 This is our COVID-19 weekly briefing for Tuesday, November the 9th. We are honoured to be here on the territory of the Musqueam and the Squamish of the Slay-Wa-Tooth First Nations. We are honoured to be here on their lands. With that, it is my honour to introduce Dr Bonnie Henry. Thank you very much and good afternoon. This afternoon we will be sharing the latest updates on our COVID-19 updates on our COVID-19 updates on our COVID-19 public health response and on vaccine delivery. And while this briefing is about COVID-19 primarily, I would like to start by speaking about influenza for a moment. As I mentioned last week, we started to see a small number of positive cases of influenza in the community, just four so far, so still very low. But it is a marker to us that this virus also circulates and can cause illness. And I would like to start by speaking about influenza for a long time. And I think it is important to keep in mind that it does not cause illness. And every person in our province is eligible to get their influenza vaccine free of charge. Everybody over six months of age, for which we don't have a vaccine yet. And we know that the vaccine is distributed across the province, primarily to pharmacies. They are our partners in delivering the influenza vaccine and I encourage everybody now is the time to get your influenza vaccine. It protects you and it also protects those around you. And we know this is especially important if you are planning on visiting elder relatives or friends over the holidays. People in your family who have compromised immune systems. We have seen the devastating impacts of COVID-19. And this is compounded if we also have influenza making people ill as well. Last week in our modeling presentation I spoke about how our R not, our reproductive number has dropped just below one. This means the virus is spreading to fewer people. And this can be attributed to the fact that we are reducing our risk across the province by protecting ourselves with immunization. This is encouraging. We have been bouncing around just above one and sometimes quite a bit above one in some areas of the province for some time. But it is also very precarious. The strain of the virus that is circulating, this delta strain and we have seen this around the world now. We look at countries in Europe, the UK and places in the United States. We know that delta virus spreads way more easily. And it is that more transmissible and is causing more severe illness, particularly in younger people who did not have very severe illnesses for most of this pandemic. That has changed now. And that has put in a strain on our health care system as well. If we are not continuing to do the things that we know work, we can see cases inching up, outbreaks increasing and hospitalizations increasing. It is especially important for us all to remain vigilant now. Now that we are starting to see other respiratory viruses that we are going through the peak in the next few months, we can't afford to have gaps in protection. And this pandemic is still very much here. And we see that. We see that with our health care system across the province still feeling the strain of the infections that we have had in the past few months and the ones that continue. And health care workers are feeling the strain as well. And we are seeing that strain not in other conditions that drive people to need health care. Our vaccination rates are inching up. And that is what is going to help us get through these months. The more and more protection we have, we can see that in communities where we have very high immunization rates and we don't see that rapid transmission and growth of outbreaks. It also means we can do more. We recognize that having these measures are so important. The connections are essential to us. And those in-person connections that we have been able to have, we need to keep those going for our own mental health and support of our families and friends. To support this, we have put measures in place to allow for safe social connections. And we have been adapting our public health measures in response to the changing situation that we are seeing with the pandemic. We have been doing that in different areas of the province based on risk in those areas. But we have been doing this slowly and incrementally. We have slowly eased restrictions in some areas, on events, on gatherings. But we continue to actively monitor our progress in every area of the province. And we will continue to be cautious in our approach, to monitor as we go, to look at the things like the vaccination rates, and how we are ending up in hospital now. We need to reduce the strain on the hospitals. So here's what I'm asking you to think about as we head towards the upcoming holiday season. Keep your indoor groups small. We know that indoors is more risky than outdoors. And it's really important that if you do have an indoor group that people are vaccinated, that helps mitigate the risk of transmission. And if you have an indoor group that you are vaccinated with, you need to have time with your loved ones. And indeed, you must spend time. We need to have that time together. But have a smaller gathering this year, perhaps with one or two of your family members or your other families, rather than the full big family reunion. And make sure everyone is vaccinated. This is especially important if you have older relatives or people who are going to be vaccinated. If you are wanting to spend time with your broader family and friends, then plan an outdoor activity instead of gathering inside where it's riskier. Go sledding or snowshoeing or hiking. We have many, many wonderful things that we can do outdoors safely, even in the winter months. And if you are traveling to another community, whether for a day trip, for exercise, a holiday getaway, we have to be a respectful traveller. We know how to do this. We have been through this now together for the last 20 months. We need to continue to be aware of the impact we are having on communities we are going to and the risk that we are bringing with us and of course the risk we bring home. And we must recognize that there are some communities right now that are dealing with very