 Good morning, I'm Adrian Dix, BC's Minister of Health. Joining me today is Dr. Bonnie Henry, BC's provincial health officer. We're grateful to be here on the traditional territories of the Lekwungen speaking people, the Songhees and the Esquimalt First Nations. Grateful to be here on their lands. Since September, we've all been focused on the importance of being prepared for respiratory illness season. And as we know from our experience and what we're seeing in BC and in other jurisdictions across Canada and around the world, the season is now upon us and COVID-19 is still with us. We know what's at stake, we know what's required, we know what to do to take care. We're starting to see an increase in influenza cases, so staying diligent to keep ourselves, our loved ones and our community safe is just that much more important. In addition to COVID-19 and influenza, this year we have other viruses that cause respiratory illnesses such as RSV, which has not been as present in past years, although it was present last year, who agree but has been a factor that we're dealing with as well. We know as the weather gets colder, we will gather more indoors and we know that's okay. But after all we've been through, we also know it's important to do it safely. That means especially wearing a mask without symptoms and considering wearing a mask in indoor public spaces. It means, most importantly, staying home when we're sick. And it means washing our hands frequently with soap and water. As critical as these essential actions are, to keeping us healthy and safe, getting vaccinated is our best protection. We know this, so we all need to act right away to register and book an appointment for our COVID-19 and influenza shots. It's never been easier and we see that in the extraordinary take-up already. And we can safely get the two shots at the same time. As British Columbians, we demonstrate our commitment to protecting ourselves, our loved ones and our communities by following public health guidelines and getting vaccinated in record numbers. More than 90% of us over age 12 have received at least two doses of the COVID-19 vaccine. And since the fall COVID-19 booster program began on September 1st, nearly 1.2 million fall boosters have been administered to people in BC over the age of 12, 96% of which are bivalent vaccine products. And as of this morning, over 1.2 million of us have received our flu shots. That's more than twice as much as this time last year. We started earlier and that has an impact. We're also seeing a very strong take-up, but we need that to continue. But simply, we know what's at stake and we know what's required. And we know what to do to take care. And it's now my honor to introduce Dr. Bonnie Henry to discuss the respiratory illness season this fall and winter. Dr. Henry. Thank you very much. It's an honor to be here today. It's been a while. I, too, would like to acknowledge that we're here to present Dr. Henry Henry, and his usual singing, and his Quyemalt First Nations. We're very grateful to that. I also want to point out that today is Louis Ryal Day which is a time to learn and celebrate matee history, values and culture. And the first step that we've learned in truth and reconciliation is truth. And I encourage everyone to make an effort to learn about the truth behind the role that Louis Ryal played and the unique heritage and inherent and in this province. In September, we talked about what we might expect as we moved into the respiratory illness season here in British Columbia. We are now in that place as expected. And the respiratory season is unfolding as we expected it would. But we are in a very different place than we were a year ago. And that is largely because we have done a number of things. We started to move again, to travel, to travel internationally, to travel globally, to travel across the country, to travel within the province. And we are seeing the return of common respiratory viruses that have been mostly absent in the last two years. We know that the three main viruses we need to pay attention to and be careful about are now COVID-19 is into that mix. But also influenza and RSV. And there are a number of other respiratory viruses that have been causing illness. And all of the walking through us, through walking us through that now. Our focus throughout this pandemic and in every respiratory season prior to the pandemic has really been about protecting people who are at highest risk of severe illness or death. Protecting our health care system, our capacity, and we know that has been stretched for many reasons, not the least of which is respiratory illnesses. And keeping our communities, our families and our communities safe and functioning for all the other important things that we need to do, which includes bringing people safely back together again. So I'm going to start with talking about where we are today. Only about 51% of eligible children have received their first dose of COVID-19 vaccines. And I'm going to show some data about why we need to pay attention to that. A year ago, we didn't have vaccines for children. We now do. That's an important piece of protecting children from a virus that we know doesn't cause severe illness in most children, but can. And we know that children can also be part of transmitting it within households and families particularly. We know that over 86% of people, five and over, have received at least two doses of COVID-19 vaccines. And that is great. That means that we have a level of immunity that is higher than we've ever had. We have longer-term protection against severe illness, even in people who are who have immune-compromising conditions and in older people. And most importantly, we also know that a large proportion of British Columbians have received a booster dose. And the fall booster is incredibly important right now. We now have more protection against severe illness because of this, because of vaccination, but also as we presented in September, we also have infection-induced immunity. And we have treatments. We have treatments for COVID-19, including Paxilovid. And we have treatments for influenza, including also Tamavir. So we know from the seroprevalence that about 90% of people in British Columbia have built some immunity to the virus through vaccination, through infection, or for many people, both. But we are also learning that our immunity is complex. And I've talked about this many times. We have short-term protection with antibodies in our blood that respond when we're exposed to the virus. And we know that those antibodies protect against getting infected. Having that virus cause infection in the first place. But we know that whether those antibodies are from previous infection or from vaccine, they do go down over time. And usually that's around somewhere about three or four months. We start to see a decrease in that protection against infection. But many times, we know that that longer lasting second part of our immune system, the memory cells, the cell-mediated immunity, last much longer. And give strong protection against severe illness, hospitalization, and death after two doses. But also, that gets boosted up when you have a booster dose. So the combination now of immunity from infection and vaccination and