 Good morning, my name is Adrienne Dix, I'm BC's Minister of Health. In Victoria today, Dr Bonnie Henry, BC's provincial health officer. I'm honored to be speaking to you from the territory of the muskream of the squamish of the slave of the First Nations. Honored to be here on their lands. Dr Henry is on the territory of the Lekwungen speaking people, the Songhees and the Squamalt First Nations. Dr Henry will be presenting presentation on the current state of the COVID-19 pandemic. After that I'll speak about some issues around hospitals including on issues of rapid testing and health care workers who are currently off sick. And with that it's my honor, as always, to introduce Dr Bonnie Henry. Thank you very much. We've been looking at very intensely over the last few weeks to try and put that puzzle together of where we are in our Omicron wave and how that's impacting us in the community but also in our health care system. And this will look a little bit ha-ha. I'm just going to ask them to re-look at it was at the end slide. Let's see if we can try this again. All right. Okay. We'll start again. So on our second slide here. It will look a little bit different today because there are some measures that we have been using all along that are no longer able to be representative of the community. So we don't have geographic and we don't have things like the reproductive number because that depends on us knowing how many people each case have transmitted to. And as I've said a number of times as we've gone through this Omicron wave, we have transmissions that are happening very rapidly and we no longer are able to do that case and contact tracing because of the shortened incubation period that we're seeing with this wave. So we also need to look at other jurisdictions to help us validate what we're seeing and to understand the trajectory of what we're seeing in BC compared to other jurisdictions. So one of those is to be able to look at our case rates over time, our percent positivity, which is reflected in the colors of these graphs and compare them to what we're seeing in other jurisdictions. And one of these is here, the representation of other jurisdictions in Canada. And so the height of our peak is reflects the PCR testing. So we've been at the capacity of our PCR tests for a number of weeks now as Omicron has really transmitted in our communities. But it does give us a sense because we've been monitoring PCR testing over time, it does reflect the change in the patterns over time. Our test positivity has been very high and it's been in the 20s for the last little while. We've seen in this past week particularly that we've started to see a decrease in the test positivity and in the numbers of cases of PCR positives. And if we look at other jurisdictions in Canada, we see that Ontario and Quebec are slightly ahead of us. Not as far ahead as we initially thought in terms of the wave going through and we are seeing as well as they've reported today starting to see that decrease in community transmission in those jurisdictions as well. Other places in Canada are slightly behind us and they're still very much on the upswing. So these are the types of things that we are using to help us understand where we are now. And of course because daily cases are limited by our testing capacity and our testing strategy, we also need to watch very carefully hospitalizations and hard endpoints like people who've died from COVID. So this is again a reflection of the other jurisdictions in Canada. The hospitalizations that we're seeing compared to Ontario and Quebec and what we're seeing is we're all on an upward trajectory in numbers of new people admitted to hospital per day. We're seeing that across the board. If we look on the hospital census on the corner there, what we see is in BC that has been flatter and not as steep a rise as in some of the other jurisdictions and I believe and from data that I'll show you, part of that is because of the measures that people have taken in British Columbia, the measures that we put in place in December to try and slow things down and try and prevent hospitalizations. Also reflects who is in hospital. And I'm going to talk a little bit more about that and why we focused our booster dose program for example where we did. So this is our epidemic curve that we're seeing. So slide 4. The top line in green is the PCR test positive cases in our community and those have peaked around the 1st of January and are starting to go down. So we think that we hit the peak of community transmission in British Columbia probably this past weekend. That's important. There's a number of different indicators that allow us to say that we're still at the peak of certainty and I'm going to go through those. But we are still at the point where our hospitalization rate is going up. So new hospitalizations is still a concern. And we need to understand who is it that's being hospitalized and what can we do to try and affect that trajectory in the next few weeks. So if we look at it across BC, it's not the same everywhere. And we've seen that. We've seen that this started really early on. Particularly Omicron took off in Vancouver Coastal and Fraser Health and on Vancouver Island first. We're now starting to see it slowing down a bit in interior health and in northern health we're still on that upward trajectory. It was starting, Omicron moved into that community later than in other parts of the province. But it really is the highly populist lower mainland that is driving the epidemic curve for British Columbia. And we've seen a little bumpy bit that you see in Vancouver Coastal at the top. That's a testing anomaly. That's because we reached the limit of PCR capacity and weren't able to do additional PCR testing at that period in time. So that's why a week, 10 days ago we weren't able to say where we were in this trajectory because it was unclear if it was just because of testing or if it was because we were seeing that if we had the testing capacity we would see a peak very similar to what we see in Fraser Health in Vancouver Coastal as well. So if we look at what has happened in terms of the trajectory over the last month in particular as Omicron entered into our lexicon as well as our communities we've seen a bit of a wave that started with younger people. So people in their 20s, 30s in particular starting off with older age groups. This is something we've seen as well in all of our waves through the last two years with this virus. But what we're also seeing is it moves with highly connected people. This has been much faster than what we've seen with any other wave. What is concerning now and what we need to pay attention to is the fact that we're seeing this uptick in older people now. We're seeing who are those people and what we can do to try and make sure that we're stopping that transmission for those who are more vulnerable to having severe illness in our communities. We're also seeing a bit of an uptick in younger people and I'll show a bit more information about that. So importantly as we've seen this move through the community we want to know who is most likely to be hospitalized. So looking at the hospital data by age across BC we are seeing an increase in hospitalization in younger people and we have more information about who are more likely to be hospitalized in those younger age groups but more concerning we are seeing recently an increase a dramatic increase again in people over age 70 who are having severe illness and ending up in hospital and unfortunately that's where we're seeing an uptick in people who are dying from COVID as well. So if we look at this hospitalizations the numbers are greatest in the 60 to 79 year age group but the rate of being admitted to hospital is much highest in people over age 80. We are also seeing a little bit of an uptick in the 0 to 19 in our pediatric age group and I have more information on that that will help us understand who are those people as well. So when we look at older people being hospitalized we are seeing a lot of concern concerning things that come up. One of the most important is that we see that the rates at every age of people having severe enough illness that they need to be in hospital go up dramatically if you don't have the protection that vaccination offers. So even having two doses of vaccine before you get your booster dose it's very highly protective for most people and that's important. We have seen in the last two years to make sure that we get the best protection possible than 90% of people in BC who have got their vaccinations that is helping make sure that you don't have severe enough illness as this new strain is spreading that you will end up in hospital. Where we are seeing that that little bit of a crack is in older people over age 70 and even with two doses there is still a risk in older people to get a strong and immune response. So even if you are vaccinated with two doses it's really important to get your booster dose and one of the reasons why we have really focused on our booster dose program on older people and people who have immune compromising conditions and are more at risk is because we know that that extra dose makes a big difference. So on the next slide what this shows again is hospitalizations by age and what you can see is that line on the top no matter what age you are hospitalization risk is much higher if you don't have any protection any immune priming from vaccination and if you are over age 70 you really need that booster dose too. And we know there is about 50,000 people over age 70 who have two doses of vaccine who have not yet got their booster dose. This is really important right now it gives you that added extra protection that you need to keep you from having more severe disease that leads to hospitalization. So that's an important thing for us all to recognize. And for those who are younger and feel like you can get through this we are