New measures implemented up to April 5, 2020 by governments across Canada to respond to the COVID-19 outbreak continue to focus on increasing capacity of the health care sector (including, specifically, health care providers) and reducing the spread of the outbreak. This bulletin summarizes select legislative changes, government orders and other significant developments affecting health care providers and organizations across Canada during the past week.
For additional information and insights visit the Fasken Coronavirus (COVID-19) Knowledge Centre. Our bulletin summarizing key health sector updates across Canada up to the last week of March can be found here.
The Alberta Chief Medical Officer of Health has implemented the following recent measures:
- several exemptions from and clarifications respecting (pdf) the application of public health orders to residential addiction and treatment facilities, issued on March 30, 2020;
- an exemption (pdf) issued on April 1, 2020 from quarantine and isolation orders for individuals who require COVID-19 testing or who are required to receive scheduled critical care that can only be provided in a doctor's office, hospital or other medical facility, subject to certain requirements (including a pre-arranged appointment, private transportation where practical and that the doctor's office, hospital or other medical facility is aware of the isolation or quarantine and is still able to safely provide care). An exemption is also available for individuals who require emergency care in a hospital; and
- an order (pdf) on April 2, 2020 requiring all operators and service providers of a health care facility in Alberta to adhere to prescribed outbreak standards. This builds on the expectations of earlier orders. Operators are required to notify public health authorities, residents, families and staff of COVID-19 cases. Additionally, staff who work at multiple facilities must immediately inform their supervisors if they have worked or are working at a facility where there is an outbreak.
On April 2, 2020, Bill 10 (pdf), the Public Health (Emergency Powers) Amendment Act, 2020 received Royal Assent, amending the Public Health Act to increase fines and enforcement powers against persons violating public health orders.
On April 3, 2020, Alberta released updated public health disease management guidelines for COVID-19(pdf). Also on April 3, 2020, Alberta Health Services updated its policies, providing that no visitors will be permitted in long-term care, supportive living, congregate living, hospice care and acute care settings in Alberta, with exceptions for maternity care, children who are patients, and visitors attending to a resident at end-of-life, subject to the requirement that the visitor must be feeling well and not have certain risk factors (such as being immunocompromised).
The Alberta Emergency Management Agency's Bits and Pieces Program has been accepting submissions from individuals and organizations that have products and services to offer in response to COVID-19.
Alberta Health Services has postponed all scheduled and elective surgeries, and any diagnostic imaging procedures that are considered non-urgent by the ordering physician, and is reducing ambulatory clinic services. Physicians have been asked to relieve the health system of non-essential and routine laboratory testing.
The Minister of Public Safety and Solicitor General issued an order (pdf) on March 26, 2020 which, among other things, empowered the Minister to:
- request that local authorities take measures to identify publicly-owned facilities, such as community centres, that can be used for warehousing essential supplies, testing and medical care;
- request that all retailers, suppliers and other organizations report their inventory of essential goods and supplies; and
- direct hotel or commercial lodging operators to provide accommodation for self-isolating individuals or for supporting essential workers.
On March 31, 2020, the Government of British Columbia issued an order (pdf) extending the declaration of a state of emergency to April 14, 2020.
On April 1, 2020, the Province of British Columbia, the Digital Technology Supercluster and the Business Council of British Columbia announced (pdf) the COVID-19 Supply Hub, an online platform to co-ordinate, source and expedite medical supplies and personal protective equipment for provincial health authorities. The hub will be used to triage and prioritize offers and donations.
On April 2, 2020, the Minister of Public Safety and Solicitor General issued the Protection Against Liability (COVID-19) Order(pdf), effective until the declaration of a state of emergency (and any extension) expires, which provides that a person is not liable for damages arising directly or indirectly from an individual being infected with or exposed to COVID-19 as a result of the person providing an essential service if the person was (or reasonably believed that the person was) providing the service in accordance with emergency and public health guidance, and was not grossly negligent.
On April 3, 2020, the Government of British Columbia updated its list of essential services.
