 Good afternoon, my name is Adrian Dix, I'm BC's Minister of Health and my right is Dr. Bonnie Henry, BC's provincial health officer. This is our COVID-19 briefing for this week. I'm honored to be here on the territories of the Musqueam, of the Squamish, of the Slewa Tooth First Nations. We will have our written report for the weekend case numbers, hospitalizations, other critical information. It will be with you before 3 o'clock today. And in addition, the surgery numbers which typically we do on Tuesday will be provided later in the week, the number of surgeries canceled, so you expect that later in the week and those other numbers will come in our written report before 3 o'clock. And with that, it's my honor to introduce Dr. Bonnie Henry. Thank you very much and good afternoon. So today I would like to provide the latest update on our ongoing COVID-19 public health response. For many months now as I don't need to say, I think as COVID-19 continues to circulate in our communities I have been asking everyone to take steps to protect yourself and those around you. And those steps remain as relevant and as important as ever. As we learn more about this virus, we have adapted our approach and with us, step by step have been millions of people in British Columbia. We have seen now how interconnected we all are. That the choices we make affect not only our own health and well-being, but it affects the health and well-being of our communities, our families and our province. And we are seeing that with the challenges that are faced in different parts of our province. The actions we take or choose not to take affect the children in our lives, our elders and seniors, our neighbours, our friends. And we know the numbers over this past weekend have been stable, but they are still very high. And that means that we have had again increasing impact on our hospitals and our critical care. With this in mind, I would like to address the situation we are currently facing in BC's north. We have been closely monitoring the situation in the north and my public health colleagues and I are very concerned with what we continue to see in many communities across the north. COVID-19 is spreading at a higher than average rate. People are becoming severely ill. Even young people, mostly unvaccinated younger people and hospitals are pushed to the limit across the north. This is directly related to the vaccination rates in the communities with lower rates of immunization have higher rates of spread. The illness and the risk for everybody goes up. To address this, we have already put in regional health orders and are actively working with the northern health, my colleagues to determine what additional measures we may need to break the chains of transmission across many communities in the north. For everyone and especially people in the northern BC communities, we need to get back to the basics. The things that we know prevent transmission of this virus. This virus that we transmit to the people we are closest to our family, our friends, our loved ones, our communities. We need to determine if there is additional measures that we need to take as well and we need to ensure we are using all of the layers of protection we have available. We need to make sure that we have a safe distance from other people. We need to make sure that we have a safe distance from other people, particularly staying home when you are unwell, wearing your mask, particularly when you are around other people who are more vulnerable and in indoor public spaces. Keeping a safe distance from others and also getting vaccinated. We need to make sure that we are using certain communities as a way to manage some of this severe illness and the outbreaks that we are seeing. We know that private gatherings, ceremonies, funerals and celebrations are a source of transmission and it is transmission not just within a community but people going from community to community. I also want to remind the organizers of these types of measures. It is very important to ensure that you are using the guidelines that we have in place to protect your congregations. That you are ensuring everybody wears a mask in the indoor spaces. That you are carefully considering how or if people are coming together with high risk in communities right now and making sure that you can provide those virtual and severe illness or death from COVID-19. During this time of high risk we need to go back to those basics, those things that help prevent transmission in our communities. What I am asking people to do is not new but we know it works. Those communities that are impacted now, we are seeing the effects of the stress on our health care system in the community. We have been transferred for critical care and we know how stressful that is on families to not be able to be with their loved one when they are in serious condition. My health care colleagues across the province are also stretched and we are tired. It has been a long 20 months and I don't need to say that to people in British Columbia. It is so hard for us to stay in the province and that is because we need to get vaccination rates up to protect people from having severe illness. A number of things that we are doing right now today, the provincial health order, the provincial health officer order requiring COVID-19 immunization for all those working in long-term care and assisted living has come into effect. A similar order will be in place that will come into effect later this month and that order will be posted later today. Together these orders apply to health care workers in all settings and all workers in health care settings. It is very broad for the very reasons that we know that these are settings where transmission causes strain on the system if health care workers are infected but also can mean transmission to those who are involved in severe illness. I want to thank all of the health care workers who for your own reasons may have delayed getting your vaccine but have now taken this important step. It is not too late. Few know better than those working in long-term care and assisted living what the impact of COVID-19 has been on our seniors and elders, particularly those who live in this area. I want to thank all of the people who have supported us and