Health Committee on April 7th, 2020

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

Okay.

We're hearing some troubling reports that pharmacies in Canada are running out of hydroxychloroquine, which I understand is commonly used to treat illnesses like lupus and malaria.

Have you heard from your members that there are surges in prescriptions or demand for this drug, and what steps is your organization taking to ensure that the people who have non-COVID prescriptions for this are able to get the medication they need?

I know we have just a limited amount of time, so a short answer would be best.

[Dr. Barry Power]

As soon as we heard about surgeons prescribing hydroxychloroquine, we contacted regulators across the country. We put out a statement advising pharmacists not to fill these prescriptions and to reserve those medications for people with rheumatoid arthritis and lupus.

Most regulators around the country now have similar statements, in some cases a joint one between pharmacy and medicine, if not pharmacy, medicine and nursing, to make sure that these medications are safeguarded for people who are stabilized on them for chronic conditions, or that they are used in an acute care setting such as a hospital where it's under a tight protocol.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We'll now go to Mr. Thériault for two and a half minutes, please.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I'd like to speak to you, Mr. Power. First of all, I want to tell you that I'm pleased to see that you have not waited for the government guidelines to take action and to give direction to your members to address the drug shortage, including the 30-day prescription measure.

We know there's a supply problem. We were just talking about it. India has imposed export restrictions on several active ingredients used in the manufacture of medication. There is also a problem in getting them to Canada because of a lack of personnel and containers, not to mention the problems with the commercial flights that carry these drugs.

India is one of the main suppliers of raw materials. This country is being hit by the pandemic and its containment measures are very severe.

What are our options for dealing with raw material supply problems?

We talked about hydroxychloroquine. Are there any alternatives? Are there any other drugs that can be used instead?

Can you tell us about the situation so people will be reassured?

[Dr. Barry Power]

Thank you very much for the question, Mr. Thériault.

We've been in contact with a number of the manufacturing associations, and I believe that, as of yesterday, India has agreed to lift some of the restrictions on the export of the active pharmaceutical ingredients. We are hopeful that this will start the flow again, especially in combination with China coming back online. We still don't have a good timeline in terms of when the supplies are going to start flowing into Canada, but we are hopeful that it will pick up over the next coming weeks.

In terms of hydroxychloroquine, there is another drug, chloroquine, that can be used. Most of the focus has been on hydroxychloroquine, but they're both anti-malaria drugs and may have a similar effect. The supply for that will really depend on the ability of various companies around the world to supply the ingredients for hydroxychloroquine tablets to administer to patients.

We're definitely in a situation where there's an increased global demand for hydroxychloroquine and chloroquine as a result of all of the focus on COVID-19, and we do need all governments to encourage increased production of these medications for that reason alone. To date, the data are still somewhat questionable as to whether or not hydroxychloroquine has a clear benefit in COVID-19. Some of the research that has come out is promising, but it is not clearly showing that it has a major effect in improving the outcomes for people infected with COVID-19.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We'll go now to Mr. Davies for two and a half minutes.

Go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Ms. Silas, I take you back again to 2006 and the final report of the independent SARS commission. It said:

[T]here is no longer any excuse for governments and hospitals to be caught off guard and no longer any excuse for health workers not to have available the maximum [reasonable] level of protection through appropriate equipment and training.

On the principle that if we don't know how we got here we won't know where to go, can you explain to us how we got caught so off guard with respect to personal protective equipment after that clear warning from the SARS commission? What advice would you have to deal with this on a go-forward basis?

[Linda Silas]

Justice Campbell was clear: We had never put occupational health and safety, the safety of workers, in our health care system. And we didn't. I was educated as a nurse. For a lot of doctors, it was always, “Put patients first.” Today, since SARS, we've been faced with the reality that we have to put workers on an equal footing. You heard the example from Sandy about a firefighter going into a fire without his or her equipment. We don't do that in health care.

What the Public Health Agency of Canada needs to do is separate completely public health, public security and occupational health and safety. Occupational health and safety is under provincial and federal laws. It's an employer's responsibility to provide the training and equipment that workers need, and health care is no exception.

That's what we're trying to drive here. We are not respecting the health care workplace as a workplace. It is not an area where things will just go well if we pray enough. It is a workplace that can be very dangerous, and we need to protect our workers.