On April 3, 2020, the Government of British Columbia announced that it was partnering with the BC Care Providers Association to launch EquipCare BC, a program that will provide $10 million for infection prevention and control, quality and safety in long-term care and assisted living homes. Applications are being accepted as of April 4, 2020.
The BC Centre for Disease Control and the Ministry of Health have issued a number of relevant documents, including:
- an ethics analysis (pdf) and the COVID-19 Ethical Decision-Making Framework (pdf) for health care workers on March 28, 2020;
- a bulletin(pdf), on March 29, 2020, on the use of personal protective equipment; and
- the Interim Guidance to Social Service Providers for the Prevention and Control of COVID-19 in their Facilities (pdf) on April 4, 2020.
The Office of Virtual Health, which is part of the Provincial Health Services Authority, has created a COVID-19 Virtual Health Toolkit.
A new COVID-19 Strategic Research Advisory Committee has been announced, and will be facilitating British Columbia's research efforts.
On March 31, 2020, Manitoba's Minister of Health, Seniors and Active Living approved a series of orders (pdf) by the Chief Provincial Public Health Officer under The Public Health Act. The orders replace similar orders made in the days prior, are effective April 1, 2020 and include:
- that all persons are prohibited from assembling in a public gathering of more than 10 persons, with an exception for facilities where health care or social services are provided;
- the closure of non-essential businesses, but nothing in the order prevents health care operations and services. A number of health care, seniors care and social services are included as essential businesses; and
- that physicians, registered nurses, licensed practical nurses and midwives may practise their profession without restriction. Any other health professional who is authorized to practise may provide services to, or on behalf of, the government, a publicly funded organization or authority, and any essential business, and may also provide urgent or emergent care.
On April 1, 2020, the Minister of Health, Seniors and Active Living also announced an order modifying the registration process for former nurses who wish to return to work.
The Government of Manitoba has created a submission form for businesses that are able to supply products or services to support the province's response to COVID-19.
On April 2, 2020, the Government of New Brunswick issued a Renewed and Revised Mandatory Order(pdf), renewing its declaration of a provincial state of emergency pursuant to the New Brunswick Emergency Measures Act.
On March 30, 2020, the Chief Medical Officer of Health published a memo (pdf) to Chief Executive Officers of Regional Health Authorities providing additional restrictions for visitors in health care institutions to ensure that vulnerable patients are protected from COVID-19. Visitors with symptoms of acute infection should not visit institutions unless essential (e.g. a parent, guardian or primary caregiver). All visitors who have travelled outside of New Brunswick are restricted from entering a facility for 14 days after they have returned to the province. Family members who are deemed to be the patient or resident's primary caregiver may enter the facility, however they must adhere to self-isolation when not in the facility and practice preventative measures. This also applies to staff who are symptomatic of any respiratory illness.
On March 31, 2020, the Government of New Brunswick published an updated guidance document (pdf) for Community Pharmacies in relation to COVID-19. On April 1, 2020, the government also published an updated guidance document (pdf) for Home Support Agencies.
Newfoundland and Labrador
Effective April 1, 2020, the Government of Newfoundland and Labrador issued a Public Health Emergency Extension Declaration(pdf), extending the public health emergency for a period of 14 days.
The government announced on March 31, 2020 that its Department of Health and Community Services is extending the validity period of Medical Care Plan cards to June 30, 2020. All cards that would otherwise expire as of March 1, 2020 onward will remain valid.
The Government of Northwest Territories announced that, effective April 1, 2020, the Minister of Health and Social Services extended the territory-wide public health emergency for a period of 14 days pursuant to the Northwest Territories Public Health Act.
On April 2, 2020, the Government of Nova Scotia declared a Renewal of Provincial State of Emergency(pdf), extending the state of emergency pursuant to the Emergency Management Act until noon on April 19, 2020.
The Government of Nova Scotia announced that it is working to increase capacity within the health care sector, including through the following measures:
- increasing testing for COVID-19;
- doubling lab capacity to accommodate increased testing;
- expanding virtual care for physicians, nurse practitioners and others so they can offer appointments to patients through telephone or video;
- allowing pharmacists to renew prescriptions for most medications, with the government covering the assessment fee;
- College of Physicians and Surgeons of Nova Scotia is waiving the fee for retired doctors to renew their licences so they can more easily return to provide services;
- the province's emergency line has increased staff and technology and is now answering 100 percent more calls; and
- enhancing infection control measures being taken at hospitals, including increasing the frequency of cleaning and disinfection, focusing on high-risk areas, high-traffic areas and high-touch surfaces, and using stronger cleaning products.
