Canada must create a comprehensive quarantine, screening system for international travellers: experts

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The Canadian government must create a comprehensive quarantine and screening system for international travellers to help stop the COVID-19 crisis – and to prepare for the next threat, infectious disease specialists say.

Improvements to border control systems may be too late to prevent the spikes in infections hammering Ontario, Alberta and other parts of the country. But the pandemic may yet spawn more waves and new variants that evade vaccination. And this will almost certainly not be the last pandemic.

What a system for preventing travel-related spread might look like remains a matter of debate among epidemiologists and public-health researchers. But it is almost the consensus view among them that the federal government’s current measures are unequal, incoherent and full of loopholes. Ottawa has been slow to adjust to stop the arrival of new variants from global hot spots and has done little to deal with land arrivals. Officials react rather than predict or anticipate new threats.

Kirsten Fiest, a professor of epidemiology at the University of Calgary, said: “We are not in a good place in Canada right now. This ad hoc, reactional strategy does not resonate as an effective public-health strategy to protect our country.”

The use of border controls to stop the spread of the virus became a political hot potato at the start of the pandemic, when Ottawa and some public-health officials considered them counterproductive at best and xenophobic at worst.

More recently, after the federal government accepted that border controls are necessary, provincial governments tightened their own lax controls. (As The Globe and Mail reported Monday, domestic travel accounted for more than 60 per cent of flights linked to COVID-19 infections in April.) Ontario Premier Doug Ford and other premiers have repeatedly called on Ottawa to do more on borders, and Prime Minister Justin Trudeau has insisted that much is already being done.

“Everyone needs to calm down, step back and stop talking about it in partisan terms,” said Kelley Lee, a specialist in the impacts of globalization on population health at Simon Fraser University. “It’s not about shutting off trade or closing off the country. It’s simply border control.”

Since the pandemic began, Canada has added new travel measures almost every month. In early March last year, the government advised against non-essential travel and cruise-ship vacations. Later that month, it banned non-essential entry to to the country to all but Canadians and permanent residents, with pages of exceptions for essential travel.

Since then, Canada has introduced temperature checks and beefed up fines for failing to comply with quarantine orders. In January, 72-hour quarantine in hotels became mandatory for people arriving on international flights, which are funnelled to Vancouver, Calgary, Toronto and Montreal. Mandatory testing was also imposed for land and air entry. Fourteen-day quarantine at home still applies to all travellers, but critics say it does not include enough supervision or testing.

Travellers have booked at least 49,000 stays at the 72-hour quarantine hotel rooms, but at least 536 people in Toronto and Vancouver have blown off the requirement, willing to risk a $3,000 fine.

Direct travel from Mexico, the Caribbean, Brazil, the United Kingdom, India and Pakistan was temporarily halted, but that did not stop people from arriving on connecting flights or landing in the United States and crossing by land.

A Globe and Mail analysis of flight data from FlightRadar24 found the number of inbound international flights from January to March, 2021, grew 9 per cent. That’s due in large part to flights from the U.S. – by far Canada’s largest source of inbound international air travel – for which flight volume was up 6 per cent.

The number of flights also grew from some countries registering high levels of variants of concern. In the summer of 2020, just nine direct flights arrived from Brazil; but in early 2021, Canada registered 46 direct flights from the South American country hard hit by the P.1 variant. Flights from India, which first identified the B.1.617 variant, were up 170 per cent. Meanwhile, flights from Britain, where the B.1.1.7 variant was first identified late last year, were down 10 per cent over the same period.

The Canada Border Services Agency says overall measures have reduced non-commercial land entries by 90 per cent and air entries by 95 per cent since the pandemic started. About 87 per cent of the remaining travellers take about 110,000 weekly trips exempt from testing and quarantine rules; three-quarters of them work transporting goods or people.

The federal testing regime on other travellers captured 2,018 COVID-19 cases from Feb. 22 to April 11, about a quarter of which were variants of concern, according to the Public Health Agency of Canada. Prof. Lee said there is no doubt the tests captured only a fraction of cases. “The variants of concern didn’t swim or fly here on their own, they come through travel,” she said. “Their so-called world-class system isn’t working.”

A half-dozen experts interviewed for this story say a good border-control system for new waves of COVID-19 variants or future pandemics would treat all travellers equitably, regardless of whether they enter by land or air. Exceptions for essential travel would only be for truly vital trips and would come with other methods of mitigating risk, such as rapid testing and priority vaccination.

The system would come with a set of coherent rules and benchmarks for when to impose shutdowns.

The government would impose measures such as travel bans or border closings quickly, strictly to limit the introduction of new variants or entirely new dangerous viruses.

But most of the harshest measures would be temporary because their usefulness quickly wanes once viruses break through travel barriers. (And, the specialists say, they almost always break through eventually.)

Colin Furness, an infection-control epidemiologist at the University of Toronto, is among the experts calling for the toughest measures. He would like to see an immediate six-week shutdown of most passenger air traffic and non-essential travel at land borders, which would apply to returning Canadians as well. Such steps would deal with the current, third wave and future waves, new variants of concern or new viruses.

“You have to stop flights,” Prof. Furness said. “You don’t have to do it forever. You don’t have to do it for months. Six weeks is not too much to ask to stop importing thousands of cases.”

