 Good afternoon, everyone. My name is Adrian Dix and BC's Minister of Health in Victoria. Today is Dr Bonnie Henry, BC's Provincial Health Officer. This is an update on the COVID-19 situation in Northern health. I'm here on the territories of the Musqueam, the Squamish, the Slewa Tooth First Nations. Dr Henry is in Victoria on the Territory of the Laquangan-speaking people, the Songhees and the Esquimalt First Nations. I'm here on the Slewa Tooth First Nations. Over the past few weeks, as all of you know, our health care teams and really everyone in Northern health. Our mayors and communities, our leaders in Northern health, our Northern health leaders, our Northern health health care workers, our MLA's, of all parties, from Shirley Bond, the Leader of the Opposition, to Nathan Cullen, have spoken up and shown leadership in the need for everyone to get vaccinated. And people who are in the North have done, I should say, exceptional things in this period. And I want to start by saying today, thank you. Thank you to the health care workers who go above and beyond every day. Thank you to the business owners who are adapting the way they operate. Thank you to every single person who has taken the steps to be vaccinated. We are grateful to each and every one of you for stepping up in this difficult situation. I want to say that the situation in the North, as we reported in detail on Tuesday and previous to that, is an enormous challenge, not just for the North, but for all of British Columbia. Just to put it in context, 58, 58 people have been transferred by plane out of the North to hospitals either in island health care or in the North. And I want to say that the majority of the people who are in hospitals, either in island health in their majority or in Metro Vancouver, 58, 25, for example, from the two Peace River local health areas. All of them, very ill. Some of them, without COVID-19, but without room for them at their hospital in their region so they can get high quality care. But the majority with COVID-19, in critical condition, it's a significant situation when you think about it, when you think about communities and the impact of that. Of being going from your family, say in Dawson Creek, 900 kilometers to the Ninimal Regional General Hospital or Victoria or Royal Jubilee Hospital, it is a powerful and profound thing, something we would not wish on anybody. They are sick, desperately ill. And it's been 58 so far. On Tuesday, I told you we have 40 base critical care beds in the entire North British Columbia, that's not for COVID-19, that's for everything. And we've added 23 surge beds to support that. And they're staffed by some of the best teams of health care workers in the world. So when you're talking about moving 58 people out of health authorities that have 40 base critical care beds, all of them critically ill, that's a significant situation. And it demonstrates what we've said consistently, which is that we will do what it takes every day in the North, just as the North did when we needed to support situations in other communities, in Fraser Health, or in Whistler, or in Surrey, or indeed earlier in the North, in Prince Rupert, where significant and special actions were taken to support people in communities, we do this for one another because we believe that that is what we do as British Columbians and Canadians. We support one another in a public healthcare system that responds. But that being said, it doesn't mean that it is acceptable. It doesn't mean that the 260 cystoscopies that we've had to cancel in Northern health, other patients who need care, who are crowded out of their hospital, that they support, that supports them in a public healthcare system because of COVID-19. This is a significant situation. And this in the North, 58 people, 45 of them with COVID-19, all but one of them not fully vaccinated, who have been transferred out, demonstrates why we need to continue to take action together, why we need a circuit breaker to address, continue to support all of the other steps we're taking in Northern health. We are all in. We have thrown everything in, but the kitchen sink, and the kitchen sink went in a week ago. We are doing everything we can to support the North, and we will continue to do that. But we also need to ask people in the North to do more. As you'll know, in early August, on August the 6th, we took actions, regional actions, in the central Okanagan local health area. Actions that were, in fact, taken back on September 13th after progress had been made. We took actions specifically across interior health on August 20th because of outbreaks and because of transmission in that region. We took further action in the Northern health authority on September 2nd, it was announced here, and it was put in place on September 7th. And then in the Eastern Fraser Valley, that part of the Fraser health authority that comprises of Chillowack, Abbotsford, and Mission, and Hope, and other communities, we took action on September 28th. In a period of vaccination, the specific regional actions and measures are what Dr. Henry, and our regional health teams, our medical health, chief medical health officers such as Dr. Kim, who's on the line for us from the North today, have been there, and that is what we're announcing today, and Dr. Henry will be announcing today. We are committed to supporting the North every day. We need to take steps together to reduce transmission in the North, and I'm honoured, as it was to introduce Dr. Bonnie Henry, to detail those steps. Thank you, and thank you very much, Minister, for expressing the concerns that we've been dealing with across the North. As we know, there are pockets that are not high enough to prevent this virus from being transmitted, and transmit it rapidly amongst people who don't have that protection. Earlier this week, we expressed our growing concern about the rate of transmission that we're seeing in many communities across the North, and I've been working with Dr. Jung and Kathy Ulrich and our teams to