Maisonneuve-Rosemont Hospital: Preparing for what comes after the pandemic

Dr François Marquis exchange with his colleagues.

Despite some jolts, the pandemic seems to be taking a break. How are things progressing now? Read the second part of our interview with Dr. François Marquis, Chief of Intensive Care at Maisonneuve-Rosemont Hospital.

Are we already in the post-COVID phase?

François Marquis: Yes and no. Today, we are starting to monitor and follow up on intensive care survivors. Testimonials are emerging that shed light on a phenomenon well known to intensivists, but that still requires research: The post-intensive care syndrome.

In general, with or without COVID, surviving intensive care is a battle that can go on for years. Members of my team want to research this and are putting together a proposal to fund a study on the subject.

What are you seeing in these patients?

F. M.: Some have diminished capacity and need long-term physiotherapy. For “COVID-19” patients, one issue is especially worrysome: People who were perfectly healthy before their stay in intensive care seem particularly weakened after their long intubation.

• Will they be able to return to work?
• After such a long stay in the ICU, will they suffer psychological trauma?
• Will they be affected by physical limitations, chronic pain and long-term shortness of breath, as are patients with acute respiratory distress syndrome following an infection such as influenza?
• Will COVID-19’s legacy be that many people in our community will have to learn to live with disabilities for many years or even for the rest of their lives?

We don’t know yet…

Can we consider the first wave to have passed?

F. M.: I do not know. July 1 will remain a symbolic day, because it was when we discharged our last COVID patient. It was a relief for everyone.

We unsealed and opened the doors that demarcated the hot and cold zones. It was a symbolic gesture and it was important. We all felt good. Even if we are convinced that a second wave is imminent, we can still say that we got through the first one. That’s not a small thing.

I don’t know if it is a sign of things to come, but exactly eight minutes after our last COVID patient left the ICU, I had to go to the Emergency Room to admit another patient who was probably infected.

Should we prepare for a second wave?

F. M.: Everything indicates that a second wave is coming. Just look at what is happening elsewhere. I only hope that this in-between period will last long enough to allow us to breathe and prepare ourselves accordingly (storing material, doing a post-mortem of the last few months, fine-tuning our plans for the second wave).

Let’s just say that a respite would be welcome. It would also give us time to train our resident doctors who are now back at university.

Since July 1, did you receive reinforcements?

F. M.: Yes and no. July 1 marked the arrival of new doctors, because the medical school year begins on July 1 and ends on June 30.

But the new cohort of resident physicians comes in with less clinical experience than the previous ones. The pandemic has hampered their training. Residents will, no doubt, be less able to carry out their duties at a time when they will be asked to be particularly resilient and efficient in the Intensive Care Unit.

Can the impact of the pandemic already be assessed?

F. M.: Not completely, but the Emergency Department, for example, is finding that patients are arriving sicker than usual. Most probably because they waited a long time before consulting, for fear of contracting COVID-19.

These patients ignored increasingly severe symptoms until they became intolerable. We are seeing the same problems as before, but at a more advanced stage: heart attacks, angina and strokes. We are also encountering more patients with surgical complications as well as infections. These are all disorders that should have been treated much earlier and which now require longer and more complex hospitalizations.

Thank you for contributing to the Together for the HMR Fund!