[Don Davies, NDP, Vancouver Kingsway, BC]

You know, an alarming memo was recently sent to front-line health care workers in Hamilton, Ontario. It stated, “Staff should be keeping their first surgical mask on until grossly soiled or wet, or until an N95 respirator is needed for an aerosol generating procedure.... After the procedure, the N95 will be kept on until grossly soiled.”

Do you have any comment on that memo?

[Linda Silas]

Sick, sick, sick. It goes against all our training in disease prevention. Any training that we ever got is that you have to derobe after you leave the patient. You have to throw away anything from one patient to the other. And of course, as soon as it is soiled, never mind grossly soiled, you have to discard it.

We are looking forward to new studies around resterilizing some of the N95s, for example. When and if they prove to be safe for health care workers, we will be supporting that. In the meantime, we are going to stand ground that health care workers are going to be protected against this vile virus.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Drummond, quickly, you mentioned that you would like to increase testing to all who are symptomatic.

Yes, Mr. Chair. I'll just finish the question—

[The Chair, Liberal, Ron McKinnon]

Sorry, your time is up.

[Don Davies, NDP, Vancouver Kingsway, BC]

Oh, okay. Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We're starting the third round. We'll go now to Mrs. Jansen.

Mrs. Jansen, you have five minutes. Go ahead.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

I want to start by saying a tremendous thank you to all the witnesses, as well as all the workers on the front line—the witnesses, most especially, for their honesty and transparency here today.

I've been so worried. I've had many constituents calling me who work in the health care field. They feel such a tremendous anxiety for themselves and their families when they're being told to change the way they're using their PPE in order to make sure they don't run out. As you just mentioned, it's sick, sick, sick. It's very difficult for them to say, “I have to wait till my mask is soiled to change it.” It's been very, very concerning. I'm thankful that you've all been so open and honest with us.

I have a question for Dr. Ovens. When I had constituents calling, they would be saying to me that the information that was being shared at the briefings, whether they were provincial or federal, didn't really reflect the experiences they were seeing on the ground. In the interim report of the national advisory committee on SARS and public health, which was released back in 2004, it was noted that Canada needs a real-time alert system in place for a proper pandemic response.

Do we have some sort of software for data entry at hospital level so that we can report to the local public health in real time, so that the information shared is real-time information?

[Dr. Alan Drummond]

There is no national real-time system that I'm aware of. Data gathering varies a lot from jurisdiction to jurisdiction. Some data elements in some places are automated, but at least some data elements are manually reported, I think, pretty much everywhere.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

In your view, then, do you believe that the discrepancy with what's being reported in media briefings would be improved if we had a better system for that?

[Dr. Alan Drummond]

That's a broad statement. Obviously, the more accurate the data is and the faster we can get it up to the leadership groups, the better it would be.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Okay. I appreciate that.

Dr. Buchman, one of the recommendations in the document was that we need a better emergency preparedness response system, which would include a national emergency stockpile system. Your survey of the 5,000 physicians showed that information regarding that stockpile was pretty scarce.

Would you say that this national emergency stockpile system is inadequate?

[Dr. Sandy Buchman]

As we've heard, there are significant shortages. I'll give you an example. I'm a palliative care physician, and we're trying to ramp up our response in palliative care, because no patients should be abandoned if they are not suitable for a ventilator or if they're not going to survive on a ventilator.

There's a procedure called “palliative sedation” that allows a patient to be sedated and pass away comfortably and peacefully, but we know that some of the medications are now in short supply, in particular one called Midazolam, and some others. Another one is called methotrimeprazine. That's just a very small but important clinical example of these drug shortages that we have on an ongoing basis, as has been previously referred to. We see them—

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Sorry. I have a very quick question.

Is there such a thing as a national emergency stockpile system as you see it? Is there something that actually exists?

[Dr. Sandy Buchman]

I could be wrong, but to my knowledge we don't have adequate stockpiles or emergency medicines. It might be a better question for my colleagues from the Canadian Pharmacists Association.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

It wasn't specifically about drugs. It was also about PPE and stuff like that. I think that's what the emergency stockpile system was for.

[Dr. Sandy Buchman]

Yes, there are adequate supplies for that.