Recommendations to Block COVID Variants of Concern

Immediate Action Needed by the Federal Government to Shield Canadians From Imported COVID-19 Variants of Concern Highly infectious variants of the SARS-CoV-2 virus which causes COVID-19 (known as Variants of Concern, or VOCs) are circulating internationally. Several have been identified, with a naming strategy still being decided, including B.1.1.7 (B117) identified in the UK as well as variants identified in South Africa (501Y.V2) and Brazil (P.1). Others may exist and more could emerge.

Variants of Concern represent a clear and present danger to Canada’s health security and economic well-being. For example, the B117 variant is estimated to be 30-60% more transmissible than current circulating strains based on current epidemiology data. It quickly became the dominant strain across the UK and Ireland, causing massive increases in COVID-19 cases, overwhelming hospitals and forcing both countries into difficult new lockdowns.

Modelling for the U.S. Center for Disease Control suggests that B117 could become the dominant variant in the U.S. in March1.

The Ontario Science Table advises that B117 “could drive much higher case counts, ICU occupancy and mortality if community transmission occurs.2” If B117 or another highly transmissible VOC becomes dominant in Canada, it could cause hundreds of thousands of additional COVID cases and thousands of additional deaths. Very stringent, long lockdowns (beyond what Canadians are already experiencing) could be required to control it, causing tens of billions of dollars in additional economic damage.

While vaccine deployment will eventually add to our defenses against current circulating SARS-CoV-2 strains, and presumably VOCs, the accelerated transmission rate associated with B117 coupled with delays in vaccine acquisition and distribution raise significant concerns for the viability of current, overstretched pandemic controls in Canada.

Existing travel and border protocols have not prevented the importation of these new variants into Canada. Cases of variants B117 and 501Y.V1 have now been confirmed in several provinces. It is highly concerning that, in a number of cases, their path into Canada remains unknown.

1

https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7003e2-H.pdf

2

https://covid19-sciencetable.ca/wp-content/uploads/2021/01/Update-on-COVID-19-Projections_January-12-2021_ Final_English-2.pdf, p. 2.

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

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

Drawing upon these demonstrable successes and adjusting for Canadian realities (e.g. our land-border with the U.S.), we recommend the following 9 immediate actions by the Federal government: I. Reduce opportunities for variant entry, by restricting international travel to essential travel only: 1. Reduce the number of people leaving/entering Canada by air or by land, by defining more clearly and stringently what is essential and enforcing those criteria.

2. As a key part of eliminating non-essential travel, immediately cancel all flights to and from non-essential destinations (e.g. seasonal holiday destinations), except to allow for the return of Canadians already there.

II. Increase testing and variant screening for travellers to ensure that all VOC cases arriving in Canada are detected and sequenced. In addition to pre-boarding testing: 3. Perform a validated COVID test at point of entry for all entrants (air and land). No one can be exempted from testing, including essential workers and flight crew.

4. Require 2 additional tests during quarantine: the first several days into quarantine (e.g. Day 4/5) and the second shortly before the end of quarantine (e.g. Day 10/11).

5. Ensure all positive tests from travellers are screened for VOCs. The sequence data and adequate contextual information should be shared openly to enable national and international VOC surveillance and tracking.

III. Enhance the stringency of quarantine and isolation to limit the chance of VOC cases spreading. To prevent community exposure while possibly infectious: 6. Increase the effectiveness of the existing 14-day quarantine with daily checks by government, including in-person checks.

7. Provide designated facilities (with adequate food, resources and telecommunications) for those who cannot safely quarantine or isolate at home.

8. Strongly consider mandatory quarantine in designated hotels for all incoming travellers.

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

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

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

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

Canadians will support decisive action. In a recent poll, 87% of Canadians supported banning international travel until there were reduced numbers of COVID cases, with strong majorities across all regions, age groups, and party affiliations3. In another poll, 65% of Canadians said they would ban international travel altogether4.

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

3

Leger/Association of Canadian Studies, January 4, 2021: “Do you think that government should ban international travel until there are several consecutive days of reduced numbers of COVID-19 cases?”

4 http://angusreid.org/covid-international-travel/

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

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

Time is of the essence. Every day increases the risk of further importation of the new variants, and their establishing a widespread presence in Canada. Hesitation could be fatal to thousands of Canadians, to our economic recovery, and to Canada’s overall fight against COVID. We call on the Federal government, and in particular: Prime Minister Justin Trudeau Deputy Prime Minister and Minister of Finance Chrystia Freeland Foreign Affairs Minister Marc Garneau Transport Minister Omar Alghabra Health Minister Patty Hajdu Minister of Public Safety Bill Blair Canada’s Chief Public Health Officer Theresa Tam to act decisively and immediately in implementing these urgent recommendations.

