Health Committee on April 7th, 2020

[The Chair, Liberal, Ron McKinnon]

Dr. Jaczek, your voice is breaking up. Make sure you're speaking very clearly into the microphone and you're not using a speaker phone.

Sorry, go ahead.

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

I will do my best.

Dr. Buchman, in terms of pandemic exercises, since SARS.... When I was back in public health, certainly after SARS, in my jurisdiction in York Region we did hold specific exercises getting all the players involved and so on. Could you explain the involvement of the Canadian Medical Association, through your provincial association...? What role has the CMA been playing in terms of perhaps looking at potential gaps through these last many years?

[Dr. Sandy Buchman]

Thank you for the question. We've always taken the approach that we should have an adequately supported and funded public health care system. There have been so many pressing issues that we've undertaken and continue to undertake that, when we saw that the Public Health Agency of Canada was created and developed, this was one thing that was perceived to be actually doing quite well. We were very glad to see the differences from, say, the SARS days.

There are so many serious issues now in our system, for example access to care. Five million Canadians don't have access to a family doctor. We have inadequate access to mental health and addictions services. Seniors care is an issue. Palliative care is an issue. We have problems with our health human resources in remote and rural areas, with the remote and rural distribution of physicians across the country. There are so many issues that, once Public Health seemed to be in place, yes, attention was changed to these other pressing issues of the time, thinking that the public health system that had been set up was robust.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Jaczek.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

We go now to Mr. Webber for five minutes.

Go ahead, Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

All right. I hope you can hear me okay.

[The Chair, Liberal, Ron McKinnon]

Yes, speak up, speak slowly, speak clearly.

[Len Webber, Conservative, Calgary Confederation, AB]

All right.

Let me begin by thanking all of you for presenting here today, and all the health care workers in Canada for working day and night to help Canadians.

I want to address my first question to either Dr. Drummond or Dr. Ovens. It's regarding the uncertainty of all this. It's regarding the separation of fever and infection patients from the general population in the ER and in the ICUs. Is there separation of these patients from the general population? You talked about a lot of care being provided in hallways and about crowded ERs and crowded ICUs. Are there steps taken to separate these COVID-19 patients from the general population?

[Dr. Howard Ovens]

It's Howard Ovens. I'll take that one.

Yes, as we mentioned, our hospitals and our provinces have taken extreme measures to create adequate capacity in our hospitals. It's at the expense of a lot of people who've had their care delayed, but it has been successful, and most of our emergency departments are very efficiently being emptied of new cases. There are infection control procedures right from when you enter the hospital and go to the emergency triage desk through to admission to the wards or the ICU. The proper isolation techniques, I believe, are the norm and are being followed.

The concern, if we're unable to flatten the curve, is that as our hospitals fill, our ability to do that well may become compromised. But as of today, I think everywhere in Canada we have the capacity to do proper spacing.

[Len Webber, Conservative, Calgary Confederation, AB]

Great. Thank you for that.

That is my concern. If you're not able to flatten that curve and cases continue to grow, will we have facilities in place to accommodate that so we can separate these patients from the general population? That is a concern, for sure.

To Dr. Drummond or Dr. Ovens, with regard to the usage of personal protective equipment, we all know that the government shipped 16 tonnes of personal protective equipment to China back in February. It said we are getting millions of masks soon, but it really is not clear what our daily consumption of PPE is. Do we know? Does the government know how many masks and gloves and gowns and face shields are required on a daily basis here in Canada? Has the government communicated with you to ask these questions? What is the requirement?

You alluded also, Dr. Drummond, to the usage of masks on a daily basis and being asked to use two masks on a shift. I'm curious to know, too, with respect to the gloves, how often you change these gloves. Is it per patient or is it per shift?

Those are the two questions I'd like to ask Dr. Drummond or Dr. Ovens.

[Dr. Howard Ovens]

I'll take the first shot at that.

[The Chair, Liberal, Ron McKinnon]

Excuse me, Dr. Ovens, before you respond to that, I'd just let everyone know that I'm getting word from the technical people to remind people to mute their microphones when they're not speaking. We're getting a lot of noise. It's difficult for the interpreters and so forth to work that way.

Having said that, Dr. Ovens, please go ahead.

[Dr. Howard Ovens]

Thank you for that.

First of all, on the glove question, gloves so far have been in very good supply. We do change gloves between every patient contact and wash our hands.

