Virtual Town Hall - May 12, 2020

See the  transcription of the video.

Members of our panel:

Dr. Lawrence Rosenberg: President and CEO
Francine Dupuis: Associate CEO
Beverly Kravitz: Director of Human Resources, Communications, Legal Affairs and Global Security

Question #1 

The number of Quebecers who have COVID-19 and who have died from it are significantly higher than elsewhere in Canada. Can you tell us why our numbers are so disproportionate?

Dr. Lawrence Rosenberg: That's a great question, and I think it's a question that the provincial epidemiologists are still trying to come to grips with. It isn't clear why half the cases in the country reside in Quebec. There are reasons that we might be able to propose. It doesn't necessarily mean they're the right reasons, but Quebec does have a somewhat older population than the rest of the country and certainly most of the cases in Quebec are in the Montreal metropolitan area and areas that are known to be a little bit older than other areas. 

Other areas in Quebec that are hard hit, such as Montreal-East, Montreal-North, are lower economic areas that are known to be associated with higher incidence of chronic medical comorbidities, which are known risk factors for the COVID-19 as well. So I think for all these reasons it's sort of sets up a situation where we have a higher risk population perhaps than other areas in the country. 

Addendum to Question #1

Everybody talks about the curve. Where do you get the sense of where we're at right now?

Dr. Lawrence Rosenberg: It depends where you are in the province, and in fact, the Ministry looks at three different regions in the province. So if we look at the regions, the periphery farthest away from the metropolitan areas, those are areas that were least affected by the pandemic and are probably well on their way to returning back to normal. Then there's the intermediate geography between Montreal and the regions which also are doing much better than metropolitan Montreal and Laval are, and are also well on their way back to a more or less normal situation. 

And then we have metropolitan Montreal and Laval, which are still somewhat problematic. Now, the epidemiologists look at a figure that they call the R0 [pronounced “R Naught”], or the R zero, which relates to the number of individuals that are actually at risk of contracting the virus/might be in contact with an individual who tests positive. They would like to see this R0 figure at 1 or below 1, which is what people refer to as the flattening of the curve. Outside of metropolitan Montreal, the R0 figure actually is below one. On the Island of Montreal at the moment, as of the end of last week, it was sort of just about at 1. 

But there is some variation in that figure. So we probably won't have a more accurate idea of how things are going on the Island, and in Laval, until the end of this week. I would say the worst is probably behind us for sure, for this wave of the pandemic. Just if we look at our own territory, and particularly at admissions to the Jewish General Hospital and admissions to the intensive care unit, these admissions are falling and in fact, the admissions to the Intensive Care Unit at the Jewish are about half what they were three weeks ago.  

Question #2 

Dans un contexte de pénurie de main d'œuvre et de pandémie, quelles stratégies utilise notre CIUSSS pour acquérir et maintenir la main d'oeuvre recherchée partout? Most of the Public Health experts expect another COVID crisis come Fall/Winter. How prepared is our CIUSSS for a new crisis? What are our organizational strategies to succeed where other organizations or not succeeding?

Beverly Kravitz: Nous travaillons très étroitement avec le ministère qui nous envoie des listes des différents endroits : la liste de Je Contribue, des listes du personnel de la fonction publique. Et ainsi, nous téléphonons à chacune des personnes dont les noms nous sont envoyés pour essayer de les intégrer quelque part pour nous aider. Nous poursuivons également nos efforts habituels de recrutement: Dessine ta carrière, Design your Career. So general recruitment is ongoing and for those of you out there who know people, who have friends who want to come work within our CIUSSS, we are a top employer. We'd love to have you, so feel free to send them our way. Again,  www.dessinetacarriè [We are also] looking at tools to help palliate the difference, the lack in personnel, so we can do things a little bit better and more efficient, to close the gaps. So that's always ongoing. We're exploring technology at various different levels. And within the context of the pandemic, the Ministry issued a decree where we have different possibilities: part time workers become full time workers, smaller shifts become extended shifts. We've asked people to cancel their vacations temporarily. And just to let everybody know, the Minister is coming out with guidelines for us to be able to have all of our staff as much as possible, take vacation during the summer months. We know people who have been working extremely hard, need a much needed break. That's in the forecast as well. And we want to make sure people are rested and we continue recruitment at all levels. So come join us. 

Question #3

As a result of our response to the COVID-19 pandemic, we have seen a large uptake in telehealth activities within our CIUSSS. How do you see this shift evolving in the long-term? 

Dr. Lawrence Rosenberg: That's a great question and I think the bottom line is that we are going to continue to expand our use of telehealth and related technologies as we move forward. We are not going to go back to the old way of doing business, which means our ambulatory clinics are going to have to increasingly shift to telemedicine. It's certainly going to be a challenge for the organization to make that shift. That'll be a huge change management opportunity as well as a challenge. But it's also a huge opportunity and challenge for the population. People are going to have to start taking, I think, more responsibility for their own personal well-being and their health. But at the same time, we'll be able to give them opportunities to interact with our organization in real-time, in less time, in a way that they probably couldn't conceive of several months ago. So we're very excited by the opportunity presented by telehealth technology. Our CIUSSS actually is the first in the province this week to put online a telehealth program for Santé Mental, for mental health which is a huge, huge advance for us. And as we move forward, I think we'll be offering the population an ever-increasing number of online opportunities.  

