Health Committee on April 7th, 2020

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all the witnesses for being here.

Dr. Buchman, I would like to begin with you, please.

Four days ago, on April 3, the CMA was quoted on CTV News as asking the federal government for direct communication to physicians and nurses about the types of medical equipment and supplies coming into Canada, when they will arrive and where they're going, as well as contact information to order that equipment.

Dr. Buchman, you're quoted as saying, “We want to know the availability of what's coming down the pipeline and when it will arrive. If we know we're going to receive an adequate supply of equipment in a certain period of time, it allows us to plan and decide how much we have to ration.... It buys us some time and as we're trying to flatten the curve—which is the goal here so that we don't reach the surge that will overcome the health care system's capacity to handle it....”

I have a quick question, Dr. Buchman. Has the federal government responded to your request as of yet?

[Dr. Sandy Buchman]

Thank you for the question, Mr. Davies.

No, I haven't heard any response as of yet, but we do know that what we requested is being considered very highly.

Just to reiterate your point, what has not been clear to physicians and other front-line health care providers is what PPE is coming down. How can we plan appropriately? As a result, the experience of anxiety is considerable.

It also has other implications, like everything we're seeing about the resterilization of personal protective equipment, such as N95s. In an ordinary time we wouldn't even consider this kind of alternative, because we just don't know. We really are requesting the full information and full transparency of that information. To this point in time, it really hasn't arrived, but I'm confident that the government is aware of our concern and our ask.

[Don Davies, NDP, Vancouver Kingsway, BC]

I do note that Prime Minister Trudeau comes out every single day and gives a briefing to the Canadian people, so certainly, there are lots of opportunities for the Prime Minister to give that information if he chooses to.

Dr. Drummond, is your hospital currently rationing personal protective equipment and, if so, can you give us a brief picture of what that looks like?

[Dr. Alan Drummond]

The answer.... That's a loaded question. I think what is happening in my hospital, as an example of what's happening across the country, is preservation of personal protective equipment. Some would call it rationing. Certainly, our nurses are being told to use two surgical masks on a shift basis, which can go from eight to 12 hours. That seems like rationing.

By the same token, I think we have to be a little bit careful. I believe the promises of government that equipment and help is on the way. I think there is a little bit of concern about excessive anxiety and perhaps limited science. We know the N95, which is what a lot of people are calling for, really is for aerosol-generating procedures, such as intubations or code blue cardiac arrests.

Given the prevalence and the circumstances, I'm not really sure that's exactly what we need at this point in time, so we need to be protective of that supply until we are guaranteed its certainty. For the most part, just using droplet precautions, I think, should serve most of us quite well.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'll move to you, Ms. Silas.

You were quoted two weeks ago as saying that front-line nurses across the country “are frustrated and insulted that many of them are being denied N95 respirators and other safety equipment they know they need” and that they want “the federal government to guarantee access to the protective equipment they need when their professional judgment tells them to protect themselves.”

Has the federal government responded to that concern as of yet?

[Linda Silas]

Politicians do, but not the scientists, and then hearing Dr. Drummond, I'm shaking my head. When you do not know for certain how the virus is transmitted, that is when you up your personal protection equipment. It is not when you bring it down.

That is where the frustration lies. If you don't call having two surgical masks given to you at the beginning of your shift to wear for 12 hours or more rationing, we have a problem here. If there's miscommunication between the federal and provincial levels and then every employer in the country is doing it differently.... Even in Ontario, where they have very specific agreements with the health care unions and the government and employers on the PPE, there are still differences.

We have stories of nurses being given a paper bag to put their masks in to bring back home for the next day. We're in 2020 and we are not in a shortage today. We're worried about tomorrow and we need to protect our workers today and get the equipment in for today, because they will be dropping like flies, just like physicians, just like the rest of the health care team.

[Don Davies, NDP, Vancouver Kingsway, BC]

We hear a lot about lessons learned. Of course, we've been through pandemic-like issues before. In 2006, 14 years ago, the final report of the independent SARS commission made a number of recommendations. I want to take you through a few of them. One of them was:

That in any future infectious disease crisis, the precautionary principle guide the development, implementation and monitoring of worker safety procedures, guidelines, processes and systems.

Ms. Silas, you've said that you believe we should start with the highest level of protection, not the lowest. In your view, do the current federal guidelines respect the recommendations from the SARS commission in 2006?

[Linda Silas]

No, nor did they in 2007-08 with H1N1 or Ebola. The precautionary principle was engraved by Justice Campbell with the SARS commission report. We worked with the Public Health Agency of Canada. CMA was there. The ER doctors were there also during H1N1 and Ebola, and again today.

To say that we were surprised by this.... It is hard to accept when you're on the front line because we knew what we had to do.

[The Chair, Liberal, Ron McKinnon]

Your time is up now. Sorry.

Don, did you want to say something?

[Don Davies, NDP, Vancouver Kingsway, BC]

No, I understand my time is up, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

We'll start the second round now with Dr. Kitchen.

Dr. Kitchen, you have five minutes. Go ahead.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you, everybody, for being here today. It's greatly appreciated that you're taking the time to do this, to discuss these issues.

I'm going to follow on a bit more with what Mr. Davies was talking about on the issue of what was a step forward back in 2003. Basically, after SARS we developed the Public Health Agency to monitor all across Canada. What I'm hearing from you, Ms. Silas, as well as you, Dr. Drummond, is that we have some gaps here. There appears to be no apparent public health measures being put forward, or the ones that are there are not being followed.