Strict, supervised 14-day quarantine at designated sites could be introduced gradually afterward, Prof. Furness said, as New Zealand and Australia started doing a year ago. Returning Canadians would have to wait their turns for a spot in quarantine, as tens of thousands of Australians are currently doing. Some stranded Australians have complained to the United Nations Human Rights Committee about their treatment.

While his main concern is international travel, Prof. Furness would like to see limits on domestic flights as well when cases spike.

“Interprovincial travel is a bad idea. It’s a bad idea because it moves COVID and gives people the idea travel is safe. It’s a mistake.”

In late March and early April, Canada was still registering almost 6,000 domestic flights a week, according to FlightRadar24. That number is among the lowest since late May last year. Domestic flight volumes peaked in late August, at more than 10,000 a week.

Prof. Lee also favours a strong 14-day quarantine for returning international travellers, adding that electronic bracelets could be used to allow people to do it at home.

Julien Arino, a professor at the University of Manitoba who specializes in population dynamics in epidemiology, argues that less harsh restrictions than those suggested by his colleagues but applied more evenly might be more effective.

Prof. Arino says quarantine is one of the best measures to prevent importing disease, but neither the three-day hotel confinement nor 14-day self-isolation at home is optimal. He says officials should impose a single seven-to-10-day quarantine that would begin and end with tests. It would take place at home with frequent check-ins from public-health officials to ensure compliance – but also to offer support.

A study of Toronto international air travellers by McMaster Health Labs found 70 per cent of cases were discovered upon arrival with 95 per cent uncovered within seven days of landing. The Alberta Border Testing Pilot Program found similar results in Calgary.

The $3,000, 72-hour air traveller hotel stays currently being used only encourage people to evade the system, Prof. Arino says.

“The longer you ask people to stay, the more you know people will avoid it,” he said. “If you make it complex, expensive and too onerous, you are asking people to find ways around it. It’s better to have 80 per cent compliance with slightly less stringent measures than more people evading strict measures.”

He said the need to get public co-operation is sometimes lost in the search for bulletproof measures. “You want buy-in. This thing is going on a year and a half, and we don’t know when we will get out of it.”

He said his current research studying population and COVID-19 movements suggests border closings help reduce spread – but only for a matter of weeks.

“Once you have imported some cases, the local propagation becomes more important,” Prof. Arino said.

The four Atlantic provinces require a 14-day at-home quarantine for travellers from foreign countries and other provinces. This is often cited as a model for other provinces.

The Atlantic system has worked well to find and limit most outbreaks, said Susan Kirkland, chief of the department of community health and epidemiology at Dalhousie University in Halifax. Nova Scotia often had just a handful of cases a day, almost all among quarantined interprovincial travellers.

“If we hadn’t had those systems, people would have gone about their business and we would have seen exponential growth a lot sooner,” Prof. Kirkland said. “Travel restrictions are effective.”

Even though Nova Scotia’s system has been effective, breakthrough cases such as those currently fuelling a wave in the province can happen. “The virus is a global problem and it won’t be under control until it is under control worldwide,” Prof. Kirkland said.

Most of the experts said travel bans targeting specific countries are largely futile. Temporary bans on direct arrivals from the U.K., Brazil, India, Pakistan and southern hot spots did not capture indirect arrivals. They were also often imposed after the variants were already in Canada.

“We’re never ahead of COVID, we’re always catching up,” Prof. Kirkland said. “Hitting specific countries with massive outbreaks is too little, too late. We need policies around international travel in general, including testing and quarantine, with all the loopholes shored up.”

The matter of what to do about truck drivers and air, sea and rail crews in a country reliant on importing food and many other goods poses a stickier problem, all the experts agree. “It’s an unavoidable risk, so we have to make sure we understand it and contain it,” Prof. Arino said. “We have a huge land border that needs to be crossed. There’s no way to interrupt this flow of people. We need the food.”

Vital transport workers should be tested frequently and placed at the front of the line for vaccines, most say, including Prof. Lee. “I don’t understand why these steps haven’t been done. I don’t understand why we are always reacting instead of acting preventatively,” she said.

Prof. Fiest also doubts the U.S. border could be closed to essential travel or that flights could be grounded for an extended period. “I can understand why some colleagues call for a total shutdown on travel, but it’s just not realistic in a country the size of Canada, with the size of our border and how dependent we are on trade,” she said. “It’s just not feasible.”

And all the specialists interviewed for this story and a dozen others who have written on the subject agree on one thing: Ottawa still needs to beef up infectious disease surveillance among people arriving in the country. “There still just isn’t enough testing,” Prof. Fiest said.

Prof. Lee pointed to the arrival of the B.1.617 variant first associated with India in British Columbia and Ontario, as well as a single case in Quebec last month. Canada also saw cases of the B.1.351 variant first found in South Africa pop up in northwestern Quebec and New Brunswick.

“How did it happen? Where’s the surveillance? Why wasn’t it caught at the border?” she said. “The system is failing at the moment.”

She said that while different levels of government have had the habit of throwing blame around, the responsibility for monitoring the arrival of new variants and diseases falls on Ottawa.

“This is up to the federal government,” Prof. Lee said. “It’s the outer wall of the castle.”

With reports from Tom Cardoso and Marieke Walsh in Ottawa.

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