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Numerous provinces are seeing an increase in COVID-19 cases. What needs to be done now?

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A resurgence in coronavirus infections in several provinces in recent weeks has raised alarms about current disease control measures and what steps need to be taken to curb the spread of the virus.

BC, Alberta, Manitoba, Ontario and Quebec have all reported a clash of cases during September, and some have suspended their reopening plans as a result.

Those under the age of 40 are spurring the spread in most provinces. In Ontario, health officials have identified smaller meetings, inside, as the culprit. Young people may also work in precarious jobs when their exposure has increased, or where illness days may not be available.

Officials will need to determine which reopening policies should be reinstated and which to maintain, in cases where cases pass. These choices will have to be made quickly, infectious disease experts told CBC News.

“In the pandemic, it’s all about the speed of response,” said Dr. Matthew Oughton, an infectious disease specialist at the Jewish General Hospital and assistant professor at McGill University in Montreal.

“The slower you are to something that spreads and expands exponentially, dad and the farther you will go.”

CBC News spoke to experts in the region who are seeing huge increases in cargo in Alberta, Ontario and Quebec about what needs to be done immediately in order to keep COVID-19 case numbers as low as possible.

‘Tough decisions’ for keeping businesses open

Alberta is starting to see a similar load to Ontario and Quebec, which is troubling as the prairie province has a much lower population, said Dr. Stephanie Smith, an infectious disease expert at the University of Alberta in Edmonton.

For the first 15 days of September in Alberta, the province reported an average of 137 new cases of COVID-19 per day. This is from an average of 88 cases for the same period in August, which means that cases have increased by about 55 percent in the last month.

The province is also facing the widespread COVID-19 community outbreak, rather than the disease appearing in some specific hotspots, as an institution of long-term care, Smith said.

While part of the increase in Albertacases could be attributed to more testing in September, with over 30,000 people tested daily, these jumps in case the count is still troubling, Smith said.

LOOK | How will a ‘second wave’ of coronavirus cases be treated?

Infectious disease specialists answer questions about a second wave of COVID-19, including when it may strike and whether the growths should be treated differently from the first wave. 7:57

“If there are steady, growing cases, I think public health will have to make tough decisions to see if we need to close certain types of businesses,” she said.

“It makes it more challenging for public health because there is a great reluctance to go back … when it is so detrimental to the economy.”

Targeted information about public health measures should be provided to young people and those facing health inequality in urban centers, Smith said.

“Each individual public health unit needs to determine where they are looking at cases and determine the best steps toward trying to mitigate those growing numbers,” she said. “It depends a lot on the specific demographics.”

Large indoor meetings should stop in Ontario: professor

As Ontario continues to report an increase in coronavirus cases, the province plans to reintroduce public health restrictions on residents.

Ontario has seen an average of 184 cases per day for the first 15 days of September, compared to 90 cases per day for the same period in August. This amounts to a 104 percent increase in reported infections, month after month.

On Wednesday, the Ford government announced that boundaries at social gatherings would be enforced in some regions. Ontario has taken a stage approach to the pandemic since March and allowed changes to the reopening plan depending on the occasional load in a particular region.

LOOK | Ontario addresses the private sector to address long lines at test centers:

Health Minister Christine Elliott told reporters the province has received reports of “significant formations in many parts of Ontario” at COVID-19 testing centers. As Chris Glover explains, the Prime Minister is negotiating with private pharmacies to intervene to help. 2:39

The source of the impact on COVID-19 cases is being run by young people in Ontario, as some have begun to return to university campuses, said Gerald Evans, an epidemiologist at Queen’s University in Kingston, Ont.

And an increase in infections within that demographic age is in line with what has been reported in other countries, such as Austria, France and Spain, he said.

While young people tend to have less serious infections, there is no guarantee that the virus will not spread to more vulnerable groups.

“We know from heat maps from many countries where you see ever-increasing numbers at that age demographic, is that it appears in the general community … and in the elderly,” he said, adding that this would also affect children and school staff.

The Ontario government should also look at restricting some businesses that opened in Phase 3, such as limiting strip hours and stopping events like indoor weddings, Evans said.

The hardest hit neighborhoods need extra support

Neighborhoods that carry the COVID-19 burden in urban centers like Toronto need more targeted support as cases increase, said Arjumand Siddiqi, an associate professor at the Dalla Lana School of Public Health and Canada’s Chair of Research on Equal Population Health.

LOOK | The highest risk neighborhoods for COVID-19 in Toronto require more support:

Data released by Toronto Public Health reveals that systemic inequalities have made high-density communities with low-income residents particularly vulnerable to COVID-19. 1:58

These neighborhoods, where more people of color live, are facing long-standing health inequalities that have been exacerbated by the pandemic, Siddiqi said.

Eighty-three percent of Toronto COVID-19 cases are black people and other people of color, according to July data from the City of Toronto.

Investing in land from these counties is required to keep people safe, she said.

“COVID is the umptenth health score to show an inequality because we never get into that conversation about what we need to do essentially to fix the fact that health care is unequally distributed.”

In the short term, that investment may seem like more isolation centers for those in high-density housing that have no space for distance, as well as better access and transportation to test facilities, she said.

Also, many people of color living in these areas are in low-wage jobs that put them at greater risk of COVID-19, Siddiqi said.

“Many low-wage jobs do not have sick leave. So providing this, and encouraging the kind of policies that would ensure that people can actually use their sick leave.”

Policing private, indoor rallies is a challenge in Quebec

Dr. Matthew Oaughton says cases in Quebec are “gaining momentum” in terms of community spread and that most cases are happening to a younger population.

The average number of cases Quebec reported in the first 15 days of September was about 204 per day, compared to 90 per day the province recorded for the same period in August.

“The main contributor doesn’t seem to be a big bang … but it seems to be much more of a community broadcast based on small gatherings of family and friends,” Oughton said.

LOOK | Cases climb in Quebec despite restrictions for months:

Quebec faces the highest rate of new cases per month despite businesses and government enforcing security rules. 1:55

If cases continue to rise in Quebec, “there is a real danger” schools will have to close, Prime Minister Franois Legault said at a news conference Wednesday.

“It’s too complex to see how we can implement a maximum of 10 [people in private gatherings]or social distance in every home in Quebec, “Legault told reporters.

While Oughton says he sympathizes with the challenges the government faces, he says the province has been “aggressive” with their reopening plan in recent months and was redundant, too fast.

“The Quebec government was very aggressive in getting children back to school. Their list of medical exemptions that would allow a child to stay home and do distance learning was very, very restrictive,” he said.

On Tuesday, Quebec reported at least 377 cases of COVID-19 across 223 schools.

“We do not have a well-established large-scale program for distance learning and it seems more and more if this trend continues that we will need it,” Oughton said.

Businesses like bars can be difficult to keep open as infections increase if keeping schools open remains a priority, he said.

“This is not enough. [COVID-19] it spreads exponentially and we have to be ahead of that, not constantly playing catch, “he said.

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