President of the PHAC before the Standing Committee on Health: Canadian response to the Novel Coronavirus (March 31, 2020)

No, Canada will not declare a public health emergency for this virus based on the science and data that are available at this time. We cannot speculate on the United States’ decision-making process that led to its new restrictions on travellers.

The Government of Canada has been following the temporary recommendations of the WHO under the International Health Regulations. We continue to work with the international community and the provinces and territories to align our practices with the PHEIC recommendations.

While some jurisdictions have legislation to declare public health emergencies in order to provide access to additional powers and authorities, such as new funding, travel restrictions, and streamlined decision-making, legislation is not required at the federal level in Canada to access similar additional powers.

Canada has multiple systems in place to prepare for, detect and limit the spread of infectious disease, including COVID-19, in Canada.

These include the following:

• The Public Health Agency of Canada (PHAC) activated the Health Portfolio Operations Centre (HPOC) to ensure effective planning and coordination of the Agency's response efforts, in collaboration with international and federal, provincial and territorial partners.
• Public Safety Canada has activated the Government of Canada Operations Centre to coordinate activities across federal departments and agencies.
• PHAC, through Canada’s Chief Public Health Officer, is in close contact with provincial and territorial Chief Medical Officers of Health to share information, coordinate response efforts, and support informed vigilance as the situation evolves.
• A Special Advisory Committee of Canada’s Chief Medical Officers of Health and senior public health officials has been activated to focus on coordination of federal, provincial and territorial preparedness and response across Canada’s health systems.
• Routine traveller screening procedures are in place at all of Canada’s ports of entry, and additional border measures have been put in place at all international airports to help identify any travellers returning to Canada who may be ill, and to raise awareness among travellers about what they should do if they become sick.

The Government of Canada maintains continual preparedness for public health emergencies, taking precautions to mitigate the potential risk of introduction and spread of infectious diseases. These precautions include:

• a comprehensive surveillance infrastructure to rapidly identify emerging events and infectious diseases, including respiratory illnesses;
• routine infection prevention and control precautions in all Canadian hospitals; and
• public health laboratory capacity that is well equipped to rapidly detect serious infectious diseases.

We have been in contact with our counterparts at the Centers for Disease Control and Prevention (CDC) in the United States and are continuously assessing the situation.

Both our health care and public health systems have been alerted to identify and manage possible cases. We are prepared to address any possible cases of the virus in Canada.

Our top priority is the health and safety of Canadians. The Public Health Agency of Canada is actively monitoring the situation regarding the novel coronavirus (COVID-19) and continuously assessing the risks to adapt our response, accordingly.

The Government of Canada has created the infrastructure to respond to the public health threats of the virus, and is well prepared to act—in collaboration with provincial and territorial governments and international partners—to minimize the health, economic, and social impacts of this rapidly evolving public health issue.

Canada's response is based on plans and guidance related to pandemic preparedness, with the following guiding principles:

• Collaboration - all levels of government and stakeholders need to work in partnership to produce an effective and coordinated response.
• Evidence-informed decision-making - decisions should be based on the best available evidence.
• Proportionality - the response to a pandemic should be appropriate to the level of the threat.
• Flexibility - actions taken should be tailored to the situation and evolve as new information becomes available.
• A precautionary approach - timely and reasonable preventive action should be proportional to the threat and informed by evidence to the extent possible.
• Use of established practices and systems - well-practised strategies and processes can be rapidly ramped up to manage a pandemic.
• Ethical decision-making - ethical principles and societal values should be explicit and embedded in all decision-making.

These principles build on lessons learned from past events, particularly the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, which led to dedicated legislation, plans, infrastructure, and resources to help ensure that the country would be well prepared to detect and respond to a pandemic outbreak. Some examples include:

• The creation of the Public Health Agency of Canada, which monitors and responds to disease outbreaks that could endanger the health of Canadians.
• The appointment of a Chief Public Health Officer, who advises the Government of Canada and Canadians on the steps they should take to protect their health, working in close collaboration with the chief medical officers of health in provinces and territories.
• The development of the Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector, which sets out guidance to prepare for and respond to a pandemic.
• The enhancement of diagnostic capacity in the National Microbiology Laboratory.
• The strengthening of working relationships with the World Health Organization and other international partners, such as the United States Centers for Disease Control and Prevention.

While the Government of Canada has been focusing on containing the spread of COVID-19, it has also been undertaking coordinated planning to prepare for possible broader transmission of the virus, and to mitigate the impacts of a potential pandemic.

To support these efforts, the Prime Minister convened an Incident Response Group on coronavirus, which has been meeting since the end of January, and, on March 5, he created a Cabinet Committee on the federal response to the coronavirus disease (COVID-19). Chaired by the Deputy Prime Minister and vice-chaired by the President of the Treasury Board, the committee meets regularly to ensure whole-of-government leadership, coordination, and preparedness to limit the health, economic and social impacts of the virus.

For the latest and most up-to-date information, visit Canada.ca/coronavirus. You can also follow Canada’s Chief Public Health Officer, Dr. Theresa Tam, on Twitter at @CPHO_Canada.

A new toll-free phone number (1-833-784-4397) has been established to answer questions from Canadians about the 2019 novel coronavirus. Service is available from 7 a.m. to midnight.

Canadians travelling abroad are encouraged to consult the Travel Health Notice on travel.gc.ca.

The Government of Canada is implementing a comprehensive national public education campaign for COVID-19 that will provide Canadians with credible information on behaviours that will protect individuals and overall public health. The campaign will include advertising, social marketing, the development of information resources, the establishment of partnerships and targeted outreach to at-risk populations. This work will complement current Public Health Agency of Canada outreach and communications activities such as the website for information on COVID-19 with a virtual assistant to help Canadians get to the information they need more efficiently, a toll-free information line, a self-assessment tool, digital advertising, social media posts, and regular updates to media.

The first elements of this campaign have begun to roll out. The pieces include two 30-second national television advertisements, a radio spot and newspaper advertisements.

Public education plays a critical role in our response to COVID-19 as it helps to:

• increase awareness and understanding about symptoms and treatment;
• provide information on preventive measures such as self-isolation; and
• address misinformation and public concerns.

For more information please view the English advertisements for:

Practise physical distancing to reduce the spread of COVID-19

How hand washing can reduce the spread of COVID-19

Effective March 25, 2020, the Government of Canada has implemented a federal Emergency Order under the Quarantine Act requiring anyone entering Canada, whether by air, land or sea, to isolate for 14 days if they have symptoms of COVID-19 or to quarantine themselves (self-isolate) if they do not have symptoms for 14 days, in order to limit the introduction and spread of COVID-19.

This applies to all people entering Canada with few exceptions — and captures those who have symptoms of COVID-19 and those who do not have symptoms.

These measures will help protect the health of individuals in question, any individuals with whom they may live and Canadians in general, including older adults and medically vulnerable people who are at greatest risk of severe COVID-19 disease.

Upon entering Canada, travellers will be asked questions about their health and symptoms, which they are required to report to a screening or Quarantine officer. They will also be asked to acknowledge that they are required, under the Quarantine Act, to isolate or quarantine (self-isolate) for a 14-day period that begins on the day on which they enter Canada.

Travellers will be provided with a hand-out that informs them that they are subject to the Order, provides general public health advice, outlines the requirements of the Order, and provides a link to the Canada.ca/coronavirus website where they can obtain further information.

Failure to comply with this Order is an offence under the Quarantine Act. Maximum penalties include a fine of up to $750,000 and/or imprisonment for six months.

Further, a person who causes a risk of imminent death or serious bodily harm to another person while wilfully or recklessly contravening this Act or the regulations could be liable for a fine of up to $1,000,000 or imprisonment of up to three years, or to both. Spot checks will be conducted by the Government of Canada to verify compliance. 

The Public Health Agency of Canada will work with federal and provincial partners to verify compliance with the Order.

Persons who do not have symptoms are subject to the federal Emergency Order and are mandated to mandatory quarantine (self-isolation) for 14 days, beginning on the day on which they enter Canada, because they are at risk of developing symptoms and/or infecting others.

Mandatory quarantine (self-isolation) means that they must:

• go directly home to their place of quarantine, without delay, and stay there for 14 days
• not go into community settings
• monitor their health for symptoms of COVID-19
• Arrange to have someone pick up essentials like groceries or medication
• Do not have visitors
• Stay in a private place like their yard or balcony if they go outside for fresh air
• Keep a distance of at least 2 arms lengths (approximately 2 metres) from other

Individuals can take public transportation but must not any stops on the way home and practice physical (social) distancing at all times.

If you develop symptoms within 14 days:

• isolate yourself from others
• immediately call a health care professional or public health authority and:
  • describe your symptoms and travel history
  • follow their instructions carefully

Persons who have COVID-19 illness or symptoms of COVID-19 are required to follow mandatory isolation for 14 days in accordance with instructions provided when they entered Canada and/or on the Canada.ca/coronavirus website, and remain in isolation until the expiry of the 14-day period that begins on the day on which they enter Canada.

Persons with symptoms may be directed to a quarantine facility for isolation or allowed to isolate at home. If required, immediate medical attention will be provided upon arrival in Canada.

If they are going home to isolate, mandatory isolation means that they must:

• Go directly to the place where they will isolate, without delay, and stay there for 14 days
• Go to their place of isolation using private transportation only, such as your personal vehicle
• Stay inside their home
• Not leave their place of isolation unless it’s to seek medical attention
• Not have visitors and limit contact with others in the place of isolation, including children
• Not isolate with in a place where they will have contact with vulnerable people such as older adults and individuals with underlying medical conditions

It is important to underscore that individuals entering Canada may be asymptomatic on entry. There are individuals who may subsequently fall ill. There are unfortunate cases where an asymptomatic individual can develop symptoms and deteriorate quite quickly. All, even those exempted from the Order, are reminded to monitor themselves for symptoms for a 14-day period.

Symptoms of COVID-19 include cough, difficulty breathing, or fever equal to or greater than 38°C (signs of fever could include shivering, flushed skin, and excessive sweating). Information about COVID-19 is also available at canada.ca/coronavirus and by calling 1-833-784-4397.

Visit the provincial or territorial health authority website where you are located for more information, including when to contact the public health authority.

People entering Canada who have reported having symptoms or who a Quarantine officer observes with symptoms will be instructed to go directly home, without delay, to isolate for 14 days or will be sent to a quarantine facility or transported to hospital, at the discretion of the Quarantine officer.

Considerations include the severity of symptoms or illness, whether they have a place in which to isolate, and if they have private transportation to get to their home or place of isolation.

For example, if they have onward connections, or the distance to get home is too far for PHAC-arranged medical transportation, or if they live with one or more vulnerable persons, travellers will be required to complete their 14-day isolation in a quarantine facility established by the Government of Canada.

Earlier this month, the Government of Canada began asking all international travellers entering Canada to isolate for 14 days. This voluntary measure was put in place to contain the spread of COVID-19.

There have been reports of travellers returning from abroad who do not understand that 14 days of isolation or self-isolation is essential to help slow the spread of COVID-19 in communities and protect their health and that of all Canadians.

That is why the Government of Canada has implemented this mandatory Order — to provide clarity around the need for people entering Canada to isolate or quarantine (self-isolate) when they enter Canada. These additional measures will contribute to containing the outbreak and preventing further spread of COVID-19 in Canada.

The 14-day period begins on the day the person enters Canada.

Yes, the Order to quarantine (self-isolate) is mandatory for travellers without symptoms. Given the rapid spread of COVID-19 around the world, with widespread transmission in an increasing number of countries, people who travelled outside of Canada are considered to be at risk of exposure to COVID-19. The Government of Canada has implemented an Order requiring anyone entering Canada, whether by air, land or sea, to quarantine for 14 days in order to limit the introduction and spread of COVID-19.

There are numerous examples of asymptomatic individuals arriving in Canada and falling ill. In fact, sometimes the health of individuals can deteriorate quite quickly. It is extremely important for their own health and that of others for persons entering Canada to quarantine (self-isolate) and monitor their symptoms.

Yes. Persons not exhibiting symptoms may take public transportation and/or rent a car to get to a place to isolate. However, they must go directly to their home, without delay, or the place where they will isolate without delay.

