Greater Victoria COVID Community Task Group | March 4, 2021 Update - Divisions of ...
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Greater Victoria COVID Community
Task Group | March 4, 2021 Update
Dear Colleagues,
In this update we want to give you “the back story” on some of the recent rumours and headlines that are
causing concern. We also want to pull together some emerging themes, and to highlight some things you may
have missed in the deluge of COVID-related information.
In this update
1. Where are we at?
2. What’s the near-term plan and what will it look like in my community?
For patients 80 years of age and older
Patients 60 and older
For Primary Care Practices
For children
3. What’s the longer-term plan?
4. What should Family Doctors in Greater Victoria be doing now?
1. Where are we at?
As you are no-doubt aware, Vancouver Island has done relatively well during the COVID outbreak. Compared to
the other Regional Health Authorities, Island Health
has done well with fewer than 0.3 cases per 100
population. There are likely many reasons for this and
we will leave exploration and analysis of those for a
future debrief. Regardless, what this has meant is that
on the Island we are better-prepared to move towards
immunization than perhaps the other Health
Authorities where staff have been redeployed into
contact-tracing and other roles.
You may have noticed the recent headline about
dentists, midwives and others being called in to assist
with immunizations, or even heard from your
colleagues on the mainland that this week they were asked to sign-up for mass immunization clinics. To clarify
the headline and why physicians weren’t included—the Public Health order it specifically refers to was to give
those groups the ability to do immunizations, something they don’t currently have: as physicians we obviously
are able to do immunizations, so don’t need an Order to enable it. Of course, the headline could have been
worded better so as not to cause such confusion.As for the mass immunization clinics, the BCCDC is rolling out a “mass immunization clinic in a box,” complete
with procedure documentation, daily/hourly immunization targets, etc. across the province.
If you are interested in assisting with mass immunization clinics (likely starting in April—with more information
to come next week), please sign up to indicate your interest using the provincial registry accessible at
https://www.doctorsofbc.ca/news/are-you-doctor-interested-delivering-covid-19-vaccines. Our understanding
from Doctors of BC is that your time will be compensated at sessional rates; we do not know whether you need
to sign up for a minimum number of shifts.
2. What’s the near-term plan and what will it look like in my community?
You may have heard that the immunization program is being run like a military operation, and that is very true.
From centralized procurement by the Federal Government to centralized provincial roll-out, to local
implementation by the Health Authority. This project is very-much a provincial one, run under the close
direction of Dr. Penny Ballem (Hematology), formerly a Deputy Minister of Health and the City Manager for the
City of Vancouver. While there is some room for local/regional customization, it is limited:
vaccine supply is constantly changing and so having as simple a logistics chain as possible is key;
the two initial vaccines approved by Health Canada had stringent cold-storage requirements which
couldn’t be met by most physician offices;
record-keeping is critical, both for who has received their vaccination and what they received, and when
they are due for their second dose (if applicable);
coordination of second doses (i.e. ensuring sufficient supply);
ensuring that this program happens on a massive scale—from a rough numbers perspective (with lots of
assumptions), between 7,000 and 10,000 people a day will need to be vaccinated in Greater Victoria in
order to deliver two doses by September. For perspective, during the first week of March, the targeted
80+/65+ clinics plan to reach 20,000/week in Greater Victoria. This is a lower number given that it’s the
first week, supply hasn’t completely ramped up, and there is a smaller—less mobile—population.
Patients 80 years of age and older
On Monday, the province released its detailed immunization plan. Those individuals 80 years of age or
older who are engaged with Island Health Home and Community Care Services will be contacted (via
phone from an outbound call centre) between March 1 and 15 to set up an appointment. Clinics will be
held on-site for independent living residents. Long-term home support clients will be scheduled to receive
their vaccination at an Island Health clinic or in home, depending on their needs.
Caregiving spouses who are 70 years of age or older living in the same household will be invited to receive
their immunization at the same time—this will be organized when the 80 year old books their
appointment.
Individuals not engaged with Island Health Home and Community Care Services will be asked to call a
contact centre in order to setup an appointment. Dates are staggered to avoid overwhelming the Call
Greater Victoria COVID Community Task Group | March 4, 2021 Update 2 of 5Centre. Those providing care for individuals in these groups can call on their behalf. Caregiving spouses
are NOT included for these groups, unless they themselves meet the age criteria:
March 8: seniors born in/before 1931 (90 years+)/Indigenous peoples born in or before 1956 (65
years+) may call to book their vaccine appointment;
March 15: seniors born in/before 1936 (85 years+) may call to book their vaccine appointment;
March 22: seniors born in/before 1941 (80 years+) may call to book their vaccine appointment.
Island Health’s appointment line for seniors is 1-833-348-4787. This phone line will open March 8th.
At the moment, there is no way to lookup whether someone is on the list, so best to wait until the end of
the relevant window: if a patient hasn’t been contacted, then there will be a number to call.
Patients 60 and older
In Phase 3 (April to June) British Columbians will register and book their appointments to receive their first
and second doses of COVID-19 vaccine through an online registration tool. People born between 1942
and 1946 (ages 79-75), and Indigenous peoples born between the years of 1956 and 1960 (ages 64-60),
will be able to register for an appointment online or by phone by March 31, 2021.
