CITY’S ERS ARE ‘A TOTAL MESS’

COVID breeding grounds, sources say

Montreal’s emergency rooms, once again overcrowded, have become breeding grounds for the highly contagious coronavirus as ER staff find it harder to keep hot zones separate from cold zones among a surge of patients.

The situation is dire in the ER of the Montreal General Hospital, a Level 1 trauma centre. ER staff were tested for COVID -19 two weeks ago and again on Monday amid concerns some nurses, orderlies and clerks might be infected and transmitting the coronavirus to patients. In the past two months, 15 staff already tested positive, with some falling ill and recovering at home.

The Quebec government issued a directive on April 17 ordering hospitals to divide their ERS into three zones: green or cold for patients without COVID -19; yellow or warm for suspected cases; and red or hot for confirmed cases. At the time, Montreal ERS were eerily quiet, as many people avoided going to them in the pandemic’s early stages.

Initially, it was easy to maintain the zones. But the reconfiguration has now caused a major problem in the Montreal General ER. For example, the psychiatric ER on the ground floor was transformed into the red zone since it already has individual rooms.

That meant arriving emergency psychiatric patients were transferred to the 14th floor, a short-stay ward. But because of a staff shortage on that floor, beds are no longer available and psychiatric patients are stuck again in the main ER among non-psychiatric patients.

The yellow zone is taking up the small waiting room. Consequently, people are waiting in the green zone and sitting on chairs in a hallway. Meanwhile, the trauma bay, which usually has three spots for patients who have been in car crashes and other life-and-death emergencies, has been converted for negative pressure and can accommodate only one patient.

The hospital has pitched a tent in the parking lot reserved for ambulances. Inside the tent is a makeshift trauma unit for a second patient.

“It’s a total mess,” a source said. “When the green and red zones started, it was fine because the ER occupancy rate was 30 to 50 per cent. It was perfect. But now it doesn’t function anymore.”

As of 8 p.m. Thursday, the Montreal General ER was filled to 145 per cent capacity. Seven other ERS were overflowing, including the one at the Royal Victoria (at 139 per cent).

The source, who agreed to be interviewed on condition of anonymity for fear of reprisals, noted some ER patients are waiting up to 70 hours in the green zone before being transferred to an upper-floor bed.

“There’s no more social distancing even in the green zone, because there’s nowhere to put the patients,” the source explained. “Everybody has started to come back to the ER. And the 15th floor, which is a green floor, it’s had an outbreak and is closed for two weeks. So the ER patients are not going up to that floor. They stay in emerg.”

A similar scenario is playing out in the Lakeshore General Hospital’s ER in suburban Pointe-claire. Thirteen ER staff there have tested positive.

“Several patients came in without COVID and were put in places where COVID patients were right next to them,” a second source said. “This was necessary because the ER was overcrowded.

“These patients got discharged and ended coming back to the ER with respiratory difficulties, were re-swabbed and tested positive. While it is impossible to prove they got the virus from the patients next to them, the risk was there nonetheless.

“There is also the possibility that many staff are carrying the virus,” the West Island source added. “Mandatory testing was never implemented. Obviously, if staff are carrying the virus and have no symptoms, it puts everyone, especially COVID-FREE patients, at great risk.”

Carole Filteau, the Montreal General’s ER nursing manager, wrote a staff memo Tuesday explaining the necessity to get tested again.

“We are still more than likely infecting each other,” Filteau said in the memo. “This is another reason why it is important to wear your mask if you are unable to socially distance. We realize the coffee room is a huge problem, and I have a meeting ... to try and find us a better place for us to eat.”

Dr. Charles Frenette, medical director of infection control at the Mcgill University Health Centre, acknowledged it’s increasingly difficult keeping green and red zones separate.

“I think we have to be honest that health-care institutions are really the high-risk areas for COVID transmission and we have to do everything to protect our health-care workers and our patients,” Frenette said.

Since the start of the pandemic, the MUHC — overseeing the Montreal General, Royal Vic, Montreal Neurological, Montreal Children’s and Lachine hospitals — has tested 3,000 workers. Of that number, 600 were quarantined at home at various points.

The MUHC has also reported more than 160 exposures at its hospitals, instances where a patient or staff member is discovered infected. The MUHC has responded to these exposures aggressively, handling them almost as if they were outbreaks. In addition, the hospital was hit with three full-blown outbreaks.

So although COVID-19 hospitalizations are declining, the pressures on hospitals are ramping up, especially as they must clear a backlog of up to 80,000 delayed surgeries.