Urgency mounts as regions lurch toward Quebec's COVID orange zone
'I'm worried by what I see,' Quebec's public health director Dr. Horacio Arruda says
This is how a virus spreads: in Thetford Mines a procession of hair salon clients return to their seniors' residences. Unbeknownst to anyone, their stylist is carrying the novel coronavirus.
In Saint-Bruno-de-Montarville, a group meets for a barbecue. Five infections.
Elsewhere in the Montérégie, 17 people gather in a restaurant leading to 31 positive tests and 330 additional case files for contact tracers to run down.
In Quebec City, a mass testing campaign is launched in a school over fears one or more staff members unwittingly spread coronavirus from classroom to classroom.
Exponential curves start small and grow quickly.
The difficulty lies in establishing precisely where Quebec is on the slope. But the province seems to be somewhere on it, and public health director Dr. Horacio Arruda is plainly worried.
"It's clear some areas will be in orange soon," he told a news conference Tuesday, referring to the government's new colour-coded alert system.
If that happens — which Health Minister Christian Dubé allowed is a real possibility in the coming days given eight regions are currently at the pre-alert yellow stage — it will likely be in one of the province's outlying areas.
Since Sept. 1, three have set new records for daily number of positive tests.
The numbers aren't huge, cautioned infectious disease specialist Dr. Raymond Tellier, and that, coupled with the lag associated with the comparatively long incubation period of COVID-19, makes statistical projections tricky.
"But there's a very disturbing trend here," said Tellier, an associate professor of medicine at McGill University.
"I don't know that it's cause for great panic just now, but it certainly shows the need for caution and vigilance ... exponentials always start very low, very low, and then they shoot up."
During the first COVID wave, Montreal, with its densely populated neighbourhoods, was hit particularly hard, while outlying regions with their sparse populations were generally spared.
But that does not mean a second wave would be similar.
"The real question you have to ask is not so much the density of the population, but how many people are interacting and what's the network of connections," Tellier said.
The regional challenge
Tellier offered a hypothetical. Take a large area where few people live, and houses are all separated by several kilometres.
If they know each other or are related, and have a habit of meeting up, you "create a network of interaction that will facilitate the spread of the virus across the network."
To prevent the spread, he said, "you have to disconnect the network."
That's what public health officials in the Lower Saint-Lawrence scrambled to do in the wake of outbreaks at a CEGEP and an agricultural college.
The province dealt with a Quebec City outbreak by cracking down on karaoke clubs, and Sherbrooke has tried likewise in stopping the spread in Ascot, a neighbourhood just south of downtown.
But how does one do that at scale, in small communities and tightly-knit rural areas?
What happens when community spread sets in?
The North Shore region is in the midst of answering those questions and several more; it is currently investigating six cases that have no known origin.
They're not alone.
Liliana Romero, the public health director for the Chaudière-Appalaches region, which includes Thetford Mines, called the situation "very worrying ... we've seen outbreaks in seniors' residences, schools and workplaces, which tells us community transmission has taken root."
'The health system is fragile'
Testing capacity, public health resources and front-line care for those people who get desperately ill from COVID are less plentiful in the regions than they are in big cities.
That's not typically a problem, in that fighting the pandemic isn't entirely reliant on local resources. But as cases multiply, and the more serious ones are sent to urban centres, it piles the pressure on the health system.
It's not a coincidence Dubé buttressed his government's pleas for a heightened culture of personal responsibility with the argument that the system is "fragile".
"The issue, the area where we are most vulnerable, is personnel," he said in Quebec City on Tuesday.
The summer months provided some breathing room to bolster the ranks in long-term care facilities, but there still shortages, notably of nurses and nurses' aides.
Though the province is slowly tightening the screw, and will give it a couple more turns should a region start flashing orange or red – by closing bars and banning groupings of more than six people – public health officials are doubling down on appeals to civic responsibility and common sense.
It looks like an increasingly tough ask for a province where, in the words of Premier François Legault on Tuesday, "people are tired of hearing about it after six months," particularly those in areas where, until this month, the virus has seemed very far away.
"When you don't have any cases for weeks and months maybe it can lead to people letting down their guard," said Thetford Mines Mayor Marc-Alexandre Brousseau. "This is a pretty striking demonstration the virus is still around us."
with files from Susan Campbell and Spencer Van Dyk