What's behind Quebec's targeted approach to the 3rd wave, and could it work?

The month of March featured considerable swings in Quebec's messaging and action around the pandemic. If you've been having trouble keeping track, it's understandable.

This week, the provincial government ordered schools and businesses in Quebec City, Lévis and Gatineau to close, only days after gyms in Montreal were allowed to reopen and churches allowed to welcome a maximum of 250 people.

On Tuesday, Premier François Legault said his government was watching the situation closely in select areas but insisted changes weren't necessary — even as top experts, the province's order of nurses and public health officials were questioning the lack of restrictions.

A day later, he called a 5 p.m. news conference and ordered three regions into lockdown, abruptly shifting them from an orange zone in the province's colour-coded ranking system to a darker, more restrictive shade of red than in other red zones, including Montreal.

Education Minister Jean-François Roberge, meanwhile, ordered English school boards to comply with a decree to have high school students return to class full time, even as students held protests saying they didn't feel safe. And organizers of recreational hockey in Montreal are planning to restart in early April.

Health Minister Christian Dubé acknowledged the government's decisions can seem confusing, but he insisted there is a logic in the chaos.

"It can sometimes look inconsistent, but I tell you that we're making all our decisions based on many factors, and I believe we are staying ahead of the game," Dubé told Radio-Canada on Thursday.

So, what is the government trying to do? And is it the right move?

More targeted approach

In an interview Thursday, Dubé said the government is closely watching regions and sub-regions and acting as soon as its experts see transmission on the rise. The contagiousness of the variants means cases can spike much more quickly than in the second wave, he said.

Cases in Quebec City are now doubling every day, he said, and that region went from being a source of worry to a major concern overnight. (A single gym is now linked to more than 140 cases and 21 workplace outbreaks.)

"We act at the moment we're certain of the trend, and before a major impact on hospitals," Dubé told Radio-Canada.

Such a plan isn't foolproof.

France tried a similar, targeted approach. But, with hospitals at risk of being overrun, President Emmanuel Macron reluctantly shut down schools for three weeks as part of another round of nationwide restrictions.

Ontario Premier Doug Ford, as well, ordered new provincewide restrictions on Thursday, including the closure of gyms and stricter limits on gatherings.

Dr. Karl Weiss, a microbiologist and infectious diseases specialist at the University of Montreal, said Quebec once again finds itself at a "critical point" — and that the vaccination campaign needs to move quickly to be able to fend off the rising number of variant cases.

He noted that Quebec is in a better situation than some other jurisdictions. More of the population has received one dose of vaccine (roughly 16 per cent) than Ontario or France, both of which are seeing a more dramatic spike in cases.

Why not tighten restrictions sooner?

Legault, Dubé and Dr. Horacio Arruda, Quebec's public health director, have frequently used the word "balance" when explaining the province's approach.

They've made it clear their public health decisions involve keeping the virus in check, but also factor in the impact of disruptions to the education of school-age children, the mental health of the population and the effect on the economy.

WATCH | What's the outlook for Montreal?

The government is also seeking to keep people onside, an increasingly difficult task as the pandemic drags on. Officials closely watch survey data from the province's public health institute, which documents whether enthusiasm for restrictions is rising or falling among specific age groups and in specific regions.

"We have to find that balance because if we act too fast, we'll lose co-operation from the public," Dubé said Thursday, echoing past statements by Legault.

"We need the balance with mental health. We did everything we could so people could go to school and play sports."

But is that helpful, if less than a month later those measures are back in place?

Dominique Anglade, head of the opposition Liberals, suggested that "playing the yo-yo" can be even harder on morale.

"Go to a restaurant here in Quebec City, you have people who are crying because they didn't see it coming," she said Thursday, a day after the restrictions were announced.

"The other regions are asking themselves the same question today. If you are in Lac-Saint-Jean today, if you are in Abitibi today, if you are in Montreal today, you're asking yourselves the question, what's next? We're asking the government to tell us what's next."

Prativa Baral, an epidemiologist and doctoral candidate at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., says government messaging is crucial.

"Part of making sure people trust the government and trust the public health guidelines that are being put in place is the transparency aspect, but also thinking of things in the long term and not mixing that messaging," he said.

Why would Montreal be any different?

As Legault has pointed out, Montreal has, so far, resisted a spike in cases.

The daily case tally has remained consistent for the past several weeks. But with looser restrictions, including the reopening of gyms and high schools back at full capacity, that may not last.

Baral said Legault's categorization of Montreal as "stable" is worrisome.

"The rate of increase has not been as substantial as other regions that are going to be shut down, but we're still averaging 300, 350 cases a day in Montreal," she said.

"Because of the variants of concern, the 350 could very easily turn into a larger number of cases very quickly."

Baral called the relaxation of restrictions in Montreal "incredibly premature," and said the cause and effect is well understood: when restrictions are lifted, cases go up, as they did in the regions now in lockdown.

"There is no reason to think that the same thing won't happen to Montreal, unfortunately."

The city's public health director, Dr. Mylène Drouin, has said repeatedly she expects to see a rise in cases — the goal now is to delay that to get as many people vaccinated as possible.

Earlier this week, Drouin said she expects variants to begin to make up more cases after Easter and it will be crucial to keep them under control.

"Every day we win against the variant is a day when thousands of people are vaccinated."