 Good evening. I'm just I'm just looking at my screen and I'm not sure if if if I'm supposed to be starting just yet, Sherilyn. I think so. So, good. Thank you. Good evening. Thank you to thank you to everybody for joining us this evening for our child care discussion with public health. As we start our discussion tonight, I'd like to let you know that this, the discussion is being recorded, and it will be made available on the province of BC's YouTube page, and the child care BC health and safety page will link to that. And over the past month, we've we've received dozens of letters and emails from from you in the childcare sector. And these have been sent directly to Minister Chen. They've been sent to Dr Henry and they've been sent to childcare BC and the Ministry of Health. Many of you have asked questions, specifically about the Omicron variant are updated guidelines that were posted just on the 19th of this month. Questions about isolation practices for children, both when to stay home and when to come back when it's safe. And we've taken many of those questions into consideration. The public health guidance for childcare settings was updated. And we want to use a panel discussion this evening to both provide clarity on some of those updates and answers to the questions that we have heard coming in from childcare providers. These questions can also be submitted this evening anytime during this information session through the Q a feature that is available at the bottom of your zoom window along the ribbon at the bottom so feel free to type your questions into the Q a feature and time permitting select questions will be answered during this session. Our childcare BC stakeholder engagement team will follow up with any unique questions that have not been addressed by already by the panel, or that have not been addressed in the guidelines and will share out the information on those questions through future communication. So tonight, I myself personally am joining you from the traditional territories of the look one can speaking people or look one can speak of people's I'm sorry, known today as the song he's an Esquimalt First Nations. And I'd like to acknowledge that all of us carry out our work on the territories of more than 200 First Nations in BC, each with unique cultures and languages and traditions. And I'd also like to respectfully acknowledge the Metis and Inuit peoples that are living in communities throughout British Columbia. I wonder if we could each in our own places, please just take a moment in silence to consider the territories from which you are joining us this evening. I invite you just to think about the territories that you're that you're in tonight. Thank you for your silent acknowledgement of the territories that you're all joining from. Now, I would like to introduce the Minister of State for childcare Katrina Chen to open our evenings with her comments. Thank you so much Shannon this is Katrina Chen BC's Minister of State for childcare. Before I begin I also want to take a moment to acknowledge that I'm joining you from the unceded traditional territories of the Coast Village peoples. I begin by taking a moment to say thank you to everyone who's joining us here tonight, whether you are a childcare provider, early childhood educators, parents and families. This is a really difficult time for many of us. Thank you so much for taking the time out of your very busy schedule to join this very important discussion. So thanks to Dr. Bonnie Henry and the public health professionals and doctors here with us tonight to provide more clarifications and support everyone to go through this ever changing situations together. And I want to especially acknowledge the stress the childcare sector is under and the difficult role you have in trying to keep facilities safe for families you serve. Thank you. This is also on top of dealing with staffing shortages. And we hear your concerns. And that is why we've been taking notes of your questions and passing them on to our public health colleagues, so they can address your concerns directly tonight. This is a very challenging time for many, many frontline workers and people in our communities across BC. The situation is changing so quickly. Just weeks ago, we thought we would be spending a good holiday with family and friends, but the variant has hit us so hard. Again, as we continue to adjust and adapt to the ever changing situation. And this is also why yesterday we've announced that we will be providing rapid test to childcare providers. We have secured 250,000 tests that will be distributed directly to childcare operators. We still have a few logistical details to work out, but please be rest assured that we have those tests to you as soon as possible, and you'll be delivered right to your door. I am pleased to share that we have been working hard and ensuring that we can provide additional health and safety funding with more details to come in a very near future. Please watch for more information on both of those supports in the coming days. And as always, our ministry will continue to work closely with public health and with our COVID childcare working group to support the work you do. And now I would like to turn the session back to Shannon and all the public health experts so we can get right to your questions. Once again, thank you so much for being with us here this evening. And most importantly, as a parent of a young child myself. Thank you so much for your critical work and dedication for the wellness of children and families throughout BC communities. Please take care. Thank you, Minister Chen. Now, let's get right to our discussion. I'd like to start by introducing our panel members. Just looking for them to rate. Good. Here they are. So joining us this evening on our panel is Dr Bonnie Henry provincial health officer for British Columbia. We have Dr Rebecca Gustafson, who's the vice president public health and wellness provincial health services authority and deputy provincial health officer. We have Dr Jason Wong, who's the associate medical director of clinical prevention services for the BC Center for Disease Control. Mark Lysician, deputy chief medical health officer for Vancouver Coastal Health. Thank you all for joining us this evening and thank you for giving us your time and expertise. As we get started just to start off our session. I'd like to invite Dr Bonnie Henry, please just to maybe make some opening remarks and give us some context for our discussion tonight. Thank you and thank you very much. I'm very honored to be here with you all tonight. And I know this has been a long, long road that we've been down together and it is not over yet, but it is. You know, there are lots of things in our future that are looking brighter. I do want to start again by acknowledging that I'm coming to you tonight from the traditional and Zeta territories of fellow come speaking people here in Victoria. I'm going to be talking about the Squimalt and songies First Nation and the charter meeting nation of Victoria. So, this is an important time for us to be able to speak directly with you and as Jen has said, we've been collecting your questions and I know I heard and I have talked with many, many child care providers early childhood educators and I have family members who are in that group. I know how challenging it has been from the very beginning, but I also know how essential and how important the work is that you do every day. We know from the very beginning of this pandemic when we everything was shut down for a period of time that it was incredibly hard. It was hard on families was hard on children. It really highlighted the important their critical role that early childhood educators and childcare providers play, not just in looking after children, which is important in itself but also in the growth and development of children and it is such an essential role. We've tried very hard to support you and making sure that you can continue that role to support kids to support families and to support our communities across BC through this last two years that we've been dealing with this. I want to start again tonight by by providing a little bit of context about where we are and why things have been so changing so quickly and are so different now, even compared to what we were dealing with in November and December and I think we really got into a good place. We got into a good place where we understood who was being affected how we could test people, making sure that we are trying to get every single case. We had a very strong contact tracing and case management and contact management and that's a really strong public health role that we do all the time and we had wrapped up our teams we have been working really well and it was going. As Dr. Chan said, you know we were in a pretty good place we had a rough go of it for a few months. Delta was causing very severe illness, especially in young people and especially in younger people than what we were seeing from previous years and especially in people who didn't have the protection of vaccination. And it wasn't until it was December 18 really where we have December 12 we had our first case of Omicron and when the South Africa identified that this was a strain that was different and was spreading really really rapidly. And when we looked for it, as everybody else did around the world, we found that it was here, and it was here in large numbers, and it very, very rapidly replaced Delta and now you know 1995% of everything that we're seeing in COVID in British Columbia across the board is caused by Omicron. So what is different about Omicron that makes us have to respond differently. I said this in December 21 and then again on the 24th when we put additional restrictions in place here in BC. It was because we were trying to put all of these pieces of a puzzle together. Was it causing more severe illness or less severe illness? Was it spreading faster or was it causing more illness in people who were vaccinated or