 Good afternoon. My name is Adrian Dix. I'm BC's Minister of Health. To my right is Dr. Bonnie Henry, BC's provincial health officer. This is our COVID-19 briefing for Thursday, November the 4th We're honored to be here on the territory of Lekwungen speaking people of the Songhees and the Esquimalt First Nations. I want to start by of course Sending our best and our support To Premier Horgan on his diagnosis today, which he spoke about today or made a statement about today I've had the occasion in the last few days to speak to Premier Horgan and talk to him about a number of things including obviously his personal health, but also about the Canada Health Transfer, which he's passionate about in all of the issues in health care in other areas that Premier Horgan is passionate about and he is of course determined and positive and thoughtful and as someone who has dealt with cancer and survived before he understands both I think the challenges, but also He's engaging with real optimism. I'm I think the qualities that make him a great Premier, but also great friend and a really great human being are going to help him in this as it are the support of people I think Across the political spectrum of people of BC and I think Premier Horgan has in particular talked to me about about his appreciation of the extraordinary work of health care workers, you know, we did in the two weeks I'll be reporting on this later about 11,500 Surgeries in the two reporting surgeries periods during two public health emergencies and the work of health care workers across the board is exceptional. The Premier I know appreciates that every day and no more so than today as do we all. We're all thinking of you Premier Horgan I don't know if he's watching today, but thinking about him and sending you our support and our love and with that it's my honor to introduce Dr. Bunny Henry. Thank you very much and good afternoon today as well I want to start by wishing everybody a happy Diwali and Bandar Chordivas. I know this is an important time to celebrate triumph over hope and despair and and the coming of light over darkness and that is something that all of us can think through and be part of and as we heard the news today about Premier Horgan and his cancer diagnosis, I also want to extend my my thoughts and happy thoughts because I know the Premier and his family are taking this on with positive and strength and they will be strong and positive throughout this and we're sending our best wishes as well and and also to our many health care workers and families across this province who are dealing with similar issues all of our health care workers in BC who continue to go to work every day to provide that care for people across the province and the very best care possible and my gratitude goes to you as well. So today I'm also going to be providing the latest epidemiology data and modeling update to give a little bit of a sense of where we are here on November 4th in this pandemic. So to go back to some of the the images that will be familiar to people who have watched these updates over the last year and a half for almost 21 months now. This is the epi week of last week so ending on Saturday and it shows where we are seeing the most cases so it's the case rate by local health area residents of the people who are infected and what we see is that we still continue to have challenges across the north no surprise to people in many communities in the north. On a positive note we are seeing cases come down quite dramatically in interior health which is great news and remaining low particularly in those areas of the province where our vaccination rates have provided that buffer where the virus can't spread as easily. We continue to be affected across the entire province and this is a cumulative case rate since the 1st of January in 2020 up until the end of October and some areas have been more impacted than others but there is no community in this province that has not been affected by this pandemic and I don't need to say that to people here today. On a positive note as well what we see is the geographic distribution of vaccination coverage and that has become increasingly high and our coverage now is up to over 90% this is age 12 and above for first dose coverage. What we also can see is that in those areas where coverage is not as high in those pockets where vaccination rates are not as high those correspond to areas where we see increasing transmission and I've just put the lower mainland up as an example where we can see this side by side if we look at the coverage rates in the lower mainland in the Fraser East region those are the areas where we still see persistently high case rates and as we'll see as the data goes on where we're seeing people hospitalized from this virus. This is our epidemic curve starting in January 1st to the 1st of November this year as you can see the green line on the top we've had grumbling cases along for the last few months since that rapid increase driven in interior health in the in the summer we are seeing a steady decrease particularly in the last couple of weeks with the the putting in of new measures in particularly in northern health. What is concerning on this is the persistently high stubbornly high rates of hospitalization and we'll look a little bit deeper into who is being hospitalized and why and where and some of the data that I'll present now. This has been the challenge for us over this last few months it has been the reason why we've done things like making sure that healthcare workers are vaccinated making sure that we get booster doses out to where we're seeing people having breakthrough infections but it is also a reflection of the fact that the Delta virus is spreading more easily and causing more severe illness in younger people particularly those who don't have the protection of vaccination. So if we compare for example our cases and hospitalizations in people who are unvaccinated versus fully vaccinated the difference is stark this really is driven by the number of people who are becoming infected who have not yet been vaccinated and the hospitalizations reflect that as well. We look across the province this is the case incidence so the the number of cases test positivity and that the colors reflect the percent the rolling seven-day rolling average percent positivity and the testing rate and the testing rate we say across the board has remained high and what we are starting to see in some of those stubbornly high areas is a now a decrease in the percent positivity and the case incidence rate particularly in some of the areas of the interior and now just more recently in the north and the northeast and northwest in particular. This is the epidemic curve by health authority and we can see that Fraser health still has the bulk of the cases although this last wave has been driven initially by a rapid increase of cases in interior health that have finally now started to settle down and of course the recent cases that we're seeing across the north. When we break this down by age we last time we presented the update of the epidemiologic data we were rate as the nine to 11 and five to eight year old age group was going up as we can see it has dramatically come down and I'll show you a little bit more data about the school age children a bit later showing that our testing rates still remain high in that population so this is a true decrease and it's related again to decreases in communities that is reflected in the rates that we're seeing in school age children and particularly in those children who are not yet old enough to be vaccinated. Finally we're also seeing a decrease across the board with the exception of people over the age of 80 and where we're seeing this is people who are infected in some of the long-term care outbreaks that we're seeing but also community seniors in our communities who particularly the small number who are not yet vaccinated and the risk in that group is very very high so if we break again the age distributions out by vaccination are not vaccinated it really is a predominantly unvaccinated population where we're seeing infections take off and where we're seeing higher rates of infections in the younger age groups. Thankfully the young guest age group the 0 to 11 who are not yet eligible for vaccination have the lowest rates and those rates have been coming down. When we look again at hospitalization so the numbers of people in hospital in the top and the rate per 100,000 on the bottom we see again that in younger people 0 to 19 