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People lineup at a COVID-19 testing site on Sept. 25, 2020 in St. Lambert, Que.Ryan Remiorz/The Canadian Press

A second wave of the coronavirus pandemic has hit Quebec, its director of public health announced this week, with cases trending sharply upward since the beginning of September.

But Canada’s hardest-hit province is not experiencing a bout of déjà vu: this wave is fundamentally different from the first, according to health officials. They are pleading with Quebeckers to help them make it less deadly.

Three key differences distinguish Quebec’s spring and fall waves. Today, explained Health Minister Christian Dubé in a press conference this week, the virus is spreading in regions outside the former epicentre of Montreal; it is spreading mainly in the community, rather than in long-term care homes; and it is spreading more among young adults, not the elderly.

The new dynamic is leaving parts of the province newly on edge. The sleepy Baie-des-Chaleurs health region in far eastern Quebec has one of the highest infection rates in the province.

Brian Lipson, a lawyer in Quebec City, said the province’s second wave feels novel to him in some ways.

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“We didn’t have a first wave of community transmission here,” he said. “In the spring, we were over here and looking at Montreal and looking at New York and they were digging pits. And we were seeing outbreaks only in long-term care facilities. … So it was really removed.”

The mayor of nearby Lévis, Que., Gilles Lehouillier, is trying to manage a delicate balancing act, urging residents to limit social gatherings while supporting local business, requiring a finesse that wasn’t needed in the depths of lockdown.

“We need exceptional co-operation from the public,” the mayor said. “Our freedom of movement depends on how we behave.”

People move along Mount Royal Avenue in Montreal on Sept. 23, 2020.Ryan Remiorz/The Canadian Press

With the exception of a few dense, low-income neighbourhoods in Montreal, the province was largely spared mass community outbreaks in the spring. Rather, COVID-19 devastated the province’s long-term care homes, where it has killed nearly 5,000 people.

New cases are not mainly coming from schools, either, as many feared when Quebec launched an aggressive restart plan that required in-person attendance with rare medical exemptions. Almost 500 schools in the province have seen at least one case of the virus, according to government figures. But Public Health Director Horacio Arruda told journalists on Friday that cases in schools were a reflection of community spread rather than its cause.

Instead, officials have emphasized the damage done by large social gatherings, some of which have become notorious, such as the Quebec City karaoke night in August that has now been linked to more than 80 cases.

On Friday, Mr. Dubé, the Health Minister, asked Quebeckers to avoid social gatherings for 28 days in order to “break” the virus’s second wave.

“It’s our choice to avoid these outbreaks," he said earlier this week. "And to avoid outbreaks, stay home.”

This wave does offer one silver lining, for now: Since young people are less likely to develop serious symptoms from the virus, fewer cases on average are being sent to the hospital. The province’s hospitalization rate during the first wave was about 13 per cent. The rate was down to just 5 per cent from Aug. 10 to Sept. 6 and is expected to continue falling, according to projections from Quebec’s institute of excellence in health and social services (INESSS).

But the young will eventually infect the old, causing hospital stays and deaths to mount, researchers warn.

“If I’m young and I get COVID, I transmit to people my age, but eventually it percolates to people of all ages, and that’s when we see hospitalizations,” said Mathieu Maheu-Giroux, a public-health researcher at McGill University who worked on the INESSS projections, during a technical briefing this week.

The message of caution has not broken through to everyone. Juliette Brun, founder of the restaurant chain Juliette et Chocolat, said that her young employees and customers are most resistant to public-health measures and most likely to socialize outside of their bubbles.

Patrons are separated by plexiglass sheets on the first day after COVID-19 restrictions were lifted in Montreal, on June 22, 2020.CHRISTINNE MUSCHI/Reuters

“That’s why it’s going to be mostly young people this time, because they don’t understand the risk,” she said. “They’re the hardest to work with, or to tame.”

Martin Reisch, a photographer and videographer who lives in Montreal, said the lack of physical distancing and mask-wearing he sees on the streets of his neighbourhood brings to mind “the worst of the term, ‘back to normal’ … It definitely doesn’t feel like people are buckling down for a second wave.”

Government mixed messages seem to have contributed to public lassitude about the pandemic’s resurgence, as well. The head of a major Montreal health network, Lawrence Rosenberg, said COVID-19 “probably isn’t much more dangerous than the seasonal flu” during a TV interview earlier this month, prompting the Health Minister to denounce the remark as “erroneous” and “inappropriate.”

But Mr. Dubé sowed confusion himself this week when he suggested the government would consider allowing police to enter private homes without a warrant to enforce public-health regulations, a comment the deputy premier Geneviève Guilbault had to disavow at a news conference the following day.

Meanwhile, the government has acknowledged it is having trouble tracing the contacts of COVID-19 patients after declining to use the federal government’s contact-tracing app and abandoning plans to develop its own.

Scarred by the disaster in long-term care this spring, Premier François Legault’s government has also reinforced the province’s badly understaffed homes by hiring 8,000 orderlies and vowing to place a dedicated manager in every facility.

But Quebec continues to brace for a grim fall, with a new phase of the pandemic bearing down, and the self-discipline of its citizens in the spotlight.

“Avoid your friends,” Mr. Dubé urged this week. “If we continue like this, we will hit a wall.”

With reports from Les Perreaux

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