MONTREAL — Organizations representing doctors and nurses in Quebec say they're increasingly worried as COVID-19 hospitalizations continue to climb heading into what is normally one of the busiest times of the year for the province's hospitals.

“In a normal year, there's a surge of activity at the beginning of January,” Dr. Hoang Duong, the president of Quebec's association of internal medicine specialists, said in a phone interview.

“The first wave, it’s left its scars,” he added. “Our staff, nurses especially, are very tired.”

Many nurses are on sick leave, Duong said, leaving the health-care system short-staffed. “We have to divert staff to take care of COVID patients, which makes even less staff available,” he said.

The deteriorating situation in the province's hospitals was cited Tuesday by Premier Francois Legault as a factor that could force him to cancel a plan to allow multi-household gatherings over Christmas. On Wednesday, as the province reported more than 1,500 daily COVID-19 infections for the first time since the pandemic began, deputy premier Genevieve Guilbault announced measures aimed at slowing the spread of the virus.

As of Friday, stores will have to adhere to new limits on the number of people allowed inside or risk fines of up to $6,000. The province says enforcement, including ensuring proper distancing and the wearing of masks, will fall to mall owners and store owners.

Guilbault cited images of packed shops and malls as the reason behind the decision to regulate capacity as the busy holiday shopping season begins. She said the measures were necessary as the province reported a record 1,514 new COVID-19 cases and 43 additional deaths linked to the virus.

The number of people in Quebec hospitals with COVID-19 rose by 21 Wednesday for a total of 740, including 99 in intensive care.

Nathalie Levesque, the vice-president of Quebec’s largest nurses union, said Quebec already faced a shortage of nurses. With the pandemic, thousands of nurses are currently on medical leave or can’t work for preventive reasons. 

Levesque said she’s “very, very concerned” about the coming weeks, a period when hospital emergency rooms often see higher numbers of patients with colds, flu and stomach infections. Hospital emergency rooms in Quebec were already frequently over capacity, she said.

Last week, she said, nurses in the Montreal area were asked to volunteer to work in other parts of the province that have been particularly affected by the pandemic. In some regions, private seniors residences have asked public health authorities to provide them with nurses to assist with COVID-19 outbreaks.

Levesque said she’s worried this will leave some health-care facilities without enough staff, adding that she hopes administrators are being careful when they agree to transfer staff. 

Duong, who works at a hospital diabetes clinic, said nurses he works with have transferred to a new department dedicated to COVID-19. “I understand that, because we do have to take care of COVID patients," he said. "But that also means that diabetic patients, are not going to get, at least for now, the care that they usually do."

Quebec hospitals still haven't recovered from the almost total cancellation of non-emergency surgeries and medical imaging during the first wave of the pandemic, the province's Health Department confirmed Wednesday.

"All hospitals in Quebec have been forced to delay surgeries," Robert Maranda, a department spokesman wrote in an email, adding that the waiting list is continuing to diminish.

Dr. Matthew Oughton, who specializes in infectious diseases at Montreal's Jewish General Hospital, said there's "little resilience" in Quebec's health-care system. As the number of hospitalizations in a region rise, it reduces flexibility and the ability to provide services, putting more pressure on other hospitals.

Duong said he was relieved to hear Quebec Premier Francois Legault say Tuesday that the province is rethinking its plan to allow gatherings of up to 10 people for four days around Christmas. As a doctor, he said, he wants every precaution taken to prevent the spread of the virus, though he understands that people want to get together this time of year.

"It's a hard choice to make," he said, adding that he believes public health authorities will make the right decision.

Meanwhile, the Retail Council of Canada said it welcomed the province's new measures on store capacity, noting they were largely in line with its own recommendations to retailers.

“We understand that the government must give itself the tools to intervene with certain less collaborative retailers," the council's Quebec representative Marc Fortin said in a statement. "The health and safety of employees and consumers remain the priority of our retailers."

This report by The Canadian Press was first published Dec. 2, 2020.

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This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.

Jacob Serebrin and Sidhartha Banerjee, The Canadian Press