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Good morning! Wendy Cox in Vancouver today.

On Aug. 12, Provincial Health Officer Dr. Bonnie Henry announced British Columbia would be the first province in the country to require workers in long-term care and assisted-living facilities to be vaccinated or lose their jobs.

At the time, the seven-day average of cases sat at 466, the start of a fourth wave powered by the Delta variant that has crested in recent days to hover between 600 and 700. Dr. Henry’s decision back in August to demand vaccinations for people who work with those most vulnerable to COVID-19 was well-timed and prescient.

On Tuesday, the deadline for workers to get the jab, only 4 per cent of long-term care workers and 3 per cent of those working in assisted living facilities had declined to get at least one shot. They represent about 2,000 workers who have not yet received any doses. The sector employs about 49,000 workers.

As Xiao Xu writes today, those workers have been placed on two weeks of unpaid leave to give them another chance to get their first jab, causing staffing shortages in a handful of long-term care homes in the province. Those facilities will need some extra help from the province, Health Minister Adrian Dix said Tuesday.

He said only a handful of facilities will be impacted by losing too many workers.

Menno Place in Abbotsford could be one of them. Karen Biggs, chief executive officer of the 700-bed complex, said some of her 675 staff have chosen to retire or take termination. As of Tuesday, nine regular staff and 19 casual workers remained unvaccinated, she said.

“We go into overtime almost every single day because of shortages,” Ms. Biggs said, adding she is losing one registered nurse and four recreation aids.

“When you have specific categories that you’re losing, it makes it very tough.”

While the vaccination rate among long-term care and assisted living workers is high across the province – a rate of about 96 per cent – the rate varies by geographical region.

In long-term care, only 89 per cent of workers in B.C.’s north have received the first doses, compared to 94 per cent in Interior Health, 97 per cent in Fraser Health, 98 per cent in Vancouver Coastal Health and 95 per cent in Vancouver Island Health. Mr. Dix also said four care homes have not reached the 85-per-cent mark.

The province initially said all workers must be fully immunized by Oct. 12, but relaxed the mandate last week due to concerns about staffing in the sector.

Under the modified guidelines, workers with only one shot by Tuesday are required to undergo daily rapid testing, wear personal protective equipment (PPE), and receive their second dose in 28 to 35 days. Individuals who are unvaccinated before Tuesday, but receive one dose before Oct. 26, may, seven days after getting the first jab, work in a facility if they wear PPE and get rapid testing.

“There’s still an opportunity for workers to get the vaccine from our perspective. We hope that a very small number of workers who have not yet made that decision, take this opportunity to get their questions answered,” said Mike Old, a spokesperson with the Hospital Employees’ Union, which represents about 50,000 members across various parts of B.C.’s health-care system.

After initially saying that no one would be required to be vaccinated in Alberta, Premier Jason Kenney’s government reversed that position on Sept. 1 and announced that all front-line health-care workers would need to be vaccinated. Since then, the fourth wave has swamped the province’s emergency rooms and intensive care units with people who are not vaccinated.

The dire situation forced Alberta to create a triage plan that included children in its second phase, meaning physicians in Alberta would have to rely on a formula to determine who receives life-saving treatment if the province’s intensive care units are unable to care for all patients.

But The Globe’s Carrie Tait in Calgary reports that after an outcry from pediatricians, Alberta Health Services revised its triage protocol to shield children from being denied critical care.

Intensive care units in Alberta and Saskatchewan are overwhelmed with COVID-19 patients, and doctors in both systems fear they may have to decide who has a chance at living if the situation continues to deteriorate. The provinces have expanded their critical-care capacity by cancelling surgeries – including all organ donations in Saskatchewan – and creating makeshift ICU beds. Neither province has triggered their respective triage plans, although health-care professionals argue the standard of care has slipped under the pressure.

Alberta’s triage plan will kick in should occupancy in its ICUs exceed 90 per cent. Only patients with a greater than 20-per-cent probability of living would receive care at this stage. Phase 2 of the triage plan would begin if ICU occupancy hits 95 per cent. Then, only adults with a 50-per-cent probability of surviving would receive critical care. Under the original plan, children could be triaged in this phase.

Samina Ali, a pediatric emergency physician at Stollery Children’s Hospital in Edmonton, was among the doctors who decried AHS’s original decision to ration critical care for children. AHS’s policy shift flew under the radar, Dr. Ali said.

“It should be celebrated,” she said. “It is absolutely the right decision.”

However, Dr. Ali considers it a complicated victory. “These children still have parents and other loved ones who will be subject to triage protocol,” she said. “I wish we could spare all of our adult loved ones.”

Alberta’s ICUs were at 78-per-cent capacity Tuesday morning, according to Verna Yiu, AHS’s chief executive. When the temporary ICU beds are excluded, capacity rang in at 172 per cent.

“I’m a little more optimistic than I’ve been in quite a while,” Dr. Yiu told reporters Tuesday. While this occupancy rate is an improvement over recent weeks, she cautioned against complacency, noting it is too early to tell whether the decline will continue.

This is the weekly Western Canada newsletter written by B.C. Editor Wendy Cox and Alberta Bureau Chief James Keller. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here.

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