Primary Care Practices
On Monday the South Island and Victoria Divisions of Family Practice sent out a private survey to all
members, as well as to Office Managers. This is for those physicians, nurse practitioners, MOAs, and Allied
Health staff working in Primary Care Offices with direct or close patient contact. These individuals are
scheduled to receive their immunization during phase 2, i.e. prior to the general public (other than those
80+ or first nations’ elders 65+). Individuals who have already received their vaccination and/or are
waiting for their second dose should NOT use this survey. Please circulate to your staff: completed surveys
must be in by Friday.
Children
As you are no doubt aware, vaccines have not been tested in those under 16. Consequently, this group is
excluded from receiving the COVID-19 vaccine at this time, until robust evidence exists.
What’s the longer-term plan?
As you have no doubt heard, the approval of AstraZeneca by Health Canada, and the decision to delay the
second dose of Pfizer/Moderna vaccines has enabled the province to accelerate its immunization timeline for
first doses, from September to July.
Can we safely extend the second dose?
According to Dr. Henry, real-world data out of the jurisdictions that are ahead of BC in their immunization
roll-out (e.g. UK, Scotland and Quebec—and even in those first individuals vaccinated in BC in December)
seems to indicate that a single dose is about 90% effective after 3 weeks and that that level of protection
lasts for months.
Greater Victoria COVID Community Task Group | March 4, 2021 Update 3 of 5We now have variants spreading in our communities and schools. Even if they only have moderate illness,
a wave of unvaccinated younger patients (those less than 65 years old) could quickly overwhelm our
hospitals and ICUs. Consequently, there is a real urgency to get as many people vaccinated as quickly as
possible.
The Pfizer and Moderna vaccines seem to be operating like other multi-dose non-live vaccines where
immunity doesn’t suddenly drop off at 60 or 90-days, and in fact, longer intervals between the first and
second doses are often better.
Everyone recognizes that in ideal circumstances, we would run a formal trial with multiple intervals to
determine which is best, however, during a pandemic, where we’ve already seen more than 600,000 dead
between the US and the UK alone (i.e. almost the population of Vancouver Island), our medical leaders
are forced to balance science with both real-world evidence and our current clinical reality.
the lancet has just released a study looking at dosing intervals, and
the National Advisory Committee on Immunization has released an updated statement supporting
four-month dosing intervals.
Vaccination passports
Currently, Dr. Henry has indicated that BC will only produce paper immunization record cards, and that a
Vaccination “passport” remains a federal responsibility. While the idea of a passport appears to be gaining
traction, however, it does raises issues of global equity.
What should Family Doctors in Greater Victoria be doing now?
Until the majority of the population is immunized what should Family Doctors in Greater Victoria be doing?
Stay safe
According to Public Health, on Vancouver Island you are at the greatest risk of contracting COVID from
those who travel, followed by those you work with. This is because we tend to let our guard down in the
lunch room or when walking around the office. The temptation will be especially high once we have
received our vaccination(s); most of our patients won’t be in the same situation for a number of months.
Now is a great time to revisit your COVID Safety Plan, and also your plan for seeing patients in-person—
certainly a balance needs to be struck as some of your patients may have gone quite some time without
an in-person visit, however, it is completely appropriate to get a history over the phone or video prior to
bringing a patient in for a focused physical exam.
Greater Victoria COVID Community Task Group | March 4, 2021 Update 4 of 5Know where to turn for support
Messaging to help you Doctors of BC has created a COVID toolkit with patient-facing messaging,
help your patients FAQs, and scripts for your answering system, website and elsewhere.
Clinical supports to help Are you struggling to manage a patient with COVID systems, including
you help your patients those who are no-longer acutely ill? The RACE line now includes General
Internal Medicine for COVID.
Mental Health resources Sometimes keeping track of all the services available to your patients can
for patients be challenging, especially with changes during COVID. The Province of BC
has created a listing of virtual mental health services for those
experiencing anxiety, depression or other mental health challenges.
Mental Health resources It’s not only our patients who are feeling overwhelmed and burnt out—
for yourself counselling others often comes with a cost to our own mental health,
and if our resiliency is challenged we may not have the capacity to
provide effective care and support. Careforcaregivers.ca is a partnership
between the Canadian Mental Health Association and SelfCare BC. The
Physician Health Program is a confidential service offered 24 x 7 to
physicians and trainees.
Ensure your patients are best prepared
Undoubtedly, as more individuals are immunized, others will quickly start to relax COVID precautions such
as mask-wearing, physical distance and good hand hygiene. The BC Care Bundle was created by the
BCCDC, and is accompanied by a one-time payment funded by GPSC, to recognize Family Doctors
providing longitudinal care consistent with the Care Bundle so that those patients at highest risk of COVID
stay well. You can find algorithms and support materials on Pathways to help you implement the Care
Bundle.
Getting ready to immunize
For those in your office who may need a brush-up on immunization, consider taking UBC’s online Pearls
for Immunization practice course (CME accredited) which provides practical immunization information
and highlights important immunization resources. As mentioned, we don’t know when community
practices will be asked to assist with immunizations—at the moment we’re hearing sometime in April.
As Family Physicians, we have all been asked to carry a lot on our shoulders—by our patients, by our colleagues,
and by our leadership organizations. For each of us, this is in addition to what we already shoulder in our lives.
As a patient reminded me last week—don’t you burn out, otherwise who will be there to help me?
Remember to take some time for yourselves: balance—now more than ever.
Regards,
Drs Aaron Childs and Jaron Easterbrook
Co-Chairs, Greater Victoria COVID Community Task Group
A collaborative partnership between the Victoria and South Island Divisions of Family Practice and Island Health
Greater Victoria COVID Community Task Group | March 4, 2021 Update 5 of 5You can also read
