As Canadians begin to battle their inhibitions to resume their lives as normal, public health officials are fearing a second wave of COVID-19, and want to remind everyone we’re not in the clear just yet.
“We may have climbed up to the first mountain, but it’s the first mountain in a range, it’s like going through the Rockies, up and down,” said Dr. David Walker, Professor of Emergency and Family Medicine and COVID-19 Lead at Queens’ University.
Many people haven’t given much consideration to a second wave, and are not aware of how dangerous it could be, but Christopher Rutty, a Medical Health Historian and Adjunct Professor at the school of Public Health at the University of Toronto points to the Spanish Flu which was worse the second time around.
“The second wave of the flu pandemic of 1918 was worse than the first, the first was relatively mild and the second swept in,” he said.
The first and third waves were considered to be “fairly mild” in comparison to the second wave, which as Patrick R. Saunders-Hastings and Daniel Krewski wrote in a 2016 paper resulted in “deaths reaching into the tens of millions.”
At that time, a major reason for the spread was soldiers who were traveling after World War I, similarly a lot of the spread globally for COVID-19 has been a result of international travel.
“Globalization has driven social and economic changes that have enhanced the threat of disease emergence and accelerated the spread of novel viruses,” wrote Saunders-Hasting and Krewski.
However, Rutty is quick to point out, the spread of COVID-19 is worse than the Spanish Flu.
“This is bigger in many ways than 1918, just the rapid spread of it and how it’s attacking the hospital systems and there’s no vaccine,” he said.
When he goes through the archives, Rutty is amazed at how little was done, and could be done to actually control the virus. He notes the measures installed by public health officers now to physically distance and continue promoting good hygiene would’ve been effective to control the spread.
“Looking back there's not much you could do, so social distancing since it’s been implemented has worked and helped the hospital structure,” said Rutty.
Dr. Walker has experience in being at the helm of handling an outbreak when he chaired the province’s expert panel on SARS in 2002. As many provinces are announcing they’ve hit their peak during this wave, the focus of the public becomes to re-open society.
“We get control of the situation, the number of new cases falls off because of the success of the public health measures, we want to restart the economy and resume life,” he said.
Reopening society is something Dr. Walker understands and encourages, especially given the economy will likely be in a recession, and money to fight COVID-19 becomes essential.
“We need the economy to provide the funds for health services and education, but the way we open it, we have to be conscious of what we’re dealing with,” he said.
In 1918 the outbreaks did have major effects on the economy, but according to Rutty it wasn’t anything like what is currently being experienced.
“The economic impact of it was significant, but relatively speaking to what happened now it’s like nothing happened,” he said.
Ultimately, the upcoming waves, however big or small, Dr. Walker notes, need to be ones Canada is prepared to handle.
“Subsequent waves need to be manageable by the healthcare system, how we measure our success is by not overwhelming our healthcare system,” he said.
Canada’s top medical doctor is reaffirming how the battle against COVID-19 will be a long one, and there is no clear pathway to success.
“The first is that this will be a marathon, and we are going to have to plan, pace ourselves and not take any sharp turns. The second truth is that there are still a lot of unknowns, and no 100 percent proven path before us,” said Dr. Teresa Tam, Canada’s Chief Medical Officer of Health.
Cause for concern
According to Dr. Walker a current lack of widespread infections means less people have immunity to the virus, which would mean a second wave is likely imminent.
“It’s inevitable really until we become immune which means a good percentage of us have had it or a vaccine developed, it’s only then that we can keep this virus under control,” said Dr. Walker.
While most experts believe COVID-19 will stick around for a number of months and possibly more than a year before eventually becoming a common strain, there is some concern about how winter 2020 could play out.
“Next winter is a worry because not only will we have coronavirus with us, but we’ll have influenza, too,” he said.
Dr. Rutty is quick to note the second more deadly wave of the Spanish Flu also occurred when schools were reopened and the flu began taking its toll.
“The second wave was often spread by kids because it would happen in the fall when school was in session, because influenza season is also in full effect,” he said.
With hospitals feeling the swell of a new flu strain and being hit with COVID-19, the focus then becomes how prepared will Canada be by winter.
“The limiting factor is how many ICU beds, how many ventilators and how much personal protection equipment do we have,” said Dr. Walker.
When it comes to tracking and understanding who is ill at the time, Dr. Walker notes Canada needs to take a page out of South Korea’s handling of COVID-19.
“The way we have to handle this is to be very, very tight in the way we identify people who become ill, it includes more testing, isolating quickly and ensuring the community still continues distancing,” he said.
This is not Canada’s first go around with a virus. Back in 2003, the country was facing SARS which eventually led to the creation of the Public Agency of Health of Canada. It was a federal initiative which would work to help coordinate programs to improve health and safety and oversee disease control and prevention.
“In the course of human existence it’s been public health that has placed us where we are, the interventions of sanitation, clean water and a panoply of different things leading to longer lives,” said Dr. Walker.
Dr. Walker notes the shift changes from public health directives to individualized surgeries like artificial hips and pacemakers, but the reason we’re not talking about public health during those times is how effective it is.
“When it’s invisible we don’t pay much attention to it, it’s like if you don’t have a major fire for five years people question the need for the fire department,” said Dr. Walker.
Instead Dr. Walker hopes public health officials are more prepared in terms of stocking up ventilators and ensuring there is enough proper protective equipment for when the next viral disease hits Canada.
“We say we’re going to plan, we talk about the lessons we’ve learned, but generally we tend to be a little bit lazy about it. It happens time and time again,” said Dr. Walker.
Going forward, Dr. Walker feels the lessons learned by politicians and health officials about investing in public health will be remembered as they create policies.
“I don’t think we’ll be forgetting about the importance of public health for a while because this is really a major embarrassment for humanity,” he said.