COVID-19: Public Health Recommendations That Must Be Applied to the Reception of Temporary Foreign Workers (TFWs) to Support Agri-Food Activities in Québec in the Context of the COVID-19 Pandemic
In recent weeks, several public health directives have been issued by provincial and federal authorities to protect the general population and workers from infection with SARS-CoV-2. Thus, to limit the spread of COVID-19, Canada has implemented travel restrictions. In addition, Québec has progressively issued other directives to promote social distancing, such as the closure of public places and businesses, a ban on gatherings, and a 14-day isolation period for all persons arriving from outside Canada since March 12, 2020.
In order to safeguard the food supply, the federal government has nevertheless authorized the entry of temporary foreign workers (TFWs) into Canada on condition that the protocol for their reception be validated by public health authorities. Consequently, the Institut national de santé publique du Québec was mandated to form an expert group tasked with formulating recommendations to respond to this issue.
This document comprises the public health recommendations that must be applied to the reception of TFWs in the context of the current pandemic1. It includes public health recommendations aimed at 1) protecting the health of TFWs and those who will come in direct contact with them, including other workers, 2) protecting the general population of Québec, and 3) remaining consistent with public health measures in effect in Québec at the time of writing of this document.
At the request of partners, the expert group considered the advantages and disadvantages of allowing TFWs to begin working immediately upon arrival. The group concluded that this solution is inadequate for the reasons presented below and that isolation without work is necessary.
The grounds for imposing isolation without work for a period of 14 days are as follows:
- Symptoms of COVID-19 appear within 14 days;
- Failure to respect isolation (i.e., allowing work upon arrival) would result in close contact between the TFWs, those responsible for them and the local workforce, increasing the risk of transmission of COVID-19;
- In the event that a TFW works during their 14-day isolation period and becomes a suspected or positive case of COVID-19 during this period, any person who has been in close contact with the TFW will be required to initiate a mandatory 14-day period of self-isolation, which would postpone that person's full-time work and would also affect others who have been in close contact with the latter (TFWs, those responsible for them and local workers, possibly along with their families and loved ones), including TFWs who arrived earlier. This would intensify the period of labour shortages;
- The 14-day isolation period, with active monitoring for signs and symptoms, is the only option that allows for rapid response in the event that a COVID-19 case or an outbreak is identified among TFWs arriving in Canada.
The public health recommendations in this document were formulated using the best available information and the best public health practices in the context of a health emergency. SARS-CoV-2 is liable to spread steadily and rapidly in the population and there is currently no vaccine or specific treatment for COVID-19. Current knowledge about SARS-CoV-2 is sufficient at this time to issue these recommendations, but changes could be made as knowledge evolves. Adjustments could also be considered at the request of stakeholders, but they would have to be approved by Québec’s public health authorities.
In addition, the recommendations presented in this document are based on the following information:
- For several years, due to a lack of local labour, the Canadian and Québec governments have been allowing employers to use TFWs to support Québec's agri-food production;
- According to available information, between 10 000 and 16 000 TFWs are expected in Québec in the coming weeks;
- According to the same information, the majority of these TFWs come from Guatemala and Mexico.
Finally, it is important to mention that the expert group's recommendations presented in this document must be applied when TFWs come under Québec jurisdiction, whereas their recommendations are strongly suggested when TFWs come under another jurisdiction (e.g., federal).
Public health recommendations have been formulated for and must be applied to each stage of TFW reception
Preparation of TFWs prior to departure from the country of origin, preparation of employers and other concerned authorities prior to departure of TFWs from their country of origin, air transportation of TFWs, arrival of TFWs at Montréal-Trudeau International Airport and assisting with migration and customs procedures, taking charge of TFWs exiting from the airport and travel to accommodation, accommodation for the period of isolation and instructions for employers and workers, accommodation and instructions for employers and workers for the work period following isolation, return of workers to their country at the end of the work period.
However, two public health recommendations from the ministère de la Santé et des Services sociaux du Québec (Québec’s department of health and social services) (Gouvernement du Québec, 2020a) must be applied at all stages of TFW reception. These are the health recommendations for everyone and the directive to maintain a minimum distance between individuals required in various situations (public places, means of transportation, private residences, workplaces and outdoor gatherings).
The health recommendations for everyone are as follows:
- Frequent washing of hands with warm running water and soap for at least 20 seconds.
