 Good morning. 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 BC for Monday, November 1st. We're honored to be here on the territory of Laquangen speaking people of the Songhees in the Esquimalt First Nations. We're looking forward of course to today's briefing and addressing a range of issues. On Thursday, November 4th, Dr. Henry will be providing an update here. We're providing an update on COVID-19 on Thursday with updated modeling and other issues with respect to the pandemic, the COVID-19 pandemic in British Columbia. So you can expect that on Thursday at 1.30. And with that, it's my honor to introduce Dr. Bonnie Henry. Thank you very much and good morning. So today we're going to share latest on a number of issues around the public health response and vaccinations for COVID-19. And as the minister says, on Thursday we'll be providing a modeling and epidemiology update as well, so people are aware of where we are. As people have noticed last week, we were doing some updating and clarifying of provincial health orders. And one of those was updating the PHO order on mask wearing and indoor public places. And I have often spoken about the importance of the layers of protection that we have and how masks are one of those important layers. We need to continue to use masks in all of our indoor public spaces at gatherings and events and at schools. And that order remains in place. And the requirement and the order will be in place until we've determined that we're at a place where the risk of spreading COVID-19 has been significantly reduced. So this order extends the order and clarifies where masking is required particularly in some of the clarifying some of the issues around events and gatherings and how important it is now that we've increased capacity in many of those events and gatherings that masks be a part of how we continue to safely get through this next phase of the pandemic. I also want to mention that while not under the order specifically, I want to highlight the importance of wearing masks in faith services. We have developed in partnership with many faith leaders across the province, guidance for faith services and how to safely have faith services during this period of time. And it becomes even more important that these guidance, this guidance is followed as we're heading into respiratory season. We have seen transmission of COVID-19 in faith gatherings and in some cases that has meant that those gatherings have had to go remote and certainly in the northern health area where we have increased transmission in communities, we've gone to all remote faith services for now. This is especially important as we move into the colder winter months and spend more time indoors and as we start to enter the full respiratory season. Last year, as many people know, it was the result of our high level of influenza immunization with the combined with the precautions that we have been taken, we had no influenza cases. This year we have already started to see influenza here in the province and other respiratory illnesses. But just last week we had our first confirmations of influenza A here in BC. So this just reminds us how important it is to continue to take these levels of precautions, particularly in indoor settings. And I also remind people that it is time to get your influenza vaccination and that this is available particularly through pharmacies across the province. It is also important as we head into this respiratory season in great depth that not to lose sight of the fact that when we go somewhere, we bring that risk with us. And COVID-19 can be the unwanted package that comes with us. So the restrictions we have in place and the actions we take as individuals are not only about protecting ourselves and those we are closest to, but also protecting those in our community. And reducing the impact on our health care system, which as we know is very stretched around the province. With this in mind, I want to remind everybody that it is now a requirement for visitors at any of our acute care facilities across the province to be fully vaccinated. I know that we have guidelines and provisions are of course made for parents of children, for people who are pregnant, and for people in palliative care. But additional precautions will also be needed in those cases. And our protections must be end-to-end to provide maximum protection for people receiving care to health care workers and to those caring for all of us. I know last week as well, we clarified the provincial health officer order around the BC vaccine card. And we closed one of the loopholes that had been brought to our attention that was causing some concern for many of the sports organisations. It is important as we move indoors and as we align our vaccine card requirements that we closed this loophole that allowed coaches of youth sports or people who volunteered with youth sports not to be fully vaccinated. So now that is a requirement. It is unfortunate that we needed to do this. As you know, we've continued to put importance on stressing the importance of youth sports and making sure that we're minimising the barriers around youth sports. And initially, we knew that most coaches and volunteers were vaccinated. But unfortunately, some people were taking advantage of that not being required. And it has led to transmission. We have transmission that happened in a sports event where a number of teams came together and some of the adults spread the virus between them and that spread into children who then brought it into schools. So this means we all need to take a step back and recognise the important role we play as adults in protecting children, particularly those who are too young to be vaccinated right now. So we have been working very closely with VIA Sport and the many leagues supporting youth sports around the province. And it was at their request and in discussions with them that we put in the requirement for those people who are now working with young children, whether it's as a volunteer, a coach, leading or supporting youth sports and activities that you now must confirm proof of vaccination to continue in those roles, particularly as we move into indoor sports over the next few months. This requirement for proof of vaccination means we can keep these important youth programs safely going and keep our children safe. Last week as well, we announced that booster vaccines have been expanded to everybody on a program based on risk. And we know that for the most part, we started already with long-term care with seniors in our community, with people who have compromised immune systems. And the data has also shown as we've presented that individuals who receive two doses of AstraZeneca have had a waning of protection from infection. Thankfully, they still have very strong good protection for serious illness, but lower protection against infection. And as a result, people who receive two doses of AstraZeneca will be receiving invitations for their booster dose at six months. And this may be sooner than other healthy