Canada Gazette, Part I, Volume 157, Number 3: ORDERS IN COUNCIL

January 21, 2023

PUBLIC HEALTH AGENCY OF CANADA

QUARANTINE ACT

Minimizing the Risk of Exposure to COVID-19 in Canada Order

P.C. 2023-1 January 3, 2023

Whereas the Governor in Council is of the opinion, based on the declaration of a pandemic by the World Health Organization, that there is an outbreak of a communicable disease, namely coronavirus disease 2019 (COVID-19), in the majority of foreign countries;

Whereas the Governor in Council is of the opinion that the introduction or spread of COVID-19 would pose an imminent and severe risk to public health in Canada;

Whereas the Governor in Council is of the opinion that the entry of persons into Canada who have recently been in the People’s Republic of China, the Hong Kong Special Administrative Region of the People’s Republic of China or the Macao Special Administrative Region of the People’s Republic of China may introduce or contribute to the spread in Canada of COVID-19 or of new variants of the virus causing COVID-19 that pose risks that differ from those posed by other variants but that are equivalent or more serious;

And whereas the Governor in Council is of the opinion that no reasonable alternatives to prevent the introduction or spread of COVID-19 are available;

Therefore, Her Excellency the Governor General in Council, on the recommendation of the Minister of Health, makes the annexed Minimizing the Risk of Exposure to COVID-19 in Canada Order under section 58 of the Quarantine Act footnote a.

Minimizing the Risk of Exposure to COVID-19 in Canada Order

Definitions

1 (1) The following definitions apply in this Order.

COVID-19 antigen test
means a COVID-19 screening or diagnostic immunoassay that
  • (a) detects the presence of a viral antigen indicating the presence of COVID-19;
  • (b) is authorized for sale or distribution in Canada or in the jurisdiction in which it was obtained;
  • (c) if the test is self-administered, is observed and produces a result that is verified
    • (i) in person by an accredited laboratory or testing provider, or
    • (ii) in real time by remote audiovisual means by the accredited laboratory or testing provider who provided the test; and
  • (d) if the test is not self-administered, is performed by an accredited laboratory or testing provider. (essai antigénique relatif à la COVID-19)
COVID-19 molecular test
means a COVID-19 screening or diagnostic test, including a test performed using the method of polymerase chain reaction (PCR) or reverse transcription loop-mediated isothermal amplification (RT-LAMP), that
  • (a) if the test is self-administered, is observed and produces a result that is verified
    • (i) in person by an accredited laboratory or testing provider, or
    • (ii) in real time by remote audiovisual means by the accredited laboratory or testing provider who provided the test; or
  • (b) if the test is not self-administered, is performed by an accredited laboratory or testing provider. (essai moléculaire relatif à la COVID-19)
crew member
means
  • (a) a crew member as defined in subsection 101.01(1) of the Canadian Aviation Regulations or a person who enters Canada only to become such a crew member; or
  • (b) a member of a crew as defined in subsection 3(1) of the Immigration and Refugee Protection Regulations or a person who enters Canada only to become such a member of a crew. (membre d’équipage)
evidence of a COVID-19 antigen test
means written evidence of a COVID-19 antigen test that contains the following information:
  • (a) the name and date of birth of the person whose specimen was collected for the test;
  • (b) the name and civic address of the accredited laboratory or the testing provider that performed or observed the test and verified the test result;
  • (c) the date the specimen was collected and the test method used; and
  • (d) the test result. (preuve d’essai antigénique relatif à la COVID-19)
evidence of a COVID-19 molecular test
means written evidence of a COVID-19 molecular test that contains the following information:
  • (a) the name and date of birth of the person whose specimen was collected for the test;
  • (b) the name and civic address of the accredited laboratory or the testing provider that performed or observed the test and verified the test result;
  • (c) the date the specimen was collected and the test method used; and
  • (d) the test result. (preuve d’essai moléculaire relatif à la COVID-19)
testing provider
means
  • (a) a person who may provide COVID-19 screening or diagnostic testing services under the laws of the jurisdiction where the service is provided; or
  • (b) an organization, such as a telehealth service provider or pharmacy, that may provide COVID-19 screening or diagnostic testing services under the laws of the jurisdiction where the service is provided and that employs or contracts with a person referred to in paragraph (a). (fournisseur de services d’essais)

