Vancouver Island is awash with Omicron. What are authorities doing to slow it?

In the days and weeks leading up to the holidays, cases in BC have been on a sharp upward trajectory, and expert modelling shows the curve taking a vertical turn, with cases now expected to exceed 2,500 per day by the end of December.

Evidence from other jurisdictions shows the Omicron variant of concern, now detected in 89 countries, is doubling its infection rate in as little as two days. The first case in the United States was discovered on Dec. 1; by Dec. 20, it was already accounting for three-quarters of new cases in that country.

While scientists hoped initially that Omicron would cause a less severe illness than the delta variant, all signs point to the inevitable: even if illness is milder, which is yet to be definitively established, the sheer number of infections to come will be enough to cause severe illness in enough people to overwhelm the healthcare system because of this variant’s ability to get around two doses of vaccination.

Provinces like Ontario, Quebec, and Alberta responded to this looming threat last week and Monday by making take-home Rapid Antigen Tests available to all, shortening the gap between second and third doses to get more people protected against Omicron as soon as possible, and shutting down gyms and bars.

In BC, provincial modelling shared by the health ministry on Dec. 14 already indicated signs that in the worst-case scenario, the Omicron variant could cause up to 2,000 new cases per day by the end of December. Yet no new measures or restrictions were announced until three days later.  On Friday, provincial health officer Dr. Bonnie Henry reacted to rising case counts by announcing new guidelines on personal gatherings, pausing sports tournaments, cancelling New Year’s Eve parties, and requiring proof of vaccination for all organized events.

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The limits on gatherings don’t apply to religious gatherings, however, which can continue to operate at 100% capacity unless they decide to include unvaccinated people, at which point the limit is capped at 50%. The decision was made in spite of an outbreak on Vancouver Island in late November that was sparked by transmission at a church conference in Courtenay and was one of the sources of high case counts on the Island last week. The other main source was an outbreak linked to off-campus parties held by UVic students.

Nowhere has the Omicron variant wreaked more havoc—that we know of, based on data shared by the province—than on Vancouver Island, which had 48% of all known Omicron cases in BC (145 in all) as of Dec. 17. However it is impossible to know how many Omicron cases are actually circulating in our communities, as whole genome sequencing takes several days to confirm the strain of a positive test.

As case counts rise and the threat of hospitals being overwhelmed draws closer, calls for more measures—like providing rapid tests and speeding up booster shots—have grown louder from independent experts and scientists in BC.

These calls appear to be falling on deaf ears, however, as the provincial health officer and health minister took to the podium several times last week and provided a plethora of reasons for why they won’t be doing anything more any faster.

Their reasons range from misinformation to outright lies.

The emphasis, according to BC public health officials, remains on making sure everyone who is planning to gather over the holidays has had two doses of vaccine, despite evidence that this will not be enough to prevent rapid transmission in the community.

Adrian Dix and Dr. Bonnie Henry appear at a press conference on Dec. 17. Photo: BC Ministry of Health / Flickr

Island Health statements ‘make no sense’ amid rapid rise

Damien Contandriopoulos first found out about COVID-19 circulating at UVic from his son, a second year student, who told him about a party on Dec. 3 at which students contracted the virus.

“I heard about another bunch of people that either were people I know or friends of friends that caught COVID and they were all double vaccinated,” he said. “So connecting the dots, it was pretty easy to figure out by Dec. 9 that it was Omicron we’re dealing with.”

UVic initially said nothing to their on-campus community. A UVic spokesperson cited Island Health’s guidelines that only require them to issue a public notification “if there are high-risk contacts who cannot be identified” in their rationale for keeping quiet.

On Friday, Dec. 10, Island Health Chief Medical Health Officer Dr. Richard Stanwick announced that 30 cases had been linked to the parties. Two days later, UVic abruptly announced that all in-person exams were cancelled. As of Dec. 14, public health traced 137 cases to the UVic outbreak, 15 of which have been positively identified as the Omicron variant.

As of Dec. 17, there were 145 known cases of Omicron variant in the Island Health region alone—the highest out of any health region in BC—and Island Health said it can’t confirm whether more of those cases are linked to the UVic outbreaks.

