Canada’s COVID-19 response vs. the U.S.: Testing, universal health care and maybe a little luck

Mar 13, 2020

The Buffalo-Niagara region is home to the busiest land border crossings between the U.S. and Canada. With no current travel restrictions in place amid the COVID-19 pandemic, WBFO’s Kyle Mackie reports on precautions at the border and the atmosphere on either side.


Bridget Carroll is a college student from East Aurora in her final year at The University of Toronto. She said she crosses the border between Canada and the U.S. about once a month, usually on the bus.

The Buffalo-Niagara region is home to the busiest land border crossings between the U.S. and Canada, such as the Peace Bridge in Buffalo.
Credit Nick Amoscato/Flickr (CC BY 2.0)

“So, you know when you’re in the car and they have the little kiosks? For the bus, you kind of pull off to the side and everybody has to go in and wait in line,” Carroll said. Passengers put their bags through a scanner, customs officers ask a few questions, and once everyone gets through, they get back on the bus.

Something new happened about a week and a half ago: A U.S. border agent boarded the bus and asked if anyone had traveled to China recently.

“There was a family who had traveled to China,” Carroll said, “so they actually had to get off the bus and go through a separate screening.”

Carroll said the family eventually came back on the bus and was allowed to continue into the U.S. However, some travelers from Canada are being turned away at the border. CBC Radio Canada reported last week that at least 70 Canadian citizens and 47 permanent residents have been refused entry to the U.S. because of recent travel to countries affected by the novel coronavirus. But it’s actually Canada that’s doing a better job of restricting new cases of the virus to those related to travel, according to Dr. Anna Banerji. 

“Right now, it’s not freely being transmitted among the general population,” said Banerji, a pediatric infectious disease specialist who moved to Toronto in 2003 to help battle SARS. “There is very little local transmission. So, it’s not the same scenario versus other parts of the United States, where there are becoming outbreaks.”

As of Thursday, the Province of Ontario had 59 confirmed cases of COVID-19, the disease caused by the new virus. There were no confirmed cases in the eight counties of Western New York but 325 total cases in New York State. And Banerji said Canadians may have some advantages over Americans as both regions brace for inevitable new cases.

“Because we [Canadians] have universal health care, it’s easier for people to access testing and treatment, confinement, etc., than it is in the states.”

Banerji also said Canada learned a hard lesson from its last epidemic, which killed 44 people in and around Toronto.

“Because of SARS, we really ramped up our public health policy and had in place influenza or other virus policies in case there’s an outbreak, ‘What would we do?’”

Dr. Allison McGeer, director of infection control at the Sinai Health System in Toronto, agreed that Canada learned from SARS and remains ahead of the U.S. in testing capacity for COVID-19. But she said it’s also possible that Canada got a little lucky.

Cars line up to enter the U.S. at an inspection plaza on Buffalo's Peace Bridge.
Credit Chris Caya/WBFO News

“I lived through SARS in Toronto and at the beginning of SARS in Toronto, we were very unlucky. So, it’s kind of nice that Toronto’s not the unlucky place this time,” McGeer said. “I think the differences in between the U.S. and Canada are probably chance alone, and it’s important for all of us to recognize that this is not a disease that we can control with public health measures.”

Anything we do now, she said—like canceling large gatherings as New York State has done—will only slow the spread of the virus, not stop it. But Canada did respond in one way that surprised McGeer: The federal government fast-tracked $27 million in emergency research funding to better understand and control COVID-19. Researchers got just 10 days to apply and recipients were announced another 10 days later.

“I didn’t think it was humanly possible for them to have done that, but they did,” said McGeer, who is now part of a nationwide team working on questions like how long people with COVID-19 are infectious and how much the virus can be detected in the environment and air around a patient.

Ontario is also setting up six specific screening centers at hospitals around the province, which Banerji said can help protect regular patients and medical workers from exposure. A coordinated effort like that might not be so easy in the U.S.

“There’s not one answer in the United States, there’s a bunch of answers because we have different health care payment products,” said Dr. Anthony Billittier, chief medical officer at the insurance company Independent Health and former Erie County health commissioner. “There’s often a different answer for Medicare and Medicaid and commercial paylines.”

Billittier added that the U.S. has complex legal and regulatory systems in place that make government directives like waiving co-pays difficult.

“That’s in part what we’ve been spending our time on, trying to figure that out in a field that’s essentially presenting us with moving targets because the rules are changing all the time.”

Back at the Buffalo-Niagara border crossings, a U.S. Customs and Border Protection (CBP) spokesperson said agents are encouraged to refer travelers to the Centers for Disease Control and Prevention (CDC) for “enhanced health screening” if they display symptoms of COVID-19. CBP referred a total of 766 people from all of its land ports of entry between Feb. 2 and March 4 but did not confirm whether those individuals were denied entry to the U.S.

Of the total 63,743 travelers CBP referred to the CDC during the same period at air, land and sea ports of entry, the agency said referred individuals were most commonly citizens of the U.S., China, Canada, Vietnam and India.

The statement WBFO received from CBP read, in part:

“Due to privacy laws, U.S. Customs and Border Protection (CBP) is prohibited from discussing specific cases. However, all CBP ports of entry are following the same operational guidance as issued by the Presidential Proclamations and the Department of Homeland Security… CDC personnel are responsible for the enhanced health screening of travelers in all locations. CBP is working with the CDC to identify arriving travelers who have been in mainland China or Iran within the previous 14 days, as they require enhanced health screening. Those travelers are identified by CBP officers during their primary inspection and are referred for secondary screening where CDC personnel conduct the enhanced health screening. CDC makes any determination from there as to whether any additional measures must be taken.”

WBFO contacted the Department of Homeland Security for more information and was referred back to CBP. Additionally, the CDC did not respond to specific questions about “enhanced health screening” at local border crossings.

The Canada Border Services Agency (CBSA) said it expanded enhanced screening measures from airports to all land, rail and ferry ports of entry on March 6. The efforts include additional signage, health screening questions, providing travelers of concern with a mask kit, and providing instructions for self-isolation to travelers who have been present in the Province of Hubei, China, or Iran in the prior 14 days. CBSA is also helping the Public Health Agency of Canada track people who have been identified as a potential concern and asked to self-isolate.

Both the U.S. and Canadian border agencies said they are working to protect the safety of their employees, but the president of Canada’s Customs and Immigration Union said Thursday that CBSA isn’t doing enough as COVID-19 continues to spread across the U.S.

So, should anyone travel between Buffalo and Toronto? Experts say that’s up to your level of risk tolerance.

“For this week, in northern New York State and Southern Ontario, there’s probably no need to restrict what you’re doing, but you need to look at it on a week-by-week basis,” McGeer said.

Banerji weighed in more cautiously.

“I would think twice about non-essential travel, like for a hockey game or a concert, because it is spreading.”

Indeed, the new virus is spreading even to the home of Canadian Prime Minister Justin Trudeau, who as of press time is in self quarantine with his wife, Sophie Grégoire Trudeau, who tested positive for COVID-19 on Thursday following a speaking engagement in the United Kingdom. Reports have also confirmed that President Trump dined with a Brazilian government official last weekend who has since tested positive for the new virus.