the combinations that we've seen. And it is complex. People have had two doses and one infection or three doses and an infection or several infections and then vaccination. And all of that builds a complex picture of immunity that makes it challenging for us to tailor who needs what. What we do know is that right now it's really important for people to get that booster dose to protect us all from infection and help dampen down the transmission of COVID-19. And we know that the combinations we've seen mean that most people in BC are no longer at risk of severe illness and hospitalization. Even in long-term care, even people who are immune compromised. And that is really important. So what are we seeing right now? In terms of hospitalizations and deaths, as you know, our testing now is focused on people who will need, potentially need treatment or may end up with more severe illness. And so that's not a reflection of those who have been infected. That's not a reflection of the amount of transmission that's happening in our community. But what is important is following the people who have severe illness. And as we've seen in the last few weeks, our hospitalization rate has actually started to come down, which is goodness. The daily deaths as we started back in April reporting on all cause mortality at 30 days, that has trickled along and is also coming down to the underlying cause of death being COVID is only about 40% of those. I'll have a bit more information about that. So if we look at hospitalization rates by age, we all along in this pandemic, we have seen that it is older people that are more likely to get severe illness, more likely to be in hospital and more likely to die. And thankfully, with the booster dose program that we've started and focusing on, we're fairly making sure that people who are older get that dose, we have now started to see decrease in hospitalization in particularly people over the age 80, which is the highest risk group for COVID. Our 30-day mortality, as you know, as we get the underlying cause of death data from vital statistics, we see that about 40, 30 to 40% of people who die with a positive COVID test. COVID is one of the reasons why they've died. And that's remained relatively steady through the last several months. If we look again at hospitalizations and we standardize it by age, again, clearly we see that anybody , compared to the same age person who is non-vaccinated, people who are vaccinated with at least two doses, have half the rate of hospitalization, critical care or risk of dying. And the same, and that, again, it's four times higher if we look at people who have had at least one booster dose. Really important to remember that this makes a difference. This makes a difference for your own personal health, but it also makes a difference on your risk of ending up in hospital or passing it on to others. The most prevalent lineages, as you know, through this whole pandemic, we've been doing whole genome sequencing to help us understand what is being transmitted to people who are non-vaccinated and who are not vaccinated. There's a whole large gray part in the most recent ones. This is when Omicron, the pink and purple are Omicron, and the different shades of purple are basically BA5. As we have reduced the amount of PCR testing we're doing, there remains a whole bunch of others that we need to look at. But we have been sequencing those others. This is what makes up that gray box. As you can see, it's a whole variety of slightly different mutations, but all of these are Omicron BA5. That's really important. We've seen the evolutionary virologists have told us that we're seeing what they call a confluence, where there's not a new strain that's rising, that's causing very different symptoms or very different transmission rates. What we're seeing is it's all different variations of the same sort of variant. Most of it is a different variants of the BA5 with slightly different mutations. We're continuing to follow that really closely. It is unlikely, given what I've just talked about, with our immunity that we have in British Columbia, that we're going to see something markedly different arise in the near term here in British Columbia. We're also watching what's happening globally, because we don't know what's going on with our Omicron arose, but we would get some warning around if we started to see a different new strain arise outside of British Columbia or Canada. The other thing that we've been monitoring carefully is wastewater samples. As you can see, we've seen a gradual decrease in leveling off. It's been a little bit up and down over the last few weeks, but mostly low and stable. We're still at the point of calibrating those, so it takes some time to get enough data points to be able to look at trends over time. But what we are not seeing is any dramatic increases in the amount of virus that we're seeing in wastewater samples here on the island or in the interior as well, and we're working on being able to do this in communities in the north. This is something that's outside of our testing parameters and changing and testing, and it helps us give a barometer of what's going on. The other things that we're looking at and trying to validate are being able to use these same samples to look at how much influenza RSV we have circulating in our community. And these are relatively new techniques. It's not something that's easy to do, and so our lab is at the forefront of developing the ability to do that to help us out. So what else is going on in British Columbia? One of the things that we monitor over time, and this is all on the new dashboard that we're building on the BC CDC. So in the past we've had our influenza surveillance bulletin that would come out periodically. And now we've moved it on to a centralized database where it's interactive, so you can go on that in the BC CDC website, and the link will be in the description below. So one of the things that we have been watching over time is physician billboards and community visits to health care practitioners, so physicians and practitioners for respiratory symptoms. So this could be anything. This is a clinical diagnosis of what we like to call influenza-like illness, so it's anything that's causing a respiratory symptoms, and we can see that in December and in the last two weeks of respiratory illness in British Columbia. If we look at that and break it down by age, we see that that increase has been driven by respiratory illness in young people, and that should be no surprise. We've been seeing that in younger people needing ICU care and younger people going to emergency departments and seeking treatment across the province. One of the things that we need to do is to look at what is causing that illness especially in the last little while, we look at laboratory data that helps us understand what pathogens are causing illness, and this comes from swabs that are taken of people with influenza-like illness or respiratory illness. We know that school-age children are mixing more but also younger children, and it's important to reflect on respiratory illness across the province, and we do laboratory tests to look at a variety of pathogens, and what we can see is that for the last couple of months, one of the