Health Committee on April 7th, 2020

[The Chair, Liberal, Ron McKinnon]

I call the meeting to order.

I would like to welcome everyone to meeting number 10 of the House of Commons Standing Committee on Health. Pursuant to the order of reference of Tuesday, March 24, the committee is meeting for a briefing on the government’s response to the COVID-19 pandemic. Today’s meeting is taking place exclusively by teleconference and the audio feed of our proceedings is made available via the House of Commons website.

Since we can't see who is in the room, I would like to acknowledge who is in the room.

I'm Ron McKinnon, the chair. We have the clerk of the committee, Michael MacPherson. We have the Library of Parliament analysts Karin Phillips and Sonya Norris.

For the Conservative Party, we have Matt Jeneroux, Dr. Robert Kitchen, Len Webber and Tamara Jansen. For the Bloc Québécois, we have Luc Thériault, and sitting in as well from the Bloc we have Martin Champoux. For the NDP, we have Don Davies. For the Liberal Party, we have Tony Van Bynen, Sonia Sidhu, Dr. Marcus Powlowski, Mike Kelloway and Darren Fisher. Sitting in on the Liberal side is Dr. Helena Jaczek. We may have Jenica Atwin from the Green Party on the line as well.

As witnesses, from the Canadian Association of Emergency Physicians we have Dr. Alan Drummond and Dr. Howard Ovens. From the Canadian Federation of Nurses Unions, we have Ms. Linda Silas. From the Canadian Medical Association, we have Dr. Sandy Buchman. From the Canadian Pharmacists Association, we have Dr. Barry Power and Dr. Shelita Dattani.

Once again, everybody, when you speak, if you're reading a statement, please bear in mind that simultaneous translation is difficult in these circumstances. Speak slowly. Speak carefully. I would like to emphasize that you should please wait until I recognize you by name before speaking. When I recognize you by name, please unmute your microphone before you begin speaking. Once again, there is no moderator on the call, so please mute your line when you're not speaking.

During questions and answers, I ask that members identify the witness to whom they are addressing their questions rather than simply directing their question to the entire panel. This will allow me to recognize the witness and give that person the floor. All comments by members and witnesses should be addressed through the chair.

Members, should you need to request the floor outside of your designated time for questions, please unmute your microphone and signal this to the chair. When speaking, please speak slowly and clearly and do not use speakerphone. Should any technical challenges arise, in particular in relation to interpretation, please advise the chair, and the technical team will work to resolve them. Please note that we may need to suspend during these times, as we need to ensure all members are able to participate fully.

During this meeting, we will follow the same rules that usually apply to opening statements and the questioning of witnesses during our regular meetings. Each witness group will have 10 minutes for an opening statement, followed by the usual rounds of questions from members. We have previously agreed that we will have three rounds of questions.

I would now like to welcome our witnesses.

We'll start with the Canadian Association of Emergency Physicians.

Dr. Drummond, you have 10 minutes for an opening statement. Please proceed.

[Dr. Alan Drummond, Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians]

Thank you, Mr. Chair and members of the committee.

The Canadian Association of Emergency Physicians is the national specialty society for emergency medicine. Our 2,500 members provide front-line emergency care to the millions of Canadians who make over 15 million emergency department visits each year.

In our belief, Canadians have a right to receive timely access to quality emergency care, but the decades-long neglect of our emergency health care system has made this largely an aspirational goal rather than a reality. Emergency departments are crowded because of our inability to transfer admitted patients to the wards and the ICUs in a timely fashion, leading to care routinely given in hallways, with increases in risk of contagion and in unnecessary morbidity or mortality.

The safe occupancy rate of a hospital is known to be 85% to allow for efficient operation and to provide surge capacity. However, Canadian hospitals routinely operate at over 100% capacity. In order to achieve needed surge capacity, our provinces have had to drastically cut back on scheduled surgeries and routine ambulatory care. However, we are now extremely grateful to be at about 75% occupancy across the country. That's a good thing.

