Health Committee on Jan. 29th, 2020

[Tina Namiesniowski]

Mr. Chair, again, from the point of view of the efforts we have in place with our colleagues with the Canada Border Services Agency, they are very aligned with what's actually happening in other countries as well. From our perspective, at the end of the day the efforts are very much focused on controlling the introduction and subsequently the spread of the novel coronavirus. The types of measures and the enhanced measures that we've put in place, from our perspective, are very aligned with what our key allies are doing, so I think at this point we're quite satisfied with that.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

You mentioned in your presentation that 99% of the passengers from flight CZ311 had been contacted.

Are we talking about 10 or 12 passengers in specific rows, or passengers from the entire flight?

[Tina Namiesniowski]

No, not the entire flight.

We have a protocol that tells us what we must do in situations where contacts need to be found. We are following the protocol.

It's really a focused concentration on individuals who are in rows around the index case we're interested in. Again, based on the science and what we know about the disease, it is not a protocol that would have us look at contact tracing for everybody on the plane.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

People are coming into the country without symptoms, and going back to their homes. You say that the provinces are in charge of screening, as they see fit. Can you be a little clearer about that?

With an event like this, I wonder whether the Government of Canada has stricter authority than the provinces.

[Tina Namiesniowski]

In terms of the collaboration that's been taking place between the federal government and all of the provinces and territories, there has been a lot of work done to ensure there is agreed-upon guidance with regard to infection prevention and control measures that are utilized in hospital settings, and guidance around what should be done in the event there are individuals who present themselves at a health facility and indicate that they have been in Wuhan, for example.

That work has been under way for a number of weeks and, from our perspective, it's very clear there is commitment across the country at the provincial and territorial levels to ensure that we have consistency of approach and that cases are addressed in a way that ensures the health and safety of Canadians.

In that respect, from what we've seen to date, the system is definitely working as intended. In terms of individuals who may come through an airport and who have indicated through the kiosk questioning, for example, that they have been in one of the affected areas—as I said earlier, the questionnaire now asks about Hubei province and not just Wuhan—we're providing them with information so that it is very clear to individuals who are leaving the airport what they should do in the event they feel they are becoming sick or are concerned about their health. That has played out as anticipated.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Paul-Hus.

We will now go to Ms. Sidhu for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you all for giving us valuable information, and, Dr. Tam, thank you for your leadership.

I have heard about self-reporting. How are you ensuring the information gets to the traveller? I heard that you have set up a 1-800 line. Are there any language considerations with that? How are travellers getting that information?

[Dr. Theresa Tam]

As travellers enter the three international airports, the information is provided in English and French but also in simplified Chinese. The kiosks themselves have 13 languages, and then the handouts we are providing have French, English and simplified Chinese. The handouts not only talk about the symptoms and what people should do but also suggest calling ahead to your health provider before you present yourself to an emergency room or the ambulance service.

There are numbers at the back of that form for each jurisdiction so that people know whom to call should they experience symptoms. That's to ensure they do not walk into a clinic or hospital and contaminate the environment.

All three cases we've had so far have entered the health system in a very safe way in which all infection prevention precautions have been undertaken.

[Sonia Sidhu, Liberal, Brampton South, ON]

If a person arrives at one of the three airports where you said people were coming, and they have symptoms of a virus, what would they experience?

On isolation, you mentioned the Quarantine Act. Would that start from the airport, or what system do we have in hospitals? Does the Quarantine Act work at the hospital, or does it start at the airport?

[Dr. Theresa Tam]

At the airport, if someone was exhibiting symptoms, they would immediately be separated from the rest of the people in the airport, and Public Health Agency staff would do an assessment. The next thing they would do is to send the individual to a designated emergency room for an actual assessment should that be necessary.

For individual patients, if we take another history and they have symptoms that are compatible with the illness, they will be sent to the emergency room. Paramedics or staff at the hospital emergency room will be alerted ahead of time so they can take the necessary precautions.

Once an individual has passed the international border and is in the local jurisdiction, it is the responsibility of that jurisdiction, through the very powerful local public health acts, to isolate cases and quarantine individuals. That will be done by local public health.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

How can we avoid misinformation spreading on social media?

[Dr. Theresa Tam]

I think that is the challenge of our day. Our approach is to try to provide consistent, credible information through different channels. That's sort of escalating, of course, as we speak, with the website we have, providing regular technical briefings, and having that 1-800 number. It is quite a challenge. We have to try to improve, very broadly, Canadians' literacy in terms of health and what they can do to protect themselves but also almost their social media literacy. You cannot believe every rumour and everything you see. There are, of course, some elements of the social media environment.... I've been working in the vaccine confidence sphere, where you do have to actively look for misinformation and address it.

