Health Committee on April 7th, 2020

[Shelita Dattani]

As others have, we've had engagement with the chief public health officer through the health care professional forums. I think the engagement really accelerated around COVID around late January, early February. We were quite involved before and since that time.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you.

I'll go back to the Canadian Association of Emergency Physicians.

Has the government messaging been consistent and clear?

[Dr. Alan Drummond]

I'll let Howard take that question.

[Dr. Howard Ovens]

I think it's been pretty consistent and clear, but it hasn't always been consistent with the messaging of provinces and cities, and that's where the confusion comes from. It's been clear and it has evolved appropriately over time as the circumstances have changed, but we're hearing very different things at times on the specifics with provinces and cities.

[The Chair, Liberal, Ron McKinnon]

Thank you, Matt.

Mr. Fisher, please go ahead for six minutes.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chair.

I want to thank all of the folks who are gathered virtually here today to help us assess this situation.

I'll go right to Dr. Buchman.

Sandy, it's so nice to hear your voice, even if it's virtually. I understand that you've recently met with Minister Hajdu to discuss your members survey on PPE. I want to take a second to thank you and your organization for what I think is such an invaluable survey. It really helps inform us as we work so hard with the provinces and territories.

Sandy, based on that survey, is there a particular jurisdiction or jurisdictions that you're more concerned about than others? I noted yesterday that news reports said that Manitoba and Alberta were sharing their PPE stocks with Ontario and Quebec. I think of this as very good co-operation, but I thought maybe you could touch on particular jurisdictions that you may be very concerned about.

[Dr. Sandy Buchman]

Thank you very much for the question.

Yes, we're concerned about the jurisdictions where the rise in the number of COVID cases is happening exponentially, particularly in Ontario and Quebec.

In looking at the amount of PPE and as we try to import more PPE and try to manufacture our own domestic supply, we think it's important to have coordination at the federal level between the federal government and the provincial governments and through the different regional health authorities to be able to deploy the equipment to the areas of the country that need it the most.

Right now we're seeing the most rapid rates of rise in Ontario and Quebec, and I think it's really important to see the appropriate distribution in those places. If the curve is a little flatter in other jurisdictions, they may have a little more time and they may not exceed their capacity to handle the number of patients who are presenting. As more PPE is manufactured or imported, equipment can then be distributed appropriately to those regions as well.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Sandy, what are your thoughts on the PM's update today on Canada's plan to mobilize Canadian industry to fight COVID-19 and to help provide that vital made-in-Canada protective gear and medical equipment? How are you feeling about that effort?

[Dr. Sandy Buchman]

We're encouraged. We've been encouraged all along by the efforts that the federal government has taken to procure the equipment and to work with businesses to repurpose manufacturing facilities to produce PPE. We don't think we can let up, so yes, we are encouraged by that.

However, as we're all aware, we're also facing a critical crisis point, particularly in certain areas of the country, which is that we may exceed the capacity of our system to handle it. If we start seeing physicians, nurses and other front-line care workers getting sick or becoming emotionally or mentally exhausted and dropping out, it leaves increasing burden on the remaining health care workers on the front lines. We can't state urgently enough that the development and the manufacture of this PPE has to occur now, and we have to get it out to those areas as quickly as humanly possible.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Sure. I totally agree.

Sandy, you talked about the CMA and how it was around for H1N1 and for SARS, and I'm pretty sure the CMA was around for the Spanish flu, but probably you were very young.

Could you just talk to some of the...? We're talking about different pandemics from different eras. We've talked about what we've learned from SARS and we've talked about what we've learned from H1N1. Do you see our being in the same position in a time frame down the road, when we're going to say that we learned some lessons from what I think you called a rapidly evolving pandemic?

[Dr. Sandy Buchman]

I think there will be lessons learned. I think the first and foremost one is that we were caught flat-footed. We didn't have adequate supplies of personal protective equipment for health care workers and we had drug shortages, as has been mentioned.

I think in particular that we don't have enough ventilators and other necessary equipment and beds. They were cut short in our health human resource planning. As mentioned, we don't have an adequate number of emergency physicians or other physicians and other health care workers available, particularly if they get sick or burnt out or, might I add, refuse to go to work, which is their right if they are put in harm's way without personal protective equipment. I think there are a lot of lessons that we didn't learn from SARS or H1N1 in appropriate planning.

However, I also think this was a global problem. I don't think there was a health care system in the world that was adequately prepared for the magnitude of this pandemic and the rapidity with which it has fallen upon us.

In sum, yes, I think we've already learned some of those lessons for the next time around, and I hope for dealing with the second and even third waves of COVID-19 that are likely to come.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Sandy, how does your organization work with the provincial and territorial governments to make sure they have the protections they need to do their work?

