COVID-19: What We Know About the Second Wave and a Targeted Approach for Protecting Canadians

COVID-19

From new measures to protections for long-term care homes, we look at how health officials and governments are responding to a second wave of COVID-19. Photo: xijian / E+ via Getty Images

Experts have been sounding the warning about a second wave of COVID-19 well before the first wave had even peaked. With new daily case totals now at the highest we’ve seen during the pandemic, their predictions have — unfortunately — come to pass.

Oct. 23, 2020

Canada has hit a new high with 2,786 COVID-19 cases reported today. Of that total, Quebec reported 905 of those cases and Ontario accounted for 826. Sunnybrook Hospital in Toronto announced an outbreak of five cases in its surgical unit.

Premier Francois Legault said it’s unlikely that the 28-day partial lockdown imposed Oct. 1 on Montreal and Quebec City would end on Oct. 29 but said he will wait until early next week to make a decision about extending the lockdown.

Two provinces also hit new record high numbers of daily cases for the second straight day. British Columbia reported 274 cases and Alberta had 427. British Columbia and Alberta both broke new daily case records for the second straight day, adding 274 and 427 cases, respectively. B.C.’s Dr. Bonnie Henry blamed social gatherings. “Much of the recent surge that we have seen in new cases in B.C in the last couple of weeks is directly linked to social events,” she said. “These events have caused clusters and outbreaks that have now spilled over into our health-care system.”

Alberta’s top doctor attributed the rise in his province to Thanksgiving socializing.

The U.S. Canada border now remains closed to non-essential travel until at least Nov. 21. This week, Canada was removed from the European Union’s “safe list” but individual members of the Union may choose whether to act on the recommendation. Greece, Portugal and Italy are expected to open to travellers from Canada by the end of October.

Nevertheless, the Government of Canada continues to advise Canadians to avoid all non-essential travel.

-Judy Gerstel

Oct. 22, 2020

Quebec remains hardest-hit, recording almost half of Canada’s total COVID-19 cases. The province has reported more than 1,000 new cases for five of the past six days and another region has become a red zone under its COVID-19 alert system. In a press conference Wednesday, Health Minister Christian Dubé announced new restrictions for Mauricie-Centre-du-Québec — halfway between Montreal and Quebec City — where she said there has been a “worrisome increase” in cases. The measures, which include the closing of bars and restaurants, take effect Saturday and match those instituted earlier this month for Greater Montreal, Quebec City and Chaudière-Appalaches.

Meanwhile in the west, B.C., with 203, and Alberta, with 406, both reported record single-day increases in COVID-19 cases Wednesday. Alberta also hit a record of active cases, with 3,372 in the province — close to 15 per cent of the country’s total, which was 22, 783 as of Thursday morning.

It was also confirmed Wednesday that Alberta’s Municipal Affairs Minister Tracy Allard has tested positive for COVID-19 and that Premier Jason Kenney is in self-isolation, having attended meetings last week with Allard and three other members of his government. In a statement posted to Twitter Wednesday night, Kenney said he has tested negative but will isolate until Oct. 29, as per public health guidelines.

Oct. 21, 2020

Halloween is just the latest in a year-long line of celebrations put in peril by the pandemic. Prime Minister Justin Trudeau confirmed Tuesday that he will not be taking his kids out next week.

“Listening to public health officials means that my family will not be going trick-or-treating this year,” he said at a press conference Tuesday.

Trudeau and his family reside in Ottawa — one of Ontario’s four COVID hot spots where public health is recommending families keep festivities at home this Halloween. For the rest of the province, people should go out trick-or-treating only in household groups and the province includes wearing face masks for both those collecting and giving out candy as part of its guidelines.

What was essentially the cancelling of Halloween for parts of Ontario came a week after Canada’s top doctor said that trick-or-treating could go ahead — with precautions. Remarking on the creative ideas she’d seen for giving out candy more safely, “there are ways to actually manage this outdoors.” said Chief Public Health Officer Dr. Theresa Tam last Tuesday.

Halloween will be a mixed bag across Ontario, but also across the country as each province provides its own guidance. Trudeau urged Canadians to listen to their local health authorities. “I think families will be creative in how they respond to giving their kids as fun a holiday as we can while always listening to public health officials and respecting local guidelines.”

But experts warn that rule-following can be eroded by conflicting messaging. “Public health authorities] have to struggle with the context of local conditions being different and that can result in a variation in recommendation … and that can also result in public health authorities changing their minds as we’ve seen with masks,” Timothy Caulfield, a professor of law at the University of Alberta and Canada Research Chair in Health Law and Policy, said in an interview with CTV Tuesday.

“When you’re frustrated and perhaps have a particular ideological leaning, you are more likely to gravitate to a narrative that fits your personal brand and that’s definitely happening now, you’re seeing that more and more,” he said.

