The Premier of Quebec says he understands the anger of people towards unvaccinated adults, who represent 10% of the population, but 50% of hospitalizations. To those people who suggest that we stop treating them, he replies that this is not the kind of society we want, one that would discriminate against part of the population.
However, the Ministry of Health and Social Services published an update a few weeks ago of its protocol for prioritizing access to intensive care in the extreme context of a pandemic, which does include criteria of discrimination. This guide includes the various changes made to the prioritization of intensive care. Among these changes, we find clarifications on the roles of each, on the functioning and the processes of prioritization and coordination. Above all, we find, as the Commission des droits de la personne et des droits de la jeunesse, “two clinical parameters which relate to the age of the patients and which are expressly involved in the assessment grid for applications. admission to intensive care ”, parameters that discriminate according to age and which could deprive some people over 50 years of access to intensive care.
A matter of time
Normally, this protocol should only be triggered if the hospitals reach 150% of their capacity. In theory, there would have to be 1,600 to 1,800 hospitalizations for the network’s capacity to be exceeded. According to the most recent hypotheses put forward by the National Institute of Excellence in Health and Social Services (INESSS), this number could be reached within three weeks. However, the MSSS told us yesterday that this number has already reached, with 1,750 hospitalizations. Although the prioritization protocol has not been deployed to date, current data suggests that it could be implemented if the number of requests for access to intensive care were to exceed. the reception capacity of these services. At a time when the Omicron wave hits the employees of the health network head-on, there is reason to wonder about the real number of beds that may be available in the event of a marked increase in hospitalizations. The question would therefore not be whether this protocol will be deployed, but rather when it can be.
The goal of the government’s prioritization protocol is to minimize mortality and ensure that decisions made are fair and equitable. The proposed objective appears reasonable at first glance, from a short-term mortality prognosis perspective. However, this protocol does not take into consideration the fact that an unvaccinated person with the disease is more contagious, and over a longer period, thus promoting the spread of the virus, hospitalizations, the increase in patients in intensive care. and, ultimately, mortality, in addition to forcing establishments to postpone activities for which we do not yet know the impact on medium and long-term mortality. Under the circumstances, can we really claim that the decisions taken to reduce mortality will be fair and equitable, most likely prioritizing this minority of the unvaccinated and over-represented population at hospitalizations rather than fully vaccinated individuals who still require intensive care?
Some fairness
Although the Prime Minister does not wish to address this question, it should be asked a few days from the point of saturation of our services. Discrimination on the basis of vaccination status would moreover not be totally incompatible with certain guiding principles of the prioritization protocol. It would contribute to the allocation of resources for the benefit of the greatest number and would ensure a certain equity in access to intensive care, insofar as it would not deprive people of intensive care by favoring a minority of individuals who, by its stubbornness in not being vaccinated puts the health of the majority at risk in addition to overloading our network and paralyzing entire sections of the economy. And perhaps such discrimination based on vaccination status would finally encourage the most recalcitrant to receive their first dose.
Such an orientation would not have the effect of depriving the unvaccinated of care. All patients, vaccinated or not, should be treated. Every human life should be valued and every person deserves respect, care and compassion, despite this feeling of injustice and anger that many people have towards unvaccinated people. However, this does not mean that all patients should receive intensive care. As stated in the government’s prioritization protocol: “Those who do not receive intensive care will not be abandoned, they will continue to receive other care, the most appropriate for their condition, and possible in the context. “