On Dec. 14, B.C.’s provincial health officer presented modelling that we could see upwards of 2,000 cases per day by the end of December — and without mitigations, cases will climb exponentially pushing hospitals beyond capacity.
Despite this sobering assessment, the B.C. government and public health authorities initially offered no strategy and no immediate interventions to blunt the coming tsunami of infection.
Then, on Dec. 17, officials responded with public health orders that will place some limits on large indoor gatherings and sports events, but speaking to CBC Radio, UBC professor and COVID-19 modeller Sally Otto said capacity limits are unlikely to be enough. Ontario has announced more significant measures than B.C. Still, the B.C. government won’t distribute taxpayer-funded rapid tests from the federal government before the holidays, even as other provinces have long been distributing the same take-home tests. The government made no commitment to ramp-up third doses. Many vaccine clinics are closing for the holidays, and reports are widespread that many people at the six-month mark have not even received an invitation to book.
The Omicron wave is here. And B.C. is out of step with other jurisdictions in its (lack of) response. Norway is enlisting the military to help get third dose vaccines into arms. Even the much-criticized Boris Johnson has raised the alarm — taking to the airwaves to warn the U.K. — and expediting boosters. Alberta, Ontario and Quebec join Nova Scotia, New Brunswick and Saskatchewan in making free rapid antigen tests widely available.
Too little, too late. Once again.
A recent estimate from the Ontario Science Table calculates the effective reproductive value of Omicron to be 3.06 as of Dec. 17. This means that for every one person infected, they go onto infect more than three others on average. Delta is infectious, but in most places we successfully brought the reproductive value closer to one. Omicron blows Delta out of the water.
There has been much optimism about the potential that Omicron results in less severe illness — but early data from Denmark shows that Omicron is resulting in a higher rate of hospitalization compared to previous variants. New modelling from Imperial College London suggests that Omicron is no less virulent than Delta. And even if it was, the tremendous transmission advantage renders this irrelevant in the immediate term.
Why? Simple math. Exponential growth of Omicron means that cases are doubling in such a short amount of time that health systems — hospital beds that must be staffed with a finite pool of staff — will be overwhelmed in a matter of weeks.
At this point, B.C. officials risk losing the public’s trust. They are inviting a preventable public health catastrophe that is likely to result in large numbers of infections, hospitalizations, deaths and long COVID. Our health workforce is already at the brink; our health system will go into free fall.
Through its inaction, the B.C. government is effectively endorsing a fifth wave that will necessarily lead to hundreds and hundreds of cancelled surgeries and routine procedures. Hospitals will need to free beds and, most importantly, reallocate staff to manage a wave of hospitalizations.
The B.C. government and public health officials can bolster our trust by embracing the large body of science that will help us blunt this coming tsunami of disease. Even with this incredibly transmissible variant, we are in a much better place to prevent transmission if are willing to communicate and act on the science:
COVID-19 is airborne. There is scientific consensus that its primary mode of transmission is through tiny aerosols that float in the air. These aerosols can reach dangerous concentrations especially in poorly ventilated spaces. We can’t help British Columbians protect themselves if we don’t directly communicate how the virus spreads.
Ventilation matters. As an airborne virus, improving ventilation in schools, workplaces, hospitals and long-term care, and other congregate settings should be a top priority. Omicron can spread with fleeting contact. Provinces, including B.C., have been reluctant to set any standards or mandate mechanical ventilation improvements in higher-risk settings such as schools. In spaces with limited or poor mechanical ventilation, portable HEPA units should be used to improve filtration. Monitoring ventilation with proxy measures like C02 monitors and keeping levels below 800 parts per million is also important.
Upgrade to tight-fitting masks and respirators. Tight-fitting, high-quality masks prevent us from inhaling aerosols. B.C. nor any Canadian province has set mask standards outside of health-care settings. Public Health Ontario recently issued new guidance that health-care workers in contact with known or suspected COVID-19 patients should wear N95 respirators. This is an improvement, but no such change to protect health-care workers has been issued in B.C.
In the early days of the pandemic with mask shortages, the public was discouraged from using medical-grade respirators, including N95 respirators or equivalent. But we don’t have supply shortages now. We need to urgently set mask standards in public spaces, provide clear public health messaging about the importance of high-quality masks and provide workers and low-income people with high-quality respirators. Following other countries, KN95 or N95 respirators must be a minimum standard in public places. We regulate pollution and outdoor air, why not indoor air when it involves prevention of disease?
Test, test, test and test some more. B.C. has had the dubious record of having lower testing rates compared to the other provinces. We can’t stop chains of transmission if we’re not testing at sufficient levels. The B.C. public health officer and government continue to downplay rapid antigen tests as one part of an effective strategy. Unfortunately, officials have spread misinformation about the effectiveness of these tests, and continue to refuse to provide the public access. (On Dec. 15, Health Minister Dix said that a rapid testing strategy is forthcoming, but provided no details as to when tests will be made available.)
Rapid tests are an effective public-health tool. They have been shown — as the name suggests — to rapidly identify infectious individuals and help prevent onward transmission. PCR tests, while providing higher sensitivity, are a confirmatory diagnostic tool. In B.C., officials have misunderstood the science behind rapid antigen tests, and refuse to unlock this tool in the face of the worst wave yet.
Workers can’t stop spreading COVID-19 if they lack adequate paid sick leave. B.C. recently announced plans to bring in five employer-paid sick days. This falls short of what health experts and economists have called for, and doesn’t cover the minimum time required for isolation if exposed to or recovering from COVID-19.
Use public health orders to reduce transmission. The orders announced on Dec. 17 are insufficient to address the seriousness of Omicron. There is no question it’s been an extremely challenging two years for small businesses. But once again we must use public health orders to close indoor dining, sports events and gatherings that provide opportunities for transmission — as Omicron can now spread efficiently between the doubly vaccinated.
Roll-out third doses like it means war. B.C. officials are stubbornly sticking to their third dose vaccination interval of six-to-eight months from the second dose, even as other provinces and jurisdictions are reducing the interval and mobilizing a wartime effort to vaccinate over the holidays. In Ontario, based on the recommendation of experts and with the support of Canada’s chief public health officer, the interval between second and third doses has been reduced to three months. B.C. health-care workers are exhausted and rightly need a break. We can’t rely on the same pool of health-care workers who we will need in hospitals. But we have many other professions — even outside of health care — who could be quickly trained and supported to safely vaccinate, freeing up critical staff. We must be creative — and quickly.
Adopt a “vaccine plus” strategy. Many researchers, scientists and the head of the World Health Organization have been very clear: we can’t combat Delta, Omicron or future variants by relying on vaccines only. Many wealthy jurisdictions, including B.C., have come to rely nearly exclusively on vaccines. Omicron makes it clear — beyond a shadow of a doubt — that we need both high levels of vaccine coverage and we need to master the basic airborne mitigation measures. These include consistent use of better masks, ventilation and air filtration, much more testing (rapid antigen and PCR) and adequate social and financial supports.
Adopting a vaccine plus strategy and eliminating community transmission reduces the likelihood of more mutations and variants with even greater immune escape. This buys us time to focus on global vaccine equity in the Global South. Relying solely on vaccines — and hoarding them in the wealthy countries — means this pandemic will never end. The more we allow this virus to spread widely — uncontrolled as we have — the more we will continue to ride the COVID roller-coaster as new variants emerge.
We’ve been here before. This time it’s worse — and our government is not acting on a clear and present threat. The longer we wait, the harder it will be to blunt this potential public health catastrophe.