Ripple or tsunami? Experts reflect on how fourth wave will hit Quebec

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The fourth wave of COVID-19 expected to hit Quebec this fall won’t resemble the last three, experts say. It will race through the unvaccinated, potentially peaking quickly and leaving long COVID in its wake.

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“I think it’s very clear that another wave is coming, the question, though, is will this be a ripple or will this be a tsunami?” said Dr. Donald Vinh, an infectious-diseases specialist and medical microbiologist at the McGill University Health Centre. “There will be an increase in community cases, but will there be an increase in the people who need to be hospitalized or require ICU, or will there be an increase in deaths?”

Following an uptick in daily case numbers last week, Premier François Legault acknowledged the beginning of the fourth wave in the province, dubbed “the wave of the unvaccinated” by Health Minister Christian Dubé. In Quebec, “the unvaccinated” largely refers to younger age groups — including those who choose not to get vaccinated, those who might not have found the time, and children, who are not yet eligible for the shot.

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“The elephant in the room is that no child less than 12, really, has been vaccinated, and so are these children sitting ducks for what happens in the next two months? And the answer is yes, that’s definitely a concern,” Vinh said. “When the Delta variant sort of spreads through the community of vulnerable people, what will that look like?”

So far in Quebec, hospitalizations and deaths have remained stable despite an increase in daily case numbers. Dr. Matthew Oughton, an infectious-diseases specialist at the Jewish General Hospital, said the uptick in hospitalizations that will occur within unvaccinated groups during the fourth wave — while less significant than in previous waves — could potentially put pressure on regional health-care systems.

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“In those groups that are not as well vaccinated, there’s where you’re going to see more cases that will be severely ill and wind up requiring hospital care,” Oughton said. “If you had a large wave going through large population centres, and you still get a sudden regional surge in the number of people who are sick — and in that group, there’s going to be a proportion of them who are severely sick — that still to me risks local health-care access problems.”

“Every bed that you’re going to need to admit someone with severe COVID is still a bed that then is going to be taken away from someone else who might need it for something else,” he added.

Vinh said in some countries, after pockets of unvaccinated people have gotten sick — leading to absenteeism from school and work, and some people ending up in hospital — cases have started to plateau or decline.

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“Is that because of what we call circle immunity? In other words, in the pockets of people where there is Delta established, the ring around them is still mostly vaccinated and therefore it sort of peters out, creates dead ends? That’s one possibility,” he said. “Is it because people have gone back to doing distancing and masking?”

Though many Quebecers are now vaccinated, Prativa Baral, an epidemiologist and a PhD student at Johns Hopkins Bloomberg School of Public Health, says there will continue to be breakthrough cases in the province because the virus will still be circulating within the unvaccinated population.

“Part of that conversation has to of course include kids, because obviously kids are not eligible to be vaccinated right now,” she said. “The first thing we can do to protect them is to really lower the amount of virus circulating in our communities.”

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Another way to protect children is to maintain health measures both in schools and the wider community.

“I think it would be most prudent if we continue to enforce public health measures such as in-class distancing and in-class masking for the foreseeable future,” Vinh said. “We have to remember that the fact that our health-care system hasn’t been stressed so far by this is reassuring, that doesn’t mean we should push the envelope and see how far we can stretch it before we have to do a shutdown again.”

Though fewer people will be affected by the fourth wave, experts remain concerned about those who will. There is still much we have to learn about COVID-19 and its variants, Oughton said.

“Even if you don’t get severely sick, we know that people can have long COVID,” he said, adding that an estimated 10 to 30 per cent of the population seem to experience lingering symptoms, depending on the data. “We still don’t know everything about the very long-term consequences of infection — whether there are long-term consequences and if so, what they’re going to be.” 

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