who have highlighted. It is these people who have suffered the most both from COVID-19 itself but also from the measures that we have had in place to try and protect people and I am incredibly grateful that you are doing all you can to support them and keep them as safe as possible as we weather this situation. I want to thank those who are more vulnerable. It protects our health care system, our families and our communities. I recognize as well that our public health mandates have changed over time and they will continue to do so as the pandemic evolves and changes and just as we may increase or decrease public health measures to ensure our safety. So recognizing that young people are now wearing masks from K-12 in our school system, I am adjusting our public mask mandate and requiring it for everyone five years of age and older to wear a mask in all indoor public spaces and that will be posted in the updated order today. For youth, whether taking the school bus or the city bus, the rules are the same. I am very impressed. I continue to be amazed at the adaptability and the resilience of children across this province and many of them have told me that they know how to wear a mask now and that it is something that they do to keep themselves safe, to keep their families safe and I just want to say thank you. We are also, as you may have heard, readying our province to be able to provide COVID-19 vaccines. The vaccines are approved for use by Health Canada and we have heard that at least the preliminary data package has been submitted to Health Canada and we may have that important vaccine available to us as early as early November. So we continue to talk with school communities, families and parents to ensure the process will be as seamless as possible for everyone and make sure that we provide this vaccine as soon as it is available. In the meantime, parents can now pre-register your children in the same way that we have registered ourselves or older children over the past year and a half. Notification of eligibility to book an appointment will be provided as soon as these vaccines are approved for use by Health Canada and we have a plan to make sure we can roll out that program to protect younger children as soon as the vaccines are approved. I am also very pleased to see more and more businesses across BC and across the country are bringing in vaccine requirements in their workplaces and we know that this is something that will protect employees, will keep workplaces safe and keep businesses functioning safely so I encourage everyone to stay safe. The COVID-19 pandemic has evolved and so have we. And we need to continue to evolve to deal with each new twist we are faced with. We will continue to be nimble in our approach and adjusting as needed as we continue to weather this storm together. Things have changed and will continue to change and as many people may have heard, the U.S. has recently announced requirements for travel to the U.S. and they have recognized AstraZeneca which is an important step for I know many people in this province who receive that really important vaccine. I know they are also continuing to look at mix and match vaccines as many countries around the world, the UK, France, Italy, ourselves have used these important combinations and the data that we presented here from Canada shows how effective the mix and match combinations are and I know our colleagues in the U.S. Centers for Disease Control are looking at those data as well and we expect to hear more about this important issue which I know affects a number of people in British Columbia as well in the near future. I also want to make sure that you know that we are also looking at third doses or booster doses are needed for populations in British Columbia as you know we provided a third dose to complete the series for people who are immune compromised as well as starting a booster dose for residents of long-term care. We are looking at other populations and we will be gathering that data and looking at how we might roll those out in the future. I want to assure everybody that we have seen for everyone whether it is for someone in long-term care, for a first dose for children or if and when a booster dose will be needed. As I said before, we will weather the storm by all of us continuing to do our part and supporting each other along the way and I think right now after this weekend it is particularly important for us to thank healthcare workers across this province. And we know that you are showing up every day and caring for people across the province who need the services that we have in our healthcare system. And I want to add my gratitude and thanks to our healthcare workers. We need to continue to do our part by following all of our layers of protection. We need to do this with resolve and determination as we have been through this last weekend as well as our commitment to each other to get through this by being kind to each other, being calm and being safe and getting vaccinated. Thank you. Thank you very much Dr Henry. I wanted to start today by speaking about the situation in the Northern Health Authority and just to put it in context over the course of the pandemic we have been affected by COVID-19 differently and we have all supported one another. We have all been all in to support one another throughout the pandemic and that continues to be the case. The situation in the Northern Health Authority is extremely serious at the moment. I just want to lay it out with one set of facts. We have now transferred critical care patients 55 critical care patients have been transferred from Northern Health to hospitals on Vancouver Island in the Fraser Health Authority in Vancouver Coastal Health. Of those 55 43 are positive for COVID-19 42 are not fully vaccinated. 