The road to Canada's COVID-19 outbreak: timeline of federal government failure at border to slow
Part 2 - https://edmontonjournal.com/news/politics/the-road-to-canadas-covid-19-outbreak-pt-2-timeline-of-federal-government-failure-at-border-to-slow-the-virus-2/
Part 3 - https://edmontonjournal.com/news/national/the-road-to-canadas-covid-19-outbreak-pt-3-timeline-of-federal-government-failure-at-border-to-slow-the-virus/
By David Staples • Edmonton Journal
When the COVID-19 crises first hit in late January, Ottawa MPs of all political stripes weren’t satisfied with the federal government’s assurances that Canada had the problem under control.
For the next two months, until major changes were at last made to our border policy in late March, the MPs dug into that policy, asking numerous probing questions, examining the motives and reasons behind the initial federal response.
Here is a detailed timeline of the questions those MPs asked and the answers they got in the House of Commons and at health committee meetings.
Also included in the timeline — as a contrast to the approach taken by the Canadian federal government — are the actions taken by the government in Taiwan (compiled byDr. Jason Wang et al), a nation that has so far successfully slowed the spread of the virus, despite close travel and economic ties to China, and despite being expected to have the second biggest outbreak of the virus. So far, Taiwan has had just a small fraction of the cases that Canada has had, its schools and businesses are still open, and there’s been no community spread of the disease, meaning all cases can be traced back to travellers, as opposed to coming from unknown community sources as seen with so many cases in Canada.
Finally, some information on China’s early attempts to cover up the outbreak and silence doctors discussing it, is also included for context. A full timeline with linked sources on China’s cover up was recently compiled by The National Review.
Dec. 30, 2019: Doctor Li Wenliang a message to a group of fellow doctors warning them about a possible outbreak of an illness that resembled severe acute respiratory syndrome (SARS) in Wuhan, Hubei province, China, where he worked, reportsThe Lancet.Meant to be a private message, he encouraged them to protect themselves from infection.
Dec. 31, 2019: Taiwanese officials, on guard against an outbreak of strange pneumonia cases in China, board and inspect passengers coming into Taiwan, looking for fever or pneumonia symptoms on direct flights from Wuhan.
December 31: The Wuhan Municipal Health Commission declares, “The investigation so far has not found any obvious human-to-human transmission and no medical staff infection.” This is the opposite of the belief of the doctors working on patients in Wuhan, and two doctors were already suspected of contracting the virus, reports Jim Geraghty of The National Review.
Jan 1, 2020: Doctor Li Wenliang was summoned to the Public Security Bureau in Wuhan, The Lancet reports, and was made to sign a statement in which he was accused of making false statements that disturbed the public order.
Jan. 3, 2020: The WHO issues public warnings over Twitter: “China has reported to WHO regarding a cluster of pneumonia cases in Wuhan, Hubei Province …Chinahas extensive capacity to respond to public health events and is responding proactively & rapidly to the current incident in Wuhan — isolating patients, tracing close contacts, cleaning up the market, and searching for the cause and for additional cases.”
Jan. 3, 2020. Caixin Global, which reports business and financial news from China, reported that “China’s National Health Commission (NHC), the nation’s top health authority, ordered institutions not to publish any information related to the unknown disease, and ordered labs to transfer any samples they had to designated testing institutions, or to destroy them.”
Jan 5: The Taiwan Centre for Disease Control is now notified if passengers from Wuhan have fever or other symptoms.
Jan. 7: China confirms it has a new disease, now known as COVID-19, then called coronarvirus.
Jan. 9: The WHO issues travel guidelines, urging restraint: “WHO does not recommend any specific measures for travellers. WHO advises against the application of any travel or trade restrictions on China based on the current information available … According to Chinese authorities, the virus in question can cause severe illness in some patients and does not transmit readily between people.”
Jan. 11: Tedros Adhanom Ghebreyesus, secretary-general of the WHO, tweets: “I sincerely thank all the Chinese scientists and health workers who have been working around the clock, for their commitment to keeping China and the world safe.”
Jan 15: The World Health Organization tweets: “According to the latest information we have, there is no clear evidence of sustained human-to-human transmission and there are no infections reported among health care workers.”
Jan. 21: In Taiwan, Wuhan is given a Level 3 travel alert designation, changing border procedures from Taiwan, Wang reports, which changed customs procedures at Taiwanese airports. “Persons with low risk (no travel to level 3 alert areas) were sent a health declaration border pass via SMS (short message service) messaging to their phones for faster immigration clearance; those with higher risk (recent travel to level 3 alert areas) were quarantined at home (for 14 days) and tracked through their mobile phone to ensure that they remained at home during the incubation period.”
Jan. 22: Canada implements screening requirements related to COVID-19 for travellers returning from China to major airports in Montréal, Toronto and Vancouver. Passengers with symptoms are to be alerted that they should go into voluntary isolation for 14 days, with voluntary self-isolation essentially being the Canadian policy for the next two months.
Jan. 22: In Taiwan, entry permits are canceled for 459 tourists from Wuhan set to arrive later in January. One day later, Wuhan residents are banned from Taiwan.
Jan. 24: The World Health Organization again advises against travel bans: “WHO advises against the application of any restrictions of international traffic based on the information currently available on this event.” At the same time, the WHO says early screening at airports had identified the majority of cases in newly infected counties. “The risk of importation of the disease may be reduced if temperature screening at entry is associated with early detection of symptomatic passengers and their referral for medical follow up.”
Jan 25: Canada confirms its first case of COVID-19 related to travel in Wuhan, China.
Jan 25: In Taiwan, tours to China are suspended. Hubei Province is given Level 3 travel alert status, with the rest of China a Level 2 travel alert.
Jan 25: federal Liberal Health Minister Patty Hajdu says of Canada’s border controls: “Measures to mitigate the risk of introduction and spread of diseases like the new coronavirus in Canada are in place, including messaging on arrival screens at the Toronto, Montréal and Vancouver international airports reminding travellers to inform a Border Services Officer if they are experiencing flu-like symptoms, and an additional health screening question on electronic kiosks used by international travellers.”