determine what it is that we can do that will put a stop on the transmission that is getting sick from this virus ending up in hospital, and we know that it's affecting across the province. We are in a very different situation than we were in even a few months ago. The new variant, the Delta variant that we are seeing across the province, almost 100%, is way more transmissible. It spreads faster, and it spreads with a limited, a small amount of exposures in a different way than what we have seen in the last few months. We are seeing strains of the virus that have been in our community in the last year and a half, and we are seeing it cause more severe illness in younger people. So if you are somebody who is young and healthy and thinks I'm just going to get through this, no problem, that's not the case now. We're seeing this across the province, but particularly in communities in the North, where communities are ending up in critical care, ending up in hospital, and today, tragically, we had a young person in their 20s die from COVID in the North. We need to take additional measures to stop this transmission, to stop this severe illness in young people, in middle-aged people, in people whose immune systems aren't working as well across the North. As Minister Dix mentioned, we are seeing hospitals in ICU filling up with young, otherwise healthy individuals, struggling to breathe with COVID-19. And many people, even if they have mild illness, are now having long-term effects. This is affecting not only the people who have COVID and their ability to get care, but as we're seeing now, it's spilling over into communities, meaning that young people can't get care for the issues they have, people who need cancer treatment, people who have COVID-19. It's now a challenge for everybody in our community, so we need to take additional actions. As you know, regional orders came into effect in September, and today, additional regional orders by Dr Kim, the Chief Medical Health Officer, under the Provincial Health Officer order will come into effect, and we will be stepping up the restrictions that we already have in place across much of the region. And that is where we are seeing the transmission, where it is greatest. And that is those indoor gatherings where we're coming together, where we're not necessarily wearing masks, where we're mixing with the unvaccinated people, and this is where we're seeing spread. These changes will apply to the entire northern health region, with the exception of the local health areas west of Kitawanga, including the Niska areas. So those are areas where we have seen this virus not being able to spread because of those high rates of vaccination, and people taking the precautions that we've asked. But effective midnight tonight, through Friday, November 19, we're trying to make this as time limited to address two incubation periods to stop the hospitalizations to stop the severe illness. The following orders will become in place. Personal gatherings, both indoor and outdoor, will be restricted to fully vaccinated people only. If you are unvaccinated or have unvaccinated people in your households, then you need to stay with your household only. In addition, indoor gatherings will remain restricted to five people and outdoor gatherings to 25 people if they are all fully vaccinated. All indoor and outdoor organized events, so these are the weddings or parties that you are having with an organized event, require a safety plan, a COVID safety plan like what we had in place. It requires everybody to wear masks and to ensure that everybody is fully vaccinated, and that means using the BC vaccine card to ensure that any attendees are fully vaccinated. Indoor events will be limited to 50 people, even fully vaccinated and outdoor events up to 100 people are permitted. We have had a lot of challenges and I have worked and I want to give my thanks to the many faith leaders across the North and across the province. We have put in guidance to help ensure safe practices, but unfortunately with the amount of transmission we are seeing in the North, it is no longer safe for us to be vaccinated in these worship settings and for the next period of time worship services will be limited to virtual services only. We can have a single person services where you can go and have quiet reflection in a religious service, but like what we had in the spring, we are now going to be restricting in those areas where transmission is greatest, those high risk environments including worship services. We also know that we have issues with people being able to use the BC vaccine card. It is an effective measure and we have seen that in many communities to ensure that we are mitigating any risk in some of those indoor environments like restaurants, bars and nightclubs. Right now we are seeing that those are not enough in areas in the North. And restaurants will be able to continue to allow in-person dining or in-side dining with the use of the BC vaccine card. So if you have full service, meal service, but we are restricting the serving of alcohol to 10 p.m. For bars and nightclubs, unless a full meal service is provided, these premises with a license to serve liquor must now close at 10 p.m. Sorry, I'm sorry. We will now be closed for this period of time. In addition, sports events with spectators, so indoor and outdoor will be limited, as we know, to 50 percent capacity. They must have a COVID safety plan and attendees must wear masks when in the indoor setting and it must use the BC vaccine card to show proof of being fully vaccinated to attend as a spectator. In addition to these changes, we are strongly encouraging people to remain within your community, unless it is essential to travel for work or for medical reasons. We know these viruses, this virus right now, is spreading rapidly and we take the risk from where we come, we take it with us when we are traveling, we bring it into that community and we take that risk home with us. We know this virus transmits most easily to those people