unvaccinated? Was it causing more reinfection? Was it more people ending up in ICU? Who was being affected? All of these things that we didn't know about this new strain, all we knew was we were seeing hundreds and then thousands of cases a day. And we knew that things like hospitalization, leg, that rising cases by about two weeks before it starts, and then the peak legs by about another week, and then, and we knew that our healthcare workers were strained and stressed and tired. And we also knew from experience with other viruses that if the things that we were seeing happen in places like the UK and in places like South Africa and a little bit ahead of us in Quebec in Ontario, we're going to play out here. But we would see a very, very rapid peak, and we needed to do things to try and settle that down so that we could understand more. So we took some measures and put in some orders close a few things down. In December, and unfortunately that meant that we had to have quiet holidays, but we did. You know, it worked here in BC. It worked, and we were able to flatten our curve much more than what was expected. And we continued with the same level of transmission that we had. And over this past, really, it's been five weeks since we've really had this takeover in BC. We come to understand new things. One of the most important ones that we know now is that Omkron spreads much more rapidly. The average incubation period has gone from five, six, seven days to two, three, four days. And what that means is that tool that we have called contact tracing and case management is no longer effective. It takes time before you realize you're sick, before you get a test, before that test gets reported to public health, before we can contact you and then contact you, before that you've been in contact with during the period you were infectious. What happens with Omkron is that all of that is compressed, and we're seeing what we call the generation time. So I get infected. I realize I'm sick. And by the time that happens, the person I was in contact with before I even had symptoms myself is starting to show symptoms and has passed it on to somebody else. This is what we're faced with now with this strain of the virus. It's not that we don't want to do contact tracing, it's just it's not viable, it's not possible. When you have a virus that's spreading that quickly to so many more people and that's why I think everybody on this call tonight, I'm sure, knows at least somebody who has COVID. And that is really, really different from even a few months ago. So it is spreading in a different way. It's spreading much more rapidly. The, and it is spreading in people who are vaccinated and unvaccinated. So what we are seeing is that yes, vaccine, which was highly, highly effective at preventing even infection from Delta is less effective. We are seeing that it probably 30 or 40% so it does reduce your risk a little bit. But it, it means that the whole community is now at risk of getting infection. But we are also seeing that vaccination makes a huge difference in the, how serious severe that infection is. And we're seeing that people who have even just two doses of vaccine on board are are immensely less likely to have severe enough illness that they need to be in hospital or have critical care, and 30 times less likely to end up in ICU or to die from. So this is really, really important and I presented what we call a heat map of, you know, who's getting Omicron who's ending up in hospital and who what are the risks. And some of those risks are very much the same as what we've seen with every other strain of the SARS CoV-2 virus that's come through here in BC. So it is as you get older, so people over age 70 in particular and people over age 80, people who have immune compromising conditions and we have delineated those is what we call clinically extremely vulnerable. Those are people who have transplants who've undergoing cancer treatments who are uncertain immune suppressing drugs, so very specific people. There's about 160,000 of those people in British Columbia, and we've prioritized those people to get vaccine very early on. So we know that that they're still at risk. We know that pregnant people are at higher risk. So these are things that we've learned over these last few months. What we've also learned is that, well, this will be no surprise to anybody, our PCR testing capacity. So that most accurate test that we want to diagnose COVID-19. The capacity is about 20,000 tests a day. And that's what we, that's our maximum that we can scale up to. That's what we have people for, machines for, reagents for. That's the most that we can do. And what we are seeing and what we're seeing across the country and around the world is that way more people are getting affected. And so we've had to change our strategy for testing, because as I was mentioning, it's spreading much more quickly. And because so many people are vaccinated in BC, most people are having mild illness that they recover from very quickly. And the test is not going to make a difference in about how they manage their symptoms and the risk that they have of ending up in hospital. So we needed to preserve our more accurate PCR tests for those people that were more at risk, so that we knew that we could make sure that they had what they need to prevent them from going into hospital. We have some treatments that are available, a new one, Paxilib, but another one, what we call a monoclonal antibodies, the troverman. So these are really important things to help us manage individuals who might need extra care to prevent them from getting extra sick or from getting into a hospital. So that's what we needed our PCR testing for. And we needed it to, because the other thing that we see when this type of virus that's spreading so rapidly is going through communities, is that people get sick with it, and workers get sick with it, and families get sick with it, which means healthcare workers get sick with it. And at the same time that we were seeing the surge in people needing hospitals, getting sick with this and needing hospital care, healthcare workers were getting sick with it as well. So we needed to make sure that we had testing for healthcare workers so we could manage that risk and keep our healthcare system going. But we also recognize that the data was showing us that people who were vaccinated and have mild illness, they tend to get over it really quickly with them home on, and they're less likely to shed virus for a longer period of time. So that's why we were able to change that period of isolation. It doesn't mean that there are some people that shed for up to 10 days, as we've seen with every other strain of SARS-CoV-2 that's come through. But it does mean that the milder illness you're less likely, and we've seen it fall off. So the risk of shedding live virus so you can infect somebody else after five days with Omicron is about 15%. So what we are doing is balancing those risks and the need to have people getting back when they're feeling well, getting back to work and school and childcare and education and everything else is mitigated. So it's not zero, but we are able to manage it by doing things like you wear a mask, especially when you're with other people with a good well-fitting quality mask. You try and avoid those highest risk settings and really what we're talking about are long-term care homes and some of those settings where there are those people, you know, cancer centers, places where there are people that even with vaccination are still likely to get sick with this and may get really sick with it. So that's the context that we're in right now and I won't go on and on. But what we're seeing is that we needed to manage and change our approach to this so that we can continue to function in society. And we've talked from the very, very beginning about our goals in this pandemic and their goals are to reduce people getting sick and dying from COVID-19. It's to preserve our health care system and we saw this really in the north of particular in October and when the health system was so overrun with people with serious illness from COVID that people in Salmon Arm had to go to another community to deliver their babies. People could not get cardiac care. We had to move 155 people who needed ICU care and ventilated care from the north to communities across the South, whether it's Vancouver, the interior of Vancouver Island, because our health care system couldn't keep up. So we have all of these things that we want to do, that we need to do, and we're taking these measures to manage COVID. But the other really, really important one is to minimize the disruption on society. And we saw that when we closed things down in March of 2020. It was hard on families. It meant that people were off work and it was meant that families were at home. And those have health impacts. They have health impacts on children. They have health impacts on families. They have mental health impacts. They have emotional impacts. So all of those things we have to take into account as well. And now I know, you know, now we know a whole lot more about this virus. We know about the effects that can happen if we, if people are off of work. We've learned a whole lot more about who in our community needs to be at work to support our community functioning at all. And early childhood educators, childcare providers are definitely in that group, along with healthcare providers, along with families and our fire services and our grocery store workers and our pharmacy workers. And we've learned so much about how dependent we are on each other. So the new guidelines and we'll talk about some more. The details of those are to take into account this changing scenario that we're in, where most people are not going to get tested because that capacity needs to be preserved for those who I just talked about. Where we know that the things that we can do make a difference. We've got a lot of experience with it now. We know how to