Communicable Disease and COVID-19

Provisional Direction and Guidance for Cadet and Junior Canadian Rangers Activities for Spring and Summer 2023

22 March 2023

CJCR Medical Liaison Officer Group

Foreword

1. The Cadets and Junior Canadian Rangers Group (CJCR Gp) is monitoring the epidemiology of the COVID-19 pandemic and has consulted with the Canadian Army Surgeon and the Canadian Armed Forces (CAF) Directorate of Force Health Protection, Communicable Disease Control Program. A common approach to Communicable disease and the communication of medical guidance is key to successfully plan for spring and summer 2023 activities.
2. The following direction and guidance (D&G) are in effect for calendar year 2023, or until otherwise directed by Comd CJCR Gp. The recommendations made within this document are considered preliminary guidance by CJCR Gp, under the advice of CAF Health Services, and intended to assist operations and planning staff as well as medical support staff. This document and guidance herein may be subject to change or revision based on the course of the COVID-19 pandemic. While this direction and guidance provides more focus on COVID-19, the management of other communicable diseases is covered in general terms, noting that principles of their management are universal to a large extent.
3. This D&G was authored by CJCR Gp medical liaison staff and approved at the Office of CAF Health Services Directorate of Medical Policy, Senior Staff Officer (SSO) Primary Care.
4. The Senior Medical Authority (SMA) is the CAF Health Services Base Surgeon (BSurg) or Regional Surgeon (RSurg). From time to time, temporary or permanent changes to this D&G may occur because of SMA or Medical Liaison Staff recommendations.
5. Significant amendments or modifications which are expected to be of interest to CJCR Gp personnel will be promulgated when indicated. In the event of a conflict between this D&G and higher-level directives/orders, the higher-level directives/orders will take precedence.

Section 1

Prerequisite Planning Considerations and Immunizations

General Considerations

• 1.1 It is impossible to reliably predict the course of the COVID-19 pandemic or to predict outbreaks of other communicable diseases. The extant risk of emergence of highly transmissible variants of COVID-19 pose a continued risk of impact to cadet and Junior Canadian Rangers (JCR) activities and operations. It follows that corps/squadrons, Cadet Training Centres (CTCs) and Regional Cadet Support Units (RCSUs) should continue to be poised to adapt to risks of disease transmissibility and to potentially changing public health recommendations. Risk mitigation measures and compliance in general health and hygiene practices will remain key in ensuring a safe and effective spring and summer of cadet and JCR activities.

Immunizations and COVID-19 Vaccination Requirement

• 1.2 Vaccines are effective at preventing severe illness, hospitalization, and death from COVID-19. Therefore, in line with Health Canada’s National Advisory Committee on Immunization (NACI) recommendations, CJCR Gp strongly recommends, but does not require, that staff, cadets, and JCRS be up to date^{Footnote 1}  with the COVID-19 vaccine primary series and booster doses for which they are eligible, along with all other immunizations against vaccine-preventable illnesses.

• 1.3 Canadian Cadet General Order (CANCDTGEN) 004/23, Update – COVID-19 Vaccine Policy and General Disease Prevention Guidance was issued to reflect the current CAF policy and cancelled all previous CANCDTGENS relating to COVID-19 vaccine requirements. Recognizing that the implementation of vaccine policy is a decision requiring strategic and administrative consideration, it may become necessary to revise the vaccination policy if the epidemiologic or public health requirements change, or if federal/provincial legislation changes. Personnel should also recognize that contracted locations not on federal property, CAF infrastructure, and deployments on Royal Canadian Navy (RCN) Ships or Royal Canadian Air Force (RCAF) aircraft could have different entry/access requirements and may require proof of vaccination. Recognizing that cadets may embark on RCN Ships, CJCR Gp has consulted with the RCN Surgeon regarding the vaccine policy within Naval General Messages (NAVGEN) 026/22, RCN Directive 001/22 – Implementation of CDS Vaccination Directive 003 (link accessible only on the DWAN) and its applicability to cadets. We have been advised that the RCN is presently in the process of updating vaccine recommendations and although they do not require cadets to vaccinated, they strongly recommend that cadets be vaccinated and have received a bivalent booster against COVID-19. This notwithstanding, anticipatory review and clear communication of these policies would be prudent in allowing participation and sufficient time to meet vaccination requirements, where required.
• 1.4 Strategic CAF guidance regarding COVID-19 and useful references are provided in the CF Health Services Advisory Message 6636-80 COVID-19: Force Health Protection Recommendations (link accessible only on the DWAN) and in the CDS Directive 003 on CAF COVID-19 Vaccination for Operations and Readiness.

