MONTREAL — Quebec's public health director told a coroner's inquest Thursday he can't remember whether he had recommended preventing staff in long-term care homes from working in multiple seniors facilities in the early days of the pandemic.
Dr. Horacio Arruda told the inquiry he would have to verify whether he had given formal written advice on the risks associated with workers moving from one facility to another. The movement of staff between long-term care homes during the spring of 2020 is considered to be one of the reasons for the high number of COVID-19 outbreaks and the high death toll among vulnerable Quebec seniors.
"We had discussions about it being a risk factor," he testified. "Anyone who is moving from one place to another could increase the risk of infection."
Arruda was the latest to testify at the inquiry led by Coroner Géhane Kamel into the deaths at Quebec's long-term care homes during the pandemic's first wave. About 4,000 people died of COVID-19 in those facilities in the spring of 2020.
The doctor defended his decision during the pandemic's first wave to ban visits by caregivers, which left many residents to die of COVID-19 alone, only able to say goodbye to family through video.
He said there was neither a vaccine at that time nor effective treatment for the novel coronavirus. He added the only "weapon" public health had at its disposal to prevent transmission was to reduce contacts inside the embattled long-term care homes.
Staff had access to personal protective equipment, Arruda said, but he added that he was worried caregivers would not know how to use it properly.
"It was truly to protect them as to protect the establishment," he told the inquest about his decision to ban caregiver visits.
At one point during Arruda's testimony, Kamel said she was disturbed that the Health Department hadn't put in place pandemic preparation plans. Arruda responded that the COVID-19 pandemic was historic and hit the province at a time when its health-care system was facing an unprecedented labour shortage.
"I found myself in a pandemic like the Spanish flu, in terms of speed, impact, etc., in a system that was already fragile," he said.
Arruda said the province faced a shortage of masks and testing kits in the early days of the pandemic, adding that personal protective equipment was prioritized for the places it would have the most impact.
Asked why some workers who brought their own masks were told to stop wearing them, Arruda said that directive didn't come from public health authorities. Arruda, however, said some individual facilities may have prohibited workers from wearing masks they had brought from home.
Arruda's testimony is to continue Monday morning.
Earlier Thursday, Dr. Richard Massé, a strategic medical adviser to Arruda, told the inquest that the province had difficulty securing personal protective equipment during the early days of the pandemic when there was a "ferocious battle" for things such as masks and tests.
Even if authorities had enough protective equipment, it's unclear whether they would have known the best ways to use it, he told the inquiry. Until late March 2020, it was thought the virus was spread mostly by people with symptoms.
"There were people who said, 'we think it's transmitted by asymptomatic people,' but there was no consensus," he said, adding that neither authorities in the United States nor at the World Health Organization recognized asymptomatic spread as a significant mode of transmission.
Public health officials, he said, did not have a sense of how rapidly the virus was spreading at long-term care facilities, including at Montreal's Résidence Herron, a private centre where 47 people died.
"It was a shock to see there were outbreaks of that magnitude that rapidly," Massé said.
Meanwhile, Quebec reported 663 new cases of COVID-19 and four more deaths attributed to the novel coronavirus on Thursday.
Health officials said COVID-19-related hospitalizations dropped by five from the day before, to 215, and 42 people were in intensive care, a drop of three.
Quebec's public health institute said 90.8 per cent of residents 12 and over have received at least one dose of vaccine and 88.3 per cent were considered adequately vaccinated.
This report by The Canadian Press was first published Nov. 11, 2021.
This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.
Jacob Serebrin, The Canadian Press