A TRAIL OF DEATH, SORROW & WHAT-IFS
Besieged on multiple fronts and ill-equipped to defend itself, Quebec would end up with one of the highest per capita death tolls anywhere, with most fatalities in its largest city. René Bruemmer traces what went wrong.
Quebec considered itself well-prepared to respond to the COVID-19 pandemic. Yet it would become one of the hardest-hit jurisdictions in the world — with Montreal at the epicentre. René Bruemmer looks back at how that first wave hit us.
FEB. 28, 2020: ‘THERE IS NO CAUSE FOR CONCERN’
It started with the travellers. A Montreal-area woman who had been in Iran showed mild symptoms and went to a Verdun medical clinic to be tested. On Feb. 28, she became Quebec’s first reported case of COVID -19. She went into isolation.
“The detection of this case shows our system is efficient; it’s reliable,” Health Minister Danielle Mccann said. “We have been very vigilant as a government. … All the measures that are necessary to really protect the population are there. … “There is no cause for concern.” Quebec had in fact prepared. Seven thousand hospital beds and 1,000 ICU spots were freed up, at the ready for a surge. We would not be Italy, where doctors had to choose between who would get a ventilator and who would die.
A week later, three more cases. Quebec travellers again. One had been to India, another to France, another on a cruise. Still no cause for concern. What we didn’t know was the virus was already circulating liberally among us. And being spread liberally.
Eventually it would invade a territory sorely unprepared to handle a cunning enemy — one that hid inside unwitting caregivers to infiltrate leaky fortresses housing thousands of the most vulnerable.
In Montreal, three-quarters of its government-run long-term care centres known as CHSLDS would be invaded. Dozens more public and private seniors’ residences were hit.
Infected workers spread it among multiple institutions, and brought it back to their homes and communities. Many who cared for our elderly would die themselves.
By the time the cracks started to show a month after the first reported case, it was too late. Besieged on multiple fronts and ill-equipped to defend itself, Quebec veered into prolonged tragedy. It would become one of the hardest-hit jurisdictions on the planet, with more than 5,000 dead in three months. As of July 3, the province’s public health institute reported Quebec had 651 deaths per million, a rate higher than the U.K, Italy, Spain and the United States.
Most of those deaths would hit Montreal.
FEB. 29: THE BALL HOCKEY GAME
On a crisp Saturday, Domenico Farinaccio and 20 others gathered for a ball hockey game in the Eastern Townships village of Racine. Some had recently returned from trips.
Later that week, Farinaccio, 57, developed a cough and body aches. On March 12, he was hooked up to a ventilator at the Jewish General Hospital. Fifteen of those at the gathering would test positive. For two weeks, they had circulated freely in Quebec.
Farinaccio survived, but he was upset health officials didn’t warn of the risk of travels earlier. His was one of thousands of similar gatherings.
The problem was no one knew the extent of the global spread at the time, said Université Laval epidemiologist Marc Brisson, head of a research group studying how travellers influenced the pandemic. Countries close to the epicentre like Taiwan and Hong Kong had early warnings to limit and quarantine travellers from a handful of trouble spots. By the time Quebec’s spring break started in late February, the virus had already surreptitiously infiltrated multiple travel destinations in Europe and the U.S.
“We were concentrated on Italy and Spain, but suddenly there was Switzerland, Belgium, the U.K., New York,” Brisson said.
Quebec’s early spring break meant many had already been there and back before the province became one of the first places in North America to shut down on March 13, when it had only 24 reported cases.
It was already too late. On March 12, the day before the lockdown, hundreds gathered at a wedding in Westmount. Five days later, one of the attendees was rushed to hospital, where she tested positive. She was a resident of the King David seniors’ residence in Côtest-luc. A canary in Montreal’s coal mine. The wedding was just one of many gatherings. A week later, three more King David residents tested positive.
When the SARS virus hit in 2003, it spread mainly in hospitals. That, along with footage of overloaded hospitals in Italy and China, likely encouraged Quebec to focus there, said Benoit Mâsse of the Université de Montréal’s School of Public Health.
“But it turned out this virus spreads in the communities,” Mâsse said. “And we didn’t have enough PPES.”
Collective pride may have also contributed to our fall, said Erin Strumpf, an associate professor in Mcgill’s department of epidemiology, biostatistics and occupational health.
“We were so obsessed with protecting our health care system,” she said. “Because if the Canadian health care system that we take so much pride in collapsed, it would be tragic on multiple levels, including in terms of our confidence.”
Seniors’ centres aren’t considered part of the health system.
MARCH 26: ‘AVOID THE WEST END’
The virus spread in communities first. It hit boroughs like Côte-stluc, Côte-des-neiges—notredame-deGrâce and Outremont to such an extent public health director Horacio Arruda told Quebecers to “avoid the west end of Montreal.” Arruda surmised much of it had been brought back from New York.