we are closest with, the people we are close with, the population may not be great when we are not wearing masks, when we are eating, when we are talking loudly, when we are singing with each other. Those are the things that we need to scale back now so that we can stop this transmission, we can prevent those people who are not yet protected through vaccination from getting seriously ill, we can take that pressure off our health care system. We are not yet too young yet to be protected and people whose immune systems are compromised where they can't mount a strong immune system even with the three doses that we are now recommending. These are not orders to be gained or to be got around to try and float the rules because you think they don't apply to you. These are your community members, these are your family members, these are our family members who are protecting our health care system. We are also stepping up our coordinate enforcement of the BC vaccine cards where they are required to help support those businesses in staying open, being able to support people who are protected to gather in those safe settings. We do not take these actions lightly. I recognize the impact of what we are requiring of everybody living or working in the northern health care system. We are intending this circuit breaker to save lives, to lower the rates of transmission, to allow our hospitalizations to stabilize and enable us all to come back together safely to celebrate during the upcoming holiday season, I hope. Along with this, I just want to make people aware, I have talked about this in the last couple of media briefings that we have had, we have a long-term care for healthcare workers outside of long-term care, so in acute care and community care. That order is posted now on the PHO website and it is broad. It covers healthcare workers that are staff for our health authorities, the PHSA, the BCEHS, Providence healthcare, anybody who works for the Ministry of Health and Mental Health and Addictions, as well as employees, contractors and health professionals in the community. So I want people to be aware that it is very broad. It is because we recognize the absolute importance of protecting healthcare workers by making sure we are immunized, to protect ourselves and our families, to protect our colleagues so that we can continue in our very stretched system to provide care for others as well, and to protect those most vulnerable that we care for. So we will require staff to report their vaccination status to their employer and students are included as well. And we will, staff must have at least one dose of vaccine by October 26. Follow a prescribed preventive measures that we have talked about and get the second dose within 28 to 35 days. If people do not have their first dose by October 26, then there will be increasing provisions for them to be off work and progressive enforcement up to and including termination. So the order contains rules for outside healthcare, personal care, support, personal service and other outside providers, as we call them, with respect to access and vaccination status, similar to the requirements already in place for long-term care and assisted living. I also want to say that this order will apply to regulated health professionals in private practice. And I'm working in a process with the colleges to make sure that we have that in place in a way that supports physicians, nurses, dentists, all of the health professionals across our province to be protected and to protect those we care for. I don't have to say this, but the COVID-19 virus is putting us all to the test. And we have seen in some parts of the country where we have been able to manage and to cope and to suppress the transmission, and that is the good news that we are seeing. But there are regions of the province where we have not yet made enough progress to get there. And that is challenging our health care system, the people who care for us, it is causing hardship and it is causing loss. But we have a way through this storm and through the vaccines that we have been able to do to protect all of our layers of protection, following all of the public health orders that are there because we know they work to protect us, to keep our families, our communities, and ourselves safe. Follow the guidance we have in place. And let's all continue to do our part together here in BC while being kind to each other and remembering the importance of staying calm and staying safe. Thank you. I think that is being handled in Victoria and it will be on the questions Dr Henry will respond first unless it is directed to me and we will go from there. So over to you. Over to you. Thank you very much, Minister. A reminder, you will be limited to one question and one follow-up. For our first question we go to Oli Herrera, CKPG. Oli, are you there? Hello, sorry I was on mute. Hi, Dr Henry, my first question is can the conference figure out which demographic is responsible for the rising cases in northern? Yes, so it is not just one single demographic. We know there are very high rates of vaccination in older people. We are seeing some breakthrough in older people particularly in long-term care homes. So we know that it is not enough for them to be protected with vaccination by themselves and it is one of the things that we have started to give a booster dose to residents of long-term care. We know that the immunization rates are lowest in the 12- to 17-year age group even though they have been eligible for some months now. And we are starting to see increasing movement in some communities in the 20s and 30-year-old age group and 40-year-old age group. But I will ask Minister Dix to address this because I know you have the numbers off the top of your head for many of the communities in the north. I will say that what we are seeing now though, it is unvaccinated younger people, people in their 30s, their 40s, their 50s who are getting severely ill and sadly are dying and they are unvaccinated people. Please go ahead. Thank