Richard Masse, public health strategic advisor responds to reporters on projections during a news conference on the COVID-19 pandemic, April 7, 2020 at the legislature in Quebec City.Jacques Boissinot/The Canadian Press
Quebec is expecting to reach a plateau in COVID-19 hospital admissions around April 18, according to public health projections unveiled Tuesday that have sparked hope the province might restart some economic activity next month.
However, those same models offer a grim picture of a mounting death toll that is likely to rise from 150 to at least 1,263 people by the end of the month, in even the most optimistic scenario.
Public health authorities and Premier François Legault warned Quebeckers must remain disciplined on distancing measures that will be lifted only gradually. “If we want to slowly start returning to a normal life in May, we have to stay very disciplined for the entire month of April,” Mr. Legault said, adding a gradual relaunch of the construction industry idle for two weeks could be the first step.
Quebec offered a simple snapshot Tuesday comparing the province’s epidemic trajectory with those of Italy on the pessimistic side and Portugal and Germany on the positive side. The pessimistic scenario for deaths is nearly 9,000, but Quebec’s recent trajectory in new cases, hospital admissions and deaths places it nowhere near Italy.
number of cumulative deaths in quebec
Scenarios from April 7
Optimistic - Germany
Pessimistic - Italy
Actual
9,000
8,000
7,000
6,000
5,000
Est. proj.
based on rate
of decline
4,000
3,000
2,000
1,000
0
March 12
April 1
April 15
April 30
JOHN SOPINSKI/THE GLOBE AND MAIL
SOURCE: government of quebec
number of cumulative deaths in quebec
Scenarios from April 7
Optimistic - Germany
Actual
Pessimistic - Italy
9,000
8,000
7,000
6,000
5,000
Est. projections
based on rate
of decline
4,000
3,000
2,000
1,000
0
March 12
April 1
April 15
April 30
JOHN SOPINSKI/THE GLOBE AND MAIL
SOURCE: government of quebec
number of cumulative deaths in quebec
Scenarios from April 7
Optimistic - Germany
Actual
Pessimistic - Italy
9,000
8,000
7,000
6,000
5,000
Est. projections
based on rate
of decline
4,000
3,000
2,000
1,000
0
March 12
April 1
April 15
April 30
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: government of quebec
Alberta is expected to release its own modelling data on Wednesday, although Premier Jason Kenney used a televised address Tuesday evening to tell the province to brace for the potential of thousands of deaths.
Public-health officials in Alberta say their “probable” scenario would have infections peak in mid-May, with 400 to 3,100 deaths. Under a more pessimistic scenario, if physical distancing measures aren’t as successful, the peak would arrive earlier, in early May, and there could be 500 to 6,600 deaths. And with no social distancing measures, Mr. Kenney said, the number off fatalities could be as high as 32,000.
“These models are not a done deal,” Mr. Kenney said. “I want Albertans to see them as a challenge – perhaps the greatest challenge of our generation.”
number in intensive
care in quebec
Scenarios from April 7
Optimistic - Portugal
Pessimistic - Italy
Actual
1,200
1,000
800
No. of intensive care beds available
600
400
Est.
projections
based on rate
of decline
200
0
March 12
April 1
April 15
April 30
JOHN SOPINSKI/THE GLOBE AND MAIL
SOURCE: government of quebec
number in intensive care in quebec
Scenarios from April 7
Optimistic - Portugal
Pessimistic - Italy
Actual
1,200
1,000
800
No. of intensive care beds available
600
400
Estimated
projections
based on rate
of decline
200
0
March 12
April 1
April 15
April 30
JOHN SOPINSKI/THE GLOBE AND MAIL
SOURCE: government of quebec
Number in intensive care in Quebec
Scenarios from April 7
Optimistic - Portugal
Pessimistic - Italy
Actual
1,200
1,000
800
No. of intensive care beds available
600
400
Estimated
projections
based on rate
of decline
200
0
March 12
April 1
April 15
April 30
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: government of quebec
Ontario, with a 72-per-cent greater population, projected 1,600 deaths for April during a similar exercise last week. Ontario also projected 3,000 to 15,000 people could die over the next two years. Quebec’s modelling does not carry on beyond the end of the month. Dr. Horacio Arruda, Quebec’s director of public health, said anything beyond a one-month time-frame is guesswork.
Other wildcards remain in play for stemming Quebec’s epidemic. Outbreaks in long-term care homes and other seniors’ residences have accounted for more than two-thirds of Quebec’s death toll.
Quebec cleared 6,000 hospital beds, readied 3,000 ventilators and has 633 intensive care beds free for COVID-19 patients. Even in the most pessimistic scenario, hospital admissions would peak at 3,028 cases. The more likely scenario puts the figure near 1,404. The province is on track to stay below the 468 ICU cases of the low-end model.
Since Quebec had fewer hospital admissions from COVID-19 than expected, the province will reallocate staff to long-term care centres and seniors’ homes. “We’ve made some efforts but it’s not enough, we need to do more because that’s where our priority should be,” Mr. Legault said.
The health-care workers being transferred include physicians and nurses specializing in preventive disinfection, Health Minister Danielle McCann said.
She also called on former nurses to come out of retirement to help elderly patients and added that family doctors would pitch in, too. “Come help us. We need you.”
Mr. Legault said the reinforcement in health-care workers would enable facilities to reduce staff turnover and enforce sanitation practices properly.
Nursing homes and care centres that have been hit by a coronavirus outbreak now have to separate patients and staff who have been infected into a different floor or wing.
Dr. Arruda said officials are looking back at the impact of infections from employees or visitors who showed no symptoms or only had mild symptoms.
“I think it was a very important factor. That notion about symptoms is relatively recent. We weren’t talking about that in early February.”
Asymptomatic transmission might have played a role in two places, at the Sainte-Dorothée long-term care centre in Laval, north of Montreal, and the Laflèche centre, in Shawinigan.
Sainte-Dorothée has 105 confirmed cases and eight deaths. The Laflèche centre has 78 confirmed cases.
Carol Filion, chief executive officer of the Mauricie regional health centre, which oversees the Laflèche facility, confirmed last week that employees there, who had been under 14-day quarantine orders, had to return to work after only a week if they showed no symptoms.
“We were confronted with the fact that the situation was threatening our ability to offer care,” Mr. Filion said. “A long-term care centre is an essential service.”
Jeff Begley, president of the FSSS-CSN trade union, which represents health-care workers in Quebec, noted that even before the pandemic there were chronic staffing shortages in long-term care homes because overworked orderlies were increasingly requesting sick leave.
Furthermore, Mr. Legault noted that, mostly in private care centres, the staff often worked in several facilities at the same time and became vectors of transmissions.
“We knew even before the coronavirus that there was a problem.”
Public-health officials believe about 700 Quebec facilities for elderly people are infected, although only 150 have confirmed cases.