The other major chronic challenge is insufficient human resources. We are chronically short of trained emergency physicians and have insufficient residency positions across the country to alleviate that shortage. Our collaborative working group on the future of emergency medicine identified in 2016 that Canada had a shortfall of around 500 emergency physicians, estimated to increase to about 1,100 by this year, and no changes have been made in the intervening years.

With respect to the COVID-19 pandemic that was declared by the World Health Organization in March, the novel coronavirus has lived up to the phrase “novel”. Though we are slowly coming to an understanding of its epidemiology and its transmission, we are already aware of its potential to rapidly evolve and cause serious respiratory illness and death. There is no cure for COVID-19, and management at this point is purely supportive.

It's important to keep a perspective. While it appears to be a mild illness for the majority of people infected, hospital admission rates of over 10% have been reported, with an ICU admission rate of approximately 3%. The overall case fatality rate for the population is estimated to be between 1% to 3%, but the total rises as the individual ages, with a case fatality rate of at least 13% to 14% in those over age 80.

For those who require a ventilator, the case fatality rate is extremely high, and the time on the ventilator is often long, measured in weeks. For survivors, the extent of persistent health problems beyond their time of ventilation is unknown.

The challenge facing us in Canada is that we have been provided with a very precious window of opportunity to learn from the lessons of our colleagues in Italy and New York and those other areas that were hit hard early, and to use that time wisely to maximally prepare for what may befall us should the curve not be flattened appropriately.

In our view, there are three main components of the overall challenge we may face as a nation, but all can be encapsulated by the word “capacity”. This falls, then, into three components: health human resources, technology and physical space.

With respect to health human resources, our first challenge will be to maintain adequate human resources in the emergency departments. Emergency physicians and nurses on the front lines are clearly at increased risk of exposure and thus of being unable to work because of quarantine and/or infection. Staffing, particularly in rural departments with a smaller pool of physicians to draw upon, is tenuous on a good day, and given our overall shortage of emergency physicians, this will undoubtedly be a major issue for them.

The only way to maintain such capacity in emergency departments is to provide sufficient quantities of personal protective equipment to staff. Our members are sharing with us disturbing reports, as you're aware, of insufficient quantity, rationing or uncertain availability. The pandemic has not yet peaked and the virus will be with us for some time, so we need to continue to build our supply and distribution chains coast to coast so that all front-line staff have the appropriate protective equipment to provide care safely.

With respect to technological resources, there are two major concerns: access to adequate and appropriate laboratory testing and screening, and access to ventilators.

By necessity, current testing has needed to focus on the highest-priority groups, including health care workers and patients in hospitals, long-term care facilities and other facilities, but we must radically increase capacity to allow us to expand testing to all who are symptomatic, as well as develop a well-designed surveillance strategy to complement this testing. Public Health will need to increase capacity to react to an increased testing volume to ensure we promptly contact and isolate trace positives. Only when these two steps are in place should we safely loosen current public restrictions on gathering and movement.

The second concern, as you are undoubtably aware, is the availability of life-saving equipment, most notably ventilators. We know, following the H1N1 pandemic in 2009, that the Canada-wide ventilator supply was about 5,000, with regional disparities such that in Alberta there were 10 ventilators per 100,000 people, while in Newfoundland it was as high as 24.

Worryingly, when the Ontario government developed a plan for an influenza pandemic in 2005 and used a standard modelling exercise and an attack rate of 35%, it was estimated that at the peak of an influenza pandemic, patients would require over 170% of available ICU beds and about 120% of the ventilators in Ontario. Sobering also was the estimate that up to 50% of health care providers could become infected. This model envisioned an almost apocalyptic, but now very realistic, scenario in which more than twice as many patients would require intensive care with less than half the usual staff available to provide it, underlining the aforementioned critical need for personal protective equipment, surge capacity and a stockpile of ventilators.

With respect to space, we've talked about ICU space and we've talked about emergency department crowding, but hospitals will also need to provide space for those patients requiring supportive and/or palliative care. No Canadian should ever be allowed to die in a hallway.

We also need adequate space to continue to care for other patients needing acute care. They cannot be forgotten.

I am now going to pass you over to Howard Ovens.

[Dr. Howard Ovens, Member, Public Affairs Committee, Canadian Association of Emergency Physicians]

Thank you.

