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Canada Why reopening Montreal is a riskier bet than Legault is letting on

13:52  25 may  2020
13:52  25 may  2020 Source:   cbc.ca

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Canada's provincial premiers meet in Toronto © REUTERS/Carlos Osorio Canada's provincial premiers meet in Toronto

The riskiest part yet of Premier Francois Legault's plan to end the lockdown gets underway today, as retail stores across the Montreal area open for the first time in nearly two months.

At the same time, factories in Quebec will also be able to resume operating at full capacity. This follows the first weekend after the government ended its ban on small outdoor gatherings, and there was nary a Montrealer left inside. 

So in the span of a few days, hundreds of thousands of people will be back working, shopping and commuting in the Canadian city where the novel coronavirus has spread most widely and been most deadly.

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  'Society failed': Legault visits Montreal as Quebec becomes the world's seventh deadliest COVID-19 epicentre MONTREAL — For the first time since the beginning of the COVID-19 pandemic, Quebec Premier Francois Legault visited Montreal on Thursday, to announce the province recorded 131 new deaths linked to the virus — 91 of them in the hard-hit city. The figures make the province of Quebec the seventh deadliest COVID-19 epicentre in the world, according to reports by LaPresse and CityNews . Montreal — the epicentre of the COVID-19 contagion in Canada and Legault’s hometown — is still so “fragile,” the premier said, that he had little choice but to cancel the rest of the school year for elementary students in the area.

But now that Legault 's government has started to open things up again Legault has set dates for reopening the economy and returning children to school that he was unable to keep in Montreal . None of this suggests that Legault is in trouble (although he's probably hoping the trend lines stabilize).

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The previous phases of Legault's plan were a safer bet. When elementary schools, daycares and stores outside Montreal were allowed to reopen, transmission rates were already decreasing. 

And so far — fingers crossed, knock on wood — these areas of the province haven't seen a serious uptick in cases, hospitalizations or deaths.

But there is a different order of uncertainty when it comes to lifting confinement measures in Montreal, and the suburbs that ring the island.

While there have been some improvements in the key indicators, it hasn't been enough to completely erase the fears of epidemiologists.

"There are some small signs of hope, but I'm very worried about what will happen in the next few weeks," said Mathieu Maheu-Giroux, an assistant professor at McGill University who helps prepare projections for the province's public health research institute.

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"Hopefully this will give us some respite to be able to mount a more effective response for a potential second wave that could be worse than the first one."

But as Legault continues to lift restrictions, several factors that have contributed to the ongoing disaster remain unaddressed. 

The staffing crisis in long-term care homes

The scope of the tragedy in Quebec — nearly 4,000 dead — can be explained in no small part by the staffing shortage it caused in the health-care system. 

Until last week, there were routinely more than 11,000 health-care workers who were absent on any given day. In many cases, these were front-line workers — doctors, yes, but more critically nurses and patient attendants.

These absences compounded already existing staffing shortages in the system, particularly in the province's network of long-term care homes (known as CHSLDs).

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  'Not the time to take a stupid penalty and lose the game' — Legault QUEBEC — Premier François Legault has warned he won’t hesitate to hit the brakes on lifting restrictions imposed to fight COVID-19 if Quebecers fail to respect health rules and the coronavirus further ravages Quebec. One day after announcing retail business in greater Montreal will re-open as planned May 25, Legault said he doesn’t want people to get the impression the war is won or that COVID-19 is only a “Montreal thing” — even if the numbers are promising for a second day in a row.

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It was understaffed long-term care homes that generated the most vivid traumas to date: elderly patients left unattended for hours, dying alone, sometimes in their own filth.

Less dramatically, but no less importantly, the staffing shortage prevented the implementation of a policy that could have saved dozens of lives.

On April 3, Quebec issued a directive urging CHSLD staff to avoid working in several different facilities, fearing they were carrying the disease with them as they went from one location to another. 

A similar policy was implemented in British Columbia, and public health experts there have lauded it for effectively halting the spread of COVID-19 in the province's nursing homes. 

But more than a month later, Quebec still hasn't been able to put an end to the practice. 

Given the continuing shortage of workers in the CHSLD network, it's either that or leaving patients without basic care. Health-care managers are forced to choose the lesser of two evils.