42 not fully vaccinated people transferred in critical care. Over the Thanksgiving weekend yesterday, Monday, Thanksgiving Monday 4 people were transferred from Northern Health to either Vancouver Island or Metro Vancouver. On Sunday 1, on Saturday 5, on Friday 4, that's 14 people transferred. I want to put in context these numbers in terms of the critical care beds that are in place for everyone in Northern Health that usually in fact more than satisfied demand in ordinary circumstances in pre-pandemic circumstances for critical care, although there are many challenges everywhere in our health care system. That is regularly the case. We have 40 critical care bed in all of Northern British Columbia. There are 42 patients with COVID-19 from the north in critical care not just sick enough to be in hospital but in critical care today in hospitals in the south there are 23 further surge beds that have been added in critical care capacity in the north. That makes 63. We have patients in those beds, in the base beds today and obviously the pressure of hospitalization in all our hospitals, particularly in UHMBC where our staff of doctors and nurses and health sciences professionals and health care workers are doing simply epic work to support people dealing in particular with COVID-19. We have ourselves today 55 patients transferred over the weekend over this Thanksgiving weekend 14 patients flown from communities in the north hundreds and hundreds of kilometers it's about 800-900 kilometers by air as the crow flies from Dawson Creek to Victoria, for example transferred this weekend that's how they dealt with their Thanksgiving weekend I want to assure everyone in the north we are all in to support them on contact rates on support for health care workers 55 transfers, we added two planes that we have worked with the private sector to add to our BCHS fleet over the weekend we are all in to support them but the people I want to speak to today are people who today are walking in communities in the north because the people in critical care are going to provide them with the best care in the world and support their families and do whatever it takes to help them and help them get well from this vicious nasty virus but for those people walking around unvaccinated who might be in those critical care beds in two or three weeks I say to them now is the time, surely now is the time to get vaccinated with the whole health care system all in and support now is the time to get vaccinated now is the time to read off some of the clinics some of the locations of the clinics across the north and this is true by the way of everyone in BC who is unvaccinated and needs to get vaccinated right now at the lake districts hospital in Burns Lake the Chetwin Primary Care Center the Tansi Friendship Center at the Chetwin District Rec Center there are different immunization clinics coming up at the Dawson Creek Health Unit at the Stakeen Health Unit at the Fort Nelson Health Unit the Fort St. James Health Center the Fort St. John Health Unit the Northern Lights College Campus there will be vaccination clinics at Old Fort Road and Fraser Lake at the Fraser Lake Community Health Center the Grand Isle Health Center at Ridge Memorial Hospital in the Hazelton area at Coast Mountain College in Houston at the Hudson Hope Health Center at the Kitimat General Hospital multi-purpose room at the Card Phillips Hall McBride area at the McBride Health Center in Prince George area at the Kariya Sukkani Family Services and the CN Center and the Prince George Conference Center in Prince Rupert the Core Space the Charles Hayes Secondary School Prince Rupert Community Health Center at the Quinnell Senior Center and Smithers and area at Coast Mountain College Smithers Campus at the Healthy Living Center in Southside and area at the Southside Health Wellness and area at Coast Mountain College the Terrace Health Center at the Tumble Ridge Medical Clinic in Vailmont at the Vailmont Health Center in Vanderhoof at the Vanderhoof Health Unit in the Village on Heidegwai the Heidegwai Hospital and Health Center I just want to say to everybody that we need to come together now and raise vaccination levels you know and I know the vaccination levels are high across BC 88.8% in our province across our province 82.6% fully vaccinated of all those over 12 which is impressive by any standard but we simply need it to be higher and I'm asking everybody to be part of this effort to continue to be part of this effort and to continue to support this effort as Dr. Henry has said the requirement for mandatory vaccination in long-term care and assisted living comes into place today and I just want to take you through some of the numbers with respect to that so that you have a sense of where we are and the preparations that have been made for this important and significant milestone not just for workers but to keep our long-term care homes safe there are 546 long-term care and assisted living homes covered by the order we have the data for 542 we are working with the other 4 care homes this reflects the data in 542 out of 546 care homes we have 48,879 staff reporting in total in assisted living and long-term care and the number of people who received their first dose is 46,924 or 96% the total received second dose is 45,457 or 93% the total remaining is 1,955 in assisted living vaccination rates are slightly higher 97% overall 94% second dose of the 7,789 staff reporting in assisted living 7,555 received their first dose 43,322 their second dose 234 remaining in terms of long-term care across BC 43,304 staff reported 41,572 have received their first dose 40,273 their second dose that's that leaves 1,732 in long-term care 234 in assisted living I think that we would say that what that tells us is that we've seen from the time when Dr. Henry put the order into effect to a present a significant increase in vaccination rates in long-term care homes which are over 90% of the time just over 90% and are now over 96% in long-term care and assisted living and we're going to continue to work with health authorities and care operators to make sure that all workers continue to have the support they need to get vaccinated. As a result of the change coming into effect residents in the vast majority of care homes will have the same care as they do today with the added confidence that everyone working in their care home is vaccinated against COVID-19. The province is working with health authorities and operators on a home-by-home basis that do not make the decision to get vaccinated contingency plans are in place to ensure residents continue to get the care they need. A lot of work has gone into this and obviously a significant portion of the remaining people who are not yet vaccinated