Specifically with respect to the role of the federal government, there has been no apparent national coordination of public health measures, leaving a very confusing and differing set of measures on business closures and public gathering restrictions, varying from city to city and province to province. There must be clarity and federally coordinated messaging with respect to strict and uniform preventive public health measures, including public masking, gathering sizes and travel restrictions.

The importance of consistent messaging for effective communication should outweigh potential jurisdictional concerns. Until now, the federal government has only been one voice among many, which has led to conflicting and confusing direction to the Canadian public and to health care providers. CAEP believes that it could have a partnership role in a stronger federal role, in that emergency physicians are generally perceived by the public as knowledgeable and credible, since we are on the front lines of the battle and we're ready to help.

To avoid provinces competing with each other for needed supplies as we approach the surge in the coming weeks, we need the federal government to ensure the rapid and continuous procurement and distribution of vital PPE, laboratory supplies, testing kits and ventilators. Of all these things, right now personal protective equipment is the top priority, in order to secure the health and trust of the acute care and emergency workforce. Expert-based, standardized recommendations for PPE must continue to be developed as we get new knowledge and disseminate it across the country, especially to ensure that rural and smaller centres that may not have local expertise are provided with the same level of comfort and safety as larger centres. To the extent possible, transparency in this is necessary to ensure that recommendations are indeed based on an appropriate abundance of caution rather than the availability of supplies.

During a crisis, it is well established that an effective and lean command and control system is critically important, yet we still do not have an integrated incident management system in place. As a result, we have multiple ministries, departments and agencies involved in a confusing and overlapping span of control. An IMS approach would help implement all of our recommendations and ensure the ability to respond quickly to changing science and circumstances.

Therefore, we see an immediate need for the following: one, create a national incident management system, vertically integrated with provincial systems; two, standardize public health measures and communication nationally; three, use the IMS and the emergency powers act to ramp up domestic production of PPE, equipment and medication, and create a national distribution system to avoid balkanization; and four, ramp up national testing capacity and standardize an aggressive national surveillance strategy to go along with isolation and contact tracing of positives.

Canada faces an unprecedented public health crisis. A national crisis requires national leadership. We need the federal government to provide a steady, clear voice that signals decisive leadership and clear command and control. As emergency physicians, we will stand with you as we embark on this unique challenge and a national enterprise of delivering hope to our citizens.

On behalf of our colleagues, Dr. Drummond and I thank you for the opportunity.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Ovens.

We go now to the Canadian Federation of Nurses Unions. Ms. Silas, president, please go ahead for 10 minutes.

[Linda Silas, President, Canadian Federation of Nurses Unions]

Thank you very much. I'd like to thank the members of this committee for coming together to tackle what represents our generation's biggest challenge.

I have the honour of being invited here as president of the Canadian Federation of Nurses Unions, but I'm also here to give a voice to the close to one million health care workers across Canada. We're all in this together. Regardless of whether your job is to keep the place spotless or to perform an intubation to a critically ill patient, health care delivery is and always has been a team sport. This means the recommendation your committee will be making to the Government of Canada impacts the lives of not only those who care for the sick in our country but also the lives of the millions of others who live alongside us.

I wish I could be here to recognize the strong work of the Public Health Agency of Canada and Dr. Tam's team, in which I include all the chief public health officers across the country, for what they have done in public awareness and education—and I stress “public”. People across Canada understand that they have an important role in flattening the curve of the outbreak to help the country out of this pandemic.

I wish I could be here to comment on the many initiatives the government has announced to support Canadian workers today and to kick-start our economy tomorrow. Unfortunately, I am not. I'm here to bring light to the sad and scary realities of our health care system.

As you know, the Public Health Agency of Canada was created in the wake of the SARS crisis. Since its beginning, it has taken its public health duties very seriously. However, workplace safety has never been PHAC's primary focus, and the agency has unfortunately failed, over and over, to consider and appropriately protect the health and safety of health care workers. That's why I'm here. It's to implore you to take a stand for the health care workforce by calling for the Prime Minister and the government to invoke the measures of the Emergencies Act to help our health care system survive this global pandemic.

