Quebec coroner’s inquest hears COVID-19 models overlooked long-term care homes

Flowers are laid outside Maison Herron, a long term care home in the Montreal suburb of Dorval on April 12, 2020.Graham Hughes/The Canadian Press

A mathematical model of the spread of COVID-19 that influenced how the Quebec government reacted to the new disease made no mention of nursing homes, the facilities where the new virus would eventually kill the most victims.

Details of the model were shown at a public inquest Monday, during a hearing where coroner Géhane Kamel raised questions about the lack of indications that the province had prepared for the impact of the coronavirus on elder-care homes.

Ms. Kamel’s inquest is looking at the death toll in Quebec long-term care centres during the first wave of the pandemic, in the spring of 2020, when more than 4,000 elderly residents died.

Senior health officials have previously insisted at the inquest that the government had started preparing in mid-January and was aware that elderly people were vulnerable to the emerging infectious disease.

However, the inquest heard Monday that it was only around March 9 or 10 that experts in infection prevention at Quebec’s public-health institute, known by the abbreviation INSPQ, began looking at recommendations geared specifically for nursing homes.

Jasmin Villeneuve, medical adviser and leader of the INSPQ’s team dealing with infections in health facilities, said those recommendations were eventually released March 18.

Dr. Villeneuve said he could not remember when his team became aware that nursing homes were vulnerable. “We knew that elderly people in general were vulnerable. But that wasn’t just for nursing homes. It was for elderly people in general, as much in the community as in nursing homes,” he said.

His remarks were echoed by another witness, Jocelyne Sauvé, the INSPQ associate vice-president for scientific affairs, who said the institute’s experts initially didn’t focus specifically on nursing homes because most seniors live in the community.

Dr. Sauvé presented to the inquest the 26-slide mathematical model that the INSPQ showed to senior officials at the Quebec Health Department on March 9, 2020. Based on data from China, South Korea and Italy, the model showed four different scenarios.

Scenario 2, the most dire of the four, forecast that hospitals would be swamped by COVID-19 cases. It was instrumental in making the government prioritize the protection of hospitals at the expense of long-term care.

Ms. Kamel said she was concerned about what appeared to be a lack of activities between the end of January, when government health officials said they first started to be concerned about the new disease, and mid-March.

“I don’t doubt people were working between these two [dates] but I have nothing consistent telling me that we were in a state of high alert. It’s as if the high alert only happened in March,” Ms. Kamel said.

Dr. Villeneuve also testified that the shortage of protective equipment was not the reason why the INSPQ recommendation for health care workers to wear masks at all times was not made until April 3.

“If we think the recommendation is to wear masks, we’ll make that recommendation. Managing the stockpiles is not up to the CINQ,” Dr. Villeneuve said, alluding to the acronym for his expert panel on health care associated infections.

“We can’t adjust recommendations because there will be mask shortages. What we’ll give is, if there’s a shortage of masks, what the other options are. But the recommendations will remain to wear masks.”

But he did acknowledge that the government had urged the INSPQ to consider logistical issues.

“To say there’s no pressure would be a lie … in the case of lack of equipment, it didn’t change the recommendations.”

The inquest heard earlier that there were no written records of thousands of visits conducted during the pandemic to verify if medical directives were followed in elder-care homes.

Natalie Rosebush, the assistant deputy minister responsible for elder care, testified earlier that the information was recorded in files that were overwritten after each new visit.

However, Premier François Legault has since denied that the data were lost.

Ms. Kamel said Monday that the only documents the inquest received were blank evaluation forms and a spreadsheet.

Ms. Rosebush is expected to return to the witness stand this week. Ms. Kamel said she still wants to see copies of the reports.

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