Effective April 2, 2020, Nunavut's Minister of Health issued an order (pdf) extending the state of public health emergency until the end of April 16, 2020.
On March 30, 2020, the Government of Ontario extended the Declaration of Emergency pursuant to the Emergency Management and Civil Protection Act ("EMCPA") and associated emergency measures for a period of 14 days.
On March 30, 2020, an order was published, effective March 27, 2020 pursuant to the EMCPA, which expanded the powers available to long-term care homes when managing their responses to COVID-19. In particular, long-term care homes are authorized to take any reasonably necessary measures in accordance with the order to respond to, prevent and alleviate the outbreak of COVID-19. The order increases flexibility with respect to:
- Reporting - licensees are not required to report any complaints or other information to the Director, other than critical incident reports and mandatory reports under the Long-Term Care Homes Act, 2007 ("LTCHA") and O. Reg 79/10;
- Documentation - certain documentation requirements for licensees pursuant to the LTCHA are removed or relaxed;
- Staffing - licensees may fill any staff position with a person who has the adequate skills, training and knowledge, and are not required to (i) ensure that the minimum number of staffing hours set out in the LTCHA and O. Reg 79/10 are met for a position (provided certain requirements are met), (ii) meet the screening measures set out in the LTCHA and O. Reg 79/10 (provided other measures are adopted to ensure resident care and safety), or (iii) meet the training and orientation requirements set out in the LTCHA and O. Reg 79/10 (provided that they ensure staff and volunteers take measures to ensure resident care and safety);
- Care Requirements - licensees are not required to (i) hold care conferences at intervals set out in O. Reg 79/10 (provided that they ensure care conferences take place based on the clinical needs of the resident) or (ii) ensure that a physical examination of a resident occurs annually, but they must ensure that a physical examination occurs within a reasonable period of time after the resident's last examination;
- Admission, Transfers and Discharges - licensees may use flexible processes for the admission, transfer and discharge of persons (but nothing derogates from the requirements under the LTCHA to seek consent from such persons);
- Licensing/Management Contracts - licensees are not required to follow all steps under the LTCHA and O. Reg 79/10 when seeking approval from the Director to obtain a licence or management contract under the LTCHA (unless otherwise required); and
- Administration of Drugs - licensees may adopt flexible practices related to the administration of drugs to residents (provided that the practices are within the scope of practice of the administrator of the drug).
On April 2, 2020, the Province of Ontario issued two orders under the EMCPA: the first order in relation to work deployment and staffing measures in every board of health within the meaning of the Health Protection and Promotion Act, and the second order in relation to deployment of staff in every retirement home under the Retirement Homes Act, 2010. Pursuant to each order, boards of health and licensees of retirement homes, respectively, shall and are authorized to take, with respect to work deployment and staffing, any reasonably necessary measure to respond to, prevent and alleviate the outbreak of COVID-19 despite any other statute, regulation, order, arrangement or agreement (including a collective agreement).
The orders require and authorize boards of health and licensees of retirement homes, respectively, to take the following measures:
- identifying staffing priorities and developing, modifying and implementing redeployment plans, including the following:
- redeploying staff within different locations in (or between) facilities;
- changing the assignment of work and the scheduling of work or shift assignments;
- deferring or cancelling vacations, absences or other leaves;
- employing extra part-time or temporary staff or contractors;
- using volunteers to perform work; and
- providing appropriate training or education as needed to staff and volunteers;
- requiring and collecting information from staff, contractors or volunteers about their availability to provide services for the board of health or licensee, as applicable;
- requiring and collecting information from staff, contractors or volunteers about their likely or actual exposure to COVID-19, or about any other health conditions that may affect their ability to provide services;
- cancelling or postponing services (or interdisciplinary care conferences in the case of retirement homes) that are not related to responding to, preventing or alleviating the outbreak of COVID-19 or services that are not deemed to be critical; and
- suspending any grievance process with respect to any matter referred to in the order.