wear masks. We know how to do all of the other things in our, in our communities. And we know that most people because vaccination rates are so high are having mild enough illness that they can get back to work in school and childcare within a few days. So, I'll just start it with that to put some context of what we're dealing with right now. And I want to say that I am so grateful for all of the work that you do. And I know it's been so so challenging, keeping up with all these changes and trying to know what's happening, what's affecting K to 12 and how does this all work together. And so I'm hoping tonight we'll be able to share some of that information with you, and that we can all go forward with a bit more confidence about how we're going to get through this next few months. So, thank you, Dr Henry for that opening context I think it's helpful to to understand sort of the stage that that that we're on in the time that we're in so I do appreciate that. I'd like to move into talking about about the guidelines themselves so that the child care guidance document was updated on the 19th of January so just a just a little while ago maybe a week ago. Along the same time that the guidance for the general population also is updated so there was some changes in in the overall population advice as well as in the childcare settings. And I think there was, you know, sort of three areas within the child care guidelines that you know draw do the most attention and the most questions shall I say from childcare providers and Dr Wong I'm going to invite you please if you could speak to the specific changes in guidance related to isolation and to the definition of a close contact, and then also about symptoms. Dr Wong. Thanks. Thanks so much Shannon and thanks to Dr Henry for I think laying out the context because I think the two are really related as to, you know what we know about Omicron now, you know, given the month and a little bit experience and but also experience from other jurisdictions around the world as to how Omicron behaves and the impacts that has on kind of the guidance that we recommend for childcare, but also I think the general population and large. So I'll maybe go in reverse order for what you just spoke so I think Dr Henry kind of spoke a bit as to how Omicron behaves and how the, and how the transmission is most likely really within the first five days but really I think mostly in the first five days as well. And so there was an overall change to to the self self isolation recommendation so this was not just for childcare it was across the general population. And so we are recommending that adults were vaccinated were fully vaccinated as well as children isolate for five days if they test positive for COVID-19 and adults were unvaccinated to self isolate for 10 days. And so there were updates to the to the guidance to reflect that those recommendations in the population. So that's one of the recommended that one of the changes in the in the childcare guidance that wants to draw people's attention to. The other you mentioned was around just close contacts or I think the general concept of contact tracing. And Dr Henry also spoke to this as well so just with this the the rapidity of their how fast or how easily Omicron is spreading. Many people are exposed to to Omicron COVID-19. And so the utility or the effectiveness of contact tracing is much lower now with I think the volumes of cases of Omicron, but also just how widespread it is. And so one of the other changes we made was also to direct to no longer recommend that people who are exposed to COVID-19 or Omicron self isolate. So as long as you don't have symptoms, you can continue to return to your regular activities. But we do advise or recommend that people do continue to monitor for symptoms of COVID-19, particularly because some of the symptoms can be quite mild. So this is I think not different just given how widespread exposure. So whether or not you've been notified that you've been exposed that we do recommend that people monitor for for COVID-19 symptoms. And then the third change that I just wanted to bring up I'm trying to this, what it was now. I think it was, I might have forgotten was the third one that you wanted to highlight. Certainly, it was about the symptoms themselves. The symptoms. Thank you. Thank you. So, so the other piece I think was around the impact of those testing guidance and how we wanted to focus those testing resources on people who would most likely to benefit from it. So people who are more likely to be at higher risk for severe illness. And so for most people, we don't recommend that they get tested for COVID-19. And so if people do have symptoms of COVID-19 or just other respiratory infections. I recommend that they stay home until they feel well enough to return to their regular activities. And I think one of the questions that we often get asked is, Well, that could be one or two days. And I think, yes, theoretically, it could be one or two days. But I think our experience in the literature suggests that if it is COVID-19, it does not tend to be one to two days it does tend to be a bit longer. And so this was kind of general guidance that we could provide so that people can continue to manage, I would say, not only just COVID-19 but respiratory infections as well. So like influenza and other types of respiratory infections. So I think those were just kind of some of the key or the most substantive changes in the guidance that was released last week. And I tried to also include some more context as to, you know, what, what do we know about Omicron that I would say Dr. Henry, you did a much better job of trying to explain that because there is quite a lot of nuances to that that is challenging to capturing the guidance. But that's just in a nutshell, what are some of the things that we wanted to include in these updated guidance. Thank you, Dr. Wong. Just before I go on with the other the with some other questions that we have, I'm just going to pause actually and retrace my steps I should have mentioned at the beginning that we do have a closed caption function available this evening if anybody would like to use the closed caption function. And you can turn that on by clicking on the live transcript button, which is just at the bottom of your screen so I apologize for not mentioning that earlier. Okay, so thank you, Dr. Wong for that for that sort of overview of the isolation guidance and a little bit more in the close contact and symptoms. I do want to ask you, though, just if you don't mind just a question of clarification on on the symptoms themselves and and and actually just in particular on the runny nose symptom. And I, you know, I'm just thinking back to when my my daughter was of childcare age and and she had such bad allergies back then. And frankly, I think she had a runny nose most of the time. So I'm wondering if you can talk about symptoms that are common to coven as well as as other causes or as you're mentioning other respiratory diseases and what is a parent or childcare, excuse me, what is a parent or childcare operator to do when when something seems a little bit complicated like that. Sure. So I think the question, if I'm understanding correctly is like so if people have some of these milder symptoms. What, what do they do. And so I think one of the things that we would mention is that there are many reasons for why people might have some of these symptoms already knows being the example here like, for example, allergies, but as well as other respiratory infections as well. So I think the first thing is, if it's related to a diet, like an existing condition that people already know so for example somebody's already known to allergies. And it's not a change from before so if it's not new or worsening symptoms, then we would advise people to continue with their, their regular activities as if it was, you know, with any other types of like just the regular activities. And then, so I think that's probably kind of trying to help provide some of those guidance. I might also share I think this is some of the experiences that I have working as a as a family doctor as well as that. Many times I see in the in the pediatric world and for children the parents really know what's normal for their kids. And that sometimes, you know, some of the behavior of their kids is just, you know, parents can often say, you know, it's just really unusual for them they're a little bit less active they're a bit more lethargic where they're as they used to. And so sometimes I think I would just suggest the parents just be mindful of what their child's normal activities are like. And so if they have a runny nose and maybe, you know, not eating as well, you know, that might be suggestive of something more than just allergies. And so, you know, I often rely very much, you know, in my clinical judgment on parents and their assessments as well as to what their child is like and so, you know, part of the guidance we do, you know, recommend that parents monitor their kids for symptoms, including some of these kind of more vague symptoms, but also to encourage their kids to talk about when they have symptoms and what that's what they're experiencing. Great. Thank you for that. Okay, so now jumping into some of the questions that we've received from childcare providers and parents over the last little while. And just about the vaccination status we know that vaccination is important for the protection against all variants of COVID. So, one of the questions that we've received. And Dr. Lysician I'm hoping you can perhaps answer this is how is it safe for an unvaccinated child who has been directly exposed to COVID. A parent that has tested positive to come into a childcare setting. So, our childcare providers are saying that they don't feel safe working with them as they can't wear a mask because they're they're too young. And the childcare provider themselves can't physically distance from the child in the in the setting. So I'm wondering if you