COVID-19 in Quebec: 69 more deaths announced Sunday as hospitalization numbers stabilize

The latest:

• Quebec has 24,107 confirmed cases of COVID-19 and 1,515 people have died — an increase of 69 deaths since Saturday.
• There are 1,518 people in hospital, including 215 in intensive care. Here's a guide to the numbers.
• Public Health Director Dr. Horacio Arruda says he now recommends people wear a mask in public if they anticipate being in a situation where they cannot stay two metres away from other people.
• Quebec will release details on how it will ease restrictions this week. The process is expected to start May 4.

With the Quebec government set to release details this week about how it will reopen schools and businesses, concerns and confusion emerged over the weekend about the role herd immunity should play in the plan. 

Last week, Premier François Legault and provincial public health director Horacio Arruda said the concept of herd immunity will factor into their decision-making.

"We want people to be immunized, then it will help us reduce transmission," Arruda said Friday. "That will help us."

On Saturday, though, Dr. Theresa Tam, Canada's chief medical officer, warned against relying on the population developing an immunity to the virus until more research is done.

"While this particular virus can have a very devastating impact on seniors and elders and underlying medical conditions, it can actually result in quite severe outcomes even for the young and for the rest of the population," Tam said Saturday.

The appearance of conflicting messages prompted one of Quebec's largest teachers unions, the Fédération autonome de l'enseignement (FAE), to issue a statement, saying teachers and students "should not pay the price" for differences in opinion between Canada and Quebec on public health and immunity.

"Many legitimate questions remain unanswered, more particularly those relating to the safety of staff and students," the union statement said.

Parents are also anxious about Quebec's plans to reopen schools. Legault has already said attendance won't be mandatory, but some question whether it simply turn their children into vectors of the disease.

"I'm at home since March 15, ordering online, following all the rules," said Monica Restrepo, who has three children. "And then it's like we have to throw all this in the garbage and send the kids back to school and normal life? I don't think so. I'm nervous."

Her son has a compromised immune system, and she worries her daughters could bring the virus home and infect him. So her daughters will stay home.

"I'm not going to have my kids be guinea pigs."

Amid the heated debate about herd immunity, Montreal's Jewish General Hospital — one of the main centres for treating COVID-19 in the province — sought to correct "the false belief" that the disease only affects the elderly and those with pre-existing conditions.

In a video released Saturday, an emergency room physician notes that federal government statistics indicate the greatest number of cases have been in those between 40 and 59 years old.

"After that we see a lot of cases in those between 20 and 39 years of age," Dr. Jonathan Cooperman says in the video. 

He adds: "Coronavirus can affect anybody. Stay home and don't become a statistic."

Epidemiologists urge caution around immunity

On Sunday, several epidemiologists sought to explain how best to understand the concept of herd immunity and how Quebec's leaders should approach the issue.

"There's a very high likelihood" that an infected person would be immune against a second infection, said Dr. Benoit Barbeau, an epidemiologist and professor at the Université du Québec à Montréal's department of biological sciences.

But, for now, there is no data proving that immunity to the virus is widespread among recovered patients, a point Tam underscored over the weekend.  

Barbeau said Tam's comments may seem to be "a contradiction at the surface" to what is being said in Quebec, but he noted the province has indicated any return to a semblance of normalcy would be very gradual.

And he said that while Ottawa appears to taking a more cautious tone, Quebec is still being responsible in its approach. 

He pointed to more drastic plans such as the United Kingdom's initial strategy to use herd immunity to fight the virus, a direction from which the country has since changed course.

"They stopped very quickly that measure because of the number of deaths and the toll on their medical system was way too high," Barbeau said.

By relaxing confinement measures, the disease will circulate more freely than before, Barbeau and other experts said. But that is different from having herd immunity as the goal of de-confinement.

"The focus on herd immunity is not the right focus," said Dr. David Buckeridge, a public health physician who teaches at McGill. 

"The focus should be on how do we reopen society in a way that makes sense, while maintaining control over both the rate of infection in the population and making sure vulnerable subpopulations are less affected?"

Achieving herd immunity would, moreover, likely take several months, if not years, and cost several thousand lives, said Dr. Cécile Tremblay, an infectious disease expert affiliated with Quebec's institute of public health, the Institut national de santé publique du Québec. 

But she said there are other public health reasons that can justify a careful and gradual lifting of the lockdown, especially for children. 

"De-confinement is not the equivalent of herd immunity," Tremblay told Radio-Canada. "Collective immunity may not be a concept on which we should base our decision to lift confinement measures; we can lift confinement for other reasons."

She said before Quebec goes forward, though, there needs to be a sustained decrease in the level of transmission to ensure the health-care system can handle any successive waves.

Quebec's government has suggested that lifting confinement measures — which include the banning of all gatherings and the closure of schools, daycares and most businesses — won't happen all at once, and would be accompanied by guidelines on wearing masks in public and more widespread testing.

Barbeau says it will be critical that the number of new cases each day is closely monitored, and that adjustments be made if there are signs of another wave of infection.

As of Sunday, there were 24,107 confirmed cases in Quebec, an increase of 840 from a day earlier.