Application

(2) For greater certainty, this Order

Pre-boarding COVID-19 test

2 (1) Every person who enters Canada on a flight originating from the People’s Republic of China, the Hong Kong Special Administrative Region of the People’s Republic of China or the Macao Special Administrative Region of the People’s Republic of China must, before boarding the aircraft for the flight to Canada, provide to the aircraft operator evidence of a COVID-19 molecular test or evidence of a COVID-19 antigen test indicating that they received

Non-application

(2) Subsection (1) does not apply to any of the following persons:

Evidence

(3) Every person who enters Canada must

Effective period

3 This Order has effect for the period beginning at 00:01:00 a.m. Eastern Standard Time on January 5, 2023 and ending at 00:01:00 a.m. Eastern Standard Time on February 4, 2023.

EXPLANATORY NOTE

(This note is not part of the Order.)

Proposal

This Order in Council, entitled Minimizing the Risk of Exposure to COVID-19 in Canada Order, is made pursuant to section 58 of the Quarantine Act.

This Order applies to persons entering Canada on a flight originating from the People’s Republic of China (China), Hong Kong Special Administrative Region of the People’s Republic of China (Hong Kong) or Macao Special Administrative Region of the People’s Republic of China (Macao).

The Order is complemented by Transport Canada’s Interim Order Respecting Certain Requirements for Civil Aviation Due to COVID-19. No. 74 made under subsection 6.41(1.1) of the Aeronautics Act.

This Order will be in effect from 00:01:00 EST on January 5, 2023, until 00:01:00 EST on February 4, 2023.

Objective

This Order implements Canada’s efforts to reduce the introduction and further spread of SARS-CoV-2, the virus that causes COVID-19, by decreasing the risk of importing cases from outside the country.

This Order requires every person, with very limited exceptions, seeking to enter Canada regardless of vaccination status, to test for COVID-19 prior to boarding, if they depart on a flight originating from China, Hong Kong or Macao.

Background

COVID-19 is caused by a novel coronavirus capable of causing severe illness, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Although 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), SARS-CoV-2 is more contagious.

COVID-19 was first detected in Wuhan, China, in December 2019. The disease is caused by a strain of coronavirus that was novel in humans. Information about the virus, how it causes disease, whom it affects, and how to appropriately treat or prevent illness has been developing over the past three years. Information continues to develop and evolve as new variants of the virus emerge.

SARS-CoV-2, the virus that causes COVID-19, spreads from an infected person to others through respiratory droplets and aerosols that vary in size when an infected person breathes, coughs, sneezes, sings, shouts, or talks. Large droplets fall to the ground rapidly (within seconds or minutes) near the infected person, while smaller droplets, sometimes called aerosols, linger in the air, especially in indoor spaces.

COVID-19 can be a severe, life-threatening disease. Patients with COVID-19 may present with symptoms that may include fever, malaise, dry cough and shortness of breath. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and death. Older individuals, unvaccinated persons and those with a weakened immune system or an underlying medical condition are at a higher risk of severe disease. The incubation period, from exposure to onset of symptoms, can vary considerably among those infected, with an estimated median of 5 to 6 days. For the Omicron variant, the incubation period is shorter, an average of 3 days. Approximately 95% of those infected will develop symptoms within 14 days of exposure. Evidence indicates that the majority of individuals infected with COVID-19 who have a healthy immune system may transmit the virus up to 10 days after becoming infectious.

The World Health Organization (WHO) declared an outbreak of what is now known as COVID-19 to be a public health emergency of international concern on January 30, 2020, and a pandemic on March 11, 2020. COVID-19 has demonstrated that it can cause widespread illness if not controlled. Since September 2020, multiple countries have detected SARS-CoV-2 variants whose mutations may increase pathogenicity and/or transmissibility, and potentially reduce vaccine effectiveness: these are referred to as variants of concern. The introduction of new, more transmissible variants of concern of the virus causing COVID-19 has increased the negative health impacts of COVID-19. COVID-19 vaccines are effective at preventing severe illness, hospitalization and death from COVID-19; however, they may be less effective against new variants of concern.

