Dedicated staff felt overwhelmed on all levels by COVID outbreak at CHSLD: Quebec coroner hears
'Virus was always a few steps ahead' crisis manager said of Shawinigan CHSLD where 44 residents died
When Dr. Nathalie Brui walked into CHSLD Laflèche in Shawinigan, Qc., in early April of last year she found staff exhausted, anxious, and in mourning.
Laflèche was one of the first long-term care homes to be gripped by a COVID-19 outbreak, and it became one of the worst hit in Quebec. Of the 138 residents, 107 contracted the virus and 44 died.
Coroner Géhane Kamel spent the week hearing about how the first wave of the pandemic played out at the institution, as part of a sweeping public inquiry into how people living in care homes were treated during the first wave of the pandemic.
Dr. Brui testified she spent six weeks working nearly every day at Laflèche. She said the first shifts were very difficult.
The usual treatments to soothe patients in respiratory distress weren't working. She testified she turned to a private Facebook group for physicians working in long-term care homes in Quebec to exchange ideas with colleagues and figure out how best to treat her patients.
She faced a shortage of some medications.
Several witnesses testified that when Quebec prepared for the pandemic it took direction from what happened elsewhere in the world, notably in Italy. Authorities made sure that hospitals had plenty of empty beds and lots of medication.
That left CHSLDs (centres d'hébergement de soins de longue durée) cruelly unprepared to be walloped by the virus. In the first wave of the pandemic nearly 4000 people died in care homes.
"I'm glad they weren't my [regular] patients. It was easier to be emotionally detached," Dr. Brui, who usually worked in another CHSLD in town, testified. "The patient attendants were close to those patients, and they had to see them die."
Chronic understaffing
Staff and senior managers — even the CEO of the health board — testified the home had struggled with chronic understaffing before the outbreak.
It was the norm for teams to be down one person. A union rep testified that, in the two months preceding the outbreak, nurses and auxiliary nurses worked 1,100 overtime hours.
The problems only got worse when the virus first appeared in the home.
Public health put some staff on preventive leave to isolate. Others fell ill. In total 84 staff members contracted COVID. Two orderlies were intubated.
A nurse, whose name is under a publication ban, said early in the outbreak she and her colleagues cared for patients to the detriment of their own health, working 16-hour days and skipping meals and breaks.
She said she felt an immense loss of control and called her union a few weeks in to say "do something, otherwise we [the staff] are going to end up in the psychiatric wing."
Outside the walls of the CHSLD, families were left with questions.
Sofie Réunis testified she called ten times per day, leaving messages asking for news from her mother, Maria Lermytte, but only heard back the day her mother was moved to palliative care.
Despite the challenges staff faced, several witnesses testified the residents were well cared for. They were always fed, hydrated and cleaned.
Slow response criticized
The first positive case of COVID-19 was declared on March 22, 2020. But staff testified it wasn't until nearly three weeks later that real help was finally sent in. By then 93 residents had tested positive.
On April 10, the CEO of the health board, Carol Fillion, visited Laflèche and brought a new manager, who specialized in crisis management.
"The CEO came in as a savior two weeks too late," testified Dr. Jean-François Turmel who worked alongside Dr. Brui during the outbreak.
Care staff, uniforms, and extra equipment were also sent in as reinforcements.
"The extra staff made all the difference," the nurse testified.
During his testimony, Fillion's voice cracked and he became emotional when he explained he felt he was on the brink of losing control of the situation at Laflèche during 10 days.
"But did I act in consequence to get it back? The answer is 'yes'", he testified.
Coroner Kamel reminded Fillion the goal of the inquest is not to point fingers but rather to find out what happened and prevent anything similar in the future. She congratulated him and thanked him for his honesty.
'The virus was always a few steps ahead of us'
In the early days of the outbreak doctors struggled to get tests and results.
Public health directives at the time provided testing only to people who had travelled, which excluded the residents at Laflèche.
Dr. Brui testified a colleague ordered a COVID test for someone but it was denied by the infection control and prevention nurse. Later, the nurse reversed her position and granted the test.
Results would often take three to four days.
Staff tried to set up hot and warm zones, but they would fill within hours. Residents' belongings were packed into boxes and put into storage, then people were moved from floor to floor.
"We moved the problem around more than solving it," testified the nurse in charge of infection prevention and control.
The same nurse who called her union for help testified that unidentified residents were wheeled to her unit without their medical files. She didn't know who they were or what care they needed.
She says the risk of making medical mistakes was enormous, but luckily none happened.
"The virus was always a few steps ahead of us," said Claudia McMahon, a manager who was brought in to handle the crisis.
Admissions continue into outbreak
Turmel testified he was deeply frustrated that the health board continued with admissions during the outbreak.
"Where was the CIUSSS's proactivity?" he asked, saying the staff was working with teams short by two to three people. "No one had the decency to at least stop the admissions."
Earlier this week, nurse and unit-manager Chantal Rivard recalled how she spent much of a night reorganizing a hot zone at the home, slept at the CHSLD then admitted a new resident on March 28, something she said she was "uncomfortable with."
Rivard testified she had asked a superior at the health board to stop admissions as soon as the first case was declared.
Coroner Kamel said she was "floored" to hear new people were coming to live at the home in the week following the first cases being declared.
The inquest will now move on to study other residences, including CHSLD Herron in Dorval, as well as the overall management of the crisis by the province. It is expected to take months.