The CFNU believes that the current situation in both acute and long-term care settings across Canada fits the law's definition of an emergency that rises above the ability of one province to cope, thereby representing a risk to other provinces. The time for our government to act is now.

You just heard Dr. Ovens say that government is only one voice among many. We are humbled by the gratitude government officials have expressed for our work, but gratitude will not save lives. Given the amount of uncertainty around this novel virus and the real threat to the safety of health care workers across Canada, CFNU is pleading with the government to designate, at a minimum, airborne precautions and the use of N95 respirators at all times in so-called clinical hot spots. These include intensive care units, emergency rooms, operating rooms, trauma centres and units for managing COVID-19 patients. Our goal is to make sure that health care workers are protected 100% of the time when they're providing care to those patients—well, I have to say, as close as we can get to protecting them.

We're also asking that you recognize the critical importance of point-of-care risk assessment: the idea that individual health care workers are in the best position to determine the appropriate PPE required, based on the needs of their situation and the interaction with the individual patient. I find it striking that as recently as a couple of months ago, government, employers and managers around this country respected the clinical and professional judgment of the health care team, both in identifying the most appropriate care for our patients and in determining what health and safety measures we needed to protect ourselves. Today the same governments, employers and managers are locking up personal protective equipment to keep it away from the health care workforce.

Shame on us all. We've clearly failed in our duties to those who care for the sick and the vulnerable.

CFNU's view, and that of numerous experts we've consulted with, is that the government's approach fails to recognize the fundamental importance of the precautionary principle and its guidelines. Nurses and doctors sadly learned from our experience with SARS that the precautionary principle must be applied. We lost two nurses and one doctor with SARS, and that was with 44 deaths in all. Today, between 10% and 15% of those infected with COVID-19 are health care workers.

This is not fearmongering; this is the reality on the front line. We want decision-makers to understand that no infection prevention and control guidelines and PPE measures can be developed and implemented without working with unions and joint occupational health and safety committees. Until the Public Health Agency of Canada's guidance document for acute care facilities for COVID-19 is updated to reflect our various serious concerns, we are encouraging all health care workers to follow the letter of the law when it comes to occupational health and safety, and that is to report any hazard and protect their own health and safety.

I shared with you by email the joint statement issued by the Canadian labour organizations that represent all health care workers. It calls on the Public Health Agency of Canada and all provincial health offices to protect health care workers and their patients by adhering to the precautionary principle. In a nutshell, our message to you is this: When faced with this level of uncertainty around the new coronavirus, especially around something as fundamental as how it is spread, we should start with the highest level of protection for health care workers, not the lowest.

As members of the health committee, you are all well aware that our health care system is already running over capacity. We simply cannot afford to erode staffing levels any further by having health care workers become sick or having to self-quarantine. Front-line workers across the country who are directly involved in the care of presumed and confirmed COVID-19 patients are not being provided with the PPE they need to do their jobs. This is simply outrageous and unacceptable in a world-class health care system like ours.

However, there are examples of best practices that are beginning to appear across the country. Joint agreements between unions and employers to respect the clinical judgment of health care teams have now been signed in British Columbia, Alberta, Ontario and, last night, in New Brunswick. In Quebec, Newfoundland and Alberta, uniforms are being provided to those caring for COVID-19 patients. In Nova Scotia, we are seeing new measures being developed to assist the long-term care sector.

Some see the shortage of PPE supplies as the driving factor behind regulations advocating the use of surgical masks over N95 masks. CFNU and other health care unions have offered to work hand in hand with government to address the PPE supplies issue and to ensure their appropriate use, but we need transparency, honesty and leadership from our governments.

To conclude, you may be aware that I started my career as a critical care nurse in beautiful New Brunswick. Since then, medical technology has come a long way, but one thing that hasn't changed is that as health care workers, we cannot anticipate and plan for every situation. Patients who are anxious or in respiratory distress cannot be expected to be calm. Patients won't always cough into their elbows, nor will the nurse always have the opportunity to maintain a two-metre distance from a patient. Machines fail, and human error is an unfortunate reality.