main causes of respiratory illness has been enteroviruses and rhino viruses, and those are ones that we call the common cold and enteroviruses in particular can also cause some more severe illness. We've seen EVD, enterovirus in particular strain of the virus that can cause more severe illness in children, and that has been one of the drivers of children needing hospital care and medical care over the last few months. In the last week and a half we've also seen, you can see in a purple line there that dramatic increase in influenza, and this is almost all influenza A, mostly influenza A H3 and N1, although we haven't figured out each one in one. What we've seen, though, is a leveling off of SARS-CoV-2, so that's not what's causing most of the respiratory illness that we're seeing right now, and we've seen an uptick in RSV, not the dramatic increase that we're seeing in influenza, but still an important increase. If we look at the BC Children's Hospital laboratory data, which is something that gives us an understanding of what's representative, but not inclusive, and if we look at the upper picture, the smaller picture has SARS-CoV-2 included, and then if we take that out, because that was a large proportion, we saw lots of younger people having Omicron essentially since January of last year, but if we take that out, the light green is RSV, and so we did see in BC a fair amount of RSV circulating last winter, and that's important to note, one of the concerns that we've had and I've talked about is that we have several cohorts of young people who have never been exposed to RSV before, which we're seeing in some parts of the country, particularly Ontario, we're seeing a lot of that, where RSV is causing not more severe illness, but because more children have not yet developed immunity to it and increased numbers of children requiring hospital care. We're not seeing the same picture yet here in BC, though we're continuing to watch, we did have quite a lot of RSV circulating last fall and we're starting to see it increase now, but what we're really seeing that's making a difference in this province right now in children is influenza in influenza A in particular. So the other thing that this has to look at SARS-CoV-2 in the Children's Hospital, we can see very small numbers and the percent positivity bouncing around in small numbers. So it's not the main driver of what's causing people to need hospital care right now. RSV is increasing and the percent positivity of the test is increasing, the number of children requiring the test has increased as well, but really where we're seeing the big increase in young people is to make the point really importantly, influenza is a vaccine preventable disease. We have good vaccines that work well in children. Children over the age of six months of age are eligible for influenza vaccine for free. There's also the nasal spray influenza vaccine that's available for children that's very effective. And this is a warning to us. We're starting to see influenza circulating. So this is the time to make sure we're best protecting children by getting them vaccinated against this virus in particular. I want to just talk a little bit about it's not possible now to tell if you have symptoms of COVID, influenza and coronavirus RSV. They all cause very similar types of illness in most people across the board, but the actions we take to prevent the transmission and the spread of the virus. One of the things we've had in place for a long time is saying if you have COVID you need to stay home for five days. That's no longer relevant in the setting that we are in now. Instead, if you have symptoms of any respiratory illness, we suggest, well, we recommend the guidance is to stay home and to limit close contact with others until you no longer have a symptoms themselves. It's hard to differentiate if it's one or the other and it doesn't really matter in terms of our risk to others. But we need to be cautious. We need to be cautious and that means if you have any symptoms at all, even mild symptoms, wear a mask when you're around others, even in the home and one of the things where masks actually are more effective is when you're in close contact with families, with siblings, between parents and children, grandparents and others in those settings where we don't think about wearing masks. And it is particularly if you have somebody who is more vulnerable within your household or you have an infant, you can protect them by trying to keep people who are sick away from them as much as possible and to wear masks in those situations. Or a higher risk of getting sicker with these viruses, seniors, elders, infants in particular and young children and those who are immune compromised. If you can postpone those visits, that would be good. Particularly bringing children in to visit people in long-term care. When there's a lot of viruses around and people have the sniffles, it's very risky that you can wear a mask. It is important to reduce the amount of time that you spend in the place to wear a mask and to take all of those other measures like hand hygiene, looking at ventilation, looking at whether you can do it outdoors etc. We also need to avoid those social settings, especially indoors where we may inadvertently spread to others. So move the visit outside, if you do have symptoms, but it's essential to be in close contact with others, then we need to use all of our preventive tools. So masking, washing hands, following respiratory etiquette, paying attention to space and distance and ventilation and that goes for common spaces like workplaces, schools to reduce risk of transmission. And I would like to take a minute to talk about masks and where they are most often not in isolation. It was in the context of what we were facing at the time, including severe illness in many adults as immunization was increasing, but not yet at the level that we needed. We had no vaccines available for children. We had adults who were getting very sick and putting pressure on our ICUs and hospitals, plus we had absenteeism of healthcare workers and many workplaces in schools. We had gathering restrictions and travel restrictions and barriers and capacity limits. We had reduced activities in schools. And in that context, masks were incredibly important and necessary in a broad range of settings, including the structured settings like workplaces and transit and schools. We are in a different situation now. As I mentioned, we have a very high level of immunity in schools. We have treatments for influenza and treatments. We have treatments for influenza and COVID, we have treatments for RSV. Masks still need to be available and accepted in workplaces on transit and other indoor settings. We know that we had last year, for example, restricted activities for children and that had consequences for the way schools functioned and for the health and well-being of that school's play, not just for children but for families and communities. And it is more than just education in a school setting as we know. It's the physical, emotional, social needs that school communities provide for children and families. And we have pulled together in this province to ensure that we keep these essential environments open. And really, again, our