Health Committee on Jan. 29th, 2020

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Mr. Chair.

I want to thank the three of you for your service and leadership on this file, and no doubt on many others. We talked today about the importance of this committee and this discussion around awareness and education. If you could, would you unpack the terms “presumed cases” and “confirmed cases” for us?

[Dr. Theresa Tam]

Again, in collaboration with the provinces and territories, we have case definitions. At the beginning of any emerging infectious disease, we have to develop the laboratory test. Now we have that.

At the beginning of any outbreak, not every laboratory can do the test, but they're beginning to acquire the testing capabilities. For example, Ontario has managed to develop a molecular test based on the sequence of the virus from China. It is a very good test, but we want to double-check it in the reference lab in Winnipeg, the National Microbiology Laboratory.

What you will see is that they'll be called “presumptive confirmed” until they've had that second check. They are confirmed. They are actually being treated as a confirmed case on all accounts, whether it's contact tracing or managing them. Until that second test comes back at the National Microbiology Laboratory, we will not call it actually “confirmed”. As you will see later on in the outbreak, many more laboratories will be able to confirm, and maybe we won't necessarily have to send that to Winnipeg. Every confirmed case will be reported to the Public Health Agency.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you so much. It is a question on terminology and common literacy that has come from my constituents as to what those terms mean, because it's very important to them.

I have a second question. If a person were to arrive at one of our airports and had the virus or was suspected of having the virus, what would they experience—I'm a visual learner—and what would they see at the border?

[Dr. Theresa Tam]

As you come through the border, first of all, you will be able to see those arrival screens saying, “Tell the border services officer if you're sick and you come from this area.” You would go through the kiosk and have the screening questions. When a flag comes up from that kiosk, the CBSA officer will look at that and say, “Okay, this is someone from an affected area.” In fact, they would screen anyone who's sick. That's their normal job every day, actually.

At that moment in time they will ask you.... In fact, they're not wearing masks and are not suited up. These are regular CBSA officers. As soon as they see that checked box, if you like, from the kiosk, and if you have any symptoms or you say you've had symptoms, you will be safely asked to distance yourself. Then, as appropriate, there are areas at the airport where you can undergo further assessment as needed.

The border services officers will ask you to wait. They will be calling the Public Health Agency's quarantine service for further assessment. Then, if necessary, if you actually have symptoms—and we have a very low threshold for further assessing someone—a quarantine order for examination will be put in place.

You will be safely transported to the emergency room. We already have designated hospitals, which have been collaborating ahead of time, next to those airports, which will then receive you. You will then be assessed by the physician in the ER. Then, depending on what they find, you'll be appropriately managed.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you so much.

Just as a follow-up on the threshold of assessment, can you break down the threshold of assessment, in two minutes or less?

[Dr. Theresa Tam]

We will be looking for anyone with a reported fever, cough or difficulties breathing. Those are the really key ones.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you so much.

[The Chair, Liberal, Ron McKinnon]

You have 28 seconds.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

That's the first time for a Cape Bretoner to talk less, but I do have some other questions here, again around definitions and around terminology. I hear that the risk to Canadians is low, and you've mentioned it several times today. Can you unpack that again around the terminology of “low”? I think it probably ties into a lot of what the previous answer referenced. Thank you.

[Dr. Theresa Tam]

It can get very technical, but on a broader scale, the risk is obviously very high in China. It has 99% of cases and transmissions. We have had, not unexpectedly, some imported cases that are being well managed. What we look at is the likelihood of importation by volume of travellers from an affected area, followed by essentially looking at the impact from its severity but also looking at impact in terms of whether we have the measures to mitigate the impact. It's a balance of all of those things.

Right now, the cases are in China. Very few are exported. Yes, there's human-to-human transmission, but those are generally for close contacts. With regard to the severity of illness, there are some severe cases, but the deaths have occurred in older people with underlying medical conditions. With all of that pulled together, for the general public who have not been to China, the risk is low in Canada.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We go now to Monsieur Thériault once more, for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

I have two and a half minutes. Okay.

Just now, you said that tracing was very limited to the first cases, the passengers who were most at risk, given the way in which the virus spreads.

How long does it take to find those people? Once they have been tracked down, for how long are they monitored? It is possible that they have no symptoms. Is that during the incubation period? Specifically, how do you do what you do?

[Dr. Theresa Tam]

The expectation for any contacts is that they will be actively monitored for 14 days. That is the longest incubation period that is being observed. Local public health will monitor the contacts, and doing that generally involves public health having some contact every day with the individuals who have been identified.

