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One of her key recommendations is to develop a surveillance system to monitor the collateral impacts of health measures and find ways to reduce them, especially on the most vulnerable. "We’re not all equal when faced with health emergencies," she told reporters via video conference.

"People’s exposure to risk is different, their capacity to put in place protective measures, and their capacity to recover is determined by their vulnerability," she added.

Drouin said of all the regions in Quebec, Montreal felt the greatest impact from COVID-19, both in terms of deaths and in the imposition of strict health measures.

Consequently, she said, the city reported higher levels of anxiety and depression at the height of the pandemic and also saw a spike in alcohol and cannabis use. There are indications that domestic violence also rose, she said.

Drouin said less affluent Montrealers were more likely to be exposed to COVID-19 because they worked essential jobs with less sick leave, while they were also more likely to experience certain of the collateral impacts, such as job loss and food insecurity.

"We know crises exacerbate social inequalities, and that’s why its so important in our way of planning and deploying our interventions to integrate, from the start, this assessment of inequality," she said.

She said the pandemic underlined the importance of working with community groups to help reach vulnerable people — as was done with pop-up vaccine clinics and door-knocking campaigns that boosted vaccination rates in lower-income communities.

Drouin said the pandemic has shown that the drive to prevent deaths and reduce strain on the hospital system should not completely overshadow the risk of augmenting other health problems. As an example, she said she's heard from seniors groups that banning caregivers from visiting seniors' residences and long-term care homes may have led to increased isolation and deterioration of residents' physical and mental health.

"We always have to make sure we have a balance between protective measures and making sure elders can have their loved ones around them to support them," she said.

Other recommendations in the report include keeping the city's emergency plan up to date, ensuring it has the resources, staff and experts to respond to an emergency and ensuring it communicates clearly with the public in times of crisis.

Drouin was also asked to weigh in on whether mandatory masking needs to return, as the province once again grapples with overflowing emergency rooms. This time, it's influenza and a cocktail of respiratory viruses that are to blame, many of them affecting children.

Like Quebec's College of Physicians, Drouin recommended wearing masks in crowded places but stopped short of calling for a government edict.

She said she isn't in favour of reinstating mask mandates in schools, because evidence shows that most transmission happens after class and on weekends. While keeping children home for every runny nose is impossible, she said those with symptoms could be asked to mask in class.

On Tuesday, Premier François Legault said it was "out of the question" in the short term for the government to impose a new mask mandate for public spaces.

The province's health minister and public health director will hold a news conference on Wednesday, where they are expected to recommend masks rather than impose them.

Drouin said models show the current surge in influenza and respiratory viruses will probably peak at the end of December, during the Christmas holidays.

This report by ºÃÉ«tvwas first published Nov. 15, 2022.