British Columbia public health officials held a virtual town hall Wednesday evening aimed at answering parents’ and workers’ questions about new COVID-19 guidance for the province’s child-care facilities.
The province released the new guidelines last week, which allow children or staff members who have been a close contact of a COVID-19 case to still attend the facilities, if they remain symptom free.
Under B.C.’s updated guidelines, children and vaccinated adults must stay away from child-care facilities for five days after catching COVID-19, while unvaccinated staff must stay away for 10 days.
The guidelines also say daycares should not close for public health reasons unless directed by a medical health officer.
Some parents have said they do not feel safe sending their kids to daycare under the new guidelines, while others have questions about how the new regulations operate.
Here’s a look at some of the key questions officials answered Wednesday.
How is it safe for an unvaccinated child who has been exposed to COVID-19 to come to daycare?
The change in guidance around close contacts is a reflection of the fact that the Omicron variant is much more transmissible, but less likely to cause serious illness, said Dr. Mark Lysyshyn, deputy medical health officer for Vancouver Coastal Health.
Children in particular, he said, are less likely to contract or transmit the virus.
“It’s really an infection that acts a lot more like seasonal respiratory viruses that we are very familiar with in society, like influenza,” Lysyshyn said.
“So we need to shift our management much more to how we manage those viruses.”
The most important thing is for people to monitor for symptoms and stay home when they are feeling unwell or developing symptoms, Lysyshyn said.
The reality is that there is a general risk of exposure in the community at present, he said.
“There’s widespread transmission of the virus in the community. People may know about certain exposures, but they’re being exposed in other ways as well,” he said.
“It’s just not a feasible strategy across our population to have contacts all be isolating right now.”
What is the definition of ‘feeling well enough’ to return to daycare?
Deciding when symptoms have improved enough to end isolation after five days will require people to be aware of what is normal for themselves and their children, and base decisions on that, said Dr. Jason Wong, associate medical director of clinical prevention services for the B.C. Centre for Disease Control.
“I appreciate how it’s a little bit vague,” Wong acknowledged.
Wong said evidence to date has shown that most transmission happens in the early days of infection, and that as people start to feel better their chance of spreading the virus decreases significantly.
“We are asking people to reflect and think of how they are feeling, and typically when they are feeling better the risk of transmission is lower,” he said.
Lysyshyn said if someone still has a fever, they should continue to isolate, but that if they still have other symptoms that are improving, such as a sore throat or runny nose, they can begin returning to normal activities.
If unvaccinated adults must isolate for 10 days, why not unvaccinated kids?
The updated isolation guidelines reflected the lower risk of children getting or transmitting COVID-19, but also the need to balance the harms of restrictions against the harms of the virus itself, several participants in the town hall said.
Deputy provincial health officer Dr. Reka Gustafson said after five days the benefit of isolating longer is much smaller, and that the trade-off of isolating a child for the extra time is not worth it.
“Whenever we apply public health measures we also want to think about the harms of the measures, and keeping kids (in) school and daycare where they do their social and emotional learning is extremely important,” added Lysyshyn.
“We thought it was important to decrease the isolation for children so they would miss as little school and daycare as possible, because it’s extremely important to their development.”
What about daycare centres with immunocompromised staff members?
Daycares with immunocompromised staff will operate under the same guidelines as all others, provincial health officer Dr. Bonnie Henry said.
Henry said the most important thing those staff members can do is get vaccinated, stressing that booster doses have proven highly effective at both preventing infection and serious outcomes.
Ensuring staff and children stay away if they aren’t feeling well is also crucial, she said.
“You need, as an immunocompromised person, to do all of those things that protect you best, which is getting vaccinated yourself, making sure you’re wearing a mask, taking all of those precautions to protect yourself, and those things, along with all of the other measures that are in place in the daycare, should protect everybody,” Henry said.
“All of the things that are in place make it a low-risk environment, even for people that are immunocompromised.”
Why shouldn’t daycares close for health reasons unless directed by a medical health officer?
This guideline reflects concern that some daycares could overreact to a staff member testing positive and close the entire facility unnecessarily, Gustafson said.
The message to operators is that they should check with their medical health officer before closing if they have concerns.
Lysyshyn said experience has shown that most exposures in daycare settings don’t actually result in transmission.
“So to close the entire facility when there’s been an exposure can really disrupt the service that’s being provided to essential workers and all sorts of people who need to keep working,” he said.
Wong said the guideline doesn’t ban daycares from closing, noting that they may have business or operational reasons for closing the doors — such as a lack of available staff.
Daycares should continue to notify their licensing officer and parents if they learn of a confirmed case, Lysyshyn said, but noted that with less testing there will be fewer cases confirmed.
Why is there no vaccine mandate for daycare staff?
Workplace vaccination requirements are for the most part not within the powers of the provincial health officer, Henry said.
The one exception to this is the health-care sector, such as doctors, nurses and long-term care staff, she said.
“In every other setting it really is about the employer and employee relationship around vaccination and the risk in their settings,” she said.
“There are many settings where we strongly recommend it and where we have been supporting employers.”
Henry said she believes all daycare workers should be vaccinated, and that they were given early access both to their initial shots and, as a result, to their booster shots.
How will the rapid tests for the child-care system be used?
B.C. is distributing a quarter-million rapid antigen tests to government-funded child-care centres.
Henry said the tests aren’t for children, and are to be used by symptomatic staff members.
She said the tests are not a silver bullet, and are only one tool to be used in conjunction with all other layers of protection.
A positive test is a “red light,” she said, but a negative test is not a “green light.”
“If you have symptoms and you test positive, then you should stay home for five days or 10 days depending on your vaccination status,” she said.
“If you test negative then you have to look … ‘How bad are my symptoms? Can I go into work?’ And if you make that decision to go into work, then you have to wear a mask, you have to make sure you are meticulously hand washing, you are doing all of those other things that are in place to protect us from spreading, even when we don’t know we have the virus.”
Bars, gyms and dance studios were ordered to close, so why not daycares?
Henry said the decision to close certain businesses was not taken lightly, and had to be weighed against their negative impacts.
Businesses that were ordered to close are home to more discretionary activities or social gatherings, while schools and daycares provide an essential service, she said.
“We know the downside impacts on children, on families, on people who work in that sector, but we also know they can be safely operated, and this is how we need to adjust to ensure we’re giving those important supports to children in our care,” Henry said.
Gustafson said when B.C. implemented more widespread closures early in the pandemic, it was partly because much was unknown about the virus.
She said public health had learned much about COVID-19 since then, including that it mostly spreads at home and in unstructured gatherings.
Officials do not want to further normalize closures as the primary response to infection prevention, she said.
“By and large, that’s not how we manage communicable diseases, and we’re returning again to that way of managing COVID-19.”