By Laura Keil
This week’s COVID-19 question is: What is the history of lockdowns and mandates in Canada during epidemics?
We found a great resource on the subject in the book “This is Public Health: A Canadian History” by Christopher Rutty, PhD and Sue Sullivan, published in 2010, which is freely available online and makes for a fascinating read (tinyurl.com/28fz77pu). We’ve put together an abridged timeline of epidemic responses covered in the book as well as information on more recent epidemics. Quotations not otherwise attributed come from this book.
1710 – Efforts to inspect ships carrying immigrants into the Port of Quebec became more organized in 1710, including a quarantine act in 1721, due to fears of the Black plague spreading from Europe.
1720s – It’s discovered that smallpox can be prevented through arm-to-arm inoculation (this practice had been known in Asia centuries earlier). The first vaccine in England wasn’t created until 1796.
1830s – Pandemic cholera spread across Britain and Europe and immigrants brought it to Quebec. Soldiers were dispatched to Grosse Isle, an island 50km east of Quebec City, to build a quarantine station for inspecting and cleansing the arriving immigrants. “The quarantine station was quickly overwhelmed, while apparently healthy but infectious immigrants passed through and the human wastes from the succession of arriving ships infected the St. Lawrence River. Cholera spread to Montreal and Upper Canada in June and by the time the epidemic had passed, cholera had killed about 2,300 people or 10% of the population in Quebec City and 4,000 or almost 15% of the population in Montreal.” In anticipation of its spread, the governments in the Maritimes strengthened quarantine provisions, cleaned up the cities and towns especially poorer neighbourhoods and established local boards of health. Another cholera outbreak occurred in Upper Canada in 1834 despite quarantine regulations and clean-up efforts.
1847 – 100,000 Irish emigrants fleeing famine fell victim to typhus on their way to North America. 6,100 died on route, 5424 died at Grosse Isle and thousands more died in Quebec City, Montreal, New Brunswick and Upper Canada.
Early 1860s – compulsory vaccination measures were introduced in the United Canadas and Prince Edward Island to combat smallpox. The Hudson’s Bay Company launched a vaccination campaign that kept the disease under some control among some Indigenous communities, although many Indigenous nations were decimated by smallpox during the gold rush. The government mandated the rapid burial of deceased victims of infectious diseases, despite a public outcry. But legislation requiring inspection of food and drink by a qualified chemist to identify adulteration was shelved.
1870s – Smallpox outbreak in Montreal. Many working families lived in crowded, unsanitary and poorly built housing. A Citizens Public Health Association was established to increase knowledge of public health, creating awareness of “sanitary evils” and promoting sanitary legislation.
1875 – Quebec adopted compulsory smallpox vaccination, despite strong opposition, and gave Montreal’s health officer much more power.
1883 – A “portable isolation hospital” was put on display at the Toronto Industrial Exhibition. It was hoped municipalities would invest in such inexpensive systems to mitigate the spread of infectious disease.
1880s – Ontario, Nova Scotia, Manitoba, New Brunwick set up provincial boards of health and passed Public Health Acts.
1884 – Smallpox epidemic struck eastern Ontario. The Provincial Board of Health ordered schools and churches to close, banned public gatherings and suspended stagecoach services into the community. Constables were posted on the roads and railway stations to control the movement of anyone who might be sick. Medical students conducted house-to-house vaccinations, disinfected and fumigated all homes and issued a pamphlet that attacked the anti-vaccination views of a local practitioner. The region saw 202 cases and 45 deaths, but they managed to keep it from spreading outside the region.
1885 – Two Pullman-car conductors infected with smallpox arrived in Montreal. Smallpox spread quickly and public health officials tried to enforce vaccination and isolation of the sick but were met with resistance. Some were assaulted as they tried to remove corpses from the worst-infected neighbourhoods. Police were called in to disperse angry mobs that roamed the streets.
