HEPL blog series: Country Responses to the Covid19 Pandemic

Quebec’s response to the coronavirus pandemic

Greg Marchildon [1] [2]
Amélie Quesnel-Vallée [2] [3]
Madeline King [2]
Antonina Maltsev [2]

[1] Institute of Health Policy, Management and Evaluation, University of Toronto
[2] North American Observatory on Health Systems and Policies
[3] McGill Observatory on Health and Social Services Reforms, Department of Sociology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University

Background and Scope

Quebec has been the hardest hit jurisdiction in Canada yet among the first provinces to begin reopening. With a population of just over 8.5 million (22.5% of the Canadian population), Quebec has 55% of confirmed coronavirus cases in Canada. By 10 May, the death rate was significantly higher in Quebec than in any other jurisdiction, with most cases and deaths concentrated in the Montreal metropolitan area. With the number of cases growing in Quebec, plateauing in Ontario, and declining in British Columbia (BC), Quebec has become Canada’s epicenter of the pandemic.

Public Health Measures and Reopening

On 13 March, the Government of Quebec declared a provincial public health emergency and closed all educational institutions for two weeks (since extended until the fall for all but elementary schools). The following day, the government ordered the closure of all cultural, recreational and daycare centres, and banned any non-essential visits to long-term care (LTC) facilities. On 20 March, all indoor and outdoor gatherings of two or more people were suspended. On 23 March, the government imposed a lockdown on all private and public seniors’ homes including LTC facilities, prohibiting non-essential visitors and only allowing residents to leave for health care services. On 25 March, the government suspended all non-priority services and workplaces unless capable of engaging in telework and e-commerce activities. On 29 March, the government introduced provincial border restrictions and encouraged residents to restrict interprovincial travel to reduce the spread of infection, especially to rural regions of the province.

The Government of Quebec has been gradually reopening the province since early May. With the exception of the Montreal metropolitan area, which is slated for reopening on 25 May, retail businesses have been opened since 4 May and preschools, primary schools and educational childcare facilities and smaller manufacturing operations were re-opened on 11 May. All reopened facilities must follow strict hygiene and distancing measures. Additional reopening measures include lifting certain travel restrictions between regions of the province and recommending mask wearing.

Health Systems Planning and Capacity Building

Through the Ministry of Health and Social Services (Ministère de la Santé et des Services sociaux du Québec or MSSS), the Quebec government has the key stewardship responsibility for health system direction and planning. All healthcare facilities in Quebec have provincially established coronavirus triage and treatment protocols. COVID-19 patients have been funneled to 13 (initially 4) designated hospital centres in the province.

The National Institute of Public Health (Institut national de santé publique du Québec – INSPQ), provides recommendations on the safe operation of businesses, facilities and public places during the pandemic to support the provincial Minister of Health and the regional public health authorities. The INSPQ raised concerns about the government’s decision to reopen schools given the potential for an increased infection rate and warned against the idea of herd immunity.

To support reopening efforts, the province announced plans in early May to expand their daily testing capacity to 14,000 tests, more than double their capacity at the time. However, as of 13 May, this testing capacity has not been reached, even though the professional scope of practice regulations that were thought to have stymied it were overruled on 10 May.

The coronavirus outbreak and resulting deaths have been highly concentrated in Quebec’s LTC facilities. As of 8 May, residents in LTC and retirement homes made up 84.2% of all coronavirus deaths in Quebec, compared to an estimated average of 82% in Canada as a whole. On 21 March, the provisions outlined in the collective agreements in force and the employment conditions that apply to non-unionized employees were amended to facilitate worker reallocation. Bearing the brunt of the contagion, some LTC staff also became infected and others refused to work, citing unsafe working conditions.

The LTC staff shortage that was rampant pre-pandemic due to a booming economy at full employment was thus exacerbated by the pandemic. This led to several attempts at remedial actions, including allowing a single pre-existing primary caregiver to be allowed to visit and care for a patient, authorizing students about to graduate from certain college or university permit-granting programs to practice, asking the federal government to send in over 1,000 Canadian Armed Forces medical personnel to fill the gap, and calling on anyone else with relevant experience to offer their services in the LTC sector. By 7 May, there had been outbreaks in 273 LTC homes, creating what some called two separate worlds in Quebec, one inside LTC and one outside. 

Intersection of socio-economic determinants and urban density

Another epidemiologic fault line is emerging, which is setting the metropolitan area of Montréal against the rest of Québec. Montréal is now among the 10 hardest-hit cities globally, due to a combination of bad luck (early spring break with many returning travelers from Europe), high public transit use, and concentration of socio-economic deprivation in very highly densely populated areas. Some of these areas count high proportions of precarious workers staffing LTC facilities and other essential businesses and suffered the consequences of poorly protected working environments. 

Socio-Economic Impact

As in the rest of Canada, social and economic life was severely restricted between mid-March to early May. Early in the pandemic, the Government of Quebec launched several initiatives to reduce the impact on both individuals and businesses. One of the first programs was to provide lump-sum payments to those required to undergo isolation. Thanks to the federal government’s introduction of the Canadian Emergency Response Benefit (CERB) on 10 April, provincial support now makes up the difference between CERB and the remuneration normally received by an eligible individual.  While a provincial program provides temporary financial support to businesses facing cash flow difficulties due to COVID-19, the primary provincial strategy for lessening the economic impact of the pandemic is through the early reopening of targeted industries and businesses.

Reflections on the Quebec Response

The Quebec government’s decision to reopen has been questioned and criticized, as the province does not even meet the first two of the six pre-conditions set by the WHO to ease lockdowns. As of 11 May, cases were still growing in Quebec, with increasing numbers attributable to community spread. In addition, many hospitals are at or exceeding capacity, and others are facing COVID-19 outbreaks. However, these worrisome indicators primarily affect the Montréal region. This put pressure on the government to lift economically painful restrictions on the rest of Québec, and may partly explain what seems to other Canadian provinces like a premature decision to ease the lockdown. Nevertheless, the structural conditions (worker shortage, poor access to PPE) that facilitated the spread in LTC facilities are to be feared in other workplaces and schools now slated for reopening, and thus raises the prospect of a second wave.

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