Arruda was worried about asymptomatic two months before Legault

The national public health director was concerned about symptomless carriers of COVID-19 as early as January, internal documents reveal. But the government says it was not informed of the risk until the end of March.

While the national director of public health of Quebec, Horacio Arruda, will be questioned at the end of the day by the deputies of the National Assembly, internal documents reveal that he was aware of the risks of transmission of COVID-19 by carriers asymptomatic as early as January, two months before the government was informed.

On February 1, the day after the Special Advisory Committee on COVID-19, created a few days earlier by the Pan-Canadian Public Health Network, was held, Horacio Arruda wrote an email to the then Deputy Minister of Health, Yvan Gendron.

He reported on discussions at the committee regarding Canadians repatriated from China by charter plane, returning travelers in general and contact management of confirmed cases. Dr Arruda mentions that his Canadian counterparts recommend that a 14-day voluntary isolation be provided for only charter plane passengers. And he doesn’t agree.

Speaking of him in the third person, he writes: On February 1, in the morning, the National Director of Public Health of Quebec (DNSP) contacted his federal counterparts to underline his great discomfort that different measures were applied for similar risks in travelers not benefiting from this charter flight or if they are close contacts of cases.

The DNSP has said it would recommend a more cautious procedure to its political authorities in the context of new information that raises a hypothesis of pre-symptom transmission, even though this mode of transmission is less significant.

Horacio Arruda, National Director of Public Health of Quebec, in an email dated February 1
Horacio Arruda also adds that other countries have even more coercive measures . He also explains that following these discussions, the federal public health authority will propose Quebec’s position to Ontario, British Columbia and Alberta, and subsequently to the other provinces .

Given the political risk, we need to be careful.

Horacio Arruda, National Director of Public Health of Quebec, in an email dated February 1
Despite these calls for caution, the Quebec government has always claimed to be aware of the risk at the end of March.

We realized, at the end of March, the beginning of April, that asymptomatic people could spread the virus, which was a situation that really changed the course of things.

Danielle McCann, former Minister of Health of Quebec, on May 22, at the National Assembly
So it was only in April that the Ministry of Health plans to test the entire staff of nursing homes , where the virus was rampant, and tried, in vain, to prohibit the movement of personnel .

Scientific studies from January
He brings a branch of his glasses to his mouth.
As of January 31, the director of the National Institute of Allergies and Infectious Diseases, Anthony Fauci, recognized that the transmission of the virus by asymptomatic carriers was “no doubt”.

On January 22, when the new virus is still very little known, the National Institute of Public Health of Quebec (INSPQ) sends an internal note to the Ministry of Health.

It reads: Information known for other coronaviruses indicates that transmission before the onset of symptoms or by asymptomatic people is possible, although its importance remains difficult to assess for the 2019-nCoV virus.

In the current context, it therefore seems more prudent to consider the possibility of transmission before symptoms as low, but not zero.

Notice from the INSPQ sent to the Ministry of Health on January 22
As of January 29, Radio-Canada reported on its website a second case of COVID in Ontario from the Chinese city of Wuhan which is presented as “asymptomatic” .

On January 30, the New England Journal of Medicine publishes a German study which shows that the virus can be carried by carriers without symptoms. There is no doubt about it , said Dr.Anthony Fauci, director of the American Institute of Infectious Diseases, in a CNN article the next day.

In February, the CISSS de Chaudière-Appalaches recognizes transmission before symptoms

A few days later, the CISSS de Chaudière-Appalaches quotes this study in its newsletter(New window)health report for the month of February: “Transmission of COVID-19 is possible before symptoms appear, although its importance remains difficult to assess. ”

Several other studies are published in February:

On February 13, in the International Journal of Infectious Diseases , researchers measure 31% asymptomatic carriers among Japanese returnees.
On February 19, in the New England Journal of Medicine , it is shown that the viral load detected in asymptomatic patients is similar to that found in symptomatic patients.
On February 25, in the Journal of Microbiology, Immunology and Infection , researchers assess up to 20% of patients infected with the coronavirus who remain completely asymptomatic.
This was not confirmed until the end of March maintains the Ministry of Health
There is a very big difference in the scientific approach between considering that something is probable and having it confirmed , explains the spokesperson for the Ministry of Health, Marie-Claude Lacasse.

There have been several shifts in knowledge for COVID-19 , she adds.

It was in fact at the end of March that public health was notified that transmission by asymptomatic people was considered confirmed.

Marie-Claude Lacasse, spokesperson for the MSSS
The Ministry of Health explains that the scientific and public health approach is a delicate process which requires both not ruling out any possibility, but also to prepare adequately according to the assessed risk .

Last month, during a webinar with medical specialists, Horacio Arruda called himself a “tightrope walker on a wire with precipices on either side”.

The national director of public health has effectively found himself on a tightrope several times in recent months, and several subjects could emerge during his hearing by parliamentarians.

The return of spring break

As of March 12, the government and public health are asking Quebecers returning from a trip to place themselves in voluntary isolation for 14 days. Government, education and health workers even have an obligation to do so. But the measure is not retroactive, although the school break week [from March 2 to 6] ended a few days earlier.

The regional director of public health of Montreal, Dr. Mylène Drouin, had nevertheless called for retroactivity , because health personnel began to develop symptoms. If it had been retroactive, Dr Arruda would have had to self-isolate for 14 days, as he had returned from Morocco on March 8 .

During this trip, during a conference, he minimized the threat by saying that the coronavirus is an important issue, but which takes up a lot of space in the media. But there are several public health issues, in my opinion, which are not put in place , the Journal de Montreal revealed in a video.

The obligation to wear a mask
Masks are for the healthcare system ,Dr Arrudasaid on March 18 , saying that they can create more harm than good and that there could be a shortage if the population used them for the purpose of prevention. In the weeks and months that follow, the government will come under pressure to make the face covering mandatory, without giving in. It was not until July 13 that Quebec finally agreed to make the mask compulsory in closed public places .

No written record of reviews
Communication between the national director of public health and the office of the prime minister has been the subject of strong criticism from the opposition in Quebec, while Dr. Arruda has confirmed to render several opinions only orally. Several deputies asked to be able to consult the written justification for the decision to close restaurants and gyms or even libraries , when they were not places of outbreak.

Aerosols
Dr. Arruda considers transmission by microdroplets in the air not significant , referring to the opinions of the National Institute of Public Health of Quebec (INSPQ). However, the World Health Organization (WHO) recognized aerosol transmission in July , the United States Centers for Disease Control and Prevention on October 5, and federal public health in early November . The government has asked a committee of experts to look into the matter. A report is expected next week.

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