Quebec hospital plan could see ‘harm-reduction approach’ taken to COVID-19

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The latest surge in COVID-19 hospitalizations is showing signs of subsiding, Quebec Health Minister Christian Dubé said Tuesday, shortly before officials outlined a contingency plan to keep overwhelmed hospitals operating.

That plan could see hospitals place less effort into trying to keep COVID-19 infections out of their facilities and instead adopt a “harm-reduction approach” to the spread of the virus, Marie-Eve Bouthillier, chair of the province’s COVID-19 ethics committee, told reporters at a technical briefing Tuesday afternoon.

If the plan is fully implemented, then workers who have been exposed to or infected with the virus would continue working rather than isolating. As well, family members of patients would be asked to provide basic care for their relatives so health-care workers could focus on clinical tasks.

Quebec hospitals would also reduce the minimum level of care offered, Bouthillier said. Hospitals, she added, would “care for more people at a lower level, rather than give fewer people an optimal level of care, so we can ensure that no one finds themselves without care.”

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Read more: Quebec reports 89 new COVID-19 deaths as hospitalizations continue to rise

The contingency plan would also see hospitals look for ways to discharge people sooner and provide more home care.

Dr. Duong Hoang, president of Quebec’s association of internal medicine specialists and one of the authors of the contingency plan, said he hopes the most serious parts of the plan won’t be put into practice.

“Decreasing the level of care to be able to care for a larger number of patients isn’t something we learned in medical school, but it’s something that could be necessary if we get there,” he told reporters.

Dr. Lucie Poitras, one of Quebec’s top hospital officials, said she wouldn’t speculate on the odds that the plan would be implemented.

“It’s to make sure that if the worst arrives, no patient will be left without care,” she told reporters, adding, “I don’t have a crystal ball, I couldn’t tell you if it’s going to be implemented. I hope not.”

Quebec’s health-care system has struggled to keep pace as the number of COVID-19 patients in the province has risen to record levels, reaching 3,417 on Tuesday.

Read more: Quebec looks abroad to solve nursing shortage, but experts warn it’s not a quick fix

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About 12,000 health-care workers are absent due to COVID-19, Dubé told reporters in Montreal. While that number has dropped from a recent high of 20,000, it remains at the level reached during the peak of the first wave of the pandemic, he added. Another 50,000 “potential” health-care workers are off for other reasons, he said, including burnout and other illnesses.

“In all likelihood, the number of cases has already peaked,” Dr. Luc Boileau, Quebec’s interim public health director, told reporters. “We’re starting to see the rise in hospitalizations slowing down, which is a very good sign, even if the situation in hospitals remains very fragile.”

COVID-19-related hospitalizations rose by 36 on Tuesday, the lowest daily increase in more than three weeks. But with hospitalizations still rising, Dubé said it was too soon to lift public health orders that have shut bars, restaurants and gyms.

“I know it’s tough; it’s tough for everybody,” he said, adding that measures will be lifted gradually.

Earlier Tuesday, officials outlined Quebec’s plan to distribute the anti-COVID-19 drug Paxlovid, which is made by Pfizer and was approved by Health Canada on Monday.

Sylvie Bouchard, the head of the drug evaluation division at a Quebec government health-care research institute, told reporters the drug will be initially offered to immunosuppressed patients who are not hospitalized. No consideration will be given to a person’s vaccination status, said Bouchard, with the Institut national d’excellence en sante et services sociaux.

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Read more: Quebec set to distribute Pfizer’s pill to treat COVID-19, but with limited availability

Quebec officials will identify who is eligible for the first round of Paxlovid before the province receives its first shipment of the drug, which is expected to be around 6,300 treatments this month, said Dominic Belanger, interim director of pharmaceutical and medical affairs at the Health Department.

But Dr. Lucie Opatrny, assistant deputy minister in charge of Quebec’s hospitals, said the drug may not have much effect on hospitalization rates in the province.

Studies done by the manufacturer indicated that one hospitalization could be avoided for every 19 people treated, but Opatrny said that research was conducted on unvaccinated people who were facing the Delta variant of the virus, not the Omicron variant that is currently dominant in Quebec.

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