Jan. 26. China restricts all non-essential travel to and from Wuhan, essentially putting 50 million people into quarantine. Canada advises against “non-essential travel” to Wuhan.
Jan. 27: In Taiwan, the National Health Insurance Administration (NHIA) and the National Immigration Agency integrate patients’ past 14-day travel history with their NHI identification card data from the NHIA; this is accomplished in one day, Wang reports, and allows the medical system to know crucial information about each patient. Taiwan citizens’ household registration system and the foreigners’ entry card allow the government to track individuals at high risk because of recent travel history in affected areas. Those identified as high risk (under home quarantine) are monitored electronically through their mobile phones.
Jan. 27: Edmonton MPMatt Jeneroux asks the first question in the House of Commons about COVID-19 after a second case was reported in Canada: “How can Canadians be assured that this spread is being properly contained?”
“The risk to Canadians remains low. Our systems continue to work extremely closely together,” Hajdu replies.
Jan. 27: Conservative MP Todd Doherty asks Hajdu: “Every day thousands of passengers from China and elsewhere in Asia arrive at our ports of entry: Vancouver, Montreal and Toronto. Often times, they board domestic flights and connect throughout Canada and elsewhere in North America. Calling the coronavirus a grave situation, China has quarantined whole cities and millions of people. The WHO has now listed the global threat as high. The safety of Canadians is currently dependent upon screening in China and self-reporting by infected passengers. When will the government institute a real plan that includes an enhanced screening process?”
Hajdu replies: “In fact, our government has been well ahead of the World Health Organization’s strategies in terms of screening at ports of entry. We have multiple measures to alert travellers from the affected regions about what to do if they suspect that they have the illness. We have trained our CBSA officers to ensure that they have the tools they need to support people who may be ill. We have worked with partner airlines to ensure there is information on flights.”
Jan. 27: MP Garnett Genuis of Sherwood Park asks if the government will support Taiwan being allowed into the WHO, from which it’s currently banned due to pressure from China, meaning the WHO does not closely monitor the significant measures Taiwan has already instituted. Genuis gets no answer from Foreign Affairs Minister François-Philippe Champagne other than: “Canadian officials in Ottawa and in China are working closely together with their Chinese counterparts to address this situation that we are currently facing.”
Jan. 27: Conservative Leader Andrew Scheer asks: “Will the Prime Minister support observer status in the World Health Organization for Taiwan?”
Prime MinisterJustin Trudeau‘s only answer is: “We continue to work with the WHO. We continue to work with allied countries around the world to ensure that we are dealing with this health challenge.”
But a day later, Trudeau adds: “As we did during the time of the SARS virus, we support Taiwan’s meaningful participation in international multilateral forums, especially when its presence provides important contributions to the global public good. We believe that Taiwan’s role as an observer in World Health Assembly meetings is in the best interest of the international health community.”
Jan. 28: In Taiwan, all of China (except Hong Kong and Macau) is given Level 3 travel alert status, meaning all incoming travellers go into mandatory quarantine.
Jan. 29: Tedros Adhanom Ghebreyesus, head of the WHO, praises the Chinese response: “I was struck by the determination of Chinese leadership and its people to end the new coronavirus outbreak. They are suffering the most. Their lives & economy are bearing the brunt of the outbreak as they make sacrifices to contain it. China needs the world’s solidarity & support.”
Jan. 29: MP Jeneroux continues to press in the House of Commons, with three cases now in Canada: “Other nations are stopping flights in and out of China and introducing more rigorous screening processes. Is the Prime Minister satisfied with the actions of his government?”
Trudeau replies: “I can reassure Canadians that the health risk to Canadians continues to be low. We are taking all necessary precautions to prevent the spread of infection… Preventative measures are in place in airports in Toronto, Vancouver and Montreal, and we continue to co-ordinate with the WHO, with our international partners, to ensure that we are doing everything necessary to keep Canadians safe.”
Jan. 29: Liberal MP Marcus Powlowski, a doctor from Thunder Bay, Ont., questions Dr. Theresa Tam, Canada’s chief public health officer, at the Parliamentary Health Committee: “The BBC was reporting today that their ministry of health was asking all people coming from China to voluntarily self-isolate for two weeks upon returning to the country, I think because the idea is that it got out of Wuhan. When you look at the numbers and what’s happening in China, it’s not isolated to Wuhan. It would seem to me to be a fairly feasible thing for us to do, and a precautionary thing, to have anyone coming from China self-isolate for two weeks. Have you considered making that recommendation, potentially under the Quarantine Act? I don’t know if there’s a means to enforce that.”
Tam replies, defending the policy of voluntary self-isolation of only those travellers showing clear symptoms: “Right now, we have protocols in place, together with the provinces and territories, on isolating cases. Certainly, doing rigorous contact tracing and monitoring is the key to preventing any spread from a case in Canada. That, I think, is of primary importance. For other completely asymptomatic people, currently there’s no evidence that we should be quarantining them.”
Tam stresses the need to work to have affected communities work with everyone else. “Otherwise, they’ll be stigmatized. They will be asked to take measures beyond what is currently the public health evidence. It is a matter of balance when you’re restricting someone’s freedom, essentially, to move about in the community after return. I think that is not something that we would take lightly.”
Powlowski continues: “The New York Times are reporting that they think the disease is communicable during the incubation period, meaning that when people are asymptomatic it can be transmitted… Britain has already taken action in terms of voluntary co-ordination. It would seem to me to be something that maybe we ought to consider. I don’t know how drastic that is.”
Tam says that Canada was working on this with the WHO. “They know they have to get to the bottom of this, but we do know that even people with mild symptoms don’t transmit very readily. Could they? It’s possible, but that’s not what drives an actual epidemic … I think we have to be reasonable in our public measures and just balance out the risks and benefits. In terms of the impacts, they are not simply health impacts, but psychological and other health impacts, as well as non-health impacts, those being societal and economic as well.”