Respectfully, Members of the COVID Strategic Choices Group Dr. Jeff Kwong Professor, Department of Family and Community Medicine and the Dalla Lana School of Public Health, University of Toronto Professor Caroline Colijn Canada 150 Research Chair in Mathematics for Infection, Evolution and Public Health, Simon Fraser University Professor Christopher Cotton Professor of Economics Jarislowsky-Deutsch Chair in Economic & Financial Policy Ms Marion Crowe First Nations Health Administrator CEO Dr. Christopher McCabe Executive Director and CEO, Institute of Health Economics

Professor Ashleigh Tuite Assistant Professor, Dalla Lana School of Public Health, University of Toronto Ms. Tasha Ayinde Associate Director, Faculty of Medicine and Health Sciences, McGill University Dr. Andrew Morris Infectious Diseases Specialist, Sinai Health and University Health Network, and Professor, Department of Medicine, University of Toronto Jean-Paul Soucy Studying for a Doctoral degree in infectious disease epidemiology at the Dalla Lana School of Public Health, University of Toronto Mr. Brett House Deputy Chief Economist, Scotiabank Dr. Jaspreet Khangura Department of Emergency Medicine, University of Alberta Emergency Physician & Clinical Instructor Robert Greenhill Professor of Practice, McGill University Canadian Epidemiologists, Virologists, Scientists, Doctors and Public Health Professionals Dr. David Fisman Physician, Epidemiologist (and Lead of the Institute for Pandemic's Centre for Pandemic Readiness at the Dalla Lana School of Public Health) Dr. Lynora M Saxinger Infectious DIseases, University of Alberta co-Chair COVID-19 Scientific Advisory Group, Alberta Health Services Professor Kelley Lee Professor, Health Sciences, Canada Research Chair Tier I, Simon Fraser University Dr. Jason Kindrachuk Virologist, Assistant Professor, Canada Research Chair – University of Manitoba Dr. Amy L. Greer, MSc, PhD Canada Research Chair in Population Disease Modelling and Associate Professor, University of Guelph

Dr Srinivas Murthy Physician Health Research Foundation and Innovative Medicines Canada Chair in Pandemic Preparedness Research Professor William Hsiao University Professor Associate Professor, Faculty of Health Science, Simon Fraser University Professor Jean-Christophe Bélisle-Pipon Bioethicist Assistant Professor, Faculty of Health Sciences, Simon Fraser University Dr. Robyn Lee Infectious disease and genomic epidemiologist Adjunct Professor, Infectious Disease and Genomic Epidemiology, Dalla Lana School of Public Health, University of Toronto Dr. Karen Grépin University of Hong Kong Associate Professor Dr. Tehseen Ladha Pediatrician Assistant professor Dr. Malgorzata Gasperowicz Developmental Biologist, General Associate, University of Calgary PhD Dr. Larissa Matukas Medical Microbiologist and Infectious Diseases Specialist Head, Division of Microbiology, St. Michael’s Hospital, Unity Health Toronto and Associate Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto Dr. Amy Tan Physician, Adj Associate Professor Dr. Gerald A. Evans Infectious Disease Specialist, Kingston Health Sciences Centre Professor & Chair, Division of Infectious Disease, Dept. of Medicine, Queen's University Miss Lyana Patrick Assistant Professor, Health Sciences, Simon Fraser University Mrs Lucy Henry International Health Research Manager Director, Research in Health Dr. Rupert Kaul Infectious Disease Physician Division Director of Infectious Diseases, University of Toronto

Dr. Kamyab Ghatan Infection Prevention and Control IPAC Officer Dr Selina Liu Division of Endocrinology & Metabolism, Department of Medicine, Western University Assistant Professor Dr. Mona Loutfy Infectious Diseases Specialist, Women's College Hospital Professor, University of Toronto Dr Yvonne Yau Medical Microbiologist Assistant Professor, University of Toronto Dr Lindsay Cohen Physician Emergency Medicine Physician Dr. Benoît Duguay Full Professor PhD, MBA Dr Leyla Asadi Infectious Diseases Physician PhD student, University of Alberta M. Doucet Normand Préposé aux bénéficiaires PAB Unité Covid en CHSLD Dr Marzieh Abedpour Dardashti Family Doctor MD FCFP Dr Catherine Pound Physician MD, MSc Dr Tina Whitty Anesthesiology Doctor M. Sébastien Gagné Infirmier clinicien M Dr Anne-Marie Nicol Academic Researcher Associate Professor Dr. Diego G. Bassani Associate Professor, Department of Paediatrics & Dalla Lana School of Public Health PhD Dr. Cindy Holmes Social Work Assistant Professor, University of Victoria