“During this era, French Canadians were generally more suspicious of vaccination than English Canadians, although anti-vaccination sentiment could be found across the country. French Quebeckers associated vaccination with British surgeons … Homeopathic advocates called the vaccinators charlatans and many among the poor saw a conspiracy of the rich and powerful trying to kill their children.”
Ontario took the extraordinary action of extending its authority across provincial lines, by deploying medical inspectors to Quebec to ensure all persons and freight boarding trains to Ontario were free of smallpox infection, through inspection, vaccination and fumigation. The strategy was remarkably effective, limiting smallpox deaths in Ontario to 30 in 1885, compared to 5,964 in Quebec.
1886-87 – Quebec passed a public health act and established a provincial board of health. Canada also passed a law requiring all passengers and crews of arriving ships to show evidence of smallpox vaccination or submit to vaccination upon their arrival in Canada.
Early 20th century – police powers of local public health services were widely used. Ex. public health officials could get warrants to enter private homes and seize children who were, or thought to be, contacts of contagious diseases such as diphtheria and typhoid. As a result, public health acquired an image of heavy-handed authoritarianism.
1909-10 – Polio first appears in Canada. Its cause was unknown and people weren’t sure at first whether or not it was contagious. Toronto isolated patients in a room. Only Ontario and BC made polio a reportable disease by 1911, but a survey of physicians showed 658 cases and 46 deaths between Nov 1909 and Oct 1910.
1911 – typhoid cases hit Ottawa, leaving 987 sick and 83 dead between January and March. The cause was sewage-contaminated drinking water but no action was taken and another outbreak sickened 1378 people and killed 91 by the following July. The feds imposed a $100/day fine on Ottawa until they fixed the water supply. Unpasteurized milk was another growing source of typhoid in the 1910s leading to amendments to the Public Health Act and creation of the Milk Act.
1910-1919 – Public Health science evolved and customs like the “common drinking cup” once a mainstay of parks, schools and railways stations, were banned as unhygienic. Science had also revealed the dangers of kissing, showing how TB and diphtheria-causing microbes swarmed on lips—especially bearded lips.
1915 – Some 29 per cent of Canadian troops were infected by venereal diseases. The Canadian Medical Association Journal estimated that 50-60 per cent of adults would have gonorrhea at some time in their lives.The Public Health Journal proposed that this public health threat could be prevented through “sex hygiene education” targeting school children. Ontario’s legislation gave public health the power to detain women suspected of having venereal disease and force them to seek medical treatment through provincially-funded hospitals.
1916 – A polio outbreak in the north eastern United States causes 27,000 cases and 6,000 deaths. Cases made it to Windsor, but they enacted strict quarantine measures, including preventing people from going to work. The government was forced to feed all quarantined families, which cost a huge sum.
1917 – The “Spanish” Influenza likely originated from China, and spread quickly during WW2. It swept across Canada in 1918. At least 1/6th of the Canadian population, predominantly young adults, became ill, and 50,000 died. Some Haida villages were completely wiped out.
With little understanding of its viral cause, the severity of the flu epidemic was not recognized until too late, when major outbreaks had occurred in most parts of the country. Many health workers fell ill. There was little that could be done to prevent, control or treat the disease, despite some efforts to use surgical masks in the community.
Torontonians were advised to “secure proper nourishment, proper rest and sufficient exercise as a preventive measure.” An article from Ryerson University says Eaton’s and other stores advertised sensational cure-alls. “People tied mothballs around their necks to ward off disease. The sick were treated with lard, tree resins, and mustard among other ‘home-made’ remedies. Doctors used baking soda, milk, and heroin for their patients. Some people refused to wear masks, provoking anger from those who did.”
1919 – Conference setting into motion the creation of a federal department of health.
1922 – 52 venereal disease clinics were established in every province except Prince Edward Island, providing free, compulsory treatment. Physicians were required to report confirmed cases but carelessness or ignorance of the provincial reporting regulations limited this. The legal community became concerned about the “tremendous power” given to medical officers of health. A 1922 article by Toronto’s assistant crown attorney put it this way: “What was intended to be treated as a disease is treated as a crime.”
