Montreal's director of public health says small gatherings among friends and family are among her biggest concerns as she observes an increase in the spread of the virus in recent weeks.
Dr. Mylène Drouin told a news conference Wednesday that if the trend continues, the city could move from "green" to "yellow," which is considered the early warning stage under a new provincial alert system.
A "yellow" designation would mean an increase in enforcement of public health guidelines and, potentially, an increase in fines.
"We want to reinforce the message that it is important that we be more vigilant," she said, stressing the importance of distancing, washing hands and wearing masks.
"Those small outbreaks are the source of cases that will go in schools and into elderly homes, where the result will be more dramatic."
There are currently four regions in the yellow tier: Quebec City, the Eastern Townships, the Outaouais and Laval. The province's other regions, including Montreal, are in the lowest tier.
A region's alert level is based upon three criteria: the epidemiological situation, the rate of transmission and the capacity of the region's health-care system.
The good news, Drouin said, is the spread of the virus remains for the most part under control in settings such as workplaces, schools and daycares.
Public health is investigating 20 small outbreaks in workplaces, two in schools and one in a daycare, she said. As of Wednesday, there have been 69 cases reported in 64 schools across the island.
Drouin said public health wants to avoid having to limit activities and gatherings or close bars.
"Yes, we can have social activities, but we have to reduce contacts to be able to reduce secondary transmission," she said.
Quebec reported 180 cases on Wednesday. The province now has a seven-day moving average of 21.9 cases per million inhabitants.
Quebec's health authorities had previously said they hoped to keep that number below 20 cases per million.
Testing isn't always helpful, Drouin says
Drouin also cautioned parents not to get their children tested if they haven't been exposed to COVID-19 and show no symptoms.
She said there have been long waits in some testing centres, particularly on the west end of the island, since the start of school.
WATCH | This is how Quebec's COVID-19 alert system works:
"What we've seen with the reopening of school is that when there was one case in one school, the parents were preoccupied and went for a screening test when it wasn't [necessary]," Drouin said.
Staff working at a testing site in Beaconsfield said they have seen a jump in the number of people being tested since students went back to school.
Leasa Ewen, a nurse who does testing at the suburb's Elm Avenue location, said before the school year started, about 300 people came for testing on a daily basis. Now, she said, the centre gets double that amount.
Ewen, who went back into nursing to help during the pandemic, says one of her patients told her they had waited in line for four hours. She recommends bringing folding chairs and snacks for the wait.
"Yesterday, when I got to work, there were so many cars in the driveway," Ewen said. "I was so nervous, I didn't know what to expect."
The local health agency, CIUSSS de l'Ouest-de-l'Île-de-Montréal, told CBC News that testing efforts will be increased in the West Island.
Dedicated teams are being added to the Beaconsfield screening clinic in order to meet the high demand, the CIUSSS said in a statement, and details will be announced shortly about a new clinic in Pierrefonds.