A/C in CHSLDS a calculated risk: Drouin

‘Immediate health threat’ posed by heat is balanced against COVID-19 danger

As temperatures continue to climb this week, Quebec’s public health institute says it can’t know for sure whether or not using air-conditioning units and fans could further spread the novel coronavirus in places housing COVID -19 patients.

Despite the uncertainty, Quebec’s Ministry of Health and Social Services issued directives Tuesday giving all long-term care centres, or CHSLDS, the green light to use the units to protect vulnerable residents from the heat. In Montreal, where many centres are fighting COVID -19 outbreaks, public health director Mylène Drouin explained the plan as a calculated gamble — the risk of having residents die from the heat weighed against the risk of them contracting COVID -19.

“For us, the risk tied to the heat is an immediate health threat. When there’s an extreme heat wave, the impact can be fatal,” Drouin said at a news conference, explaining the balancing act public health authorities performed.

“(The heat) is an immediate risk that we judged prevailed when compared to the risk of spreading COVID-19.”

As of Tuesday, 170 public retirement homes and CHSLDS in the greater Montreal area had at least one confirmed COVID-19 case.

Ahead of this week’s heat wave, many of the centres had looked to the Institut national de santé publique du Québec (INSPQ) for guidance on whether it is safe to use air-conditioning units or fans, unsure whether circulating the air could further spread the virus.

The institute’s answer finally came on Monday, but did not offer the clarity some had sought: The decision, it said, should be made on a case-by-case basis.

“In the absence of evidence and in light of the literature consulted,” the institute said in a notice published online, all centres, hospitals or residences with COVID-19 patients should assess the risks locally to determine whether “the benefits outweigh the disadvantages of using these devices.”

“The benefits of comfort versus the safety of users and staff must be closely analyzed,” the institute said, “and a safe and comfortable environment must be provided.”

Though it stopped short of recommending whether or not the machines should be used, the INSPQ did offer general guidelines for those who opt to use them.

To avoid propagating droplets from infected residents, it suggested turning off the units when nurses or doctors are treating a patient, routinely disinfecting the units and, as much as possible, trying to avoid directing them toward a resident’s face.

Before the health ministry’s directive was issued Tuesday afternoon, there appeared to still be confusion over what should be done.

The Montreal Gazette had contacted the city’s five regional health authorities to ask how they interpreted the INSPQ directives and whether they would deploy air-conditioning units across their networks. The answers differed from one region to the other.

But the ministry’s directive later made it clear.

“For Quebec’s director of public health, Dr. Horacio Arruda, it is appropriate, even in the context of the COVID-19 pandemic, to add air conditioning in health care environments,” the notice sent to health authorities reads, “considering that the benefits of the use of these devices are greater than the possible inconveniences.”

Less than one-third of rooms in Quebec’s CHSLDS have air conditioning — a situation patient-rights advocates decried this week as “inhumane.”

During previous heat waves, centres without air-conditioned rooms would move residents into cooler common areas to help them escape the heat. But that might not be an option this year.

At least two of Montreal’s health authorities, which oversee a combined 17 long-term care centres, confirmed Tuesday they do not intend on using common air-conditioned areas to allow residents to cool down, deeming it too risky.

Both have started installing air-conditioning units in rooms instead.