As COVID-19 cases mount in Quebec's regions, some hospitals may be nearing a tipping point

Thehospital in Maria, Que., constructed in 1954,is one of at least four civicinstitutions in town of 2,500 currently grappling with a COVID-19 outbreak.

The hospital, which has 82 beds, serves a population of about 33,000 peoplein an areathat has some of the highest per capita infection COVID-19 infection rates in the province.

The way the second coronavirus wave has washed over theGasp area illustrateshow quickly things can go wrong in Quebec's outlying regions.

In the Gasp, as in other far-flung parts of the province, community spread has taken root within tightly knit, socially active populations.

There arefraying health infrastructures. Thereis a shortage of health-care workers and the ones who are on the job in facilities such as the Maria hospital say they're exhausted.

The cramped building has been updated over the years, but even PremierFranois Legault describeditsemergency ward as "dysfunctional and dilapidated" when he passed through town in July.

Themain intake department is a corridor that is only about threemetres wide. Hospitalbeds lineone of the walls;some are separated frompassing traffic by a curtain.

Aunion representing paramedics in the region has expressed concern that asymptomatic COVID-19 patients could spreadthe virus in that part of the hospital.

"Everyone passes through the same place," said Andr Tremblay-Roy, vice-president of the union andhimself a paramedic who transported patients to the hospital last weekend. "The emergency ward is really dated."

Bricks and mortar buildings are one concern, but the mainissue in the Gasp, as everywhere else, is people.

"The challenge is human resources but we had a challenge before COVID," said Connie Jacques, vice-president and director-general ofthe CISSS Gaspsie, the local health authority.

With staff resigning, sick with COVID-19,resources are stretched

During the pandemic's first wave, 13,500 health-care workers provincewide were infected, according to a study conducted by the provincial public health research agency. That represented one-quarter of all cases.

Orderlies and nursing assistants accounted for 70 per cent of cases among health-care workers,partly because nearly half the cases were in long-term care facilities. Almost one-third of those 13,500 workers were inhospitals.

In the Gasp, the local nursesfederation and the union representing orderlies, maintenance and kitchen workers are both reporting members resigning in bunches. Others are sick with COVID-19.

Because thenumbers in the regions are all smaller the main COVID-19 hospital in Gasphas 10 beds set aside for coronavirus patients every absence or empty position has an impact.

"When one person goes out it makes a big difference," Jacques said.

The resultis having to move staff, and sometimes patients, around within the system. That's one of the ways the pandemic spread through the CHSLD network in and around Montreal last spring.

Union leaders say it's happening againthis time in the regions.

"We're at the stage now that the major centres were in last spring," said Pierre-Luc Boulay, president of a union thatrepresents orderlies and support workers in the Gasp.

The health authority says workers are moved only when it's "absolutely necessary."

The big-citybottleneck

Eastern Quebec has a safety net of sorts:if someone becomes severely ill, they are typically sent first to Rimouski, and in dire cases to Quebec City's Heart and Lung Institute or the Htel-Dieu Hospital in Lvis.

But Rimouski, Quebec City and Lvis are all seeing their own cases rise,including among health-care workers.

Lvis's Htel-Dieu is the treatment centre for acute cases in Chaudire-Appalaches, one of the regions hit earliest and hardestby the second wave. Ittoo is dealing with outbreaks among staff and patients.

One of those patients, a former orderly for the health region named RaphalBlouin-Durand, provided a discomfiting account of his COVID-19 ordeal to Radio-Canada last week.

When Blouin-Durand started feeling unwell, he first went to his local hospital in Saint-Georges-de-Beauce, where he says he found a similar situation to the one paramedics in Maria describe: non-COVID patients in relative proximity to suspected COVID-19 cases, and staff walking from one zone to another.

"Yes, they were changing and there's a door, but the fact is when the minister says people aren't going from red zones to green zones in the same day, it isn't true," he told Radio-Canada.

When Blouin-Durand's symptoms worsened a few days later, he was taken to Lvis, where he said harried workers were also moving from one zone to the next. He said he wasalso left unattended at points andcould easily have moved around in the hospital despite being diagnosed withCOVID-19.

Moving patients recovering from COVID-19

Then there's the problem of what to do with recovering patients. Some CHSLD and seniors'homesdon't allow residents return to their rooms until after they've been symptom-free for two weeks.

But in some small, regional hospitals with few beds, recovered patients aremoved off the COVID-19 ward well before 14 days have elapsed.

One elderly COVID-19 positivepatient in Maria, who suffered from dementia, was turned away by hisseniors' residenceafter leaving the hospital. Regional health officials found him a bed in the town'sCHSLD, where he died a few days later.In that case,family members went public with their anger.

Several regions have tried to address those types of problems.

The Chaudire-Appalaches CIUSS has opened a "non-traditional"convalescence ward across the street from the hospital that has 60 beds, roughly one third of which are occupied.

A similar facility has been set up in Saint-Georges, andnearly all of its 19 beds are taken.

Central Quebec grappling with similar problems

In the Mauricie-Centre-du-Qubecregion, halfway between Montreal and Quebec City,the main COVID-19 intake centre is theCentre hospitalier affili universitaire rgionalde Trois-Rivires, where21 of 40 bedsare occupied.

Afurther 16 beds can be made available in Drummondville, 70 kilometres away, a CISSS spokesperson said.

The worry in Trois-Rivires is the institution is fighting a major outbreak in its neurological unit, with 46 positive cases. Of those,27 have been detected among staff members.

If one is looking for a sliver of good news in the regional picture, it can be found by looking northward. The Abitibi-Tmiscamingue's COVID-19 centre is at 10 per cent occupancy. There are zero COVID-19 patients in intensive careand there are no outbreaks currently being investigated.

Sinking morale among health workers

The additional beds and recovery wardslike other COVID-19resourcesin Quebec City, and Gasp, and Saguenay, and Trois-Rivires and elsewhere in the regions didn't exist six months ago. Plus, they're being staffed mostly with people who nominallydo other jobs.

"It's very, very hard. Morale is very low," said Boulayof the orderlies' union in Gasp. "More resources are leaving than coming inpeople are tired. They're burned out."

The situation in Chaudire-Appalaches is described in similar terms.

"We've had a lot of resignations, people deciding to leave for the private sector because of overwork," said Sonya Leboeuf,vice-president of the union representing professional and administrative workers in Chaudire-Appalaches. "Morale is not good."

In the Saguenay, which is steadily moving up the scale on the province's colour-coded alert map, the local nurse's union is raising the alarm. It contends more and more staff are quitting. The health region reports it is dealing with 23 separate outbreaks.

Local health officials have declared outbreaks in three seniors' residences in recent days, and the Saguenay police service is being ravaged by illness; about one-fifth of the force is currently either infectedor in quarantine awaiting test results.

"In two days, we've had 11 hospitalizations," said Julie Bouchard of the Fdration interprofessionellede la sant du Qubec'sSaguenay chapter. "We're worried about whether our network here in the Saguenay-Lac-Saint-Jean is going to be able to cope."