adults in the community where we know there's very good strong protection that's lasting well. So those people who receive two doses of AstraZeneca, you can expect to receive your invitation for a booster dose in the coming months, depending on how long it's been since you received your dose too. And I will say the booster doses will be with an mRNA vaccine and that that combination, particularly a viral vector and an mRNA combination has been shown to be very good and long lasting. Finally, we also will be clarifying a number of the other provincial health officer orders in the coming days. First, the food and liquor serving premises order, we will be, we've heard from a number of different restaurants and food premises that they would like more clarification on the requirement and expectation for those, those premises that are what we're calling quick serve counter service. So the counter service only model. And although we are not requiring them to check the BC vaccine card, there are expectations about numbers of people about spacing and distances and barriers and other things that need to be in place to ensure that those premises are safe as well. And additionally, we're working with the colleges, the regulated health professionals to ensure that regulated health professionals in the community are also vaccinated. As you know, we have a mandatory program for healthcare workers in our health system. And this is working closely with the colleges, particularly physicians and nurses and dentists to make sure that we are all protected so that we protect ourselves, our colleagues and our offices and the patients that we care for. As you know, we're working to protect those who are at highest risk. And I am grateful particularly to everybody who has the millions of people throughout BC who are doing their part as well. It is your simple efforts of getting your COVID-19 and your influenza vaccination, staying home and away from others if you're feeling unwell, getting tested, cleaning your hands regularly, that will make all the difference. We have all made sacrifices in this past almost 22 months and we have felt the impacts of COVID-19. It is doing these things now that help us get back to those important activities in our life and help us do it safely and mitigating the risk of this virus impacting our families, our loved ones and those we don't know. It's with this compassion and care that we will get through this next few months as well by being kind, being calm and being safe. Thank you. Thank you, Dr Henry. And in today's update I'm going to address a number of subjects. Just see what they are. I'll be addressing the proof of vaccination requirements for the BC public service, the healthcare worker proof of vaccination requirement which was brought into place last Tuesday for healthcare workers across the system, an update on booster shots in long-term care, an update on acute care capacity levels, and an update, the usual updates on surgical and on contact tracing numbers. But before I begin all of that I wanted to thank BC's Chief Coroner Lisa LePont for her report on the heat wave experience this summer. The coroner service of course will complete its investigations through now, through the beginning of 2022 and a death review panel will provide recommendations in the spring of 2022 as people will know in the healthcare system. And the Chief Coroner reported through the period principally the period around June the 28th or June the 28th to July the 2nd, but also through that period that 595 people passing away which is extraordinary. You will know that on June the 28th during this unprecedented heat wave, BC emergency health services received 2000 ambulance mismatches which is the highest ever received in one day. The efforts of everyone in the healthcare system to respond to the heat wave including and especially frontline workers and those in public health were remarkable. But the impacts as we all know as we see by today's report were tragic and the loss of life devastating. It's vital that we learn from these events and that's exactly what we will do and we'll be following very closely the independent review being conducted by the coroner. As you know we're also beginning with that work already in particular with our ambulance service. We announced new measures, we've already announced new measures to strengthen BC's ambulance service to ensure it's faster and more responsive to British Columbians. It's a better place to work for paramedics and dispatchers that can meet changing demands and needs. From 2017 we've invested extraordinary amounts in BC EHS with the exception of mental health and addictions. It's the area of healthcare that's received the most increase in support since 2017. Its annual budget is going from 424.25 million to 559.12 million a year. We're reinforcing ambulance operations with hundreds of new paramedic positions including the 85 announced in mid-July, 30 new dispatchers, 22 new ambulances with dozens of rural and remote communities that are seeing an increase in service particularly full-time paramedics and we expect to fill these positions this month. Some are filled but will largely be filled this month. These actions reflect our commitment to the health and safety of British Columbians and the ambulance paramedics they are counting on. We also know in order to manage heat waves we must all work together on many core issues from housing affordability and safety and infrastructure, income inequality, municipal supports and services and of course at the center of it all climate change on which BC is a world leader but we must continue to work together. We are taking significant steps, extraordinary steps on all these fronts to prepare for future events. Dr. Henderson, Dr. Sarah Henderson, the BC CDC, we are leading our own review of these events and with the provincial health office has noted this is a one-in-thousand-year event. It has now happened. It's no longer a one-in-one-thousand-year event. It's a one-in-one-year event and we need to respond and become more resilient not just as a health system but as a province. I wanted to update you on public service agencies vaccinations several weeks ago. We told you of the coming requirement for all those employed by the BC public service to be vaccinated against COVID-19. The BC public service showed leadership and set an example for other employees by requiring all those employed by the BC public service to be vaccinated. Here's where the effort stands today. Employees who do not provide proof of vaccination or refuse to disclose their vaccination status by November 22nd will be considered unvaccinated. Public service employees who do not have at least one dose of the vaccine by November 22nd, where there is not an approved accommodation based on a medical condition or other protected grounds, will be placed on unpaid leave for three months. Partially vaccinated employees, those having received only one dose, may be offered alternative work arrangements and will be required to provide proof of