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The world could face a 2nd wave of COVID-19: Here's what Canada needs to do now to prepare – CBC.ca

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Countries including Canada must prepare for a second wave of the COVID-19 outbreak to emerge once social distancing measures are eased, and they should only lift those measures gradually, infectious disease experts say.

A second wave of an outbreak is an increase in infections that occurs after a sustained period of time when there are no — or very few — new cases of that illness, said Dr. Isaac Bogoch, a Toronto General Hospital Research Institute clinical investigator, who specializes in infectious diseases.

“Essentially, what we have now is physical distancing measures in place as one of a multi-pronged approach to curb the Canadian epidemic,” said Bogoch. “Now, of course, we cannot sustain these physical distancing measures for an infinite period of time.… They’re tough on the individual level, they’re tough for communities, they’re tough for businesses, tough for kids.”

The good news is that Canada has the opportunity to learn from countries where the epidemic started months earlier by observing how public health measures in those places work to keep the case load from bubbling up again once people start to emerge from their homes and go about business as usual, he said.

Some Asian countries are facing a second wave of the virus now. For instance, on Friday, Hong Kong recorded its biggest daily jump in cases since the pandemic started, though mostly connected to infected travellers, who are returning from abroad after being prevented from going home before.

Canada’s chief public health officer Dr. Theresa Tam speaks at a news conference on Parliament Hill in Ottawa, March 19. She warned that Canada needs to be prepared for another wave of the outbreak. (Blair Gable/Reuters)

Dr. Theresa Tam, Canada’s chief public health officer, warned last week that “this virus is going to be with us for some time. It will not be eradicated from the world in months.”

“We will need to be prepared for another wave, potentially.”

Like Hong Kong, Singapore and Taiwan, Canada will also experience its own second wave after seeing initial success containing the virus through the social distancing measures currently in place, Bogoch believes.

When we start to lift those measures in the months down the line, are we going to start to see a rebound of the virus? The answer is most certainly yes.– Dr. Isaac Bogoch, Toronto General Hospital Research Institute

“When we start to lift those measures in the months down the line, are we going to start to see a rebound of the virus? The answer is most certainly yes. We probably will see, to some extent, a greater number of cases as people mingle again as life slowly returns to normal.”

Lifting social distancing measures slowly

Several modelling studies have been conducted to explore how effective social distancing is at dampening disease spread, said Bogoch, and almost all show that when the reins are eventually loosened, cases will tick up again.

But he said there are steps we can take to minimize the extent of a second wave.

“The hope is that we can slowly lift these measures, rather than have them completely lifted, and we can control the rebound of the virus such that it does not cause a situation where we overwhelm our health-care system and negate everything that we’ve done for the past few months.”

The key will be to change social distancing policies “very slowly and carefully,” he said.

Eleanor Fish, a professor of immunology at the University of Toronto whose research group conducted treatment studies during the 2003 outbreak of SARS in Toronto, said a true second wave of an outbreak involves new community transmissions, not just sick returning travellers who are swiftly moved into quarantine.

Vehicles of ‘snowbirds’ and other Canadians return at the U.S.-Canada border crossing at the Thousand Islands Bridge in Lansdowne, Ont., after it was announced the border would close to non-essential traffic to combat the spread. Allowing Canadians to return home right away should make a difference in the scale of any second wave, said Eleanor Fish, a professor of immunology at the University of Toronto. (Alex Filipe/Reuters)

She said countries like China, where new cases are also travel-related, could face a second round of the outbreak but are “nowhere near” that territory yet.

‘We haven’t locked down our borders’

Fish also said she believes a second wave is “unlikely to happen here.”

“We haven’t locked down our borders to Canadians. So any of those who might want to return, are returning. We’re asking them to self-isolate for 14 days.” That means Canada is less likely than other countries who shut their borders to citizens to have cases shoot up again upon their return.

Fish said she’s optimistic that the government is listening to the scientific community and learning from places, like Italy, by preparing for a surge of severe cases by doing things like securing more ventilators. She also said she was buoyed by progress of research groups testing various forms of treatment.

