Health Committee on April 7th, 2020

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

In regard to the surge capacity that we heard the Prime Minister talk about, has it been made available by cancelling other medical procedures, or is there another, better way to create surge capacity, such as having a plan for pop-up hospitals, instead of taking away services for regular patients?

[Dr. Sandy Buchman]

That's a very good question. I feel that I don't have the expertise to answer it carefully, but I do know that in other countries of the world, there are pop-up hospitals that are separating regular patients from COVID-19 patients. I'm presuming there is evidence to support that. Again, I would defer to my colleagues, maybe Dr. Drummond or Dr. Ovens, who might be able to respond to that.

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

Is that possible, Dr. Ovens?

[Dr. Alan Drummond]

Actually, I'd be happy to respond.

We have talked extensively of lessons learned from previous issues such as SARS, H1N1, Ebola and MERS, and, quite frankly, I think there are some lessons that have gone unheeded.

One of the major ones is about the consistent lack of surge capacity in our hospitals. We know that a safe occupancy rate is 85%. Most Canadian urban hospitals try, and sometimes fail, to provide decent levels of care at over 110% of capacity, and that's routine. We have suggested to all levels of government that this is something that needs to be taken care of, both from a basic human decency perspective and also for pandemic planning.

Now we are in a situation in which cancer surgeries are being postponed and radiologic investigations are being delayed because hospitals have had to take extraordinary measures to get surge capacity down to a reasonable level, so shame on them.

This is not really the time to point fingers, but this is the one lesson we must learn. These pandemics are not going away. In the last two decades, how many have we faced? This is something that we really must learn.

Is there a role for field hospitals? There is going to have to be, if this becomes more than just a passing thing. I could see a role for the army, particularly in rural communities, where hospitals may rapidly become overwhelmed and field hospitals will be needed. Let's hope that the military and the Canadian Forces medical services are considering an active role in the provision of patient care.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mrs. Jansen.

We go now to Dr. Powlowski.

Dr. Powlowski, you have five minutes, please.

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

Thank you.

For the witnesses who may not know, I'm a long-term emergency room doctor. I would like to compliment everybody on their great presentations. You all did an excellent job.

In support of what you have all been saying, let me also lend my support to a lot of people's emphasis on the importance of transparency at the federal level, provincial level, local level, hospital level and even the ward level, especially with respect to PPE. If we're asking health care workers to risk their lives and their families' lives, we ought to be telling them what we are doing in terms of procuring PPE.

I know that our federal government is doing absolutely everything it can in order to make sure that, as much as possible, we're getting the PPE to the people out there. I spoke to the parliamentary secretary responsible for this yesterday. They're leaving no stone unturned to try to get those things to you and to get them to you as soon as possible. I think that, at every level of governance, whether it's at the hospital level or at the federal level, we need to be forthcoming and transparent with the front-line workers as to how many masks, how many N95 masks, how many gowns and when they're going to come.

Having said that, let me get to the actual question, and it's regarding the controversy over whether the virus is transmitted by droplets or also aerosolized. Listening to the head of the nurses speak, I know that a lot of nurses are really worried about the possibility of it being aerosolized, and I think for good reason. Some of you and the doctors may have looked at that study out of Nebraska on the 10 patients with COVID-19. They tested their rooms to look for where the virus was, and it was everywhere. It was under the bed. It was on the toilet seat. It was in the air. It was outside the rooms, even though the rooms were negative pressure rooms. In addition, I think there are infectious disease people who have also speculated or believe that it is aerosolized.

The CDC is now suggesting that people consider wearing masks, partly with the idea that asymptomatic people or mildly symptomatic people may be transmitting it and wearing the mask may help to prevent their transmitting it.

Dr. Buchman from the CMA and the ER guys are kind of saying, no, it's droplet spread. To lend a bit of support for the nursing position, I'm a little curious about the precautionary principle that she talks about. Certainly, as doctors, isn't that the way we operate? We don't dismiss the worst-case scenario. We have to first prove that it isn't the worst-case scenario. As ER doctors, we don't go in and look at a 35-year-old and say, “Yeah, your chest pain is just heartburn.” No, we're always thinking about the worst-case scenario: It's an MI, a PE, a pneumothorax or whatever.

Why are we so quick to dismiss the possibility of it being aerosolized? Isn't it better to consider it aerosolized and act according to how the nurses want us to?

[Dr. Alan Drummond]

I don't mind weighing in.

Nobody is discounting for a moment the concerns of our nursing colleagues, who are the backbone of the emergency health care system—truly, no argument.

The reality of it is that we need to keep a bit of perspective on this, and I think that may be a little bit lacking. Ninety per cent of the people who get this disease are going to have a cough, a cold and a runny nose. Between 7% and 10% will end up in hospital and certainly some will end up in the ICU, and the case fatality rate is going to depend on their age. If we choose to go with N95s and all manner of maximum protection at an early stage of the disease when we're not sure of the disease prevalence, are we going to end up putting somebody at risk when they do go to intubate or perform chest compressions if we've burned out all of our available supply?