Additionally, the second order also requires and authorizes licensees of retirement homes to suspend (i) required staff screening measures (including a police record check) if other screening measures that ensure the care and safety of residents are conducted, and (ii) any requirement to document or post new information, except for requirements to document an incident of a significant nature or where documentation is required to ensure the proper care and safety of a resident. Licensees are also required and authorized to conduct any skills and experience inventories of staff to identify possible alternative roles in priority areas. Further, licensees are required to report an outbreak of COVID-19 to the Retirement Homes Regulatory Authority on the same day that the outbreak is reported to the local medical officer of health or designate under subsection 27(5) of O. Reg 166/11 made under the Retirement Homes Act, 2010.
On March 30, 2020, the government announced that the Province of Ontario and the Chief Medical Officer, in consultation with the Ontario Nurses' Association, Ontario Health and the Ontario Hospital Association, are issuing a directive on health and safety standards for frontline nurses in hospitals to prevent exposure to and transmission of COVID-19. The directive (pdf) outlines:
- precautions for interactions with suspected, presumed or confirmed COVID-19 patients;
- point-of-care risk assessments for every patient interaction to assess appropriate health and safety measures; and
- training on safe use of all personal protective equipment.
Additionally, the Government of Ontario introduced the following legislative and regulatory changes over the past week which are relevant to responding to COVID-19:
Connecting Care Act, 2019
On April 1, 2020, the government announced that the transfer order to move the Ontario Telemedicine Network ("OTN") into Ontario Health came into effect. The transfer order was first issued on March 18, 2020 by the Deputy Premier and Minister of Health under the Connecting Care Act, 2019. The announcement indicated that work locations and reporting obligations for OTN will remain the same. The government stated that this transfer helps further pave the way for digital-first approaches to health care in Ontario, including virtual care and improving the integration and efficiency of digital assets across the health system.
The announcement indicated that, based on guidance from Ontario Health, the transfer of health system funding, planning and coordination functions of the Local Health Integration Networks ("LHIN") will be postponed as Ontario continues to actively respond to COVID-19. Plans will be made to transfer LHIN functions into Ontario Health at a later date.
Ontario Drug Benefit Act and Drug Interchangeability and Dispensing Fee Act
To respond to the possibility of drug shortages in the province caused by COVID-19, Ontario announced that its Ministry of Health is proposing to change the effective date of regulatory amendments made to O. Reg 201/96 under the Ontario Drug Benefit Act ("ODBA"), and to Regulation 935 under the Drug Interchangeability and Dispensing Fee Act ("DIDFA"). This change will allow private label products ("PLPs") to be designated as listed drug products under the ODBA and as interchangeable products under the DIDFA on April 1, 2020, rather than on July 1, 2020. Accelerating the commencement date of the PLP changes will make PLPs eligible for public funding under the Ontario Drug Benefit Program, and make it easier for pharmacies to sell PLPs to private and retail customers, at an earlier point in time.
Further, the province announced that its Ministry of Health is proposing regulatory amendments to O. Reg 201/96 under the ODBA to align Ontario's rules for determining brand reference prices with the national approach used by the Pan-Canadian Pharmaceutical Alliance. These changes will remove certain barriers related to the listing of some generic drug products on the Ontario Drug Benefit Formulary, which is expected to improve the pharmaceutical supply chain to offset the possibility of drug shortages in the province due to COVID-19. The proposed effective date of these regulatory changes is April 1, 2020.
Prince Edward Island
On March 31, 2020, a Public Health Order (pdf) was issued, to be in effect for 30 days, which orders:
- health care workers to self-isolate as follows:
- if diagnosed with COVID-19, until they receive two negative test results (24 hours apart) and are cleared by a public health official; and
- if symptomatic and awaiting the results of a test for COVID-19, until a negative test result is received;
- the closure of non-essential services, including:
- regulated health professionals, unless the services to be provided are to address essential health care or an emergency health care situation. Virtual care for non-emergency/elective care services is permitted if professionals are authorized to provide this care within their scope of practice and by their governing college; and
- unregulated health care providers, with the exception of those that are providing direct support to regulated health care providers in essential health care or an emergency health care situation; and
- visitations to nursing homes and community care facilities are prohibited, unless for exceptional circumstances including end-of-life.
