I would love to. Thank you so much. Good evening, everybody. My name is Isaac Bogoch. I'm an infectious diseases physician and I'm a scientist based out of the Toronto General Hospital and the University of Toronto. Thank you very much for inviting me to the Standing Committee on Public Safety and National Security.
Obviously the main issue here is to discuss the quarantine hotels, but clearly this is a symptom of a much larger issue, and that's how to protect Canadians from the external introduction of COVID-19 with sound border and travel measures.
Now, this is a rapidly changing environment. We need border policy that will adapt to growing immunity that we get from vaccine scale-up in Canada, the U.S. and elsewhere.
The key here is that the policy today will hopefully look very different from the policy we'll have in the months ahead as we gain population-level immunity and as we have a better understanding of what the true protective effect is of these vaccines for, as an example, the emerging variants of concern that we've heard so much about.
The immediate issue, however, is obviously to discuss these quarantine hotels. It's clear that they are not without harm. We've heard about the disturbing reports of sexual assault. We've heard about logistical issues, costs and loopholes.
It's important to remember that the key goal here is to prevent the importation of COVID-19 and variants of concern that are more transmissible or have the potential to escape immunity. Essentially, it's to buy us time in Canada to vaccinate ourselves.
It's interesting that the Public Health Agency of Canada has instructed all Canadians to avoid all unnecessary international travel since March of 2020. It's been a year.
These most recent prohibitive measures really accomplished two related tasks. They basically dissuaded travel by adding cost and inconvenience, but they also created mechanisms to decrease the likelihood that imported cases of COVID-19 and the variants of concern would spread within Canada.
How helpful is this? How helpful are the quarantine hotels? Emerging data will answer this and address whether we truly are getting incremental benefit from them, and if so, how much.
Of course, this isn't a long-term strategy, so what are the better alternatives? There are ample ways to prevent infection from getting into Canada or a country in general and to ensure that people adhere to quarantine measures. In isolation, none of these is perfect, but bundled together they provide incremental safety.
The big categories are these.
Number one is travel bans. You either prevent people from leaving your country or from coming into your country. That is not an ideal long-term solution.
Number two is testing. We've seen here pre-travel testing and testing on arrival. Those are very effective and helpful.
Number three is home quarantine. You can add to this periodic check-ins by phone or in person, and of course, you can add technology to really ensure that people are staying at home and to track movement.
I'm not saying we should do this; I'm saying this is on the buffet table of options that are available to us.
Then, number four is hotel quarantine. We already know what the problems are with this. It's expensive, it's a tough environment to control, it's logistically challenging—but it's still an option.
There are a few other semi-related items that we should be considering. The measures have to be commensurate with the current and future threats.
The problem is that we don't fully appreciate the full impacts that the variants of concern have. To what extent do they evade immunity? How protective are our current vaccines approved in Canada against them?
We have emerging data suggesting that some of the vaccines, such as the Pfizer vaccine, may provide decent protection against all the major variants of concern. There still are many unanswered questions, however, and we will have more clarity in the weeks and months ahead.
We also should consider that fully vaccinated people pose far less of a threat. The vaccines aren't perfect, but they are really good. It's worthwhile to start the conversations about considering allowing fully vaccinated people to travel without warranty—perhaps if they have negative testing.
There is already behavioural guidance now for vaccinated people in the United States. For example, the CDC says that those who are fully vaccinated don't need to quarantine, if they are exposed to someone with COVID-19 and are asymptomatic. Other countries, such as Cyprus, recently announced that they are allowing fully vaccinated tourists in the near future.
With requiring proof of vaccination at the border there are obviously ethical challenges, but this is likely going to happen in many countries around the world, and even these obvious ethical and equity issues can be imperfectly ameliorated by providing vaccination free of charge at the border. We can also do such things as shorten quarantine periods to seven to 10 days and test at the tail end.
Lastly, I think it's important to recognize that close to 75% of travel across the land border is currently exempt from quarantine regulations, so it's a good idea to prioritize those essential travellers for vaccination.
In sum, it's important to adhere to the precautionary principle in the context of an unknown and potentially devastating threat from the variants of concern: either that they are more transmissible or that they escape immunity, or sometimes that they might even be more deadly.
We'll have a rapidly growing understanding of what threat these variants pose in the coming weeks and of how our vaccine program will fare. Let's look at the available data, which is growing; let's look at the available data from the quarantine hotels. Then we can make value judgements and see whether it's worth continuing this plan in the short term while we simultaneously look for an exit strategy that can heavily rely on testing and perhaps home quarantine, with additional tools and support for better follow-up.
We also have to plan for all of this to change with time as the Canadian and global population level immunity grows.
Thank you for your time.