or unvaccinated in the system a significant number of those are casuals and not scheduled to work these weeks but adjustments have been made accordingly if a long-term care or assisted living worker refuses to be vaccinated they will be in breach of provincial health officers residential care preventative measures order the public health act and employer policy they will be subject to progressive discipline up to and including termination the message remains get vaccinated protect yourself protect your colleagues and protect vulnerable seniors in long-term care long-term care workers who have received their first dose can in certain circumstances work pending full vaccination as long as they get their second dose 35 days of their first dose and remain eligible to work additional measures such as using PPE and rapid testing will remain a requirement until they are fully vaccinated with respect to contact tracing I just want to report as to where we are since my last report health authorities have hired an additional 43 individuals to support contact tracing bringing to 1,439 the number of contact tracers in place across the five regional health authorities and the provincial health services authority as of October 8th as 504 in Fraser health 198 in Interior health 159 in Northern health 198 in Vancouver Coastal health 129 in Vancouver Island health and 251 in the PHSA there are plans to add dozens more across the province and I will continue to provide another update this week in conclusion I just want to thank you after this weekend of Thanksgiving in our province all those health care workers who are working in the communities are exceptional staff and teams of paramedics and dispatchers people who are in the air and on the ground in BC emergency health services our health care workers our health sciences professionals our nurses our doctors our folks in the community we are continuing to deal with two public health emergencies and the dedication that we have come to expect from them the fact that we've come to expect this doesn't make us any less grateful it makes us more grateful I want to express my gratitude to all of them we are happy to take your questions as a reminder to media on the phone please press star one to enter the queue you will be limited to one question and one follow-up please also remember to take your phone off mute you will not be audible until your name is called our first question today is from Richard Zussman global news please go ahead Dr. Henry is the province prepares to immunize children can you give us an update on where kids may be able to get their vaccine is the province considering using doctors offices schools community halls how is that going to work and how will priority be established for kids will we start with 11 year olds and work down to five year olds or will it be based on regions where there is transmission yeah so we are still in the organizing and planning phase of that Dan said the second question first no it won't be often families have more than one child so it will be all of that group there's about 340,000 children between 5 and 11 across British Columbia so yes of course we'll be highlighting communities where transmission risk is highest that will be important but we're trying to do a broad based approach across the province to make sure access is there for everybody when the vaccine is available and we'll be taking a number of different approaches it probably will not be in physicians offices yet we're still waiting for details of whether the vaccine is going to be fridge stable and for how long we had indications it might be but right now we're hearing that it will need to be transported frozen and it will have a limited time in the fridge but we don't know those details yet so those are all things that we need to factor in to play but the other really important thing and this has been important from the very beginning of this program is making sure that we can document in our provincial immunization registry every dose that each individual has had and I know there's been a few challenges but our BC vaccine card is a good example of that we know that that works because it is able to get that information from individual bases and that's really important it's really important so that we can monitor safety of vaccines and effectiveness of the vaccines so we do not yet have a way for average physicians offices to be able to enter the information directly into the immunization registry however we do know that physicians are really great at giving immunizations to children and they've been a huge part of our mass immunization clinics so I expect there will still be a role for physician immunizers but also the other immunizers who now are very experienced with the COVID vaccines and so our immunization program Dr. Ballum is working with our teams across the province to determine what is the best approach for different communities for some communities some of them are more remote communities we may be able to go in and offer for example a booster dose making sure as well that we offer first and second doses for adults at the same time as being able to offer vaccination for younger children and do a whole of community approach we know that was very effective for many First Nations and other smaller communities so it's going to be a whole variety of different approaches there will be some pharmacies that will be involved but also health authority clinics in various different settings Richard did you have a follow up With October 24th fast approaching proof of two shots for the vaccine card what consideration is being given to event capacity has BC made a decision yet on whether we are going to expand capacity at that point considering we are the only province this side of the maritime that has not increased the capacity to 100% in cities where there are NHL teams so what is BC doing about capacity Those are things that I am actively working on our intent was always when the full vaccine card came into effect that we would be able to go to 100% capacity and take away some of the other restrictions that we have in some events like around dancing and remaining seated so those are things we are looking at looking at the epidemiology in different parts of the province