- Use of an alcohol-based disinfectant if there is no access to soap and water.
- If a tissue is used, it should be discarded as soon as possible and the user should wash their hands afterwards.
- Avoidance of direct contact greetings, such as handshakes.
- If a person is ill, they must avoid contact with those who are more vulnerable, including the elderly and the chronically ill. For example, they must not visit persons in hospitals, long-term care facilities or private seniors’ residences.
The directive to maintain a minimum distance between individuals in various situations is as follows:
- A minimum distance of two metres shall be maintained between all persons.
- This applies to public places, means of transportation, private residences, workplaces and outdoor gatherings.
Preparation of TFWs prior to departure from the country of origin
The recommendations are:
- Inform each TFW about COVID-19, about the risk factors related to the epidemiological situation of COVID 19 in Québec and about the working conditions, the health recommendations for everyone and the minimum distance directive (a minimum of two metres between persons) that will be imposed on them in Québec upon their arrival and during their stay. Ideally, a document written in Spanish or in a language understood by each worker should be provided and explained to each worker and a signature affirming that the information has been transmitted and understood should be obtained. Cases of functional illiteracy should be taken into account.
- Record specific information about each TFW (age, health conditions, information about their exposure to COVID-19 cases in recent weeks, their means of transportation to the airport, their accommodation conditions before boarding in their home cities and when regrouping at the airport).
- Ensure that airlines monitor passengers for COVID-19 symptoms before they board (taking temperatures and checking for symptoms of a cough, fever and respiratory difficulties (e.g., shortness of breath)) as recommended by the federal government (Government of Canada, 2020a).
- Have an industry contact person on hand to record the monitoring information about the TFWs.
- Workers presenting any of these symptoms (including a fever of 38 degrees Celsius or higher) may not take the plane, as recommended by the Government of Canada (Government of Canada, 2020a). This withdrawal and the reasons for it must be indicated in the documented information about the TFW. This documentation should be made available to public health authorities on arrival upon request.
Preparation of employers and other concerned authorities prior to the departure of TFWs from their country of origin
Instructions for employers
It is recommended that:
- Each employer prepare accommodations for the isolation period as described below:
- Must provide a clean and safe environment where the health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) are respected.
- May be on the farm or in buildings in the region where work will be carried out.
- Must accommodate a maximum of two persons per room with one bed per person. The employer may decide to accommodate one person per room, but will need to consider the psychosocial needs of TFWs.
- Must have common areas (bathroom, kitchen, dining room, etc.) that enable the health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) to be respected. Ideally, the common areas would be used on a rotating basis by TFWs from one room at a time.
- Must enable waste to be managed in a manner that ensures the protection of TFWs and those responsible for collection.
- Must have soap and other products for cleaning and disinfecting hands and the environment.
- All rooms (bedrooms and common areas) must be disinfected a minimum of once daily. Disinfection can be performed with the usual disinfectant products in accordance with the manufacturer's instructions. Ideally, bathroom facilities should be disinfected twice daily, dining areas after each meal, and frequently touched surfaces (light switches, door handles, etc.) twice daily.
- All rooms must have the health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) posted in Spanish.
- No pets are allowed.
- Must allow TFWs to go outdoors while respecting the health recommendations for everyone and the minimum distance directive.
- Must have a sufficient number of isolation units, based on the number of TFWs involved, to allow for individual isolation of a TFW as soon as COVID-19 is suspected. These units must allow for required care to be provided to the TFW. The employer must plan out who will provide health care and how it will be provided and how the ill TFW(s) will be fed if they are not sick enough to be hospitalized, while taking the required precautions to protect the caregiver and others who are not ill. The mandatory isolation units for suspected cases of COVID-19 and the isolation conditions must comply with the recommendations presented in the INSPQ publication entitled Mesures pour la gestion des cas et des contacts dans la communauté : recommandations intérimaires (INSPQ, 2020) (in French only). These recommendations are: single-occupancy room (must sleep alone in a bed); a dedicated bathroom if possible or disinfected after each use; the patient must limit contact with other members of the dwelling place; the patient must not occupy the same room as other members of the dwelling place or, if it is impossible to arrange this, must maintain a distance of two metres from others or wear a procedural mask (or cover their nose and mouth with a clean cloth or tissue); the patient's mask must be changed regularly (if damp); where possible, common areas shared with the patient, such as the kitchen or bathroom, should be well ventilated, including by opening windows; ideally, only those contacts already exposed to the patient in the dwelling place and those essential to care shall remain in the dwelling place.
