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A 2nd wave of COVID-19? Alberta scientists warn of asymptomatic spread as province reopens

Click to play video 'Health matters: Social distancing key to limiting 2nd COVID-19 wave' Health matters: Social distancing key to limiting 2nd COVID-19 wave
WATCH ABOVE: As Alberta starts to reopen for business, virology experts are warning the province it's too early in the pandemic. They say a second wave of infections is inevitable. Su-Ling Goh reports. – May 5, 2020

As COVID-19 restrictions in Alberta and across Canada are beginning to be lifted in stages, infectious disease experts say a likely second wave of the virus will only be limited if people continue to social distance.

“I would urge caution and wait longer until we have very few new cases. Because otherwise I think there will be a second wave and more people are going to get sick,” Dr. Michael Houghton, the director of Edmonton’s Li Ka Shing Institute of Virology, said.

Houghton is cautioning those who believe the risk has diminished.

“There’s a big sigh of relief that I’m hearing almost audibly in the community, but really, we still have to be very cautious. We’re not out of the woods yet,” he said.

“We’ll waste all the efforts of the last couple of months if we go back too soon.”

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Dr. Craig Jenne, an expert in infectious diseases at the University of Calgary, said that people need to understand that nothing has changed risk-wise since the virus first reached Alberta.

“Unfortunately, between where we are today and where we were, for example, at the beginning of February, we as a society are no more protected from this virus than we were before,” Jenne said.

READ MORE: Coronavirus: Alberta phased relaunch strategy will see some restrictions eased Friday

While physically distancing has slowed the spread, Jenne added that once restrictions are lifted, some people may believe it is no longer required and start a chain reaction.

“It only takes one person for example, going to grab dinner at a restaurant to infect two or three others, then each of them infect two or three others, and by the end of a week, we’ve got another cluster of several hundred cases,” he said.

Click to play video 'Virology expert concerned about Alberta reopening' Virology expert concerned about Alberta reopening
Virology expert concerned about Alberta reopening – May 5, 2020

Historical comparisons to multi-wave Spanish Flu

The Spanish Flu was a pandemic that hit the world hard between 1918 and 1920.

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It came in multiple waves: the first in spring of 1918, then in the fall of the same year, when a mutation of the virus produced an especially deadly strain. Then the third and fourth waves took place in the spring of 1919 and spring of 1920.

“I think one thing that we would always look at is how past pandemics have happened,” said Dr. Kirsten Fiest, an assistant professor at the University of Calgary’s Critical Care Medicine department with a PhD in Epidemiology.

READ MORE: Here’s how the Spanish Flu is similar and different from the coronavirus

However, Fiest added that while the 1918 pandemic had multiple waves, the issue with predicting the current COVID-19 outbreak is that there simply isn’t enough research on the virus itself yet.

“For COVID-19, we just have really limited information on both the transmission and the transmissibility of the virus. I think this is what makes the prediction challenging.”

Epidemiologist Cynthia Carr, the founder of EPI Research Inc. in Winnipeg, MB., said she believes a key difference between the 1918 pandemic and the current COVID-19 situation is the public education effort from health officials.

“[In 1918] It was actually Spain that was saying, ‘Hey everybody, there’s a serious flu going around here,'” she said. “But the countries that were at war were saying, ‘Nope, nothing wrong here. Soldiers, get on those crowded ships… because we’re not going to admit that we’re sick.’
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“Transparency in communication is absolutely key in stopping the spread of a virus,” Carr said.

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She added that the key right now continues to be following social distancing and protective measures.

“21st Century science actually played a pretty small role in controlling these diseases [like the 1918 pandemic],” Carr said.

“It wasn’t a treatment that solved it — it was the collaboration, it was the the communication and it was the prevention of spread through basic hygiene, through hand washing, through social distancing.”

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‘A perfect strategy to keep spreading’

One major issue with the COVID-19 spread has been the asymptomatic nature of some infections, Carr said.

“The asymptomatic spread and the long incubation period is a sign of a really smart virus. It has a perfect strategy to keep spreading,” she said.

