How Quebec's desperate attempt to fill staffing holes is spreading COVID-19 in hospitals and nursing homes

Eight weeks after the WHO declared the spread of COVID-19 a pandemic, health officials in Quebec continue to play whack-a-mole — dispatching staff from one health-care facility to a short-staffed one elsewhere, to try to meet the most basic needs of thousands of ailing long-term care residents. 

But as they're shuffled from place to place, health-care workers may be inadvertently spreading the virus from infected establishments to vulnerable patients elsewhere, says a Montreal infectious disease specialist.

"Whenever an outbreak is being detected … a month after visitors have been asked not to come anymore, we have to ask ourselves, how did the virus get there?" said Dr. Yves Longtin, the chair of the infection prevention control program at the Jewish General Hospital.

"Quite naturally, we're suspecting that some of these outbreaks were caused by a health-care worker who introduced a virus into those institutions."

On Tuesday, Quebec's public health director, Dr. Horacio Arruda, admitted that was a strong possibility. In his daily briefing, he said the number of outbreaks in seniors' homes had probably been exacerbated by staff being moved from one facility to another.

The case of CHSLD Denis-Benjamin-Viger

At least one long-term care home in the Montreal suburb of Île-Bizard is experiencing an outbreak that fits Longtin's description. 

None of the 124 residents of the Centre d'hébergement Denis-Benjamin-Viger had COVID-19 when several patient attendants, or préposés aux bénéficiaires (PABs), and nurses were sent to help beleaguered nursing homes in LaSalle last month.

By the time the patient attendants and nurses returned, five out of seven of them had contracted COVID-19. 

Then the residents at Denis-Benjamin-Viger started getting sick. As of Tuesday, 31 of 124 residents had tested positive for the novel coronavirus.

"We were not contaminated at the time. We didn't have any positive cases, yet our bosses were forcing, outright forcing our employees to go," said one patient attendant who is now off work, sick with the virus. 

"The girls were crying. They didn't want to go."

CBC News is protecting the identity of that health-care worker because she is not authorized to speak publicly. 

"A lot of us are so angry. We were fine," she said.

The regional health authority, the CIUSSS de l'Ouest-de-l'Île-de-Montréal, disputes the sick PAB's account, saying staff members at Denis-Benjamin-Viger volunteered to go there.

More staff the priority

The risk of health-care workers spreading the virus from an infected establishment to one that has been COVID-free has been understood since COVID-19's arrival in Canada. 

On March 21, two weeks after a resident at a North Vancouver nursing home became the first Canadian to die of complications from the coronavirus, B.C.'s public health officer, Dr. Bonnie Henry, ordered that health-care workers be limited to working in a single facility, to try to limit the further spread of the virus.

Weeks after that, asked why Quebec was still allowing people to work in more than one place as outbreaks began cropping up in one long-term care institution after another, Quebec Health Minister Danielle McCann said it was a stop-gap measure intended to keep people alive amid a growing staffing crisis.

"I think the priority right now is to get more staff," said McCann on April 14. "If we have more staff, we're going to be able to have the people devoted to some units, and they won't go from one unit to another or from one establishment to another.

In the face of that continued staffing shortage, Quebec has gone in the opposite direction — issuing a government decree on April 25 that gave the Health Ministry the right to redeploy all staff within its network. 

But as staff are shuffled from place to place, more are getting sick. And even replacing them with military personnel, health-care teachers and students, specialists and other people who have stepped up or been made to help out, more of them are getting sick.

Last week, Premier François Legault said there was a shortage of 9,000 health-care workers in the network. On Tuesday, he said the number is now more than 11,000 personnel —  the bulk of them missing from long-term care homes.

On Wednesday, Health Minister McCann acknowledged the practice of redeploying workers from one health-care institution to others is a continuing problem — and one the system is struggling to find ways to fix.

"What we need are people full-time people — teams that are the same teams going to the same residence, the same CHSLD, day out, day in," the health minister said. "That's what we're building now, and it's done in many places. But there are still places where we require more staff to do that."

"What we're telling the organizations is that this is the basic principle to really stop this propagation ... and we want the organizations to follow this principle very strictly."

Unions raise alarm

Recent outbreaks in Quebec hospitals have also been linked to the movement of staff. A union spokesperson for health-care workers at Montreal's Lakeshore General Hospital said an outbreak was caused by nurses moving from a "hot" or infected zone into a cold zone.

A union representing workers at Quebec City's Jeffery Hale Hospital said too many personnel were being sent into the hospital from other locations, increasing the risk of contagion.

At the Jewish General Hospital in Montreal, there have been two separate outbreaks in non-COVID zones.

Some nurses and PABs recently returned from working shifts in a short-staffed long-term care home and subsequently became sick, but the regional health authority overseeing the Jewish, the CIUSS Centre-Ouest-de-l'Île-de-Montréal, denies any link between the outbreaks and returning health-care workers.

"These situations are now under control and they are localized to specific areas of the hospital," said CIUSSS spokesperson Carl Thériault. "None of these events were triggered by sick health-care workers."

Stavros Birbatakos, the president of the local union representing health care professionals at that CIUSSS, said there's no question that moving staff to different locations increases the risk of contagion.

"Our position has been that if people are working in what we call a hot zone they should be remaining in hot zones — that the risks associated with COVID19 inevitably should be minimized to be passed on either to co-workers or to patients," said Birbatakos.

But Longtin, the head of infection prevention at the Jewish, said staff in hospitals should already be trained and prepared to go from wards with contagious illnesses to other wards. He said they have been doing it, on a smaller scale, since long before the pandemic.

Longtin said there is always a risk of catching the virus when treating COVID-positive patients, but it can be lowered to an acceptable level if medical staff are equipped with the proper protective gear. 

But many Quebec health-care providers, particularly those who are working inside long-term care homes, say they are still not being provided with the appropriate or sufficient quantities of PPE, all these weeks into the pandemic.

Fewer staff, inadequate care 

At Denis-Benjamin-Viger, a staff member who has remained healthy says about half of the staff are now off work because they are sick.

The West Island CIUSSS didn't give an exact figure, but confirmed that it is "now facing issues related to the lack of staff."

"The CIUSSS is currently working to mobilize a healthcare team, composed mainly of PABs, to send reinforcements to the CHSLD as soon as possible," spokesperson Guillaume Bérubé said in an email. 

A longtime health-care worker who is still at work at CHSLD Denis-Benjamin-Viger said PABs are struggling to care for residents. With fewer people on hand to feed, wash and change them, that hands-on care is done less frequently, she said.

"My residents have vaginas as red as tomatoes right now. It hurts to wash them," she said. "It's breaking my heart to give them proper hygiene because it hurts them."

The remaining staff also feel an overwhelming pressure to care for the people still inside, she said, and she is nearing burnout.

Bérubé said the CIUSSS is trying to limit staff movement as much as possible, but the CIUSSS must ensure essential health care across the network.

But for health-care workers at CHSLD Denis-Benjamin-Viger — both those at work and those at home, on the mend — and for their beloved residents, the damage of the government's policy has already been done.