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VULNERABLE40 disease. The 2006 and subsequent minor amendments also facilitated coordination with international actors by bringing the Quarantine Act into line with the International  Health  Regulations. The provincial response to SARS has been variable, with vari- ous amendments to provincial public health laws coming into force in the years following the SARS outbreak. When the disease hit Ontario, the government amended its Health Protection and Promotion Act to include SARS as a disease to which the legislation applied,25 which meant that individuals such as health professionals had to report cases of the disease to public health officials and public health offi- cials were empowered to require infected individuals to submit to examinations or isolate. The most significant amendment to provin- cial public health laws has been to clarify that public health orders, such as those compelling isolation, could be directed not only toward individuals, but to groups of persons.26 These powers have been used extensively during COVID-19, for example, with respect to returning travellers and symptomatic individuals. Some provinces also made post-SARS changes to their emergencies laws to make them more responsive to disease outbreaks. For example, Ontario amended its Emergency  Management  and  Civil  Protection  Act (as it is now called) to define “emergency” as including a situation caused by “a disease or other health risk.”27 H1N1 H1N1 was the first real test of post-SARS public health reforms. The pandemic manifested itself in two waves in Canada, with the first peaking in May 2009, and the second, more severe wave, cresting in November 2009. Unlike SARS, the victims tended to be younger, with 25. Health Protection and Promotion Act, RSO 1990, c H 7. 26. Ibid, s 22(5.0.1). Toronto’s Medical Officer of Health at the time of SARS explained the rationale for this amendment: “There was an instance wherein we had an entire group of people who needed to be put into quarantine on a weekend. It was physically and logistically impossible to issue orders person to person on a Saturday afternoon for 350 people who happened to live in three or four different health units all at once…” (The SARS Commission, SARS and Public Health  Legislation:  Second  Interim  Report, vol 5 [Toronto: The SARS Commission, 2006] at 320, online [pdf]: Archives of Ontario <http://www.archives.gov.on.ca/ en/e_records/sars/report/v5.html>). See also Public Health Act, SBC 2008, c 28, s 39(3). 27. Emergency  Management  and  Civil  Protection  Act, RSO 1990, c E 9, s 1.