Activity Planning: General Considerations

• 1.5 Currently the CJCR Gp is planning for a resumption of overnight training activities with shared quarters for the spring and summer 2023. This notwithstanding, leaders will need to anticipate, monitor, and follow preventive health measures and be aware that activities may be subject to further constraints and direction provided by the CAF or contracted facility, as applicable. For example, if a contracted location or base requires proof of vaccine, or enforces parameters on distanced bunking, etc., then such constraints will need to be adhered to.
• 1.6 It would be important to highlight that responsible planning for spring and summer Multi-day overnight activities will need to incorporate additional staff and lodging (suitable and sufficient isolation quarters) to support communicable disease outbreaks, including COVID-19. Isolation quarters are an essential prerequisite planning consideration for overnight activities. Nominally, and in the absence of other guidance, it would be reasonable to provide a minimum of one and ideally two isolation spaces for every ten participants who are housed in shared facilities, with the potential to surge to a higher ratio should the epidemiologic circumstances of COVID-19 or another disease require. See Section 3 and the Provision and Standards of Isolation Quarters for further details and recommendations in this regard.
• 1.7 RCSU, CTC, and Canadian Ranger Patrol Groups (CRPGS) Commanding Officers (COs) should be mindful of the potential need to temporarily support isolating cadets and JCRS beyond the planned conclusion of their activities, in cases where it would be inappropriate for the cadet or JCR to travel, home if they still have an active case of a communicable disease.

Lodging and Activity Planning: Disease Transmissibility / Prevention Measures

• 1.8 Guiding principles to minimize transmission and the impact of outbreaks are listed below and can be implemented at the discretion of COs, recognizing that there may be instances where climatic conditions, such as active precipitation or extremes of temperature, or other circumstances prevent their use. Common sense will always prevail. Where possible, and insofar as practicable, the following recommendations are suggested to guide the planning and execution of cadet and JCR lodging and activities:
  1. Accommodations planning should minimize crowding and minimize the number of persons sharing accommodations and spaces. A spacing of 2 meters is recommended between beds to reduce the risk of disease transmission but it is acknowledged that this may not be always practical due to constraints on room dimensions. In these instances, a density of 1 person per bunk bed or 1 meter spacing should be achieved;
  2. Ventilation should be maximized within the accommodations and spaces (windows open, HVAC/air exchange, etc.);
  3. Activity planning should endeavor to employ “cohorting”, which is the practice of keeping members of the same groups or subgroups together over a given period of several days, where feasible;
  4. Activities should be planned outdoors, but only insofar as practical to do so, affording careful consideration the risks of environmental illness, such as sun exposure, heat illness, insects, etc.;
  5. Adequate supply of alcohol-based hand sanitizing gel or hand washing stations should be provided, as well as a supply of and routine use of disinfecting wipes for high-traffic surfaces, particularly at dining facilities and in lodging;
  6. An adequate supply of masks, as well as instructions that invite participants including staff and volunteers to wear these should be provided; and
  7. A sufficient allotment of isolation quarters should be incorporated into the infrastructure planning in order to isolate individuals who test positive or exhibit symptoms of COVID-19 or another communicable disease.

Early Communication to Cadets/JCRS and their Parents/Guardians: Participation and Communicable Disease Policy

