The Government of Canada provides the following case definitions to aid surveillance: a Person Under Investigation (PUI) is an individual with a fever and/or cough who meets the exposure criteria and for whom a laboratory test is requested; a Probable Case is a person with fever and/or new onset of (or exacerbation of chronic) cough and meets COVID-19 exposure criteria and in whom laboratory diagnosis of COVID-19 is inconclusive, negative, or positive but not confirmed by the National Microbiology Laboratory (NML) or a provincial public health laboratory (PPHL); a Confirmed Case is a person with laboratory confirmation of infection with the virus that causes COVID-19 (performed at a PPHL or NML) (PHAC, 2020b).
Provinces and territories (PTs) each have access to an integrated Public Health Information System (iPHIS) and Panorama, which are information systems used in Canada to report case information and facilitate national surveillance (PHAC, 2012). Identification of an individual as a PUI, probable, or confirmed case of COVID-19 triggers management from the relevant PT public health authority (PHAC, 2020h). PT public health authorities are required to report confirmed and probable cases of COVID-19 nationally to the PHAC within 24 hours (PHAC, 2020h). PHAC does not accept reports from the public or individual health care providers (PHAC, 2020h). The extent of monitoring of cases and PUIs varies by PT public health authority but generally encompasses daily contact with the case/PUI to monitor the progression of illness and provide public health instruction to the individual and/or their household (PHAC, 2020h).
All confirmed and probable cases, including those in long-term care and home care settings, should be reported to the Public Health Agency of Canada (PHAC). Since January 22, 2020, COVID-19 has been a nationally reportable communicable disease in Canada; thus, all medical authorities, including physicians and hospitals, are required by PT laws to report all confirmed and suspected cases of COVID-19 to their local public health authority (I.e., medical officer of health) within 24 hours of identification (Grant & Andrea, 2020). As the country experiences outbreaks of COVID-19 within long-term care facilities, PTs have expanded their public health measures within these settings. For example, on April 15, 2020, Ontario released a COVID-19 action plan that detailed efforts for more aggressive testing, screening, and surveillance in these communities (Ontario, 2020d).
Close contacts of confirmed and probable cases are traced by PT public health authorities (PHAC, 2020h) except for those occurring among First Nations peoples on-reserve where close contacts of confirmed cases are traced by the Indigenous Services Canada (ISC) Communicable Diseases Team and, in certain cases, alongside PT authorities (Canada, 2020az). The federal government provides the following recommendations: for any suspected or confirmed case, a contact risk assessment should be conducted by the PT public health authority, whereby the contact’s exposure risk is determined (high, medium, or low) (PHAC, 2020h). This classification guides the conditions of required isolation and the contact management by the PT public health authorities (PHAC, 2020h). An individual with a high-risk level is recommended self-isolate at home for 14 days from the last unprotected exposure, while a medium-risk level case would require self-monitoring for the same time period, and a low-risk level case would require no monitoring (PHAC, 2020h). Medium- and low-risk patients must still follow recommendations for the entire population, including staying at home as much as possible, practice physical distancing, avoiding crowded places, and isolating themselves should symptoms develop. Suspected or confirmed cases should isolate at home until symptoms are resolved and the individual has met the clinical and laboratory criteria set by their local PT public health authorities for discontinuing isolation (PHAC, 2020h).
On April 9, 2020, the Government of Canada released its national-level COVID-19 trajectory models, for the first time; these models included simulations of the impact of various public health measures on COVID-19 case counts, hospitalizations, intensive care admissions and mortality, which included a projection of 500-700 deaths by April 16 (PHAC, 2020p). A federal update released on June 4, 2020, demonstrated that Canada’s reproduction rate (Rt) had trended near one since early April (Breen, 2020). The latest update was released on June 29, confirming that Canada’s Rt had been below one for eight weeks (PHAC, 2020aa). Several provinces have also released their own COVID-19 modelling projections.
Beginning the week of March 8-14, ISC has released data on confirmed COVID-19 cases among First Nations communities weekly that is disaggregated by province of location, age, and sex (Canada, 2020af). ISC data does not include First Nations people living off-reserve and Métis people, or those living in the territories (Canada, 2020af). This gap in data collection was acknowledged by Minister of Indigenous Services Marc Miller in a press conference on May 9 as reported by Raisa Patel of the CBC (Raisa, 2020).
On May 19, 2020 Sioux Lookout First Nations Health Authority in Ontario assumed responsibility for public health surveillance, case management, contact tracing, and contact management across the 33 communities under their jurisdiction. ISC continues to provide funding for these services and remains responsible for both community and public health nursing while Sioux Lookout has taken over responsibility for setting public health directives and policies from the federal government (ISC) (Canada, 2020ax).
Over the course of the pandemic, several PTs published plans for increasing testing and contact tracing, including mobile applications (“apps”). For example, Alberta launched its own contact tracing application, AB TraceTogether, on May 1, the first of its kind in North America (Government of Alberta, 2020a, p. 41). The app is voluntary and aimed to help Albertans protect themselves and others while maintaining their privacy. Meanwhile, the Government of Ontario announced that their efforts to hire more personnel and attract volunteers significantly increased contact tracing capacity (Ontario, 2020h).
On July 31, the federal government announced a new national exposure alert mobile app, COVID Alert (Canada, 2020bh). The app helps notify users if they have been exposed to someone who has tested positive for COVID-19. When an individual tests positive for COVID-19 they can enter a one-time key in the app; once the key is entered, users who may have come in close contact with that person for at least 15 minutes in the past 14 days is notified (ibid). The mobile app was first launched in Ontario while the federal government worked with PTs to rollout the technology. The app later became available in Newfoundland and Labrador on September 3, 2020 (Canada, 2020bt), in Manitoba on October 1 (Canada, 2020ce), in Quebec on October 5 (Canada, 2020ck), and in the Northwest Territories on November 26 (Canada, 2020cx). In a federal announcement on October 30, it was confirmed that updates to COVID Alert enabled the app to send notifications based on a more precise timeline, providing a better estimate of the period in which an individual may have been most infectious to others (Canada, 2020cq).
On September 11, 2020, the federal government announced that Transport Canada, provincial and territorial governments, public health authorities, and Canada’s largest air carriers had established a consistent approach for air carriers to ensure they are collecting and sharing passenger information to be able to accurately inform people who may have been exposed to COVID-19 (Canada, 2020bv).
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’.