and where this might not be in effect seeing the situation in the north comes to mind so we will be making a decision about that by the end of this week I know that people need to have some time to plan so we are looking at that right now Our next question is from Lisa Kordasko Thank you This is a question from the Minister of Health We have been hearing reports over the weekend about people being on fold with 911 calls because no BC ambulance dispatchers were available to take their calls I know the province is in the process of hiring from the additional ambulance dispatchers but I guess the question is just enough and has the review group made any recommendations about how many dispatchers are actually needed and when or if you will be able to hire more You are right Lisa We are in the process of hiring both more ambulance paramedics and more dispatchers and adding ambulance capacity both in urban BC and across BC and rural and remote communities as well We are in the process of hiring We were in the process of hiring in the hundreds of new full time paramedics in advance of this and we are hiring a bunch more There are from time to time challenges in terms of the resources and dispatch but we have been adding in weekends when we have been under significant number of calls for ambulance paramedics We have been adding and supporting ambulance paramedics both with management services and other supports at both the dispatch level and others and certainly it continues to be a challenge because we are seeing right now in the health care system an increased call on ambulance care services we have seen a lot more ambulance calls than we saw in the pre-pandemic period and through a good part of the pandemic and we are responding to it by adding resources but the issue is the issue will be I think addressed on the dispatch level by the adding of those resources and it is my intention and it is our expectation I know it is for BC emergency health services to be ready and to provide care when people call for 911 and we are adding resources to see that that happens A lot more ambulance paramedics a lot more dispatchers as you saw last year those are right now fully occupied and we are adding more of those to deal with transfers from the north so BC EHS has been seen in the recent months as you know record a number of calls and we are responding to it by adding resources to make sure people get responses and on the details that we can be happy to get you some detailed responses as well Lisa did you have a follow up Yes thank you I believe in that these 30 ambulance dispatchers that have been hired these additional ones that is enough to cover the kinds of weights that we saw over the weekend I believe so and we are in the process of hiring those and adding resources and clearly the support of the dispatch level is really important as is having the ambulance paramedics on the ground because our dispatchers and people have supported it's a whole operation it's not just the dispatchers but yeah that's a very significant increase in the number of dispatchers and that's going to help significantly as of other steps that we're taking I think one of the most important steps and it's really challenged right now because of the challenge in emergency rooms and some of the challenges in some regions of the province with COVID-19 but one of the most important way is to ensure that amulets get in and out of emergency rooms more quickly those are some of the measures that that our team our leadership team have put into place during busy weekends throughout the summer especially in the subsequent weekends when we had heat waves in July and in August so it's a big challenge but we are we've added since 2017 massive new resources to the BCHS with the exception of mental health and addictions it's received the largest increases of any area of the ministry of health in that time and we continue to do so now to meet this test and we're hopeful as well that as we return and we hope to return to more normalcy in our primary care system that all of that will also relieve some of the pressure on BCHS Our next question is from Lisa Yuzda, News 1130 Please go ahead Regarding the number of people who still aren't vaccinated just a couple of things you know remember back in I don't know if it was June or July when we're thinking that 70% was going to be enough to get us back to normal and now we're pushing 90 and it's still on enough so I don't know if you can talk about your frustration you know that the people who are getting sick now are getting sick because someone at some point has chosen not to be vaccinated and are you surprised at how high it needs to be to give us the protection that we need to be able to function as normally as possible We have really good questions and I think what we're seeing is a very high rate across the board and yes it was higher than what we originally thought we would need to be across the board and that is a reflection of the change in the virus and the increased transmissibility has meant that it spreads more rapidly there's less leeway in breaking precautions and we've also started to have to try and get back to some degree of normalcy and that's where things like the vaccine card come into effect because we know we can mitigate that risk we can't get rid of it entirely but we can make it much much less if only vaccinated people are together but we also see that the people who are not yet vaccinated it varies by community and so there are pockets where it's very low but if we look at some of the communities where it's high there is where we have had a lot of transmission in the past like in parts of Surrey in Vancouver coastal where we are seeing good protection that this virus just runs into walls when we have those layers of protection that include most people being immunized so it really is looking at those communities where there's issues where there may be an increased level of suspicion where there's concern about whether we're overreaching the government response and tackling the individual issues for people in those communities and we're seeing this make a difference we're seeing it making a difference for healthcare workers who had questions and now need it to make a decision and most of them thankfully are