serious outbreaks of this virus still, particularly in the Vancouver Island, in the interior, and in some areas of the lower mainland. And they may not be ready to accept visitors right now. So check before you grow. It also includes following all of the public health orders. Just because things look different in a different community doesn't mean you can let your guard down. Here in BC, respectful travel means being fully vaccinated. Using your vaccine card, if you are going into access services or going to events in any community, wearing a mask in all indoor public venues, including local stores, ski hills, all of those areas where we know that extra layer of protection is so important at this time of year as we are moving into respiratory season. Whether there is a vaccine mandate in place or not, it is important for everybody to follow public health orders. That is what will allow us to continue to open things up and to safely gather together. So here are five steps I am asking everybody to take right now. One is get your first or your second dose of vaccine. That is important. And when it is your turn, get your booster dose as well. Get your influenza vaccine to help us get through this season like we did last year, without having that additional impact of influenza making people sick. Register your children. We know that the vaccine for five to 11-year-olds is being reviewed right now by Health Canada and we are hopeful that it will be approved very soon and we can protect the younger ones in our life too. And use your safety basics all the time. We know what we need to do. We need to keep our groups small. Stay home and away from others if we are feeling unwell, whether it is a mask or not, we need to make a difference and wearing a mask as an additional layer of protection. I do want to also talk about a little bit of news we have about vaccines. We have been confirmed by the federal government that they have got a limited supply of J&J vaccine that should be coming into the country very soon and we have not received it yet, but we are expecting to receive some here, a limited amount here in British Canada in early next week. It is a limited amount and our first priority will be offering it to health care workers who have been affected by the PHO order and who want this vaccine as an option for them to continue to safely work in health care. So that will be our priority over the next few weeks once this vaccine comes in and I know that our health care teams are working to connect with people who are in the hospital and I know that anyone else and I know there has been a lot of people who have reached out to me asking for the J&J vaccine. We will have some available and we will be providing you with the details next week of how you can access this through a central call number. So stay tuned for that. It is a limited amount but we are hopeful and we have been asking for a number of months as I know many of you are coming in and we will be focusing on health care workers first but there will be some available for others who want to use this as an option and we will let you know more details next week. Finally, I want to recognize two things, one that yesterday was the day to honor First Nations and Métis veterans and I just want to pass on my gratitude for those veterans and to the injustice that many of them felt after serving their country, our country. And with remember and stay ahead, let's look to our veterans again who have shown us how important it is to work together, to support each other, to do our part and to persevere and we are persevering. This has been a long pandemic and it is the time once again for us to remember that we are in this storm together. We are not all in the same boat but we are in this storm together and it is continuing but we have tools now that will help us get through it and this next few months are going to be important for us to remember that and to work together. So let's honor and support our active military family and veterans everywhere by continuing to do our part. And let's protect the health care that they are caring for us day in and day out through this long, long storm. Our colleagues and friends and our neighbors and we do this by protecting ourselves and by taking all of those important measures that we know work. So let's protect our veterans this remembrance day and continue to be kind to each other, to be calm and compassionate and to be safe. Thank you. Thank you very much, Dr Henry, and on this day when we have received more information, the monthly report from the coroner about overdose deaths, we want to especially emphasize that we are living in two public health emergencies, that the need to build a comprehensive system of mental health and addiction care in BC is to say the least more important than ever and we are driving to that goal together but we think of those families, those who have been hurt by the overdose public health emergency, we think and we want to acknowledge their grief and pain today and commit ourselves to continue to act in that area. I also wanted to speak about a number of issues and bring updates that we regularly bring on Tuesday. First is about the health care worker mandate and just to give you some up to date numbers and say that it is a great effort by health care workers and the system to ensure that people are safe and that health care workers are protected, the patients are protected, the residents of long-term care and assisted living are protected. On the health care workers side, since we last reported to members of the media and through you to the public on Friday, we have added 1,548 vaccinated health care workers, we are at the beginning of a week and they are vaccinated. We have added I think in total and this is a data correction, 30 vaccinated people so it has been a very significant increase in those vaccinated through the health care system. I wanted to just briefly and note that by health authority we are now, if you look at the unvaccinated population, it is 2% across the province, 5% in interior health, 4% in northern health, 1% in province health care, 2% in provincial health services authority, 1% in the Vancouver coastal health authority, and 2% in the Vancouver Island health authority. So this reflects I think the very strong vaccination of employees across the system. There has been a lot of interest in looking at the vaccination numbers by job category. So I am going to give you two sets of information today. One is that of the 3,000 and now 71 not vaccinated health care workers to the order applied. That is the order of two weeks ago today. 