year age group that that remains low and this is something that we have been following of course since the summer in particular when we started to see increased rates of children being hospitalized in the states and in some parts of the country thankfully we have not seen that here and we know that part of that is protection that's afforded by those around young children being vaccinated and by the measures we've taken to protect young children where we see the rates going up as I mentioned in people over the age of 80 and some of that is related to breakthrough infections in people who are fully vaccinated and we know that happens because our immune systems aren't as strong as we're older as we get older and because they were at the highest risk our seniors and elders have always been disproportionately affected during this pandemic and we prioritize people over age 80 to be immunized early on and many people received their immunization at a shorter interval and we now know that that extended interval between dose one and dose two does indeed as we expected give longer lasting stronger protection so this is one of the reasons we have prioritized people over the age of 70 across the board to receive booster doses and that has started in the past week. This is just an update again of the impact of the pandemic across the age groups we can see that younger people under the age of 10 are still underrepresented compared to the proportion of younger people in the population and that the main burden of this virus and the pandemic has been on people over the age of 50 and particularly people over the age of 70. When we look at vaccination progress we can see that we've made tremendous progress across the board so we are at about 90% coverage of people over the age of 12 and that is fantastic but it also reflects that that small percentage of people left is still has a tremendous burden on our health care system and if we look at all ages so our entire population we're about 80% of the entire population that's been protected through vaccination and we see in communities where those vaccination rates are high how protective that is at preventing the virus from spreading even if it cause mild illness in some people so when we look at then the proportion of people who are unvaccinated who become cases about 60% of the people who are infected with COVID in the month of October are from that 10% of people who are not yet vaccinated and the vast majority of hospitalizations 72% in the month of October and over 90% of the people who required critical care are people who are not yet vaccinated when it comes to the small number thankfully of people who've died from COVID about half of those people are not yet vaccinated mostly younger people whereas we know that this virus can still have devastating effects on older people in long-term care homes if it gets into that setting and this is a this is a summary we call it our placemat of looking at the vaccination rates in the on the cross the top and then that small gray portion then percentage that result in cases and and on the right hand side the bars show the age so what we see is that the number of cases in people who are unvaccinated at a younger age is much higher and importantly the hospitalizations on the third row down we are seeing unvaccinated young people being hospitalized and sadly have seen deaths in young people who are unvaccinated most of the hospitalizations and the the deaths in people who are fully vaccinated are in those who are older with underlying conditions whose immune systems aren't as strong and able to prevent severe illness if they do have breakthrough cases but really what we look at by age the you can see the dramatic impact of protection that vaccination gives across the age span that purple line that's relatively flat on the bottom is is consistent across the age groups that these vaccines are highly highly protective at preventing severe illness even in older people who get infected and this is really putting it all together when we look at it by age so this is adjusted for age for so a 50 year old person who is unvaccinated has a 10 times increased risk of the same age person who's been fully vaccinated of becoming infected with COVID the risk of hospitalization is 50 times greater than somebody the same age who's been immunized and 46 times greater risk that they're going to succumb to COVID than somebody who's been protected through vaccination these are the important things that help us understand how well these vaccines are working and how they are protecting people I want to talk a little bit more about the pediatric groups of our our children particularly school age children and young children we've been following this very closely as we've mentioned so in the past epidemiologic week we've had one additional case admitted to hospital in the zero to four five to 11 and 12 to 17 one each in those age groups and there's been two children one in the five to 11 age group and another child 12 to 17 who've been admitted to critical care we've had no additional deaths in any of these ages which is good news for all of us if we break it down again by geography and age to help a better understanding of who where children are being infected and at what age we see that it does very tremendously by the rates of transmission in the community and again those reflect the rates of vaccination in our communities so we see in the interior in the 12 to 17 age group where immunization rates have come up quite dramatically in many communities that we've seen a steady decrease in cases in children in that who are vaccinated as well we're starting to see the corner turn in northern health as immunization rates go up but it still shows us that the impact is much more felt in communities where vaccination rates are lower and again breaking this down by an unvaccinated versus vaccinated particularly in the 12 to 17 I think this is really important for us to realize hospitalizations are low across the board for children that is good that's important for us to know but there have been no hospitalizations none in the past month since July in fully vaccinated youth so children at 12 to 17 who've been protected by vaccination it is working extremely well we've had very few cases and we've had no hospitalizations that's important for us to think about as vaccines are now becoming available for the younger age group as well and this is just to show that we are continuing to test at very high levels so we are looking for cases in young people across the spectrum and the rates and the percent positivities are coming down dramatically so that's important for us to remember as well and finally I'm going to talk a little bit about our update on our modeling so this is the reproductive number rt and for the first time in several months across the board we've come dipped down below one what we have been seeing is sort of bouncing around at one which means for every person who who's infected they infect one other person on average now we're seeing that below one that's good news but it's just below one which means that we have right now a fragile balance we're going down slowly it is important for us to recognize that the things that we're doing to prevent transmission including being sure we're vaccinating getting our booster doses staying away from others if we're feeling sick ourselves managing the size of our gatherings particularly if people are unvaccinated in those settings these are all the things that are making a difference right now but we are going into the respiratory season we've started to see influenza appear on a horizon we're started to see rsv cause some infections particularly in children so this is not the time to let off in any way what we are doing to protect ourselves our families and our communities and finally the modeling the transmission scenarios that we've been using as we talked about the last time we presented this we're looking at the shorter term implications given what we've seen in the past about modeling and on the right hand side it talks about hospitalizations and sorry on the left hand side hospitalizations on the right hand side cases and where we are right now we should continue to see a steady decline in cases and hospitalizations over the next month but this is a fragile balance that we're in but it is an important balance and when we look at what we could be at had we not had vaccination right now we would have been in a very different situation in this province and you know people have asked