“The public needs to be reassured that there’s a lot coming up that’s going to be very positive.”

Jason Kindrachuk, an assistant professor at the University of Manitoba’s department of medical microbiology, said that during the 1918 Spanish flu pandemic, there was both a second wave and a small third wave of the outbreak.

Improving supply of equipment, testing materials

But he said Canada can prepare now for a second wave of COVID-19 illnesses in a number of different ways.

It can improve the supply of personal protective equipment for front-line health-care workers, as well as the materials needed for testing, both of which have already been a challenge in the first phase of the epidemic, said Kindrachuk, who holds a Canada Research Chair in emerging viruses.

A sign urges people to practise social distancing and keep 1.5 metres apart, in the Vondelpark in the centre of Amsterdam on March 21. (Peter Dejong/The Associated Press)

And although little is known yet about the seasonality of the virus and how much immunity people will have after recovering from the illness, Canada can look to the nations that are months ahead of it in the progression of the pandemic.

We can learn from what those countries do in terms of when they start reducing the requirements for social distancing to help guide our own procedures and time frame for doing that so we don’t see spikes in increased transmission.– Jason Kindrachuk, University of Manitoba’s department of medical microbiology

“We can learn from what those countries do in terms of when they start reducing the requirements for social distancing to help guide our own procedures and time frame for doing that so we don’t see spikes in increased transmission.”

The true long-term strategy, said Bogoch, is the creation of an effective vaccination, “which we know is more than a year away.”

“But for now, we just have to put up with the physical distancing measures.”

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Coronavirus: Trudeau says he’s ‘proud’ of Canada’s COVID-19 response as U.S. cases soar – Global News

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As U.S. President Donald Trump slowly comes to grips with his country’s grim prognosis for the novel coronavirus, Prime Minister Justin Trudeau conceded Monday he’s taking a measure of comfort from early signs that the caseload in Canada is on a different trajectory than the United States.

Trudeau said he’s proud that Canadians appear to be taking seriously the importance of staying home and keeping their distance from others — the one measure public health officials say is paramount to slowing the spread of COVID-19.

And while the success or failure of those efforts won’t become clear for at least another week, Trudeau said, there’s little doubt that Canada is doing better than its southern neighbour at limiting the scope of the illness.


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“I think I would say we’re not necessarily on the same trajectory,” Trudeau said in French during the daily fresh-air briefing outside his Rideau Cottage residence. “We were quicker to get the screening done, and I think we have had more success in getting people to self-isolate.”

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The U.S., however, has hardly set a high bar.

There were more than 156,000 cases by midday, nearly 13,000 more than the day before, and the number of deaths was hurtling towards 3,000. A shortage of beds, ventilators and masks had hospitals in hard-hit New York City operating well past the breaking point, using refrigerator trucks as makeshift morgues. The USNS Comfort, a hospital ship, docked at Manhattan’s Pier 90 to help with the overflow.






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Alarming spikes in the caseloads in New Jersey, Florida, Pennsylvania and Louisiana had officials in those states bracing for the worst, well aware they might be ill-equipped to handle it. In New Orleans, home to America’s worst per-capita COVID-19 death rate, the mayor said she’d have cancelled Mardi Gras last month if only the federal government had warned her.

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Dr. Anthony Fauci, the lead voice of medical reason on the White House coronavirus task force, has warned the U.S. death toll could land between 100,000 and 200,000 — and that’s after Trump abandoned his “aspirational” target of April 12 for reopening parts of the country, extending stay-at-home measures until the end of the month instead.

“By very vigorously following these guidelines, we could save one million American lives,” Trump said Monday during a Rose Garden news conference as he spelled out the need to keep the country shuttered for another month.

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“This is our shared patriotic duty; challenging times are ahead for the next 30 days. We’re sort of putting it all on the line, this 30 days.”


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To the horror of public health experts, Trump had been musing about a celebratory Easter long weekend marked by packed churches, open shops and an accelerated return to American normalcy, insisting he didn’t want the “cure” to be worse than the “problem.” But early indications from Washington state, which reported the first known U.S. case, suggest the social-distancing strategy is having an impact.

