Could I ask Dr. Kumar to respond?
Evidence of meeting #37 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was h1n1.
A recording is available from Parliament.
Evidence of meeting #37 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was h1n1.
A recording is available from Parliament.
4:15 p.m.
Conservative
4:15 p.m.
Doctor, As an Individual
Do you mean on the narrow question of moving people around?
4:15 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
No, on the question of whether we are ready from the acute care perspective.
4:15 p.m.
Doctor, As an Individual
I think we are close to ready. There are some areas where we can still improve. I think the hit that we're going to take is actually potentially manageable if we prepare. It's not going to be an overwhelming hit, but even if we prepare, we can't be ready for it. If we prepare for it, we can be ready and we can handle it. I think we are getting close to that.
4:15 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Thank you, Madam Chair.
I'd like to thank the panel members. Also, I'll be the first to say in this committee that I am happy to roll up my sleeve in front of any media to get my vaccination and I certainly will encourage everyone I can to also have their vaccination. Certainly, as you clearly identified, it is a hugely important strategy in our movement forward.
I have actually a number of questions for a number of different people on the panel, but to start, Dr. Kumar, you were part of that technical expert group that looked at treatment in acute care. Is there some best practice? Has some best practice been developed for our more acute care patients?
4:15 p.m.
Doctor, As an Individual
It has, from the context of the ICU. I've been involved in that portion of it, and in fact the Public Health Agency of Canada will shortly come out with guidelines on management of ICU patients. Several of the comments that Dr. Duncan made will be addressed. They will recommend that even after 48 hours you get treated, and they will recommend that 10 days of antiviral therapy be used instead of the standard five that people had been doing.
In addition, it will make clear that the diagnostic test, which has been said to be 100% sensitive, in real life is in fact not 100% sensitive, so if you have a case that looks like it's the real deal, then you will treat it like the real deal until you're certain. There are a bunch of guidelines that will come out along those lines.
4:15 p.m.
Conservative
4:15 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Great.
I was also quite interested when you talked about applied research. We obviously all heard of some great research work and about funding for research work on a more long-term basis. When you were talking about applied research, what were you seeing as some of the interests, the gaps, and things like that? What were you thinking of in terms of needs?
4:15 p.m.
Doctor, As an Individual
There are two or three areas I can think of right now. One example is that most intensivists think we really need to have a system whereby we can have a real-time understanding of what the bed situation is and where the bed stresses are across the country, particularly in a pandemic. Right now we don't even know how many ventilator-capable ICU beds there are across the country. We're trying to collect that information. The Canadian Critical Care Trials Group is doing that, but real-time intelligence to allow you to redeploy resources to hot spots if you need to doesn't exist. We have no hope of doing that right now. The development of a system like that is important.
There are other important issues along the same lines. You may not know it, but the funding that exists does not actually fund therapies that are close. For example, in the case of hyperimmune globulin therapy, which I think is by far the most likely unapproved therapy to be useful in critically ill patients, we're struggling to find development funding because there's no mechanism for it. You go to pharmaceutical companies and try to find some money and try to figure out a way to get it done, but federal funding and that kind of thing....
For example, the WHO has said that one of the key questions is to find out whether standard-dose antivirals or high-dose antivirals are more effective. There are all these very practical things. Another example is just looking at the testing to see how effective it is. These are very practical, immediate things, but to a great extent the mechanisms for funding them don't exist.
4:20 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I was wanting to move on, but I think you've tweaked some interest there. Certainly this is a global pandemic, and it would be very interesting to have different countries take on the different pieces of this challenge, as opposed to everyone doing the same thing. I think that who is tackling which piece is certainly part of the conversation that I'm sure is happening. Again, there might be some opportunity there.
4:20 p.m.
Doctor, As an Individual
Let me just mention that Dr. John Marshall of the Canadian Critical Care Trials Group, who is at St. Michael's, has actually been instrumental in setting up a worldwide network to do exactly what you're suggesting, so that different people work on different areas.
4:20 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
My next question is for Ms. Fralick.
Certainly the federal government has its role and the provinces have their roles. We have regional health authorities and a number of different organizational structures in our provinces. From your member organizations, how are you getting a sense of their planning processes across the country in terms of the provincial and the regional health authorities? Are you getting the sense that in the last couple of years people have really tackled this? Are they feeling more confident?
4:20 p.m.
President and Chief Executive Officer, Canadian Healthcare Association
We certainly stay in touch with them regularly. We meet via teleconference with the CEOs of the provincial and territorial health bodies or whoever is representing on our group. To a great extent, they feel they're getting sufficient information at the provincial and territorial levels. We believe that's because there's a good system of information flow in place, so they haven't needed quite as much from us.
That having been said, we did hold a teleconference with them just last week. The number one issue is H1N1, and consistency of messages, surge capacity, and staffing issues. All the things I mentioned in my presentation are still of great concern, as much as things have improved.
4:20 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
But they're sort of in the planning process--
4:20 p.m.
President and Chief Executive Officer, Canadian Healthcare Association
Very much so. They're very much involved. In fact, in most calls we have, one or two can't come because of dealing with H1N1 in their particular region. So they're very involved with it.
I may be missing part of your question.
4:20 p.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Okay.
Certainly our health care system and our provinces have had to deal with ethical issues throughout time. Dealing with ethical issues is not unique. Usually structures are in place to deal with ethical issues within, again, the different structures that are there, if anyone wants to expand on the discussion around ethical issues. As I say, we deal with these all the time in many ways, and we have bodies that I think are in good position, because they have structures in place.
4:20 p.m.
Conservative
The Chair Conservative Joy Smith
Well, our time is about up, but perhaps someone would quickly like to make a comment on that. Ms. Fralick.
4:20 p.m.
President and Chief Executive Officer, Canadian Healthcare Association
Since I raised it, the brief comment is that I believe why this has come forward from our members at this point in time is because of the immediacy and the unpredictability of what we're dealing with. I mentioned there are ethical review boards, academically and in every hospital, whether or not they have the capacity to deal with immediate issues.
Frankly, one might look at the situation in Manitoba and the body bags and how that decision was arrived at. Is there an ethical component to that that might have been deployed to prevent that situation from having arisen?
You look confused.
4:20 p.m.
Conservative
October 19th, 2009 / 4:20 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thanks for being here and educating us.
I want to ask you about the prevention side, because I hear from you the importance of preventing people from getting the virus through a mass vaccination program. I am not aware that there has been clear direction to that effect from the Public Health Agency leadership, other than, yes, there'll be enough vaccine for everybody. Are you aware of there having been a strong directive to all the provinces and territories saying, do mass immunizations in your area?