 Good afternoon, my name is Adrian Dix. I'm BC's Minister of Health. To my right is Dr Bonnie Henry, BC's provincial health officer. This is our COVID-19 briefing for Tuesday, December the 14th. We're honoured to be here on the territory of the Musqueam of the Squamish of the Slewa Tooth First Nations, honoured to be here on their lands today. I would note, for those of you looking forward to future weeks, future weekly presentations will be a briefing on December the 21st. And then the briefing following that will be December the 29th, obviously. Dr Henry and I will be present, be around during this period, but those are when the regular weekly briefings are, so you can plan for that. And with that, it's my honour to introduce Dr Bonnie Henry. Thank you very much and good afternoon. Today we'll be sharing the latest on our COVID-19 public health response and our December epidemiology and modelling update. We will be sharing the latest on our modelling update. Before I share the modelling information, I did want to pause and acknowledge the fact that we have lost a record number of our community members to the toxic drug crisis here in BC in the month of October. Like those who have died as a result of COVID, these are our uncles, brothers, family members. We have a lot of people who have lost their families, family members, friends and colleagues. And we mourn with all of our families, the loss of our community members. And I commit to continuing the efforts that we have been making too slowly, unfortunately, for so many since the toxic drug crisis started a number of years ago. And back to COVID-19, we are in a place right now where there is still a degree of uncertainty as we talked about yesterday. So it is important and timely for us to go through where we are with our pandemic here in British Columbia. To start with, this is the geographic distribution of COVID-19 by local health area with the week of November 28 to December 4. As you can see, we continue to have high rates of transmission in the province, but we have also seen dramatic decreases in communities where vaccination rates in particular have gone up. So we still have challenges in areas in the north, particularly in the peace region. We have seen cases come down in Fort Nelson, and that is great to see as well as in areas around golden and in the interior. This is the cumulative case rate over the last since the start of the pandemic. We can see that there are no parts of the province that have escaped this virus, and that is what we are seeing now. The virus is in our community and that we are learning the important things that we can do to protect ourselves from illness, protect ourselves from transmission, and particularly to protect ourselves in our communities from severe illness and hospitalization. And one of the most important tool that we have now, and if we reflect on it, it has been a year since our very first vaccination clinic, which was on December 15th last year. And in that year, we have immunized close to 9 million doses of vaccine have been delivered across the province. We have seen now that we across the province, our rates of first dose of COVID vaccine are above 70% and actually closer to 80% across the province now for the first time. So that is great news. Where we see the triangles indicates where we are seeing the most increase in first doses. And that is great to see is in places in the Peace River, Fort Nelson, in the Carriville Chakotan areas, and Quinnell. Important gains that we have made in protection in those communities. If we look at second dose, again it reflects that we now are above 60% and close to 70% across the entire province and increases in those areas that have been dramatically affected in the most recent months. And we have seen the protection that we get from vaccination. And now we know that we need to focus as well after six months on enhancing that protection through the booster dose program. I will talk more about that. But we see here that we see the rate of vaccination in communities and the rate of transmission of COVID-19. This is our epidemic curve from January of this year. And we can see that in August, September we really saw that surge in cases primarily in interior health. We have seen that come down now. Leveling off a little bit in the last week or so. And we have seen a dramatic decrease in northern health finally in the last few weeks. Where we have seen an increase that is concerning, of course, is on island health that has had very low rates for most of the pandemic. And there is a couple of reasons for that in island health. And we are also seeing a leveling and a slight increase in Vancouver coastal health. So this is our epidemic curve broken down by cases on the top. As we can see, we have had a nice steady decrease over the last couple of months and we have seen a lot of cases coming off in the last two weeks which we need to understand more thoroughly. Importantly, we have seen we have turned that corner on hospitalizations which continue to come down. And thankfully, we have had low rates of deaths across the entire pandemic. But if we break this down of where we are seeing cases, it really tells us the picture of people who don't have the protection that vaccination gives us at a higher rate of getting infected with COVID-19, getting sick with COVID-19 and being hospitalized with COVID-19. Related to the very low rates of hospitalization, particularly that we see in people who are vaccinated. And if we look at this over the entire, the health regions as well as by BC, we see that we have had a dramatic decrease in Fraser health, in the interior in the north and we have had a significant increase both in cases and hospitalizations which is very good to see where we see an uptick a little bit in Vancouver coastal but concerningly, of course, on Vancouver Island. In the background which is a little bit faded, those are our testing rates. This is something from the very beginning that we have focused on, making sure that we have the accurate PCR testing available to people in the community and we have had very good results across the communities, across BC, over the last period of time during this wave and we are now starting to see decreasing percent positivity. I think it is important. One of the focus that we have had is making sure we have the right test for the right people and that means making sure we get the gargle test for children who have been exposed who have symptoms who can get tested easily, making sure we have nasal testing and NP testing and where it is appropriate, of course, the rapid antigen testing to supplement. This is the PCR testing that we have had the highest amounts of testing across the province over the last few months and that gives us a good sense of where we are seeing transmission and you can see that we have had decreases everywhere, particularly important in the north where we are down below 10% positivity for the first time in many months. If we look at the epidemic curve by age groups we can see that the highest rates of cases, the highest numbers of cases continue to be in young adults in particularly the 30 to 45 age range and that is what is driving much of the pandemic. We are seeing an increase in younger children still at a relatively high level but we have also seen the impact of the booster doses in the 70 plus where those rates are coming down nicely. If we break down this, of course, by vaccination status we see again the dramatic protective impact that vaccination has across all age groups and this is a year into this knowing how important it is to get that primary series of vaccine and now, of course, the booster doses driving down risk in older age groups if we see the 60 to 79 in the last few weeks and where we still see a leveling off of transmission and some spread in communities is in younger children who are not yet vaccinated, particularly that 9 to 11 age group, so that is where we need to focus and make sure that we protect our children and stop transmission. If we look at, again, we have been following especially since the past summer where we saw increase in hospitalization rates in younger people. We have been following the hospitalization counts and rates. They still remain low for children under age 19. We see nicely in this graph the rate per 100,000 and the numbers of people over age 80 has gone down. Again, that reflects the booster dose program that started a few weeks ago. If we look at our vaccination in BC over time , we have seen a number of people over age and dose number. The dose 3 is on there now is the darkest purple line. We can see that as of December 7, we had been fully vaccinated which is two weeks past dose 3. About 60% and we have now by the end of this week will have up to 80% or close to 90% to people over age 70 have received their booster dose. We are making really good progress. When we put this booster dose program , it was for all adults and it was using that six-month marker as an important marker of where we were starting to see decrease in vaccine effectiveness and breakthrough infections that led to hospitalizations. I will show you some of those data in a minute. But