Measures implemented over the past two weeks by governments across Canada to respond to the COVID-19 outbreak focus on safely re-opening various businesses and services, including in the health care sector, while continuing work to reduce and recover from the outbreak and support frontline workers. Government efforts continue to be directed to supporting vulnerable populations, particularly in the long-term care sector. In several provinces, governments have announced plans to make testing more widely available.

This bulletin summarizes key recent legislative changes, government orders and other significant developments affecting health care providers and organizations across Canada during the past two weeks.1

For additional information and insights visit the Fasken Coronavirus (COVID-19) Knowledge Centre. In addition, see our previous bulletins summarizing key health sector updates across Canada in March 2020, up to April 5, 2020, up to April 12, 2020, up to April 19, 2020, up to April 26, 2020, up to May 3, 2020 and up to May 17, 2020.

Alberta

On May 18, 2020, the Government of Alberta announced that it has invested over $170 million in long-term care, designated supportive living facilities, and seniors lodges to enhance staffing, acquire extra cleaning supplies, and address lost accommodation revenue. $14.2 million will be allocated per month until orders from Alberta's Chief Medical Officer of Health are lifted, retroactive to March 15. Facilities will need to report on spending and return funds not spent on COVID-19.

On May 22, 2020, the government announced, as of May 25, 2020, voluntary testing for asymptomatic residents and staff in long-term care and level 4 designated supportive living facilities (those providing a higher level of support to people with more complex needs). Testing of the public has also been expanded to include anyone in Alberta, whether they have COVID-19 symptoms or not, with priority to those who are symptomatic.

On May 22, 2020,the government also announced the resumption of additional health services. Day surgeries resumed on May 3, 2020 - now, non-urgent surgeries will expand to include more day surgeries and those requiring an overnight stay.

On May 25, 2020, the Chief Medical Officer of Health issued an order outlining updated operational and outbreak standards for auxiliary hospitals, nursing homes and licensed supportive living facilities.

On May 25, 2020, the government announced funding of $26 million to support new capital maintenance and renewal projects for seniors housing facilities, with a focus on renovations and emergency repairs to the facilities. The projects are intended to increase the health and safety of residents, as well as create jobs.

On May 29, 2020, the government announced that it would distribute non-medical masks to the public, including through fast food restaurants at their drive-thru windows.

On May 30, 2020, the government announced that they will be investing $21.6 million to expand online resources and virtual supports for Albertans who are seeking help for mental health and addiction challenges due to the pandemic. The funding is the first portion of a $53 million COVID-19 mental health action plan announced in April 2020.

British Columbia

On May 19, 2020, British Columbia's Ministry of Finance announced that health and social service workers delivering in-person, frontline care will receive temporary COVID-19 pandemic pay as part of the cost-shared program with the federal government. On the same day, the Ministry of Health issued a communiqué to Health Authority CEOs, setting out new infection prevention and control measures.

On May 26, 2020, the Lieutenant Governor in Council ordered that the declaration of a state of emergency made on March 18, 2020 be extended for a further period until June 9, 2020.

On May 29, 2020, the Government of British Columbia issued an order amending the Residential Tenancy Regulation to provide for emergency shelters in relation to COVID-19.

Manitoba

On May 18, 2020, the Government of Manitoba announced that residents of Manitoba experiencing COVID-19 symptoms no longer require a referral before attending a community site for COVID-19 testing. On May 22, 2020, the government announced that it was developing options for sentinel testing, including introducing voluntary asymptomatic testing in a number of health-care settings.

On May 21, 2020, the government unveiled a preliminary plan that will guide the safe reopening of additional businesses as part of Phase Two of its re-opening plan and on May 27, 2020 announced the draft Phase Two plan. This plan builds on Phase One, described in our last bulletin. Phase Two includes lifting occupancy limits for regulated health professions.

On May 29, 2020, the Chief Provincial Public Health Officer issued new COVID-19 Prevention Orders intended to allow the implementation of Phase Two, replacing previous orders issued on May 21, 2020. On the same day, the Chief Provincial Public Health Officer issued a new order restricting travel to Northern Manitoba, with an exception for health care providers.

