When Debbie Grigg found out the highly contagious U.K. variant of the novel coronavirus was tearing through her mother’s long-term care facility, she was terrified.
“My mom’s floor is really, really bad right now. It’s very, very scary,” Grigg said.
“I feel for all the residents in there and all their families as well. So many people have passed away unnecessarily.”
Grigg’s 75-year-old mother Evelyn VanEmbden is one of more than 120 people infected with COVID-19 at Roberta Place, a long-term care home in Barrie, Ont.
Sixty-three residents and one essential caregiver who worked at the home have now died from the virus since the outbreak, linked to one case of international travel, began around Jan. 8.
Public health officials have confirmed at least six cases of the U.K. variant at the home, while nearly 100 others at the long-term care facility have received a positive test result for a COVID-19 “variant of concern.”
Infectious disease specialists and family members like Grigg say this shows the government hasn’t done enough to contain new variants of the virus or to keep residents at long-term care facilities safe.
“It’s very, very maddening that (governments) haven’t done things to stop more travel, more people coming in one way or another and to protect Canadians,” Grigg said.
“It drives me crazy.”
Anyone entering Canada for non-essential purposes is required to quarantine for 14 days upon their arrival. Anyone who’s sick must self-isolate regardless of whether they are deemed essential.
The federal government announced new travel rules on Jan. 29, including mandatory COVID-19 testing for travellers returning to Canada, a mandatory three-night quarantine in a hotel at a cost of roughly $2,000 per person, and increased enforcement by private security firms.
All international flights must also land at one of four airports: Montreal, Toronto, Calgary or Vancouver.
Airlines, meanwhile, have agreed to suspend direct flights between Canada and some popular sunny destinations in Mexico and the Caribbean until the end of April.
“We’re very concerned by the arrival of variants of this virus,” said Prime Minister Justin Trudeau on Jan. 29 when speaking about the cases in Barrie.
“One single case spread very quickly in the community. So we must do everything to prevent the arrival of these variants.”
Asked why the government didn’t act sooner, especially given that premiers had been calling for an outright ban on international travel prior to the announcement, Trudeau said Canada has “some of the strictest restrictions on travel of any of our allied countries around the world.”
He also said the new restrictions will “significantly reduce” the risk of importation of new variants across the country, while striking the right balance between “feasibility and maximum safety for Canadians.”
8.5 million border crossings
There have been more than 8.5 million border crossings into Canada since the start of the pandemic, according to statistics provided by the Canada Border Services Agency (CBSA).
This includes four million commercial vehicles, 2.5 million passenger vehicles, 1.3 million international air travellers and 500,000 people flying from the U.S.
But the CBSA said 74 per cent of these travellers — or 6.3 million people in total — were exempted from quarantine measures because they were deemed essential.
There have also been thousands of domestic and international flights in Canada that had confirmed cases of COVID-19 on board, according to the Public Health Agency of Canada (PHAC).
Global News contacted four major airlines and federal, provincial and local health authorities in the provinces where most international flights have landed to determine what, if any, contact tracing efforts are underway to warn passengers they may have been exposed to COVID-19 because someone with a confirmed case of the virus is identified as having boarded a commercial flight.
Their responses reveal a system where almost no one takes responsibility for directly contacting passengers to tell them they were on a flight with confirmed COVID-19 cases, even if they were seated immediately next to someone who subsequently tests positive for the virus.
Instead, health officials rely on passengers to consult a website run by the federal government that lists potential exposures to the virus on flights in the past two weeks.
One key reason for this is that public health officials in Canada don’t agree on who’s responsible for contacting travellers to let them know about potential exposure to COVID-19 on commercial flights.
Some local health agencies, such as York, Peel, Toronto and Hamilton, said it’s either the province or federal government’s responsibility to notify travellers, while provincial health officials said the federal government is in charge. The federal government, meanwhile, said it does not contact passengers directly.
“Effective March 27, passengers seated near a case of COVID-19 (that) was recognized after arrival are no longer directly notified of their potential exposure,” said a spokesperson for B.C.’s Ministry of Health. “Instead, that information is posted online.”
A spokesperson for Quebec’s Ministry of Health and Social Services said it’s PHAC’s responsibility to notify passengers of potential exposures on flights.
Following a positive COVID-19 test in Quebec, individuals are asked questions to determine if they recently travelled and whether they may have been contagious during their trip. If the answer to this question is yes, local health officials notify the airline and PHAC with the passenger’s details, the Quebec spokesperson said.
The airlines then provide PHAC with passenger details, including rows on board the aircraft that may have been at risk of exposure, so public health officials can publish this information on PHAC’s website.
Quebec said there is no direct communication with passengers to warn them they were on a flight with potential exposure to the virus.
“There is no individual follow-up that is done with potentially exposed travellers. They are responsible for checking the Government of Canada website to see if a case of COVID-19 was subsequently detected on their flight and to follow the requirements of the Quarantine Act,” a ministry spokesperson said in a written statement.
COVID-19 cases related to travel
While government officials, including Canada’s chief public health officer, Dr. Theresa Tam, have said the risk of contracting COVID-19 on a flight is low, data on the source of many infections in Canada is incomplete.
Details on how people became infected are available for about 70 per cent of Canada’s 711,893 known cases of the virus, according to data from the federal government.
About 2.4 per cent of all infections — or 12,000 cases in total — are either directly or indirectly linked to travel. But more than 180,000 cases have no known source. Provinces have also reported cases of the new variants with no known links to travel.
PHAC, meanwhile, said the decision to directly warn travellers of possible exposure on board a flight should be made by provincial, territorial and local health officials following a risk assessment that includes an analysis of the type and severity of the illness, local guidelines and legislation around quarantines, and the “incremental benefit” of contacting people seated within two rows of an infected passenger.
