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Made-in-Canada COVID-19 vaccine effort slowed by manufacturing delay – Yahoo News Canada

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Made-in-Canada COVID-19 vaccine effort slowed by manufacturing delay

In early February, a tiny tube of yellow-tinged liquid was packed into a sealed container designed to withstand an airplane crash. 

The sample was from the first Canadian case of COVID-19, and destined for the University of Saskatchewan campus in Saskatoon, where research scientists were mobilizing their efforts to develop a vaccine. 

At the time, the Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac) was one of only a handful of labs around the world working on a potential COVID-19 vaccine. 

The team, which is now one of more than 160 research groups around the world working on a vaccine, set an incredibly tight timeline considering vaccines usually take around a decade to get approval.

VIDO-InterVac’s plan, if trials were successful, was to have a vaccine ready to manufacture for targeted groups — such as front-line workers — by March 2021. 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="But now, despite long workdays and promising early results, the team says a lack of manufacturing capacity is slowing down their efforts at a made-in-Canada vaccine — something that matters given concerns&nbsp;over "vaccine nationalism," which could prevent access to a product that’s not made at home.” data-reactid=”37″>But now, despite long workdays and promising early results, the team says a lack of manufacturing capacity is slowing down their efforts at a made-in-Canada vaccine — something that matters given concerns over “vaccine nationalism,” which could prevent access to a product that’s not made at home.

VIDO-InterVac/University of SaskatchewanVIDO-InterVac/University of Saskatchewan

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VIDO-InterVac/University of Saskatchewan

 A typical day for director Volker Gerdts could begin with a meeting with the World Health Organization as early as 6:30 a.m. CST and end as late as 10 p.m. with a call to China.

“We all sense the urgency and the importance of our work and so it’s hard to explain to yourself taking time off when people are literally dying in the hospital,” said Gerdts in June. 

“We have a really good team … however burnout is a real thing.”

Early test results were good. Ferrets given the vaccine candidate showed a strong immune response to COVID-19, generating antibodies and having a decreased viral infection. 

Regardless of the encouraging signs, the researchers were always at the mercy of external factors like global politics and manufacturing capacity. Now, Gerdts says the timeline of a VIDO-InterVac vaccine being ready to manufacture, if it’s successful, has been delayed by both.

Before it can proceed to human clinical trials, the facility needs to complete more studies using higher-grade materials than what they needed for their early animal studies. But waiting for busy manufacturers to provide them is holding up the process.  

Had the federal government invested more in a proposed manufacturing facility at VIDO- InterVac before the pandemic, Gerdts said, a Canadian vaccine would be at the front of the race.

“We’ve been telling the government, and I don’t want to use this as a blaming, but we have raised the issue of Canada’s unpreparedness for pandemic diseases for quite a while,” Gerdts said. “You need to have manufacturing capacity. You need to have the ability to quickly respond.”

CBC News asked the federal government  why it didn’t invest more in manufacturing at VIDO-InterVac before 2020, and whether it feels it did enough to prepare for a potential pandemic before COVID-19. 

“The health and safety of Canadians is the Government of Canada’s top priority,” said part of a statement from Innovation, Science and Economic Development Canada in response.

“That’s why the government is mobilizing Canada’s world-class researchers to deliver rapid responses to fight COVID-19.”

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="Inside the lab” data-reactid=”74″>Inside the lab

Darryl Falzarano’s work day begins with a series of biosecurity protocols including changing his clothes twice, showering and going through a secure corridor.

He works in the Level 3 high containment lab with SARS-CoV-2 — the virus that causes COVID-19 — and other viruses. His uniform includes a face shield and a head covering that pumps clean air around his face.  He puts duct-tape around his wrists where his gloves meet the sleeves of his suit. 

Matthew Garand/CBCMatthew Garand/CBC

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Matthew Garand/CBC

Falzarano said people ask him if he is scared about working in containment labs.

“For myself, that’s not the case,” he said.

“Of course you’re working with a pathogen that can infect you and in some cases cause a … high fatality rate, but being fearful, that’s not the right attitude to have.”

Falzarano, who is also working on a vaccine for the MERS coronavirus in camels, needs to prepare samples of SARS-CoV-2 for what the researchers called “challenge” studies. 

The study involves giving ferrets or hamsters two doses of the vaccine over a period of two months. After that, the animals are infected with the virus. The scientists then monitor the infected animals to see how well they are protected by the vaccine. 

The VIDO-InterVac vaccine is made with the spike protein on the outside of SARS-CoV-2. If successful, it would work by using that protein to trick the immune system into thinking it has COVID-19 so it will generate the antibodies and T-cells that fight the virus. 