• 1.9 Before a cadet or JCR attends an activity, it is essential that supervisors communicate expectations to parents/guardians, so that all parties are clear on how communicable disease management will be approached. Inclusion of this D&G into Joining Instructions, the Operational Plan, and an acknowledgement of parent/guardian understanding of the guidance and procedures herein is advised.
• 1.10 In addition to the guidance and procedures in this document, cadets, JCRS, and their parents/guardians must clearly understand the following:
  1. Only those who do not have an active communicable disease or new infectious symptoms may attend the cadet or JCR activity. See Section 2 Pre-Arrival Considerations and Suggested Screening Methodology;
  2. Testing positive or having symptoms of a communicable disease, specifically including COVID-19, may preclude participation in cadet or JCR activities by up to one week, either through deferred arrival/attendance, a period of isolation while the cadet or JCR attends their activity, or, in instances where an illness takes place near the end of their activity, an earlier than anticipated return home; and
  3. Parents/guardians are encouraged to pick up their cadet or JCR if they test positive for COVID-19 or require a period of isolation from communicable disease, and that the preferred location of isolation from communicable disease is generally at their home, but only if it is feasible and practicable to do so.
• 1.11 Recognizing that staff and isolation facilities may be limited, the “stay home when ill” approach above is most prudent due to the burden that communicable disease and isolating persons creates and should be employed where it is feasible and in the best interest of the cadet or JCR. It is acknowledged that this may not be a feasible option for cadets or JCRS who have travelled a greater distance to attend the activity, or where no parent/guardian is immediately available to support the cadet or JCR.

Section 2

Routine Procedures

Pre-Arrival Considerations and Suggested Screening Methodology

• 2.1 Those individuals who become ill immediately prior to joining the cadet or JCR activity will isolate at their home, deferring their attendance until their isolation period has finished.
• 2.2 Cadets and JCRS should be encouraged to self-monitor and self-report possible symptoms of infection. It is recommended that adult staff implement an active “pre-screening” step prior to departure, but on the same day as arriving to the cadet or JCR activity. If verbal screening is employed, this should be done by a responsible adult in a location and manner where privacy is respected. Movements officers will be authorized to deny loading onto transportation if verbal screening is performed at departure. If signage is used for screening, it should be legible and written in both official languages, where applicable.
• 2.3 At activities that are supported by on-site medical personnel, such as CTCS, a summary register/record of names of screened cadets or JCRS who have passed/failed screening questions should accompany the group and be issued to the receiving senior nursing or medical technician staff during intake/arrival phase. This screening record should be arranged alphabetically, by the cadet/JCR’s last name, and include date/time of screening, and if the cadet or JCR passed the screening questions (yes or no). 
• 2.4 Written questionnaires and screening processes which were used during the early stages of the COVID-19 pandemic may continue to be used. Where not available, the following screening questions are recommended:
  1. Do you feel unwell today?
  2. In the last 7 days, have you tested positive for COVID-19?
  3. Have you developed symptoms^{Footnote 2}  of COVID-19 that started in the last 7 days?
  4. For either travel or for medical reasons, have you recently been told to quarantine or isolate from others?

• 2.5 Those who do not answer “no” to all screening questions are likely not fit to attend a cadet or JCR activity until they are feeling better, and their isolation/quarantine period is completed. The general expectation is that those who fail pre-screening questions would follow the isolation and COVID-19 testing guidance below, as applicable, unless and until otherwise directed or cleared by a medical provider.
• 2.6 Temperature screening is not a recommended primary screening mechanism to identify individuals with COVID-19. Temperature checks have been used at some facilities during the COVID-19 pandemic as an additional layer of screening. Though it may be useful in demonstrating proactive policy, there is questionable evidence surrounding the utility of this practice.

Masking: Advice for Cadet and JCR Settings

• 2.7 The best fitting and best quality masks available are recommended. Non-medical masks can help prevent the spread of COVID-19 and other illnesses, however medical masks are the recommended option, as they must meet established filtration standards.
• 2.8 The use of masks may be temporarily required during the cadet or JCR activity to mitigate the risk of transmission of communicable disease such as COVID-19, as detailed below in COVID-19, Cold and Flu Symptoms - Symptomatic Cases and General Isolation Procedures. Provided they are in isolation and do not risk coming in close contact (2 meters) with others, persons who are unwell and in active isolation do not need to wear a mask unless they were specifically advised otherwise by medical staff.
• 2.9 Non-medical or medical masks may also be worn voluntarily by any person, at any time. Cadets, JCRS, and staff will be kind and respectful of people’s personal choices with regard to the wearing of masks.

