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A health care worker get equipment ready in a temporary addition to the Verdun Hospital in Montreal, on April 29, 2020. The situation in the Greater Montreal area is more challenging than the rest of Quebec, Quebec Health Minister Danielle McCann said Wednesday.Paul Chiasson/The Canadian Press

Hospitals in Quebec are struggling to handle an influx of COVID-19 patients even as the province – the hardest hit in Canada – moves to reopen some schools and businesses.

Quebec is moving ahead with a gradual reopening of society and the economy despite a steady rise in cases and a large number of hospital admissions. Nearly 1,700 people in Quebec were being treated in hospital for COVID-19 as of Wednesday, with 222 of the patients in the intensive care unit.

Quebec’s Health Ministry said in a statement the province took many steps to prepare for an increase in admissions related to COVID-19, such as postponing non-essential services. While infectious disease experts say hospitals appear to be managing the rising rates of COVID-19 admissions, information from Index Santé’s website this week showed the stretcher occupancy rate in several Montreal emergency rooms was more than 100 per cent, indicating a strain.

The situation in the Greater Montreal area is more challenging than the rest of Quebec, Quebec Health Minister Danielle McCann said Wednesday, citing not only problems in facilities for seniors but also in two hospitals. “Montreal remains a hot zone,” she said.

Since the beginning of the pandemic, out of 1,761 people hospitalized in Quebec because of the new illness, 1,078 were admitted in Montreal hospitals. The rising number of hospital admissions has forced two Montreal hospitals to cancel surgeries.

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One major reason the hospitals are facing a capacity crunch is they’re not able to transfer seniors into CHSLD’s, or long-term care homes, because of a provincial rule designed to prevent the spread of COVID-19.

Donald Vinh, an infectious disease specialist and medical microbiologist at the McGill University Health Centre in Montreal, described the situation as a “vicious circle” that is making it hard for some hospitals to manage capacity levels.

Quebec, like Ontario, has seen major outbreaks of COVID-19 at long-term care facilities, as well as some transmission in the community. In Ontario, residents of long-term care homes are typically treated where they live with oxygen, intravenous fluids, pain medication and other treatments, which means they don’t need to be transferred to hospital.

Dr. Vinh said that in Quebec, many long-term care homes aren’t set up to deliver such medical care, which is one reason hospitals are seeing a rise in COVID-19-related admissions.

Ontario, by comparison, had 977 patients in hospital with 235 in the ICU as of Wednesday.

Earlier this week, Quebec Premier François Legault announced that schools, some retail stores, construction and civil engineering companies, as well as manufacturing companies, would be able to start reopening next month.

Dr. Vinh said reopening school is a “contentious" issue, but the province, like all others, is in “uncharted territory.”

The majority of children infected with COVID-19 experience a mild form of the disease and some research suggests they don’t transmit it to others very well. Dr. Vinh said it will be incumbent on officials to keep careful watch to determine whether infection rates are climbing and be prepared to bring in restrictions if the situation starts to get out of control.

Matthew Oughton, an infectious diseases physician at Montreal’s Jewish General Hospital, said the reopening strategy must balance the risks of COVID-19 transmission with the potential fallout from continued closings. For instance, many patients with non-urgent health problems have been forced to wait for appointments and procedures. Continued physical distancing can also lead to an increase in substance abuse, domestic violence and mental health problems, he said.

“There’s not one option that is risk-free,” Dr. Oughton said.

As for the Montreal hospitals, Ms. McCann mentioned two with COVID-19 outbreaks, Maisonneuve-Rosemont and Sacré-Coeur, where investigations have been launched. “It’s clear it’s worrisome for Montreal,” she said.

Montreal patients are now being transferred to three suburban hospitals south of Montreal, Suroît, Pierre-Boucher and Charles-Le Moyne, Ms. McCann said.

One reason for the problem is that Maisonneuve-Rosemont receives a lot of emergency patients, including a large number with COVID-19 infections, she said. There are 165 infected patients at the Maisonneuve-Rosemont ER.

The Health Minister said both Montreal hospitals have aging infrastructures and are also close to north-end neighbourhoods where there have been more COVID-19 infections. The Montreal-North borough has the highest number of confirmed cases and highest per capita infection rates in the city.

Ms. McCann defended the decision to designate Maisonneuve-Rosemont as one of the hospitals dedicated for COVID-19 patients. “We had to tap all the hospital centres that we could open, because we needed all of those beds.”

Quebec Director of Public Health Horacio Arruda said the problems in Montreal would be a factor as the government gradually tries to reopen schools and businesses.

“Our ability to treat people in hospital has to be there, because it’s clear that when we end confinement there’ll be cases to treat, and hopefully not too many deaths,” Dr. Arruda said.

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