still seeing high rates of hospitalization in younger people who don't have any protection and that right now we talked a little bit about breakthrough and reinfections so people who have been infected with other strains of this virus Omicron is more likely to infect you right now and more likely to cause severe enough illness that you are going to need hospitalization if you don't have vaccine as well. So it is important to recognize that as more of this virus spreads in our community and we have people who are vaccinated getting infected the people who are not vaccinated your risk goes up being exposed to the virus and after being exposed to the virus the risk goes up of having more severe illness and ending up in hospital and of course the other part of that is ending up in critical care so what we have seen as even two doses of vaccine in older people is highly protective of keeping you out of the ICU and critical care in our hospitals so yes we are seeing an uptick that will end up in hospital but not in ICU and that is not the case for people who don't have that immune priming that vaccination gives so when we look at again across the board about 17% of people in British Columbia and that includes young people 0-4 years of age for whom there is not yet a vaccine those people are right now 47% of people in our hospitals are mostly adults not the 0-4 but mostly adults who have not been vaccinated and 70% of people in critical care in the past month are people who have not been vaccinated and this is mostly Omicron and combination of Omicron and Delta and two thirds of the people who have died from Covid in the past month have been people who have not been vaccinated from the very small percentage of people who don't yet have vaccine in BC and this breaks it all down it's quite a busy slide that's what I call the placemat but it shows you that age is still the number one most important risk factor for having severe illness for ending up in hospital and that's really important and vaccination works vaccination protects you from that severe illness and I think I can't say this enough that level of protection is what is getting us through this wave with out overwhelming our hospital system stretched as it is and as I mentioned the risk profile has changed for people who don't have that protection on board because we know that if you have been vaccinated this Omicron is causing infections in vaccinated people which means that extra protection unvaccinated people had from the community being protected is no longer there so if you don't have a vaccine on board right now if you don't have that immune stimulation that protection you're at much higher risk than you were even two weeks or six weeks ago and if we look at this from the perspective of age standardised so somebody the same age as me who's vaccinated with two doses of vaccine so not even with the booster dose my risk if I don't have not yet been vaccinated is 12 times higher of having severe enough illness that I need to be in hospital 27 times higher of developing severe enough illness that I need critical care for people who are not vaccinated right now it shows us that vaccination is really protective for people having severe illness and staying out of hospital and this is another way of looking at it I know when we look at the numbers every day and there's been a lot of people who have been remarking on the fact that there's more vaccinated people in hospital than unvaccinated people but that number comes from a much, much bigger pool of people and the number of people who have been vaccinated is dramatically lower and I think it's putting the perspective on those numbers if you're somebody who doesn't have the protection that vaccines are offering right now your chances of having a severe enough illness that you need hospitalisation are much, much higher I spoke a little bit about the pediatric profile so this is slide 16 we have seen an increase just this week and younger people ending up in hospital and there's been nine admissions this week in the 0-4 age group and two each in 5-11 and 12-17 thankfully we have not seen any of these children yet requiring critical care and we've got no new deaths in this age group but this reflects again the fact that this virus is spreading widely in our community and how important it is for all of us around young people to have a 0-4 particularly young people making sure that we're vaccinated to do the best we can to protect them from transmission we know that the case rates are higher when you don't have vaccine and the same goes for children as well we've only had one case of a child hospitalised who's been vaccinated so it offers you protection as a child yourself for children over age 5 but it also makes sure that we do our best to try and reduce the risk of transmission to others and it is really important for us to pay attention to that right now I will say that with Omicron we're seeing a different pattern for younger people it's more of an upper respiratory illness we saw this in the US we're seeing this in other jurisdictions and we've been watching it here and talking to our pediatric colleagues it behaves more like some of the other respiratory viruses in triggering things like asthma and airway disease and bronchiolitis in young children so that's most commonly the reason why they're in hospital after infection with COVID and now mostly Omicron but I will say we do have other respiratory viruses that are circulating this year and are causing illness in young people and in long-term care homes last year we didn't see very much of influenza RSV we didn't see very much of anything and partly that's because of international travel and all the measures that we're taking so the things that we do do make a difference in preventing these other infections as well what we have seen this year is quite a large increase in respiratory syncytial virus much more like what we would see on a normal respiratory virus season but it's a little bit of influenza not a lot this year but it is out there and it is causing illness in young people it's one of the most common reasons RSV particularly while younger children are being admitted to hospital over the last couple of months in addition to the small number that we're seeing related to COVID the other thing that we're seeing is that RSV can cause and we've known this outbreaks in long-term care homes that we've seen in the past month in a long-term care home has been caused by RSV so those measures that we have in place to protect long-term care homes they do protect against this RSV and influenza as well one of the things I will say is that with so much virus circulating we have a lot of milder illness caused by Omicron primarily in long-term care homes across the province and we're working with the long-term care homes to make sure that the measures that we take are proportional to the change in illness that we're seeing partly because we have so much good protection of residents with the booster doses in long-term care homes and Omicron itself is causing a much milder illness in long-term care for the most part so those are things that we're working through with the long-term care homes right now. So understanding the new reality that we're in, this new wave of Omicron and how it has changed is something that we've been adjusting to and trying to make adjustments for over the last few weeks and this is the whole genome sequencing pattern that we've seen across the province since the pandemic started and what we can see is the red there is Omicron and it has rapidly replaced Delta in a much shorter time frame than we've seen any of the other variants emerge and replace over time and that has meant that it is a different game that we're in now it's a different pandemic and we've had to adapt and adjust and make these changes with the imperfect information that we have in real time essentially so we've seen this replace here in BC in about four weeks which is similar to what we're seeing in other jurisdictions where it's about four to five weeks for Omicron to come in and rapidly replace other strains that are circulating. It's not the same across the province what we saw is it emerged first in Vancouver coastal and Fraser and Island Health and move very quickly there a little bit later in Interior Health but now has mostly replaced Delta there and a little bit later in Northern Health although it is replacing Omicron so what does that mean for us and how do we understand with this rapidly changing virus that as we've talked about we now know has a shorter incubation period for most people because of vaccination has a shorter duration of illness so most people aren't getting a severe enough illness that they need to be hospitalized that's the good news the challenging part is understanding where we are on the trajectory in terms of transmission in our community and also what is going to be the impact on our health care system the important things that help us getting through this pandemic recognizing that transmission in the community and impact on the health care system is now affected by two things people in hospital how long they stay there but also the fact that this is infecting health care workers and even with illness that doesn't make me go to the hospital myself health care workers having to be at home recovering from their illness has led to staff being off ill in higher numbers than ever before in this pandemic so in trying to understand that we've been looking at models and we look at analogies from other communities and other parts of the world as I've mentioned before so one of the things we're looking at is how is our trajectory comparing to other jurisdictions where Omicron has become the dominant variant in a very similar pattern and a very similar time frame and particularly we're looking at a couple of urban centers so that's on the left and we've compared it with London which is ahead of