Quebec’s public health body was hampered by outdated software, testing program delays in pandemic’s early days, inquest hears

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As the pandemic began, the public-health body advising the Quebec government had to wrestle with a flood of scientific papers, outdated software, delays in creating a testing program and a misguided expectation that hospitals would be hit before elder-care homes, a coroner’s inquest heard Wednesday.

It was the first time that representatives of Quebec’s public-health institute, known by the abbreviation INSPQ, appeared before coroner Géhane Kamel. Her public inquest is looking at the impact of the pandemic’s first wave on the province’s long-term care centres. More than 4,000 elderly residents died during that period.

The testimonies by two INSPQ physicians opened a window into the high-pressure challenges faced by the institute, which helps the province devise its pandemic response.

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However, many pivotal questions about the role of INSPQ will not be answered until two higher-ranking physicians testify later – chief executive Nicole Damestoy, who is to appear on the witness stand next week, and medical adviser Jasmin Villeneuve, scheduled for Nov. 29.

The inquest previously heard testimonies suggesting that strategic decisions by the government – such as giving priority to hospitals over nursing homes, failing to recognize asymptomatic transmission and delaying the widespread use of masks – made things worse for elder-care facilities.

Witnesses previously told Ms. Kamel that the government’s initial handling of the crisis showed a blind spot toward the elderly, with a lack of representation from geriatricians among the crisis committees set up to deal with the pandemic.

Jocelyne Sauvé, the INSPQ associate vice-president for scientific affairs, testified Wednesday that the institute was aware that elderly people were more vulnerable, but expected this would result in a surge of hospital admissions.

The institute presented its forecasts to the health department on March 9, 2020. “In the most catastrophic scenarios it would completely knock over the short-term care system,” Dr. Sauvé testified.

Jacques Ramsay, a physician acting as an expert assessor for the coroner, asked how many people had experience in elder care among members of the CINQ, the institute’s nosocomial infections committee, which advises the government on infection prevention and control.

“They are not unknowing about what takes place in long-term care ... but of course the focus on nosocomial infections has historically been placed on short term,” Dr. Sauvé replied.

She mentioned other hurdles, such as computer systems that needed to be updated, unreliable reporting of COVID-19 deaths and delays in testing. A test procedure was ready on Jan. 23, but initially could handle only 50 samples a day. Until March 11, the results had to be verified by the National Microbiology Laboratory in Winnipeg. “We had a hard time getting data in real time.”

Chantal Sauvageau, an INSPQ physician, testified that by February there were five scientific papers raising the possibility that the novel coronavirus could be transmitted before a carrier displayed symptoms.

However, both Dr. Sauvageau and Dr. Sauvé said the INSPQ did not have enough evidence at that point to accept the possibility of asymptomatic transmission.

“It’s a bit easy in hindsight to say there was a paper published in some journal in some context. There were thousands of papers being produced,” Dr. Sauvé said.

She added that “in a mass of papers, one paper is never, or rarely, the impetus for intervening.” Papers can later be retracted or refuted, she said, especially during the pandemic, when research was often made public before peer review.

Patrick Martin-Ménard, a lawyer representing the families of six deceased nursing-home residents, and Maxime Dupuis, a lawyer for the FIQ union of health care workers, said the institute failed to follow the precautionary principle of applying maximum precautions rather than wait for definitive proof that there was a risk.

Nursing-home staffers were initially told they couldn’t wear masks unless they were in proximity to a resident who showed symptoms. It was only on April 3, 2020, that the directive was changed to require masks within two metres of a resident, even without symptoms.

Those rules relied on the belief, held at the time, that the virus could be emitted in respiratory particles through larger-sized droplets rather than smaller airborne aerosols, Dr. Sauvageau said in her presentation before the inquest.

However. Mr. Dupuis presented an INSPQ advisory from March 18, 2020, that mentioned the possibility that the virus could be carried by particles of different sizes, in a “continuum” from mist-like aerosol to larger droplets.

Dr. Sauvageau argued that while there could be transmissions without symptoms or by aerosol, in practice people more often got sick after prolonged exposure while in close contact.

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