New Brunswick

On May 20, 2020, the Government of New Brunswick announced that it has sent a written request to the federal finance minister outlining a program to provide a monthly top-up of approximately $500 for 16 weeks for frontline workers in a number of sectors. Those eligible for the funding would include employees in home support, special care homes, community residences, and group homes. Workers must earn $18 per hour or less to be eligible.

On May 22, 2020, the government announced that the province's COVID-19 recovery plan is moving gradually to the second level.[2] The second level includes the reopening of more businesses and activities while working to prevent a resurgence of the virus. Effective immediately, non-regulated health professionals and businesses may open, including acupuncturists and naturopaths. As of May 29, 2020, elective surgeries and other non-emergency health care services will increase.

On May 28, 2020, the declaration of emergency under New Brunswick's Emergency Measures Act was extended for another 14 days.

On May 29, 2020, a renewed and revised State of Emergency mandatory order was issued under the Emergency Measures Act. Among other things, the order declared that the directive issued on March 17, 2020 by the New Brunswick College of Pharmacists, limiting prescription medications to a 30-day supply per patient, is now of no force or effect. Pharmacists are now directed to supply patients with a 90-day supply unless a particular medication is in inadequate stock to do so.

Newfoundland and Labrador

As of 5:00 pm (EDT) on May 31, 2020, there have been no recent legislative changes or orders affecting the health sector in Newfoundland and Labrador.

Northwest Territories

On May 26, 2020, the Government of the Northwest Territories announced the extension of the territory-wide Public Health Emergency under the Northwest Territories Public Health Act and the territory-wide state of emergency under the Emergency Management Act. Both extensions took effect as of May 27, 2020 and will expire on June 9, 2020.

Nova Scotia

On May 27, 2020, the Government of Nova Scotia announced the next steps toward reopening the province. Effective June 5, 2020, various health care providers will be able to reopen, provided they follow the protocols in their colleges' and associations' plans, as approved by Public Health. These providers include dentists and other self-regulated health professionals such as optometrists, chiropractors, and physiotherapists, as well as unregulated health professionals such as massage therapists, podiatrists and naturopaths.

On May 29, 2020, the government announced that it will be adding 23 new long-term care beds in Bedford to help meet the need caused by COVID-19, as some long-term care facilities have slowed or stopped admissions due to the outbreak.

Nunavut

On May 28, 2020, the Government of Nunavut announced that it will be launching a new program, the Nunavut Essential Workers Wage Premium, through which the territory will fund eligible employers to pay their lower-wage workers more for the hours they work. Employees who earn $20 or less per hour will be able to receive an extra $5 per hour. Employees who earn between $20 and $25 per hour will receive enough to bring their wages up to $25 per hour. Funding will be available for employers to support this higher pay for up to 16 weeks. To start, the government is targeting employers who provide health and social services.

Ontario

The Government of Ontario's efforts over the last few weeks in responding to COVID-19 have largely focused on supporting the long-term care sector, through (1) investigating the most significantly affected long-term care homes, (2) announcing an independent commission into the province's long-term care home system and (3) working with hospital partners to assist long-term care homes with clinical, infection prevention and control, and other areas.

Investigating Long-Term Care Homes

On April 22, 2020, the government formally requested that the federal government provide assistance of the Canadian Armed Forces (CAF) to support five long-term care homes that were in crisis. A government news release dated May 26, 2020 announced some of the progress that has been made with CAF support and discussed the findings of a report made by the CAF. The CAF reported that the homes have begun stabilizing.

On May 27, 2020, the government announced that it is taking additional action at high-risk long-term care homes following the CAF report. According to the announcement, the Ministry of Long-Term Care has deployed long-term care inspection teams to conduct comprehensive, detailed inspections at six long-term care homes (including those captured in the CAF report) over 21 days. The inspections will include record and chart reviews; interviews with staff and residents; and observations in order to determine the extent of the issues. After an inspection is completed in a high-risk home, the Ministry will set up regular status calls, monitoring, and regular unannounced in-person follow up inspections. Results of these and all other inspections will be posted on the Ministry's website.