- Ideally, these accommodations should be inspected by inspectors prior to the arrival of TFWs to ensure compliance with the requirements for a 14-day isolation period.
- Each employer ensure that the following elements are taken care of for each TFW during the isolation period and in the event of further isolation if the TFW becomes ill from COVID-19:
- Food, basic needs (e.g., washing and drying of clothing, bedding and towels, provision of hygiene products and, if necessary, of personal medication), supportive assistance, means of communication and regular communication with other TFWs and with their families, psychosocial support. All of these elements must be taken care of without TFWs having to leave their accommodations.
- Non-sharing of objects.
- The availability and accessibility of communication in Spanish at all times among TFWs and with the employer or other persons responsible for their stay.
- Each employer ensure the following during the isolation period and in the event of further isolation if the TFW becomes ill from COVID-19:
- Identify the persons who ensure ongoing contact with TFWs during the 14-day isolation period. These persons must not present any specific risk factors for COVID-19 (e.g., 70 years of age and over, close contact with persons in isolation, presence of the following chronic diseases: immunosuppression, chronic cardiac and pulmonary diseases, cancer and diabetes (INESSS, 2020; Gouvernement du Québec, 2020b). These persons must be trained/informed about the context, their role and preventive measures.
- Each employer ensure they:
- Inform local health authorities (e.g., public health authorities, primary care services, first responders (ambulance attendants), emergency rooms, hospitals, Commission des normes, de l’équité, de la santé et de la sécurité du travail (Québec’s commission on labour standards, pay equity and occupational health and safety)) of the arrival of TFWs to ensure the availability of services, including translation and attended transfer to hospital if necessary.
- Formulate an intervention plan to be enacted if a case of COVID-19 or an outbreak is identified during the isolation period and during the work period. This plan must include measures to (1) ensure access to evaluation and screening resources while isolating and caring for the ill TFW, (2) take charge of persons considered to have been in close contact with the ill TFW, (3) replace the employer if the employer becomes ill, (4) communicate with health authorities, and (5) communicate with the ill TFW in Spanish. This plan must also see to the provision of the necessary personal protective equipment as required: procedural mask and disposable gloves (if there may be contact with infected bodily fluids) for both the ill TFW and for attendants.
Instructions for the concerned authorities:
It is recommended that:
- All authorities responsible for TFWs during their stay in Québec coordinate their actions and define their respective roles and responsibilities in preparation for isolations.
Air transportation of TFWs
Conditions of air travel
It is recommended to:
- Transport TFWs by charter flight only, with industry escorts who can translate instructions into Spanish or into a language understood by the TFWs.
- Know the seating location of each TFW in the aircraft.
- As far as possible, avoid filling the aircraft and respect the minimum distance directive of two metres between individuals (flight personnel and TFWs). Ideally, two passengers should occupy a row of three seats (leaving one empty seat between passengers).
- Post the health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) and ensure they are respected.
- Have procedural masks on hand to be worn by anyone who might develop symptoms on the aircraft.
Specific considerations for flight personnel regarding TFWs
It is recommended to:
- Instruct flight personnel to observe TFWs for symptoms during the flight, isolate any TFW who may be exhibiting symptoms and instruct them to wear a mask, as recommended by the Government of Canada (Government of Canada, 2020).
- Instruct flight personnel to report any individual who may have exhibited symptoms of COVID-19 to the industry contact person upon arrival.
- Instruct flight personnel to provide any person who becomes ill during the flight with a mask that covers the mouth and nose, and to ask them to wear it at all times; to the extent possible, flight personnel must isolate that person from other passengers during the trip and when disembarking.
- Instruct flight personnel to remind passengers of the health recommendations for everyone and the minimum distance directive (minimum of two metres between persons).
Arrival of TFWs at Montréal-Trudeau International Airport and assisting with migration and customs procedures
It is recommended to:
- Isolate passengers with symptoms of cough, fever or respiratory difficulties (e.g., shortness of breath) as soon as they disembark, so that they do not mix with others.