While in transit, people need to follow the instructions of quarantine officer and screening officers to avoid spreading infection to others. For example, this means avoiding contact with others as much as possible and maintaining a 2-metre distance from others, and practising hand hygiene and cough etiquette.

Under the terms of the Order, public transportation includes an aircraft, bus, train, taxi, subway or ride-sharing service.

Yes. Persons not exhibiting symptoms may take connecting flights to their final destination to quarantine (self-isolate). Under the terms of the Order, public transportation includes an aircraft, bus, train, taxi, subway or ride-sharing service.

Travellers will be instructed by quarantine officers or screening officers to follow precautions to avoid spreading infection to others. For example, practice physical distancing — maintain a 2-metre distance — hand hygiene and cough etiquette.

People entering Canada not exhibiting symptoms may be permitted by the instructions of a quarantine officer or screening officer to stay at a hotel for an overnight layover before making their connecting flight the next day. They should go directly to their hotel without any unnecessary stops along the way.

While staying at a hotel, travellers should stay in their room to avoid contact with others, practise physical distancing (maintain a 2-metre distance) and practise good hand hygiene and cough etiquette at all times. To get a meal, use a drive-thru or room service as long as your meal is delivered and left outside the door of your hotel room.

It is not recommended to stay with friends or family where it could be harder to avoid contact with people compared to a hotel room.

Asymptomatic individuals may be permitted by the instructions of a quarantine or screening officer to stay in a hotel overnight if necessary, but should go directly to their hotel without any unnecessary stops along the way.

While staying at a hotel, travellers should stay in their room to avoid contact with others, practise physical distancing (maintain a 2-metre distance) and practise good hand hygiene and cough etiquette at all times. To get a meal, use a drive-thru or room service as long as your meal is delivered outside the door of your hotel room.

It is important that travellers avoid any unnecessary stops on their way home and contact with others.

Asymptomatic people travelling in an RV will generally receive instructions that it is permissible for them to stay in their RV overnight. Their RV is, essentially, their first place of self-isolation. They must avoid going into stores to make purchases.

It is important for asymptomatic travellers entering Canada to avoid contact with others. As per the instructions provided upon entry into Canada, go to the place where you will isolate without delay.

If you must stop, follow precautions to avoid spreading infection to others. Avoid contact with others ( maintain a 2-metre distance), and practice hand hygiene and cough etiquette at all times.

If getting gas, pay at the pump. Use a drive-thru to get a meal. If you need to stop to rest, use rest areas or other places where you can park and rest in your vehicle.

Once home, use food delivery services or online shopping to purchase essential items, and ask family, a neighbor or friend to help with essential errands, if possible.

Persons entering Canada who have a fever and cough, or a fever and difficulty breathing, or where there are reasonable grounds for them to believe they have these symptoms, are considered to be symptomatic and will not be able to continue onward travel using public transportation.

Persons aged 65 and over, and those of all ages with compromised immune systems or underlying medical conditions, are at an increased risk of more severe illness.

No. It is important that you avoid contact with others. Go to the place where you will mandatorily isolate without delay. This means you must:

• Go directly to the place where you will isolate, without delay, and stay there for 14 days
• Go to your place of isolation using private transportation only, such as your personal vehicle
• Stay inside your home
• Not leave your place of isolation unless it’s to seek medical attention
• Not have visitors and limit contact with others in the place of isolation, including children
• Not isolate with in a place where you will have contact with vulnerable people such as older adults and individuals with underlying medical conditions

If you must stop, follow precautions to avoid spreading infection to others. Wear the mask given to you at the border and avoid contact with others (maintain a 2-metre distance) and practise good hand hygiene and cough etiquette.

If getting gas, pay at the pump. Use a drive-thru to get a meal. If you need to stop to rest, use rest areas or other places where you can park and rest in your vehicle.

Once home use food delivery services or online shopping to purchase essential items, and ask family, a neighbour or friend to help with essential errands, if possible.

No. It is important that you follow the instructions of a quarantine officer or screening officer and avoid contact with others.

Once home use food delivery services or online shopping to purchase essential items, and ask family, a neighbour or friend to help with essential errands, if possible.

If private transportation is unavailable, PHAC-arranged medical transportation, up to a distance of 12 hours, may be provided to get the traveller to their home or place of isolation.

If the traveller has onward connections, the distance to get home is too far for the PHAC-arranged medical transportation, or if they live with one or more vulnerable persons, travellers will be required to complete their 14-day isolation in a quarantine facility designated by the Chief Public Health Officer of Canada.

Transportation from the point of entry into Canada to the quarantine facility will be arranged by the Government of Canada. Quarantine facilities, for example, hotels designated by the Government of Canada, will be used to lodge symptomatic persons unable to isolate because they do not have private transportation or if they live with a vulnerable person(s).

The Government of Canada has established quarantine facilities, for example hotels, to prevent the potential spread of COVID-19. Quarantine facilities will be used to lodge symptomatic persons who are unable to isolate because they do not have private transportation or live with a vulnerable person(s). Transportation from the point of entry to the quarantine facility will be provided by the Government of Canada.

These measures will help protect older adults and medically vulnerable people, who are at the greatest risk of severe COVID-19 disease.

The Government of Canada has established quarantine facilities, for example hotels, to prevent the potential spread of COVID-19. Quarantine facilities will be used to lodge symptomatic persons who are unable to isolate because they do not have private transportation or live with a vulnerable person(s). PHAC is working with partners to provide the necessary needs, including food and any medical needs, of travellers who will be in isolation at a designated quarantine facility.

Persons requiring care for other medical conditions will have access to medical care and emergency medical services at the quarantine facility.

If you are an individual entering Canada and not sick, you must quarantine (self-isolate) for 14 days.

Mandatory quarantine (mandatory self-isolation) means you must:

• Go directly to your place of quarantine, without delay, and stay there for 14 days
• Do not go to school, work, other public areas and community settings
• Monitor your health for symptoms of COVID-19
• Arrange to have someone pick up essentials like groceries or medication for you
• Do not have visitors
• Stay in a private place like your yard or balcony if you go outside for fresh air
• Keep a distance of at least 2 arms lengths (approximately 2 metres) from others

If you develop symptoms within 14 days:

• isolate yourself from others
• immediately call a health care professional or public health authority and
  • describe your symptoms and travel history
  • follow their instructions carefully

When you have COVID-19 or symptoms of the illness, you must isolate. It is mandatory. If required, immediate medical attention will be provided upon arrival in Canada.

Mandatory isolation means you must.

• Go directly to the place where you will isolate, without delay, and stay there for 14 days
• Go to your place of isolation using private transportation only, such as your personal vehicle
• Stay INSIDE your home
• Not leave your place of isolation unless it’s to seek medical attention
• Do not go to school, work, other public areas or use public transportation (e.g., buses, taxis)
• Stay in a separate room and use a separate bathroom from others in your home, if possible
• Not have visitors and limit contact with others in the place of isolation, including children
• Not isolate in a place where you will have contact with vulnerable people such as older adults and individuals with underlying medical conditions

If your symptoms get worse, immediately contact your health care provider or public health authority and follow their instructions.

For all Canadians, you can go for a walk if you:

• Have not been diagnosed with COVID-9
• Do not have symptoms of COVID-19
• Have not travelled outside of Canada in the past 14 days.

If you go out for a walk, do not congregate and always practise physical (social) distancing by keeping at least two metres from others at all times.

For travellers entering Canada, during their 14-day period of isolation or quarantine:

• For those in mandatory isolation, stay inside your home.
• For those in quarantine (self-isolation), you may go outside for fresh air in a private place like your yard or on a balcony; however, you must stay on your property and not go into community settings.

To our knowledge, a 14-day post-exposure isolation period has been applied with success. Further exploration on the length of the incubation period is needed to support decisions on changing the isolation recommendations.

One of the findings of the study is that approximately 12% of patients had an incubation period that they self-estimated was longer than 14 days. The incubation period is inferred from the recorded date of onset of symptoms and reported date of contact with another case. There are a number of ways by which these dates may be imprecise, including patients being unable to precisely remember when symptoms began and certainty about when an individual actually acquired infection.

It is possible that more information will be available following the study’s peer review. We continue to collect, analyze, and monitor new evidence as it becomes available.

The Quarantine Act is administered 24 hours a day, 7 days a week, at all points of entry into Canada, including marine ports. Under the Quarantine Act, all ship operators are required to report to PHAC any passengers or crew onboard who may have a communicable illness before arrival in Canada.

The Act also gives PHAC the authority to inspect and implement quarantine measures on ships entering Canadian waters where it suspects that someone on board could cause the spread of a communicable disease that poses a significant risk to public health.

The Public Health Agency of Canada was informed on March 17 that several crewmembers aboard the Siem Cicero were presenting symptoms consistent with COVID-19.

Under section 39 of the Quarantine Act, if an environmental health officer has reasonable grounds to believe that the cargo ship could be a source of a communicable disease, the officer may take any reasonable measures to prevent entry to Canada.

The ship did enter Canadian waters; however it was denied port access and is currently being held off shore. The Government of Canada took these steps to prevent the potential introduction of the novel coronavirus, and to prevent supply chain disruptions at the port of Halifax.

The ship will be held and not allowed to dock until 14 days after the date the last person started to have symptoms.

In considering whether the cargo ship should dock, some of the general considerations were:

• Is there a public health risk on board the ship?
• Is there potential for Canadians to interact with ship-based crew?
• Is the cargo considered “essential” or “non-essential”?

For this specific cargo ship, several crewmembers were reported to have symptoms consistent with COVID-19, which poses a public health risk for Canadians.

As it is a car-carrying ship, Canadian longshoremen are required to board the vessel to off-load each car, and they would have potential interaction with some crew. The cargo on board is considered non-essential.

Allowing the ship to dock could also impact the supply chain, as the Halifax Port Authority has indicated that it may result in a closure of the Port.

It is important that we focus on allowing healthy workers in the trade and transportation section to cross the border when they are contributing to essential services. We need essential trade and transportation to continue, such as in areas supporting health (food and medical services), and critical infrastructure.

At this time, when there is a concern of workers with symptoms consistent with COVID-19 and it is not for essential services, but rather for optional or discretionary purposes, such as tourism, recreation and entertainment, we must not allow this movement across the border.

The Public Health Agency of Canada’s Global Public Health Intelligence Network (GPHIN) is an early-warning and situational awareness system for potential chemical, biological, radiological and nuclear public health threats worldwide—including outbreaks of infectious disease.

GPHIN users include non-governmental agencies and organizations, as well as government authorities who conduct public health surveillance. GPHIN is a significant contributor to the World Health Organization’s Epidemic Intelligence from Open Sources. 

Every given day, about 7,000 articles are captured in the GPHIN system.  The web-based application in the GPHIN system continuously scans and acquires news sources of information worldwide in nine languages (Arabic, Farsi, English, French, Portuguese, Russian, Spanish, and simplified and traditional Chinese). 

GPHIN’s main data provider is Factiva, a global news database and research platform that contains nearly 33,000 sources, including newswires, newspapers, and trade publications. GPHIN also mines specific RSS feeds from relevant publications and twitter accounts.

In addition, GPHIN analysts have programmed specific Google Alerts and monitor other news aggregators applications, such as ProMED and HealthMap, to further increase the variety of what is included in GPHIN.

GPHIN analysts have extensive lists of websites and social media accounts from official governmental sources, medical expert forums and other relevant sources that they monitor on a daily basis. Once the data are in the GPHIN system, they are processed, validated, and assessed.

On December 31, 2019, at 05:16 AM EST, an article called “China probes mystery pneumonia outbreak amid SARS fears” was published by Agence France Presse and uploaded in the GPHIN system at 05:42 AM EST.

The GPHIN analysts conducting their daily review recognized the potential importance of this issue and highlighted it in the Daily GPHIN report, which was distributed at 07:50 EST that day to Canadian public health practitioners at the federal, provincial and territorial levels. The report included the following summary:

International Events of Interest

China - China probes mystery pneumonia outbreak amid SARS fears (Media)

Authorities are investigating an outbreak of viral pneumonia in central China amid online speculation that it might be linked to SARS, the flu-like virus that killed hundreds of people a decade ago. There were 27 cases of "viral pneumonia of unknown origin" reported in Wuhan, in central Hubei province, the city's health commission said in a statement. Seven patients were in a critical condition.