COVID-19, Cold and Flu Symptoms - Symptomatic Cases and General Isolation Procedures

• 2.10 Persons with cold or flu symptoms should isolate themselves from others, undergo rapid test for COVID-19, if rapid tests are available and if recommended by province/territory at the time, and wear a mask to limit the spread of contagion until they can isolate.
• 2.11 Rapid tests should be administered by medical staff where they are available and supporting cadet or JCR activities, otherwise cadets or JCRS who are capable of doing so can self-administer a rapid test. Persons who refuse or do not tolerate a rapid test should isolate as if, they were positive.  
• 2.12 Fluids and rest are generally advised in most cases for those who are unwell, particularly with those who have a fever. Common sense measures to reduce disease transmission, such as the use of masks, hand hygiene, routine disinfection of high traffic surfaces, maximal ventilation, and personal spacing (2 meters) should be employed in these instances.
• 2.13 In scenarios where it is impossible or impractical for an individual to isolate, then to the furthest extent practicable, maximal disease prevention concepts and measures should be employed, as outlined above. For any respiratory illness, those measures should include consistent wearing of a well-fitting face mask by the infected individual.
• 2.14 Those who test positive for COVID-19 should be isolated as per guidelines, or as otherwise advised by medical personnel if they are supporting the activity. In keeping with guidance in 6636-80 COVID-19: Force Health Protection Recommendations (link accessible only on the DWAN), and in the absence of other direction provided by a SMA, it is reasonable to suggest a 7-day period of isolation, plus 3 days of masking afterwards (not in isolation, where personal spacing cannot be assured), starting the date of symptom onset for COVID-19 positive individuals. The duration of isolation may be modified or further reduced based on provincial and/or territorial public health recommendations in place at the time, and under the direction of the SMA. Close contacts, those who were in proximity under 2 meters for several minutes, may monitor themselves for symptoms for 14 days and be tested should they feel unwell or have symptoms.  
• 2.15 In general, those who are symptomatic from an illness but have a negative COVID-19 test are advised to continue to isolate and repeat a second rapid test 24 hours later, to reduce the likelihood of a missed COVID-19 case. Those who continue to test negative should isolate a minimum of 48 hours from the onset of their symptoms, and remain isolated until they are feeling well, and have demonstrated a period of at least 24 hours with definite and significant clinical improvement to their baseline, with no occurrence of any fever (without use of antipyretic medication such as Advil or Tylenol), or until they can be assessed by a medical provider supporting the cadet or JCR activity, where available. While in the company of others, and where personal spacing of 2 meters cannot always be assured, it would be reasonable to suggest the cadet or JCR wear a mask for the first day of return from isolation as a precaution.
• 2.16 Should a cadet or JCR require isolation while they participate in a cadet or JCR activity, then the parent/guardian of that person should be notified by medical support personnel, or in their absence, by a responsible adult supervisor, as soon as practicable after their wellbeing is assured. Parents/guardians should be advised of the procedures in place if a cadet or JCR contracts COVID-19. Where it is convenient and feasible, and if supported by parent/guardian, isolation of a cadet or JCR should take place at their home, unless circumstances or undue hardship precludes doing so. Recognizing the brief duration of some cadet or JCR activities, the chain of command may recommend an early return to home and/or rescheduling their engagement in activities to a later date. All cadets or JCRS in isolation require regular health and wellness checks by adult duty staff and by medical staff, when they are available during clinical hours. Further guidance and procedures can be found below in Monitoring and Wellness Checks for Isolating Persons.

Isolation of Staff Members

• 2.17 When planning for isolation from communicable disease, chains of command should understand that similar considerations apply to adult staff, keeping in mind that there may be different challenges with accommodation, feeding and cleaning.
• 2.18 Where they exist, local supporting CAF facility directives should be followed; adult staff members who are lodged in designated DND accommodations are subject to local supporting base policies, and the direction of the SMA from the supporting Base or Wing Surgeon. For example, some Bases and Wings have previously directed that CAF personnel who are required to isolate do so in designated Base Accommodations with meal delivery and cleaning services tasked to the CTC.
• 2.19 Isolating adult staff should be cohorted and have isolation barracks that are distinct and separate from youth. Adult staff who are in isolation will not be called upon to monitor cadets or JCRS.
• 2.20 Adult supervisors and medical staff may already have lodging where it is clearly practical and convenient to remain in place, that is to simply isolate in their own quarters. This is reasonable, provided personal spacing of 2 meters from others is strictly maintained, and isolating persons reside within their own walled off, separately ventilated room, with separate use of their own dining area and toileting/bathing areas. In such instances, isolation barracks need not be used. Where isolation cannot be feasibly maintained, coordinating temporary lodging for isolation in alternate location is reasonable. In all cases where transit through public areas is unavoidable and necessary, medical masks will be worn by infected individuals.