vaccination, full vaccination within 35 days of having received their first dose. Partially vaccinated employees who are not fully vaccinated within that timeline will be placed on unpaid leave. Employees who are still unvaccinated after the three-month unpaid leave may be terminated. This is a necessary step to support vaccination and help protect all our workplaces and communities from COVID-19. We know the vast majority of people are already vaccinated with at least one dose over 12. That number is 89.9% today. And I thank all public servants and all British Columbians who have made the decision to get vaccinated. I also want to thank everyone who works in the BC public service for the work they've done over the last two years, showing the highest level of professionalism and dedication during these unprecedented and difficult times. With respect to mandatory vaccinations for healthcare workers, I'm going to bring you an update as to the numbers there. We have 127 excluding long-term care and assisted living, 127,448 total healthcare workers in BC, as people who worked at least one shift in the last three months. As of today, 122,000, should I say yesterday at midnight, 122,059 or 95.8% are fully vaccinated. 2,064 or 1.6% have received one dose and 3,325 or 2.6% are not yet vaccinated in an unpaid leave. By health authority, just to put that in context, and there has been some improvements as you'll note in these numbers over the last number of days, with across the health authorities, unvaccinated numbers in Fraser health are 2%, that's 587 employees. In northern health, 4% or 320 employees. Vancouver Coastal health, 2%, or 478 employees. Interior health authority, 5%, or 1,018 employees. Providence healthcare, 1%, or 104 employees. And staff. And in Vancouver Island health, it's 2%, or 480. Again, these are people across the board who worked at least one shift in the last three months. So it doesn't represent FTEs, but it is obviously a significant challenge. Principally, it's been a challenge in the Interior Health Authority. You'll know that this week, two operating rooms are down in order to respond to the staffing challenges involved. That will be reduced to one next week, and we hope all will be restored in two weeks. That has a real impact there. There's some impact on lab times and responses. In a community such as Carameas, where a large percentage of a relatively small group of people in the facility there mean that hours are being adjusted in Carameas. None of this is desirable. It's necessary. Interior health, and all of the staff in Interior Health in particular, are doing an excellent job in responding to these circumstances. With respect to long-term care, as of yesterday, 93% of facilities of long-term care and seniors assisted living facilities in the province, 93% of facilities have received their booster doses to date for residents. That's 491 out of the 536. They are completed in Vancouver Coastal Health and Northern Health. There are 15 remaining in Fraser Health, and they'll be complete by tomorrow. In Island Health, 100 out of 117 are complete. The remainder to be completed this week. In Interior Health, 126 out of 139 sites are complete. The remainder will all be completed this week, but as we see, the work is substantially done, and I am very appreciative of our teams, our vaccination teams, and everyone working in long-term care for this effort. We wanted to get it done, largely done, by the end of October, and that has been achieved. We're doing the rest in the next few days. On May 7, 2020, we made our surgical renewal commitment to patients, since then, through successive waves of COVID-19 and other provincial and local challenges that we've encountered, we've adhered to that commitment. We've never wavered from this promise, we've never stepped back from this key touchstone, that every patient whose surgery is postponed will get another call. One that tells them that their surgery is being rescheduled, and they will get the surgery they need. Every patient whose surgery is postponed will get the surgery they need. On Thursday, I'll report on our surgical completions and postponements, just as we have done since May. Across BC, the vast majority of our operating rooms continue to run, but due to a variety of challenges, there have been some reductions, as you know, as we've described, particularly with the challenges in Northern Health, as we know, and in Interior Health. So today, I'll go through the current status of operating rooms across each health authority. Here's where we stand. Kelowna General Hospital, as I've discussed, has reduced two operating rooms this week to compensate for staff who did not meet vaccination requirements who are on unpaid leave. This will improve next week with just one operating room reduced, and then we hope in two weeks the situation will improve further. Kelowna General Hospital has postponed non-urgent eye care procedures in the eye care centre in order to respond to critical care surge planning needs. At Royal Inland Hospital, a number of inpatient surgeries have been postponed. The number will be reporting on Thursday and replaced by same-day surgeries to support the current demand for critical care, which as you know, in Interior Health is high. In Fraser Health, a small, very small number of surgeries have been postponed. As a result of staff who do not meet vaccination requirements, but no further post-moments are expected. Abt-surge Regional and Royal Columbian Hospital each continue to reduce one operating room due to ongoing demand for critical care. This is part of the reductions we've been talking about for some weeks now. Abt-surge Regional will focus on same-day surgeries that don't require a stay in hospital for November due to demand for critical care in COVID-19. In Vancouver Coastal Health, no surgical post-moments have occurred as a result of unvaccinated staff. Ongoing demand for critical care and staffing pressures have reduced a number of operating rooms for an extended period of time. These include two operating rooms at Lionsgate Hospital, three operating rooms at St. Paul's, one operating room at Mount St. Joseph's, and one operating room at Richmond Hospital. Plans are in place to resume surgeries in these operating rooms beginning in the new year at Richmond Hospital and in February at St. Paul's, Lionsgate, and Mount St. Joseph's. In Island Health, no surgical post-moments have occurred as a result of staff who did not meet vaccination requirements. At an enamel Regional General Hospital, non-urgent surgeries continue to be postponed this week, with some resuming next week, November 8th. One to two operating rooms will continue to be reduced daily at the hospital to support the ongoing need for critical care. Royal Jubilee Hospital will continue to have one operating room reduced through December 17th to support again critical care demands. Victoria General Hospital has resumed non-urgent surgeries. In Northern Health, no surgical post-moments have occurred as a result of non-unvaccinated staff. At