To make it, the researchers grow the spike protein in human cells then combine it with an ingredient called an “adjuvant,” which kicks the immune system into even higher gear. 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="WATCH | See inside the high-security lab in January, as work began on a COVID-19 vaccine” data-reactid=”106″>WATCH | See inside the high-security lab in January, as work began on a COVID-19 vaccine

To test the vaccine, VIDO-InterVac identified ferrets and hamsters as the animals who experience the effects of the virus most like humans.

The researchers said ferrets tend to be infected most strongly in the upper respiratory tract. The vaccinated ferrets had a strong immune response to the virus.

But the researchers wanted their tests to show the vaccine also reduces the amount of virus in the lower respiratory tract: the lungs. Hamsters were better suited to show that effect. 

In late July, the researchers learned the experiment involving the hamsters, which takes two months, would have to be repeated to try a higher dose of the virus. 

The researchers said the vaccine also generated an immune response in the hamsters, but not as consistently as it did in ferrets. 

Falzarano said that, despite the tight timeline, he has to filter out the pressure that comes with working on a vaccine the world is waiting for.

“I don’t feel that so much. I actually think that’s a bad thing that leads you to want to cut corners or, you know, look at potentially your data differently,” he said. 

“I think it’s very important that doesn’t happen.”

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="Manufacturing creates delays&nbsp;” data-reactid=”115″>Manufacturing creates delays 

In June, Gerdts laid out his ideal timeline for progressing to human clinical trials and then manufacturing, if all went well: begin manufacturing in the new year to have 10-20 million doses by March or April 2021

But now, he expects manufacturing to begin in June 2021 at the earliest. 

The researchers need higher-grade ingredients to prepare the virus for an essential phase of the animal testing process and to proceed to human clinical trials, but have been unable to get those ingredients manufactured by suppliers without delays. 

A vaccine must go through three phases of human clinical testing to be approved. 

The first involves one to 100 volunteers and the second phase involves 20 to 500. The third and final phase traditionally takes years, as up to 30,000 volunteers are vaccinated and the researchers wait to see how the vaccine works in volunteers who happen to get infected. 

Concerns are already being raised by some scientists about demand for the vaccine outweighing the capacity to manufacture it around the world. 

Matthew Garand/CBCMatthew Garand/CBC

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Matthew Garand/CBC

VIDO-InterVac is in the process of building a pilot manufacturing facility, but it is not scheduled to be ready until the end of 2021. 

The facility received an initial $3.6 million from the federal government in 2018. Even before the pandemic, VIDO-InterVac leaders were trying to get more funding, but an additional $12 million that allowed the facility to start construction didn’t come until March. The facility also received $23 million to develop the vaccine.

Gerdts said his team could now be as far along the approval process as front-runners like Oxford University/AstraZeneca and Moderna vaccines, neither of which are Canadian, if the funding had come earlier.  

Earlier this month the federal government made a deal to purchase millions of doses of the Pfizer and Moderna vaccines, saying it is still considering similar deals with other developers.  

Gerdts said not having the manufacturing facility has created delays for his team. 

Bonnie Allen/CBCBonnie Allen/CBC

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Bonnie Allen/CBC

“It is the unfortunate reality and it is disappointing because we have kind of predicted this to happen,” said Gerdts. 

“We need to have a manufacturing facility and when this thing hits you need to be able to quickly respond, and all in-house so that you don’t have to go outside and hire others.”

He said that manufacturers elsewhere are understandably busy now.

“So you can’t just simply expect that a manufacturing facility stops all what they are doing now to produce your vaccine.” 

Andrew Casey from BIOTECanada, an association that supports the vaccine industry, said Canada’s capacity to manufacture an eventual vaccine will depend on what type of vaccine it is, and how closely it resembles ones that have been gone before. 

The ease of manufacturing, and the time and cost of doing so, could also play a role in which Canadian vaccine, if any, is finally made available to the public, he said.

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="Emergency fast-tracking seems less likely: Gerdts” data-reactid=”173″>Emergency fast-tracking seems less likely: Gerdts

A June start-date for manufacturing would only be possible if Health Canada granted an emergency authorization to allow some manufacturing for at-risk groups — like seniors and healthcare workers — before Phase 3 of human clinical testing was complete. 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="Gerdts said he originally thought that&nbsp;was a strong possibility, but that it seems less likely now.&nbsp;Russia’s decision to start using a vaccine without completing Phase 3 was not well received by many scientists.&nbsp;&nbsp;” data-reactid=”175″>Gerdts said he originally thought that was a strong possibility, but that it seems less likely now. Russia’s decision to start using a vaccine without completing Phase 3 was not well received by many scientists.  