[Luc Thériault, Bloc, Montcalm, QC]

Okay, but were those people in quarantine, in isolation, for 14 days? If not, did they undergo different tests? Do they have to report the slightest symptom? What happens during those 14 days, specifically?

[Dr. Theresa Tam]

There are different types of contacts. For example, if someone is an actual family member or a fellow traveller, they would have had much closer and more prolonged exposure to the case. Those are the high-risk contacts. They will be essentially in isolation or quarantine for 14 days to protect against any further transmission. Other passengers or other contacts will be followed up on by local public health using their protocols.

Right now it is not necessarily keeping them completely isolated. It involves active monitoring by the local public health departments.

[The Chair, Liberal, Ron McKinnon]

Thank you, Monsieur Thériault.

Ms. Kwan, you have two and a half minutes.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much.

Thank you to our witnesses.

I'd like to get back to the point about differences of opinion around asymptomatic situations versus what we understand, from the media anyway, the health minister from China has indicated, which is that you could be asymptomatic and still spread the disease.

I guess WHO is looking into this to try to get clarification. When do you expect an answer?

[Dr. Theresa Tam]

They are trying as hard as possible, but, as I said, even if that is the case, I think there are two things the experts will be looking at. One is whether they are truly asymptomatic, because they could actually have symptoms, so they would be looking at that first. Then even if there are asymptomatic people who could transmit, is that just a rare event or is that frequent? If it is rare, it's really the extent to which this phenomenon occurs, so it might take some time for that to be looked at.

We know with coronaviruses and many other viruses that even if you are infectious at the start of the illness, you don't really readily transmit. It's when you are coughing the virus up and the droplets spread. You are coughing; you are sneezing. You are much more likely to transmit when you have symptoms, so basically we're looking at not just whether it happens but whether it is a very rare phenomenon. We want to understand the extent to which this occurs.

We do know that asymptomatic people are not the key driver of epidemics. That is very important to understand.

[Jenny Kwan, NDP, Vancouver East, BC]

If I may ask just very quickly, I know that Wuhan is the epicentre. The second source, from what we understand now from China, is Guangdong province in China, in terms of people with the virus.

I'm wondering what plans we have, by way of the government, to support both the people who might be in Guangdong province and Canadians who might be there visiting over the holiday season who are tyring to make their way back. Is there any process in place with respect to that?

My second question is with regard to safety measures. I raise that because B.C. is the twinning province of Guangdong province. In my riding of Vancouver East, many of my constituents have travelled over to Guangdong and may have had contact with people—I don't know—and may be trying to make their way back. I'm very worried about them, both about their situations there and about whether or not they've been exposed and, if not, whether they will be able to make their way back.

I'm wondering what actions the government is taking with respect to those things.

Last, for people who—

[The Chair, Liberal, Ron McKinnon]

We're at three-and-some minutes, so....

[Jenny Kwan, NDP, Vancouver East, BC]

Oh. Sorry. Can I finish?

[The Chair, Liberal, Ron McKinnon]

Just finish really quickly.

[Jenny Kwan, NDP, Vancouver East, BC]

Okay.

This is with regard to people who may not be from Wuhan—for example, people who have travelled to, let's say, Japan, Korea and other places—who might have contracted the virus. In terms of measures for those other secondary individuals, what plans or considerations are being undertaken with respect to that from the Canadian government's point of view?

[Tina Namiesniowski]

Mr. Chair, maybe I could note that in relation to the question around what might be planned with respect to repatriation, that's really a question that is better directed to our colleagues at Global Affairs Canada.

In terms of the other question that was asked with respect to individuals who may have been in Wuhan, might now be in other parts of the world, and who would subsequently come home to Canada on a flight other than directly from China, the measures we have in airports would still apply. We talked about the measures we put in place in Montreal, Toronto and Vancouver. We actually had a couple of individuals who came through a couple of other locations and self-reported. They indicated that they had been in Wuhan at one point prior to their return to Canada, and the same sort of screening taking place in the other three airports was applied.

It's consistent across the country in the sense that, again, referencing back to the Quarantine Act, any time a traveller returns and indicates to a screening officer—all of our Canada Border Services Agency agents are screening officers pursuant to the Quarantine Act—that they're not feeling well for whatever reason, then, as Dr. Tam has indicated, there is a reach-back to our quarantine service. So that applies.

[The Chair, Liberal, Ron McKinnon]

Thank you, everyone.

Thank you so much to our witnesses, and thanks very much....

Yes.