making the right decision which is to protect themselves and their communities so we need to continue to do that to be that voice of rational thought to help people understand what credible information there is to support their decision making and to make sure that vaccines are available in those communities where people have that opportunity to make that right choice and it's so so important right now as the minister was talking about it is people in communities where this virus is circulating and it's everywhere here where it's not taking off is where we are protecting ourselves and each other by being vaccinated and that's what we need to focus on for the next few weeks because it's going to get harder before it gets easier we know that we have influenza coming we know that we are starting to see other respiratory viruses cause illness and when people come together that's what's going to happen the strain that we're seeing which is almost all delta virus across this province it spreads rapidly when it finds a toe hold when people are not protected through vaccination. Lisa did you have a follow up? Yeah I'm going to start at double end as you mentioned Dr. Henry is going to get harder before it gets easier is there anything more that you can do to corner the people who haven't got vaccinated I mean you're taking jobs away from people they're healthcare workers there's umpteen places people can't go if they're vaccinated is there anything more you can do to get them vaccinated and they're not seeing the clinics yet is there a delay in flu shots or is it just is this a regular season and people are just more antsy about it this year so flu shots yes it's not a delay we generally do it near the end of October middle end of October we started to receive flu vaccine and it will be available and we're doing a large push this year like last year we know that community pharmacies are a convenient place for people to get immunized against influenza so we'll be doing more about that in the next few weeks we started in the highest risk settings as we do every year so long-term care healthcare workers it's available now and starting next week it'll be broadly available in communities around the province primarily through physicians offices and pharmacies like we have in the past and it is important this year we've not seen a lot of influenza yet but we know that with more travel internationally and more travel within our communities that influenza spreads more easily and I will caution as well we know that influenza spreads really easily amongst younger children it can cause severe illness in especially infants and young babies but it can also cause severe illness in school aged children and can spread really rapidly so these are the things that we need to start thinking about right now as we move into the fall and in terms of what can we do you know I think we need to go back to those communities where we're starting to see the impact and I had the privilege of talking with a number of our First Nations leaders last week with community leaders about making the case that we now are seeing the breakthrough in some cases that we are seeing is people who are not vaccinated getting really sick with this virus this virus has changed it's not the same as it was last summer where young healthy people had relatively mild illness we are seeing severe illness in young people without underlying illnesses and that is what is overwhelming in some cases our health system and it also means now that people who need other types of health services are able to get it in their community so we need to go back to those basics for young people who thought that they could just weather this you need to be vaccinated that is your protection from severe illness right now and it makes a difference today tomorrow get your vaccine as well we need to start doing those things keeping our groups small making sure we're protecting those who don't mount a strong immune system response your doses to some people but even then if you have somebody who is going through cancer treatment if you have somebody who is too young to be immunized the most important thing you can do to protect them is to be vaccinated yourself we've seen increasing evidence of this that having others in the family immunize protects those who can't mount a strong immune system response themselves or who are too young to be vaccinated yet so these are the important things that we do to keep our schools open which our children need so much these are how we keep people healthy in our family and our community our next question is from Rasha check news please go ahead oh hi Dr. Henry I just wanted to ask about the U.S. CDC rules again on the AstraZeneca doses what is going on there when you talk to them about how we can improve our mixed doses and how confident are you that you can convince them to do that what is the hold up and hesitation there you know I think I can't really comment on how decisions are made in the U.S. but there's a number of different bodies who are involved they have a strong their advisory committee on immunization practices but I also think they had a very structured approach to how they were providing and it was really following the manufacturer's recommendations we have taken a more flexible approach using what we knew about the immunology and the fact that extended intervals have been shown with other vaccines to have a stronger longer lasting effect and we're now seeing the data that shows that that was correct that that worked and it worked better to support people so now that that data is being published and our team at the BCCDC is part of that across Canada in Quebec, Ontario we've had similar results and in Canada we're one of the countries that is leading the world in publishing this data about the effectiveness of the mix and match schedules whether it's two different doses of mRNA vaccine or whether it's AstraZeneca and mRNA vaccine but we're not alone in this there are many other countries that are using these mix and match schedules as well and that data is starting to be available and be published so once that is all synthesized I am confident although I can't guarantee it but I know that my colleagues in the US are looking at these seeing that it works