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The second wave of the COVID-19 pandemic: How bad could it get?

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Written by Paul Taylor

Question: COVID-19 cases are on the rise in different parts of the country and it looks like a second wave of the pandemic might be underway. How bad could it get?

Answer: In some ways, we are in a better position than we were back in February when the first Canadian case was identified.

Since then, the medical community has learned a great deal about the novel coronavirus that causes COVID-19.

We now know that wearing masks, keeping two metres apart and proper hand washing can substantially help prevent the spread of the illness. Furthermore, public health officials have had time to set up testing centres and create contact-tracing processes to keep on top of outbreaks.

However, many infectious diseases experts are concerned that our testing and tracing systems could be overwhelmed by a significant and prolonged surge in cases. Long lines are already snaking around COVID-19 assessment centres.

The arrival of cold and flu season will be an added challenge, says Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

“Seasonal respiratory viruses can produce the same symptoms as COVID-19 and while we normally don’t test for these viruses in the community, this year we are going to have to sort them out,” says Dr. Leis. “That will put added pressure on our testing capacity.”

To further complicate matters, winter is coming. That means people will be heading back indoors, where it’s easier for the illness to spread. The virus is transmitted through respiratory droplets from an infected person coughing, sneezing and talking.  At least during the summer, folks could gather outside and a simple breeze might be enough to prevent the droplets from reaching another person.

But possibly the most troubling trend is that many people are showing signs of pandemic fatigue.

“This has been going on for months and they are just tired of it,” says Dr. Janine McCready, an infectious-diseases specialist at Michael Garron Hospital in Toronto. If people let down their guard, they could increase their likelihood of catching the virus and spreading it to others.

During the first wave, many were willing to heed the advice of public health officials.

“In the beginning, there was a certain sense of terror in the population,” says Dr. Matthew Muller, medical director of infection prevention and control at Unity Health, a collection of medical centres in Toronto.

“When people were told to stay inside, don’t go out, they really listened. On the news, you would see pictures of highways with no cars during rush hour.”

Government measures to close schools in the spring and curtail certain business activities also slowed the advance of the pandemic.

Dr. McCready noted that a large proportion of those originally infected included front-line service workers and those who lived in multi-generational homes where it’s difficult to self-isolate. Older adults living in close quarters in long-term care homes were also vulnerable to infection.

“People who were able to stay at home didn’t have to risk exposure,” says Dr. McCready.

With students returning to school and many sectors of the economy reopening, “infections will become more widespread across communities,” she predicts.

And if a second wave emerges from these cases, governments will likely be limited in their ability to introduce sweeping control measures, says Dr. Leis.

He thinks there is neither the public support nor the political will for another major lockdown.  Schools, which are widely considered to be an essential service, need to keep operating. So, government interventions will probably be targeted at specific areas and limited in scope.

“These smaller-scale measures may not be as effective in rapidly reducing community cases as we saw with the lockdowns in April and May,” says Dr. Leis. “We could have more prolonged COVID activity in the months ahead.”

Problems could arise if COVID-19 testing can’t keep pace with increased demand.  A person is infectious two days before developing symptoms and for up to ten days after becoming ill. So, it is critically important to have a relatively fast turnaround between the testing and availability of the results.

Dr. Muller points out that the health-care sector still hasn’t recovered from the disruption caused by the first wave of the pandemic. There is a huge backlog of delayed surgeries and postponed screening tests.  A second wave would probably add more patients to existing wait lists.

Even so, a big second wave isn’t inevitable, says Dr. McCready, adding that, “it all depends on human behaviour.”

With continued vigilance, and adherence to proven prevention measures – such as proper mask wearing (over the nose and mouth) and physical distancing – the number of new cases can be curbed.

And getting an annual flu shot would help to minimize influenza cases, which can be confused with COVID-19, says Dr. Leis.

But, the question is, do we have the collective will to do what’s necessary?

About the author

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Paul Taylor

Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Email your questions to AskPaul@sunnybrook.ca
and follow me on Twitter @epaultaylor