it really showed us that it was older people who don't mount a strong and immune response that we were seeing breakthrough cases in. The focus has been on making sure we are protecting those who are most vulnerable and we have known from the beginning of this pandemic that age is the most important risk factor. Our booster program has been focused on those over age 70 who received their doses first but we have also been making sure that we provide booster doses to healthcare workers starting from those who received their vaccines first so people in long-term care and assisted living and acute care and that program is ramping up as well and we have been providing booster doses to anybody who reaches past six months people who had two doses of AstraZeneca and Indigenous people who we know got early doses of vaccine in a whole of community approach and now being able to provide both dose one, dose two and booster doses for the elders and seniors and of course the all-important dose one for children in many communities around the province. That has been our focus in the next little while and today we have made the announcement about working with pharmacies and onboarding pharmacies to the system so that they can provide booster doses in communities around the province and over 500 pharmacies are part of that now and by early January we will have over 1,000 pharmacies to speed up and provide booster doses to people by risk as you reach that six-month time window. So we have added a little bit more information to our donut slide as I call it so this is a look at the whole population in British Columbia. We have 73% of the population who has had two doses and we have had another 4% who have received either a third dose because they are immune compromised or a third dose as a booster so with the very small percent of population that is unvaccinated and a good proportion of those are children, it's about 9% that are not yet eligible for vaccine and those people account for 54% of the cases that we saw in that month between November and December. But more importantly what we are seeing is if you don't have that protection that immune support that vaccination gives you are much more likely to end up in hospital and 68% of people are hospitalized are people from that very small group who have not yet been vaccinated and 78% of people in our ICUs in critical care are people who have not been vaccinated. If we break that down further and this looks at the age groups and it really shows that picture that age and not being vaccinated are what put you at risk of being hospitalized, what put you at risk of requiring ICU and critical care and put you at risk of dying. I talked about the breakthrough cases that we had in people who have been vaccinated and that in terms of hospitalizations it really is people over the age of 70 particularly that were much more likely to be hospitalized and that's one of the pieces of information that drove our early booster dose response for people who are in that age group and we see again the next highest risk for hospitalization or need for critical care as people 60 to 69 and we are focusing on those people as well now. If we break it down by age it becomes really apparent this is hospitalization by vaccination status and age and it is unvaccinated people as we get older who are more and more likely to end up in hospital and in many cases people had to be flown out of their home communities and our hospital system was stretched to care for people and the challenge that we have is we now know that these types of hospitalizations even with the Delta variant with the Omicron variant that we are seeing now we need to protect ourselves by getting vaccinated and there is no more time to speak now that this is important as we head into this uncertainty of the new strain that we found here in BC that is here across Canada that we are now dealing with globally you need to get vaccinated to protect yourself to protect your family and protect your community if we look at age adjusted data that we have from here in BC it tells us that you are seven times more likely to get infected with COVID-19 you are 30 times more likely to end up in hospital and 50 times more likely to end up in ICU then your partner your friend, your colleague who is vaccinated at the same age this is important this is what we need to focus our attention on making sure we are all protected so that we are not ending up in hospital we don't have to go through the issues that we know lead to long-term side effects lead to long COVID all of the other things that happen when you are infected with this nasty virus just to give an update on the pediatric profile between December 2nd and 8th the latest data thankfully we only had one new hospitalization in children in that age group however we still are seeing 500 young children in the 5-11 age group a week being infected with COVID-19 thankfully most of them get mild illness but you can bring that illness home you can transmit it to others we know the disruption it has been causing to schools to activities that are so important to young people and now we have a pediatric vaccine that works specifically to protect young people we have got to about 40% of children who have been registered so 40% of the 5-11 year age group across the province have now been booked or have received their vaccine but we need to get those numbers up now is the time to protect those young people as we are seeing new and more transmissible strains being entered into our community too if we look across the province of where we are seeing younger people the incidence really reflects the incidence in communities as we know in the interior and northern health we started to see a decline although that has leveled off a bit and again we are seeing transmission in those younger age groups that are not yet protected through vaccination and we have seen an uptick as well on island health which is a little bit concerning we know there has been some outbreaks or increased transmission in communities in northern part of island health and that is reflected in some of these data as well recent outbreak in older children and young adults at UVic if we look then at what we are seeing about vaccinated or unvaccinated in pediatric age groups we have seen zero hospitalizations in any 12 or 17 year old who has been immunized and now we have started to see the 5-11 young people being immunized as well and there has been no hospitalizations or unvaccinated children in this province that really tells you how important this is and the cases are considerably higher in children who are non-immunized we continue to do a lot of testing of children this has been a focus as I mentioned to make sure that we have rapid PCR testing available for children to be able to detect COVID most accurately particularly when it affects their school and their activities we have seen the high rates of testing across the province and across the age groups and most of those test positivity rates are now coming down we have seen a leveling off that is still concerning in that 9-11 year age group again next I am going to talk a little bit about our whole genome sequencing and how we have been using this to understand which strains of the virus are causing illness in the province and how they are changing over time back to January of 2021 as you can see we had a whole variety of different strains or variants of the virus and then we were really had a dual pandemic of mostly alpha which is the purple on the top and gamma, the orange so those took over in about March of last year as we were coming out of our third wave and we had a lot of both of those but in different areas of the province so we were unique across the country in the patterns that we were seeing of variants that were causing transmission and causing outbreaks and causing community transmission across BC compared to other provinces even our neighbouring province of Alberta and we see that as well with Delta so we have broken this down into Delta as it has emerged over time has mutated slightly but there are several different variations of that lineage be like siblings essentially that are slightly different and we have seen different patterns of transmission of those lineages which means we have had introductions that have had some small mutations and changes as the virus has moved through populations in different parts of the province. We can see that we did have Delta introduced back in April of last year and it was the summer where it really took off and replaced both the alpha and gamma and it was primarily the AY 25 and 27 the western variants that we have been seeing on a provincial basis but we have seen some focal areas of transmission of other Delta lineages and if we look at this it just puts the to me it looks like a bit of an art picture of the island health for example where we have had much more of the Delta AY 4 particularly in the last little while compared to some of the other areas and this highlights as well that in VCH we saw a lot of gamma while in places like interior and the north it was really alpha that was causing primarily the transmission earlier on this year