gratitude goes to all of the educators, staff and parents who have made this a safe reality for our children. I will also say every single school in British Columbia has had a ventilation assessment and we continue to make that a priority. We have a committee that is continuing to meet weekly to review what's happening in schools. We're monitoring absenteeism and schools remain a supportive, inclusive environment where masks are available in every class and where it is accepted whenever people feel they need to. But I think we all need to recognize we are all human and masks are protective equipment but they're only as effective as we make them. And that can be a challenge especially for children sometime. And I do not believe we need that heavy hand of a mandate to send a clear message that masks are an important tool that we can all use during this time and we should have one with us. We should use it in situations where it makes sense. And it may differ depending on the situation. I think about it. I may wear a mask one day on the bus if it's crowded and the windows are closed or if I'm worried that I might be getting the sniffles but on another day if I'm feeling fine and there's lots of space and good ventilation I may choose not to. I may have to bring masks in as a tool that we can use when it's necessary. If I have a sick child at home I may wear a mask in my workplace to be extra cautious even though I'm feeling well and I need to go and I can go into work or I may participate in a meeting where there's more people in a crowded setting remotely rather than in person. The settings where masking is necessary for our healthcare settings across this province at all times. These tools are necessary all the time. So we have vaccination requirements for healthcare workers across our healthcare settings in this province and everybody in long-term care hospitals, vaccination clinics, community clinics wears masks throughout this respiratory season. These are important additional measures in those areas we have in long-term care including that residents are protected through testing and ensuring visitors are also vaccinated. All of these are important but our best protection remains protecting us from getting infected in the first place through immunization and as we can see we have very high rates of immunization and high rates of boosters protecting people particularly at older age but we have very high rates of COVID-19. Now is the time to make that appointment. You can get your influenza vaccination, your COVID booster at the same time. As well as I mentioned there is nasal flu shots for children and flu vaccines are available to everyone six months of age and older. The other thing that is different this year is that we have enhanced influenza vaccines for all seniors and the standard vaccines because they stimulate a stronger immune response. I encourage everyone to register and book your appointment for your flu shot and your fall booster now. So as we are going through the respiratory season and as I mentioned we knew this was coming and we have been preparing for this as best we can and the things we all do in the last 10 months. As we all look forward to the holiday season as well it is important to keep our personal toolkit handy. We have many tools that can help protect us, our loved ones, our community from all of these viruses that are circulating now. First and foremost is getting vaccinated but also having a mask with you, wearing it in those crowded indoor settings, wearing it when you have children, avoiding touching your face and eyes and nose, using respiratory etiquette, coughing in your sneeze, covering your cough and disposing of your tissues remembering your hand hygiene. You can also choose where you gather and when you gather with friends and family, looking for open spaces with good air flow and looking at postponing some of those visits if there is illness in the home and avoid contact with others especially people who may be more at risk. I want to thank everybody in British Columbia for their continued commitment and we have seen this all along of recognizing that we are all coming from different places and that we need to be supportive of each other. If you are wearing a mask today, given the situation that you are in, we need to be supportive of that and practice respiratory season and practice, be part of how we do this every year as we know that these viruses are going to be coming around again. Thank you. I will turn it back to minister. Doctor Henry is leaving me with a clicker. Only one person has the clicker here. Thank you, Doctor Henry. This is going to go on with presentation with respect to current hospitalization and where we expect to be. In September, we said that we had to prepare our hospitals for respiratory illness season and a possible surge in patients. Our hospitals have well established systems in place to manage high patient volumes including regional and provincial surge plans. They have been planning for various scenarios and are ready to respond to an influx of patients requiring care for them. We are not at a point where we need to implement them yet. But we are ready if we need to. Our readiness plans include improving and increasing the hospital bed capacity and emergency department efficiency. We go on to the next slide which I think is this one. No, it is back. We are still on that one. In terms of capacity, in October, COVID-19 hospitalizations as Doctor are relatively similar to September levels. Hospital occupancy is up from September, rising by 1.95.4% of base bed capacity and when we include surge beds in those numbers the occupancy increased to this point in November is 2.2%. We see that reflected in that slide. There is a lot of interest in children's critical care capacity. I would note that this is because overall in the province we have amongst children's high QT beds and neonatal intensive care beds. We have 243 beds but a change of one or two can very significantly change the information in each site. For example, on Monday there was an over capacity at Colonial General Hospital. Today we are under capacity for that because there is a small number of beds and the reduction or increase of those numbers. The pediatric ICU rates tend to change more of course as we have said but essentially we are at as of today as of yesterday it was 67%. I think we reported that in our children's critical care beds today at 64%. In terms of our children's high QT units it is up slightly from 74 to 76 from yesterday to today to give you a sense of the day-to-day changes. In terms of the number of visits over the last period we have seen an increase overall in November on average from where we are in September and October. In September and October it was roughly 6,700 visits a day. In November that number is up to 6,765. Understanding that at different sites that can be a varied amount on different days. Next slide please. The first step is integrating priority actions into health authority surge response plans. These plans include improving emergency department triage processes to better and more quickly connect patients with community care to avoid or shorten hospital stays. They also include hiring more patient care coordinators to improve the flow