1,032 of those are casuals. 989 are full-time. 819 are part-time. And there are 16 that are not identified. So those, that gives you a sense of the impact, the FTE impact of the health care mandates. Vaccine mandates or proof of vaccination. And then by job category, just to give you the job categories that have come together that are over 1,000 so they are not identifying to any group. If you look at allied health, there are 20,379. Often allied health is represented by the Health Sciences Association. There are only 420 unvaccinated people in this category. That is 2%. In emergency medicine and critical care, 1,445 people in the category, 20,000 and in the category, 28, not vaccinated, 2%. In general medicine, 5,445 in the category, 105 not vaccinated, that is 2%. Health care assistance, that includes those in the communities who have a slightly higher rate of not being vaccinated and carries in acute care facilities principally. It is 7,548 of whom 247 are not vaccinated or 3%. In internal medicine, 1,000 are not vaccinated or 1,703. We will be providing this to all of you. 19 not vaccinated or 1%. In nursing, 40,181 nurses, registered nurses, LPNs, nurse practitioners, 40,181, 906 not vaccinated, 2%. Paramedics, 2,837. The category, 86 not vaccinated or 3%. Resident doctors, 1,361. We will be providing this to all of you. Drs, 1,366 in the province, 10 not vaccinated. And in our specialized surgical units, 1,422, staff, 27 not vaccinated and 2%. That gives you a sense. The broadest final category is the category of all others which include administration and support staff, people who clean the hospitals and so on are at 3%. That is 1,061 of 3,435. That is 1,361 of 3. In short, the efforts, the number has continued to rise of the percentage of those who are fully vaccinated and partially vaccinated is falling and not vaccinated has fallen significantly, as you can tell, over the last couple of weeks. And it is our, of course, hope that people will continue to get vaccinated so we can reduce the numbers of people who are on leave of absence without pay and or have lost their positions. We can reduce that number as much as possible. Dr. Henry talked about getting the flu shot. That was item number three on the list of five, I think. And just to say that as of November 8th, we know that at least 485,049 doses of influenza vaccine have been administered to British Columbians. We're off to a good start. We also know that the number of doses is actually higher than that. The vast majority of those doses have been delivered by community pharmacy. That number, I believe, is in the neighbourhood of 249,381. And so that program is going well and we want to express our appreciation to community pharmacy across BC. We've distributed out through the BCCDC 1.9 million doses to date. We, of course, have more coming. And we're very pleased that the take up of this campaign want to encourage everyone to get their flu shot. And we'll remember we'll have a test at the end about the other four items. So that's positive news. With respect to COVID-19 vaccination, just to note that we're now over 90%, I think it's 90.4% over the age of 12, which is by any standard in the world exceptional. That means 4,187,281 dose 1 vaccinations as of last night and midnight. And dose 2, 3,992,679, that's over 86%. And third doses, booster doses, doses that complete the course is 181,975. So that number continues to grow as the booster dose campaign continues to address and protect those who are most vulnerable in BC. I note that every care home and every assisted living home in BC has now had its booster dose clinic. That's important to say. In terms of occupancy in our hospitals, just to put this in context, because as we know hospitalization is a lag indicator, meaning that when cases start going up, hospitalizations follow some period thereafter. It's the same as cases come down. But we currently have overall in our hospitals, COVID-19 and all other issues, 9,247 people in hospital in BC. And that's based on, that is on approximately 1,500 total beds based in surge, but 9,229 base beds. So that is over our base bed capacity. In terms of critical care, we have 510 critical care beds in BC, 218 surge beds. We're currently at 478 people in critical care in BC. And obviously this continues to be a challenging situation. It is why, and I'm getting to the surgical numbers in a moment, why we continue to manage our healthcare system to make sure our healthcare workers are able to support people in these very challenging times and why these actions are necessary and why we absolutely need more people to get dose one and dose two and when their time comes, their third dose of a COVID-19 vaccine. Over the last period, as you know, people have been coming down from the Northern Health Authority to other health authorities. That number is now 109, 97 of whom are COVID positive and the vast majority of those are not vaccinated. Clearly, that is a heavy price to pay and we provide the best care in the world to everybody. I am proud of our healthcare workers on Vancouver Island and Fraser Health, Interior Health and Vancouver Coastal Health and of course the Northern Health itself for the work they're doing on behalf of British Columbians. This is what we do for each other but what would be better is that the preventable cases of unvaccinated people far from home in critical care by people getting vaccinated. I want to particularly acknowledge the work of the municipality of Fort St. John and Mayor Lori Ackerman who continues to be an outstanding advocate for vaccination in her community. Fort St. John, which used to be well below 60, we can remember those times is now at 77% plus and rising and it's one of the places in BC where vaccination has risen the most and I appreciate the work of both