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Montreal Mayor Valerie Plante tours one of six city buses converted into mobile COVID-19 test clinics, in Montreal, on May 5, 2020.

Paul Chiasson/The Canadian Press

As the spread of coronavirus slows across Canada, and the much-desired flattening of the curve begins, there is one notable, glaring exception: Montreal.

“We are not lowering the epidemic curve,” says Mylène Drouin, Montreal’s director of public health.

On Tuesday, the city recorded 385 new cases of COVID-19, as many as the entire province of Ontario, and 78 deaths, more than the rest of the country combined, and there is no sign of a slowdown.

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May 7 on Instagram Live: Reopening society after COVID-19

The infection rate in the city is 822 per 100,000 population, five times the national average of 164 per 100,000.

Montreal has, from the get-go, been the epicentre of Canada’s coronavirus outbreak. The reasons for this unenviable distinction have been well documented.

Coronavirus hit Montreal early and hard, in large part due to bad luck.

Spring break began on Feb. 28, right around the time politicians and public-health officials were just starting to take the threat of coronavirus seriously.

Quebec long-term care workers share horror stories of pandemic working conditions

International borders were still wide open. Quebeckers are big travellers, and their favourite destinations include New York, Florida, France and Italy, all of which became hot spots for the virus.

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By the time the World Health Organization declared COVID-19 to be a pandemic on March 11, Quebec’s travellers were already back at work and school. (Schools in the province closed March 13.)

That the virus spread so much more readily in Montreal than the regions is likely due to a variety of factors, ranging from population density, to being slow to test.

Montreal is one of Canada’s poorest cities and, like everywhere else in the world, those hit hardest by COVID-19 have been low-paid workers without the luxury to self-isolate. The neighborhoods with the highest rates of coronavirus infections – such as Montreal-Nord and St-Michel – correlate closely with low socio-economic status.

In many jurisdictions, long-term care facilities are hotbeds of COVID-19 infections and deaths, but in Montreal, the problem seems to be orders of magnitude worse.

On the island of Montreal alone, there are 135 long-term care facilities that currently have active coronavirus outbreaks. As has been noted in many grim post-mortems, these facilities were crippled by chronic staff shortages well before coronavirus came along.

In Montreal, personal support workers earned as little as $13 an hour, with no benefits such as sick leave, for back-breaking work.

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What has received less attention is the outdated infrastructure where many residents are housed. Many of the homes, especially in Montreal, date back to the 1960s, when dormitory-style rooms with two to four beds and shared bathrooms were the norm. These conditions allowed the virus to spread like wildfire.

The horror show in long-term care facilities has also had a ripple effect.

In most of the country, emergency rooms are eerily quiet, and hospitals are operating at 70- to 80-per-cent capacity. But many of Montreal’s ERs are overflowing, and hospitals are under strain, too.

There are 1,055 COVID-19 patients in the city’s hospitals and that number is growing because once patients leave their care facilities to be treated, they cannot, under the current rules, return.

Yet, paradoxically, despite all these challenges, the Quebec government is aggressively planning to reopen the economy, an approach it admits is a risky gamble.

On Monday, many non-essential businesses reopened in most of the province, and daycares, primary schools will follow suit next Monday. Montreal is supposed to follow suit on May 19, but that may be delayed further.

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Even Premier François Legault has hinted that he’s having second thoughts given Montreal’s struggles. He says that while the “situation is under control” now, the return to work will translate directly into more infections, illness and hospitalizations, and hospitals don’t have much buffer right now.

This is a dance that, in the coming months, cities and provinces are going to have to learn: opening up despite the risks, and hoping the increase in cases is manageable.

But with 5 per cent of the country’s population and 30 per cent of the cases, Montreal, more than any other city, will have to watch its steps.

Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.

Editor’s note: This article has been updated to fix the dates of reopening.

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