of patients through hospitals and heightening integration with urgent and primary care centers and the investments we made in patient transport. Next slide. Pediatric in terms of pediatric ICUs we have a dedicated provincial pediatric team that coordinates our pediatric resources. We have pediatric ICUs of course located at BC Children's Victoria General and the University of Northern British Columbia and neonatal ICU beds in many jurisdictions and many hospitals across the province. This dedicated team is focused on a daily basis on when it's taken responding to the demands of respiratory illness season and so you see that and you see that in the response specifically at that care and some of the numbers I spoke about just a few minutes ago. If we move on to the next slide. In terms of increasing our capacity in community this was a part of our plans and it's something in a term which I'll explain. It's called alternate level of care or ALC patients. Essentially those are patients who are in hospital but are really ready or should be in long-term care and they're being provided hospital care as they either wait for a long term care chancellor and available bed and that is one of the ways that we measure patient flow in the system and also it's a way to measure patients by creating more access to long-term care beds in the community and that's precisely what we've been doing. We've seen in October a reduction of ALC patients as a percentage of occupied beds that is decreased and we have specific measures that we put in place including the opening of beds to ensure that we're ready as we need to address potential demands on capacity from respiratory services across all health authorities in long-term care to allow for more space in acute care. This is not an issue of moving acute care patients to long-term care. It's a case of patients who are long-term care patients but in acute care moving over to long-term care and creating capacity at a time when there are capacity pressures in the system and there's lots of details by health authorities in the community. That's it. Just to say finally that we're opening long-term care beds and we're supporting operators of long-term care beds who are often health authorities are often private for-profit or non-profit providers including staffing float teams and virtual nursing services and providing casual staff with more flexible opportunities for regular part-time and full-time work. Including providing casual staff opportunities for regular full-time and part-time work, adding capacity and home support and adult day programs. Ensuring quicker access to transitional care for complex patients discharged from the hospitals. Our hospitals need to be ready and as you can see from Dr Henry's presentation we need to continue to be ready as we go through this season. We need to make sure that we don't have to worry about our doctors but we need to prepare for them and we all finally with those plans in place need to do our part. We need to be ready too. We need to get vaccinated. We need to wear masks especially if we have mild symptoms. We need to stay home if we are sick and we need to wash our hands frequently and we need to keep doing what we do. Please press star 1 to enter the queue for the opportunity to ask a question and a follow-up. We are going to start here in the room today. First question comes from Binder Sajj and CTV News. Hi. Just wondering if you are a parent of a child who gets fairly sick. I know we have talked about the ICU numbers. But you are heading to hospital often facing hours long waits whether they are waiting hours and hours and hours and what advice do you give parents who are worried about their sick little ones? I know this is a challenge that we face a lot and it is so hard to know with young children particularly. So I encourage people to talk to their primary care provider to call 811 where they can get advice as well. When you do go to emergency departments some of them are very busy but if you are in the hospital, don't put off that visit if you need to go to the emergency department. You will be seen and triaged and we will all need to be patient. But we know it is important to get that care if you need it. I don't know if you want to talk about it. It is a challenge. So say the important way that the capacity changes are important is it creates space on the wards. We are admitted to the hospital but in the emergency room and it is an important measure of patient flow in the hospital. It sounds like a technical thing but it is important. We want people who are sick and are admitted to the hospital to be on the wards because that allows less pressure and less sense of pressure in the emergency room. So it is important for that reason and fundamentally if you don't have space in the emergency room and you don't have the capacity to go to the emergency room as to all the measures we are taking, care coordinators and others to help people in those periods. We have at different hospitals on consecutive days sometimes significantly different numbers of patients coming in. And as Dr Henry has said everyone gets triaged. And it is a challenge sometimes. There are other services in the emergency room in a day. So we dramatically expanded that service. It has come back down to a daily average of about 1,800 check every morning to see how we are doing in response to those calls whether we are losing them. Yesterday we responded to 99% of the calls. So we have created capacity there to assist and obviously through the other actions we are taking. But it is a challenging time typically in the pre-COVID era that would be on one of the bases of healthcare workers we use about 8,000 to 9,000 workers across the problems and can hit the entire group of workers in a particular part of the acute care hospital. Whatever the nature of the illnesses. So that is one of the challenges facing the healthcare system in every part of the country and certainly here in BC. Follow up, Binder? Yeah. And speaking of that issue we are talking about the capacity and the demands differ on a day-to-day basis. I know you talk about having surge beds available but if you do have healthcare workers who are off sick you are not necessarily staffing those surge beds until the need is there but how quickly can you get those staffed and how quickly can you get whether it is children's hospital because I know that is a huge concern right now or it happens within hours, a day, a week. I am not sure how long it takes. I will talk to you a little bit and turn it over to you. One of the reasons we have set up the EOCs, the emergency operations centres, I get children's hospital and the provincial one that we have is to be able to do that on a day-to-day basis. So children's hospital, they look at all of the things very rapidly so sometimes it is a day-by-day thing and it is dependent very much on healthcare workers and so there are systems and processes that we have put in place and these emergency operations centres to be able to do that on a day-to-day basis so it is rapid, the equipment, the pieces are there so it is finding the healthcare workers to transition into the places across the province right now as we are heading into more and more respiratory illness. I think you