As noted in last week's bulletin, on March 29, 2020, the Government of Quebec made an order (pdf) extending the public health emergency until April 7, 2020. This order also extended prior orders to the same date.
On March 30, 2020, the Minister of Health and Social Services made an order (pdf) requiring all retail commercial establishments to be closed on Sundays. Pharmacies are exempted from the order. The order also allows pharmacies and stores offering pharmacy services to extend their hours of operation in order to meet demand. On April 4, 2020, an order (pdf) was made adding pharmacies not in malls, for online or telephone orders and for delivery of medications and pharmaceutical, hygienic and sanitary products.
On April 1, 2020, the Minister of Health and Social Services made an order (pdf) restricting access to several health regions in the Province of Quebec, notably Saguenay-Lac-Saint-Jean, Nunavik and Gaspésie. Access to these regions is permitted for certain persons, including persons working in a priority service, persons whose travel is necessary to obtain care or services required by their state of health or to provide such care or services to a person requiring them, and persons whose travel is necessary for humanitarian purposes. Additional territories were added by an order (pdf) on April 4, 2020.
On April 3, 2020, the College of Physicians of Quebec and the Professional Order of Physiotherapy of Quebec announced (in French only) an agreement to allow physiotherapists to perform COVID-19 screening tests after completing short training.
On April 4, 2020, the Minister of Health and Social Services made an order (pdf) modifying previous orders affecting collective agreements in the health and social services network to implement measures including the following:
- requiring salaried persons who cannot work because of health risks or an isolation order to be remunerated as if they were at work;
- providing that a salaried person who works in one of the work environments listed below receive an 8% bonus for the hours worked in that environment:
- emergency units (except psychiatric emergencies);
- intensive care units with at least one diagnosed case of COVID-19;
- clinics (screening and evaluation) specific to COVID-19;
- units reserved for patients with a positive COVID-19 diagnosis;
- units in a residential and long-term care centre;
- other residential units, if at least one diagnosed case of COVID-19 is confirmed; and
- pneumology units; and
- that intermediate officers and ambulance technicians are to receive a bonus of 4% for hours worked.
On April 5, 2020, the Premier of Quebec announced (in French only) that the lockdown of non-essential services will be extended from April 13, 2020 to May 4, 2020.
The most recent public health order issued in the Province of Saskatchewan was on March 26, 2020, as reported in last week's bulletin. On April 1, 2020, the Deputy Minister of Health sent a letter to the Saskatchewan Health Authority, outlining how the restrictions apply to long-term care. The Saskatchewan Health Authority has also prepared standards and tools with respect to visitors for continuing care services.
On March 30, 2020, the Saskatchewan Health Authority published guidelines for donations of supplies.
In Saskatchewan, the Ministry of Health has been working with professional health bodies to provide temporary licences for retired, non-practising and student members, and the Government of Saskatchewan is covering the fees for these professionals.
As of March 27, 2020, Yukon's Chief Medical Officer of Health ordered the territory's dental practices to suspend all non-urgent treatment until further notice.
On April 1, 2020, a regulation was published in the Canada Gazette, adding COVID-19 to the Schedule of reportable illnesses under the Quarantine Act. Travellers and conveyance operators must notify authorities of any suspected or confirmed status, or exposure to the disease. Prior to COVID-19 being added to the Schedule, travellers were not required to notify Canadian authorities, in the absence of being asked, of their suspected or confirmed presence or exposure to COVID-19.
 This bulletin addresses updates published up to April 5, 2020.
 In a news release, the Government of British Columbia explained that the order was introduced because essential service business owners identified challenges with their insurance as a result of the pandemic.
 As are convenience stores, service stations, restaurants for drive-through, take-out and delivery, as well as grocery stores for orders placed online or by telephone and delivery.