Bulkley Valley District Hospital, day-to-day surgical post-moments continue in order to support critical care. Dawson Creek Hospital is prioritizing urgent, emergent, and cancer surgeries to support critical care capacity and increasing COVID-19 admission. Fort St. John Hospital is prioritizing urgent, emergent, and cancer surgeries to support critical care capacity and increasing COVID-19 admissions. UHMBC continues and Prince George continues to have reduced surgical operations but is expected to increase to four operating rooms starting November 8th. At Prince Rupert Regional Hospital from the month of November, operating room staff are being redeployed in the emergency department due to staffing pressures. At the PHSA, the provincial health services authority, no surgical post-moments have occurred as a result of unvaccinated staff. BC Children's and BC Women's will experience an impact on some future surgeries due to the upcoming implementation of the clinical and systems transformation project designed to improve safety, quality, and consistency of patient care. Finally, when it comes to contact tracing, with the past week an additional 33 staff are reported as supporting contract tracing for a total of 1,575 as of October 29th, 2021. This exceeds the number of contact tracers we had reported for the third wave of the COVID-19 pandemic. The highest number reported at that time was 1,563. Finally, since September 5th, 92 northern health patients have been transferred to ICUs and other health authorities. That's 92 people, all critically ill, have been transported away from home during the most challenging of times. These numbers show just how critical is that each of us takes all the steps we can to reduce the pressures on our health care system in the north and across BC. And finally, just on the overall numbers in our health care system, we have, as you know, in public health care as we've reported many times, 9,229 base beds in our health care system. We've added 2,353 surge beds in the system for a total of 11,582 beds. As of today, they're in our base beds. We have 8,840 people, meaning 389 base beds that are available. In our surge beds, we have 4,178, sorry, people in those surge beds, and that leaves 1,875 available. So we have across the health care system, and this has increased 9,318 people across the public health care system right now. I want to thank everybody working in health care in these difficult and challenging times for all the work they're doing. That 9,318 is slightly less than it was, say, in December of 2019 in a busy period for health care, but with two public health emergencies and the challenges that are brought for being in the midst of a pandemic. We are taking actions every day. That's why these steps are being taken with respect to surgeries in different places in order to ensure that we can provide adequate and appropriate care to people in critical care. But I have to say this again, finally, everyone who can be vaccinated in this problem, and that's basically everybody, needs to get vaccinated. We are seeing and continuing to see a massive number of people, massive share of those in hospital with COVID-19 are those who are unvaccinated. And this puts pressure on everybody on our entire health care system. 89.9% of people have been vaccinated. More than 85% of people who got both doses of the COVID-19 vaccine, over 120,000 people received a booster dose. But we need those numbers to still be higher. I'm asking anyone who hasn't been vaccinated today to contact our numbers and to book an appointment either on through our website or alternatively by calling us directly. It is important now, as ever, we need to continue to work together to protect one another from COVID-19. We're happy to take your question. A reminder to reporters on the line, please press star one to enter the queue. You will be limited to one question and one follow-up. Our first question today goes to Lisa Kordasko, Vancouver Sun. Good morning. I'd just like to start off by saying that you gave us a long, long list of all kinds of important information today. I'm hoping we're going to see that list in print. And I just want to voice my concern that these could have been broken up into several news conferences. As far as my question, we're seeing more and more outbreaks in care homes in BC yet. We're being told these care homes for the most part receive their boosters. So why aren't they working to prevent outbreaks? And this is the thing that we are learning from this virus, that it can still spread particularly in people who don't have a strong immune response. And so that is why it is so important to get those booster doses in there. We also know that it can come in in unvaccinated healthcare workers, which is one of the reasons why we've put those measures in place as well. So we are continuing to see small outbreaks, mostly small outbreaks. And I think that's important. We have a very sensitive definition. As soon as we see a single case, we do increase testing and monitoring. And what that does lead to is identifying many people who maybe have very, very mild symptoms or be asymptomatic. And so we do include all of those cases as we monitor these. But we are hopeful that with the booster dose and with the measures that we've taken around healthcare workers and visitors that will start to see that come down as well. But it just reminds us this virus can be vicious when it gets into those very high risk settings. And despite the effectiveness of vaccination, we still have to take additional precautions to protect those seniors and elders in those settings. Lisa, do you have a follow-up? Yes, thank you. So this means that your booster program started to light. And you know what responsibility do you take for these outbreaks? Yes, so I don't believe our booster program started late. We waited for the data that we had that showed what the optimal interval was. And as you know, very early on, we extended the interval between dose one and dose two in most of our long-term care homes, which is different from some other jurisdictions, including other jurisdictions here in Canada. So as we started to see increases in the community, we start to see spillover into long-term care. And we saw that in the summer immediately after many of our long-term care homes had received their second doses. So it just reminds us of how important it is for all of us to be vaccinated, to have our best protection, but also to take additional precautions in settings like this where this virus can transmit very easily, particularly the strain that we're seeing now, this Delta strain. And I've said this many times over the last few weeks. It is a different game now. We are seeing transmission that's much more rapid. We are seeing more severe illness in younger people who are unvaccinated. And although we are seeing some breakthrough in older people, particularly who are immunized early, it is mostly a milder illness if you're vaccinated. So that is the best protection that we have. For the next question, we