Ask the Pharmacist

Q. It looks like our area did not have many cases of the coronavirus. Do we need to still be concerned about a second wave of the pandemic?

A. Our community surely has had fewer cases than what was anticipated proving that enacting the State of Emergencies in the municipalities and the provinces which threw everyone into a lockdown type situation certainly paid off.

There are, in fact, some who believe we have done almost too good of a job, if such a term is indeed possible. They are of the opinion that we have reduced our caseload to such an extent that we are now simply prolonging the shutdown.

This theory is based upon the principle of achieving herd immunity. Herd immunity occurs when a large enough percentage of a population has become immune to an infection (whether by being previously infected or vaccinated against that particular bug) that the disease essentially “peters out” due to the fact that there are so few susceptible people left to infect. In other words, by having so many people around who are immune to the disease, we indirectly protect those who haven’t yet contracted the infection (or who cannot be safely given a vaccine in some immune suppressed individuals) as there is, in theory, no one in their immediate environment who can infect them. We’ll go into greater detail next week on this particular topic.

As for the “second wave”, remember in early March when we were seeing this coronavirus first “hit” our country how judicious most of us were at staying home whenever possible, practising socially distancing and regularly washing our hands. Are you still washing your hands frequently? And for the suggested 20 seconds? That was great but humans are social beings by evolution and it is difficult to keep everyone locked up for too long.

Now, three months later, many of us are suffering from “quarantine fatigue” and have relaxed our behaviours immensely. Combine this with the lifting of restrictions where more and more people are out and about within the community (perhaps getting that much needed haircut!) and also driving to other towns to visit family, friends, attending long awaited medical appointments and/or shopping, we just might be setting ourselves up for another rise in Covid-19 cases.

Do we need to be worried about a second wave of the virus? Will it be worse than the first? Nobody can say for certain. It is a novel virus meaning that everyone is learning about the pandemic as it evolves. Recall how the information we were learning was changing daily in the beginning of the pandemic (e.g. see early recommendations about travel restrictions, the wearing of masks…).

Considering we have yet to achieve herd immunity, develop a vaccine and/or perfect contact tracing, there is the potential for a second wave of the pandemic to hit. Historically speaking, second waves in pandemics occur only sometimes.

Looking at our contemporary history, for which we have the most accurate data, there have been 10 pandemics dating back to the one that appears to have originated in Russia in 1889. Of these 10, 5 pandemics have been described as having a second wave (or more). In some cases, such as the 1889 pandemic and the infamous “Spanish flu” of 1918, the second wave was significantly more deadly than the original.

In the 1957 pandemic, the mortality rates of both waves were roughly the same. So, the chance of a second wave is there and it may well be severe. The odds of this occurring are compounded by our new “old” habits. As we stated earlier, more people are out and about shopping, visiting hair salons, going to patios for food/beverages etc. which we need for both our mental psyche and to keep our neighbours employed.

It feels good to go visit your favourite store that has just reopened and support a business that has been closed for months. All of these interactions however, do come with a risk which is further complicated by the lack of concrete data on this novel virus.

The elderly, those with compromised immune systems or those taking immune suppressing medications may have (and in fact should have) a lower tolerance for risk compared to someone who is young, healthy and needs to keep their job which may not be able to offer a “work from home” option.

It is also important to bear in mind that your comfort level may be very different from others who are at the same “risk level” as you, and that is okay. To reiterate, we do not know for a certainty just which behaviours are a problem and what should be fine. But there are general guidelines, that if followed as our economy opens up, are likely to keep most of us relatively safe.

Apart from keeping yourself at home without any interactions with the external world, the lowest risk situations include activities that are outside (such as a park) where the 2 metre social distancing protocols can be easily maintained.  The extreme high-risk situations include crowded indoor activities that do not allow for appropriate social distancing such as concerts and sporting events.

Since most functions that encourage crowds have been either canceled or postponed, with the exception of the impromptu protests and, of course, Donald Trump’s campaign rally scheduled for an indoor arena, most activities fall into the moderate to high risk category.

To help quantify this, epidemiologists were asked to rate everyday activities on a scale of one to five (with one being the lowest risk of becoming infected). Activities deemed to be at the moderate risk level include going shopping (2.5), returning to the office (2.6), visiting an elderly relative (3.2), getting a haircut (3.4), going to a restaurant (3.4) and going to an indoor dinner party (3.8). Higher risk activities include sending your child to summer camp (3.9) and riding public transport (4.1). Obviously, all of these activities can vary widely in the degree of risk they contain but this list at least gives you an idea of what the experts are currently thinking.

To reduce the risk of a second wave and thereby avoid another full or partial shut-down of our economy, it is important to participate in activities according to your own individual risk level. It is even more important that as you re-engage in some of these activities that you further reduce your risk of an infection by trying to maintain a 2-metre distance from others. Masks are also strongly encouraged, although they are not yet mandatory at this time in most settings. However, if we all wore one during close encounters, it would go a long way towards keeping everyone safe! And of course, don’t forget to wash those hands or sanitize frequently.

Lastly, if you do feel unwell, then call your nearest Covid-19 testing centre and STAY HOME! So, to answer if we need to be concerned of a second wave, the answer is nobody can say for sure. But it sure does look as though, if we do not act in a safe manner, there could be another influx of infections that some experts predict could be even worse than the first. For more information on this or any other health topic, contact your pharmacist.