GPHIN consists of two critical components:

• A professional multidisciplinary team of life science analysts, reviewing information in nine languages and conducting rapid risk assessments to detect public health threats; and
• An Information Management Tool that uses machine learning and natural language processing to facilitate the work of the analysts.

GPHIN requires a free subscription from eligible users, which include non-governmental agencies and organizations, as well as government authorities who conduct public health surveillance.

ProMED uses information coming from volunteer “rapporteurs”, as well as information from subscribers and from staff-conducted searches of the Internet, media, and various official and unofficial websites. Moderators assess these reports for plausibility, edit them as necessary, and often add comments or context before posting.  ProMED is one of the many data sources of GPHIN.

HealthMap's content is aggregated from freely available information (including ProMED) and automatically processed by machine learning algorithms.  Unlike GPHIN, there is no human assessment of the information published, which could influence the system performance.

BlueDot is a private company for which you need to pay a subscription to access the data. It gathers information from official and mass media sources including the WHO and ProMED-mail.

Much of this work is complementary, and organizations rely on a broad range of inputs to help identify potential threats and provide early warning.

The Public Health Agency of Canada (PHAC) National Microbiology Laboratory’s (NML) response to the current COVID-19outbreak is a whole-of-community effort, with more than 75 staff directly contributing at this time. Almost all NML staff have training in emergency response, and all have something to contribute from their various areas of expertise. 

The Influenza and Respiratory Viruses section is leading the laboratory diagnostic efforts, including the design and implementation of testing approaches. This team is directly supported by Science Technology Cores and Services (leading on genetic sequencing) and the Canadian Public Health Laboratory Network Secretariat (leading on collaboration with provinces and territories). NML scientists with broad scientific expertise in virology and response to emerging pathogens are now developing research plans to characterize the virus, to develop animal models, and to pursue collaborative studies on vaccine research and development. Scientists are also contributing expertise in knowledge synthesis and disease modelling.

The NML’s Emergency Operations Centre has also been activated, drawing upon experts across all disciplines and from all areas of the NML, including administration, logistics, communications, informatics, emergency response, and our business office.  

Scientists from the NML are also onsite at Canadian Forces Base Trenton to test any symptomatic individuals from the charter plane from Wuhan, China.

The NML is exceptionally proud of its contribution in response to this outbreak.

This is not true. The Public Health Agency of Canada (PHAC) has released items form the National Emergency Strategic Stockpile (NESS) in support of provincial and territorial COVID-19 response efforts. This has included specific types of personal protective equipment such as surgical masks, gloves and N95 respirators, as well as other items such as disinfectant and hand sanitizer.

Canada’s stockpile has always offered support in instances when a jurisdiction may have run out of equipment while waiting for orders to come in and facilitates transfers of personal protective equipment between jurisdictions. In addition, PHAC is actively working with Public Services and Procurement Canada, to advance bulk procurement orders on behalf of jurisdictions. A number of requests have been actioned and others underway. The federal government is working to enhance its own stockpile to support provincial requests or those from other federal partners who may also be in need of equipment.

It is not the practice of the National Emergency Strategic Stockpile (NESS) to divulge details about the specific type and quantity of stock in its holdings. The NESS contains supplies of personal protective equipment and ventilators. Allocation and distribution are always determined based on need.

In addition to ventilators that have already been procured and are held within the NESS, the federal government has contracted for more than 600 ventilators and is also working to support the acquisition of additional ventilators in response to provincial/territorial requests. The demand for ventilators globally is high and the Government is pursuing a variety of purchasing strategies to increase the number of ventilators available for use should there be a need to augment existing supply in the short term.

Orders for PPE and medical supplies were placed early on by federal, provincial and territorial governments to supplement their existing stocks. 

The Government of Canada is working closely with its provincial and territorial counterparts to plan for the adequate supply of ventilators.

The Government uses several strategies to plan for resource requirements, including looking at the dynamics of the outbreak (e.g., how many people are infected, the affected age groups and other characteristics of the population) as well as the impact of public health interventions (e.g., physical distancing) on the observed trends.

Based on the science to date, about 80% of COVID-19 cases are relatively mild and can be treated at home. However, there is a smaller percentage of individuals who may need medical care and hospitalization. In the worst cases, assisted breathing through a ventilator may be required.

In addition to ventilators that have already been procured and are held within the National Emergency Strategic Stockpile (NESS), the federal government has contracted for more than 600 ventilators and is also working to support the acquisition of additional ventilators in response to provincial/territorial requests. The demand for ventilators globally is high and the Government is pursuing a variety of purchasing strategies to increase the number of ventilators available for use should there be a need to augment existing supply in the short term.

There is also a mutual provincial and territorial assistance agreement in place should there be a need for ventilators or even personnel or other resources from one province to another.

The Government of Canada is exploring all avenues to secure medical supplies, including personal protective equipment (PPE), in order to prepare for and respond to the COVID-19 outbreak.

The Notice that went out on Buy and Sell to identify additional suppliers will benefit federal, provincial and territorial governments, including the National Emergency Strategic Stockpile (NESS).

More information on the Government of Canada’s response can be found at Government of Canada takes action on COVID-19.

PHAC follows appropriate laws, policies and guidelines with respect to the procurement of supplies or assets for the NESS. Competitive procurement practices such as the use of established supply arrangements, or requests for proposal, are routinely utilized to access the supply chain. 

On March 14, 2020, PHAC requested, and received, a National Security Exception for the Procurement of Goods and Services required by the Government of Canada to respond to the COVID-19 outbreak. With this authority, PHAC will not be required to go to tender to replenish NESS supplies and will work with Public Services and Procurement Canada to determine the best procurement strategy.

Since the 2011 evaluation, the NESS has evolved to better align with the ever-changing risk environment and is investing in strategic assets, such as medical counter-measures and mini-clinics, to enhance the Agency’s ability to support surge requests during health emergencies. In addition, there has been increased engagement with provincial and territorial partners and other stakeholders to increase awareness of NESS capabilities.  

Health Canada is aware that groups here in Canada and in other countries (e.g. the UK, the U.S., Italy, China) may be using various manufacturing techniques to address some supply issues.

Health Canada, together with other federal organizations and private sector, is facilitating the assessment of existing 3D printing capacity in Canada and will help determine possible next steps to augment capacity where needed.

It is important to note that Health Canada remains the regulatory authority for all medical devices that are intended to be sold or imported and has dedicated processes to quickly assess safety, efficacy, and quality for medical devices manufactured for the COVID-19 response, including those manufactured by 3D printing.

Health Canada has reached out to its trusted 3D printing network in the medical device industry, hospitals, universities, colleges and industrial manufacturing facilities. As of March 20, we have received responses from 34 organizations with 3D printing experience who are willing to help.

Medical devices sold, imported or distributed in Canada must meet the safety, effectiveness, and quality regulatory requirements of the Medical Devices Regulations or the Interim Order in cases of devices involving COVID-19. These regulated devices include medical devices manufactured via 3D printing. Health Canada is the regulatory authority for all medical devices and has dedicated processes to quickly assess safety, efficacy and quality for medical devices manufactured for the COVID-19 response.

There are risks if devices such as personal protective equipment are not of high enough quality to properly protect patients and healthcare workers. We are working with conventional medical device manufacturers and certified 3D printing organizations regarding required device specifications and quality so Canadians can have timely access to medical devices that are safe, efficacious and of high quality.

The Government of Canada has sent personal protective equipment (PPE) to China to support the ongoing response to the novel coronavirus outbreak in that country.

The equipment consists of protective clothing, face shields, respirators (masks), goggles and gloves, and has been provided in collaboration with the Canadian Red Cross and the Red Cross Society of China.

The additional PPE sent to support response efforts in China did not diminish the supplies available within Canada of items on the potential shortage list.

The Government of Canada sent personal protective equipment to China in February 2020 in response to the World Health Organization’s call for donations in support of global efforts to contain the outbreak of COVID-19 in that country. The equipment consisted of protective clothing, face shields and gloves. It was provided in collaboration with the Canadian Red Cross and the Red Cross Society of China. Given the dire situation China found itself in, Canada felt it important to offer support.  Not only was this important for China but it was extremely important for Canada given our commitment to helping to contain the global spread of the virus. While small, Canada’s donation assisted China in helping address the situation locally and prevent further exportation of cases to the rest of the world.

This donation did not impact Canada’s domestic response. Canada continues to work with international partners, such as China, to secure additional supplies as needed.

At this time, Health Canada is not aware of any impact of COVID-19 on Canada’s pharmaceutical supply.

The Department has engaged pharmaceutical industry stakeholders to seek any early signals that may indicate impacts on the drug supply chain, and none have been reported to date.

Health Canada has also contacted all Drug Establishment Licence holders in Canada to remind them of the requirement to report any anticipated or actual drug shortages on drugshortagescanada.ca within specified timeframes. Timely public communication of drug shortages and discontinuances by drug companies is an essential part of preventing and managing shortages. It helps the drug supply chain and the healthcare system respond appropriately, in order to minimize the impact on patients.

The Department will continue to monitor the situation closely and will take action if needed, in collaboration with companies, the provinces and territories and other stakeholders, to mitigate any impacts on patients. Health Canada is also engaged with international regulators to monitor any impacts of COVID-19 on global supply.

At this time, Health Canada has not received any medical device shortage notifications from manufacturers of medical devices as a result of COVID-19.

The Department has engaged medical device industry stakeholders to seek any early signals of potential supply issues and none have been identified to date. Health Canada continues to monitor the situation and will take appropriate action, as required, to mitigate any impact on Canadians.

The safety of healthcare workers remains our top priority and the Government of Canada continues to work with provincial and territorial partners to prepare for and respond to the COVID-19 outbreak.

Orders for personal protective equipment and medical supplies were placed early on by federal, provincial and territorial governments to supplement their existing stocks.

Federal, provincial and territorial governments continue to work together to promote the appropriate use of personal protective equipment, assess potential shortfalls, identify priority items and collaborate on procurement. 

Initial collaborative and bulk purchase orders are underway with a number of jurisdictions. We anticipate that this will be an ongoing process, with a variety of partners, as demand for and supply of products will change as the situation evolves.

Products are being sourced from a number of suppliers from a number of countries.

Addressing the complex issue of drug shortages is a multi-stakeholder responsibility requiring collaborative action from provinces and territories, manufacturers, distributors, health care professionals, and the federal government. Health Canada works closely with the provinces and territories, who notify the Department of shortages of concern.

When a critical national shortage occurs, Health Canada works with stakeholders across the drug supply chain to coordinate information sharing and identify mitigation strategies. Factors such as whether the shortage is national in scope, whether alternative supplies are available, and whether the product is considered medically necessary are considered in determining the potential impact and any necessary actions by Health Canada. More information on the roles and responsibilities in addressing drug shortages can be found at Roles and Responsibilities to Address Drug Shortages website.

These are interim measures implemented given the unprecedented demand and the urgent need for products that can help limit the spread of COVID-19, including hand sanitizers, disinfectants and personal protective equipment (e.g., masks and gowns). This is not a new regulation.

It is an interim measure and expedited approach. It is meant to facilitate access to imported hand sanitizers and disinfectants that do not fully meet the regulatory requirements under the Food and Drugs Act. Health Canada will allow certain products to be sold in Canada under this interim measure, including:

• products that are already authorized for sale in Canada but are not fully compliant with Health Canada requirements (e.g., labelling in one official language, different packaging from what was authorized); and
• products that are not authorized for sale in Canada, but are authorized or registered in other jurisdictions with similar regulatory frameworks and quality assurances.

Health Canada will allow these low-risk products to be distributed in Canada to address the current shortage in supplies. The expedited process requires an attestation form that helps Health Canada maintain a record of all hand sanitizers and disinfectants on the Canadian market. As with all health products, Health Canada will continue to monitor the safety of these products once they are on the market and will take action to protect the health and safety of Canadians, if necessary.

For hand sanitizers and hard surface disinfectants subject to this interim approach, products may be imported and sold as soon as companies have submitted a complete notification form that meets the established criteria.

For personal protective equipment (class I medical devices), products may be imported or sold immediately after Health Canada issues a medical device establishment licence. Health Canada is currently issuing these licences within 24 hours of receipt of a completed application.