you know what is it that's keeping the hospitalization rates up why is there so many cases in transmission and part of the answer is the strain of the virus that's circulating right now is that much more transmissible and is causing more severe illness in the younger people and in people who aren't vaccinated and if we had not had the protection of immunization that we have had across the province we would have had a much more challenging situation so that's the update right now and what does this tell us overall that the risk is and continues to me dramatically higher for people who are not yet vaccinated and I know that you've heard me say this we've heard the minister say this over and over but this is showing us how important and how protective and effective the vaccines that we have are this is now a preventable disease particularly severe illness hospitalizations our seniors and elders continue to be vulnerable and that is why we've rolled out the vaccine booster dose to them so quickly right now and we know that we'll get to booster doses we've managed all of our long-term care assisted living and people in the community are receiving their invites now to get your booster dose and I encourage you to get this now we're also focusing on health care workers who were immunized early particularly those who had it at a reduced interval in December and January last year because we know how important it is to protect you from any illness even mild illness because it can be so disruptive to our system and while the north is continues to be more severely impacted right now we've seen clusters and peaks in different areas across the province and there's been no part of the province that has been unaffected by this as we know as well we know what's happening in the north is having spillover in the hospital stretched systems across the province once restrictions are in place that limit for the potential for the virus to spread and we see that in the north we start to stabilize and come down this is important the number of new cases per for every on average for every case is now below one but it's just below one and this is where we need to keep it we all need to continue to do the things our collective efforts are making a difference to slow the spread and to reduce the impact on our communities and our hospitals so how do we stay on track these are the the five things i'm asking everybody to continue to do as we go through this next few months get your booster dose when it's your turn get your first and second dose now these will protect you protect your family protect the people you're closest to get your influenza vaccine this will help us to weather the influenza season and we don't know how that's going to turn out but we started to see some transmission register your younger children and get them vaccinated when we have vaccine available in the coming weeks it will be important to protect them as well and we are working to provide all of the information to parents so you can make those choices for your children remember how important it is now more than ever to stay home if you're feeling unwell to stay away from others to get tested if you need to but all of those important things that we have been doing all along washing our hands staying away from others if we're feeling sick and wearing masks in indoor public spaces when we're around other people and we don't know their vaccination status i want to start is finished by saying thank you everybody who's doing your part it has made a difference and we're continuing to make a difference and we all need to remember that that is what is going to get us through this next few months and to the light and to a better and brighter few months ahead thank you thank you very much dr henry and just to underline the age adjusted number 50 times more likely to be in hospital if you're unvaccinated 50 times and i think it's important to reflect on that and why it's important that we did i think approximately 3000 first time first doses in the last reporting period of vaccination and why we need to continue to need to drive vaccination amongst the unvaccinated particularly in some regions but really across in every part of bc from the central part of Vancouver island to the north the other areas where there are significant rates of transmission today i'm going to provide an update on surgeries and postponements on mandatory vaccination for bc's healthcare workers and booster doses and long-term care and assisted living with respect to mandatory vaccinations for healthcare workers approximately 2% remain unvaccinated that's 3091 workers totaled by health authorities that's 573 in Fraser health 959 in interior health 306 in northern health 101 in Providence healthcare 399 at the provincial health services authority 33 in Vancouver coastal health and 485 in island health i think that's actually mistake in Vancouver coastal health will get you that number i'll note that i'll note that we're going to provide a breakdown tomorrow of some major occupation groups to give you a sense but i'll tell you that there is not really significant differences between occupation groups all of them do extremely well are close to our either are largely 97 and 98 percent all of our major occupation groups through the healthcare system we'll make this point though and i think it's important to recognize how positively people have responded to the provincial health order with respect to mandatory vaccination you will recall um on october 20th when we spoke about this and gave you the numbers for the first time the numbers of of unvaccinated workers in our healthcare system was 5,512 there has been of course some data cleanups since then but also a lot of people have got vaccinated and the results are a healthcare system that's safer for workers safer for patients safer for families safer for the community and i'm very proud of everyone who's been involved in that i also want to note just something similar with respect to the previous the order that was in place on october 12th for long-term care and assisted living workers by sharing the following statistics that on august 12th um 2021 when the when dr henry announced the intention to proceed with mandatory vaccination amongst long-term care workers and assisted living workers the number of staff vaccinated on that date was 45,357 or 90.1 percent that number to yesterday on november 3rd was 48,598 healthcare workers or 96.5 so that's an increase of 3,241 net in count and 6.4 percent in percentage for second doses those increases were 5,495 and 10.9 percent what it says is what we know that this order is necessary and important and has made our healthcare system safer for everybody and we are of course going to continue to proceed with this requirement throughout our healthcare system in the interests of everybody but in particular for those working in the system and for those who need healthcare at these at this difficult and challenging time and we're going to of course continue to work with health authorities to address the impacts from unvaccinated staff i wanted but i would say this that the biggest risk to a health human resources is COVID-19 and these actions these clear actions to make things safer and better are good for everybody in particularly for those who work in the system as they say long-term patients and residents i wanted to provide an update on efforts to protect those living in long-term care and seniors assisted living booster dose vaccination is 98 percent complete in long-term care and seniors assisting facilities across the province with 526 of 536 facilities receiving their booster dose to date that's 100 percent of sites in ventura coastal northern health and phraser health 94 percent in island health that will be finished in the next day and 98 percent of the sites in interior health and finally as we reported on monday across bc most operating rooms continue to perform surgeries although there have been as i've noted reductions as many will remember when we started our weekly surgical reports when all non-urgent surgeries were suspended across the province back in march and april of 2020 we noted that in addition to scheduled surgeries being postponed others were not booked during this time on a much smaller scale that's what's happening now what we said in may 2020 when we launch our surgical renewal commitment stands true today our commitment is to catch up with surgeries lost to COVID-19 and keep up with the man for surgeries now and in the future no matter what challenges