Front Burner - Quebec’s high-stakes plan to re-open

Episode Date: April 30, 2020

Quebec’s premier, François Legault, has announced a plan to re-open the province in May, and he says the province’s COVID-19 crisis is now under control — at least, outside long term care facilities. But is it really under control? And will reopening the province trigger deepen community transmission of the disease? CBC Montreal’s Kate McKenna and Jonathan Montpetit join us to talk about what’s happening in the epicentre of Canada’s coronavirus pandemic.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. So of all the provinces in the country right now, Quebec has been the hardest hit by the coronavirus. They have the most cases and they have the most deaths. As of Wednesday afternoon, 1,761 people have died, followed by Ontario, the second hardest hit province, with 1,066 deaths.

Quebec's Premier Francois Legault has repeatedly said that there are two worlds playing out in the province, one in its long-term care homes and its dire. Where we continue to do everything we can to bring in more staff. The other outside those homes. Where the contagion rate seems to be under control. And because of this, Legault is planning to reopen Quebec back up during the month of May,

easing travel restrictions, sending kids back to school and nearly half a million people back to their jobs, including construction, some retail, and manufacturing. It's worth noting he is the only premier to put a fixed date on reopening schools this spring, and his plan is happening much faster than anywhere else. So is it a smart plan? Does he have a point? Today, what's going on in Quebec?

CBC reporters Kate McKenna and John Malpetit are with me. This is FrontBurner. CBC reporters Kate McKenna and John Malpetit are with me. Hello to you both. Hello. Hey, Jamie. Thanks so much for joining me today. So John, I want to talk to you about the situation outside long-term care homes in a moment. But Kate, first, I know you've been following the stories playing out in these homes very closely. We know that long-term care facilities are really at the heart of Canada's COVID-19 problem. Deaths in these kind of facilities make up 79% of coronavirus-related fatalities across the country. It's really a stunning number. Even as the confirmed cases start to slow, more people have died than expected. From 2.2% on April the 9th to 5.5%

as of April the 27th. And so what has the picture been like in Quebec? I know it's one of the hardest hit provinces. Well, this has been the big crisis that's been unfolding in Quebec since nearly the beginning of the pandemic. And the situation actually appears to be getting worse. The government started publishing a list of long-term care homes and seniors homes with outbreaks. And as of right now, there are nearly 100 long-term care homes with outbreaks that are considered critical. That's double as many as there were last week. So there are homes where there have been dozens of deaths.

There's one in Laval that's had 85 deaths so far. Nurse Sylvie Morin says she's stressed. It's sad because the patients that get it and die they die so fast I've never seen it. We can't give our best. It's too much we have too much to take care of. It's really a hard situation. And another one that we're covering extensively is the Heron

where almost everybody there is sick and at least 33 people have died. Hi my name is Christy Lynn Kemp and I'm an LPN at Maison Erron. So when the outbreak occurred about 12 of us stayed and we saw everything that happened. We saw a lot of people pass away and we're all very much not okay for having experienced that. I genuinely loved every single one of the residents that we've lost. These homes have been chronically understaffed. The unions for health care workers have been warning about these shortages in the homes for actual decades, like since at least 2000 in Quebec. So most of the long-term care homes didn't even have protective gear.

Some of them still don't. They were just, it seems like they were just fully unprepared for this to happen. Like we did a story last week that said that one employee was wearing like a blanket as a gown in one of the long term care homes. Like they still don't have protective gear. We've been hearing, you know, stories here in Ontario too of long term care homes sort of begging for PPE from nail salons and stuff like that, too. I know that you spoke with some of those frontline workers at the facility in Laval that you mentioned, and they quit because of the conditions. And what kind of conditions are we talking about here? Well, so you can imagine that if the staff don't have PPE, then the staff gets sick.

here? Well, so you can imagine that if the staff don't have PPE, then the staff gets sick. There's already a shortage of staff in these homes, and then the people who are there get sick. And so what you have left is just a very, very bare bones, not enough staff, no ability to take care of the people who are living in the home. So I profiled the Fernand Laroque Long-Term Care Home in Laval. This is a small home with 97 beds. 70 people are sick and 20 people have died. So that leaves seven healthy people. And, you know, I spoke with the nurse, Valerie Gilbert, who actually quit on Friday. She says she went into her car and just wept. And she just realized, you know, she said to herself, I think I'm getting PTSD working in here. We were lacking some medical supplies.

