The Quebec City region, which was mostly spared during the first wave of COVID-19 last spring, is now, somewhat mysteriously, one of the hardest hit areas of the province.
As of Tuesday, the Quebec City area had registered 5,392 COVID-19 cases since the pandemic began in March.
Nearly half of them — 2,490 to be precise — have been identified in the last three weeks. Though the daily total dipped from Monday to Tuesday, there have been 598 new cases in the last four days and the trend is pointing sharply upward.
If the city and its immediate surroundings were a house, flames would be licking at it. The Capitale-Nationale region's daily rate of infections for the past week has averaged 239 per million inhabitants, one of the highest in the province.
But where did the fire start? And how can public health hope to extinguish it?
The answer to the first question is complicated. There have been well-known hot-spots in the historic city since August, including karaoke night at Bar Kirouac, and the outbreak at the Quebec Heart and Lung Institute.
Those are only symptoms of the deeper problem of rampant community spread.
"Transmission within the community is growing, and so every (contact tracing) investigation becomes that much more difficult," said Dr. André Dontigny, who is the region's public health director.
Contact tracers have been dealing with 200 or more new investigations per day for more than a week now, and they are overwhelmed. It's to the point where Dontigny, who has been on the job for only two weeks, made a public appeal on Wednesday for the citizenry "to team up with public health."
In short, he's asking people to ease the pressure on the public health department by tracing their own contacts and alerting anyone in their circle who may have been exposed to a moderate risk of transmission.
Many outbreaks traced back to workplaces, schools
Answering the second question — how health authorities can hope to regain control of the problem — is also tricky.
Simply put, the virus is everywhere.
Health Minister Christian Dubé said last week that roughly half the outbreaks in Quebec City could be traced back to workplaces.
But the virus has also hit 94 schools. It's also affecting seniors' residences, and is hitting health care workers.
Dr. Paul Poirier, a cardiologist at the Heart and Lung Institute, told Radio-Canada the hospital is essentially "running on summer hours" because of a lack of personnel. Transplant surgeries have been postponed, as have a host of elective procedures.
"We're full to the brim ... the elastic is stretched to the maximum in all departments," he said.
Poirier also said his hospital has been dealing with an outbreak among staff and patients for the better part of two weeks.
He said, "(staff) are catching it elsewhere, they're catching inside the walls as well. That's the problem: we have patients coming in COVID negative, and leaving the hospital COVID positive."
Shortage of health-care workers
The city's situation is compounded by a mounting shortage of nurses, nurses' aides and orderlies.
According to the local health authority, the CIUSSS de la Capitale-Nationale, there are currently 172 vacant positions among nurses, 120 among auxiliary nurses, and another 65 for orderlies.
The situation in the CHU de Québec-Université Laval hospital network's five institutions is worse: 507 nursing vacancies, 81 among nursing aides, and 276 for orderlies.
To put those shortages in context, overall, there are roughly 7,000 nurses, 1,800 auxiliary nurses and 4,100 orderlies in the Quebec City region, according to the Institut de la statistique du Québec's most recent figures.
According to the Association du personnel professionnel et technique de la Santé et Services Sociaux (APTS) Capitale-Nationale — a union that represents lab workers among others —there is also a labour shortage in the public testing sphere.
The union said there are 53 vacant jobs in the Quebec City region's six testing labs, and that a steady drip of staff has been bolting for the private sector, where the hours tend to be less demanding.
But even those private labs are under strain.
A union official said one of them recently had to send 2,000 test samples back to a hospital laboratory because it ran out of the reactive agents required to conduct the tests.
Poirier pointed to a bureaucratic problem with the city's testing capacity. The Heart and Lung institute has the capacity to do its own in-house testing— up to 2,500 per day —and the equipment required to return a result in three to six hours. But, he said, testing is centralized, and thus the institute's capacity isn't being used.
The hospital's medical personnel pointed the problem out last spring, Poirier said; he added that it hasn't been resolved.
"It's Groundhog Day," Poirier said.