go to Lisa Eustace, City News. Good morning. Regarding the masking, and you talked, Dr. Henry, about how vital it is to have masks worn. We saw, you know, at the Kinects game, we saw there's a video from the Eric church concert where there was a lot of people inside the arena. It looked like more than not, we're not wearing masks. And so I'm wondering, is that okay? Whose responsibility is it to make sure people wear masks? Is it even possible to ensure in those sorts of situations that people are masking? Well, I haven't seen anything from the Eric church concert, but certainly at the Kinects game, the vast majority of people were wearing masks, with the exception of when you're seated and eating or drinking, as we know. But it is something that we all need to do. Absolutely. We want to make sure that the venues who are hosting these are doing the best that we can to mitigate those risks. So really important that we're checking the vaccine card that is only vaccinated people who are attending. That helps immensely in mitigating that risk. And then wearing masks, particularly when we're out and about moving around people and that when we're close to people that we don't know. But yes, we do have exceptions for when people are sitting down and eating. Lisa, do you have a follow-up? I do. I'm going to try and squish one. And do you think people are going to take advantage of that being allowed to sit and eat and say they're eating and drinking the whole time? Also, with the volunteers and people working with kids, does that extend to things like dance schools or art classes or other things that aren't really sports, but are people working with children in extracurricular activities? So the first one is most people, I would say, are being reasonable about this. And that's what we want people to be. And they are wearing masks when it's appropriate, making sure that especially if we're moving around or standing around, if we're cheering, that we're wearing masks. And I think that is important for us as we head into this respiratory season. It's going to protect us from COVID, but it's also going to protect us from those other things that are causing respiratory illnesses. In terms of what we have, the loophole that we had was particularly specific to youth sports and activities. So yes, it's where the vaccine card program had requirements. And we were trying to make it so that we were not impacting the youth sports and activities. But particularly the sports is where we heard that there was a challenge. So the orders are set out where we now expect that organizations will check the status of people working with children. For the next question, we go to Shannon Patterson, CTV. Oh, hi, guys. I'm hoping I might be able to get both of your opinions on this, just as people who've been intimately involved in this for the last 20 months. Basically, what is up with interior health? Why is it that their unvaccinated healthcare numbers are so much higher than other regions with much higher populations? Have either of you spoken to people in the interior about why there seems to be more hesitation with healthcare workers there? And is anything being done to try to stop misinformation that might be driving this? Absolutely. This is something obviously that I've been very concerned about, not just for healthcare workers, but many of the communities in the interior and in the north. And yes, I've had ongoing work with my colleagues in public health, both in the north and the interior. Many communities where immunization rates, we've talked about this all along where there's pockets of communities and places in communities where vaccination rates are just too low. And this virus is spreading rapidly in those communities and is causing serious illness in unvaccinated, even younger people. And that's what's putting this drain on our hospital system in the interior, in the north end, spilling over into other parts of the province, as we know. So, yes, we've spent a lot of time talking with community leaders, with faith leaders, with public health leaders. Also, I think that the healthcare workers reflect the communities that they work in, and we're seeing that in the numbers and the percentages, both in the north and the interior. As we have moved through this last couple of weeks, starting with long-term care and now acute care, we're doing a lot of work, reaching out one-on-one to each individual healthcare worker to try and answer their questions, understand what is the issue for different healthcare workers, and it varies. It varies by each individual's understanding, the questions that they have. And some people are quite dogmatically against vaccination, which is unfortunate. But I think we are doing everything we can and we're happy to take any other suggestions that people have. But this is important, and I think there was a sense of, you know, are we going to follow through with this? And I hear overwhelmingly from my colleagues that they are supportive of this, how important it is for us as healthcare workers so that we can show up, even if it only causes a mild illness, it can have a tremendous impact if a healthcare worker gets sick. Plus, we can expose our colleagues, which we also know has impacts both in acute care and long-term care and in the community. And of course, most importantly, we can expose those people that we care for. So it is important. It is something that we are individually addressing with each healthcare worker who's been affected. And we've seen a steady increase in people being protected. And of course, Lisa, I'd say with respect to Interior Health, just looking at the numbers, and we'll be sharing these, is 95% of healthcare workers in Interior Health have got a COVID-19 vaccination, 95% has 19 out of every 20. It's just that the differences, these differences that the margins between health authorities mean a lot when we're supporting health systems in these regions, in the regions. So 95%, the vast majority of people, I think it's in the 80% now that they're doing immunization against COVID-19 in the Interior Health Authority. And we've seen the actions that many Interior communities have taken from Kelowna to Kamloops to Castlegaard to Cranbrook to other communities throughout the Interior Health Authority they've taken a recent time. So we have gone since we put the, since Dr. Henry and Dr. Pollock put the Interior Health Orders in place, we have reduced our test positivity from in the region or Interior Health has from 14 to 15% in that range when the orders came in to 5 to 6% today. So progress is being made and the level of vaccination is very high. It's just, it's just relative to, to other communities, it's, it needs to be higher. And so the impact on healthcare when you have 1,018 workers, albeit out of 20,430 not vaccinated is significant and we have to make adjustments for that and we're making those adjustments and the teams at Interior Health are doing that. I would say as well again that this represents people who have worked at least one day every three