but it has been replaced by Delta but different types slightly different strains of the Delta and other parts of the province and we of course have been using whole genome sequencing to understand transmission patterns to understand outbreaks to understand where introductions are coming and of course right now to help us understand where we are seeing Omicron where it is spreading where it is coming from and how we can manage to try and contain it and slow it down if we can and that is one of our cases unless there is an issue with one of the sample so close to 100% of cases it is still Delta that is causing the majority of our infections we have had as of the end of December 12 44 confirmed Omicron cases of the five in island health four of those are associated with the outbreak at UVic and it looks like that outbreak has been driven by Delta as well as an introduction in part way through of Omicron related to a rugby tournament that has sadly spread Omicron to communities and university communities across the country. We are continuing to detect Omicron and there will be more cases we will be updating the numbers twice a week to make sure that people have an understanding of the virus. It is important to know that we have transmission in the community now and that we are learning more and more from the global community about what that means with Omicron and what are the measures that we need to think about to get us through this period as we learn more about the virus. So we have had 24 cases in Fraser health the age range is relatively young and that of course reflects people who travel for the most part. We have had a number of cases yet of people who have been identified with Omicron. That again reflects the fact that most of them have been vaccinated and that they are mostly younger. So we still can't say much yet although we have been sharing information across the country and we know that in places like Ontario and less so but also Quebec Omicron is spreading rapidly and we are getting more and more information of who has been infected. Most of our cases still have recent travel histories to a number of different countries. More so recently we are seeing cases coming in from the USA as well as Iran where we have had a history of exporting cases into British Columbia. So the early identification of the outbreak through sequencing helps us understand what is going on at UVic as of yesterday there are 124 cases associated with a number of social events off campus for the most part and so we are now looking at how many of them are Delta and Omicron and what are the connections and managing to control that outbreak with Island Health through the use of sending people home with rapid testing. If you are in isolation you can test yourself sequentially to see if you develop this illness and that helps support people to isolate appropriately as we get through this. This is a highly vaccinated population, about 97% of the university community at UVic has been vaccinated so we expect that we have so far seen very mild illness in most people although it is not innocuous. There are some young people who are getting quite sick with this not sick enough to need hospitalization but it certainly is a serious illness. Finally I wanted to talk a little bit about one of the other surveillance tools that we have developed and are using here in BC and I mentioned this last week and that is our Wastewater surveillance program. This is a really innovative program that we have been partnering with researchers at UBC and the BC CDC team and they have developed protocols for sampling wastewater which sounds simple but how do you detect virus that might be in a very small amount? So those are the protocols for how to do that, how to isolate the virus and how to then go ahead and do whole genome sequencing on wastewater samples has been something that has been really helpful for us and has been a really innovative way of trying to understand the virus in our communities and so this work has been done in the lower mainland on the Metro Vancouver area and about 50% of BC's population and while in and of itself it doesn't tell us exactly what's happening, what it is is another stream of surveillance that helps us put a bigger picture together of whether we are missing something, if we see an indication of something going, lighting up as we call it in the wastewater surveillance we can go back and look at what's going on in that community is there something we are missing and we can help us understand the ratio of different variants and what types of strains of the virus we are seeing in different communities. So this is the pattern that we are seeing from the Fraser Health region, from Anansis Island and the Langley area and the circles represent where we have had virus detections in the wastewater and we can see that it really nicely reflects what's going on in the community around it and it has been helpful for us. We have had these measures to see if we are missing transmission and missing cases and for Anansis Island for example and Fraser North and South as we saw cases come down the wastewater detection and surveillance stayed low as well so those are reassuring things that help us know that we are not missing things and we have seen the same pattern in signals from around Vancouver coastal areas, Lulu Island and Lionsgate. So this is just one of the other tools that we have been using all along to help us understand how this virus is moving through our communities and what different strains of the virus we are seeing and then that helps us understand what measures we need to take to try and control this and minimise the impact. So finally the modelling, recent trends we have seen that we had been slightly below one for the last few months which reflects the reproductive number that every case has been transmitting to less than one. Over the last week we have seen that gradually rise in some areas and that is something we need to pay attention to. It tells us that we are starting to have more contacts where infectious contacts where this virus can be transmitted. Fraser Health is still below one but we have seen an increase in Vancouver coastal and Vancouver Island I mentioned related to some large community transmission events . We have seen interior creeping a little above one where we have seen a dramatic decrease in the north where the impact of this virus has really been tremendous over the last few months. So that is something that tells us that we are on a path that has been slowly going down but now is leveling off and can become worrisome. So the modelling that we have put together is some potential scenarios with a lot of uncertainty. These are the things that we are looking at to say what could happen with different scenarios if Omicron starts to spread widely and displace the delta that we have been dealing with for the last few months. So what this does is offers us a chance to look at different potential things that could happen and understand what we need to do to prevent those from happening to keep our rates low and slow over the next period of time. So we know there is a lot of uncertainty still about Omicron. There is consensus that it spreads faster than delta that it is more infectious than we are expecting to know. We know that it can cause increased breakthrough or increased reinfection in people who have had previous infection. That has been shown clearly in South Africa where there is a high rate of previous infection in the population and people are more likely to get a new infection with Omicron than they were with delta with beta with the other variants of concern that we have seen. That is another reason that we are seeing more than ever if you have had a previous infection you still need to be vaccinated. Vaccination protects against this reinfection that we are seeing more commonly with Omicron. We don't know yet if Omicron will be able to evade the immune defenses that are given through vaccination. There are some smaller studies we are putting these pieces together but there are some smaller studies that are neutralizing antibodies. Using antibody from blood and see if it binds to the virus that suggests that antibody response is less against Omicron than it was against delta. What that doesn't tell us though is the second part of the immune system. Whether our cell mediated immunity still has a strong response against Omicron and one of the things that we look to that is hospitalization rates. There is still a lot we do not yet know about this new strain and how it may affect transmission and how it may affect the people who go to hospital. What we do know is if cases go up the percentage of people that end up needing hospital care go up as well. This is a time more than ever that we need to hold the line. We need to continue to do those things that we know work and they work against the strains that we have been dealing with for the last year and a half but particularly for the last few months and they will work against Omicron. That means getting vaccinated. Making sure everybody in your family everybody in your community is protected from this strain, from delta, from hospitalization