Quite simply, unpredictable and unforeseen circumstances are part of working in the health care environment. That is why, as a society, we need to protect our health care teams. Unlike many of us, they don't have the luxury of working from home. As policy-makers, we have to respect their clinical judgment, because ultimately, it's the health care workers who will be providing care for one of our loved ones.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Silas.

We go now to Dr. Sandy Buchman, president of the Canadian Medical Association.

Please go ahead, Dr. Buchman. You have 10 minutes.

[Dr. Sandy Buchman, President, Canadian Medical Association]

Thank you very much, Mr. Chair.

I am honoured to have the opportunity to appear before you today, and I am honoured to appear with my colleagues, Dr. Drummond and Dr. Ovens of CAEP and Ms. Silas of CFNU.

That we are gathered here virtually rather than physically simply serves to further underscore the gravity of the situation we all face as Canadians.

In exploring Canada’s response to the COVID-19 pandemic, I am pleased to represent the unique perspective of the front-line workers who are entrenched in the daily battle to defeat it.

Again, my name is Dr. Sandy Buchman. I have over 20 years of experience in practising comprehensive family medicine, with a special interest in primary care, cancer care, palliative care, HIV/AIDS, global health and social accountability. I have spent the last 15-plus years practising home-based palliative care, including providing palliative care to the homeless in Toronto.

Today I appear before the committee as president of the Canadian Medical Association.

I wasn’t around for the Spanish flu in 1918, but the CMA was. I wasn’t the president when SARS hit in 2003 or when H1N1 came in 2009, but the CMA was there. The organization that represents Canada’s physicians has witnessed significant outbreaks during its 153-year history. The Canadian Medical Association represents the interests and well-being of the very physicians who care for our nation’s health. I have the humble honour today to speak for our members, those front-line physicians.

As we are all aware, the COVID-19 pandemic is evolving rapidly. We did not get to control if it came to us and we did not get to control when it came to us, but to the degree to which we are equipped, we can control how we respond to COVID-19.

Messages about the health of Canadians and the health of the economy mean nothing without an equal pillar: the health and safety of our front-line workers. At this point, it is of incredible urgency that we support our care providers and that we understand how important it is to be armed with information to make the decisions to make it happen.

We have heard through our members that the inadequate supply of personal protective equipment is even starker than has been reported, so we launched a rapid survey to collect real on-the-ground stories from physicians. On March 30 and March 31, we heard from close to 5,000 physicians. They represented an almost equal split between community-based physicians and hospital-based physicians. This poll was essential to accurately inform us of the situation at the front lines. We now have a clear snapshot of physicians’ observations and experiences around the personal protective equipment that is available to them. That equipment includes surgical masks, N95 respirators, face shields, gowns and gloves.

The feedback received shows a dark reality. The results don’t just reveal the issues with supply and distribution of PPE; the results unveil the enormous lack of information available about the status of supplies and how health providers can get supplies. The toll that is paid for this uncertainty weighs heavily on health care workers across the country. They are scared. They are anxious. They feel betrayed. They don’t know what supplies are available.

More than a third of physicians in community care—that is doctors’ offices, walk-in clinics and health hubs—said they believed they would run out of masks, respirators, eye and face shields, and goggles and glasses within two days or less, or indeed they had already run out. That was just seven days ago. Seventy-one per cent of physicians in community care have tried to order supplies in the past month, but fewer than 15% received confirmation that supplies were en route or had been received. In Nova Scotia, only 2% of physicians indicated that their recent order had been received or was being shipped. That’s fewer than 50 doctors.

When it comes to alternative supply sources, one in 10 physicians waiting on supplies was aware of a government source of supply. The rate is highest in Alberta, at 26%, and lowest in Nova Scotia and New Brunswick, at 5% and 0% respectively. Physicians who work primarily in hospitals where COVID-19 cases are being directed were largely unaware of how long their current supply will last. A great many respondents are being asked to ration supplies.

Physicians are saying there is lack of information and transparency. They are facing unclear and inconsistent messaging about PPE supply and use. This has become a major concern and source of anxiety.

Ninety-four per cent of those who work in the community responded that they are able to provide patient care virtually over the phone to some degree, over one-third are able to do video conferencing and one-quarter can provide patient care via email or text, but physicians noted that there are many situations where patients must be examined in person.