Mayor Ackerman, community leaders like Dan Davies and everyone in the community for that. I want to note on terms of contact tracing we now have we've added 20 additional staff to contact tracing this week. We now have 1,595 staff as of November 5th that is 2021 and this is higher than the highest level of contact tracing we had during the third wave. That number was 1,563 in the months of May and we have added contact tracing capacity. Obviously the number of active cases is significantly less than that but the importance of the work and the central work that our contact tracing teams do in all of the health authorities continues to be critically important. Finally I just wanted to talk a little bit about surgeries in our province and surgical renewal. As you know last week I reported that the cross BC most operating rooms continue to run but due to a variety of challenges there had been reductions in some operating rooms and I reported on those in detail last week. The situation remains largely unchanged but there are developments. Last week in interior health Colonna General Hospital had reduced two operating rooms to compensate for staff who did not meet vaccination requirements and who are on unpaid leave. This week only one operating room has been reduced for this reason. To support critical care though Colonna General Hospital has reduced an additional two operating rooms meaning that it is performing surgeries with three fewer operating rooms. Some surgeries continue to be postponed across health authorities as they continue to respond to COVID-19. During the reporting period October 31 to November 6 health authorities postponed 288 non-urgent scheduled surgeries. That's 52 in Fraser Health 16 in Northern Health 134 in Vancouver Coastal Health 28 in Vancouver Island Health and 58 in Interior Health. No surgeries were postponed in the Provincial Health Services Authority. So if you add all of the postponements from September 5 to November 6 that number is now 2,671. Despite these postponement surgeries are continuing across the province from October 17 to October 23 health authorities report that 6,960 surgeries were completed. This is 1,029 more surgeries in the same week in 2019 although that week in 2019 included Thanksgiving. For patients who have had their surgeries postponed and for patients who are waiting for their surgery this is an especially difficult time but I hope some measure of comfort is taken from this. We will get you your surgery. We will get you your surgery. Your life is as strong today as it was in May 2020 when we made our surgical renewal commitment to patients. No matter what challenges we face we will deliver. We are working as hard as we can so we can call you as soon to book your surgery and it's a message to everybody in the time when we're facing and we're approaching respiratory illness season we're starting it and we're into it to get your COVID-19 vaccine first dose if you haven't got it to complete it if you haven't yet completed it to go and get your third dose when you're invited to book to get your influenza vaccine and to follow public health orders right now this is the December period is an important time of people coming together and it makes it more important that we follow the guidance and the set out through public health order in our province it's important for us it's important for people waiting for surgery it's important for our healthcare workers it's important for your friends your elders, your community, your children it's important for everybody that we work together to get this done together in this challenging time thank you very much we're happy to take your questions. Thank you. As a reminder to reporters in the phone please press star 1 to enter the queue. You are limited to one question and one follow-up. Please also remember to take your phone off mute. You are not audible until your name is called. Our first question is from Lisa Cordasco Vancouver Sun. Go ahead please. On the data that you have on the rates of exposures of COVID-19 in schools in places like the interior and northern health are vaccine mandates being recommended? Are you talking about for staff at schools or for for students? I'm talking about for staff I understand that health authorities are meeting with various school districts to help them make decisions and just wondering in terms of interior or northern health are the data showing that the rates of exposures at schools in those areas are much higher than the provincial average or within acceptable levels? Really good question and we have as you know put together the provincial committee put together guidance for school districts and it is an important consideration about the local epidemiology what's actually happening in schools in those areas and transmission in the communities in those areas because we know that schools reflect what's happening in the community as well and yes I know that my colleagues the school health officers in interior health and the north have been working with their school districts and supporting the need to make sure that everybody in the school is vaccinated who's eligible so yes they are very supportive of vaccine mandates in those areas particularly because of what we are seeing about the impact on schools and thankfully younger people don't get as sick with this virus and that continues to be the case but we don't want children to be getting sick and we don't want their school we know how important it is for families and for the growth and development of children to have in classroom schools and this week in the interior there's been three outbreaks in schools so yes we are very supportive of mandates in those areas particularly because of the risk in the community right now Do you have a follow up? Yes so we've heard that on the lower main land at least we are communication rates are very high and there's a lower transmission rates in schools that the boards who have decided so far have opted to not implement vaccine mandates as parts of policy how likely is it that areas in the north and the interior will opt in fact to go with vaccine mandates what is your sense of that at this point in time? Well I think we look at what's