Steroids, inhalers and ventilators: What Quebec doctors are learning about COVID-19

Steroids, inhalers and ventilators: What Quebec doctors are learning about COVID-19

At the beginning of the COVID-19 pandemic’s first wave, Dr. Joseph Dahine and his colleagues could spend over an hour huddled around the bedside of a patient in the ICU in Laval, Que., brainstorming treatment options.

There were no textbooks to tell them what to do, so they became medical detectives as Quebec faced a surge of cases, learning everything they could about the physiology and nuances of COVID-19 to save lives.

Dahine, an intensive care specialist at Cité de la Santé hospital, said he worked gruelling, 12-hour days through the spring, huddling with his team on breaks. 

“We experimented a lot,” he said.

What was clear from the outset was that COVID-19 was no normal respiratory disease. Often, patients would come in with extremely low oxygen saturation levels.

“Usually that’s an emergency. The patient is dying, they are gasping for air and you need to put the tube immediately,” said Dahine. 

But these patients didn’t appear to be in distress.

“It’s weird to tell someone, ‘OK, we’re going to put you in a coma now and we’re going to put a tube down your throat and they’re like, ‘Well, I’m fine,'” said Dahine.

Over time, Dahine and his team learned more about when to intubate a COVID-19 patient. 

In some cases, they were able to avoid it altogether. They practiced the same restraint when they removed someone from a ventilator.

Although the World Health Organization had warned it took COVID-19 patients up to three weeks to recover, Dahine recalls a 60-year-old patient who, four days in, seemed to no longer require intubation. The medical team decided to take him off the ventilator.

But when they began to dial down the pressure that kept the patient’s airways open, his lungs couldn’t take it. They had to quickly bring him back up to 100 per cent oxygen.

The man’s lungs were still too fragile. 

“We’re not surprised anymore when a patient deteriorates when we decide to wean them,” said Dahine.

“We needed to be more patient for the inflammation and the disease to improve.”

WATCH | Dr. Joseph Dahine on lessons learned during COVID-19’s first wave

One of many lessons learned treating patients this spring includes finding alternatives to early intubation. 1:21

But there are still curveballs. Inflammation of the lungs isn’t always the culprit if a patient starts to deteriorate.

COVID-19 patients in the ICU are sometimes prone to blood clots and kidney disease, which requires dialysis.

After a relatively quiet summer, a patient came in to the Laval hospital last month with cardiogenic shock — a serious condition that occurs when the heart cannot pump enough blood and oxygen to the brain, kidneys and other vital organs.

“That first case, it scared us,” said Dahine. He was worried cardiac complications might be the defining feature of COVID-19’s second wave.

But so far, it was just that one patient — and that patient pulled through.

What works, and what doesn’t

It is difficult for Quebec’s doctors to measure the degree to which improved methods have helped decrease the mortality rate of COVID-19 and length of hospital stays, given the multitude of factors at play.

(In July, the World Health Organization estimated the infection fatality rate at 0.6 per cent.)

The province’s second wave of COVID-19 has seen an increase in cases among teenagers and people in their 20s, who are less likely to suffer serious complications from the virus and, in many cases, don’t stay as long in hospital.

While doctors say there is still much to learn about the virus, new treatments and techniques have helped.

Medications such as dexamethasone, an inexpensive steroid, and remdesivir, an antiviral drug, have been shown in clinical trials to help patients with COVID-19.

Dr. Matthew Oughton, an infectious diseases specialist at the Jewish General Hospital in Montreal, said both those drugs have helped improve recovery times.

“We also know things that don’t work,” he said, mentioning, like Dahine, not putting a patient on a ventilator right away. Sometimes, the solution is as straightforward as having a patient rest on their stomach, rather than their back.

Oughton said the patients are, on the whole, spending less time in hospital. Still, the number of people being admitted has climbed in recent weeks, particularly in certain regions, such as Quebec City.

“I wouldn’t say that they have skyrocketed up, but it is making it challenging,” he said.

“It looks like we may be able to keep control on this. I say that with great trepidation, though.”

Dr. Horacio Arruda, Quebec’s public health director, on Monday said the mortality rate from complications of the virus seems to be improving in the province, and that new treatments are especially effective in young people. 

“But it’s still a disease that, if you have any underlying health conditions, can be very difficult. And even if you survive, you can have pulmonary problems, agnosia,” Arruda said at a news conference Monday. 