by getting their first dose by getting their second dose. We need to be protected because we do not want them to be sick with this virus. It means importantly making sure that we get your booster dose when you are due for it. We are ramping up the booster dose program to make sure we can get as many people as possible in the next little while. Large part of that is because we have had the onboarding of pharmacies across the province and that will be ramping up in the next few weeks. We have also been expanding our all-of-community approach to make sure that First Nations communities, Indigenous people across the province are protected through vaccination. These are the things that we know work and that will work against Omicron as well. The other things that we have here in place in BC that are really important that are supporting us being able to manage and live and have the things that we need in our lives and the mask mandates. We increased the expanded the scope to make sure that masking was an important part of faith services. All of the indoor settings where this virus can be transmitted and we know it is transmitted easily, more easily indoors where there is poorer ventilation where people are crowded together. Wearing masks makes a difference. Now is the time making sure you wear a good quality mask and protecting people by wearing your mask and they protect you by wearing theirs. We also have our BC vaccine card in place and that is a program that helps us mitigate the risk in some of those settings where we can come together knowing that everybody in that setting is vaccinated. It does not eliminate the risk and we have seen that. We have seen that in group gatherings and we have not had the structure of the events where people need to wear masks unless they are seated and eating. Those are things that are really important right now. We should not be having large parties where we are coming together indoors particularly with people we don't know where we don't know their vaccination status. That is where this virus is taking hold and spreading rapidly and we know that is going to be a big part of this holiday period. I am asking people to rethink those situations and rethink those parties where you want to be together with groups of people that you may not know. That is a risky thing right now and we need people to step back to focus on having those groups with people who are close friends and close family in a way that protects them and that means if you are going to have people over to your host have vaccinated people over to your host and particularly if you have elders if you have people in your host who are immune compromised. These are important things for us to get through this holiday season. These are the precautions of course that we are all familiar with. We have a common foe as we have across the country we know that. The experience here in BC when and how the virus has spread and how we have approached vaccines and now boosters is aligned with the country but unique to the experience that we are having here. Our pandemic response is tailored to our pandemic in BC. But we must remember that we can and must all influence how this pandemic progresses in our families and our communities today and tomorrow. That is ensuring everyone in your family has their vaccines whether they are 5 or 75. Keeping our groups small. Close friends, close family. Staying outside. Keeping ventilation in our homes. Opening windows makes a difference. We want to ensure that this time of the year is a joyous time of the year. We want to remember to do those things that are so important to get us through this new and certain time. So that means going out for a walk with somebody. Remembering to find that joy every day in our lives. Take the precautions that we are all familiar with. We know work and support each other to do that as we have been all along with kindness and compassion. Thank you. Thank you very much. For those watching at home, sometimes it is hard to read the slides. The copy of the presentation is being posted at the BC CDC website and will be available at the government website as well. I encourage people to go through in detail where we are in the pandemic today. To follow the presentation and review of the slides involved. I wanted to update you on a number of issues related to the COVID-19 pandemic and then we are happy to take your questions afterwards. Firstly, our vaccination campaign and program in this BC is going exceptionally well and that is to the credit of the people of BC of our incredible immunization teams across the province. Who are doing an excellent job. Today, this morning here in Vancouver, Dr Henry and I visited a pharmacy that is part of the significant increase in capacity of the system to provide booster or third doses. Two people in BC pharmacies are on board. They have on board for a little while. It will be up to past 500 at the end of this week involved. Fully integrated into the system. And then we will be able to get a new appointment of pharmacy the same way you would at a health authority operated clinic and more than 1,000 pharmacies in January. This greatly increases our capacity for third doses and indeed for first and second doses of mRNA vaccines. To date, 4,316,478 first doses of administered in BC 4,105,425 second doses. And now, 610,200 and 10,264 third doses which is ahead of the schedule that we presented. There is sometimes discussion of when we present something against other jurisdictions. Note that we laid out our plan in detail seven weeks ago. We are ahead on that plan. The numbers that we presented in terms of our expected vaccinations between seven weeks ago and the end of the year. We are expecting to do 35% better than that. I note that 60% of people over 70 have already been immunized against COVID-19. I want to also note that in long-term care we have gone from the beginning of November to more than 20 outbreaks in long-term care assisted living and independent living to one outbreak in long-term care at Ponderosa and Kamloops and one outbreak in assisted living at Laurier in Prince George in the entire province of British Columbia. This reflects the effectiveness of the vaccine mandate and I will get to the numbers of healthcare workers who have been vaccinated at the moment but that number is 99% across the province and no less than 98% in any health authority in BC. Those measures have had a significant effect. Obviously for everyone involved either as a family member, as a resident or in long-term care having booster doses for residents and healthcare workers in long-term care and in the tens of thousands healthcare workers in long-term care have received their booster doses as well and for family members and visitors it is an important and successful effort to date. I wanted to note as well on the 5-11 vaccination program that we have as of today 146,426 people registered or 42% that 127,976 of book appointments and 73,457 children 5-11 have been vaccinated in BC those numbers are 40 to 37 and 21% and what that tells us is that we are quickly going to catch up to the number of people registered as we are vaccinated at a high rate and so what we want to encourage everyone to do today whose child is not registered with immunization BC is to get registered and book your appointment. This is an important way that you can protect your children and your family against COVID-19 and the program as we say across the country in the hundreds of thousands across the world in the millions of people who are not registered with immunization BC and that program is going very well but we need you to get registered that's 1-833-838-2323 if you want to phone but the best way is to go online through our get vaccinated website. I just wanted to note finally that with respect to the campaign we are expecting as I say from the time of our announcement of the campaign to do 1.2 million doses which is an increase of 35% and we are moving along very effectively and well with that campaign and again want to express our appreciation to pharmacists across BC for that. I want to briefly comment on actions being taken with respect to suspicious vaccine records. Throughout the week of December 14 letters will be mailed to approximately 1,715 people who have tried to submit vaccine records into the BC provincial immunization registry without successful uploads. Letters will be personally addressed and will encourage them to get vaccinated at the earliest opportunity. Records entered into the registry are reviewed under strict processes to prevent fraud and to ensure people are entered into the provincial system have in fact been vaccinated. Records that are submitted and are suspected to be fraudulent are reported to be unenforcement. In addition, there are a small number of records that are not able to be entered due to a variety of issues and or errors. The provincial health services authority will continue to work with the small number of British Columbians that have been vaccinated and are experiencing difficulty having their record entered into the registry. Currently, as you all know, people are required to be fully vaccinated with a complete series