us and we're doing this over time Washington DC and New York City are good representations of the movement of Omicron over time and we can see that our populated urban areas are following a very similar trajectory and particularly if we look at Vancouver Coastal I mentioned there's that flattening bumpy bit we saw a very similar thing in London as testing capacity was reaching limits there and so it was difficult to tell if we were seeing a slowing down or if it was still going up and we just weren't measuring it but we can now say with some confidence that the pattern shows a sustained decrease and that pattern reflects what we're seeing in other jurisdictions that have a similar Omicron dominant outbreak right now and if we look at this from a regional perspective BC is following a very similar pattern and what we saw in South Africa what we're seeing in the UK and we've put in there Florida and Denmark as well as two other jurisdictions that are going through a very similar situation than we are obviously it's not perfect and this is just one way that we look at it we sort of triangulate and look at many different things to see if we can say with some confidence where we are in the course of the pandemic and the surveillance measures we've been watching over time and I've presented this before is the wastewater surveillance and so when we look at wastewater surveillance it's not dependent on who gets tested it really is a barometer of how much virus is in a community and we see that it follows quite closely to peaks that we've seen in the past and we're seeing that again in the last few weeks that has been ongoing for over a year peaked around the first week of January which is very similar to the data we're seeing from the PCR testing which is very similar to the other surveillance measures that we've been looking at and that we're now on a decreasing trajectory of concentration certainly not back down to the levels that we were seeing in Vancouver Coastal and Fraser in the summer for example and we're seeing more confidence that we are at least in terms of transmission in the community we've reached the peak and we're starting on that downward trajectory. Of course the other really important things is the impact on our hospital system. Over time we've also always been looking at hospital occupancy so this is census so this is on a day-by-day basis how many people are in a hospital in BC with a positive COVID test and it's an overestimate of the number of people who are in hospital because of COVID but it helps us understand the impact on our health care system in particular on the hospital system and we've been following this over time we can see that there's been an increase particularly we were at a nice low at the end of November and then as Omicron moved into the community we started to see this increase on top of the residual increases we had from the Delta wave that we were dealing with most of the fall and on the very bottom the dark blue is critical care so that senses number of people in critical care with a COVID positive test and this is something that we've been following very carefully and as we have rapidly changing situations it's a more important daily measure of the impact on our health care system but it's a composite measure that tells us a bunch of different things and we need to understand a little better who's included in that census so we will be reporting hospital census data starting on a daily basis starting today which will mean a jump in numbers of people included in that number and I'll talk through a little bit where we get what that means some of the things that we've been following over time and the impact that Omicron is going to have on our hospitals are things like emergency department visits for COVID and this is looking at the visits in Vancouver Coastal and Providence health care for the month over the past year up until January 11th as we can see there's been a dramatic increase in people going to the hospital to the emergency department related to COVID so that may be because of COVID because another condition is exacerbated it may be because they tested positive and they have concerns so those visits have increased and they're starting to perhaps level off they have not started to come down yet so it's an early marker but what we are looking at really carefully is the proportion of people who visit an emergency department who end up being admitted to hospital and we can see that that proportion is much less than what we had in previous waves in March and April and May of 2021 where that proportion was much higher so that's something that tells us a little bit about severity of the illness with Omicron the other thing that we are looking at is how many people in hospital are there because of Omicron how many people are there because they've been infected with Delta which we know causes more severe illness in general and we've come closer to this week there's still a number of people who have been admitted to hospital and we don't yet have a sequence a whole genome sequence because there's a delay in being able to do those sequences but what this helps us understand is for those that we know are Omicron are they in any way different and this gets at severity of illness and the impact on hospitals and we've seen in other countries in South Africa and Copenhagen that people who are admitted because of an Omicron infection tend to have a shorter length of stay and not as severe illness so we need to understand if that holds true in our population here in BC so what we have looked at is for those between the end of November and the 7th of January looking at people who we know had Delta people we know had were infected with Omicron and then the unknown and what this tells us is consistent with what we're seeing in other jurisdictions so the median length of stay is about half of what we're seeing with people with Delta so compared to Delta Omicron people aren't as sick and the need for critical care is down by about two thirds so only 12% of people who are infected with Omicron compared to people who are infected with Delta and the same thing goes for severe enough illness that it leads to death so there's a whole lot of caveats here in that we know a younger population was infected early but it really does align with what we're seeing in other places that people who are admitted to hospital are admitted at a lower rate and have a lower need for critical care and also a shorter length of stay and so those unknown people if we look at the pattern that we're seeing in that 358 people who are admitted in the last seven days many of them are still in hospital so we can't say anything about length of stay yet but they are more reflective of what we're seeing with Omicron so that's telling us that we're starting to see the Omicron impact on our hospitals and so we need to know is it because of COVID and Omicron that they're being admitted or is it an incidental finding and then we need to have an understanding of how long this trajectory is going to go so we've been trying as we have across the country to try and separate this this has not been as important an issue before Omicron because there is so much transmission in the community we are now finding that people are being incidentally testing positive what that means is they're being admitted for something else most commonly we're seeing it people admit it for surgery people admit it to labor and delivery or to medical wards mental health issues who are being screened with a test on admission to hospital and those tests are turning up positive so they're not being hospitalized because of the impact of COVID either directly or indirectly from exacerbation of other illness but they're being found incidentally and this is something we've been trying to tackle with I mentioned this before with my colleagues across the country Ontario presented some data this week on how they're looking at it this is tricky to get to because it really means we have to look at do a chart review of every individual case and we're trying to find a way to automate it so we have a better sense of what we're doing and the chart reviews that we did do was all of the hospitalizations in the month of December so it was up until the people who are admitted up until January 11 in Vancouver Coastal Health and this gives us a representative sample of what we might be seeing in other places and we have been working with each health authority and it probably is about the same in each health authority so what this tells us is that in the hospital with a COVID positive test it was an incidental finding and about 50% of them it was actually because of their COVID diagnosis and right now as we're transitioning and what I just showed you most of the people being admitted to hospital still are related to Delta so that's the blue in this slide and people requiring invasive intervention so that's mostly critical care ICU needing oxygen or intubation again most more likely to be infected with Delta so this gives us an indication of what we might be seeing in our hospitals right now it's not across the board and what we're looking at is how do we get that picture on an ongoing basis so what we are going to be reporting and our daily hospital numbers will be that composite number of hospital census so today yesterday I think it was about 534 was in our hospital people in hospital starting today we will be using the census numbers and that will jump up a little bit it will be about 600 and some and there's a couple of reasons for that one is because it includes all of these different people so it includes people related to COVID-19 or incidentally found to have COVID-19 and it includes people who were part of an outbreak or a cluster in a hospital so it acquired it while they were in in hospital for something else it also includes people who are hospitalized because of social circumstances and people from