A joint online survey released Monday by polling firm Leger and the Association for Canadian Studies suggested, among other things, a difference in attitudes between the two countries when it comes to modifying behaviour to curb the spread of the virus.

Only 86 per cent of 1,004 U.S. respondents said they were keeping the requisite two-metre distance between themselves and others, compared with 95 per cent of the 1,590 Canadians surveyed, while 85 per cent of the American survey group said they had stopped going out for necessities — nine percentage points less than their northern neighbours.






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And while 86 per cent of the Canadians polled said they had asked friends and family to keep their social distance, only 72 per cent of the U.S. respondents could say the same.

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“Everything depends on the choices that people have made and continue to make,” Trudeau said.

“I’m very proud of the way that Canadians have rallied and continue to abide by the guidelines. I think they understand that we all have an opportunity to have a direct impact on Canada’s ability to come out of this.”

When confronted with the failings of the American response, Trump frequently claims that things would have been far worse had the U.S. not slammed the door back in late January on travellers from China, where the outbreak originated. Most major airlines by that point had already suspended flights to China.






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Canada, however, didn’t take significant steps to restrict international travellers until mid-March. On Monday, Trudeau — asked whether that should have happened earlier — seemed to acknowledge that with the benefit of hindsight, more could have been done.

“We’re obviously not, in an unprecedented situation, always going to get things perfectly right,” he said.

“We’re going to continue to be committed to doing the right things as best as we can and figuring out what works, what doesn’t work, and moving forward in a way that is both nimble and focused on helping Canadians, insomuch as a government can be nimble and agile.”

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Canada and the U.S. agreed to close their shared border to non-essential travel two weeks ago while still allowing two-way trade, supply lines and commercial interests to continue, including workers who live in one country but commute to the other. The U.S. has also banned foreign nationals from China, Iran and parts of Europe.

Given U.S. social-distancing restrictions will remain in place through April, those existing travel bans would likely be extended as well, Trump said — “maybe even toughened up a little bit.”

© 2020 The Canadian Press

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This week ‘critical’ for Canada’s fight against coronavirus, officials say. Here’s why – Global News

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As Canada continues to grapple with the coronavirus pandemic, officials say this week will be “critical” in the country’s fight against the outbreak.

“This is a really critical week in our fight against the coronavirus,” Canada’s deputy prime minister, Chrystia Freeland, said at a press conference on Monday, urging Canadians to continue physical distancing.

“I know that it is hard, but we all must stay strong and stay at home unless we are doing essential work like stocking the shelves in our grocery stores, like working on the frontlines of our health-care system.”


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Freeland’s remarks echoed those from Canada’s chief public health officer, who on Sunday said this week would be “very, very important” to understand trends in the pandemic and to determine whether physical distancing has been effective.

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Dr. Theresa Tam said she would be keeping an eye on what’s happening in Quebec, Ontario and Alberta — where there has been community transmission of COVID-19 — to see if there has been a drop in new cases, like what has been reported in B.C.

Across the country, federal and provincial health officials have banned large gatherings, closed non-essential businesses and advised Canadians to practise physical distancing to limit the spread of COVID-19.


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On Friday, health officials in B.C. released modelling that showed the province’s rate of increase in cases had dropped from about 24 per cent to 12 per cent.

B.C.’s health officer, Dr. Bonnie Henry, said the results left her feeling “cautiously optimistic” about the future.

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Tam noted, though, that Canada is a “big country” and different regions are experiencing different timing of the pandemic, with different periods of acceleration and deceleration.






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Dr. Suzanne Sicchia, an associate professor at the Interdisciplinary Centre for Health and Society at the University of Toronto Scarborough, said this week and next are important because they will give health officials a “better sense of whether the measures we’ve taken to flatten the curve have been effective and to what degree.”

“To these ends, the experts will be watching to see if there is a decrease in the rate of new, confirmed cases,” Sicchia wrote in an email to Global News.

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She said health officials will “no doubt” use this evidence to inform the ongoing public health and health-care responses to the virus.


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Dr. Jeff Kwong, an infectious disease specialist and associate professor in the department of family and community medicine at the University of Toronto, told Global News that based on mathematical models and what we know about the virus’s incubation period, this would be the week many may begin having symptoms.