Monitoring and Wellness Checks for Isolating Persons

• 2.21 The chain of command will designate a responsible adult duty staff person who is on site and capable of attending to the needs of isolating cadets or JCRS throughout the day. In all instances, cadets/JCRS in isolation will have 24/7 contact with a supervisor or a designated responsible adult such as a Duty Operations staff, who can respond to their wellbeing and attend to their needs. Persons in isolation will have regular, daily contact with adult duty staff to check in, observe and attend to the needs of isolating cadets/JCRS, and with medical staff while they are on duty and supporting the cadet or JCR activity.
• 2.22 Medical clinics may be assigned to support larger-scale cadet or JCR activities, such as CTCS. Command teams should plan their duty staffing routine under the assumption that supporting medical clinics will typically be limited to daytime/business hours and have reduced or no operations evenings and weekends.
• 2.23 In all instances, when supporting medical staff are not immediately available, then health focused wellness checks should be conducted periodically (twice daily is suggested) by adult duty staff who are qualified in first aid. These wellness checks should include an understanding of general wellbeing (“sick” vs “not sick”), level of alertness, mood, pain levels, and screening for any breathing difficulties, food, and liquid intake so that regular urine output is assured. Fluids and rest should be encouraged.
• 2.24 Most persons with COVID-19 and viral syndromes have mild and limited symptoms which resolve after a few days. Questions about medical management can first be directed to the provincial or territorial telehealth access line to connect to a nurse to support decision making and provide management advice. If symptoms of COVID-19 or another communicable disease are severe or the state of the cadet/JCR is concerning to the cadet/JCR or staff, the isolating person should immediately be assessed by a community Urgent Care Facility or Emergency Department as appropriate. In such cases duty medical staff must be informed.
• 2.25 The chain of command for cadets or JCRS should ensure that a designated adult staff members provides periodic (every 2 days is suggested) updates to parents/guardians while their cadet or JCR is in isolation and be mindful that the parent/guardian may wish to make arrangements to pick up their cadet/JCR to temporarily allow them to isolate at their home.

Section 3

Standards of Isolation Quarters and Mental Wellness of Isolating Persons

Provision and Standards of Isolation Quarters

• 3.1 The provision of designated isolation quarters should continue to be incorporated into planning efforts to insulate against the potential impact of COVID-19, and other communicable diseases. The principle of isolation is fundamental in controlling communicable disease spread.
• 3.2 The required ratio of isolation spaces to participant is difficult to forecast. Modeling tools such as those generated by Defence Research and Development Canada (DRDC) can be useful in predicting the prevalence of COVID-19 in various regions across Canada, however it is largely impractical to make inferences or plan for the months ahead based on this data. Nominally, and in the absence of other guidance, it would be reasonable to provide a minimum of one to two isolation spaces for every ten participants who are housed in shared facilities, with the potential to surge to a higher ratio should the epidemiologic circumstances of COVID-19 or another disease require. A ratio of two isolation spaces per ten individuals (2:10) would allow for up to 20% of the group to be isolated. 
• 3.3 Where possible, isolation quarters should be maintained to a high standard and afford a high quality of life. These spaces should be tidy and clutter-free, cleaned/disinfected routinely, be well ventilated and supplied with potable water, and have their own toileting/wash facilities that is distinct from those used by non-isolating persons.
• 3.4 Since an individual may require sustained use of an isolation quarters over several days, these quarters should be equipped with amenities to support morale and welfare, including the provision of Wi-Fi, a means of communication, and a common area/living space if feasible. Isolation quarters should be clearly marked, and distinct and separate from the main body, but in reasonable proximity to medical clinics that may be supporting the cadet or JCR activity. Isolation quarters will have access to outdoor spaces to allow isolating persons opportunities for light activity/movement and leisure, such as going for walks, etc.;
• 3.5 As part of their pre-inspection site visit, medical staff, typically the RMLO or supporting Base Surgeon, will verify the integrity of isolation barracks at CTCs to ensure they are suitable. Preventative Medicine (PMED) staff, when available, will also report on the readiness of isolation facilities.  
• 3.6 Medical staff supporting cadet and JCR activities will report on but will not be responsible for the execution of cleaning and upkeep of cadet infrastructure including isolation areas and quarters. Rather, the onus is on cadet or JCR leadership to make arrangements with Base Operations or other services that may assist in this regard.

