COVID-19: Quebec’s response to the second wave deemed late and timid

Once again failed in the field of bad students, has Quebec, at the head of infections in the country, failed to detect the start of the second wave? Clear signs of a resumption of the epidemic were underestimated by the end of the summer, according to some experts. But the Minister of Health and Social Services, Christian Dubé, does not question the sequence of decisions taken by his government.

“Me, I really place the start of the second wave in the week of August 23. There has been a clear resurgence of cases at this time, ”says Dr.r Marc Dionne, medical consultant in public health and researcher at the CHU de Québec research center.

On August 23, Quebec had 78 cases (or a moving average of 90 over 7 days). Everything seems to be fine, after a temporary surge of 100 to 150 daily cases recorded in mid-July, in the wake of a call for screening of bar patrons. But from August 31, the counter jumped to 129 cases (moving average of 150 cases over 7 days) and crosses the 247 cases mark on Wednesday, September 9.

It was not until September 21 that the national director of public health, Dr Horacio Arruda, declares the “second wave” initiated and that the Minister of Health, Christian Dubé, calls on Quebecers to roll up their sleeves. The new infections then crossed the 586 case mark.

On September 17, Minister Dubé even said he was “confident”, and Dr Arruda hesitating to move to the orange zone. “If we react on a peak[si], the next day it goes downhill, it’s like using a cannon to kill a fly “” We are in […] the scenario of wavelets. It’s still too early to talk about a second wave. “Two weeks later, the Legault government begged Quebeckers to” break “this 2e vague and he has kept hammering this message since.

We were slow to completely close the bars [1er octobre] despite the outbreaks that occurred this summer. We pick ourselves up with something severe. The Quebec City region is still living with the remnants of the karaoke outbreak. We’ve lost control and it’s hard to catch up.

In an interview on Friday at Duty, Minister Dubé denied that the signs of a 2e wave were noticeable in late August. ” The answer is no. I think Dr. Arruda has been asked quite often: were you in? Of course, it’s easy to say you could have said it was there … The date is the date that Doctor Arruda made it official. “

“What’s important to me is that we didn’t wait for a wave to break out to make actions. My plan for the second wave, it was ready on August 18th, “he defended himself.

However, for several specialists and clinicians, several signals were red long before September 21, and the timidity of certain measures helped breathe new life into the pandemic.

“We are still at the bottom of the class in Canada. We were slow to completely close the bars[1[1[1[1er October]despite the outbreaks that occurred this summer. We pick ourselves up with something severe. The Quebec City region is still living with the remnants of the karaoke outbreak. We have lost control and it’s hard to catch up, ”laments epidemiologist Benoit Mâsse, from the School of Public Health at the University of Montreal.

On August 23, the famous outbreak at the bar Le Kirouac caused more than 80 direct infections and caused two known deaths. On August 30, Prime Minister Legault was shocked: “We feel a relaxation” Minister Dubé is indignant: “This is not correct! But it will take three weeks for Quebec to close the karaoke bars. Last week, no less than 17 deaths and another 1,000 new cases of COVID were deplored in the national capital.

“These big outbreaks [comme celle du Dix30 le 5 juillet, et celle du Kirouac] partly explain the rapid increase in cases. This is the difference with the first wave. A major event can quickly create 1000 cases. Stop this type of outbreak … Cases always escape investigation, “says Dr.r Antoine Delage, pulmonologist-intensivist at Charles-LeMoyne hospital and president of the Association of pulmonologists.

To lose control

Contact tracing still appears to be the Achilles heel of the government’s response to the second wave as backup to trace contacts of positive cases is overdue. The duty revealed this week that Quebec looked up earlier this summer on the workforce offered by Statistics Canada, capable of making 20,000 calls per day.

“Without a vaccine, all we have as weapons against COVID are personal protection measures, containment and contact tracing. However, we are not always able to do a quick search. What do we have left? The partial closure of classes or businesses ”, believes Dr Marc Dionne, from the CHU du Québec.

“The teams are growing, but one wonders why this staff was not hired earlier in August. The deadlines are stretching. This week I did the surveys of people who had their results last week, ” Duty an investigator from the Montreal area, on condition of anonymity.

In data | To know everything about COVID-19

“The DSP has hit a wall with young people who have dozens of contacts. It undermined the ability to isolate cases ”, judge Dre Marie-France Raynault, Head of the Department of Public Health and Preventive Medicine at the CHUM. As of September 9, Montreal’s director of public health, the Dre Mylène Drouin said she has 30 people to find an average of 80 contacts per case. Today, the Montreal DSP claims to have 184 people in place.

Too little, too late

The strategy of small steps and injunctions without concrete measures also weighed down the government’s prevention messages, believes the Dre Marie-France Raynault. “The new measures [fermeture des bars et restaurants, port du masque à l’école, etc.] have just been implanted. We wasted all summer saying what not to do, without getting tough. Early intervention by Public Security could have changed the game, ”she thinks. Today, the late measures imposed by Quebec affect the entire population, for lack of having acted sooner towards delinquents, she deplores.

In the field, the repercussions of the first summer outbreaks can still be seen today. “The first wave was regional, concentrated in Montreal, in CHSLDs. There, it happens throughout Quebec, in healthcare settings that have not had the experience of 1re wave. One case quickly becomes 5, 10, 15 cases. That’s what hurts, there are outbreaks everywhere, ”says Dr.r Gilbert Boucher, representative of the 180 emergency medicine specialists in Quebec.

The early start to school, and without masks, in several campuses and high schools in Quebec, also explains the gap between Quebec and Ontario. According to the federal government, there have been 250 schools across the country affected by infections since the start of the school year, against 1000 schools in Quebec, of which 781 still have active cases.

“Back to school always signals the start of respiratory disease and flu epidemics, and COVID is no exception. As the downtown buildings are still almost all closed, it is especially the management of schools that differentiates us from Ontario, where students are masked and present only every other day, “says Dr.r Carl Weiss, infectious disease specialist at the Jewish General Hospital.

The hesitations and delays on the prolonged wearing of the mask, the complex health messages to grasp did the rest, he believes. “Several patients tell me that they don’t really understand the government’s instructions. No matter how much treatment is given, he says as an example, if the patient does not take the pill, we cannot hope to treat the disease. “

On the defensive

This week, Premier François Legault spun around explaining the divide between Quebec and Ontario, calling the more enviable situation in Toronto an enigma. At 959 cases of infection per 100,000 inhabitants, Quebec has an infection rate more than twice as high as its neighbor Ontario (390 cases / 100,000 inhabitants), exceeds the United Kingdom (805 cases / 100,000 inhabitants ), behind France (1017) and Belgium (1189).

Several observers deplore the fact that the preparation for this anticipated crisis has remained centralized in Quebec. “If we knew what the plan is, where we’re going, it would be more unifying. Apart from public health, few professionals in the health network were consulted on the preparation for this 2e vague, ”says Dr Butcher.

Even if this 2e wave hits more young people, the Dr Delage is concerned about the pressure already on some hospitals. “Young people in hospital are rare, but sometimes they are for weeks. It takes few cases to overload an intensive care unit. Last winter, the elderly died. The system is already overworked. We do not have much play. Floors are already transformed into COVID zones by removing beds from other patients. Where and who should we cut? “

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