Pandemic: Dr. Marquis answers your questions – Part 2
8 December 2020
Dr. François Marquis, Chief of Intensive Care at Hôpital Maisonneuve-Rosemont, answered questions about the pandemic from Patrice L’Écuyer.
As an invited guest at the À Votre Santé! event, Dr. François Marquis, Chief of Intensive Care at Hôpital Maisonneuve-Rosemont, answered questions about the pandemic from Patrice L’Écuyer and participants. Read on.
Patrice L’Écuyer: Requests for funding that reach the HMR Foundation come from all departments of the HMR, not just Intensive Care?
Dr. François Marquis: Absolutely. The Together for the HMR Fund was created to meet the needs of the Hospital at large. It supports:
- The acquisition of state-of-the-art equipment and technology;
- The training of health care personnel;
- Increased screening capacity.
I was in the Emergency Room recently where my friend and colleague, Dr. Éric Gagnon, needs a new rapid ultrasound machine. Why does he need it? Because the other machines were all worn out. This ultrasound machine allows for quick diagnosis as soon as the patient arrives. It avoids having to move him or her to another department. It minimizes the risk of contagion and saves time.
For its part, the oncology team wants to train its nurses to an international standard. To do so, they have to take certification exams from the Canadian Association of Nurses in Oncology, which is very expensive.
These are very specific demands which quickly translate into benefits for the patients. They are pieces of equipment that we greatly need.
P. L.: You have just pointed out how important training is. Do you still have time to train staff?
F. M.: We have no choice, because life goes on. There are other diseases besides COVID. We need to make sure that the HMR teams are ready in all cases. We continue to train doctors, nurses, respiratory therapists and caregivers. We do a lot of team training. Today, there was one team in training at the simulation center and another in intensive care.
P. L.: If you’re sick, don’t hesitate to go to the hospital. You mustn’t be afraid.
F. M.: Absolutely. That’s something we saw during the first wave. People were so scared that when they started having symptoms, they would say to themselves “I’ll wait”.
As a result, we saw people with common illnesses that turned up much too late. We do big campaigns to prevent strokes, heart attacks, so that people react quickly, and now we are seeing people who, as in the 1980s, had a heart attack two days earlier and stayed home.
At this point, I would like to pass on a message of hope: COVID is under control in the hospitals. If you need medical care, don’t wait. I have heard of patients cancelling their surgery. Do not cancel.
P. L.: Just out of personal curiosity, do patients ever ask to be treated by you or a known face from the De garde 24/7 series?
F. M.: Yes, it happens. Often what people want is a known face. A lot of doctors were featured in the De garde 24/7 series and when people come to the Emergency Room and they recognize a nurse, a doctor, a respiratory therapist, or an attendant, it reassures them. They feel confident. This has led more people to seek care at Hôpital Maisonneuve-Rosemont.
P. L.: Not many people are aware that the HMR treats patients from all over Montreal and beyond?
F. M. :
Of course, the population in the east end of Montreal constitutes the majority of our patients, but we attract people from all over Quebec and Canada. Why? Because the Hospital has a unique expertise in certain fields: We are a leading center in hematology, in the treatment of some blood cancers; the HMR is one of two centers in Canada to offer CAR-T cell-based therapy, for bone marrow or corneal transplants; in oncology, we attract a population from way beyond our catchment area in Montreal. What is important is to maintain this balance: To be there for our local population at all times, but welcoming all those who need Hôpital Maisonneuve-Rosemont’s expertise in Quebec and in Canada.
In the context of the current COVID pandemic and the ensuing lockdowns, we never told people who started a treatment protocol in January, February, or who were set to undergo surgery, “We’re closing. Come back in six months. It’s not possible!” These treatments follow guidelines, an extremely precise protocol, that must be adhered to. It was a challenge during the first wave and even more so in the second wave, because everything that could be moved, we moved. Today, we have to live with it and deal with it. COVID doesn’t take time off. That’s why the need is so great. We want to be there for our local population, but also for the rest of Montreal, Quebec and Canada.
Gwendoline Bonnet*: Why are there fewer hospitalizations during the second wave?
F. M.: There are many reasons. We know more about the disease. We know who to keep in hospital, who to send home.
The first wave hit the most vulnerable people head-on, whereas today we have younger, healthier people affected. The paradox of this is that we have fewer patients in intensive care, but they are more severely affected. The challenge has less to do with the number of patients than with the severity of the cases.
Nathalie Dallaire*: Do you think that people view health care professionals in a different light now?
F. M.: I do think that COVID has made everyone aware of the importance of having a strong health care system. Almost everyone has a family member, a colleague, or a friend who has been affected by COVID and has been able to see how the system works from the inside.
Also, an extraordinary series like De garde 24/7 allows people to see and understand what the reality on the ground is. People are smart. When they are informed, when they can see what is happening, they revise their judgment. It’s when we don’t know, when we don’t see, that we make up things.
Charlotte Castilloux-Rancourt*: Will there be a before and after to this crisis?