Jan. 29: Conservative MP Pierre Paul-Hus asks for a quarantine on travellers from affected areas. “People are coming into the country without symptoms, and going back to their homes. You say that the provinces are in charge of screening, as they see fit. Can you be a little clearer about that? With an event like this, I wonder whether the Government of Canada has stricter authority than the provinces.”
Tam says: “As travellers enter the three international airports, the information is provided in English and French but also in simplified Chinese. The kiosks themselves have 13 languages, and then the handouts we are providing have French, English and simplified Chinese. The handouts not only talk about the symptoms and what people should do but also suggest calling ahead to your health provider before you present yourself to an emergency room or the ambulance service. There are numbers at the back of that form for each jurisdiction so that people know whom to call should they experience symptoms. That’s to ensure they do not walk into a clinic or hospital and contaminate the environment. All three cases we’ve had so far have entered the health system in a very safe way in which all infection prevention precautions have been undertaken.”
She adds: “As I have always said, the epidemic of fear could be more difficult to control than the epidemic itself.”
Tam downplays risk to Canada: “Right now, the cases are in China. Very few are exported. Yes, there’s human-to-human transmission, but those are generally for close contacts. With regard to the severity of illness, there are some severe cases, but the deaths have occurred in older people with underlying medical conditions. With all of that pulled together, for the general public who have not been to China, the risk is low in Canada.”
If someone did have close contact, protocols were in place, she says: “The expectation for any contacts is that they will be actively monitored for 14 days. That is the longest incubation period that is being observed. Local public health will monitor the contacts, and doing that generally involves public health having some contact every day with the individuals who have been identified.
“We do know that asymptomatic people are not the key driver of epidemics. That is very important to understand.”
On the issue of travel bans, Tam says she does not support them: “Right now, let’s say, WHO does not recommend travel bans, and any measures that a country is to take must not be out of proportion to the risk and must not inappropriately impact travel and trade. We are a signatory to the international health regulations and we’ll be called to account if we do anything different.”
Jan. 29: Conservative MP Len Webber asks if other countries had put in travel bans.
Tam, a special advisor to the WHO, mentions some regional bans, but she does not specifically mention Taiwan’s ever more strict bans: “Not countries, but I think there are three areas. I believe the Hong Kong Special Administrative Region, for example, has put on a sort of block, but I believe there are three jurisdictions.”
She says the WHO’s focus is not on a country like Canada. “Right now, the World Health Organization is particularly worried about countries without capacities, particularly in the African region. I think the assessment of WHO as to whether it considers this a public health emergency of international concern isn’t necessarily focusing on countries that have capacities like Canada’s. They have to look at the whole world, including countries that don’t have the necessary capacity to prepare… We are of course a lot better than some of the other countries, which I think collaboratively, globally, we have to support, because a global containment strategy only works if every single country is part of it and there’s a cohesion in how we respond.”
Tam praises the Chinese response: “What we have seen, given my close communication with WHO, is how impressed they are by the work of China. The astoundingly rapid way in which they tried to get a handle on what is causing the outbreak, and giving the world the sequence of the virus, was very helpful. They’ve been providing information about cases, which is extremely helpful. You’ve seen the incredibly extraordinary measures that China has put in place to try to contain this within its borders. Even if this virus is capable of transmission from human to human, as I said, 99% of the cases are in China. Not that many—like 1%—are outside, so they are really trying very hard, and I think we have to be very supportive of the efforts.”
Tam expresses full support for the WHO: “For any global epidemic situation, international collaboration is key. Having the international health regulations and everyone sort of working under that umbrella, and having WHO’s leadership, is very important. They’ve strengthened a lot of that.”
Tam talks about importance of detecting imported cases. “The key to detecting an imported case is at that first encounter with the health system, taking the travel history and doing the regular routine infection prevention control. I think hospitals have learned that this is really important and have raised their capacity to do that.”
Tam says local health officials are tracking cases. “Right across Canada the system is so alerted that our local jurisdictions are investigating a number of people. They’re regularly assessing people who have returned from China. Anyone who then fits the case definition doesn’t have to wait for a test or for a diagnosis. They are immediately put under isolation so you don’t have to wait for the test. They are going to be managed clinically, and then for the lab test, many provinces can actually do at least the first step.”
Jan 29: At health committee, NDP MP Don Davies from Vancouver asks why there is not thermometer testing done at airports. He points to a report done years earlier on the 2003 SARS outbreak, which Tam had co-authored, which found: “In spite of intensive screening, no SARS cases were detected. SARS has an extremely low prevalence, and the positive predictive value of screening is essentially zero.”
Tam then spells out her philosophy, with the focus on the main line of defence being a country’s hospitals, not its borders: “This is a virus. It can cross borders. This is a layer of a multi-layered response. The most important layer, of course, is the initial entry into the health system. We’ve talked a bit about that. At the actual international border, I see it as a great opportunity to absolutely make someone aware of what to do if they’re sick after entry. In that paper, what I recommended was that…. This is a moment in time; someone is paying attention as they’re crossing the border. You can give them the information they need in that moment of education as to what they should do if they get sick. In that paper, what I did not find effective were thermal scanners (with SARS outbreak). That was a lot … I think we scanned 6.3 million people, both on entry and exit, and couldn’t pick up a case, for a very specific reason, which was that in the incubation period people can be asymptomatic. Also, for other reasons, that was just not … On that predictive value, if it’s rare, you actually don’t expect a case. It’s actually not very effective. That’s the thermal scanning bit, not the education bit.”
Tam does not see great risk for Canada, she says: “Canada’s risk is much, much lower than that of many countries. It’s going to be rare, but we are expecting cases. It doesn’t matter how few those cases are. We are preparing the whole country in the event that you might pick up a rare case. That actually is what we’re doing right now, preparing. It is going to be rare, but you’re going to have some.”
Jan. 30: WHO declares a global health emergency. In China, the virus has infected nearly 8,000 and killed at least 170. There are now 98 cases in 18 other countries.
Jan. 30: The WHO’sGhebreyesus tweets in support of the WHO’s open borders policy: “This is the time for facts, not fear. This is the time for science, not rumours. This is the time for solidarity, not stigma.”
