Q & A with Island Health

Island Health: Q & A about COVID issues

This is the last in a series of articles coming out of a ZOOM conference that Island Health officials had with a group of Cortes Island community leaders. First, Michele Crobsy, Director of Clinical Services Delivery for the Campbell River and Strathcona Corridor, gave an overview of how they respond to a COVID situation. Then, Charmaine Enns, Medical Health Officer for North Vancouver Island, explained, “There is a plan and it works.” This series concludes with select questions from a Q & A about COVID Issues.

The questions have been altered to preserve the identities of individual participants. 

What about schools?

Q/ I am totally in support of withholding the identities of individuals who test positive for COVID, but what about situations where there is a higher degree of exposure – like schools? 

A/ (paraphrased) – Schools have their own system in place. For example, there was a school exposure at Carihi High in Campbell River recently. It was publicly announced so that everyone at that school could watch themselves for symptoms. 

Close contact testing

Q/ What are the criteria for close contacts? 

Testing

Dr Enns said,  “Even on Vancouver Island, we only swab someone with symptoms but … right now, 99% of the people we swab do not have COVID. So, out of a hundred we swabbed yesterday, only one came back positive and [almost] invariably they were a close contact.”

When someone swabs positive, a nurse interviews them to determine the infectious period. They start at the point when their symptoms began. 

“Even people who have underlying medical conditions … can invariably say this is when something changed. On this date, I lost my taste and smell … I’m always healthy, never have a problem, but on that day I had a bit of a fever and a dry cough,” continued Dr Enns.

“Once we know when the symptoms started, we go backwards two days to identify anyone who has been exposed to that person during what we call the presymptomatic period. Then we go forward ten days from when symptoms started. So that full twelve days is what we’re calling the period of communicability.” 

“That [first] two days is a very precautionary capture of people, because we don’t have a lot of evidence that there is transmission in that period. It is our very precautionary approach to identify people who may have been exposed.”

“ … Once someone has gone ten days from when their symptoms started, we are very confident that they aren’t infectious anymore. In fact, the literature says probably by day 8, but we extend it by a couple of days to make sure we are going beyond that period of infectiousness. Occasionally some people test [positive] at the very end, or just past, and are infectious.”

“ … The test can pick up the virus for 100 days after somebody has been infectious because it is a very sensitive test that picks up genetic material of the virus. So a positive test does not mean you are infectious, it just means we have to investigate and define your infectious period. We have many people who are testing [positive] and are past their infectious [period]. That’s not a surprise anymore.”

Close contacts

She continued, “If you are sitting at the break room, across the table from each other, talking – maybe laughing, which increases the droplet transmission; you are sitting there for ten minutes, but you do that for two days in a row – that’s an exposure. That is a close contact because it is cumulative for more than 15 minutes during that period of infectiousness.”     

“ …. Sometimes masks will factor in; sometimes they won’t. So we do make a risk assessment based on the exposure and they types of exposure during that time and we will err on the side of caution.

Unreliable close contact information 

Q/ Have there been times when close contact information is not truthful?

A/ (paraphrased) – There are occasional errors, which Island Health believes are unintentional. When there is a concern, the community nurses follow up on the report and this has led to further information.  

How far back does contact tracing go? 

Q/ Does contact tracing go back to the origin points of the virus? Or is it  primarily concerned with the spread of the virus? 

 “When we do our case investigation, we always ask where you may been exposed … We are always trying to understand how that transmission occurred. … But we are in a Global pandemic, it is everywhere … we don’t live in isolation. Even in a remote community, people still come and go from their communities. So being able to say that person was responsible, means that person needs to identify that they were a close contact of a COVID case,” said Dr Enns.

She added, “We ask where have you been, what have you done over the incubation period. [if they respond] ‘Well I was in Alberta visiting family’ – there is our exposure. We don’t know exactly who they were exposed to, but they were in an area with increased activity. It is only reasonable to say that is where your exposure was.”

“ … Some people will say, ‘I have no idea’ – but that is not usually our story. Most people can give us an indication they were in the Lower Mainland, they went to visit family in Edmonton, or they had people visiting that had a cough and a cold …”  

They can rarely trace the origin point beyond geographic areas of exposure. 

Transportation for vulnerable people

Q/ Do you have advice about transporting vulnerable people, who do not have a car, to get their mail or pick up supplies? 

“ … First of all do a health check, make sure nobody has symptoms. Nobody should have symptoms … please do not pack the vehicle … If you are sharing a vehicle, you should all be wearing a mask … try to keep your windows down a bit …” said Dr Enns.

The passage describing the space between people in a vehicle was not clear, but this segment sounds like the BC Centre for Disease Control guideline for people who are self isolating, where it states, “ … sit as far away from others as possible.”

Dr Enns continued, “…if it is a van, you could spread it out more … People’s lives need to go on. So access to food, mail and other services needs to happen and it can happen, it is just a little weird right now.”

(Dr. Enns had to leave at this point, and Michele Crosby answered the remaining questions.)    

Reporting locations

Q/ Would it be possible to identify the communities where people test positive? I think something like 85% to 90% of the cases in North Vancouver Island are reported so vaguely that you can’t tell if they are anywhere near us. There have been rumours, but the first time I heard of a confirmed case on Cortes Island was about a week ago and it really brings home the point that COVID is here.

“That is certainly a conversation that I have been a part of for the last ten months … What I hear Charmaine’s voice [saying] in my head, is that we all just have to assume that it is everywhere,” said Crosby.

Communities get into trouble if they do not take precautions until they know the virus is among them.

“The virus has the ability to sneak in and spread among a whole bunch of people.”

Rapid Testing Kits

Q/ What does the government plan to do with the rapid testing kits? 

“I asked that question yesterday and here is the answer I received. Some Point of Care tests will be trailed on Vancouver Island over the couple of weeks, but at this time those sites need to be in a community with an Island Health lab to provide validation. With successful pilots we will then be able to consider and deploy to rural and remote communities,” said Crosby. 

Socializing for home Schooling kids

Q/ How can homeschooling kids have contact with other kids in a setting that is following the rules? 

Ms Crosby said she will look into this and subsequently emailed, “For home schooled children, there does not seem to be a public health sanctioned way to provide socialization with other children, this is proving to be detrimental to these children – are there suggestions of how the community might remedy this. I have attached the link to the province wide restrictions:
https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/restrictions

“This is a very readable document with many suggestions”

“Organized activities with a COVID safety plan look to be possible, it looks like this could be organized through the community centre or I would suggest reaching out to the school district to see if you can work with them to set up something for these children”

Youth Activities

Q/ What about youth activities like Teen Szene and horse back riding?

Ms Crosby replied by email, “Again I am going to refer to the link https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/restrictions
Under the section called sports and extracurricular activities there is a section called youth extracurricular activities that states that these activities can continue with a COVID safety plan in place.”

Visits: What about going for a walk?

Q/ It seems like inside family gatherings are no longer possible, what about going for a walk? 

“Gathering outside is fine if you are 6 feet apart … unless going for a walk with one or two people ends up going for a walk with twenty people and suddenly you are having a big gathering where you are not able to social distance … We are trying not to get within 6 feet of each other without a mask on, unless it is essential, “ said Crosby. 

She added that people visiting outside are less likely to transmit the virus. 

Top photo credit: Social Distancing Tandem by Mike Finn via Flickr (CC BY SA, 2.0 License)

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