are absolutely right to the extent that the higher the population hospital the more pressure there is in the system and it is unequally felt one of the places where I think our healthcare workers and nurses have done exceptional work is Royal Inland Hospital which has a base bed capacity of 258 and it has been in place for many weeks and when I say many weeks I say more than 52 so they adjust with surge bed capacity all the time as do all hospitals but you want to relieve to the maximum extent possible and there we open long-term beds during the pandemic to create capacity and if necessary and this is not necessary yet and we are doing record numbers of surgeries in our healthcare system every month which is necessary those steps are available as well. You recall a year ago and that was the delta variant of concern that we had to transport people from ICUs in the northern health authority in particular in the hundreds down to the southern health authority so we have levels of action that we take in our emergency responses we are not there and we don't want to be there and part of that is why we are here for what would come in respiratory illness season is to prepare for exactly those scenarios but it is not easy and it is just not easy and if you have some people who are off sick and especially in a smaller hospital it can profoundly affect your ability to deliver service which is sometimes why we have diversions because people are off sick and you simply can't replace them in a small period of time and you have been reporting on that so those are some of the challenges facing the system so we are able to but there are limits and once those numbers go up and up and up and up then you have to take other actions the reason we deferred surgeries at different times in the pandemic in March of 2020 because we weren't sure what was going to happen and during the amicron variant of concern was to reduce hospital capacity so we could care for people who were off sick and we had lots of options available to us but obviously some of those options all have other consequences that we don't want to see happen and that's why we are taking these preventive steps. Next question. Is there any hesitation over bringing back a mask mandate because of the view that the public has moved on and it would be hard to enforce the mask mandate but I am trying to explain that mask mandates were in the context of where we needed them to be worn by everybody over broad areas, over broad settings in the context that we were in at the time so I don't see a mandate as being required by itself right now in the situation that we are in. We all need to learn about that tool and where it is best used and we are trying to provide some guidance on that and that's what we all need to focus on because this is going to happen every year and mask are one of the tools that are important, that work that help in the situations where we use them most so if we are not feeling well, if we are going into a crowded situation with poor ventilation where people we don't know those are when we need to wear masks and that will continue. So right now I don't see that as an issue because we have many other tools and we have a high level of protection from a variety of these respiratory illnesses that are circulating right now. Is there any particular of all the metrics you monitor? Is there any in particular that will continue to change your mind? We have talked about that a lot. It wouldn't be a mask that is getting sick and overwhelming our health care system prevent morbidity and mortality, sickness and death and so the situations that I can see would be an entirely new virus for which we don't have immunity anymore where every single one of those tools needs to be in place in a broad way across the population so it would be in the context of other things that need to be in place too like capacity to do when we didn't have protection against something that was causing very severe illness in the large numbers of people. Next question comes from Richard Zussman Global News. You describe a scenario where you wear your mask close proximity to others. You don't know poor ventilation. Many people would describe that as a school situation. I know you mentioned that ventilation has been worked out. Why is there such a reluctance considering that kids have largely been able to train themselves to wear masks properly to put masks in that situation when we have even seen studies out of the U.S. that community spread has gone down in areas where there has been masking in schools. Just to address those studies because these are things that we have been looking at and it's not going down. Masking was part when the community rates were high. Community rates come down. So it's very challenging. They're not causing effect in those studies. So I suggest that we have a lot of data that shows us that schools are not uncontrolled environments. There are lots of things that children do in schools and it's really important to normalize that. We've put a lot of pressure through this pandemic in many, many ways. So it is important for us to make it a very inclusive environment where masks are there, where they're available, where kids can wear them, where they are trained to wear them, where it's normalized when they need to wear them. We're not in a situation right now where I think every single child and adult in a school setting has to wear a mask all the time. So it's important to have pieces that go together to make it a safe environment and to give children what they need in a school environment which is activities and being in person all the time, the social connections, all of the learning that they do in the school community and school environment. So that's what we're focusing on. Making sure that the ventilation is paid attention to. So it's important to stay home and to make it easy for children to be able to stay away if they're getting sick. Follow-up, Richard? On the wait-time issue. Really important to get vaccinated for children. That's one of the best ways we protect them even if they're not going to get that sick themselves. It's really important. On the wait-time issue of BC children, I know people are still facing double-digit-hour waits. What should parents do with children looking at that situation, considering in some cases they are having a hard time accessing family doctors or other parts of the medical system and is there any work being done to address wait-times in the overall system, not just the children's in terms of care. I think I will defer to minister Dix for most of that, just to say as I said again, 811 is there to provide you with advice. There are pediatric trained people in emergency departments across the province. Children is very specific and we know people get referred there for more severe illness sometimes, but it is important if you are concerned about your child and if you call 811, get some advice, but if you need to go, the emergency department will be there for you and we are working behind the scenes to make sure that we maximise that as much as possible. I think it detailed some of the measures we are taking specifically with respect to emergency rooms to assist people who are visiting, especially with children on a given