Health committee  If I could add to that, another thing we learned during SARS was that the amount of time and energy that has to be put into producing pamphlets and getting pamphlets onto airplanes, handing them out, especially in an airport such as Toronto's, where you might have 80 or 90 airlines, is huge.

Health committee  If I could just add to that, in our understanding, what happened in Vancouver as opposed to Toronto was what happened right at the beginning. In fact, it was a mask that was put on a suspected case of SARS, on an individual, a patient, as opposed to the utilization of masks by health care workers, that in fact then I think, perhaps to a great extent, led to the difference.

Health committee  Thank you, Madam Chair. Of course, I'm always on the same planet as Dr. Butler-Jones. Over the last two weeks we've seen that the rate of increase of influenza-like illness in first nations communities is levelling off, as per Canada as a whole. According to FluWatch, since the beginning of the second wave of the pandemic after August 30, aboriginal people represent 4.5% of hospitalizations, 6% of ICU admissions, and 7.8% of all deaths.

Health committee  Might I add to that? As I've alluded to, we do have good information in terms of coverage on the first nations communities. What we've learned is that the effort that has to be put into getting the consent form, recording that, collecting that information, which may be by fax to a regional health authority and to the province, and then collecting all that, is actually a huge effort.

Health committee  Thank you, Madam Chair. As Dr. Butler-Jones has said, we're still seeing widespread influenza activity across Canada. And the experience among first nations, as we know it, is a reflection of that. This means that we will see some severe illness, hospitalizations, and deaths in first nations and among other aboriginal people.

Health committee  If I could just add to that, Madam Chair, I think that in first nations communities, for example, often one would want community leaders and others in the community to maybe translate, promote, explain, and be available to explain in another language. Often there are very different ways of explaining and understanding and enabling people to ask questions in another language.

Health committee  Perhaps I could enlarge as well. You are absolutely correct. Because certain individuals with neurologic disease may be more prone to pneumonia, for example, by virtue of their basic neurological problem, it may affect their ability to breathe properly. In addition, sometimes for people who have advanced neurologic disease it would be actually difficult to tell, perhaps, if they did have symptoms of H1N1.

Health committee  If I could add to Dr. Grondin's answer, in terms of first nations communities we will be implementing a system to collect similar but very specific information so that the nurses will be collecting information in all the communities where Health Canada will be immunizing. In some ways it will be a more complete collection of information because of the way those communities are isolated.

Health committee  If there's a prescription for Tamiflu, it is a requirement if there is a severe reaction. Therefore, that would be reported. The requirements vary slightly from province to province, but certainly that would be in place.

Health committee  That varies from place to place. In first nations communities and some provinces nurses can say they would like it to be prescribed and they will call the physician. In situations where there are provinces that enable nurse practitioners to practise, they can make that decision.

Health committee  I will answer in English, if I may. The way we have approached this is that the regions know very well the communities that do not have a plan, and they are working with those communities. We think that's where the responsibility should lie, because they do know those communities, and in fact we do recognize that there will always be some communities who either do not wish to have a plan or, because they're so small, in fact may not have the capacity to have a plan.

Health committee  Thank you, Madam Chair. Thank you for inviting me back again. We continue to monitor cases of influenza-like illness in first nations communities in collaboration with the provinces and territories. As Dr. Grondin mentioned, there has been an increase in influenza activity nationally, in particular in British Columbia and now in Alberta and the Northwest Territories, and cases in first nations communities have reflected the activity in the provinces and territories.

Health committee  Yes, we do. There's annex B in the Canadian pandemic influenza plan, which specifically relates to first nations and roles and responsibilities. And what we are doing for first nations, particularly remote and isolated communities where we're responsible for care and treatment, is ensuring that what we would expect the province to do elsewhere in terms of access to care and treatment and tertiary care and so forth is available in those communities--recognizing, though, that there are certain specifics relating to difficulties of transportation, but also recognizing the increased risk of transmission in some communities as well, which is being recognized in the sequencing of vaccines relating to remote and isolated communities.

Health committee  Exactly. That's exactly what we're sharing. In fact, it would be interesting to pose that question to all communities across the country of varying sizes about preparedness. We have that information and that's what we have given to you. We have confidence in that information.

Health committee  I can confirm. I've seen the figures and I have the information in terms of the supplies that have been purchased by Health Canada and distributed by the regions to the communities. That includes the N95 mask, which may be useful at times. It includes the gown, the gloves, and so on.