Like many things coronavirus-related, the chance Canada will need to tighten restrictions again is hard to predict, according to disease experts.
Ontario, B.C. and Alberta are all seeing cases climb, although the numbers are a far cry from the daily counts in March and April.
Experts aren’t convinced we’re on track for a second lockdown. In fact, some are cautiously optimistic.
“It’s less likely to occur this time around because preparations have been made this time,” said Dr. Alon Vaisman, an infectious disease and infection control physician at the University Health Network in Toronto.
“But that doesn’t mean it’s off the table.”
Recent modelling data from the Public Health Agency of Canada lays out the best- and worst-case scenarios over fall and winter.
The best case: Canada sees multiple small spikes in cases — fluctuating numbers — over the next few months. The worst case: Canada falls into a second wave that overwhelms the health system, followed by smaller spikes over the following months.
The data makes it clear “there’s always the possibility” that things could get worse again, Vaisman said, “but it’s hard to know how likely that will be.”
“This is a back-and-forth thing. Ultimately, people should expect a dynamic situation.”
How could we know?
A second wave of the virus would be the first sign of tightening up again.
Although there’s no set number of cases that would define a second wave — simply the slope of the curve rising rapidly — there’s “no question” Canada will see some form of one, said Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto.
But for things to shut down, he said the rise in cases would need to be substantial enough that it “overwhelms” the ability to rapidly test and trace contacts.
“That’s the line in the sand,” Furness said. “As soon as we lose that, we’re in trouble. We have uncontrolled spread.”
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Summertime has so far provided a buffer for the virus’s spread, said Furness. As colder conditions force more people inside, cases will likely “bloom,” he said, but that doesn’t necessarily mean Canada will revert to March-level lockdown orders.
Since the pandemic’s onset in the spring, Canada has ramped up testing and contract tracing, secured more personal protective equipment (PPE), enhanced public health measures, increased compliance to those measures and “transformed” its health-care system to handle this type of emergency, Furness said.
There will inevitably be outbreaks, he acknowledged, but that won’t force everyone to shut themselves in.
“We will be smarter in how we respond and how we defend ourselves against COVID in a way that we just weren’t in March.”
What could happen?
Canada will likely take cues from other countries that have endured somewhat of a second wave, the experts agree.
Places like Spain and France have recently seen large increases in cases, but not in deaths and hospitalizations. It has prompted some tightened restrictions, but nowhere near the curfews and shuttered economies of March and April.
“A lockdown would only be considered if health system capacity gets overwhelmed, which does not seem to be the scenario in European countries, which opened earlier than us,” said Dr. Prabhat Jha, an epidemiologist at the University of Toronto and director of the Centre for Global Health Research at St. Michael’s Hospital in Toronto.
There are a number of factors contributing to this, Jha said, which are being reflected in Canada.
For one, he said more young people are getting tested and showing up in testing data. There’s also a better understanding of triaging and protecting hospitals and nursing homes.
“Elder folks are exposed less to younger folks now. They’re more isolated,” he said.
Vaisman believes Canada would see a “reverse of phases” if cases spike again, with higher-risk activities being shut down while lower-risk ones are maintained.
It would cascade from there. Should lower-risk things become higher risk as cases continue to climb, more closures could be imposed.
“There’s low-hanging fruit that we can cut out first,” Vaisman said.
Schools a ‘big test’
Schools are a “major variable” in what could worsen the COVID-19 situation in Canada, lending way to more tightened restrictions, said Vaisman.
“It will be a major test of our system because it essentially introduces a breakage in a lot of people’s bubbles and opens up potential chains of transmission with lots and lots of people,” he said.
“And then we’ll be waiting two or more weeks after the date of opening to really understand the effect of that.”
Some countries have had to close schools a second time when outbreaks swept through classrooms. Israel closed schools two weeks after fully reopening them, as did South Korea and some in Germany.
“Every time you open something up, you’re throwing coins on the risk pile. You’re making that bigger,” Furness said. “If you want a balance, every time you throw something on the risk pile, you need to throw something on the safe pile. Opening schools is throwing a lot in the risk pile.”
Can we avoid it?
The tried-and-true protocols — hand hygiene, mask-wearing, physical distancing — are and will continue to be crucial as Canada heads into fall and winter.
“Mask-wearing is an enormous tool that we have and we’re seeing high compliance,” Furness said. “Compliance tends to go up when things get scary, not down.”
Bolstering testing is another way to ramp up protections, said Vaisman. He pointed to pressure to expedite Health Canada approval for at-home testing kits and saliva testing as ways to simplify testing and make it more accessible.
A push to get more Canadians on the country’s coronavirus exposure notification app, Covid Alert, is also an important tactic, said Jha.
The app has been downloaded roughly 2.2 million times in the first month it launched, but just 90 people have logged a COVID-19 diagnosis so far. Experts are worried it’s not enough.
“It’s been poorly promoted,” said Jha. “Where’s the advertising? Why aren’t bars and restaurants trying a ‘no app, no entry’ approach? Without high coverage of the app, it won’t be effective.”
Ultimately, Canadians looking for “light at the end of the tunnel” might have to look past winter when flu season passes and a vaccine draws closer, said Vaisman.
“There’s no reason why a lockdown can’t happen, but you just have to prepare for the worst and hope for the best.”
— with files from the Associated Press and Global News’ Leslie Young