F. M.: Yes, absolutely. To start with, everyone who thought there would never be a major pandemic had to face the stark reality. It means that, in the future, hospital design and management will increasingly take into account patient isolation and flow, for example.
We’ll have to live with COVID. Quietly, the waves will become background noise, but we will continue to have COVID patients in the coming years, just as we still have patients with H1N1, the famous swine flu.
COVID is a new disease with which we will have to deal forever. Probably not in the circumstances we know today, but there will be a before and after this pandemic, that’s for sure.
Éliane Tessier*: How did you become a media spokesperson?
F. M.: It all started with De garde 24/7. When COVID erupted, people knew that I worked in intensive care, a department directly affected by the pandemic. The media started calling me and I immediately thought it was a great opportunity to communicate with and inform the public. I was starting to hear all sorts of things about COVID and I thought “If I’m asked, I’m going to be there, answering as many questions as I can and being available.” It simply snowballed from there.
P. L.: How will we defeat the pandemic?
F. M.: It’s going to be a cocktail of many things. There are no magic solutions.
- Population, population, population: Every action counts. Only a large-scale exercise in democracy will succeed in getting us out of COVID. You can’t believe or think “what I do doesn’t have an impact”. Respecting social distancing measures is important and has an impact.
- Using the resources in the health care system wisely so we don’t get overwhelmed by COVID.
- One day, we will have treatments. There are great things happening at the HMR. Maisonneuve-Rosemont is part of the regional, Canadian and global teams conducting major studies on COVID. We’re working on some pretty impressive things, not just vaccines. The vaccine, or probably vaccines, will help us with prevention, but there will always be people who will be sick, who will get it, for whom we will need treatment. Everywhere, there is an extraordinary mobilization, as much in Maisonneuve-Rosemont as in the rest of the world. There will be a before and after COVID, because this spirit of mobilization, I’ve never seen anything like it in my entire career.
Catherine Guy*: How do you deal with your emotions when in contact with patients?
F. M.: You have to manage your emotions. If they get out of hand, or overwhelm you, you’re no longer very useful. With training, you become extraordinarily calm. You absorb information, analyze it and organize the team’s work. It’s a bit like being an orchestra conductor. I’m not saying that emotion can’t catch up with us, but while we’re with a patient, it’s rare. We are in our “zone”, but sometimes it catches up with us later. It can take time. We are not machines.
Michel Bento*: How do you find balance on a personal level?
F. M.: That’s an excellent question. It’s not easy. It’s important to be well surrounded. I’m lucky to have a lot of supportive people around me, starting with my wife. You also need to have some time to yourself. You don’t have a lot of it. Me, I’m a tinkerer. I have my shed, with my tools, etc. which I use to make prototypes. I program computers. This alone time is very important. There aren’t tons of them, but when I’m in my shed, not much can bother me. These moments allow me to clear my mind so that I can then go back to my daily life.
Jean-Philippe Beauvais*: When we get a vaccine, who will have priority?
F. M.: There are several strategies possible. Let’s say the population is on a desert island with no way in or out except by a boat. If I have limited quantities of vaccine, I will vaccinate the captain and the crew, because the virus can only pass through them.
When we’re going to get the vaccines—there will probably be several—, we’ll start by protecting the most vulnerable, followed by those who are more susceptible to catch it or transmit it: the people working in the health care system, those who provide home care, for example. A balance will have to be found.
Patrice L’Écuyer: When will the population of Quebec be vaccinated?
F. M.: What we want is to vaccinate 70% to 80% of the population. I’m not worried about the logistics of the vaccination, i.e. distributing and administering the vaccine. The main challenge will be to actually get the number of doses we need.
P. L.: Once we have been vaccinated, will we still be contagious?
F. M.: It depends. There will be different types of vaccines, all with their respective advantages and disadvantages. Phase 3 studies that are currently making the headlines are focusing on that. Then there will be Phase 4 studies to assess the efficacy of the vaccine in the field, on millions of people, trying to find much-needed answers to questions such as: Will we need one, two, or three doses? If a second dose is required, when does it need to be given? Is a booster dose needed? If so, when? Etc.
But the priority is to stop the pandemic by vaccinating as many people as possible. Then, we will have time to answer all of our unanswered questions.
P. L.: So, there will be different vaccines for different types of people? A vaccine that would be good for me might not be good for my daughter?
F. M.: I wouldn’t say good or not good, but optimal. The vaccines will all be effective, but it will be necessary to determine which one is the optimal vaccine, the one that’s best for each person.
The chance we have is that we’re going to have several types of vaccines, because we’re not in a race with only a single winner. There is room for more than one vaccine. This will help us to have enough doses, because they are not all made with the same technology.
P. L.: Being vaccinated will simplify the work of health care teams?
F. M.: On a daily level, yes. It will allow us to streamline our protective equipment. It will make an extraordinary difference.
If you would also like to ask Dr. Marquis a question, please send it to us at: info@fondationhmr.ca.
* Participants in À Votre Santé!
