COVID-19 taught Canada a costly lesson — that early border closures can work
Canada's reluctance to close borders against the pandemic led to 'two lost months,' says one expert
This is the first in a series looking at some of the lessons learned from the first months of the COVID-19 pandemic and how Canada moves forward.
This year has given new meaning to the old expression "hindsight is 2020."
Three months ago, Canada's government closed the land border with the U.S. just days after closing its airports to international flights — a move that followed weeks of government assurances that border closures to limit the spread of the pandemic don't work.
As the U.S. experience has shown, money and power provide little protection against the pandemic unless there is a competent government to harness them. Some of the world's worst-hit countries have issues of citizen mistrust, government dysfunction, corruption, inefficiency or partisan gridlock (Italy, the United States, Brazil and Russia).
The democracies that have achieved the very best outcomes tend to have smaller populations and good governance — and tend to be surrounded by water (Iceland, Taiwan, Ireland and New Zealand).
"It's probably not a coincidence that those places are islands," said Dr. David Fisman, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health. "Not having a land border just gives you a lot more control over the influx of people."
Both P.E.I. and Newfoundland and Labrador used strict travel restrictions to beat back the pandemic. But being an island doesn't help if you don't take advantage of your geography — as the example of the United Kingdom demonstrates.
"I think countries that don't have that luxury of being an island being cut off by the sea can maybe still learn from that about ... more stringent controls at the border," Fisman said.
The Australian experience
"In Australia the situation is very good. It looks to be completely under control, with a focus on contact tracing and masks to prevent the spread," said Valentina Constantino, a biosecurity researcher who advised the Australian government in the early days of the pandemic. Her team's research in January contributed to Australia's early decision to close the country to all traffic from mainland China on February 1.
Australia's pandemic has closely tracked her modelling. Her team's analysis, published in the Journal of Travel Medicine, suggests that Australia experienced only 14 per cent of the infections it would have faced if borders with China had remained open.
As February turned into March, the ban was extended and Australia added South Korea, Iran and Italy. Many in Australia were deeply concerned about the border closure's effects on the economy.
But today, said Constantino, the same modelling would recommend re-opening Australia to travellers from China because the costs of closure are outweighed by the benefits of admitting what is now a low-risk population. She said she expects Australia to keep its borders mostly closed for the rest of 2020, but to re-admit students sooner.
The time factor
"Time is the most important variable in this," Constantino said. Australia acted at a point when more than 90 per cent of its cases could be directly linked to overseas travel.
"For example, if the U.S. implemented a travel ban, it's not going to fix anything now, because most of the transmission is local," she added.
Read more from the series:
Canada's COVID-19 experience differs from Australia's in that cases entered Canada from a broader range of locations. But Canada does have a fairly well-controlled border with only one country, and the vast majority of travellers from outside the U.S. must reach Canada by air. Could Canada have taken Australia's path and avoided needless deaths and hardship?
On the day Australia closed its borders to China, Canada had four confirmed COVID-19 cases, all linked to travel from China. At the time, the Trudeau government was still committed to the idea that travel bans don't work and even suggested that those proposing them might be racist.
The U.S. had declared a public health emergency the day before, and the New England Journal of Medicine had published a report saying that COVID-19 could be spread by asymptomatic carriers. Health Minister Patty Hajdu said Canada saw no need to declare an emergency and that Health Canada had seen no evidence of asymptomatic spread.
"We're comfortable that we're completely up to date in terms of our approach and what the science says. There is a very low risk to Canadians," Hajdu said on Jan. 31. "We've been following closely the recommendations of the World Health Organization."
The 'lost months'
On February 3, the U.S. followed Australia's lead and froze travel with China. Asked in the Commons why Canada was not doing the same, Hajdu denounced "the spread of misinformation and fear across Canadian society" and called on the opposition to "not sensationalize the risk to Canadians."
Wesley Wark is one of Canada's leading experts on intelligence. He said Hajdu's low-risk assessment would dominate government thinking for at least another four weeks, as documented by the daily situational reports produced by the Public Health Agency of Canada.
"(The reports) said throughout that the risk posed by COVID-19 to Canada and Canada's interests was low," Wark said.
"That is, in my view, an astonishing failure of judgment, and it means as far as I'm concerned that a radical rethink has to take place in how we do global health surveillance.
"January 2020 and February 2020 were effectively lost months for Canada in terms of us preparing for the impacts of COVID-19."