We were lacking people to work. Like, it was hard to see the people that I took care of for so long, like dying and suffering, being alone. People weren't getting fed. People weren't getting water. They weren't getting changed. And she just said, I couldn't watch anymore. I had to quit. My heart still belongs there. And I'm still thinking about my co-workers and my residents, even if they're not my co-workers anymore in my head, they're still a part of me. Everybody thinks I'm brave and courageous and

whatever, but I just feel like I was not strong enough to hold on. And so she was one of four people who left that day. It's awful, these stories. I can't even imagine how difficult that must be for the people working there. I know that in an attempt to manage this situation, the military has been brought in. But I also understand that now speech therapists nutritionists they're being forced to work in these long-term care homes in Quebec and so can you tell me a little bit more about what's been going on there yeah so last week the province announced that there was a shortage of 9,500 health care workers and that the bulk of them were in these long-term care homes so basically they like conscripted anyone in the health sector

in Montreal who was not like immediately needed to do their job. So we're talking about like psychologists, nutritionists, social workers and told them that they had to go into these long-term care homes or risk losing their job. They said it wasn't optional and so you can imagine these people have never even imagined that they've been in this situation. And they're scared because they see in the news every day that people are dying and they don't know how to do this job. And they never thought it would happen to them. So I spoke with a number of them and they told me that they were given a two hour training session before being sent into a home. They had no control over which home it was, whether it had serious outbreaks or not. And, you know, you can imagine like a nutritionist mother of two who is suddenly working

overnight shifts in a long-term care facility that is seriously hit by COVID-19. You know, these people are upset. But I have to say that, you know, heroically, everyone I spoke to rose to the challenge. they're in these homes they're doing their best they just feel a little bit concerned and worried. Okay so even with these measures the military being brought in and it's my understanding that about half of the 1,000 troops that the province requested will be brought in soon. Members of the Canadian Armed Forces are learning the ropes in a deployment unlike any they've ever had. Most certainly unusual, but we are ready to adapt and overcome any challenge in our way. And we're mostly proud to be here. We're going to be

helping our own population of Quebec. And also, you know, all of these extra people that the province has either requested or basically repurposed to work in these long-term care homes, you know, that the situation is still very much not under control there. You mentioned before that the number last week was 50 critical long-term care homes, and now we're at 100, right? That's right. And I think that the government understands that. The government has been saying today, for instance, they still called it a crisis that's unfolding. It's just ripping through these places. A good friend of mine is now working in one of these homes.

He's just a volunteer. But he put it in perspective for me. He said some people take an hour and a half to feed. And if you are one orderly or one orderly assistant you might be assigned 10 people. Well if one person takes an hour and a half to feed you can't feed everybody. It's a monumental, dare I say catastrophe that's happening right now and dispatching such a large group of people to help with it, it's a big task. So we've got the situation that is very much continuing to unfold in the long-term care homes in Quebec. And it is still very dire.

term care homes in Quebec. And it is still very dire. And John, I want to bring you in here now, because I want to talk to you about Legault's point that there are two worlds in Quebec. He's basically conceding that the situation in these long term care homes is awful. And he has taken some responsibility for that. We're doing everything we can to get through the emergency. It won't always be perfect. But he's also saying that the situation outside of these long-term care homes is generally under control and that this is why he wants to start opening up the province in the next month with this relatively ambitious plan. Our challenge is to gradually restart the economy without restarting the pandemic. The idea is to gradually add workers and analyze the effect on the contagion.

So before we move on, you know, I know we know that Quebec is the hardest hit part of the country when it comes to cases and deaths. Montreal is particularly bad. when it comes to cases and deaths. Montreal is particularly bad. And as of Wednesday afternoon, 60% of the recorded deaths in the province are coming from Montreal. And so how did the city become the epicenter of the pandemic in Canada?

Is it almost exclusively because of the long-term care homes or is there something else going on there? Well, the way that the epidemic in Montreal has evolved is they felt that the first set of cases came from returning travelers. Now, Quebec has an earlier spring break than most of the other provinces. And all these people came back, they were able to travel before the travel restrictions were put in place. And that allowed the disease to really circulate very widely, especially in Montreal.

