Is Canada ready for the second wave of COVID-19?

Vogel examines Canada’s preparation for a second wave of the coronavirus disease 2019 (COVID-19) pandemic.1 As restrictions ease, patients with chronic diseases are contacting physicians to inquire when they can return to work safely. Employers are posing similar questions. There is a consensus among many physicians responding to these questions: there are no answers. Few formal return to work recommendations focus on people with chronic diseases.

In our experience with patients with lung disease, the decision to return to work is compounded for two reasons: they may be at greater risk of acquiring COVID-19 or experiencing adverse outcomes if infected. Data suggests a lower-than-expected prevalence of COVID-19 in those with asthma and COPD, but it is unclear whether diseases like pulmonary fibrosis, cystic fibrosis or cancer put patients at higher risk of infection.2 One meta-analysis found an elevated odds ratio for developing severe COVID-19 in people with lung disease.3 With a return to routine social practices in the fall, finding strategies to get patients back to work safely will be vital.

The pillars of preventing workplace disease transmission will undoubtedly rest on principles of masking, hand washing, physical distancing and staying home when ill. These measures are inexpensive and adaptable to most settings. Beyond this, return to work plans could stratify people by age, disease severity and occupation. As older age is linked to worse outcomes, young people might return sooner.3 Due to lack of evidence, disease-specific advice remains limited. The Canadian Thoracic Society (CTS) recommends patients with asthma work from home.4 If those with severe asthma cannot do so, they should remain off work until social distancing is not mandated.4 The CTS recommends patients with COPD stay home as much as possible.5 These proposals are based on expert opinion and past experience with influenza outbreaks. Moreover, while essential workers may be at increased risk of acquiring COVID-19, people employed in industries like retail, hospitality and transport likely are too.1,4 Studies assessing exposure risk in non-healthcare settings are needed.

Medical societies must translate data to make disease-specific return to work recommendations. The CTS is on the mark to use flexible statements that are updated regularly. As evidence builds, guidance may be more targeted. For example, patients might be stratified more precisely by pulmonary function test results.

Physicians are best positioned to provide personalized guidance to patients. Recognizing there is a paucity of good data, some uncertainty will be inevitable. However, more professional consensus will empower physicians to offer the most evidence-informed advice and advocate for patients to receive needed accommodations. Until the pandemic wanes or a vaccine is available, physicians will share responsibility for deciding when and how people with chronic diseases should return to work.