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Vol. 137, No. 14 — July 2, 2003 Registration QUARANTINE ACT Regulations Amending the Quarantine RegulationsP.C. 2003-931 12 June, 2003 Her Excellency the Governor General in Council, on the recommendation of the Minister of Health, pursuant to subsection 21(1) of the Quarantine Act, hereby makes the annexed Regulations Amending the Quarantine Regulations. REGULATIONS AMENDING THE QUARANTINE REGULATIONS AMENDMENTS 1. Section 3 of the Quarantine Regulations (see footnote 1) is amended by deleting the word "and" at the end of paragraph (c), by adding the word "and" at the end of paragraph (d) and by adding the following after paragraph (d): (e) severe acute respiratory syndrome (SARS), 20 days. 2. Section 7 of the Regulations is replaced by the following: 7. The person in charge of a conveyance arriving in Canada or departing from Canada shall, when required by a quarantine officer, arrange for all persons on board the conveyance to be presented for inspection to the quarantine officer in an orderly manner. 7.1 If a quarantine officer believes it is reasonably necessary to preserve public health, the officer shall require the person in charge of a conveyance that is arriving in or departing from Canada to distribute health information and questionnaires to all persons on board or intending to board the conveyance before its arrival or departure, as the case may be. 3. Paragraph 8(a) of the Regulations is replaced by the following: (a) any illness or symptom of illness among any of the passengers or crew; and 4. Subsection 19(2) of the Regulations is replaced by the following: (2) Subsection (1) applies in respect of the following airports: (a) Gander International; (b) Goose Bay; (c) St. John's International; (d) Halifax International; (e) Sydney; (f) Montreal International (Dorval); (g) Montreal International (Mirabel); (h) Quebec, Jean Lesage International; (i) Hamilton; (j) Toronto, Lester B. Pearson International; (k) Ottawa, Macdonald-Cartier International; (l) Windsor; (m) London; (n) Winnipeg International; (o) Saskatoon, John G. Diefenbaker International; (p) Regina; (q) Edmonton International; (r) Calgary International; (s) Vancouver International; (t) Victoria International; and (u) Kelowna. COMING INTO FORCE 4. These Regulations come into force on the day on which they are registered. REGULATORY IMPACT ANALYSIS STATEMENT (This statement is not part of the Regulations.) Description Severe Acute Respiratory Syndrome (SARS) is an infection in which affected individuals develop a fever, followed by respiratory symptoms such as cough, shortness of breath or difficulty breathing. In mid-February 2003, China reported 305 cases of atypical pneumonia, with 5 deaths, in the Guangdong province. On March 12, 2003, the World Health Organization (WHO) issued a Global Health Alert about cases of a severe respiratory illness occurring in Vietnam, Hong Kong and China. As of June 10, 2003, Health Canada has received reports of 425 probable or suspect cases of SARS in Canada. There have been more than 30 deaths. To date, transmission has been limited to specific transmission settings such as households, hospitals and specific communities. There is no vaccine against SARS nor is there any cure for it. On June 5, 2003, the WHO reported a cumulative total of 8,403 probable SARS cases with 775 deaths having been reported from 29 countries. This represents an increase of 6 probable cases and 3 deaths compared with the previous report dated June 4, 2003. Currently, the specific cause of SARS is unknown, although there is growing consensus that a recently identified coronavirus plays an important role. Furthermore, it is not known at this time exactly how SARS is spread, but it is safe to say that it is highly contagious in specific settings, as evidenced by the recent resurgence of infections in Toronto in May 2003. It is therefore critical that the Government of Canada uses all means at its disposal to contain further spread of the disease, both within its borders and beyond. The Quarantine Act (the "Act") and the Quarantine Regulations (the regulations) help protect Canadians from the importation of dangerous and infectious diseases which might pose a threat to public health through the international movements of persons, goods and conveyances. The Act contains a Schedule of infectious and contagious disease which may be amended from time to time by the Governor in Council. The Schedule currently lists cholera, plague, smallpox and yellow fever. The addition of a disease on this Schedule provides quarantine officers stationed at ports of entry and exit in Canada with the ability to request persons suspected of having a scheduled disease to undergo a medical examination and detain that person if necessary. This power applies both to persons arriving in and departing from Canada as compared with the powers under the Act for dangerous diseases that apply only to persons arriving in Canada. Given the serious implications for the public health of Canadians if SARS continues to spread, and the obligations Canada has with respect to ensuring infectious diseases are not exported to other countries, it is necessary for the protection of public health to add SARS to the Schedule of infectious and contagious diseases. The WHO has recommended that screening measures be implemented for travellers departing from areas of recent local transmission. SARS was added to the U.S. list of communicable diseases by Executive Order of the President on April 4, 2003, thus authorizing the use of quarantine measures. Section 3 of the regulations will also be amended to indicate that the incubation period for SARS is 20 days. SARS is a newly identified infectious and communicable disease of which little is known. At this time, only the most severe forms of the clinical spectrum have been identified by health care practitioners. However, it is likely that undetected milder forms of SARS exist in the population. Similarly, the spectrum of the duration of the illness has not been fully elucidated. For example, global data based on the currently identified cases (i.e., the most serious end of the spectrum of illness) indicates that, in general, the median incubation (see footnote 2) is around 4-6 days. Canadian data suggest that the upper limit for the incubation period is approximately 10 days. However, emerging global data suggest that the upper limit for 95% of the identified cases could be as long as 17 days and may be longer in 5% of cases. The WHO recently considered this information and re- confirmed use of the 10 day quarantine period. The rationale for the recommended 20 day incubation period is as follows. The Act authorizes a quarantine officer to detain a person for a period not exceeding the prescribed incubation period. In ascertaining the appropriate length of quarantine in a given case, all relevant information, including the WHO's incubation period, will be taken in account by Health Canada's quarantine officers. At the same time, other sections of the regulations are being amended to address the unique circumstances that have been presented by SARS and to update the regulations to the extent possible. These amendments are as follows: 1. Section 7 contains minor revisions to make the language more clear and provide greater flexibility to the quarantine officer in terms of where inspections are conducted. 2. A new section 7.1 is added to provide a quarantine officer with the authority to require the person in charge of a conveyance that is arriving or departing from Canada to distribute health information and questionnaires to all persons on board before its arrival or departure.