Canada is known for its health care, but the holes in our system have been evident to those of us working in it for far too long. The delay of measures to ensure greater safety are now even more evident, and to more people. The pressing needs of today, all of them, are those that our nation has thirsted for in times of general health. Too often and for too long, they have all been pushed to the back burner. Even in the best of times, hospitals across the country are at overcapacity, millions of Canadians don't have access to a regular family doctor and countless communities grapple with health care shortages.

There are populations that are especially vulnerable in this pandemic, such as our homeless and those on limited incomes; our elderly, especially those in long-term care; our indigenous peoples; those residing in prisons; people of all ages with complex medical conditions and disabilities—to name but a few. They have challenges in accessing care, and their increased susceptibility to the disease is of grave concern.

Virtual care is in its near-infancy. National licensure is only in discussion.

We appreciate that the federal government is working to make this a priority. We applaud the innovative efforts of our very own industries that are pivoting production to supply PPE. We understand the global competition to supply this protective gear for our care providers. Still, asking health care workers to be on the front lines of this pandemic, without the proper equipment, is unacceptable. Shortages must be addressed immediately, and information about supplies must be disseminated. People's lives are on the line.

Would we expect a firefighter to enter a burning building, risking his or her life, without adequate protective equipment to keep them from harm? Physicians and other front-line health care workers have a call to duty. They're willing to place themselves in harm's way, but they have rights too. It is their right to be protected when they put themselves at risk of harm.

It is not only themselves that they put at risk. It is also their families and loved ones. Society and government have a reciprocal moral responsibility to protect them from harm, hence the critical necessity of adequate PPE at the front lines. We cannot win this COVID-19 war without it.

These are very exceptional times. I appreciate your recognizing the urgency being felt at the front lines. History has repeatedly demonstrated that times of crisis can define the path forward. We can employ this crisis to guide us towards a healthy future. Despite being in crisis now, we cannot in the future forget these lessons in preparedness. We need to ensure that health care workers are safe.

If we are to do this together, we need the physicians and all health care workers to be kept top of mind.

In conclusion, allow me to thank the committee once again for the invitation to participate in today's proceedings and to share with you the experiences of Canada's physicians. We must apply armour to those who are defending us. Without it, they are defenceless. Without them, Canadians are defenceless.

Thank you. Meegwetch.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Buchman.

We'll go now to the Canadian Pharmacists Association, with Dr. Barry Power, senior director.

You have 10 minutes. Please go ahead.

[Dr. Barry Power, Senior Director, Digital Content, Canadian Pharmacists Association]

Thank you for inviting the Canadian Pharmacists Association to appear today, during this rather unusual time.

I'm Dr. Barry Power and I’m joined by my colleague Dr. Shelita Dattani. We are here on behalf of our 43,000 pharmacist colleagues from every province and territory.

We’d like to start today by giving you a quick glimpse into the lives of pharmacists, about 80% of whom are in community pharmacies and close to 15% are in hospitals. We would also like to touch on three issues that are front and centre for pharmacists and their teams at this time.

What are we seeing in pharmacy? The last few weeks have been very intense, to say the least. We have seen an incredible surge of people coming into our pharmacies across the country seeking help and support. They are often scared and concerned that they can’t get through to the 811 line or to their doctor's office, which is closed, and they or a family member are sick and need help. We are there for them. We are answering their questions, allaying their fears and providing the care they need.

Pharmacies are also trying to adapt quickly to the changing environment and needs of their patients. To create a safe space for clients, many pharmacies have implemented special hours for seniors and other at-risk individuals. They're adding additional cleaning and disinfecting procedures, often after hours, and are coming up with innovative ways to support physical distancing, like curbside pickup. I've never been so proud of those in my profession who are on the front line and who are showing up every day to work. Unlike many of us who can work from home, they cannot, so we’re very humbled to be able to have this opportunity to bring forward some of the major issues and challenges they are experiencing at the moment.

