As a flood of new coronavirus cases outside of China have made headlines and stirred fears of a looming pandemic, global health authorities on Tuesday pointed to that country’s response as an example for the rest of the world.
“China changed the course of this outbreak,” said WHO epidemiologist Bruce Aylward, the Canadian expert who led recent fact-finding trip to China, which has taken a series of aggressive — at times draconian — steps to halt the spread of COVID-19 in Hubei, its worst-hit province with nearly 65,000 confirmed cases and 2,563 deaths.
The authoritarian government’s actions — from putting millions of people on virtual lockdown, to closing public transit to building new hospitals at breakneck speed — have played a key role in slowing the outbreak, Aylward told reporters at WHO headquarters in Geneva.
“Hundreds of thousands of people in China did not get COVID-19 because of this aggressive response,” he said.
But as the outbreak begins to rapidly spread outside China, how much of an example can a one-party state with little concern for trampling human rights be for a democracy like Canada?
Health authorities in this country say the risk to the public is still low — so far there have been only 11 reported cases, seven in B.C., four in Ontario, and no deaths — but what can they do if that changes? Can officials here go “full Hubei,” shutting down schools and transit, even sealing off whole neighbourhoods or cities?
Here’s what we know:
How far can health authorities legally go?
The Health Protection and Promotion Act gives Ontario’s medical officers broad powers to restrict the mobility and actions of people, or groups, to quell public health threats.
“In short, the powers in that act are extraordinary” University of Toronto epidemiologist Dr. David Fisman said. “There is very little that you could not do in the name of public health,” he added.
The if — and it’s a big if — is that restrictive steps need political support, he said.
As an authoritarian state, China can move much more quickly, and with fewer checks and balances than Canada. In Hubei, which has a population of nearly 60 million, entire cities were locked down with public transit and schools cancelled — there were even reports the government was using drones to spy on people seen outside without masks.
Penny Washington, a partner at Norton Rose Fulbright Canada and head of the law firm’s Health Care Group, said medical officers of health in Ontario’s 35 regional public health units could get an order to shut down a school or a hospital or even get court orders to compel people into treatment, but large regional actions would involve working with the feds.
“If it got to that level where we were considering broader quarantine such as an area of Toronto, or the whole city, or a transit system, we would be working with the federal government under their broader emergency powers,” she added.
Federal law, under the Quarantine Act, has already been invoked with Canadians returning from affected areas — but there is no Canadian precedent for a Hubei-style lockdown.
That would be new territory, because the law has “primarily been used to keep disease out, not to deal with outbreaks within,” Washington said.
How far should we be prepared to go?
Just because health authorities have sweeping powers, doesn’t mean it’s a good idea to use them.
Dr. Ross Upshur, the Dalla Lana Chair in Clinical Public Health at the University of Toronto, has done extensive research on the ethics of quarantines, travel bans, school closures and other extreme steps.
He and his team have developed a framework around four ethical criteria that need to be met to justify such restrictive measures: the scale of risk to the community; that the measures are proportionate to that threat and that they’re the least-restrictive necessary to achieve their goal; that affected people are supported and don’t lose their jobs or medical care; and that there’s transparency and accountability from authorities.
So far, the coronavirus outbreak is unfolding “in ways that as a student of quarantine I never thought I’d see play out, to be honest,” Upshur said, adding he hopes Chinese authorities are researching how their actions are affecting citizens, “to better calibrate responses in the future.”
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Upshur notes that there have been seven major outbreaks since the 2003 SARS epidemic, including the related Middle Eastern Respiratory Syndrome, Zika, two different Ebola outbreaks and the H1N1 flu pandemic.
“These are happening every couple of years, and we can’t keep freaking out, we need to normalize our response and use science to calibrate our responses,” he said.
“Yes, there are justifications for overriding civil liberties but those need to be balanced by the obligations of those asking for the restriction, it’s not a one-way street.”
Other countries are having the same conversations about balancing safety and rights: In northern Italy, where deaths and cases are mounting, towns have been sealed off and people face fines for entering or leaving outbreak areas. At a hotel in Spain’s Canary Islands, hundreds of guests have been put on lockdown after a visiting doctor tested positive.
As for what can go wrong, history shows extreme restrictive measures can have “very racist and xenophobic undertones,” Fisman added.
One example of an attempt to control disease gone horribly wrong is when much of Honolulu burned down in 1900 when the wind shifted after officials set deliberate fires in the city’s Chinatown, in an effort to control an outbreak of bubonic plague.
Tess Sheldon, an assistant professor at the University of Windsor, said it’s important to think about how vulnerable people, like people with disabilities, and the very young and old, might be impacted under a strict outbreak response.
“Marginalized communities of any kind they’re the first to be forgotten,” she said.
For example, the Health Protection and Promotion Act permits “class orders” directed at groups of people — say, everyone who attends a certain church where a case of the virus is reported.
But enforcing these restrictions can get thorny, Sheldon said, as these kinds of classes can overlap with protected groups under the Ontario Human Rights Code.
And already during this year’s outbreak there have been reports of racism against Chinese Canadians and others of Asian descent.
What’s being done so far
In Toronto, Mayor John Tory told reporters on Tuesday that the city’s public health unit has access to “a very broad range” of emergency powers, but authorities have so far “very successful contained” the virus. The risk is “still very, very low,” he said.
Toronto Public Health has a pandemic plan in place that outlines planning, preparedness, response and recovery said spokesperson Lenore Bromley.
Canada’s chief public health officer Dr. Theresa Tam said Monday that the “global risk situation is evolving” and officials are monitoring the situation closely while preparing for the possibility of more cases in Canada.
As more countries around the world are affected, Canada’s health care workers need to be prepared to test travellers from all affected areas, she said.
“If you come from a coronavirus-affected country, we are asking everyone essentially now to observe your symptoms but avoid crowded conditions,” she said.
As the number of countries grows, “this advice is applicable to practically all travellers” — and you should of course “absolutely stay home if you’re sick.”
A spokesperson for Ontario Minister of Health Christine Elliott did not respond to a request on provincial powers by deadline.