You're a physician. I'm a physician. We know that the science on this is a little sketchy. This is a disease in process. It's rapidly evolving and our understanding is evolving, but we have to protect to save lives. To be sure, we have aerosolization concerns during invasive ventilation, intubation and cardiac arrest, but do we really want to burn through our precious supplies at this point in time to prevent somebody from getting a cough or a runny nose?

I don't want to be flippant. I'm just trying to be very straight here. We have to keep our perspective.

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

Let me suggest that maybe a better thing would be not to dismiss the nurses' concern about it being aerosolized, but to say, “Yes, maybe it is, and when we have enough N95 masks, we're certainly going to get them to everyone, but at present, we think the risk is low. Because we think the risk is low and we really need to preserve those N95s for those aerosolized procedures, we're going to suggest that, but as soon as we have enough N95s, we're going to be there for the nurses to give them those N95s, as they're suggesting.” We know some hospitals are suggesting to leave it to the individual to determine, but at the moment maybe we have too much of a shortage.

Let me go on to—

[Dr. Alan Drummond]

Excuse me. Nobody is being dismissive of our nursing colleagues, not for a moment. We work side by side. We are a team, but we have to let a bit of science into this discussion as we know it and as we understand it going forward, unless we want people to actually contract a fatal disease while trying to intubate a 25-year-old. I understand your point, but I think that science is probably a little more in favour of, at this point, preserving our capacity.

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

I don't think the precautionary principle is contrary to science. There's a bit of—

Ms. Silas, are you jumping in? I guess I'm still on.

[Dr. Howard Ovens]

It's Dr. Ovens. May I comment briefly?

I want to say, in addition, very briefly, that just because you can find the virus on a surface, that doesn't mean it can be transmitted. When we look at the R-naught, it really suggests that the majority of the spread is by droplet contact. There's really very little clinical evidence that this is being spread in an aerosol fashion.

The argument about this can distract from what's really very effective, which is good hand hygiene and very dedicated use of droplet contact precautions with careful coughing.

[Linda Silas]

It's Linda here. May I interrupt?

We're not asking permissions here. We're asking our employers to respect our professional judgment when we're in front of the patient.

[The Chair, Liberal, Ron McKinnon]

Dr. Powlowski, your time is up.

We'll now go to Mr. Jeneroux, for five minutes, please.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

I want to reiterate the first question I asked about two hours ago.

I asked the Canadian Association of Emergency Physicians if they had been contacted by Public Health to work collaboratively on COVID-19. They said they hadn't. Then one of the Liberal members indicated that they had talked to the minister in March, two months after we had been raising that this was an urgent issue. The response from the emergency physicians was that it wasn't actually a meeting on COVID-19 or the public health aspect of it.

To the members on the other side, this is a non-partisan committee. This is something we're trying to do collaboratively with each other to better support and better advise the government. I just ask the members on the other side, when the minister's office sends them an urgent email to read into the committee record, that they certainly don't have to do that. All it does is that it ends up essentially embarrassing them and the government at hand, because, quite frankly, this is a committee that's trying to better support and get better advice for the government so we can work together to do better for Canadians.

I appreciate at least the clarification from the emergency physicians on that.

My last question before my time is up, Mr. Chair, is for Dr. Buchman.

We've been hearing that there has been a lack of modelling data provided. I'm just curious as to whether your association has been receiving any of the national modelling data to know what to prepare your association and your members for.

[Dr. Sandy Buchman]

We haven't received any differing or different modelling data than anyone else has received, so we haven't been partial to receiving anything particular that no one else has.

Really, what's available in the public realm is available to us.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Are you aware if the government has internal modelling data that would be helpful at all to your association?

[Dr. Sandy Buchman]

I'm not really able to comment on what data they have or they don't have, but we are hopeful that any data that governments have, federally or provincially, would be shared publicly. That is, again, within the principle of transparency that we were talking about earlier. We think it would be critical to share anything that is known or available.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

In my final few seconds, I'm going to quickly jump over to the Canadian Pharmacists Association.

We spoke a little about the limited refills for one month. Are there any exceptions being considered, particularly in rural and remote communities, where we know it is often more difficult for individuals to get the medication?

[Dr. Barry Power]

Thank you, Mr. Jeneroux. It's Barry Power speaking.

Absolutely. They are in the recommendations and in many of the directives that we've seen come out from many of the colleges. There is a recommendation that the pharmacists exercise their clinical judgment. Absolutely, if somebody has to drive two hours to get to a pharmacy, it's not reasonable. They could be provided with a larger quantity—if somebody has an extreme immunodeficiency, for example, as well. They could be provided with an additional quantity. It really is intended to be an individual decision. For the broad majority of the Canadian public, however, we strongly recommend that there be a 30-day limit.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Great.

Mr. Chair, I cede the rest of my time—

[Shelita Dattani]

If I could just add one more point to Dr. Power's point.... The other way we're mitigating that and helping seniors and people who cannot come into the pharmacy is managing that through delivering out to those communities—those rural communities and places where those people might be—and discouraging those vulnerable populations from coming into the pharmacy any more than they need to. We will bring medication to them.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux. Did you say you were done?

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Yes. I cede my time, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

Thank you very much.

We go now to Mr. Van Bynen. You have five minutes. Go ahead.