Effective February 28, 2022, the Government of Canada issued a Travel Health Notice, Level 2, meaning that the Government is advising travellers to practise enhanced health precautions when travelling internationally. Additionally, on December 23, 2022, the Government of Canada issued a Travel Health Notice of Level 2 for China concerning the upcoming Chinese New Year in January 2023.

COVID-19 situation globally

The cumulative number of COVID-19 cases reported globally is now over 651 million and the number of deaths attributed to COVID-19 exceeds 6.6 million. Though SARS-CoV-2 continues to circulate around the world, due to an increase in vaccination coverage and population immunity, most countries, including Canada, lifted many of their COVID-19 restrictions during the fall months of 2022. Cases and hospitalizations continue to increase in many G7 countries, while in Canada, cases and hospitalizations have stabilized, though they remain elevated.

On December 7, 2022, China lifted its most strict “zero-COVID” policies and will remove remaining measures effective January 8, 2023. These measures include the requirement to quarantine or isolate for all inbound travellers, removal of pre-arrival and post-arrival testing and easing of restrictions on the number of international passenger flights into China. On December 21, 2022, a WHO official stated that China has become an unreliable guide in its monitoring of the COVID-19 situation. Media reports indicate that the country has experienced a spike in cases this winter despite a decrease in testing across the country.

Reports indicate that China has been experiencing a dramatic increase of COVID-19 cases since November 2022 due to low levels of immunity among the Chinese population. Health experts in China are predicting three COVID-19 waves in the upcoming months: from December 2022 until mid-January 2023, from the Chinese New Year celebrations on January 21, 2023 onward, and from late February to mid-March 2023 as people return to work after the holiday. Thus, the limited data on COVID-19 cases, including data on circulating SARS-CoV-2 variants, from Chinese authorities requires a prudent posture pending more accurate and timely scientific information to limit the risk of increased importation from China’s reopening posing a severe risk to public health in Canada.

Several countries have introduced border measures for travellers entering from mainland China and its regions. The United States (US) announced the implementation of border measures effective January 5, 2023, for travellers entering from China due to lack of adequate and transparent epidemiological and viral genomic sequence data being reported by China. These measures include requiring pre-departure testing within two days prior to departure, for all flights originating from China, Hong Kong and Macao as well as those transiting through Canada (Toronto Pearson International Airport and Vancouver International Airport) and Incheon airport (Seoul, Republic of Korea). Additionally, the US is expanding its voluntary Traveler-Genomic Sequencing program to include approximately 290 weekly flights from China and surrounding areas. The program serves as an early warning system to detect and characterize new and rare variants of the virus that causes COVID-19.

On December 30, 2022, Israel implemented a requirement for a negative PCR test from non-Israelis traveling from China. Within Europe, Italy introduced a new “Interventions in place for the management of SARS-CoV-2 for winter season 2022-2023” for its residents and travellers. Italy has ordered COVID-19 antigen swabs and virus sequencing for all travellers coming from China after one in two passengers tested positive for COVID-19 on two flights from Beijing and Shanghai to Milan’s airport (Malpensa) on December 26, 2022. Spain will require all air passengers coming from China to have negative COVID-19 tests or proof of vaccination and would be stepping up COVID-19 health controls at Spanish airports. France and the United Kingdom have also followed suit in implementing additional testing requirements for travellers arriving from China.

The majority of measures implemented to date have come from neighbouring countries in Asia. Effective December 30, 2022, travellers who had been in China (excluding Hong Kong and Macao) within the 7 days prior to entry to Japan are required to take an on-arrival test at a quarantine station. Travellers who test positive will be required to quarantine at a quarantine station for 7 days. This requirement is in addition to measures being taken to limit the number of direct flights from China, Hong Kong and Macao to Japan’s main international airports. Additionally, as of December 30, 2022, Malaysia announced that it will screen all inbound travellers for fever and test wastewater from aircraft arriving from China for COVID-19. South Korea will require travellers from China to provide a negative PCR test within 48 hours of departure, or a rapid antigen test taken within 24 hours, followed by a PCR test after arrival, in addition to restricting short-term visas for Chinese nationals. Thailand will be testing wastewater from planes arriving from China with reverse-transcription PCR testing to detect COVID-19. Taiwan’s Central Epidemic Command Centre announced, effective January 1, 2023, travellers arriving from China via air and marine will be tested for COVID-19. Similarly, India announced that, beginning January 1, 2023, travellers from China, Hong Kong, Japan, South Korea, Singapore and Thailand will be required to present proof of a negative COVID-19 test report before departure. India also announced the start of randomly testing two percent of all international passengers arriving at its airports beginning in January 2023.