One of the things pharmacists are most concerned about during this pandemic is ensuring all Canadians have access to their medications. We've seen a number of troubling trends over the past few weeks. The first sign came about six weeks ago, when almost overnight the supply of masks, hand sanitizer and gloves were sold out. Then about three weeks ago, as public health officials started to implement social-distancing policies across the country and recommend that people stockpile food and medications, the demand for medications skyrocketed. What we saw was the volume of demand increase by over 200% in March, threatening the integrity of our drug supply chain. If left unchecked, we would have run the risk of running out of medications for our patients.

For fear of medications becoming the next toilet paper, we quickly took action by recommending a temporary 30-day supply limit for medications. This was critical to protect supply chains, address panic buying and most of all to ensure that patients would continue to have access to their drugs in the coming weeks. In addition to the need to manage demand, we are also concerned about the increase in drug shortages. In the months leading up to March, the government’s mandatory drug shortage website was listing approximately five new shortages per day. In the last few weeks, the number has increased about 35%, and we are seeing some early signs that those shortages have increased more rapidly in the first few weeks of April. That is in addition to some of the shortages that we’ve already seen of medications that are being used directly to treat COVID.

Currently, Health Canada has identified three such COVID-related severe shortages. First is hydroxychloroquine, the subject of much press, having been touted by some prominent figures as a cure to COVID. While there is currently no evidence that this is the case, the demand for hydroxychloroquine is now making it difficult for patients who rely on this drug for conditions like rheumatoid arthritis or lupus.

Second is inhalers used for asthma and COPD. The demand for inhalers in the last few months has increased significantly, both from hospitals as they prepare for COVID and in the community setting as people stockpile medications.

Third is medications being used in hospitals, particularly the sedative medications used in ICU settings for ventilated patients, drugs such as fentanyl and propofol.

COVID is and continues to be a threat to Canada’s drug supply. We recognize that measures such as the 30-day supply impact patients. Thus, we have been urging governments and private insurers to ensure no patient is out of pocket for the additional costs associated with the 30-day supply. Thankfully, progress is being made to address this concern.

We also want to minimize the risks to patients who might need to refill their prescriptions by visiting pharmacies more often. I’ll turn it over to my colleague Shelita to address this issue.

[Shelita Dattani, Director, Practice Development and Knowledge Translation, Canadian Pharmacists Association]

Thank you, Barry.

Thank you, Mr. Chair.

We know physical distancing is especially important for vulnerable Canadians such as seniors, people with chronic diseases and those who are at particular risk of coming into contact with COVID, which is why it’s critical that we help those people stay at home and why pharmacies have ramped up home medication deliveries in the last few weeks.

In fact, pharmacy deliveries have increased on average 85% to 150% per pharmacy, which translates into an increase of about 36 deliveries per day per pharmacy in this country. For many pharmacies, the dramatic increase in deliveries has been a challenge to manage, from a cost perspective but also from a labour perspective, in making sure that they have delivery staff who are also protected. This is why we’ve asked the federal government for $60 million in funding to support free medication deliveries for seniors in our country.

Increasing deliveries is just one way to protect people at risk while also protecting pharmacy staff.

I would now like to turn to our final point, regarding access to personal protective equipment, which, as my colleagues have all addressed, is necessary to protect front-line health workers, and pharmacists are no exception.

Pharmacies have been deemed essential services meaning that we stay open when others close. Pharmacists, as my colleague Barry noted, are the most accessible health care workers in the community and even more so now. We are seeing patients every hour of every day, many of whom are sick, without the necessary protective equipment. While many pharmacies have put in place some protective measures, such as plexiglass and other barriers, and are encouraging people with symptoms not to visit the pharmacy in person, there are still many times when we are in direct contact with our patients. We are afraid not just for ourselves but for our families and for our patients—because if we get sick, who will be there to care for them?

In Spain over 50 pharmacies have already closed due to illness. Tragically five of my pharmacist colleagues have died. We have already seen a number of pharmacies close in Canada due to exposure.

Best available evidence suggests that in addition to contact precaution, droplet precaution PPE should be used by health care workers who may be in close contact, i.e., within two metres, of someone suspected of having COVID. We know that droplet protection PPE consists of four elements: a disposable surgical procedure mask, which is used in community pharmacy settings; a full-length, long-sleeved gown; disposable gloves; and eye protection, which can include a face shield or goggles.

