Health Committee on Jan. 29th, 2020

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

I know that this has been mentioned earlier, but I would like to get more detail on how, if there is a viral outbreak, we are better prepared to respond than we were in the past with SARS. Can you contrast our readiness now with the SARS readiness? How much further ahead are we now in our ability to respond?

[Dr. Theresa Tam]

For any global epidemic situation, international collaboration is key. Having the international health regulations and everyone sort of working under that umbrella, and having WHO's leadership, is very important. They've strengthened a lot of that. You've seen countries that previously didn't have the capacity, like China, having acquired that capacity.

In Canada, the Public Health Agency didn't exist at the time. We now have that. In Ontario, there's Public Health Ontario. We've enhanced our laboratory capacity and our surveillance capacity. Having this diagnostic done very rapidly was very important. We have this formalized federal-provincial-territorial coordination mechanism so that I can immediately contact all of my colleagues and set up the best processes to coordinate, because coherence in response is really important. Otherwise, the public will be confused and the health system will be confused. We're trying to be in lockstep and have a coordinated effort.

The infection prevention control practices in hospitals are really important. The key to detecting an imported case is at that first encounter with the health system, taking the travel history and doing the regular routine infection prevention control. I think hospitals have learned that this is really important and have raised their capacity to do that.

Then of course there's everything else. Public health agencies regularly do the case identification and contact tracing and management that you've seen Toronto Public Health, Vancouver Coastal Health and others doing right now, and I think obviously they provide information to the public on a regular basis. I take my role very seriously, and I'm going to try to communicate what I know, what I don't know and when I'm going to potentially be able to tell you new information. That is absolutely important.

The fact that we had all the systems alerted in such a short time and picking up these cases, and how well they've managed that, is a testament to how the system has improved over time.

[The Chair, Liberal, Ron McKinnon]

Thank you. You're out of time.

We'll go now to Mr. Thériault.

You have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Earlier, you talked about close collaboration between Quebec and the other provinces. I would like to know specifically how that is done.

In Quebec, there were only six cases, reported voluntarily, and they turned out to be negative. However, if someone were to be found carrying the virus, how long would it take for the entire system to go into operation, and for other countries to be made aware?

Not counting the technical and scientific screening procedures, if a case like that is detected, do things happen instantaneously, say, in two hours, in one hour, in a day?

[Dr. Theresa Tam]

Right across Canada the system is so alerted that our local jurisdictions are investigating a number of people. They're regularly assessing people who have returned from China. Anyone who then fits the case definition doesn't have to wait for a test or for a diagnosis. They are immediately put under isolation so you don't have to wait for the test. They are going to be managed clinically, and then for the lab test, many provinces can actually do at least the first step.

Quebec, for instance, will be able to test for all sorts of viruses and maybe the first step of the coronavirus testing. That's critical. Then the transportation of course to the National Microbiology Laboratory can take a number of hours, and we will run the test very fast, also within hours. However, that doesn't mean the individual, the sick person, has not already been managed. It's really fast.

[Luc Thériault, Bloc, Montcalm, QC]

Suppose I declare that I have symptoms. From that moment, how long would it take for you to know whether I have the virus? One minute, five minutes?

[Tina Namiesniowski]

Mr. Chair, I will try to answer the question.

It is almost instantaneous.

The provinces and territories are very seized with the importance of ensuring that the federal government in particular is aware as soon as they think they have a presumptive case. We've been getting notification, at least in the context of the three cases, very, very quickly. As soon as they know, they're engaging us.

[Luc Thériault, Bloc, Montcalm, QC]

Is that the case in the United States? The American border is not far away.

[The Chair, Liberal, Ron McKinnon]

Very quickly, please.