you. And in terms of demographics, I think what you see across the province is that over 65 people have seen the highest risk of COVID-19 from the beginning and have seen that especially in the first year of the pandemic and then subsequent to that. We see relatively little differences between health authorities such that over 65, it is about 92, 93% of people in Vancouver Coastal health. And 87 or so people in Vancouver Coastal health. And we are seeing a lot of difference between the 77 or so people in northern health which is a difference but not a large difference. Where we see the largest difference is under 65 of adults. Where the rate of vaccination overall across northern health is about 79% today. First dose over 12 compared to say 89% or 90% in Fraser health and 92% in Vancouver Coastal and 90% in Vancouver Island. And the mid 80s in the interior health authority. So that's across the board. Where we see the highest differential is certainly in those categories of for example youth 12 to 17 and people in their 30s, people in their 40s where we see a significant difference between Vancouver Coastal health and the north. So I would say we need adults working age under 65. If you work over 65 between up to the age of 65 to increase vaccination rates across demographics in the north. And obviously you see different communities as well with significantly different rates of vaccination. Kinamat for example is in the 90% plus range and has been for some time. Prince Rupert is in the mid 80s but other communities are lower than that and we're making significant efforts. No community has raised its vaccination rate more than Fort St John but we need that to be higher. So what we're saying to everybody in the north is there is a path here. This is the frustrating thing for health care professionals is that many of the cases we see in critical care today in BC, in our hospitals, people struggling to breathe are preventable by vaccination. It's available in all communities and everybody needs to do it. That is the path that we need to follow. Yes, the measures are important over the next month but we need to continue to raise those vaccination levels and if we do that, we can significantly improve the situation. We have to continue to do that, continue to work on that and I expect that people will and it's time to get vaccinated everywhere. Ali, do you have a follow-up? Yes, my follow-up question regards military health. In Alberta, they brought out the military to help out with the workload in hospitals. We have a local nurse here who told us there is more than 400 open jobs. Does the province have any plans right now to potentially bring military help to these hospitals, especially here in the north? Minister, I will ask you to address that one. I think the issue and what we are doing and what we have been doing is very different than in Alberta where we have higher hospitalizations and critical care and we want them to succeed because when they succeed we succeed and we are very supportive of all the efforts made by health professionals in Alberta. Right now, if you look at critical care in our province, we are within our base bed capacity overall but in the north with 58 patients essentially in the south you see how we have responded and it's been a massive response to ensure that we have adequate support for these hospitals. Yes, there are unfilled positions in the north. We are working hard and we put together announcements and programs to address that and we are going to continue to do that. Right now, it's not the military we need. What we need is vaccination. What we need is a reduction in transmission and that's what we are doing. So we are dealing with the situation. It's basically if you look at BC as a whole a very similar number of people in hospital now as we are in hospital a month ago. But what has changed is that we have had to cancel some surgeries and other procedures and exercise management meaning that some people who would be getting care sooner are getting it later because of the spread of COVID-19. So our teams everywhere and in every health authority are doing a great job. There is no easy answer. We have got to continue to give all of the focus weekend to hiring more people especially in the north and that's what we are doing. It's not an issue of bringing the military in but it is an issue of increasing vaccination so we can reduce those rates and in the meantime everybody in health care in BC is doing everything they can to support the north. For the next question we go to Matt Preprost, Alaska Highway News. Hello, good afternoon. Thank you Dr. Henry and Minister Dix. Just to clarify the orders that were announced today particularly for organized outdoor events are you saying that people are going to be fully vaccinated to attend Remembrance Day services in northern BC? The short answer is no. What we are talking about is an organized party or a wedding or that type of event. Those types of important ceremonies are what we call in our sort of technical language flow through events where people are able to keep a distance from each other where it is outside. Having said that we encourage people to keep them small and I know we have worked with the legions across BC and the Yukon last year and again this year keep it small. Invite only immunized people to come and others to watch it on TV or in a small place by themselves. We know that the few veterans that are still with us from the Second World War we know that people who want to come to Remembrance Day ceremonies are more likely to have severe illness or susceptible to COVID. Let's respect them, keep the events small, wear a mask, keep your distance from others, keep them outside and have those measures in place to protect each other. Matt, do you have a follow-up? Thank you. Yes. In regards to the vaccination clinics particularly here in Fort St. John obviously the mass clinic that we had at the mall has closed and the clinics have moved solely so far this month to the public health unit which if