- Monitor for symptoms of COVID-19 on arrival at the airport (temperature taking and checking for symptoms of fever, cough and respiratory difficulties (e.g., shortness of breath)). Workers presenting these symptoms, as well as those who are considered to have had close contact with them, will be taken in hand by the public health authorities responsible for travellers on arrival.
- Ensure that the industry contact person records the monitoring information in the same log created prior to departure.
- Ensure that the health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) are respected.
Taking charge of TFWs exiting from the airport and travel to accommodations
Instructions concerning transportation conditions
It is recommended that:
- Each employer immediately take charge of TFWs for whom they are responsible at the airport.
- TFWs be transported in small groups to their accommodations.
- The health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) be respected in transport vehicles.
- The employer contact the COVID-19 line if there is doubt about the health status of one of their workers when taking charge of them or during travel. The numbers to dial are as follows: 514 644-4545 for the Montreal region, 418 644-4545 for the Québec City region and 1 877 644-4545 for elsewhere in Québec.
Cleaning instructions for transport vehicles
It is recommended to:
- Clean and disinfect the vehicle before and after travel, paying particular attention to the interior and exterior surfaces likely to be touched, using a disinfectant wipe.
Accommodation for the period of isolation and instructions for employers and workers
It is recommended to:
- Apply the recommendations presented in the section Preparation of employers and other concerned authorities prior to the departure of TFWs from their country of origin, as regards accommodations and instructions for employers.
- Isolate TFWs for 14 days, ensuring compliance with the health recommendations for everyone, the minimum 2-metre distance directive between individuals, and application of the Public Health Recommendations: Instructions on Returning Home from Abroad (MSSS, 2020a).
- Monitor COVID-19 symptoms daily (taking temperatures,2,3 and checking for symptoms of fever, cough, respiratory difficulties (e.g., shortness of breath)) and record this information in writing. Workers presenting these symptoms, as well as their close contacts, must be immediately isolated.
- Use this 14-day period to train workers for their future work and inform them about COVID-19 health effects and preventive measures and, if possible, about other health and safety issues.
- Ensure that psychosocial and health aspects of TFWs are respected during the isolation period. Means of communication among TFWs and with their families as well as entertainment activities (games, cards, radio, television) must be provided. Ensure that multi-user communication devices (e.g., shared cell phones) are disinfected before each use.
- Apply the following instructions if necessary: Instructions for People with COVID-19 Symptoms who Are Waiting to Either Be Tested or for a Screening Test Result (MSSS, 2020b), Instructions for People with COVID-19 in Home Isolation (MSSS, 2020c) and Instructions for People Who Have Been in Contact with a Confirmed Case of COVID-19 (MSSS, 2020d).
Accommodation and instructions for employers and workers for the work period following isolation
It is recommended that:
- The health recommendations for everyone and the minimum distance directive (minimum of two metres between persons) be respected.
- TFWs be informed on a daily basis about the current health situation, current public health instructions and the importance of monitoring their temperature and symptoms (fever, cough and respiratory difficulties (e.g., shortness of breath)). Daily verification of workers’ temperatures2 and monitoring for symptoms of fever, cough and respiratory difficulties (e.g., shortness of breath) by the employer would be the most responsible measure to take in the current circumstances. If this measure is applied, the employer must explain the rationale behind it to all workers.
- Each TFW be given a procedure to follow (who to contact, supportive assistance, planned follow-up) if symptoms consistent with COVID-19 are present.
- TFWs be informed daily through clear instructions about key activities outside of work (e.g., errands, transportation to and from work, if applicable, religious and social activities) if these are permitted under current health emergency decrees.
- The employer immediately isolate any worker exhibiting symptoms of COVID-19, as well as the worker's close contacts, while awaiting instructions from the regional public health authority or until the health care system takes charge of the case.
- The following directives be applied if necessary: Instructions for People with COVID-19 Symptoms who Are Waiting to Either Be Tested or for a Screening Test Result (MSSS, 2020b), Instructions for People with COVID-19 in Home Isolation (MSSS, 2020c) and Instructions for People Who Have Been in Contact with a Confirmed Case of COVID-19 (MSSS, 2020d).