The May 27th government news release also indicates that the Ministry has begun the process of appointing temporary management at certain long-term care homes. Working with hospitals and other partners, each of these homes will be required to submit a plan to the Ministry that details how they intend to return to acceptable levels of care.

The government noted that aspects of the CAF report trigger requirements for the Ministry to share its findings with other agencies, which may result in police investigations and potential criminal charges; Ministry of Labour inspections into worker health and safety; Public Health inspections into food preparation, etc.; or referrals to professional colleges for practice standard violations.

The government also indicated that inspectors will continue to be deployed to ensure all long-term care homes are compliant with the Long-Term Care Homes Act.

Independent Commission into the Long-Term Care Home System

As discussed in our previous bulletin, on May 19, 2020, Ontario's Minister of Long-Term Care announced the creation of an independent commission into Ontario's long-term care system. The purpose of the commission will be to provide guidance on how to improve the province's long-term care system and better protect residents and staff from future outbreaks. On May 27, 2020, the province announced that the commission will begin in July 2020 (rather than September 2020 as initially indicated).

Hospital Partners Assisting Long-Term Care Homes

On May 25, 2020, the government announced that the Ministry of Long-Term Care issued Mandatory Management Orders appointing local hospitals to temporarily manage two long-term care homes for 90 days (and may be extended past 90 days if necessary). Additional orders may be made on a case-by-case basis. The province is working with its health partners in addressing challenges in the long-term care sector by involving hospitals in deploying Infection Prevention and Control teams to homes, continued staff and resident testing, addressing personal protective equipment supply issues, and redeploying hospital staff to help with critical staffing shortages in long-term care homes.

On May 28, 2020, the government announced that it is extending the mandate of the Incident Management System Long-Term Care Table. This table is composed of health care professionals who make immediate decisions to deal with issues related to staffing levels, infection management and resources in long-term care homes during the COVID-19 outbreak. The extended mandate itself has not yet been announced.

In addition to measures to address COVID-19 in long-term care, the Ontario government took the following actions over the past two weeks:

On May 19, 2020, the Government of Ontario announced that it is working with Medical Innovation Xchange (MIX), Canada's first industry-led hub for med-tech start-ups, to provide non-medical manufacturing companies free support as they retool to provide essential supplies and equipment to health care facilities during COVID-19. Non-medical manufacturing companies that have received funding through the Ontario Together Fund or a Purchase Order with the province can access MIX members' medical advisory services, including assistance navigating regulatory hurdles and increasing efficiencies. To support the development of proposals submitted by businesses and individuals through the Ontario Together web portal and help businesses retool their operations, the government launched the $50 million Ontario Together Fund. All submissions received through the portal are being reviewed and prioritized to focus on solutions that can respond where the need is greatest and can be implemented quickly.

On May 21, 2020, the government announced funding for the first phase of research projects focused on preventing, detecting and treating COVID-19. The government indicated that the first 15 projects, funded by the government's $20 million Ontario COVID-19 Rapid Research Fund, focus on areas of research such as vaccine development, diagnostics, drug trials and development, and social sciences.

On May 26, 2020, the government issued an order (O. Reg. 106/20), which extended all emergency orders in force under the Emergency Management and Civil Protection Act until June 9, 2020.