How the situation has evolved since then, it has been outside of the long-term care homes as well. And that's the borough of Montreal North. Montreal North will be opening what it calls sanitary corridors. So essentially widening sidewalks in order to allow people to respect physical distancing. And the borough says this is particularly important because some of its neighborhoods are amongst the most densely populated in Canada. Right, Montreal North. Can you tell me more about this? What's going on here? So Montreal North is kind of a poorer neighborhood in Montreal, is a high immigrant population, is particularly home to a lot of Haitian immigrants. One of the things that public health officials think is going on there in Montreal North is that there's a high degree

of the population there that works in long-term care homes. And so what epidemiologists think has happened is that a lot of people who work in long-term care homes caught the disease there, especially with the issues around PPE. And then they brought the disease back into Montreal North. And now it's circulating, not just in long-term care homes there, but in the community at large as well. Right. So is it fair for me to say that there is still quite a bit of transmission happening outside of long-term care homes, speaking about Montreal North specifically. The public health officials talking about it earlier this week said that community transmission was 60%. So there is certainly, I think think still a fair degree of community transmission

outside of the long-term care homes now um it's believed to be lower than or the the r0 is believed to be lower than one um outside of the greater montreal area now r0 of course is the this is the figure that I just discovered. It's basically how many people one person who has disease infects. And when you can get it under one, that's when public health officials feel it's safe to begin easing confinement measures. And so that's believed to be the situation outside of the greater Montreal area. And when the government goes forward with its deconfinement plan, it will begin in these areas outside of Montreal.

Inside of Montreal, it's believed to be closer to one and probably higher in Montreal North, as you were mentioning, Jamie. So the hope, the belief is that we will see it get closer to one and dip under one in the kind of three weeks between now and when deconfinement is going to begin in Montreal itself. So, John, you know, when we're hearing from experts, they're saying this is what we need before opening up. And one of the things that they say we need are sustained decline in cases before reopening. And is that something that Quebec is seeing more broadly and the epicenter of Montreal as well?

The feeling from epidemiologists is that the number is getting lower. It is approaching that point. But, you know, there's a big question mark about what exactly the situation is in the population at large because the testing right now has been so targeted on health care workers. And so, you know, Quebec, the last few days or so has been been testing around, you know, on average, about 5000 people per day. Epidemiologists want to see that number to get up to like around 15,000, 20,000 a day, for them to really feel comfortable with this kind of gradual easing of the confinement measures.

My name is Nima Machouf. I am an epidemiologist at the Latin Quarter Clinic in Montreal. My name is Emma Machouf. I am an epidemiologist at the Latin Quarter Clinic in Montreal. The more you do tests, the more you have information about what is happening locally. As soon as we know who is infected, we can stop the spread of the virus from the positive individual. We're being promised that we're going to get there very soon in terms of testing, but there's still, you know, about a gap of 10,000 tests that need to happen to kind of make those experts feel a lot more comfortable what's happening. Right. And we know, of course, that increased testing, an increased testing regime is also one of the benchmarks of opening up. John, I can't help but wonder, listening to you speak, that a lot of what the officials are saying right now are sort of, it's not in past tense, right? It's like they're

still trying to figure out Montreal North. They feel like testing is going in the right direction, but they're testing less now and they need to ramp up testing more. Are people concerned that perhaps this is all moving too quickly? Because the province is looking to reopen starting in about a week, right? This is when the first sort of measures to reopen manufacturing. We'll also start reopening our civil engineering construction, road construction and factories. And then schools go back like mid-May, no?

Yeah, schools will go back May 11th, May 19th in Montreal. And when we're talking about schools, we're just talking about elementary schools. Patricia Claremont's kids are eager to get back to school, but she's nervous about the province's plan. If we don't succeed this reopening, it would mean that we have done this confining for nothing. And it would be a major feeling of failing. There's this kind of cognitive dissonance between the premier saying on the one

hand, we're in control of the situation. It's safe for us to go forward. And on the other hand, every day, the province is announcing anywhere between 50 and 100 new deaths in long-term care homes. That is a real cause of concern, and not just concern, I think, amongst Quebecers, it's a source of anger. You know, for years, Quebecers have been complaining about the conditions in these places.

And to kind of see them at the epicenter of the crisis surprised no one, but there's a kind of anger there that nothing has kind of been able to, that the government hasn't been able to do anything yet to really kind of get a control of that situation. In the Dragon's Den, a simple pitch can lead to a life-changing connection.

Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. You mentioned actually before we started this interview, which is this idea of this two worlds that Legos put forward. They're not totally separate from each other, right? The long-term care homes and what's happening more widely in the province. And this has to do with how they kind of collide in the hospital system, which is another benchmark that experts are saying you have to make sure you have an order before you start opening up. You know, one of the reasons why we've done all of this very extreme social distancing is to ensure that we don't overburden our system. And so, you know, how is that playing into concerns that people might have about reopening up as well? Well, so this, I think this is possibly the most fragile

part of Premier Legault's plan. So you can't reopen if your hospitals are full, because when you reopen, there's going to be an increased cases. That's just, you know, there's nothing you can do about that. And you're probably also going to see a spike in hospitalizations. Now, so you have this outbreak in long-term care homes. So when an elderly patient is sent to a hospital for treatment, they can't leave the hospital because the situation is so dire in the long-term care homes. And so they're staying in hospital, they're taking up spaces in a hospital. So that reduces, of course, hospital capacity. The other thing that's starting to happen is that the ERs are starting to fill up, possibly from COVID patients, possibly also from people who are feeling things or are getting back

to some level of normal and are starting to go to hospitals again for broken bones or aches and pains, what have you. And so hospitals, waiting rooms are starting to fill up again. And so that will be a key indicator of whether or not Quebec is ready for the next step, whether or not Montreal is ready for the next step. If those hospitals continue to fill up, if those hospital beds continue to be taken by COVID patients or other patients, the province and the public health officials have been very clear that we cannot go forward. My question is for you, Dr. Arruda.

What, for you, is the breaking point where we'll have to take a step back? First, having community transmission that is so high that we'll have hospitalizations that will surge significantly. So it will be the rhythm of hospitalization, the rhythm of increase of cases. So this whole plan is all dependent on there being enough space in hospitals to be able to treat whatever anticipated increase in COVID patients we'll see down the line. Right. Kate, I'm interested, you know, when you listen to officials, including Legault, they talk about this need for a balance, right? Like balancing

these public health objectives, but also with people's mental health and financial losses and kids that are actually receiving their meals at school that now are not because they haven't been able to go to school. Do you fear that you're underestimating the risk to children going back to school? No, I find that if we're talking about children that have a hard time learning, for example, it's a question of balancing out the inconveniences. There's a lot more risk of, you know, preventing them from going to school for six months than the risk of having serious consequences of going back to school. And so what are you hearing from people you're talking to, from everyday citizens?

How do they feel about how the provincial government is handling this? Well, there are definitely people who are in favor of it, and there are people who are against it. But what I've heard overwhelmingly is that people feel a little bit of whiplash because, you know, just a week ago, the government was pleading with people to go into the long-term care homes. The situation did not appear to be under control. It still, as you mentioned, doesn't really seem to be under control. And I think, you know, the government has two responsibilities here. The first and the most important one is obviously keeping people

safe. But the second one is reassuring them that they have a good plan and that things are under control. And I think what I've been hearing is that for the last little bit, you know, they've been saying things in their daily news conferences that haven't actually happened. Like, for instance, they said that they were going to test everyone in long-term care homes. Then they said that they actually couldn't do that. They also said there was enough PPE and volunteers for the long-term care homes, but we're hearing that they're still understaffed and under-resourced.

So people are really supportive of Legault's leadership and action, but they're beginning to see these little cracks, and it's adding to the anxiety, and it's adding to the worry that they're feeling. So, you know, people are anxious to go back to work. People are anxious to go back outside. But I don't think that it's all sunshine here yet in terms of how the public is feeling about this. Certainly, I mean, my phone number was shared in a bunch of Facebook groups. And yesterday, I just took call after call after call from people who were extremely worried about

their children, and extremely worried about the changing nature of this situation. And I mean, it's changing every single day. Okay, thank you so much to you both. We really appreciate this conversation. Thank you. Thanks, Jamie. So we reached out to the Quebec government to ask about their response to long-term care homes. They said they were operating under a global shortage of personal protective equipment and did their best to get it to long-term care homes, but added that there's enough now. They reiterated that the situation in the general population is under control, allowing them to plan to gradually open up the province. allowing them to plan to gradually open up the province. Also yesterday, Quebec said that starting Monday,

it would begin to relax travel restrictions in areas of the province where the spread of COVID-19 is under control. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner, and we'll talk to you soon. For more CBC Podcasts, go to cbc.ca slash podcasts.