What British Columbia got right in the fight against COVID-19

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      During her daily B.C. COVID-19 briefings, B.C. provincial health officer Dr. Bonnie Henry has often credited British Columbians with helping to avert a major health disaster. Our ability to wrangle the pandemic under control has been admired by many, including the New York Times.

      Yet the recent resurgence in Australia and news of American states reentering lockdowns demonstrate that mismanagement, complacency, or reopening too fast and too soon can undermine progress.

      To help counterbalance the troubling news of the past few months, here’s a look at what B.C. did right in the effort to stem the spread of COVID-19—with an eye on what needs to be dealt with to sustain this effort over the long term.

      B.C. provincial health officer Dr. Bonnie Henry and Health Minister Adrian Dix

      Pacific Rim proximity

      With our trans-Pacific travel routes, population demographics, and nearness to Asia and Washington state, many experts anticipated the pandemic would hit B.C. hard.

      University of Ottawa health sciences associate professor Raywat Deonandan was among those who believed so, based on those reasons plus the opioid epidemic and what B.C. physicians had told him.

      What happened in B.C. defied many expectations, however.

      “The rate at which it got under control was a little shocking to me,” Deonandan said by phone from Ottawa.

      Likewise, some of the earliest-hit locations close to China—including Taiwan, Vietnam, Thailand, Australia, and New Zealand—responded more effectively than some farther-flung places: Iran, Italy, Spain, Ontario and Quebec in Canada, and New York and Florida in the U.S.

      While the great mask debate rages stateside, Metro Vancouver citizens may have benefited from being well-acquainted with seeing Asian people customarily wearing them and stores selling them. In addition, Chinese Canadians, taking cues from and paying attention to China’s situation, became an advance-warning system in the Lower Mainland by taking precautions such as vacating restaurants and malls—a foreshadowing of what was to come.

      University of Ottawa associate professor Raywat Deonandan was shocked at how fast B.C. got COVID-19 under control.

      Timing and testing

      Many experts, including Henry, have partly credited B.C.’s success to timing and luck.

      B.C.’s school spring break, from March 15 to 26, took place later or lasted longer than those of Quebec (March 2 to 9) and Ontario (March 16 to 20). Prior to spring break, Henry had approved of people visiting outdoor-oriented locales, such as Whistler. However, the large numbers of infected travellers returning to Quebec from abroad prompted B.C.'s warning not to travel.

      Deonandan credits B.C. with testing quickly, with effective data-sharing (B.C. used its own test, whereas other provinces had to await federal confirmation), and—after health-care staff working at multiple long-term care or assisted-living facilities were found to be virus transmitters—with faster implementation of a single-site strategy for workers than Ontario and Quebec.

      On the line with the Georgia Straight, B.C. Health Minister Adrian Dix pointed out the Interior and Northern health regions didn’t have care-home resident cases (there were two staff cases), while there weren’t any care-home cases at all on Vancouver Island.

      However, Deonandan feels that all regions failed in hunting cases down as they arose, and that B.C. was slow to start that process.

      “Given that it’s an asymptomatic pandemic, you can’t just rely upon symptomatic people to present themselves—you’ve got to go out and find the asymptomatic ones,” he said.

      However, Dix said the early testing in B.C. was “essential” in breaking transmission chains and slowing virus spread, such as identifying the so-called Case 6 from Iran and those from Washington state, which recognized new sources of incoming cases not from China.

      Dix said that within this province, the places closest to the I-5 transportation corridor and Metro Vancouver struggled the most. Consequently, being early advocates for the closure of the Canada–U.S. border, he said, proved crucial. (Premier Horgan has also asked deputy Prime Minister Chrystia Freeland to address the issue of U.S citizens travelling through B.C to Alaska.)

      Another critical factor was amassing enough personal protective equipment (PPE) for health-care workers before shortages affected their ability to treat patients.

      Although Dix said that B.C. already had a “fairly good stockpile of PPE” before the pandemic took root, the usage rate increased “exponentially in February and March”. As supply chains from traditional sources like 3M collapsed because of demand, Dix said B.C. had to seek out nontraditional sources, independent of the federal government.