day, including increasing support for people who are visiting in most hospitals, which is really important, BC Children's is a little bit specific because obviously we are not, we don't have ALC beds in BC Children's hospitals, so it is a specific circumstance. All of the things we are putting in place, including the expanded capacity at 811, including we have added a couple in the last week's urgent and primary visits across the province every day and coordinating those more closely with emergency rooms and the work we are doing to get people and get people supports at home so they can leave hospitals sooner. One of the challenges in the emergency room in general and if you are a child outside of the metro Vancouver, you see one of the challenges in the emergency room is ensuring that there is no pressure on the emergency room because that can be problematic for the delivery of care and obviously problematic for everyone around the care, makes it feel more crowded than you want it to be in those circumstances, so all of those steps we are taking are important and obviously on the primary care question, we have recently working with the province's doctors and all of the health care workers to increase the attachment to a family doctor and I think that is work that we did together, we have signed a historic agreement that is waiting to be ratified and we put interim measures in place to facilitate need to practice doctors to provide care in the community. We are taking steps on internationally educated doctors and of course the transitional funding which we have done in the last couple of years in the communities, but it is a difficult time, like this is we have seen and we are seeing some significant increased demands and we respond to those demands. There has been an increase for example in Vancouver coastal health in gynecological referrals, so our team of surgeons met last week and we will be increasing that capacity in the coming few days in BC's health care system since January 2020 which has been an emergency organization of the system continues to be needed and required especially this fall and winter. Moving to the phones now, our first question comes from Andrea. There is recent research showing that even among those who have been immunized each subsequent COVID infection raises a person's risk of serious death or development of disorders affecting the lungs, brain and heart and the body's blood, musculoskeletal and gastrointestinal systems. Does that not warrant a stronger public health response beyond widespread vaccination especially given that we know that immunity does wane after a few months? I guess we have to put it in context and I am aware of that study and there is many of those studies that have varying results about impact and some of it short term, some of it potentially longer term but what we are also seeing on the ground is we are not seeing as many people develop long COVID symptoms particularly after vaccination. We know that vaccination reduces that risk by at least half, maybe more. Since Omicron we are also not seeing as many people with long-term symptoms. I think we have to put that in the context of we know that those broad measures that we took to prevent transmission had downside impacts on people's health as well. If we look at the things that you could do so more public health measures it would be stopping sick people from being around well people and that is hard to do. We know that happens with influenza so we only need to look at places like China for example where they are continuing to try and do that to recognize that there are very severe down tied impacts on communities, on families and on individuals. So I think what we need to do is recognize that the best protection we have is vaccination and put in place all of the other things that we do individually and collectively to try and get us through this. This virus is going to be with us so we have to find that balance of not causing more harm from the measures that we put in place and doing our best to protect people. We have seen our evidence is clear that if you are vaccinated and with the level of hybrid immunity that we have right now most people are not going to be vaccinated right now. Follow-up, Andrea? Yes, please. How many pediatric elective surgeries have been cancelled or postponed in response to the increase in respiratory infections today? I am not aware of any of them in this province. There are on a daily base occasionally surgeries that are cancelled but essentially across the system we have been doing record numbers of surgeries. I am happy and ordinarily in these reports when they occur on Thursday and we will have the numbers coming in on Thursday we will let you know how many surgeries have been performed in BC but prior to the pandemic we really never hit 7,000 surgeries. We have hit that mark consistently and that obviously includes pediatric surgeries at a particular site. There may be issues on a surgical nurse hall and it affects the delivery of the surgery in that case but in general we are delivering surgeries at a very high level and historically high levels across the province. That is one place should the situation become more challenging where you can adjust to allow for more capacity in the system but it is obviously not desirable to delay surgeries that people are medically necessary. We have time for another question from the phones before we come back to the room next we hear from Wilden at Paul Radio Canada. Bonjour. My question is for the Port-du-Masque. You mentioned it today, the mask is not mandatory. Le Québec recommends the Port-du-Masque in some public places in Chalandais. I would like to know how is it for the British Columbia? Do we recommend it? Do we leave the choice to the public? What do we recommend here in Chalandais? I think the advice of our health system is the same as other provinces. There is an important exception. We have measures in place in the health system that we do not have in Ontario or in Le Québec. We have to maintain the mask in hospitals but also in long-term care centers. That is important and essential. It is also important to note in our public health system that it was mandatory for the employees to be vaccinated which is not in place in other provinces in Canada. I do not comment on what they do. I think that the efforts are exceptional. I had the opportunity to talk with the Prime Minister last week. I think that the effort in Quebec is extraordinary. But I think that there are particularities and on the question of masks. The peculiarity of the British Columbia is that there is a mandate for our health system. Follow-up, Wildinette? Yes, I would like to answer the question. Mr. Dix, for the mask, what do we say to the British Columbia? Do we recommend it? Do we recommend it? Do we advise it? Do we tell them in public places? What is the position of the British Columbia at the moment on the port of the mask? Simple. I think that we take measures other than these necessary measures. We follow the advice of Dr. Henry and his team on these questions. It is important for you to know that often there are circumstances that are important to wear a mask for your own protection and the protection of people we love in our own family. It is