Germany has also stated that as of December 29, 2022, there is no evidence of a variant of concern emerging in China compared to the COVID-19 variants circulating in Germany; however, it has issued a federal notice to inform travellers that the number of infections are currently at their highest level in China since the beginning of the pandemic and that the Chinese healthcare system is under severe strain.

The European Centre for Disease Prevention and Control announced on December 29, 2022, that screening and travel measures on travellers from China is “unjustified”, given higher population immunity in the European Union and the ability of health systems to manage the impact of higher levels of infection.

At this time, the WHO has indicated that it requires more information on disease severity, hospital admissions, and requirements for ICU support to make a comprehensive risk assessment of the situation on the ground in China. However, WHO has requested China’s National Health Commission for regular sharing of specific and real-time data on the country’s epidemiological situation — including more genetic sequencing data, data on disease impact including hospitalisations, ICU admissions and deaths —and data on vaccinations delivered and vaccination status, especially in vulnerable people and those over 60 years old.

Variants of concern

Since fall of 2020, more transmissible variants of the SARS-CoV-2 have been detected in the United Kingdom, South Africa, Brazil, India and multiple other countries. These more transmissible variants have spread to other places around the globe, including the US and Canada. The Omicron variant of concern has a high number of mutations, including mutations in the spike protein, as well as in locations thought to be potential drivers of transmissibility. Omicron and its sub-lineages are able to spread faster than previous variants and have the ability to evade immunity from vaccination and prior infection. To increase immunity, Canada and many countries now use vaccines that target Omicron, which are not in use in China, based on available information.

Canada continues to monitor the international situation, including activity related to Omicron sub-lineages. In fall of 2022, clinical sequencing shows steady increases in immune evasive Omicron sub-lineages BQ.1, BQ.1.1, and BF.7, while previously dominant BA.5.2 and BA.5.2.1 lineages continue to decline in Canada.

Based on available information, as of December 2022, the Omicron and its sub-lineages BF.7 and BA.5.2 are reported as the main lineages circulating in mainland China, but other internationally common sub-lineages BQ and XBB are now being reported as well. However, a variety of Omicron sub-lineages could be present at any given time.

Testing

Testing capabilities advanced significantly over the course of the pandemic. Many countries have reintroduced testing requirements for travellers from specific regions. Although Canada continues to monitor for variants of concern using domestic sample sequencing and shared international data, there are some limitations and time lags. As a precautionary measure, a pre-arrival test requirement for travellers from high-risk regions would help to slow the importation of potential novel variants of concern into Canada before they could be detected and/or categorized.

As is the case with many other viruses, a person may continue to obtain a positive molecular test result for a period of time after their infection, even though they may no longer be considered infectious. The Order continues to recognize that positive COVID-19 molecular or antigen test results of previously infected individuals, for tests performed on a specimen collected from 10 to 90 days prior to travel, are not considered evidence of a new infection posing risk, but rather that a person has recovered from a prior COVID-19 infection. Since a positive test result may inadvertently prevent a recovered patient from entering Canada, acceptable proof of prior infection from an asymptomatic traveller is accepted as an alternative to a negative pre-arrival test. Requiring that prior positive test results be performed on a specimen collected at least 10 days before the initial scheduled departure (by air) allows the time needed to become non-infectious, thus preventing those persons who may be infectious from travelling and possibly transmitting COVID-19 upon travel to Canada.