Jan. 30. In Taiwan, Wang reports, four million masks are produced daily by local manufacturers. Of the masks produced, 1.4 million each day are allotted to hospitals and medical workers, with remaining 2.6 million for consumer sales. Mask prices are currently fixed at NT$8 apiece (USD $0.27). Taiwan’s High Prosecutors Office starts a nationwide campaign to stop profiteering by any seller raising prices on disease prevention products; penalty is one to seven years in jail and a fine of up to NT$5 million (US$167,000).
Jan. 30: A Change.org petition starts calling for Tedros Adhanom Ghebreyesus of the WHO to resign.
Jan. 31:The WHO’sGhebreyesus tweets: “WHO continues to have confidence in China’s capacity to control the outbreak. We would’ve seen many more #2019nCoV cases outside China by now, & probably deaths, if it were not for the government’s efforts & the progress they’ve made to protect their own people & the world.”
Jan. 31: In the House of Commons, the NDP’s Davies notes the WHO has just declared COVID-19 a world health emergency. “One of the chief reasons for this move is they are concerned that this virus will spread to countries that are not prepared to deal with it, a serious state of affairs that increases the risk for all nations.”
Health ministerHajdu says: “We are so fortunate to have Dr. Tam as our Chief Public Health Officer, who is an expert adviser to this very committee. We have been following the World Health Organization recommendations since we noticed the cluster in late December. We will be closely reviewing the recommendations. I will mention, though, that some of them really do speak to the need to support weaker countries that do not have the same integrated systems that Canada has and to preventing the misinformation that is leading to racism and stigmatization of so many Chinese Canadians and other people of Chinese descent around the world.”
Jan. 31: The NDP’s Davies asks in Health Committee: “So far, we’ve been focused on people coming from Hubei province. Now, with the possibility that this virus is going to other countries that may not have the same vigilance — and I think there’s been quite a consensus that China has done a very good job of containing this — how do we respond to passengers who are perhaps coming from countries that may not have the same rigorous standards to deal with this? How has that affected our border entry controls and how we might be dealing with that?”
Paul MacKinnon, executive vice-president of the Canada Border Services Agency replies to Davies: “Our officers are trained from the moment they join Rigaud to do this very work on a daily basis, so in some sense, they rely on their standard operating procedure to always be checking for individuals who may be arriving at Canadian airports showing signs of illness. Certainly we are more focused on the questioning we have about whether they are coming from Hubei province. That questioning is working well for us at this point.”
Jan. 31: Liberal MP Powlowski asks of MacKinnon: “You seem to be gaining all of your identifying of passengers — asking questions, following them up — specifically with people from Wuhan or Hubei province. I would question why you’re limiting it to this group rather than all of China.” He notes the hundreds of other confirmed cases in other parts of China.
Davies asks if border guards had a list of the then 24 countries where the virus had spread.
Mackinnon says, “At the border we do not have such a list.”
Feb. 1:Trudeau speaks at large Lunar New Year celebrations in Toronto and addresses COVID-19 outbreak: “There is no place in our country for discrimination driven by fear or misinformation,” Trudeau says. “This is not something Canadians will ever stand for.”
Feb. 2:Trudeau’s office issues a public statement on COVID-1: “The government remains fully engaged on the issue, and will do all that is necessary to ensure the safety of Canadians, both at home and abroad … The Prime Minister remarked on his visit yesterday to Toronto where he celebrated the Lunar New Year with Chinese Canadians and again underlined the importance of Canadians’ support for each other, and of combatting fear, stigma, and racism.”
Feb. 3: In Taiwan, Wang reports, a new name-based rationing system is announced for purchase of face masks (starting Feb 6): National Health Insurance card holders can purchase two masks per week at contracted pharmacies for NT$5 apiece (US$0.17). NHI cards ending in odd numbers can purchase on Mondays, Wednesdays, and Fridays; NHI cards ending in even numbers can purchase on Tuesdays, Thursdays, and Saturdays; Sundays are open to all. Each person can buy masks for one other person with their NHI card.
Feb. 3: Conservative MP Jeneroux in the House of Commons:“Other countries are taking proactive measures by declaring a public health emergency. Other countries are cancelling all flights into and out of China. The United States said it is implementing these measures to increase its ability to detect and contain the coronavirus. Why has Canada not done the same?”
Hajdureplies: “Here in Canada we have very different processes in place than in the United States. For example, we do not need to call a public health emergency here because we already have the structures, the systems and the authorities to spend appropriate dollars necessary to respond, treat and maintain our public health systems.”
Hajdu also scolds opposition MPs: “One of the interesting elements of the coronavirus outbreak has been the spread of misinformation and fear across Canadian society. That was actually noted by an interviewer on the weekend. In fact, she asked me how Canadians can be assured that they are getting the right information. One way might be if the opposition does not sensationalize the risk to Canadians and allows Canadians to understand where they can find a wealth of information.”
Feb. 4. NDP MP Davies at health committee, asks Dr. Tam: “The United States has implemented emergency measures to temporarily deny entry to foreign nationals who have visited China in the 14 days prior to their arrival. Restrictions also apply to U.S. citizens who have been in China’s Hubei province in the two weeks prior to their return to the U.S. Upon their return, those citizens will be subject to a mandatory quarantine of up to 14 days. They’ll also undergo health screenings at selected ports of entry. In light of your comment earlier that the time to contain is now — I think that was your wording — and that it’s very important that we get a good grip now, shouldn’t Canada be taking similar protective measures now, following the precautionary principle, to make sure we’re doing everything we can to contain this virus at the earliest possible opportunity? If not, why not? Why aren’t we doing that?”
Tam continues to defend Canada’s policy of screening for symptomatic passengers only from Hubei province and voluntary self-isolation for only those sick individuals: “The most effective piece of containment, of course, is at source, in China itself, where you’re seeing some of the extraordinary measures that are being taken. As you move further away from that epicentre, any other border measures are much less effective. Data on public health has shown that many of these are actually not effective at all. We are doing some of those and adding those layers, but each of those layers is not a complete barrier, if you like. We have provided travel health advice from a health perspective to indicate to travellers to avoid the province of Hubei and to limit non-essential travel to the rest of China. That advice is provided to travellers…WHO advises against any kind of travel and trade restrictions, saying that they are inappropriate and could actually cause more harm than good in terms of our global effort to contain.”
