By Special To The Washington Post · Amanda Coletta · WORLD, THE-AMERICAS
Quebec, which borders New York and three other states, is the Canadian province hit hardest by the coronavirus. Home to roughly 22% of the country's population, it has suffered more than 60% of its deaths.
It's also the province now moving most aggressively to reopen.
Epidemiologists are unsure cases in the French-speaking province have peaked. But retail businesses outside Montreal opened this month. So did elementary schools - a step that provinces with zero cases have not attempted. Construction and manufacturing resumed. Some businesses in Montreal reopen next week. Dentists resume work next month.
The approach - Quebec's top doctor described it as a "weighted risk" - is being closely watched. Critics have called for more data before pushing ahead.
"My big concern is that we are starting a bit early," said Benoît Mâsse, a professor of public health at the University of Montreal. "I think we should wait a bit."
Prime Minister Justin Trudeau, who represents a constituency in Montreal, said he was "worried" for Quebecers.
"I understand how much people do want to go outside," he said this month. "But we need to do it in ways that we are sure are going to keep people safe."
Quebec confirmed its first case in February, a month after Ontario and British Columbia. But it was the first to declare a public health emergency, and mobility data from Google showed residents were largely complying with orders to stay home and maintain social distance.
Nonetheless, the province has reported roughly 46,000 of the country's 84,000 cases, and 3,900 of its 6,400 deaths.
Analysts offer several explanations for the outbreak's severity.
Quebec's public school students took spring break during the first week of March, earlier than other provinces. Families decamped for Europe, Mexico and the United States, where the virus was on the march.
At the time, public health officials in Canada said the threat posed by the virus was "low." By the time federal officials advised against nonessential travel and sealed Canada's borders, most Quebecers had already returned to work or school.
"If you're the virus, you cannot have chosen a better time to allow people to travel," Mâsse said.
In mid-March, officials in Montreal were so concerned by what they said was inadequate screening by border agents that they deployed their own public health workers to airports to screen travelers.
The coronavirus quickly gained a foothold in the province's ill-prepared and long-neglected long-term care homes. Caregivers, often lacking protective gear, worked at multiple facilities, increasing the opportunity for spread.
At one point, Quebec Premier François Legault said the health-care system was missing some 11,000 workers who were stricken with the virus or afraid to work. Hospital staff have filled in, and the federal government agreed to send more than 1,000 military troops to overwhelmed care homes. Some of them are now sick, too.
The results have been calamitous. At the Résidence Herron in Dorval, 31 residents were found dead after some staff abandoned the facility. Some survivors had not been fed or changed in days. At the Sainte-Dorothée in Laval, at least 87 residents have died.
Legault said he took "full responsibility" for the nursing home crisis, which is responsible for roughly 70 percent of Quebec's covid-19 deaths. Deaths in long-term care homes account for 81 percent of Canada's deaths from the coronavirus, with the vast majority occurring in Quebec and neighboring Ontario. He acknowledged facilities were "poorly equipped" for a pandemic.
There are also hot spots outside long-term care homes, though analysts said they might be related. In Montreal-Nord, the borough with the most coronavirus cases in the city, infected health-care workers make up 25% of cases. The median income of the densely populated borough is roughly $16,800, according to the 2016 census.
Some workers live in crowded quarters with multiple generations of a family, making isolation difficult and potentially hastening the virus's spread through the community.
"It's not like you can say, 'Most of the cases are happening in long-term care homes or in hospitals, so we don't need to worry about what's happening in the community,' " said Ashleigh Tuite, an epidemiologist at the University of Toronto. "People move back and forth and interact."
Montreal, with a metropolitan population of 4 million some 40 miles from the U.S. border, is the epicenter of Canada's outbreak, with more than one-quarter of the country's cases. Matthew Oughton, an infectious diseases specialist at the city's Jewish General Hospital, said the virus's "unfortunate predilection for the vulnerable people in our social fabric" has played a role. The city has some of Canada's poorest neighborhoods.
Legault said conditions there remain "worrisome."
When Quebec announced its reopening plan in April, Horacio Arruda, the province's top doctor, said new cases were inevitable but the goal was to keep the number manageable. He said he hoped "not too many people will die," and that he would change course if necessary.
"We know that it's a risk. We cannot eliminate the virus," he said. "It is circulating. The question is, how do we do it? How do we balance things out?"
The province has altered its pandemic response before. Initially, Legault pushed the concept of "herd immunity" as he discussed plans to reopen schools, before backtracking. He twice delayed the reopening of schools in Montreal before canceling the rest of the school year last week.
The decision came after the province's public health institute released projections indicating deaths could skyrocket to 150 per day in the greater Montreal area by July if all restrictions were lifted.
"It's hard to keep the entire province shut because of the hot spot in Montreal," Tuite said. "The challenge is that Montreal is highly connected to the rest of the province, and so there's a bit of a balancing act there."
In recent days, new cases and hospitalizations in Quebec have plateaued, but analysts say it's too soon to tell whether they've peaked.
Critics say more testing and contact tracing is needed before reopening the economy. The province has not been able to administer the 14,000 tests per day that officials promised, and some are concerned that areas that haven't experienced outbreaks don't have the resources to identify and deal with them.
"I wish the government would err on the side of caution," said Kate Zinszer, an epidemiologist at the University of Montreal. "My big worry is our capacity to respond as things degenerate."
Mona Nemer, Canada's chief science adviser, told Radio-Canada this month that she had asked Quebec "several times" for its plan for widespread testing, but had not seen one.
Arruda said he was not accountable to "this lady," but to his bosses and the people of Quebec. He then criticized the "gérants d'estrades" - a phrase that translates loosely as "back-seat drivers."
Mâsse noted the tension between Ottawa and Quebec.
"When the federal government comes in and tells us what we should do, it doesn't go too well," he said. "But at some point, we had to call the army to help us, so you cannot have it both ways."
He added: "I had the same question [as Nemer]."