Canada

Analysis: Quebec needs to brace for a second COVID-19 wave, experts say

Quebec public health director Horacio Arruda has conveyed a reassuring message all week that the crisis has stabilized, but twice mentioned the prospect of a second wave at a news conference on Friday.

Is the worst over?

Some Quebecers might be tempted to ask that question after a slew of government announcements this week aimed at reopening the province following 10 weeks of strict confinement in the COVID-19 pandemic. Premier François Legault and Dr. Horacio Arruda, Quebec’s chief public health officer, have conveyed a reassuring message all week that the crisis has stabilized amid a drop in the number of hospitalizations.

But a wide range of experts in Canada and the United States have been warning against complacency, and are predicting a second, possibly more dangerous wave of COVID-19 infections in the fall — perhaps coinciding with the start of the seasonal flu.

It’s telling that Arruda on Friday twice mentioned the prospect of a second wave at a news conference in Montreal, even going so far as to suggest it could strike in the autumn.

Dr. Anne Gatignol, a McGill University microbiologist who has studied virus-cell interactions, was one of the earliest critics of Quebec’s response to the pandemic, urging the government in January to require that people returning from China self-quarantine for 14 days upon their arrival. In the first week of February, Quebec followed some of her advice, demanding self-isolation for those coming back from China’s Hubei province.

I cannot tell if the worst is over for Montreal,” Gatignol said on Thursday. “The only thing I know is that we need to learn how to live with the virus, because it is going to be with us for a while.

“Yes, hospitals still have a number of COVID cases, there is community transmission and there are still deaths,” she added. “This is why we need to reopen very gradually with physical barriers, cleaning hands and wearing masks at every place where the two-metres distancing is not possible, (including) public transportation, grocery stores, shops and on every busy street.”

Gatignol did not hesitate when asked about the prospect of a second wave.

“For sure, there will be a second wave, but we do not know when it will happen. If we relax all measures too fast, it will be in a month or so. If we are more reasonable, it may be at the beginning of winter coming with the flu season. We should not believe that the summer will slow down the virus. We just have to look at the southern hemisphere and what’s happening now in Latin America. The warm weather does not kill the virus.”

Gatignol was alluding to the pandemic in Brazil, which has reported more than 21,000 COVID-19 fatalities, the second-highest death toll after the United States. Brazil’s president, Jair Bolsonaro, has continuously called for an end to lockdown measures in order to jump-start the country’s stalled economy.

In Canada, Ontario reported a nearly two-per-cent rise in cases on Friday, likely fuelled by family gatherings on Mother’s Day. And although authorities in Quebec have been focusing on a decline in hospitalizations, the number of outbreaks in long-term care centres and seniors’ residences increased by three to 166 across the province on Friday from the day before.

Catherine Hankins, a pioneer in the AIDS pandemic and co-chair of the federal government’s COVID-19 Immunity Task Force, is also warning of the possibility of a second wave.

“A second wave is highly likely without a vaccine, so we need to be alert and cautious while we try to enjoy the summer safely,” Hankins, a professor of population health at McGill, said in an email to the Montreal Gazette.

Experts note that every pandemic in recorded history has had a second wave. Ominously, the second wave of the 1918 Spanish flu pandemic, which took place in the fall of that year, was even deadlier than the first wave from March to May.

This has led experts in the United States to express concern about the likelihood of a double blow to the health system during a COVID-19 second wave.

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, told the Washington Post.

“We’re going to have the flu epidemic and the coronavirus epidemic at the same time,” Redfield added.

The flu season in Quebec runs from November to the end of March, and it usually has two peaks. The first occurs from the last week of December to the first full week of January, and the second from the end of February to the beginning of March.

During those peaks, some Montreal emergency rooms are filled to 200 per cent of their capacity. There can be no doubt that the flu season will hit Quebec once again, and it will come as the province’s health-care infrastructure has been under tremendous stress amid the pandemic, with many nurses suffering from exhaustion.

Even without a second COVID-19 wave, the seasonal flu might prove too much for Quebec’s overtaxed health network after months of the pandemic. Authorities will likely urge Quebecers to get vaccinated en masse against the flu for several reasons.

Initially, at least, some of the symptoms of COVID-19 and the flu are hard to tell apart: a high fever and a cough. During the prolonged first wave of the pandemic in Quebec, authorities have been unable to test all health-care workers for the coronavirus for a lack of resources.

During the upcoming influenza season — even if COVID-19 were on a low burn in the community and in long-term care centres without a second wave emerging — authorities will be under pressure to screen everyone with respiratory symptoms for COVID-19 even if some individuals have the regular flu instead.

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