Dr. Susan Erikson Professor, Faculty of Health Sciences, Simon Fraser University Professor Dr. Farha Hussain Family physician MD CCFP Dr. Christine Froelich MD, FRCPC Associate Clinical Professor, University of Alberta Dr. Nicole Bechard Pediatric Resident Dr Dr. Jill Alston Physician Geriatrician Dr. Rajinder Cheema Family Physician MD Dr. Joanne Vaughan MD Doctor Dr. Jan McPhee Family medicine Physician Dr. Lillian Bartha MD Doctor Dr. Giorgia Tropini Resident physician MSc MD Dr. Jo Ling Foo Medicine Family physician Dr. Zainab Abbas Family physician Dr Dr. Ian Sempowski Physician, Associate Professor MD CCFP (EM) Dr. Emily Ching Medical physician Dr Ms. Antonia Benton Nurse practitioner

Dr. Jesse Shapiro Evolutionary microbiologist Associate professor, McGill University Professor Ronald Labonte Professor and Distinguished Research Chair, Globalization and Health School of Epidemiology and Public Health, University of Ottawa Dr. Shraddha Pai Ph.D. Research Scientist, Genomics and Bioinformatics Independent Investigator, Ontario Institute for Cancer Research Dr. Kashif Pirzada Emergency Physician and Co-chair of Masks4Canada Assistant Clinical Professor, McMaster University Dr John Challis OC University Professor University Professor Emeritus, University of Toronto: Adjunct Professor Simon Fraser University Dr. Joe Vipond Emergency Physician MD CCFP(EM) Dr. Kate Trebuss Physician Resident, Care of the Elderly Dr. Cherelyn Lakusta MD, FRCPC Clinical Assistant Professor, University of Calgary Dr. Noah Ivers Clinician Scientist Canada Research Chair, Implementation of Evidence-based Practice Dr. Dick Zoutman Infectious Diseases & Medical Microbiology Specialist Professor, Queen's University and University of Toronto Ms. Isha Berry Epidemiologist PhD Candidate Dr. Stirling Bryan Academic Professor of Health Economics, UBC Professor, Faculty of Health Sciences, Simon Fraser University Professor Dr. Linda L. Smith

MD CCFP FCFP Physician Assistant Clinical Professor Dr. Howard Ovens Emergency Physician Professor, Dept. of Family and Community Medicine, University of Toronto Dr. Jeff Round Health Economist Director of Economics, Institute of Health Economics Dr. Maya Gislason Assistant Professor Simon Fraser University Dr. Malcolm Steinberg University Instructor Director Public Health Practice Dr. Rachel McGovern Lecturer, Health Sciences, Simon Fraser University; Medical Writer Limited Term Lecturer Dr. Diego Silva Bioethics Lecturer Dr. Leonie Beauchamp Pathologiste Dr. Rina Lee MD Cardiologist Dr. Mandy Schwartz Family physician CCFP Dr. Claudine Storness-Bliss Obstetrics and Gynecology Physician Mrs. Annie Gagnon Family physician Dre Miss Nancy Saulnier Hospitalist Dre Dr. Edith Hui Family Physician MD Mrs. Bernadette Couture Primary Care Nurse Practitioner RN, MScN Ms. Roojin Habibi

Researcher Doctoral Candidate, Osgoode Hall Law School Dr. Sonja Hansen Physician Family Medicine Dr. Christine Gibson Medical Doctor Dr Jeremy Grimshaw Physician scientist Professor and Senior Scientist Dr Tim Hillson Eye Physician and Surgeon Assistant Clinical Professor, McMaster University Dr. Mark Lechner Faculty of Health Sciences, SFU University Lecturer Medical Microbiologist Assistant Professor, University of Toronto Dre. Cloe Trottier MD Doctor Dr Richa Agnihotri Physician Paediatrician Dr Nitin Wadhawan Physician MD CCFP Dr Jennifer Lush Family physician University Plaza Family Practice Ms. Daphne Broadhurst Registered Nurse Clinical Nurse Specialist Professor Olena Hankivsky Professor School of Public Policy Simon Fraser University Ms Wendy Somerville Infection Control Practitioner Coordinator, IPAC program McGill Faculty of Dentistry Richard Ingram Physician, University of Calgary, Alberta Dr. Dr. Vivian Welch School of Epidemiology and Public Health, University of Ottawa Associate