of Health Canada approved vaccines to receive a BC vaccine. I wanted to further, just go on to a couple of regular updates. The first is around surgeries and around acute care capacity. On acute care capacity, as you know, we have 9,229 base acute care beds in BC 2353 surge beds for a total of 11,582. Well, the number of people active cases of COVID-19 has been declining. In our hospital in recent weeks, we do have significant number of people in hospital as we typically do this time of year. That number is 9,335 just above our base bed capacity. Of course, well below our surge bed capacity, but very significant. As you also know, we have 510 critical care beds in BC and 218 surge beds. As of today, there are 465 of those beds are full. So below our base bed capacity, but our hospitals and our healthcare workers are working full on. Regarding patient transfers, that number of patient transfers from the north has slowed as rates of transmission and case counts have slowed in the north. Regarding patient transfers, 153 total critical care patients have been transferred by air out of northern health to hospitals in other regions of the province. And 118 of those are confirmed with COVID-19. I will just briefly update with respect to the issue of rapid testing. And just say that regarding rapid tests for personal use tests, we need the at-home tests to be delivered by the federal government. And we have talked about this for a while. And they are working hard to get us those tests. We spoke about those as early as November. We are expecting a supply of these at-home tests to arrive from the federal government in mid to late January. And then we will be taking immediate action. And we will be taking those tests. In the meantime, we have ample supply and ongoing supply of rapid tests which we are getting from the federal government to expand the use of them across our system. I just note that people know 35,000 rapid tests are used every week in BC. And I believe the total, overall total tests have been used in BC is 534,333. We will continue to expand. The use of rapid tests were appropriate particularly in rural remote areas with businesses with congregate living and in other circumstances such as the outbreak in New Vic. Rapid tests play a crucial role in our infection control initiatives, our transmission control initiatives against COVID-19 and they will continue to do so. And with the supply of more effective tests, ones that can be used at home, that role will continue to increase. And we are making plans and will be presenting plans to you as that new product will be available. Finally, I want to provide our weekly surgical renewal update. Health authorities have reported 6,609 surgeries were completed from November 14th to November 20th. That is 1,113 more surgeries in the same way last year which contained a statutory holiday. Well, surgeries are continuing around the province from December 5th to December 11th. Health authorities postponed 114 non-urgent scheduled surgeries. 17 in Vancouver Coastal Health, 5 in Vancouver Island Health, 80 in Interior Health, 4 in Northern Health. No surgeries were postponed in the provincial health services authority. The cumulative number from September 5 to December 11th there have been 3,789 surgical postponements. Each of these patients will get the surgery they need. That is the promise of our surgical renewal commitment and it is a promise that we have and will keep. I want to also note that the extraordinary work done by everyone in our health care system to provide those surgeries, the vast majority of surgeries, in fact, similar numbers would have been done in the past performed, every work we can be seen. Both urgent surgeries, emergency surgeries and of course non-urgent scheduled surgeries. Every one of those surgeries is important to us and it is remarkable the extent to which in the midst of all the health emergencies that our health care system is responding to the ongoing need for surgery every day, every kind in every hospital around BC. 18 months ago in a briefing just like this, probably just here, we asked about our own experience with COVID-19. Do we fight or give up? Our answer was clear and BC were fighters. We followed public health orders. We adhered to public health guidance. We used our COVID sense. When vaccines were developed, when it was our turn, we got our shots. More so than I think almost any other jurisdiction in the world, both here in Canada and here in British Columbia. We started with boosters, more than 600,000 of them since we started. We are making sure our children age 5 to 11 are protected by getting them the vaccines. Global searches of COVID visit upon us locally have always provoked us that we do not give up. Not in the face of the earlier variants of concerns. Not in the face of the Delta variant of concern. Not in the face of the Omicron variant of concern. Not in the face of any variant of concern. And there will be more. Because our BC pandemic is about moments and the difference we make in each of them. That is the test that is before us now. One that we have proven time and time and time again. We do not give up. We are going to continue to fight and do what is necessary in this period to protect ourselves while ensuring that the overall health of British Columbians is supported and protected. And we have during this coming holiday season new memories with one another that we all need to have for our overall mental and physical health. I want to thank all of you for all that you have done and we are happy to help you. Thank you. A reminder to media on the line, please press star 1 to enter the queue. You will be limited to one question and one follow-up. Our first question today goes to Rob Shaw. Check news. Oh, hi, Minister, can I just follow up on your rapid test comment? You said that if you could get that Roche brand take home rapid tests from Ottawa by mid-January, you would be distributing them in some way or another province? Short answers, yes. We have been talking and I mentioned this in October, November. One of the things, there are different types of rapid antigen tests that are available. Many of them that we have are ones that require a health professional to take an MP swab. We have deployed those in areas where they are most useful. There are also rapid tests that can be broken down into smaller numbers and given to people. Those we focused on areas like correctional facilities, we have been using them in outbreak management schools. I also, as mentioned, we have been upping our ability to get rapid PCR testing available to people who have had exposures. One of the things that we have been looking at for some months is the at-home test similar to what is used in the UK. They have lateral flow tests they are used in the UK as well. They come in kits of about five with the dropper. Those are the ones that we had been hoping would be coming earlier on and yes, our plan was to use them particularly for situations where people have been exposed. Where you want to understand if you are infected or not. So where your pre-test probability goes up because you have been exposed to somebody with COVID-19. So somebody in your family or your household has been diagnosed with it, your child in a classroom in a school where there has been transmission in that classroom. So while you are at home in isolation , you can serial test with the rapid antigen test to see if you have developed this. And more and more, those are going to be really helpful for us. For those situations where people have had an exposure, where they are close contact, where they have been vaccinated, this is a means of getting rapidly without having to go for a PCR test. And if it is positive, then you go get your PCR test. So that is the program that we have been looking towards. Unfortunately, there is a global supply issue with many of these tests. We have not been able to get them in in the numbers that would be helpful for us across Canada or here in BC yet. I know the Feds are working really hard on this. And I think the proof for use and last we heard is it is likely to be early January. So that is one of the strategies that we have been looking forward to. Right now, we don't have a lot of the tests that would be amenable to that type of use in the community. And we are focusing on using the test that we do have in the program that we have right now. So I think that is one of the things that we will be planning for and we will be distributing. And yes, our testing strategy has been different from those used in other provinces all along the way. And we have really been focusing on making sure we get the right test and the right person, the right test at the right time. Rob, do you have a follow-up? Sure, thanks. Doctor Henry, could you just walk us through the UVic rugby team situation again? You mentioned a tournament at Queens. How widespread was that tournament? And what does it mean for the UVic outbreak? Could you walk us through that again? Sure. So the last update I got, which was late yesterday, there is about 124 people involved with the outbreak at UVic. It involves several large social gatherings off campus. But has many