happening in the lower main land and we see the effects of having very strong immunization rates in communities and in school staff so the school districts are the ones who know best what is going on with their particular schools and the employees that they employ in the school staff so they made the decision looking at the balancing of risks and benefits and what was happening in their individual school districts and that I expect will happen as well is happening I know my colleagues have been meeting with their school districts across the north and interior and I think we will see the decisions made in those areas reflect what is happening in those communities as well Next question Richard Zussman Global Go ahead please Mary there has been a doctor in Saskatchewan yesterday was speaking about what is essence variant of the Delta variant connected to western Canada have we seen this in British Columbia how worried should people be about this and how should people describe what this variant is in terms of compared to what we've seen with Delta variant Okay I'm not entirely sure which variant you're talking about I'm not familiar with exactly who was saying what but I can tell you that we do whole genome sequencing on not all cases right now but on a representative sample and we are in the 80,000 whole genome sequencing sequences that we've done and we look for some of the mutations that may confer an advantage to a virus and some of the Delta mutations that we've seen if you look on the BCCDC website we have a report up every week and they've now been divided into several different sub-clades of the Delta variant and we've been particularly watching one that was detected in the UK that has a slightly different mutation which there was concern that it made it even that much more transmissible we've had seen very small amounts of that so far and so what we are seeing that what we have seen in other parts of the world are bearing out here that the Delta virus is very transmissible it's transmissible at a much smaller amount so the dose that you need to get to become infected is much lower than the other strains that we've been seeing over time and that's one of the reasons why we need such higher immunization rates currently and we've seen that across the west we're seeing it in other parts of Canada as well younger people are having more severe illness with the strain of the virus that's been circulating in our communities right now and that means that if you don't have the protection of vaccination even as a younger person your risk is higher of ending up in hospital in some communities where there's a lot of transmission with the virus we're seeing it in those congregate living settings multi-generational households where a lot of people are together and there's a lot of virus we're seeing 5-10% hospitalization and ICU rates in very young people and that's much higher than what we have seen throughout this entire pandemic so it's not 100% we know that but these vaccines are very very effective at preventing those severe illnesses so that's one of the reasons why we've changed our focus around how much vaccination we need in communities because we are seeing when it's 90% you see less risk less transmission, less hospitalization so it all goes together as ways of protecting yourself and your community and what we do see is that people who are vaccinated are less likely to become infected they shed virus for a shorter period of time so they're less likely to transmit it to others but it's those people that you're living with that you're closest with that you're more likely to transmit it to and that's why we need to give extra boost to the particularly older people who are immunized early and to make sure that everybody around you is vaccinated there's some great studies that show that the rate of transmission even in the household the people you live with goes down by 60-70% if you're not immunized so for children for example your risk goes down incrementally by the number of adults who are around you who are protected through vaccination so these are the things that we need to do now I can't say this enough it's the most important thing and the prevention of transmission means that we're preventing the development of new strains of the virus the transmission of these new variants so follow up and I think this may be what you're referring to but these are AY25 and AY27 so if it's not what you're referring to if you could sort of add to that, that would be great but for other stories we're working on I know you've been asking about this before but different ski hills are now putting in different policies around vaccine cards some are requiring vaccine to ride the gondolas or chairlifts others or not there are guidance around whether the vaccine card may be used at ski hills considering people are in close contact in these gondolas and for Minister Dix are you worried about the impact on the overall system of losing these 86 paramedics you mentioned knowing that we already have a lot of pressure on the paramedics in this province just around ski hills I know we have been working with the local public health ski hills have been reviewing the safety plans with each individual ski hill and there's a couple of things that all of them must adhere to regardless of where their headquarters are one of them is we have an indoor mask mandate and gondolas are like a public transit for example an area where mask wearing is required absolutely and that is the same across the board as well we know that most ski hills have a mask or a vaccine mandate for their workers which is something that protects all of the workers on the hill that's important as well and the BC vaccine card is required in all of those settings where you have either license premise where you're serving food, restaurants sit down restaurants etc so we know that there's very strong protection plans and my colleagues have been working with each of the ski hills to make sure that they are robust and we know we've seen this from last year when we didn't have immunization that skiing is not necessarily a higher risk activity we were not seeing transmission outdoors we're not seeing transmission in gondolas