Legault is gradually reopening Quebec. Are we ready?
More testing, clearer guidelines crucial as province prepares to ease restrictions, experts say
Premier François Legault has announced plans to gradually reopen the province, including schools, daycares and some businesses. He has stressed, as well, that any changes will be done in consultation with public health and will include measures to limit the spread of COVID-19.
But is the province ready for such a move? Experts say there needs to be additional testing capacity, a better handle on the outbreak in long-term care homes, and clearer guidelines for schools and workplaces before things are allowed to return to normal.
The World Health Organization released guidelines earlier this month for what should be in place before easing restrictions.
"Control measures can only be lifted if the right public health measures are in place, including significant capacity for contact tracing," said the WHO's director-general, Tedros Adhanom Ghebreyesus.
"Each government must assess their situation while protecting all their citizens, and especially the most vulnerable."
In all, the WHO outlined six areas that must be addressed by any jurisdiction. The Canadian Press recently took a look at how the situation shapes up at the national level.
Here is our look at the situation in Quebec, the province with the most deaths and where the outbreak is far from being contained in dozens of long-term care homes. As the province opens up, it does not appear to meet many of the criteria laid out by the WHO.
Is transmission of the virus in the province under control?
Beyond the province's long-term care homes, many of which remain in crisis, the spread of the virus appears to be waning, particularly outside the Montreal area.
But experts caution more testing needs to be done to ensure that the rate of transmission remains low.
Dr. Matthew Oughton, an infectious disease specialist at the Jewish General Hospital, said that while things provincewide, and in hospitals, are under control, that isn't the case in the CHSLDs.
"It will be a major and ongoing story for quite some time yet. There are still going to be a lot of cases there. I'm sure there are going to be more deaths there, and I think the province is realizing the seriousness of this."
Does Quebec have the capacity to test and treat every case and to trace every contact?
Quebec, and the rest of Canada, need to ramp up testing before restrictions are eased, experts say.
Erin Strumpf, a health economist who teaches in McGill's department of epidemiology, biostatistics and occupational health, said while our hospitals have not been as overwhelmed as we feared they might be, "we're not doing as well in Canada or in Quebec in testing either acute cases or doing the blood testing to see who has already had the virus and recovered."
Strumpf also said Canada isn't up to speed in terms of contact tracing — the practice of tracking people who may have been exposed to the coronavirus.
This week, the province said it has the capacity to ramp up to 15,000 daily tests almost immediately, and plans to get to 20,000 eventually — but hasn't given details about how it will do that.
Jorg Fritz, a McGill University professor of immunology and microbiology, said the province must be capable of determining who already has the antibodies considered likely to fight off an infection. For that, a serology test is required, and for now, such tests remain a research tool in Canada and aren't available to the public.
"The problem is we don't know very well what is a good antibody test," Fritz said.
Without more testing, Fritz said physical distancing must remain in place "as much as possible to limit community spread."
Horacio Arruda, Quebec's director of public health, has said the province is conscious of the need for more testing.
"That will be part of the strategy when we're going to open different sectors, to test the population," he said.
Are outbreak risks minimized in special settings like health facilities and nursing homes?
In Quebec, the answer is a clear no. The vast majority of deaths — more than 80 per cent, at last count — were among residents in long-term care homes and other kinds of seniors' residences.
"We're clearly dealing with a crisis in seniors' residences at the moment, and getting that in hand quickly is going to be very important and doesn't seem like where they are quite yet," Strumpf said.
Strumpf said we can expect to see continued problems in places where there are communal living situations, such as CHSLDs and prisons.
And in recent days, hospitals in the Montreal area and Quebec City have reported outbreaks of the virus. Arruda acknowledged that if the situation in Montreal's hospitals worsens, it could force the government to delay its plans to reopen schools and businesses.
Legault has repeated over the last few days that there are two different realities playing out in the province — one inside seniors' homes, especially in the greater Montreal region, where things are bad, and another in the rest of Quebec, where things are under control.
The province has taken steps in recent weeks to reduce the spread by establishing hot zones, limiting visits, adding staff including members of the Armed Forces, and more protective equipment.
While in some homes many residents have already been infected, health officials maintain the new measures could, at least, prevent further infections elsewhere.
Are preventive measures in place in workplaces and schools and other essential sites?
All elementary schools and daycares in the province will be open again by May 19, but students won't be required to attend. High school and post-secondary institutions will remain closed.
Legault has said measures will be in place to protect teachers, including limiting classrooms to a maximum of 15 students, and the two-metre distancing rule will have to be respected wherever possible.
Fritz believes the province will closely watch what happens in Europe after schools reopen and draw lessons from the outcomes there.
The province has already allowed the return of residential construction work and some other businesses, but those sectors are required to adhere to certain rules.
Strumpf said to expect additional changes as we go forward.
"When we think about moving to this new normal, it's going to be things like having your temperature taken before you sit down at a restaurant, or schools and workplaces having desks that are farther apart than they used to be."
Are the risks of spread from outside Quebec being managed?
At the national level, the federal government has already adopted measures to prevent more cases of COVID-19 from arriving in Canada. Those include banning most non-Canadians from entering the country and a 14-day mandatory quarantine for anyone who does.
Quebec has also put in place restrictions on travel within the province. Those could be reinforced, given that, as Legault has pointed out, the majority of cases are in Montreal and Laval.
Experts say there are a variety of potential avenues to reopening the border and managing that risk.
Being able to screen potential visitors, preferably with on-the-spot testing at airports and other ports of entry, would make it much easier to identify carriers and either bar them from coming into Canada or put them into quarantine.
Are communities fully educated and empowered to adjust to the "new norm"?
In Quebec, the news briefings by Arruda, Legault and Health Minister Danielle McCann were a daily ritual. Legault, however, has announced they will be cut back to roughly three a week.
Strumpf said communication between officials and the public has been fairly effective to date, in terms of stressing the importance of staying home as much as possible, and adhering to physical-distancing measures when in public.
"But the longer this goes on, the more challenging that is for everybody to keep up. As other countries start to reopen, as certain sectors start to reopen, and as the spring moves into summer, it all becomes more challenging," Strumpf said.
As the government starts lifting restrictions, she said, communication will be even more important — and not only in order to keep the infection rate under control.
For example, she said, when restaurants start to reopen, it will be crucial for officials to explain that the reason they are open again is because experts believe it's safe to do so.
"There's no point in having them open if people are too scared to go."
With files from Daybreak, Quebec AM and The Canadian Press