of the young people involved lived in campus housing. So the whole university community has been affected by this and is responding. And I think they are doing a great job. I want to put kudos out to UVic and to Island Health in managing this. Young people have been supported to isolate at home, whether they are infected or contacts of cases. The age range is from 17 to about 24. So it is mostly younger people and very highly vaccinated population. So that means that we are not seeing severe illness. People are recovering. But it is still a challenge. So we are using rapid testing to support that. And what we found so far from the early tests, where the whole genome sequencing identified that there is probably several introductions. And there were a number of the cases are Delta. The AY variants that were seen circulated around the Island Health. But we also know that there was some transmission from the varsity rugby team which participated in a rugby game and I don't have all of the details of how many teams were there. But it has led to outbreaks in several other universities across the country as well. And so some of the more recent cases are related to varsity rugby players that have tested positive for Omicron. We have a number of more tests in the hopper for whole genome sequencing so I expect that more of them. So it is a mixed outbreak where we are seeing both Delta and Omicron being transmitted in this group. Next question. What new restrictions in British Columbia should we expect before the holidays considering that grim potential forecast you showed with the thousands of new cases a day if things go in the worst case scenario? You know, I think what we have tried to do is put in place the restrictions in those areas where we know transmission is the highest risk. So we have in place fairly strong restrictions around events and gatherings. One of the things that we are looking at is the events that starts the vaccine card requirement and the other COVID requirements kick in at 50 whether we say all the events and gatherings need to have a vaccine card and the CD safety plans so the plans in place including mask mandate and making sure we are checking the QR codes and the vaccine card so those are some of the things we are looking at. We have expanded the mask mandate and it is really important now more than ever. This is a virus that is easily transmitted and Delta was easily transmitted and it is a virus that is transmitted to all particles. Those are the situations where it will spread faster so those large host parties we have seen what can happen with those even if people are vaccinated. So what I am telling people right now is to rethink what you are doing over the holidays in terms of having gatherings with people particularly large social gatherings with people that you don't know their vaccination and their status. We need to be thoughtful about how we approach these holidays and more than ever need to be prudent. Focus on protecting your family your community. Focus on having those close gatherings with your close friends with your family. We all need that. We need to have that connection especially after last year. We are in a different place. We have high rates of vaccination. We are protecting people. Those are the things that will help us but we need to be thoughtful and prudent about our social interactions especially over the next few weeks. Richard, do you have a follow-up? Dr. Henry, will there be any further measures put in place for the Vancouver Connect considering another outbreak? I know they operate under strict COVID protocols connected to the NHL but the team now has cases considering we had this outbreak with the team in March. Is there going to be additional guidance from you about potentially postponing games considering these cases? I know the NHL has strict protocols about games and how they manage those. I wasn't aware of the cases in the Canucks recently but the protocols that the NHL has in place are important. I think it reminds us of rapid tests which are used in many of these situations are not a panacea. They are one tool that helps understand what's going on but everything else is important too. The things that I'm concerned about are watching the games and we know that the measures that are in place and right now we need to go back to those basics wearing our masks and in watching a hockey game particularly when you're in those places around the concessions, around the washrooms, moving in and out where you're crowding together with people for a short period of time. Making sure that we are checking the QR code in those events. Those are important things. And if you are somebody who is at risk whose immune system is not that strong postpone going to those events right now. Next question. Hi, Dr. Henry, you just said we are waiting for the at-home rapid test but other provinces like Alberta is going to make rapid test kits widely available. One of these things is not making this free rapid test kits available to anyone who wants one. So Alberta and some of the other provinces in particular have a type of at-home kit that we don't have in BC. We were a kit that is more amenable to distributing to people the BTNX kits. We have not had those here in British Columbia and part of our strategy was looking at where we would use them and we were waiting on the other ones that we thought were coming before now. So I understand they are distributing a certain amount of those that they have through pharmacies I understand or through communities but for people again, the strategy that we need to where those tests can be useful is where somebody has been exposed or has somebody in their household who is a case and it can help you manage your risk during that period of time and that's how I would advise people. I know Alberta is coming out with their program. I think they made the announcement today. It is important to know that this is one tool. This is one tool in many that we have and that our testing strategy as I mentioned has been focusing on getting the right test to the right person in the right strategies. They are not always perfect and we have been modifying them as we go. I do want to caution that especially in a highly vaccinated population all of these rapid tests have limitations. When you are vaccinated and we have seen this in UVic for example you can have a low level of infection and you are not shedding a lot of virus and doing a single rapid test so that you feel that you can safely go to a party or something like that. These tests are not designed for that and they don't pick up low levels of virus even though you may be infectious in certain situations that you may still be able to transmit the virus. We have had challenges both detecting the virus and somebody who has it and in falsely positive tests as well which can be as a third or sometimes even up to 40-50% depending on the situation. When we look at tests we have to put it in the context of where they are being used and there are examples from around the world there are examples from here where people have done rapid testing and gone to large group gatherings indoors where there has been a lot of transmission despite everybody testing negative so we can't rely on them for that sort of single use I will just test myself and I am fine we need to continue to take all of those precautions and to be mindful and prudent through this period of time. Do you have a follow-up? Yes, thanks. The province government is making rapid test kits available to business and why does this program ensure that some workers get this service at a government expense because they are being provided free while others if their business declines to participate don't get this service. We have offered it there is a number of different programs for businesses and business organizations have been working with us and with the federal government directly so there is quite a few different businesses around the province that are using rapid testing in different ways to support ongoing operations. One of the ones that we were involved with early on where we really were pushing this to be an important adjunct to vaccination and other measures is in some of the large industrial camps we have been focusing on especially where there is group accommodations so temporary farm workers large industrial camps the correctional facilities but I know there is a number of other businesses maybe the minister can talk to some of those. The numbers are significant and again when we make rapid tests that we of course received from the federal government available those will be free as well of course the about 377 organizations have been provided access to test kits for screening across BC and significant number of them 141 with the government of Canada the remainder with the provincial health service authority and the problems of BC we know that about 35,000 tests are given a week as I noted well over 500,000 tests 533,000 tests and we provided rapid tests and provided across BC and that will continue to be the case and we encourage more involvement in that program not less so those programs are available widely obviously we are working with