There are products already on the market. More information can be found at Expedited access to disinfectants, hand sanitizers and personal protective equipment to help limit the spread of COVID-19, as well as swabs for testing.

Information about this expedited process was shared with all drugs, natural health products and medical device establishment licence holders and product licence holders in Canada and with relevant industry associations.

Products permitted to be sold under this interim measure are being added to the list posted on the Expedited access to disinfectants, hand sanitizers and personal protective equipment to help limit the spread of COVID-19, as well as swabs for testing at Health Canada’s website. At the time the advisory was posted on March 18, only hand sanitizers and disinfectants had met the criteria for sale under this interim approach. Since then, medical devices have been identified and will be added to the list in the coming days.

No. While these products are typically subject to certain regulatory requirements, such as licensing and bilingual labelling, Health Canada is allowing these low-risk products to be distributed in Canada to address their current unprecedented demand to help slow the spread of COVID-19.

The expedited process requires companies to complete and submit a notification form that allows Health Canada to maintain a record of all hand sanitizers, hard surface disinfectants and personal protective equipment being sold in Canada under this interim approach. As with all health products, Health Canada will continue to monitor the safety of these products once they are on the market and will take action to protect the health and safety of Canadians, if necessary.

Health Canada will continue to use all tools at its disposal to expedite the supply of safe and effective health products related to COVID-19. However, the department is not providing blanket approval of unauthorized drugs or devices.

We will update Canadians with any new information as it arises.

Consumers and patients are encouraged to report any health product adverse events to Health Canada.

Canada takes a risk-based approach to the regulation of medical devices, where the level of review before approval depends on the potential risk that the use of the device presents. This approach balances the need to provide the healthcare system with timely access to new and innovative technology, with the appropriate level of oversight and time required to assess safety and effectiveness.

In Canada, medical devices are categorized into four classes based on the risk associated with their use, with Class I devices presenting the lowest potential risk (e.g., a mask or gown) and Class IV devices presenting the greatest potential risk (e.g., a pacemaker). Class II, III and IV medical devices must have a Medical Device Licence to be sold in Canada. Companies selling Class I medical devices in Canada are required to have a Medical Device Establishment Licence. However, during this pandemic situation, Class I to IV devices can instead receive authorization under the Interim order respecting the importation and sale of medical devices for use in relation to COVID-19.

Health Canada is currently expediting its review of licensing applications related to any medical device related to COVID-19. In addition, as with hand sanitizers and disinfectants, Class I medical devices that may not fully meet all regulatory requirements and are notified to Health Canada under this interim measure are being allowed on the market.

Health Canada will maintain an updated list of products sold in Canada through this measure on its website for consumers to consult.

Hand sanitizers and hard surface disinfectants authorized for sale by Health Canada have an eight-digit Drug Identification Number (DIN) or Natural Product Number (NPN) on the product label. These products are listed on Health Canada's Drug Product Database or Licensed Natural Health Products Database.

Class I medical devices are not licensed by Health Canada, but companies importing or manufacturing them do require a Medical Device Establishment Licence from Health Canada. These are listed on Health Canada’s website.

If consumers see a hand sanitizer or disinfectant for sale that does not have a DIN or NPN on the product label and is not on the list identified in the advisory, or if they become aware of a company importing or manufacturing a class I device without the required licence, they are encouraged to report it to Health Canada.

COVID-19-specific medical devices authorized for sale by Health Canada are listed on Coronavirus disease (COVID-19): For health professionals website.

The Minister of Health signed an Interim Order on March 18, 2020, to speed up access to medical devices for COVID-19. The list of COVID-19 medical devices authorized under the Interim Order is available on Health Canada expedites access to COVID-19 diagnostic laboratory test kits and other medical devices Health Canada’s website.

Healthcare professionals can request access to COVID-19-related medical devices not yet licensed in Canada and drugs related to the management of patients with COVID-19 through Health Canada’s Special Access Program (SAP). Applications are considered on a case-by-case basis.

For questions related to the SAP for medical devices, please contact the program via email at: sap.devices.mdb@hc-sc.gc.ca.

Health Canada has been actively working with manufacturers to enable market access for commercial diagnostic devices in order to increase Canada’s COVID-19 diagnostic capacity.

On March 13, 2020, Health Canada received two applications for a diagnostic device: one from Roche Diagnostics and one from ThermoFisher Scientific. These applications have received expedited review and are now approved for access by healthcare professionals through our Special Access Program (SAP). 

Health Canada will immediately communicate the availability of these diagnostic devices to the concerned laboratories, the Public Health Agency of Canada and the provincial and territorial ministries of health. 

 Health Canada is also working with a number of other companies that are in the process of preparing and submitting information for review and will expedite those applications as well.

This Interim Order makes it easier and faster for certain medical devices, such as laboratory diagnostic test kits, to be imported and sold in Canada. This would help improve access to medical devices that could permit faster and more convenient testing of patients, which would avoid needing to send samples to the NML lab in Winnipeg, facilitating quicker test results.

Point-of-care diagnostic tests are in development and may become available through this Interim Order, which would permit quicker and more convenient testing of patients. Quicker test results would enable healthcare providers and patients to take appropriate actions more quickly in order to help reduce the spread of the disease.

Interim Orders have been needed a few times in recent years to permit access to health products quickly in exceptional circumstances to deal with a significant risk to health or safety.

The last use of an Interim Order was in August 2018 to facilitate the immediate importation and sale of AUVI-Q epinephrine auto-injectors as an emergency measure during a national critical shortage of EpiPens.

An Interim Order was also issued to allow immediate temporary access to naloxone nasal spray in July 2016 until a review for Canadian authorization was completed.

The Interim Order creates a tailored approval pathway for the importation and sale of medical devices that support Canada’s response to COVID-19. This Interim Order, and the tailored approval pathway it creates, provides the Minister with flexibility to consider the urgent circumstances relating to the need for the medical device, authorizations granted by foreign regulatory authorities, or possible new indications of use for medical devices that are already approved in Canada.

As with all drugs and medical devices, Health Canada will assess and monitor the safety and effectiveness of all products authorized under this Interim Order, and will take immediate action if required to protect the health and safety of Canadians.

Manufacturers will still be required to follow strict post-market safety requirements such as mandatory problem reporting, recall procedures and complaint handling.

We anticipate that there will be adequate supply of diagnostic tests. It would be at the company’s discretion to allocate kits if demand exceeds supply.

Currently, there is no approved vaccine that protects against coronaviruses in humans.

The World Health Organization (WHO), along with the Coalition for Epidemic Preparedness Innovations, is coordinating an international collaboration to help advance research and vaccine development for the COVID-19.

The Public Health Agency of Canada and the Canadian Institutes of Health Research—in consultation with international partners, including the WHO and the Global Research Collaboration for Infectious Disease Preparedness — is assessing how scientists at our National Microbiology Laboratory, along with the broader Canadian research community, will participate in the global research efforts.

Coronaviruses are a group of viruses that can cause a wide range of illness, ranging from the common cold to Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS-CoV). The challenge of developing a vaccine that protects against coronaviruses is that infection by human coronaviruses does not provide long-lasting immunity, meaning someone can be re-infected in the future following recovery from an initial infection.

Although a vaccine that provides long-term immunity remains a challenge, an outbreak vaccine aimed to provide short-term protection (similar to a pandemic influenza vaccine) to respond to a novel coronavirus outbreak could potentially be developed.

In the case of a vaccine for a specific coronavirus, it could take years for researchers to develop a vaccine.

For example, there are currently no licensed vaccines or specific treatments for Middle East Respiratory Syndrome coronavirus (MERS-CoV)—a particular coronavirus that was first identified in 2012. We are aware of work being conducted elsewhere to better understand how MERS-CoV infections might be prevented and to develop a MERS-CoV vaccine. This includes vaccine development efforts being coordinated by WHO and the Coalition for Epidemic Preparedness (CEPI).

At present there is no specific drug or medication treatment for people who have COVID-19.  Researchers are looking at the effectiveness of existing antiviral treatments.

World Health Organization has provided advice to health professionals that includes recommendations for early supportive therapy, management of symptoms and prevention of complications.

The novel coronavirus causes a range of illness from mild to severe for some individuals. Therefore, if you have travelled outside Canada, it is important to monitor your health when you return to Canada. While abroad, you may have come in contact with the novel coronavirus. PHAC asks that you monitor your health for fever, cough and difficulty breathing for 14 days after you arrive in Canada. If you develop fever, cough, or difficulty breathing, call your health care professional or local public health authority to inform them about your symptoms. They will provide advice on what you should do.

There is no scientific evidence that establishes a link between ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and the worsening of COVID‑19 symptoms.

If you have symptoms of COVID-19, speak with your healthcare provider regarding the most appropriate health products for the treatment of fever or pain. If you are currently taking ibuprofen, especially for a chronic illness, do not stop taking your medication.

There is some evidence to suggest that these drugs may be effective for some patients; however, these are preliminary findings from a few, very small studies. There are also some known significant safety risks associated with both drugs, such as QT prolongation, which is a serious heart rhythm condition. A healthcare practitioner may choose to use these medications off-label based on his/her patient’s needs including the seriousness of the patient’s illness if the potential benefits outweigh the known risks of the drugs

In Canada, a doctor’s decision to prescribe a particular drug to a patient, whether it’s to be used for a labelled indication or off label, is part of the practice of medicine. While Health Canada regulates drugs, it is the responsibility of healthcare professionals to consider information from medical journals, reports, and peer-reviewed studies when prescribing medication.

Health Canada is aware of several ongoing or planned clinical studies with hydroxychloroquine in Canada and internationally for the treatment of COVID-19, and is closely monitoring their developments.

Any company or healthcare practitioner treating patients with COVID-19 who wishes to conduct a clinical trial to evaluate the effectiveness of these or other drugs is encouraged to contact Health Canada.

Hydroxychloroquine is an antiparasitic drug that is indicated for the treatment of malaria, as well as autoimmune diseases such as rheumatoid arthritis and lupus. Hydroxychloroquine has been shown in in vitro studies to decrease coronavirus replication, and may lead to a reduction in the viral load of SARS-CoV-2 (the novel coronavirus that causes COVID-19.

Azithromycin is an antibiotic used in the treatment of pneumonia and other bacterial infections.

At this time, there is no vaccine for COVID-19 or any natural health products—including traditional Chinese medicines—that are authorized to treat or protect against COVID-19.

Selling unauthorized health products or making false or misleading claims to prevent, treat or cure COVID-19 is illegal in Canada. The Department takes this matter very seriously and will take action to stop this activity.To date,Health Canada has not approved any product to treat or cure COVID-19. Health products that have been authorized for sale by Health Canada will have an eight-digit Drug Identification Number (DIN), Natural Product Number (NPN) or Homeopathic Drug Number (DIN-HM). The Department is taking action to address complaints regarding unauthorized products on the Canadian market making false or misleading claims for the treatment, prevention or cure of COVID-19.

The Department encourages anyone who has information regarding potential non-compliant sale or advertising of any health product claiming to treat, prevent or cure COVID-19, to report it using the online complaint form.

When Health Canada identifies or is notified of potential non-compliance with the Food and Drugs Act or its associated Regulations, it takes steps to confirm whether non-compliance has occurred and takes action based on the risk to the health of Canadians. A number of compliance and enforcement options are available to correct non-compliance or mitigate a risk to Canadians, including site visits, public communications, recalls, and the seizure of products and advertising materials. The primary objective of the Department’s compliance and enforcement approach is to manage the risks to Canadians using the most appropriate level of intervention, in accordance with Health Canada’s Compliance and Enforcement Policy.

No, natural health products are authorized to protect against, or treat COVID-19. This includes traditional Chinese medicines, Ayurvedic medicines and homeopathic products.

In Canada, alcohol-based hand sanitizers are considered natural health products. Alcohol-based hand sanitizers that have been authorized for sale by Health Canada will have an eight-digit Natural Product Number (NPN) on the product label.

Health Canada has received complaints about health products that make false or misleading claims related to COVID-19. The Department is currently addressing these cases and has directed companies to remove these claims from their websites and advertising materials. Health Canada continues to monitor websites for these claims and is working with online retailers to ensure that products making these claims are removed. Selling or advertising health products making false or misleading claims is illegal. The Department takes this issue seriously and will not hesitate to use all mechanisms and tools at its disposal to stop these activities.

