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A health care administrator teared up Tuesday as she described how she decided not to quarantine people with dementia who had been infected with the coronavirus because they couldn’t be safely relocated within their nursing home.

Marie-France Jobin faced that extreme quandary when residents started contracting COVID-19 last year at the Sainte-Dorothée long-term care facility in Laval, north of Montreal. More than 100 seniors died there, the highest toll in a Quebec elder care home during the first wave of the pandemic.

Ms. Jobin is testifying this week at a coroner’s inquest into the impact of the first wave on Quebec elder care facilities, where more than 4,000 seniors died in the spring of 2020.

The inquest heard that managers didn’t realize immediately that COVID-19 could be transmitted by people who didn’t have symptoms yet.

A Feb. 6 memo from INSPQ, Quebec’s public-health advisory institute, noted that “some papers mention the possibility of transmission before symptoms appear.”

But the initial rules still stated that masks needed only to be used when dealing with staff or patients with flu-like symptoms.

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It was only on April 3, as cases started mounting, that officials decided to go beyond the guidelines and test all the remaining residents at Sainte-Dorothée. They found that 69 of 174 tested positive.

The first case at Sainte-Dorothée was previously confirmed the evening of March 25.

Ms. Jobin said that, the next day, she set up a “hot zone” on the ground floor, where residents who tested positive could be kept apart. She also gathered a team to call all the residents’ families before the bad news would spread in the community.

The phones started ringing at the nursing stations on every floor as relatives tried to get updates about their loved ones.

Like other Quebec nursing homes, Sainte-Dorothée was chronically understaffed and the situation got worse. “Some were absent because they were scared, some because they had symptoms,” Ms. Jobin said.

Around March 28, she was in touch with Maude Saint-Jean, head of the microbiology service for the local health authority, known as CISSS Laval. Ms. Jobin is the deputy head of support programs for the elderly at CISSS Laval.

Ms. Jobin and Dr. Saint-Jean received news of a first case in Unit 1C, a ward for 21 residents with dementia, whose propensity for wandering made it hard to quarantine them.

“They walk hand in hand. They sleep in people’s beds. And if we try to stop them, you set off behavioural problems like you wouldn’t believe. You can’t restrain them. You can’t tie them up.”

Ms. Jobin and Dr. Saint-Jean discussed whether the infected patient from 1C could be safely relocated to the “hot zone.” By midday, as faxes arrived with more test results, they realized that more than half of the ward had tested positive.

“Maude, we have 11 out of 21. Do you sincerely think it is worth it to take them downstairs?” Ms. Jobin said she told her colleague.

She said they concluded it would be safer to leave the dementia residents in their ward rather than move them and risk infecting more people.

“It was one of the hardest decisions I had to take with Maude,” Ms. Jobin testified.

“So we left them there. What it meant is that we were condemning them. Not easy for a manager.”

Most of the 21 contracted COVID-19 but she said more survived than in other units in the nursing home. She said it might have been because their wandering kept them in better shape than other seniors who were confined to their rooms during their crisis and slowly declined.

While the head of the inquest, Coroner Géhane Kamel, said 102 people died at Sainte-Dorothée, officials there have previously said there were 108 fatalities during the first wave.

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