out of country or out of province who are hospitalized in BC so it is the overall impact of COVID but it does represent the impact on the burden of COVID-related illness in our hospitals and then as we get the automated processes in place to be able to tease apart these three different groups of people in hospital will be presenting that on a periodic basis as a snapshot and I know this sounds complicated but we know that about 30-40 people have been admitted a day and there's an equal number of people that are discharged from hospital so it's a very fluid situation and people move into critical care and then back onto the ward and then are discharged and so it's a challenging to try and keep up with that transition on a day-to-day basis so what we'll be presenting is the overall hospitalization senses and then on a periodic basis as we're able to try and automate it right now about 45% of the people in hospital at this point are people who are incidentally found to have COVID it does have an impact on things like infection control practices in the hospital but it does also give us a measure of where we are in terms of impact we will also be so part of the reason why we had presented hospitalization the way we did from the very beginning was linking it with our line lists so we can understand severity of illness how many people in DC who have a diagnosis of COVID-19 end up in hospital at any point in their illness and that's really important for us to know because it helps us understand the severity of COVID as we're progressing through this pandemic but that is because it means linking of data it's a little bit delayed but we have rapidly increasing cases and this was something that became apparent when we started to have rapidly increasing cases in the interior, in the summer those measures can be there can be a gap and a delay and understanding that so we're going to be presenting the census on a daily basis and then weekly we'll be looking at that severity index in more detail so what does this mean for where we are going to be looking at the impact we've seen that in the community we're on that downward trend we need to keep it there which means we need to continue to hold the line and do what we're doing to try and prevent us being a source of transmission further in the community but we also need to understand what we can do to infect hospital senses so we looked at our modeling and taking into account the same rates of transmission so this is what we call the scenario the higher transmission scenario same rates of transmission that we were seeing in December prior to putting in the public health measures that we did which was stopping night clubs and gatherings and putting restrictions on places where people were inside and it looks at booster doses being provided to about 40% of the population whether they're the most high risk or not so it's 40% across the board and this gives an indication of what we could potentially see over the next little while it also takes into account and this aligns with what we are seeing in other jurisdictions that once you see the peak of transmission in the community there's a lag of about a week before you see the peak of new admissions to hospital and then there's a lag of about another week and then you see a decrease in hospital senses and this model, the bottom on the purple line it takes into account Delta the fact that we're still seeing people hospitalized with Delta the green line is the Omicron impact and the black dots are where we are right now and then the orange line at the top is the composite the total of both of those so what we expect from this modeling and the trajectory that we're seeing is that our new admissions to hospital on a daily basis are likely to peak between January 15th and 22nd so sometime next week so a lag of about a week after we started to see that peak in community transmission and with a lower transmission scenario so this is taking into account that we put in place on public health measures and we're going to do that rapidly in December as we started to see cases dramatically increase and before we knew all of the information about severity and who was most affected we if we have that lower transmission it blunts the peak of hospitalizations but it spreads it out a little bit more so the peak might be a little bit later next week again this doesn't take into account so this is just new admissions we'll watch this very carefully but we expect them to start to decrease hopefully by mid to end next week and then about a week after that we'll start to see a decrease in our hospital senses so this tells us that we need to keep doing what we're doing right now and that it's going to be a challenging few weeks on our hospitals we know that this is at the peak is coming at the same time we need to keep our healthcare workers off ill and not be able to go into work and we've been working very closely in every hospital, every community to make sure that we can try as best we can to support as much as we can the measures that we took in December to do things like stopping of non-urgent surgeries backfilling health human resource management putting all of those protocols in place are to try and get us through this next few weeks that are going to be the most challenging yet on our healthcare system so I do want to talk a little bit about the orders that we put in place so we needed to do this in December and I said that at the time that we put these orders in place there are many things that we look at when we put orders in place one of them are the factors related to the virus the transmissibility, how much of it we're spending in the community and when we were December 18th is when we had our first Omicron by that next week we were seeing it dramatically increase and we were seeing transmission rates explode in our communities and that's when we had to think down the line what does that mean in terms of potential for people ending up in hospital and you've seen some of the modeling that has shown that the potential could have been quite dramatic but we don't know that's one of the things then we also look at what are the settings where this virus can transmit more readily and who is in those settings and what are they doing so that's where wearing a mask becomes more important that's where if you're seated and wearing a mask versus exercising vigorously or singing or yelling whether you're in an indoor environment or you're quiet your own personal risk and vaccination status those are all things that we take into effect and the fact that we know the vaccine card made a difference in terms of who was in some of these settings because we were able to understand vaccination status of people in the settings plus we look at things like prior outbreaks what we had seen in patterns over the last two years and transmission change where they were highest led to us putting in the restrictions that we did around bars and nightclubs where it's an indoor environment and gyms as well and fitness centres indoor environment with vigorous exercise or where you're not wearing masks so the risk profile in those settings is much higher where we've seen outbreaks in the past many outbreaks and chains of transmission from those areas we've also put in as you know gatherings and events some of which were stopped for the period of time others where we put in increased capacity limits for those where people are seated and masked and not moving around and of course really important recognizing that because there's a lot of this virus in the community and because we have a high level of vaccination many people will have asymptomatic or very mild symptoms and they may not recognize it so that's where things like COVID safety plans in businesses like the plans we have in schools and daycares and childcare centres are really important because it means that you're wearing a mask in those settings it means there are other measures in place to try and prevent transmission that look at all of these risk factors above so that is the state of where we are right now in terms of this wave of the pandemic I will also share that we have been adjusting and trying to understand in real time from multiple sources what's going on and what we need to do we also need to adjust our measures and we are making changes to our testing guidance as we've talked about but the starting point for all of us remains unchanged if you're feeling unwell and if you're struggling with your illness seek medical care if you're a close contact of somebody who you know has COVID you need to self monitor and limit your interactions wear a mask if you have mild symptoms you don't need to get tested but you need to stay home and tell you're well enough to resume your regular activities and of course you're encouraged to inform your workplace schools or childcare but you don't need to contact public health but you need to avoid high risk settings if possible when you are ill so it's not the time to go visit older members of your family but you also need to follow COVID safety plans in your workplace in your school, in your childcare if you develop symptoms and are high risk or live or work in a high risk setting then you do need to get tested and that's what we are preserving our testing capacity for right now and we are also providing public health guidance including requirements for self isolation based on vaccination status so staying home for five days if needed given the rate of transmission at this time testing should not be the indicator to be cautious and to take care and the data that we've shown there are some people that need to take care because there's a lot of virus in our communities right now still so if you are older if you are somebody who's going through cancer treatments if you are on immune suppressing drugs you do need to take those extra precautions and we need to take extra care with those people in our communities and our