On March 18, 2020, in light of the unprecedented demand and urgent need for products that can help limit the spread of COVID-19, Health Canada issued an advisory announcing that the Department is facilitating access to products that may not fully meet current regulatory requirements, as an interim measure. This includes hand sanitizers, disinfectants and personal protective equipment (e.g., masks and gowns), as well as swabs. While these products are typically subject to regulatory requirements, such as licensing and bilingual labelling, the Department is allowing certain products to be sold in Canada that may not fully meet all requirements under this interim measure. Health Canada is maintaining an updated list of products sold in Canada through this measure on its website for consumers to consult.

In addition, Health Canada is expediting approvals of products, as well as establishment and site licences related to these types of products. A list of more than 550 authorized hand sanitizer products has been published on Hard-surface disinfectants and hand sanitizers (COVID-19): List of hand sanitizers authorized by Health Canada's website. The list is updated daily and includes information on alcohol-based hand sanitizers. If consumers see a disinfectant or hand sanitizer for sale that is making false or misleading claims, they are encouraged to report it to Health Canada using its online complaint form.

More information to help inform Canadians on buying and using drug and health products safely is available at Buying and using drug and health products safely website.

Health Canada received inquiries from a few jurisdictions regarding measures that would facilitate access to certain medical treatments during the pandemic. The Department has taken quick action to respond to their concerns and to prevent potential issues related to accessing medical treatment during the pandemic.

In response to the COVID-19 outbreak, Health Canada has temporarily exempted certain new activities that apply to pharmacists who are registered and entitled to practice pharmacy under the laws of their province or territory and are entitled to conduct activities with controlled substances. The availability of these new activities depends on the province or territory and licensing authority adopting these measures. Health Canada recommends contacting the provincial and territorial licensing authorities for more information.

Given the seriousness of the COVID-19 outbreak, Health Canada is working quickly to help jurisdictions maintain access to medications for Canadians.

Pharmacists are medication experts and play a significant role in monitoring patients and medication to ensure safe and optimal use while contributing to outcome-focused patient care. Regulations under the Controlled Drugs and Substances Act state that a pharmacist is authorized to sell or provide a controlled substance to a person if they have received a prescription or a written order from a practitioner.

While these regulations do not permit pharmacists to prescribe, other related activities that are included in the meaning of sell or provide are permitted as long as the quantity dispensed does not exceed the amount originally authorized. These activities include, but are not limited to:

• Adjusting the formulation: adjusting the dosage form in which the drug is prescribed
  • e.g., change from pill to liquid formulations;
• Adjusting the dose and regimen: a structured plan that specifies the frequency in which a dose of medication should be ingested
  • e.g., change from 20mg per day for 5 weeks to 10mg per day for 10 weeks;
• De-prescribing: the planned and supervised process of reducing or stopping a medication; and
• Part-filling: dispensing a quantity of a medication that is less than the total amount of the drug specified by a practitioner
  • For greater clarity, this includes part-fills requested by a patient, when a pharmacy is dealing with an inventory shortage or other situations where the nature of the part-fill is a matter of discussion between the pharmacist and patient.

With the goal of supporting better medication management and protecting the health and safety of Canadians, Health Canada has shared with pharmacists an interpretive guide related to prescribing activities with substances regulated under the Narcotic Control Regulations, Benzodiazepines and Other Targeted Substances and Part G of the Food and Drug Regulations.

With this exemption, pharmacists can be authorized to renew or extend prescriptions in order to maintain a patient on a medication. Pharmacists are not authorized to initiate a new medical treatment with controlled substances (e.g., narcotics).

This exemption will apply to other healthcare professionals, including nurse practitioners, dentists and veterinarians, allowing them to verbally prescribe narcotics (depending on the prescriber’s scope of practice and provincial and territorial authorization).

Pharmacists are medication experts and play a significant role in monitoring patients and medication to ensure safe and optimal use in patient care.

With the goal of supporting better medication management and protecting the health and safety of Canadians, in March 2019, Health Canada launched an official consultation seeking comments on ways to modernize pharmacists’ role in the healthcare system. The Department is currently analyzing all feedback received. There will be another opportunity to comment on any draft regulations that are developed in Canada Gazette Part I. Health Canada encourages everyone to participate in the consultation.

Health Canada recognizes that local pandemic precautions may impact the operations of supervised consumption sites and services. The Department continues to work directly with site operators to assess each individual situation and develop appropriate modifications to their protocols and practices. Operators are encouraged to contact the Office of Controlled Substances’ Exemptions Section at hc.exemption.sc@canada.ca.

You can stay healthy and prevent the spread of infections by:

• washing your hands often with soap under warm running water for at least 20 seconds;
• using alcohol-based hand sanitizer only if soap and water are not available;
• avoiding touching your eyes, nose or mouth with unwashed hands;
• avoiding contact with sick people, especially if they have fever, cough, or difficulty breathing;
• covering your mouth and nose with your arm to reduce the spread of germs;
• staying home if you become sick to avoid spreading illness to others.

If you are a healthy individual, the use of a mask is not necessary.

However, if you are experiencing symptoms of an illness that spreads through the air, wearing a mask can help prevent the spread of the infection to others. The mask acts as a barrier and helps stop the tiny droplets from spreading around you when you cough or sneeze. Your health provider may recommend you wear a mask while you are seeking or waiting for care. In this instance masks are an appropriate part of infection prevention and control measures that put in place so that people with an infectious respiratory illness do not transmit the infection to others.

If you are caring for a sick person or you are in direct contact with an ill person, wearing a mask can help protect you from catching the virus, but it will not fully eliminate the risk of illness.

When wearing a mask, make sure to:

• properly cover your mouth and nose
• avoid touching the mask once it’s on your face
• properly discard the mask after each use
• wash your hands after removing the mask

It is not recommended that healthy people or people who have not travelled to a COVID-19 affected area wear masks. Wearing a mask when you are not ill and are not at high risk for developing symptoms may give a false sense of security. Masks can easily become contaminated and need to be changed frequently and fitted properly for them to provide adequate protection.

You can stay healthy and prevent the spread of infections by:

• Washing your hands often with soap under warm running water for at least 20 seconds.
• Using alcohol-based hand sanitizer only if soap and water are not available.
• Avoiding touching your eyes, nose or mouth with unwashed hands.
• Avoiding contact with sick people, especially if they have fever, cough, or difficulty breathing.
• Covering your mouth and nose with your arm to reduce the spread of germs.
• Staying home if you become sick to avoid spreading illness to others.

FAST is a device that is available now for Ontario physician offices using OSCAR (an electronic medical record software). While the physician identifies patients with flu-like symptoms, the FAST tool will extract a list of predefined variables from the electronic medical record and transfer that data to the Public Health Agency of Canada . The tool creates a seamless link for data relevant to influenza-like illness surveillance between physicians and PHAC. The tool removes potential errors in data entry and late reporting by physicians since it is automatically pulled from the electronic medical record and sent to PHAC. Previously, physicians would have to manually input the data.

While no patient or practice identifying information or data are transmitted to PHAC, all other information is stored on a secure platform at the Agency.

PHAC currently routinely tracks influenza outbreaks through the FluWatch program. We are currently developing methods to track outbreak data for COVID-19 surveillance.

FAST is a new way to collect influenza-like illness data from physicians, it does not change the way influenza-like illness surveillance is currently done at PHAC. More information can be found at Flu (influenza): FluWatch surveillance website.

Using the FAST tool is voluntary.

Identifiers are not used to track the data. Allvariables collected are essential for surveillance of influenza-like illnesses and are variables outlined in the WHO Guidance for surveillance during an influenza pandemic.

FAST is an OSCAR (an electronic medical record software) specific tool that was developed by McMaster University.

We are open to working with electronic medical record (EMR) vendors to develop a similar tool to deploy in their respective EMR.

The FAST tool has the potential to be modified to track other infectious diseases.

Canadians can be confident in the methods and laboratory capabilities of Canada’s NML.

The NML is internationally recognized for its scientific excellence.

Multiple provincial public health laboratories can now test for COVID-19 with a very high degree of accuracy.

BC, AB, SK, ON, and QC are able to confirm laboratory diagnostics for the virus that causes COVID-19. For all other provinces, their results undergo additional testing at NML because this is a previously unknown virus and it is good practice to use additional tests to provide further confirmation of initial laboratory findings.

There are multiple testing approaches that will be used by the laboratory to confirm cases. Follow-up results from the NML are expected to be available within 24 hours after receipt at the NML.

The NML is providing all provinces and territories with laboratory reference services. These testing services provide a variety of support to provincial and territorial laboratories across Canada including confirmatory testing, quality assurance, and in-depth analysis of difficult to diagnose specimens.

The Public Health Agency of Canada is working with provincial and territorial colleagues to monitor the situation and plan for all possible scenarios based on evidence. We want to have the most accurate picture of what is happening in our communities. While testing in Canada is focused on people who present with symptoms consistent with COVID-19, Canada’s testing strategies continue to evolve as the outbreak of COVID-19 spreads.

Frontline health providers and laboratories have been vigilantly triaging and testing possible cases. Public health authorities have carried out detailed investigations and contact tracing on all confirmed cases to identify possible community spread.

Public health laboratories across Canada are also working together to report COVID-19 test results. These reports will allow us to monitor where COVID-19 is occurring, which can provide us with an early signal of potential clusters that can indicate community spread.

We continue to work with our provincial and territorial partners on a national testing strategy that will help us maximize the impact of our testing resources and delay the spread of COVID-19 in high-risk settings, such as hospitals and long-term care facilities.

At the same time, Health Canada has been working with manufacturers to enable market access for commercial diagnostic devices in order to increase Canada’s COVID-19 diagnostic capacity.

The Minister of Health has signed an Interim Order, as an emergency public health measure, to allow expedited access to COVID-19-related medical devices.

With the Interim Order, two new diagnostic tests are made readily accessible in Canada:

• the Roche Molecular Systems Inc. cobas SARS-CoV-2 diagnostic device; and
• the ThermoFisher Scientific TaqPath™ COVID-19 Combo Kit.

This will help improve access to medical devices that could permit faster and more convenient testing of patients in Canada.

All levels of government are working together to advance testing technologies, secure access to more test kits and accelerate test results.

Provincial public health laboratories can test for COVID-19 with a very high degree of accuracy and the vast majority are able to confirm laboratory diagnostics for the virus that causes COVID-19.

For Prince Edward Island, Manitoba, and parts of Northwest Territories and Nunavut, their results undergo additional testing at the National Microbiology Laboratory (NML).

The results from these jurisdictions are shipped to the NML for confirmatory testing. This adds additional time to receive results.

The NML strives to have follow-up results within 24 hours of receipt; however, because of increased volume, some results may take 48-72 hours. The NML is working around the clock to process results as quickly as possible.

For questions about provincial and territorial testing turnarounds, please contact the appropriate public health authority in that jurisdiction.

We anticipate that there will be adequate supply of diagnostic tests.

Health Canada has been working with manufacturers to enable market access for commercial diagnostic devices in order to increase Canada’s COVID-19 diagnostic capacity.

The Minister of Health has signed an Interim Order, as an emergency public health measure, to allow expedited access to COVID-19-related medical devices.

With the Interim Order, two new diagnostic tests are made readily accessible in Canada:

• the Roche Molecular Systems Inc. cobas SARS-CoV-2 diagnostic device; and
• the ThermoFisher Scientific TaqPath™ COVID-19 Combo Kit.

This will help improve access to medical devices that could permit faster and more convenient testing of patients in Canada.

Point-of-care diagnostic tests are in development and may become available through this Interim Order, which would also permit quicker and more convenient testing of patients.

While we don’t have all the evidence we would like on this aspect of the novel coronavirus transmission, what we do know for certain is that the virus is most often being spread through close contact with a person who is showing symptoms (i.e., symptomatic cases). Testing asymptomatic individuals can confer a false sense of reassurance because an asymptomatic individual who tests negative could still go on to become symptomatic and develop the disease within the incubation period.

While experts believe that spread from a person who is asymptomatic (i.e. not showing any symptoms) is possible, this is has been the subject of scientific debate and is difficult to confirm.