can address the safety of the fact that children are vaccinated and maybe exposed to to others. Yeah, well, we've heard that with the Omicron variant, COVID has really changed for us. It's become an infection that's much more transmissible and is much less likely to cause severe illness, particularly in young children and particularly in people who are vaccinated. It's really an infection that acts a lot more like other seasonal respiratory viruses that we're very familiar with in society like influenza. So we need to shift our management, much more to how we manage those types of viruses. And the most important thing that we can do to keep people safe is stay home when we're sick and so that's what we're talking about. That is the most important measure to keep people safe. We're not recommending that contacts stay home right now because there's widespread transmission of the virus in the community and so people may know about certain exposures but you know they're being exposed in other ways as well. And so it's just not a feasible strategy across our population to have contacts all be isolating right now. And we also know that kids are less likely to get COVID, they're less likely to transmit COVID. So, you know, that's always been something that that that keeps, you know, childcare facilities a little bit safer than some of the other environments that we see as well. So this is really about shifting our approach to make it more like how we manage other respiratory viruses, and the way that we're keeping childcare center safe is really asking people to stay home when they're sick, just like we did before when we were sick. And, you know, there's even more attention on that now of course because, because, you know, we know there are viruses that are of concern circulating and so everybody should be monitoring themselves. Obviously, if there's a case of COVID in the family people are going to be monitoring themselves very carefully and will quickly identify if they have symptoms and be more likely to stay home sooner or to err on the side of staying home. And so that will also limit transmission. Okay, thank you. And I just had one other thing and of course the other important thing is making sure that all of the staff and educators and childcare providers are vaccinated themselves because that's your best protection. Thank you. So still sort of on the theme of being in contact with individuals who have tested positive. In the case of a parent or a guardian who test positive for COVID. We've heard that, you know, sometimes there's still taking the children to daycare so that, you know, the children seem to be fine. And they're bringing the children to daycare but is it okay for somebody who has tested positive to be, you know, coming to the daycare to take the children. Is that sort of breaking isolation protocol or what's the best advice on that, Dr. Gustafson. Sure. So we recommend that people who do test positive for COVID-19, if they're immunized, we ask them to self isolate for five days and if they're immunized, we ask them to self isolate for 10 days after the beginning of their symptoms. So no, we would ask those parents not to be the ones picking up their child. Now, life is not perfect. And I think that's really important. And as a proud graduate of childcare myself. I know that pick up time is, is, you know, if you can't pick up your child that's an incredibly stressful thing, you happen to just test positive. So, should there need to be an exceptional circumstance where a person is not able to self isolate or needs to pick up their child they're late. That's where you use your layers of protection you make sure the person is wearing a mask. They can phone ahead they can say, can I pick up my child outside. And so, so I think it is important that, and just following up on what Dr. Mark position said about managing COVID as we manage other respiratory viruses. In many ways you need to go back to everything you knew before 2020 or late 2019 about just the common sense things that we do to both ensure limiting transmission of communicable diseases, respiratory viruses, but also keeping everybody safe and if the child needs to be picked up, there are other things you can do. Okay, thank you. So, in terms of some of the guidance I guess for the general population. I can rate if, if somebody had if a child care center has an immuno compromised staff person that they need to consider does this change any of the recommendations in the guidance on either closures or staying home. If there's immuno compromised staff in the facility. We always have to be aware of the risks that people have. But the bottom line is, you need as an immuno compromised person to be able to do all of those things that protect you best, which is getting vaccinated yourself, making sure that you're wearing a mask that you're taking all those precautions to protect yourself. And those things, along with all of the other measures that are in place in the daycare should protect everybody, including people who are immuno compromised. But it is incredibly important once again to reiterate the, the value, particularly for people who have immune compromising conditions of vaccination. We know that for some conditions. You need a third dose as part of the primary series, but for everybody. And this is another thing that we've learned in this short period of time that yes we're seeing people who are vaccinated. But that booster dose makes a big difference. It makes a big difference in about 50 to 60% protecting you from infection altogether, including boosting your, your, your chances of not having a more severe infection. I don't think I said that in the backwards way, but so really all of the things that are in place, make it a low risk environment, even for people who are being compromised, and keeping sick people out of that environment is really, really important in making sure we're doing everything we can to protect ourselves by being immunized is really, really important. Don't know if the rest of you would add anything to that. No, doesn't look like it. Okay. Good. Thank you. Just in terms of the isolation period. So Dr. Wang you talked about the isolation period of five days for for folks that are vaccinated. Correct me if I'm wrong five days for folks that are vaccinated in children in 10 days for individuals that are not right so far. Yeah. Yeah, okay, good. And, and that, and also that that individuals can turn to return to their daily activities when they're starting to feel better so we have had some questions come in about what is the definition of when you feel well enough to participate in activities and feeling like childcare providers are feeling like maybe that's not quite clear enough in terms of allowing children back into the facility or maybe even parents trying to figure out what that is for their, their own family. Sure. So, I mean, I think a lot of us have been sick before and kind of know it can kind of take the wind out of you for quite a bit. So I think part of it is, you know, this type of a self awareness I guess of like what what you can do and what what is normal for you. And so that is kind of the type of guidance and I, and I, I appreciate how it's a little bit vague, but some of the challenges with with COVID is it's, you know, the way when one is, when one is, you know, not going to spread virus anymore. It's not exactly like a, it doesn't switch on and off. And so we do know that as people start to feel better that the chances that they spread. COVID-19 is lower and even I think Dr. Henry even begun in the beginning that most of that transmission is really happening in those very early periods. And so we are asking that people kind of reflect and to say how how they're feeling to think about how they're feeling. And typically when they are feeling better the risk of transmission is much lower. And that is kind of the type of guidance that we're trying to provide in order to support people to be able to kind of transition back to their, to their regular activities following an infection. I think one of the key symptoms that we always look for is fever, you know, when, when people still have a fever they're still sick. And so often, you know, we recommend people stay home from work and school when they have a fever. You know, if they still have a bit of a sore throat or runny nose and those symptoms are getting better, then, then those are the kinds of symptoms that, that you could return back to work or school or daycare. You know, we know particularly with COVID sometimes people will develop a cough, and that will persist for a long time, well beyond the five days but that doesn't mean that people are infectious. You know, the one symptom that we do ask people to really look for is, is fever. You know, that's one where you would stay home but the others as long as they're improving and you're having the energy to go to go back then you can go back. Okay, super. I mean, fever without taking, I mean, it's not taking antipyretic medication so not taking the Tylenol and Motrin to bring your fever down. You know, being, because that really, it's, fever is one of those things that your body's telling you, you know, something's going on and you need to rest. Thank you. That was a really helpful conversation. I know we were getting questions in through the Q&A about, you know, about exactly what you just said, Dr. Lisician, about what if some of the symptoms are lingering. So I think that was a really good, a really good piece of advice for people to tuck into their, into their pockets, if you will. Okay, so let's talk a little bit more about vaccinations, if that's okay. Dr. Henry, can you, many people have asked why there isn't a vaccination mandate for childcare providers, and parents have expressed that they're concerned about taking their children into a facility where the provider may be unvaccinated so you know therefore why not mandated. Yeah, so I think there's been a lot of talk in a lot of different scenarios about