Public health officials in BC are expecting a major spike in hospitalizations related to COVID-19 and influenza this fall, but will not reinstate public health measures to prevent the spread of the viruses. 

Provincial Health Officer Dr. Bonnie Henry and Health Minister Adrian Dix announced on Wednesday that they expect up to 700 COVID-19 hospital admissions across the province at a time starting mid-November—the current number is around 350 people in hospital—and up to 1,200 admissions caused by influenza. 

To prepare, the province is looking to reduce the number of patients currently in hospital, by moving some to long-term care facilities or shifting their care to community clinics. In the worst case scenario, they are also getting ready to postpone scheduled elective surgeries again.

However, public health officials remain resistant to bringing back any measures that would prevent transmission of the viruses in the first place. 

‍

“We know that the impacts of this pandemic and of the measures that we’ve put in place across the board to protect people have had a differential impact on some people more than others,” Dr. Henry said. “We know that it’s impacted racialized communities. We know that seniors have been impacted.”

Though the summer months have typically offered respite from severe illness due to COVID-19, this year was different. Hospitals across BC experienced a summer surge in August, with the province’s reliance on vaccinations acting as its only widespread layer of protection against the virus.

“Bleak” situation in hospitals

At Saanich Peninsula Hospital, Dr. Jeff Unger says the summer wave of COVID-19 patients has mostly constituted young unvaccinated people, and people over the age of 60. 

“It’s the worst it’s ever been in my 22 years of career,” Dr. Unger told Capital Daily. “It’s COVID partly, and also there’s a huge worry among all frontline people about what will come with the flu this fall.” 

For the past two and a half years, the measures in place to keep COVID-19 from spreading also meant other viruses were kept at bay. Now, Dr. Unger says, there are already more people with respiratory illnesses ending up in the hospital—often with another illness made worse by COVID.

That’s in addition to patients ending up in the hospital due to complications from chronic illnesses after not being able to access proper care—either from a lack of primary care physicians or because their elective surgeries were postponed earlier in the pandemic. 

Combined with staff shortages, the situation has meant that over the summer the Saanich Peninsula Hospital has been running at up to 150% capacity. Before the pandemic, a five-hour wait time at the hospital’s emergency room was considered long. Now, Dr. Unger says he regularly sees people having to wait nine to 11 hours for treatment. 

“It's bleak. It's morally distressing. It's awful for patients,” Dr. Unger said. “It's hard to maintain your resiliency. Every time I think, ‘God it's a crisis and it can't get worse,’ it seems…to get worse.” 

Dr. Unger says he has heard talk of moving patients from hospitals to long-term and community care in order to reduce hospital occupancy and add more capacity to take on the fall surge of patients. Whether that’s feasible will depend on the province’s ability to find more staff.

“I just wonder how realistic that is, where they're going to find the beds for those people and where they're going to find the nursing staff at long-term care facilities to do that,” Dr. Unger said. The hospital’s emergency department, he said, is about to lose four long-serving nurses to retirement or other work. 

Virus spreading in schools

The start of the school year earlier this month has, anecdotally, coincided with more children in the hospital, according to Dr. Unger. 

“Most kids are pretty resilient and often can be managed as an outpatient, but…my sense is I'm seeing more sicker kids in [emergency] again now that need inpatient care than I did pre-COVID,” Dr. Unger said. “Lots of those kids didn't get exposed to the normal infections they would have over the last three years, and so now there seems to be a boom in all of those other respiratory infections.”

While the province no longer tracks COVID-19 case counts, some parents across the Island are sounding the alarm about the virus spreading in schools.

Dr. Amy Tan, a physician who lives in Greater Victoria, said her 13-year-old son tested positive for COVID-19 after exhibiting symptoms last weekend. Dr. Tan says her family takes heavy precautions (like wearing N95 masks) and limits their interactions (including no indoor dining in public spaces), so they believe he got infected at school.

“He's the only one masking in his class, including his teachers,” Tan told Capital Daily in a message. “No one else has been masking, including in the hallways during locker/class changes etc.”

Nanaimo resident Merle-Ann Breingan told Capital Daily her grandson caught COVID-19 in the first week after he returned to school. Then, eight more of her family members did too. No one in her family has been infected before, and all are vaccinated.

“I believe the vaccines help keep people from dying and out of the hospitals with serious problems,” Breingan said in an email. “But I also hear from a lot of acquaintances that they are not getting the next round of vaccines. They don’t usually give a reason.”

Dr. Tan said she has been practically begging the province to allow her son to get his fourth dose, or second booster shot, since he had to return to school seven months past his last dose. 

“To be clear, I didn't even want the bivalent for him... just the original booster as I know the studies show waning immunity at 3-6 months,” Dr. Tan said. Still, she said she was told to wait for an invitation. 

“We need more than vaccines, including masks and ventilation changes, but we also need the ability to access the vaccines within the window that science tells us they are needed,” Dr. Tan said. 

In BC, people aged 18 or older, and immunocompromised children aged 12 to 17, are eligible to get the bivalent vaccine—which targets the original SARS-CoV-2 strain and the Omicron BA.1 variant—when invited. Twelve to 17 year olds who don’t have other risks should be able to get a regular, unmodified COVID-19 vaccine as their fall booster shot.

Monitoring wastewater

Besides preparing to move some patients out of hospitals and encouraging people to get their booster shot, the provincial government said it is expanding some of the ways it monitors the spread of the virus.

In the next two weeks, the BCCDC will start collecting wastewater surveillance data in Victoria, Nanaimo, and Comox. This data has been available for months in the Lower Mainland, and shows the prevalence of COVID-19 in communities based on how much of it shows up in their sewage.

But, according to UVic professor and BC COVID-19 Modeling Group expert, Dr. Dean Karlen, this data will provide little information on how the virus is spreading in real time.

“If you look at it as a real-time monitor, it is very problematic,” Dr. Karlen told Capital Daily. 

According to him, wastewater surveillance data over a longer period of time does correspond with the level of hospitalization seen in communities, as the raw data evens out over time. But it varies greatly from day to day. 

“From a scientific perspective, we have yet to see any value in the wastewater data from BC,” he said. 

What is needed instead for people to understand how the virus is behaving in their community, is a count of daily hospitalizations due to COVID-19—something that is not available in BC. “Unfortunately, the monitoring data here in BC is limited to the weekly report of hospital admissions from a few weeks ago,” Dr. Karlen said. 

Hospitalization data is the only reliable metric of the extent and severity of COVID-19 in BC, as case counts are no longer reported accurately.

A recent BCCDC pre-print study, co-authored by Dr. Bonnie Henry, found that between September 2021 and March 2022, COVID-19 cases among all age groups were under-reported by 92 times.

‍