — made 20 years ago! — to computerize health data has remained a dead letter, and it is the turn of the current Minister of Health, Christian Dubé, to tackle this essential modernization.
Joanne Castonguay believes that the governance of the Ministry of Health is the fundamental cause of “our collective failure” during the first wave, this centralization and this insistence on production volumes and respect for costs. The ministry must get out of this rut and focus its actions on “the results that matter to people”, on the “value” of care. It’s another way of talking about a system centered on the user, on the patient, on the health of the population. It’s a safe bet that Christian Dubé understands perfectly well that this is the way to go. Now it’s up to him to play.