Analyzing BC’s new restrictions amid exponential COVID-19 growth

After BC announced a slew of new restrictions on Monday to curb a recent exponential growth in COVID-19 cases, Flight Wang, 24, says his life won’t be altered much.

The Victoria resident, who was diagnosed with chronic myeloid leukemia four years ago and lives with the illness, says all he has been doing for the past year is attending online courses at UVic and staying away from others.

As for others in his age group, Wang says they’re “very responsible in terms of trying to keep everyone safe... staying indoors and [they] only travel when they really need to.”

So when Premier John Horgan laid the blame for transmission rates he calls “unacceptably high” squarely on the shoulders of young people aged 20 to 39, Wang, like many others, felt it was an unfair assessment.

Horgan kicked off Monday’s announcement—in which provincial health officer Dr. Bonnie Henry and Health Minister Adrian Dix outlined a host of new restrictions—by stating that young people aren’t following the rules.

“The cohort from 20 to 39 [years old] are not paying as much attention to these broadcasts and, quite frankly, are putting the rest of us in a challenging situation… My appeal to you is do not blow this for the rest of us,” Horgan said on Monday. No data was presented to support the argument that young people behaving irresponsibly is the cause of this uptick.

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Horgan has since tempered his comments. In a Twitter thread on Tuesday afternoon, he acknowledged that “most young people have made tremendous sacrifices to fight COVID-19,” and that “They're also more often working front-line jobs or living with roommates.”

The alarming rise in cases is reflected across all age groups. Over the past week, the rate at which people across BC have been testing positive for COVID-19 has nearly doubled from a steady 6% to around 10%. The test positivity rate in the Island Health region also spiked from around 3.3% two weeks ago to 5% on March 28.

While the Island Health region had been spared the worst of the pandemic, this recent exponential growth has left no area untouched.

“What we saw in October is repeating itself now. We start to see a slow increase and then a rapid takeoff, and it starts where the population is greatest, where the number of cases is greatest, but it very rapidly spreads,” Dr. Bonnie Henry said on Monday.

“And we’ve started to see an increase on Vancouver Island over this weekend, and in the Interior.”

Imported variant cases seen in Island Health

Last week, the health authority set two back-to-back records for highest one-day case numbers on Thursday and Friday: 58 and 61 cases respectively. Before this past week, the record had been set at 46 cases on Feb. 19.

Much of transmission is being driven by variants of concern, after the province reported 320 cases involving variants since Monday. Overall, 313 variant cases are currently active.

Though no clusters have been identified on Vancouver Island, Henry said people who contracted COVID-19—or one of its more dangerous cousins, the P1 variant linked to Brazil—at the Whistler Blackcomb Ski Resort have returned home to various parts of the province.

Cases linked to those travellers have been popping up everywhere, including in the Island Health region.

To date, there have been 13 cases involving variants of concern detected in the Island Health region, 11 of which are the B117 variant linked to the UK, one case of B.1351 or South Africa variant, and one case of the P1 or Brazil variant.

All of the variants seen in the region to date have been linked to travel from other parts of the province and there is no evidence of community spread on the Island yet. None of the variant-of-concern cases in the region are currently active.

According to Island Health chief medical health officer, Dr. Richard Stanwick, the province will most likely soon have to face a situation where one of these more transmissible and sometimes more dangerous variants of concern becomes the dominant strain.

“All the mathematical modellers are saying it’s just a matter of time before one of the other variants becomes the [main] strain we see in the community, so nobody should be surprised if one of those strains becomes the one that we’ll have to deal with going forward in the next three to four months,” he said at a media briefing on Tuesday.

“At this point, the betting still is on the B117 as the likely strain that’s going to push the other ones to the side.”

New restrictions

In response to this growth, public health officials have implemented a list of new measures as of midnight on March 30. These restrictions, labelled ‘circuit breakers’ by the province, will remain in place for three weeks, until April 19.

The previously announced allowance of indoor gatherings for religious ceremonies has been revoked.

Indoor dining has been suspended at all establishments serving food and liquor in BC, except patios where full meals are offered. Places that serve snacks or appetizers only must also shut down for the next three weeks.

Group fitness activities for adults that take place indoors have also been suspended. Until April 19, places like gyms and fitness studios can only offer individual or one-on-one training activities.

Students from grade 4 and up across BC must wear a mask full-time while they are in school—a measure that was initially only required in the Surrey school district. Public health officials are now also strongly encouraging children who are younger than Grade 4 to wear masks in school.

The Whistler Blackcomb Ski Resort has been shut down due to a cluster of P1 variant cases as well as heightened regular COVID-19 transmission. Its Vancouver Island counterpart, however—Mount Washington Alpine Ski Resort—remains open for business.

Finally, although travel restrictions haven’t changed, Henry reiterated that people need to limit all travel between communities to essential purposes, as travel over spring break has been transporting the virus to various parts of the province.

"I was very hopeful, even as late as last week, that we could keep where we were. But the dramatic increase in the last five or so days prompted this,” Henry said.

In the Island Health region, public health officials say travel from other parts of the province over spring break led to increased case counts over the past week, but another factor driving transmission rates is the number of people each person is in close contact with.

“Part of [transmission] is being driven by 4.3 contacts per case. For much of the last year we were running less than two per case,” Stanwick said.

“This is somewhat reflective of people socializing more… A lot of the activities, from reports we’re getting, are taking place indoors and a lot closer than the two-metre [distance] we’re recommending.”

Responses

The new measures are mostly welcomed by experts, many of whom had been worried when the province continued to ease restrictions even last week, despite a clear growth in case counts and variants of concern.

