Note: Data in the charts last updated on Sept. 23 at 9 a.m. EDT. (Some provinces include their weekend numbers in Monday’s data announcement.)

Just as they do with Canadian economics and politics, the Big Four provinces dominate the current COVID-19 statistics. British Columbia, Alberta, Ontario and Quebec account so far for an average of 96 per cent of Canada’s cases in September. In the week ended on Monday, those four reported 7,205 new cases. (In contrast, the other six provinces reported only 247, including a mere 22 in Atlantic Canada.)

What has changed since the spring COVID-19 crisis? The two westernmost provinces are amassing large numbers of cases. In April, B.C. accounted for just 2.4 per cent of the 45,623 cases that Canada reported that month, while Alberta’s share was 10 per cent; virtually all the other cases were in Ontario and Quebec.

For the first three weeks in September, Canada added 16,634 new cases, and now they are more evenly divided between the Big Four:

B.C.: 2,416 cases (14.5%)

Alta.: 2,837 (17.1%)

Ont.: 5,132 (30.9%)

Que: 5,636 (33.9%)

“It has been a long haul and we have a ways to go in this storm,” said Dr. Bonnie Henry, the provincial health officer, as B.C. reached more than 8,000 cumulative cases on Monday. That day, B.C.’s rate of new cases stood at 26 per million population on a seven-day rolling average. It’s the second highest-daily rate ever posted by the province, and the highest in the past week (the daily record is 31.2 on Sept. 14). Though there are a record 2,000 active cases in the province, Henry doesn’t classify the current situation as the second wave of the pandemic, instead calling it a mogul or smaller wave.

One factor behind Henry’s thinking is that B.C.’s hospitalization rate is relatively low. As of Monday, B.C. had 60 residents in hospital, with 20 needing intensive care.

Like B.C., Alberta has relatively few hospitalizations: only 51 people in hospital, with nine of those in intensive care. Still, it is adding new cases at a higher rate than British Columbia: On Monday, Alberta added 29.3 new cases per million population, just shy of its average of 31.3 per day for the first three weeks of September. Yet that relative steadiness in terms of new cases has pushed Alberta’s reproduction rate below one, meaning that each 100 residents newly infected are passing COVID-19 to around 90 others. In contrast, Ontario and Quebec, which have experienced surges in daily cases, have “R values” of 1.32 and 1.37, respectively.

The same day Dr. Henry discounted that her province was experiencing a second wave, Dr. Horacio Arruda, Quebec’s director of public health, announced that his province was “at the start of a second wave.” In the past week, Quebec’s rate of new cases nearly doubled to 48 per million population by Monday. That is nearly double the national rate and the province’s highest daily rate since early June. As was the case during the spring, Montreal is the epicentre of the province’s new cases, with a rate above 50 per million. As well, city hospitals are reporting an uptick in admission of COVID-19 patients. “The second wave seems to have arrived,” Dr. Lawrence Rosenberg, whose healthy authority includes the Jewish General Hospital, told the Montreal Gazette.

The caseloads in Quebec and Ontario are rising so quickly that they are forecast to soon surpass their spring highs. While long lines at testing centres are still common, one big difference is the overall amount of testing. In the spring it was harder to get swabbed, in part because of a shortage of supplies. In April, Ontario averaged around 7,500 tests a day, while Quebec was doing around 4,900. Now, both provinces have improved their testing capabilities, the criteria is far more relaxed and provinces are testing at far higher levels.

In the first three weeks of September, Ontario averaged 29,200 tests a day while Quebec completed an average of 12,800. That means both provinces are likely finding cases now that would have escaped detection at the beginning of the pandemic. In turn, residents getting positive results are able to self-isolate before spreading their infections to others. That’s what happens in Germany, where high testing and tracing levels means it uncovers lots of cases, but authorities have been able to keep spread largely under control.

As a result, Germany has been able to keep its death toll relative low, recording roughly the same number of deaths as Canada though it has more than double the population. After Canada posted a month of declining numbers of deaths, that trend ended for the third week in September, when B.C., Ontario and Quebec all posted double-digit counts. Again, the number of seniors dying in this country is rising.

The majority of deaths in Canada since March were of elderly residents of long-term care facilities. As summer officially turned to autumn, the number of active outbreaks at long-term care facilities in Ontario jumped from 23 to 29. The worst is at the Extendicare West End Villa in Ottawa, where 23 members of the staff as well as 15 per cent of residents have COVID-19; at least 11 residents have died since the beginning of the month.

The autumnal resurgence of COVID-19 in Canada is being echoed in many Western countries, including France, Spain and Britain, and to a lesser extent, Germany. As well, the situation south of the border, which had improved late in the summer, appears to be turning worse in recent weeks as the U.S. now averages around 40,000 cases a day. The Covid Exit Strategy site, which tracks state-level progress against criteria established by the White House, has just three states, all in the northeast, trending better. Another eight are in the “caution warranted” category while 39 are getting worse, including Texas, which has experienced a 43 per cent increase in per capita cases in the past 14 days.