vaccine mandates and whose responsibility is that and where does it come from. And, and I think what people are thinking about a lot is a provincial health officer order that requires people to be vaccinated in order to do their job. And there's only one setting where that is in place, and that is healthcare workers. And for a variety of reasons, it's because it is, if we look at the legislation that I work under the Public Health Act, it says that you have to really believe that there is a health hazard that exists and that this is a requirement to manage that health hazard and the only setting where the responsibility falls to public health to manage that risk is in healthcare. And particularly, we started with long term care, but also acute care. And so it has been so so important that we do have this vaccine mandate for all healthcare workers in all settings across the province and that's one of those things that's allowed us to, to to manage with a lot of people off with mild illness around this last period of time. It's kept us from having severe illness in healthcare workers and the risk of transmitting it to people who are very vulnerable to having severe illness themselves. So whether that's seniors and elders in long term care, or people who are in hospital in critical care. So there are many different reasons why we have a public health order that has mandated vaccinations for, for healthcare workers. In every other setting, it really is about the employer and the employee relationship around vaccination and the risk in their settings. There are many settings where we strongly recommend it. And where we've been supporting employers. I made the recommendation to the public service agency. So everybody who works in the public service across the province is required to be vaccinated. But that is something that they manage as part of the employer employee relationship. We've been working with school districts who, according to the way that things are organized in that K to 12 system here in the province. The employers of teachers and staff and schools are the school districts. So we have been providing them with the advice around the importance of vaccination. And the same thing goes for, for every other private business but also for childcare and early childhood educators. It really is those local decisions and I know it's very complicated in this sector because there are many different models of how things are organized and small to large and many different ways of doing this. I will say that from the very beginning we have prioritized early childhood educators and childcare workers along with school staff and teachers, all at the same time. We prioritized to get vaccination early relative to people with their same age and the population. And so that means that we had special clinics we had a special code for people many, many people we did a lot of work to try and encourage and control and ensure that people had early access to vaccination. And that means you also have early access to booster doses. And that's really, really important, not only to get us through Omicron, but to get us through what's coming next, because we are not quite out through this yet, as much as we would like to be. And we need to make sure we have the optimal stimulation of our immune systems that will protect us for next fall and next winter, too. We're going to be in a different place. I really hope we'll be in a much more positive place, especially as Omicron has been moving through and we have this very high level of immunity. But you know, these are the things that we need to consider every time we look at what what a mandate is and who's who's the best person or organization to require it. So I would say that I absolutely believe that every single person in early childhood education and in childcare should be vaccinated and we provide it vaccine, and it's available for everyone and if you have not yet made that decision. You can walk into any of the over 1000 clinics that we have across the province and get your vaccine. Thank you, Dr. Henry and also for for sort of talking about, you know, the prioritization for booster shots as well because I know that that's a question that has come through loud and clear this evening folks were asking about why, you know, given that they're vaccinated population that don't wear masks, how it is that, you know, could they be prioritized, but it sounds like where we're at and just I just wanted to maybe poke at this a little bit more that where we're at. What I heard is where we're at with our vaccination with the rollout of our vaccination and the that you know the second vaccinations and booster shots that we're actually at a point I think you said where anybody that's 18 and an older at this point can go get a shot quite freely is did I hear that correctly. Absolutely, if you've not got your dose one yet, or your need does one or those two absolutely walk in. You will get an invite when you're at six months for your booster dose. And because we prioritize childcare workers early on. Most of you should have already received your invite or will be receiving it within the next few weeks. Okay, perfect. Thank you for that clarification that was super helpful. Thanks back to just one more question maybe well a few more questions on vaccination. Dr one, can you talk about the employers and can, can employers ask their staff, the childcare employers ask their staff about their vaccination status. I also had I think some discussion about this in our childcare working group as well so, and part of this has to do with the childcare licensing regulations. And within the regulations it does speak about licensed childcare operators, having the having evidence of compliance with the BC's the provincial immunization program. One of the things that we've clarified was that the covert 19 vaccines are part of the provincial immunization program. And so licensed childcare operators should have evidence of the vaccine status of their of their employees. I think maybe I'll just also speak and just echo some of Dr Henry's comments before about that employer employee relationship as well so this is just having evidence of their vaccine status. We're trying to encourage people to have to be vaccinated that is I think some of those pieces about that employer employee relationship and so trying to encourage people and enabling people to their staff to also get vaccinated. And just as we're talking about vaccinations, a question that has come up from the, from our participants, Dr Wong and I'm just going to direct it to you again, because it, it, it sort of is the intersection of two pieces that you've spoken about. So as children are in fact are unvaccinated younger children obviously you were saying that children should isolate for five days earlier on in our discussion so a question has come up in that because they are unvaccinated. Why would they not isolate for 10 days. Because you're saying that unvaccinated individuals would need to isolate for 10 days, yet children for five days so I'm wondering if you can maybe just expand on that a little bit. Sure, so I think actually this is some comment that Dr Lezition mentioned as well so we do know from. So both the Omicron and previous variants of of COVID that children are less likely to transmit COVID-19. And so that is evidence that you know continues to be true we know children are also less likely to get serious illness of COVID-19. And so those are some of the reasons that children are recommended to self isolate for a shorter period of time compared to adults. I think the other thing that's important to think about too is whenever we apply public health measures we also want to think about the harms of the measures and keeping kids away from school and daycare where they interact, you know and they do their social emotional learning and everything is extremely important and so that was another reason why we felt it was important to decrease the isolation time for children so they would miss as little school and daycare as possible, because that's so important for their growth and development. I could just add to that I think it is important as as you're thinking through all these all these rules and or recommendations and do they all make perfect sense and not if you only look at COVID-19 but again we're looking at looking at the entire health of the child we're looking at the impacts of those of those restrictions and and we're because this community transmission is important we're not in an elimination we can't we can't do that we're mitigating the impact. So there's an incremental benefit for a staying home a staying home past your past the point where your symptoms resolve and you're ready to participate so I think it's important that when we make these recommendations all of those things have been taken into consideration. So it sounds very much like things just aren't black and white right it's just not that easy there's so many things that layer layer on top of each consideration and you have to consider the sort of complexity of all of that with the with the guidance that's provided. Is, you know I've been saying this for two years now it's a great trying to find the best way forward that minimizes the risk to everybody. And it's become really really clear and especially now that we can't eliminate the risk entirely, but it's in all facets of our life. So yes, if we, you know have some kids who are home because they've been sick with COVID in our daycare, then maybe we wait and not go visit our elderly parents for a couple of days until we check our symptoms and and make sure we're feeling okay. These are all decisions we're going to have to start doing ourselves, because we aren't able to test everybody all the time. Yeah. And you know, I wonder if, if this might be a good time to talk about rapid tests and how this fits into all of this because Yeah, we're I mean we're all really excited to hear the announcement just yesterday I think it was about the up