“It’s still a serious disease, and I think preventing it is better than getting it.”

Keeping patients out of the hospital

There are also signs of improvement outside the hospital setting.

Dr. Nicole Ezer, a researcher in the respiratory diseases program at the McGill University Health Centre, is among those working on new medications that will keep people from having to be admitted.

Ezer is testing the efficiency of ciclesonide, an inhaled and nasal steroid drug currently used for asthma and nasal rhinitis, on patients with milder symptoms of COVID-19.

If successful, the medication would allow doctors to treat patients with more mild symptoms at home — and avoid them having to go to hospital.

“I think in general there’s a lot of enthusiasm for vaccines, but we don’t know yet the efficacy of the vaccine,” said Ezer, who is also an assistant professor at McGill University.

“For us, COVID is always going to be present.”

Uncertainty remains

Despite everything doctors have learned about the disease, Dahine says it’s too soon to tell if it will mean fewer deaths for those patients that need to be hospitalized.

“Flattening the curve in the spring, making sure that each hospital did not have too big of an influx of patients at the same time, prevented us from making mistakes that would have gotten us a higher mortality rate,” he said.

Quebec’s second wave of COVID-19 has seen an increase in cases among teenagers and people in their 20s, who are less likely to suffer serious complications from the virus. (Ivanoh Demers/CBC)

The emotional burden on the families of people hospitalized with COVID-19 is something Dahine will never forget.

His hospital alone has seen households that will be forever changed by the disease. In one case, a couple came in — the wife made it, but the husband did not. There was also a son and his mother. The son survived, but his mother died.

Dahine still doesn’t know why some patients took a turn for the worse even when they had the same treatment, doctor and support team.

“I can’t take solace in the fact that it’s the patient’s fault,” said Dahine. “Certainly it’s the disease’s fault.”

Quebecers need to further reduce contacts to slow COVID-19, projections suggest

Quebecers need to further reduce contacts to slow COVID-19, projections suggest

Quebecers will need to be more diligent about physical distancing and further reduce their contacts to avoid a rise in the number of COVID-19 cases, hospitalizations and deaths, according to the latest projections by government-affiliated experts. 

The projections suggest that even with the closure of bars and restaurants, the cancellation of organized sports and further restrictions in schools put in place at the beginning of October, those numbers will continue to rise into the New Year.

But if the population reduces its contacts by another 25 per cent, according to one model, by maintaining two metres of physical distance in public spaces, wearing masks and limiting gatherings, the spread of the virus is likely to plateau and even decline. 

The findings were presented Friday by Quebec’s public health research institute, the INSPQ.

The presentation included three mathematical models: one if no measures had been introduced after cases started to climb in the middle of August and September; another if the restrictions imposed in early October are maintained; and a third that showed the impact of reducing contacts. 

Dr. Jocelyne Sauvé, vice-president of scientific affairs at the INSPQ, said the modelling suggests Quebec was headed for a “fairly catastrophic” rise in cases in September had nothing been done, with a death toll that could have exceeded the first wave.

But she said the projections show that further effort from the population will be necessary to stabilize the pandemic.

Marc Brisson, a health economics professor at Université Laval who presented the findings, said in practical terms this means further cutting back on non-essential contacts and keeping two metres apart while, for example, speaking to another parent during school drop off.

All three models were prepared with the assumption that Quebec’s long-term care homes and private seniors’ residences are better protected than they were in the spring.

Brisson said the INSPQ is preparing another round of projections to be released later this fall that would include the impact of more effective testing and contact tracing on the rate of transmission.

The previous round of INSPQ projections was released in July and forecast that a second wave would hit Quebec sometime in September. Its force would depend on how well Quebecers were following health guidelines.

Health Minister Christian Dubé said Friday the projections reinforce what the province has been saying — that the actions of individuals have major consequences.

Dubé also pointed to another study, prepared by Quebec’s health research institute INESSS, that suggested Quebec’s hospitals were under less strain than they had been a week ago.

“We have been doing well on stabilization, but we want those cases to continue to decline. Why do we do this? We want to protect our health system and have as few victims as possible,” he said.

“We would have hit a wall if we didn’t do what we did Oct. 1.”