Isolation and Mental Health of Cadet/JCR

• 3.7 The chain of command should be mindful of the deleterious effects of the pandemic way of life on the mental health of youth and adolescents. The interruption of activities caused by quarantine from illness can be especially difficult for this population. Medical staff have faced commensurate challenges with more mental-health related visits, particularly in 2022.
• 3.8 Regular communication and social interaction are of utmost importance; an “in Isolation but not alone” approach is best. The behavior, morale and welfare of isolating cadets and JCRS should be carefully monitored by staff, and by medical staff if supporting the activity. This can be as simple as asking how their mood is or how they are feeling.
• 3.9 Adult staff can employ the use of local youth crisis lines, Kid’s Help phone, youth advisor, the chaplain, or other resources. These and other such resources should be advertised and freely available for persons in isolation.
• 3.10 Feelings of homesickness can be normalized by staff with displays of understanding, remaining compassionate and focusing on the finite duration of their separation. Efforts can be made to build new social connections, and strategies to employ their unique skills and character strengths can be emphasized. Those who have religious beliefs should continue their routine prayer or meditation practices. Studies of youth in overnight summer camps have shown that the following coping strategies can assist in reducing homesickness:
  1. Activities with distraction and social connection such as games and activities;
  2. Contact with home through writing a letter/email/text or looking at a family picture;
  3. Social support by going to see someone whom they can talk with to help them feel better;
  4. Social connection by reaching out to make new friends;
  5. Optimism and focusing on positive aspects such as activities and new friends;
  6. Perspective and remembering that time away from home or activities is short; and
  7. Vicarious social support and thinking about what loved ones would say to help.
• 3.11 Isolation in the medical sense is a precautionary medical recommendation intended purely to prevent disease spread and guide the safe reintegration of the cadet or JCR to their activity. However, the requirement to isolate at a CAF facility is never absolute. If it is determined by the cadet, JCR or responsible adult staff that the psychological stress of social isolation while at CAF facilities is too great for a cadet or JCR to endure, or that isolating a person causes undue harm, then the CO or Officer in Charge (OIC), in consultation with medical staff, will coordinate an alternate plan, including if necessary, the cessation of cadet or JCR activities and return to home, or referral to a medical/mental health provider if necessary. Caregivers will be immediately notified and consulted during these instances.

Affording Outdoor, Social and Leisure Time to Isolating Persons

• 3.12 Isolating persons/cohorts will be provided regular voluntary access to outdoors or recreational spaces, to provide opportunity for either leisure or light exercise if these persons feel well enough to engage in these activities. Those who have fever or chills or underlying respiratory illnesses such as asthma are generally encouraged to rest and invited to join when they are feeling better.
• 3.13 A frequency of outdoor leisure of two to three times per day is suggested, but at the discretion of staff. The wellbeing of cadets and JCRS in isolation who are outside will always be monitored by a responsible adult staff member, who will be masked (unless outdoors in open air and maintaining at least 2 meters spacing from isolating persons) to the maximum extent possible.
• 3.14 Unless otherwise restricted by medical staff, leisure and activity levels of those who are in isolation should be light to moderate, and only as tolerated. Activities like walking, kicking a soccer ball, or shooting a basketball are examples. Staff-led interactive and social activities or games are encouraged for the isolating group cohort provided persons can maintain minimum 2 meters personal spacing outdoors. As an added measure of safety, unless climatic conditions prevent, masks should be worn by isolating persons when together in a group or social setting, both outdoors and indoors.
• 3.15 All isolating cadets and JCRS should always ensure they are adequately hydrated and protected from climatic stress such as sun exposure and extremes of temperature or humidity. Supervising staff should ensure this detail is attended to. Common sense may dictate deferring outdoor time depending on environmental factors or coordinating access to another suitable climate-controlled recreational space. 
• 3.16 Staff will ensure the separation of the isolating cohort from non-isolating persons, including offsetting schedules or providing designated areas and/or equipment for isolating persons. Isolating persons will wear masks while travelling to and from isolation rooms, and until 2 meters spacing is guaranteed from all persons. Isolating persons will ensure their mask is easily accessible during their activities. Hand hygiene must be performed before and after outdoor activities, and all equipment must be sanitized after use.
• 3.17 Medical or nursing staff supporting CTCs can field additional questions about outdoor activities for those under isolation and may recommend a restriction of this practice or modify the guidance above depending on the scenario.