The issue is that some people may be infectious without knowing it. Carr said that is what differentiates COVID-19 from the flu and even severe acute respiratory syndrome (SARS), which is also part of the coronavirus family.

“SARS, like the flu, came on fast. You kind of knew immediately that you’ve been hit by something, you felt sick right away,” Carr said. “That alerted the medical system more quickly that something was going on.”

READ MORE: Could there be a second wave of coronavirus? Experts say it’s possible but unclear

The asymptomatic nature of some COVID-19 cases is what’s raising concerns from experts as the reopening begins. Alberta is set to begin Stage 1 of its reopening on May 14 if things go well with the current reopenings.

Click to play video 'Alberta announces Stage 1 of relaunch strategy for economy' Alberta announces Stage 1 of relaunch strategy for economy
Alberta announces Stage 1 of relaunch strategy for economy – Apr 30, 2020

“When people go back to work, they need to understand the threat that they are for other people,” Houghton said.

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“The young people, if they get infected… most of them will not be severely affected, but they can pass it on to elderly people they interact with.”

Carr said that the high infection rates in long-term care facilities show that the virus was clearly brought into those environments by potentially asymptomatic people.

“[Those in care] are the groups that aren’t leaving. They aren’t out in the population. So that really does show the impact of a weak immune system,” she said.

Fiest said her hope is that the first wave has led to changes in behaviour that could help prevent the second wave from spreading.

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“[Now] people are washing their hands more, if they’re self-isolating if they’re experiencing symptoms, if they’re wearing a mask… that could help,” she said.

“These second and third waves are going to be the result of people interacting more closely and most likely asymptomatic transmission of the disease,” Fiest said.

READ MORE: Coronavirus cases around the world surpass 3.5 million as rate of new cases slows

Alberta Health announced Monday that it would begin testing all close contacts of confirmed COVID-19 cases, even those with no symptoms.

“[COVID-19] has been able to hide and spread even though it doesn’t tend to make most people really sick,” said Carr. “It just makes some people really sick. And because there’s no treatment, it’s very dangerous for [that] segment of the population.”

No immunity

Another issue with a second wave is that there has been no evidence that people are immune to COVID-19 after they recover from it.

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“As far as we know, there’s no immunity that’s garnered by having been infected by COVID[-19] before,” Fiest said. “Without a vaccine, without immunity to the virus, it’s really hard to expect it’ll just go away.”

READ MORE: WHO says ‘no evidence’ that recovered COVID-19 patients cannot be re-infected

Dr. Jenne said he believes it’s possible the virus could become a continuous cycle as opposed to a just a few waves.

“Until we have a vaccine, I think we’re going to see a continual drop in cases, relaxing of restrictions, an uptick in cases,” he said.

Following up on pockets of cases will be key as the relaunch strategies roll out, Carr said.

“We do need to keep on top of it,” she said. “We don’t know what our actual immunity is, what our body is doing with the information [if it is] coming into contact with the virus already.”
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Coronavirus outbreak: Herd immunity ‘not a concept that should be supported’, Tam says – Apr 25, 2020

Testing and tracing key in areas with high infection rates

Carr said that in Alberta, officials appear to be monitoring outbreaks in the province carefully.

Calgary zone has seen 67 per cent of the total confirmed cases in the province, as of May 5.

“With data comes power,” she said. “Alberta has done a great job with high rates of testing. Alberta has also put forward an app to assist with tracing.

“We want to make sure we have enough testing so if there’s outbreaks, we can immediately identify — is it associated with a physiotherapy office or a coffee shop [for example]? So we definitely have to be careful, and that’s why there’s the stages of approach,” said Carr.
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READ MORE: $1.7M donation helps Alberta expand COVID-19 testing capacity to 16,000 a day by June

Key areas that should be monitored will likely be the areas that have already been hit hard by the first wave.

“I think a second wave could happen anywhere, however, given the large proportion of cases that have occurred in the Calgary zone and the South zone of Alberta, I would say that the likelihood [is] the second wave would likely follow the same pattern as what we’ve originally seen,” Fiest said.

“I think at least 14 days needs to have elapsed between phases of relaunching.

“Because we just won’t know the effect of the initial launch until 14 days after.”

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