Medical experts say Quebec is right to start vaccinations in long-term care centres

·4 min read

MONTREAL — While other provinces focus on front-line workers, Quebec stands alone in its decision to install vaccine distribution sites in long-term care homes and begin inoculating residents along with health staff.

And medical experts say the province's strategy makes sense.

"I think that's the correct way to do things," said Dr. Quoc Nguyen, a gerontologist at the Universite de Montreal hospital centre, noting that care home residents are particularly vulnerable to the novel coronavirus.

Older people are at a significantly higher risk of developing serious cases of COVID-19, he said in a phone interview this week, and people in long-term care are often already unhealthy, putting them at even higher risk.

While the Pfizer vaccine has been proven effective at preventing people from getting COVID-19, Nguyen said there's not yet hard data indicating it prevents people who are asymptomatic from spreading the disease.

"It's better to protect older adults directly because, we know that the vaccine really does that, rather than this idea that we'll protect them by protecting those in contact with them," he said.

Quebec reported Wednesday that it had administered 1,613 COVID-19 vaccinations through Tuesday, with long-term care residents and staff at the care facilities first in line. The province reported 1,897 new infections and 43 more deaths linked to the virus. Officials said hospitalizations rose by 16, to 975 and 128 people were in intensive care, a rise of three.

Dr. Zain Chagla, a professor of medicine at McMaster University who practises at two Hamilton hospitals, said Quebec's approach makes "total sense" on paper.

"The biggest bang for the buck for this vaccine is reducing death and disability, and we know the group that got hit hardest with death and disability is seniors within congregate care facilities," he said in an interview this week.

In practice, however, it may be easier to distribute the Pfizer vaccine — which must be stored at around -70 C — at hospitals rather than at long-term care centres, he said. There are also risks, he added, the virus could spread to residents from workers coming to care homes to be vaccinated.

Pfizer has asked Canadian governments not to move boxes of the vaccine once they are delivered. That request has led provinces to create designated vaccine distribution sites. Quebec placed its first two distribution sites at long-term care facilities, one in Quebec City, the other in Montreal.

The next four vaccine distribution sites in the Montreal area will also be at long-term care facilities, including the veterans hospital in Sainte-Anne-de-Bellevue, said Sonia Belanger, the head of the regional health authority that covers much of central Montreal.

Workers at the vaccination distribution sites will be vaccinated after residents. Following that — and depending on how many doses remain — other health-care workers and people who live in private seniors residences will be vaccinated, Belanger told reporters Wednesday.

"The vaccination sites are set up where there are large proportions of the population that need protection," Belanger said.

The vaccine made by United States biotech company Moderna, which could soon receive Health Canada approval, does not have the same storage requirements. "The rest of the provinces, I think, are banking on the fact that Moderna is coming soon and that will probably be the better vaccine to roll out into long-term care facilities," Chagla said.

New Brunswick, which has yet to begin its vaccination campaign, has indicated long-term care residents will be among the first people in the province to get the vaccine, but details aren't clear. The province said it will begin vaccinations this weekend at the Miramichi Regional Hospital.

Ontario has said it doesn't plan to vaccinate long-term care residents until the Moderna vaccine is available. Saskatchewan has said it likely won't vaccinate long-term care residents until April.

"At the end of the day, getting more vaccines in the arms is more important than exactly which process works the best," Chagla said.

Health authorities in Montreal said Wednesday that there were more than 400 outbreaks in the city. Public health director Dr. Mylene Drouin told reporters there were 130 outbreaks in schools, 172 in workplaces — mostly retail stores — and 72 in the health-care system.

Almost half the outbreaks in the city's health network are in hospitals, Belanger said, describing the situation as "very concerning."

Currently, 429 health-care workers in Montreal have tested positive for COVID-19 and can't work. Around 500 are waiting for test results. Drouin said the majority of cases in Montreal are the result of people catching the virus from someone in their household.

Quebec has reported 168,173 COVID-19 infections and 7,613 deaths linked to the virus since the pandemic began.

This report by The Canadian Press was first published Dec. 16, 2020.


This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.

Jacob Serebrin, The Canadian Press