Health Committee on Jan. 29th, 2020

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Do they report that information back to you, through you? I would suspect that as the president of the Public Health Agency of Canada you would be interested in how many people would still be out there. Is that information that's sent to your agency?

[Tina Namiesniowski]

In terms of the role the province plays, they are the ones responsible for the case management of the individual. We support them in terms of helping to find where those individuals might be and how to get a hold of them, but in terms of reporting back to us on who those individuals are, there is no obligation for them to do that.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Okay, interesting—

[Tina Namiesniowski]

Obviously, in terms of any kind of confirmed case or a suspected case, we are certainly working very closely with the provinces and territories. They definitely report that to us.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

The minister said just this afternoon that the plan is to repatriate Canadians stuck in China, and said they have secured a plane. As of now, there are160 people, I believe, who have asked for help, out of the 250 in China.

If the government is successful in getting these individuals home, what's the plan once they arrive here in Canada?

[Tina Namiesniowski]

We are working very closely with our colleagues at Global Affairs Canada, who are leading that particular initiative. As our minister indicated, that includes how we will assess and deal with people when they return to Canada. That work is under way.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Certainly we'll support the motion to get the foreign affairs officials here as well.

The minister said they'd be quarantined once they arrived. I suspect that then falls within your jurisdiction. Does it?

[Tina Namiesniowski]

We have responsibility for the administration of the Quarantine Act, and we're working closely, as I said, with our colleagues at Global Affairs Canada, as well as others, in terms of coming up with what we think is the best approach in terms of dealing with individuals when they return to Canada.

As our minister highlighted today, we're all very much concerned with ensuring the health and safety of Canadians, as well as those Canadians who would be returning to Canada on that plane.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Help me understand it, then. Do we check them prior to their leaving China, or are they checked once they land? In terms of quarantining, are they quarantined at hospital? Are they quarantined at home?

What's the process, going forward?

[Tina Namiesniowski]

We're working through all those details at this point in time, so it's premature for me to pronounce on that because we've yet to conclude the way in which we are going to operationalize the return of the flight. However, we're working through that as quickly as possible.

It's safe to say that we are very much attuned to ensuring we are doing the requisite public safety or public health measures—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Is there not a protocol, though, that would be in place? Is there not a standard that would be the usual practice of some sort if somebody is to be quarantined? I would be concerned if we just don't have a plan once they land. Why are we sending the plane over there? Perhaps you could shed some light on that.

[Tina Namiesniowski]

The Quarantine Act is focused on preventing the introduction and spread of communicable diseases, and the Quarantine Act applies at all ports of entry. Pursuant to that act, we definitely have the authority to take measures that would help us ensure that the health and safety of individuals who are coming home to Canada is dealt with appropriately.

We are working through all of the details that will ensure we are fully aligned with the obligations of the Quarantine Act.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

Next is Dr. Powlowski. You have six minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I know that different countries are responding in different fashions to this outbreak. I'm not sure to whom I should be addressing this question. When you look at the map of China and where their cases are, they start off around Wuhan. Looking at it from day to day, I saw a little red blob where they had cases, and then the next day it was bigger and the next day bigger, and now it's looking like a lot of China.

The BBC was reporting today that their ministry of health was asking all people coming from China to voluntarily self-isolate for two weeks upon returning to the country, I think because the idea is that it got out of Wuhan. When you look at the numbers and what's happening in China, it's not isolated to Wuhan.

It would seem to me to be a fairly feasible thing for us to do, and a precautionary thing, to have anyone coming from China self-isolate for two weeks. Have you considered making that recommendation, potentially under the Quarantine Act? I don't know if there's a means to enforce that.

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

Right now, we have protocols in place, together with the provinces and territories, on isolating cases. Certainly, doing rigorous contact tracing and monitoring is the key to preventing any spread from a case in Canada. That, I think, is of primary importance.

For other completely asymptomatic people, currently there's no evidence that we should be quarantining them. I think what you're proposing is a sort of voluntary self-measure.

I would say, as our president of the Public Health Agency has said, that you have to be very cognizant that the global effort to contain the virus requires the absolute commitment and engagement of the communities that are affected. Otherwise, they'll be stigmatized. They will be asked to take measures beyond what is currently the public health evidence. It is a matter of balance when you're restricting someone's freedom, essentially, to move about in the community after return. I think that is not something that we would take lightly.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Let me say—and this may be an added question—that the Chinese authorities, in my understanding at least, as reported in regard to Mr. Ma in the New York Times, are reporting that they think the disease is communicable during the incubation period, meaning that when people are asymptomatic it can be transmitted.

