British Columbia Is Starting To Flatten The Curve. Heres How Theyre Doing It

We’re not out of the woods yet.

That was the message conveyed by British Columbia ’s chief public health officer Dr. Bonnie Henry during her daily briefing Monday alongside Health Minister Adrian Dix.

But it’s a message that follows the slightest sigh of relief, and acknowledgement that strategies to limit community spread of COVID-19 are working — B.C. may in fact be “flattening the curve.”

“Our percentage of new cases, as you can see, has been slowing, has been bending, and that’s really important and is a testament to the effort that everyone here in British Columbia has been making for these past few weeks,” Henry said Monday.

“But we must keep that firewall strong.”

WATCH: B.C.’s public health officer says the province is holding its own against COVID-19. Story continues below.

While overall case numbers continue to rise, the daily number of new confirmed cases in the province has slowly dwindled, from more than 100 a day the weekend of March 27, to a handful this past week. As of April 8, the province has recorded 1,336 total confirmed cases and 48 deaths.

Even more optimistically, close to two-thirds of all confirmed cases — 838 people — in the province have “fully recovered.” 

On March 27, when modelling projected hospital capacity for the province, Henry said there was a “slight chance of optimism” that B.C. was moving towards flattening the curve.

And while new cases continue to be confirmed almost two weeks later, that optimism that the curve is starting to flatten is a lot more concrete. 

So how did the province do it? 

How to flatten the curve

First of all, a refresher on this “curve” we’re all talking about.

The epidemiological curve is a way of visualizing an outbreak or pandemic like COVID-19. By tracking confirmed cases over time, from start to finish, a curve will form. There will be a few cases to start, which will balloon into many, and then taper off when the outbreak is controlled.

The shape of that curve, though, is up to a lot of factors. And ideally, we want to “flatten” it — that is, limit the size of that peak of infections in order to not overwhelm our health-care system.

Many countries further along in the pandemic than Canada have already reached their peaks and started to come down the other side.

Some countries, like Italy and the United States, experienced or are experiencing sharp peaks in case numbers, while other countries like South Korea managed to bend the curve and not overwhelm health-care systems. 

In Canada, it’s too early to say for sure we’ve reached any sort of peak. But in B.C., officials have acknowledged that the numbers are encouraging. 

How B.C. is flattening the curve

Here’s how B.C. compared to the three other largest provinces in Canada when it comes to confirmed cases of COVID-19.

B.C. actually exhibited one of the earliest spikes in confirmed case counts in Canada, largely linked to one of the country’s first community outbreaks at the Lynn Valley Care Centre in North Vancouver. It was here that Canada confirmed its first death from COVID-19 on March 9.

And while the rate of confirmed cases in B.C and Alberta tracked similarly to that in Ontario and Quebec for the first few weeks, things began to split off dramatically around the week of March 27. 

Here we have a logarithmic scale, which many experts use to accurately show the curve of an epidemic. The flatter the line, the fewer new cases there are every day.

Of course, more populous provinces like Ontario and Quebec will likely have more cases on the whole than provinces like B.C. and Alberta. More people means more people to not only catch the virus, but spread it too.

But it’s the per capita rate that differentiates the provinces.

In B.C., there are roughly 2.5 confirmed COVID-19 cases in the province per 10,000 residents.

In Alberta, that number is around 3.14.

In Ontario, 3.6.

And in Quebec, roughly 10 in every 10,000 people tested positive for COVID-19.

Of course, none of these numbers take into account unconfirmed cases or testing rates. However, both Alberta and B.C., which have lower per capita rates of confirmed COVID-19 cases, actually have higher testing rates than Ontario.

Looking at B.C. and Quebec’s daily confirmed case increase side-by-side shows the stark contrast in the trajectory of the two provinces.

The biggest reason for that difference? Believe it or not, it’s likely spring break travel.

Spring breakers

Most jurisdictions across Canada adopted social distancing measures to varying degrees the week of March 16. For many Canadians, that day marked the first one properly working from home and the day “everything changed.” 

Over the ensuing weeks, provinces and cities rolled out measures like shuttering non-essential businesses, limiting large gatherings and enforcing social distancing. While the exact timing of these measures varied from province to province, across the four largest provinces restrictions have been roughly the same. 

The biggest difference between these jurisdictions is the timing of spring break, and the level of international travel.

Henry chalks up B.C.’s possible success in flattening the curve to being able to enforce social distancing measures before spring break — which in that province came two weeks later than Quebec’s — rather than after it.

“Some parts of it are luck, and some parts of it are being prepared, but we were able, I believe, to not have a lot of community spread before we recognized that we had some community transmission and put on the very restrictive measures just prior to our March break,” Henry said Monday.

“My colleagues in Quebec were reporting to us that their March break was two weeks earlier than ours and people were coming home from March break and getting sick.”

Quebec’s March break this year occurred from March 2 to 9, before Canada even recorded its first death related to COVID-19. By the time B.C.’s spring break rolled around on March 16, most people had cancelled their trips in the wake of the virus. 

Globally speaking, Canada is one of the more recent western countries to be hit by the epidemic. Community transmission of COVID-19 was already well underway in Europe in February and early March, when many Quebec residents were travelling for spring break.

That means many international travellers had already returned with the virus by the time Quebec started to implement protocol around containing community transmission. In B.C., on the other hand, measures were put in place before people even left, limiting new cases coming in from the outside and those people transmitting the virus within the community. 

“We put the measures on around the same time, but [Quebec] had a lot more community spread so they’re still catching up, and I believe that’s a similar situation in Ontario,” Henry said.

For every returning international traveller with the virus, there’s the possibility of them spreading it to others. Ontario is likely experiencing a sharper curve than B.C. because of the greater numbers of international travellers coming into or returning to the province, therefore spawning more spots of community transmission. 

But she also says at the end of the day, a lot of it comes down to luck.

“It’s very hard to know exactly why [B.C. is flattening the curve],” she said. “We took a lot of measures quite early. A lot of the work we did early on, we spent a lot of time doing wide testing.”

Henry highlighted the province’s rapid contact tracing of initial travel-related cases as a big reason community transmission hasn’t taken off outside of isolated outbreaks. But, Henry has continued to stress that things are far from over. Modelling released by the province March 27 predicted the outbreak’s peak could still happen in the coming weeks and months, depending on how strictly British Columbians adhere to social distancing and other preventative measures. 

“While there is some evidence we are flattening the curve, we need to double down now,” Henry said.

“My focus this week is to be supporting you all in making sure we keep doing what we’re doing — that’s making a difference.” 

On Wednesday, Henry acknowledged that B.C.’s trajectory going forward will be a “balancing game” as to when to ease up on social distancing restrictions.

“From the moment we put on these restrictions, we were talking about how and when to lift them,” she said. “There are ongoing conversations.”

She also said that how case rates continue to increase in other provinces, whether Alberta maintains a similarly levelled curve and what happens in the United States will also impact B.C.’s trajectory. 

“It’s all going to factor into what’s happening in the next 10 days,” she said.

CORRECTION: A previous version of this story gave the per capita rate at 1,000. It is per 10,000 residents. 

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