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BC Public Health’s pandemic response, the great TRIZ game!

BC is embarking on its fifth COVID-19 wave on the back of a yet to be resolved 4th Delta wave. Feels like déjà vu, except this time, it’s Omicron, a much more transmissible variant that evades antibody immunity provided by prior infection or a second dose of vaccine.

In BC, many double vaccinated adults are way beyond 25 weeks past their second dose and at a point where their vaccine protection against hospital admission with Omicron sits at 52% or less. As of January 3, only 19% in BC , across all ages, have received a third dose which boosts vaccine effectiveness to 88% against an Omicron hospital admission. 

More often than not, it seems like BC Public Health is playing TRIZ, a game often used by teams to help them innovate and reassess what they are doing to meet their goal.

Here is how TRIZ works: you aim for the exact opposite outcome to the one you want to achieve. You list all the interventions you would take to achieve this obviously ridiculous outcome. At the end, the team reviews the list and takes stock of all the things they're doing and that are preventing them from achieving their real goal.

Humour us and let’s give it a try.

How many things can Public Health and the BC government do to maximize the spread of Omicron infections in our province? Here are our entries:

  • Let’s fail to recognize that COVID is spread through aerosols in the air we breathe and share.
  • Let’s promote poorly fitting masks like “baggy blue” medical masks or poor filtering cloth masks by making sure to wear them (but not when speaking) at every BC government COVID-19 briefing.
  • Let’s not allow immunizers and staff working at vaccine centres to wear higher quality masks or respirators and let’s ask the public to replace their higher quality masks with a poorly fitting medical one.
  • Let’s make sure to keep restaurants open during unprecedented high case counts and encourage individuals to take off their masks for several hours at their tables.
  • Let’s not use the Rapid Antigen Tests provided by the federal government more than a year ago to screen individuals for their ability to infect others. (They are not sensitive enough to diagnose COVID so we shouldn't use them at all, or at least not until we run out of Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) tests and have no other option!)
  • Let’s make sure there are not enough testing centres and make them hard to reach. That way people will use public transit to get to them and share the virus with other passengers.
  • Let’s make sure the pandemic data we have is incomplete, delayed, hard to find, and hard to apply to everyday life.
  • Let's make sure contact tracing exposure notifications are few and slow to come, particularly in schools. Because you know, schools are “safe” and we don’t want to worry parents and teachers.
  • Let’s make sure to always be two steps behind. This time it is with rolling out the third dose of the vaccine during an Omicron wave. Last fall it was with the third vaccine dose to residents in Long Term Care.
  • Let’s avoid providing access to federal financial support for businesses and employees impacted by Omicron. Instead of asking non-essential businesses to close and giving them access to federal funds, let’s encourage them to plan to operate with 20-30% of employees infected or in isolation.
  • Let’s all rejoice when, just as the Omicron wave turns into a tsunami, our BC Public Health Officer throws in the towel and says “I want to get out of the [Public Health] Order business.” 
  • Finally, let’s make sure to shorten isolation protocols with a highly contagious variant in circulation. Five days for “fully vaccinated” workers who test positive for COVID or have symptoms of COVID, but ten days for the unvaccinated. Testing prior to leaving isolation to make sure you’re no longer infectious to others? Bah, why bother?

You get the gist of how the game goes. We’re sure you can come up with more ways to spread COVID in BC.

For us, the final cherry on the proverbial sundae was the shortened isolation period during a wave of the highly contagious Omicron variant.

It is obvious that BC Public Health followed the US CDC guidance in shortening the isolation period. However, the science underlying a shorter isolation of five days is hard to come by.

Dr. Eric Topol, American cardiologist and scientist captured it well in his post:

Just like the two metre distance rule, five days is not a magical number of days after which COVID positive vaccinated people stop being infectious.

By now, many on Twitter have posted pictures of positive Rapid Antigen tests well past Day 5 of isolation:

The US CDC has been pressured to revisit its new shortened isolation guidelines and has now added a Rapid Antigen testing prior to ending five days in isolation but it is not a requirement: “If an individual has access to a test and wants to test.”

California, on the other hand, has mandated testing to end isolation after five days. And in the UK, anyone showing symptoms or testing positive for COVID requires ten days of isolation, which can be limited to seven days ONLY in the absence of symptoms AND after two consecutive negative Rapid Antigen Tests. Perhaps the most instructive reaction to this new recommendation is Taiwan’s rejection of the US CDC shortened isolation policy because they found that some cases of Omicron are infectious beyond twelve days.

Whether BC will adjust its isolation measures when they can no longer deny the overwhelming evidence that even here, in “our own pandemic”, individuals infected with  Omicron can be infectious well beyond five days, remains to be seen.

Returning to our TRIZ game, we need to review our list and identify which of the many egregious things BC is currently doing could be stopped tomorrow to ensure that COVID-19 does not infect our entire province.

We have all the tools we need to reduce community spread. The question is, is there any political will to do so in BC?

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