New communication strategy needed for possible 2nd COVID wave: report
Who does what and who’s in charge?
The answers are critical when a crisis hits like the one brought on by the COVID-19 pandemic. But on the island of Montreal they aren’t simple or clear, a report produced within Quebec’s health and social services ministry to draw lessons and prepare for a possible second wave has found.
The 45-page report, which is dated July 23 and was made available to media on Thursday, was produced by Dominique Savoie, a provincial mandarin who was until recently responsible for governmental health resources for the health ministry. She was appointed deputy minister of health and social services in late June.
Savoie, who interviewed two dozen administrators on the island for her report, offers 24 recommendations to better prepare for a possible second wave. One-third of them involve simplifying communication and coordinating decision-making on the island. That’s because the report takes particular issue with a provincial model that has created a multi-headed public health beast on the island of Montreal.
“For many, the crisis situation that Quebec was plunged into over the past months brought out more sharply certain problems that had already been identified and for which solutions weren’t necessarily put in place,” the document says. It also noted that the two-tier system of provincial and regional public health authorities across the province seemed to “generate confusion” in Montreal.
“It must be noted that when the state of health emergency was triggered in Quebec (in March), the regional public health mission in Montreal was confronted by obstacles that would need to be smoothed out before a potential second wave.”
The web of structures on Montreal Island — including five health and social service centres, or CIUSSS, five independent institutions with regional or provincial missions, a regional public health director who doesn’t have control over all public health personnel on the island, plus multiple committees, coordinating teams and tables — led to poor co-ordination of operations, notably with COVID -19 testing and mobile testing sites, it says.
For example, Quebec gives regional public health responsibility to the CIUSSS du Centre-sud-del’île-de-montréal, even though the law doesn’t allow one CIUSSS to exercise authority over another.
So while the regional public health director, Mylène Drouin, is attached to the CIUSSS du Centresud-de-l’île-de-montréal, other health and social service centres on the island manage their own public health workers.
As a result of this set-up, Drouin wasn’t very involved in decisions by certain health and social service centres to open COVID -19 testing centres on their territories this spring.
Savoie notes in her report that different CIUSSS directors she interviewed were critical of the lack of co-ordination between their operations and the public health department.
Everyone who was interviewed for the report seemed to agree that the division of responsibilities between each CIUSSS and the public health department needs to be clarified, the report says. Problems that “generated lost energy and time” were encountered not only with testing sites but with resource management and the distribution of swabs used to test people for COVID-19.
The multitude of structures makes it difficult to “identify clearly the tactical/operational decision-making bodies” for the island, the report says.
The problems are important to sort out now as the province braces for a possible second wave of COVID-19, the report says, particularly since the onslaught of flu season in the fall will only increase demand on lab testing and require greater supplies of swabs given that flu symptoms are similar to those of COVID-19, the report says.
Among her recommendations, Savoie suggests a co-ordinating committee bringing together all CIUSSS directors on the island, the regional director of public health, a representative of the city of Montreal and any other partner whose presence is considered important. The committee would co-ordinate operations and meet regularly, even daily, if the situation warrants it, the report says.
And with good communication and clear roles should come a coordinated, island-wide strategy for COVID-19 testing, Savoie writes. The testing strategy should be approved by every CIUSSS director and be closely monitored by the coordinating committee.
CIUSSS directors should also have regular and even daily exchanges with municipal elected officials, who complained they were getting information from the media and other sources during the pandemic, the report says.
The report also recommends the different partners make better use of Montreal’s emergency response co-ordination centre, which has operated throughout the crisis but told Savoie it could have offered more help. At the same time, Savoie also notes the province’s regional civil security office “wasn’t mobilized to its full potential” during the pandemic.
Some of Savoie’s other findings relate to the movement of health personnel as CHSLDS, in particular, faced a shortage of workers and a lack of crisis preparedness and a lack of training in infection control in private seniors residences.
Regions of Quebec that weren’t as affected by the pandemic as Montreal sent too few reinforcements to the island and too late, the report says. In response, Savoie recommends the health and social services ministry draw up a plan with target numbers of resources that could be deployed to institutions and come up with lists of potential volunteers before a second wave hits. The ministry, it says, should co-ordinate inter-regional
The crisis situation that Quebec was plunged into ... brought out more sharply certain problems that had already been identified.
deployments.
At the peak of the crisis, 6,450 health workers on the island were absent from work, the report says.
Savoie recommends a ban on personnel movements between facilities, imposed late, be maintained to prevent the spread of COVID-19 by workers who are pre-symptomatic or asymptomatic carriers of the virus.
If there was one positive lesson learned, the report says, it was from the Canadian Armed Forces, which sent complete multidisciplinary teams to help in CHSLDS, rather than individuals. The model, the report says, should be followed if there’s a second wave of infections.
Private seniors’ residences were particularly isolated and many were poorly prepared for the crisis, the report says.