families who are in that category as well we will of course to continue to monitor and adjust as we learn more in the coming days and weeks my message to everybody today is that we all need to remain vigilant and we must also use our common COVID sense now this is different but it is not something that is but it is still something that we know how to handle and we know what to do this is the respiratory season which means we have COVID we also have a little bit of influenza quite a bit of virus being and other viruses circulating so the protections you are taking for COVID-19 also help you with these other viruses for parents with children in K-12 or childcare if your children are ill please keep them home if they have mild illness they can return to school when symptoms have resolved and they are feeling better and up to their usual activities and the same applies for childcare I know this is different from where we have been trying to make sure we are keeping COVID out of everything but the reality is that we don't transmit the virus as much if we are well so these are the things that we need to consider now and I recognize that clear definitive unchanging guidance is what we really want but COVID is not allowing for that the virus is changing and we need to adapt as well it doesn't mean what you did yesterday was wrong and certainly we have more and more evidence that all of those things we did have made a tremendous difference in blunting the impact that this changing virus has had in our communities and I think that's really important and especially and appreciative of everybody being cautious and taking those measures over the holiday season when I know it was challenging and it's hard and we really want it to be with others but I'm asking everybody today to do their best and safest thing for my loved one and for yourself today and that's what we are going to need to do to get us through this wave but we are resilient and we are strong and I'm confident we will get through this wave as well and very soon get through this storm thank you I'll turn it over to Minister Dix Thank you very much Dr. Henry and I wanted today to follow up first of all by saying that the presentation PowerPoint presentation by Dr. Henry will be available on the BCCDC website and we will be sharing it on social media channels as well because it is useful I know for people it's sometimes difficult when these are presented and you are watching say on television to see or to spend time with the information that's provided so that will be available shortly I want to provide an update on rapid test inventory and use as well as the impact of sickness on health care workers and the health care system overall I just want to briefly touch though on the booster dose campaign over the last week from January 6 to 13 319,752 booster doses have been administered in BC an extraordinary achievement yesterday a record number 58,685 that's not all doses that's just booster doses in that period and I think it was 57,723 on Wednesday in addition 378,825 appointments have been made I want to express my appreciation because with all of this going on the booster dose campaign is ramped up to extraordinary degree and the people who support that campaign both the volunteers and staff who make all of the arrangements of stations are extraordinary team of community pharmacists who do that work and the health care workers who of course would frequently be doing other things that are doing many other things in health care and the people who support it and administer those doses is an exceptional success and as the presentation by Dr Henry underlines the decision to focus first on those who are most vulnerable is justified now by the evidence as we expected would be the case and as is the case in terms of providing protections one of the most important groups including was clinically vulnerable people who have massively responded to an early invitation to get their doses but in particular those over 70 right now approximately 77 or 78% of all those over 70 have received their booster dose and about 85% of those eligible think about it there are 7 or 8% of people over 70 who have not received their initial who are not vaccinated so 85% of those are eligible but that said there are still a significant number of people in risk groups who are urging to get their booster to call today to go online today to book your appointment today there are appointments available in all health authorities in BC in the coming period and we need you to book your appointment today what the evidence showed is shown starkly by Dr Henry is the need for people in this category there are currently 53,000 people in the 70 and over category and it has been overwhelming and has been positive 53,000 who have received invitations and have not yet booked and I am speaking to those people today and people such as me people with type 1 diabetes who are otherwise clinically vulnerable to respond and to book your booster appointment today if you have not already done so this is important for you for your family and for your health equally all those who are still unvaccinated and received their second dose or partially vaccinated or who are still unvaccinated now is the time to get vaccinated you cannot see more starkly the result of that and the importance of that I will say that approximately 155,000 children 5 to 11 have been vaccinated with the special pediatric vaccine provided for them and that number continues to grow and it is well today for parents to register their children about 190,000 been registered to date but I think it is critically important particularly if you are in that category particularly if you are over 70 particularly if you are clinically vulnerable particularly if you have some immune suppressing condition that affects you to be careful right now and to book your booster dose today I cannot I hope be more clear than that I am closely monitoring sickness levels across health services especially in hospitals, in long-term care and home support and I wanted to brief you and bring you up to date on those numbers we provided some numbers on Monday and I wanted to bring you up to date with more information I can report that for the period January 3rd to 9th across all health authorities 21,517 total health care workers were off sick due to illness of all kinds including COVID-19 and as Dr Henry says there are a number of other respiratory illnesses and of course there are many other reasons why people would be off sick from January 10th to 12th 11,010 total health care workers were off sick due to COVID-19 or other illnesses in this period so a relative stability because the weeks are somewhat different January 3rd to 9th included a statutory holiday and then January 3rd to weekend days so relatively the same level but a very high level I think what everyone who is analyzing this would like to know is what is the base for that there are about 188,000 active health care workers in BC so there is a lot of health care workers but this is still a lot of people who are affected in some way by sickness whether it was one day or two days or more and I just want to give you some comparisons I can report that compared to the previous years so if you compare to the previous years in the in 2021 which was of course during the COVID-19 pandemic in 2020 prior to the first case of COVID-19 coming to British Columbia here is what we have for all health authorities except Vancouver Island and Interior Health so we wanted to get this data to you so you could have it for comparative purposes so across those health authorities so PHSA, Fraser Health Providence Northern Health and Coastal Health in 2022 this year 14,591 from January 3rd to 9th in 2021 that number was 7,573 and in 2020 which was a higher influenza and respiratory illness year if you recall 8,802 health care workers called in sick in the equivalent week to January 3rd to 9th of those years so roughly double the number of sickness on a base of 188,000 health care workers this is significant I just want to say what it means for our system it means that two things I think that we need to take home one this is an immensely challenging time when you have incrementally 10,000 more health care workers off sick in a given week or more that has an impact on services and we are adapting everywhere and you've seen some of that adaptation in the last number of days the cancellation of non-urgent scheduled surgeries for example necessary both to free up staff to support people coming into a hospital and necessary to ensure that acute care is well protected but make no mistake about the challenges not just in our major acute care centers but in our local health care centers full co-points obviously people coming in with COVID-19 as Dr. Henry has described but also services that depend on a smaller group of workers home support services say in the caribou or in the Kootenays or in the peace country that are affected by COVID-19 which with a smaller base of workers where the loss of one or two or three workers can have a profound effect the message to everyone is twofold the message that is being delivered is unprecedented at every level right now our health care workers are producing more output than ever before but we need to be patient because these circumstances are affecting the system this is the nature of this moment this wave this moment in the pandemic but secondly if you need care get care don't stay home don't wait if you have a serious reason to get care if you are not tired by this our health care teams are doing a remarkable job not just dealing with COVID-19 not just dealing with the overdose public health emergency which occupies us enormously every day not just dealing with every other issue and every other issue dealt with the public but in providing a high quality of service there will be challenges yes patients are required yes but if you need care get care