Legault practicing ‘the art of deconfinement,’ says health expert

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Quebec’s decision to gradually lift public health guidelines two weeks after saying its health-care system was on the verge of collapsing may seem premature, but some health experts say we’ve reached a point where there’s no other choice.

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In an ideal world, the province would remain closed longer to let the Omicron wave of COVID-19 decline — but mounting pressure from the public means Quebec risks losing support for measures altogether if it doesn’t ease up at least a little, said Benoît Mâsse, a professor of public health at Université de Montréal who works on projections for the provincial public health institute (INSPQ).

“From the perspective of public health, losing the support of the population would be the worst thing because if it becomes where people decide to let go of the measures altogether, that will be a disaster,” he said. “That has to be a concern from public health officials as well.”

While acknowledging the fragility of the situation, Quebec announced on Tuesday public health restrictions will be lifted across the province on a gradual basis over the next few weeks, beginning with restaurants reopening and limited private gatherings being permitted as of Monday.

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“The idea is to go gradually, prudently, slowly,” Premier François Legault said Tuesday. “We’re all aware many Quebecers are fed up, they’re fed up of the restrictions, it’s been 22 months. I understand, also, that many Quebecers’ mental health is beginning to be affected.”

Interim public health director Dr. Luc Boileau said the decision to lift restrictions gradually is consistent with the idea of ​​living with the virus, and that it was based on data pointing to a decrease in hospitalizations over the next few weeks coupled with the need for people to socialize.

“I think the calculation was well done,” he said.

Dr. André Veillette, an immunologist at the Montreal Clinical Research Institute, said that while the situation remains fragile, reopening gradually is reasonable as long as the impact of the changes is closely monitored.

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“We can’t have people locked up forever, right? We have to keep the right balance,” he said. “I don’t think this is unreasonable, but this is beyond science. That’s why I call it the art of deconfinement… there’s no science to that. I think it has to be done carefully, slowly, cautiously — you have to observe what’s going on.”

Quebec should require third doses for the vaccine passport as soon as possible, Veillette said, and to get a better idea of ​​how present COVID-19 is in the community, it should fund wastewater testing.

“I think that would be good to see what’s going on even before we see people in the hospital, you could see that cases are going up,” he said. “Unfortunately, they’re not doing that. It’s not very expensive.”

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For Dr. Donald Vinh, an infectious-disease specialist and medical microbiologist at the McGill University Health Centre, there isn’t enough data to say whether a gradual reopening right now is “a good thing or a bad thing.”

While hospitalizations appear to have peaked last week, Vinh pointed out they have now plateaued .

“That tells us that there’s still ongoing activities, significantly, in the community,” he said. “If the whole purpose of all the public health measures that we had was to try and preserve the health-care system surge capacity and avoid the ‘delestage’ and then try to go back to having a functional health-care system where people who are waiting for surgeries can still get them… there is no current optimization on the horizon that we’re heading in that direction yet.”

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Since students only returned to in-person schooling last week, the province hasn’t yet seen what impact, if any, that will have on hospitalizations, Vinh said. That will only become clear in another week or two.

“Right now, my biggest concern is whether this is a poisoned apple,” he said. “We’re being tempted to try and reopen businesses, relax social activities either for political, economic or social reasons, but is this a temptation that’s going to end up being a poison for us? Will this lead to a bump, another spike on the plateau, which means that it will really essentially collapse our health-care system? That’s the biggest concern I have.”

Vinh stressed he’s not against reopening, as long as it can be done safely. But in the absence of data outside of hospitalizations and deaths — the latter being a lagging indicator — he said it’s unclear how the province is making its decisions, especially considering how dire it said the situation was two weeks ago.

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“We went from an impending collapse of the health-care system to ‘everything’s going to be OK, we see a light at the end of the tunnel,'” he said. “Unfortunately, that light is a train going in the wrong direction.”

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