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Lockdowns and a second wave? What the coronavirus pandemic could look like this fall

New modelling suggests shutdown not needed for COVID-19 second wave
The Public Health Agency of Canada's new modelling suggests the country could get through a second wave of COVID-19 without having to shut down schools and businesses again.

The upcoming fall season could go in a few different directions, according to coronavirus modelling data recently released by the Public Health Agency of Canada.

In a more optimistic scenario, we see many small spikes in coronavirus cases, moving up and down, over the fall and winter.

In a “worst-case scenario,” Canada experiences a massive second wave in the fall that overwhelms the health system, followed by smaller spikes over the following months.

Read more: Coronavirus cases could exceed Canada’s health care capacity this fall, officials warn

It’s not clear yet which of these will come to pass, as it depends on public health measures, public behaviour and even a bit of luck. But experts say it’s clear that over the next year, we will be battling rises and falls in case numbers, and may have to lock down again as a result.

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“We’re certainly going to be living with this through the winter and beyond,” said Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto.

“I think it’s really, really important to remember that what the next little while looks like really depends on how well we have things under control.”

Tuite expects cases, and the public health measures to deal with them, to ebb and flow over the foreseeable future.

“It’s not like we’re going to be in full lockdown for the next year,” she said. “But there are certainly going to be periods where we are in more of a lockdown situation than we are right now.”

Coronavirus: Canadian health officials say they’re looking at changes in human behaviour this fall and its impact on COVID-19
Coronavirus: Canadian health officials say they’re looking at changes in human behaviour this fall and its impact on COVID-19

Tuite co-authored a paper in the spring that predicted this situation: intermittent lockdowns interspersed with periods where “occasionally we get to come up for air.” This would help to keep the pandemic at a manageable level while the world waits for a vaccine, she said.

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Jason Kindrachuk, who holds a Canada Research Chair in emerging viruses at the University of Manitoba, has another fear about the fall: flu season.

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“I think that’s the worst-case scenario — you’re basically just adding on COVID-19 to everything that we already face,” he said.

While there are signs that social distancing measures put in place to mitigate the spread of the coronavirus might also cut back on flu infections, he worries about what could happen.

Read more: Coronavirus prevention crushed Australia’s flu season. Can Canada expect the same?

Generally, though, he holds a similar opinion to Tuite: that cases will rise and fall throughout the year as kids go back to school and people spend more time indoors.

“There are likely going to be ebbs and flows in this pandemic.”

He imagines that unlike the blunt instrument of massive lockdown that we saw in the spring, future lockdowns will be targeted to specific regions that are experiencing a problem, or specific activities that are contributing to it.

People need to prepare for the possibility of lockdowns, said Steven Taylor, a professor and clinical psychologist at the University of British Columbia.

“It’s going to be a kind of grumbling acceptance,” he said.

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But while no one will like another lockdown, he thinks it’s worth examining the last time you went through one.

“What did I learn from that experience? What worked well, what didn’t work so well? What could I do differently? And how can I avoid the long lineups of panic buyers and things like that?”

Recognizing which kinds of coping strategies helped you get through a previous lockdown can help you prepare for this one, he said.

Read more: Temperature checks and ‘deep cleaning’ aren’t good at stopping coronavirus. So why do we bother?

According to his research, he said, people who coped relatively well during the spring lockdown had set a routine, were exercising regularly and weren’t over-using drugs or alcohol. It also helped if people reminded themselves that they were making these sacrifices for the good of the community, he said.

Dealing with uncertainty is difficult mentally, he said, so it would help too if governments were able to set clear expectations or deadlines, if possible, on what a lockdown might consist of and how long they expect it to last.

According to Tuite, some calculations show that it takes three weeks of lockdown to reduce infection rates after one week of exponential spread – meaning it’s much better to prevent infections in the first place, rather than trying to undo the damage later.

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Coronavirus: Canada’s top doctor says it’s up to Canadians whether a ‘fall peak’ will be seen
Coronavirus: Canada’s top doctor says it’s up to Canadians whether a ‘fall peak’ will be seen

But not everyone is so sure that we will be spending time locked in our homes over the winter.

Dr. Matthew Pellan Cheng, an infectious diseases doctor at the McGill University Health Centre, sees reasons to be slightly optimistic about the upcoming season.

While he believes that Canada will experience a “second wave” of COVID-19, he doesn’t think it will be as bad as what we saw in the spring.

“When you compare where we are today to the onset of the pandemic, we now have an effective treatment. We didn’t have that at the beginning,” he said.

The treatment he’s referring to is dexamethasone, which has been shown to improve outcomes among hospitalized COVID-19 patients sick enough to require oxygen supplementation.

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Read more: Cheap drug could help save lives from coronavirus, early study results show

“We have increased diagnostic test capacity,” Cheng said. “We have drive-thru testing ability. We didn’t have that at the beginning. We also have more public awareness. People are social distancing. People are wearing masks. We didn’t have that at the onset of the pandemic. And people are travelling a lot less.”

All these things, he hopes, will make upcoming waves of infection less than what we have already experienced.