Health Committee on April 7th, 2020

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

I would like to start by saying that a genuine statement about close collaboration across all health care providers is important, and it's critical that we recognize that everybody is contributing. I also agree very much that we shouldn't be making partisan statements, and to portray that kind of genuine statement as a partisan statement is totally inappropriate.

On behalf of my constituents, I would like to thank all the health care professionals whom the witnesses represent for their tireless work in this unprecedented and historic pandemic. I certainly hope that doesn't become portrayed as a partisan statement.

Having said that, we are hearing that there are a lot of retired doctors, nurses and other health care professionals who are coming back from retirement to assist in the fight against COVID-19. Our government has also opened up a recruitment campaign for those with medical education and experience.

Now, I would ask Dr. Drummond whether he believes these initiatives will ease the burden and the risk of burnout for the health care professionals who are working on the front line around the clock. Is there any new training these professionals need to do before joining the front lines?

[Dr. Alan Drummond]

Thank you for the question.

I think it's all hands on deck in the coming weeks, as we expect a bit of a surge. We have concerns that elderly physicians, out of a sense of social conscience, good citizenship or community spirit, will feel compelled to go back to work. We have to be very clear that it's a choice that depends on one's own personal circumstances and one's own comfort as we get older. I'm 66. As we get a bit older, our exposure is the same but our risk is worse.

We are saying that if you're going to go back, just make sure you understand what you're asking of yourself and your family, because you may end up a fatality, and you have to weigh that up. If you do go back, perhaps it's not on the front lines in the emergency department, but doing something else that is necessary.

Absolutely, the government freeing up the workforce is helpful. Clearly, our residents are concerned that there may be some restrictions on entering practice because of a delay of examinations that needs to be considered. As a matter of fairness, if we are going to recruit foreign doctors, we must then make sure that they have access to working in the Canadian workplace beyond COVID-19.

Yes, I salute the government for that. It is all hands on deck, but we do need to be careful about what we are asking. Linda Silas's comment about personal protection is really important, and we would expect nobody to place themselves in harm's way without adequate protection on the front lines.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you. I appreciate that. I appreciate your concern and I appreciate your candour. I've heard a lot about gaps that seem to be present today.

Rather than looking through the rear-view mirror, I'd like to put our focus on going forward and what your suggestions are as part of the solution after COVID-19. For example, I've heard there is a limited number of health care professionals and that's a concern, but in the long term, what can be done? Should there be programs to increase the inventory of health care professionals? How can that be accomplished?

[Dr. Alan Drummond]

Is that a question for me?

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Yes.

[Dr. Alan Drummond]

Okay, thank you.

Yes, I think there is. We've been very clear. For five years now, we've been saying we have a critical shortfall of emergency physicians, and that's going to get worse at a time when the population is getting older and not necessarily healthier. We're talking about a shortage of 1,100 emergency physicians, as we speak. That problem is certainly going to be worse in rural environments. They are always tenuous in terms of their capabilities, which is why we have emergency departments closing down in P.E.I. and Nova Scotia after midnight, and in British Columbia, because of limited physician supply.

I think we also have to look at our colleagues as physician assistants, as nurse practitioners in community paramedicine to help in the future, in terms of preparing not only for the day-to-day emergencies but also for any future pandemic. We have a workforce of people who are really willing and able to help, but there may be restrictions. I'm talking about physician assistants and community paramedicine in that particular light.

[Dr. Sandy Buchman]

Mr. Chair, it's Sandy Buchman. May I just add something here?

In the long term, we need national health human resource planning, so I echo Dr. Drummond's words, but we have no national plan of how many physicians, nurses and other health professionals are needed. We have data, but we have no national entity that can put that together.

We have to plan for 10 and 20 years hence. We have a growing seniors population, of course, but we have about 10 times the number of pediatricians graduating versus geriatricians. It's really just to say that we have before us a major challenge, and that is national health human resource planning and introducing these innovative interprofessional models.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you. That's a great segue to my next question.

Are we suggesting that there should be a restructuring in the way health care is being delivered at the federal, provincial and municipal levels? Should there be a change in the roles of the different levels of government to address some of the gaps that seem to continue to exist?

Again, I put that out to the doctors.

[Dr. Alan Drummond]

I would echo Dr. Buchman's call for a national health human resources strategy.

What can happen is that Nova Scotia trains an emergency physician who suddenly finds himself up in southwestern Alberta. We need to get a handle, especially in the emergency department, on the number and types of providers that we need for the various practice locales, whether it be Sunnybrook hospital in Toronto or Sundre in Alberta. We need to start thinking about who is going to practise in our emergency departments and what level of training they are going to require. For sure, that's true.