regarding our rapid tests as of end of day January 13, 2022 BC has received 4,859,800 rapid tests total and deployed 3,430,400 of these tests to key strategic areas that leaves a current inventory of 1,429,400 tests 563,000 of the current inventory are not suitable for deployment for take away or personal use they require special equipment administration by trained health care professionals and cannot be broken down or repackaged for self-administration these tests will continue to be used at the discretion of medical health officers in appropriate settings to manage clusters and outbreaks that leads 866,100 tests that are more suitable for self-administered use this week we have already allocated and sent out approximately 165,000 to acute health care facilities for testing of symptomatic health care workers 90,000 for repackaging and distribution to testing sites across BC to replenish their supply 200,000 are being prepared to support testing of symptomatic staff in the K-12 education sector across the province over 100,000 will be deployed for use by businesses and organizations as part of the point of care screening program the balance will be allocated over the week ahead consistent with the plan that was outlined in detail on December 21, 2021 in addition to the facilities and facilities that are suitable for self-administered use to the following 100,000 tests are being prepared for deployment to the K-12 sector for testing of symptomatic students another 100,000 are being deployed to the acute health care facilities for health care workers more will be repackaged and distributed to testing sites 115,000 more tests are being sent to the First Nations health authority 50,000 will be deployed to the K-12 sector over 100,000 will be deployed for secondary education for symptomatic faculty and students the balance and new inventory will be allocated over the days ahead consistent with the plan outlined on December 21 replenishing long-term care education sectors and acute care hospitals for staff and testing sites for almost two years we have been doing these briefings the first one was at the end of January 2020 and a lot has changed and some things haven't COVID-19 is still the same it still lives to spread it spreads to live and in that purpose it's relentless it's not interested in our discussions or in our debates it spreads to live and we have seen how it can do so again and again in the pandemic the opportunities we give to COVID-19 secondly are essential to its survival and we need to take the actions follow the guidance and the orders that have been provided and the measures we are taking because when we allow cracks in our defenses COVID-19 will exploit those gaps third one of the great assets is frankly our public health teams who have been exceptional the provincial health office led by Dr. Henry the BC Centre for Disease Control all of our teams have been exceptional the guidance they provided the work they have done unfailingly every day seven days a week I have a huge asset to British Columbians and I for one am grateful to them and to Dr. Henry for those efforts and that brings us I think to the fourth thing we know the greatest asset in our battle against COVID-19 has been and always will be us each one of us when we hear about the challenges in our hospital sector there are things we can do both to protect ourselves and to support our health care workers including adhering to orders following guidance using masks where appropriate every time we choose action over delay attention over disregard awareness over denial and finally I would say in battling COVID and maintaining our humanity what we do what matters is what we do in the moment if you haven't been vaccinated up to now get vaccinated and join the fight if you haven't been following all the rules up to now no judgment start to do that start to support one another and we need to make sure that you don't know we need to more than ever before we dedicate our efforts in these next weeks these difficult weeks for our health care system and the information that we provided today illustrates that cases may have peaked hospitalizations have not and we need to work together to support each other in these difficult times and with that we are happy to take your questions . Thank you for your time and one follow-up. Our first question comes from Justin Humpton or rather global mail. We'll move on to Richard Zussman Global News. Dr. Henry Dr. Marcellus Fishin did a presentation yesterday to coastal health and part of it he said we do have a number of health orders that were put in place and they were put in place largely and now that we are certain it is less severe they will have to be stepped down. So first is it responsible for somebody in a position like Dr. Lusitian to be saying that health orders should be lifted soon considering we are not even at the peak of hospitalizations left and how should people read that should we anticipate that next week you will be easing those current restrictions that are in place. So I think from the very beginning and you know I talked to my public health team of which Dr. Lusitian is one pretty much every day but you know formally about three times a week so you know I think the presentation he was giving to other health care workers reflects some of that discussion and we have always from the very beginning tried to put in as I have called it the least restrictive means trying to do what we need to do based on what we know about the factors that we look at going into those orders and yes absolutely in December when we were looking at this curve going up and there were so many unknowns that we needed to take action that would protect our health care system as much as possible and account for the worst case scenarios that could happen and we try and do that in a measured way and finding that balance between not interfering with societal the things that we do in society that are so important for us including the economy and people working is important people going to school is important so it has always been about trying to find those balance and I as you know made those orders come up for review on the 18th and I gave you some sense today of where we are and we are in the process of looking at what is it that we need to do to change these things and look at the restrictions that are in place and are they needed anymore and I will have more to say about that on Tuesday. Richard do you have a follow up? Some of the data you presented here around severity we are seeing in some cases many people as province are making different decisions we are seeing some people make the decisions that they are going to get on with their lives and they may get COVID and they may not be able to do so. Are you worried at all about a lax attitude towards Omicron and people making decisions that could lead to problems and just if you could and for Minister Dix we have seen this example where a hockey team in Burnaby traveled to Alberta to play in a tournament because there are no tournaments allowed here. Is that okay to do that even though the rules and basically an indication that they are not particularly worried about risk and there could be COVID cases now linked to that travel? I think I am disappointed to hear that because we made it very clear that tournaments are a source and look at the information I presented those are places where people come together over a longer period of time and so it is not surprising to me that there are cases related to that. I think what I have been trying to say is we need to look at risk and for many people the experience that they have now we have seen a lot of people with COVID there is everybody I know somebody that has had COVID now which is different which is different from even in November when Delta was circulating in our province. So it has changed our thinking and for many younger people who are highly connected who are vaccinated it has not been such a big deal for many young people including some of the young people in my life it actually has been a big deal they may not have ended up in hospital because they are vaccinated but they have been feeling really lousy and it is not a nice thing to be sick with this virus so there is a balancing of those risks what we are saying is yeah we need to get on with our lives we are in a challenging time right now we are learning more about this there are some people who are still more likely to get severe disease and if there are people in our families and our communities we need to support them and help them through this period of time and particularly older people people who have underlying illnesses so that part is the same even if you are vaccinated if you are over 70 you need to take some precautions right now in your group settings give yourself another few weeks for us to get through this wave if you are somebody who is going through cancer treatments we know that you have always had to take precautions prior to this pandemic people who are going through cancer treatments had to be very careful especially during respiratory season because a virus can cause severe illness regardless of your immune system and the amount of vaccine that you have so we all need to think about those things in our situation right now and we are trying to be able to adapt to what we are seeing going on right now in our communities so we do have a period of time that we are not yet there we are going to have a tough time in our healthcare system and we talked about this because healthcare workers are getting sick enough that they cannot go into work for a period of time so if you have an elderly relative who is getting home care you might need to call them and support them right now they might need some extra help from family and friends during this period of time because of resource constraints so it is us moving to try to get on with our lives to interrupt society as least as we can but we are also