TORONTO -- People coming to Canada from Ebola-affected countries -- including returning health-care workers -- will need to undergo a more formal 21-day monitoring period, the federal government announced Monday. And some will be told to stay at home for the duration of that time.
Some public health officials and aid groups that had been anticipating the release of a new federal policy expressed relief at what they saw, saying earlier iterations had been more restrictive. The fear has been the government might adopt a policy that made health-care workers returning from Ebola missions feel like pariahs, which could discourage others from volunteering to join the battle.
"We were concerned the Quarantine Act would be used to impose things that we did not feel are reasonable. And I think we can work with what they've got now," said Dr. Bonnie Henry, British Columbia's deputy provincial health officer.
"They do give some leeway for a case-by-case basis for local public health to really work with the people who are returning and make sure that we have the right measures in place, both to support them but also to protect the public."
Up until now people coming into Canada from Ebola-affected countries have been asked to identify themselves to quarantine officers at their point of entry. There they went through an interview and may have had their temperatures taken.
If they were not showing symptoms of illness, they were asked to monitor their health for 21 days -- the disease's incubation period -- and take their temperature daily. If they developed symptoms consistent with Ebola, they were told to report to public health.
The new policy, which went into effect Monday, makes the self-monitoring requirements more formal.
The policy statement, pushed out after the end of the working day, raises a number of questions. But a request for an interview with Dr. Gregory Taylor, Canada's chief public health officer, was not granted Monday evening.
The policy covers people who are not sick and are coming into Canada from Ebola-affected countries. Anyone who is sick would be immediately isolated and held until testing reveals whether he or she has Ebola.
At this stage, the policy will mainly apply to returning health-care workers and people who work for humanitarian aid groups in the Ebola-affected countries. That's because Canada has stopped issuing visas to travellers from countries with widespread Ebola transmission.
Even before it took that action, few people from those countries came to Canada. Statistics Canada data shows only 956 people from the three countries -- Guinea, Liberia and Sierra Leone --travelled to Canada in 2013. And in the first eight months of this year, only 737 travellers from those countries came to Canada.
Under the new policy, incoming travellers are classified as either high risk or low risk. High-risk travellers would have had contact with a known Ebola case; low-risk travellers are people who have been in Guinea, Liberia and Sierra Leone but who have no known exposure to Ebola cases.
High-risk travellers will be ordered to report immediately to a local public health authority and isolate themselves at home or at a facility for 21 days. They will be monitored daily for symptoms, including fever and are urged to stay in proximity to one of their province's designated treatment centres.
Low-risk travellers will be ordered to report to a public health authority within 24 hours and to monitor their health daily for 21 days, including taking their temperature twice a day. They must report immediately if they develop any Ebola-like symptoms and must tell public health if they plan to travel. They do not have to stay in their homes.
Returning health-care workers are not automatically slotted into the high-risk category. Instead, the guidelines say local public health authorities can decide on a case-by-case basis whether to require a returning medical worker to isolate themselves in their home or be kept in a facility for 21 days.
Stephen Cornish, executive director of Medecins Sans Frontieres Canada, said the organization believes health-care workers will be treated as low-risk travellers.
"We have been on record from the beginning defending the fact that those who do not show symptoms should not be treated as if they are (sick)," he said. "We're hoping and understanding that the way they refer to humanitarian workers puts them in the low risk (category)."
Cornish said MSF had been concerned Canada might follow some other countries that have put some more restrictive policies in place for returning health-care workers, policies that are not warranted based on what is known about when Ebola patients are contagious. It is believed people with Ebola are not infectious until they have symptoms.
Adopting policies based on fear, not science, is unfair to returning health-care workers and could discourage others from going to help in the containment effort, he suggested.
"It adds to people's fears and creates great concern and difficulties for aid workers, who we really need to be celebrating and sending to West Africa, not ostracizing them when they return."
Henry, who has herself worked on an Ebola outbreak response in the past (not the current epidemic) said she feels the new policy is fairly balanced.
She noted that the recent case of Dr. Craig Spencer, an MSF doctor who developed Ebola after returning to New York City from an Ebola mission in Guinea, highlighted that the risk from returning health-care workers is not zero.
"I think that really made people -- people in my position, anyway -- go 'Hmm -- we need to have a balancing here,"' Henry said.
"We've had half a dozen health-care workers who have worked either with Red Cross or WHO or MSF who've come back -- and we have one who's still in his incubation period. And we've managed them in a rational, I think, and caring way."
Henry said many health sector employers are asking returning health-care workers to refrain from patient care during the 21-day incubation period, though they are allowing them to do other work. For instance, two physicians who returned from Ebola missions sat on the province's Ebola planning task force, she said.
