Canada

How B.C. aggressively 'flattened' its curve

The growing evidence that B.C. has weathered the coronavirus pandemic more comfortably than its Canadian neighbours has left many wondering why

The 271 beds with their clean white pillows, spaced metres apart in neat rows, are empty. The four nursing stations are unused. The temporary showers are dry.

Such is the scene inside the shimmering glass walls of the large building that looks out onto Vancouver Harbour. In normal times, the Vancouver Convention Centre was a bustling hub for thousands of people attending large events, day in, day out. Now, it is an overflow medical facility. One that may never be used.

The city itself is quieter than usual. Runners and cyclists get their exercise on quiet residential streets and in Stanley Park, where roads are shut. The sound of city traffic never fully wanes. On sunny days, the warmer weather draws clusters of two or three who sit on blankets at the beach, drinking from Thermoses, two metres apart.

The idea that a lone dog-walker could be fined just for walking through a park, as one man was in Ottawa in April, feels distant and laughable.

READ MORE: How a smallpox epidemic forged modern British Columbia

But although British Columbia has held back from some of Canada’s strictest social distancing rules, the province, guided by much-exalted provincial health officer Dr. Bonnie Henry, has so far succeeded in the elusive goal of “flattening the curve.” The now-familiar line on the graph that tracks the trend in COVID-19 cases is noticeably more horizontal, and more stable, for B.C. than for more-populous Ontario and Quebec.

In late April, about 2,100 people had tested positive for COVID-19 in B.C., and more than half of them had recovered. As in other provinces, B.C.’s elder-care facilities have been harder hit. Of the 109 who had died at the time of writing, a majority were residents of long-term care homes.

The province is far from out of the woods. But the feeling—and the growing evidence—that B.C. has weathered this global storm more comfortably than its Canadian neighbours has left many wondering why.

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The one “uniquity” B.C. has had during this pandemic is Dr. Bonnie Henry herself, says Jason Kindrachuk, a virologist and assistant professor at the University of Manitoba. “She has been such a strong voice of leadership through this entire crisis. She’s been able to really galvanize the public,” he says.

Henry, who took on her job in 2018, was part of the SARS response in Toronto, served on the front lines of Ebola outbreaks in West Africa, co-authored Canada’s pandemic preparedness plan, helped co-ordinate the H1N1 response in Vancouver and wrote a public health book, Soap and Water & Common Sense, in 2009.

She’s at the helm of a public health system in B.C. that is well-connected and boasts a “strong presence” in the province even at the best of times, says Susan Brown, president and CEO of B.C. Interior Health, one of five health regions. “Those linkages really help when you are in times of crisis.”

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Henry’s personal style is one people can relate to, Brown says. British Columbians have shown their appreciation with fan clubs, artwork and pet names (the SPCA named a pair of baby corgis Bonnie and Henry). The website of Vancouver shoemaker John Fluevog crashed as his new design, the “Dr. Henry,” went on sale and sold out almost immediately, with proceeds going to food banks. “We clearly underestimated your enthusiasm,” the brand’s Twitter account posted.

That she shed a few tears for families dealing with COVID-19 during a press conference was headline news; so was her DIY home haircut. Henry told the New York Times in early April the public accolades were in turn scary, embarrassing and touching. (Maclean’s made several requests for an interview with Henry, but provincial officials did not make her available.)

“She’s showing that she’s part of the community, too: ‘We’re all in the same boat. Don’t worry, I’m not breaking any of the rules that I told you,’ ” says Eric Li, an associate professor of management at the University of British Columbia. “I think it’s really a communication success story.”

Besides the fact that Henry is well-liked, there are signs the timing of her recommendations made a substantial difference. In B.C., public messaging on social distancing was stronger, and came earlier, than elsewhere, says Kindrachuk. “That ultimately had a really central role in decreasing the early transmission of the virus.”

“We were testing early and quickly,” says Christine Sorensen, president of the B.C. Nurses’ Union. “In the early days, there was some time lag, but it’s very quick now. Dr. Henry put in a number of measures early, and we managed to do those just prior to a large movement of people, which was spring break.”

READ MORE: Coronavirus in Canada: how to get tested, what the symptoms are, where to get help

Henry advised against non-essential travel outside of Canada on March 12, before school break, and asked returning travellers to self-quarantine for 14 days. On the same day, Ontario Premier Doug Ford was saying families should “go away, have a good time, enjoy yourselves.” The federal government didn’t mandate quarantine for returning travellers until March 24.

And while B.C. and Ontario both moved to ban gatherings of more than 50 people on March 16, Henry’s initial ban on March 12 covered gatherings of 250 or more. If nothing else, that meant four fewer days of concerts and conferences. Also on March 16, the province halted elective surgeries—a “very tough decision,” Brown says, but a key one that allowed hospitals across the province to brace for a surge.

