How the West Island's Lakeshore General learned from COVID-19 outbreaks within its aging walls
Using plexiglass and doing on-the-spot renovations, Lakeshore found fixes to prevent further spread
In March, just as Quebec declared a public health emergency to try to thwart the spread of the novel coronavirus, staff at the only hospital serving Montreal's West Island received a phone call from the provincial government. They were asked to step up and prepare their regional hospital to become a COVID-designated centre.
Within two weeks, the Lakeshore General Hospital transformed its short-term stay unit into an intensive care unit for COVID-positive patients.
Hospital leadership readily admit their building was not the ideal place to deal with an infectious disease, especially not one that spreads as easily as COVID-19.
"The hospital performed to the best it could, but not necessarily always to the very best standard," said Dr. Rolf Loertscher, a nephrologist and head of the hospital's specialized medicine department.
"In an old structure, it is limited what can be done."
They did their best to make made significant improvements, he said, learning hard lessons along the way about how the virus behaves.
A spokesperson for Quebec's Health Ministry said Lakeshore was chosen because COVID patients in the western part of Montreal needed a hospital ready to receive them.
But Lakeshore was built in the 1960s, with additions in the early 2000s, and unlike Montreal's new superhospitals with their layouts designed to prevent the spread of infectious diseases, the Lakeshore still has wings where four patients share a room.
One of those areas is the general medical ward, located in a wing built in 1963.
On a tour of the hospital with CBC News, Loertscher acknowledged that ward was the site of one of the Lakeshore's outbreaks — meaning patients who entered the hospital for reasons other than COVID-19 ended up being infected with the virus.
The hospital responded by renovating the floor on the spot. It built new walls, to convert rooms with four beds into single rooms.
The small, crowded nursing station was also expanded so that nurses could remain physically distanced, as much as possible.
"Ever since that was put in place, there's been no further transmission of COVID to patients," Loertscher said.
WATCH: A behind-the-scenes look at Lakeshore General Hospital
Dialysis posed heightened risks
The hemodialysis unit was another problem spot.
Dialysis can take up to four hours, three times a week. Before the pandemic, patients would sit for the entire treatment in a shared, open space. '
Some patients came from long-term care homes, not knowing they were sick, and unfortunately ended up spreading the infection.
The unit responded by creating two dialysis treatment beds specifically for patients at risk of having COVID-19. They surrounded the beds with closed plastic bubbles with zippered doors which sealed tight.
At the time, it still wasn't clear how exactly the virus was spread and how important it was to have proper air ventilation.
Two nurses who were tending to those patients ended up sick with COVID-19.
The hospital adapted yet again, this time installing floor-to-ceiling plexiglass around the beds in the unit, in order to create negative pressure rooms with ventilation systems.
Since then, they've had no more more transmission of COVID-19 in the dialysis unit.
The nurses who caught COVID-19 have recovered and are now back at work.
Many regular dialysis patients ended up falling ill, and roughly half of those infected with the coronavirus died. The hospital said it knows of only two patients who caught the disease while in the dialysis unit. One of them recovered and one died, but from a cause unrelated to COVID-19.
Latest expertise, but not the resources
Lakeshore General Hospital is a teaching hospital associated with McGill University, where Loertscher is an associate professor of medicine.
Loertscher said it's important to understand that while the medical staff were on top of the latest expertise on the disease, applying that to the realities of a regional hospital with limited resources is an entirely different ball game.
"When it comes down to the little nitty gritty ... you read the bigger report, but then when it has to be translated into action, you're really still starting from scratch," he said.
Paul Brunet, head of the Quebec Council for the Protection of Patients, said it's good the hospital is adapting, but it's not an ideal situation.
"Even though they're trying, and we have to give them [credit], it is not the best place or the best way to securely treat patients. Especially with the risk of infection and risk of COVID spreading."
He said while having patients behind plexiglass lowers the risk of spreading infection, it's far from perfect.
That point is not lost on Loertscher, who agrees ideally, major renovations are the answer. He said he hopes the government will recognize the need to invest in a hospital with enormous potential, a place he calls "a diamond in the rough."
"If there is an effort made to make it into what it should be, to serve the population — an aging population and a growing population — then investments have to be made."
He said the Lakeshore General Hospital should continue to deliver community-level care, but of a very high quality.
While the hospital looks to its future and prepares for the possibility of a second wave of COVID-19, it's also building a new annex — a negative pressure modular complex with space for 24 stretchers.
The extension has been under construction for about 10 weeks and is expected to open in the next few days.
Loertscher hopes they can continue to modernize and update the hospital, with more financial support from the provincial government.
A spokesperson for Quebec's Health Ministry said the level of care available at the Lakeshore during the pandemic was appropriate.
ABOUT THE AUTHOR