On March 27, Mayor Valérie Plante declared a state of emergency to protect Montreal’s homeless population, considered a “ticking time bomb.” The city started handing out $1,500 tickets to people congregating in parks.
Meanwhile, in British Columbia, once contact tracing showed health care workers were the vectors of the disease, some authorities banned them from working in multiple institutions starting March 18. Quebec never did.
B.C.’S spring break started March 16, by which time authorities were advising against international travel.
To date, Quebec’s death toll (5,560) is 31 times British Columbia’s (177).
Our efforts to “slap down the curve” appear to be working,” Arruda said on March 29, famously smacking his hand to make his point. No new deaths had been recorded in the previous 24 hours.
But Montreal was seeing hot spots in more neighbourhoods, particularly those with CHSLDS. They included Rivière-des-prairies, Plateau-mont-royal, Ville-marie and Lasalle. With less than a quarter of the province’s population, Montreal had half the confirmed cases in Quebec.
“Everyone was working under such stress and working so hard to get a handle on things, it feels like we didn’t open our eyes to some of those vulnerable populations that we should have,” Strumpf said.
On April 2, Montreal’s public health director made it official.
“Montreal is the epicentre of the pandemic,” Mylène Drouin said. At 2,642 cases, it had the highest number of any city in Canada.
By June 22, it would have 10 times that amount. And more than 3,000 dead.
MARCH 30: ‘THEY WON’T LET US SPEAK TO MY FATHER’
The warning signs started midmarch. Quebec reported its first COVID-19 death on March 18. It was at a nursing home in the Lanaudière region northeast of Montreal. Mariette Tremblay, 82, great-grandmother of nine, had been in contact with a recent traveller. Within a week, three more people at her residence would die.
On March 30, one union reported orderlies responsible for bathing and changing residents weren’t being supplied masks and gloves. Another union revealed nurses’ aides showing symptoms were forced to continue working due to lack of staff.
On March 31, desperate family members told the Montreal Gazette they couldn’t contact their relatives. Peter Wheeland hadn’t been able to reach his 85-year-old father for two weeks after he was admitted to the CHSLD Lasalle. All he wanted, he said, was “to tell my father that he hasn’t been abandoned. That he is not alone.”
APRIL 6: ‘WE ARE SEEING LIGHT AT THE END OF THE TUNNEL’
At the Herron Résidence in Dorval, co-owner Samantha Chowieri told the Gazette on March 31 three residents had been hospitalized with COVID -19 and there were no new cases. She didn’t mention her residence had been taken over by the local health authority two days earlier because most staff had fled. A relative described her family member at the Herron as a “sitting duck.”
In early April, eight people were reported dead and 28 infected at a Verdun long-term care facility. At the Centre d’hébergement Ste-dorothée in Laval, officials said 105 of 174 residents tested positive. Eight had died.
Despite the signs, the government was still cautiously optimistic. Or in denial.
“Things are stabilizing,” Premier François Legault said, referring to the number of hospitalizations. “We are seeing light at the end of the tunnel.”
On April 9, Legault said most outbreaks were concentrated at six Montreal-area long-term care centres, intimating the situation was under control. The peak in cases should come around April 18, Legault said.
“We have not forgotten you,” Mccann told the province’s elderly. “We will do all we can for those who built Quebec.”
Union officials said they suspected officials weren’t sharing the true mortality figures. Patients’ advocates reported they had begged since mid-march for residents and staff to be tested, but were told the resources weren’t there.
APRIL 11: HORROR AT RÉSIDENCE HERRON
A Montreal Gazette report published April 11 revealed the Résidence Herron in Dorval had been taken over by the local health authority on March 29 because staff had fled en masse. The emergency replacements found two seniors in critical condition who would die that night. Many residents were too dehydrated to speak; some had been lying in full diapers for days. Thirty-one patients there had died since the start of the pandemic.
Health Minister Mccann said she learned of the situation in the Montreal Gazette.
It feels like we didn’t open our eyes to some of those vulnerable populations that we should have.
All pretence of things being under control were shattered. Politicians who had looked cautiously optimistic now appeared visibly shaken.
Observers started to speculate whether Quebec’s labyrinthian and unwieldy health bureaucracy had been able to properly prepare for and manage the pandemic.
APRIL 16: 75% OF MONTREAL CHSLDS INFECTED
Drouin revealed 59 of Montreal’s 79 CHSLDS were infected — three out of four CHSLDS. Twenty-three per cent of private seniors residence also had cases.
Quebec would in fact reach its COVID-19 peak around April 13. And then it would plateau there for more than a month. From that day forward, Legault would pronounce a daily litany of infection and death. Quebec registered between 700 and 1,000 new cases and 80 to 140 dead, every day, until May 17, when the curve finally started to descend.