other sectors as well as we get more access to rapid tests we will be able to grow those programs but we also want to note that we are doing now and have been doing the last number of months more gold standard PCR testing we have done since the beginning of the pandemic between 90 and 100,000 tests a week and those of the tests from which we generate and those of the tests are required to support rapid testing as well where it occurs should there be positive tests and those tests are being done at a very significant rate in the problems of BC and those tests are where we get our regular numbers and our main understanding of the COVID-19 pandemic in BC . Next question. Hi there. I'm wondering when you expect Omicron to be the dominant strain in British Columbia and speaking up on what Richard asked with regard to restrictions given the cluster on Vancouver Island with you, Vic, is that something that you're considering some restrictions for that area? We know a lot of students would be going home for the holidays. So is some sort of travel restriction on the table for Vancouver Island or between Vancouver Island and other places? I'll answer the second one first. We don't have travel restrictions anywhere but it is a warning to people. Of course we take the risk from where we come and we bring the risk home from where we've been. So if we look across the country we look across the globe we are seeing this surges in cases of COVID-19 some of it driven by Omicron much of it driven still by Delta we're seeing it in Ontario we're seeing it in Quebec we're seeing it in France, Germany and the UK so people need to be aware of that the protections that we have work when we use them and that includes masking, testing and vaccination those are the key things and yes, there have been measures taken by Island Health in and around the outbreak we believe that it's contained in UVic and so things like exams are gone to online and the social events and a number of things have been cancelled over the last little while to manage that outbreak but what we're doing and what we have been doing all along is taking that focused approach and trying to manage these outbreaks as they arise these clusters in cases whether it's a school, whether it's in a business whether it's this larger one on Vancouver Island so I think we need to recognize that this virus is with us and we cannot stop all of it spreading but what we can do is take those measures that make a difference in keeping us out of hospital that prevent us from transmitting it to people who may have more severe illness and end up in hospital and I'm sorry, I've forgotten your first part of your question . It's too soon to say you know we look at if you look at it the modern art picture of our whole genome sequencing we had a rise of gamma and alpha at the same time and there was a little bit of delta that was in there for quite a long time then delta really took off as we controlled those other two so it's hard to know right now we have very limited community transmission with Omicron here in BC there's a lot more in Ontario that they're finding as they're doing that backward tracing and whole genome sequencing but we also know it's more transmissible so it's a bit too early for us to say a timeline of what might happen here in BC we are continuing to do our case and contact management very actively across the province that's one of the things that we hope will slow this down and we understand more about the virus more about what are the important measures to control it and of course to get more booster doses in people. Do you have a follow-up? I do. So just back to the rapid test because I know there's a lot of confusion because federal documents show that we still have around 2 million rapid tests on hand so how many of those can be taken at home and why not offer the tests? So we don't have the ones that Alberta is offering so that's they had a certain amount of a different type of tests that we don't have about 1.3 million, 1.4 million of the tests that we have so the federal government puts it in a big bucket are ones that require a healthcare provider to administer so they are ones that have a little test box and it's a nasal pharyngeal swab and you do the swab you do the test that has the machine that does the test so the machine is the limiting factor you can't send that home so those are the types of tests the rapid antigen test that we are using in the correctional facilities in places where the test machine stays there and the test is done as people come in we are using them in some of the long-term care homes in some businesses so those ones are not amenable to going home so most of our tests I think it's 1.28 million of those are those ones that require the machine or require a healthcare provider so the number that we have is about 700 and some thousand that could be broken down from the kits that they arrive in which comes in boxes of 25 or 35 with a single bottle of the diluent they could be broken down and we are expecting some of the single dose bottles of the testing solution to arrive maybe by the end of December but it's really challenging to break those down it takes a lot of time it takes people power from a lab that has been running full steam from public health people so that's the challenge that we face we have been doing it on a basis of where we need them to send home with kids in a school that has had a note break UVic for example where we will be breaking down about 10,000 but it takes a lot of time and effort to do that so we don't have those test kits like the ones in Alberta that they are sending out that come in a batch of five like the ones they are using in the UK they come in a kit of five with the solution for those five tests so yeah we have been trying to balance the resources that we have the stretch that we have in our labs and where we find those most useful to manage cases and one of the things that I mentioned before is really they work best with the material testing so testing every second day after an exposure for example so those are the types of situations we have been looking at when we get the test kits that are put together we will make them more available for people across the province next question good afternoon obviously noting a year of vaccination in the province and it has been noted previously that it is a pandemic of the in-vaccinated now wondering if the province is looking at obviously having a list of those who are vaccinated and children that are getting vaccinated now if there is a potential of the province comparing this list of the vaccinated with the BC health numbers and then that would allow the province to leave no British Columbian behind as far as vaccination and potentially being vaccinated I am not sure I understand the question to encourage people to be vaccinated I think that happens already I mean obviously everyone the reason we can give very precise numbers about the number of say healthcare workers or a number of British Columbians who are eligible to be vaccinated and numbers who are is that we know and we have a very comprehensive database of both those who are eligible for vaccination and those who can be vaccinated and the numbers who over 12 represent about 9% and I can tell you for every one of those people they are welcome any time to get vaccinated and that group of people represents of course that small group of people represents the vast majority of critical care cases and particularly hard and vaccinated people so everyone is eligible for vaccination certainly first and second dose have been widely available and everyone has been offered it at the latest by July and we are working hard to convince the small number of remaining people to be vaccinated and working hard in new groups of people like children 5 to 11 to get them vaccinated as well but the numbers are impressive we have them all provided by local health area by community health service area Dr Henry did today the detailed information on who is vaccinated and who is not and everybody is welcome whether they are residents of BC or not whatever their circumstance if they are in BC they are welcome to get vaccinated . Can walk into a pharmacy in many parts of the province and I know for many people it is still convenient for people so walk into a pharmacy and get your dose one. Go ahead with your follow up. Different topics somewhat. I think it was touched upon by some of my colleagues both in the presser today and in the tech brief previously. But this comes from our warriors of freedom they are sending me some questions this week and they want me to ask you if the province this week or before Christmas is going to be implementing a health pass or a passport system that relates to walking into grocery stores in British Columbia? No. Our BC vaccine program was thoughtful and we put a lot of thought and time and effort into what was included in the BC vaccine program. So what is included in the BC vaccine program are businesses like restaurants where having vaccinated customers is another measure that allows us to keep those businesses opening functioning. It means being able to go to theater, being able to go to