Feb. 4. Bloc MP Luc Thériaultasks: “Dr. Tam, you said earlier that enhanced controls might do more harm than good. What did you mean by that?
Tam then spells out a key rationale behind the WHO policy: “I think one of the members asked about travel bans, stopping people from actually travelling. The reason the World Health Organization doesn’t recommend something like this is that, in general, it may do more harm than good. I think someone mentioned what the United States was doing. If you stop traffic entirely, there are a number of issues. The international community must come together in solidarity to contain. Having measures that very negatively affect a certain country that’s trying very hard to do its best can impede whether this country in the future will ever share anything transparently with others. China posted the virus genome very quickly. What are they getting out of it? I think the idea is to support China. Obviously, the number of flights has already been reduced, because nobody is actually going to China, but Canada has not closed its borders. It’s using these layers of measures to screen people coming in, in order to keep movement across the border. The other thing is that if you’re going to support China’s efforts, then medical aid, such as teams or supplies such as masks, gowns or something else, must continue to flow. For all those reasons, the World Health Organization will never recommend doing that, except in very exceptional circumstances. As I said, the border measures that are most effective are at source, in China.“
Feb. 7.Doctor Li Wenliang dies from COVID-19 infection.
Feb. 7: In Taiwan, foreign nationals with travel to all of China, now including Hong Kong or Macau, in the past 14 days, are banned from entry. Foreigners must see an immigration officer and cannot use e-Gate (quick entry). Also, a Taiwanese couple is fined NT$300,000 (USD $10,000) for breaking the 14-day home quarantine rule.
Feb. 9: Global Affairs Canada, a federal agency, announces Canada will ship medical supplies to China: “To support China’s ongoing response to the outbreak, Canada has deployed approximately 16 tonnes of personal protective equipment, such as clothing, face shields, masks, goggles and gloves to the country since February 4, 2020.”
“Canada is saddened by the impact of the novel coronavirus outbreak, especially the loss of life, on the Chinese population. Personal protective equipment is essential to prevent and limit the spread of the virus,” says Karina Gould, Minister of International Development
Feb. 9: Canada expands its COVID-19 screening requirements for travellers returning from affected areas to 10 airports across 6 provinces, putting in place the same voluntary self-isolation for symptomatic people, but for no one else.
Feb. 11: Travellers entering Taiwan must complete an accurate health declaration form or be fined up to NT$150,000 (US$5,000), Wang reports.
Feb. 11: The WHO issues a new statement of travel bans, opening the door for some restrictions: “Evidence on travel measures that significantly interfere with international traffic for more than 24 hours shows that such measures may have a public health rationale at the beginning of the containment phase of an outbreak, as they may allow affected countries to implement sustained response measures, and non-affected countries to gain time to initiate and implement effective preparedness measures.”
The WHO advocates for containment, “including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection.”
Feb. 12: In Taiwan, the government declares that violators of the mandatory home isolation regulations will be fined up to NT$300,000 (US$10,000); violators of home quarantine regulations will be fined up to NT$150,000 (US$5,000), Wang reports. Cases of severe influenza that tested negative for influenza since Jan. 31 are to now be retested for COVID-19.
Feb. 14: In Taiwan, Taipei City, the government tracks down three Hong Kong visitors who disappeared for almost a week without undergoing quarantine. Each is fined NT$70,000 (US$2,350) and transferred to specially assigned quarters for medical isolation. The Entry Quarantine System launches to fill out health declaration form electronically and allow for faster immigration clearance.
Feb. 17: Daily mask output is now now five million masks in Taiwan, with the goal of reaching 10 million per day.
Feb. 20: Canada confirms its first case related to travel outside mainland China.
Feb. 21: In Taiwan, with school to restart after an extended Lunar New Year holiday, the Ministry of Education guidelines for any new suspension of classes due to confirmed coronavirus cases: If 1+ in a class (student or teacher) at the K-9 level is diagnosed with COVID-19, that class is suspended for 14 days; If there are 2+ cases in a school, the school is closed for 14 days; If one-third of schools in a township, city, or district are shut down, all others are closed; If a student or teacher is diagnosed in a high school, college, or university, all classes they attend or teach are suspended for 14 days; If 2+ cases of COVID-19 in an institution at any level, it will close for 14 days.
Feb. 23: In Tawan, 6.45 million surgical masks are distributed to K-12 schools and after-school institutions before spring semester starts along with 25,000 forehead thermometers and 84,000 liters of alcohol-based sanitizers
Feb. 26: At Health Committee, Jeneroux asks about a statement Tam had made to CTV on Feb. 24: “She stated that the more countries are infected, the less effective and feasible it is to close our borders. I am curious if this is some sort of admittance that the government should have shut down the borders when China was — from what we understood at the time — the only country that was heavily infected.”
Dr. Howard Njoo, Deputy Chief Public Health Officer, Public Health Agency of Canada replies to Jeneroux: “Not at all. We certainly understand that border measures are just one layer in a multi-system approach to preventing and hopefully controlling the spread of COVID-19 in Canada. It’s never been understood or recognized that border measures alone will stop it. We know that with this disease — as with many other infectious diseases — there is something called an ‘incubation period.’ Someone could actually be harbouring the disease, virus or bacteria and come into Canada feeling totally well, having no symptoms at all, and then only declare and come forward with symptoms once they have actually entered the country.”
Njoo insists Canada is doing well: “We have contained the virus. There have been 12 cases to date in Canada. That’s a relatively low number compared to other countries. All of the cases, I would say, are isolated or at least isolated to travellers coming to Canada or their very close contacts. Nine of the cases coming to Canada were all linked to travel to China. Now the three most recent ones — which is quite interesting in many ways — are linked to travel from Iran.
