Quebec pins all its hopes on the vaccine, but experts say action is needed on multiple fronts

The old saying holds that only fools and the dead never change their minds.

Health Minister Christian Dubé is neither of those things. Eighteen days ago, at a news conference about Quebec's COVID-19 vaccination plan, Dubé insisted his hands were tied by Pfizer's requirements that second doses of the two-dose protocol be held back to observe the prescribed 21-day interval between shots.

A course correction followed a few days later and this week, he announced second doses would be delayed up to 90 days.

"This is the best strategy," he said, citing the urgency of the situation.

On Dec. 29, Public Health Director Dr. Horacio Arruda sat next to Dubé at a news conference and alluded to the possibility that Pfizer could reduce its supply to Quebec if the province didn't follow the recommendations, a prospect since echoed by federal officials.

Dubé this week: "We're not asking permission."

The reversal was sudden, it also represents an unusually aggressive move by a government whose response to the pandemic has been typefied by cautious decision-making.

Going it largely alone on delaying doses for months suggests, above all else, that the Legault government is pushing its entire stack of chips onto the square marked "vaccines."

The decision is based on the advice of experts from the province's vaccine committee, the Comité sur l'immunisation du Québec, which studied clinical evidence. And it runs counter to guidelines from Pfizer and the National Advisory Committee on Immunizations.

A high-stakes gamble

The contrast with other major decisions made since the turn of the year is informative.

In the same week Dubé announced his department was going full bore on vaccination, it also announced an easing of restrictions on rapid testing.

And, last week, the province highlighted the portion of an expert panel's report on air purifiers and filters in schools that confirmed the devices won't interrupt the main causes of disease transmission — mainly, proximity of students — rather than the part indicating they help lower the number of viral particles in the air.

Take, as well, the provincial curfew that went into effect a week ago, which in effect relaxes a series of previously existing measures and does little to tackle what provincial statistics indicate are a key venue for transmission: workplaces, particularly in the construction and manufacturing sector.

The rationale has been that shutting down those industries on a large scale could imperil supply of essential goods.

It's true there are few easy policy choices in the middle of a raging pandemic.

Why the unusual forcefulness and speedy action on vaccines, then? Perhaps because there is no discernible Plan B.

Still more that could be done

Many experts believe the new restrictions that went into place last Saturday won't be enough — and argue more needs to be done in a number of areas including testing and contact tracing, stronger measures in schools and in the many workplaces that remain open.

The headline grabber of early 2021 is the curfew that requires people to stay home between 8 p.m. and 5 a.m. Non-essential retailers, as well as non-essential offices, restaurants, bars and gyms, were ordered to remain closed, while manufacturing and construction sectors — both major sources of new outbreaks — were allowed to stay open, unhindered.

"If the manufacturing industry is accounting for ongoing community transmission, which I suspect that it is, then there needs to be more control to ensure public [health] measures there," said Dr. Donald Vinh, an infectious diseases specialist at the McGill University Health Centre who is also a science advisor for the federal COVID-19 therapeutics task force.

Quebec Labour Minister Jean Boulet issued a statement Friday suggesting they may finally crack down. In a follow-up interview with Radio-Canada, he said inspectors will be "vigilant."

"We won't hesitate when there are violations of the health guidelines to hand out fines," he said, though they have only handed out 21 at construction sites in the past week.

Schools, too, have been allowed to reopen. While the benefits of keeping them open are clear, Vinh said the government could still do more to get a handle on transmission, including a clearer stance on ventilation.

"If internally within schools there could be stricter public health measures, I think that would be helpful," he said.

Premier François Legault has defended the measures by saying the curfew is a way to seize the public's attention and to limit exposure to older people while they await the vaccine.

He has pointed out, repeatedly, that 80 per cent of those hospitalized are over the age of 65.

But, it remains unclear whether the curfew, and the other measures in place, will be effective on that front.

Testing, testing

Then there's the question of interrupting the contagion in the community.

As Eastern Townships Public Health Director Dr. Alain Poirier said this week, the virus "is everywhere." Quebec has been reluctant to more widely employ rapid tests as a way to better understand exactly where the virus is spreading.

On Thursday, after 200 Quebec scientists published an open letter calling on the province to make more use of rapid tests, Dubé retreated from comments on Monday that the tests were unnecessary.

Based on a report from a panel of internal experts issued that same day, Quebec will start using rapid tests to bolster its regular testing capacity on a limited basis, in highly specific circumstances.

Is the change of heart enough? Not in the view of Dr. David Juncker, a testing expert who is chair of bioengineering at McGill University and a scientific adviser to Rapid Test and Trace Canada, which advocates for a large-scale implementation of the technology.

"It's a step in the right direction … but it's a little bit too little, too late," Juncker told CBC's Quebec AM. "That's the real risk, that we're trapped in cycles of too little, too late here."

He likened the government's approach to rapid testing — which it plainly views as unreliable and a major drain on human resources — to the discussion surrounding face masks in early 2020.

Provincial public health officials initially opposed masks, before realizing they could be a key tool in preventing the spread of the virus.

The National Testing and Screening Expert Advisory Panel, which issued its first report Friday, suggests rapid antigen tests could be exactly another useful tool, given the ability to test frequently and obtain instant results.

In a technical briefing this week, officials with Quebec's Health Ministry defended their approach to rapid tests, saying the current testing regime is perfectly adequate, and that, in any event, they don't have enough people to deploy them at scale.

What's frustrating to experts like the signatories of the open letter is there doesn't appear to be a plan to develop that capacity any time soon.

'We need to kickstart now'

Frontline doctors remain concerned about the coming weeks, with intensive care wards in Montreal at risk of being overwhelmed.

Even if hospitals are able to hang on until Feb. 8, when the measures are set to lift, the province isn't expected to begin vaccinating older people outside care until the middle of the month.

Vinh said Quebec's situation is rendered "tricky" by the fact vaccine procurement and supply are out of its control.

The announcement from Pfizer on Friday that it would temporarily reduce shipments of its vaccine to Canada due to issues with its supply chain underscored the risks involved in the Legault government's plan.

The pharmaceutical giant is pausing some production lines at its facility in Puurs, Belgium, in order to expand long-term manufacturing capacity.

The move means Quebec will receive 8,775 doses instead of the 46,800 originally scheduled for the week of Jan. 25, and 39,000 of the 82,875 doses expected the following week.

The disruption is far from catastrophic, given the doses will be replaced in later deliveries and Quebec is also receiving tens of thousands of vaccines from Moderna. But it will have an impact.

That was the week the province was supposed to begin vaccinating in private retirement homes.

In a statement, a spokesperson for Dubé said the supply chain hiccup merely reinforces Quebec's decision.

"The strategy remains the same: we need to kickstart now and vaccinate as many vulnerable people and health-care workers as possible, as quickly as possible," reads the statement.