3. Revise paragraph 8(a) to specify "...illness or symptom of illness among the passengers or crew;...".
4. Amend subsection 19(2) to update the list of airports to which the person in charge of an aircraft arriving in Canada must report, prior to arrival, cases of illnesses or death on board the aircraft. The revised list is as follows:
Goose Bay St. John's International Halifax International Sydney Montreal International (Dorval) Montreal International (Mirabel) Quebec, Jean Lesage International Hamilton Toronto, Lester B. Pearson International Ottawa, MacDonald-Cartier International Windsor London Winnipeg International Saskatoon, John G. Diefenbaker International Regina Edmonton International Calgary International Vancouver International Victoria International Kelowna Alternatives 1. Amend the Quarantine Act It is recognized that the Act is outdated. Efforts are being made under the Health Canada Legislative Renewal initiative to create a modern legislative mandate for public health. However, amending the Act itself through the legislative process is both time consuming and unresponsive to the urgent need to remedy gaps in the current Regulations. 2. Overhaul the Quarantine Regulations It is also recognized that certain parts of the regulations are outdated. However, due to the urgent nature of these amendments, there is not sufficient time to update other parts of the regulations that are not linked to containing SARS. A general revision of the regulations will be undertaken under a future exercise. 3. Status Quo The status quo is not acceptable as the current provisions available under the regulations do not provide the full range of authority needed to contain the spread of SARS in and outside Canada. Unless SARS is scheduled as an infectious and contagious disease under the Act, it is considered a dangerous disease. Measures under the regulations applicable to dangerous diseases only apply to travellers entering Canada. To engage the full range of powers established by the Act, SARS must be added to the Schedule and consequential amendments made to allow for appropriate screening. SARS presents unique public health challenges that are not covered under the current regulatory regime. 4. Incubation period See rationale in Description section. 5. Section 7 It is deemed essential that airlines and other carriers be legally obliged to cooperate with Health Canada officials by providing relevant information to passengers and to quarantine officers. Although airlines have been cooperative to this point, Health Canada does not want to find itself in a situation where valuable time is lost negotiating with carriers in cases where they refuse to cooperate. Subsection 19(2) There are no alternatives other than to ensure that the list of airports contained in subsection 19(2) is current. Benefits and Costs These minor additions and changes to the existing regulations will clearly demonstrate that Canada is fulfilling its domestic and international obligations to prevent the spread of SARS in Canada and the exportation of SARS to the global community. The additions and changes to the existing regulations poses no significant increased cost for airports, the airline industries and shipping companies. As SARS has already been added to the list of communicable diseases in the United States, there will be no impact trade-wise with that country. Consultation Given the urgent nature of these amendments, no consultation with affected parties was possible. However, in letters to the Air Transport Association of Canada, the American Air Transport Association and the International Air Transport Association on April 30, 2003, the Minister of Health asked for the cooperation of member airlines in implementing enhanced procedures for screening departing passengers for SARS at Pearson International Airport and in screening incoming passengers at all international airports in Canada. In the letter, the Minister advised these associations that all measures would be reassessed on an ongoing basis. As mentioned, the cooperation of airlines has been positive to date. Compliance and Enforcement Compliance will be monitored by Health Canada officials and appropriate enforcement measures taken as provided under the Act and regulations. During the current SARS public health crisis, additional quarantine officers are being allocated to the Toronto and Vancouver airports. Additional scanning equipment is being leased or purchased as required. Any additional expense related to these initiatives will be funded within Health Canada's current budget allocations. Contact
Dr. Ron St. John
C.R.C., c. 1368 The incubation period for infectious diseases is defined as the period of time from the moment of infection to the appearance of the first symptoms of the disease |
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