you crunch the numbers has been keeping busy doing well over 20 shots an hour but accessibility supply availability continue to be a concern whether that is not enough people to administer doses, people looking for AstraZeneca over Moderna or Pfizer or people not being able to get a shot through their local pharmacy what is being done to address accessibility supply availability concerns for people who want to get vaccinated here in our region. I don't think demand is that low actually I think it is higher than the recent numbers actually suggest. No, I absolutely agree with you and we have been working with MSBC and with the North to try and expand the opportunities for people to get immunized. Northern health has a number of clinics with some of the large industrial camps and employers across the north which have been stepping up and requiring immunization of workers and I know there is plans to increase availability. I will just say one thing about, you know, we do have supply issues in a resupply issues in a limited way particularly in the north where we have many small communities so at some clinics one or the other vaccine may be the only one available but we can make provisions for people to come back at a time when the other vaccine is available I also continue to encourage people to take what is there on the day that you arrive. The Pfizer and Moderna vaccines are interchangeable. They are both very safe and effective and we are learning more and more people say it. I know there has been concerns about having a mixture of Pfizer and Moderna and travel and that is being worked on and I am confident that we will have that sorted out in due time. We have been engaging with pharmacies in the north as well and I don't know Minister if you want to add to that. Just to say that for St. John as I mentioned my earlier remarks have seen the highest increase it was from a lower base but we have seen a significant uptake in vaccination and I want to express my appreciation to Mayor Ackerman and her team for that work. A lot of major employers as well who have been advocates of vaccination in the region who are playing an important role. We talked today obviously we briefed today Northern MLA it was one of the points that MLA Dan Davies made and I want to thank Dr Henry and to the health ministry team at that briefing was the need perhaps to extend into off hours vaccinations as well to allow for people to get vaccinated and we have given a lot of opportunity to get vaccinated. You can tell that by how well St. John has done and tell people that they can also drop in to our vaccine clinics as well and I encourage everyone to register and get vaccinated as soon as possible and we are going to meet that demand in Fort St. John and as we have in the peace country in both Dawson Creek and Fort St. John and CHET went to another place in the past that has involved as well as supplementing northern health staff in the past with other staff and so we are going to look at all those options to make sure that everyone can get vaccinated but I think the evidence is that we are doing well in Fort St. John and that is because of the incredible healthcare workers and people in that community. Thank you. I wanted to ask Dr. Henry you mentioned briefly about breakthrough cases I notice if I am looking at the numbers it looks like it is a higher proportion of fully vaccinated people who are now ending up in hospital I wondered how that might impact your timing and thinking for more widespread boosters. So there is a couple of things around breakthrough cases that we are watching carefully we know that as more people are immunized the numbers of breakthrough cases and therefore the percent in a day will go up but if we look at it in terms of rates for fully vaccinated people it is still 50 times lower risk of hospitalization and infection than people who are not yet vaccinated so it is because such a smaller number of people who are not yet vaccinated in terms of booster doses we are looking at this and we started with people who don't mount a strong and immune response to their first series so the first two doses so people on cancer therapy solid organ transplants people on dialysis and we have started that program to provide a third dose to try and get them a boost at all of the primary series and we started booster doses for our elders and seniors and we are looking very actively at are there other groups where it is important at this point in time to receive a booster dose and we will have more to say on that in the coming days because there is increasing data and evidence that we are reviewing around that so that would be seniors and elders in the community, people who are immunized first, people who are immunized with a shorter interval than others because we know that longer than we have been using has meant longer lasting protection I will say that for most of us young, healthy people that we are still seeing very strong protection from the two dose vaccine program that we have here in BC and that vaccine effectiveness is lasting 6 months, 7 months, 8 months so we will have more to say about that soon but that is one of the things that we are looking at in some detail over to Minister Dix . The first dose immunization 82.9% have been fully vaccinated in BC that is the vast majority of people so 82.9% fully vaccinated an additional 6.1% have received their first dose partially vaccinated many waiting for their second dose now there is a delay there is an interval between the doses so obviously that means the vast majority of people are vaccinated in BC if you look at the critical care numbers there are 153 people in critical care essentially in that case less than 10% of those in a province where almost 90% of people are fully vaccinated are represented by fully vaccinated people so there is a tendency to look at the difference between 16 in one day and 13 in another day if BC was made up solely of fully vaccinated people we would be in a completely different situation this is a pandemic