to 250,000 rapid tests that have been secured for the childcare sector. And we're now working through the the details of you know how to to get all those out to everybody and right to their doors so more on that soon. But in terms of the rapid tests themselves and we're talking about you know the different layers and the different things that both individuals and organizations can do actions that they can take to to address their own safety and the safety of others around them. So Dr. Henry, I'm wondering if perhaps you can talk about how does the rapid test fit into this concept of layers of protection. Sure. And I'll start tonight I think the rest of the gang can add it in. So very clearly and I've said this from the beginning you know rapid tests are a tool, and they provide some benefit, but where they provide benefit is when people have symptoms, and they are not a light, not a green light. So it means if you test positive, and you have symptoms and you test positive then you should stay home for five days or 10 days depending on your vaccination status. If you test negative, then you have to look at all of the things that we were just talking about how bad are my symptoms. And if you make that decision to go into work, then you need to wear a mask you need to make sure that you're meticulously hand washing you're doing all of those other things that are in place to protect us from spreading, even when we don't know we have the virus because that's what's happening right now there's a lot of people out there that are spreading this virus before they even recognize it themselves. So the rapid tests are not going to be a panacea, therefore staff, therefore, not for children in the daycare, the child, early childhood education center, they, they, and we don't actually recommend using them and children under age five, because it's the swath is actually quite hard and large. So it is. So it is one thing that we can use and we've started to use them in in K to 12 as well for the same reason is for staff who have mild symptoms and can test and determine if it's COVID. So it's a red light, not a green light as I said you still need to be cautious and it's, you need to still need to be on orange if it's negative. But it can help you determine if it is COVID. And in the school setting, as we get more and more of these rapid tests, one of the challenges we have had from the very beginning is there are many different types of rapid tests. And these ones that we're talking about are what we call lateral flow tests. They're little pregnancy tests. They're at home tests and they're designed to be done by yourself at home, not by a healthcare provider. And we've only recently got quite a few of these, like several million of them. Up until December, the rapid tests that we have were ones that were not easily converted into ones that could be done at home, although we did do that with several hundred thousand of them. We have others that are used in a healthcare setting where you can get a set where, or buy a healthcare provider so it's one of those ones where the nasal pharyngeal swab, reticle your brain, and it needs a machine, or it needs somebody who's trained and how to use them. So they are used in some settings, we're using them in long term care homes, we're using them in a number of businesses. And the ones that we're going to be providing to early childhood education centers and childcare providers are the ones that you can do at home, and it's for use when you have symptoms and we'll be developing and maybe I'll turn it over to Jason or Marika and Mark who want to talk more about this, but we'll be developing some guidance for you, very similar to what we've developed for the K2TOL on how to use these. Oh, super. Yeah, I'd love, we'd love to hear a little bit more about that. Dr. Gustafson or Dr. Wong? For the guidance for the rapid tests, it is actually going to be very similar. I was answering some questions in the chat, sorry, so I needed to. The guidance for the rapid tests, we hope that most people will be using them, according to the testing guidance and really it's for people who are, who are maybe eligible for treatment, but they also are available for everybody else. And it can be a useful tool. And that useful to, so really the guidance will be similar to what our testing guidance is, and then just some information about the mechanics of how to use it, how to see a video. And I think that the best description of how they may or may not be a useful self management tool is that, you know, we talk about developing symptoms or feeling unwell and but the world is not black and white, and it's another piece of information that you can use to assess yourself. Sometimes you use a thermometer. A rapid antigen test can be an additional piece of information to tell you whether or not your symptoms that you may or may not, you know, you may not be certain about or are not specific or are not related to COVID. I think it is important with this rapid, with these rapid antigen tests that we're, we're making them widely available, sort of very similar to the timeframe that they became available there it's a relatively new technology. And one of the things that I hope we can do is actually evaluate whether they're useful or not in at a population level. We can figure about them there's some people think we should use the, everybody should have them other people thinks, why, why are we doing this. And I think again it's a tool that's available to us, we can use it, we can determine for ourselves whether or not it's a useful tool. We've had other point of care testing in the past for other infections and we, we tended to find that they were particularly useful in situation when needed to test anyway, but it wasn't all that easy to get at that time. We found that it was useful but the guidance is coming it's not going to be very complicated. It's this is how you use it. This is what it can and cannot value. Great. So for our childcare providers, I think that the takeaway from this is that the tests are here they're in BC. They will be coming to your door from, you know, sent from from from the ministry of children and families to your door but the guidance will be coming from BC CDC and will be we as ministry will be receiving that from you and posting it for the Does that sound about right. Yes, and I think the other thing to keep in mind is that they again they will be useful they will be potentially useful but it's also important not to sort of think that you can't function safely without them. The guidance almost all of the guidance we have in place is really in the absence of rapid antigen test. It's an additional tool that's available to you when it comes to your center. And I am very hopeful because these lateral flow tests and as we said that they've only recently become available. I had we had heard from the federal government that we might be getting them back in October, November and I was quite excited about that because I think they will be helpful for us to make decisions about their own family and our own concerns on the day to day basis or a periodic basis if we have a call and I think they'll be future they'll be really helpful in the future for whatever we're dealing with next in terms of COVID. So, we are getting more. And at some point, we'll have enough that we'll be able to give them out to people across the province and we can use them for those days when we have, we have symptoms, and we're not sure. We're not sure how to manage and it can help us make those decisions for ourselves and for our children right now not youngest children, but for sure. Great. That's super helpful. I like the, I like the simple. I know it's going to stick in my mind. Dr. Henry, what you said that it's a green light, not a red light. I think that's really, I really think it's the opposite. It's a red light, not a green light. But, but it's, you know, it's a really good thing to just remember just about as a mantra, and, and that it is something that is a part of the mix of protections that people can use and not a panacea as you say. So, thank you. Another piece of information that we can use to make those decisions about do I need to do something different today. Do I need to maybe postpone that visit to my immune compromise friends or postpone that visit to the long term care home to see my loved one. You know, those are the important things that these, these can support us in doing. Yeah, because I think Shannon you were going to ask a question is, well what should people do if they have symptoms and they test negative. And this is that this idea that it's not a green light so you know if you test positive then it's clear what you need to do you can isolate for five to 10 days from your symptom onset, but if it's negative then you have to go back to assessing your symptoms, and you have to decide are my symptoms compatible with me going back to work or to school or to daycare. And if not then you need to continue isolating until they are so that that may end up being five days it may end up being only two days. You know, if you still have those those significant symptoms like a fever, and you've tested negative that that doesn't mean you should go back to work school or daycare it's you know you need to wait until that fever results. But it does, you know, so it gives you some information that you don't have to do the five to 10 days or you might not have to do the five 10 today days but it doesn't mean that you can just go back to your regular activities. And new question. Any, any, any idea if if we will be receiving a vaccination for children younger than five. I can address that too. There has been studies done by Pfizer Biotech in six month to five years in children six months to five years of age. We generally, the people, children have a developing immune system and they don't respond as well to vaccines in the first six months of life. Another reason why it's really important for pregnant people to be immunized because some