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The CHSLD Sainte-Croix long term care facility, Oct. 29, 2020, in Marieville, Quebec.

Ryan Remiorz/The Canadian Press

Large COVID-19 outbreaks at two long-term care facilities in Quebec underline another factor in the rising spread of the novel coronavirus during the second wave of the pandemic – medical staff growing less vigilant because of physical and emotional exhaustion.

Centre d’hébergement Saint-Eusèbe in Joliette, 75 kilometres northeast of Montreal, was spared in the spring. This fall, 91 residents caught the disease, and 15 died.

Centre d’accueil Marcelle-Ferron, southeast of Montreal, a privately run facility on a government contract, was also unscathed during the first wave. This fall, 79 residents became sick, and 28 died.

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In both cases, health officials say employees might have let down their guard.

The situation prompted provincial Health Minister Christian Dubé to write to the heads of Quebec’s local health boards, reminding them to make sure health care workers follow infection-prevention and control practices.

“Our employees might be fed up, tired, and might get a bit less alert at some moments in the day,” Mr. Dubé told reporters this week while visiting the Saguenay, a region hit hard in the second wave. “… When you forget [safety] practices in the health care network, it’s usually followed by deaths.”

Overwork and understaffing are chronic issues in long-term care. After the first wave, the province launched a program to hire and train more personal support workers. However, a shortage of nurses requires many staff to do compulsory overtime, or work at more than one facility.

“There’s a link between working conditions, available resources and the fact that it’s not enough. Anyone can make a mistake," said Sonia Mancier, an executive for FIQP, the union that represents workers at Marcelle-Ferron. "The fatigue is there. You can’t work 16 hours and come back the next day at 7 a.m. That’s what is happening right now.”

Burnout among health professionals is a classic problem in a prolonged medical crisis, said Joanne Liu, who was the international president of Doctors Without Borders during the 2014-2016 Ebola epidemic.

“In the beginning, people are energized, there is a lot of adrenalin. You don’t realize that you’ve embarked on something that will last months or years,” said Dr. Liu, a Montreal emergency pediatrician.

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“To be on edge 24/7, always watchful, always wearing masks and protective gear, it’s exhausting. The front-line workers are more exposed than someone working from home. … It’s a permanent state of stress,” she added.

The outbreak at Saint-Eusèbe began with two infected employees, said Daniel Castonguay, the chief executive officer of the local health board. Within days, 80 residents and 55 employees tested positive and seven people died.

He said staffers were not taking proper precautions during their breaks. “One thing is clear is that they contaminated each other in the break room, then they went to different wards,” he said in a media video conference recording that was supplied to The Globe and Mail by CFNJ radio.

“People have let down their guard. It is a vulnerability that we have to deal with now,” Mr. Castonguay said.

Saint-Eusèbe workers shared harrowing details on social media. One nurse described staffers in tears after three residents died within hours one weekend, and the anguish they felt calling relatives about the loss of a parent as the news of another death came in.

Others asked for donations of popsicle moulds so ailing residents could suck on popsicles to prevent dehydration.

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One personal support worker was despondent because she had been quarantined and couldn’t be present as promised when a resident who had a degenerative illness received medical assistance in dying.

Mr. Castonguay said staff at Saint-Eusèbe had a false sense of safety because “in the workplace, it becomes like a family.”

Richard Deschamps, CEO of Marcelle-Ferron’s local health board, told reporters “there were oversights in using individual protective equipment and following infection preventive practices, perhaps because of fatigue.”

In his Nov. 8 letter, Mr. Dubé told health board CEOs to make sure community transmission doesn’t spread into care facilities through workers. “During these hard times, it is understandable that people yearn to be with colleagues during breaks or at lunch time. It is crucial to keep those rest times safe,” the letter said.

Dr. Liu said staffing schedules should recognize workers’ strain. “Human factors need to be considered. People get tired, they get burnt out, they get infected.”

While the percentage of infected people who die is not as high as it was in the spring, the coronavirus remains a threat for nursing home residents. The province’s COVID-19 mortality rate dropped from 10.1 per cent during the first wave to 1.3 per cent during the summer, according to a study by the Quebec Institute of Public Health. Among long-term care residents, the decrease went from 40.5 to 24.4 per cent.

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The problem of lower vigilance is seen in other workplaces too. The Auberivière primary school in Lévis, south of Quebec City, had to close this week after 80 students were infected. Liliana Romero, the local director of public health, told Le Journal de Québec that teachers had lapses in vigilance, failing to wear masks and keep a safe distance during their breaks.

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