[Dr. Sandy Buchman]

Right now we're working with the federal government, as I mentioned earlier, to ensure there is transparent information that will come down the pipes to advise the provincial and territorial governments with regard to the supply of PPE and other equipment.

We work through our provincial and territorial medical associations, specifically within their jurisdictions as they deal with their local, provincial or territorial governments. It's by working together with our provincial and territorial counterparts.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Fisher.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thanks, Sandy.

Thank you, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

We go now to Mr. Thériault.

Mr. Thériault, go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I thank all of the speakers for their enlightening comments.

There are some constants in what you say. I've noted the issue of the lack of personal protective equipment supply, but before I address that, I'd like to talk about something that I'm struggling with. I'm going to speak first to the representatives of the Canadian Association of Emergency Physicians.

At one point, you said that in order to have more cohesion and leadership, an emergency measures act would have to be invoked. On March 17, there were 460 cases of COVID-19 in Canada, and five deaths. Now there are 17,063 cases, and 365 deaths. Quebec was one of the first to implement much stricter measures. On March 14, it declared a state of health emergency. Yet Quebec is one of the places with the highest number of these 17,063 cases. However, when we look at the ratio of deaths, hospitalizations and intensive care patients, we can see that the system's ability to take care of people is working. What would you have done more than what we have already done in Quebec, with emergency measures legislation? That's my first question.

Second, why should the supply of personal protective equipment, which is the responsibility of the federal authorities, not simply be added to the jurisdiction of Quebec and the provinces? In a crisis like this one, it seems to me that everyone should look to their own skills and expertise. If we need to get things moving, if we need to approve more products, if we need to allow companies to retool, let's do that. The federal government must do its job. How would emergency measures legislation solve the problem?

[Dr. Howard Ovens]

From what I know, Quebec has done a very good job in its response to the situation, with some of the more stringent precautions being put in place very quickly and some very good communication from your premier to the public. I think the problem is that, when we have people listening to media that go beyond our borders in any one city or province, and in some places you're allowing gatherings of 250 people, in other places gatherings of 50 people and in still other places gatherings of 10 people, and when the biology of the virus is the same in every one of those locations, it becomes very confusing for people and they start to lose a little trust in what they're being asked to do.

Our request was not a criticism of anybody's efforts. It's more a desire to make sure that the public is getting clear and consistent messaging.

Obviously, PPE is a shared responsibility. Our concern is that, at a time of great demand, we—

[Luc Thériault, Bloc, Montcalm, QC]

I'm sorry to interrupt, but Quebec is currently using the containment strategy that was implemented in China. Our least affected regions are under containment. You raise a public safety issue, but earlier you mentioned a leadership problem with respect to the ability to protect first-line workers. I understand that, but you have to look at it from a public health perspective, not a public safety perspective. You didn't address that earlier. I'm asking the question from a public health perspective. I'm wondering about our ability to provide equipment to the health care community to really protect them and to ensure that the health care system can hold up in the face of the strength and virulence of the pandemic.

From a public health perspective, how would emergency measures legislation improve the situation in our health care environments?

[Dr. Howard Ovens]

If we look at what has happened internationally, we can see the danger if we don't have a coordinated approach in Canada. Just as we've seen in the U.S., where governors have been competing with each other for available supply and driving up the cost, or where one jurisdiction—as the U.S. tried to do to Canada—prevents export, imagine if Ontario said that its businesses could not sell masks to Quebec, or if Quebec could not sell gowns to Nova Scotia, or if the supply chain became interrupted because of provincial boundaries. I think that would be a tragedy under the circumstances. It's that type of maximum co-operation that I think is in the best interests of our country.

Thank you.

[Luc Thériault, Bloc, Montcalm, QC]

It is the federal government's jurisdictional prerogative to do exactly what you say. It doesn't need emergency measures legislation to be able to exercise its jurisdiction competently.

[Dr. Howard Ovens]

I'm an emergency physician, not a constitutional lawyer. The intention of my comments, I think, are clear. I'll leave it to other people to interpret them in the most appropriate fashion from a legal and constitutional perspective.

Thank you.

[Luc Thériault, Bloc, Montcalm, QC]

If I understand correctly, aside from emergency measures legislation, and after what you have seen of Quebec's management of the pandemic, you are not suggesting anything different from what Quebec has already done to deal with the current pandemic.

[Dr. Howard Ovens]

Once again, I'm not trying to criticize anybody. I think even Quebec would benefit if Ontario, Nova Scotia and other jurisdictions on your boundaries were as aligned as possible. In fact, at one point we were asking that the rest of Canada align with the excellent steps that were being taken earlier and more stringently in Quebec. The question is not who's right or who's wrong. The question is how we can all get to the safest place together.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Ovens.

We go now to Mr. Davies for six minutes.