There is another success story in the province’s prioritization of contact tracing, Kindrachuk says. “B.C. did a good job at going out to private laboratories and additional epidemiologists to try and get more hands on deck to help out,” he says. “Having the ability to do more testing, and to do more contact tracing, ultimately has been one of the game-changers.”

Olga Bitzikos is the senior environmental health officer with Vancouver Coastal Health, coordinating “pods” of health-care workers tasked with contact tracing and patient follow up. She helps oversee a communicable disease team of more than 120 people, some of whom worked in community health centres until recently, were former employees or did immunization work. Before the pandemic, it was a team of just 13.

Bitzikos often works late. At the end of hectic days spent in back-to-back meetings, helping teams navigate tricky situations, things are a little quieter and it’s easier to get stuff done. “The signal that tells me what time it is and that I should go home is usually when I hear the 7 o’clock cheer—the noise of people in the community banging their pots and pans to acknowledge health-care workers,” Bitzikos says in an email. “That’s when I realize I should get home for dinner.”

The job can be stressful, especially when clusters are identified that require more detective work to figure out who may have been exposed to the virus. Language barriers can be difficult. Some people are hard to reach: They may not have housing or a phone.

“I know we’re making a difference. But in order to make the difference, it does require us to make hard decisions. I think what’s challenging right now is that people don’t know when the end is,” says Bitzikos. “Right now the light seems a little bit far away at the end of the tunnel. But I think all of us who work here know what we’re doing is necessary and hopefully temporary.”

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Because Canada’s small population is distributed over such a massive geographical area, it will eventually be possible to understand why things worked or didn’t work with a regional lens, Kindrachuk says.

Emphasis on the future tense. While the pandemic rages on, experts agree it is a mug’s game to attribute B.C.’s relative success to one person or one policy, much less other factors outside of government control. Could warmer weather play a role? Does it matter if a population is more outdoorsy?

Although medical geographer Tom Koch, an adjunct professor with UBC, acknowledges much of the province’s success in controlling the spread has come down to luck—add to the list of factors that Quebec, which saw the biggest spike in cases, had its March break fully two weeks before B.C. and Ontario’s—but he thinks population density could be a factor.

B.C. has seen fewer COVID-19 cases than other provinces despite less strict social distancing (Alec Jacobson/Redux)

B.C. has seen fewer COVID-19 cases than other provinces despite less strict social distancing (Alec Jacobson/Redux)

“Frankly, just look at its size. The bigger the city, the denser the housing. The denser the housing, the more likely it is for a virus to prosper,” Koch says. Although Vancouver has more high rises than it used to, much of the city is low-rise sprawl. This can hamper the virus’s spread.

And British Columbia is a large province, Koch notes. What’s happening in Prince George is different from what’s happening in Victoria. “What goes on in Kamloops, you might say, stays in Kamloops,” he says. “The whole broad issue of the B.C. curve is something of a misnomer because it’s really what’s going on in each one of these cities.”

The Interior Health region has 22 hospitals across vast geography, including six mountain ranges. “Because we are so spread out, it makes it essential for all our staff, all our physicians, to be prepared to look after a client who may be positive,” says region president and CEO Brown. Being well-coordinated is important when a sick patient may need to access any one of the spread-out health facilities, she says.

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Emergency planning is robust after wildfires in 2017 forced the evacuations of 19 facilities, including four hospitals. “That brings a level of thinking that is unprecedented, even in this province,” says Brown.

The region is conducting its own testing, which can yield results within hours. “That really helps with getting on top of the contact tracing right away,” Brown says. But with remote cases come special challenges. If someone with a positive result lives six hours away from a hospital, they can recover at a “community cohort centre,” sometimes a hotel, closer to health care resources. With only 169 positive cases and two deaths in the region at the time of writing, Brown says no one has availed themselves of the option yet.

For doctors closer to the Canada-United States border, their position on the map played a pivotal role in triggering early preparation. If you drive north from Peace Arch Hospital in White Rock, B.C., you reach the heart of Surrey, a large Vancouver suburb, in about 25 minutes. If you drive south, the Washington border is just eight minutes away.

On Jan. 21, when North America’s first confirmed case of the novel coronavirus was announced in Seattle, the hospital’s proximity to the U.S. was top-of-mind for its staff.

“We have a lot of patients that transit between Washington and Canada. So that was definitely something that put us on high alert,” explains Gurinder Johal, an emergency doctor. “It led our team to be reading more about COVID-19 earlier, and trying to identify it earlier.”

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The province had another early warning system in its large Chinese-Canadian community. Some are convinced governments and public health officials—including Bonnie Henry—should have paid more attention.

Even before China locked down Wuhan, where the virus originated, on Jan. 23, business was slowing down in Richmond, B.C., a suburb of Vancouver with a majority Chinese population. Malls were emptying, according to anecdotal accounts, which members of the community attribute to early, precautionary social distancing.