Question #4 

Considérant le portrait des personnes qui résident en CHSLD/RPA/RI/RTF peuvent présenter des difficultés cognitives, des démences, des difficultés de compréhension et d'apprentissages; Considérant que le portrait physique et cognitif et plusieurs autres facteurs, il y  a une importante difficulté d’adhérence au port du masque procédural pour les résidents et résidentes; Considérant que la toux et  les éternuements sont bien documentées comme des actions pouvant générer des aérosols; Pourquoi tous et toutes les salariés qui ont la tâche de faire des soins de toilette/font manger/prennent soins des personnes en CHSLD/RPA/RI/RTF ne sont pas équipés de masques N95?  

Francine Dupuis: Ce qu'on peut répondre à cette question-là, c'est que la Santé publique, tant régionale que provinciale que pancanadienne, s'est penchée sur la question depuis le début. Et il a été clairement établi pas les scientifiques que le masque de procédure est une excellente protection contre les gouttelettes qui peuvent être propulsées par qui que ce soit, résidents, ou même quelqu'un qu'on croise sur la rue. C'est vraiment suffisamment efficace. La différence évidemment avec le N95 c'est que ça prend un exercice de « masque-fitting », comme on dit. Alors c'est extrêmement fermé sur tous les côtés. Mais ce n’est pas requis pour se protéger contre ce type de virus. Ce n'est pas un virus aéroporté, où les gouttelettes ce maintiendraient partout dans l'univers, le plafond, les murs, etc. Et, à ce moment là, nécessiterait une plus grande protection au niveau du côté hermétique. Mais sinon, c'est amplement suffisant. Ce sont les microbiologistes, les épidémiologistes qui nous l'ont confirmé "over and over again", et nous suivons ces recommandations.  

Maintenant, il y a des exceptions, des patients ventilés, en tout cas, certain cas au niveau des hôpitaux. Et chaque fois que c'est requis, nous nous assurons que le personnel l'utilise. Mais dans d'autre cas il y a des alternatives. Il y a les visières, qui sont extrêmement aussi protectrice. Ça ne nous empêche pas non-plus de procéder au lavage des mains très fréquent. C'est sûr que la distanciation sociale est plus difficile avec certaines clientèles. Mais à ce moment-là, faut augmenter encore la protection avec les autres moyens qui sont à notre disposition. Mais ce n'est pas une indication de la Santé publique d'utiliser des N95. 

Question #5

As an employee of our CEO's in SAPA Benny Farm, I'm curious about employee testing, whether via PCR or serology. As we know, many people in our population are asymptomatic and shedding virus, potentially infecting other unknowingly. I'm presently torn about the possibility of being a vector. Any comforting words? Is a mask going to protect the vulnerable clients and staff? Our goal is to maintain physical distance during visits. 

Dr. Lawrence Rosenberg: Social distancing is going to be very important into the future probably. That includes not only maintaining an appropriate distance from other individuals, but continuing to wear masks and continuing to wash your hands with sanitizer, soap and water. These are absolutely critical. And if one sticks to these very fundamental activities you can protect yourself, and your colleagues and our clients. With respect to testing, it's a little bit more controversial. You could have a PCR test today that shows you're negative and being positive tomorrow. So that isn't very useful. In fact, there are a certain percentage of people who have false positive PCR tests as well as false negative PCR tests. But with respect to serology testing, there isn't yet any approved Health Canada serology test to identify antibodies to the virus. Although, on an experimental basis, our CIUSSS is preparing to undertake serology testing, probably starting next week. We will start by validating the test internally on patients who we know have the virus and then will thereafter, start testing staff, probably beginning in our long-term care facilities since the residents there are the greatest at risk. And we'll just have to take it a week at a time and see what kind of information we actually get from these tests. But I think the bottom line is continuing to respect social distancing, wear a mask and wash your hands. 

Question #6 

A few staff members have reported skin breakouts and breathing problems from wearing those blue procedure masks. Can we send these masks to be tested for chemical compounds just to know that we're not endangered with something else in the long run. Now that it's mandatory, it's clearly affecting some of us.

Dr. Lawrence Rosenberg: I've never had a problem with them and there may be specific individual issues that people have. But generally speaking, there are no chemical compounds in these masks. They're inert. If individuals are having issues with the masks, then certainly they should be brought to health and safety.

Question #7 

What is our CIUSSS doing for those who may need to reach out to someone these days? Are you concerned about any of the emotional fallout for employees after the pandemic is over?

Beverly Kravitz: This seems to be our mantra. We are very concerned. We know these are unprecedented times and our staff are seeing, living, and going through very difficult situations. What I want to say to them is that it's perfectly normal to feel either upset or anxious or distraught. Whatever you're feeling is fine and it is reasonable and you should not feel shy or ashamed or afraid to seek out help. We have the employee assistance program that's available 24/7. They've increased the number of sessions for staff from the traditional three or four to now eight more sessions even are available if needed. 