Monitoring an asymptomatic individual who is a contact of someone with COVID-19 and recommending 14-day self-isolation does more to prevent the spread of the virus than a potentially false negative test result.

Canada has and will continue to test all symptomatic individuals, as part of our evidence-based containment strategy, while considering the evolving science on other testing scenarios. As the science evolves, our approach will keep pace, and policies and protocols will be updated accordingly.

Based on the latest available data, the main driver of the COVID-19outbreak is symptomatic cases.

That means the primary focus for containing the COVID-19 outbreak is to prevent exposure through direct and close contact.

The most effective way to control this type of spread is through good hygiene measures in community settings (handwashing, cough etiquette and staying home if sick) and strict infection prevention and control measures in health settings to prevent spread in hospital settings.

You can stay healthy and prevent the spread of infections by:

• washing your hands often with soap and warm running water for at least 20 seconds
• avoiding touching your eyes, nose or mouth with unwashed hands
• avoiding close contact with people who are sick
• coughing or sneezing into your sleeve and not your hands
• staying home if you are sick to avoid spreading illness to others

If you do not have symptoms, but believe you were exposed to a source of COVID-19, the Public Health Agency of Canada asks that you, for the next 14 days:

• monitor your health for fever, cough and difficulty breathing; and,
• avoid places where you cannot easily separate yourself from others if you become ill.

To further protect those around you, wash your hands often and cover your mouth and nose with your arm when coughing or sneezing.

If you develop symptoms of COVID-19, isolate yourself from others as quickly as possible. Immediately call a health care professional or the public health authority in the province or territory where you are located Describe your symptoms and travel history. They will provide advice on what you should do.

It is not yet known how long the virus causing COVID-19 lives on surfaces, however, early evidence suggests it can live on objects and surfaces from a few hours to days. 

Surfaces frequently touched with hands are most likely to be contaminated. These include doorknobs, handrails, elevator buttons, light switches, cabinet handles, faucet handles, tables, countertops and electronics.

The best way to prevent COVID-19 and other respiratory illnesses is to:

• avoid touching the eyes, nose and mouth;
• consistently use good hand hygiene measures, which includes frequent handwashing with soap under warm running water for at least 20 seconds, or using an alcohol-based hand sanitizer if soap and water are not available;
• maintain good respiratory etiquette, such as covering your mouth and nose with your arm or sleeve when coughing and sneezing, disposing of any used tissues as soon as possible, and following with handwashing or use of alcohol-based hand sanitizers where soap and water are not available;
• regularly clean and disinfect surfaces that people touch frequently such as toilets, bedside tables, doorknobs, phones and television remotes with a product that cleans and disinfects.

It is not yet known how long the virus causing COVID-19 lives on surfaces, however, early evidence suggests it can live on objects and surfaces from a few hours to days. 

The risk of spread from products shipped over a period of days or weeks at room temperature is very low.

Products shipped within or from outside of Canada could be contaminated. However, because parcels generally take days or weeks to be delivered, and are shipped at room temperature, the risk of spread is low. There is no known risk of coronaviruses entering Canada on parcels or packages.

To protect yourself from COVID-19, make sure to do the following when handling products shipped within or outside of Canada:

• use good hygiene measures
• regularly clean and disinfect surfaces
• do not touch your eyes, nose and mouth

There is currently no evidence that food is a likely source or route of transmission of the virus. Scientists and food safety authorities across the world are closely monitoring the spread of COVID-19.

Coronaviruses generally do not survive on surfaces after being contaminated. The risk of spread from products shipped over a period of days or weeks at room temperature is very low.

If the CFIA becomes aware of a potential food safety risk, appropriate actions will be taken to ensure the safety of Canada’s food supply.

At present, there is no evidence to suggest that COVID-19 spreads through food or water.

Current evidence suggests that COVID-19 is most commonly spread from an infected person through:

1. respiratory droplets generated when they cough or sneeze,
2. close personal contact, such as touching or shaking hands, or
3. touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands.

In general, coronaviruses are a large family of viruses, some that causes illness in people and others that circulate among animals, including camels, cats and bats.

COVID-19 not been identified as a foodborne pathogen.

No, there is currently no evidence to suggest that this virus is circulating in animals in Canada (wild, livestock or pets).

It is possible that some types of animals may be able to get infected with COVID-19 virus but it is not yet clear whether they would get sick.

A pet dog in Hong Kong tested positive for COVID-19 virus, following close exposure to an infected person. Although the test used can’t tell us for certain that the dog is infected (only that virus genetic material was found in its nose and mouth), experts believe that this dog has a low level of infection. This dog did not show any signs of illness. The most likely explanation is that the virus spread from the owner, a confirmed case, to their pet dog. At this time, there is no evidence that pets, including dogs, can spread COVID-19.

To date, there have been no reports of livestock being infected by COVID-19 virus.

It’s important to remember that the highest risk for COVID-19 infection is through contact with an infected person, and not through animal contact. However, until we know more, similar to the recommendations for reducing the risk of infection to other people, if you have been diagnosed with COVID-19 and have a pet or other animals:

• avoid close contact with them
  • do not snuggle or kiss them, or let them lick you, sit on your lap, or sleep in your bed
• practise good cough etiquette
  • avoid coughing and sneezing on your animals
• if possible, have another member of your household care for your animals
  • if this is not possible, always wash your hands before touching or feeding them
• limit your animal's contact with other people and animals
  • this may mean keeping them indoors

As always, livestock producers should follow normal biosecurity measures, including limiting visitors or workers who may have travelled to, or been in contact with, someone from an affected area. For more information on on-farm disease prevention, producers are encouraged to consult the National Biosecurity Standards and Biosecurity Principles and National Farm-Level Biosecurity Planning Guide.

These recommendations will be updated as more information becomes available.

All animals entering Canada must meet import requirements set out by the Canadian Food Inspection Agency. There are currently no specific requirements in place in Canada restricting animal importation related to the COVID-19 outbreak as there is no evidence that pets or other domestic animals can spread the virus. However, until we know more, importers, rescue organizations and adoptive families should consider limiting or postponing importing animals from affected areas.

Any animals that are imported from an affected area should be closely monitored for signs of illness. If an animal becomes sick, contact your veterinarian and inform them of the situation. Call ahead to ensure they are aware of the circumstances.

Animals imported from other countries can carry a variety of diseases that we don’t have in Canada, and that can spread between animals and people. Therefore, it is always a good idea to have a recently imported animal examined by a veterinarian so that they can advise you on appropriate treatments and vaccinations to keep them and your family healthy.

Take these precautions to prevent infectious diseases from spreading between animals and people:

• Always wash your hands after touching animals, their food/supplies, or cleaning up after them;
• Do not kiss animals, share food, or let them lick your face; and
• Regularly clean and disinfect areas where animals live.

Further information on animals and COVID-19 can be found at:

1. Animal and environmental investigations to identify the zoonotic source of the COVID - 19 Virus (PDF - 339.36 KB)
2. Coronavirus disease (COVID-19) advice for the public: Mythbusters

Yes.  As part of the Government of Canada’s enhanced border measures to contain further introduction and spread of COVID-19, airlines are conducting conduct a health check of all travellers before boarding a flight to Canada. The health check is based on guidance from the Public Health Agency of Canada, in line with the World Health Organization’s recommendations. Individuals will be screened for fever, cough and difficulty breathing by airline personnel, and be asked to answer the following questions:

• Do you have a fever or feel like you have a fever?
• Do you have a cough?; “Is this normal for you?”
• Do you have difficulty breathing?; “Is this normal for you?”
• Have you been refused boarding in the past 14 days due to a medical reason related to COVID-19?

If airlines observe a traveller with symptoms or if the passenger answers yes to any of the questions on the health check, they will be refused boarding for a period of 14 days or until they provide a medical certificate confirming that their symptoms are not related to the COVID-19 virus.

Further instructions and advice will be provided to travellers who are denied boarding advising them to follow the guidance of local public health authorities. These travellers will also be directed to the appropriate consular services.

Any traveller who provides false or misleading answers about their health during screening could be subject to a penalty of up to $5,000 under the Aeronautics Act.

These measures will help protect the health of all Canadians.

The Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 taught us that temperature checks at airports are not an effective measure to prevent the introduction of infectious disease across borders. More than 6.5 million screening transactions occurred at Canadian airports including inbound and outbound travellers. Of these, 2.3 million travellers were screened using thermal scanners. Despite this intensive screening effort, no cases of SARS were detected using these methods.

Border measures alone are not a guarantee against the spread of this new virus. This is why Canada maintains a multilayered system with all levels of government and health authorities across the country working together to prevent and control infectious diseases. In addition to border measures, our system includes:

• a comprehensive surveillance infrastructure to rapidly identify emerging events and infectious diseases, including respiratory illnesses;
• routine infection prevention and control precautions in all Canadian hospitals; and
• public health laboratory capacity that is well equipped to rapidly detect serious infectious diseases.

Travellers who are denied boarding will be provided with further instructions and advised to follow the guidance of local public health authorities. These travellers will also be directed to the appropriate consular services to assist with isolation.

On January 22, 2020, enhanced screening measures were put in place at the Vancouver, Toronto and Montréal international airports.Then as of February 9, 2020, they were put in place at the following airports:

• Calgary International Airport
• Edmonton International Airport
• Winnipeg Richardson International Airport
• Billy Bishop Toronto City Airport
• Ottawa International Airport
• Québec City Jean Lesage International Airport
• Halifax Stanfield International Airport

The Public Health Agency of Canada (PHAC) and the Canada Border Services Agency (CBSA) have worked together to put in place enhanced screening measures at these airports to identify travellers who may have symptoms upon arrival, but more importantly to provide specific reference materials to travellers who may become ill after their return.

At this time, the Government of Canada has barred foreign nationals from all countries from entering Canada for recreation or tourism. The measure would not apply in designated exceptional circumstances, including to air crews, travellers arriving in Canada in transit to a third country, Canadian permanent residents, diplomats, or immediate family members of Canadian citizens.

Enhanced screening measures are in place in 10 Canadian international airports. Travellers arriving in these airports will see additional signage in French and English asking them to alert a border services officer if they have a fever, cough or difficulty breathing. Additional information, in the form of a handout, advises travellers what they should do if they develop these symptoms before or after they reach their destination or arrive home.

All international travellers at these 10 airports will need to respond to a screening question that has been added to electronic kiosks. This question is available in 15 languages.

All travellers from outside of Canada are advised to self-isolate for 14 days. These efforts will contribute to slow the introduction and spread of COVID-19 in Canada.

Upon returning to Canada travellers are also being asked to monitor their health for fever, cough or difficulty breathing, wash their hands often for 20 seconds and cover their mouth and nose with their arm when coughing or sneezing.

In addition, some provinces and territories may have specific recommendations for certain groups such as health care workers.

In general, when a traveller shows signs and symptoms of an infectious disease upon arrival in Canada, border services officers or airport and airline staff contact a Public Health Agency of Canada (PHAC) Quarantine Officer following a preliminary screening of the traveller based on criteria developed by PHAC (e.g., fever or signs of fever, coughing, difficulty breathing, rash and other symptoms). Travellers displaying symptoms are then moved to a designated area in each airport or an isolation room.

The PHAC Quarantine Officer then performs a more detailed assessment. If deemed necessary, the Quarantine Officer can then take additional measures to address the potential public health risk, such as ordering the traveller to be transported to hospital to undergo a medical examination and/or to report to the local public health authority.

These measures complement routine traveller screening procedures already in place to prepare for, detect and respond to prevent the spread of serious infectious diseases in Canada.

If pressed on thermal scanners:

It is important to note, in the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, more than 6.5 million screening transactions occurred at Canadian airports including inbound and outbound travellers. Of these, 2.3 million travellers were screened using thermal scanners. Despite this intensive screening effort, no cases of SARS were detected using these methods.

Measures are in place to identify and isolate a potentially ill traveller from other travellers to help minimize the spread of the 2019 Novel Coronavirus into Canada.

Once a potentially ill traveller is identified, measures are in place to isolate them from interacting with other travellers. At the earliest opportunity ill travellers are escorted to a dedicated area and are processed at a distance from others to reduce the risk of potential transmission. If possible the traveller is provided with a surgical mask along with hand sanitizer.