As for the issue of demand, I can't speak for what information the federal government in Ottawa is receiving. I can speak most informedly about Ontario, where I'm quite familiar with the arrangements. We are continuing to improve our modelling of what the demand for PPE will be in various scenarios as the outbreak may worsen. We were really overusing PPE early in the outbreak, when the actual risk to our colleagues was quite low. The danger was that we would run out of it before we even got to the most dangerous part of the wave.

The other thing is that we don't know long this will last. If we flatten the curve, it will actually extend the period of active treatment. Do we have enough data on how much we need? Probably we need to continue to refine that, but I believe there is a lot of activity going on, from hospitals up through the provinces, which are hopefully channelling that information to Ottawa, on not just how much we're using right now but how that models into our needs for the future.

[The Chair, Liberal, Ron McKinnon]

We go now to Mr. Kelloway.

You have five minutes, please.

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

Thank you, Mr. Chair.

I'd just like to echo what everyone has said here today. It's a real honour and a privilege to talk to the witnesses today. I thank them and all the health care professionals who may be listening to this discussion today.

My focus, for at least one question, will be the Canadian Pharmacists Association. We know that there was more of a push, pre-COVID, for collaborative health care teams. Now we know even more so that's the case. There's an “all hands on deck” approach here.

Do you feel that pharmacists could be better utilized in the fight against COVID-19? If so, how?

[Shelita Dattani]

Thank you for that great question.

Absolutely. As I alluded to in my remarks earlier, pharmacists are doing everything they can and working within the full scope of current practice across the country, which is unfortunately quite fragmented.

In our province, Alberta, pharmacists are being immensely utilized. They are able to prescribe for many conditions. They are able to extend therapies, and they're able to do a lot of different things in terms of scope of practice. As primary care environments are more and more burdened, pharmacies are going to start becoming almost the sole universally available primary health care provider.

Being able to help patients and fill those gaps in primary care right now—obviously still in a collaborative way and interacting with our physician and nursing colleagues, but having the ability to exercise some of those things more independently, in a harmonized way across the country—is very much needed.

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

Thank you for that.

I see that your organization—and you referenced this in your 10-minute statement—recently released guidance to pharmacists to fill prescriptions for only one month at a time. Can you go a little deeper as to why you decided to issue this guidance?

There is a reason I am asking. I am getting a lot of calls in my riding, predominantly from people over the age of 60 or 65. A good chunk of my electorate is made up of seniors, and they are becoming concerned about this filling of prescriptions only once a month. I just wonder if you could elaborate a little more on that for us.

[Dr. Barry Power]

Sure. Thank you, Mr. Kelloway.

This is Barry Power speaking.

Actually, I was speaking to a pharmacist in Sydney last week about this very issue. She was explaining some of the concerns that have been brought back to them from patients.

The situation in Canada is that we get about 80% of our prescription drugs from China and India, with the bulk of them coming from China. China has been in shutdown since January, and the manufacturing processes and the shipping of medications into Canada have pretty much come to a standstill. As a result, we had double the normal volume in March, and we've seen drains on the warehouses and the stockpiles of medications we have in Canada.

We already have a system that's very fragile. We have drug shortages, and we were very concerned about pharmaceuticals going the way of toilet paper and hand sanitizer, with those very constituents having to go from pharmacy to pharmacy to try to fill a prescription, so we had to make a decision quickly.

We decided that 30 days would give people enough prescription drugs to allow them to shelter in place for two full 14-day quarantine periods, and we would be able to make any subsequent deliveries to them. We did reach out immediately to drug plans, provincial drug plans and private payers, to try to get them to come on board as part of the COVID-19 response in Canada to cover some of the co-pays that people are seeing.

We absolutely recognize that this is a burden on people, and we continue to advocate for all payers to help offset some of the costs that people are being faced with.

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

Thanks so much.

How much time do I have, Mr. Chair?

[Shelita Dattani]

Maybe I can just—

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

Sorry, my apologies. Go ahead.

[Shelita Dattani]

Maybe I could just reinforce what my colleague Dr. Power was saying in terms of what we've done.

We're also really trying to alleviate the burden on many of the seniors we serve every day. The points that I made in my remarks about deliveries are part of that, recognizing that we want these folks to stay at home and we want to give them the access to medications they need. That's part of our plan to dramatically increase our deliveries happening every day.

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

Thank you, both, for those answers.

Mr. Chair, how much time do I have left?

[The Chair, Liberal, Ron McKinnon]

You have one minute.