of those antibodies that you develop when you're pregnant, protect your child in that first few months of life and then you've seen that be really effective with with COVID vaccinations So Pfizer and Moderna is also working on their still on their, they're doing six to 11, just to confuse us all hasn't been a proof for use yet. The trials that Pfizer was doing in the younger age group with two doses like we had for the, the five to 11 and the 12 to 17 didn't show a strong immune response, which was a bit of a surprise it was a reduced dose so the pediatric formulation. It's the same as what we see for five to 11 year olds but they're what they measure is what we call correlates of immunity how much antibody and how does that compare to what the protection that we're seeing in older people and it wasn't there so they've gone back to the drawing board a little bit, and they're there are third doses needed for the primary series for younger children, or whether they need to up the antibody levels in the vaccine. So the quick answer is we're not, it's not in the near term that there will be a vaccine available for younger children, which is unfortunate, because we do know that, especially the very young can get very sick with with COVID. Thankfully, not so much with Omicron but we are seeing a rise in, in pediatric hospitalizations, most of them are short, but they're similar to what we see with like influenza where it exacerbates asthma or airway disease in younger children. But so that's that's something that's not in the short term horizon. I will say one other thing for for anybody out there who's not yet vaccinated or for who have family members or friends who are not yet vaccinated. There are two additional vaccines that will be coming, hopefully very very soon we are hoping to have them by now. They're more traditional sub unit protein that's the protein sub unit vaccines. One of them is produced by Tobago, which is a Canadian company, it's made in, it's a virus like particle made in tobacco plants. And the other is one that's a baculovirus from a moth baculovirus vector that is done. That's made by Novavax. And both of them have very good protection in the clinical trials that they did. And both companies had challenges with scaling up the manufacturing. So Health Canada is reviewing the submissions for both of these for safety and effectiveness and the good vaccine manufacturing processes. And we expect that one or the other, or both will be available in Canada or will be approved for use in Canada probably middle of February and there's contracts that these will be available. And they need to provide supply to Canada within two weeks of approval for use by Health Canada. So we may have some additional options for people who have concerns about the mRNA vaccines, at least for adults, starting in late February or early March. Great. Thank you. Okay, I see that we're past eight. So I did want to ask a couple of questions that are maybe more on related to the operational pieces that are within the guidance. So one thing that's in there and maybe Dr. Wong, I'll ask you about this. So the updated guidance as of the 19 says that childcare facilities should not be closed for public health reasons, unless directed by a medical health officer. So a question has come up that if an individual runs their own childcare business, why aren't they allowed to close when they want to? Yes, so maybe this is something we can clarify a bit more in the guidance. I think the key here was the public health reasons. So public health or medical health officers can provide direction to close childcare sectors if they deem that was necessary. But childcare facilities are private organizations and that there may be other operational or business reasons for why they may need to close or suspend their operations. So one example could be, you know, to staff are sick and so they just can't maintain the staffing to child ratios that are required. And so that might be some of the operational reasons that they might need to close. So the focus here really is for public health reasons that those public health reasons should come from public health. Like you're the licensing officer with the medical health officer. Okay, thank you. That's clear. So relying on the advice of the medical health officer, licensing officer before you close your doors and say you're closing because of public health concerns. You might close for business concerns, but you're going to get direction from public health if it's a public health concern. And may I add to that just for a second? I think the reason that made it to be added was because operators wanted to do the right thing. And they wanted to be careful, wanted to do the right thing and often sort of in the aim of being cautious perhaps did more than they needed to to actually manage the disease. So I think the reason that needed to be put in is that if you're thinking you might need to close for public health reasons, please check with your licensing officers because you in most cases you will probably not have to. And this was really just to prevent those from happening because I think sometimes people get a test they start worrying and just kind of take an immediate action that that doesn't serve them or the families and doesn't actually impact disease control. You know, and because because our experience managing exposures at childcare facilities is that the vast majority of them do not result in any transmission in the facility that you know that's been our experience across the pandemic. Sometimes there are clusters and you know and then the cases can grow but that's not the norm of what we see. So most often when there's exposures there's no transmission or very little transmission. And now of course Omicron is more transmissible and so we may see that that you know there's two or three cases where previously we were seeing only one or two. But you know we we don't most exposure don't result in a lot of transmission and so to close the entire facility when there's been an exposure can you know really disrupt the service that's being provided to essential workers and to all kinds of people who need to keep working in the context of this pandemic so that that's really why we we wanted to put that statement in and as medical health officers you know we're happy to you know take consultations on this point and so you know when we were doing contact tracing we were more in contact with the facilities and so that we could give that advice now we won't be doing that but through the licensing program we're happy to give that advice. Maybe just a bit of a follow up on that mark or something or something along the same line. I'm sorry Dr. LeCision. So we're hearing that some child care providers are are being asked to report every COVID case that comes up to licensing officers others are not. I'm wondering if you can talk about what our child care operators required to do in reporting COVID cases or maybe even communicable diseases in general. Yeah well the child care licensing regulations do require operators when they become aware of a communicable disease or communicable disease cluster to report that to the licensing officer and also to notify parents. So you know if they do become aware of a confirmed case of COVID-19 in their facility they should you know make those notifications but going forward. You know people are not going to be tested as much so people are not going to know that they have COVID and they're not going to report necessarily to the child care facilities and so going forward. So we shouldn't rely on those notifications because much more often people will have the illness they won't know that they had it and they'll stay home a few days and they'll be back. So, you know this kind of aggressive kind of figuring out if people have it and reporting it is not the kind of framework we're in anymore. But if people do become if operators do become aware then there are reporting requirements. Oh good good and also just to just to note for the listeners on the line that in the updated guidelines if if you have had a case of COVID positivity within your center there is some suggested language in the updated guidelines on how you might communicate that out to families if you if you wanted to do so so that's that's in the guidelines for a little bit of a help as well. Okay, also, let's see. Okay, in terms of the guidelines this is sometimes a point of confusion if somebody runs a child care center on school grounds. Which guidelines do they follow. Yeah, I mean they really have to follow both guidelines. You know the childcare guidelines are designed to help them organize the activities inside the childcare center but obviously the school guidelines, you know, are for that broader environment. They really to some degree have to follow both of them we've been careful to align the two guidelines so there shouldn't be, you know, too much that they shouldn't really conflict. But you know they do need to be aware of the school guidelines, since you know they're their staff sometimes the kids will be passing through this the school areas as well. Okay, good. Thank you. It is, they have been changing at a different pace so there has been some times where they have not been aligned. But we've tried really hard and kudos to Jason and to the team that includes representatives from the sector and I really want to just say that they've been working really hard to try and make sure we're keeping up with the rapidly changing advice and that they are aligned we believe now and if you find issues where that come up please let us. Yes, thank you. We will and I wonder, Dr Wong if you want to just take a few minutes and talk about how the childcare sector was involved or in the in the development or consultation or how the feedback is used in the development of these guidelines. Sure. And I alluded to this before this childcare working group because I think it does have quite a diversity of stakeholders on it so includes from the