even in the absence of vaccination so it is very important to have those safety plans it is a requirement to wear masks on gondolas, on ski lifts in line ups when you're close to people and more and more important this year of course we also encourage everybody who's going there to be vaccinated we know that traveling into the country you need to be vaccinated we know that travel within the country now you need to be vaccinated so those are all things that will protect us and I think that's a really important consideration as we go into this ski season too Thank you I just add to that Mayor Crompton, Mayor Jack Crompton called me today spent some time talking about this issue advocating obviously forcefully for his community and I think it's also important for the employer in that case to respond to the wishes of the community as well and we're hopeful they'll do so I know other ski hills across BC have done that so Mayor Crompton is advocating very strongly and certainly directly to us as well on this question because they want to have a great ski season in Whistler one where people of course stay well and get healthier on their trip and not have to deal with COVID-19 I'm concerned about every healthcare worker and that's why we've made such efforts and significant areas to hire as you know hundreds of new paramedics this year and we're going to continue we're continuing those efforts the paramedics those positions that I announced a number of months ago have all been hired people have been put into place those hiring decisions have been made and we're certainly working hard to do more a very high level of paramedics are vaccinated as you can tell from the numbers 97% and we're hopeful that many of the remainder will continue to do so so everything is a challenge in all of these areas in every area that you can imagine there's challenges at this point in the pandemic working flat out for 21 months and counting and so we don't want to lose anyone at the same time the main threat to staffing in our healthcare system is COVID-19 is outbreaks in terms of COVID-19 is its impact on our staff its impact on our patients and our residents that's the thing that we have to deal with and that's why these mandates are necessary and in place and I think the response of healthcare workers 98% of those who've received their first dose and 97% who've received both doses at this time indicates that they in massive numbers agree with that so it's a challenge we're going to continue to work on it and I'm very pleased with the response of paramedics and everyone else to this need to be vaccinated to keep the people they work with safe Our next question is from Shannon Patterson CTV the minister and Dr Henry going back to the Johnson & Johnson announcement for next week can you tell me people that don't know what is different about this vaccine that makes it different from the vaccines that have been offered so far in British Columbia and you said you've heard from people who want it can you expand on that are there people in the healthcare system that will only get vaccinated with this particular vaccine and people in the general public as well and why and yes the Johnson & Johnson Janssen is their vaccine arm vaccine is a viral vector vaccine so it's the same class or type of vaccine as the AstraZeneca CovaShield vaccine that we have had but it is the trials were done as a single dose vaccine so it's been widely used in the US as a single dose vaccine and it has good strong protection about the same as the two doses of AstraZeneca over time so many people have contacted me I would say there's probably an estimate in a couple of thousands of people yes we do know that some healthcare workers have said that this is the only option they would consider right now I will say there's other vaccines in the pipeline and we were very hopeful for example that Novavax which is a more traditional protein subunit type vaccine would be available before now but they have had challenges both with their clinical trials and with their manufacturing and scaling up of manufacturing we hope that that vaccine will be available but sometime in 2022 so it will be an option for the future but it's not going to help us get through this very critical period right now so yes I have heard from people mostly I believe because it is a single dose of the vaccine and that makes it you're able to travel you're able to have your BC vaccine passport etc having said that in the US Johnson & Johnson have just got approval for a second dose as a booster dose and it is recommended by the US CDC that people who got the Johnson & Johnson vaccine do get a second dose a booster dose after six months applied for that here in Canada and very importantly if people they're holding out for this vaccine we are very hopeful we've been asking for it from the federal government in writing several times over the last year but we're hopeful that we're going to get it in hopefully by the end of the week or early next week and it will be available first for any healthcare worker who wants to use this as their way of getting back to work Shannon do you have a follow up question for my colleague there's been a recent violence attack on a frontline healthcare worker a nurse in Metro Vancouver and it's leading to calls from the union for dedicated security for emergency departments more security guards trained in de-escalation and personal alarms for healthcare workers among other measures what will the province do to increase workplace safety for these workers in the hopes of preventing similar attacks from happening not unfortunately something new in our system yes and there's that case and there are other cases in BC that we've seen in recent months that show the need to have more safety and so we have ongoing work both with the BC nurses union with the hospital employees union the health sciences association the doctors of BC and security in our healthcare settings and it's a high priority for us it continues to be we've been going forward for years but this indicates the need to continue to improve the situation and we fully intend to do that working with both the unions and our workers and also working with the community