Why B.C. is flattening the COVID-19 curve while numbers in central Canada surge

The COVID-19 outbreak is currently more severe in Canada's two largest provinces than it is in British Columbia.

That's not opinion;it's fact.

Whether you go by confirmed cases or hospitalizations, by raw numbers or a per capita comparison,the virus has steadily grown in Ontario and Quebec.

But in B.C., hospitalizations and active cases have been flat for the last week. The disease growth curve, at least at this point, has been flattened.

So, what's the explanation?

"It's very hard to know exactly why," said B.C.'s chief medical health officer, Dr. Bonnie Henry, when asked about the difference on Monday. "Some parts of it are luck, and some parts of it are being prepared."

It's undoubtedly true that B.C. was able to learn from having a few isolated cases in January and February. It's also true the province has been lucky not to have a viral "super-spreader,"as has been the case in other places.

However, there's a little bit more to it than that.

Preparation, preparation, preparation

Dr. David Fisman, an epidemiology professor at the University of Toronto, said British Columbia's institutions for disease control have long been a model for the rest of the country.

"You've got a functioning public health system, with integration of lab and epidemiology and service in British Columbia," he said."Here in Ontario, we have had difficulties with public health leadership culture for a long time."

Fisman says B.C. was able to, as Henry put it, "take a lot of measures early" because it had the lines of communication to quickly scale up a unified response relatively early.

It meant a unified responseand messaging to the public were underway before COVID-19 was on the radar for many politicians.

Whereas in Ontario, it took a little longer for everyone to get on the same page.

Ontario Premier Doug Ford "has actually stepped up as a leader," said Fisman. "[But] one has to realize Doug Ford's not a public health physician. He's not a microbiologist, and he's not an epidemiologist. So, he's very much dependent on the advice he's given."

Timing of spring break

One way that played out was over spring break.

On March 12, B.C.recommended against all non-essential travel outside of Canada, while Ford told families to "go away" and "have fun" during the week-long holiday.

"You could see this coming," said Fisman."There was talk in the epidemiology field that we really can't have a million people return to Ontario from places with unfettered COVIDtransmission. It's gonna be a very bad thing for us, but we didn't use that opportunity."

At the same time, British Columbia was fortunate that the scheduled spring break for students was later than in other jurisdictions allowing health officials to adapt.

"We learned from Quebec," said Henry.

"Their March break was two weeks earlier than ours, and people were coming back from places like France, and coming home from March break and getting sick."

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Henry's role

Fisman also credited B.C.for putting in an early measure to stop health-care workers from working at multiple care homes, which was a big factor in preventing community transmission.

But ultimatelyhe believes a big part of B.C.'s fortune comes from the person who speaks to British Columbians at every news conference.

"Bonnie Henry stays at press conferences and answers the questions and doesn't shade the truth. She's frank and honest and emotional with people," he said.

"And given that part of this response depends on being altruistic and doing the right thing to help other people who we will never meet, having a leader who can articulate how we're all in this together and make a convincing case for why you need to do your part is very important."

Playing 'the hand we're dealt'

Henry's direct experience in overseeing Toronto's SARS and Canada's H1N1 outbreaks is the type of background that's impossible to quantify in a situation like this. Henry herself doesn't mention it at news conferences.

"Part of [curve-flattening] was the system we had in place to detect cases and part of it was luck, and part of it was timing," she said.

But Fisman believes Henry's experiencehas been crucial.

"We all play the hand we're dealt. [British Columbia] has played the hand they've been dealt very, very well. And you can see it in the numbers," he said.

"Ontario has played the handthat it's dealt in a way that is not the United States but I think Ontario is lagging."