Njoo shoots down idea of closing borders: “Let me respond to the previous comment about the border measures. I can’t speak for Dr. Tam — I’m sure she’ll have the opportunity to maybe clarify or speak for herself in terms of border measures — but it’s not about closing the borders. From a public health perspective, closing the borders has never proven to be effective in terms of stopping the spread or the introduction of disease into any country. I think what Dr. Tam might have been thinking about with the border measures was in terms of looking at what’s happened in other countries, such as Italy now, and the spread to many other countries and regions. The supplementary border measures that we’ve had up to date include giving additional information to travellers from China, from Hubei province. You can imagine how if that list gets expanded — to Japan, South Korea, Italy and so on — obviously, there will be a trickle-down effect in terms of what provincial authorities may need to follow up on.”
Njoo also adds: “At the same time that Canada is still maintaining its containment posture, if I can put it that way, we’re also starting to prepare for a possible pandemic. We can’t do this with our eyes closed and not recognize what might happen weeks and months from now, which has nothing to do, maybe, specifically with Canada but with what’s happening internationally.
“To give you an example of the kinds of things we’re looking at — I think it’s the same for other countries around the world — should there be widespread transmission in Canada and in many other parts of the world, we would be looking at such measures as what we call “social distancing.” Do we need to start looking at cancelling mass gatherings and public events? Would there be things like looking at what we need to do with schools, and students attending schools, and people sick in the hospitals and so on?
“That’s all in the future. We’re certainly not there yet, but we are actually taking a close look and making sure we’re prepared for that.”
Feb. 26.Liberal MPPowlowski asks Njoo if the screening measures recommending self-isolation were done only from travellers from Hubei, Province.
Njoo says: “The direction or the advice for self-isolation is for travellers coming back from Hubei province, but for mainland China up to now, there’s also been advice given that they should be monitoring for symptoms in the next 14 days — obviously, that’s if they’ve come from mainland China in the past 14 days — and that, should they be coming down with symptoms consistent with COVID-19, they should contact local public health … We will now go forward and give that same advice to travellers who come back from the other six countries that we’re now adding to what we call an ‘affected region’ list — Hong Kong, Singapore, Japan, Italy, Iran and South Korea.”
Feb. 29. The WHO issues its latest statement, continuing to advise against travel restrictions to countries experiencing COVID-19 outbreaks. It explains this measure, saying that such restrictions may help some countries early in an outbreak to prepare, but: “In general, evidence shows that restricting the movement of people and goods during public health emergencies is ineffective in most situations and may divert resources from other interventions.”
It also says such disruptions would be disruptive to countries experiencing an outbreak. “Travel bans to affected areas or denial of entry to passengers coming from affected areas are usually not effective in preventing the importation of cases but may have a significant economic and social impact.”
The WHO downplays temperature screening as an effective tool. “Temperature screening alone, at exit or entry, is not an effective way to stop international spread, since infected individuals may be in incubation period, may not express apparent symptoms early on in the course of the disease, or may dissimulate fever through the use of antipyretics; in addition, such measures require substantial investments for what may bear little benefits.”
In total, 39 countries have now reported significant travel restrictions to the WHO, ranging from denial of entry of passengers, visa restrictions or quarantine for returning travellers.
March 4. Trudeau’s wife Sophie Gregoire Trudeau is in London England for a major event, WE Day. She posts image on Instagram and posed for photos with celebrities including Idris Elba and Lewis Hamilton.
March 8.Gregoire continues to post on Instagram.
March 9: Canada confirms its first death related to COVID-19.
March 9:Alain Rayes,Conservative MP for Richmond-Arthabaska, Que, asks in the House: “Many countries are starting to talk about COVID-19 as a global pandemic. As of today, the vast majority of developed countries have already implemented measures for travellers. Here in Canada, there are no restrictions on or monitoring of people entering the country. My question is for the Minister of Public Safety and Emergency Preparedness. Does he intend to ban travellers from countries such as China, Iran or Italy from entering Canada?”
Hajdu replies: “We have been carefully screening travellers from a variety of countries, based on expert advice from the World Health Organization and many other medical professionals that have indicated to us that the best effort is to ensure we are asking travellers at the border to identify themselves, if they have travelled from specific regions. There are special questions on the kiosks. If a traveller is unwell, he or she is referred to public health and the local public health authorities.”
Bloc MP Kristina Michaud asks: “On Friday, travellers at the Montréal-Trudeau International Airport complained that passengers arriving from at-risk areas were not being tested. Some travellers even likened the airport to a sieve. We need to protect the public against the spread of this virus. The government must issue clear directives to ensure that no cases of the virus are allowed in. Will the government set up detection measures for the coronavirus at all border crossings, starting with airports?”
Hajdu responds: “I would like to thank the hard-working men and women of both the CBSA and the Public Health Agency of Canada who have been working together so diligently for several months to ensure that we can support the health of Canadians as they come back home and also support the health of international travellers … As you know, and as I have been saying for two and a half months, this is a situation that is very fluid. It has been evolving across the globe, and we see it is evolving very rapidly here in Canada as well. The number of cases in Canada and around the world continues to increase, and globally now there are more than 100 countries affected. I am sure you all saw that the World Health Organization has declared that this is a pandemic. However, that is not shocking to us because we have been acting as if it had this potential in the early days, and certainly over the last several weeks and months we’ve been working to prepare Canada for a worst-case scenario. I will remind the members that we have been acting as if we were in a pandemic since the beginning. When we noticed the small cluster of illnesses in Wuhan, we knew that this was an issue of significant concern. Dr. Tam is an expert adviser on the World Health Organization committee that continually reviews the evidence. We have been having these conversations daily.”
March 11: The World Health Organization declares the global outbreak of COVID-19 a pandemic.
March 11: Dr. Tamat Health Committee: “The WHO did call this a pandemic today, but the key message is that all countries can still change the course of this pandemic by doing a number of things. I will go through them very quickly, but I believe we’re already doing them.”
In her list of things needed to be done, she did not include border closures or strictures, but says: “Second is to detect and then to protect the population, and to treat if necessary. I think the detection is very important. We have been setting up surveillance systems and laboratory testing since the start.”
