Quebec finally gets a handle on COVID outbreaks in long-term care, but is it ready for a 2nd wave?

For more than two months, the novel coronavirus ran rampant in Quebec's long-term care homes, killing several thousand people and hospitalizing hundreds more.

Recent figures suggest public health officials have finally managed to control the outbreaks. But experts worry some of the problems that contributed to the crisis in the first place haven't been resolved. 

At the height of the epidemic in mid-May, nearly half of the 412 long-term care centres in Quebec, known as CHSLDs, were dealing with at least one confirmed case of COVID-19.

By the start of this week, only 23 per cent were dealing with an active case. 

Since May 18, when the provincial government last changed its counting methods, there has been a 60 per cent decrease in active cases.

The situation has improved dramatically in private seniors' residences (RPAs) as well.

There were 1,091 active cases in 180 different residences across the province on May 18. By Sunday, there were 414 active cases in 114 different residences.

Not out of the woods yet, expert says

Quebec's Health Ministry said in a statement that the improvements are due to better staffing levels, as more and more health-care workers who were in isolation are returning to work.

The ministry also said infection-control measures are being applied more widely. 

But experts warn several issues still need to be addressed if the province is to avoid further outbreaks in long-term care homes.

"Are we completely out of the woods? I would not say so. There's still a lot to be done to really bring that number down to zero," said Dr. Quoc Dinh Nguyen, a Université de Montréal geriatrician who is part of a task force advising the province.

On April 8, as the outbreaks began to spread out of control, Premier François Legault promised that all patients and staff in CHSLDs would be tested for the virus. 

But a month later, staff still weren't being tested systematically. Even now, only 65 per cent of CHSLD staff has been tested, the Health Ministry said.

Ideally, Nguyen said, health-care workers would be tested for COVID-19 every few days to avoid unknowingly spreading the virus to vulnerable patients.

A growing body of evidence suggests that could be key to containing the virus in health-care institutions.

"That needs to be developed and thought about," he said. Public health officials need to get better at responding when cases are identified in order to break chains of transmission more quickly, Nguyen added.

He also said that more personnel, and ensuring they are properly trained to use personal protective equipment, will be crucial to avoid future outbreaks. 

"You need to be perfect at all of this in order to have zero cases," Nguyen said.

Will new recruits be ready? 

In order to address the staffing shortage and prepare the long-term care system for a potential second wave, Quebec is attempting to hire 10,000 new patient attendants by September. 

To meet that deadline, the government is offering a training program over the summer that takes less than half the usual required time to work in the public system.

"The staff will not immediately be trained and ready. That will be a challenge," said Cécile Tremblay, an infectious disease specialist at the Centre hospitalier de l'Université de Montréal.

There are also concerns about the safety of long-term care facilities themselves, many of which are decades old and badly in need of repairs. 

Tremblay said the ventilation systems of these older homes could present an additional hazard.

Public health officials are trying to determine if a faulty system is to blame at CHSLD Vigi Mont-Royal, where all 226 residents contracted the virus.

"We can't take for granted that others are protected," Tremblay said.