“We haven’t really seen any of the governments saying under an emergency authorization we want this to be used earlier,” Gerdts said. 

“I think there is a concern in the public that some of these vaccines are maybe not safe enough, because they were developed too quickly.” 

Gerdts said he is not concerned about others getting to make a vaccine first, because the world needs multiple vaccines with different abilities. But losing momentum, he fears, could lead the government to invest in other vaccines that are progressing faster, potentially from international companies outside Canada. 

Gerdts said the team plans to continue pushing forward with its vaccine with as much urgency as it had at the start of the pandemic.

“I think the scientist in me says I have a better vaccine than many of these vaccines that are out there right now and that’s really — our results show that,” said Gerdts, who has tested some other vaccines. 

He said he expects some vaccines to start coming out early next year, but they may not be as effective as people want.

“Then there will be a second round of vaccines coming forward which will be better than the first round,” he said.

“Ours will be one of those.”

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="LISTEN | CBC’s Alicia Bridges discusses VIDO-InterVac’s hunt for a vaccine on Frontburner” data-reactid=”184″>LISTEN | CBC’s Alicia Bridges discusses VIDO-InterVac’s hunt for a vaccine on Frontburner

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Canada at risk of another lockdown as coronavirus cases surge – Hindustan Times

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Canada’s two largest provinces have warned they may have to lock down parts of the economy again after a spike in Covid-19 cases.

Quebec, which has had more virus deaths than 40 US states, is an epicenter of the problem. The province has about 5,000 active cases, a 71% jump from the beginning of August, and is on the verge of closing bars and restaurants again in its two biggest cities, Montreal and Quebec City. Hospitalizations went up 26% in six days.

Ontario, the largest province with 14.7 million people, reported 700 new cases Monday, the most ever in a day, though it’s also testing far more people than it was in spring. A group of hospitals called on Premier Doug Ford’s government to revert to stricter “stage two” measures in Toronto and Ottawa, which would mean restricting or closing indoor businesses such as gyms, movie theaters and restaurants.

“It’s up to each of us. Together our collective actions will decide if we face a wave or a tsunami,” Ford said Monday at a news conference during which he pleaded for residents to follow rules and get the flu vaccine — but did not move the province back to stage two.

It’s a reversal of fortune for a country that avoided the summertime spike that hit the US As the pandemic got worse in Sun Belt states, a largely compliant Canadian population hunkered down and wore masks.

Provincial governments, which set the rules for most companies, allowed the vast majority of businesses to open up again, sometimes with capacity limits and new sanitation rules. In Toronto, the financial capital, many restrictions were lifted on July 31.

As Labor Day neared, virus cases started to rise again. They flared in British Columbia, praised for its early handling of the crisis. Nationally, active cases have more than doubled since Sept. 1, to 12,759. Almost 95% are in the four largest provinces, with the greatest problems in big cities.

Six months of restrictions left some Canadians just as restless as their counterparts in the rest of the world. Across the country, the spike in new cases is being driven by social gatherings among people in their 20s and 30s, fed up with social distancing and hoping to take advantage of the last weeks of warm weather.

“What we’ll tell people is: Stay home. We’re going to ask for a considerable social sacrifice,” Quebec Health Minister Christian Dube said in an interview on Radio Canada late Sunday. “There’s going to be difficult decisions for bars and restaurants” he added, as Quebec City and Montreal are about to be declared a “red zone,” the highest level in the province’s alert system.

The greater concern is that Covid-19’s toehold is becoming a foothold just as the country begins its rapid slide through autumn to winter, said Colin Furness, an infection control epidemiologist at the University of Toronto. This coronavirus survives and stays in the air longer in cold, dry weather, he said — people’s mucous membranes are less effective at filtering it out and infection rates are much higher indoors. Despite a run on fire pits and patio heaters, most policy makers are not expecting Canadians to dine outside in sub-zero temperatures.

Lower Mortality

One bright spot in the situation is the relatively low mortality rate in Canada. With the tragic exception of elder care facilities in Ontario and Quebec, where death rates soared early on, Canada’s fatality rate, per capita, is less than half that of the U.S. since the pandemic began — roughly 25 people per 100,000 population versus 63 in the U.S.

As treatments have improved, along with better protection for the elderly and, crucially, greater testing — and therefore identification — of cases in younger people, so have the mortality numbers.

But while a lower fatality rate is good news, it doesn’t protect hospitals from being overwhelmed by a surge in cases, especially during flu season. And there are significant health consequences with the virus, Furness said.

“If we focus just on the death rate, eventually everyone is going to say this is no big deal,” Furness said. “We should reframe our understanding of Covid as vascular disease that causes widespread brain damage in the population.”

