A senior B.C. public health official says the province is approaching a “transition phase” in its fight against COVID-19 — a point where health officials “stop counting cases like we have for this past 18 months.”
The comments, made by BC Centre for Disease Control (BCCDC) deputy provincial health officer Dr. Reka Gustafson, were heard Sept. 14 during an online seminar to help physicians and nurses navigate the pandemic across the province.
Instead of counting cases, Gustafson said B.C. needs to move to a “much more important measure” — hospitalizations, deaths and vaccination rates.
Others on the expert panel noted that B.C. is not quite at the point where it can stop counting cases, and that vaccination rates still need to improve to treat the virus as an "endemic" disease.
Glacier Media reached out to the province’s COVID-19 task force to confirm whether the province has a plan to draw down testing, but did not receive a response by the time of publication.
The comments come as COVID-19 case data from the BCCDC suggests the province’s mask mandate and other public health measures have curbed transmission of the virus in the Interior, a hot spot over the summer.
And in recent weeks, the announcement and roll-out of the BC Vaccine Card — required to enter bars, restaurants and several public gatherings — has led to a spike in unvaccinated people seeking out a first dose.
That’s all positive news. But according to modelling released Sept. 15 from the BC COVID-19 Modelling Group, there remain many blind spots. Growth in cases in northern B.C. “remains concerning” and it’s not yet clear what effect school reopening will have on transmission.
And while the announcement of the BC Vaccine Card nearly doubled the rate of unvaccinated people seeking out their first jab, full vaccination of eligible British Columbians is still far off, said Caroline Colijn, an infectious disease modeller at Simon Fraser University and researcher with the BC COVID-19 Modelling Group.
“According to the rates that we have seen in the past week or so, it'll still take a couple of months to get half of the people currently eligible and unvaccinated to be vaccinated,” said Colijn.
THE CASE FOR CONTINUED TESTING
While it's not clear when and how the province would move away from counting cases, Colijn said moving away from regular testing could reduce public health’s ability to track the effects of COVID-19 in three important ways.
First, reducing widespread testing would hamper public health’s ability to see what’s coming.
“I do think there's a case for counting cases because it gives us an earlier warning of what's happening than looking at hospitalization,” she told Glacier Media.
It takes time for an infection to take hold and a person to get tested, and only tracking hospitalizations would likely lead to a two-week delay, said the researcher.
Second, Colijn said tracking cases helps the public health system understand breakthrough infections, or those that occur in fully vaccinated individuals.
“Do breakthrough infections that don't cause hospitalization still give people a risk of long COVID? Because we might want to know that, and if we don't have the cases, and the testing, we aren't going to be able to know that,” she said
Third, as the virus evolves, Colijn said not testing widely will limit B.C.’s ability to understand if breakthrough infections are linked to a dangerous new mutation more severe or more transmissible than even the Delta variant.
“If you don't test, you don't have samples of the virus to sequence, so you can't sequence them and then you can't see how the virus is evolving.”
CONTACT TRACING AND ISOLATION
Alberta chief medical health officer Dr. Deena Hinshaw has been criticized for signing off on a plan to reopen the province too early.
After reopening on Canada Day, Premier Jason Kenny’s “best summer ever” quickly turned into a public health crisis as cases surged.
Later, the province would move to eliminate testing, as well as contact tracing and mandatory isolation.
On Tuesday, Vancouver Coastal Health public health nurse Nomi Mate, who coordinates COVID-19 vaccines for inner-city vulnerable populations, signalled to the expert panel that the health authority had already moved to reduce contact tracing and mandatory isolation.
“We are not isolating all of our contacts anymore. There’s very few people that are being isolated now, and it’s only pretty much if they haven’t been vaccinated or just recently vaccinated,” she said, adding her teams were only completing “initial contact tracing.”
“I don’t know what the magic answer is around the testing,” added Mate, signalling Gustafson and other health officials on the call, “but they have mentioned a shift in not necessarily testing to find every single case.”
Contrary to Mate’s comments, Marielle Tounsi, a spokesperson for the Ministry of Health, said contact tracing has fluctuated throughout the pandemic as needed, and that in the last number of weeks, more people have been hired to deal with rising cases.
