Quebec faring better than other provinces during third wave
Experts point to several key strategies that worked to province's advantage
After recording some of the highest case counts and fatality numbers in Canada during the early onslaught of COVID-19, Quebec finds itself faring relatively well as the third wave flares.
The contrast is particularly stark with Ontario, which is posting daily case counts three times higher than Quebec, and where experts warn numbers could rise to as much as 18,000 cases a day unless strict restrictions are enforced.
Surging numbers in the Outaouais region that borders on Ontario, however, as well as other hot spots in the province signal Quebec's condition is precarious.
In Montreal, the former Canadian epicentre of the pandemic, health officials are crediting quick work in containing the more transmissible variants for keeping numbers stable. For the province as a whole, experts say Quebec's relatively low percentage of variant cases, stricter sanctions enacted sooner and faster vaccine rollout are all factors in its lower rates.
Alberta, Ontario, British Columbia and Saskatchewan are posting higher numbers for average daily cases per capita than Quebec, according to data published by the Institut national de santé publique du Québec Thursday.
Over the last week, Alberta's per capita case count has been 57 per cent higher than Quebec's. Ontario has seen 46 per cent more cases. Both British Columbia and Saskatchewan are posting daily rates more than 30 per cent Quebec's average. Only Manitoba and the Atlantic provinces have better numbers than Quebec.
In Ontario, which reported a record 4,812 cases on Friday, and 25 deaths, the surge in cases has led to more than 1,900 people admitted to hospital, 701 of them in ICUS, and 480 of those on a ventilator. Health authorities warn the province is edging closer to the point when decisions may have to be made on who will receive critical care. In B.C., higher case counts and a spike in more transmissible variants have led to hospitals in Vancouver hitting close to 100-per-cent capacity.
Quebec's numbers are rising, but not at the same rate. On Friday, the province reported 664 patients hospitalized with COVID -19. There are now 167 COVID-19 patients in intensive care, a quarter of Ontario's total.
While comparisons are complicated by differences in how provinces compile data, Quebec — with close to 20,000 cumulative cases of variants according to INSPQ data — is recording far fewer variant cases than Alberta, Ontario or British Columbia. When those provinces reported dozens of cases by early February, Quebec had only 10.
“There's no doubt it's the number of variants causing higher numbers in other jurisdictions and provinces,” said Dr. Sarah-amélie Mercure, associate medical chief of infectious disease prevention and control for the Montreal public health department. “We've seen that all over the world, and now we're seeing it here.”
Montreal is seeing less than half the numbers of COVID-19 per capita than hard-hit regions like Chaudières-appalaches and Outaouais, as well as other provinces, in part because of a deliberate effort to tackle the variants aggressively from the start, Mercure said.
“We reorganized our entire response plan as soon as we heard of the new variants,” Mercure said.
The health department quickly worked with testing laboratories to identify variants cases using less complex screening tests, ready in less than 24 hours. Anyone with a suspected case was contacted immediately, along with their contacts and the suspected source of the infection. All were ordered to quarantine and be tested. The combination of fear surrounding the new variants and Montrealers' experience with serious COVID -19 outbreaks meant “people really collaborated better when we told them they had the variant,” Mercure said.
The emphasis was on speed and shutting down transmission. Unlike standard COVID -19 infections, just one case of a variant was enough to be considered an outbreak, temporarily shutting down workplaces and classrooms. Entire schools were closed, something that was rare during the second wave, and widespread testing recommended. Families of suspected cases were ordered to quarantine as well.
“Everything in our arsenal — testing, contact tracing, targeting outbreaks — was modified with the coming of the new variant,” Mercure said.
Montreal's efforts to vaccinate its more vulnerable populations, including its homeless, and to vaccinate the parents of children in schools where the variant was detected, also contributed.
Quebec's decision to concentrate vaccinations in Montreal early on to counter a possible third wave means nearly 30 per cent of residents of the province's most densely populated region have been inoculated.
Despite these measures, variants have gone from accounting for 40 per cent of Montreal's COVID-19 cases last week to 48 per cent this week, Montreal public health director Mylène Drouin said. Beyond the 50-per-cent mark is when cases could start to rise exponentially, she warned. But Mercure said cases have been rising gradually as opposed to exponentially so far, giving hope.
“Our strategy is to hold it off for as long as possible to have the time to vaccinate as many people as possible in order to protect them,” she said.
Saverio Stranges, chair of the department of epidemiology and biostatistics at Western University's medical school, said the numbers indicate variants are driving the third wave in Canada.
At the same time, stricter regulations imposed by some provinces have shown to have had an effect, Stranges said. Quebec has had among Canada's tightest restrictions since it locked down most sectors of the province starting during the Christmas break, and enacted an 8 p.m. curfew on Jan. 9. Restaurants and bars have been closed to in-person dining since Oct. 1. All but essential retail and business services were shuttered until Feb. 8.
“That's definitely a contributing factor, as we've learned through three waves of this pandemic,” Stranges said. “Generally speaking, lockdowns worked. Strict measures in Quebec definitely played a role. In Ontario, they had a slower reaction for the entire province in terms of closing things down.” In early March, Alberta eased restrictions as their daily case count dropped to 278 cases a day. On Thursday, the province, roughly half the population of Quebec, reported 1,646 cases, with 1,020 of them registered as variants.
The fact more virulent strains of the coronavirus are increasingly being transmitted by young people is particularly affecting some communities, Stranges noted. In one postal code zone in London, Ont., populated largely by university students, 29 per cent of residents tested in early April registered positive — the highest rate recorded in Ontario.
A comparison of stringency levels between provinces indicates those that were stricter and acted sooner fared better.
The Centre of Excellence on the Canadian Federation, a Montreal-based think tank that falls within the Institute for Research on Public Policy, looked at 12 separate policies, including restricting gathering sizes, use of masks, school closures, closing of restaurants and travel restrictions. They used data from the Oxford University's international COVID -19 government response tracker.
As of March 11, Quebec had the highest score for stringency levels, followed by Newfoundland and Labrador, Ontario and Manitoba. Near the bottom of the index sat Saskatchewan, which also had the highest rates of coronavirus infections per capita at that point.
“In wave two in the fall, Saskatchewan and Alberta reacted very slowly,” said Charles Breton, executive director of the Centre for Excellence and co-author of the research project. “Cases were going up and they weren't putting up any kind of restrictions. Even B.C. waited a bit longer.” Quebec, on the other hand, has remained relatively strict since its nearfull lockdown that started before Christmas.
“It's clear what Quebec did in January worked,” he said.
How long it can hold out is another question. On March 1, Ontario was recording just over 1,000 cases a day. A month and a half later, daily case counts are approaching 5,000, and projected to go even higher.
And Premier Doug Ford announced he is installing checkpoints at the Manitoba and Quebec borders, ostensibly to keep the variants out.
Some health experts suggested the move would actually help to protect neighbouring provinces from Ontario.
Everything in our arsenal — testing, contact tracing, targeting outbreaks — was modified with the coming of the new variant.