The Island of Montreal would record 60 per cent of all the deaths in Quebec. Eighty-six per cent of the 3,200 who died in Montreal by mid-june were in care centres.
Ken Wheeland, 85, died on April 4. His son Peter counted himself among the lucky, because he finally managed to be with his father before he died. Many would die alone.
Quebec was in crisis mode, first calling for 1,500 doctors and nurses to fill in at centres, then volunteers, and finally 1,400 members of the Canadian Armed Forces. Increased staffing and supplies of protective equipment and the forced societal lockdown finally allowed the plateau to start dropping in mid-may.
The attack on seniors’ centres was similar to that seen in countries like Spain and the U.K, and in Ontario, said David Kaiser, a preventive medicine specialist with Montreal’s public health department.
“The difference between jurisdictions is the amplitude of that, how bad the situation was,” he said. Ontario has registered 2,672 deaths so far, just over 70 per cent in seniors homes.
Long-term care centres, with their concentrated populations of individuals with multiple health issues and limited mobility, often living in older buildings that are harder to protect, are particularly vulnerable, Kaiser said. Quebec’s rapid outbreaks and dearth in testing materials made it impossible to do the contact tracing needed to quell the spread, Kaiser said.
“We had a lot of virus circulating here, compared to other provinces,” noted Mcgill epidemiologist Strumpf. Contact tracing is much more manageable when you have 60 cases a day, versus 1,000. Using fax machines to trace contacts, as Quebec does, didn’t help.
Legault apologized, saying low salaries (which he blamed partly on unions), decades of health cuts and limited staff were to blame. In Montreal, 5,575 health-care workers tested positive, amplifying the labour shortage.
It wasn’t that Quebec didn’t know the protocols to protect its elderly, Mccann said. It just didn’t have the resources to follow them. Legault removed Mccann as health minister in a cabinet shuffle on June 22. He mentioned the difficulty of working within the “monster bureaucracy” of Quebec’s health system and its “archaic” data-processing technologies.
Anne Kettenbeil, who lost her life partner of 35 years, Solange Arsenault, 70, at the Alfred Desrochers seniors’ centre in March, saw another culprit: “The government didn’t properly prepare.”
MAY 1: MONTREAL NORTH DECLARED A HOT SPOT
The weekly graphs issued by Montreal’s public health department sketch a portrait of the enemy’s pattern of infiltration.
COVID -19 hit mostly in communities first. The spread moved to the long-term care centres, infecting residents and health-care workers alike. And then the numbers in the community start to rise again.
While studies are not complete, it’s believed health-care workers, who accounted for 21 per cent of all cases in Montreal, brought the virus home, as did others working in essential services.
The numbers are showing a correlation between neighbourhoods with higher rates of essential workers, sometimes working in close quarters in factories, and living conditions that have more crowded housing and a greater risk of community transmission, Kaiser said.
“That would explain some of those cases you see now, where there isn’t really so much of it in health-care workers or CHSLDS any more — we’re really seeing it in neighbourhoods in Montreal.”
There is also the element of randomness, noted epidemiologist Mâsse.
“That’s the nature of outbreaks,” he said. “They’re never uniform in a region.”
The disease migrated from boroughs with many health-care workers and CHSLDS, like Montreal North and Hochelaga-maisonneuve, to neighbourhoods with more mixed working groups, like Ahuntsic-cartierville, Rivière-des-prairies—pointe-auxtrembles
and Villeray—st-michel—parc-extension.
The Montreal-laval region, with its many CHSLDS, suffered a death rate of 1,539 per one million inhabitants, worse than Boston or Chicago, but better than densely populated cities like Paris or London, Le Devoir reported.
Montreal’s death rate was four times that of Toronto’s.
JUNE 16: VIRUS IN RETREAT
Three months after lockdown, Drouin announced the virus appeared to be in retreat in Montreal, despite 35 outbreaks at workplaces. She credited hygiene and distance measures.
An analysis by Montreal’s public health department determined those in poorer neighbourhoods are 2.5 times more likely to be infected than those in the wealthiest neighbourhoods, due to a higher proportion of essential workers, dense populations and higher rate of pre-existing health conditions.
JUNE 17: CORONER ORDERS INVESTIGATION
The office of Quebec’s chief coroner announced it has ordered a public inquiry into the thousands of deaths at CHSLDS, private nursing homes and other care centres during the COVID -19 outbreak.
At the Herron Résidence alone, which had beds for 150 individuals, 51 seniors died.
JULY 3: ‘WE FAILED THEM’
The Royal Society of Canada made public a report about what it calls the tragic and avoidable death toll in Canada’s seniors’ centres. Canada had a far higher proportion of COVID-19 deaths in nursing homes than other comparable countries — 81 per cent in Canada, compared to 28 per cent in Australia, 31 per cent in the U.S. and 66 per cent in Spain.
“We failed them,” the authors conclude.