“If the province/territory determines that notification to potential contacts is required, the public health authority can follow local protocols for publicly communicating when a case has had a history of travel during their period of communicability,” a PHAC spokesperson said.
Kelley Lee, Canada research chair in global health governance at Simon Fraser University, said travel cases have been undercounted throughout the pandemic as health officials aren’t adequately screening everyone who comes across the border
“(Public health officials) are underrepresenting the actual travel-related COVID cases. And it’s the way we’re counting them that is the problem. We’re missing a lot,” she said.
The recent results of a pilot program at Calgary’s international airport showed about 1.15 per cent of returning travellers were infected with the virus. A similar testing program at Toronto’s Pearson airport has a positivity rate of just over two per cent.
Lee also said it’s difficult for health officials to effectively track and monitor international travellers because of the numbers and a lack of national strategy. Even with the number of people entering Canada reduced by about 90 per cent compared to previous years, there are still about 200,000 people who cross the border every week.
“What you point to is a kind of fragmentation and lack of coherent policy so they’re different levels of jurisdiction, different policies across provinces that are not joined. There is no whole government approach to this,” Lee said.
“We are not following this closely enough to track it in the time-frame we need to keep it from spreading in the community.”
Meanwhile, Dr. Allison McGeer, an infectious disease specialist with Mount Sinai hospital in Toronto, says it’s not the government’s job to warn travellers they might be at higher risk of contracting COVID-19.
“If you and I are travelling, it’s nobody’s responsibility to tell us there’s risk,” McGeer said.
“If you’re travelling and you don’t understand, there’s risk and you don’t understand the need to quarantine yourself after travel. There is a limit that the government can do for you.”
McGeer also said that while the risk of contracting COVID-19 onboard a commercial flight is low, getting to and from the airport, plus the things travellers do at their destinations, increases the risk of transmission because the total number of contacts increases with every activity.
On Jan. 7, the government announced new rules requiring that anyone arriving in Canada by air would be required to show proof of a negative COVID-19 test before being allowed to board their flight. Canada also temporarily banned flights from the U.K. but lifted the ban when the testing requirement was announced.
The new rules initially granted exemptions to passengers arriving from some Caribbean countries because of the limited availability of coronavirus testing.
Air Transat, which operated flights from the Caribbean with passengers on board who subsequently tested positive for COVID-19, said it is making every effort to strictly follow Transport Canada guidelines for air travel aimed at slowing the spread of COVID-19.
Air Transat said that because of this exemption, the company couldn’t deny boarding to some travellers, even if they couldn’t prove whether they were tested.
The airline also said it’s only when passengers return to Canada and are confirmed positive for COVID-19 that it is made aware of the potential exposure on board its flights.
“In the event that a passenger tests positive for COVID-19 after their flight, it is the government authorities who will contact the passengers deemed at risk (according to public health standards in effect),” a company spokesperson said in a written response.
WestJet, meanwhile, said it contacts passengers directly to inform them they may have been exposed to COVID-19 onboard one of its flights. An email notification is sent to any passengers to inform them they may have been exposed to the virus.
The airline said it has been contacting passengers directly since September and has been posting public notices of potential exposures online since February.
Air Canada did not say whether it contacts passengers directly to inform them of possible exposure.
A spokesperson for the airline did, however, say it provides flight manifests to any Canadian health authority upon request within 24 hours.
Air Canada also said that just because a passenger who travelled on one of its flights subsequently tests positive for COVID-19 doesn’t mean they were infected at the time of the flight.
Variants could be Canada’s third-wave
Contact tracing is a cornerstone of slowing the spread of COVID-19 and the new U.K. variant, known as B.1.1.7.
The variant was confirmed at Roberta Place on Jan. 23. The variant has since been found in another long-term care home in the Simcoe Muskoka region of Ontario, where two staff members at Bradford Valley Care Community tested positive. There were two more confirmed cases of the variant in the region, bringing the total number of cases to 10.
Colin Furness, an infectious control epidemiologist and assistant professor at the University of Toronto, said he fears new variants, such as the U.K. variant or a South African variant known as N501Y.V2, could be the source of Canada’s third-wave of the virus.
He also said it’s possible any efforts the government takes now to slow their spread could be too little, too late.
“(COVID-19) moved from Wuhan all the way around the globe on airplanes. So the concept of safe air travel is an oxymoron in my estimation,” he said.
Furness said other countries, such as Taiwan and New Zealand, eliminated the spread of COVID-19 because their governments took decisive action quickly.
Taiwan, for example, used cellphone data to actively monitor people in quarantine. Anyone whose GPS indicated they were not isolating at home was visited by police. Health officials also called people in quarantine multiple times a day to make sure they were with their phones.
This type of approach, Furness said, is why just seven people in Taiwan have died from the virus out of a total population of more than 23 million.
“The problem with travel is that it doesn’t take very many people to be contemptuous of the whole thing. And there are people who are contemptuous,” he said.
Brad Wouters, executive vice-president of Science and Research at Toronto’s University Health Network, said both the U.K. variant and the South African variant – recently confirmed in Ontario – could overwhelm local and provincial health capacities if more isn’t done to stop their spread.
“We know that the variants are still increasing in numbers,” Wouters said. “If we don’t do something about them, they will eventually break through, they’ll become the dominant form of the virus in Canada and the measures we have in place won’t be strong enough to contain it.”
Ultimately, health experts say, Canada needs to reduce the number of non-essential travellers in order to limit the introduction of the virus and newer and possibly more contagious variants into the country.
Grigg, meanwhile, said she and other families at Roberta Place feel like the government should have implemented stricter travel measures sooner.
“They fell short on that,” she said. “That should have happened a long time ago.”