months. So I think Interior Health in many communities has done just an exceptional job overall. Just the Health Authority for people living in Interior Health. And we see there in the healthcare system a slightly higher rate of people are unvaccinated. Obviously, vaccination rates are considerably higher in Interior Health than they are in the north and we see the impact on the north in the patient transfers, the 90 plus patient transfers we've seen in the last little while. So we just have to continue to work hard, I think, but the massive majority 17 out of 20 people over the age of 12 and 19 out of 20 healthcare workers are vaccinated in Interior Health. And so we just got to keep pushing to raise those numbers because the difference between 85% and 90% you look at in the flip side is the difference between 10% and 15%. And one is considerably higher than the other when COVID-19 is ripping through unvaccinated populations in our province and causing considerably harm with the worst health outcomes going to those who are unvaccinated by a wide margin. Shannon, do you have a follow-up? I'm very concerned that while it is only 3,300 healthcare workers, but a lot of them are quite highly trained. They're nurses. I'm assuming a few of them are even doctors, paramedics, frontline patient workers. Is there concern we can lose them for good if they never get vaccinated? Not only could they be terminated, but I think it might be difficult to get rehired because they were terminated for cause. So is there a thought that these healthcare workers could be done and we could lose thousands of these trained people in BC because of the mandate? Yeah, you know this is something obviously that we think a lot about. There are some important measures that we have in our public health world that have changed the course of lives and vaccination is the number one of those. If we think about the things that have saved lives over the many years since we've had immunizations, the WHO has come out with the top 10 public health measures that we have in place and immunization is the most important one of those. So we need to understand where it fits in our healthcare system, whether and right now, of course, the impact that we've seen in the last almost two years now of this pandemic. If now is not the time that you start to believe in the importance and the value of vaccination in protecting people, then I don't know when is. So if people are in our healthcare system and not recognizing the importance of vaccination, then that's probably not the right profession for them to be frank. And I've said this before that it is incredibly important that we see the many different reasons why we as healthcare providers should be protected, one for ourselves, to protect our families, to protect our colleagues, but most importantly, to protect the people we care for. And we see this every year, whether it's measles, whether it's influenza, but right now particularly our way through this pandemic and the way of supporting our healthcare system is by getting immunized. And I can't say that more strongly. So yes, it's across the board. The people who have not yet been immunized in the healthcare sector, there are some doctors, very few. There's some nurses, there's some a variety. I think the only one that's 100% that I'm aware of are people like perfusionists. And the perfusionists are the people who put people on ECMO, which is that end-of-life saving measure that we've seen far too many people with COVID-19 have. So if our ICU doctors and physicians and respiratory therapists and the perfusionists are the ones that are being immunized, you know that they have seen the impact of this virus. For the next question, we go to Rob Monroe in phone news. Thank you. Dr. Henry, you talked about the long-term care outbreaks being largely, you know, very small. In Cottonwoods in Kelowna, this is the second outbreak. Almost half of the residents there are, they have 163 beds, 70 of the residents have been infected with COVID. Can you tell me whether they had all received their booster shots? And what else may be going on there? I know there's a lot of shared rooms, but can you talk more about what's going on at Cottonwoods? Cottonwoods is a very good example of that outbreak started in August. When we started to see increases in the community, it spilled over into that care home, and it has been a very difficult outbreak. As it was the first time, they had an outbreak earlier on in the pandemic as well. And it is a variety of factors. They had, were at the point where second doses, so it was people were still getting their primary series. Most of the residents were vaccinated and that remains the case. They have also received booster doses for those who are eligible. But we did not have a very, there was a number of people who had been moved into the facility that were not yet vaccinated and the staff rates weren't at the high enough level as well. So that has been a very challenging outbreak to manage. There are many different factors, including repeated introductions, the strain of the virus that we're seeing, the fact that it is multi-bedded rooms. So it has been one of the most challenging ones, and it is one of the, you know, Willingdon is the other where we've had very long protracted outbreaks that have been difficult to control and there's many factors related to that for sure. Rob, do you have a follow-up? We also have some doctors here who are actively campaigning against vaccination. There's one I know of who's signing certificates to say people don't need to wear masks or be vaccinated, which I'm sure you're going to say there is no such thing. Can you crack down on these doctors and stop them from practicing? I know they may be investigated by the college, but do you or the health ministry have any ability to intercede to stop some of this disinformation? Yeah, so we have put, I've been working very closely with the College of Physicians and we've put out guidance for physicians on, you know, what constitutes a valid medical exemption and what constitutes fraud, to be frank. And yes, there are no, this is not, I've seen a number of the so-called certificates from a number of physicians. And yes, the college has the responsibility as the regulatory authority to reach out and take action. And we have been working together. And as I mentioned, you know, the colleges, their primary goal or their primary purpose is to protect the public. And part of that means ensuring that healthcare providers are not posing a danger to those we serve. And that is one of the reasons why we are working with the colleges around ensuring that everybody who is a regulated health professional is vaccinated in this province. Next question goes to Richard Zussman, Global News. I know the province at one point was thinking about moving healthcare workers from parts of the province where there was less pressure on the system, areas where there's more. Is that still being considered? Could a nurse or healthcare worker parts of the island or parts of