On May 29, 2020, the government announced the next phase of the province's COVID-19 testing plan, Protecting Ontarians Through Enhanced Testing, which expands testing for the general public, frontline workers, first responders and workplaces. The new testing plan includes three branches of testing:

  1. Assessment Centre Testing: expanding who gets tested to now include asymptomatic individuals concerned about exposure and continued routine symptomatic testing. The government indicated that to enable increased access to routine symptomatic testing, as of May 24, 2020, people no longer require a referral to go to any of the assessment centres in Ontario. The testing plan clearly states, "No Ontarian will be declined a test at an assessment centre (either through appointment or walk-in, per the processes of each individual assessment centre), especially those who are symptomatic or who are concerned they have been exposed to COVID-19".
  2. Targeted Campaigns: detecting and containing cases by expanding asymptomatic surveillance for vulnerable populations, including in long-term care homes and other shared living spaces like shelters and group homes. This will include testing symptomatic and asymptomatic frontline staff. Ontario will also work with higher-risk sectors including first responders, home care workers, essential workers and other workplaces that are gradually reopening to design and implement expanded testing . According to the testing plan, the province is looking to expand testing to additional essential workplaces, including retailers, transportation workers, auto workers and educators and school staff, among others. Moving forward, the province expects that private-sector workplace testing will leverage private and public resources as the government works with private-sector employers to develop the appropriate models for their environments; and
  3. Outbreak Management: in response to a declaration of an outbreak in a specific neighbourhood, region or institution such as hospitals, long-term care homes, educational settings and workplaces, the province will rapidly deploy agile testing resources, such as mobile testing units, to contain any spread.

Appendix A to the new testing plan includes a short-term timeline (up to June 7, 2020) of the expanded testing. Appendix B sets out the landscape of populations and settings for testing that will be considered and incorporated into the testing plan as it advances. The testing plan is an evolving plan, and more information will be provided as the approach is continuously refined and adjusted.

The testing plan also indicates that the government will release a renewed strategy to support public health units with case management and contact tracing, including launching a new exposure notification app that will alert Ontarians when they may have been exposed to COVID-19 and recommend appropriate actions, such as monitoring for symptoms, self-isolation and/or appropriate next steps on getting tested.

Additionally, Ontario has introduced or proposed new legislative and regulatory changes over the past two weeks:

On May 26, 2020, the Ministry of Health proposed a regulation that would amend O. Reg. 329/04 (General) (PHIPA Regulation) under the Personal Health Information Protection Act (PHIPA) to, among other things, introduce new provisions to enable the proclamation of Part V.1 of PHIPA (Electronic Health Record). Ontario Health has been identified as the prescribed organization for the development and maintenance of the provincial Electronic Health Record. While not directly in response to COVID-19, this move towards proclaiming Part V.1, enacted in 2016, is notable as the health care system continues to develop alongside the pandemic.

On May 30, 2020, the government made amendments (O. Reg. 242/20) to O. Reg. 166/11 under the Retirement Homes Act, 2010, enabling the Retirement Homes Regulatory Authority (RHRA) to provide more support to seniors living in retirement homes during the COVID-19 outbreak. The amendments increase the emergency payment the RHRA can pay to eligible retirement home residents from $2,000 to $3,500. In the event of an emergency, such as an outbreak, this funding can be used to support residents to cover costs for transportation, alternative accommodation or temporary care. The amendments also require retirement homes to report infectious disease outbreaks to the RHRA during COVID-19 and beyond.

Prince Edward Island

On May 21, 2020, Prince Edward Island's Chief Public Health Officer issued a Public Health Order revokes and replaces the previous order issued on May 15th.

On May 28, 2020, the government announced that it will move to further relax restrictions within the province as Phase 3 of the Renew PEI Together plan begins on June 1, 2020. Phase 3 includes continuing to increase non-urgent health services.

Quebec

The public health emergency in Quebec has been renewed by orders issued on May 20, 2020 and May 27, 2020 (until June 3, 2020).

On May 20, 2020, the Government of Quebec announced that private health clinics (including dental care, physiotherapy, psychology, optometry and others) may open starting June 1, 2020 as long as they have a door with direct access to outside.[3] The government's May 27, 2020 order (described below) implements this announcement.