we face this remains our commitment and we will see it through and as we have week after week since we made our surgical renewal commitment we will monitor our progress and report on our efforts in fulfilling that commitment and with that here's this week's report you'll recall that uh or i should say that during the reporting period of october 24th the 30th health authorities postponed 238 non-urgent scheduled surgeries that's 31 phraser health 12 in northern health 61 in bankrupt coastal health 71 in bankrupt island health and uh and uh no surgeries were oh 61 sorry in interior health no surgeries were postponed in the provincial health services authority from september 5th to october 30th there have now been 2 389 surgical postponements i want to note this in the period from october 2nd to 9 uh 7004 surgeries were completed in that week which is i think a significant achievement really similar to some of the highest levels of surgeries we had in the pre-pandemic period and this is an extraordinary achievement given the challenges in acute care it shows how hard and how determined our staff is in providing care to people from october 10th october 16th health authorities report 5582 surgeries were completed i'll note that that that that week concluded thanksgiving so there was a statutory holiday in that week which is the responsible for the largest share of the of the lesser number than the previous week but it's also a significant achievement so when you look at the numbers of surgeries canceled in a week or postponed in a week of 200 and those completed in the week of october 2nd to 9 7000 you'll see the that overwhelmingly people are getting both for non-urgent scheduled surgeries and of course in all cases of urgent scheduled surgeries the care they need let's say finally about our health care system and where we sit right now we have as all of you know from these briefings um 9229 acute care beds base beds in our province and 2353 surge beds we have 510 base ICU beds and 218 surge beds and just to give you a sense of where we are right now of those 11582 beds the 9229 base beds are our senseless that means everyone in health care today which is a key number that we use in monitoring our system is 9199 so it's under our base bed capacity and under where we were in the pre-camp pandemic period but still extremely challenging given the particular challenges of COVID-19 in uh in ICU beds uh our occup we have 480 beds occupied today of the 510 base beds of course there are 728 base and surge beds that gives you a sense of where it is uh where those numbers are it shows a health care system that is delivering an enormous amount of uh in terms of services for people of surgeries and of care for people at the same time is challenged by two public health emergencies and and finally to say this 100 people now have been transferred ICU patient been transferred from the north to other health authorities since halloween since sunday nine more have been transferred six from the two peace river local health areas and what this tells us what dr henry's modeling tells us is the absolute need to continue to increase our dose one vaccination and our dose two vaccination in in addition to getting your um booster doses when you are invited to do so this is absolutely critical every one of those cases requires people being supported by health care teams at every stage of their journey and of course people who are who are in facing serious health difficulties far from home it fills me with awe for our health care workers in our communities and the work that communities are doing together to increase vaccination rates from mayor ackerman and fort saint job to to uh mla's but mostly just to people in the community we're seeing those rates go up more than 76 percent now for example in fort saint john and going up i'm in awe of them and of our health care workers we're determined everyone in the health care system is determined to support the north 18 test positivity against four percent for the rest of the province we must support the north and we're determined to continue to do that through the bccdc and supporting contact tracing and through the entire health care system and supporting patients in the north but also i would say real sadness because the vast majority of people who've been transferred are dealing with COVID-19 some have other ailments and other problems and other illnesses which they are being supported for and we we need to provide outstanding care but it is preventable it is preventable and i want to say to everyone today look at the numbers but imagine those the people involved who did not get vaccinated or in a community far from home getting assistance and breathing it's time for everyone everywhere in bc to get vaccinated against COVID-19 thank you we're happy to take your questions a reminder to reporters on the line please press star one to enter the queue you will be limited to one question and one follow-up our first question today goes to Richard Zussman Global News Richard please go ahead Dr. Harry what i'm struggling to get my head around is this almost 50 percent of those who have died in the last month were vaccinated against COVID-19 can you walk us through the pre-existing health conditions the impacts of age whether this was predominantly long-term care and someone seeing those numbers that's over the age of 70 or 80 who's vaccinated in this province what should they be thinking yeah so there's a couple of things the number one risk factor for having severe illness or dying from COVID is age always has been continues to be the best thing that we can do to protect people at any age is vaccination but as we get older our response to to vaccination is not as strong our immune system doesn't mount as strong as a response or as long a lasting response so we are seeing breakthrough in some people in the community in particular as we see over age 70 over age 80 so it is the people around our elders and seniors who also need to be protected through vaccination because if they get infected the risk of having more severe illness is that much higher and that leads to people ending up in hospital and sadly to people dying so it is that combination but the most people as we get older we're much more likely to have underlying illness as well other things that put us at risk but a good proportion of those cases are in those high risk settings in long-term care and assisted living but also in communities where we have large numbers of multi-generational families people living in in houses together where there's crowding where we can't effectively isolate from each other and we have seen that in some communities where it gets into the population we know there's been some large events that have happened in a community and that has led to transmission and when it and when people are exposed to this virus that's circulating right now in an intense situation like that particularly in long-term care it can still spread and for most people it still causes a very mild illness but that risk goes up as you get older so if we look at people over age 80 very high immunization rates and so those deaths reflect the small number of people that are still susceptible and the fact that the people around them they've been exposed to this virus and their chances of getting severity ill and dying is just that much greater. Richard do you have a follow-up? Is there any advice to those 70 plus about how they should be living their lives now if they are immunized especially now that we have flu season coming upon us and with this strain of the flu are we worried that this is going to impact older people separately are we worried this is impacting younger people so you know what are we seeing with the flu and what should people over the age of 70 do if they are immunized in terms of making decisions about how they're living their lives? Yeah so I think for people who have immune systems that aren't as strong so immune compromise because you're going through cancer treatments or because of age we still need to take those precautions and it and that includes wearing masks it includes staying away from others who are non-immunized particularly in those crowded indoor settings where we don't know the people around us and I know this is hard but we need to take those precautions through this respiratory season because yes there are other things and and of course for people over age 70 that is why we're rolling out booster doses that will help that will give you that little bit of extra protection