Policy responses for Canada - HSRM

Canada


Policy responses for Canada

1.3 Isolation and quarantine

PHAC’s COVID-19 webpage provides specific guidance regarding self-monitoring, isolation and quarantine measures. Specifically, self-monitoring for symptoms of COVID-19 is recommended for all individuals and, particularly, those at increased risk of acquiring COVID-19; self-isolation is recommended for any symptomatic person suspected of having, or known to have, COVID-19; any asymptomatic person with high-risk of exposure to the virus; and, known as quarantine, travellers entering the country from abroad (PHAC, 2020d). Further, protective self-separation (maintaining two-metre separation from others when outside of the household) for any person at high-risk for severe illness from COVID-19 is recommended (PHAC, 2020d).

Notably, early in the COVID-19 pandemic, all written communication from PHAC used terminology that is inconsistent with technical epidemiological language, as appropriately used in most other countries, when describing quarantine and isolation requirements  (PHAC, 2020d). Namely, PHAC recommended “self-isolation” for individuals confirmed to have COVID-19 and recent travellers, while individuals possibly exposed to COVID-19 were asked to “isolate” for 14 days  (PHAC, 2020d). The correct terminology was sometimes used during press briefings by Drs. Tam and Njoo, although not consistently. This resulted in considerable confusion among the public and health officials, particularly given the closeness of the terms “isolation” and “self-isolation”. Since April, PHAC’s communication has increasingly used the terminology of quarantine and isolation  (PHAC, 2020d); albeit, the use of terminology sometimes still does not align with their technical definitions and, often, both sets of terms are used. For example, asymptomatic individuals with close contact to a confirmed/ probable COVID-19 case or otherwise exposed to COVID-19 are asked to “quarantine (self-isolate)”, while individuals diagnosed with COVID-19 (or awaiting laboratory confirmation of COVID-19), having symptoms of COVID-19, recent contact with a confirmed or suspected COVID-19 case, or otherwise told by public health officials are asked to “isolate” (PHAC, 2020ae). Asymptomatic travellers arriving in Canada from abroad are subject to a mandatory 14-day “quarantine”, while symptomatic travellers are subject to a mandatory “isolation” period (PHAC, 2020ae).

According to PHAC, isolation includes not going to school, work, or any other public area, avoiding public transportation, and having supplies delivered to the home (PHAC, 2020ae). If leaving home for a medical reason, a mask should be worn, and the health care facility should be notified in advance (PHAC, 2020ae). While isolating, individuals are asked to monitor symptoms and will be advised by local public health authorities when they are no longer required to isolate ((PHAC, 2020ae). Isolation/quarantine is generally recommended for 14 days, except in the case of symptomatic individuals, who are required to isolate until their symptoms have resolved (PHAC, 2020ae). Specific recommendations are provided by local public health authorities, e.g. some require an individual to isolate for at least 24-48 hours after symptoms have resolved (PHAC, 2020ae).

On February 3, 2020, Health Canada announced an order under the Quarantine Act which mandated that individuals arriving by the federally secured aircraft to repatriate residents from Hubei province, China to Canadian Forces Base (CFB) Trenton must remain at the site for a 14-day period and undergo any health assessments that a quarantine officer required (Department of Justice, 2020a). On February 6,  the first Canadian-operated repatriation flight arrived at CFB Trenton (MOH, 2020a). On February 17, the above order was expanded to include any person arriving in Canada by means of flight organized by the Government of Canada from a foreign country in which there was an outbreak of COVID-19 (Department of Justice, 2020a).

Starting February 8, 2020, all travellers from Hubei, China were asked to self-isolate for 14 days upon entering Canada (Staples, 2020b). The Government of Canada extended its COVID-19 screening requirements on February 9, 2020 to include travellers from “affected areas” and advised voluntary self-isolation for those who were symptomatic, according to media sources (Staples, 2020b). On February 11, officials stated they were considering extending their self-isolation request to include all travellers from China; this decision was further supported by a group of Chinese-Canadian physicians on February 27, who urged PHAC to extend this order to include travellers from all of China and other high-risk areas (Blackwell, 2020b). The following day, Canada’s Customs and Immigration Union urged officials to deploy more public health staff, particularly quarantine officers, to airports (Vogel, 2020). Since February 26, 2020, PHAC has recommended that individuals travelling from the affected region list self-monitor for 14 days after arrival to Canada (Staples, 2020b).