Section 4

Special Procedures

Exceeding Isolation Capacity Thresholds: Surge/Contingency Isolation Quarters

• 4.1 It is prudent to plan for surges in the requirement for Isolation quarters. This may involve providing contingency lodging for infected personnel, such as the provision of temporary soft shelters (tents) or securing additional contracted rooms. Contingency isolation quarters, when used, will endeavor to maintain the same principles and standards as regular quarters, including cleanliness, provision of amenities to support quality of life, staff supervision and monitoring of well-being.
• 4.2 In all situations where there is either insufficient capacity, or where contingency lodging is clearly inadequate, then consideration must be given to returning persons to isolate within the infrastructure at their home. As a last resort, temporarily cohorting the infected individuals within a suitable shared space can be considered, provided medical masks are used and physical barriers such as plastic sheeting is erected to segregate individuals when 2-metre spacing cannot be assured. Before considering this course of action, consultation with supporting medical authorities is required, either through consultation with CAF Health Services personnel or the supporting public health representative. For guidance, staff can consult the section Medical Authorities and Questions from Supervisors.

Disease Incidence and Thresholds for Notifying Medical Authorities and Higher Headquarters

• 4.3 In all instances where the incidence of confirmed or suspected communicable disease (including COVID-19) exceeds the level which would normally be expected over a period of time, and/or when there is concern of potentially exceeding the capacity of isolation spaces, then the SMA must be consulted and the CJCR Gp National Medical Liaison Officer (NMLO) informed. Medical staff may seek advice and recommendations from the CAF Directorate of Force Health Protection (DFHP), Communicable Control Program, or officials from the supporting public health unit. In such instances, an investigation may be warranted and mitigating considerations up to and including the suspension of activities may be recommended, depending on the circumstances and the gravity of public health implications at the time. If there is a confirmed case of a communicable disease reportable to public officer of health, then medical authorities and the notification procedures in the section Non COVID-19/Reportable Disease Outbreak - Communications and Reporting should be followed.

Transportation of Cadets or JCRS in Isolation

• 4.4 Depending on the nature of the illness and the public health recommendations, the use of public transportation of cadets or JCRS who are in a period of isolation is generally discouraged. A reasonable alternative which may result in a cost to the family, provided acceptable to all parties, is to coordinate transportation of the cadet or JCR with their family or the use of an individual vehicle if the isolating person is well enough to travel.
• 4.5 Parents/guardians participating in transportation of their ill cadet or JCR should be briefed by a medical staff member on the health risks involved, counselled on measures to protect themselves and others from contracting the illness (including the use of masks, hand hygiene measures, etc., and have the opportunity to ask questions from medical personnel.
• 4.6 Case-by-case considerations and common sense will always guide travel home arrangements. Medical staff or local public health nurse can provide guidance with this subject, as outlined in Medical Authorities and Questions from Supervisors.
• 4.7 Unless otherwise advised by medical staff, ambulance/Emergency Medical Service transport should be used if it is necessary to transfer to a higher-level medical care facility such as a hospital.

