British Columbia appears at the cusp of two possible pathways with the number of positive COVID-19 tests rapidly rising, largely concentrated in the Fraser Health region, and hospitalizations increasing.
One pathway could see cases spreading from the Fraser Health region to the Vancouver Coastal Health region and the prospect of reintroduced restrictions.
The other pathway could see successful contact tracing and isolation putting a cap on escalating cases in the Fraser Health region, a method that has been used successfully in B.C. previously, which could keep the rising cases and hospitalizations under control.
University of B.C. epidemiologist Daniel Coombs says the optimistic view is that outbreaks in the Fraser Health will be controlled through contact tracing and case numbers will start to decline in the region that runs from Burnaby to Hope.
“The less optimistic picture is that this outbreak in Fraser Health will ripple outward through the Lower Mainland, maybe into the Interior, maybe to Vancouver Island, and it will be the start of a much larger, more significant winter season of coronavirus,” said Coombs.
An eye will need to be kept on the rising numbers in the Fraser Health region and also on what is happening in schools, which reopened in September after being closed for most of May and June, said Coombs, who has expertise in mathematical models of pandemic growth and control.
Coombs noted the picture emerging in some other parts of the world is already concerning.
Case numbers in some European countries have reached record numbers and resulted in new lockdown measures.
For example, last week, Germany announced the closure of business such as restaurants, bars, gyms and theatres for at least a month. At the same time, France announced it will return to measures introduced during an eight-week lockdown in the spring, where people have to stay in their homes except to buy essential goods, seek medical attention or go out for one-hour of exercise a day. On Saturday, the United Kingdom announced another national lockdown.
Case numbers have also reached daily highs in the United States.
In British Columbia, in the month of October, there were more than 3,500 COVID-19 positive tests in Fraser Health, according to information from the B.C. Centre for Disease Control information.
The infections accounted for nearly 70 per cent of the new cases in the province and were nearly twice the level of new cases on a population basis compared to the Vancouver Coastal Health region. The last month of Fraser Health infections also account for one quarter of tested coronavirus cases in the past eight months in all of B.C.
Many of the increasing coronavirus cases in Fraser Health, the most population health region in the province at 1.8 million, are being linked to social gatherings such as weddings, celebrations of life, and holidays. The provincial health officer, Dr. Bonnie Henry, has already stipulated new rules that no more than six people can gather inside homes who are not among those living there. She has said more restrictive measures could be coming.
Hospitalizations in B.C. as a whole have gone up to levels similar to those from last spring, according to centre for disease control data.
As of now, hospitalization increases on a population basis are similar in Fraser Health and Vancouver Coastal Health, which has a population of about 1.25 million.
Deaths are on the rise, but have not reached the same rates as during the spring.
Caroline Colijn a Simon Fraser University epidemiologist, said the major concern of the “super fast” rise in cases in the Fraser Health region is that infections will spill into the populous Vancouver Coastal Health region and from age group to age group.
Recently, infections have spiked in younger age groups — particularly the 20 to 39 year age-group — but there is concern more cases means a greater risk of infections spreading to groups at risk of serious illness or death, including the elderly and those with underlying health conditions. To date, 85 per cent of deaths have occurred in people 70 years and older, nearly 70 per cent in those 80 years and older.
“You know there’s extra risks that (the increased cases) give to introducing COVID-19 to schools, to long term care, to workplaces, to farms, to gyms, to spins classes to karaoke,” said Colijn, a public health mathematician who joined Simon Fraser University in 2018 as a Canada 150 research chair from Imperial College in London.
These are the types of setting where COVID-19 is potentially going to cause large outbreaks, observed Colijn.
“No age group is an island. No, school is an island, no long term care facility is an island, we all have links to each other,” she said.
Despite the rising case numbers and hospitalizations, British Columbia is faring better than other nearby jurisdictions.
In B.C. there have been 51 deaths per million population and 282 COVID-19 test-positive cases per 100,00 population.
In Washington State, where there have been 324 deaths per million population and 1,470 test-positive cases per 100,000 population.
In Alberta, there has been 74 deaths per million population, with 632 cases per 100,000 population.