childcare sector so childcare operators licensing officers representatives from the Ministry of Child and Family Development Ministry of Health, as well as medical health officers. I don't know if I said licensing officers in there as well so it has quite a diversity of perspectives and so that was some of the places that we got some feedback around around the guidance and some of the practice I think as well like what the on the ground is like as well so I think that was really some of the feedback and I think actually Minister Chen spoke about this in her opening remarks about some of the feedback that she's received and I'm not sure if she passed to Bonnie who passed it to us or if it just went directly from us as well so some of those feedback has also been looked at and considered in developing some of these guidance. So what I wanted to say was, you know, it is partially has to do with the changing context and, and of like all the time specifically, and how the characteristics of that virus and, and how it behaves and in our populations. So how do we respond to it did also need to shift with it as well so I did also want to kind of bring in some of that scientific and academic piece of it in our experience as well. So I think that with COVID and Omicron to inform some of the ways that we develop these guidance so that was I think some of the processes that we utilized and revising these guidelines and continue to, you know, continue to look at what our response is telling us and what new emerging things might be happening in order to try to manage not just COVID I would say but actually other respiratory infections and so thinking about that in that bigger context of how do we manage the infection and how do we manage that kind of in our society. Good. Let's see. Oh, this I think I'm just going to ask this as a closing question. Dr Henry. And this I think came up quite a bit in the earlier days of the pandemic, but then also just as Omicron was was really spreading as well and so the question that we've received is about about closures so given that young children are vaccinated and the transmissibility of Omicron. Why hasn't the province order childcare centers close. So not, you know the mandatory vaccination but why haven't there been orders for closures or partial closures when other types of operations that serve a vaccinated population have been ordered to close or operate at limited capacity. And we take closures as we've talked about a few times here, really, really seriously and we look at where, what are the impacts, what are the impacts of people working there what are the impacts to the people they serve depending on the issue. And our aim of this entire pandemic has been to minimize as much as possible that downside impact that closures have. So with Omicron, we closed some of those more discretionary things like those big parties and wedding celebrations and gatherings that because that's where we were seeing transmission happening. We put in place the COVID safety plans in many businesses again to because the COVID safety plans are the things that that work to help prevent that transmission, even when there's lots of people in the community with relatively mild illness for the most part. So we made some temporary closures on some activities that were higher risk and indoor settings like some of the gyns and fitness centers. They're now starting to reopen as we've learned more. So it really is about the minimum amount the least restrictive means to make sure that we can safely get through this period of time. And we've reopened schools, we've reopened all of those critical essential services and childcare fits into that. So there was, we know the downside impacts on children and on families and on people who work in that sector. But we also know that they can be safely operated and that this is how we have to adjust to make sure that we're giving those important supports to the children in our care. So it was not a decision that we take lightly. And when you look at all of the impacts both what could be a benefit and it would be very small if we close childhood and a lot of negative impacts on a lot of families and communities. I don't know, Mark or Reika or Jason if you want to add to that because it really is something that we do a lot of thinking about before we close things. Yeah, I mean I think there would be great harms to society closing childcare facilities but also, you know, we, as I mentioned before, you know, we've not seen the same kind of transmission in what we would call structured settings in schools in childcare as compared to party settings where there's alcohol involved and things like that. So it's, you know, those social settings we really throughout the pandemic have seen a lot more transmission than in structured settings like childcare facilities, schools where, you know, there's lots of layers of protection in place, you know, so it's just not been necessary to close them because they've always been safe environments. And the other thing I just like to add to that is, one of the biggest challenges in the pandemic is, and we haven't had one in the days of social media yet, is that some actions were taken in March of 2020 when this virus was emerging. There was a great deal unknown about the virus. At that point, it wasn't yet clear what even the severity was in children versus adults who drives transmission what settings drive transmission hindsight is 2020 probably many of the things that we see could have been predicted but we didn't know. And so, one of the, the types of closures that we have seen in the past, which we call public health measures, we're really there to give us time to figure it out. And Dr. Lecition said, we have found that the vascular transmission happens in the home, or through very, very unstructured social gatherings. And, and so, so there's the, there's the risk element, and then there's the element that we look at about how essential how important that activity is to the well being of ourselves and our society. And some of those things were brought into consideration and I think now looking back, some of the things that British Columbia kept open, other people are referring to as the example of how to do it. And so, but it was very, it was, I think one of the challenges was is that we've normalized closing things as if that's how we manage communicable diseases by and large that's not how we manage communicable diseases. We're returning again to that way of managing COVID-19, we now have a largely a very, very high immunization rate in British Columbia, and all those other things that we have talked about before are secondary. The most important thing is that the majority of the population is immunized and, and everyone that risk of serious illness can be immunized. And I think that's probably a really, a really, really important thing to remember that the effect that that COVID-19 is disproportionately affects older adults with comorbid conditions and we have vaccine for them and everybody can receive that vaccine. Great. Thank you. We only have a few minutes left. Dr. Henry, do you have any closing comments perhaps? Sure, I do. And I just want to say, you know, thank you for, for tonight. I hope this answered some of your questions. You know, as Reika said, it's messy and we know that things are not always simple, especially in your environments and you're dealing with people and children and it's, you do such important work. And I just want to say that I am so grateful and proud of how you have done this over the last two years, despite everything that we've been through and that I have real confidence that we will get through this too and we'll manage this and we'll be able to look back on it and remind ourselves of the things that we've learned and how we've been able to get through this. COVID's not done with us, as I said, so keeping on changing, adapting as we learn more will be really, really important and we have committed to continuing with our working group with you to try and get things as quickly as possible. And we'll be with you in public health. I think this is a really rational approach that we need to take together, and it is going to help us get through this and I just want to express again my appreciation for everything you do for looking after children. It is so, so important in so many ways. Thank you. Thanks very much. And thank you to everybody for joining us this evening for sharing some of your time with us. Certainly to our panel members, doctors Henry, Gustafson, Wong and Lysician we appreciate you sharing your time and your expertise with us. And to the many childcare providers and parents and members of the public we appreciate your participation and the questions that you sent in in advance and the ones that you sent on the Q&A function tonight. I know there's ones that we didn't get to and we certainly will, as I was mentioning at the beginning, do some follow up on those questions and make sure that the responses to the questions that weren't addressed this evening and aren't and have not been addressed in the guidelines will be answered to. As I also mentioned at the beginning this information session was recorded, and it'll be posted to the government's YouTube account and also linked off our childcare BC health and safety pages. We'll get this video up as soon as possible but certainly no later than Friday. And then we'll distribute that link out to our childcare providers as soon as that is available. And I might take one more opportunity to remind our participants of our current engagement process outside of discussions about COVID we are having engagement about where the next phases of our childcare BC plan where that's heading and and you can certainly help to make that conversation so please again visit our childcare BC website for details on the engagements and for information on how you can sign up for those discussion sessions as well. So thank you everybody, please stay healthy and safe, and enjoy your evening.