recalibrating and adjusting as we are learning as we are going right now Minister? I wanted to say two things that Dr. Henry and Public Health brought in new measures on December 23 and December 31 and I know because I watch this obviously closely and we are in multi daily contact with everyone and teams working together between health systems and public health what they go through when they make those decisions understanding that they have impacts on other people and put in place restrictions and so when those decisions and I think the balance between restrictions and what people can do has been really clear-sighted a full understanding both the impact of COVID-19 and the impact of potential restrictions so if you ask our restrictions being reviewed they are reviewed every single day by public health and have been for months and months whether it is in the impact on long-term care and how it can be profound I can tell you that personally how profound it can be the second thing I want to say is that we announced some weeks ago in advance not because we needed to on that day but in advance that we were delaying and postponing non-urgent scheduled surgeries an enormous decision, a huge sacrifice for the individuals involved so when people talk about sacrifice is being made by the people who provide that care but more importantly the people receiving surgery and their families that is a massive sacrifice surely more important than being able to go to Alberta to play in a hockey tournament and I think that we have to put it in context how seriously we take it and how sometimes you have to bring in measures and orders in advance before they are effectively needed in order to make the changes that are required I'd say with respect to that there's a tendency I think to point fingers at people the people involved there probably are dealing with COVID-19 now they need to be told it or scolded or anything else not at all we all make mistakes all the time and I don't think we need to dwell on it but what I said is at the beginning Richard is the most important thing COVID doesn't listen to us it doesn't listen to our excuses and say okay this is a way around the rules it lives to transmit and how we respond to it reflects who we are as well and what we care about together and I think the people of BC their response to the booster campaign everywhere I go their response in the way they treat people in public places everywhere I go the support they give to one another the work done by teachers and workers in grocery this is inspiring so there are no lectures to give start today if you made a mistake yesterday start today if you haven't got vaccinated up to now get vaccinated today so let's not talk about what people could have done yesterday let's talk about what we can all do today and not offer lectures or lessons to too many people all the time to focus on what we can do today to help one another during these really challenging times I wonder if you can tell me how accurate will the modeling data be now that with the Omicron variant I think one and at the end how accurate is the Omicron modeling or is the modeling given Omicron because of how Omicron is affecting everyone I mean how accurate is the data given through modeling until now we've had pretty good estimates of where we are but with Omicron affecting everyone how accurate is this data now given through modeling and what is next after this? so models I've said this many many times models are always dependent on the inputs what you put into them the parameters that you use and that's why all models are different and all models are wrong but some of them are very useful and so yes we've been working with our modeling team there's several modeling teams across the country and that's why we try and do things look at the same picture using several different methodologies and what you'll see is we didn't present the reproductive number because that is not something that is robust with the data that we have right now but what we focused on is hospitalization and the new admissions to hospital and that is robust data it's robust data given what we know about our hospital system about who's being admitted and also about things like we can have a pretty good estimate of transmission rates in the community an estimate we also have a pretty good estimate of things around booster doses and who's got them and stuff like that so there are many, many different caveats and what we call sensitivity analysis that are done with these models and our team at VCCDC and Mike Irvine and Jack Zandu and Michael Otterstetter and our team at VCCDC have been immersed in this for two years now and Kate Malina and the team anyway there's a whole group of them who look at all of these different parameters so accurate they're never a prediction what they are is a set of scenarios that we can get a good sense of what might happen so I am confident in them you can see if you look at the model that we've presented with Omicron taking into account all of the things that we've learned about incubation period and length of stay and all that stuff and you can see there's a whole wide shaded area and that's important and the universe of what could be the true the true path or the true pattern so these are all things that help us it all has to be put in a context as well of values and preferences and choices that we make in judgments so it is really important and we've been working with these models since I presented the first one in March of 2020 so none of them are a prediction or accurate in that sense but they do help us understand the trajectory and I am confident in these models that we're presenting helping us understand what's going to happen in the next few weeks in terms of what's next in terms of this pandemic you know I think we've seen such a dramatic change with the change in the virus in Omicron and I've read that we now have a level of excuse me combination immunity from both Omicron but also vaccination that I do think this is a step closer to us living and the virus becoming endemic in our in our community over time what we don't yet know is how those patterns are going to look in the coming years and how much change we're going to see in the coming years so how long our booster dose is going to be protective whether we're going to see it follow other respiratory viruses and be worse in the winter or summer or whether we're going to see it vinyl so there's many things we don't yet know and I think the WHO made that comment and it's not influenza yet because we know a lot about the patterns that influenza undergoes but we're getting there and I think this is a big step towards that I do I was also wondering Dr. Henry how many homeless people are affected by this new wave and do we have any numbers on them or and how are we catching them and isn't it especially important that we catch them because they tend to move so they are both at a higher level I'm sorry can you maybe try and speak closer to the mic because you keep breaking up and it's difficult to hear I think what you asked was about people who are homeless or I'm having a problem with my phone I was wondering if you can tell me how many homeless people are affected by this new wave and do we have any numbers or why aren't we tracking them especially since the segment of population tends to move around a lot more so they have a higher chance of getting the virus as well as spreading it . So a couple of things we don't actually we do support people who are homeless in a whole variety of ways and one of the things that we focused on from the very beginning is making sure that we have resources in place for people who are homeless for testing that's something we started very early on in a number of communities and also prioritizing people who are homeless or under housed or living in shelters for vaccination so that is something that we have done in many communities around the province and we have been working with the communities the downtown East side we saw quite an increase in numbers of cases during Delta in the fall in that community in particular and we are monitoring we are not seeing huge outbreaks in that community right now and the kudos go to the teams working in the shelters and the supports in places in the downtown East side and our public health teams and the community nurses and the outreach teams who are supporting people in those communities so we are not seeing a tremendous impact in people who are homeless in different communities around the province more so than any other community and we are obviously trying to make it as easy as possible for people to get booster doses and second doses and first doses in that community again too Next question I wanted to ask a question around the restrictions and the possibility of them being lifted or being reviewed on Tuesday given that the next two or three weeks are going to be challenging what exactly would you have to see in order to lift or reduce restrictions on Tuesday? So those are ongoing discussions that we are having around the different aspects so there are different things in place in different parts of our community I think you will see that the COVID safety plan structure is going to stay in place for some time so those are ongoing discussions and I will have more to say about this next week Do you have a follow-up, Gordon? I am just trying to get a sense a little bit on the hospitalization and the health care workers are we at a point where the number of staff sick are impacting the ability to care for people with COVID or other people in the hospital at this point? Minister, that is probably best for you to answer that I think it affects in a number of ways Obviously the number of people who walk in with other conditions with COVID-19 and Dr Henry has spoken about this and we have been doing things such as the cohorting we like to do in hospitals and have been doing essentially separating