Tounsi also said that while all test-positive cases are contacted, “the most intensive case and contact management is now prioritized to support individuals at highest risk of severe outcomes.”
The goal to complete contact tracing and notification remains at 24 hours, said Tounsi.
“We are achieving this goal in most cases around the province,” she wrote in an email.
Would dialling back contact tracing and mandatory isolation put B.C. at risk for an Alberta-like wave? Not likely, said Colijn.
For one, the province has an indoor mask mandate and vaccine passport system in place, as well as a higher vaccination rate than its neighbour (86.3 per cent of eligible British Columbians have received their first dose compared to 79.6 per cent of Albertans).
While Colijn is quick to criticize any plan to curtail testing, she’s more open to reducing contact tracing and mandatory isolation. That’s because reopening public life in B.C. makes contact tracing increasingly expensive and infeasible — the more people visit schools, friends, colleagues and other businesses, the number of calls a contact tracer has to make starts to balloon, she said.
“Maybe instead of just abandoning the idea and importance of contact tracing, we should be saying to people who test positive, ‘It is very important, but not mandatory, that you isolate, it is very important, not mandatory, that you inform your contacts,” she said.
“We could be exploring wider use of rapid testing instead.”
SCHOOLS: A WILDCARD?
Despite a number of cases in B.C. schools last year, multiple studies have found transmission remained low among students and staff. But those studies were conducted before the more infectious Delta variant took hold in B.C. With a large share of the population over 12 years old already vaccinated, it's likely children will make up a greater percentage of those infected.
Still, Gustafson stressed structured activities like school, post-secondary institutions and workplaces carry very little risk.
"Returning to normal societal function is a priority, it’s a health priority, it’s a societal priority and it’s an economic priority," she said.
In one question to the panellists, a physician asked what can be expected when vaccinations are finally approved for children under 12.
Dr. Manish Sadarangani, head of the Vaccine Evaluation Centre at BC Children's Hospital, said vaccine approval would likely come in stages, with those between six and 11 likely approved first because that's who is furthest along in the mRNA vaccine trials. Younger cohorts, he said, would come later.
"The earliest could be one to two months," said Sadarangani, stressing the timeline could easily be extended. "I don’t know what our recommendation will look like. It could be a universal recommendation, it could be a high-risk-group-only recommendation."
Gustafson, meanwhile, warned that a vaccine recommendation for all children under 12 was not a certainty.
"This is an infection of everybody but an illness of adults, and particularly older adults," she said. "So it is not a given that even if a vaccine is approved, it will necessarily be recommended or universally recommended."
In the United States, where some have been alarmed over a rise in cases among children, the number of kids dying of the disease remains a mere fraction of the total deaths. Of the 545,000 deaths due to COVID-19 across the country, less than 550 occurred in people under 17 years old. That's less than 0.1 per cent.
In Canada, federal health authorities have recorded 15 COVID-19 deaths among those under 19, accounting for about 0.1 per cent of the total deaths.
But for SFU's Colijn, relatively low risk in a global pandemic does not mean no risk, as was seen Sept. 17 in Ontario with the death of a child under 10.
“They are at less risk than adults. But if the risk for adults is kind of terrible, then being less than that doesn't actually mean it's low, you know, low enough that you don't worry about it,” said Colijn.
A LARGER CULTURAL SHIFT
Asked how long COVID-19 will threaten B.C., Gustafson said British Columbians will need to learn to live with the virus.
Even if the province can achieve significantly higher vaccination rates, the health official said the best we can hope for is that it will become an endemic disease like influenza.
In the meantime, more people need to get vaccinated.
“We’re still at a stage where it’s too risky to have natural infection because of its potential to overwhelm our hospitals and intensive care units,” said Vancouver Coastal Health's deputy chief medical health officer Dr. Mark Lysyshyn.
Testing, said Lysyshyn, needs to still be available in the near term.
But as Gustafson put it, such heightened surveillance will have an end date.
“We’re in a transition phase where our perception of the risk of COVID is causing as much destruction to society as COVID itself,” she said.
“We have focused solely on COVID-19 for so long. It is on BCCDC’s dashboard — with cases being the number one thing and I apologize for that.”