Quebec's second wave driven by community transmission, muddled messaging, expert says

MONTREAL — Quebecers following the COVID-19 news in recent days may be feeling a certain sense of deja vu.

The government has been announcing 700, 800, even close to 900 new cases per day — numbers not seen since the first wave of the pandemic swept through the province this spring.

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And on Monday, after a summer of relative freedom and encouraging news on case counts and hospitalizations, the government ordered its largest cities to return to a kind of modified lockdown, closing bars and restaurant dining rooms as of Thursday and telling people not to invite anyone to their homes, with few exceptions.

In just over a month, government leaders went from describing the province's situation as "one of the places where COVID-19 is best controlled in the world" to "critical."

The reversal highlights both the virus's ability to spread silently and the Quebec government's failure to get one step ahead, according to one expert.

"I think of it a bit like a fire, but it's an invisible fire that's been burning, and it's been gradually building and building," said Matthew Oughton, an assistant professor in the department of medicine at McGill University.

The province's public health director, Horacio Arruda, has said transmission during the second wave is largely occurring in the community, fuelled by private gatherings and a relaxing of safety measures such as physical distancing and handwashing.

"We forgot," Arruda said at a news conference on Monday. "We wanted to act like COVID-19 was no longer there, but it's there."

At the same news conference, Premier Francois Legault announced that three regions, including Montreal and Quebec City, were being put at the red, or maximum COVID-19 alert level for a 28-day period in an effort to "break" the second wave.

He said the new measures, which include closing museums, libraries and bars but leaving stores and schools open, was to limit instances where people can have "prolonged" contact of more than 10 minutes together.

"It's true that Quebecers like parties, and it's a good thing we like parties, but we have to make an effort," he said.

Oughton, an infectious diseases specialist, said the virus had been spreading throughout the summer, even when case numbers seemed low.

The pandemic appeared under control because the main spreaders were young, healthy individuals who were less likely to seek medical attention, he said.

"What a highly contagious virus does is it spreads, and it starts slowly but it gets faster and faster and faster," he said in a phone interview.

"And usually by the time it gets to the point where you're aware of the problem, it's already not only increasing linearly, but exponentially."

Some 50 per cent of new recent cases have been found in people age 30 and under. But Oughton said the virus eventually spreads to more vulnerable groups, causing a delayed effect on hospitalizations and deaths.

While the rise in cases has roughly corresponded with the opening of schools, Oughton believes the rise in transmission began earlier.

Currently, there have been confirmed cases in 443 schools, according to government data, but Oughton says in most instances the cases appear to be scattered, suggesting they originated elsewhere.

"I think the fire was already lit, but it was under the radar screen because the population that was spreading it is not the population that would give a lot of red flags unless you're very actively looking for it," he said.

While Quebec is once again Canada's pandemic hot spot, Legault noted that the province is hardly the only place to have a resurgence in cases, nor to reimplement some of the restrictive measures from the spring.

"We will have to open at some point, look at whether we can regain a bit of normal life, then if there's more, or if there is less collaboration from the population, well, we'll have to return backwards," he said.

"But it's a fragile balance and it's like that in most countries."

While Legault rejected blame, Oughton believes the Quebec government's failure to send a clear message contributed to the current situation.

Government messages to reduce contacts and not gather often came across "like a suggestion" rather than a rule, he said, and before Monday, the government had not yet clarified what measures would be taken at each alert level.

He also believes the government needs to quickly adopt a contact tracing app, which it has agreed to do in the coming days, as well as impose mask-wearing in classrooms in order to prevent future transmission, which it has not.

While he supports the government's decision to impose new restrictions, Oughton believes many measures could have been taken earlier.

"That being said, it's better to act today than next week," he said.

This report by The Canadian Press was first published Sept. 30, 2020.

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