“It’s going to be this week or the next week that we’re going to see a wave of people who are really sick,“ Kwong said.

Kwong said this has already begun, with hospitals across the country already treating patients infected with COVID-19.

But he said what we have seen so far is just the “tip of the iceberg.”






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“We know there’s lots cases out there — most are mild — but how many of all these cases are going to be severe?” he said. “That’s what we’re going to start to see this week.”

On Monday, Tam said 6,671 cases of COVID-19 had been confirmed in Canada.

Of those cases, Tam said approximately seven per cent require hospitalization, three per cent are critically ill and one per cent of cases have been fatal.

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Tam cautioned, though, that these rates could fluctuate as more cases are reported.


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According to Kwong, this week will also provide important insight into whether Canada needs to implement more stringent physical distancing measures.

He said if Canada sees fewer cases of COVID-19 than modelling has predicted, it will show that Canadians have done a good job.






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If there is a dramatic spike in cases this week, Kwong said more stringent measures may be justified in order to prevent the health system from “collapsing in another three to four weeks.”

“I hope it does doesn’t come to pass, but, you know, it’s hard to say,” he said. “I mean, who knows what’s going to happen?


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Asked about the data from B.C., Sicchia said it is “promising,” but that we need to be “very cautious in making any definitive claims and even more so when it comes to generalizing these findings to other provinces.”

She said, though, that if the trend continues in B.C., we will know that we have been effective in flattening the curve in that province, and “that bodes well for us all.”

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But Kwong said regardless of whether the rest of Canada sees encouraging results, the country “can’t afford to let up on physical distancing.”

He said it is likely the measures will need to stay in place “for months.”

© 2020 Global News, a division of Corus Entertainment Inc.

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In Canada and abroad, COVID-19 super-spreaders could be anywhere – CTV News

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TORONTO —
You may have heard of “patient 31” in South Korea, a woman who was thought to be the source of thousands of COVID-19 infections in that country. Or more recently, a man in India who had returned from Europe and reportedly infected people in more than a dozen villages. They are known as “super-spreaders” – individuals who can infect a large number of people easily.

The World Health Organization estimates someone with COVID-19 can infect between 2 and 2.5 individuals, but super-spreaders infect a large number of people, often in a crowded and busy environment like a church or a conference.

“In a weird way, that seems to be the pattern for this disease. It’s not just that it spreads universally across the landscape,” said CTV News’ science and technology specialist Dan Riskin.

“You get these hot spots where a whole bunch of people get infected at once, and when that happens you can call that person a super-spreader.”

In Canada, while no specific individual has yet been identified as super-spreader, there have been clusters, or hot spots, from coast-to-coast involving a significant number of people.

More than 60 cases of the 135 cases identified in Newfoundland and Labrador are tied to two wakes held at a funeral home on March 15. The funeral home has since been closed as the investigation continues.

“Many of our numbers right now are related to this one cluster, either directly or indirectly, and that will have an influence on what we see,” Dr. Janice Fitzerald, the province’s chief medical officer of health told reporters over the weekend, when asked when she might expect to see cases peak in the province.

On the other side of the country, up to 32 people infected with the virus could be tied directly or indirectly to the Pacific Dental Conference held in Vancouver earlier this month, according to the province’s medical health officer, Dr. Bonnie Henry. One of those attendees has since died.

Some of the factors that can make a patient a super spreader may be related to biology – if they produce more of a virus, for example, or if they take longer to recover from an infection and spread the virus over a longer period, according to experts.

Historic research showed that Mary Mallon, a cook in New York City infamously known as “Typhoid Mary”, was the source of a typhoid fever outbreak in the early 1900s that infected thousands, despite never having any symptoms herself. Scientists are researching how much of a role silent carriers of COVID-19 – those who exhibit no symptoms – play in unknowingly spreading the disease.

This is why self-isolation is important, Riskin said.

“It’s a reminder that for Canadians, we all have to take this seriously, because you don’t know if you’re that one person who unknowingly could infect thousands.” 

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