WHY HASN'T COVID'S THIRD WAVE FLARED UP YET IN MONTREAL?

Former epicentre of contagion in Quebec sees slow burn as virus rages in regions

Since the start of the pandemic, Montreal has time and again been one of the hardest hit Canadian cities. Last spring, the city became the epicentre of the contagion not only in Quebec but the whole country.

But so far during the variant-driven third wave, it's the regions of Quebec — and not Montreal — where the pandemic is surging. What explains this reversal?

Before answering that question, it's instructive to show just how Montreal has differed from the three COVID -19 hot spots of the Outaouais, Capitale-nationale and Chaudière-appalaches. Two months ago, on Feb. 15, those three regions posted COVID -19 cases of nine, 30 and 12, respectively.

In contrast, Montreal on that date declared 328 cases, not far off from the average of 340 in the city since Sunday.

Yet the latest figures in the three regions are staggering: Capitale-nationale on Thursday reported 273 infections, the Outaouais 167 and Chaudière-appalaches 191.

The Quebec City area has been buffeted by two super-spreading outbreaks in fitness gyms and its hospital intensive care units have reached full capacity, forcing authorities to resume a policy known as délestage, purposely ramping down clinical activities to absorb the influx of COVID-19 patients.

This is not to suggest that Montreal has been exempt. Since April 1, the number of COVID-19 hospitalizations in the city has risen from 245 to 289 on Thursday.

But senior hospital managers in Montreal who held a teleconference meeting on Wednesday ruled out délestage.

“It's not that things have suddenly exploded in Montreal in the same way that we've seen in Quebec (City), in conjunction with that gym in the super-spreading event,” said Dr. Matthew Oughton, an infectious disease specialist and professor of medicine at Mcgill University.

“It's that Montreal is on a slower burn, but it's still heating up.”

Since the peak of the second wave in mid-january, both the provincial government and the Montreal public health department took aggressive measures in the city, while pandemic restrictions were later eased in Quebec City, Gatineau and Lévis.

Health Minister Christian Dubé reallocated more vaccine doses in Montreal, fearing the third wave would surge in the city first.

The result of the accelerated vaccine rollout in Montreal is that 28.96 per cent of the city's population had received at least one shot by Thursday in contrast with 24.37 per cent in the Capitale-nationale region.

What's more, Dr. Mylène Drouin, head of Montreal's public health department, launched a pilot project in three West End communities — Côte-st-luc, Côte-des-neiges and Snowdon — to inoculate the parents of children attending schools where variant outbreaks were cropping up.

And during much of this period, Montreal remained a red zone, with an earlier 8 p.m. curfew.

But in regions that turned back to orange zones — like Capitale-nationale, Outaouais and Chaudières-appalaches — restrictions were lifted, including reopening restaurants to a limited extent and setting the curfew to 9:30 p.m. In retrospect, the relaxation of restrictions allowed the more transmissible B.1.1.7 and B.1.351 variants to take root in those regions.

Oughton suggested another reason the third wave has not been as intense in Montreal.

“You could make the argument that maybe what happened with the first two waves — with there being so much disease in Montreal during those waves — that what we're seeing is the combined effect of natural immunity in those who recovered in one of those two waves, plus the vaccination effort and the various preventative measures,” he explained. “Collectively, these things may have been enough together to prevent this from spreading more quickly.”

Yet Montreal remains in a precarious position. Quebec's public health institute released data on Thursday showing that Montreal recorded 243 more variant cases, the highest of any of the regions.

Montreal is also the sole spot in the province to confirm all four different variants, not just B.1.1.7 (which arose in the U.K.) and B.1.351 (from South Africa) but P.1 (detected in Brazil) and B.1.525 (from Nigeria).

And as Premier François Legault noted this week, Montreal and Laval are densely populated, making it that much easier for the variants to spread.

For these reasons, Oughton maintained that the government should temporarily close schools and non-essential businesses in Montreal just as in the three regions.

Yet so far, the premier has not seen the need to do so.

What we're seeing is the combined effect of natural immunity in those who recovered in one of those two waves, plus the vaccination effort.