Infectious disease specialist Dr. Ronald St. John was the first director general of the Centre for Emergency Preparedness and Response at the Public Health Agency of Canada, and national manager for Canada's response to 9/11 and SARS.
'A bit slow'
He's also the founder of Sitata, a company that runs a travel safety app that monitors health information from open sources. Sitata first notified its subscribers of the risk of a new virus on January 2, when COVID-19 was still just a mysterious local outbreak in one part of China.
St. John said it's important not to be too harsh when judging the actions of officials who faced an unprecedented situation with few good or easy options available to them. Nevertheless, he said, he "personally" thinks Canada's response in January "was a bit slow."
"We already knew by that time that the disease had spread to South Korea, that Japan was reporting a few cases, and we knew that this was a respiratory disease, a virus," he said. "And a respiratory virus is probably one of the easiest things to get transmitted all over the place ...
"It probably should have been taken a little bit more seriously than it was that time."
First in, first out
Australia and New Zealand are now reaping the benefits of their early, aggressive border action. They are planning to create a "Trans-Tasman travel bubble" allowing for free movement between the two countries, although New Zealand PM Jacinda Ardern warns that "we will not have open borders for the rest of the world for a long time to come."
Ardern was able to begin rolling back lockdown measures on April 27, while the pandemic was still growing rapidly in most parts of the world.
On June 8, New Zealand declared itself "COVID-free."
Here in Canada, gene sequencing and contact tracing have revealed that many Canadian COVID-19 cases were linked to travel from Europe, while other early cases involved travel to Iran.
No one will ever know how many COVID cases entered Canada after Prime Minister Justin Trudeau told Canadian snowbirds on March 16 that it was "time to come home," triggering an exodus from Florida straight through the American COVID-19 epicentre of New York and New Jersey.
Ottawa changes its mind
Canada began to close its borders to international travel that day, but exempted U.S. citizens. Ottawa announced it was closing the border to non-essential travel on March 20.
It was a remarkable turnaround for a government that previously had insisted that travel bans did not work. Hajdu was still denouncing border closures as late as March 13: "Canadians think we can stop this at the border," she said. "But what we see is a global pandemic, which means that border measures are highly ineffective and, in some cases, can create harm."
"[The World Health Organization] 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," Theresa Tam, Canada's chief public health officer, said on Feb. 3.
The government has been accused of being too subservient to a WHO that was advising against border closures at the start of the epidemic. Its actions may also reflect an internal conflict between ideology and epidemiology.
In February, Hajdu told CBC News she feared COVID-19 would provoke racist reactions.
Watch: Health Minister Patty Hajdu on the pandemic and racism
Although there have been ugly incidents of pandemic-related racism, none have resulted in fatalities. The virus itself, however, has killed thousands of Canadians and crippled the economy.
The experience of the countries that closed their borders early has effectively ended the notion that travel bans don't work. But while Canada may have learned that lesson, it will still have to innovate in order to reopen its borders at a later date.
Countries that depend on tourism from Europe to the Caribbean are admitting foreign travellers, but some are choosy about where they can come from (Greece will accept Japanese and Germans but doesn't want any Canadians yet). Accurate intelligence about the state of the disease in foreign countries is critical to informing those decisions.
Reopening the border safely
Antigua has opened its borders to every country in the world. But anyone entering the country must undergo much more rigorous procedures than those in place at Canadian airports, including an overall health check, temperature readings and a COVID swab.
Many European countries that have reopened to their neighbours require travellers to produce recent negative COVID molecular test results.
Will Canada have to adopt one of those approaches at its airports and land border as it reopens? Given the alarming state of the pandemic in the United States, said Fisman, Canada doesn't really have a choice.
"I'd love to see stronger efforts to, for example, test truckers, folks who were coming across the border into Canada bringing essential goods and supplies and going down to the U.S.," he said.
"Anecdotally, they've been a group that's been relatively hard hit. Embrace technology for that in terms of keeping track of people and keeping in contact with people."
He said Canada also should see airports and the border as ideal places to gather public health intelligence.
"I think the airports being open provides an excellent opportunity to gain situational awareness about what's happening with COVID in other countries because you can swab travelers as they're coming in," he said."That's what they've been doing in Taiwan … gaining that knowledge by testing travelers as a condition of entry to the country.
"As disease activity declines in Canada, as I expect it to, that will become more and more important in terms of limiting large scale importation of disease."