Quebec’s two highest-ranking public-health officials defended their pandemic strategies before a coroner on Thursday, saying that their efforts to counter COVID-19 were hobbled by “structural elements,” such as the shortage of health care workers, masks and testing capacity.
Quebec’s National Director of Public Health, Horacio Arruda, and his strategic medical adviser, Richard Massé, appeared before coroner Géhane Kamel, who is holding an inquest into the deadly impact of the first wave of the pandemic on nursing homes.
Previous testimony at the inquest questioned some of the directives issued by the Quebec government, which protected hospitals at the expense of nursing homes, didn’t immediately mandate a broader use of masks among health care workers and didn’t acknowledge more quickly that the novel coronavirus could be transmitted by carriers who didn’t have symptoms.
Both Dr. Arruda and Dr. Massé said they faced “structural” challenges, meaning that the health care system had inherent labour shortages that couldn’t be addressed easily when the coronavirus struck. “We were not equipped to face a crisis of this scale with the resources that we had. It wasn’t a matter of planning,” Dr. Massé testified.
Both physicians were questioned about the government’s decision not to enforce mask usage more widely just before large-scale outbreaks began in March, 2020.
Speaking about suspicions that the virus could be transmitted by people who had no symptoms, Dr. Arruda began to say the word “anecdotal,” but stopped and said instead that “certain reports” had raised that concern, but the belief was that the risks were slim.
There was also a worldwide shortage of medical protective equipment, Dr. Arruda said. “In March [of 2020], the availability of masks and testing procedures wasn’t limitless,” he said. “We had to make sure the stockpile was used in the most efficient way.”
The inquest has heard testimonies about the chaos created by the virus in understaffed, poorly equipped Quebec nursing homes, resulting in mass deaths among the elderly residents. More than 4,000 Quebec long-term care residents died in the spring of 2020.
Dr. Arruda began his testimony by offering his condolences. “Every night, when we received the epidemiological reports, we were well aware that behind these numbers, there were fellow citizens and their families who were grieving,” he said.
Previous witnesses said the government’s response showed it had a blind spot toward older Quebeckers, given its failure to protect elder-care facilities.
Dr. Arruda testified that he knew early on that elderly people were more at risk.
He defended decisions the government made in mid-March to declare a medical emergency, barring visitors from nursing homes and advising elderly people to stay home. At the time, there were no vaccines or treatment, so reducing social contacts was the best option, he said.
Such lockdown directives helped keep the number of deaths down, Dr. Arruda said. “It was a very hard decision to take … but it had a very important impact.”
The most controversial aspect of those decisions was keeping family caregivers away from their loved ones in nursing homes. The inquest has heard that it deprived short-staffed facilities of extra sets of helping hands, allowing neglect to take place away from public eyes.
Dr. Arruda said preventing caregivers from entering long-term care facilities was necessary, especially since many such visitors were also elderly. “The directive was also aimed at protecting them.”
The inquest has also been told that private nursing homes were further affected by quarantine rules requiring health care workers to isolate for two weeks if they had been exposed to the virus. That resulted in ailing residents being left without basic care or hydration.
“If those workers had brought the disease into the facilities … we would have had another problem on our hands,” Dr. Arruda said.
Dr. Arruda’s testimony will resume Monday morning, when he will be questioned by Maxime Dupuis, a lawyer for the FIQ union of health care workers, and Patrick Martin-Ménard, a lawyer representing the families of six deceased nursing-home residents.
Dr. Arruda’s adviser, Dr. Massé, acknowledged during Thursday’s testimony that long-term care homes were not “at the same level of preparedness” as hospitals. “It’s not a matter of planning – it was a matter of structure, of resources, even of culture,” he said.
“It’s not a matter that could be solved in a month or two weeks or six weeks. It’s structural and more fundamental than that.”
Mr. Martin-Ménard asked Dr. Massé about Quebec’s 2006 plan for a possible influenza pandemic, which forecast some of issues later observed when COVID-19 emerged.
The 2006 plan, for example, underlined the need for speedy data collection and warned that up to a third of the health personnel might be lost to illness.
Dr. Massé said planners were aware of those potential issues but never had the resources to replace a large loss of health care workers.
He added that when the coronavirus struck in 2020, Quebec health officials went through a four-week crash course that addressed many of the concerns raised by the 2006 plan. “But it wasn’t done in the [previous] 14 years,” Mr. Martin-Ménard replied.
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