Their 1-800 number is 1-800-425-9301. In addition, we've put up a psychosocial support hotline, and I believe it's having a positive impact from the feedback we're receiving and also from the number of calls. We've received over 8,000 calls to-date since the start of the pandémie. There are two numbers out there for staff to call. 

One is 514-265-6588, the other is 514-266-2529 so please, if you need help, don't hesitate to reach out and seek the help you need. We're here for you. There's also a list that's published regularly on the daily updates on COVID of all the resources that are available to staff, even if they want to take a few moments. And it's highly recommended to meditate, to do yoga, do various relaxation type exercises. Please don't hesitate to call anybody in HR if you feel you need help, we're here for you and thank you so much for all that you're doing each and every day.

Question #8

Pourriez-vous installer des distributrices de désinfectant « Purell » sans contact (mains libres) dans les entrées des Centres, CLSC et autres ? Du moins il n’y aurait pas de contact direct avec la distributrice que tous les patients contaminent en la touchant en entrant pour leur rendez-vous. 

Francine Dupuis: I remember speaking with George Bendavid, our Director of Technical Resources on that and he gave me assurance that it was not necessary to do that. He was not worried about the safety of the system we are using. 

Question #9 

Est-ce qu'il est sécuritaire de rouvrir progressivement la société à l'heure actuelle ?  

Dr. Lawrence Rosenberg: Yes, I believe that it is safe to gradually start reopening up society, and I believe that it would be probably more problematic not to begin reopening up society. We have to obviously balance the risks and benefits in both directions. But you can only close down a modern society for so long. There are a lot of people who are at home, a lot of individuals who are quite literally dying to get out. I mean, one of my biggest preoccupations over the last several weeks is: where have all the sick people really gone to? Our emergency room is empty. We don't have people coming to our ambulatory clinics. Clearly there are people with multiple medical issues that need to be attended to. Where are they? If they're afraid to come to the hospital, or they're locked and at home, this is not a good thing. So I think we're at a point in time where if we're safe with respect to how we open up, I think we should begin to open up absolutely.

Addendum to Question #9 

Erin Cook from our Segal Cancer Centre was stressing that if people need medical attention, they shouldn't wait, and that they should seek out the medical attention because the protocols are in place and that they should feel safe presenting to our CIUSSS, if the situation is right. Could you maybe just unpack that a little bit because some people are waiting. She said it's a trend that we're seeing that people are waiting because they're afraid of COVID and don't maybe show up when they should. Is that something you can talk about? 

Dr. Lawrence Rosenberg: I think people are afraid because the messages that the media are giving out are causing people to probably be a little bit more hysterical about what's going on than what's actually going on. I mean if one looks at the actual number of individuals affected by the virus and who become symptomatic, it's a very small number of people relative to the entire population. We know now who the at-risk populations are. They are the elderly. So clearly those over the age of 75 or 80, especially those in long-term care facilities, and as well, individuals with chronic medical conditions such as heart disease, lung disease, diabetes, and obesity. We should be focusing our efforts on protecting those individuals and letting the rest of the population, which is really over 99% of the population, get back to some semblance of normality while respecting the requirement for masks and social distancing. It's unconscionable really to keep people away from the medical care that they need. And there are a lot more individuals with chronic medical issues that need to be attended to, including people who need their cancer care and surgery, than there are people seriously sick from the virus.

Question #10 

J'ai trois semaines de vacances à prendre. Elles ont été reportées car je travaille dans l’Équipe de prévention et contrôle des infections. Puis-je donc prendre mes vacances en été? Comment cela fonctionne-t-il et que dit la Politique des vacances? 

Beverly Kravitz: Alors présentement nous sommes dans l'attente, probablement dans les prochains jours, de recevoir du ministère nos balises pour octroyer les vacances pour l'été. Ils sont en train de réfléchir c'est quoi la période des vacances, est-ce qu’elle doit être prolongée ou raccourcie. Il y a du pour et du contre pour chaque. Et aussi de voir combien de semaines par employé nous serons capable d'octroyer. Il y aura aussi une possibilité pour les employés s’ils veulent qu’une partie de leurs vacances soit monnayée, ils peuvent la monnayer à temps et demi aussi, ce qui peut être intéressant aussi pour quelques employés. Mais ce qui est important, c'est que c'est important de prendre des vacances, parce que c'est important de vous reposer et de prendre soin de vous également. Donc on attend les balises dans les prochains jours. 

Question #11 

Pourquoi ne pas tester les employés avant de les réaffecter ailleurs et tester au retour à l'emploi? On sait maintenant que des gens sont porteurs asymptomatiques. 

Beverly Kravitz: [Employees are] supposed to be wearing protective equipment to protect themselves and to protect others, in any event. And as Dr Rosenberg mentioned earlier, the testing can give a false sense of security. You can test negative one day and positive the next. Plus there's the false positives and negatives. And it's not the directives, again, from our public health and our own infection prevention authorities. 

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