Canada Gazette, Part I, Volume 154, Number 7: ORDERS IN COUNCIL

February 15, 2020

PUBLIC HEALTH AGENCY OF CANADA

QUARANTINE ACT

Minimizing the Risk of Exposure to 2019–nCoV Acute Respiratory Disease in Canada Order

P.C. 2020-59 February 3, 2020

Whereas the Governor in Council is of the opinion that

Therefore, Her Excellency the Governor General in Council, on the recommendation of the Minister of Health, pursuant to section 58 of the Quarantine Act footnote a, makes the annexed Minimizing the Risk of Exposure to 2019–nCoV Acute Respiratory Disease in Canada Order.

Minimizing the Risk of Exposure to 2019–nCoV Acute Respiratory Disease in Canada Order

Entry requirements

1 Any person who arrives by aircraft at Canadian Forces Base Trenton, directly or indirectly from Hubei province, China, must

Non-application — hospital stay

2 The requirement referred to in paragraph 1(a) does not apply to

Non-application — inconsistent requirement

3 The requirement referred to in paragraph 1(a) does not apply to a person if the requirement is inconsistent with another requirement imposed on that person under the Quarantine Act.

Quarantine Act — powers and obligations

4 For greater certainty, this Order does not affect any of the powers and obligations set out in the Quarantine Act.

Effective period

5 This Order has effect for the period beginning on the day on which it is made and ending on March 31, 2020.

EXPLANATORY NOTE

(This note is not part of the Order.)

Proposal

The Order in Council, entitled Minimizing the Risk of Exposure to 2019–nCoV Acute Respiratory Disease in Canada Order, has been made pursuant to section 58 of the Quarantine Act.

Objective

The objective of this Order is to protect the health of exposed travellers as well as the health and safety of the general public from the 2019–nCoV acute respiratory disease outbreak through heightened oversight of all individuals arriving to Canada from Hubei Province, China, as part of the Government of Canada’s action to bring Canadians home.

Background

There is an outbreak of a communicable disease in a foreign country:

On January 30, 2020, the World Health Organisation (WHO) declared an outbreak of what is now known as 2019–nCoV acute respiratory disease to be a Public Health Emergency of International Concern (PHEIC). The 2019–nCoV acute respiratory disease is caused by a novel coronavirus capable of causing severe illness. It is part of a family of viruses that includes Middle East Respiratory Syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome coronavirus (SARS-CoV). Coronaviruses are mainly responsible for mild upper respiratory tract infections; common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. 2019–nCoV has clearly demonstrated that it can cause severe, life-threatening respiratory disease. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and death.

The introduction or spread of the disease would pose an imminent and severe risk to public health in Canada:

Patients infected with novel coronavirus (2019–nCoV) present with symptoms that may include fever, malaise, dry cough, shortness of breath, and damage to the lungs. Current data suggests that approximately 25% of cases are severe or critical in nature. Older individuals and those with a weakened immune system or underlying medical condition have been seen to be at a higher risk of severe disease. The time from exposure to onset of symptoms is currently estimated to be up to 14 days, with an average of 5 days. Current treatment is supportive and aimed at relief of symptoms and treatment of associated medical complications. There are no specific treatments for 2019–nCoV acute respiratory disease, and there is no preventative vaccine currently available.

Coronaviruses are spread among humans through the inhalation of airborne infectious respiratory droplets (when an infected individual coughs or sneezes) or through contact with objects or surfaces contaminated by infectious droplets. Human-to-human transmission is the main driving force of the current 2019–nCoV acute respiratory disease outbreak.

The Canada Border Services Agency (CBSA) is carrying out enhanced screening of all travellers who have been in Hubei Province, China, in the past 14 days. Travellers who are feeling sick or unwell, are assessed for symptoms including fever, cough and difficulty breathing. Public Health Agency of Canada (PHAC) officers assist the CBSA in the screening assessment and then completion of a health assessment that includes gathering information on travel history, exposure risk, and signs and symptoms of illness.