the population and testing positive for COVID-19 when there is more people in the hospital and look, let's be clear you start with you have about 10,000 more health care workers off sick in the same period last year that has an impact and it has an impact in hospitals and we have made adjustments for that to take the steps on non-urgent scheduled surgeries that involves obviously thousands and thousands of people every day of health care workers so that we are able to redeploy and also redeploy and support immunization which we have been doing as well so yes it affects it and in particular Gordon I think it affects it with respect to services applied not so much in the hospital although it has profound impacts there but also in the community and every long-term care home there is lots of talk about visitation but when outbreak protocols are announced in long-term care homes they have really profound impact on other activities including social activities within the care home that are important to the lives of residents and equally in other services in the community that are critically important we have smaller numbers of staff people providing those services so yes the level of COVID-19 has an impact yes we have taken very strong action to deal with that but the health care workers are reviewed every single day because they can affect a facility in a small town in that day and if it is interior health or northern health in that case or hospitals as large as Vancouver General and Surrey Memorial Hospital the same the short answer is yes it affects the health care system but I want to encourage people if they need to go to hospital if they need care to get that care that our health care workers continue 188,000 of them and there will be some need for patients our teams are working and we are putting plans in place if the situation worsens or is worse in some places to make adjustments both regionally and across every part of public health care so yes it affects it yes you can't have more people off sick and not affect the amount of care you can do and that's why we are taking action under our surge plans every single day to do that our administrators who have formidable work under these circumstances are frequently now both at BCHS and everywhere else working at the front line as we supplement and try and support our staff teams I want to thank everybody from at every level of health care health care workers, members of the HAU the HSA, the BCNU, our administrators members of the doctors of BC members of the BCGU many other unions the UFCW, many other unions who are involved in health care and the workers who are members of those who are making such a huge difference today and we are just going to continue to work every day and we are going to have to make adjustments sometimes several times a day to make sure that we support the most urgent care . Hi thank you for taking my question my first question is on behalf of a colleague and it relates to long haul COVID they are wondering in light of the fact that the province is discouraging many people from getting a PCR test unless you are in a vulnerable group what do you say to folks who are getting long haul COVID or may be in the future and are unable to work and need to bring in a WCB application and don't have proof that they were diagnosed with COVID because they didn't get a test? It is a reality that we are facing right now that there just is not a PCR testing available for mild cases and I will say that we are still trying to understand whether Omicron leads to that type of long term complication as much as other variants like Delta in particular I have also been talking with our clinical care team with the long haul clinics that we have and there are other ways of being able to determine if somebody was actually infected with COVID-19 once they have symptoms down the line so not readily available tests but you can do serology and a few other things so we are working out how to manage that and the same goes for working with WorkSafe around worker compensation issues but the bottom line right now is we just don't have that testing capacity and for many people the rapid test is what they need which will be more available so those are all challenging things that we will have to work through and we are not alone in that this is happening everywhere so being able to determine if people have ongoing symptoms related to a COVID infection is something that we can do post-hoc as it were. Rob, do you have a follow-up? I do I think this is peaking or already having peaked hospitalizations likely to peak in the next couple of weeks natural immunity from Omicron spreading as well as we will know there will be more vaccines and boosters in people's arms by February. Can you give us a sense of this being a big step towards becoming an endemic? What might the end of February March look like? Could this be a big step around Tuesday? Are there going to be any restrictions that may get lifted or modified in relation to gyms or otherwise? I am going to defer the question to Tuesday but I do think this spring we are going to be in a different position across Canada, across North America across much of Europe. The caveat that we have is that this virus continues to change and modify itself and surprise us in many ways. Persist as well. Until we globally have that level of protection we are still at risk of something else arising. So there are still those concerning caveats and as I mentioned we don't yet know what the patterns are going to be of this virus circulating in our communities. We are going to be like other coronaviruses that eventually become another cause of the common cold for most people. Are we still going to have more severe illness being caused in certain populations and which populations are there? We have a pretty good idea probably of who they might be. But those are some things that we are going to work out over time but I do think this is a real transition in our moving out of the pandemic . I have said this for the last three years but if we make it to Easter I think we are going to be in a really different place. I do think we are going to be able to put aside some of the things that we have been having to do on a regular basis. It goes back to how I tried to talk about these things. The many layers become more important when there is more virus and more transmissible and more risk . Like last summer when we had very little virus, things like mask wearing in every situation were less important if we kept a respectful distance from people and did all of those other things to try and make sure we weren't putting people at risk. It is going to be a transition . It is not going to be an abrupt change. I think a transition as hopefully this virus will settle down in a little while. Next question. Justine Hunter, Globe and Mail. Justine, are you on mute? We have time for one more question. We are going to move to John Hernandez, CBC. John, please go ahead. Hello, good morning everyone. Dr. Henry, you mentioned children with mild illness can return to school when their symptoms have resolved. Why do you think there is still symptoms but with COVID in their household can go to school? There is confusion because it is a change. It is a change to adapt to the situation that we are in now. It really is making these recommendations in real time given what we know. We know there is a lot of viruses circulating right now. We know that access to testing is limited. The best advice that we have right now is that if your child is ill, keep them home from school, from child care. When they are better and able to fully participate in activities, they can go back to school or child care. That is an important adaptation to where we are right now with Omicron in our communities. The same goes for if Omicron is in the household. It is often very difficult to tell whether it came in an asymptomatic child or if the child was exposed we need to do our best for somebody who has tested positive. If you test positive, then the five-day period of isolation. If you have mild illness and not tested, it goes for all of us right now that we can go back to activities when the symptoms are resolving and we are fully able to participate in our normal lives. John, do you have a follow-up? Yes, I do. I will also just ask for these answers in French at the end. Dr. Henry, what are you hearing about when booster doses will be approved for kids 12 to 17 in Canada? Many teams are quickly approaching that six-month anniversary of their second dose? Whether a booster dose is needed in 12 to 17-year-olds is something that is still under active discussion. The National Health Service FDA approved it and they have a different process than we do and they approved it for children so the question is out there. Many other countries have been looking at the data and not made a decision about whether booster doses are actually needed for most children. I will tell you that the National Advisory Committee on Immunization is actively looking at the data on that question. We had some discussions this week and we will have more to say about that probably end of next week or early the week after. We will have more to say about the National Advisory Council on Immunization and we will wait for their advice with nature and with a lot of will. So we are ready to follow this law but it must follow the evidence and we will continue to support this idea of the evidence that the public health is so important to everyone. From all sides we have a large number of people. Last week more than 300,000 people received their third dose. We must continue to do it. There are 54,000 people who are more than 70 years old who received an invitation that is not a meeting with us for their third dose and I encourage everyone to take the first dose or a second dose or a third dose to call us or to go to our website today. Thank you very much and we will see you on Tuesday.