and seeing that it might be important for the US as well as they're starting to introduce new doses to augment the effectiveness of different vaccine schedules that they have in the US in particular there's a lot of concern about whether there's a booster dose needed with Johnson & Johnson now and whether it would be better to use an mRNA vaccine as a second dose for that. I also think globally this is really important we don't want countries to have to hold doses back or wait for manufacturers to be able to give people the full protection they need when they're seeing outbreaks in other countries and we saw this in India for example so it is really important globally that we're able to use whatever vaccines are available to support people to have good protection and that's one of the things that we're seeing with our program that we've had here in Canada that supports that and that means that we can get more people protected faster globally and that protects all of us Rob did you have a follow up? Sure thanks just to build on Richard's question about the idea of opening arenas and concerts up again at the end of August when you announced the vaccine card program and then a little bit later with masks you kind of sketched out what the fall might look like revisiting the the arenas issue, revisiting the masks in January maybe are we where you thought we would be now in the middle of October when you made decisions at the end of August and if not what does the rest of our fall look like are we still looking at January as the kind of date when you revisit the things you put in place in late August or maybe you can sketch that out I think what we're learning is that so much depends on what's happening in your community we're seeing right now that the north is a challenge part of that is related and it's not universal across the north there are some communities particularly in the west the northwest Haida Gwai for example Prince Rupert where vaccination rates are really high and we're not seeing that type of transmission but there's other communities where things are not going as well we look at Fraser East where we see a lot more transmission and COVID in the community compared to Surrey and other parts of Fraser Health and Vancouver Coast or the lower mainland so it is in many parts of the province where I hoped we would be and I think I can signal some that we're looking at that in a more regional basis now so it may not be as we had hoped in August that we would have the same approach across the province but I think I said in August that I was hoping we'd see a full arena for a Canucks game or for her concert for the symphony I think in many parts of the province that is still in the cards I think masking is going to need to be with us for a while longer we know and now there's some good evidence that keeps coming up that even in fully vaccinated populations when you're crowded together indoors for a period of time it makes it safer for everybody to wear masks so that part of it may need to stay for longer Our next question is from Jauju Globe and Mail please go ahead Thanks for taking my question Will the province reveal vaccination rates in individual care homes if there is 5% of the workforce on vaccinated is there a place where those numbers are higher than others by health authority the answer is yes and provided the preliminary numbers this week but those numbers continue to be the case in terms of assisted living it's pretty stable across the province so 95% in Interior Health 96% in Fraser Health 99% in Vancouver Coastal Health 97% on Vancouver Island and 94% in Northern Health obviously there are fewer overall numbers in assisted living across the province there are 7,789 staff reporting in the more significant area which is long-term care number is 94% in Interior Health 97% in Fraser Health 98% in Vancouver Coastal Health 95% in Vancouver Island Health and 89% in Northern Health and those are the first dose numbers across the province by health authority I think it's hard to say the number of care homes I think the number if you look at all care homes with more than 10 employees I think it's 4 or 5 that are under 85% and we're going and we've gone through plans through care home by care home to ensure that we're ready for especially this first week of transition because these are the first shifts where the provincial health order will be in effect and people who are not will be entirely excluded starting today so there is differences between care homes as you can see the numbers are very high everywhere and significantly higher than they were a while ago it's our obvious hope that we're going to continue to make even more progress this week there's been very significant preparations for this in the Northern Health Authority for example where we've provided additional supports to certain care homes already to ensure that they're able to maintain the high quality of care you'd expect might add that we've added thousands of care workers in the last in the last period across long-term care in BC and that also supports this as well and we're going to continue to look to that well look regardless of all of that regardless of the fact that some of the significant number of the care home staff who are not yet vaccinated are casual and its effect isn't the vaccination rate is very high 96% in long-term care 97% in assisted living there is no question that this represents a challenge for us and we are fully mobilized to the task of supporting care homes and making sure that the residents in long-term care they continue to get the support they need did you have a follow-up yes I do I'm wondering if there are some care homes struggling with staffing we were told by the ministry staff last week that the government will allocate resources as needed if some regions are going to face a major staffing shortage could you please elaborate on how is this going to work like where will this resources or workers come from well this has happened from the beginning of the pandemic it obviously particularly happened in wave 2 and in the case of some care homes I think the little mountain care home I believe it was around 90 care staff from Vancouver Coastal Health went in to support that including at the time a vice president who went