of the unvaccinated I want to say to people that in the province that people aren't have either not paid attention or stopped paying attention COVID-19 is with us particularly in the north in a way and a transmissibility that it hasn't been and this is the time to get vaccinated you need to take this seriously you need to take it seriously for your own health someone passed away in their 20s in the north today and you can imagine how their family is grieving you need to take care of that you need to take care of your loved ones for people in your community for people in the province it is time to get vaccinated there is going to be all kinds of detail about the increases amongst those who are fully vaccinated and there have been so far clinically vulnerable and people in long-term care about 40,000 people who have a third dose either to complete their course or to get boosted against COVID-19 all of them seriously clinically vulnerable and not taken but I would say to everybody it is time to take this as seriously as you would as if your health was at stake because it is because of the ones you love health at stake because it is and take the actions and the measures that have been put in place today and the need to get vaccinated with all the seriousness that you would with anything else that threaten the ones you love David, do you have a follow-up? I wanted to follow up on the US land border reopening the Canadian travelers maybe more movement because of that my question is are we seeing travel whether international or between provinces significantly play a role in spreading the virus at all and second part of that I know it is federal jurisdiction but do you support continuing mandatory negative testing for those coming into Canada? So complex questions we are on a call today with transport Canada and CBSA and we have seen some introductions through travel and it has varied as we have gone through this pandemic. The travel restrictions have been effective and if we look at last year respiratory season, the international travel restrictions that were in place meant that things like influenza was almost non-existent well, essentially non-existent here in BC anyway last year. We are seeing other respiratory viruses start to increase in the community now and part of that is because we are moving around more and we are getting together more, we are doing more things and we can do that because of vaccination. We have a program at the borders now and there is a risk assessment that has been done where pre-screening somebody having a negative test before arrival is actually a very effective way of preventing somebody who has active COVID from traveling. So for international travel by air I think that will still remain a part of it. It is less of an issue in the land border from the data that we have seen. So I know we are looking at whether it is still going to be required at land border crossings particularly with the U.S. obviously as we move into November when that is going to happen. And I think more important will be making sure that we have a clear vaccination status and that people can prove they are protected through vaccination. So we have seen a decrease in the introduction of new strains through travel once immunization came into effect and since the borders have reopened to international travel the fact that we are requiring both the testing and the proof of vaccination has kept that at a low level. For the next question we go to Richard Zussman Global News . I am hoping to get an update from you in terms of the number of COVID cases linked to Willingdon care center. How many of those are in the residence and how many in the staff? And for Dr Henry considering the rapid increase in cases we have seen at the care center does this show that we were a little bit too slow to put booster shots in place to the most vulnerable in long-term care and the other most vulnerable in our population. Thanks Richard. Maybe I will take the first and then hand it over to you, Dr Henry. There are 89 cases at the Willingdon care center. The majority of those are amongst residents and obviously significant number among staff. I think I don't have them all memorized but I think it is about 70, 20, 70, 17, or 65, 22. But it is available of the number of people who are tested positive for COVID-19 as part of the report we did this morning. There have been a number of people who have passed away. As you know we don't report that. Immediately it takes a couple of days sometimes to report it. I understand that there have been a significant number of people who have passed away from the Willingdon care home when they passed away were positive for COVID-19 which is obviously a huge consideration. So the steps we have had and continue to take in long-term care are significant including third doses including high dose flu zone for everybody to protect against the flu. Obviously the mandatory vaccination for staff all of those are recent steps and then all of the other steps from the single-site order to others that we are taking in long-term care. We have had a number of cases in the last period in long-term care particularly in interior health but Willingdon is currently by a significant margin our most significant outbreak and so that is why we are taking the steps we are. Those are the case numbers and I think you will also see an increase in the number of people who have passed away reported over the next number of people who have passed away. It was 3 in the report this morning but I believe once we report over the next couple of days we will be up to 10. We will come back to Dr. Henry here in Victoria. Minister Dix there was a little bit of confusion off the top so perhaps you would like to speak after Dr. Henry for this question to reiterate your first few points you made in that response. I will hand it over to Dr. Henry to answer her portion of the question. I will start by answering the second question first which was around the timing of booster doses. This is obviously something that