I believe, Dr. Buchman, you said that we were caught “flat-footed”. I'm wondering where the guidance is here. Is there any guidance at all, and do you see it that way?

[Dr. Sandy Buchman]

Yes. I don't think we were adequately prepared or we wouldn't have found ourselves in this situation. As mentioned, the rapidity and magnitude of this pandemic wasn't anticipated, but that's what you have to prepare for, these crises. I think even our Minister of Health explained that public health has been underfunded in this country for quite some time, so yes, we weren't prepared, and hence we're scrambling at this point in time.

I think we are getting up to speed. We just hope that we can flatten the curve enough so that we don't exceed the capacity of our system to handle it, in addition to the risk health care workers are exposed to and, of course, the vulnerable and more at-risk parts of our population. We are scrambling right now. We shouldn't be in that position and we need to to do whatever we can to ensure our system has the capacity now.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You would agree that the Public Health Agency—not only in communications across the country—should be in a position to administer and ensure that we have those PPE supplies ready, the ventilators ready, the health care workers that we need and the medications prepared for such a situation, and should be regularly monitoring this aspect. Is that correct?

[Dr. Sandy Buchman]

It should be, but this is in conjunction with the roles and responsibilities of the federal, provincial and territorial governments. Each jurisdiction, right across the country, should have all these measures in place. I think that's a joint responsibility within our whole system.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

You mentioned the aspect of basically ramping up national testing policies. I'm assuming when you talk about that, you're talking about the testing to say whether someone has COVID. There's a lot of discussion going on right now. As we start to hopefully flatten that curve and try to transition out of that, and get Canadians back out into the public and get the economy back rolling, what measures and steps are going to be needed to make certain that the people who are actually out there have developed immunity such that they can be out in public?

Do you see value in the expansion of more of the immunity testing as well as the testing we're doing right now to determine whether somebody has the virus?

[Dr. Sandy Buchman]

Yes. Our ability and capacity to test is absolutely critical to responding to this pandemic. It's really the testing that allows us to know who is potentially infectious or who is immune, and will, therefore, guide the public health response of what we should do. We are seeing our testing capacity increase day by day. Again, that's kind of where we got cut short as well, but we're seeing it increase now day by day as we sort of.... It also reflects the increasing numbers of positive cases.

I'm encouraged actually by the recent announcement about the government's actions, but we're not where we need to be yet. We should really ramp up our testing as much as possible. We should also get serological testing. We need to know what our level of immunity is out in the community, and that will help guide the public health measures we need to take.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Along that line, as we have seen and as we have heard from the nurses and doctors, a lot of our health care workers are becoming sick. My wife was an emergency nurse, and I have family who are emergency nurses, etc., and the reality is that these people are the ones going into the crisis. They are the ones stepping forward, and they want to do that. Not only do we need to make certain that we are protecting them, but they desperately want to get back, so is that a process that we need to be ramping up more for our primary care workers?

[Dr. Sandy Buchman]

I would defer to my public health expert colleagues in that regard.

I do think that it would be important for health care workers to be tested and also to know what their immune status is. If they are immune already, hopefully they are safe within those environments, but there is still very much that is unknown about the coronavirus and how long immunity might last, for example. We are in an experiment in real life now. We have to continue to do these studies right as we're in the middle of it, so yes, I think it's critical to ramp up testing as much as possible.

[The Chair, Liberal, Ron McKinnon]

We go now to Dr. Jaczek.

You have five minutes, please.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you very much. I want to thank all the witnesses for coming today. Obviously they represent so many of our front-line health care workers who are doing such extraordinary work. I'm so glad that we have the opportunity to hear you today and learn from you.

I want to make sure that everyone has understood that our government is extremely interested in hearing from everyone. I see in some of the background information with which I've been provided that apparently there was a meeting with the Canadian Association of Emergency Physicians in March. Obviously, neither of our witnesses today was present, since they mentioned that, but every effort is being made, as I understand it, and this was reinforced last week when we heard from officials from the various agencies involved in this pandemic that they were extremely anxious to listen, learn and adapt in this rapidly evolving situation.

I would like to clarify a point from Dr. Ovens. In terms of the consistent messaging that you were asking for, it seemed to particularly involve public health messaging, in terms of the advice that should be given across the country. I was wondering if you could clarify, exactly, the piece about the need for a national standard.

[Dr. Howard Ovens]

Thank you, Dr. Jaczek.

Just to clarify, Dr. Drummond and I were aware of the meeting with the ministries of health. The question for us was whether we had been contacted by the Public Health Agency of Canada. Perhaps we were overly specific.

In terms of the public health messaging, there has been quite a variation over the last month about the allowable size of gatherings, which businesses are essential and non-essential and whether it's appropriate to be outside exercising, and in which fashion and where. Now we have some inconsistency about public masking.

The problem is that if you've heard these things are different in different communities, yet you know the virus is the same, it erodes your trust in the strategies that you're being asked to follow, and unfortunately that leads to a potential erosion in public co-operation.

That was the concern we were trying to express.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

I see.

Of course, some of the epidemiology has varied from province to province. We have [Technical difficulty—Editor] across the country, and of course we do have a division of powers between the federal health ministry and its agencies, and the provincial and territorial jurisdictions. However, it's a point that you've made clearly. As every effort to [Technical difficulty—Editor] I can hear, and knowing that there are some new guidelines that are going to be coming out shortly in terms of the use personal protective equipment, your suggestions are clearly very well heard.

If I have a little time left, I would like to ask Dr. Buchman about pandemic—

[The Chair, Liberal, Ron McKinnon]

Dr. Jaczek?

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Yes?