As resources get tight, Quebec health staff learn how to pick who gets life-saving COVID care

Intense COVID-19 pressure is forcing Montreal hospitals to cancel increasingly urgent non-COVID medical procedures, including colon cancer screenings and kidney transplants, a top Quebec health official said Monday.

At the same time, the province is organizing trainings and simulations for health staff around the COVID-19 life-saving protocols -- meaning who gets life-saving care, should resources get too tight to give it to everyone -- since that hypothetical is also becoming more and more possible.

"For the time being, we have not deployed that protocol that decides those choices, but the [health] network has been asked to set up training and simulations," said Dr. Lucie Opatrny, assistant deputy minister of health, in a press conference Monday.

"This exercise is something that we considered to be only hypothetical a few months ago, and unfortunately... this recourse is becoming more and more of a possibility."

When asked if she predicted needing to use the protocol in a matter of days or weeks, she said "we're talking more in terms of weeks."

But her other comments made it clear just how little breathing room Quebec's hospitals, particularly those in Montreal, have right now.

"A lot of activities will have to be left aside," said Opatrny, specfically listing colonoscopies meant to screen for cancer, kidney transplants from living donors (with the exception of children's transplants, which will continue), joint replacements for people who are in pain, and many other important consultations.

"The choice of which activities [to delay] is more and more difficult to do," she said.

This decision to offload certain procedures, which hasn't been done since last spring, is in place across most of the province, she said.

However, it's particularly urgent in Montreal, where the number of COVID-19 hospitalizations has almost doubled since mid-December, Opatrny said.

"In Montreal, it also must be understood that the situation is even more serious because of a significant lack of staff," she said.

She spoke at length about the huge absenteeism rates of health-care staff in the province, many from illness, and the resignation of many workers who have left for the private health-care network or other jobs.

So when people speak of a lack of available beds, it doesn't always mean there aren't enough physical beds, she said -- there aren't enough people to staff the beds, so they're not being used.

"There were bed closures because of a lack of staff," she said. "That is why, right now, the guideline has been given that unfortunately, in the Montreal area, we have to reduce the amount of surgeries to be able to reorient the nurses to open those beds that were closed."

There are already 140,000 people waiting for surgery in Quebec.

Picture "someone who needs a colonoscopy to screen a possible colon cancer and we can't give them a date," she said.

"You will understand that the impacts are huge and will be felt for many months, perhaps years."

She, as well as Premier François Legault and two other health officials, asked the public to keep this in mind and respect public health laws, "as the consequences of not respecting these guidelines will be dramatic for the network and for patients at large."

However, even as Opatrny discussed life-saving protocols, Legault said that Monday's numbers also brought a bit of hope in terms of what may happen a few weeks from now.

"First come the cases, a few weeks later the hospitalizations, and then the deaths," he said.

"So as you can see, today there are relatively a lot of hopsitalizations and deaths, but... there are few cases," relatively speaking, he said -- today was the first day in several days that Quebec posted less than 2,000 new cases.

"It's encouraging for in two weeks, two-and-a-half weeks... for the time being it looks like it will give good results," Legault said.

"I wish to thank Quebecers for all their efforts in coming together."

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