Quebec nursing homes have stopped their most severe COVID-19 outbreaks and are down to single digits in new cases per day across the province, offering the first hint vaccination may be working in the care system where a quarter of Canada’s pandemic deaths took place.
The province made it a top priority to get a first dose into as many as possible of the 35,456 seniors who live in long-term care homes. This week the homes are averaging six new cases a day, down from more than 60 a month ago. Twelve people with COVID-19 have died in Quebec nursing homes this week, down from 17 people a day a month ago.
Quebec defines its most severe outbreaks as those where 25 per cent of residents or more have been infected. The last home in that category moved out of that zone Thursday. Ten homes were dealing with such major outbreaks a month ago, as the full vaccination campaign started.
Officials and medical experts say reduced community spread, more effective containment measures in the homes, systematic testing and the completed first round of vaccination three weeks ago are bringing relief to the beleaguered residents and caregivers.
However, the officials and experts caution, the effectiveness of a single vaccine dose in the frail older population is still unknown and new variants could throw the system back into disarray. Quebec has decided second doses could wait up to 90 days to be delivered, three to four times longer than manufacturer recommendations.
“I think it’s the combination of vaccination and the overall reduction in cases,” said Paul Le Guerrier, an infectious disease physician and public-health specialist who sits on the vaccination planning committee for Montreal. “I am very hopeful the vaccines are having an effect. They are very good vaccines, but it’s early to say they are entirely responsible.”
The vaccination campaign in Quebec nursing homes started just before Christmas but it went into full swing on Jan. 4, a day nursing homes posted 71 new infections. Health care staff had vaccinated 92 per cent of residents three weeks later.
Dr. Le Guerrier said the vaccines start to be effective after 14 days and reach maximum effect after 21 to 28 days. Quebec has also seen a general decline in cases, particularly among the 70-and-older category most at risk from COVID-19, amid a curfew and restrictions on business, recreation and socialization.
More than 5,500 of Canada’s 21,000 COVID-19 deaths took place in Quebec nursing homes since the pandemic began almost a year ago. At the height of the first wave, more than 100 Quebec nursing-home residents were dying every day.
“There is definitely some relief. We do see a light at the end of the tunnel,” said Ginette Senez, the interim director of care settings outside hospitals for the pandemic in the south-central Montreal health district.
Ms. Senez noted nursing homes are carrying on with stringent measures, including limiting visits, contact and movement among residents. Not all residents are vaccinated and only about 40 per cent of workers are. She said the workers have hesitated to get the vaccine because the second dose is delayed. “Residents are certainly happy to get vaccinated; they feel more protected,” she said. “But everyone will be even happier when we have the second dose.”
Family of residents say that while the vaccinations have brought a little relief, the strict limits on contact and movement mean quality of life hasn’t changed much.
“It’s business as usual, as it should be,” said Thérèse Perreault, whose mother Gisèle Lemire, 92, lives in a Montreal nursing home. “We need to not go too crazy with the vaccinations. We need to be careful. They’re strict where my mother is, and that’s okay. It’s very important we are still careful because nobody knows exactly how the elderly people will develop immunity.”
Dr. Perreault retired as a physician in the fall so she could help care for her mother, who has Alzheimer’s, on a near full-time basis. She noted the balance between COVID-19 protection and quality of life for people nearing the end is difficult. “Quite frankly, if my mother dies of COVID, so be it,” she said. “But there are other people to consider.”
Élise Boulanger, a doctor in Montreal’s Father Dowd nursing home, said “we can see things are getting better” but cautioned that the situation remains fragile.
She pointed out vaccination among health care workers and in retirement homes is far from complete. “They’re the ones who end up in hospital and strain the system,” Dr. Boulanger said. “It’s all very precarious and still relies on limiting community transmission. We need to avoid these waves.”
Most Quebec nursing home residents received the Moderna shot, which is simpler to handle than the Pfizer-BioNTech vaccine, which must be mixed by trained teams.
Faced with delivery delays for vaccines, Quebec, like Alberta, Manitoba and other provinces, went ahead with giving first doses to nursing home residents and front-line health care workers despite delays for second doses that might exceed recommendations.
The decision sparked controversy because the vaccines were approved on the basis of the shorter schedule. But Dr. Le Guerrier said a growing body of evidence suggests single doses deliver a high level of immunity, although duration is unknown.
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