1920s – Persistent outbreaks of typhoid and smallpox. Anti-vaccination sentiments were often reinforced when physicians improperly stored or administered vaccines. When a smallpox outbreak in Toronto resulted in 33 deaths, the city hesitated to make vaccinations mandatory. As a result, the United States required proof of recent smallpox vaccination in order to cross the border, and similar quarantine restrictions were imposed on anyone from Toronto entering Manitoba and Quebec.
1923-1924 – A severe smallpox outbreak in Windsor led to a mortality rate of 71 per cent among the unvaccinated. No one who had been vaccinated over the previous 12 years contracted the disease and no one who had ever been vaccinated died in Windsor, leading local health officials to conclude that “the value of vaccination as a means of prevention has been proven as never before.”
1923 – Typhoid epidemic in Cochrane, Ontario caused by contaminated water (50 deaths).
1927 – Typhoid epidemic in Montreal, caused by contaminated milk (533 deaths).
1927 – Canada becomes a global leader in the production and testing of diphtheria toxoid and shows the value of a non-living vaccine. The toxoid was effective and diphtheria declined dramatically in Canada and elsewhere.
1920s – Immunization campaigns take root across the country to get more people vaccinated against diphtheria, typhoid, and smallpox.
1920s – Polio increases in prevalence. Widely known as “infantile paralysis” it did not just strike infants. No one could predict which cases would prove mild and which would result in disability or death. Alberta closed schools, ordered quarantines and placed restrictions on public gatherings and travel for children. Manitoba rejected school closures in favour of public education emphasizing the early use of convalescent serum in treating polio and engaged newspapers and radio to prevent public panic. Ontario took a similar approach to Manitoba.
1938 – Ontario orders compulsory pasteurization of milk and milk products (there had been 688 deaths due to contaminated milk since 1912)
1920s & 30s – Tuberculosis ran rampant among Indigenous people and threatened to spread to the non-Indigenous population. Due to abysmal federal health care for First Nations, the mortality rate was 10-20 times the national average depending on the region. While provincial governments offered to provide better health services to reserves, the federal government rejected the idea.
1932 – Smallpox outbreak in Vancouver (56 cases and 17 deaths). Many residents were unvaccinated.
1930s – Polio epidemic spreads. In 1937 there were an “alarming number” of the most severe form of the disease where the virus attacked the brainstems’ motor neurons. Without an iron lung respirator, the patient usually died. The Hospital for Sick Children in Toronto quickly assembled 27 iron lungs in the basement of the hospital and shipped them to where they were needed. Ontario piloted a nasal spray solution to counter polio, but stopped the testing after children lost their sense of smell and the solution didn’t appear to work.
1943 – Health education, treatment, contact tracing, condoms and prophylactic packages reduced the incidence of venereal disease among returning soldiers. Federal health grants allowed provinces to give free antibiotic treatments leading to a 72 per cent drop in syphilis rates and 36 per cent drop in gonorrhoea between 1944 and 1951.
1940s – Immunization efforts were hampered by apathy and complacency among parents and many in the medical profession. Lapses in diphtheria immunization for preschoolers and limited uptake among medical staff fuelled persistent diphtheria cases in Canada.
1946 – Virulent smallpox outbreak in Seattle prompts B.C.’s provincial officer of health to urge all citizens to get vaccinated. The public responded, and vaccines were rushed to vaccination clinics that were open for 12 to 14 hours a day to accommodate the steady lines of people. Later the vaccine was available elsewhere in the province and soon proof of vaccination was required to cross the Canada-United States border. 300,000 people were vaccinated in the Vancouver and coastal areas and no significant smallpox complications were reported.
1947 – Polio outbreak among Inuit population on the western coast of Hudson’s Bay. A 40,000 square mile regional quarantine was imposed. Around the same time, an influenza outbreak killed 18 people near Cambridge Bay. Very few of the non-Inuit living in the area were affected as badly. There were efforts to identify the strains responsible for the outbreaks and officials saw a need to immunize the Inuit as well as non-indigenous entering their territory.