Oct. 20, 2020

It was reported Tuesday that the U.K. will spend £33.6 million ($57.3 million) funding the first human challenge trial of a vaccine for COVID-19.

Unlike Phase 3 clinical trials, during which thousands of volunteers are given an experimental vaccine with a certain percentage expected to be exposed to the virus naturally, researchers will dose participants with a vaccine candidate as well as the virus that causes COVID-19.

Although human challenge trials are considered to be more efficient, requiring less volunteers — as few as 100 — and less time, participants are generally healthy and young (18 to 30), which is not representative of people at higher risk for severe outcomes from COVID-19. And there is still no effective treatment for the respiratory illness should a volunteer need it.

Such a trials are “never undertaken lightly,” said Peter Openshaw, study co-investigator, professor and director of the Human Challenge Consortium. “However, such studies are enormously informative.”

“It is really vital that we move as fast as possible towards getting effective vaccines and other treatments for COVID-19.”

The trial may begin as early as January. After exposure to the novel coronavirus that causes COVID-19, vaccinated volunteers will stay in a biosecure facility at London’s Royal Free Hospital until they are no longer infectious. They will be monitored for a year afterward, with researchers looking for any side effects.

According to the World Health Organization, of the more than 100 vaccines for the novel coronavirus in development around the world, 10 are currently in Phase 3 clinical trials. And as the CBC reports, one of 11 candidates being developed in Canada is now in Phase 1 trials.

A recent survey of 1,539 Canadians by polling and market research firm Leger found that 63 per cent said they intend to get a COVID-19 vaccine once one is approved by Health Canada and is free of charge. The firm also queried 1,000 Americans for the poll, with 47 per cent saying they would get vaccinated.

Oct. 19, 2020

As Canada closes in on 200,000 cases of COVID-19, more of the country adopted stricter public health measures Monday in an effort to curb spread of the novel coronavirus.

In Ontario, York Region joined Toronto, Ottawa and Peel Region, moving back into a modified Stage 2 for 28 days. Gyms and movie theatres have been closed as part of the measures and, indoor dining is banned at restaurants and bars while public gatherings have been capped at 10 people indoors and 25 people outdoors. Visits to long-term care homes are also now restricted to essential visitors, including caregivers, at facilities in the York Region to match measures already put in place for the province’s three other hot spots.

Ontario has also officially advised against traditional Halloween celebrations in the four areas now under tighter restrictions. In a statement released Monday, the province’s Chief Medical Officer of Health Dr. David Williams said: “Given the high transmission of COVID-19 in the modified Stage 2 public health unit regions of Ottawa, Peel, Toronto and York Region, traditional door-to-door trick or treating is not recommended.” He suggested that, instead, people have a candy hunt with members in their own household, and went on to warn families to “not travel outside of their neighbourhood to celebrate Halloween.”

Meanwhile, in Winnipeg and surrounding areas, where the vast majority of Manitoba’s new cases are concentrated, gatherings have been lowered to a maximum of five people for two weeks starting today. Nightclubs, bars, casinos, bingo halls and live entertainment venues have also been closed. Restaurants, however, will stay open but are now limited to 50 per cent capacity and can only seat up to five people at a table.

According to the Public Health Agency of Canada, as of Sunday there have been a total 198,148 confirmed cases of COVID-19 and 9,760 deaths related to the respiratory illness.

Oct. 16, 2020

The U.S. Centres for Disease Control and Prevention (CDC) has put rec hockey in its crosshairs for potential to be a “superspreader event” for COVID-19.

In its Morbidity and Mortality Weekly Report released today, the CDC detailed its review of a mens league game back on June 16 in Tampa, Fla., from which 15 people became ill and 13 tested positive for the novel coronavirus. All but one, an arena staff member, were players, aged 19 to 53, nine from one team and five from the other.

The agency stated that the players did not have other common exposures in the week before the game and, that the “index patient” — the first documented case — started showing symptoms two days after the game.

“The ice rink provides a venue that is likely well suited to COVID-19 transmission as an indoor environment where deep breathing occurs, and persons are in close proximity to one another,” the CDC wrote in its report.

Amateur leagues across Canada have taken measures to limit contact in an effort to curb spread of COVID-19, including the closure of locker rooms, banning of spectators and reducing play to 3-on-3 or 4-on-4. And, as reported, Ontario, Saskatchewan, Alberta, and British Columbia would also consider taking play outdoors, if necessary.

In its conclusion, the CDC said: “The indoor space and close contact between players during a hockey game increase infection risk for players and create potential for a superspreader event, especially with ongoing community COVID-19 transmission.”

“Superspreader events, in which one infectious person infects many others, can lead to explosive growth at the beginning of an outbreak and facilitate sustained transmission later in an outbreak.”

Oct. 15, 2020

Demand for the annual flu vaccine is causing long lines and shortages across the country.