With COVID-19 surging, Quebec health minister calls on entire province to stay home

With COVID-19 surging, Quebec health minister calls on entire province to stay home

Following a sharp increase in deaths and hospitalizations, Quebec Health Minister Christian Dubé is calling on all Quebecers to stay home, regardless of the alert level in their region.

Quebec broke another record Tuesday, reporting 1,364 new cases — the highest single-day total ever reported in the province. It was the fifth consecutive day with more than 1,000 cases recorded. 

More than 200 of those new cases were in Quebec City while the Montérégie had 223 and Montreal 442. 

Dubé said that, contrary to the first wave of the pandemic, which was concentrated in Montreal, the entire province is feeling the impact this time, and more regions could be dubbed “red zones” — the highest alert level — later this week. 

“Today’s numbers and tomorrow’s numbers are the results of the last 10 days,” Dubé said. 

“It’s important to understand that. So if they’re even worse tomorrow and even worse the day after that, it’s because of what we saw at Tam-Tams a few days back.” 

Dubé was referring to the popular weekly Sunday gathering at the foot of Mount Royal in Montreal as an example, but he said gatherings across the province have been an issue, and that’s another factor that makes this wave even harder to control than the first.

The increase in deaths and hospitalizations is stemming largely from community transmission, he said, as opposed to the first wave, where most cases were associated with long-term care homes. 

“This time is totally different, totally different,” said Dubé. “It is very difficult to say where you got it.” 

While some experts have argued the province should have acted sooner in imposing restrictions, Dubé said the government did all it could to prepare for a second wave. He blamed the increase in cases on people not taking public health regulations seriously. 

“Please don’t take the risk, please don’t test the hospital system,” he said. “The nurses, the doctors, what they are asking you — what they are asking Quebecers — is to please stay home.” 

On Monday, the province introduced further restrictions in red zones, including banning organized sports and leisure activities as well as making masks mandatory in the classroom for high school students.

WATCH | Quebec health minister says it’s harder to identify how virus is spreading:

Health Minister Christian Dubé says community transmission makes it difficult to identify exactly where people are catching COVID-19. 1:39

Quebec City struggles to keep up with contact tracing 

Over the past month, Quebec City went from having about 100 cases per week to having more than 1,000.

Now, health officials in the region are asking the public to help curb the spread, and not just by following hygiene guidelines such as handwashing, physical distancing and mask-wearing.

“This spread, which is largely community-based, is making each public health investigation more difficult,” said Dr. André Dontigny, public health director for the Quebec City area. 

For the second day in a row, more than 200 new cases of COVID-19 have been confirmed in Quebec City, with more than 1,250 cases confirmed in the last seven days. (Olivia Laperrière-Roy/Radio-Canada)

He said contact tracing teams have been working at maximum capacity, conducting about 200 investigations per day.  But that’s not enough, and some people aren’t being reached in a timely manner, he said.

In a newly revamped website, health officials in the region have compiled information on contact tracing and how it works. They have also put out a call for applicants to help with contact tracing efforts and testing.

Officials are also asking those who have COVID-19 to reach out to to those with whom they came in contact themselves.

Quebec hospitals ‘bracing for impact,’ specialist says

Quebec’s hospital network has space for new patients now, but it is “bracing for impact,” said Dr. Matthew Oughton, a specialist in infectious diseases at Montreal’s Jewish General Hospital.

“The more cases we have spreading in the community, the more likely it is that you’re going to see spillover into vulnerable groups,” Oughton said. 

“And then all of a sudden, in one region, you are going to have a huge surge in people who are sick and need hospitalization.”

About six per cent of the province’s daily tests are coming back positive, he said, and generally, anything above five per cent indicates the situation is getting out of control.

Pedestrians walk along Ste-Catherine Street in Montreal on Tuesday as Quebec reports a record 1,364 new COVID-19 cases. (Ryan Remiorz/The Canadian Press)

Nine months into the pandemic, hospitals in Quebec are better equipped and staff more knowledgeable about the coronavirus, but health-care workers are still recovering from the first wave, he said.

“I think we have a lot of battle fatigue,” Oughton said. “I am pretty sure the system is increasingly fragile.”

As the number of patients increase, there may be burnouts and staff heading home to isolate, Oughton said, and that could, in turn, bring other hospital services to a standstill once again.

The best way to prevent the health network from being overwhelmed, he said, is for people to do their part by following the health restrictions and for the province to crack down even more.