1950-1959 – Infectious diseases decline thanks to immunization programs and wide use of antibiotic drugs.
1953 – Polio crisis peaks in Canada. Nearly 9,000 cases that year and 500 deaths. The Royal Canadian Air Force was enlisted to make emergency deliveries of iron lungs across the country. At the peak of Winnipeg’s polio crisis, 92 cases required respirators at the same time. This situation was repeated on a smaller scale across Canada and the Health Minister declared a national emergency. Polio vaccine trials began the following year in the U.S.
1954 – The Salk polio vaccine is approved for use in Canada. Despite this, polio outbreaks continued from 1958 to 1960, prompting more aggressive polio immunization campaigns across the country.
1960s – Patchy immunization frustrates public health authorities. A 1961 survey in Victoria, B.C. found that only 31% of all adults had been vaccinated. Most said they believed “that polio is a child’s disease and that vaccine is available only to those under 40.” In addition to being misinformed, it appeared the public had lost its fear of polio. Tuberculosis was far more persistent than polio in Canada, however. In 1965, there was a 5.6% increase in newly active cases and an 11.4% increase in the number of new cases reported in children under 10. The high rate of TB infection among Indigenous people had left “the Indian population as a whole with reservoirs of quiescent or inactive disease ready to blossom with the first sign of lowered resistance.”
1965 – Provincial vaccine programs had reduced the incidence of paralytic polio in Canada to zero.
1974-1975 Measles outbreaks in Calgary and Saskatoon were fuelled by low vaccination levels. The Canadian Journal of Public Health called for “a much more vigorous campaign … so that parents once again realize that measles can be a dangerous disease” and that vaccination could eliminate it.
1976 – A new strain of Influenza A virus (swine flu) caused an outbreak among 273 army personnel in New Jersey. U.S. and Canada launched flu vaccine programs, but there was a dispute about the safety of the vaccines (a link now called into doubt) and the campaign was shelved.
1980s – New highly purified vaccines were created targeting meningitis, hepatitis, typhoid, cholera and malaria.
1980s & 90s – The AIDS epidemic claimed many lives around the globe. Money was pledged towards research, safe sex education and awareness.
1979 – Canada contributed to an international immunization program against all vaccine-preventable disease in developing Commonweath and Francophone nations. An estimated 5 million deaths and 10 million disabilities occurred each year among children due to diphtheria, pertussis, tetanus, polio, measles and tuberculosis.
2000 – E coli in Walkerton, Ontario (7 deaths, 2,500 cases, some with permanent damage to liver or kidneys). Contaminated groundwater had not been properly tested, water-testing facilities had been outsourced to the private sector.
2001 – Cryptosporidium outbreak occurred in North Battleford, SK. Many (5,800–7,100) people became ill due to the event. The outbreak had some possible causes: inadequate facility planning, antiquated technology, ineffective management, and communication.
2003 – Severe Acute Respiratory Syndome (SARS) caused more than 400 probable cases and 44 deaths in Toronto. SARS spread through the Scarborough Hospital and led to the closure of its emergency and intensive care services. Anyone who entered the hospital after March 16, was asked to quarantine for 10 days at home. The government named SARS a reportable, communicable and virulent disease which allowed it to track infected people and issue orders. A provincial emergency was called. Long-term care created SARS units to care for patients and all hospitals in the GTA activated Code Orange emergency plans ie) suspended non-essential services. They were required to limit visitors, create isolation units and provide protective gear for staff. The outbreak led to serious economic impact to the city when the WHO issued a travel advisory warning people of the risk of travel to Toronto. It’s estimated that SARS cost the city $35M a day. Microbiologists discovered that SARS was due to a coronavirus transmitted mainly by droplet spread at close quarters.
2009 – From April to December, influenza A (H1N1), otherwise known as swine flu, hit Canada. The virus began in North America and became a global pandemic. It was more severe than the typical seasonal flu. 428 Canadians died.