1) Montreal on Saturday crossed a grim milestone, reporting a #COVID mortality rate per million population that's now higher than Italy’s. In this thread, I will show how the #pandemic is attacking the city's health network more than ever, and address the shortcomings in testing.

2) Let me emphasize it was not my idea to compare Montreal, a metropolis, with Italy, a country. A senior infection-control specialist at a major hospital made that comparison on his own on Thursday. Montreal’s rate now stands at nearly 459 #COVID deaths per million population.

3) In contrast, the #COVID death rate in Italy is 436 per million population. I presume the specialist made this comparison in a presentation to underscore the seriousness of the situation in Montreal, overwhelmingly the epicenter of the #pandemic in Canada.

4) In my previous thread, I suggested the city made some faint progress on Friday. Only a day later, the situation has grown much worse in nearly every respect. One sobering stat is the number of outbreaks in nursing homes (CHSLDs) and seniors’ residences has climbed to 119.

5) Dr. Lawrence Rosenberg, head of Montreal’s Centre-West health authority, told me he’s dispatched dozens of health workers to the privately run Vigi Mont-Royal to try to contain its outbreak. Such transfers of staff pose problems of their own, about which more later.

6) Meanwhile, the scenario I feared the most and raised in an earlier thread appears to be coming true, at least at Sacré-Coeur Hospital, where the #pandemic has caused a full-blown crisis. At least eight city hospitals have had outbreaks, but the worst is at Sacré-Coeur.

7) The most dangerous scenario is when the #pandemic strikes both acute-care hospitals and nursing homes. At Sacré-Coeur, all staff and patients will be tested for #COVID in the coming days, according to superb reporting today by Isabelle Paré of Le Devoir.

8) The decision to test everyone follows a #COVID outbreak on four floors that infected at least two dozen oncology and dialysis patients, with two dying from the respiratory illness. The suspected cause is staff moving indiscriminately between hot and cold zones.

9) The number of deaths from #COVID climbed to a total of 895 in Montreal, the third highest increase. The death toll almost doubled in a week. And given the worsening outbreaks in residences housing society’s most frail and vulnerable, that toll is still likely to go up.

10) The breakdown in Montreal’s health-care institutions shows a surge of deaths in hospitals — from 10 on Friday to 50 today. Is that a reflection of the #pandemic now manifesting itself in hospitals? I caution against drawing conclusions because this data is often unreliable.

11) What we do know is the city’s ERs — considered a barometer of the pressure on the health-care system — are dealing with a lot more overcrowding than during the early stages of the #pandemic. During ER overcrowding, it’s harder to keep the #COVID hot and cold zones separate.

12) One might be tempted to think the epidemiological curve in the city is now flattening, given that there has not been a steady rise in new #COVID cases. However, one must consider that Quebec is testing for #COVID less than it did a couple of weeks ago.

13) Certainly, a review of Montreal’s neighborhoods reveals a spike in new cases in at least once area. Montreal North reported 110 additional #COVID cases since Friday, with many of those likely occurring in CHSLDs and seniors’ residences.

14) On April 8, Health Minister Danielle McCann vowed that everyone in CHSLDs would be tested for #COVID amid early reports of outbreaks. Yet 10 days later, McCann acknowledged that it would not be possible to test everyone. Why not?

15) Countries that have dealt with the #coronavirus crisis more successfully, most notably South Korea, have tested a lot more and began much earlier in the #pandemic. And they’ve made sure to continue testing aggressively before reopening their cities.

16) Bizarrely, in the midst of the pandemic in Montreal, Premier @francoislegault has been priming Quebecers in his daily briefings for the possibility of reopening the province very soon. He’s also floated the controversial idea of herd immunity.

17) The rationale for herd immunity is to let people contract the #coronavirus, hoping that they don’t get too sick and that they recover with enough antibodies that they become immune. If, say, 60 per cent of the population is immune, the pandemic is stopped in its tracks.

18) If this is what the Premier is truly planning, let me urge him to consider today's warning by the World Health Organization. The WHO stated that there’s “no evidence that people who have recovered from #COVID19 and have antibodies are protected from a second infection.”

19) If the WHO is correct, reopening parts of Quebec might run the risk of some people getting sick with #COVID more than just once. Would that be the prudent thing to do, especially at this time when there’s still so much to learn about the #coronavirus?

20) The Premier must also consider the province’s capacity to test for #COVID. At present, testing is clearly lacking. Knowing which parts of Quebec to reopen first would require a blitz of testing as well as contact tracing, which officials here have spoken about so little.

21) And since no uniform testing is going on in Montreal’s elder-care centres, staff sent to those centres from hospitals risk getting infected and bringing the #coronavirus back into acute-care settings in what would be a horrific boomerang effect. End of thread and stay safe.