we have been watching really carefully. We have been looking at the vaccine effectiveness, we have been looking at outbreaks, we have been looking at how we have been able to manage them and suppress them and we have seen that when this virus particularly the delta strain that we are seeing is introduced into those communal living settings with very vulnerable people and we were looking at the data from around the world of when is the best timing and the national advisory committee on immunization as you know recommended six months between dose two and a booster dose and that is what we have gone with here in BC. It is out there now. We are immunizing residents across the province and in many cases concurrently giving protection against influenza for their coming season and we are looking at the very same data. We have good data that shows us that seniors and elders in our community are still well protected. But we know that other places around the world that does wane over time at least from infection although we seem to have good strong protection against severe illness for some time. But it just reminds us that this virus is here. It is spreading. We do the best we can to protect ourselves by being vaccinated but we can't let go of those other important things particularly when we are in settings where this virus can spread really rapidly which is indoor settings when we can't, we don't know who we are around, when the ventilation may not be great. That is where things like mask wearing, staying away from others if we are not feeling well ourselves, making sure we are washing our hands. It is important for us to not forget right now. And we will send it back to Vancouver now. Minister Dix if you would like to reiterate the first few points of your response. Sorry about that. From memory I think it is 89 cases at the Willingdon care centre in total. I think in the range of the significant majority of those cases are residents I think it is 65 to 70 in that range. 17 to maybe 25 are among staff and that information is available on the report that was sent out this morning as noted in my first answer Richard I think on that report three people have passed away and more people have passed away and we will be reporting those out in the coming days. I believe the number confirmed with COVID-19 as we report out those cases as the number of days lag will be right now is 10. And that is a significant tragedy at the Willingdon care centre and for everyone involved there and so what that tells us is all of the steps that Dr Henry has described are needed to continue to protect long-term care. Willingdon is our most significant case we saw some significant cases in August of care homes with very important outbreaks in the Interior Health Authority and we can have to continue to take steps to protect long-term care and that is why the vaccine mandate came in effect on Tuesday and we are looking at third doses that is why other orders to protect long-term care settings are in place for all of those reasons to ensure that because of the vulnerability of people there to ensure that they are protected to the maximum possible degree as well as being able to live as normal a life as possible as you can in those settings during a pandemic. Okay Richard do you have a follow-up? As we look at these boosters now and we look at those in long-term care but also extended to those who are clinically vulnerable what factors being at play in terms of what vaccine people are receiving Dr Henry some of the guidance that is being given is that if you receive Pfizer for your first two it may be better to get Moderna as a third what numbers are we looking at to indicate that are you worried about what that may mean for people in terms of mix and matching and we have received multiple doses of AstraZeneca considering that that is no longer available as a third dose. Right, so couple of things. Booster doses will be with the mRNA vaccines. Right now they are an off-label use they are not approved by Health Canada for use as a booster dose. However we do use a number of things off-label but the booster doses will be primarily with the mRNA vaccine so somebody who has had AstraZeneca you can expect if and when we need a booster dose that it will be with an mRNA vaccine and that is because of the studies that have been done showing their effectiveness as a booster dose. Whether you get Pfizer or Moderna depending on what you have had before or whether it makes a difference that is something that is interesting because we are increasingly getting more information about whether it works as well or better than the other. There is ongoing information mostly based on what we call immunogenicity so the antibody levels in our blood and as I have said many times we don't yet have an absolute correlate of protection but that Moderna seems to give higher antibody levels that stay longer so Moderna vaccine is not surprising if we think about it it has got a higher amount of the antigen, the mRNA in it compared to Pfizer and it seems to give a stronger response. For specific groups Moderna is preferred and that is for people who have solid organ transplants some people who are severely immunocompromised and the studies that were done with a third dose using Moderna gave a higher proportion of people who developed a stronger immune response so we have been preferentially saying that people should use Moderna if you are somebody who has a solid organ transplant or it gives the best possible chance of boosting that immune system and getting it up there so a full dose of Moderna is something we are also recommending for long-term care but it is not as clear for people in long-term care whether there is a significant difference between Pfizer and Moderna so it is whatever is available I will say we are not going to be changing our definition of what is fully vaccinated right now with booster doses the vaccine card for example will be based on the two doses or currently a single dose if you have J and J but yeah there is lots