Dr. Kumar.
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.
4:35 p.m.
Doctor, As an Individual
I think you're right. I've heard from some of my colleagues indirectly that many of them are skeptical that it's worth getting the vaccine. I find that, quite frankly, absolutely astonishing.
There are many reasons, I think, that people are somewhat unwilling. What's going on right now is that there's a lot of bad information out there, and the best way to fight bad information is to generate good information. The way to do that is to do the research and come up with the numbers.
To give you an example, it has been estimated that during the swine flu pandemic of 1976 one in 100,000 people got Guillain-Barré syndrome--which is a problem, in great part because the pandemic never took off. Had the pandemic taken off, as it is clearly doing here, what you'd find is a mortality rate, a death rate, probably on the order of one in two and a half thousand. And by the way, influenza, in and of itself, causes Guillain-Barré probably on the order of one in 100,000.
So you have equal risk of Guillain-Barré, but you don't have the risk of death, which is one in two and a half thousand.
4:35 p.m.
Conservative
4:35 p.m.
Doctor, As an Individual
Guillain-Barré is an autoimmune disease. It's an illness where your body's own immune system is tricked into attacking itself, and in this case it attacks your peripheral nerves so you become paralyzed, basically. That paralysis can be for weeks, or on occasion it can be permanent. So it is something that you definitely want to avoid, but quite frankly, if you go through regular influenza, you're going to see on the order of one in 100,000 cases of it.
I think you counter bad information with good information, and you publicize it.
4:40 p.m.
Bloc
Nicolas Dufour Bloc Repentigny, QC
We were just talking about getting accurate information out to the public and about discounting some of the inaccurate facts that may be circulating. I question the media's actions.
Do you think the media have done their job and sufficiently emphasized the benefits of the vaccine, or the problems that could arise if a pandemic is declared? Do you think the traditional media have been an ally on the H1N1 issue?
4:40 p.m.
Doctor, As an Individual
I think the media have their own interests, as everybody does.
Do I wish they had emphasized more the importance of vaccination? Yes.
How can you bring it out further? I don't know. Maybe with some TV spots. But without question, the issue of vaccination is going to be a major issue going forward, because if you don't get sufficient penetration we are going to see a good number of very serious cases over the next six months.
4:40 p.m.
President and Chief Executive Officer, Canadian Healthcare Association
Thank you.
I think the media are in a very difficult position, because they need to tell stories, tell news, keep people informed, and that doesn't always match well with our needs as health providers.
I will say one thing, though. In Toronto approximately 60 very desperately mentally ill people jump in front of the subway every year, and you do not read about it in the media. There is an agreement, unwritten, amongst the media. They do not report, because the research has shown there are copycat acts.
I believe the media can and want to be very responsible in how they deal with issues. Perhaps we need to connect in different and improved ways with the media to make them stakeholders in this as well.
4:40 p.m.
Conservative
4:40 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
Thank you, Madam Chair, and my thanks to our presenters here this afternoon.
This is an issue that we have been studying for quite some time, and rightly so. When we meet with different people, we get different perspectives. We're learning, and that's good. What we're hearing is encouraging. I think that we're going in the right direction.
It's also encouraging to hear people such as Dr. Kumar say that we're making progress. But I don't think anybody is going to say we're ready, and that's a wise thing. That is a good position to be in. I don't think we ever will know if we're ready. We need to have a fluid plan that will keep evolving as situations arise and we react to them. The readiness plan is to put as many different things in place as we can so we can react in many different ways. That's what we've been trying to do, and according to the people we've spoken with, we are heading in the right direction. We're not there, as everyone would agree, but we are going in the right direction.
We've been very strong on collaborating with the provinces and the territories. All the pandemic planning lays out a hierarchy, if you want to call it that, for different levels of government to be doing different things. That's extremely important for everybody to realize. No level of government is capable of supplying everyone and being everything to everybody.
We've been working to make sure these strategies are put in place in the other jurisdictions. We've released some interim guidance on infection prevention and control measures for health care workers and emergency workers. Could you elaborate on that, Ms. Lynkowski? Do you have an involvement in it?
4:45 p.m.
Chief Executive Officer, Canadian Public Health Association
We haven't had a direct involvement through CPHA, other than through our medical officers. I would agree that the mechanisms and the forums we now have in place, which we didn't have during SARS, have allowed for a coordinated and standardized response. This is particularly true of the level of coordination between the federal government and the provinces and territories. It has been a real success story with H1N1, one that we simply didn't have before. Through better coordination and communications we've been able to integrate with some of the health care associations and other providers of primary care.