“I was very worried before today to see the disconnect between what we know about COVID, how it's transmitted, and the measures that were implemented,” said Dr. Astrid Brouselle,  director and professor at the School of Public Administration at UVic on Monday.

“BC has been a bit slow in adapting their measures and sending out the message to the population. And I think that today, what we see with the declaration is really a readjustment to make sure that we send the right message to the population.”

The British Columbia Teachers’ Federation released a statement lauding the mask mandate for students in school—a measure they had been calling for for several months.

“Our unwavering advocacy has delivered some of the results we have been seeking, and now it’s time to shift our focus to the remaining health and safety concerns in schools throughout the province,” BCTF president Teri Mooring said.

The federation continues to request more hybrid learning options and ventilation systems in classrooms—something Brouselle also feels strongly about.

Citing WHO guidance on what constitutes a high-risk environment for COVID-19 transmission, Brouselle says classrooms qualify as they are confined spaces in which multiple people gather.

“In a very high-risk environment [like classrooms], what you need to do is to ventilate, to change the air around,” she said. “So this is one measure that should be implemented in schools, but for the moment, it's not the main recommendation [of the province].”

New kinks in vaccine rollout

Brouselle also notes that it may be time for BC to rethink its current vaccination strategy and switch its focus from an age-based rollout to targeting superspreaders or people who are more regularly exposed to COVID-19.

The province had launched an immunization program using the AstraZeneca vaccine that concentrated on front-line workers, in an initiative that ran parallel to the age-based rollout using Pfizer and Moderna vaccines.

However, like the rest of Canada, BC paused that program on Monday after the National Advisory Committee on Immunization (NACI) advised against administering AstraZeneca vaccine doses to people under the age of 55, following rare instances of blood clots in some people who were immunized in Europe.

According to Henry, there have been fewer than 30 instances of blood clots linked to this vaccine worldwide, out of millions of doses administered, but she said health officials are taking every risk seriously.

"Right now, if you have received the AstraZeneca vaccine, and it [has been] more than 20 days since you did, there is no risk," she added.

The ministry is expected to release more information about the AstraZeneca vaccine rollout in the next few days, after health officials complete their risk assessment. So far, there is no information about how much of a setback the suspension of these doses will cause in the grand scheme of BC’s immunization plan.

According to Stanwick, the Island Health region will be relatively unaffected by this pause of AstraZeneca vaccine delivery. The health authority only received 1,000 doses of this vaccine to begin with.

Out of those, only 427 doses were administered to workers at food processing facilities in the region; the rest were returned to the Lower Mainland where case counts have been higher for weeks.

“Our plan is to pivot to either Moderna or Pfizer, given that there’s an adequate supply of both of those vaccines,” Stanwick said.

For people like Flight Wang, who qualify for immunization as members of the “clinically extremely vulnerable” group, the AstraZeneca vaccine program is not the only kink left to work out. Though he received a mailed invitation to register for the vaccine on March 29, Wang has yet to be able to book his shot.

“I called the number I was supposed to call, and I called them, I guess, five times now,” Wang said. “I still wasn't able to book the appointment because there’s so many people trying to book it.”

The province will launch its online vaccine registration portal—currently only available in the Fraser Health region—provincewide on April 6.

So far, about 110,000 doses of COVID-19 vaccines have been administered in the Island Health region. According to an Island Health spokesperson, 15.9% of the region’s population had received at least one dose of the vaccine as of March 29.

Stanwick added that the health authority is well on its way to reach the target of offering at least one dose of the vaccine to every adult by July 1.

Blaming the youth

According to Brouselle, the very fact that most of the 20 to 39 age cohort won’t receive their first dose for months means this group will see higher rates of transmission than older populations.

“We always try to find the culprit… to put the burden on another's behaviour. But I think this is unfair,” she said, citing Premier Horgan’s decision to blame young people on Monday for this spike in cases.

“What we've seen with COVID is that the population over 60 is at risk of dying of the disease, and this is why we've decided to vaccinate [them] first… But what we'll see with the variants is that there will be a higher rate of transmission, and it will be [among] the youngest because the people over 60 will have some protection due to the vaccines.”

The premier’s comment also elicited anger and backlash online, with prominent figures like BC Green Party Leader Sonia Furstenau pointing out that people aged 20 to 39 are a demographic that perform many essential tasks in the workforce and do not have adequate support to work from home.

“Instead of blaming young people and telling them ‘not to blow it for us’ maybe government could look at the data and systemic conditions that are leading to higher case counts in this demographic and step up to help them. Just like we did for seniors,” Furstenau wrote on Twitter.

She points out that many people in this age cohort cannot afford to miss work because of the financial impacts of the past year. Many young people may also find it difficult to isolate as they live with roommates, rely on public transit, and care for younger children or relatives.

Despite announcing a closure of indoor dining spaces—a measure that is sure to disproportionately affect young people working in the hospitality sector—BC did not announce new financial supports for them. Horgan noted that his government is working on creating more financial support programs, but no details have yet been released.

The premier also incorrectly stated that restrictions on evictions remain in force. In fact, the ban on evictions for non-payment of rent in BC ended on Sept. 1, 2020.

Across the province, health leaders continue to call on people to follow all prior and new restrictions to bring COVID-19 and variants of concern under control.

On Vancouver Island, Brouselle says many have called for the province to take advantage of the region’s geographical isolation from the rest of BC and implement stricter rules against travel to the region.

For her part, she says travel to and from the Island can’t be avoided, as there are several reasons why people need to move back and forth, including for medical purposes and to transport food and other goods.

“We need to take into consideration that the virus will be everywhere, potentially, and just take the measures that will protect every one of us,”  Brouselle said.

“Thinking that we can just be on our own island, isolated? I think this is utopic.”