Experts warn outbreaks in Quebec's long-term care homes could get worse before they improve

As several long-term care homes in Quebec grapple with major COVID-19 outbreaks among staff and residents, some experts are warning the situation could worsen before it gets better. 

Nine care homes in the province are reporting significant COVID-19 outbreaks, with more than 200 residents infected in facilities located in Montreal, Outaouais, the Montérégie and Lanaudière.

The homes are on the government's "red zone" list, meaning more than 25 per cent of their residents are infected with the virus.

Dr. Sophie Zhang works at the Paul-Bruchési Nursing Home in Montreal's central Plateau neighbourhood, where 21 residents — almost a third — are infected with COVID-19 and one has died. She says despite most residents having received their third dose, numerous care homes, known by the French acronym CHSLDs, are seeing similar outbreaks due to the rapid spread of Omicron. 

"[It] kind of bypasses vaccine immunity and even has breakthrough infections among people who have already had COVID," she said. 

Zhang, who oversees 15 nursing homes on the island of Montreal and co-chairs the community of practice for physicians in CHSLDs, also says overloaded testing capacities are preventing homes from catching COVID-19 cases early. 

"Unfortunately, we won't be able to contain the numbers like in the previous wave.… Now I think we're going to be looking at really high numbers and big percentages."

Mild symptoms for most fully vaccinated residents

Dr. Christopher Labos, a Montreal epidemiologist and cardiologist, says the situation in CHSLDs isn't surprising. 

"The risks in long-term care homes is dependent, to a certain degree, on how much community spread we have," he said. On Friday, Quebec reported 16,461 new cases of COVID-19. 

That's why, in order to protect themselves and the most vulnerable populations, Labos said the most important thing is for all Quebecers to get adequately vaccinated, especially amid the soaring number of breakthrough cases. 

"Vaccination is not like a shield," he said.

With three doses of a COVID-19 vaccine, Labos said "you have very good protection against severe illness, you're unlikely to get severely sick and end up in hospital, but its possible that you can still get a mild infection."

He said the hope is that high vaccination rates will help control the situation in CHSLDs, along with other health measures such as proper ventilation, limiting turnover of staff and making sure all staff and visitors are fully vaccinated, asymptomatic and are wearing masks. 

Staff fuelling infections among residents

Zhang says it's clear that staff are the main drivers of infection due to high case numbers in the community, but she's less worried about the illness among residents — the majority of whom she describes as having mild symptoms — and more worried about what happens if much of their staff get sick at the same time.

"There will not be enough staff members to be able to give basic care to our residents, and that is currently, I think, the greatest risk that we are facing," she said. 

She said several staff members have already been infected at Paul-Bruchési, leaving some shifts operating with half their regular staffing.

At the CHSLD Marguerite-Rocheleau in Saint-Hubert just south of Montreal, two thirds of residents are infected, totalling 75 cases, in addition to with 33 employees. Two residents have died.

Paul Arbec, president of Arbec Health Group, the company who runs the residence, says he was lucky that placement agency workers were hired to replace infected staff, but he said he would have brought back asymptomatic infected workers should the situation have called for it. 

"If we look at the numbers, we have a good idea of where we're headed.… I think it's a good card to have up our sleeve in case we do fall into a dire situation." 

Zhang agrees, saying some infected workers coming back to work with full protection, such as N95 masks, could be an acceptable measure. 

"It's better that than not being able to give basic care to many of our residents."