'COVID is making a comeback' in Quebec, says MUHC specialist

Many people have been able to enjoy the summer, while pushing away thoughts of the pandemic. This fall, however, there's been a rise in cases of COVID-19 in Quebec and there's new information about how the virus behaves now and should be managed.

Mutsumi Takahashi interviewed Dr. Donald Vinh, an infectious diseases specialist at the MUHC, about the COVID-19 landscape now and what to expect in the coming months.

This interview has been edited for clarity and concision.

Q - What is the situation right now with COVID-19 in Quebec and in Montreal?

A - Well, the situation in Montreal, and indeed, across the province and in fact, across the country, it's not very encouraging. In Quebec, in the first week of September alone, there were 127,000 confirmed cases of COVID. And during that time, there were also about 560,000 people who self-reported viral respiratory symptoms, but who didn't get tested.

Overall, the INSPQ estimates between 18 to 29,000 new cases daily. And keep in mind that these numbers are just an underestimate of what's actually going on. And they're also a few weeks old. But all this tells us that there's a significant increase now over what was happening in August. And over the same time, there's also been a doubling in the number of hospitalizations directly caused by COVID to now about 300 beds. So COVID is making a comeback.

Q - But how sick are people getting? Is there concern they will fill the hospitals again, because you're giving us all these numbers, but most of us would think that this is not happening.

A - Right. So that is the question that worries us as well. What will be the burden on the hospitals, right? Well, we know that the severity of acute COVID is definitely not what it was at the start of the pandemic, where people could rapidly go into fulminant respiratory failure or need the ICU. But people are still definitely getting sick. You know, otherwise healthy people are getting flu like syndromes where they have fever and sore throat and muscle pains. They can be debilitated for a few days.

There are still people with various underlying medical conditions who are getting fevers and pneumonias from COVID and require hospitalizations. I'm on call, I can attest to that directly. And if this number in this last group continues to go up, hospitals, but particularly those who have limited bed capacity, or who are understaffed, will have trouble providing care in the next few weeks to months.

Q - We keep hearing about the new variants. Now, what does that mean in terms of people who've already been vaccinated, people who've had COVID earlier? How much protection do we have?

A - So the current variant that's predominating, and problematic, is called EG.5.1, which is currently about 45 per cent of detected strains. This variant is concerning for the same reasons that we've talked about for previous variants. Firstly, it's more transmissible. This means that if someone is infected with it, they are very contagious, and they can easily spread it to others.

Second, although it is in the Omicron family, its mutations allow it to evade immunity for most previous variants. In other words, a previous COVID infection prior to say around May or June, that's when the EG.5 started becoming problematic, likely doesn't offer much protection against becoming sick if you're infected now. Now, although the risk of a life threatening disease is not as high, as I mentioned before, you can still get quite sick. And of course, there's always the risk of developing any of the complications from long COVID.

Q - So what's being recommended now in terms of vaccinations?

On September 12, Health Canada approved an updated COVID vaccine from Pfizer and Moderna And this targets the XBB.1.5 variant. Now, although XBB.1.5, and EG.5 are not exactly the same strain, they are within the same lineage. And studies show that this updated vaccine that's going to be available soon is effective, against not only EG.5, but other related variants that we haven't talked about that are also currently circulating. And with this updated COVID vaccine. NACI (National Advisory Committee on Immunizations) recommends that in the fall, which is just in the next few weeks, individuals who are six months of age or older and who have not had a COVID infection or vaccine dose in the last six months get this one. And it's strongly recommended for those who are in the high risk groups.

Q - And what about wearing masks? Is this something we should all be considering again?

A - In settings where there may be sick people, I would recommend it. In the hospital settings there are patients who may have COVID, who can transmit it to others. There are health-care workers who can spread it to patients or other health-care workers. And there are visitors who can bring in COVID and spread it to patients or health-care workers. And this can not only prolong a patient's hospitalization because, you know, they become sick but it can also make health-care workers sick and this leads to understaffing. So in that setting, I would definitely recommend wearing a mask.

But of course, sick people aren't only located in hospitals, right? Ideally, if you're symptomatic, you should stay home. And once you've recovered, you should wear a mask for five more days when you're out in public. But that relies on an honour system, which is not always predictable. So rather than having trust in a crowd, it may it'd be more prudent to just wear a mask around others.