this is a very very challenging period in healthcare and what we need to do is what I think the vast majority British Columbians are doing when we hear stories like this it obviously affects both the morale and the sense of personal security of our staff across the system and we're with them and we're going to continue to work to improve security which may involve in different places different actions because there are different requirements in places but it's our strong intention to do that and it's a necessary thing in order to support workers and to ensure that our healthcare settings are safe for workers, safe for patients in long-term care and assisted living safe for staff and for residents our next question is from Cindy Harnett times colonist thank you so much for taking my question some seniors are getting conflicting messages around the booster shots they're being contacted to book but they're not sure they're being asked to book at 4 months but they're being told it's ideal at 6 months so what is the advice for their best immunity so I've heard a few people who've had some confusing messages and I'm sorry about that what we have done and I think Dr. Ballum and I presented that early on and we know that we are seeing breakthrough in our seniors particularly people over the age of 70 and most of them were people who received the vaccine early on in our program because they were at highest risk but a large bolus or a large group of people would be eligible sort of later in December and we wanted to move them up to make sure that they get the extra protection from the booster dose during this highest risk period so yes we've got invitations to receive their booster dose at around 4 or mostly it's around 5 months to 6 months and some people who are younger and healthier will get it a little bit later and that really is to try and smooth it out and get those people at highest risk their booster dose as soon as possible during this highest risk period so any time after 8 weeks is really the minimum but 4 months is fine you will get a good strong long lasting protection from that booster dose and I know on the other hand some of our clinics were not aware we've had we have a number of clinics in many different places and that message didn't necessarily get to everybody that some people will be in slightly before their 6 months some of them maybe as around 4 or 5 months so we've got that message out I hope there now if you have your invite that is safe and it's recommended for you to go out and get your booster dose right now. Cindy do you have a follow up? Yeah, excellent thank you so in the breakthrough cases can you expand a little bit more are these mostly people with underlying health conditions are you seeing a large increase in breakthrough cases in healthy seniors in the community as well and if you can just clarify a little bit on the answer to Richard the various plus Delta variant, excuse me virus if we see something like that in the near future with 14% unvaccinated what is your concern or worst case scenario there? Yeah, so just to go back to sorry Richard that's what happens when you put all those questions together so it's the AY24, 25 and 27 we have seen a little bit of the AY24 I don't know I haven't looked at today's or yesterday's actually usually comes out on Tuesdays to see if we have the 25 or the 27 but it is a slightly different mutation on one of the areas of the spike protein and that there is concerns mostly in the UK where they detected it first that it might convey another advantage around transmission so we have seen a little bit of the AY24 but the rest of my answer is actually taking into account those specific mutations and oh there now I've forgotten sorry what was the first part of your question Cindy? Cindy can you repeat the first part of your question? We've seen those mostly in seniors in their 70s with underlying health conditions or we've seen an increasing number in healthy seniors in the community so we've seen the breakthrough cases it goes it's very low in people up until about 65 and then it goes up a little bit but it really goes up a bit at 70 and then at 80 goes up dramatically and it's very difficult to tease this apart because as we get older we are more likely to have those underlying conditions that make us more at risk as well so we've said this from the very beginning and we continue to see this age is the number one risk factor on this for ending up in hospital with COVID-19 and that remains the case and that's how we did our immunization program because we recognize that age was overwhelmingly the single most important risk factor so we started with the immunization program with our oldest seniors and elders so people over age 90 and over age 80 so that means there's two things going on one they have that highest risk and they receive the vaccine the longest period of time ago so that's why we're trying to move everybody up and the vast majority of them along with age have other conditions whether it's heart disease or lung disease or diabetes that comes because those are much more common with age as well. Our next question is from a Mandelina Latinero CFJC News Hi Dr. Henry we have two outbreaks at Royal Inland Hospital in Kamloops with COVID-19 protocols in place why do you think this is still happening? This reflects again the community and what's happening in the community there so the first outbreak started a little while ago it's pretty much settled down there were I believe two or three staff members involved more recently there's been some exposures that have led to transmission on the ward between patients not vaccinated staff it's people who are in the hospital for other reasons who are unfortunately exposed to COVID and I know they're doing a detailed investigation to try and figure out where was the introduction and how it got transmitted between people but we are seeing that these outbreaks are not to the same degree as we saw a few months ago when we didn't have as much vaccination but it still reflects the fact that this virus is circulating in the community and can be transmitted in those indoor settings particularly if there's groups of people in a hospital room or ward together