With each new wave of COVID-19, the healthcare system 'collapses around us' | Coronavirus

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With each new wave of COVID-19, the healthcare system “collapses around us” | Coronavirus

Thousands of healthcare workers have left the field after two years of crisis.

Last summer, when COVID-19 cases dropped significantly, healthcare workers were able to take a breather. As a seventh wave hits in the middle of July, many believe that Canada's health care systems, overstretched after almost three years of crisis, are on the verge of collapse.

It's no surprise: the health care system in Quebec, Ontario and elsewhere in the country was fragile long before the pandemic. But seven waves of infections in two years have exacerbated the situation.

Dr. Judy Morris thinks the public doesn't know how difficult the situation is in the healthcare system, especially in the emergency room. I think there is a desensitization; people say to themselves, “The ER has always been overflowing.” But it is a critical situation. It's worse than before, she says, lamenting that the public seems more concerned about queues at passport offices than queues at emergency rooms.

Yes, the system has been in trouble for 20-30 years. But the pandemic has accelerated the deterioration of the health care system, adds Dr. Katherine Smart, president of the Canadian Medical Association (CMA).

The situation is becoming more and more untenable and the more waves there are, the faster the health care system in Canada will crumble, she says.

The health system is at the end of its tether, if it is not already [under] an artificial respirator. If we are not serious and we do not take the necessary measures to [address] the challenges, we will end up with a code blue situation in the coming years, adds Paul-Émile Cloutier, President and CEO of HealthCareCAN, an organization that represents research hospitals, health centers and health organizations across the country.

At the rate at which the system is falling apart, the reality is quite different from previous crises, says Damien Contandriopoulos, a professor at the University of Victoria School of Nursing and a public health policy expert.

And no, he insists, the strain on the healthcare system caused by the pandemic cannot be said to be of the same magnitude as during a flu season.

“The flu was a bit of a long wave every winter. But here, it's the same thing, but bionic version, year-round.

— Damien Contandriopoulos, Professor at the University of Victoria School of Nursing

If the pandemic has exposed the flaws in the system, Dr. Morris says we no longer have the capacity to live with other overflows.

The system has no was not designed to cope with such continuous pressure, adds Paul-Émile Cloutier.

The more the virus circulates, the more healthcare workers become infected and have to isolate themselves, which exacerbates the workforce problem, adds Dr. Smart. Each more stress, each more wave pushes the system even more towards failure. The healthcare system is no longer able to handle waves again and again.

For example, as of July 15, in Quebec there are over 7,000 healthcare workers absent due to COVID-19. If this is less than the 20,000 absentees in January 2022, it should be remembered that the Minister of Health of Quebec, Christian Dubé, affirmed in December 2021, when there were 7,000 absentees, that the province has a stake in society. We have more and more sick people, but fewer and fewer people to care for them.

Even during the lulls between the waves, there were always more than 3,000 Quebec workers absent .

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The question haunting these experts: Which wave will be the deathblow for the healthcare system?

That's why they believe that in order to help the healthcare system survive, it must first and foremost reduce the transmission of SARS-CoV-2.

We need a credible COVID-19 exit scenario. We were sold the scenario "epidemiologically" crazy that it's the last wave and it's over, denounces Mr. Contandriopoulos, who is not very optimistic for the next few months, especially if governments do not intervene.

“We decided we don't want to wear masks anymore, even though it's a very effective measure. But can we afford not to do it when hospitals are cracking? »

— Damien Contandriopoulos, professor at the University of Victoria School of Nursing

Judy Morris, president of the Quebec Association of Emergency Physicians

According to Dr. Judy Morris, president of the Association of Emergency Physicians of Quebec, if we choose not to put in place certain sanitary measures, we will have to hire massive numbers of health care workers.

It is still necessary to be able to find these workers, in a context of shortage and professional exhaustion.

There is an extremely high number of workers who have worked tirelessly for two years, who have taken care of a large volume of sick people. They're burned out, says Dr. Smart, adding that more and more people are leaving the healthcare field. These workers are sick of being in a broken system, she says.

She says that in the first quarter of 2022, there were nearly 137,000 job vacancies in healthcare across Canada, an all-time high. If the trend continues, it is obvious that there will be a break.

But this rupture is already being felt. According to Dr. Smart, ER wait times across the country are at their highest in 14 years; one in seven Canadians does not have a family doctor. And that's not counting the ever-growing surgery waiting lists.

At the beginning of June, Quebec's chief physicians were sounding the alarm: in a letter, they expressed their concerns about not being able to provide safe services for the summer period. Six emergency departments will be partially closed this summer in Quebec due to staff shortages.

In Ontario, several regional ERs will also be closed. Same scenario in New Brunswick, Alberta, Manitoba, Newfoundland and Labrador and British Columbia.

This is a very worrying situation for these communities, says Mr. Cloutier, who fears that these closures will occur more frequently or become permanent.

Emergency departments in Newfoundland and Labrador hospitals experience regular service interruptions.

Dr. Smart worries when she hears more and more heartbreaking stories from Canadians who don't have access to proper care. She cites the death of a patient in the waiting room of a New Brunswick emergency department or that of a 91-year-old Montrealer who died on her balcony after waiting for an ambulance for 7 hours. /p>

“These are no longer single stories. It is reality. What that means is that primary care as we know it and expect it to be is slowly dying.

— Dr. Katherine Smart, President of the Canadian Medical Association

Canadian Medical Association President Katherine Smart

This week, provincial premiers and territorial governments, gathered at the Council of the Federation, demanded that Ottawa substantially increase its share of health care costs.

But according to Mr. Cloutier, Dr. Morris, Dr. Smart, Mr. Cloutier and Mr. Contandriopoulos, the solution to the problem is not necessarily more money.

C' It's a bit sad to see this spectacle of premiers blaming federal funding for health problems and the federal government promising money, but only under certain conditions, Contandriopoulos said. Having more money without a concrete plan will not fix the situation, he says.

Damien Contandriopoulos, professor at the School of Nursing at the University of Victoria and holder of the Research Chair in Policy, Knowledge and Health at Canadian level.

Dr. Smart agrees. Nobody has the courage to tackle a change in the system and we dare not adopt innovative solutions. This is the fundamental problem and this is why we are not seeing any changes.

If a complete overhaul of health care systems in Canada is necessary, the urgency is to first to tackle workforce retention.

Politicians need to come up with a plan in which workers see a light at the end of the tunnel, says Contandriopoulos. Otherwise, the haemorrhaging of labor will not stop. People don't want to wait their whole career to see changes.

Several organizations and associations representing healthcare workers are proposing various measures to begin this overhaul of the healthcare system, such as following:

  • harmonize licensing across the country to allow for better labor mobility;

  • simplify the requalification of foreign workers;

  • encourage universities to graduate more people in areas with labor shortages;

  • have better national labor data work;

  • reorganize the structure of primary care;

  • reduce the administrative burden on physicians.

While the task may seem daunting and insurmountable, Dr. Smart believes the pandemic has shown that it is possible for the health system to change rapidly. For example, before the pandemic, there was almost no telemedicine in Canada. And almost overnight, we pivoted to online dating. So it's possible to make a difference when we work together.

Even though it's one to midnight, Dr. Smart remains hopeful that governments will act in time. The alternative is the complete collapse of the healthcare system.

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