On March 11, Dr. Tam announced that every international traveller was being advised to self-monitor and, since March 13, all Canadians have been advised to avoid all non-essential travel outside of Canada (Staples, 2020a). On March 16, the federal government recommended all Canadians entering the country to voluntarily self-isolate (quarantine) for 14 days, even if asymptomatic (Staples, 2020a). Further, for those who are asymptomatic, self-isolation (quarantine) has been advised if individuals had close contact with someone who has, or is suspected to have, COVID-19 or if they were told by public health authorities that they may have been exposed and need to quarantine (PHAC, 2020n).

On March 25, 2020, the Minister of Health announced that all travellers entering Canada must quarantine for 14 days upon entry, with the exception of workers who are essential to the movement of goods and people (PHAC, 2020e). This is mandated by an emergency order under the Quarantine Act. Maximum penalties include a fine up to CA$750,000 and/or imprisonment for six months. A person who causes a risk of imminent death or serious bodily harm to another person while contravening this act or the regulations could be liable for a fine of up to CA$1,000,000 or imprisonment of up to three years, or both (PHAC, 2020e).

On April 14, 2020, an emergency order under the Quarantine Act was updated to require that any traveller arriving in Canada (whether symptomatic or not) cannot isolate or quarantine in a place where they would be in contact with vulnerable populations, such as adults aged 65 years or over or with pre-existing medical conditions (PHAC, 2020r). Upon arrival, every traveller will also need to confirm that they have a suitable and credible place to isolate/quarantine; e.g. travellers cannot isolate in the same residence as an elderly person (ibid). Travellers are expected to make plans for where they will isolate/quarantine in advance of arriving to Canada (ibid). Travellers who do not have an appropriate isolation/quarantine plan, will be required to go to a location, designated by Canada’s Chief Public Health Officer, until their isolation/quarantine period is over or until a suitable plan is delivered to authorities (ibid).
 
The Government of Canada advises individuals to follow quarantine and self-isolation recommendations from provincial and territorial (PT) public health authorities to prevent transmission of COVID-19 (PHAC, 2020d). However, similar measures have been taken across the provinces and territories. On February 6, 2020, the Ministry of Health and Social Services in Quebec first recommended isolation/quarantine for 14 days for individuals travelling from Hubei province, and as of March 12,  all individuals entering Quebec from a foreign country were asked to isolate/quarantine (MSSS, 2020a). The British Columbia (BC) government has legally required all travellers entering the province from abroad or other parts of Canada  to submit a 14-day self-isolation plan since April 8, 2020 (British Columbia, 2020e). The plan can be submitted online or completed in person on arrival and must show that arriving travellers have the ability to safely self-isolate for two weeks (i.e. plans to order groceries online instead of visiting grocery stores) (British Columbia, 2020e). If an individual has an inadequate plan, the person may be taken to a site to begin quarantine until the outstanding details of their plan are included (British Columbia, 2020e). ).

On September 11, the federal government announced CA$13.9 million in funding for Toronto Public Health in Ontario to establish a voluntary self-isolation centre (PHAC, 2020ag). The centre provides 140 rooms to individuals needing a location to isolate (PHAC, 2020ag). Another CA$6.5 million investment was announced in November 2020 to establish another voluntary isolation site in Peel, Ontario (PHAC, 2020al).

In addition to isolation and quarantine measures, some First Nations communities have instituted community-wide curfews to limit the transmission of COVID-19, as reported in local news sources. For example, on March 24, Fort McKay First Nation and the neighbouring community of Fort McKay Métis in Alberta  implemented a ‘Stay Safe at Home’ curfew prohibiting vehicle traffic between 9pm and 5am daily (Fort McKay First Nation, 2020). The following day, March 25, a similar order was implemented by Peerless Trout First Nation in Alberta who instituted a community-wide curfew between the hours of 10pm and 6am daily for all members of the First Nation with a CA$500 penalty for those found to violate the curfew (Peerless Trout First Nation, 2020a). On May 14 this curfew was revised to 12am to 6am (Peerless Trout First Nation, 2020b).  Amidst a rising rates of COVID-19 infection on the reserve, Siksika First Nation in Alberta instituted a community-wide curfew between the hours of 11pm and 5am daily announced by Chief Crowfoot on July 3, 2020 via video posted on Facebook (Siksika Nation Administration on Facebook Watch: July 3, 2020 Update from Chief Crowfoot, 2020).

Specific PT measures are reported by the North American Observatory on Health Systems and Policies on their dedicated COVID-19 page (https://ihpme.utoronto.ca/research/research-centres-initiatives/nao/covid19/).

See full reference list under ‘Key links and articles: Full list of references’.