According to a report by the CBC, an online reservation system in Montérégie, Que., crashed on Tuesday — the first day residents were able to book an appointment for this year’s flu shot. And in B.C., there are already long wait times being reported as the province’s flu vaccination program gets started.

None the less, health officials are urging people to get inoculated against influenza especially this year in order to avoid what experts are calling a “twindemic” — a convergence of people becoming ill as both influenza and COVID-19 circulate.

Expecting higher demand for the flu shot this year, Health Canada increased its order from 11.2 million last year to 13 million doses this year. There were nearly 49,000 cases of influenza recorded in Canada during the 2018/19 flu season but only four out of 10 Canadians got the 2018/19 vaccine — a dose reported to have prevented 60 per cent of influenza cases.

In response to demand in Nova Scotia, Chief Medical Officer of Health Dr. Robert Strang said: “We’re asking people to be patient.” He assured residents that anytime over the next eight weeks is a good time to get vaccinated, anticipating a rush that normally happens when the shots are first available.

Oct. 14, 2020

Although Quebec, Ontario and Alberta continue to see the largest resurgence of COVID-19, smaller provinces are also starting to see a concerning uptick in cases.

Manitoba reported its third record-breaking day in less than a week, with 124 new cases on Tuesday. The province’s Chief Public Health Officer Dr. Brent Roussin confirmed that the increase in cases has strained contact tracing efforts. He recommended people reduce their contacts in general and noted that a number of new cases had exposure to others while symptomatic.

“We just cannot succeed in this pandemic if people are out and about when they’re symptomatic,” he said at a daily press conference.

Roussin also said that another lockdown — as we’ve seen in hot spots of Ontario and Quebec — is possible as the province is running out of “targeted tools” to stop the spread of COVID in Winnipeg, where 95 per cent of new cases are located.

Meanwhile, New Brunswick declared a second special-care home outbreak. The facility, in Campbellton, had one of six new cases reported Tuesday, bringing active cases in the province to 82 — the highest number seen in N.B. during the pandemic.

Moncton, where the first special-care outbreak was declared, and Campbellton were put back into a more restrictive Orange Phase Friday past “because of additional potential public exposure to the virus identified through the investigation of existing cases, possible community transmission and reports of low compliance in some higher-risk settings,” Premier Blaine Higgs said.

On Tuesday, P.E.I. — one of four provinces in the Atlantic bubble along with N.B. —  advised islanders to avoid non-essential travel to the Moncton region.

Oct. 13, 2020

As we wait on the edge of our seats for a vaccine, Monday brought news of a set back for one candidate.

Drugmaker Johnson & Johnson has paused all clinical trials of its Covid-19 vaccine candidate. ENSEMBLE, because of an unexplained illness in a study volunteer. “Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” read a statement from the company.

“Adverse events – illnesses, accidents, etc. – even those that are serious, are an expected part of any clinical study, especially large studies.”

The company did not say what the illness was but made it a point to note that such a development is par for the course. “A study pause, in which recruitment or dosing is paused by the study sponsor, is a standard component of a clinical trial protocol.” Doctors will now work to determine whether it’s a dangerous side effect or a coincidence.

Johnson & Johnson is one of four pharmaceutical companies with which Canada has deals to purchase doses of successful vaccine candidates.

This is the second Phase 3 coronavirus vaccine trial to be paused in the U.S. The American portion of a global clinical trial by British-based AstraZeneca is yet to resume after pausing last month, with the US Food and Drug Administration investigating a neurological complication that arose in a study participant last month.

The Next Best Test

Two weeks ago Health Canada approved a second rapid test from U.S.-based Abbott Laboratories. The first antigen test to be given the green light, it works by detecting the presence of viral proteins and has shown to be effective 93.3 per cent of the time. Although less effective than the PCR test currently in use across the country, it’s touted as easier to administer and less expensive. Public Services and Procurement Minister Anita Anand announced at the same time that the federal government signed an agreement to buy more than 20.5 million of the tests in the coming weeks and that they will be distributed to COVID-19 hot spots.

The news came a week after Health Canada approved the ID NOW rapid test on Sept. 29, also from Abbott, It can provide results from a nasal swab in as little as 13 minutes. Premier Doug Ford applauded the federal government for its plan to purchase 7.9 million of the tests, saying the move will be “a game changer.” As reported, Air Canada has also ordered 25,000 of the rapid test kits — in partnership with McMaster University, the airline has been testing them with passengers returning from abroad to Toronto’s Pearson International Airport.

In the Greater Toronto Area increased demand for testing has led to long lines and multi-day result delays. To increase capacity, testing was opened up to symptom-free residents at select Shoppers Drug Mart locations near the end of September. With the province working to clear a backlog, assessment of the pharmacy swabs is being outsourced to a lab in California, according to a report by the CBC.

