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.¹

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.

Alberta

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.

British Columbia

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.²

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.

Manitoba

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.

New Brunswick

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.

Northwest Territories

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.

Nova Scotia

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.

Nunavut

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.

Ontario

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.

Quebec

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.³ 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.

Saskatchewan

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.

Yukon

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.

Federal

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-19.⁴

Footnotes

1 This bulletin addresses updates published up to April
5, 2020.

2 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.

3 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.

4 Thank you to articling students Andrew Gunpat, Anna
Lu, Jessica Nolan, Lina Bensaidane, Marissa Di Lorenzo, Rachel Kardal and Rob
Legge for their research assistance.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.