in to work there every day of Vancouver Coastal Health and we are going to continue to do that so those resources in those care homes that are there's a relatively small number of care homes that require support we're going to seek all of the means we have and that will include moving and adding care staff to support care homes that are are seeing a significant number of unvaccinated people but overall we're I'd say we're pleased with the number we're at right now we're pleased that we're at 96 plus percent in long-term care 97 plus percent or 96 percent 97 percent in assisted living so overall at a significantly high level but we'd much rather be at 100 percent and we're going to yes in some cases should that be required add resources to sustain care homes especially the small number care homes that are significantly below that and that's I would say about four care homes across the problems that are below the 85 percent mark for example those have already received some support but others who are going to face some challenges in the coming weeks because this is this is in spite of the 96 percent 97 percent numbers still a significant challenge at a time when healthcare is being challenged everywhere and we're also preparing of course for the significantly larger challenge in terms of sheer numbers of workers almost three times the number of workers who are still to come in the broader mandate for all healthcare workers that Dr. Henry and the provincial health office have put into place and that work is ongoing right now and that will be in terms of change an even more significant challenge we have time for one more question our last question today is from Isabel CBC Hi there this question is for Dr. Bonnie Henry but if we can please get an answer in French will BC's vaccine card program be extended to include children 5 to 11 once vaccines are widely available for people in that age group that's a very good question and one that we have not actually worked through but my first thought is probably not the intent of the vaccine program of course is to look at those situations that are discretionary that mostly adults attend to and we've made specific provisions for youth sports for example and other programs so we'll look at that as we approach this but the vaccine card is also not meant to be a permanent thing it is to get us to that point where we can safely gather together because we have those high rates of vaccination and low rates of transmission in the community so we're not there yet clearly but that's you know it's one tool that we're using to try and be able to support businesses to stay open to support the arts and culture and sports that are part of our lives where the vast majority of people have been vaccinated already and to be able to allow them to more safely gather during this period of time and just to say 3,565,665 people have downloaded and have the BC vaccine card which is a very impressive response from people in BC and we are thankful for that real tangible show of support for the BC vaccine card program to say that remember the vaccines for children 5 to 11 are not yet approved in Canada so it's going to be and Dr. Henry is quite right I think this category of people have children will have a different need with respect to the BC vaccine card but remember the BC vaccine card program was announced in August brought in in September after and so we are a good deal away from even considering a time when children 5 to 11 are in that category although we are receiving very positive news in general about vaccinations of children I would say that the BC vaccine card program in the province was announced in December and started in September we do not imagine we do not envision the extension of this program for children 5 to 11 years old there are two reasons for that first, these vaccines are not yet approved in Canada or in other countries but it's going to be soon but it's going to take months before children are in the same position as other people more than two years that's the first thing the second thing is that the situation of children as Dr. Henry just said is much different than adults even young people two to 17 I think the circumstances are different for them for obvious reasons and so we do not currently have this change for children for the moment Isabelle, did you have a follow-up? I did Dr. Henry what is your sense of how Halloween should go this year with your advice for your treaters and people who want a handout candy and how would you compare what happened last year when we saw people getting creative with candy shoots and things like that how would you compare it and what can parents and treaters expect for this Halloween and Mr. Dick please now that we finish Thanksgiving we need to think about Halloween you're right I do think that a lot of the creative things we saw last year are good things for us to consider this year as well because we still have transmission we know that this virus is transmitting in communities around the province and the new strain that we're seeing can transmit more effectively and we still do not have vaccine for young children particularly that age group that enjoys going out and trick-or-treating so this year as well I think keep it outside keep groups small do some of those really fun things that worked last year or events for especially if they involve children who are under 12 and not yet vaccinated so I think that's a good thing to start thinking about for this year and all of the creative stuff that we saw last year I think bring it on again this year Yes indeed for Halloween this year I think we need to be more careful especially in the regions of the province where we send the highest level of transmission of COVID-19 this year and I think we can use as Dr Henry has just said our imagination to be protected but to celebrate this celebration which is important for children also but the limits especially for adults on the evenings the limitations especially in Interior Health Authority Northern Health Authority East Fraser are always in place and we need to be careful and follow the rules that are in place and to protect us all we need to have imagination but I think we can see an Halloween that will create its own memories. Thank you very much