      He added that this will remain an issue, as the province has to continue to build up supplies for both the coming period and the long term, increase capacity for testing and contact tracing, and establish a plan for influenza season.

      B.C. Health Minister Adrian Dix

      Population and public messaging

      Overall, Dix also credits the leadership of Henry, deputy health minister Stephen Brown, and “outstanding [regional] medical health officers” such as Vancouver Coastal Health’s Patricia Daly, as well as Premier Horgan for not intervening as much as other premiers.

      Dix had also previously stated at a briefing that he thinks B.C.’s health authorities—five regional health authorities, the First Nations Health Authority, and the Provincial Health Services Authority—worked effectively together on a coordinated response, whereas Ontario has to work with a much greater number of health jurisdictions.

      In addition, B.C.’s population (5.1 million) is smaller than those of Ontario (14.7 million) and Quebec (8.6 million) and distributed differently. Also, B.C. only has one major metropolitan centre, compared with a few in Ontario, as Deonandan pointed out.

      Although Dix acknowledged that B.C. didn’t always get everything right, he said he believes that the province’s willingness to adapt is a strength.

      While Deonandan noted how Dr. Henry has previous pandemic experience, including SARS, to draw upon, he said he admires how she responds to and incorporates new developments.

      Both Henry and Canada’s chief public health officer, Dr. Theresa Tam, previously didn’t recommend masks, but they changed their advice after increased understanding of the virus. And Henry remained consistent in advising that masks protect others, not the wearer, which Deonandan said is accurate, whereas in the U.S. mask-wearing is portrayed as protecting oneself.

      In addition, B.C. proved to be innovative as well. Dix said that the self-isolation system for returning travellers was unique in Canada, and B.C. also implemented a system for quarantining temporary foreign workers (24 of whom tested positive while in quarantine).

      B.C. provincial health officer Dr. Bonnie Henry

      Needless to say, Henry’s communication abilities have been widely lauded.

      “Enough can’t be said around the singularity of the vision and consistency in messaging and the sobriety of that messaging,” Deonandan said of Henry. “She answers questions quickly and always in a consistent voice and a nonpolitical voice at the same time.”

      UBC psychiatry professor and The Psychology of Pandemics author Steven Taylor also approved of Dr. Henry and Dix's briefings, stating that they have established themselves to be “trustworthy sources” and consistent, in contrast to unreliable or non-science-based political figures.

      “They’ve been straightforward; they don’t sensationalize things; they acknowledge uncertainties; their advice is generally sound and practical,” he said by phone.

      When asked why Henry was allowed to take centre stage rather than the government (as in some other provinces), Dix explained that Henry led daily briefings from the outset because he thought medical announcements should come from medical professionals.

      “I personally felt it was important to not have…too many spokespeople,” he said, “that we had to give clear messages, that they always had to come from the same place at the same time.”

      Dix opted to cover “system announcements”, such as surgeries and strategies, and backed up Dr. Henry, often providing stronger stances on political issues including border control and anti-Asian attacks. He explained that their on-camera presentations reflect their organizational structure behind the scenes.

      B.C. provincial health officer Dr. Bonnie Henry and Health Minister Adrian Dix

      In contrast, Deonandan pointed out how Ontario's COVID-19 presentations made things unnecessarily complicated, had inconsistent messaging, were unclear about who was in charge, and focused on message management more than message transparency.

      “We made so many mistakes that we’ll be rewriting the textbook on how to manage this in the future,” he said of Ontario, “but it looks like the B.C. playbook will be one of the positive ones that we will look to rewrite that textbook.”

      Nevertheless, he believes that all of public health can learn how to improve messaging and conduct it in a more nuanced and strategic manner as we continue into new stages of the pandemic, with new challenges to face.

      Meanwhile, Dix expressed gratitude for the collective effort by British Columbians.

      “It’s one thing to provide public-health information, as Dr. Henry did—it’s another thing when people follow it and you can see the action in terms of flattening the curve from what people did,” Dix said. “It’s beyond moving.”

      You can follow Craig Takeuchi on Twitter at @cinecraig or on Facebook