While Island Health and UVic both insist transmission has been happening off-campus, Contandriopoulos—a professor in the university’s nursing department who held an applied public health chair from the Canadian Institutes for Health Research—said that statement makes no sense.

“By summer 2020, it became clear COVID was an airborne virus, meaning the way it is transmitted is just people breathing out tiny particles that are so light, they float in the air, and as soon as one person is infected in a room, that person is going to contaminate the air and someone else is going to breathe the same air and become infected,” Contandriopoulos said.

“For at least a year now, this is proven. What we are dealing with here is UVic communication, Island health communication, saying stuff that is very hard to discuss because it doesn't make any sense. Obviously, there is transmission on campus. Why wouldn't there be?”

Contandriopoulos himself knows of double vaccinated people who suspect they contracted the virus at CARSA, the main gym and athletic training facility on campus, because they were not close contacts of anyone who attended the parties, but it is difficult to ascertain where exactly they may have picked it up.

Island Health’s approach ignores evidence that COVID-19 spreads through aerosol transmission, and that approach extends to their plan for K-12 schools. By denying that COVID-19, and particularly the Omicron variant, can be transmitted in the air, the health authority is able to state that there’s no transmission within classrooms, thereby justifying their new approach to school exposure notices. Over the weekend, Island Health quietly updated their website on school exposures with a new statement:

“With the understanding and evidence that schools are not sites of any significant COVID-19 transmission and with high vaccine rates in 12 year old plus population and those 5-11 years old being vaccinated, Island Health will not be requiring schools to assist with determining any potential classroom COVID-19 exposures that may have occurred before the Christmas break,” the statement reads.

At last count, the site had 25 schools in Greater Victoria alone with active exposure notices, and 52 schools across the Island.

While public health officials continue to insist they are pausing exposure notices in schools because the transmission risk in those settings is low, this move appears to be one of the first signs of breakdown within the province’s contact tracing abilities. Henry herself admitted, on Dec. 17, that contact tracers will not be able to keep up with the demands of this fifth wave of the pandemic and will have to prioritize case management based on the level of risk, starting with cases in long-term care homes, congregate living settings, and hospitals. Everyone else will be expected to do their own contact tracing.

“[That means] for people who are having milder illness—vaccinated, younger people—being able to self-manage and notify their own contacts,” she said.

But residents in BC don’t have access to the same tools in other jurisdictions that would allow them to trace and contact their own close contact exposures, and the advice they receive in accordance with public health guidelines also has many confused.

Contact tracing on the brink of breakdown

Lauren, a community nurse and UVic student who requested anonymity to protect the identity of her close contacts, found out she had COVID-19 on Dec. 12, after testing herself using a rapid antigen test she had purchased at a nearby pharmacy. She then decided to get a PCR test for confirmation, and was asked to go inside the Victoria Conference Centre to do so.

“I was told by the nurse that I wouldn’t find out what variant I had,” Lauren said. “However, I had been reading a lot about Omicron and I listened to an interview with a South African chief medical health officer describing the symptoms and they were consistent with mine.”

Contact tracers, who were following the current public health guidance, then told her close contacts that because they were vaccinated, they would not need to self isolate. They were told to simply monitor themselves for symptoms. This information worried Lauren, who says she had told them that she had been to the UVic gym and knew about an outbreak among varsity athletes.

“I was really surprised, just based on what I had described to them in terms of the risk of my exposure, that they felt confident in telling me that my contacts didn't need to self isolate,” she said.

As a healthcare worker who knew the risks and had paid attention to how the new variant behaves, Lauren told her close friends to isolate anyway. Sure enough, some of them developed symptoms just days later. Had they not self-isolated right away, they may have unwittingly spread the virus to others due to how quickly Omicron becomes contagious—as little as three days.

There are currently no known plans for the provincial government to change their guidelines for when close contacts of COVID-positive patients need to start isolating.

In the aftermath of the outbreaks at UVic, Henry stated in response to a reporter’s question that about 10,000 rapid test kits would be made available to students, staff and employees and the university. These tests, however, will only be made available to those who Island Health identifies as an asymptomatic close contact of someone who tested positive for COVID-19.