Kenneth Fung, a clinical professor in UBC’s school of population and public health, says knowledge of the situation in Wuhan and experiences learned during the SARS crisis meant Chinese-Canadians were wearing masks and cutting down on social activities early. “Governments were not as sensitive as the Chinese community,” he says.

Fully seven weeks before the province banned large events, many celebrations around the Jan. 25 Lunar New Year were being cancelled. “Both social- and work-obligation wise, everybody was, just, ‘Yeah, let’s consider not doing it this year,’ ” says Kevin Huang, executive director of the non-profit Hua Foundation, which runs programs in Vancouver’s Chinatown. “For me, it’s been very interesting to see how the community was so responsive, even though the Canadian government was like, ‘Don’t worry, we’ll keep an eye on it, it is far away.’ Very much the community was like, ‘No, no, we’re not risking it.’ ”

(“The risk is low to Canadians,” federal Health Minister Patty Hajdu was saying on Jan. 23, a day before the country’s first case was confirmed in Toronto.)

READ MORE: Footprints of the coronavirus: How it came to Canada and went around the world

Apparently confirming Fung and Huang’s theories is data from Vancouver Coastal Health’s deputy chief medical health officer, Dr. Mark Lysyshyn, who said in a Facebook live video in late April that about 10 per cent of the health region’s cases were in Richmond. Based on the suburb’s population, Lysyshyn’s estimate implies its rate of infection is about half of Vancouver’s, and about a third of Canada’s overall.

Huang laments the “silos of information” in B.C. that may have kept government from noticing this early preventative action. Where English is spoken less, community organizations on social media have had more to do with the dissemination of public health information than government communication, he says, although B.C. offers information in several languages. “A lot of the grassroots groups, including ones that are newly formed, are taking on the heavy labour.”

Social media has also bolstered compliance, says Eric Li, the UBC management professor. “It’s a very close-knit community. People know. ‘Eric, you came back from China yesterday.’ If you saw me in Walmart, you would share it with my group. ‘Eric’s not behaving today. He’s not following the 14 days,’ ” Li explains as a hypothetical, adding, wryly: “The fear of becoming the public target on social media is probably the same risk as getting the coronavirus.”

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Whether the province maintains its trajectory depends entirely on individuals. “This difference between what could have been and what has happened is because of the collective action of B.C. citizens,” an April 17 government report says. Its projections predict an exponential spike in COVID-19 cases if things go back to normal any time soon. “This slowdown is due to public health action, not herd immunity—and what happens next will also be due to public health action,” the report concluded.

Despite B.C.’s relative success, things have not been perfect. A conference attended by some 14,000 dental professionals managed to go ahead from March 5 to 7, the week before Henry banned events a fiftieth the size. The Pacific Dental Conference was linked to nearly 50 cases in several provinces. It is lucky that number wasn’t higher.

B.C. was also home to the country’s largest prison outbreak, with 120 inmates—40 per cent of its population—testing positive at the Mission Correctional Institution. One prisoner had died, with human rights groups demanding an inquest. And in late April, the province identified outbreaks in two chicken processing plants, with 92 employees testing positive for the virus between them. Henry said she found the new outbreaks “very, very concerning,” adding now is not the time to let up.

But like other Canadians, British Columbians are feeling economic and emotional strain.

On the third weekend in April, police arrested 14 people who broke into a closed Vancouver school and occupied it overnight to protest a lack of adequate, physically distant shelter for the city’s homeless. The same weekend, an “anti-lockdown” protest, in which some marchers were shoulder to shoulder, raised ire because it received a police escort. In an email, Const. Tania Visintin said the Vancouver Police Department had been “monitoring the situation” around the protest and tried to reduce its impact on the public. She didn’t say whether warnings had been given to those breaking social distancing rules, but confirmed police have as a rule not been issuing tickets.

And in a city that was caught up in protests against the Coastal GasLink pipeline not so long ago, others decry a double standard in the application of social-distancing measures, given that construction work continues on resource development projects.

In a much-watched YouTube video from mid-March, roommates Amy Shier and Vicki Ferguson pay tribute to Bonnie Henry. “You will lead us through self-isolation. We’ll work from home for you, ordering groceries, too,” they sing, in matching shirts. “We will cancel all our fun vacations. We’ll stay inside for you.”

But just as relevant for B.C. contrarians is Duncan Martin’s lesser-known “Nuanced Rebuttal to the Ballad of Bonnie Henry,” which has a verse that goes like this: “Bonnie Henry, Bonnie Henry, we give you thanks aplenty. Your glasses frames and Fluevog shoes must cost a pretty penny. But if teachers must do online class, and preachers cancel Easter mass, we’ll praise your name and pay your ass—but maybe shut down Coastal Gas.”


This article appears in print in the June 2020 issue of Maclean’s magazine with the headline, “The exceptional province.” Subscribe to the monthly print magazine here.