that's going to carry you through this next few months and and hopefully much longer than that but it's not a hundred percent and for people who are at that highest risk you still need to do those things that you would do normally through a respiratory season about being cautious about being around people who are unvaccinated being around settings where the virus can still spread quite easily for the rest of us it also means we have to be aware of older people in our lives and the risk that they may have so making sure that we take that option of meeting outside if we're not feeling 100 percent staying away and having a remote visit if we're if we are the other family members aren't feeling well and making sure that you only have vaccinated people that are in indoor gatherings around people what we do we don't have enough influenza yet to know exactly we've had I believe it's one B and three A's of two different ones the A H1N1 and the other was an H3N2 so we don't yet know we know that the H3N2 does more cause more severe illness and older people in general and that the B's and the H1N1 tend to cause illness in younger people so it's too early to tell we do know that so far the strains that we're seeing are in the vaccine and that the vaccine this year is a quadrivalent so it has both B's and two A's so I encourage everybody to go out and get vaccinated it is free for everybody over the age of six months we don't have a vaccine for influenza and people under the age of in infants under six months but everybody else can get vaccinated this year and that will help protect you from that one other respiratory virus that causes outbreaks in long-term care homes it causes outbreaks in schools it causes outbreaks in our health care system every year so we don't need that on top of what we're dealing with continually with with COVID this year next question Hi Dr. Henry keeping on with what Richard was asking about flu shots there's been a few signs around town just anecdotally people talking to us that sorry we're out of flu shots sorry out of flu shots any concern there that there aren't enough flu shots out there for everyone who needs them no concerns that I know of yet well these are things that we do monitor and and actually we can get some updates next week about where we are with flu shots we're delivering a lot of them are going to pharmacies this year directly and our partners in the pharmacies are ready and able to give flu shots as well as public health clinics but we're relying on our pharmacy partners for a lot of that this year just just to say singin that we we got 2.4 million doses of flu shot this year just by comparison that's compared to 1.5 million doses two years ago so we are we are preparing for a major campaign that's going on right now last year the vast majority of those flu shots are delivered in community pharmacy and I expect that to be the case this this year we're full on there are more than a million shots out there in community vaccines I should say doses out there right now so there's a lot of vaccine out there and we have we believe more than than is required to ensure that everyone can get a flu shot remind people to get it done it's free and it's good for everybody and and we encourage everyone to do that but this record year everyone made sure of it that was a real commitment of public health this year to make sure that we had enough flu shots for everyone so there was no question about that and we encourage everyone to get involved and next Tuesday at our briefing will be also briefing on the number of people who have received flu shots already and then we'll do that successively through the month's the end of November and into December singin do you have a follow-up I do thank you both for that the follow-up is for Shannon Patterson I'm sure Dr Henry you've heard that two of the biggest school districts in the province and several others actually are deciding against the vaccine mandate and it looks like others are following your thoughts on the potential Dr Henry that no school district will have this mandate in the province yeah well from the very beginning we've provided advice to school districts about the things that they need to consider and that is I know it's nine points I believe and it is important that each school district look at the impact that they're seeing within their own area and I know my colleagues in the local public health units the school mHOs have been working with their school districts to make sure that the actions that are taken reflect the the risk in those school communities so I obviously am very strongly supportive of making sure that everybody who's eligible all of the staff in our school system are vaccinated as the best protection for them and to make sure that we can keep our schools running and keep our children from getting sick as well but I also know that the vaccination rates are very high in many of the many of the school districts and that's one of the first things that people have to consider where our vaccination rates where are you seeing transmission right now and I know my colleagues have been working with their school districts to make sure that that's reflected in the decisions that are made at that local level next question jiaozhu global mail please go ahead hi dr. henry uh yeah also on the vaccine mandate in schools the education minister has said the province will not make a move to require vaccine vaccine because your office has not deemed it a requirement you also mentioned that the vaccinations are pretty high among teachers but the government told us it does not have rates in individual school districts so why do teachers not marry the same levels of workplace safety as someone working a government office or on a ferry yeah I absolutely agree with you and I think what the minister meant to say was that there's not a pho order around schools as there is not for other employment private industries for other businesses for other areas I have provided advice and my advice is that workplace safety is important and the safety of staff in the school system is important that each employer needs to look at how do they best have a safe environment for employees and in this case that's the school districts who are the employers and that is part of their responsibility and public health is providing them advice around that but I absolutely agree with you I think that it is an important consideration it is a workplace safety issue as well as an important function to make sure that our school communities are supported Jiao do you have a follow-up yes I do yeah according to a letter sent to parents from the landly school district the board says Fraser Health said a vaccine mandate may not impact transmission and may impact operations such as staffing how can you explain to parents that authorities and business have concluded a vaccine mandate is required to ensure safety in all sorts of workplaces including the legislature but that an overall high rate of vaccination among teachers means a mandate should not be required and if vaccinations are really high why would there be concerns at all about losing staff thanks yeah so as I said these are issues that each employer works through with their situation in their community given the vaccination rates in the community given their relationship their understanding of who's vaccinated in their amongst their employees and our advice has remained that they need to look at all of the positive and negative impacts of a vaccine mandate they have to understand the vaccination rates in their community in their schools in their employees and that remains the same and I have provided the same advice as I have to the public service agency that these are the things that they as employers need to look at and the importance of immunization and protecting workers in the workplace in protecting everybody else who is in that in that school or in that setting as well and I'm very strongly supportive of making sure that we have high rates of immunization that are protective in the in the workplace and we also know that there are additional measures that are working to protect schools so so each school district has to balance what they're seeing within their schools and we've presented some of the data already that shows that those other measures are working and that we're not seeing a large outbreaks in transmission in schools in many of these communities where those decisions have been made so they have to balance that risk benefit it's a different situation when