Quebec health officials were ill-prepared to weather the first wave of the COVID-19 pandemic, with no coherent emergency plan and a health system that left vulnerable seniors in the lurch, the province’s health and welfare commissioner said Wednesday.
Joanne Castonguay’s final report into the care and service offered to seniors in the pandemic’s early months was released Wednesday, highlighting a need to overhaul the provincial Health Department.
In the 300-page report, Castonguay recommends transforming the health system from one that focuses primarily on providing medical and hospital services to one that gives priority to the patients’ needs amid an increasingly aging population. She said that as the system is now designed, senior care, public health and prevention are in the government’s blind spot.
Castonguay, who was asked to investigate by the provincial government in August 2020, said her findings and recommendations aren’t about assigning blame. “Responsibility for the crisis that we have experienced is collective,” she said.
“The pandemic has shown, unequivocally, that we can do better,” Castonguay told reporters on Wednesday. “We have that responsibility for those who died, their families and health workers who found themselves in extremely difficult situations, to seize this opportunity to mark a progressive transformation of our health-care system.”
Of the 5,718 deaths reported in Quebec during the first wave from February to July 2020, 4,836 were in elder care and long-term care.
The majority of the deaths — 64 per cent — occurred in long-term care homes, known as CHSLDs in the province. Castonguay’s report notes that only 0.5 per cent of the population live in such settings. Nearly half of the 14,000 health workers who became infected during the first wave worked in long-term care.
Castonguay pointed to the lack of a tested crisis plan and confusion about roles and responsibilities as evidence of how unprepared Quebec officials were for the pandemic. There was also a serious shortage of equipment, she said.
Castonguay described a “paternalistic attitude” of the health system towards seniors, one that did not look closely at their needs. She gave the example of the removal of outside caregivers from long-term care homes, which was intended to limit the spread of the virus but often left residents without adequate care. She said the decision might have been different if the caregivers had been consulted.
She said an emphasis on the protection of personal information prevented officials from having data readily available that could have quickly identified an emerging crisis in long-term care as the pandemic began.
“Certain indicators showed a clear and early signal of the rapid spread of the pandemic in CHSLDs in Quebec,” Castonguay said. “If the public health monitoring system had been appropriate, this data could have been observed and the alert or attention would have been directed more toward the CHSLDs.”
She also called for the role of the province’s public health director to be revamped so they communicate directly with the public instead of having their message filtered through politicians. While the role differs by jurisdiction, Castonguay noted that the independence of a public health director improves transparency and the public’s willingness to accept recommendations.
Health Minister Christian Dube welcomed the report and said some of the failings identified have been addressed by health authorities. “This report invites us to adopt a new vision for the future, which we are committed to doing, together with our partners,” he said in a statement.
Quebec’s opposition leaders have been calling for months for a public inquiry to investigate the province’s pandemic response. Liberal Leader Dominique Anglade said the commissioner’s report confirms the need for an independent public probe, while Quebec solidaire’s Vincent Marissal said the report doesn’t shed light on what really went wrong in the management of the pandemic.
But Castonguay said that in her opinion, the three existing probes — including her own — are sufficient.
“Between the report from the ombudswoman, the upcoming report from the coroner and our reports, we have everything we need to engage in a transformation and look to the future,” she said.
“It’s really time that we move to improving our health-care system to deal with future crises and improve its overall performance.”