In Montreal, public CHSLDs that have remained “cold” since the start of the pandemic can be counted on the fingers of one hand. Among the rare ones spared by COVID-19: the Camille-Lefebvre Pavilion, in Lachine. Here is how this establishment, which housed a very vulnerable clientele, prevented the virus from wreaking havoc there.
CAROLINE TOUZIN and GABRIELLE DUCHAINE, La PRESS+ June 29, 2020
“There is no doubt that the consequences will be fatal for our most vulnerable patients. ”
Even before the virus arrives in Canada, while COVID-19 hits China hard, Dr. Ewa Rajda is concerned about the fate of ventilator-assisted patients at the Camille-Lefebvre Pavilion.
In this public CHSLD in Lachine, 20 beds out of 135 are reserved for this “extremely vulnerable” clientele, dependent on a respirator to ensure ventilation.
“You can’t afford to take any chances,” said the infectious disease specialist at the McGill University Health Center (MUHC).
The Camille-Lefebvre Pavilion is the only public CHSLD in Montreal to be run by a university hospital center – the MUHC.
The other public CHSLDs in the metropolitan area are under the responsibility of the Integrated University Health and Social Services Centers (CIUSSS) – megastructures which include, in addition to CHSLDs, hospitals, CLSCs, rehabilitation centers and protection centers of childhood and youth.
Dr. Rajda was affected very quickly to protect the Camille-Lefebvre Pavilion adjacent to the Lachine hospital (also the responsibility of the MUHC). Its mission: to prevent the virus from wreaking havoc.
Since the start of the pandemic, only 3 of the 60 public CHSLDs in the metropolitan area have remained “cold”. In other words, no resident was infected with COVID-19, according to data transmitted to La Presse in mid-June by the five CIUSSS which cover the territory of the metropolis. The Camille-Lefebvre Pavilion is therefore one of the very few saved.
It is not a coincidence.
First, unlike many CHLSDs under the responsibility of the CIUSSS, there is a boss on site. More precisely a patron: Chantale Bourdeau. Don’t be fooled by her title of deputy director, “she’s the boss,” says MUHC CEO Dr. Pierre Gfeller. And she has taken “energetic measures” to prevent an outbreak, he says , by taking advantage of Dr. Rajda’s expertise.
Inspired by what has been put in place at the MUHC, Ms. Bourdeau took the initiative to set up an emergency measures coordination committee for the Lachine hospital and the Camille-Lefebvre Pavilion, a committee that meets every day for three months. “We tackle the problems of each sector as they arise and we find solutions together,” explains the manager.
SCHOOL BREAKS AND STAFF MOVEMENTS
In addition to closing its doors quickly to visitors, the CHSLD forced its employees who returned from a trip abroad after the school break – the first week of March – to quarantine themselves, starting March 8 . They therefore did not return to work on Monday morning, unlike those of other health establishments where there were outbreaks thereafter.
Remember that it took four days after the break week for the Quebec government to ask all Quebecers who returned from travel to isolate themselves in a preventive manner for 14 days; an announcement made on March 12.
Another crucial measure: the CHSLD, which has 280 employees, has prohibited any movement of personnel. For the past three months, the sharing of employees between the hospital and the CHSLD has ceased. “At the beginning, our concern was really this proximity to the [Lachine] hospital. We are literally glued, “describes Ms. Bourdeau. And nobody – except exception – now circulates between the two sites.
Not only that, but the team that works with ventilator-assisted patients no longer changes floors. “We have segregated the staff, even inside the CHSLD,” summarizes the manager.
NO EMPLOYMENT AGENCIES
Also key: the Camille-Lefebvre Pavilion does not do business with private placement agencies. These personnel rental services are singled out for their contribution to the spread of the virus in CHSLDs.
That said, Dr. Gfeller is not throwing stones at his fellow managers who have used them to meet their labor needs.
“It’s hard to wean yourself off agencies all of a sudden. When my colleagues realized the role it was playing in the pandemic, it was already late. The fire was on. ”
– Dr. Pierre Gfeller, CEO of the MUHC and former CEO of the CIUSSS du Nord-de-l’Île-de-Montréal
As the risk of contamination comes from asymptomatic employees or those with mild symptoms, an “aggressive” triage with a very detailed questionnaire on their state of health has been set up at the Camille-Lefebvre Pavilion and at the Lachine hospital, continues the Dr Gfeller.