“It’s very simple: The more face-to-face, close contacts you have, the more chances there are for transmission of this virus, the longer it is going to transmit and the harder it is going to be to get it under control,” Oughton said.

Quebec faces pressure to act against anti-Indigenous racism after Joyce Echaquan’s death

Quebec faces pressure to act against anti-Indigenous racism after Joyce Echaquan’s death

Pressure is mounting on the Quebec government to address the racism evidenced in a disturbing video Joyce Echaquan recorded just before dying in a Joliette hospital, but Indigenous leaders say the provincial minister handling the file is missing in action.

Sylvie D’Amours, the provincial minister responsible for Indigenous affairs, has faced repeated criticism for her inaction since the Viens report, which documented discrimination Indigenous people face when receiving public services, was made public a year ago.

Echaquan, a mother of seven from the Atikamekw community of Manawan, died on Monday. The minister has yet to answer questions publicly and has held no media availability.

Several Indigenous leaders contacted by CBC News, including Constant Awashish, Grand Chief of the Conseil de la Nation Atikamekw, said they had not heard from D’Amours since Echaquan’s death.

An orderly who was attending to Echaquan was fired on Thursday, the second health-care worker to be dismissed since the video surfaced. A nurse was fired on Tuesday.

Echaquan’s death is the subject of three investigations: two by the local health authority and a coroner’s inquest.

Quebec Premier François Legault did say Thursday he had been in touch with Echaquan’s partner, Carol Dubé, the father of their seven children, and had expressed his condolences.

WATCH | Carol Dubé, Joyce Echaquan’s partner, calls for change:

Carol Dubé pleads for accountability after his wife’s death in troubling circumstances. 0:55

Pandemic has slowed progress, Legault says

Legault said Dubé wants to make sure something like this never happens again. On that front, Legault said, his government is making progress.

But he said the pandemic delayed the government’s ability to act on the recommendations in the Viens report.

“It’s not that easy. We first want to have an agreement with the First Nations because they don’t want us to apply recommendations without their consent, so it wasn’t possible in the past seven months to continue having those meetings,” he said.

Echaquan’s death has prompted outcry far beyond the borders of her home community of Manawan, and has become the focus of opposition politicians in Quebec City.

One of Joyce Echaquan’s children attended the vigil earlier this week near the Joliette hospital where her mother died. (Ivanoh Demers/Radio-Canada)

Liberal Leader Dominique Anglade has called on D’Amours to resign, while Québec Solidaire tabled a motion calling on the province to adopt the United Nations Declaration on the Rights of Indigenous Peoples, one of the key recommendations in the Viens report.

Veronique Hivon, a Parti Quebecois MNA representing Joliette, said she is hopeful Echaquan’s death will lead to swift change.

She wants the government to follow through on recommendations in the Viens report that might have helped Echaquan, including ensuring health authorities “set up services and programs based on cultural safeguard principles developed for Indigenous peoples and in co-operation with them.”

“I think today it’s really important to send a signal that actions must be taken,” she said.

Jennifer Brazeau, the executive director of the Native Friendship Centre in Lanaudière, said she has heard dozens of stories of wrongdoing by medical staff in Joliette. She said Indigenous people living elsewhere have similar stories.

“As an Indigenous person, you often feel that you’re not going to be believed or that people are looking to see what your fault is in this,” she said.

In a statement earlier this week, D’Amours condemned racism against Indigenous people and said she has a plan in place to follow through on 51 of the 142 calls to action in the Viens report.

Legault, for his part, said his government’s action plan on racism will be tabled in the coming weeks, and said his government will act on those recommendations.

Quebec gives police legal tools to enter homes quickly to stop gatherings during COVID-19

Quebec gives police legal tools to enter homes quickly to stop gatherings during COVID-19

Quebec Premier François Legault says police in the province’s red zones — regions where COVID-19 cases are surging — will be issuing $1,000 fines to those who violate newly strengthened public health rules.

With fees, those fines will top $1,500 and can be issued for gathering in private residences or protesting without a face covering. 

Speaking during a late-afternoon news conference on Wednesday just hours before the new rules went into effect, Legault said the negligence of a few has led to the crackdown.

“Lives are at stake. We want to keep our children in schools,” Legault said. “We also want to protect our health network”

Quebec reported 838 new cases of COVID-19 but no new deaths Wednesday. Since the start of the pandemic, there have been 74,288 confirmed cases and 5,834 people have died in the province. 

