The second wave hits the hospitals of Quebec, where workers are exhausting themselves fighting COVID-19 and fear an even more difficult winter with the flu and the impacts of Christmas parties.
The newspaper had exclusive access in the midst of a pandemic to the medical teams leading the battle against the coronavirus in the five hospitals of the CHU de Québec.
An exhausting war, while the care of infected patients requires nearly 35% more staff (see other text below).
Shortness of breath, disgust, discouragement, the second wave is trying for health workers, who would have taken, we are told, “a few more weeks” before plunging head first into the heart of the pandemic.
Six outbreaks have already “mortgaged” many employees since the start of the second wave. Alone, an outbreak in a “hot” unit at L’Enfant-Jésus hospital infected some 40 employees.
This general exhaustion on the part of employees, all sectors combined, was observed during our visit to L’Enfant-Jésus hospital. “It’s like always being in a marathon. It takes a lot of patience, ”says Danielle Goulet, director of critical care, responsible for the five emergencies at the CHU and intensive care.
Unlike last spring, far fewer employees raised their hands to lend a hand. The load shedding was also much less important this fall (30%), than during the first wave (70%). “When I made a call for volunteering [à la première vague], I had a list of 350 names. There, that’s three calls for volunteering that I make and I have 30 names ”, laments Brigitte Martel, director of nursing at the CHU.
Photo Elisa Cloutier
“When the population [le nombre de cas de COVID-19 dans la population] increases, we know that we have an increase in intensive care about two weeks later, ”says the tactical committee, the daily meeting of all the managers of the pandemic in the five hospitals of the CHU de Québec.
Staff requirements have skyrocketed to handle the heaviest cases, which sometimes require one or two nurses for a single patient, all the time.
Flu and parties worry
The uncertainty is also palpable in Quebec hospitals as the flu season approaches. “Will the coronavirus hide under influenza or will coexist in the same patient? It can happen, a respiratory virus is not exclusive, ”worries Danielle Goulet.
According to her, “the peak” is to be expected after the holidays, a time when, usually, the occupancy rate in emergencies explodes.
Medical staff are also worried about the repercussions that Christmas parties could have in hospitals. “When people go to parties, it is clear that the transmission continues and it is clear that it has an impact [dans les hôpitaux] », Affirms Valérie Dancause, responsible for the infection prevention and control program.
COVID IN QUEBEC
- 414 patients hospitalized since the start of the pandemic (as of November 20)
- 67 in intensive care (as of November 20)
- Aged 15 at 54 years old
- Average hospital stay: from 3 at 7 days
- Some stayed for more than 14 days
- Near 5 % of positive patients present to the emergency room for another reason
- Near 20 % of hospitalized patients end up in intensive care
Shortage of over 500 nurses
The labor shortage in the five hospitals of the CHU de Québec is so severe that the nursing staff were not sufficiently equipped to face this second wave.
This is what Brigitte Martel, director of nursing at the CHU de Québec, says. To fill its significant labor shortage, it could hire 500 nurses “tomorrow morning”, she says.
In addition to being deprived of 30% of its workforce who are on salary insurance (maternity leave, health insurance, etc.), Mr.me Martel says the recent outbreaks and administrative isolation are hurting him “very much”. As a result, at least a hundred nurses are absent every day.
Health measures thus represent a real headache, while we must constantly “move the nurses” from one place to another, unheard of, says Mme Martel. These involuntary movements also have repercussions on the morale of the troops. “It changed the mood, for sure,” she admits.
The story is the same in intensive care, where administrative segregation “costs money” for teams, who have to work more overtime.
Since the start of the pandemic, intensivists on duty have had to sleep in the hospital to monitor patients with COVID-19. A first at the CHU. “It’s an additional charge. There is exhaustion since their turn often returns, ”says Danielle Goulet, director of intensive care.
Shedding and outbreaks
The recent load shedding, during which 15 operating theaters were closed, made it possible to recover some forty nurses, who went to lend a hand to the teams in the so-called “hot” units, where patients with COVID- 19 are hospitalized. But an outbreak among the employees turned everything upside down. “We have to wait until there are no more cases for 14 days to be able to recover these nurses”, explains Mme Martel.
Some employees are still in isolation. “It’s a new element [les éclosions] for which our teams were not prepared. We knew what we had to do theoretically, but we did not expect that, ”adds Valérie Dancause, director of the infection prevention and control program.
In addition, the stabilization of COVID-19 cases in Quebec has allowed the CHU to reopen operating rooms, allowing operation at nearly 90%.
Sicker than in the first wave
The second wave swept through Quebec hospitals, bringing with it the first seriously ill COVID-19 patients who require acute care, including oxygen assistance.
On average, for 50 hospitalized patients, 10 go to intensive care, where we find the “seriously ill”.
In some cases, one or two nurses may need to be assigned to a single patient at all times.
“We have had patients who required very high levels of care. The patients were much sicker than during the first wave at home, ”says Danielle Goulet, director of critical care.
“High level patients”
For the first time, intensive care teams have installed patients in respiratory distress in a prone position, to promote their oxygenation.
“Ventral ventilation opens up the alveoli. They are high level patients ”, explains Mme Goulet.
Several patients with COVID-19 have also demonstrated serious intestinal problems. “I have seen some who vomited as much as they had difficulty breathing. ”
35% more staff needed to take care of patients
Caring for patients with COVID-19 requires 35% more staff, in addition to numerous precautionary measures and equipment, which make medical teams less productive.
Even though the number of patients hospitalized for COVID-19 may seem minimal to the population, the highly contagious nature of the virus monopolizes workers.
“To take care of 50 patients with COVID, for example, we need around 110 to 115 staff members,” says Marie-Frédérique Fournier, director of two “COVID” units at L’Enfant-Jésus hospital .
The corridors, units and trajectories dedicated to the virus also affect the efficiency of teams.
“We cannot be as efficient as before. But if we do not put all these processes in place, we will create contamination among vulnerable customers. Here come people with chemotherapy, cancer patients, people with kidney problems, etc. », Specifies Dr Roger Grégoire, coordinator of surgical activity during the pandemic.