To prevent the introduction and spread of communicable diseases that are of significant harm to public health, the Public Health Agency of Canada (PHAC) collaborates with border partners, such as the Canada Border Services Agency (CBSA), to administer the Quarantine Act at all international points of entry into Canada, 24 hours per day, 7 days per week.

Travellers arriving in Canada who answer YES to the screening question enquiring whether they have been to Iran, Hubei province, China in the past 14 days are referred to a CBSA Officer, who asks the traveller if they feel sick or unwell and, if yes, ask additional questions about their symptoms (e.g., are you experiencing fever, cough or difficulty breathing?). If the traveller shows signs and symptoms, CBSA Officers or airport and airline staff contact a PHAC Quarantine Officer who is available 24 hours a day, 7 days a week.   

The PHAC Quarantine Officer then performs a more detailed assessment by asking additional questions regarding the traveller’s symptoms and confirming information about the travel history and any high-risk exposure to a communicable disease, such as close contact with a sick person. If deemed necessary, the Quarantine Officer can then take the appropriate measures to address the potential public health risk (e.g., order the traveller to be transported to hospital to undergo a medical examination or to report to the local public health authority).

PHAC has increased its public health officer presence at key airports to partner with Border Services Officers, who are also designated as screening officers under the Quarantine Act, and has trained quarantine officers that are experienced in the screening and assessment of ill travellers, and also available during business hours or when flights from China arrive. The number of personnel at each airport is adjusted to address any increase in the number of traveller assessments required. PHAC personnel also acts as a resource and support for CBSA Officers as well as airline and airport authority staff, facilitate communication, and coordinate response activities with partners.

The Government of Canada has put in place enhanced border measures at Canadian airports and land borders to help identify any travellers returning to Canada who may be ill—regardless of where they are coming from.

None of the Canadian passengers on the Costa Luminosa were amongst the confirmed cases of COVID-19.

The passengers who became ill disembarked at the first available opportunity. The rest disembarked in Marseilles, France, and were sent on chartered flights to their countries of origin. Canadian passengers travelled through Atlanta, Georgia.

The Government of Canada worked closely with the provinces and territories to ensure that appropriate measures were in place to minimize the risk of exposure to COVID-19. This included having health assessments conducted at every leg of the journey, ensuring that a Quarantine Officer assessed all passengers at the point of entry in Canada, obtaining contact information for follow-up, and having all passengers self-isolate for 14 days in Canada.

The Government of Canada will continue to use different quarantine options, based on risk assessments, ranging from self-isolation at home to federally designated quarantine facilities.

To date, the Government of Canada is not aware of any Canadian passengers from the Costa Luminosa having tested positive for COVID-19.

The Public Health Agency of Canada is supporting local public health authorities to follow up with travellers who may have been exposed on a flight.

At this time, we consider passengers who were seated within a two-metre radius of the case, and the flight crew who served the individual, to have potentially been exposed.

As part of the follow-up, information about self-monitoring for symptoms, and what passengers should do if they start to experience any symptoms, would be provided to these individuals.

This information is also available on Canada.ca/coronavirus. A new toll-free phone number (1-833-784-4397) has been established to answer questions from Canadians about COVID-19. Service is available from 7 a.m. to midnight.

We urge any travellers to Canada who experience symptoms associated with COVID-19 within 14 days of their return to Canada to contact health care professionals immediately.

Please ensure that you alert health care professionals to any recent travel before coming into contact with them so that the appropriate protocols can be taken as a precaution.

No, if a person is not experiencing any symptoms there is no need to see a health care provider. Instead, passengers on the flight should monitor themselves for symptoms, which include fever, cough and difficulty breathing. If they if develop symptoms, they should avoid contact with others and follow-up with their health care professional.

In addition, accessing health care services when there are no signs of being sick can impact the availability of services for those who are sick and need treatment.

More information about symptoms and treatment can be found at: Canada.ca/coronavirus.

Airlines are an important partner in mitigating the potential risk of introduction and spread of communicable diseases. airlines will prevent all travellers who present COVID-19 symptoms, regardless of their citizenship, from boarding international flights to Canada. Airlines will conduct a basic health assessment of all air travellers based on guidance from the Public Health Agency of Canada.

As part of the Government of Canada’s efforts to mitigate the spread of the novel coronavirus (COVID-19), the Public Health Agency of Canada (PHAC) has provided guidance for disinfection and sanitation practices for airlines with direct flights arriving from China.

PHAC recommends that in addition to regular cleaning practices, airlines thoroughly clean and disinfect frequently touched areas. Increasing the frequency of routine cleaning and disinfection of frequently touched areas is an important measure in controlling the spread of infection during any outbreak. The guidance includes recommended cleaning equipment and disinfectants, frequently touched areas and cleaning and disinfection instructions.

In addition, if a passenger on a flight has been identified as suspected of being ill, PHAC will advise the airline so that the area within a two-metre radius of the passenger’s seat can be thoroughly cleaned and disinfected, in addition to the enhanced routine sanitation practices.

Cleaning of touchscreen kiosks and other communal areas happens regularly throughout the day. The best way to prevent illness after touching a common surface that could be contaminated with a virus is to avoid touching your eyes, mouth or nose until you are able to wash your hands with soap under warm running water for at least 20 seconds, or use an alcohol-based hand sanitizer if soap and water are not available. The responsibility of maintaining and cleaning communal areas and kiosks falls under the individual airport authority.

For traveller screening areas such as the Canada Border Services Agency (CBSA) hall and Public Health Agency of Canada assessment rooms, the CBSA has been using a specialized cleaning solution to sanitize these areas multiple times daily.

Protecting the health of Canadians, front-line workers and in this case, flight attendants is of the utmost importance.As part of the Government of Canada’s efforts to mitigate the spread of COVID-19, the Public Health Agency of Canada (PHAC) has provided guidance on hand hygiene and respiratory etiquette and for disinfection and sanitation practices for airlines. PHAC recommends that in addition to regular cleaning practices, airlines thoroughly clean and disinfect frequently touched areas.

Increasing the frequency of routine cleaning and disinfecting of frequently touched areas is an important measure in controlling the spread of infection during any outbreak. The guidance includes recommended cleaning equipment and disinfectants, frequently touched areas and cleaning and disinfection instructions. In addition, if a passenger on a flight has been identified as suspected of being ill, PHAC will advise the airline so that the airline can contact staff from that flight to closely self-monitor and so that the area within a two-metre radius of the passenger’s seat can be thoroughly cleaned and disinfected, in addition to the enhanced routine sanitation practices.

Like all Canadians, airline crew should closely self-monitor for symptoms, isolate as quickly as possible should symptoms develop and contact their local public health authority for further direction, which will include where to go for care, the appropriate mode of transportation to use and precautions to be followed.

In addition, Transport Canada is working with air carriers to strengthen current practices in order to ensure that if a traveller becomes symptomatic in-flight, air carriers isolate the passenger quickly according to international standards, and flight crews don appropriate personal protective equipment. In addition, the flight crew would have to notify air traffic control of a passenger presenting COVID-19 symptoms.

Health Canada’s Public Service Occupational Health Program (PSOHP) provides occupational health services and occupational hygiene consultative services to Government of Canada departments.

As per usual protocols for these types of situations, PSOHP issued a general Occupational Health Advisory to departments and agencies which provided information on novel coronavirus and recommended precautions for employees such as: frequent hand hygiene, proper cough and sneeze etiquette, and self-monitoring for symptoms.

The advice and information is based on the science and risk level as assessed by the Public Health Agency of Canada and the World Health Organization.

In addition, given the variety of federal work settings, PSOHP developed supplemental advice for specific workplaces. The first priority was advice for employees based at airports who interact with travelers, for example, what personal protective equipment should be used when searching luggage or escorting an ill traveller. Health Canada Occupational health nurses are also supported our departmental partners with information sessions for personnel at airports and CFB Trenton.

The department is also working with Global Affairs Canada to ensure that departments and agencies with employees in affected countries have all of the occupational health information they require.

Health Canada’s occupational health experts will continue to work closely with departments to ensure the health and safety of employees in the federal public service.

A Health Canada employee who works at Tunney’s Pasture has tested positive for COVID-19. The employee is in self-isolation and is following the direction of local public health authorities.

The Department followed established protocols:

• The area where the employee works, including common areas, has been properly cleaned, according to Public Services and Procurement Canada standards. This was done in collaboration with Statistics Canada as the two departments share common work space.

In addition, local public health authorities have been in contact with the employee for any relevant contact tracing. This involved contacting certain colleagues who have also been advised to self-isolate by local public health authorities.

The Government of Canada has asked teleworking to be used whenever and wherever possible, subject to each department’s operating requirements.  Departments and agencies are actively exercising this flexibility.  We are constantly re-assessing the situation and striving to balance both our duty to Canadians and the health and safety of all public servants.   

The government is working on a means to centralize information on confirmed cases within the public service. Treasury Board Secretariat has been working closely with Health Canada and the Public Health Agency of Canada to provide workplace-related information and advice to departments and agencies so they can manage their workforce accordingly.

The funding will support the development and implementation of a comprehensive national public education campaign for COVID-19 that will provide Canadians with credible information that promotes behaviours that will protect individuals and overall public health. This will include advertising, social marketing, the development of information resources, the establishment of partnerships and targeted outreach to at-risk populations. This work will complement current Public Health Agency of Canada outreach and communications activities such as the website for information on COVID-19, a toll-free information line, digital advertising, and regular updates to media.

Public education plays a critical role in our response to COVID-19 as it helps to:

• increase awareness and understanding about symptoms and treatment;
• provide information on preventive measures such as self-isolation;
• address misinformation and public concerns.

Effective March 25, 2020, the Government of Canada has implemented a federal Emergency Order under the Quarantine Act requiring anyone entering Canada, whether by air, land or sea, to isolate for 14 days if they have symptoms of COVID-19 or to quarantine themselves (self-isolate) if they do not have symptoms for 14 days, in order to limit the introduction and spread of COVID-19.

This applies to all people entering Canada with few exceptions — and captures those who have symptoms of COVID-19 and those who do not have symptoms.

These measures will help protect the health of individuals in question, any individuals with whom they may live and Canadians in general, including older adults and medically vulnerable people who are at greatest risk of severe COVID-19 disease.

Upon entering Canada, travellers will be asked questions about their health and symptoms, which they are required to report to a screening or Quarantine officer. They will also be asked to acknowledge that they are required, under the Quarantine Act, to isolate or quarantine (self-isolate) for a 14-day period that begins on the day on which they enter Canada.

Travellers will be provided with a hand-out that informs them that they are subject to the Order, provides general public health advice, outlines the requirements of the Order, and provides a link to the Canada.ca/coronavirus website where they can obtain further information.

Failure to comply with this Order is an offence under the Quarantine Act. Maximum penalties include a fine of up to $750,000 and/or imprisonment for six months.

Further, a person who causes a risk of imminent death or serious bodily harm to another person while wilfully or recklessly contravening this Act or the regulations could be liable for a fine of up to $1,000,000 or imprisonment of up to three years, or to both. Spot checks will be conducted by the Government of Canada to verify compliance. 

The Public Health Agency of Canada will work with federal and provincial partners to verify compliance with the Order.

Persons who do not have symptoms are subject to the federal Emergency Order and are mandated to mandatory quarantine (self-isolation) for 14 days, beginning on the day on which they enter Canada, because they are at risk of developing symptoms and/or infecting others.

Mandatory quarantine (self-isolation) means that they must:

• go directly home to their place of quarantine, without delay, and stay there for 14 days;
• not go into community settings_
• monitor their health for symptoms of COVID-19
• Arrange to have someone pick up essentials like groceries or medication
• Do not have visitors
• Stay in a private place like their yard or balcony if they go outside for fresh air
• Keep a distance of at least 2 arms lengths (approximately 2 metres) from others

Individuals can take public transportation but must not any stops on the way home and practice physical (social) distancing at all times.

If you develop symptoms within 14 days:

• isolate yourself from others
• immediately call a health care professional or public health authority and:
  • describe your symptoms and travel history
  • follow their instructions carefully

Persons who have COVID-19 illness or symptoms of COVID-19 are required to follow mandatory isolation for 14 days in accordance with instructions provided when they entered Canada and/or on the Canada.ca/coronavirus website, and remain in isolation until the expiry of the 14-day period that begins on the day on which they enter Canada.

