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To Stop COVID, We Need ‘Gold Standard’ Border Control

It involves three essential parts, but so far Canada has failed miserably in implementing them.

Andrew Nikiforuk 28 Apr

Tyee contributing editor Andrew Nikiforuk is an award-winning journalist whose books and articles focus on epidemics, the energy industry, nature and more.

Last week, the Canadian government once again belatedly reacted to another potentially dangerous COVID-19 variant by banning direct flights from India and Pakistan for 30 days.

Available evidence suggests the new variant, B1617, is so contagious that it has propelled India’s infection rates from three per cent to 36 per cent — meaning more than one in three people tested were infected — in less than a month. Mask-free political campaigning also played a role in the spike.

But experts on effective border controls were not impressed with Canada’s slow response.

On CBC’s The Current, Kelley Lee, Canada Research Chair in global health governance at Simon Fraser University, called the government’s response “reactive,” because the Indian variant had already arrived in Canada weeks ago.

“If there’s a gold standard of how a country can manage its borders to curb the spread of COVID-19, Ottawa hasn’t met it yet,” said Lee. “I’d say maybe Canada is like a bronze medal standard, possibly.”

Evidence from around the world speaks volumes about effective border restrictions: nations that rapidly acted to identify incoming cases and prevent community spread using strict border controls effectively kept infections and deaths to a fraction of those in North America and Europe.

Early border controls made the greatest difference in fighting COVID-19.

The early border restrictors included Taiwan, Vietnam, China, Australia, New Zealand and Singapore, and none have experienced continuous lockdowns or even third waves.

By locking out the virus with effective border controls, these nations simultaneously protected public health and shielded their economies — a lesson Canada has not yet appreciated. (More than 12 million travellers have entered Canada since March 2020 compared to 97 million in 2019.)

So what does a gold standard look like?

Well, it’s not a single measure, but a comprehensive package of interventions applied in a preventive and timely way that routinely includes airtight quarantines, rapid or PCR testing and border bubbles (free travel in COVID-free zones) as well as good contact tracing.

The Tyee put the question to Julianne Piper, project co-ordinator and research fellow for SFU’s Pandemics and Borders project. She boiled down a gold standard to three essential components: timing, universality and multi-layered approaches.

1. Timing matters. Border controls must be proactive, not reactive. Their goal is to prevent trouble. A nation can only do that by being prepared and acting quickly. Canada, for example, restricted non-essential travel in March 2020, but it wasn’t until early this year that mandatory testing and quarantine in government-managed hotels were set up. By then, variants from the U.K. and Brazil were already circulating widely in the community.

“We are seeing a very reactive response to a very serious situation,” said Piper. “We should have had measures in place before we saw the problem.”

The evidence shows that East Asian countries ignored the advice of the World Health Organization (no need for border controls, the agency then advised), and imposed far more effective border controls at the beginning of the pandemic. And they steadfastly maintained them.

They implemented and enforced mandatory 14-day or 24-day quarantines. (Canada has a 14-day quarantine for international travellers, with the first three days spent at a designated government hotel.) Quarantine protocols in Asia Pacific nations helped those countries not only control the pandemic, but in many cases eliminate the virus. In contrast, governments in North America and Europe routinely reacted after the fact and let their hospitals become borders.

2. Take universal measures. Countries that have mostly stopped the virus at the border have applied screening, quarantines and testing to most, if not all travellers. “They didn’t have people slipping through the gaps,” said Piper.

In Canada, measures have never been universal. There are a handful of categories of travellers exempt from border restrictions, including testing and quarantines. Travellers flying into Canada must submit to short hotel quarantines, but people walking across the border don’t. People exempt from the rules include cross-border workers, diplomats, international students, government officials and the military. “We have a lot of exemptions,” added Piper.

In contrast, places like New Zealand, Australia, Singapore, Hong Kong and Atlantic Canada have strict rules that apply more broadly.

3. A multi-layered approach secures the border. Given the pace and scale of globalization, novel pathogens will always show up at the doorstep, but they don’t have to invade the house if a layer of interventions secures the way.

Discouraging all non-essential travel is the first protection. Repeated testing and screening all travellers before, at and within the border forms the next layer of defence. The third consists of a well-enforced quarantine program that applies to most everyone.

Canada's current three-day hotel quarantine is only for air travellers, followed by home quarantine. Much of Europe only applied restrictions haphazardly, and often had no testing or quarantine protocols until the second wave. In contrast, Australia and New Zealand have had a mandatory 14-day quarantine enforced by the police or the military since the beginning of the pandemic. Hong Kong insists on 21 days.

“We haven’t seen these measures applied consistently in Canada or universally. The countries that managed quarantine rules have managed well,” said Piper. (The small number of exempted travellers, such as flight crews or truck drivers, should be vaccinated.)

Last year, a Lancet study reviewed the COVID-19 response of nine high-income countries in Europe and Asia Pacific countries. It found that the Asia Pacific countries, most notably New Zealand, Singapore and Hong Kong, uniformly did a much better job of taking border control seriously and locking the virus out. All travellers entering these countries were subject to mandatory testing and 14-day quarantines at home or designated facilities.

Vietnam, a nation of 97 million that borders China, stands out as singular example. Last March, it cancelled all inbound commercial flights. It then used a contact tracing system to track down cases, which never exceeded 110 a day. It also restricted travel within the country. Citizens that lived in a region with a high case rate weren’t allowed leave until cases had been suppressed in that region.

As a result, Vietnam achieved Zero COVID. It also recorded one of the highest economic growth rates in Asia last year. Limited air travel to low-risk neighbours — such as South Korea, Taiwan and Japan —has now resumed. Yet everyone arriving in Vietnam by air, sea or land must be tested and wait out a mandatory 14- to 21-day quarantine period.

It is noteworthy that Vietnam never experienced rolling lockdowns the way Alberta and Ontario have. It simply didn’t have the budget for a mitigation strategy that used its hospitals as the front line of defence.

Asked why Canada has lagged behind successful Asia Pacific nations in effective border controls, Piper said that’s an issue the Pandemics and Borders project has been pondering.

“It is best to ask the federal government.”  [Tyee]

Read more: Travel, Coronavirus

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