The number of persons infected with the novel coronavirus (2019–nCoV) continues to rise, with 25 countries outside of mainland China reporting cases. The majority of cases continue to be in Hubei Province, China. As of January 31, 2020, the WHO reported that a total of 9 826 cases have been associated with 2019–nCoV acute respiratory disease globally, including 213 deaths. Some patients have already successfully recovered and have been discharged from care. However, as human transmission involving large numbers of patients is possible, it is important to mitigate the health risks associated with people who have been in direct contact with the virus through intervention and proper care.

The entry of members of a certain class of persons into Canada may introduce or contribute to the spread of the communicable disease in Canada:

The Government of Canada is finalizing plans to repatriate up to 250 Canadian citizens who have been living or staying in Hubei Province, China, under regional travel restrictions introduced and enforced by the Chinese Center for Disease Control and Prevention (CCDC), for an extended period of time. This means that these individuals have been living in the epicentre of the outbreak for an extended period of time, longer than those who will have travelled prior to the closure of Wuhan and other areas within China. The flight returning travellers to Canada will also include personnel (employed or contracted) from other Government of Canada departments who will have potentially been exposed during the course of their duties supporting the repatriation of Canadians on this flight.

The CCDC will take measures to screen passengers for infection prior to allowing travellers to access the plane. Canadian Forces Health Services medical personnel will conduct a final pre-boarding assessment of all travellers, will accompany the travellers on the flight, and will monitor all on board for onset of any symptoms of respiratory illness throughout the approximately 13-hour duration of the flight. An interim refueling stop, en route to Trenton, Ontario, will take place in British Columbia, where travellers will be reassessed and deplaned only as appropriate for medical investigation and care if they have developed symptoms of 2019–nCoV acute respiratory disease while in transit.

Based on the life cycle of the virus, when passengers disembark in Canada they may continue to be asymptomatic, but infected, for 2 weeks as they could have been exposed immediately prior to boarding the plane, in flight, or during the health assessment period. Even with all prior care, an abundance of caution is appropriate to further protect individuals from a novel virus that can cause serious illness. Given the high risk to individual health once exposed, it is appropriate to have the Canadians cared for in an environment that supports their well-being for a period of up to 14 days, while protecting the general population from unnecessary exposure.

No reasonable alternatives to prevent the introduction or spread of the disease are available:

For travellers without symptoms from most areas of China where the risk of infection is lower, currently measures of self-isolation or local public health follow-up are considered adequate for disease containment. Self-isolation has worked in a limited number of cases in Canada, through the auspices of excellent civic duty and care exercised by returning Canadians (e.g. initial Toronto, Ontario, cases) and effective contact tracing and follow up by local health authorities. However, the present extraordinary case of a one-time flight with up to 250 Canadians is a unique situation as public health officials are now better informed of the potential risks of the virus. The travellers in question have been sequestered in an area with the highest concentration of cases over a longer period of time. Their risk of exposure and potential illness is increased relative to other travellers from China. It is now known that the virus is transmissible between humans, that vulnerable populations are more susceptible to serious illness, and there continues to be no vaccine currently available. It is in the best interest of Canadian public health, both for the travellers and the general public, to provide medically supervised observation for this group of Canadians for the duration of the incubation period.

Implications

Key obligations for travellers

The Order will obligate all individuals to remain under medical supervision for up to 14 days at CFB Trenton, Ontario, Canada. They will be monitored for signs and symptoms of 2019–nCoV acute respiratory disease for the duration. Travellers who exhibit symptoms of 2019–nCoV acute respiratory disease on arrival or during the 14 days following will be issued an order to undergo a medical examination and will receive appropriate medical care as required.

Failure to comply with this new Order is an offence under section 71 of the Quarantine Act. The maximum penalties (on summary conviction) are a fine of up to $750,000 and/or imprisonment for six months.

With this Order, Canada is aligning the objectives of our approach with those of our international counterparts in the United Kingdom, the United States, and Australia.

Consultation

As the host province, the Ontario public health authority has been consulted on the Order. The PHAC will continue to collaborate with provinces and territories on the implementation of the Order and address any forthcoming challenges or concerns.

Departmental contact

George Samiotis
Director
Office of Border and Travel Health
Public Health Agency of Canada
Telephone: 343‑542‑6031
Email: george.samiotis@canada.ca