Housing conditions: The federal government's minimum housing requirements (Government of Canada, 2020b) do not enable the minimum distance of 2 metres between persons to be respected (e.g., minimum distance criterion between beds of 45 cm). Ideally, the employer should offer housing conditions that respect the minimum recommended distance and opt to house a minimal number of workers per room. These suggestions are aimed at best protecting the health of workers and ensuring that the risk of viral transmission is minimal, since this risk increases with the density of people. TFWs grouped in pairs during the isolation period should remain grouped together in the work period accommodations. In addition, the disinfection recommendations specified for the isolation period accommodations should continue to be followed in the work period accommodations.
Return of workers to their country at the end of the work period
It is recommended to:
- Follow the recommendations for 1) preparation prior to departure, 2) transportation to the airport, 3) taking charge of TFWs at Montréal-Trudeau International Airport. However, these recommendations must be validated with public health authorities beforehand since they are subject to adjustment depending on the health situation in Québec and in the TFWs’ countries of origin at the time of their respective returns.
1 Some of the recommendations in this document may also be useful for the reception of TFWs to support other economic activities in Québec.
2 A dedicated thermometer or a non-contact thermometer must be used to avoid contagion.
3 It is important to mention that temperature taking is not a failsafe strategy because 1) not every case of COVID-19 presents a fever, 2) fever can fluctuate greatly over the course of a day, 3) individuals may have taken antipyretics prior to temperature taking, 4) the temperature-taking method (e.g., remote measurement) is not always reliable. These arguments underscore the importance of checking for symptoms in addition to taking temperatures.
- Government of Canada. 2020a. Aviation measures in response to COVID-19. [Online]. URL: https://www.tc.gc.ca/en/initiatives/covid-19-measures-updates-guidance-tc/aviation-measures.html
- Government of Canada. 2020b. Hire a temporary worker through the Seasonal Agricultural Worker Program: Program requirements - Schedule F. [Online].URL: https://www.canada.ca/en/employment-social-development/services/foreign-workers/agricultural/seasonal-agricultural/requirements.html
- Gouvernement du Québec. 2020a. Instructions and directives in the COVID-19 context. [Online]. URL: https://www.quebec.ca/en/health/health-issues/a-z/2019-coronavirus/
- Gouvernement du Québec, 2020b. Self-care Guide. [Online]. URL: https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/19-210-30A_Guide-auto-soins_anglais.pdf?1584985885
- Institut national d’excellence en santé et services sociaux, 2020. Personnes immunosupprimées. [Online]. URL: https://www.inesss.qc.ca/covid-19/presentations-cliniques/immunosuppression.html
- Institut national de santé publique du Québec (INSPQ), CERDM. Mesures pour la gestion des cas et des contacts dans la communauté : recommandations intérimaires. [Online]. URL: https://www.inspq.qc.ca/sites/default/files/covid/recommandations-interimaires-suivi-dans-la-communaute-covid19-2020-03-24.pdf
- Ministère de la Santé et des Services sociaux (MSSS). 2020a. Public Health Recommendations: Instructions on returning Home from Abroad. [Online]. URL: https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/covid-19/20-210-19WA_consignes-retour-pays-etranger_anglais.pdf?1586885718
- Ministère de la Santé et des Services sociaux. 2020b. Instructions for People with COVID-19 Symptoms Who Are Waiting to Either Be Tested or for a Screening Test Result. [Online]. URL: https://publications.msss.gouv.qc.ca/msss/en/document-002496/
- Ministère de la Santé et des Services sociaux. 2020c. Instructions for People with COVID-19 in Home Isolation. [Online]. URL: https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/covid-19/20-210-17WA_consignes-personne-atteinte-isolement-maison_anglais.pdf?1586885716
- Ministère de la Santé et des Services sociaux. 2020d. Instructions for People Who Have Been in Contact with a Confirmed Case of COVID-19. [Online]. URL: https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/covid-19/20-210-18WA_consignes-personne-identifiee-contact_anglais.pdf?1586885717
Proposed Québec government documents to be posted in accommodations
- Ministère de la Santé et des Services sociaux. 2020. Staying at home means saving lives. [Online]. URL: https://publications.msss.gouv.qc.ca/msss/en/document-002470/
- Ministère de la Santé et des Services sociaux. 2020. Washing hands - Simple and effective. [Online]. URL: https://publications.msss.gouv.qc.ca/msss/en/document-000438/
- Ministère de la Santé et des Services sociaux. 2020. Respiratory hygiene - Protect the health of others. [Online]. URL: https://publications.msss.gouv.qc.ca/msss/en/document-000451/