On May 22, 2020, the Minister of Health and Social Services issued an order, adding to her April 15, 2020 order (described in our previous bulletin):

  • allowing the president, or in the president's absence, the executive director or the secretary, of the Ordre des infirmières du Québec (Nurses) to issue a special public health emergency student authorization to students who have reached a minimum level of education prescribed in the order;
  • allowing the president, or in the president's absence, the executive director or the secretary, of the Ordre des inhalothérapeutes du Québec (Respiratory Therapists) to issue a special public health emergency student authorization to a person who has completed prescribed training;
  • authorizing nursing assistants and medical technologists to perform COVID-19 screening tests without a prescription;
  • authorizing midwives to perform COVID-19 screening tests;
  • authorizing midwives to prescribe, perform and interpret a glycated hemoglobin test in relation to a mother and to prescribe and perform analyses necessary for preeclampsia screening; and
  • authorizing midwives, in the practice of the profession, to prescribe or administer medications such as vancomycin, azithromycin, valacyclovir and domperidone under certain circumstances.

On May 25, 2020, the Ministry of Labor, Employment and Social Solidarity and the CNESST announced (in French only) the immediate deployment of 1000 prevention officers from several departments and agencies. The teams will educate employers and workers on workplace health standards put in place to reduce and control the spread of COVID-19.

On May 27, 2020, the government issued an order that, among other things:

  • provides educational support services for students receiving services from rehabilitation centres for young persons and disabled students; and
  • lifts the suspension of activities applicable to private health consulting rooms or offices, for professional services and other therapeutic care enterprises, whether physical, psychological or social, not exempt by previous orders.

Also on May 27, 2020, the government announced (in French only) a campaign to promote positions and jobs in the CHSLD (long-term care homes) sector, hoping to hire 10,000 workers.

Saskatchewan

On May 19, 2020, Saskatchewan's re-opening of the health system began, resuming some health services in varying parts of the province including certain everyday services such as outpatient physiotherapy, kidney health services, some laboratory services, home care and expanded immunizations. A pause on non-urgent and elective surgeries remains in effect.

On May 20, 2020 the Chief Medical Health Officer issued a new public health order, restricting travel to the Northwest Region of the province (with exceptions including travelling for medical treatment and persons delivering critical public services and allowable business services).

On May 20, 2020, the Government of Saskatchewan lifted supply limits on prescription drugs that were introduced (initially on March 18) to guard against drug shortages, with the limited exception of specific drugs that remain in short supply.

On May 25, 2020, the government announced the availability of voluntary testing for anyone working outside the home or returning to work.

On May 26, 2020, the Ministry of Health, the Saskatchewan Health Authority, health sector unions and the Health Sciences Association of Saskatchewan, issued a Joint Statement on Principles for Protecting the Health and Safety of Healthcare Workers, Patients, Clients, and Residents.

On May 28, 2020, the government announced that the Provincial State of Emergency had been extended for two weeks. Also on May 28, 2020, the government announced additional respite funding for caregivers of people with intellectual disabilities during the pandemic.

A number of new and updated resources for health care providers have been made available.

Yukon

On May 29, 2020, the Government of Yukon announced that the territory is on track to begin Phase II of its reopening plan on July 1, 2020 if conditions continue trending positively. The government indicated that decisions about how and when to move through each phase of the reopening plan continue to be guided by careful risk assessments and six "criteria for transitioning between phases" including community engagement and public health capacity, such as the capacity to contact trace and maintain fast testing turnaround time.[4]

Footnotes

1 This bulletin addresses updates published up to 5:00 pm (EST) on May 31, 2020.

2 However, on May 27, 2020, the government announced that the Campbellton region is transitioning back to the first level of the recovery plan immediately. In only the Campbellton region, non-regulated health professionals and businesses such as acupuncturists and naturopaths cannot operate at this time. All other zones in New Brunswick are still currently transitioning to the second level.

3 Information about the re-opening of private health care is available under "Private health care, body and beauty care services (Starting from June 1, 2020)" at https://www.quebec.ca/en/health/health-issues/a-z/2019-coronavirus/reopening-maintaining-economic-activities-covid-19/.

4 Thank you to articling students Marissa Di Lorenzo and Rob Legge, and to summer law students Katerina Ignatova, Rachel Hung and Gordon Lee for their research assistance.

Originally published June 2, 2020.

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