The #CanadianShield starts at the border.

Immediate Action Needed by the Federal Government to Shield Canadians From Imported COVID-19 Variants of Concern

Highly infectious variants of the SARS-CoV-2 virus which causes COVID-19 (known as Variants of Concern, or VOCs) are circulating internationally. Several have been identified, with a naming strategy still being decided, including B.1.1.7 (identified in the UK) as well as variants identified in South Africa (501Y.V2) and Brazil (P.1). Others may exist and more could emerge.

Variants of Concern represent a clear and present danger to Canada’s health security and economic well-being. For example, the B.1.1.7 variant is estimated to be 30-60% more transmissible than current circulating strains based on current epidemiology data. It quickly became the dominant strain across the UK and Ireland, causing massive increases in COVID-19 cases, overwhelming hospitals and forcing both countries into difficult new lockdowns. Modelling for the U.S. Center for Disease Control suggests that B.1.1.7 could become the dominant variant in the U.S. in March.

The Ontario Science Table advises that B.1.1.7 “could drive much higher case counts, ICU occupancy and mortality if community transmission occurs.” If B.1.1.7 or another highly transmissible VOC becomes dominant in Canada, it could cause hundreds of thousands of additional COVID cases and thousands of additional deaths. Very stringent, long lockdowns (beyond what Canadians are already experiencing) could be required to control it, causing tens of billions of dollars in additional economic damage.

While vaccine deployment will eventually add to our defenses against current circulating SARS-CoV-2 strains, and presumably VOCs, the accelerated transmission rate associated with B.1.1.7 coupled with delays in vaccine acquisition and distribution raise significant concerns for the viability of current, overstretched pandemic controls in Canada.

Existing travel and border protocols have not prevented the importation of these new variants into Canada. Cases of variants B.1.1.7 and 501Y.V1 have now been confirmed in several provinces. It is highly concerning that, in a number of cases, their path into Canada remains unknown.

There is a brief window to prevent the scenario that is unfolding in the UK. Without immediate additional action by the Federal government, Canada faces a very significant risk of an escalated new, variant driven COVID wave. Delays in significantly reducing the risk of importation could be ruinous.

Several other jurisdictions, with more rigorous approaches to border control than Canada, have successfully limited the importation of VOCs. These include Taiwan, Australia, New Zealand and South Korea. They are succeeding due to tight travel restrictions alongside domestic measures (notably strict quarantine requirements) adopted earlier and applied more strongly than current Canadian policy.

Drawing upon these demonstrable successes and adjusting for Canadian realities (e.g. our land-border with the U.S.), we recommend the following 9 immediate actions by the Federal government:

1. Reduce opportunities for variant entry, by restricting international travel to essential travel only:
1. Reduce the number of people leaving/entering Canada by air or by land, by defining more clearly and stringently what is essential and enforcing those criteria.
2. As a key part of eliminating non-essential travel, immediately cancel all flights to and from non-essential destinations (e.g. seasonal holiday destinations), except to allow for the return of Canadians already there.


2. Increase testing and variant screening for travellers to ensure that all VOC cases arriving in Canada are detected and sequenced. In addition to pre-boarding testing:
3. Perform a validated COVID test at point of entry for all entrants (air and land). No one can be exempted from testing, including essential workers and flight crew.
4. Require 2 additional tests during quarantine: the first several days into quarantine (e.g. Day 4/5) and the second shortly before the end of quarantine (e.g. Day 10/11).
5. Ensure all positive tests from travellers are screened for VOCs. The sequence data and adequate contextual information should be shared openly to enable national and international VOC surveillance and tracking.


3. Enhance the stringency of quarantine and isolation to limit the chance of VOC cases spreading. To prevent community exposure while possibly infectious:
6. Increase the effectiveness of the existing 14-day quarantine with daily checks by government, including in-person checks.
7. Provide designated facilities (with adequate food, resources and telecommunications) for those who cannot safely quarantine or isolate at home.
8. Strongly consider mandatory quarantine in designated hotels for all incoming travellers.


4. If a COVID-19 vaccine is demonstrated to reduce transmissibility (as is expected), deploy strategically to limit the entry of VOCs from the U.S.:
9. Vaccinate, as a joint US-Canadian responsibility, the 200-300 thousand truckers and 25-50 thousand essential workers that make up the majority of US-Canada land-border crossings.

Given the very high stakes involved, it is better to act very strongly now and have the ability to relax constraints in the future versus not to be tough enough and lose forever the chance of shielding Canadians from the onslaught of new higher-transmission variants.

If the Federal government is not able to enact protective measures immediately, provincial governments should implement them without delay. A prudent response would be to enact protections against entry of VOCs into Canada by this week’s end.

In addition, provincial and federal governments should continue to coordinate on critical domestic actions to identify and eliminate VOCs already in Canada. Genomic sequencing of non-travel COVID cases should be expanded, and appropriate screening surveillance protocols developed, to identify VOCs already in the community. Inter-provincial travel should be restricted to essential activities in order to limit the geographic spread of VOCs until baseline surveillance is established and current data reviewed.

Canadians will support decisive action. In a recent poll, 87% of Canadians supported banning international travel until there were reduced numbers of COVID cases, with strong majorities across all regions, age groups, and party affiliations. In another poll, 65% of Canadians said they would ban international travel altogether.

These actions are not easy. However, they are not nearly as difficult as the restrictions already in place in many provinces. Compared to stay-at-home orders for 15 million Canadians plus nightly curfews for 8 million more, addressing deadly COVID outbreaks in hundreds of long-term care homes, or curtailing entire business sectors, stopping flights to holiday destinations and requiring all arriving passengers to have additional COVID tests is not unreasonable. Certainly, these restrictions are not as severe as the implications of not implementing them, if Canada then experienced a severe VOC COVID surge.

These actions will be difficult for our hard-hit airlines who have just announced a new round of cuts and are struggling to ensure pre-boarding testing of passengers. There is a strong case for sectoral support, as has been provided in other countries. However, these considerations should not block or delay painful but necessary actions to protect the health of Canadians and the viability of our fragile health systems.

These recommendations will protect Canadians from further importations of VOCs that have already been identified. They will also protect Canadians from the importation of future VOCs that have yet to be detected.

Time is of the essence. Every day increases the risk of further importation of the new variants, and their establishing a widespread presence in Canada. Hesitation could be fatal to thousands of Canadians, to our economic recovery, and to Canada’s overall fight against COVID.

We call on the Federal government, and in particular:

• Prime Minister Justin Trudeau
• Deputy Prime Minister and Minister of Finance Chrystia Freeland
• Foreign Affairs Minister Marc Garneau
• Transport Minister Omar Alghabra
• Health Minister Patty Hajdu
• Minister of Public Safety Bill Blair
• Canada’s Chief Public Health Officer Theresa Tam

to act decisively and immediately in implementing these urgent recommendations.

Respectfully,

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