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Quebec needs 'early warning system' to avoid another long-term care disaster, report finds

Quebec's health commissioner has concluded poor communication, a “paternalistic” attitude toward seniors and a lack of a coherent pandemic plan contributed to the deadly first wave of the COVID-19 pandemic in Quebec’s long-term care homes.

'Paternalistic' attitude toward seniors made things worse, health commissioner says

The report by Quebec's health and welfare commissioner found that 4,836 people died in long-term care homes in the province during the first wave, which represents nearly 85 per cent of all of the COVID-19 deaths during that time. (Graham Hughes/The Canadian Press)

Quebec must create an "early warning system" to avoid another disaster like the deadly first wave of the pandemic that tore through the province's long-term care homes, a new report has concluded.

Quebec's health and welfare commissioner, Joanne Castonguay, presented her final report Friday into why the health-care system failed seniors during the first wave of the COVID-19 pandemic.

The report found that poor communication and the lack of real-time data about high infection rates and positivity rates among elderly residents of long-term care led to sluggish decision-making by health officials.

"A strong early warning system would have allowed officials to rapidly reconsider the initial pandemic plan of focusing on hospitals," Castonguay said in a news conference.

Infection rates for people over the age of 80 had already started to spike by the week of March 22, 2020, according to the report. 

By April 2, more than one in three residents of CHSLDs, the French acronym for long-term care homes, was testing positive.

Quebec health and welfare commissioner Joanne Castonguay said an 'early warning system' to watch for spikes in positivity rates among seniors might have helped prevent the disastrous first wave in long-term care homes. (Radio-Canada)

But without this data at their fingertips, public health officials did not sound the alarm promptly, Castonguay said.

She said the lack of a coherent pandemic plan left health officials cleaving to their standard bureaucratic structures, instead of pivoting to crisis mode.

"If we had had a good plan going into the pandemic and it had been put into action, people would have understood their role in a crisis, and there would have been less of a mess," she said.

Castonguay also found that health officials lacked up-to-date information about everything from employee availability to reserves of personal protective equipment.

'Paternalistic' attitude toward seniors

The report echoed the findings of Quebec's ombudsman released in November that the government put too much emphasis on preparing hospitals and that seniors were essentially "cast aside."

Castonguay said the failure to consult seniors at the start of the pandemic amounted to a "paternalistic" attitude by the government and likely worsened the crisis.

"The main committee that was put in place in order to manage the crisis: at first they didn't invite anyone to represent the elderly, and they didn't invite nurses either. So they didn't consider their specific needs," she said.

She questioned whether the government would have proceeded with its decision to bar caregivers from entering long-term care homes, had it consulted seniors first. 

The report was welcomed by groups representing both subsidized and non-subsidized private seniors homes. They criticized the government for not taking the needs of the long-term care sector into account at the outset of the pandemic.

The failure to consult seniors about their needs at the outset of the pandemic amounted to a 'paternalistic' attitude, according to the health commissioner's report. (Radio-Canada)

'Excess mortality' highest in CHSLDs

While the final report looks at the health system as a whole, it laid out the full extent of the deadly wave in long-term care homes in Quebec. It found:

  • 4,836 people died in long-term care between the end of February and early July 2020, accounting for nearly 85 per cent of all of COVID-19 deaths during that time.
  • 3,675 people died in CHSLDs specifically, representing 64 per cent of the deaths over that period, even though CHSLD residents represent only 0.5 per cent of the population.
  • 40 per cent of CHSLD residents who caught COVID-19 died, compared to only 2 per cent of the general population.
  • 47 per cent of the 14,000 health-care workers who caught COVID-19 during the first wave worked in CHSLDs.

As well, there was a 34 per cent excess mortality rate in CHSLDs during the first wave, compared to 15 per cent for the general population. 

Excess mortality refers to the percentage of additional people who died, compared to what would have been expected in a normal year. 

Premier François Legault has said that excess mortality, and not reported COVID deaths, is the best statistic to use when comparing different jurisdictions. Castonguay's report finds that Quebec had the highest excess mortality rate of all provinces during the first wave.

Public health needs more transparency

The report also draws attention to the "perception of a lack of independence of Quebec's public health director," as well as a "lack of transparency in the creation of directives."

The former public health director, Dr. Horacio Arruda, stepped down earlier this month amid criticisms that the government was basing its pandemic measures on politics, not on public health interests.

Dr. Horacio Arruda, Quebec's former director of public health, resigned earlier this month. The health commissioner's report says to foster public trust, the public health director should be able to make recommendations directly to the public, independent of political decisions. (Jacques Boissinot/The Canadian Press)

While the report does not lay blame on individuals, Castonguay did recommend that in order to foster more public trust, the public health director should be able to communicate directives directly to the public, separately from the government.

She said that would help the public "understand what is the difference between what is good for [public] health and what is a government decision based on what is possible to do."

Québec Solidaire health critic Vincent Marissal said this recommendation was "music to my ears."

"We did ask the government to take the opportunity to change things with Horacio Arruda leaving his post," said Marissal. "I hope that they will read Madame Castonguay's report and finally move in that direction."

The report also noted that Quebec spends less on public health per capita than any other province and is the only province to see this funding diminish between 2010 and 2019.

No need for full public inquiry, Castonguay says

In addition to the health commissioner's report and the ombudsman's report, an inquiry by Quebec's coroner is expected to hear closing remarks this week.

Castonguay believes that the existing reports will provide the government with all of the information it needs to reform the health-care system and to better respond to a future pandemic. 

However, opposition parties are still calling for an independent public inquiry.

Liberal opposition leader Dominique Anglade said families of seniors who died during the pandemic still deserve to know why the government did not focus on protecting long-term care homes from the outset of the pandemic.

"We still don't know who was aware and when they knew it," said Anglade. "There are still lots of contradictions within the same government."

In a statement, Health Minister Christian Dubé said his government is already working to respond concretely to Castonguay's recommendations.

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