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New COVID approach: Hospital masking returning, but less talk of outbreaks

The province’s fall COVID-19 and flu-shot campaign is set to roll out.
COVID-19 antigen test kits are stacked up on a counter at the Yates Street London Drugs this week. DARREN STONE, TIMES COLONIST

As the province’s fall COVID-19 and flu-shot campaign rolls out today, expect to hear it billed as a respiratory season plan, with less talk of pandemic, boosters, mandates and outbreaks.

Once the vaccines arrive, shots will go first to those deemed most vulnerable, followed by other ages and groupings. Free shots will be delivered through pharmacies, public health units and doctors’ offices.

Medical masking by workers, visitors and volunteers will be required in hospitals and other health-care areas starting Oct. 3.

Island Health chief medical health officer Réka Gustafson, vice-president of population health, said once the health authority receives the vaccines, they will be made “immediately available” to people in long-term care facilities.

The new formulation is a “monovalent” vaccine, consisting of one Omicron subvariant, XBB.1.5. It’s expected to be effective against other circulating Omicron strains — EG.5 and XBB.1.16 as well as BA.2.86.

The National Advisory Committee on Immunization suggested in July that people get the updated vaccine if it has been six months or more since their last dose or infection. COVID-19 vaccines and flu shots can be given during the same appointment.

Invitations to book typically open up within days of the immunization campaign announcement.

What will be new this fall, however, is the terminology and tone around COVID vaccines and illness.

Provincial health officer Dr. Bonnie Henry has described the newest COVID vaccines as more updates than boosters.

Also, the threshold for announcing COVID outbreaks in hospitals is different than it was when fewer people had immunity.

Gustafson said COVID remains a significant illness for the very young and those who are older or have underlying medical conditions, but is generally a lot milder for most other people, with more than 90 per cent of the population having pre-existing immunity via infection or immunization or both.

“As well, the virus itself had evolved and changed and became a much less serious infection,” said Gustafson.

In its most recent report, the B.C. Centre for Disease Control said the province has seen increases in COVID-19 cases and deaths. The latest monthly situation report said there were 628 COVID cases in the province in the week ending Sept. 16, versus 366 in the week ending Aug. 26.

The centre says the number of deaths more than doubled to 22 in the week of Sept. 10-16 from 10 in the week of Aug. 20-26. On Vancouver Island, there were four deaths in the week ending Sept. 16.

Six outbreaks were reported in acute-care facilities and four outbreaks in long-term-care facilities in the week ending Sept. 16, in Interior Health and Fraser Health.

At Saanich Peninsula Hospital, about 18 patients had tested positive for COVID as of Aug. 31, but no outbreak was ever declared.

Island Health at the time would only say there were respiratory illnesses on the acute ward and in extended care, but the cases did not warrant calling an outbreak.

Gustafson said whether or not to call an outbreak is not solely determined by the number of cases under provincially agreed-upon definitions that change over time. COVID-19 is still changing and adapting, she said.

The B.C. Centre for Disease Control website says there are circumstances where cases of COVID-19 at a health-care facility do not meet the threshold for an outbreak, but require the same enhanced monitoring and additional measures to prevent further transmission.

Gustafson said one has to consider what calling an outbreak would change if the infection-control response is the same. When there’s a lot of COVID in the community, there will be COVID in health-care facilities, she said, adding the overwhelming majority of COVID-19 transmission happens in the community.

Factors that might trigger declaration of an outbreak include the severity of the illness in circulation, vaccination rates amongst patients, any increased prevalence of cases or spread of linked cases acquired in hospital or long-term care.

When an emergency-room physician at Saanich Peninsula Hospital complained to Island Health about COVID-19 cases at the hospital not being labelled an outbreak, a medical director expressed concern in an email about unintended consequences, such as patients not wanting to come to the hospital.

In the email, the medical director referred to the current approach as a more “informed approach” that does not “alarm the public and staff.”

A handwritten note was eventually posted on the doors of Saanich Peninsula’s acute-care ward advising patients and staff about increased respiratory illness on the unit and that “enhanced measures” were in place, including limiting visitors to one per patient and use of personal protection equipment.

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