1) Despite the decline in #COVID hospitalizations and deaths in Montreal, the city’s top public health officer warned this week that what keeps her up at night is the prospect of a second wave. In this thread, I will try to explain how a second wave could very well occur.

2) First, let me applaud Dr. Mylène Drouin, @Santepub_Mtl, for the courage to speak out against the mishandling of the #pandemic by Premier @francoislegault, who stubbornly chose to run things from Quebec City. I'd also like to praise @LP_LaPresse for its bombshell report today.

3) It was Dr. Drouin, and not @ArrudaHoracio, Quebec’s chief health officer (often seen with the Premier), who worked hard to bring under control Montreal’s measles outbreak in the spring of 2019. She’s smart, works hard and is very progressive.

4) It was Dr. Drouin who also last year proactively developed a plan with the city of Montreal to reduce the impact of heat waves on the elderly population. One wonders what might have happened with the #pandemic in Montreal had Drouin been given all the resources she needed.

5) Earlier this week, Dr. Drouin responded at a news conference to a question of mine about what keeps her up at night. Her reply: a second #COVID wave that could strike the city in November at the start of the flu season. But I’m worried about a possible wave even before then.

6) Let me first share some of the progress that Montreal has achieved to date in the #pandemic thanks to the confinement measures and collective efforts of Montrealers in maintaining #PhysicalDistancing — progress that we can’t afford to squander.

7) The orange line in the chart below shows the city reported its lowest number of #COVID cases on Friday. It’s now taking 31 days, a full month, for the incidence to double in Montreal — a heartening sign the epidemiological curve is flattening.

8) Meanwhile, the number of #COVID deaths continues to trend downward in the metropolis, as the dark blue line in the chart below shows. It’s now taking 26 days for the mortality incidence to double, almost a month, another welcome trend.

9) Provincially, the number of #COVID hospitalizations has dropped by 280 from May 19 to May 28. The number of active #COVID cases in long-term centres and seniors’ residences in Montreal decreased in a single day by 168 to 2,316 on Friday.

10) Quebec surpassed its daily testing target on Wednesday (there’s a two-day lag in reporting this), completing 14,743 #COVID analyses. Although some asymptomatic Montrealers are being tested, the public health department needs to follow Calgary's lead in asymptomatic screening.

11) Amid the progress, there are warning signs. The city’s hospital infrastructure — especially emergency rooms — is overwhelmed, a subject I have reported on extensively. And there are at least three neighborhoods where community #COVID transmission looks to be on the rise.

12) The public health department released a chart earlier this week (see below) showing #COVID transmission at the community level — that is, outside of institutions. We must pay attention to Villeray-Saint-Michel-Parc-Extension, Saint-Laurent and Ahuntsic-Cartierville.

13) Over the past two days, Ahuntsic-Cartierville has observed 47 new #COVID cases, Villeray-Saint-Michel-Parc-Extension 53 and Saint-Laurent 26. This may result from ramped-up testing in these areas, but the increases also call out for greater vigilance.

14) On Thursday, the Institut national de santé publique released its latest #COVID projections. As the chart below shows, the INSPQ is warning of a possible second wave of hospitalizations in July and August if there is weak adherence to confinement measures.

15) Many Montreal stores have been open since Monday. People are gathering in groups greater than 10 in parks with little #SocialDistancing. On June 15, hair salons reopen. I’m worried what keeps Dr. Drouin up at night might happen sooner than November. End of thread. Stay safe.