I understand that this hasn't been confirmed. Other agencies, such as the CDC, have questioned whether that's really the case, but certainly I think the foremost authorities on the novel coronavirus are going to be the Chinese, so if they figure it's that way.... Britain has already taken action in terms of voluntary coordination. It would seem to me to be something that maybe we ought to consider. I don't know how drastic that is.

I was under quarantine under SARS II. When I saw someone who, when SARS was supposedly over, turned out to have SARS without any precautions, I put myself in quarantine, figuring, “I know he's got SARS.” Sure enough, he did, but it took about six or seven days for the Public Health Agency to report that to me. I don't know if it's asking too much, given the possibility of asking people to voluntary quarantine. If the British are doing it, I would suggest that we ought to think about it.

[Dr. Theresa Tam]

I know that the World Health Organization is actively in China looking at the evidence. That is a very key piece of evidence that we are trying to ascertain. We do know something about coronaviruses, given that we've had other coronaviruses that cause anything from a mild illness through the common cold all the way to a more severe end of the spectrum such as SARS, the coronavirus and MERS, or Middle East respiratory syndrome coronavirus. Based on what we know about those coronaviruses, is it possible that an asymptomatic person could transmit the virus? Even if it's possible, it is, we believe, a rare event. It is not that type of transmission that drives the force of an epidemic.

I think we have to be reasonable in our public measures and just balance out the risks and benefits. In terms of the impacts, they are not simply health impacts, but psychological and other health impacts, as well as non-health impacts, those being societal and economic as well. It's something that we're pursuing very actively with the World Health Organization. They know they have to get to the bottom of this, but we do know that even people with mild symptoms don't transmit very readily. Could they? It's possible, but that's not what drives an actual epidemic.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

You brought up the World Health Organization. In response to SARS, there was the impetus to create the new international health regulations, which set up a mechanism for the monitoring of outbreaks of infectious disease; a mechanism for reporting for WHO; and then, if it's considered something that could potentially be a public health emergency of international concern, convening a committee to make the decision on whether to call it a public health emergency of international concern.

I understand you've been in contact with WHO. This would certainly seem to be a public health emergency of international concern. We were meeting as a caucus, on a Sunday, to consider this. It's front page on every newspaper in the world. Why hasn't that been declared?

[The Chair, Liberal, Ron McKinnon]

If the witnesses have a quick answer to that, they can go ahead, please.

[Dr. Theresa Tam]

I know that the committee is meeting tomorrow morning. I think we need to await the actual deliberations. The final decisions are up to the director general of the World Health Organization.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to the Bloc.

Monsieur Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

As we begin our work, may I recognize the interpreters, who have been doing a remarkable job since our sitting began, as they always do. They have my congratulations. I will try to speak more slowly in order to help everyone to better understand.

Dr. Tam, Ms. Namiesniowski was telling us that we have to combat disinformation. I am therefore hearing that we must focus on accurate information. We have to prevent this epidemic from becoming a pandemic.

As we speak, is it still true that, in Canada or outside China, there is no case that results from secondary contamination?

[Dr. Theresa Tam]

As our president said earlier, 99% of the cases are in China. Of the cases that are related to travel to affected areas of China, there have been, I think, about three instances of human-to-human transmission in a very limited way among close contacts. Every country that's had the imported cases is very much monitoring all the close contacts to make sure they don't actually spread further into the community. All of the evidence related to the exported cases shows that they continue to be the close contacts of the cases.

[Luc Thériault, Bloc, Montcalm, QC]

Let me focus my question.

Is it true that, in Canada, people in whom the virus has been detected are those who have been in direct contact with China, the site of the epidemic?

In other words, is it true that no Canadian who has not set foot in China has been infected? Are we rather talking about people who were infected over there and who sometimes return with no symptoms when they declare their health status? If so, is that also the case in other countries?

[Dr. Theresa Tam]

In Canada we've had three cases. They're all connected to travel to Wuhan. In the other countries, the vast majority are connected to Wuhan. Maybe one of the cases is connected to another area in China.

Currently in two countries that are looking at their cases, Japan and Germany, there has been a very specific case of someone who has not travelled but has contracted the virus from people from Wuhan. In those countries, this suggests that even though they did not travel, they were in direct contact with someone who did come from China.

Those instances are rare and very limited. For sure, in the general population in Canada, the risk is low.