Everything takes place in a tent set up outside the two establishments.
“As of March 16, we implemented this sorting system, a bit like a border crossing that must be crossed before entering the hospital or the Pavilion; a barrier between the community and our healthcare settings. ”
– Claude Briault, head of the material installations department
This system works day and night, seven days a week. “It takes time, I’m not going to lie to you, but it helped us a lot to stay cold,” said Dr. Rajda.
If there is any doubt about the symptoms, the employee is sent for a screening test – also in a tent. He does not return to work until he has received his result.
And if an employee’s health deteriorates during a shift, he is immediately removed from the care unit. “We send him to be tested without delay,” said France Nadon, nurse and infection prevention and control (PCI) counselor at the CHSLD.
Like the passport to cross the border, a coupon system has been implemented. To be able to enter work, employees must show the security guard posted at the entrances the coupon received at the yard.
A total of 10 employees – from the CHSLD and the Lachine hospital combined – have been declared positive for COVID-19 since the start of the pandemic. Among them, only one had been in contact with patients during a shift and he did not contaminate anyone.
Epidemiological investigations were carried out quickly, said Dr. Rajda, to identify all those who had been in contact with the infected colleagues – go back 48 hours before the onset of symptoms – and to isolate them if necessary.
Employees initially found the triage system “intrusive”, adds Dr. Gfeller. But they understood that all of this was in place to protect the most vulnerable, he said.
“At the MUHC, we have great expertise in infection prevention and control. Dr. Rajda has done an outstanding job, “says the CEO of the MUHC. “D can be called re Rajda day and night,” adds me Nadon Advisor PCI.
Also, the wearing of mandatory masks has been introduced in both establishments. “We have developed a culture of infection prevention to the point that today, a maintenance or hardware worker will stop you in the corridor if you do not wear your mask correctly to explain how to wear it,” says M me Nadon.
With the deconfinement of Montreal, the CHSLD relaxed its rules a little, among other things by reopening its doors to family caregivers. Except that by doing so, the risk of contamination increases. A team from the MUHC produced a video for them. During the week of their return, caregivers had to watch it every morning. “They know it by heart,” says the NIC counselor.
Faced with the specter of a second wave, the CEO of the MUHC does not want to be “triumphant”. “It remains a fragile place. It can always come in, insists the CEO of the MUHC. And if it enters our ventilo-assisted, it will be very serious. ”
THE THREE PUBLIC CHSLDS IN MONTREAL SPARED BY COVID-19
- The Camille-Lefebvre Pavilion (MUHC)
- Father-Dowd CHSLD (CIUSSS du Center-Ouest-de-l’Ile-de-Montréal)
- The CHSLD Dante (CIUSSS de l’Est-de-Montréal)
Sources: the MUHC and the five CIUSSS on the territory of Montreal
SIX LARGE MONTREAL CHSLDS HAVE WEATHERED THE STORM
On the Island of Montreal, 6 CHSLDs of 100 beds or more were spared by the pandemic, registering no deaths among their residents. According to the La Presse compilation , 5 of the 6 establishments are public and one is private. On average, in the 170 CHSLDs that La Presseanalyzed, the death rate is 13%. The worst death rates exceed 40%, especially in Laval. Among these 6 establishments on the Island of Montreal, three public CHSLDs did not even have any cases among residents (see other text). They are CHSLD Father-Dowd, CHSLD Dante and Pavillon Camille-Lefebvre (McGill University Health Center). Privately, this feat on the island was carried out by Château Westmount. In the metropolitan area, other CHSLDs do not record any deaths. Among them are the Résidence Riviera (private agreement, Laval), the Montarville accommodation center (public, Saint-Bruno) and the Manoir Trinité accommodation center (public, Longueuil).
MONTREAL CHINESE HOSPITAL
MASKED EMPLOYEES FROM JANUARY
More than two months before the pandemic began in Quebec, employees of the Montreal Chinese Hospital were already wearing their own masks at work. From the outside, some thought they were exaggerating. Today, the CHSLD has one of the best results in the metropolis. Analysis of another success.
