Health Committee on April 18th, 2007

[John Cuningham]

I think the decrease is compared to what the new Quarantine Act and the current wording of section 34 would have done. But compared with the current actual regulations that apply and that applied before the new Quarantine Act, there's no decrease. The previous regulations continue to be in force and apply to marine and air.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

So there has never been coverage of advance notification for land conveyance. Is that correct?

[John Cuningham]

As far as I know, no, not in Canada.

[Dr. Howard Njoo]

The other aspect is that conceptually, as a previous question alluded to, public health authorities were all on board, in terms of the previous Quarantine Act. I think the question comes to the practical application--for example, even the technical problem with the wording: the operators of conveyances are obligated to report to the nearest point of entry. Those were things that we didn't recognize in a practical sense, until we got into the practical implementation.

Things have advanced. As has been alluded to several times, when we had the discussion and the negotiations for the revised International Health Regulations, this was certainly a part of the discussion among all member states of the WHO. Because of the same types of issues we're discussing here, from a practical risk management point of view it made sense. Therefore the internationally accepted standard is not a decrease in coverage; it's really that the appropriate and necessary application of risk management applies to air and marine. So in Canada, we're not doing more or less; we're basically being consistent with what's being done around the world.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

But are we being consistent with what's being done now and what was being done previously in Canada? That's my question.

[Dr. Howard Njoo]

Yes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay, so we are not decreasing coverage for Canadians from what we had previously.

[Dr. Robert Clarke]

No, we're not.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay.

I have another question.

I live in a border municipality in southern Ontario. It is very common for residents in my community to drive, either by bus or personal vehicle, to Detroit to fly to any number of destinations. These people could fly to Cuba, Central America, Mexico, or wherever, outside of the continental U.S., and return. Then they return to Canada by land. This does not require any advance reporting mechanism. But if they are flying in the United States, is there an advance reporting mechanism there that would follow that person?

[Dennis Brodie]

If they are travelling from a country outside of the United States to Detroit, U.S. law would apply and the airline would be required to notify Detroit. So there would be a requirement under U.S. law.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

And if somebody is coming from Mexico and it is determined there is somebody on that flight into Detroit who has a communicable disease, would the other people on that flight be tracked into Canada if they were coming by land from Detroit?

[Dr. Howard Njoo]

Yes. The quarantine program in the U.S. is similar to ours. If there were an ill passenger on an aircraft arriving in the United States, as is similar to us, we would take the appropriate measures in ensuring the proper follow-up of any passengers on that flight regardless of where they were going. So the practice is similar in both countries.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

So if there is a known illness, it is tracked. Otherwise it's up to the individual to report it anyway. Is that correct?

[Dr. Howard Njoo]

Yes.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Beaumier.

[Colleen Beaumier, Liberal, Brampton West, ON]

Thank you.

I have some serious problems with a number of things that have been said.

You were saying that it was naive to think we will stop infectious disease coming across the border from the U.S. Well, that's no more naive than it is to think that we're going to stop it coming from a developing nation. We're not talking about taking a sick person off a bus and getting them to a hospital. We're not talking about the sick person, because he already has it. We're talking about a contagious disease.

If someone is sick on a plane, does that mean everyone on the plane goes into quarantine until they decide what the problem is? What happens if there's a sick person on a train? Do they take this person and everyone else off the train and put them in quarantine until they can determine whether it's a communicable disease?

Many people travel from developing nations with lots of money. They travel on trains and buses, and they go from the United States to Canada. We're not talking only about Americans with diseases that we love and can deal with. We're talking about all these horrible people coming with rare communicable diseases from developing nations. But some of these people have lots of money and they do a lot of travelling.

It's not the sick person who is the issue here. You keep referring to the fact that they'll take the sick person off the bus. What about the people who have been exposed to the virus? The SARS report said we were caught with our proverbial pants down. It looks to me like we're opening up another opportunity for these diseases to come through.

I thought advanced reporting was to prepare for a quarantine situation upon arrival in the country. That's the problem I'm having here. We're not talking about sick people; we're talking about people who have been exposed to a potentially deadly virus. I don't see why trains and buses would be taken off that list.

[Dr. Robert Clarke]

Irrespective of how they came into the country, in a case where someone is incubating a disease, I think it could be a number of days, for example, before someone figured out exactly what was wrong with them. This is why the quarantine officer and the medical officers in the hospital, as Howard mentioned, would have to make an assessment of what illness this person is likely to have.

If they determine that this looks like a suspicious disease that could be contagious, that could be problematic irrespective of how they came into the country. Depending on what disease we thought we were dealing with, our epidemiologists would then be tracking people who had been exposed to this person, following up with them, having them medically examined, and then taking the appropriate containment measures.

Those procedures are already in place. We work very closely with our counterparts in other countries to do those kinds of things. Even if we're tracking people in another country, if we think they were potentially at risk, we provide information on travellers and who was exposed or who was sitting near somebody.

[Colleen Beaumier, Liberal, Brampton West, ON]

Did the problem with SARS not occur because people exposed to the SARS virus weren't quarantined and isolated soon enough? That was the impression I think we all got.

[Dr. Howard Njoo]

No. I was one of the people involved in the SARS crisis. It was an individual who came in, but they exposed that family after they came to Canada. So it was more that in the hospital setting they didn't have appropriate infection control measures in place. It had nothing to do with what happened at the border.

[Colleen Beaumier, Liberal, Brampton West, ON]

I'm not saying it had anything to do with what happened at the border and that we could have spotted it at the border. But my opinion is that once it was discovered we weren't able to round up others fast enough and put them into quarantine. If someone had shown the effects of SARS when they were on the plane, the other people could have been quarantined and watched, and it would have minimized the spread.

[Dr. Robert Clarke]

The problem is that often in these situations, by the time someone determines what the illness is and the person becomes sick because of incubation periods and what not, it's after the fact. It's not that easy in some cases to do this at the border, because the person may not be exhibiting symptoms.

[Colleen Beaumier, Liberal, Brampton West, ON]

Then why do we bother doing it on planes and boats?

[Dr. Robert Clarke]

It's only one measure. We need to have other measures in our toolkit. We have to make sure that doctors in emergency rooms and other places as well will detect these diseases.

[Colleen Beaumier, Liberal, Brampton West, ON]

What if they come in by bus?

[The Chair, Conservative, Rob Merrifield]

Your time is gone.

I'll go to the second round of questioning, but if the committee will allow me, there are a couple of questions I'd like to clear up for the committee.

When was the Quarantine Act in Canada last implemented, acted on, enforced, or required?