Home gatherings can lead to fines

Beyond the few exceptions, such as for caregivers or romantic relations, house guests are not allowed, Legault said.

Police are authorized to demand proof of residency and if residents refuse entry, officers will be able to obtain warrants faster through a new, virtual system that was established in collaboration with the Crown, the premier said.

“We had to give the police the means to intervene,” said Public Security Minister Geneviève Guilbault.

Public Security Minister Geneviève Guilbault says the goal is not to fine everybody who violates the rules, but instead encourage compliance to protect the population. (Jacques Boissinot/The Canadian Press)

Normally the process for obtaining a warrant can take a day or two, but that won’t work when police want to break up parties that very same evening, Legault said.

He said people who shrug off the rules and host parties are “putting the lives of other people in danger.”

Protestors to be fined for refusing to wear masks

Quebec made masks mandatory inside public spaces, like bars and shops, on July 18, but there have been several protests since.

Now, anti-maskers will have to cover up if they want to march or police will be issuing fines.

Guilbault said protesting without masks cannot be tolerated and she is not ruling out using force to disperse protests if needed.

“Eventually, we will cross that bridge when we get there,” she said.

All gatherings prohibited, travel discouraged

Legault said all gatherings will be banned, even outside in public parks — an activity that has grown more popular in places like Montreal during the pandemic. 

“Police officers will start by trying to disperse the gatherings, but if people don’t co-operate, fines can be given,” he said.

Police will again be cracking down on those who gather in public parks within Quebec’s red zones. (Graham Hughes/The Canadian Press)

Legault said people from red zones cannot travel to orange zones to eat in a restaurant or gather in a home. They will face fines if they do. 

He said restaurants will not be required to verify residency, but police can issue a ticket if they catch people violating the rules.

People should not travel between regions to pick up groceries or run similar errands, Legault said. People can go to their cottage, for example, as long as they bring their provisions with them. 

In recent months, some demonstrators in Quebec have denounced what they consider government fear campaigns over COVID-19. The new measures included a mandatory rule on wearing masks during demonstrations. (Graham Hughes/The Canadian Press)

Legault made no mention of roadblocks, something that occurred last spring. However, Guilbault said signs will be posted, warning people they are entering or leaving a red zone.

Guilbault said the idea is not to issue as many fines as possible, but to ensure people are staying in their zones and decreasing the spread of COVID-19.

She said police will try to educate and inform before resorting to tickets.

Back in the spring, hundreds of fines were issued to people who ignored the two-metre rule or threw parties at home.

WATCH | Quebec’s premier says it’s time to protect others: 

Quebec premier explains the punishments for breaking restrictions that begin at midnight . 2:17

Restrictions to take effect at midnight

The new restrictions take effect 12:01 a.m. ET on Thursday and are set to last for 28 days, until Oct. 28, in the red zones. The restrictions are: 

  • A ban on home gatherings, with some exceptions, such as a single caregiver, babysitter, tradesperson or technician, allowed per visit.

  • All bars and casinos are closed. Restaurants can offer only takeout.

  • Museums, cinemas and theatres are closed.

  • Being less than two metres apart will be prohibited. Masks will be mandatory during demonstrations.

  • Houses of worship and venues for events, such as funerals and weddings, will have a 25-person limit.

  • Hair salons, hotels and other such businesses will stay open.

  • Schools will remain open.

Libraries were on the list of buildings to close, but Legault clarified on Wednesday that libraries will remain open to borrow books only.

Quebec officials expected to outline how new public health rules will be applied in red zones

Quebec officials expected to outline how new public health rules will be applied in red zones

Quebec Premier François Legault is expected to clarify details surrounding the new public health restrictions in the province’s newly christened red zones — regions where COVID-19 is surging.

Questions have been swirling since Monday’s announcement that residents in red zones won’t be allowed to visit friends or family at home or sit down at their favourite restaurant for 28 days.

Back in the spring, hundreds of tickets were issued to people who ignored the two-metre rule or threw parties at home.

The premier said on Monday that banning inter-regional travel is not in the plans, but it is strongly encouraged that people stay within their zones.

For now, elected officials from places like Charlevoix and Portneuf do not believe that roadblocks are necessary to keep out people from red zones, like Montreal and Quebec City. 