Bloc MP Montcalm asks: “You said earlier that, from the start, you’ve managed this crisis as if it were a pandemic. With all due respect, I doubt this very much … The federal government must — and this falls under its jurisdiction — protect the public, properly identify cases and determine any restriction. In that respect, the news isn’t necessarily good, based on what we’re hearing from the customs workers. Will you tighten up these measures? When will the Public Health Agency of Canada take responsibility for tightening up screening measures and send clear guidelines to the Canada Border Services Agency officers working at the border? Your current approach is to inform people and let them decide what they must do in terms of good practices to protect themselves. When will the Public Health Agency of Canada take responsibility for tightening up screening measures and send clear guidelines to the Canada Border Services Agency officers working at the border?”
Hajdu replies: “I’ll first of all say that we’ve been using science and evidence to make the decisions around borders. I’ll point you to Italy, who had some of the strongest border measures in the G7, who closed their borders in fact to China, and who then, all of a sudden, had an incredible outbreak. That’s because … of course, the science will settle this as well, but there is some speculation that it’s because people came in from a whole bunch of other routes that were not as direct.
“Instead, we chose to use World Health Organization recommendations that said it is much better to have targeted measures at the border. That helps you identify the people who are coming from severely affected areas, which can help ensure that you know who is coming in, that they have the information about what to do and that we can monitor them as they self-isolate.
“The first location that was added to the screening kiosk was Hubei. When people came from an affected region, they were met by CBSA and public health officials. CBSA would pull them aside and ask them some questions about their health. Public health would work with them, if in fact they were symptomatic, and would transfer them to the local health facility. If they were not symptomatic, then they were asked to self-isolate at home with a mandatory requirement to check in with public health within 24 hours. We have evidence that there was a very high compliance rate. We added Iran as a country of concern as well, because Iran, obviously, had cases that in fact weren’t detected until we had identified a case from Iran. I would also remind you that a virus does not know borders. Over 100 countries now have coronavirus in their country. No country will be left unaffected by the time this is over.”
Tam adds: “I think that in the public health domain we certainly have to remember that our borders are not a solid wall, as was just said. They’re but one layer of protection, and it is never a perfect layer. The greater the number of countries affected, you can imagine that trying to screen people at the borders becomes a much more ineffective means of addressing the coronavirus outbreak.
“Nonetheless, we do use a very rigorous risk assessment. We’ve also put several countries on our level three travel health notice, those being China, Iran and, now, all of Italy and some areas of Korea. You have to focus your efforts. Otherwise, you’re screening every single traveller.
“What we have chosen to do, which I think is really important, is to tell every international traveller that when they come back into Canada or come into Canada they must watch for symptoms, immediately go home if they’re sick and then call ahead to their health system. It is not manageable with over a hundred countries having coronavirus. You need to shore up your health system, protect the vulnerable, such as those in long-term care facilities and hospitals, and protect your health workers.
“It is a massive societal effort. Every aspect of the public health system is already turned on and fully alert, but you cannot flatten this curve without every member of the public working with you. That’s why, while borders are one layer, the other layers are more important if you’re going to actually do something about breaking any chains of transmission in Canada.
“I do know that we have really stepped up our presence at the border. I think the border is the moment for education and telling people what to do when they come in.”
Tam mentions the mortality rate for this virus was just under 1 per cent. “I think we can assume that this is an outbreak that’s very serious … Right now the best estimate is that it could be just under one per cent, depending on which country you’re in, whereas a pandemic influenza, the worst one, is going to be one per cent to two per cent. If this is close enough to a one per cent case fatality, it is a very serious situation.
“It is the first coronavirus to cause a pandemic. It is probably a virus that has hit the sweet spot. It is not completely lethal, so there are people with mild illnesses and a range of clinical symptoms who can transmit the virus, for instance. The severe end of the spectrum is with people who are older in age and have underlying medical conditions, but there’s a bulk of the illness in working-age adults. We’re not seeing it much in kids.”
March 12. It is announced that the Prime Minister’s wife Sophie Gregoire has contracted COVID-19 and the Prime Minister has gone into 14-day sequestration.
In the House of Commons, Conservative Leader Scheer sates: “The World Health Organization has declared coronavirus to be a pandemic, and while the government says that the risk to Canadians is low, countries around the world are taking decisive action. Italy is one of the hardest-hit countries and it has initiated many measures to lock parts of that country down. However, when the final flight out of Italy landed here, passengers were not screened. No temperatures were taken and no one was quarantined. They were given a pamphlet and sent on their way. Is the government convinced that a departmental pamphlet is enough to reduce the spread of this disease?”
Chrystia Freeland,deputy prime minister and minister of intergovernmental affairs replies: “We need to continue to listen to our medical experts. They are telling us that the situation will get worse before it gets better. They also say that Canada is well prepared.”
March 12: Bloc MP Claude DeBellefeuille asks in the House: “Just yesterday, travellers arriving from Italy at Pierre Elliott Trudeau airport were shocked to see that no one asked them any questions. They were coming from one of the largest outbreak zones in the world, yet they were simply handed a pamphlet. This afternoon, the government’s travel advisory for Europe still indicated the lowest possible risk level, even though when we are in a full-blown pandemic. There is a happy medium between panicking and doing nothing. Will the government finally take real measures to monitor the coronavirus?”
Bill Blair, Minister of Public Safety and Emergency Preparedness, replies: “Mr. Speaker, let me assure the member opposite that we, in fact, have implemented very significant new enhanced screening and detection processes for all of our CBSA officers. In addition, we have made sure that they have the training and equipment they need to do this important job. All persons who enter this country from affected regions are subject to questioning by our CBSA officers, and those who are determined to be symptomatic are quickly referred to our public health officials. I want to assure the member opposite that our officers stand ready. They have the tools and training they need to do their part to assist in this public health crisis.”
March 13: Canada advises Canadians to avoid all non-essential travel outside of Canada until further notice. “My advice is to postpone or cancel all non-essential travel outside of Canada. This means reconsidering your vacations, going to sporting and entertainment events, large international conferences,” Tam says during a press conference.