For policy makers and politicians, protecting the hospitals, which already have enormous backlogs of delayed surgeries, and keeping the schools open are key. But the rising numbers threaten disruption on all fronts.

“If politicians do not have the political fortitude to reintroduce some restrictions, then our risk of sliding into something much worse — like the U.K. or Spain — that’s still on the table,” said Furness. Canada needs to implement rapid testing across the country, tighten definitions on “non-essential” travel and hold the line on 14-day quarantine periods for those who have been out of the country, he said.

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COVID-19 cases will climb in Canada before effects of latest restrictions kick in, experts say – CBC.ca

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Cases of COVID-19 will likely continue to climb in Canada’s most populous provinces for a while even if people start to hunker down, experts say, because of the nature of the infection.

Epidemiologists look at the effective reproductive number of COVID-19, which describes how many other people an infected person will pass the coronavirus onto on average.

Public health experts like to see the value significantly below one so cases don’t snowball and spread out of control.

The effective reproductive number of COVID-19 in Canada continues to hover at 1.4, the Public Health Agency of Canada reported on Friday. That means for every 10 people who test positive for COVID-19, they’ll likely infect 14 others who then pass it on to 20 others and so on.

Christopher Labos, a physician in Montreal with an epidemiology degree, said the effective reproductive number also varies depending on the population in which a virus is spreading.

“If nothing changes, certainly it’ll keep rising and may even surpass a number of cases we had before,” Labos said. 

The doubling time depends on how contagious someone is, the likelihood they’ll contact and infect another susceptible person and the frequency of contact.

But Labos said there’s another important factor: individual changes in behaviour.

A woman wears a face mask as she walks by a sign instructing people to wear masks at a market in Montreal on Sept. 13. The city’s restaurants will face new restrictions this week. (Graham Hughes/The Canadian Press)

“We probably will see rising case numbers in the next few days, maybe in the next few weeks. But if we take action now and control stuff, we might see this virus plateau before the end of the year. And that’s really what we’re trying to hope for.”

To that end, Quebec’s premier announced on Monday partial shutdowns in areas with high case counts, namely Montreal, Quebec City and Chaudière-Appalaches, south of the provincial capital.

“We see that our hospitals are in a fragile situation,” Premier François Legault said.

As of Thursday for 28 days, visiting those in other households won’t be allowed (with exceptions), restaurants will be serving delivery and takeout only and other gathering places such as bars, concert halls, cinemas, museums and libraries in the affected regions will close, he said

To explain why, Legault said protecting people in school communities, hospitals and long-term care homes are a priority.

Sacrifices required to change course

“None of this is a given. We can change the outcome,” Labos said. “It simply requires us to sacrifice a little bit.”

Nicola Lacetera, a behavioural economist at the University of Toronto, first studied compliance with physical distancing during the start of the pandemic in Italy. He found that the more frequently governments extended lockdown dates, the more disappointed the public tended to get, which could lessen co-operation.

“People say, ‘Well, I don’t know anybody who has COVID,'” Lacetera said. “From a statistical point of view, it makes no sense. But people tend to over-weigh what’s closer to them, like having known someone who got COVID.”

When the public can’t see the health consequences of COVID-19 directly in their daily lives then Lacetera said making hygiene, distancing and wearing masks more of a habit, alongside consistent messaging from different levels of government and communicating the science, could help.

Dr. Eileen de Villa, Toronto’s medical officer of health, announced new restrictions for restaurants to help curb COVID-19 spread. (Michael Wilson/CBC)

‘Targeted’ measures

Ontario’s Chief Medical Officer of Health, Dr. David Williams, suggested “targeted” measures are under consideration. His Toronto counterpart, Dr. Eileen de Villa, called for new limits in restaurants on Monday, such as reducing the number of patrons from 100 to 75 and requiring establishments to collect contact information from those attending.

De Villa also said the extent of spread of the infection in the city means the concept of the bubble or a social circle “no longer reflects the circumstances in which we live.” 

Jacob Wharton-Shukster said his Toronto restaurant would stay open until 2 a.m. before the pandemic. He voluntarily chose to close at 11 p.m. after watching what can happen elsewhere in the world late at night when people have been drinking alcohol.

“The numbers are doubling from last week, and this is all reasonably foreseeable,” he said. ” We would have had to have taken a mitigation strategy a month ago to see any result now.”

Epidemiologists agree, saying the effects of measures only become apparent two weeks down the road because of the lag when someone is newly infected, develops symptoms, gets tested and receives the result.

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How Quebec went from COVID-19 success story to hot spot in 30 days – CBC.ca

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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.

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