Why easing COVID-19 restrictions will present challenges between provinces

Infectious disease experts say provinces looking to relax restrictions related to COVID-19 need to consider their neighbours.

Prince Edward Island, where the caseload is low, is aiming to ease its public health orders on May 1 and reopen businesses in mid-May.

The Saskatchewan government outlined a plan Thursday for some businesses and services to be allowed to resume next month.

Dr. Craig Jenne, an infectious disease researcher at the University of Calgary, said easing restrictions in one province could present challenges for others.

"Many provinces in Canada have no hard borders," he said in an interview with The Canadian Press. "Alberta, Saskatchewan, Manitoba we are not exactly islands where we can cut off travel between provinces.

"We are going to have to make sure we're on the same page with this."

As of Wednesday, Saskatchewan had recorded 326 cases, including four deaths, but less than 20 per cent of cases were considered active.

Premier Scott Moe said Thursday that reopening businesses and services would be done with physical distancing in place.

"We will carefully monitor the case numbers each and every day and we will adjust our plan accordingly if required," he said.

Interprovincial travel 'strongly' discouraged

Moe said travel was the source of many of the province's early COVID-19 cases.

"We continue to strongly discourage all non-essential interprovincial and international travel," he said.

He said he doesn't believe that Saskatchewan easing restrictions will be a risk to other provinces.

Next door, in Alberta, there are more than 3,400 cases, including 66 deaths.

Dr. Stephanie Smith, an associate professor in infectious diseases at the University of Alberta, said it may make sense for provinces with a low number of cases to consider letting up on COVID measures.

"When they do that, the most important thing is that they still have an ability to identify new cases and new contact tracing," she said. "(They need) really robust testing and tracing so that you can identify any new patients and make sure they are actually self-isolating.

"It's important in terms of ensuring you don't get into an uncontrolled situation again."

Localized outbreaks

Jenne added that outbreaks in High River, Alta., and several long-term care homes show how quickly a situation can change once the novel coronavirus starts spreading.

"As soon as we let our vigilance down in screening and isolation we will see a spike back in Canadian communities, we will see an increase in cases, we will see an increase in hospitalizations and, unfortunately, we will see an increase in deaths once these hotspots start popping up."

For example, an outbreak at Imperial Oil's Kearl oilsands project in northeastern Alberta has been linked to cases in Saskatchewan, British Columbia and Nova Scotia.

"This virus does not travel in the air," said Jenne. "It travels on people and the more people move between provincial borders and even within their own community, this is how this virus gets around."

Jenne and Smith said that's why social distancing has been so effective in reducing the number of cases in Canada.

Different approaches

Each province and territory has different approaches for how to limit the spread of COVID-19.

Manitoba has set up checkstops on major highways to help inform travellers about public health measures in place.

Some jurisdictions such as New Brunswick and the northern territories have restricted non-residents from entering or require anyone who comes into the province to self-isolate for up to 14 days.

Valorie Crooks, a geographer who specializes in health services research at Simon Fraser University, said it would be difficult to control movement across provincial boundaries.

"It raises a whole lot of questions about how you enforce and what kinds of abilities you have to enforce measures you put in place," she said.

Crooks added that it would be easier to protect populations in the North or on Canada's islands, but it's simply not practical to patrol every road between provinces.

Both infectious disease experts said closing the border with the United States has been an effective tool, but Jenne noted it's not a perfect solution.

"It has to be done in concert with everything else, including high levels of screening, contact tracing and self-isolation within communities," said the University of Calgary professor.

"Closing a border alone is really a false sense of security if it's not coupled with enhanced measures."