I think that's part of the strategy as well. It is of considerable significance. As I have always said, the epidemic of fear could be more difficult to control than the epidemic itself. I think everybody needs to do their part to try to address that.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu.

We go now to Mr. Kitchen for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

First of all, I'd like to thank you all for what you do and for the great work you're doing in stepping forward here. We haven't seen this, as we're well aware with SARS, etc., for quite a while, so it does come forward. I appreciate the good work you do. We want to find out, because there will be people watching this show; we want to make certain that Canadians understand the level they're at and to educate them at the same time. That's one of the things we want to make sure we get out of this, and I appreciate that.

Ms. Namiesniowski, in your answer to Dr. Powlowski, when he was asking about self-isolation, you indicated that there were protocols you have in place on how to do that. Can you share those with this committee so that we can understand that, see what those protocols are and what those steps are? Is that possible?

[Tina Namiesniowski]

Do you want me to share them now?

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

No, no, in writing. I assume you have them in writing, because they would be for you and you would also hand that down and disseminate this. Is that possible?

[Tina Namiesniowski]

Yes, Mr. Chair, that's possible.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Okay. Thank you.

In my practice many years ago, before I became a member of Parliament, at times I had patients who would come in and ask me about SARS, etc. I know that if I were in practice today, that same thing would be happening. We want to make certain we're able to reassure Canadians that while there is an issue here, we're talking about a virus. We're talking about a virus that, as you are well aware, at this point in time appears to be of low risk but is there, and we need to take the proper steps. It is flu season, and we need to make certain we're doing the proper things that we need to do. I think that's important.

Perhaps you can just help educate Canadians on where we're at on this. The reality is that we're looking at a droplet that's being exposed. Then there is the question of exposure to that droplet, and then incubation time. Is that correct?

[Tina Namiesniowski]

Yes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

As we see that, the question is about that droplet. What is the lifespan? Do we know at this point in time whether that droplet lies dormant or expires after a certain length of time? Can you explain that to people?

[Dr. Theresa Tam]

It's correct that this.... The current understanding of coronaviruses in general, and we believe with this one, is that it is spread through droplets that people cough or sneeze out but also through contaminated surfaces—e.g., if someone coughs up a droplet on this table. It depends on what surface it's on. I think the survival of the virus on different types of surfaces is probably being worked on right now, but viruses can survive for a number of hours on a surface. There is a lot you can do. As with other respiratory viruses, washing your hands is absolutely critical. You're touching all sorts of things all day. It doesn't matter whether it's a doorknob or a table; it's something that people can actually do. Of course, to stop droplets and sneezes and to protect other people, if you're sick, please don't show up anywhere. Don't go to work. Also, cover your cough. That's really important to protect everybody.

It's like other respiratory viruses, even though it is new. We know how you can protect yourself against a respiratory virus. These are some of the really sensible things you can do. It is true that it's not just the droplets directly from someone else. They can also land on a surface. Cleaning and disinfection are appropriate as well.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

That brings me to my next question. As recently as Friday, I came in internationally and landed in Toronto. As we came into the international airport and were walking through the airport, multiple planes came in at the same time. We all came to that very first point, so here's my first question.

I believe it has changed, but the reality was that the screening—so that people can actually see the documentation talking about this issue—when I came through was not very evident. I understand that it got bigger so people can see more of it. That brings me to the issue of how people come through to the computer and start to punch in numbers. We're basically touching a computer program that someone may or may not have put that droplet on.

As that goes through, there's a concern about it, and I'm hoping that you've looked at this issue and how you are going to advise on that. As it goes forward, the next step, as you mentioned, is to then go to the customs officer. I notice that the customs officers are being protected, and rightly so, with masks, facial masks that are actually protective. That's instead of the simple surgical mask that we see; as you know, the lifespan of those is very short.

The reality is, what orders are being given to those CBSA officers to identify that? As I went through there, I was scared not about this issue but just about so many people and so much confusion. Where would they go from there? How are they going to...? What authority are you giving them to make the decision on whether or not someone is sick?

[Dr. Theresa Tam]

The CBSA officers all have been trained by our agency's quarantine service, and that's very important. They are directly authorized through the Quarantine Act because they are the first screening officers, so they have authority. Also, should they be at all concerned about anyone, they then also have a reach-back mechanism to our staff, who can then manage the situation as appropriate.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kitchen.

We go now to Mr. Kelloway for five minutes.