Births, cancers... Here is what changes with level 4 of the load shedding

Health establishments in Estrie, Montérégie-Est and Mauricie-Centre-du-Québec have obtained the green light from the government to move to level 4 of load shedding, since the 50% reduction in surgeries (level 3 ) was not enough to stem the massive influx of COVID-19 patients into their hospitals.

To free up more beds, and especially nursing staff, other regions will move to level 4 in the coming days , Assistant Deputy Minister Lucie Opatrny announced on Thursday. The first to switch will be Lanaudière, Laurentides, Montérégie-Centre and Montérégie-Ouest. The other CISSS Integrated Health and Social Services Centers and CIUSSS Integrated University Health and Social Services Centers will follow.

Dr. Lucie Opatrny is Assistant Deputy Minister in the Academic, Medical, Nursing and Pharmaceutical Affairs Branch of the Department of Health and Human Services.

Photo: Radio-Canada / Sylvain Roy Roussel

But what does level 4 load shedding actually mean? In addition to postponing as many non-urgent surgeries as possible, the Quebec plan provides for changes in almost all areas of care to free up hospital capacity, and it is of course the clientele who will suffer the consequences.

Emergency rooms will close

Level 4 allows the closure of small, medium and large emergency rooms, when another emergency is nearby to redirect the clientele .

If you go to the emergency room for a minor case (priorities 4 and 5), like half of the visits in normal times, you could be redirected to a clinic.

Another visible change in the emergency department: paramedics may be asked to lend a hand when they arrive at the hospital with a patient they continue to monitor, in support of the nurses. The government made this possible in October.

Change of region to be expected for pregnant women and babies

Births will be concentrated in hospitals and midwives will join the obstetrics teams. Birthing centers will be used to carry out low-risk deliveries that should have taken place in a hospital setting.

The plan provides for pregnancy follow-up to be relocated from small structures to larger ones, depending on the volume of activity and geographical particularities . Accommodation will be offered to parents who have to travel a long distance.

Once the baby is born, in neonatology, the plan provides for the orientation of the clientele according to the level of care and not according to the region of belonging .

In paediatrics, activities will be concentrated in a regional service, but pediatric intensive care will not be affected.

Fewer cancer follow-ups

In oncology, people with a semi-urgent condition for whom hospital treatment is not necessary could see their appointments postponed.

For cases of cerebrovascular accident CVA , infarction and traumatology, activities will be concentrated in certain centers in order to promote the convergence of resources . Radiology will be reserved for patients on stretchers.

The frequency of hemodialysis treatments will be reassessed according to medical advice, without postponement of appointments, and in endoscopy, the deadlines will be reviewed and postponements of appointments will take place.

With respect to hemodynamics and electrophysiology, anything non-urgent will be kept to a minimum .

Impact on end of life

For patients at the end of life, we will no longer opt for hospitalization at home. Transfer to a palliative care home will be preferred. Medical assistance in dying will continue to be used.

Mental health load shedding

The Ministry of Health and Social Services is very cautious with regard to mental health and wishes to maintain as many services as possible for adults and young people, considering the growing needs of the population . However, Sanity will not completely escape Level 4 offloading.

For example, non-urgent assessments will be deferred in favor of urgent assessments only .

The government will also prioritize the use of private purchases of psychotherapy services.

As far as social services are concerned, there will no longer be any social or psychological consultation, except in exceptional situations. People will be redirected to the Info-Social 811 line.

Level 4 load shedding will be insufficient

All these postponements, concentrations and displacements will not even make it possible to release all the necessary resources in the Quebec health system to deal with this fifth wave. It was Assistant Deputy Minister Lucie Opatrny who admitted it on Thursday.

Level 4 load shedding will not be enough to get the hospital capacity we will need to treat all the patients we will have in the coming weeks , she revealed.

Nearly 2,000 Quebecers are currently hospitalized with COVID-19, and this number could increase to 3,000 within two weeks, according to the most recent projections. At the same time, 20,000 healthcare workers are absent.

With the collaboration of Daniel Boily