[Tina Namiesniowski]

Mr. Chairman, we are working very closely with our colleagues in the United States. We have daily calls with the CDC, the Centers for Disease Control; I think “prevention” and “disease control” are actually in their official title. They are sharing information with us quite quickly. Obviously, they have their own system, and there's no obligation for them to tell Canada in advance of reporting to WHO, but we're working closely together. We're each aware of what the other is doing.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Davies, you have two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Tam, are there any countries that you're aware of, like France, quarantining people, their citizens in China, for 14 days?

[Dr. Theresa Tam]

I'm not. I don't think I can be absolutely certain about that. It sounds like the U.K. may be doing something like that, but—

[Don Davies, NDP, Vancouver Kingsway, BC]

You're not sure at this point.

[Dr. Theresa Tam]

I think each individual country does have some variation.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Dr. Tam, in 2005 you co-authored a study. I'm going to quote from it. It found that:

...from March through May 2003, Canada introduced various measures to screen airplane passengers at selected airports for symptoms and signs of SARS.... In spite of intensive screening, no SARS cases were detected. SARS has an extremely low prevalence, and the positive predictive value of screening is essentially zero. Canadian screening results raise questions about the effectiveness of available screening measures for SARS at international borders.

In your view, Dr. Tam, are available screening measures for the novel coronavirus any more effective today than they were for SARS, when your study was published?

[Dr. Theresa Tam]

We know that entry screening—into Canada, for example—can never be 100% in terms of stopping any.... This is a virus. It can cross borders.

This is a layer of a multi-layered response. The most important layer, of course, is the initial entry into the health system. We've talked a bit about that. At the actual international border, I see it as a great opportunity to absolutely make someone aware of what to do if they're sick after entry.

In that paper, what I recommended was that.... This is a moment in time; someone is paying attention as they're crossing the border. You can give them the information they need in that moment of education as to what they should do if they get sick.

In that paper, what I did not find effective were thermal scanners. That was a lot.... I think we scanned 6.3 million people, both on entry and exit, and couldn't pick up a case, for a very specific reason, which was that in the incubation period people can be asymptomatic. Also, for other reasons, that was just not.... On that predictive value, if it's rare, you actually don't expect a case. It's actually not very effective. That's the thermal scanning bit, not the education bit.

[Don Davies, NDP, Vancouver Kingsway, BC]

Yes, and we're not doing that now.

[Dr. Theresa Tam]

We're not doing that, yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll get one quick question in. It may be an unfair question. We have three cases in Canada. Are you working with any modelling to project what might be the range of cases Canada might expect? If so, what are those numbers?

[Dr. Theresa Tam]

I think there are models that have been done in terms of flight paths and the numbers over January to March from Wuhan, for instance, so we have those numbers, but Canada's risk is much, much lower than that of many countries. It's going to be rare, but we are expecting cases. It doesn't matter how few those cases are. We are preparing the whole country in the event that you might pick up a rare case. That actually is what we're doing right now, preparing. It is going to be rare, but you're going to have some.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings us to the end finally, I think.

Thank you to the witnesses for their excellent and comprehensive responses to excellent and comprehensive questions. As we progress, we may want to invite you back at some point, and I hope you'll be able to come.

I remind everybody that regular meetings are starting Monday, 3:30 to 5:30 and Wednesday, 3:30 to 5:30. Get your witness lists to the clerk, and we'll try to sort something out so we have proper witnesses as we go forward.

Ms. Kwan.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much, Mr. Chair.

In preparation for the next meeting, I'm wondering if the analysts can prepare some information for the committee members, including what the other countries are doing, for example, on the question that was just asked about France in terms of the evacuation procedures and in terms of the U.K. How many countries have embarked on putting forward a travel ban, and so on? All of that kind of information that is out there we are getting haphazardly, I would say. It would be so lovely for the committee members to get that factual information.

[The Chair, Liberal, Ron McKinnon]

Okay.

Are there any more comments?

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Mr. Chair, could we just make sure ahead of time that the meetings are televised, going forward, for the Monday and Wednesday meetings as well?