Vaccination

Virus transmission is linked to population immunity. The higher the level of transmission, the more chances the virus has to evolve. The key contributors to the emergence of variants are the number of active infections and their duration within individuals across a population, combined with the frequency of opportunity to transmit to a new host. Despite the fact that immunity wanes over time, COVID-19 vaccination reduces both the number of infections and their duration, thus reducing the number of mutations generated and transmitted within a given population. Consequently, the emergence of variants of concern may be less likely to occur in higher-vaccinated populations.

The Canadian population is highly vaccinated. Eighty percent (80.5%) of the population have completed their primary series of vaccination: fifty percent (50%) have received at least one booster dose, while over twenty-six percent (26.4%) of adults have completed their primary series or received a booster dose in the last 6 months. In addition to acquiring immunity through vaccination, since the arrival of the Omicron variant in late 2021, a high proportion (>70%) of the Canadian population has also acquired post-infection immunity as shown by seroprevalence data to the end of October 2022. There are high levels of hybrid immunity and ongoing Omicron transmission domestically.

In comparison, the Chinese population has not gained substantial infection-acquired immunity through most of the pandemic due to the zero-COVID strategy. Immunity of the Chinese population due to vaccination is thought to be relatively low, even amongst older adult populations (66.4% of the population >80 years have completed a full course of vaccination, and only 40% have received a booster). Currently, eight COVID-19 vaccines have been approved for use in China consisting of protein subunit, non-replicating viral vector and inactivated vaccines (CanSino Convidencia, Cansino Convidencia-Air, KCONVAC, Sinopharm/Beijing, Sinopharm/Wuhan, Sinovac Coronavac, Zifivax, V-01). mRNA vaccines are not approved for use in mainland China, but are available in Hong Kong and Macao. Based on available data (Institute for Health Metrics and Evaluation), mRNA vaccines generally have higher vaccine effectiveness against severe disease and infection than the vaccines commonly used in China.

COVID-19 situation in Canada

In Canada, COVID-19 case counts have stabilized and hospitalizations are stable but remain elevated. Modelling suggests that the fall 2022 wave of infections and hospitalizations is past its peak in all major provinces and in Canada as a whole. Overall, wastewater trends also indicate a decrease or stabilization of activity with some regional variation. Emergency rooms are running at full capacity due to a combination of multiple factors such as respiratory syncytial virus (RSV), influenza and COVID-19, and are very stretched due to limited health human resource capacity.

Traveller volumes

In the month of December 2022, there were a total of 9 760 arrivals (2 440 arrivals per week) into Canada from China (Mainland) and 19 495 arrivals (4 874 per week) into Canada from Hong Kong. Over the previous 4 weeks (November 27 to December 24, 2022), 82.2% of travellers entering Canada from China (Mainland) entered directly and 17.8% arrived indirectly (via a connecting country – Hong Kong included as connecting country) whereas 89.3% of travellers entering Canada from Hong Kong entered directly and 10.7% arrived indirectly. Of the direct arrivals, the most common points of entry in Canada were Vancouver International Airport (66% China (mainland, 74% Hong Kong)) and Toronto Pearson International Airport (34% China (mainland, 26% Hong Kong)).

Preliminary modelling has highlighted that the potential impacts of China’s reopening on the Canadian health care system are unknown due to limited data; however, reports from the ground indicate a dramatic increase in the number of cases in China since November 2022. An increase in the number of infected travellers entering Canada may pose a potential burden on a strained Canadian health care system. Furthermore, infected travellers can cause secondary transmission to household members or the community. To reduce the burden on the Canadian health care system, it is important to reduce the risk of travellers introducing cases of COVID-19, including new variants of concern, into Canada from countries or regions that pose an imminent and severe risk to public health in Canada.

Government of Canada response to COVID-19 pandemic

The Government of Canada’s top priority is the health and safety of Canadians. To limit the introduction and spread of COVID-19 in Canada, the Government of Canada has taken unprecedented action to implement a comprehensive strategy with layers of precautionary measures. Between February 3, 2020, and June 27, 2022, 80 emergency orders were made under the Quarantine Act to minimize the risk of exposure to COVID-19 in Canada — to reduce the risk of importation from other countries, to repatriate Canadians, and to strengthen measures at the border to reduce the impact of COVID-19 in Canada. Together, these measures were effective in significantly reducing the number of travel-related cases. All emergency border measures were lifted on October 1, 2022.