The problem with this approach is twofold: the imminent breakdown of contact tracing abilities means many will go undetected; and not making rapid tests widely available to all means cases like Lauren’s will not get caught, as she was not a close contact of anyone who attended the off-campus parties and is not a varsity athlete or a contact of one.

The fact that BC has no publicly available system to dispense rapid tests—and won’t announce their plan to distribute them until Tuesday afternoon—means Lauren’s friends, who were her close contacts, live outside the city, and don’t own a vehicle, were encouraged by a public health nurse to take a taxi to Langford just to get a PCR test on site.

Over the past week, the PHO and health minister provided numerous reasons for why take-home rapid tests are available in other provinces but not in BC. First, Henry said BC wasn’t sent the right type of test that can be taken home, like other provinces. Then, she said the tests we do have come in large boxes of 25-30 tests and breaking those down into smaller kits for individual use would take too much manpower. Nova Scotia solved this problem in September by enlisting the help of volunteers.

The next day, minister Dix chimed in, saying none of the 24 rapid tests in Canada are “on label designed as at-home tests,” and implied that other jurisdictions don’t “follow the science” like BC. Then on Friday, when asked why they won’t expedite any plans to distribute rapid tests, Henry said simply, “We can’t make things available that we don’t have.”

Federal data shows BC has been given 3,399,612 rapid tests, and only 326,019 (or about 9.5%) have been used—Dix said on Dec. 15 that we’ve used about 555,000 rapid tests, which is not corroborated by Health Canada’s chart. The BC health ministry has not provided its own accounting of the tests.

Even as late as Dec. 14—the day Alberta announced their plan to roll out rapid tests for everyone—Henry was downplaying their significance as a layer of protection ahead of the holiday season. “Where those tests can be useful is where somebody has been exposed or has somebody in their household that is a case… that’s how I would advise people,” she said at the time.

Slow 3rd dose rollout among high risk groups

The second big difference between BC’s approach and that of provinces like Nova Scotia, Ontario, Saskatchewan, and Quebec is the interval between second and third doses.

While other jurisdictions have begun shortening the gap from six months to three, BC continues to follow the official guidance from the National Advisory Committee on Immunization (NACI). Both NACI and the American CDC currently recommend six months between second and third shots.

Booster shots in BC were prioritized for seniors, Indigenous peoples, and healthcare workers—all vulnerable groups that were supposed to get their third dose within six months of double vaccination.

But people like pharmacists and community healthcare workers who got their second doses earlier have been waiting longer than six months for their booster.

Dr. Bonnie Henry appears at a London Drugs pharmacy in December to recognize the "pivotal role" pharmacies are playing in the vaccine rollout. Photo: BC Ministry of Health / Flickr

“A lot of my friends and colleagues actually have been in the past couple of weeks, really confused about where they are going to be getting their vaccine,” Lauren said. “There's been this delay in boosters for health care workers and I would say that my colleagues are absolutely at risk right now.”

In a statement, the College of Pharmacists of BC confirmed rumours that community health care workers wouldn’t receive an invite to book their boosters until early January 2022.

The province also plans to use community pharmacies as additional sites for booster shot administration—a process that will be completed by mid-January—but the current plan for pharmacists themselves means they’ll be left vulnerable to Omicron.

When asked why the province isn’t speeding up their provision of booster shots and whether there is a supply or staffing issue, Dix simply stated that the province’s booster program is already speeding up. Ministry of Health data shows that as of Dec. 20, about 14% of the population of BC has received a booster shot.

“In general in BC, we follow the science. We laid out a detailed plan on October 26,” Dix said, referring to a booster shot plan that was created before Omicron was detected anywhere in the world. “This is not an issue of supply.”

Instead of ramping up booster shots to make them available at least to everyone who got their second shot six months ago, the province is shutting down vaccine clinics over the holidays. In the Island Health region, there’s an expectation that some vaccine clinics will close for holidays   in the next two weeks. The government website listing their hours, however, was down “for maintenance” for several hours leading up to publication time on Monday.

It’s too late for Denmark

While BC’s public health officials talk about following the science, data from one jurisdiction the science is based on paints a frightening picture of what’s to come.

According to a recent Washington Post article, scientists in Denmark—a country that as of last week conducted double the number of COVID-19 tests as Canada despite having a much smaller population—found that even in a moderate scenario, hospitals in the country could see 500 new COVID-19 patients being admitted every day in two weeks’ time. The nation has never had more than 1,000 COVID-positive patients in hospital at any time during its peak.

