It is time for Canada to take COVID-19 border controls seriously
By: Winston Bharat
Tags: Politics, Sars Cov2, Covid 19, Travel, Canada

In March, as SARS-CoV-2 spread globally, the federal government invoked the Quarantine Act to pass a series of orders addressing international travel into Canada. The land border with the United States was effectively closed to all but “essential workers” and restrictions on who can enter the country were implemented, along with exceptions to these rules.

With the identification of the novel UK mutation, much public attention has been focused on our borders. Doug Ford, Premier of Ontario, spent two days lambasting the federal government for the volume of international passengers arriving at Pearson International Airport in Toronto, and what he believes are minimal checks for these passengers. Seemingly in response, on December 22, Patty Hajdu, federal Minister of Health, and Bill Blair, Minister of Public Safety and Emergency Preparedness, defended the Liberal government’s response, stating that that the government would be using the 72-hour window of restricted UK arrivals to “examine the evidence” around its border policies, while claiming that less than 2% of all cases in Canada are travel related and Canada’s border controls are among the most stringent in the world.

In Ontario, the second wave of COVID-19 has produced case numbers so high that contact tracing has effectively collapsed in some areas, with only high-risk, largely congregate outbreak situations receiving such attention. This has resulted in many of Ontario’s second-wave cases having no known confirmed source: 65% for Toronto Public Health and 49% for the combination of Toronto, Peel and York.

It is thus impossible for the federal government to make accurate claims as to the percentage of cases attributable to international travel. Moreover, in response to a Freedom of Information request I submitted, the Public Health Agency of Canada (PHAC) has acknowledged not having any records on to the number of passengers who have tested positive; the breakdown between citizens and permanent residents on one hand and those falling into the exapanded categories of allowed traveller on the other; or the number of individual passengers contacted in qurantine checks. Bill Blair claimed that one million checks have been made thus far. However, over one million travellers returned before the end of March; what of those who have arrived in the nearly nine months since? We have not been able to make even a single check -in with each quarantined passenger, let alone multiple checks over the two-week period.

Canadian leaders have developed the unfortunate habit of benchmarking our performance against those doing poorly, such as the United States, rather than those who have found success. It is not clear to what countries Ministers Hajdu and Blair compared Canada’s border controls as they were not identified, but it is abundantly clear that ours are seriously lacking when compared to those of countries that have successfully contained this virus to a manageable number of cases, defined here as that which allows robust contact tracing and isolation. This group of nations famously includes Australia and New Zealand, but also Japan, South Korea, Taiwan, Vietnam, Thailand, Singapore as well as Hong Kong and, yes, China. In fact, while lockdown stringency has different within and among these jurisdictions, a vigilant approach to the identification and isolation of imported cases has been common to all.

Korean Air summarizes these international border control regimens. They have utilized three general strategies: tight restrictions on who can enter the country, managed quarantine and mandatory testing. The first of these is obvious, and has generally restricted arrivals to citizens and permanent residents, occasionally truly immediate family. The third is similarly obvious, encompassing some combination of proof of negative test before arrival (including IgM antigen tests in the case of China), plus mandatory testing upon arrival and prior to the exit from quarantine.

Managed quarantine refers to the quarantine of travellers at designated facilities, usually hotels, for the duration of the quarantine period. This essentially eliminates the risk of imported cases spreading to household contacts and the broader community; the CDC has demonstrated the secondary infection rate among household contacts to be as high as 53%, far higher than originally thought in the spring. It further allows for the identification of onset of symptoms in travellers after arrival and lengthening of quarantine as appropriate. Designated facilities tend to be located at the point of arrival. In New Zealand, this required managed quarantine in Auckland before going anywhere else in the country. Travellers themselves are usually required to pay for associated hotel quarantine costs. The integrity of managed quarantine was so prioritized in Australia that during Melbourne’s second wave all international flights were diverted out of Victoria and the number of arrivals sharply cut to 4000 per week to maintain the integrity of the system.

In contrast to Australia, Canada’s federal government made it easier for more people to arrive from abroad during our second wave. On October 2 the list of allowed travellers was expanded to now include the extended family of those in “committed dating relationship” with a citizen or permanent resident, for example. Doug Ford has noted 64,000 weekly international arrivals at Pearson alone, where travellers can hop on connecting flights and subsequent public transportation to reach the eventual quarantine destination, which could be an apartment shared by others whose mobility isn’t restricted during the quarantine period. There is no direct supervision of these travellers for subsequent onset of symptoms, instead relying on an honour system of electronic reporting. There is no requirement for negative testing prior exiting quarantine, thus only those travellers who develop symptoms (usually required for testing) and choose to get tested will be identified. This is incongruent with our knowledge of asymptomatic transmission and, for instance, the absence of paid sick leave acting as a disincentive for testing in the case of quarantine households shared with essential workers who would have to miss work. Comparing our measures to the above, it is difficult to take Patty Hajdu and Bill Blair seriously.