'Avoid the emergency' pleads Jewish General, as it hurries to find safer ways to evaluate mildly ill patients

Update on April 4, 2020: A new temporary clinic composed of six trailers will be located on Côte-des-Neiges Road in the parking area between the Jewish General Hospital's Pavilion A and Pavillion N. The goal is to have this evaluation clinic up and running by mid-April, a spokesperson said.

The Jewish General Hospital plans to set up trailers outside its main building, where people with minor COVID-19 symptoms can seek medical attention.

Unlike the drive-thru testing clinic going up in the parking lot of the Cavendish Mall in Côte Saint-Luc this weekend, the trailers will be more medically oriented, said Francine Dupuis, the associate CEO of the CIUSSS Central West.West-Central Montreal, the health agency that oversees the hospital.

After evaluating the patient, doctors will determine if that person is well enough to be sent home to wait until the symptoms disappear, or whether they should be sent to a clinic or to the emergency ward.

"We really want people to avoid the emergency," said Dupuis. "It's the last place to go."

"Those who go there should be sent there because a doctor has determined that their symptoms were acute enough."

As soon as the trailers are set up, within the next week or so, an infection control specialist will figure out how to make them safe to ensure patients don't contaminate one another, she said.

"We are looking for doctors in the community to staff these trailers," she said.

Dupuis said anyone who has mild symptoms could be evaluated there.

Spreading out COVID-19 patients

At the beginning of the crisis, the Jewish General Hospital was designated as the main COVID-19 treatment centre in Montreal for acutely ill adult patients.

But as the number of positive cases rises, the province has designated more hospitals in the Montreal region to spread out the load.

"It's better to share with other hospitals, because if the other hospital has a fair number of ICU beds, it allows us to continue giving services to other sick people," said Dupuis. "It's a balance."

As of Thursday night, Dupuis said the Jewish General had 37 COVID-19 positive patients, with 14 of those in the intensive care unit.

"But it changes every hour," she warned."So it's very dangerous to give the numbers because the very next hour may be different."

For acutely ill, recovery is slow

Recovery is a slow process, but Dupuis confirmed some patients in ICU have improved enough to be moved to a unit for less acutely ill patients or have gone home.

But with so much still unknown about the virus, Dupuis said, those patients are being closely monitored.

"It's not clear how long we have to monitor them before they are completely out of [danger]," said Dupuis.

She said health care teams here have looked at the Hong Kong experience, where in some cases, patients started doing better, and hospitals "stopped being very conservative in terms of monitoring, and the contagion started going up again."

Dupuis said she believes a careful, cautious approach — including the social isolation provisions Quebec now has in place — will keep the number of deaths low in Quebec compared to what some European countries are witnessing.

Staffing levels remain good at the hospital, Dupuis said. Nurses who are acute care specialists are where they should be, leaving other nurses to cover less critically ill patients.

"We've also had a large number of nurses, more recently retired, who decided to come back and help us," said Dupuis.

The cancellation of elective surgeries has also freed up some doctors who can help cover off other areas of the hospital.

Dupuis said the Jewish General still has room to treat COVID-19 patients and considers the situation under control and manageable.

"Our staff is very well-trained, and it's quite under control," said Dupuis.