of more data that is coming available from around the world that is showing us that actually Moderna gives the bodies immune system several different ways of responding and it may actually give you stronger, longer-lasting response We have time for one more question and we will go to John Hernandez CBC Hello there and I will just ask for questions for answers in both English and French just going back to the border the US hasn't indicated if it will accept travelers with mixed doses will you commit to offering a third dose to people who have had mixed doses if the US doesn't accept them and if not why not and you mentioned the rules might change in due time but how long do you think that might take? If you have been watching it has been changing sometimes one thing daily but certainly weekly around the world this is an active area of discussion, debate review and the advisory committee in the US is looking at these issues right now and we will go to the advisory committee for the WHO these are important questions not just because we have used them here and we have shown how effective they are but these data need to be shared it is important for us globally to be able to mix and match vaccines and know that they work because of the way the vaccine supply has been sometimes interrupted challenges and dates and expiry and getting vaccine so this is an important global question to make sure that we can increase protection for people around the world so that is why I am confident because Canada has been leading in some of this data so is the UK there are 19 European countries that also use mix and match schedules so these are things that are going to be accepted as this data becomes available and it shows how well it works and now we will go over to minister and talk about some of the projects for French not priority it is always the health of people and so it is our priority in what concerns a third dose of a COVID-19 vaccine now I think we have vaccinated 40,000 people in the long-term care centers and secondly those who are vulnerable clinically so this is our priority for the third dose and it will continue to be our priority here in the future the question of the acceptance of other countries in the world of what is happening and of course a success that is to say the decision to give doses as soon as possible and it will continue to be given doses as soon as possible to the people despite the type this is a successful policy in terms of health it is a political question of other countries in hard work to ensure that everyone is in measure to travel but their priority for the third dose is those who are vulnerable primarily those who live in our long-term care centers yes I do this one for Minister Dix and again I will ask for both English and French on Tuesday you indicated that about 1900 long-term care and assisted living staff are not vaccinated can you update us on how many of those staff members have now been placed on unpaid leave and what is the percentage of unvaccinated health care staff in hospitals and clinics around the province ? on Tuesday that is to say that 96% of people who work in long-term care centers and 97% of people who work assisted living in our province were vaccinated which is like an impressive answer everywhere in the province there are a lot of centers a lot of houses in the province where in the totality of people we were vaccinated we have as I just said 1900 people who were not yet vaccinated and what is clear what is following our decision that more than a month ago now that they are not currently working and they are not yet paid so everyone in these categories must say that people often work in a sector as part or provisional and of course there is a significant number of people who are in these categories in hard work for everywhere in the province to respond to that and we see that in all our centers our goal obviously is to ensure the health of people who live in our centers and who work in our centers with this measure and we are confident to be able to do it but it is not easy what I said in French was it is not easy obviously the vast majority of people in long term care 96% the vast majority of people have received at least a first dose vaccination in COVID-19 and the rules are very straightforward the provincial health order applies to everybody so that means you are not vaccinated you are not working right now in long term care in assisted living Dr Henry has talked about the order for acute care and the order for acute care in other parts of the healthcare system that will be coming in force October 26 and that has been posted now but in long term care the situation is you have to be vaccinated and the reasons for that I think are obvious for everyone it is the protection of those working in the sector the protection of those living in long term care and assisted living in our province and you don't have to you know to have seen the significant impact on people's lives over the course of the pandemic because I think obvious why that is important is also important because we don't just want people working in long term care because in some fashion their bodies have failed them but we need people to be able to continue to see the ones they love and that means ensuring that everyone is vaccinated so that we can have more normal life and normal activity people paid an extraordinary price in long term care and these actions the vaccine mandate is a requirement for us to continue to ensure people are protected and we intend to see it implemented all the people working in long term care and who have worked very hard on this and it is my hope that even more people amongst the small percentage of people who are not vaccinated at the moment will get vaccinated and continue to do that important work because our long term care workers have been I think a source of inspiration encouraged in this pandemic and we want to continue to work together all of us as part of a team. Thank you everyone for participating that concludes today's event.