Asked if Canada was considering a similar ban, or imposing border measures between our country and the United States, Minister of Health Hajdu says: “Canadians think we can stop this at the border. But what we see is a global pandemic, which means that border measures are highly ineffective and, in some cases, can create harm. We see that in countries that had the worst expressions, the tightest borders.”
March 16: The federal government changes direction abruptly, with Canada closing its doors to the world by severely restricting international flights. The federal government advises all returning Canadians entering home to voluntarily self-isolate for 14 days. Prime Minister Trudeau also says all international visitors to Canada will be turned around at the airport, with the exception of Americans, diplomats and flight crews.
“We will be denying entry to Canada to people who are not Canadian citizens or permanent residents,” Trudeau says.
At a press conference, Tam says they’ve asked that no one go outside the border unless it’s essential and that when you come back you self-isolate. “We have to maintain essential movement of people and services as well. And I think that’s the key to every country in the world,” she says.
Is self-isolation mandatory? “We’re asking that all travels who come back self-isolate. This is not essentially ordered … It is impossible to keep tabs on every traveller that comes in.”
Before they had asked every traveller to self-monitor, Tam explains, now they’re asking to self-isolate.
Why not close the border?
“Countries that have enacted travel bans have not been able to keep out this particular virus,” she says.
The key, she says, is rapid detection, looking to contact tracing and breaking the chains of transmission in Canada. “The front end border is but one layer of protection and is never perfect. You can get people coming in in other ways as well.”
Countries impacted by the virus the most have sometimes had the most stringent border measures, she says.
March 18: Canada implements the ban on foreign nationals from all countries, except the United States, from entering Canada. The Canada-U.S. border is closed to all non-essential travel, and redirected international passenger flight arrivals to four airports in Calgary, Vancouver, Toronto and Montreal.
March 19: Tam: “All persons arriving in Canada: You must self-isolate for 14 days. Join Canada’s effort to disrupt the transmission of COVID-19.
March 22: Travel advice from the Government of Canada: “Travellers arriving in Canada should self-isolate for 14 days and monitor their health for #COVID19 symptoms. If you have symptoms upon arrival, you will be given instructions on the next steps to take.”
March 24: Tam: “To lower travel-related cases, travellers coming into Canada MUST self-isolate at home for 14-days, even if no symptoms. As long as no symptoms, it’s okay to go outside for walk but keep 2 metres away from others.
March 25: Again going against WHO policy, Canada puts in mandatory self-isolation for incoming travellers, with large fines for violators.
March 25: Tam: “Day over day increases in COVID-19 cases and a fundamental shift from mostly travel-related cases in the early part of the outbreak, to now over half of new cases being linked to community spread… GOC advisories to avoid non-essential travel have reduced travel related cases, but we still need to do all that we can to reduce the impact and spread from travel imported cases. Today the GOC began implementing new measures making 14-day isolation mandatory under the Quarantine Act for all travellers coming to Canada. This is part of an all out effort to #SlowTheSpread.”
March 26: China brings in a travel ban, making it the latest country to go against the WHO guidelines to not ban travel.
March 26:Canada now has 4043 cases of COVID-19, 39 deaths. Taiwan, expected to have the world’s second biggest outbreak, has 252 cases and two deaths.
March 26:Justin Trudeau tweets: “We are implementing the Quarantine Act to keep all Canadians safe. So let me be clear: If you do not go home and stay home for at least 14 days after coming back into Canada, you could face serious fines or prison time.”
March 26: Tam: “The lesson we are learning from COVID-19 pandemic is that none of us can be safe and healthy unless we are making sure that all of us, worldwide, are safe and healthy. #OneWorld #StrongerTogether… The seriousness of COVID-19 cannot be overstated.”
March 26:Molly Thomas of CTV asks Trudeau: “I want to ask about, there’s more than 30,000 cases alone in New York, that’s a state that borders parts of Ontario and Quebec.
Would we ever ban essential goods or people coming in specifically from that hotspot?
Trudeau says: “We understand that part of protecting Canadians is ensuring a good supply of food, of medical supplies, of necessary equipment across our border. We will continue to look for ways to make sure we’re keeping Canadians safe while providing us with the things we need.”
March 28: The Chinese Embassy in Ottawa tweets of a supply donation to Canada: “On March 27, Bank of China donates medical supplies (including 30000 medical masks, 10000 sets of protective clothing, 10000 goggles and 50000 pairs of gloves, followed by N95 medical masks) to Canada fighting against COVID-19. We are together!”
In response, Canada’s Minister of Foreign Affairs François-Philippe Champagne tweets: “Thank you for this donation. In the face of a global pandemic, supporting each other is not only the right thing to do, it’s the smart thing to do.”
March 28: Hong Kong english language show The Pulse broadcasts interview (17:00 minute mark of Youtube video for full segment) with the WHO’s Bruce Aylward. Aylward is a Canadian, an international infectious disease expert, and an advisor to the WHO director general. Aylward refuses to address whether Taiwan should be part of the WHO or discuss in specific terms Taiwan’s success. A clip of him trying to avoid the questions on Taiwan goes viral internationally. As The Federalist described the interview:
“Will the WHO reconsider Taiwan’s membership?” asked Yvonne Tong.
Her question was met with an awkward silence prompting a “hello?” from the interviewer.
“I’m sorry, I couldn’t hear your question, Yvonne,” said Aylward.
“Let me repeat the question,” Yvonne said back.
“No, that’s okay. Let’s move on to another one then,” said Aylward.
When Yvonne refused, Aylward ended the interview and logged off. After reconnecting, Yvonne asked about Taiwan again, and Aylward declined to discuss the topic.
“We’ve already talked about China, and you know, when you look across all the different areas of China, they’ve actually all done quite a good job, so with that, I’d like to thank you very much for inviting us to participate and good luck as you go forward with the battle in Hong Kong.”
March 28: Numerous commentators from around the world rapidly weigh in on the Aylward interview.
From the progressive U.S. outlet, Daily Beast columnistGordon G. Chang says: “Aylward’s behavior reminds us that either we remove China’s pernicious influence in multilateral institutions like the World Health Organization or the world’s free states defund them and start over.”