we're talking about healthcare and we have seen the impact of having even small numbers of unvaccinated healthcare workers but it doesn't mean we give up all of the other things that we are doing in the healthcare system as well so it is important to continue using personal protective equipment making sure that we have things in place that prevent transmission of infections as well as making sure that everybody in those settings it are immunized because the risk of introducing the virus into both the workplace and those we care for in our care settings is just that much higher and we continue to see outbreaks we've seen outbreaks related to unvaccinated staff members in acute care in long-term care homes and we've seen the devastating impacts that those can have so it is a different situation and every workplace and every employer needs to look at the situation that they are facing and what measures they have in place to protect people in their situation. Next question Camille Baines Canadian Press. Thank you this is a question for Minister Dix I'd like to know with Ontario and Quebec about faith on mandatory vaccination for healthcare workers what can you say about where BC may go with its own policy because a considerable number of these employees do remain unvaccinated? Yeah I will start with that because it is my order and we are we have very strong support and I cannot be more proud of my colleagues in healthcare across this province and we talked a little bit about the impact that we're seeing but we've recognized how important it is to protect our healthcare system to protect each other but to protect the people we serve and the people we care for and we are committed to doing that we've been working with our colleges our regulatory colleges and with healthcare workers across this province and I think we have a very strong committed healthcare workforce that are vaccinated because they know the value of protecting themselves their families and the patients that we care for. Yeah I just think it's just plainly the right decision doesn't mean it's an easy decision but it's plainly the right decision. You've seen since the orders came forward and implemented we've seen a significant uptick in vaccination and people are safer it means that in long-term care and assisted living today 100% of the workers are vaccinated it means to visit someone in long-term care and assisted living you have to be vaccinated it means that all residents there's a few care homes still left to be done but all residents have been offered their third dose immunization from COVID-19 and after the year we've had and the impact of outbreak and yes some of our outbreaks have been very are very significant you think of Willingdon care center you think of Cottonwood's care center in different parts of the province right now the majority of our outbreaks are less but when an outbreak it occurs it profoundly affects the lives of everyone in the facility the staff of course but primarily the residents who are separated from one another who don't do the same social activities this is their home who can't receive visitors in the same way in a very challenging time and so this is an absolutely necessary order to protect the lives and safety of health care workers and of residents in long-term care equally in acute care we see the same thing and this is supported I think across the board I think in communities the need to ensure that health care workers are safe and are protected across categories of workers we've seen we see 98 percent immunization across 127,000 people who serve us in acute care and in the community directly for health authorities 127,000 workers 98 percent first dose immunization 96 completed second dose immunization in that number that gap is closing every day so this is the right thing to do it is necessary to protect everybody it is of course challenging and difficult but the main challenge in our health care settings is COVID-19 itself and its impact when it comes in those settings and and so we think that this is the right approach when people support this approach and it's one that is pro-healthcare worker and it's pro-patient and it's pro-resident and it allows us together to deal with a pandemic that affects health care in particular more than anything else. Camille do you have a follow-up? Yes thank you for health authorities where there are higher numbers of health care workers that aren't getting vaccinated how will you deal with that? Well across the board and the minister can talk about this too but for every single individual health care worker we're having a one-on-one conversation with them and the largest number is in interior health and that is happening to make sure we understand why and make sure people have access that their questions are answered that we support them in being immunized and that is happening right now and every day we're seeing more and more people coming on board and making sure that this is something that they're doing as a part of a health care profession. And just to say with respect to long-term care and assisted living one of the advantages in that in that area is the 6,000 people we've added to the care teams in the last year across the programs we've introduced to in terms of infection control and care the fact that we've significantly added resources and still it is an enormous challenge particularly when a care home faces an outbreak and people are not able to come to work either because they're sick or because of their contacts and that has a profound effect on the facility. So this is not neutral when COVID-19 comes to a facility it affects staffing and reducing the impact of COVID-19 on our facilities is good for dealing with staffing and that's one of the reasons why these are such important steps to take. Dr. Henry has said about five percent now it's down seven percent recall on October 20th when we provide the statistics first it's five percent now in interior health in Providence health care it's one percent and in the majority of the health authorities it's one or two percent of health care workers who are not who are currently unvaccinated and non-leave without pay but what we're doing is adjusting and I laid out in detail Camille some of the responses some of the challenges we faced and and essentially in spite of that in spite of those challenges we're performing the thousands of surgeries both urgent and non-urgent scheduled surgeries and emergency surgeries every day and all the other services that the health care system provides so it's not easy but it but but I'll have to tell you that if you want to see the cause of the challenge cause of the challenges COVID-19 and this is an important step to deal with it and keep our keep our seniors our residents and our patients safe next question Victor Kaiser radio and L Hi Dr. Henry and Minister Dix I just wanted to uh to talk about events a little bit more this time outdoor not indoor like last time uh I know uh our downtown BIA was hoping for uh some kind of approval one way or the other on a Santa Claus parade later this month they do have the approval now from Interior Health uh so I guess the question really would be is the fact that we heard one thing from the Ministry of Health saying that they could go ahead with the communications plan for a long time but then Interior Health was saying something totally different at the same time uh so in situations like this when people are hearing two different things from essentially a health officials uh what should they do who should they listen to and in situations like that again who should people follow uh when it comes to the province or Interior Health yeah so Interior Health and my colleagues in Interior Health are the people who have the local jurisdiction I think there was in that case and I've had conversations with my colleagues I think there was a misunderstanding from another agency or particularly there's a couple of outdoor unstructured events like that where it is uh you know Santa parade where it's a very low risk where people can stay away from each other outdoors etc so uh I know that's been clarified and I think that's really important particularly as we're coming up to November 11th and there can be small outdoor ceremonies although I will say to people um be aware and we talked about this just a few minutes ago with Richard Zisman's question um older people particularly the vets that we know now are in that older category and we need to make sure that it's safe for them and it may be good for many people to be