 

A provincewide recruitment effort, bonuses, redeploying medical specialists, calling in the army — none of the government's solutions have generated sufficient replacements.

Quebec still not hitting testing targets as Montreal prepares to reopen stores, ease restrictions

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CBC Montreal , Montreal , Quebec. 119,580 likes · 29,463 talking about this. Your source for breaking news and top stories in Montreal . Quebec Premier François Legault is not ruling out the possibility of taking over all private CHSLDs as his government comes to terms with the devastation COVID-19

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The staffing situation has improved more recently. By the end of last week, there were 10,415 health-care workers absent either because they've tested positive or are in preventative isolation.

That's roughly 1,000 fewer than the week before. 

But it is still unclear when Quebec will be able to obey the policy it set out for itself on April 3. 

At a National Assembly hearing on Friday, Health Minister Daniel McCann criticized the practice of moving CHSLD workers around. 

Asked when it would end, she replied: "I don't have a precise date."

Crowded Montreal hospitals 

The Legault government has said hospital capacity is one of its key criteria for determining whether Montreal is ready for looser confinement measures.

When the premier previously delayed reopening stores in Montreal, and scratched reopening schools altogether, he cited the space crunch in Montreal-area hospitals.

One benchmark that Legault has cited — borrowed from New York — is hospitals having at least 30 per cent of their beds available, in case easing the lockdown leads to a surge in new cases.

Quebec's hospital network was at 70 per cent capacity on May 16, but had climbed to 74.3 per cent by May 21, according to figures provided by the Ministry of Health. 

Montreal-area retailers reopening to public, with distancing measures in place

  Montreal-area retailers reopening to public, with distancing measures in place Montreal-area retailers reopening to public, with distancing measures in placeMask-wearing, Plexiglas barriers, frequent disinfecting and no-touch browsing are some of the measures being put in place by retailers as Quebec eases measures to contain the spread of COVID-19.

Things are even tighter in Montreal and the surrounding area. On Thursday, hospital capacity in Montreal was at 77 per cent, in Montérégie it was at 84 per cent and was at 95 per cent in Laval. 

"In Montreal, things are very, very, very tight," Dr. Germain Poirier, head of Quebec's society of intensive-care specialists, told CBC Montreal's Daybreak last week.

While there is more space available in intensive-care units, he said regular hospital beds are almost all taken. "If we have a second wave, that might be difficult."

This view clashes somewhat with government statistics on hospital capacity.

Last week, Quebec suddenly changed how it counted hospitalizations. It stopped including COVID-19 patients who are well enough to be transferred back into long-term care, but are waiting for space to free up.

That allowed the province to register more than 200 fewer hospitalizations.

a group of people walking down a street: Legault, in other words, has opted to ease the lockdown in Montreal at a moment when area hospitals have limited capacity to handle additional cases. © Jean-Claude Taliana/CBC Legault, in other words, has opted to ease the lockdown in Montreal at a moment when area hospitals have limited capacity to handle additional cases.

But as Poirer pointed out, these patients were still taking up a hospital bed and still need care from doctors and nurses. 

"Maybe the [Health] Ministry wants to show that things are better," he said. "Are they really better in the field? I'm not so sure. We still see a lot of active cases."

It's on us now

Legault, in other words, has opted to ease the lockdown in Montreal at a moment when area hospitals have limited capacity to handle additional cases.

The staffing crisis in the CHSLD network remains a major public health risk, and there is still no conclusive evidence of a sustained decrease in transmission in and around the city.

From this vantage point, it appears the government is going forward less because Montreal is out of the danger zone, and more because the heavy lockdown is no longer sustainable.

Whether the health-care system can handle what happens next is now almost entirely in the hands of citizens, and their willingness to follow the conditions attached to their newly returned freedoms: wash hands, wear masks and stay two metres apart.

Quebec least worried in North America about a second coronavirus wave, poll finds .
The survey also found a significant difference in the levels of concern among Quebec's two major language groups.The study, published Thursday by the COVID-19 Social Impacts Network with the Association for Canadian Studies, found that 86 per cent of all Canadians were concerned about another rise in cases this fall. That number falls to just 78 per cent in Quebec, while Ontario leads the nation with 91 per cent of residents polled saying they were "somewhat" or "very" concerned.

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