Quebec has outlined its guidelines for the holidays. Here's what the experts say
How do I meet safely with my loved ones? What are the consequences for January? Your questions answered
The Quebec government has issued its guidelines to Quebecers for the holiday season, allowing gatherings of up to 10 people for four days, from Dec. 24 through Dec. 27. (The province later specified people should only take part in two gatherings.)
Schools will be closed Dec. 17, two days prior to the traditional break and classes will resume the week of Jan. 4 as planned.
But high school students will do their learning online until Jan. 11, in part because there is more transmission of the virus among older children, government public health experts said at a technical briefing for journalists.
The rationale for avoiding contacts for seven days before and after the four-day window has to do with the typical incubation period for the COVID-19 virus, according to the experts.
In most cases, symptoms take four to six days to appear after a person is infected. Two days before symptoms appear, the virus is typically able to spread with more force.
For example, someone who catches the virus on Dec. 25 would be most likely to infect others between Dec. 27 and Jan. 1, even if they don't feel sick yet.
While schools are closed, companies are asked to shift to working from home as much as possible. Government employees will begin working from home on Dec. 17.
Whether all these plans can go ahead depends on the epidemiological curve lowering or at least remaining stable.
The holiday plans come with the province in the midst of a second wave, with the death toll climbing.
We asked medical experts for their views on the province's guidelines, and their own recommendations for the holidays.
Here's what they had to say.
Should families gather at all?
Dr. Don Sheppard, director of the McGill University Interdisciplinary Initiative in Infection and Immunity, says if people do choose to get together, it's important to remember basic rules, such as frequent handwashing, remaining two metres apart and cracking a window for proper ventilation, something Public Health Director Dr. Horacio Arruda also recommended.
Sheppard also advised against singing, which transmits droplets in higher quantities and with more force.
Dr. Cécile Tremblay, an infectious diseases specialist with the Université de Montréal hospital network, says it would be safer to gather outdoors. She suggests that people enjoy winter activities, such as a cross-country ski outing or a seasonal stroll.
"If we want to see more people, do it outside, and in smaller gatherings indoors for the immediate family," Tremblay said.
What about more vulnerable people, such as seniors and those with pre-existing conditions?
The pandemic has claimed the lives of almost 7,000 people in Quebec, the vast majority of whom are over the age of 60.
Given that, Tremblay said it's best to avoid physical contact with grandparents and other seniors, as difficult as that may be.
"If you can have a small gathering with just the immediate family, that's what would be better," she said.
Benoît Mâsse, a Université de Montréal epidemiologist, said the number of people gathering is less important than who is attending, such as older people or those with a pre-existing condition.
"It's clear that everyone who is infected doesn't have the same level of risk," he said.
With a vaccine likely on the way faster than expected, Sheppard advised people to hold off for a few more months.
"I think you need to keep that distance and I think you need to seriously consider mask use when you do it. Outdoors is less risk than indoors," he said.
How long do I need to isolate before seeing loved ones? What about getting tested?
The only valid precaution to prevent the spread of COVID-19 ahead of a holiday gathering is isolating for 14 days, Sheppard said.
Sheppard said his own children will be coming home for the holidays, and will be isolating for two weeks before meeting their family for Christmas.
To be tested in public clinics in Quebec, people are required to meet certain criteria, such as exhibiting symptoms or having been in contact with a known case, though there are also private options.
Since people won't get their result, usually, for at least 24 hours, it's impossible to know if they have become infectious in the time since.
"You could have been in the incubation period, and you could be developing the disease and we simply missed it," he said.
Will the planned school break be enough?
The short answer is no.
Experts generally agree it's best to measure the spread of the virus in two-week periods. Multiple studies show the incubation period for COVID-19 can last up to 14 days. One major study showed 97.5 per cent of those who experience symptoms will begin to exhibit them within 11.5 days.
It can take two of those periods to break a rising infection rate, which is why the province imposed its partial lockdown this fall in 28-day increments.
Sheppard said gatherings over the holidays will take more than a week or two to contain, even if schools are closed and gatherings prohibited.
"The incubation period can go to a maximum of 14 days," Arruda acknowledged Thursday. But "most of them are between five and six days."
But Sheppard says if classes resume Jan. 4 for elementary school students and a week later for high school students, that leaves a small window for the virus to spread.
"Nobody is going to go from Christmas to their entire family isolating for 14 days," he said.
"It will have an impact. It will not be a perfect mitigation strategy."
What are the potential consequences in January and beyond?
Experts agree that more contact means more cases, hospitalizations and, ultimately, more deaths. If large, indoor gatherings take place over the holidays, the province's "high plateau" could climb.
On top of that, January is an especially difficult month for the health-care system, with emergency rooms usually overflowing after the holidays.
The most recent projections from Quebec's public health institute, the INESSS (Institut national d'excellence en santé et en services sociaux) found that hospitals would not exceed capacity in the next four weeks. But that could change quickly.
Tremblay says a spike in cases could be a major burden for hospitals.
"If we allow ourselves to have large gatherings over the holidays, the health system will be overwhelmed in January," she said.
Sheppard said the strain on hospitals, rather than deaths from the virus itself, could be the biggest problem going forward.
"That's the real thing we need to avoid," he said. "It's not just about the elderly getting COVID and dying. It's about their sisters, cousins, brothers having access to medical care for everything else they need care for."
What are other places doing?
Manitoba, which is seeing a surge in cases, is also considering extending the school break for an extra two weeks.
Nunavut has already closed schools for at least two weeks after seeing a jump in cases.
Ontario floated the possibility earlier this week, but then quickly shot down the idea a day later.
South of the border, several jurisdictions have also closed schools. New York City, home to the largest school board in the country, opted to return to remote learning this week after a rise in cases.