Is the practice of medicine changing? Well, from a family practice perspective, this may be the dawn of a new era, as many family physicians learn to practise or try to practise medicine innovatively through the use of Skype, FaceTime, teleconferencing and video conferencing, so yes, it's time. The health care system is going to be under some level of siege over the coming years as our elderly population dramatically increases.

Yes, this is the time, and yes, there is a role for the federal government, in my view.

[Dr. Sandy Buchman]

I would just add that virtual care has already changed the health care system. For years, we've been trying to get virtual care on. We have just completed a task force with the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians Canada on advising regarding the policy, regulation and governance of virtual care.

It's taken off just through COVID-19. The genie is out of the bottle. There's no going back, so the health care system will fundamentally change as a result of virtual care. It's just the beginning, but once this pandemic is over, we need to reassess virtually everything about our health care system.

[The Chair, Liberal, Ron McKinnon]

Thank you, everyone.

We go now to Mr. Thériault. Mr. Thériault, you have two and a half minutes. Please go ahead.

[Luc Thériault, Bloc, Montcalm, QC]

I'll be brief. I'll continue in the same vein with Dr. Buchman.

In times of crisis, we see the emergence of innovative practices. We know that access to primary health care is a daily difficulty, especially in rural areas. I'm curious to know how well things are going so far.

Next, how do you feel about remote consultations, that is to say by videoconference or teleconference? Is it adequate and effective for diagnosing COVID-19, among other things, and for providing care to people with this and other problems?

[Dr. Sandy Buchman]

Thank you for the question.

Even at the present time, pre-COVID and pre-pandemic, our system does not have the appropriate capacity to serve our remote and rural communities. This is a huge problem. This would be part of the health human resources planning picture.

Specifically with regard to COVID-19, just as we are testing the more urban population or the part of the population that is better served, we need to get testing out for rural and remote communities. It is possible to provide virtual care for the mild illnesses, the 80% or so of people who will only have mild illness, but we have to be prepared, as we are, to evacuate those with more serious illness to centres that would be able to handle them.

Again, a lesson that needs to be learned is that we don't have the full capacity yet to serve our remote and rural populations. The pandemic should be a wake-up call. We are gravely concerned that people will get sick in our remote communities, particularly in our first nations communities, where the social circumstances would predispose first nations communities to the development of significant illness, given, say, the number of people who live in a particular dwelling.

To your point, I think it's very important to look at that issue critically. We'll take lessons from this to ramp up resources for remote and rural communities as much as possible, including the increased use of virtual care.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Ovens, you spoke eloquently about the need for transparency and for us to make science-based decisions. Would it be helpful to the medical community for the federal government to release its modelling of the various potential outcomes of the development course of COVID-19?

[Dr. Howard Ovens]

Within limits, yes. At its most simplistic, we can all extrapolate a line on a curve. The interesting thing is what assumptions they're currently building into their model and how they anticipate it playing out. In the end, we're going to have to see what happens. I think it would be of interest, but I don't want to put too much importance on models.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right. Thanks.

Dr. Drummond, I think one of your recommendations was that you'd like to see increased testing for all who are symptomatic. It looks to me as though we're testing about 1% of the population right now. We're certainly not testing everybody who is symptomatic. Can you give us an idea of what we would be looking at to get to the levels of testing that you think we ought to be doing?

[The Chair, Liberal, Ron McKinnon]

Is that for Dr. Drummond? Dr. Drummond, are you there?

[Dr. Howard Ovens]

If he is taking a biology break, I could try to take that, if you like. It's Howard Ovens.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Mr. Chair, I'd like my time to please be adjusted because of that delay, if that's okay.

[The Chair, Liberal, Ron McKinnon]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Go ahead, Dr. Ovens.

[Dr. Howard Ovens]

From international experience, a winning strategy is that you test aggressively everyone who is symptomatic, as well as carry out a random surveillance of key populations. That's so you know the prevalence of the disease, but more importantly, so you can follow that up by isolating the people who are positive and tracing their contacts. It's a chain that starts with testing but ends with isolation and contact tracing.

I can't give you, off the top of my head, the exact number that will be required, but it would definitely include everyone who is symptomatic, as well as a well-designed surveillance program.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. I take it we're not there yet. Is that your point?

[Dr. Howard Ovens]

We are not there yet.