arts programs, being able to go to see the Canucks, being able to go to see the hockey game in Kelowna and in Kamloops and in Chilliwack. And it is designed for those things where there are alternatives for people. So you can do take away. You can watch it on TV. You can watch a music program. Whatever. So it is areas where we know it is higher because they are indoor settings and where we want to be able to , they are in some ways discretionary but we want to be able to mitigate the risk for those people in those settings and keep those businesses open and functioning because we know how important the arts and music and symphony and sports is to our mental health and physical health and the functioning of our community and children. So it is designed specifically for that and also an incentive of course for people who want to do those things in person to be vaccinated and to do their part to make it a safe environment as much as possible for people. Where we do have is mask mandates and those are designed to protect the workers in those settings and other people in those settings but primarily the workers because if you are in a grocery store you have to protect the workers who are there all the time that you are coming into contact with so keeping your distance from people we have learned to be respectful in retail environments and I just want to do say a thing about this no we are not going to make it part of the BC vaccine program but it is a requirement to wear masks in those indoor settings retail settings malls and grocery stores for example and I know there has been some concerns that people are saying I have an exemption so I can just walk in freely that is not the case there are alternatives that we can accommodate people who have a reason why they can't wear masks and that doesn't mean that you are able to just walk in and do whatever you want it means that you can do online ordering of your groceries you can have curbside pickup you can have somebody in the retail outlets are doing this where people will get what you need and provide it to you either curbside or drive and so there are alternatives for people who feel strongly about not wearing masks and it doesn't mean you have to be antagonistic and put people at risk and that is really important right now when we are in indoor settings right now it is really important that we take those respectful measures that protect others and protect ourselves we have time for one more question we will go to Bell Curie CBC Hi there and if we could have the answers in English and French please Dr. Henry so BC made booster doses available now for everyone who appears that two doses of the vaccine don't offer enough protection against Omicron and if that happens we give enough vaccine enough system capacity to do two doses for children and booster doses for everyone else at the same time so our booster dose program is a booster dose for everybody over age 18 that is what it has been from the very beginning and the logistics of how we are doing that is exactly what we are talking about how many people are due at six months and you know Nassie has reaffirmed that is still important and that is important because it gives us that longer lasting protection but for the next variant for next winter as well so six months is the interval that we are working towards and every adult over age 18 is eligible and that is why we are bringing on pharmacies that is why we have ramped up our provision we have been focusing on those at risk first as we did with our initial primary series and that also corresponds with the people who are furthest from their dose too so every adult in BC is eligible for a booster dose at six months from dose two and that is how we are going to be rolling things out and what we have been doing already and what will happen they can't all get their booster dose one most people are sort of due for their booster dose come January, February that will be six months for the elephant as I call it of the dose twos we were giving in June and July and we are planning for that to be moving through over the next three months and that is the vaccine that we have for that that is why we are expanding to pharmacies so that we can expand the numbers of places people can get it in their community over around the province. And just briefly to reiterate that we absolutely encourage all parents of children five to 11 to register their children and we will be closing in on that number very quickly. We need more registered children to get vaccinated in this period it is going to be a very positive thing to do with respect to booster doses as noted we announced our program seven weeks ago that everyone is going to get their booster dose in BC and that we focus in the areas we focused on or the areas we focused on at the beginning of the pandemic for first doses and second doses which are long-term care and healthcare workers and indigenous communities and our elders and people who are clinically vulnerable and that will continue to be the case and we announced a program towards the end of October and in the first month and half of that program we are going to deliver 35% more doses than we thought we were which is a real success for everyone involved in the program so we are increasing the capacity to meet the demand that is coming with people requiring a booster dose after their first and second doses I would say in French that the doses the third dose for people will be offered to everyone in the province every adult in the province every person who is more than 12 years old will receive his third dose his supplementary dose to the first two doses and it will be delivered in the coming months and we are now ahead of the time we have designed to start the program it is a success of our young people who work in our vaccination program and for the people of the UK and I encourage everyone who is not vaccinated and who is not vaccinated until the end of October and who is not vaccinated until now to join us also we have you in the presentation of Dr Henry who is 32 times more likely to be in the hospital because of Covid-19 we are not vaccinated 32 times and we have to change that and we can change that and we are not vaccinated until as soon as possible Elby have a follow up? Yes, please also in English and French a woman in her 40s is telling us that she has died from several blood clots soon after her AstraZeneca shot back in April. Her hematologist said she needs an exemption despite the exemption form saying that those people with the vaccine induced condition health officers saying work is being done on potential exemptions in the future, but none have been issued so far. So where are you with that and when can we expect to hear more about this? Would someone in this case be considered for an exemption? Yes. So what we have been focusing on is people who, the health care worker program and people who have a medical reason why they can't get mostly a second dose, but very similar to the condition that this person has had experienced. And yes, we are working through that process. We initially said that we would have no exemptions to the vaccine card program, and I guess that's what you're looking for. She wants to be able to have a vaccine card to be able to attend events, for example. And we have started a process for that as well. We have started a process for that as well. As you can imagine, it is a complicated thing and it's challenging for us. So because the vaccine card is a time limited intervention program, though we are reassessing it in January, as you know. However, I do expect that it's going to be in place longer than January. So we have started a process to be able to get people a vaccine card to be able to get people a valid BC vaccine card for the BC vaccine program with a medical exemption. But it is a slow process and I know my office has been in contact with a few people who are in a similar situation. And if she received a letter, then she is one of them and yes, that process is underway. I will say that we do not have control over the federal vaccine process. It is a different process and I don't know what the process is, for example, for travel, for verification, for travel. I think what we are talking about is exemption from the BC vaccine card. I think that's what is being requested. Another sort of exemption. I would say that we said at the beginning of the BC vaccine card program that there will be no people who are excluded from the program, that is to say that you have to be vaccinated to receive a card. For a certain time, we have done a consideration of this question for the small minority of people who cannot be vaccinated. And we are working on this now, so it continues to be the case that you have to be vaccinated to receive a card of vaccination and we are going to work on this question and this work continues. It was important for people, but you have to say that the BC vaccine card is a successful program because it is a clear program and so to make nuances in this program presents difficulties to people. So we work hard on this question but for now, to receive a BC vaccine card, you have to be vaccinated. Thank you very much.