On December 7, 2022, three years after the first importation and transmission of cases of COVID-19, China lifted its COVID-19 restrictions and since then, Chinese social media indicated that China has been experiencing a dramatic increase of COVID-19 cases. The limited data on COVID-19 cases, including data on circulating SARS-CoV-2 variants, from Chinese authorities requires a prudent posture pending more accurate and timely scientific information to limit the risk of increased importation from China’s reopening posing a severe risk to public health in Canada.

Changes to international travel restrictions and advice are based on national and international evidence-based risk assessments. The Government of Canada recognizes that entry conditions place significant burdens on the Canadian economy, Canadians and their immediate and extended families.

The unexpected emergence of novel variants of concern remains a serious public health concern given the potential for a resurgence of travel-related and domestic cases in Canada. As such, there is a need to maintain a precautionary approach, particularly in the absence of information on case load, severity and genomic sequencing data from affected countries.

With new and possible immune-evasive variants of the virus that causes COVID-19, emerging in countries around the world, the Government of Canada will continue to take a data-driven, scientific evidence-based and precautionary approach to its border measures for travellers entering Canada.

Implications

In response to the epidemiological situation in China and its regions, the Government of Canada is putting in place measures to prevent new importation and secondary transmission of SARS-CoV-2 and its novel variants of concern in Canada. These measures, including the coming into force date, generally align with the measures that will be implemented by the US. This alignment is expected to lessen the risk of confusion and complication amongst travellers, since the US measures also apply to air travellers transiting through Canada, including through Vancouver International Airport and Toronto Pearson International Airport.

The Order requires most air travellers who are two years of age and older, entering Canada on flights originating from China, Hong Kong or Macao, to provide to the airline, prior to boarding, evidence of a negative COVID-19 test result, taken no more than two days before their departure. The test can be either a negative molecular (such as a PCR test) or a negative antigen test that has documentation to show that it has been monitored by a telehealth service or an accredited laboratory or testing provider. Passengers who tested positive more than 10 days but no more than 90 days before their departure flight, can provide the airline with documentation of their prior positive test, in place of a negative test result. This Order does not apply to travellers entering Canada through modes of travel other than air.

Furthermore, all travellers subject to the Order are required to retain evidence of a COVID-19 molecular test or antigen test until they leave the airport in Canada and provide that evidence to the Minister of Health, screening officer or quarantine officer upon request.

The limited exemptions from this Order include: a person who was in transit in China, Hong Kong or Macao for a period of 24 hours or less from the flight’s scheduled departure time; crew members; a person or any member of a class of persons for whom the release of the pre-boarding testing requirements is in the national interest as determined by the appropriate Minister, as long as they comply with specific conditions imposed on them by the relevant Minister in consultation with the Minister of Health; a person or any member of a class of persons who enters Canada on board a conveyance organized by the Government of Canada and is authorized by the Minister of Health, the Minister of Foreign Affairs and the Minister of Citizenship and Immigration to be evacuated from a country, and who is in exigent circumstances and suffering hardship, as determined by the appropriate Minister and who complies with the conditions imposed on them by the Minister of Health; or a person who is not required under the Aeronautics Act to provide evidence of a COVID-19 molecular test or evidence of a COVID-19 antigen test.

The Order comes into force at 00:01:00 EST on January 5, 2023 and expires at 00:01:00 EST on February 4, 2023.

Penalties

Failure to comply with this Order and other related measures under the Quarantine Act is an offence under the Act. The maximum penalties are a fine of up to $1,000,000 or imprisonment for three years, or both. Non-compliance is also subject to fines under the federal Contraventions Act scheme.

Consultation

The Government of Canada has engaged provinces and territories to coordinate efforts, where applicable. In addition, there has been consultation across multiple government departments, including the Canada Border Services Agency, Transport Canada, Global Affairs Canada, Immigration, Refugees and Citizenship Canada, and Public Safety Canada, given linkages to departmental mandates and other statutory instruments.

Contact

Pamela Arnott
Public Health Agency of Canada
Telephone: (343) 574‑2194
Email: pamela.arnott@phac-aspc.gc.ca