GABRIELLE DUCHAINE La PRESS+
The coordinator of the establishment of the Chinatown admits it immediately. When the employees of the shelter that accommodates 128 seniors with loss of autonomy, mainly of Asian origin, started to show up for work with their own masks in January, she found it a bit “extreme”.
“We weren’t there yet. We weren’t wearing masks. We were not yet in the process of canceling everything. I found them anxious, says Sandra Lavoie. I even brought in a doctor from the Public Health Department to alleviate their fears. ”
Today, she rather considers them as avant-garde.
“The rest of them knew. They were connected [to what was happening in China]. They lived it more from the inside. ”
– Sandra Lavoie, coordinator of the Chinese Hospital
Some 70% of the 200 local employees are from the Chinese community. “They had ties to family and friends there. From the start, they saw the gravity of the situation, ”says Ms. Lavoie.
While the majority of the city’s seniors’ accommodation centers have been overwhelmed by the coronavirus, the Chinese Hospital has had no deaths and only one case among its residents. In addition, the patient was not contaminated in the establishment. He contracted the virus during one of his weekly visits to a hospital where he received dialysis treatment.
Five employees have also been declared positive since the start of the crisis. Four are cases of community transmission. A fifth is an employee who had gone to lend a hand in another CHSLD. He died from COVID-19.
To date, sick employees have not infected their colleagues or their residents.
The success of the establishment in the fight against the virus is such that the CEO of the CIUSSS Center-Sud de Montréal, Sonia Bélanger, asked the School of Public Health of the University of Montreal to be the subject of it. of a study.
However, when the first cases of COVID-19 were reported in Quebec, Ms. Bélanger expressed concern for the Chinese Hospital. “I said to myself, this will be the first CHSLD [affected]. It’s going to be this one. I was convinced. ”
At the time, the links between the Chinese living in China, the cradle of the new coronavirus, and those living here aroused many apprehensions among the population. So much, says Ms. Bélanger, that the CIUSSS received many calls at the beginning of the year from parents who did not want to send their children to school with cubs of Chinese origin.
“The Chinese community was ostracized,” recalls Sandra Lavoie. I have employees who looked after their children at home because they were ostracized in the schoolyard. There are those who were told words when they went to get their coffee. ”
But while they were singled out, these nationals were preparing to face the wave that was bound to hit Quebec inexorably.
There were of course these masks, brought from home by CHSLD employees.
“Elsewhere, masks were ripped out of the faces of employees who wore them. They were told they were going to create panic. But there, we let them wear them. With all the things we know now, we believe it had an effect. We noticed this from the start. ”
– Alain Croteau, president of the CSN union of the CIUSSS Center-Sud, which represents the workers of the Chinese Hospital
Then there were the Chinese New Year celebrations that were to be celebrated in large numbers in the establishment, and which the residents’ families and participating community organizations had canceled.
“They told us they would not come. It was not safe to have rallies. And our employees were in complete agreement, ”says Sandra Lavoie.
When health measures such as a visitation ban were ordered by Quebec in March, not only did the families of the beneficiaries support them, but they “thought it was coming late”.
And since the complete equipment (mask, blouse, gloves and visor) has become the norm in all CHSLDs, “my world follows the instructions to the letter”.
Equipment, say several observers, is not the only key to success.
Other specific features of the CHSLD in Chinatown have also contributed to limiting the spread of the virus.
First, while several other establishments of the same type have been severely understaffed since March, they have had no shortage problems, says the coordinator.
“It’s an environment that is much more stable,” notes José Carufel, of the Canadian Union of Public Employees, who also represents employees.
“There are stations where you have to speak Mandarin or Cantonese. Many employees come from the Chinese community. There is a sense of belonging. People did not walk from one establishment to another. ”
– José Carufel, from the Canadian Union of Public Employees
The management also indicates that they never ran out of equipment. Better than that, the Chinese Hospital Foundation offered her support if she ran out. She also received donations from community members.
Sandra Lavoie also specifies that the building was built 20 years ago, which makes it the most recent CHSLD of the CIUSSS. The living spaces are large, which facilitates distancing. The ventilation system is recent.
The fact remains, notes Sonia Bélanger, CEO of the CIUSSS, “Fear and distrust made them respect the rules from the start. They started to wear masks before they were distributed. ”