Legault is expected to clarify the new measures while answering reporters’ questions, alongside Public Security Minister Geneviève Guilbault and Quebec’s public health director, Dr. Horacio Arruda.

Earlier this month, Guilbault did say police would not be allowed to enter a private residence without consent or a warrant.

She added, however, that if the epidemiological situation worsens “dramatically,” the government would consider giving that power to police.

How Quebec went from COVID-19 success story to hot spot in 30 days

How Quebec went from COVID-19 success story to hot spot in 30 days

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.

WATCH | Infectious disease specialist explains why Quebec is so hard hit:

Infectious disease specialist Dr. Cécile Tremblay discusses how we got there and what it means. 1:52

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.

Quebec tightening COVID-19 restrictions as 3 regions put on red alert

Quebec tightening COVID-19 restrictions as 3 regions put on red alert

Residents in three Quebec regions won’t be allowed to visit friends or family at home for most of October or eat out at their favourite restaurant as the provincial government struggles to slow the surge of new coronavirus cases.

Montreal, Quebec City and Chaudière-Appalaches regions are now considered red zones under the province’s COVID-19 alert system, Quebec Premier François Legault said Monday.

“I’m a bit heavy-hearted today,” Legault said during a late afternoon news conference.

“We looked at the results over the weekend, and the number of cases has gone up significantly.”

This rise in cases could lead to an increase of hospitalizations and deaths, he said, and the government must act quickly in the interest of all Quebecers.

“We need to make some difficult decisions,” Legault said.

The new restrictions, announced after Quebec reported 750 new coronavirus cases, take effect 12:01 a.m. ET on Thursday and are set to last for 28 days, until Oct. 28, in the red zones. The restrictions are: 

  • A ban on home gatherings, with some exceptions, such as a single caregiver allowed per visit.
  • All bars, casinos and restaurants are closed (takeout only).
  • Libraries, museums, cinemas and theatres will also be closed.
  • Being less than two metres apart will be prohibited. Masks will be mandatory during demonstrations.
  • Houses of worship and venues for events, such as funerals and weddings, will have a 25-person limit.
  • Hair salons, hotels and other such businesses will stay open.
  • Schools will remain open.

“Schools must remain open,” Legault said. “Businesses are open so parents can continue to work and earn money.”

Though people are generally following the public health guidelines, Legault said many are not and he showed frustration toward those who are throwing caution to the wind.

“That doesn’t make any sense,” he said. “We are not putting measures in place just for fun. We are putting measures in place to protect others.

WATCH | Legault announces new measures:

Further restrictions in these regions start October 1. 2:55

Legault said the government is working on compensation packages for those businesses that are being shut down by the pandemic, though he declined to go into detail about those packages.

The government is enacting the restrictions as of Thursday to give the owners of businesses that will be closed time to prepare, he said.

The government could restrict travel between regions as was done in the spring under public health guidelines, but for now it won’t be banned. 

However, travel between different regions of the province is strongly discouraged, Legault said.

Legault making right decision, specialist says

The government has been urging people to stop socializing for a month in order to slow the spread of the virus. Now that it is prohibited to gather in homes, Legault said the Public Security Ministry is now exploring how the regulation will be enforced.

Dr. Cécile Tremblay, an infectious disease specialist at the Université de Montréal hospital, said the government is making the right decision.

“People can get a serious illness even if they are young,” she said. “People can die even if they are young.”

WATCH | Infectious disease specialist explains why Quebec is so hard hit:

Infectious disease specialist Dr. Cécile Tremblay discusses how we got there and what it means. 1:52

She said the extent of long-term damage COVID-19 is causing to the heart, lungs and other organs is still not known and that it is important that everybody, including young people, does their part to prevent the spread of the disease.

Shutting down for 28 days is a good start, but it’s hard to say how effective it will be, Tremblay said. Strict health measures have prevented transmission in other countries, she said, but it all depends on how well the population respects the rules.

The hope is to limit the impact on the health-care network, especially with the cold and flu season upon us, she said.

Cases on the rise in Quebec

Quebec reported 750 new cases on Monday, 245 of which were on the island of Montreal. The Quebec City area, which had few cases during the first wave in the spring, had another 125 cases.

Quebec City and its immediate environs have emerged as a second epicentre of the fall coronavirus wave.