So far, their data shows that the hospitalization rate for those who contract the Omicron variant is slightly lower than it is for delta, but researchers won’t know for sure until a few more weeks have passed, given the lag between infection and hospitalization.

At the moment, Omicron cases are doubling nearly every two days in Denmark. Although public health officials had taken urgent measures to combat the onslaught, like closing schools seven days earlier than planned, scientists told Washington Post that even a full lockdown will not be enough to prevent this fifth wave from spiralling out of control and overwhelming hospitals.

In BC, independent experts from the BC COVID Modelling group were already calling for people to avoid large gatherings and for the province to improve contact tracing and testing capacities, among other measures, on Dec. 8. That’s when they released a report that predicted that Omicron would have a growth rate of up to 17% in BC, consistent with findings from the UK and South Africa. That turned out to be optimistic.

On Dec. 16, one of the experts from that group, UVic professor Dr. Dean Karlen, released an updated analysis of regional data and Omicron projections. The growth rate of the variant is now at 25% per day—doubling roughly every three days—which means we could see over 2,500 new cases per day by Christmas, if the province is able to keep up with demands for testing. If not—a possibility that seems likely given already extended wait times for testing on Vancouver Island and on the mainland—it could mean that cases are going undetected.

As it stands, the current information available on the BCCDC dashboard is already outdated by more than two weeks—the latest available data is from Dec. 4 when 17% of cases were Omicron, but even by that point a sharp upward trend in Omicron cases and a drop in delta was obvious.

Last week, another group of independent experts called Protect Our Province BC held a press conference addressing the need for BC to take urgent action—like making rapid tests and booster shots available faster—to reduce transmission.

“The reality is, if we base it on what’s been happening the last several waves, we’ve always been two steps behind,” said Dr. Lyne Filiatrault, a member of the group and former emergency physician who played a significant role in keeping the SARS epidemic at bay in Vancouver. “And now we need to be two steps ahead.”

She and Dr. Gosia Gasperowicz, a developmental biologist and researcher at the faculty of nursing at the University of Calgary, shared information about why these measures are necessary. Citing data from the UK, they said two doses of Pfizer vaccine are only about 40% effective against Omicron, while three doses bumps that protection up to 70-75%.

Denmark followed that science, and is currently offering booster shots at 15 weeks (or 4.5 months) to everyone aged 40 years and older.

Even if in the unproven scenario that Omicron causes less severe illness than previous variants, their modelling shows that the variant’s higher transmissibility could still cost thousands of lives.

Source: Gosia Gasperowicz

“One of the things that I find with BC is we have this jurisdictional exceptionalism,” Filiatrault said on Thursday. “We need to look at what’s working elsewhere and we need to adopt it and bring it here.”

The definition of what constitutes a full course of vaccination, Filiatrault said, also needs to change in light of Omicron.

“If two doses of the vaccine don't seem to be enough against Omicron, fully vaccinated right now looks like it's three doses,” she added. “So our vaccine passport will probably need to be rethought in the face of Omicron.”

With a lack of action from the province despite these dire warnings and calls for additional measures, the Protect Our Province BC group wrote an open letter to Henry and Dix asking for lockdown measures. In their letter, they made the following three recommendations:

• Those who are able to stay at home should do so until booster shots, N95s, and rapid self-test kits have been distributed across the province. Health care workers in BC must be prioritized for third doses, and provided with N95s or the equivalent, as they are in Ontario.
• The public must have equitable access to high quality masks to protect themselves against airborne transmission. These should be made mandatory to enter any public building, and offered for free at the door.
• All Covid Public Health Safety Protocols must be updated to address aerosol transmission, especially in Long Term Care facilities, hospitals and schools.

Henry and Dix plan to roll out their rapid test deployment program on Tuesday, Dec. 21. They will be joined by public safety minister, solicitor general, and deputy premier Mike Farnworth, at 1:30 pm, and are expected to introduce strong new restrictions at the same time.

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Update on Dec. 21 at 8:30 am: Due to an editing error, the final two paragraphs were previously omitted from this story.