4:45 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
Does anyone else have any insight into working with the emergency providers and first responders? No?
One thing that we've heard about here today is the importance of communication in convincing people that it is the right thing to do. When I talk to people on the ground, I very often hear the “why”—why get it? I think we are missing the mark on the communication end of it. How we get it out there, I don't know. It has to be multi-faceted. I don't think there's one specific way to do it.
We've talked publicly about the vaccination of this committee. It's more important to vaccinate health care workers than it is to vaccinate the eight people on this committee. Health care workers are seen as people with special knowledge in these matters. If they're not going to get it, why should anyone else? The health care workers are the ones who should know. We need a better communication and education strategy for health care workers.
4:45 p.m.
President and Chief Executive Officer, Canadian Healthcare Association
It was part of my message that communication is an issue. I don't think the people who have put these processes in place have gotten enough credit. The folks at Health Canada and PHAC have done everything they could to get the right communication strategies in place, and some of them are very effective. But we keep hearing that it's not all getting through. We can't become complacent. We have to keep doing the messaging and then look for other routes, such as the health provider associations.
4:45 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
And I certainly commend those who have done all the great work they have done on the communication. I wasn't trying to belittle that at all, but I think we do need to look at other more innovative ways, if we can, and continue that process.
October 19th, 2009 / 4:45 p.m.
Liberal
Keith Martin Liberal Esquimalt—Juan de Fuca, BC
Thank you very much, Chair.
And thank you very much, everyone, for being here today.
In the interest of full disclosure, I have to say that Dr. Kumar and I went to medical school together, so if I'm really nice to him you'll know why. It's because I know all the secrets from medical school; that's why.
4:45 p.m.
Conservative
4:45 p.m.
Liberal
Keith Martin Liberal Esquimalt—Juan de Fuca, BC
Thank you, Chair.
My first question for Dr. Kumar is this. When you're assessing our reserves of ventilators, both type and number, along with meds to keep somebody intubated and sedated and ventilated in an ICU, do we have enough stockpiled in those two areas?
4:45 p.m.
Doctor, As an Individual
A few months ago I would have said I was very concerned about the ventilator issue. Our model suggests we've probably got enough ventilators, or close to it, now. If you take into account the extra stores individual places have--the federal stockpile, etc.--I think we're there. We still could be tight.
And I have to tell you that one of the things I am disappointed about in terms of where we are right now is that we really haven't come up with a good strategy to redeploy resources from one place to another. Because the way this pandemic will play out in Canada, as it has played out in every other pandemic, is that it's going to be like raindrops falling on the country. You don't know who is going to get hit and when and how severely. One can say that overall our models would suggest we are close to being ready, but some places may be overwhelmed because they will be hit particularly hard. And the question of how one redeploys resources from one place to another is not really clear, in my mind. Yes, we have these kinds of arrangements for nurses and doctors to be able to be licensed, but on an operational level, how do you do that? So that's one concern.
The other concern, as you mentioned, is that there are some subtle supply chain issues that I don't think have been adequately addressed. For example, when we got hit in Manitoba, we found that our patients required absolutely massive doses of sedation to keep them in a state in which they could be effectively ventilated. Being on a ventilator is very unnatural, so one requires a certain level of sedation. But these people required a massive amount. We ran out of sedatives on several occasions. Because we were the only place in the country being hit, we could import sedatives. If there are a lot of places being hit at the same time, that could be a problem.
Just to give you an idea of how much sedation we used, Keith, we went through 18 months' worth of sedation in two months.
4:50 p.m.
Liberal
Keith Martin Liberal Esquimalt—Juan de Fuca, BC
That's a shocking statistic, isn't it?
I have two quick questions. Could you let us know about the concept of herd immunity and how it's really important to hit that 70% immunization level in order to be able to really retard the spread of the virus?
And secondly, in your professional opinion, if one is vaccinated against H1N1, when the virus mutates, do you anticipate there'll be a cross-reactivity between this virus and its mutated version downstream?
4:50 p.m.
Doctor, As an Individual
As for the question on the mutation, I don't think anybody knows whether a mutation is likely at all. We don't even know what happened in 1918--that's what you're alluding to--where the second wave was much worse than the first. So to be honest with you, my expectation is that there won't be a major mutation. It's possible, and whether the vaccine then covers or not, I don't know.
I'm sorry, Keith, your first question...?