The author is an emergency physician, former head of the emergency medicine department of the Montreal Heart Institute. Full professor at the University of Montreal, he teaches, participates in research in emergency medicine and frequently intervenes on health issues.
Judging decisions a posteriori is too easy. They can be easily questioned, whereas the advantageous point of view of the future should require more modesty.
We thus condemn the spring 2020 decision to transfer many patients from hospitals to CHSLDs. Why ? Because it has contributed to the multiplication of the number of deaths of elderly people. Except that despite the drama, we must adopt a legitimate perspective.
The tendency to judge from observed consequences and not from the facts known at the time involves an obvious problem: when we scrutinize what has gone wrong (except for natural disasters, and again), we always find causes. If everything had gone well in the CHSLDs, we would not examine these events carefully, whether mistakes were made or not.
The second flaw in perspective is that it is impossible to compare. The alternative solution — not sending patients to CHSLDs — was not tried and no one really knows what would have happened in this case. Hospitals may be better equipped to prevent contagion, but since the outbreaks have hit them too, who knows if the cases there might not have been inflated, to the point of threatening more patients and staff? And I remind you that there will never be an inquest on the subject, the coroner not analyzing hypothetical situations.
A third problem is questioning a posteriori the legitimacy of the decision. Let’s think about March 2020: we feared hospital tidal waves like in Lombardy (Italy) and New York. Among the various scenarios discussed at the time, freeing up beds remained the most sensible so as not to compromise the ability to provide care to everyone.
In fact, I don’t remember hearing anyone say that you shouldn’t give yourself that leeway. However, we now judge severely the fact of having freed up a maximum of beds, in particular by these transfers, even if no one could predict how high the wave would rise. In hospitals, we understood the terrible consequences of a saturation of intensive care: countless lives would then have been lost.
Imagine that the virus of March 2020 had been Omicron, with its extreme contagiousness, melting at the end of winter on our unvaccinated population. In January 2022, despite a significant vaccination rate, hospitals came close to collapsing and no longer being able to offer routine services. This kind of scenario was plausible in the spring of 2020; it is easy to understand that he pushed to take all possible precautions to avoid it. How would the decision to keep the elderly in the hospital have been judged in this case? Much more negatively, no doubt. However, this is the yardstick by which we must consider that of freeing up the beds by transferring to the CHSLDs the patients who should have been admitted there anyway.
Or, the ability of CHSLDs to prevent outbreaks and provide the required services has been poorly assessed. Could we have acted like in British Columbia and prohibited staff from moving from one CHSLD or one care unit to another to avoid contagion? Due to the chronic labor shortage, perhaps not without directly threatening the maintenance of basic care everywhere.
Finally, I would like to remind you that the idea of crisis corresponds to an overrun of adaptation capacities. Can we blame people who have no experience in this field — and I emphasize that no one really has this experience in the world — placed at the heart of the worst pandemic of the last 100 years affecting the entire health system, with risks that could lead to terrible consequences, for having made certain decisions open to criticism? Out of the eye of the storm, it’s too easy to judge.
The most important thing is not to find the culprits, but to learn thoroughly from this crisis and from our shortcomings then — and today! — to better prepare for the next storm. However, an incriminating attitude does not help when one especially wants to know as faithfully as possible what has been experienced, in order to draw all the lessons from it.
As for the questioned decision, we must keep a little embarrassment. Because not only is the device for auscultating the past, the retrospectoscope, impossible to find when you really need it, but it has not even been invented yet.
#Judge #fact