Taken together, the Capitale-Nationale region and Chaudière-Appalaches added more than 1,000 cases from Sept. 20-27.

Infection rates also continued to tick upward in the Eastern Townships, the Mauricie, the Gaspé Peninsula and Lanaudière.

Many regions have set new single-day records for COVID-19 cases; in the cases of Quebec City and Chaudière-Appalaches, they have tended to be superseded a short time later.

As Quebec City Mayor Régis Labeaume said succinctly last week: “The virus is among us.”

Hospitalizations are still manageable, but that could still change, according to Dr. Matthew Oughton, an infectious disease specialist at the Jewish General Hospital.

He said the gradual increase in cases throughout September is similar to what happened in the spring. Because it takes several days for people to develop symptoms severe enough to seek medical care, he explained, it leads to an avalanche of new patients down the road.

There have been 1,163 COVID-19 cases in 489 schools in Quebec so far this year, but public health says schools are not a driver of transmission. (Ivanoh Demers/Radio-Canada)

“It is quite clear we are going to see this wave of hospitalizations increase and likely accelerate,” he said. “It’s a little discouraging to see we are going through the same process again.”

Quebec’s Health Ministry reported Monday there were already more than 5,000 health-care workers in the Montreal hospital network on leave. 

“The rise in new cases is not simply because of an increase in the number of tests,” said Dr. Donald Vinh, a microbiologist at the McGill University Health Centre. 

“It’s that the tests are becoming positive more often. That’s what worries us.” 

So far, there has been a total of 1,163 cases in 489 schools in Quebec. There are more than 3,000 public and private schools across the province, with more than than one million students and 226,000 staff.

Neighbouring Ontario has also seen a resurgence of the virus. The province reported more than 700 cases today, the most on a single day since the start of the pandemic.

Quebec announces new COVID-19 restrictions starting Thursday as 3 regions put on red alert

Quebec announces new COVID-19 restrictions starting Thursday as 3 regions put on red alert

Quebec Premier François Legault says three regions are being moved to the highest COVID-19 alert level and stricter health measures are now necessary to curb the rate of transmission.

Those regions include Montreal, Quebec City and Chaudière-Appalaches, south of the provincial capital.

“We looked at the results over the weekend and the number of cases has gone up significantly,” the premier said Monday during a late afternoon news conference.

“We need to make some difficult decisions.”

This rise in cases could lead to an increase of hospitalizations and deaths, he said, and the government must act quickly in the interest of all Quebecers.

The entire Montreal metropolitan area will be in the red zone, including heavily populated cities like Laval and Longueuil as the zone stretches into the surrounding regions.

The following new measures will take effect as of midnight Wednesday into Thursday in the three regions:

  • Ban on home gatherings, with only one caregiver allowed at once for those living alone.

  • All bars, casinos and restaurants are closed (takeout only).

  • Libraries, museums and theatres will also be closed.

  • Being less than two metres apart will be prohibited. Masks mandatory during demonstrations.

  • Houses of worship and venues for events like funerals and weddings will have a 25-person limit.

  • Hair salons, hotels and other such businesses will stay open.

  • Schools will remain open.

“Schools must remain open,” Legault said. “Businesses are open so parents can continue to work and earn money.”

To people not respecting rules, the premier had a special message. He said most people are respecting the rules, but some are not.

“That doesn’t make any sense,” he said. “We are not putting measures in place just for fun. We are putting measures in place to protect others.

This a developing story. An earlier version appears below.

Health Minister Christian Dubé announced Sunday on Tout le monde en parle, a talk show on Radio-Canada, that both cities would move from the orange to red alert level in the coming days.

“Montreal and Quebec City are the hardest-hit areas at the moment. They’re very close to the red zone,” he said. 

“We’re going to announce it in the coming days because I think we’ve arrived at that point. We’re there, and we have to act because people are expecting us to be transparent.”

Last week, Dubé urged the public to stop socializing for the next month in order to slow the spread of the virus but said he was reluctant to close bars and restaurants because it would lead people to have gatherings in their homes.

Quebec reported 750 new cases on Monday, 245 of which were on the island of Montreal. The Quebec City area, which had few cases during the first wave in the spring, had another 125 cases.

Quebec City and its immediate environs have emerged as a second epicentre of the fall coronavirus wave.