able to do this remotely this year in the small group with the with their close vaccinated family or our friends rather than getting together in larger groups so I think outdoor events like that are very low risk and we encourage them. Victor do you have a follow-up? I do yes and I appreciate that answer there Dr Henry and curiously I know with the the outbreak at Royal Inland Hospital now here in Kamloops it's the fourth outbreak uh though with 19 cases I guess this would make it the uh the second worst in the entire pandemic the first of course the first outbreak of course being the worst uh wondering if you can shed some light as to how uh it potentially might have uh you know happened now that I guess uh stopped that are unvaccinated or aren't leave and things like that if you're able to to shed some light as to how that could have happened. Yeah you know I don't have all of the details around that specific outbreak but we do know that there are people who are in hospital who are not recognized as having COVID and unfortunately can transmit to people before it is recognized so those are all things that we need to bear in mind and that's why it is still important even with vaccination of staff that we follow infection control precautions and testing and other things and it keep a low index of suspicion for people who have certain symptoms that might be related to COVID so I know it can happen and even with fully vaccinated healthcare workers we know that sometimes there's breakthrough and they may not get sick very ill themselves but it can still be transmitted so we still have to have in place in these higher risk settings other precautions as well but we also have seen that where we have high that sort of firewall of most people being vaccinated or at least all staff being vaccinated that the the rate of growth of outbreaks and how many people they affect is much much less and that these outbreaks come under control much more rapidly. Next question leads us to city news. Hi there Dr. Henry. Regarding these pockets of areas where the cases remain high and the vaccinations remain low some weather reporter asked earlier this week like what's up with the interior and what's up with the eastern part of Fraser Valley what more can be done and I'm particularly thinking of this ahead of you know trying to get kids into the vaccinated in the 5 to 11 year old group what more can be done to break down these barriers between you know science and people who are scared of it? Yeah you know really good question things that we think about every day and it continues to be the same issues for the majority of people it's around confidence in the vaccine confidence in the information that they get and there are many different ways that we try and address that we've had town halls we've met with elected leaders we've met with faith leaders to try and make sure we're countering some of the misinformation so incorrect information but also disinformation and that is a that's a challenging thing that the intentional wrong information that's being spread by some people to to increase people's resistance or fear of vaccination so we're doing work on that and we've been talking to parents about what types of information and and what types of settings are important for them in terms of younger children being immunized but we still need to address the the confidence that people have across the board the other one is convenience and I still hear this from people that they wanted to get their vaccine but they didn't know where to go or they didn't it wasn't available right away in their community when they wanted it so we're trying to address that that's a very challenging one and especially in some rural communities and you know making making sure that it is available for people and and then there's the complacency factor so the this thought that this virus is only affecting older people it's not going to affect me I don't know anybody that's been affected by it my immune system is strong and I'll be fine and I think that is important we all need to do those things that keep our our bodies healthy and strong whether it's sleep and eating well and exercising but we are seeing with the strain of virus that's circulating now and I showed that in the data today that young healthy people can have severe illness with this virus so we need to overcome that sense of invincibility and complacency that people have and we're trying to do that as well but those are really the main factors there's a very small group of people that are really truly anti-vaccine and we hear as well that people have this feeling that it's being forced upon them and it's all about freedom of choice and and to them I'll say it really is about us being part of a community and working together to the common foe which is this virus that has affected all of us across the board some more than others and some people have suffered immense losses and you know but all of us really need to collectively do our part to help protect those we love and those we don't know. Lisa do you have a follow-up? Just to decide it's like you need a 1-800 dial a shot for people who need the convenience and show up at the door with children looking at the dip that happened in mid-october after the mask mandate was instituted I'm wondering is that what precipitated that that dip after the spike and heading into going after that same age group to get their shots what are some of the biggest challenges you see ahead? Yeah you know I think the mask mandate is an important consideration across the board but if you notice we've broken it down by five to eight and then the nine to eleven so those are the the two age groups of school age children who are not yet eligible for vaccination and we had the mask mandate in nine to eleven but not the five to eight and you see that that they pretty much followed the same trajectory so I think it is one of the measures that is important when people are in a school setting but it also reflects to us that the transmission to children reflected the transmission in their families in their social connections in their groups that they they were with both in school and outside of school in particular and in the communities they were in and we saw that when you you look at it particularly by by health authority even so there's many different factors that go into who gets infected and when but for children we know the most important thing we can do to protect them is to be have everybody else around them protected through vaccination whether it's their older siblings their family the groups that they're with in what are the challenges we see in in five to eleven I think there's a couple of challenges we've been talking to parents about this about what are the things and what we see in in in bc and there's been some stats shown around the country that you know 50 to 60 percent of parents are really anxious to get their their younger children immunized and they're going to do it right away and they're the ones that have the information the knowledge they they strongly feel that it is the right thing for their child there are about 20 percent of parents who who have a lot of questions and they want to have those answered before they commit to having their children immunized and I think that's really important and that that is something that we need to address we need to know the safety data and Health Canada is looking at independently all of the data from right now Pfizer who's providing who's developed the vaccine that is first in line to be approved for use and we are confident that we have a very strong process for assessing safety and effectiveness of vaccines and Health Canada we rely on them to do that so that's the one big important step but then we need to make it we need parents to understand the impact is going to be on their on their children whether their side effects what those side effects are likely to be how comfortable are they in the clinic making sure we have immunizers that know how to to provide immunizations and comfort level to children especially younger children so those are all things that we're doing a lot of work on to make sure that we have the right environment and we have the people who can answer questions for parents so they they can make those choices for their children I also think I've heard from from people in my life that that there's that there's two types there's two other things that I find that we will need to think through one is parents who find it really challenging that they can protect