Persons with symptoms may be directed to a quarantine facility for isolation or allowed to isolate at home. If required, immediate medical attention will be provided upon arrival in Canada.

If they are going home to isolate, mandatory isolation means that they must:

• Go directly to the place where they will isolate, without delay, and stay there for 14 days
• Go to their place of isolation using private transportation only, such as your personal vehicle
• Stay inside their home
• Not leave their place of isolation unless it’s to seek medical attention
• Not have visitors and limit contact with others in the place of isolation, including children
• Not isolate with in a place where they will have contact with vulnerable people such as older adults and individuals with underlying medical conditions

It is important to underscore that individuals entering Canada may be asymptomatic on entry. There are individuals who may subsequently fall ill. There are unfortunate cases where an asymptomatic individual can develop symptoms and deteriorate quite quickly. All, even those exempted from the Order, are reminded to monitor themselves for symptoms for a 14-day period.

Symptoms of COVID-19 include cough, difficulty breathing, or fever equal to or greater than 38°C (signs of fever could include shivering, flushed skin, and excessive sweating). Information about COVID-19 is also available at Canada.ca/coronavirus and by calling 1-833-784-4397.

Visit the provincial or territorial health authority website where you are located for more information, including when to contact the public health authority.

People entering Canada who have reported having symptoms or who a Quarantine officer observes with symptoms will be instructed to go directly home, without delay, to isolate for 14 days or will be sent to a quarantine facility or transported to hospital, at the discretion of the Quarantine officer.

Considerations include the severity of symptoms or illness, whether they have a place in which to isolate, and if they have private transportation to get to their home or place of isolation.

For example, if they have onward connections, or the distance to get home is too far for PHAC-arranged medical transportation, or if they live with one or more vulnerable persons, travellers will be required to complete their 14-day isolation in a quarantine facility established by the Government of Canada.

Earlier this month, the Government of Canada began asking all international travellers entering Canada to isolate for 14 days. This voluntary measure was put in place to contain the spread of COVID-19.

There have been reports of travellers returning from abroad who do not understand that 14 days of isolation or self-isolation is essential to help slow the spread of COVID-19 in communities and protect their health and that of all Canadians.

That is why the Government of Canada has implemented this mandatory Order — to provide clarity around the need for people entering Canada to isolate or quarantine (self-isolate) when they enter Canada. These additional measures will contribute to containing the outbreak and preventing further spread of COVID-19 in Canada.

The 14-day period begins on the day the person enters Canada.

Yes, the Order to quarantine (self-isolate) is mandatory for travellers without symptoms. Given the rapid spread of COVID-19 around the world, with widespread transmission in an increasing number of countries, people who travelled outside of Canada are considered to be at risk of exposure to COVID-19. The Government of Canada has implemented an Order requiring anyone entering Canada, whether by air, land or sea, to quarantine for 14 days in order to limit the introduction and spread of COVID-19.

There are numerous examples of asymptomatic individuals arriving in Canada and falling ill. In fact, sometimes the health of individuals can deteriorate quite quickly. It is extremely important for their own health and that of others for persons entering Canada to quarantine (self-isolate) and monitor their symptoms.

Yes. Persons not exhibiting symptoms may take public transportation and/or rent a car to get to a place to isolate. However, they must go directly to their home, without delay, or the place where they will isolate without delay.

While in transit, people need to follow the instructions of quarantine officer and screening officers to avoid spreading infection to others. For example, this means avoiding contact with others as much as possible and maintaining a 2-metre distance from others, and practising hand hygiene and cough etiquette.

Under the terms of the Order, public transportation includes an aircraft, bus, train, taxi, subway or ride-sharing service.

Yes. Persons not exhibiting symptoms may take connecting flights to their final destination to quarantine (self-isolate). Under the terms of the Order, public transportation includes an aircraft, bus, train, taxi, subway or ride-sharing service.

Travellers will be instructed by quarantine officers or screening officers to follow precautions to avoid spreading infection to others. For example, practice physical distancing — maintain a 2-metre distance — hand hygiene and cough etiquette.

People entering Canada not exhibiting symptoms may be permitted by the instructions of a quarantine officer or screening officer to stay at a hotel for an overnight layover before making their connecting flight the next day. They should go directly to their hotel without any unnecessary stops along the way.

While staying at a hotel, travellers should stay in their room to avoid contact with others, practise physical distancing (maintain a 2-metre distance) and practise good hand hygiene and cough etiquette at all times. To get a meal, use a drive-thru or room service as long as your meal is delivered and left outside the door of your hotel room.

It is not recommended to stay with friends or family where it could be harder to avoid contact with people compared to a hotel room.

Asymptomatic individuals may be permitted by the instructions of a quarantine or screening officer to stay in a hotel overnight if necessary, but should go directly to their hotel without any unnecessary stops along the way.

While staying at a hotel, travellers should stay in their room to avoid contact with others, practise physical distancing (maintain a 2-metre distance) and practise good hand hygiene and cough etiquette at all times. To get a meal, use a drive-thru or room service as long as your meal is delivered outside the door of your hotel room.

It is important that travellers avoid any unnecessary stops on their way home and contact with others.

Asymptomatic people travelling in an RV will generally receive instructions that it is permissible for them to stay in their RV overnight. Their RV is, essentially, their first place of self-isolation. They must avoid going into stores to make purchases.

It is important for asymptomatic travellers entering Canada to avoid contact with others. As per the instructions provided upon entry into Canada, go to the place where you will isolate without delay.

If you must stop, follow precautions to avoid spreading infection to others. Avoid contact with others ( maintain a 2-metre distance), and practice hand hygiene and cough etiquette at all times.

If getting gas, pay at the pump. Use a drive-thru to get a meal. If you need to stop to rest, use rest areas or other places where you can park and rest in your vehicle.

Once home, use food delivery services or online shopping to purchase essential items, and ask family, a neighbor or friend to help with essential errands, if possible.

Persons entering Canada who have a fever and cough, or a fever and difficulty breathing, or where there are reasonable grounds for them to believe they have these symptoms, are considered to be symptomatic and will not be able to continue onward travel using public transportation.

Persons aged 65 and over, and those of all ages with compromised immune systems or underlying medical conditions, are at an increased risk of more severe illness.

No. It is important that you avoid contact with others. Go to the place where you will mandatorily isolate without delay. This means you must:

• Go directly to the place where you will isolate, without delay, and stay there for 14 days
• Go to your place of isolation using private transportation only, such as your personal vehicle
• Stay inside your home
• Not leave your place of isolation unless it’s to seek medical attention
• Not have visitors and limit contact with others in the place of isolation, including children
• Not isolate with in a place where you will have contact with vulnerable people such as older adults and individuals with underlying medical conditions

If you must stop, follow precautions to avoid spreading infection to others. Wear the mask given to you at the border and avoid contact with others (maintain a 2-metre distance) and practise good hand hygiene and cough etiquette.

If getting gas, pay at the pump. Use a drive-thru to get a meal. If you need to stop to rest, use rest areas or other places where you can park and rest in your vehicle.

Once home use food delivery services or online shopping to purchase essential items, and ask family, a neighbour or friend to help with essential errands, if possible.

No. It is important that you follow the instructions of a quarantine officer or screening officer and avoid contact with others.

Once home use food delivery services or online shopping to purchase essential items, and ask family, a neighbour or friend to help with essential errands, if possible.

If private transportation is unavailable, PHAC-arranged medical transportation, up to a distance of 12 hours, may be provided to get the traveller to their home or place of isolation.

If the traveller has onward connections, the distance to get home is too far for the PHAC-arranged medical transportation, or if they live with one or more vulnerable persons, travellers will be required to complete their 14-day isolation in a quarantine facility designated by the Chief Public Health Officer of Canada.

Transportation from the point of entry into Canada to the quarantine facility will be arranged by the Government of Canada. Quarantine facilities, for example, hotels designated by the Government of Canada, will be used to lodge symptomatic persons unable to isolate because they do not have private transportation or if they live with a vulnerable person(s).

The Government of Canada has established quarantine facilities, for example hotels, to prevent the potential spread of COVID-19. Quarantine facilities will be used to lodge symptomatic persons who are unable to isolate because they do not have private transportation or live with a vulnerable person(s). Transportation from the point of entry to the quarantine facility will be provided by the Government of Canada.

These measures will help protect older adults and medically vulnerable people, who are at the greatest risk of severe COVID-19 disease.

The Government of Canada has established quarantine facilities, for example hotels, to prevent the potential spread of COVID-19. Quarantine facilities will be used to lodge symptomatic persons who are unable to isolate because they do not have private transportation or live with a vulnerable person(s). PHAC is working with partners to provide the necessary needs, including food and any medical needs, of travellers who will be in isolation at a designated quarantine facility.

Persons requiring care for other medical conditions will have access to medical care and emergency medical services at the quarantine facility.

If you are an individual entering Canada and not sick, you must quarantine (self-isolate) for 14 days.

Mandatory quarantine (mandatory self-isolation) means you must:

• Go directly to your place of quarantine, without delay, and stay there for 14 days
• Do not go to school, work, other public areas and community settings
• Monitor your health for symptoms of COVID-19
• Arrange to have someone pick up essentials like groceries or medication for you
• Do not have visitors
• Stay in a private place like your yard or balcony if you go outside for fresh air
• Keep a distance of at least 2 arms lengths (approximately 2 metres) from others

If you develop symptoms within 14 days:

• isolate yourself from others
• immediately call a health care professional or public health authority and:
  • describe your symptoms and travel history
  • follow their instructions carefully

When you have COVID-19 or symptoms of the illness, you must isolate. It is mandatory. If required, immediate medical attention will be provided upon arrival in Canada.

Mandatory isolation means you must.

• Go directly to the place where you will isolate, without delay, and stay there for 14 days
• Go to your place of isolation using private transportation only, such as your personal vehicle
• Stay INSIDE your home
• Not leave your place of isolation unless it’s to seek medical attention
• Do not go to school, work, other public areas or use public transportation (e.g., buses, taxis)
• Stay in a separate room and use a separate bathroom from others in your home, if possible
• Not have visitors and limit contact with others in the place of isolation, including children
• Not isolate in a place where you will have contact with vulnerable people such as older adults and individuals with underlying medical conditions

If your symptoms get worse, immediately contact your health care provider or public health authority and follow their instructions.

For all Canadians, you can go for a walk if you:

• Have not been diagnosed with COVID-9
• Do not have symptoms of COVID-19
• Have not travelled outside of Canada in the past 14 days.

If you go out for a walk, do not congregate and always practise physical (social) distancing by keeping at least two metres from others at all times.

For travellers entering Canada, during their 14-day period of isolation or quarantine:

• For those in mandatory isolation, stay inside your home.
• For those in quarantine (self-isolation), you may go outside for fresh air in a private place like your yard or on a balcony; however, you must stay on your property and not go into community settings.

The funding will support the development and implementation of a comprehensive national public education campaign for COVID-19 that will provide Canadians with credible information that promotes behaviours that will protect individuals and overall public health. This will include advertising, social marketing, the development of information resources, the establishment of partnerships and targeted outreach to at-risk populations. This work will complement current Public Health Agency of Canada outreach and communications activities such as the website for information on COVID-19, a toll-free information line, digital advertising, and regular updates to media.

Public education plays a critical role in our response to COVID-19 as it helps to:

• increase awareness and understanding about symptoms and treatment;
• provide information on preventive measures such as self-isolation;
• address misinformation and public concerns.

Effective March 25, 2020, the Government of Canada has implemented a federal Emergency Order under the Quarantine Act requiring anyone entering Canada, whether by air, land or sea, to isolate for 14 days if they have symptoms of COVID-19 or to quarantine themselves (self-isolate) if they do not have symptoms for 14 days, in order to limit the introduction and spread of COVID-19.

This applies to all people entering Canada with few exceptions — and captures those who have symptoms of COVID-19 and those who do not have symptoms.

These measures will help protect the health of individuals in question, any individuals with whom they may live and Canadians in general, including older adults and medically vulnerable people who are at greatest risk of severe COVID-19 disease.