March 18, 2020
Written by Jenna McHugh
Canada’s long history of communicable diseases have seemingly prepared the country for an outbreak, with a pandemic in the realm of possibilities. For over a century many parts of the world have explored the implementation of public health services and preventative practice. Those who work in the field of public health have heard of John Snow. He is considered the founding father of public health because he strategically traced the deaths and illnesses related to a cholera outbreak in London, England to a waterpump on Broad Street. Snow went on to work with sanitary conditions of labourers and used statistics to strengthen their work; he embarked on the beginnings of epidemiology in hopes of a time when societies would move away from their reliance on quarantines.
Shortly after, The Hudson’s Bay Company served as the public health agency in western parts of Canada during the 18th and 19th century. Campaigns to vaccinate populations for smallpox were led during this time. The new Dominion of Canada held strongly to the quarantine approach in public health and through the post-Confederation period an excitable group of sanitary reformers sought to institute a broader sense of public health into the new Canadian provincial and federal structure.
The Canadian Public Health Association (CPHA) was created on October 12, 1910 and throughout 110 years we have seen outbreaks such as, Typhoid-leading to the discovery of the specific causative bacillus in contaminated water or milk in 1896 and more notably The Spanish Influenza that swept across Canada in 1918. This deadly influenza spread from China to France via a group of transient workers and the war provided an ideal environment for infection across the world rapidly. The main avenues for infection were seen through Montreal and Halifax when ships of troops, hospital aids and civilians returned home in late June and early July. The infection then spread through the railways during the summer across Canada. When all was said and done, one-sixth of the Canadian population, predominantly young adults, were seriously affected and 50,000 died. There was little that could be done at the time to prevent the spread, misguided efforts and little understanding of the viral cause left the influenza unisolated until 1933, after outbreaks had occurred across the country and beyond.
The end of the war in 1918 brought with it a growing pressure for Canada to create a federal department focused on the interest of health and on February 20, 1919 there was a formal commitment from the federal government to establish a Department of Public Health. Over the next century the public health profession would develop integral strategies, research and population management tools that would encourage healthy behaviours and dissuade the opposite. During the Second World War, Canadians were faced with other health challenges such as nutrition and food safety, physical education initiatives, and smoking cessation. In 1948, Canada made significant contributions to the creation of the World Health Organization. In a research and development era, Canada would see the establishment of full-time health units, funding for venereal diseases, provincial structures put into place, the beginnings of food and safety guidelines, tuberculosis, polio spreads, and federal health services for Indigenous peoples. CPHA moved its office from Toronto to Ottawa in 1973 to strengthen its national voice, influence policy and work with other national and international organizations. During some of the 30 years leading up to the new millenium there was an outbreak of a new virus known as swine flu, a strain of influenza prompting immunization programs. If you’re passionate about the history of public health in Canada, check out this resource.
When we fast-forward to 2003, severe acute respiratory syndrome, commonly known as SARS, caused 32 deaths in Toronto and led to an economic loss of $35 million a day in the city. SARS is a coronavirus transmitted by droplet spread at close quarters. I am sure this sounds familiar. It was the SARS outbreak that brought the reality of the necessity of public health to the forefront of our current health and safety protocols. After this outbreak subsided, the establishment of the Public Health Agency of Canada was created. More importantly, the post of the Chief Public Health Officer also became the Deputy Minister, with a mandate to communicate directly to Canadians and the government on public health matters. Research and public health schooling and programs became more prominent and cultivation of more systematic planning processes in all three levels of governments became a top priority.
Throughout Canada’s history, the need for public health has rarely wavered. The discipline has been able to establish itself in the federal, provincial and municipal levels of governance warranting a sense of legitimacy. The recommendations of public health are sought after and carried out. As referenced above, our system has dealt with the onset of massive outbreaks throughout history, but as time goes on technology and travel become more advanced and maintaining and containing the health of populations becomes more complex.
When outbreaks and epidemics arise the role of the public is more pronounced because people become the vector for transmission. Authorities look to their Chief Medical Officers and are reliant on the research of epidemiologists to make decisions in hopes of changing the trajectory of illnesses. However, it is up to the population to make the behaviour changes and carry out their instructions. When the COVID-19 pandemic began, I couldn’t help but wonder, how do you police this thing? Who’s in charge and what are the rules? As it turns out, the role of the Public Health Agency and the federal government are entwined; when the rules are set they are held in place by the government.
We know that many people are always late to the party, but the most irritating type of person is the one who never quite makes it. Myself and many other Canadians have likely been frustrated at the individual level with colleagues, acquaintances and friends who have decidedly not begun to take the COVID-19 pandemic as urgently as the rest. We all know someone who is insisting that the pandemic “isn’t even as bad as the regular flu”, a lack of direction from supervisors and a general inadequacy to lead the charge in encouraging proactive social distancing. I recognize the tough decisions that business owners are having to make, the potential loss of jobs and ability to be able to carry on after the pandemic is over is jeopardized. I, myself, was heartbroken when I learned that the gym I attend would be closing its doors for the time being.
It became clear yesterday that there can be serious ramifications to these guidelines evoked by governments and the seriousness for those who are decidedly not following the rules. Doug Ford, the Premier of Ontario, declared a state of emergency amid the pandemic and insisted that bars, restaurants (except takeout and delivery), recreation programs, libraries and daycares close, effective immediately. The day before, Dr. Eileen De Villa had said the same thing for the City of Toronto, and stated that businesses who did not oblige would risk a fine of $25, 000 under the provincial health protection legislation. This comes as a warning for businesses who were not considering the repercussions of the COVID-19 spread. Moreover, Canada has a Quarantine Act, with the purpose to protect public health by taking comprehensive measures to prevent the introduction and spread of communicable diseases. This was updated in 2005 after the SARS outbreak highlighted above. If enacted, The Minister of Health may designate quarantine officers and travellers would present themselves to a screening officer immediately after entering, and must disclose whether they have or might have a communicable disease, or are infested with vectors or that they have recently been in close proximity to a person who has, or is reasonably like to have, a communicable disease (or vectors). A failure to comply is guilty of an offence and liable to a fine of up to $200, 000 or imprisonment up to six months, or both. Furthermore, every person who does not comply with screening after instruction (and more), upon conviction or indictment, may receive a fine of up to $1, 000, 000, imprisonment for up to 3 years, or both.
Instead of enacting these laws, Canada has instilled a social responsibility in our citizens who are coming from abroad, insisting travellers cut their trip short and return home immediately. This is likely not as easy as Prime Minister Justin Trudeau may have thought. There are restrictions in other countries for travel. Today, on March 18th, non-essential travel between the US and Canada border was stopped, and the borders have been closed for all non-Canadians who were wishing to enter the country. As it stands, citizens coming from international travel must isolate for 14 days at the behest of the government and public health officials. Isolation is extremely important in helping slow the spread of the virus.
I want to impress upon those who are not taking the communication from public health officials seriously, that it could get serious, quite quickly. If enacted, one would be breaking a federal law if they did not follow these directions. Moreover, if you have reason to believe you have been exposed to a communicable disease you are doing harm to the population at large. There is no reason to believe that the government will empower this Act because the virus is already upon us. In Canada, there is a system of social trust and those who are expected to self-isolate are more than likely to do so. However, if you are crossing the border into Canada from international travel, heed caution; public health has been working for over a century to establish its prominence within the government’s structure and this establishment means business.
Jenna McHugh is the Founding Editor of Vigor. Follow her at @jennoratorr.