and so the transmission was actually in the hospital Amanda Lina do you have a follow-up? Some staff are suggesting stopping visitors what do you think the solution could be? So the visitor policy have modified again recognising we're going into a higher risk period so visitors to acute care facility need to show your vaccine card now to show proof of vaccination obviously there's a few exceptions for children or people at the end of life or pregnant people but that is an important way to try and keep this virus out of acute care facilities so that has been started this week I know there's been a bit of a transmission period but certainly visitors are something we are concerned about particularly unvaccinated people and if that puts staff at risk it puts other patients at risk so there are other infection control measures that are also really important and we're beefing those up as we head into this part of the year where we know that respiratory viruses transmit that much more easily so we're going to start with questions from Ethan Sawyer CBC Hi Dr Henry small music venues in BC are wondering when the band will be lifted on standing and dancing in their establishment if bands in BC can stand dance and sing at larger events what is the difference between that and a smaller venue BC will soon be the only place in Canada with these types of restrictions in place I actually don't agree where you have people crowding together and dancing and singing so the general admission it is the same across the board for all venues those large venues they must have seated areas in front of the stage they cannot have the general admission mosh pit in front of a concert and it's the application that is the same across the board we are doing this incrementally we know that indoor settings are riskier than outdoor settings the scene card is one of the ways that we can reduce and mitigate that risk but it's not the same everywhere and we have to be mindful that some of these settings are riskier so we are doing things in an incremental way and we're looking at things like the vaccination rates in the community like the amount of virus that's circulating in the community the ability of people to wear masks and those are all things that I'm working with my colleagues across the province we have spent quite a bit of time this week and we'll be looking at how do we harmonize these and make them stronger but this is not the time to make major changes that increase risk dramatically so it does affect it affects all of those venues across the board where we are requiring people to have access to a seat because when people are seated the risk is just that much lower than when you're mingling with people Ethan do you have a follow-up? I do this one's for Minister Dix more than 3,800 people have signed a petition in Port Algreni asking for an unvaccinated pediatrician to keep his privileges at the local hospital what can you say to a community that is concerned about losing access to a specialized doctor even if he is unvaccinated are unvaccinated healthcare workers allowed to keep working in their own practices even if they can't access health authority regulated spaces and we can get an answer to this one in French as well I think I'll start with that because this is one of the things that I'm particularly aware of and it is as a healthcare professional myself part of what we do as professionals in terms of protecting ourselves and protecting those we care for and you talk about privilege and we are privileged as healthcare workers and it is our responsibility to do what we need to do to keep our partners, our colleagues safe and to be vaccinated through this pandemic so privileges and I will say I'm working we are working with the colleges who also feel very strongly about this so the colleges will come under and I put notice in our last PHO order that it is a requirement of our profession to do what we need to do to get us through this pandemic together and part of that is protecting ourselves our patients and our colleagues through immunization I think that says it well I mean there are other than medical exemptions and there is a process for that there aren't exemptions and all of the healthcare workers who are affected by this both 98% plus that have been vaccinated and the 2% who have not been all of them are affected by it all of us are affected by this in healthcare and the danger here the problem here is COVID-19 which is affecting our ability to staff healthcare and obviously as you can see with outbreaks at Royal Inland outbreaks are continuing in long-term care homes and it is a mandate to come into place Dr Henry reported in August and September about the healthcare facility outbreaks that were related to unvaccinated people and unvaccinated staff in most cases and so the decision has been taken and it is something that will be applied across the board it is obviously not desirable to lose anybody in addition to healthcare at least of which someone who has clearly got a lot of support locally but the rule is going to apply to everybody and it is going to apply here and I encourage everybody to get vaccinated because there is of course a much simpler answer to all of that and that is that people get vaccinated and in very significant numbers we have seen the increase this past week in fully vaccinated healthcare workers who were hiring and in this period that increase is going to continue and it is going to leave everybody working in healthcare safer I would say that the law applies to everybody whether it is people who work in long-term care homes it applies to nurses it applies to professionals health sciences it applies to everybody including doctors including doctors in this case so we are going I think to continue to follow this policy that is in the interest of people who work in our healthcare system and that is in the interest of people who need care in our healthcare system and for the residents of long-term care and assisted living so it will continue and it is for good reasons that we will continue to make an application equal to the need to get vaccinated That is all the time we have for today This concludes today's event Thank you everyone for joining