themselves but they can't protect their children directly and they are very anxious to have vaccines for for younger children so that they they don't get sick and and though thankfully most young children don't get very severe illness with this some do and they can pass it on to others in their family so it is really important that we take that into consideration and of course there are other parents who are saying well I'm doing everything I can by protecting myself and I'm not sure I'm ready for my child to be immunized yet so those are also a valid opinions that we will need to make sure we have the the information particularly about safety of the vaccine about what are the potential side effects and all the information that we have from around the world about how well it works and younger people so it's you know I think confidence in the vaccine is something that we take really seriously and we have some great vaccine experts here in BC and in Canada and we're working with them to make sure we have all the information that parents need to make that decision our last question today goes to bell peary cbc please go ahead hi there and of course if you could have answers in english and french please so we're looking at today's presentation and the three projections have a reproductive number of just below one or slightly over one does that mean there's no longer a plan to try to get case numbers to fall below current levels and if not why not oh absolutely not I mean obviously we want case levels to go down we know that a percentage of people who are who are infected with this virus end up in hospitals so hospitalizations are a lagging indicator so absolutely but all of the things that we're doing are the things that are making a difference in case numbers coming down case numbers don't tell the whole story though especially day-to-day case numbers what we need to look at is the rolling average over time and the testing rates that we have and that's one of the things that I presented we've been doing a lot of testing across the board in many different age groups and particularly in younger children so we are finding more cases and when we have clusters or outbreaks we do a lot of testing around that cluster or outbreak so we are finding more cases in highly vaccinated groups of people but the good news is as we are investigating every single case and public health is talking to these people the the difference that we're seeing is people who are vaccinated are so much less likely to end up in hospital or had to have severe illness so those are all the things that go into that case numbers and absolutely we want the case numbers to come down but more importantly we want people with severe illness to be protected we want people to be protected from severe illness and for our hospitalizations I see you cases to come down to and we'll see that in the reproductive number of the epidemic actually which is less than what is important what suggests a decrease in cases in the future other things being equal and these things are not always equal so this question of the intercontinental transmission but also the question of the hospitalization which is very important especially in our country for me as a minister of health that is to say that the number of people in the hospital currently at approximately 4,450 actually 430 actually now and too many of them on the measure where there are other questions for hospitals are of course not so we want this question of severe in our consideration, for example, for measures inside the planet. So it is a question of hospitalisation. It is a question of what the number of representatives represents and other things. So we see all of this and we admit that during this presentation. That is to say that there are good news in the country where we can reduce the number of people in the country. There are good news in the country where we can reduce in general cases for a few weeks. But at the same time, the challenge in our hospitals is quite difficult at the moment. So you have to consider all of these elements and that is what Dr Henry is doing and we are doing it to the Minister of Health. Belle, do you have a follow-up? On the daily case counts, the numbers that are reported, how many of the people who are being diagnosed with COVID for a second time are in that? Is the data being collected about repeat cases of COVID and are people who get the virus more than once counted as a new daily case count? The answer to the last part is yes. The answer to the first part is not really. We can retrospectively look at people who have had two incidents of COVID, a certain period of time apart, and we have done that periodic analysis. It is an important question. We also are looking at what is the community level risk, which is a combination of how many people have been infected and how many people are protected through vaccination. One of the ways we have been looking at that over time is by a serology study and the BCCDC has done I think the fifth time we have done a period in time a snapshot of the percent of people who have serologic evidence of a previous infection or from vaccination and we can tell the difference between having immunity from vaccination and having immunity from previous infection. Hopefully we will have those data to publicly very soon. I will say though that this is a really important question because I hear all the time that post-infectious immunity is better than vaccination. In the last couple of weeks there has been a number of studies, small studies that show that yes, people who are so I think we all agree that for a period of time after infection most people have immunity, but that varies. It varies depending on your own immune system. It varies depending on how severe the infection was. Some people who have very mild infection may not have strong immune protection for a long period of time. We know that it varies how long that protection from infection lasts. Just this week there was a very good study that showed that the immune system does not have strong immune protection for a long period of time. We know that it varies how long the infection lasts. Just this week there was a very good study came out of the United States looking at on a population basis in one of their HMOs so hundreds of thousands of people. It looked at people who were infected with COVID and people who so all of them had previous infection. Some of them were vaccinated as well as other people who were not vaccinated and people who were vaccinated and the risk of hospitalization was even higher than that and I can't remember off the top of my head it was like 10% higher. What we've shown is that compared to vaccinated people, unvaccinated people, your risk at the same age group of being infected is about 10 times higher. You've not yet been vaccinated. So it again is more and more evidence that vaccination even after infection is an important measure to prevent you from getting infected again and to have a stronger longer lasting immune response that we know is effective for a longer period of time and against a wider variety of the strains that are circulating. So it's important for people who have had a previous infection to be vaccinated and I know this is a source of contention for many people but it is your best protection because there's no way of measuring effectively the cell mediated immunity that memory cell response that some people develop after infection and some people don't and we know this is very strong and longer lasting. Sorry. First of all, yes, all cases are in our account. That is to say that if we have tested positive we have a positive test for 10 years 2020 and we have a positive test for 10 years today in account each time. That's the first thing. The second thing is that we do serological studies in the BC Center for Disease Control and we will be able to share these results soon. But what is important in what Dr Henry just said is that even if we have tested positive for COVID-19 we will be able to live with COVID-19 we are more protected away if we are vaccinated and vaccination is essential for everyone. That's what Dr Henry just said. It's support for the evidence and what needs to be done in all categories even if the risk is not as high as one or the other it is essential to be vaccinated during a pandemic where those who are not vaccinated are at great risk 50 times more risk to be hospitalized if you are not vaccinated and that's what is essential and that's what is important for everyone. Thank you very much.