Unfortunately, pharmacists and others working in the pharmacy are feeling extremely vulnerable at this time. While pharmacies have been deemed essential, pharmacists and pharmacy staff have generally not been deemed essential health care providers across our jurisdiction in this country, so we have had very limited access to the necessary PPE.

We're calling upon the federal government to recognize pharmacists as “essential” health care providers and to work with all of the provinces and territories to ensure that they have access to the government supply of PPE to be distributed appropriately.

Dr. Power and I thank you very much for your time and we look forward to questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Dattani.

We'll go now to our first round of questions. We'll start with Mr. Jeneroux for six minutes, please.

Matt, go ahead.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair. I hope it goes a little bit smoother than it did last week.

I'll begin by thanking all of you witnesses and everyone within your associations for working extremely hard during this pandemic. Thank you from the bottom of our hearts sincerely. I also want to ask questions today in order to better support and better advise the government on gaps. Again, I appreciate everybody being here at least virtually.

The world is facing a supply shortage because every country is planting itself in a position of trying to procure the same items. I'm going to go across the table with this question, starting with the Canadian Association of Emergency Physicians, then the Canadian Federation of Nurses Unions, then the CMA and then the CPhA. When was your organization first contacted by the Public Health Agency and Health Canada to work collaboratively on COVID-19?

[The Chair, Liberal, Ron McKinnon]

Dr. Drummond or Dr. Ovens, go ahead.

[Dr. Alan Drummond]

I'm not sure actually if we were, to be straight thinking about this. We recognize that we had a lead time of several weeks, when we were looking at what happened in northern Italy and New York. Largely this has been an effort based strictly on our own membership trying to streamline our response to the needs of our members, because there was such disorderly and fuzzy communication from all levels of government. Recognizing that this lack of clarity heightened anxiety, we decided that we would ramp up our own research as well as we could, given the limited time span we've been facing, and try to provide the best possible evidence for our members, realizing that what we say one week may change the next.

In terms of personal protective equipment, it really is a concern to our members. The lack of clarity has not helped. Some organizations call for N95s whereas we don't really feel they are really necessary unless we're involved in an aerosol-generating procedure such as an intubation or ventilation or a cardiac arrest situation—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I'm sorry to interrupt, but I just want to make sure we get to everybody else as well. If you don't mind, I'll come back to you.

[Dr. Alan Drummond]

The long and short of it is that we haven't.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Okay.

The Canadian Federation of Nurses Unions, go ahead.

[Linda Silas]

We wrote to Dr. Tam on January 24 reminding the Public Health Agency of their legal requirement under occupational health and safety. We asked them to be involved in the guidance document, as in the past with Ebola and H1N1.

On February 25, we met with the Minister of Health, because we hadn't had any response from PHAC. On March 5, a week after that, we had a meeting with PHAC, and then a face-to-face meeting with PHAC and all health care unions and other stakeholders on March 13. I'd like to remind others that on March 13 we only had 157 cases in Canada. On March 13, we also came out with our health care national unions' joint statement.

Following this, we're looking at April 7, today, and the second edition of the guidance that came out from the Public Health Agency of Canada, which we denounced earlier this week. It does not represent the precautionary principle. It does not represent the professional and clinical judgment of health care workers at the place of care, so we're—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Ms. Silas, I just want to mention that I only have six minutes. I want to make sure we get to—

[Linda Silas]

Yes, and we're denouncing their guidance.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Dr. Buchman.

[Dr. Sandy Buchman]

We've had regular communication with the Public Health Agency of Canada now for several weeks. It likely began in January, although I'm not exactly certain, but there has been a regular communication channel. There has been ongoing reassessment, and they have been aware of our concerns for this period of time.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

You had requested in your latest communication an urgent meeting with Minister Hajdu. Have you received that meeting yet?

[Dr. Sandy Buchman]

Yes, I was able to meet directly with Minister Hajdu last Friday and again expressed many of our concerns, including what I shared today during my presentation.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you.

I'll go to the Canadian Pharmacists Association.