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The question: COVID-19 cases are on the rise in different parts of the country and it looks like a second wave of the pandemic might be under way. How bad could it get?

The answer: In some ways, we are in a better position than we were in February, when the first Canadian case was identified.

Since then, the medical community has learned a great deal about the novel coronavirus that causes COVID-19.

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We now know that wearing masks, keeping two metres apart and proper hand washing can substantially help prevent the spread of the illness. Further, public health officials have had time to set up testing centres and create contact-tracing processes to keep on top of outbreaks.

However, many experts on infectious diseases are concerned a significant and prolonged surge in cases could overwhelm testing and tracing systems. Long lines are already snaking around COVID-19 assessment centres.

Cold and flu season will be an added challenge, says Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

“Seasonal respiratory viruses can produce the same symptoms as COVID-19, and while we normally don’t test for these viruses in the community, this year we are going to have to sort them out,” Leis says. “That will put added pressure on our testing capacity.”

To further complicate matters, winter is coming. That means people will head back indoors, where it’s easier for the illness to spread. The virus is transmitted through respiratory droplets from an infected person coughing, sneezing and talking. At least during the summer, folks could gather outside and a simple breeze might be enough to prevent the droplets from reaching another person.

But possibly the most troubling trend is that many people are showing signs of pandemic fatigue.

“This has been going on for months, and they are just tired of it,” says Dr. Janine McCready, an infectious-diseases specialist at Michael Garron Hospital in Toronto. If people let down their guard, they could increase their likelihood of catching the virus and spreading it.

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During the first wave, many were willing to heed the advice of public health officials.

“In the beginning, there was a certain sense of terror in the population,” says Dr. Matthew Muller, medical director of infection prevention and control at Unity Health, a collection of medical centres in Toronto.

“When people were told to stay inside, don’t go out, they really listened. On the news, you would see pictures of highways with no cars during rush hour.”

Government measures to close schools in the spring and curtail certain business activities also slowed the pandemic.

McCready noted that many of those originally infected included front-line service workers and people who lived in multi-generational homes where it’s difficult to self-isolate. Older adults living in close quarters in long-term care homes were also vulnerable.

“People who were able to stay at home didn’t have to risk exposure,” McCready says.

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With students returning to school and many sectors of the economy reopening, “infections will become more widespread across communities,” she predicts.

And if a second wave emerges from these cases, governments will likely be limited in their ability to introduce sweeping control measures, Leis says.

He thinks there is neither the public support nor the political will for another major lockdown. Schools, widely considered an essential service, need to keep operating. So government interventions will probably be aimed at specific areas and limited in scope.

“These smaller-scale measures may not be as effective in rapidly reducing community cases as we saw with the lockdowns in April and May,” Leis says.

Problems could arise if testing can’t keep pace with increased demand. A person is infectious two days before symptoms develop, and for up to 10 days after becoming ill. So, it is crucial to get test results quickly.

Muller points out that the health-care sector still hasn’t recovered from the disruption of the first wave. The backlog of delayed operations and screening tests is huge. A second wave would probably add to waiting lists.

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Even so, a big second wave isn’t inevitable, says McCready, adding, “it all depends on human behaviour.”

With continued vigilance, and adherence to proven prevention measures – such as proper mask wearing (over the nose and mouth) and physical distancing – the number of new cases can be curbed.

And getting a flu shot would help to minimize influenza cases, which can be confused with COVID-19.

But, the question is, do we have the collective will to do what’s necessary?

Paul Taylor is a Patient Navigation Adviser at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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