Quebec Premier François Legault is gambling.
We don’t know the odds, because so many of the characteristics of COVID-19 are still unknown. But the stakes are clear. And yet, Mr. Legault’s government has moved ahead with plans to reopen the province anyhow, despite the fact that Quebec has more coronavirus deaths and infections than all of the other provinces in Canada combined. Its curve is not flattening, but many of its school buses are now running. This is a gamble that simply has to pay off.
One assumption underlying reopening plans is that Quebec’s problem is confined to the Montreal area. The hope is that localized outbreaks will stay localized, despite a lack of regional controls. Thus, daycares and elementary institutions outside of Montreal reopened this past week, even though half of the province’s infections – roughly 20,000 cases, slightly less than the total in Ontario – were recorded outside of the city centre. On Thursday, Mr. Legault announced that the reopening of elementary schools in Montreal would be delayed until the fall. Yet Montreal daycares are set to open in two weeks.
Dr. Richard Lessard, director of public health for the Lanaudière region, told Le Journal de Montréal Tuesday that by his analysis, 50 per cent of people infected with COVID-19 in four regions under his jurisdiction caught it either in Montreal or from someone who went to Montreal. Mr. Legault’s wager, as schools outside Montreal enter their second week of resumed operation, is that this migration of infection will not continue, even as restrictions loosen.
Quebec has also bet on the presumption that children are poor vectors of this infection. The hope is that they won’t catch COVID-19 at school or daycare and bring the virus home to vulnerable family members.
There is research to support that hypothesis. An Australian study published in late April reported that 18 COVID-19 cases (nine students and nine staff) across 15 schools resulted in only two secondary infections, despite close contact with 735 students and 128 staff.
And yet a German study, published around the same time, reported similar viral loads in infected children and adults, meaning children may be just as infectious as adults. The researchers suggested that children are underrepresented in clinical studies and under-reported among confirmed cases because their symptoms are often mild or absent. “We have to caution against an unlimited reopening of schools and kindergartens in the present situation,” they wrote.
Disregarding this advice, Quebec’s government has guessed – or perhaps trusted – that the research that discredits their policy decision is wrong. It’s a capricious gamble.
Mr. Legault has also banked on the assumption that lower frequency in reported cases among children will lead to fewer severe COVID-19 infections – and that the rare reports of serious illness among children will continue to be rare, and that the few Quebec children who might now catch the virus in school will come down with a case of the sniffles and recover unassisted, as they would with a cold.
And yet there are reports of a severe inflammatory illness resembling Kawasaki disease now cropping up in clusters of children, with a potential link to COVID-19. Doctors in New York, Spain, Italy, the United Kingdom and Montreal have all reported a spike in children requiring treatment in hospital, with some young patients ending up in intensive care and a few succumbing to the illness.
On Wednesday, Italian researchers published a paper on an outbreak in Bergamo province, where eight out of 10 children diagnosed with the Kawasaki-like illness during the height of the COVID-19 outbreak tested positive for coronavirus antibodies. A direct link between the virus and the illness has not yet been proven, but the timing and incidence has been enough to compel health authorities in various jurisdictions, including within Canada, to issue warnings about looking out for severe illness in children. Montreal daycares, meanwhile, are still scheduled for reopening. School buses are running throughout the rest of the province.
The advice dispatched from the SARS Commission years ago was that in the absence of certainty, the precautionary principle must apply during an outbreak. Quebec hasn’t just ignored this advice; it has pursued a starkly contradictory approach.
Indeed, in the absence of scientific certainty – about the degree to which COVID-19 has and will spread beyond geographic epicentres, about the susceptibility of children to infection and about the potential for severe illness in children – the province has decided to shed its cautionary measures and gamble with perhaps the highest stakes conceivable. In Quebec, children have essentially become dice on a craps table. It’s a bet the province never should have made. If Quebec loses, the costs will be astronomical.
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