Long-Term Care Lessons Learned?

As we brace for what’s to come with a second wave, we’ve already had a harsh lesson about what can happen to vulnerable populations. The first wave of the pandemic cut a deadly swath through long-term care facilities across the country, killing more than 7,500 nursing home residents — 80 per cent of all virus-related deaths. The situation got so grim in Quebec and Ontario that the military had to be called in. Premiers of both provinces promised that changes would be put in place to ensure the second wave wasn’t so deadly.

Ontario finally responded with something concrete when on Sept. 28 Doug Ford announced that his government would invest $52.5 million to “recruit, retain and support” Ontario’s front line health care workers and caregivers “to ensure our health care system can meet any surge in demand.”

He followed, the next day stating that visits to long-term residences would be limited to staff, essential visitors and essential caregivers only in regions of the province experiencing a spike in cases. “We can’t let COVID-19 get into these homes,” the premier said at a daily press conference. To that end, Ford added an additional $540 million in funding for long-term care homes to combat the second wave.

The moves were a welcome development but, with the second wave already causing outbreaks in numerous elder care homes, many worry that it was too late.

Targeted Lockdown

On Oct. 10, Ontario put three of its hot spots — Toronto, Ottawa and Peel Region — back into a modified Stage 2, for 28 days. The move followed Quebec’s lead with three jurisdictions — Greater Montreal, Quebec City and Chaudière-Appalaches, where most of the province’s new COVID cases are concentrated — having entered a second lockdown on Oct. 1, also for 28 days.

Localized lockdown is considered a success in having avoided a major second wave of coronavirus in Australia. Restrictions are slowly being lifted in the country’s second most populous state, Victoria, after a strict quarantine was instituted on July 9. Residents in Melbourne, the state’s largest city, are still under stay-at-home orders, with Friday marking the 100th day. Victoria is home to about 24 per cent of the country’s population — comparable to Quebec, where about 23 per cent of Canadians reside.

The Bottom Line

A second lockdown could mean the end of many businesses, warned Business Council of Canada CEO Goldy Hyder in an interview with the Financial Post.

“We have to do everything we can to preserve the economic resilience of  this country — for businesses of all sizes,” he said. He added that businesses should be trusted to operate safely through a second wave because, pandemic or no pandemic, “it’s in their self interest to do so.”

Predictions have been dire for one sector hit hard by the pandemic. A survey released at the end of August by the Canadian Chamber of Commerce found that 31 per cent of food service businesses — an industry reported to employ 1.2 million Canadians — say they can only operate with social distancing in place for 90 days. The chamber fears that 60 per cent of restaurants could close permanently by December.

It’s not just the provinces and economists who want to avoid another widespread shutdown through the second wave. “To prevent small clusters from becoming major outbreaks, communities may need to enact short-term closure orders,” the Liberal government said in its recent throne speech.

And since, Prime Minister Justin Trudeau announced that his government is targeting new pandemic recovery spending with $10 billion on infrastructure projects over the next three years. “With smart, targeted investments, we can get people back on the job, grow the economy while building a healthy, sustainable future for everyone,” he said.

Short-Term Pain for Long-Term Gain

Addressing the nation in a broadcast after the throne speech, Prime Minister Justin Trudeau was confident that doubling down on efforts to flatten the curve would once again pay off, rallying all Canadians to do their part.

“We can’t change today’s numbers or even tomorrow’s, those were already decided by what we did do — or didn’t do two weeks ago. But what we can change is where we are in October and into the winter,” he said.

“It’s all too likely we won’t be gathering for Thanksgiving, but we still have a shot at Christmas. Together, we have the power to get the second wave under control.”

What’s in our control may include a very different looking Halloween. By the end of September, the US Centers for Disease Control and Prevention had come out with recommendations against trick-or-treating this year, calling the tradition a “high-risk activity” amid the pandemic.

But Canada’s top doctor said last week that Halloween can go ahead — with precautions. “There’s some really interesting ideas where people are handing out treats at the end of a hockey stick or something, using a pool noodle to tell your kids how far they should be standing apart from each other,” Chief Public Health Officer Dr. Theresa Tam said Tuesday. “So there are ways to actually manage this outdoors.”

Super Centenarians

The one thing we know beyond a shadow of a doubt is that the novel coronavirus is particularly dangerous for older people — especially those with an underlying condition. But according to one scientist, the first wave of COVID-19 yielded this surprising finding — people over a hundred years of age are inexplicably surviving it.

“When people ask me why these people are surviving, I usually answer that it’s probably precisely because they are centenarians,” says geneticist and director of the Human Genome and Stem-Cell Research Center at the University of São Paulo, Mayana Zatz, who is studying the phenomenon. “Apparently, these people have a huge resistance to any challenge coming from the environment, including COVID-19.”