As Saskatchewan residents are praised for their success in flattening the curve of COVID-19, doctors and public health experts are reminding the public there is a new next task at hand: avoiding a second wave that could be worse than the first.
"If the public behaviour changes so much back to what it was pre-virus then all we've done is delayed a massive second wave by a few months and no system can be prepared enough to handle that," said Dr. Cory Neudorf, a professor of community health and epidemiology at the University of Saskatchewan.
Dr. Neudorf is one of several medical health academics and doctors warning that complacency could lead to a surge in new cases.
Second wave usually worse: doctors
Dr. Sandy Buchman, the president of the Canadian Medical Association, raised concerns last week about the Canadian health-care system being unprepared for a second wave.
"This second wave is inevitable," said Buchman.
"Every pandemic in recorded history has shown a second wave and it's usually been worse when it's allowed to proceed unimpeded."
Buchman said it is encouraging to hear Saskatchewan specifically has expanded its criteria for access to testing. Starting May 25, anyone who works outside the home can be tested if they want to.
"Hopefully a lot of people will take up that offer because it's a good one to get the information that we really need to open up," said Buchman.
Testing is also available to acute care patients, people who are immunocompromised, health-care workers, homeless and vulnerable people, and people in high-volume work settings like factories.
Buchman raised the notion of using modern technology to do contact tracing, but said privacy and confidentiality issues would need to be addressed.
"Until we get that and have those conversations and work that out, it's important to get literally armies of contact tracers out there doing manual tracing to be able to determine where the disease is, where the outbreaks are happening, contain it and nip it in the bud," said Buchman.
He said lessons can be learned from Saskatchewan having contained an outbreak in the far north region while the rest of the province reopens, but that it is concerning that more data about how the virus is affecting Indigenous people is not available.
"People in Indigenous communities, in more remote and rural locations — they don't have the privilege of physical distancing," said Buchman.
"Many people are living together in one dwelling and so to really, again, nip it in the bud, we need to understand how prevalent it is in those communities that are a particular risk."
Preparing for a possible surge
Dr. Allan Woo, the president of the Saskatchewan Medical Association, said doctors are anxious about what comes next because there are still so many unknowns about the virus.
Woo agreed there will likely be a second wave.
"I know that the health authority is still trying to obtain more personal protective equipment in case the second wave is worse than the first," said Woo.
"If we look at what's happened with other pandemics, especially the Spanish flu, the second wave was worse."
Woo was the first person in the province to publicly self-identify as having COVID-19 after contracting it at a curling bonspiel event for physicians in early March. He was sick for 18 days.
He said Saskatchewan's response to COVID-19 has been "measured and appropriate," but he worries that Saskatchewan residents could underestimate the severity of the virus because they have not seen it personally.
"We need to be aware that just because we have achieved some success in the last two months that there is still a significant future ahead in terms of a risk for the system and to the population," said Woo.
"We can't let up."
Retesting needed?
Dr. Neudorf said now that more widespread testing is available, the next question is how frequently people will need to be retested.
"If you are continuing to see really low numbers of cases and we don't have much circulation of the virus in the province then what you are looking for is a change to that pattern," said Neudorf.
"If you are starting to see cases emerging in a certain geography or a certain work sector then you may want to be focused on testing in that sector more comprehensively, and perhaps more frequently."
Neudorf said early warning systems to alert authorities when there is an outbreak will be crucial, adding that there are concerns that people will begin to feel a false sense of security when numbers are lower.
He said Google Analytics is already showing upward trends in people's mobility.
"To the extent that we have actually knocked the virus down, we can get away with that for a while, but all it takes is a little bit higher circulation in the population and those same behaviours are going to lead to the same thing that [led to] the first wave," said Neudorf.
Search to find best outbreak indicators
Neudorf said work is underway in Canada and around the world to identify the best early indicators that an outbreak is starting.
"Other than the blunt measures we used at the beginning, which is how many people are turning up in ICUs or needing hospitalization," said Neudorf.
"If you get to that point it's too late already."
When those indicators are identified, he said it will be important to share that information with the public.
Neudorf said serological testing will shed more light on the way the virus spreads, but that will take time.
He said some preliminary results from work being done by the provinces may be available soon.
"That will give you a better idea of how many people have had it and therefore how many people are still susceptible and, among those who've had it, how many are immune," he said.
