A little over a month ago, Health Minister Christian Dubé congratulated Quebecers for their hard work at containing the spread of the coronavirus.
It was a Tuesday, Aug. 25, and the province had registered just 94 new cases of COVID-19 in the previous 24 hours.
“We have really succeeded at controlling the transmission of COVID,” Dubé said at a news conference in Montreal.
It was a statement of fact, but the ground had already started to shift. In the intervening weeks, transmission increased. At first it grew slowly, then exponentially.
On Monday, the government implicitly acknowledged it has again lost control of the virus. The province is reimposing lockdown measures on Quebec’s two biggest cities, starting Oct. 1.
Until Oct. 28, Quebecers won’t be able to entertain friends or families at home. Bars, restaurant dining rooms, theatres and cinemas will also be closed.
“The situation has become critical” Premier François Legault said Monday evening. “If we don’t want our hospitals to be submerged, if we want to limit the number of deaths, we must take strong action.”
The new measures will bring abrupt changes to the lives of millions of Quebecers. They will also prompt questions about how the public health situation could have deteriorated so quickly.
This story tries to trace how Quebec again lost control of the spread of COVID-19.
At first, a stern warning
As Dubé addressed reporters on that Tuesday in late August, public health officials in Quebec City were busy trying to track down patrons of Bar Kirouac, a watering hole in the working-class Saint-Sauveur neighbourhood.
A karaoke night at the bar ultimately led to 72 cases and the activity being banned in the province.
There were also numerous reports by then of young people holding massive house parties and flouting physical distancing recommendations. One of them, in Laval, led to a small outbreak.
WATCH | Legault explains why harsh measures are necessary:
Quebec Premier François Legault says the second wave came because Quebecers did not follow public health guidelines. 0:39
On Aug. 31, as Quebec’s daily average of new cases neared 152 cases, Legault delivered a stern warning.
“There has been a general slackening in Quebec,” Legault said. “It’s important to exercise more discipline.”
Legault and his health minister threatened stiffer punishments for those who disobeyed public-health rules, but stopped short of imposing new restrictions.
Private gatherings identified as the culprit
In late August, public health officials were attributing the rise in infections to Quebecers returning home from vacations around the province, as opposed to the start of school.
Though Quebec’s back-to-school plan wasn’t met with widespread criticism, some experts expressed concern about the large class sizes and the lack of physical distancing guidelines for students.
The government also ignored advice that it should make masks mandatory inside the classroom.
A teacher wearing protective equipment greets her students in the school yard at the Philippe-Labarre Elementary School in Montreal on Aug. 27. (Paul Chiasson/The Canadian Press)
But the first weeks of the school year went relatively smoothly. By the start of Labour Day weekend, only 46 out of the province’s 3,100 schools had reported a case of COVID-19. Importantly, there were no major outbreaks.
The problem was elsewhere. Outside schools, in the community at large, cases continued to rise. On Sept. 8, the province was averaging 228 cases per day.
By now public health officials had identified private gatherings as the main culprit behind the increase.
Montreal’s regional director of public health, Dr. Mylène Drouin, was among those who urged more caution when hanging out with friends and family.
“Yes, we can have social activities, but we have to reduce contacts to be able to reduce secondary transmission,” Drouin said on Sept. 9.
Warning signs
In an effort to spell out the consequences of the increase in cases, the Quebec government unveiled a series of colour-coded alert levels.
Areas coded green would see few restrictions; yellow zones would see more enforcement of existing rules; orange zones would be the target of added restrictions; and red zones would see more widespread closures of non-essential activities.
When the scheme was announced on Sept. 8, Quebec City was classified yellow. Montreal was classified green.
At this point, though, health experts were already concerned that more needed to curb the spread of the virus.
“It is important to intensify these measures,” Dr. Cécile Tremblay, an infectious disease specialist with the Université de Montréal hospital network, said after the alert levels were announced.
The warning signs were starting to multiply.
Officials in Montreal were investigating 20 outbreaks at workplaces on Sept. 9; a week later that number had risen to 30. Long lines were also forming outside testing centres, filled with anxious parents and their children.
And more stories were circulating of private gatherings where the 10-person limit was ignored, angering the health minister.
He told reporters about a dinner with 17 people at a restaurant in Montérégie, which led to 31 cases. A corn roast in the Lower St. Lawrence, he said, resulted in 30 cases.
“To me, that’s unacceptable,” Dubé said on Sept. 15 “If people won’t understand from these examples then, I’m sorry, but they’ll never understand.”
He moved Montreal, and four other regions, into the yellow zones and banned bars from serving food after midnight. The province was averaging 338 new cases per day.
Quebec Health Minister Christian Dubé said the province is at a fragile state in its fight against COVID-19. He encouraged Quebecers to act responsibly. (Sylvain Roy Roussel/Radio-Canada)
Second wave arrives
The warnings from the government did not curb the spread of the virus. By mid-September, authorities were reporting more cases in closed settings.
On Sept. 17, Herzliah High School in Montreal became the first school in the province to say it was shutting down for two weeks to deal with an outbreak. At least 400 other schools were also dealing with active cases of COVID-19.
Cases accumulated too in private seniors homes (known as RPAs), a major source of concern for public officials given the vulnerability of the residents to COVID-19.
There were only 39 cases in RPAs at the start of the month, and 157 by Sept. 20.
On that day the government announced it was moving Montreal, Quebec City and the Chaudière-Appalaches region into the orange zone, the second-highest alert level. Private gatherings were capped at six people.
The province was by then averaging 501 new cases per day. The second wave had begun, according Quebec’s public health director, Horacio Arruda.
Red zone
Over the last week, Quebec’s health system has shown signs of strain as authorities race to contain the spread of the virus.
Drouin, the Montreal public health director, admitted on Sept. 21 that her contact-tracing teams were swamped by the demand.
Until now, the increase in cases had not been accompanied by a corresponding surge in hospitalizations. Most of the new cases were concentrated in younger people.
But the number of hospitalized COVID-19 patients in Quebec has increased by 45 per cent in the last seven days. Hospital staff are starting to get stretched. Several thousand health-care workers are in preventive isolation.
“We’re feeling the second wave,” Dr François Marquis, the head of intensive care at Montreal’s Maisonneuve-Rosemont hospital. “We were apprehensive about it, but now it’s a reality.”
On Monday, Quebec reported 750 new cases of COVID-19. Montreal and Quebec City were classified as red zones later that evening.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
