For months in British Columbia, it has been a tale of two pandemics: cases steadily rising in the Lower Mainland, but no serious outbreaks in the Vancouver Island, Interior or Northern health regions. No longer.In the past three weeks COVID-19 cases have stayed steady in Vancouver Coastal Health and doubled in Fraser Health areas — but they've gone up by nearly 500 per cent in the rest of B.C.There are 247 cases in Island Health, 535 cases in Interior Health, and 250 cases in Northern Health.Just as concerning, the positivity rates in tests for Interior and Northern health are at six and eight per cent each, and have grown steadily for weeks. In contrast, the Lower Mainland's positivity rate is around seven per cent, and has been decreasing over the past week. "It's here. It's legit," said Revelstoke Coun. Cody Younker, whose community is at the centre of the biggest hotspot outside the Lower Mainland at the moment. "I don't want to say that people were maybe naive, but I think there was a little bit of complacency that was coming into effect here because we had a pretty good summer … but now it's not good."Revelstoke outbreakThere was a time in June when there were zero active COVID-19 cases for all of British Columbia outside the Lower Mainland — but even after cases increased slowly, Revelstoke had zero outbreaks between July and September. Now, an outbreak in the community has infected at least 46 people, or more than one in 200 residents of the town of 8,000 people. A public notification was only made once 22 cases were declared. "I do believe we should have known sooner," said Younker, repeating a common criticism of the B.C. government, which only reveals the geographic location of cases once a month. "I think that would have given us the opportunity to get out ahead, get our bylaw officers enforcing, really letting the community know that we have to hunker down." Revelstoke isn't one of the six communities in Interior Health with dedicated COVID-19 beds, and Younker is worried about what will happen if cases surge further. Outbreaks at natural resource projects?While the exact location of the active cases in Northern and Interior Health outside Revelstoke aren't known, the biggest increase last week came in the health region for Prince George, Quesnel, Burns Lake, Vanderhoof and Mackenzie. There have also been recent cases at the LNG Canada construction site in Kitimat (52 recent cases, eight remain active) and the Site C dam, where 27 workers are now in self-isolation. David Bowering, the former chief medical health officer for Northern Health, has long called for tighter restrictions on those natural resource projects because of the risk of spreading the virus. "As much as these large companies would like to isolate themselves and have protocols that protect everyone involved, including their workers, there is inevitably a fair amount of back and forth between local communities," he said. "I think the government turned a blind eye because of their economic bias. They want to see all these jobs continuing, the political points continuing. But I don't think that's realistic or even fair or appropriate."'Exacerbating the things that were already in place'Ashleigh Weeden, a University of Guelph PhD candidate working with the Canadian Rural Revitalization Foundation on how the pandemic is affecting rural Canada, says these outbreaks can be very concerning when they reach smaller communities. "It's not exposing new issues in rural-urban dynamics. It's exacerbating the things that were already in place. We know that rural communities have far more limited health-care capacity and often health outcomes," she said. Weeden said clear communication of guidelines is important, along with understanding that isolation and limited travel become bigger challenges when the community is more remote. But she emphasized that the chances of getting COVID have less to do with where somebody lives, and more to do with a host of underlying factors. "This is something that maybe rural communities thought that because of their lower density and maybe higher distances between [communities] might have been more protected," she said."But as we found out very early in the pandemic and we're finding out again now, it has very little to do with density and more to do with inequity and inequality."