Isolation Beyond Cadet or JCR Activities

• 4.8 It is anticipated that some persons may have to isolate past the end date of their cadet or JCR activity. If this scenario is anticipated, returning the cadet or JCR to isolate and get well at their home is strongly recommended, unless this is either not feasible or doing so would pose a risk of greater harm to parents/guardians, the public, or to the cadet or JCR.
• 4.9 It is recognized that factors such as lack of suitable transportation, the lack of an available parent/guardian to receive the cadet/JCR, or persons at home with health vulnerabilities may be barriers preventing travel home by a cadet or JCR who is isolating because of a communicable disease. Case-by-case consideration and common sense will be afforded to this scenario. The CO or delegated authority will be responsible for the return-home support plan, under medical and parent/guardian advice in such instances.
• 4.10 In some instances, it may become necessary to support an isolating cadet or JCR for a brief period of up to 7 days after conclusion of their activity. The CTC CO or delegated authority will develop the support plan to ensure the physical and mental wellbeing of the isolating cadet or JCR. Cadets/JCRS, their parents/guardians, and CTC COs should understand that medical support staff who may support CTC or JCR activities is limited immediately after the conclusion of the activity. At CTCS, the Senior Nursing Officer (SNO) and minimal staff will be onsite for activity closeout duties. Therefore, wellness checks for these isolating persons should be organized by CTC COs to ensure the cadets/JCRS wellbeing and attend to the needs of these persons. For further guidance on staff wellness checks, refer to the earlier section, Monitoring and Wellness Checks for Isolating Persons.
• 4.11 In rare circumstances, and if necessary, based on either the person’s underlying health condition or the nature of their illness, a tailored medical monitoring or follow up plan will be provided by the SNO with the on-site clinician or SMA concurrence. In most cases, remote/phone medical consultations with isolating persons is adequate.

Non COVID-19/Reportable Disease Outbreak - Communications and Reporting

• 4.12 Medical and adult staff should maintain an awareness that other transmissible diseases, aside from COVID-19, may emerge during cadet or JCR activities which may pose risks and be of immediate interest to a Public Health Officer. For outbreaks of certain “reportable” communicable diseases, as defined by provincial or territorial public health bodies, special reporting procedures and contact tracing requirements exist. Medical staff will ensure these requirements are carried out.
• 4.13 The medical management and specific isolation procedures for non-COVID-19 communicable disease will vary depending on the disease or condition and those details need not be stated here. However, the general principles expressed in this directive can still be applied in the absence of other direction. In general, the SMA will develop a medical response plan in consultation with DFHP and/or the public health unit.
• 4.14 Some communicable diseases are of special interest and pose a very high risk of transmissibility, where the responsiveness of outbreak management and deliberate contact tracing becomes essential. In instances such as these, careful and deliberate communications between public health bodies, medical staff, and the CJCR Gp is warranted. RCSU and CTC COs and medical staff are to contact the Joint Operations Coordination Centre (JOCC) for communication guidance.

Section 5

Questions from Supervisors and Disease Tracking

Medical Authorities and Questions from Supervisors

• 5.1 The medical authority on the management of disease outbreaks in CJCR Gp rests with the SMA, a senior medical officer within CAF Health Services. This is typically the supporting base or regional surgeon, who may consult Public Health and CAF authorities for further guidance and direction. At CTC, the SNO is typically the main point of contact for cadet communicable disease processes and may provide further directives in this regard to cadets, JCRS, and staff.
• 5.2 Most questions regarding management of communicable disease can be handled locally by medical staff who may be present at cadet or JCR activities. Queries from supervisors and COs about communicable disease can be directed to medical staff supporting the activity if available, typically this is the SNO, and in their absence to the Regional Medical Liaison Officer (RMLO). 
• 5.3 In cases where there is no CAF provided medical support and where there is difficulty or delay in contacting CAF Health Services personnel, then supervisors can seek guidance through the local health unit by visiting online public health resources in their jurisdiction, dialing a telehealth nursing consultation service, or by arranging for an assessment through a community health care professional to take initial actions. The NMLO, through the RMLO, will be informed as soon as practicable.

Statistical Capture of Communicable Diseases

• 5.4 Communicable diseases will be tracked by supporting medical staff when they are supporting cadet or JCR activities. The aggregate statistics will be stored centrally, along with other grouped diagnoses, on a national shareable platform visible to medical staff. This information should be updated daily and no less than weekly. These statistics will include the date, location, diagnosis, age of person, and numbers of cases or visits. These statistics will not include any personal health information or identifying data of any person.

References

• CDS Directive 003 on CAF COVID-19 Vaccination for Operations and Readiness
• CF Health Services Advisory Message 6636-80 COVID-19: Force Health Protection Recommendations (link accessible only on the DWAN)
• Public Health Agency of Canada, Canadian Immunization Guide
• CANCDTGEN 004/23, Update – COVID-19 Vaccine Policy and General Disease Prevention Guidance
• NAVGEN 026/22, RCN Directive 001/22 Implementation of CDS Vaccination Directive 003 (link accessible only on the DWAN)