Vancouver be moved to interior health or northern health to offset some of these shortages? And we're seeing, you know, these emergency rooms minimizing surgeries and in some cases services not being offered. Could people still be moved around? I'll just say one thing and I'll turn that over to the minister. One of the things that we know we've talked about this early on is that for certain populations of people, it can be very disruptive for them to move. And it can be very challenging to move people with certain health conditions. And in those cases, it makes more sense to have the healthcare workers move to the place where they're needed rather than trying to move. And I'm thinking about people with dementia, for example, in a long-term care home, or some people in critical care in certain conditions. So all of those are factors that we look at. Thanks for true. I think the short answer is yes, we'll do what's necessary. We don't. And that's being, those kind of options are being considered every day. Some of the places that we thought we might have to do this, when we first looked at the numbers last week, it's not, that's not materialized. Interior health is doing a very good job of managing the situation. Remember that even on the surgical front where we deferred some non-urgent scheduled surgeries, the last week we have data from more than 6,600 surgeries took place with more surgeries in the last year than we did in the equivalent period the year before. So we're doing lots of good work. But the short answer is that's already happened. It's happened with immunizers. It's happened in contact tracing, where the Rachel Health Service Authority is considerable, is supporting Northern Health. It's happening with it's been happening with workers around the province. And it happens more frequently within health authorities in small communities, where we support smaller communities, where there's an outbreak or other issues. So absolutely, those things are being considered. And if you want to see our determination to ensure that people in Northern Health, people in Interior Health continue to get the care they need, you can look at the those 90 people who've been taken from Northern Health with all of the staff and the teams required to see that that's happened to ensure they get the highest of medical care and and and supported when they're in critical care. And that demonstrates our determination in these difficult times to support one another. And we'll certainly be supporting Interior Health. Right now our team led by our president CEO Interior Health, Susan Brown are doing an excellent job in managing the situation. This is a real challenge to deal with. But at the same time, outstanding care continues to be delivered in Interior Health. And we have been aided, especially in long term care by the more than 6000 health care workers we've added since September of 2020 to support that system. It is more challenging with health care professionals who require more training, but obviously to fill that gap in care. But we're working hard to do that. Richard, do you have a follow up? On third doses, should we be worried about the impact on, excuse me, myocarditis for younger people in terms of a third dose? Should we be worried about the ethics of providing a booster for people who already have great protection when there's many people in the world who have not received a third dose? Can you explain to me also around the AstraZeneca decision today what that means for those who've received mRNAs? I'm assuming they're still at eight months gap instead of six. And the last point is on stories we did last week about a travel clinic in coastal health about whether you're concerned that some people knew about this for a third dose for exceptional reasons and others. I had no idea. I hope you're feeling better soon. So let me talk about a couple of things. Yes, and I talked about this last week. There are a number of considerations that went into our booster dose program. And one of the main ones is the data that we have from here, from Quebec, from other parts of the world that show that here in BC, most people have good, strong protection from any combination of vaccines that they've received. And that protection is lasting out to seven, eight months. So the vast majority of people are not eligible right now for a booster dose. But we want them to be prepared for the fact that it is looking more and more like a booster dose at some point at maybe eight months, six to eight months, is something that is going to give us longer lasting, durable protection. And whether that is a true booster dose or whether we find in time from the data around the world that the best, the optimal primary series is a dose out at zero and six months, for example. And that that will give us protection that may last through next year or even longer. So those are all things we're trying to sort out based on how the vaccine and the vaccine effectiveness monitoring is going both here in Canada and around the world. And that means that for the vast majority of people here in BC, it will not be until 2022 that you will be eligible for a booster dose. We know that and this is a positive thing. It tells us that it's because the protection that we have and the monitoring that we are doing of the protection we have in BC shows that we've all got good strong, most of us have good strong protection now. And that aligns with the WHO request that we not give booster doses to most people until 2022 so that we can support global vaccine needs. And that's incredibly important for us as well. I've said many times that we need to get out of this pandemic as a global community. And what we do impacts what happens in other countries and it meant it does mean that we have the ability to contribute to that global community. And we are also looking at whether we use a full dose or a half dose of Moderna as a booster dose. And that's a whole other thing. They've applied as a booster dose with a half dose. Health Canada is still considering that data as not yet approved either Pfizer or Moderna as booster doses. But we expect that to be coming soon. So that leaves us with the people who are more likely to not have a strong and immune response to have been immunized earlier with a reduced schedule, which is mostly older people who are at more risk. And where we are seeing breakthrough here now. So we need to do both. We need to be able to be part of our global community and make sure people around the world are vaccinated. And we need to protect those people who need it right now. And so that's what our booster program is designed to do, to give people the confidence and the understanding of what the program is going to look like over time and making sure that we get those people who are most at risk their booster doses as soon as we can. And that does include some health care workers. It does not include younger children because we know that most of the 12 to 17 they only received their second doses very recently. So those are people who won't