Taken together, the Capitale-Nationale region and Chaudière-Appalaches added more than 1,000 cases from Sept. 20-27.

Infection rates also continued to tick upward in the Eastern Townships, the Mauricie, the Gaspé Peninsula and Lanaudière.

Many regions have set new single-day records for COVID-19 cases; in the cases of Quebec City and Chaudière-Appalaches, they have tended to be superseded a short time later.

As Quebec City Mayor Régis Labeaume said succinctly last week: “The virus is among us.”

Montreal and Quebec City are expected to move into the province’s highest COVID-19 alert level on Monday. (Graham Hughes/The Canadian Press)

While hospitalizations and deaths remain much lower than they were during the first wave, experts warn those numbers will increase in the coming weeks, putting stress on the health system.

Quebec’s Health Ministry reported Monday there were already more than 5,000 health-care workers in the Montreal hospital network on leave. 

“The rise in new cases is not simply because of an increase in the number of tests,” said Dr. Donald Vinh, a microbiologist at the McGill University Health Centre. 

“It’s that the tests are becoming positive more often. That’s what worries us.” 

Dr. Cécile Tremblay, an infectious disease specialist at the Université de Montréal hospital, said Sunday the virus is spreading out of control and suggested the government consider taking tougher measures to prevent the death toll from increasing. 

Making masks mandatory for students inside the classroom was among the measures she proposed.

So far, there has been a total of 1,163 cases in 489 schools in Quebec. There are more than 3,000 public and private schools across the province, with more than than one million students and 226,000 staff.

“It is extremely important that people understand we are heading straight for a second wave that will be at least as bad as the first one, if not worse,” Tremblay said.

Neighbouring Ontario has also seen a resurgence of the virus. The province reported more than 700 cases today, the most on a single day since the start of the pandemic.


CBC News will have live coverage of today’s announcement. 

Online: Watch live starting at 5:30 p.m. here on cbc.ca/montreal and on the CBC Montreal and CBC Quebec Facebook pages.

Radio: Listen from 5:30 p.m. to 7 p.m. to a provincewide special on CBC Radio One and the CBC Listen app.

TV: Watch CBC Montreal News with Debra Arbec from 5:30 until 7 p.m.

Avoid all social gatherings as COVID-19 community transmissions rise, health minister urges Quebecers

Avoid all social gatherings as COVID-19 community transmissions rise, health minister urges Quebecers

Health Minister Christian Dubé appealed to Quebecers to cancel all their plans to gather with friends and family over the next few weeks — including Thanksgiving dinner.

He said the next few weeks will be key in preventing the level of shutdowns due to COVID-19 that were seen in the spring.

“We ask all Quebecers, regardless of colour code in their region, to restrict their public gatherings. This is very important,” he said, referring to the alert system that the province is now using to determine the severity of the spread of the virus.

He said cancelling Thanksgiving plans would give Quebecers a shot at having “a nice Christmas.”

One new region, MRC Avignon in the Gaspésie, moved into the yellow “pre-alert” stage Thursday. Montreal, Quebec City and Laval are already in the orange stage.

WATCH | Explaining Quebec’s colour-coded COVID-19 alert system:

Quebec has unveiled a new, colour-coded COVID-19 alert system. Here’s how it works. 1:55

Even though all Quebecers are permitted to gather in small numbers under the alert levels that are currently active, Dubé asked people to avoid meeting with those who do not live in the same household.

With schools and businesses open, Dubé said some semblance of normal life has returned. But at the same time, he said there are about 300 active outbreaks across the province.

With the virus being transmitted in the community, Dubé said exposing health-care workers to illness is perhaps his greatest worry as cases continue to rise.

“Community transmission affects the staff of our health network and puts a lot of pressure on the health-care network,” he said, adding that the province is already dealing with a backlog of surgeries and other medical services that had to be put on hold last spring. 

Officials single out dinner parties

He said Quebecers must make this short-term sacrifice or face the level of shutdowns seen in the spring.

While Dubé and Quebec’s director of public health, Dr. Horacio Arruda, singled out dinner parties, they said the province’s restaurants can remain open.

“In restaurants, there is a [level of] control that is really different from a party,” Arruda said.

Regulations put in place by the province’s workplace health and safety board require masks to be worn when customers are not seated, and in orange zones, tables of more than six are not allowed.

Those who do not comply can be fined up to $6,000.