important. So, often, when I go, for example, to Céron-Fuss, I wear a mask. It is normal. But we have a system of demand in our health system. Yesterday, we had recommendations of public health and we will continue to follow them. I think it is important here to understand that it is a way to protect against COVID-19 and other respiratory diseases. But there is a combination and the most important of all these measures. It is vaccination. I encourage everyone to be vaccinated this week. There are open meetings today. Whether it is when the COVID-19 or other people , I think it is essential that people take this fundamental measure to support against the COVID-19 in particular and other respiratory diseases. Final question from the phones before we finish here in the room. Lisa used a city news 1130. I don't know if I missed this before, but I wonder if you could address specifically the wait times for children and for adults. What is being done to address that? I know you talked about it earlier and I am sorry if I missed the entire answer. What we are seeing across the province is a relative increase. We used to use this number of about 6,500 which is average in front before COVID-19. I was going to say COVID-19 in BC. In November so far our population was 765. That is differently felt at different hospitals and different communities. We put in place as we do in periods of high volume which are by the way every year during respiratory illness season but it is more important this year because of COVID-19 in addition to influenza. We put in place a number of measures and we are putting continuing to put in place measures to ensure that those people are able to move too long-term care to create more space in the hospital. This allows us to improve flow from emergency room and that is really important for everybody who works there and everyone who gets care. We are putting in place more patient care coordinators. We have resources available to get advice on the phone and people are using those resources. We have seen a significant number of calls that we received through the 811 line and we are increasing the collaboration between urgent and primary care centers and ERs across the province. They are now more than 30 urgent and primary care centers and they have seen 1.5 million patients up to date which is a significant contribution as well. All of these steps are being taken. We have to know in this way that we are in emergency rooms. You see it in the numbers but you see it in the reality of those emergency rooms and it can be in different emergency rooms different on different days and that means that if you need to go to an emergency room, go, you will be triaged and it may take some time because we triage cases. If your child or your case or an adult's case is less serious than other cases, they are not going to be triaged or else for good reason. All of the steps we are taking to reinforce primary care and specific actions to improve patient flow in our hospitals which is important for patients. It sounds a technical term important for patients because it means we don't have people stuck in emergency rooms longer than they need to be stuck. I know there are pressures coming with this respiratory season. Things are not going to get a lot better for hospitals. I know in Metro Vancouver people wait a long time but what can be done is being done but ultimately people are still going to have to wait. And it is going to change on a day-by-day basis. The things we do as a community to try and prevent ourselves from getting sick and using the other tools in our community like 811 to get advice about things. But you are right, we have committees, the emergency operations centres who are trying to manage flow as best we can so we can make it as efficient as possible. But these are challenging times and challenging times for healthcare workers who are doing their best to try and see people as quickly as possible across the province. That is what we are going to do. We are about a month away from the heart of the holiday season. People are going to be traveling around. There are going to be parties and parties. We are also going to be a month deeper into this virus season. How confident are you that we are not going to see any restrictions whether it is masks or otherwise implemented then and what kind of metrics we are going to see. It varies year by year when we see peaks and how steep those peaks are. We are seeing influenza rapidly increase. We have seen COVID level off and go down. It is hard to know what is going to happen and we need to be prepared for lasting several weeks. Normally what we see is that the holiday season is an amplifier for influenza. We are seeing it start in the next few weeks. We all need to think about what we are going to do over the holiday season to make sure we are not putting people who are more at risk at risk. If you are being able to cancel some of those events if we are sick or somebody is in the family sick, moving it to a safer venue where there is more space. Those are things we all need to think about. I don't see us needing to watch this, of course. It depends a lot about the impact on our health care system, how we are managing that, and we will be watching that carefully. We will be looking at how much it goes up, who is getting sick. Those are all the things we will be reporting. The respiratory dashboard is updated every Thursday so people can look themselves. Traditionally what we have seen is that it comes from different age groups, different viruses and we have seen that. We have seen an enterovirus and now we are seeing influenza come up. We will be tracking it carefully to see what happens over the next few weeks. But I don't foresee we will have to do broad community based measures and the way we need it to do last year given the impact we saw last year. Follow-up, Rob? You can't get insurance without a doctor's note. It doesn't have access to a doctor. I guess it relates to primary care again. I know the province has brought in this new model for funding GPs. Before we reap the benefits of that, what do you say to families that this one and I am struggling to get a doctor? Is there anything that you are able to do and will do before we see the benefits of this new model? Do you have any details to my office? I understand some of the details of what the difficulty might be in terms of getting a doctor's note but I would be interested in getting all the details and seeing what we can do to help this person in those circumstances. In a general sense, what we have to continue to do is Nanaimo has one of our most successful for COVID-19. It has a positive impact there. It is very much integrated into the primary care system and in fact operates the medical arts building and expansion of the medical arts center and expansion of the services they provide. Building out primary care networks more than 1,200 new people to provide team-based care across communities. We are providing a lot of information and obviously the work we are doing with doctors. It is difficult to talk about a specific case knowing the details of that case but if you provide them, I would be happy to look into it personally and see what can be done. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.