be eligible for a booster dose for some time. And that plays into the question about the myocarditis, pericarditis, which we know is a very rare association with particularly second doses of Moderna, but also seen with Pfizer occasionally and mostly in younger people, mostly in males more than females. What we have, what we've seen so far from the data on the third dose, on booster doses, is that it's not as, it's not as any more common and it's certainly not as common with the booster dose. So it is something that we'll continue to watch for. But the people that are receiving that right now are those people who are most at risk. So it is that balancing of risks again. And we believe the benefit of a third dose right now for people, elders and seniors in our communities and long-term care homes in communities where they had early immunization at a shorter interval and health care workers that we're focusing on right now that that benefit risk is definitely on the side of protection and benefit. In terms of the travel clinic, we were addressing people with, and I've said this many, many times, of people to be patient because it was changing around the world what the travel requirements were for mixed and matched doses. But we have always been able to support people who had an urgent need to travel, whether that was essential work related or whether it was for compassionate reasons. We have time for one more question. We go to Bell Puree, CBC. Hello. We've received some information. I know you've been talking about patients being moved from the north to the lower mainland. But ICUs across Fraser health, we're told are full with northern health patients. So I'm wondering, you know, COVID-19 patient transfers from northern health, are they filling the ICUs to capacity? And then if people have to be turned away from those ICUs, where do they go? No. There are some patients, and Bell, I'm happy to give you where the patients went to from northern health. The largest share of those patients went to critical care units on Vancouver Island, so the largest number. But there were also patients that went, have gone to Vancouver Coastal Health and to Fraser Health. I'll give you an update on critical care capacity, which gives you a sense of where we are in, as of Saturday, in terms of critical care, which is in, you're asking about Fraser Health, that we have 136 base critical care beds in Fraser Health, 88 surge beds in Fraser Health, of 136 base beds, six were vacant as of Saturday. So that's a 95.6 percent occupancy of the surge beds, 80 were vacant of the 88. So that's a surge occupancy rate of 9.1 percent. So we do have capacity there, but it's very challenging, you know, because, and I don't, but I don't think that's principally, Bell, because of the situation from northern health, of the three health authorities in question, Vancouver Island, Vancouver Coastal, Interior Health has actually taken some patients out of Quinnell in northern health, for example, and Fraser Health, Fraser Health has received the least number of patients. So there are significant challenges, especially based on the relatively high level of transmission in the eastern Fraser Valley, there are measures with respect to that. So there are real challenges in Fraser Health, and it's our largest health authority, as you know, but it's not because of patients from northern health, they've received the fewest such patients. So I don't think that that information is accurate. Bell, do you have a follow-up? Sure, I do, but could the minister answer that one in French, please? And I'll ask my follow-up. What I'll do is I'll answer both in French when you're finished your follow-up. Okay, so the National Advisory Committee is recommending an eight-week interval between 1st and 2nd doses. Is that the interval that will be implemented in BC for vaccinations in children 5 to 11 when that's approved and it's available? Okay, let me answer that, and then I'll go back to answering one of the many questions Richard Sisman asked as well, which I forgot about, which was the AstraZeneca question, but we don't yet know what the interval will be for 5 to 11, or even whether I think when we look at younger children, both teenagers, but also 5 to 11-year-olds, they're at their prime in terms of their immune system response. So it's unclear how many doses in a primary series would be needed. It's likely to be two, and what Nassi has come out with is that's a minimum interval. We still don't know what the optimal interval is for every age, but eight weeks is a good interval for most adults to give the protection that we need, and we're using that as well for 12 to 17. We're still looking at the information for younger children. We haven't seen all of the data yet around younger children, and I know Health Canada is looking at that even as we speak, and we've seen some of the information that's come out of the U.S. for example. Still to be determined, in terms of the AstraZeneca, just to be clear, we have seen that we have, for people who've had two doses of AstraZeneca, the protection against infection is not as high as people who've received even one dose of mRNA vaccine. So the astrophes or astrodurnas are doing really well in terms of long-lasting strong protection, and in some ways may be the optimal combination. So that is why after the Nassi recommendations came out on Friday, we actually had announced that last week, but we were still waiting for some of the information from Nassi. So we are moving ahead with providing a booster dose at six months for people who've had two doses of the viral vector vaccine. So that's just to align with the recommendations that we saw from the National Advisory Committee, and based on the information that we have around vaccine effectiveness and longevity of that here in LISI. There are in the region, in our books for intensive care, these are there. There are 136 basic beds. There are 130 that are currently full. We have added 88 beds for the ICUs in the region, and 80 are currently free. So that's been a very difficult period. We don't want to be more than 100% of our basic beds, and so it's been a challenge. In general, the biggest part of the people who are from the north or south to receive intensive care is to go to Vancouver, Vancouver Coastal, and even Interior Health, Yonah, who went to the Fraser Health Agency. But it's not the reason why there are challenges in the Fraser Health Agency. The reason why there are challenges is that it's difficult in the Fraser Health Agency, especially in the east of the region, from Chelewac to Europe, to other communities that have a high level of COVID-19. For the second question, children have a more robust immunity system than other people, of course, but we haven't yet started. Dr Henry, the team hasn't yet started on the interval. We haven't yet talked about the interval between the two beds, so we haven't even had a first dose yet. We hope. We haven't had a pause until now. We're going to start in hope before the end of November. Thank you very much.