1) Montreal’s acute-care hospitals, once fairly insulated from the #pandemic, are now being pulled in every direction as bigger outbreaks ravage nursing homes and the #COVID death toll climbed above 740 on Thursday. In this thread, I'll show how hospitals are being hit hard, too.

2) Hospitals are struggling with their own #COVID outbreaks even as they treat more residents from nursing homes (CHSLDs). At the same time, they’re sending doctors and nurses to under-staffed CHSLDs. Yet hospitals can't ignore their own patients, especially those with cancer.

3) “We’re being pulled in many different directions,” one senior hospital manager said, expressing deep concerns. “Our staff are really being stretched. We certainly don’t want more fallout from this #pandemic than has already occurred.”

4) Let me cite the McGill University Health Centre, a network of five hospitals, as an example. The 15th floor of the Montreal General was hit with a #COVID outbreak that flared up in a room shared by four patients. Eight staff who took care of those patients got infected.

5) The MUHC’s Montreal General is also treating 39 #COVID patients, some sent malnourished and dehydrated from CHSLDs. The Royal Victoria is treating 89 COVID patients. A total of 31 of these patients are receiving care in the MUHC’s intensive care units.

6) Pulled in the opposite direction, the MUHC has loaned at least 60 staff to five CHSLDs: Nazaire-Piché in Lachine, Centre Vigi in Dollard des Ormeaux , the Vigi Pierrefonds, Les Floralies de LaSalle and Grace Dart in the east end. One CHSLD had one original staff member left.

7) Yet the MUHC can’t lose sight of its specialized-care mission. Its operating rooms are running at 35% of normal activity because of the #pandemic. Chemotherapy is running at 60%. The plan is to slowly ramp up those activities in the next few weeks.

8) Tonight, six emergency rooms across Montreal are overcrowded, with the Royal Vic reporting the highest occupancy rate: 118%. At the Royal Vic, 11 patients have been receiving care on gurneys in the hallways for at least 24 hours and two for 48 hours.

9) As difficult as the situation is for hospitals, the crisis is the most desperate in the CHSLDs and seniors’ residences of Montreal, the epicenter of Canada’s #COVID pandemic. The number of outbreaks in those facilities climbed to 114 on Thursday from 111 the day before.

10) Seventy-five more people have died from #COVID in Montreal CHSLDs since Wednesday, bringing the total to 491. Seven more died in seniors’ residences, bringing that tally to 80. The #coronavirus has also killed 89 elderly Montrealers in their homes.

11) Many people following this thread want to know when the #pandemic is expected to peak in Montreal. In the absence of any pronouncements from local health authorities in a week, I think it’s safe to suggest that at the very least, the number of #COVID deaths has yet to peak.

12) Reviewing the chart below, city reported its sharpest increase in #COVID deaths on Thursday: 94. Montreal has now declared as many deaths as all of British Columbia. Given the rising number of CHSLD outbreaks, I'd be surprised if this wave of death crested in only a few days.

13) Which brings us to when the number of new #COVID cases will peak. Before addressing that question, I would like to point out that the #pandemic is no longer concentrated in the city’s west end. It has since moved to the north end, with more than 1,600 cases.

14) I think this demonstrates that making forecasts about when the #pandemic will peak in Montreal, as some officials have tried already, is almost a fool’s game. The orange line in the chart below would appear to suggest new cases are still rising slightly.

15) Today, Premier @francoislegault despaired over the fact 9,500 workers are missing from the health system when needed the most. An extra 1,000 soldiers won’t make up for this shortfall. In that context, I salute those bravely volunteering in CHSLDs. End of thread. Stay safe.