Health Committee on April 9th, 2020

[The Chair, Liberal, Ron McKinnon]

Yes, you have 20 seconds.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Okay.

I'd like to take this opportunity to thank all healthcare staff for their extraordinary work. I thank them for being there, on the front lines, for us.

I think all members from all parties recognize your fine work. We're here to help you and support all your requests, if you have any.

[Linda Lapointe]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Berthold.

We go now to Dr. Jaczek.

Dr. Jaczek, go ahead for five minutes, please.

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

Thank you, Mr. Chair. I hope you can hear me; I do not have a microphone.

My first question is for Mr. Culbert.

If I heard you correctly, Mr. Culbert, you said that there were criticisms that perhaps the public health measures were not stringent enough early on in the pandemic, and you also made reference to the difficulty of changing people's behaviour: If they're not convinced that there is a real risk, they may not comply with those public health measures.

I was wondering if you could expand a little on that, and perhaps tell us what the conversations were between the Public Health Agency of Canada, your organization and various provincial public health authorities. Could you just give us a sense of those deliberations?

[Ian Culbert]

Certainly, and thank you for the question.

I want to clarify that as a non-governmental organization, we aren't privy to many of the conversations to which you refer, although I co-chair, with Dr. Theresa Tam, the CPHA's health professional forum, which brings together health professional associations. We have been receiving briefings and having consultations with the agency on a biweekly basis on a wide range of issues, and we have been able to give feedback on some of the guidance documents.

Human behaviour is challenging when you're trying to get people to change their behaviours. When you have an epidemic that starts halfway around the world, there is a sense of insulation; there's “them and us”. Then you see some cases in B.C. or in Toronto; it's a “them and us”. You slowly have to change people's thinking so that there is no “them and us”, so that it's a “we” situation, but that takes time and it takes evidence. You have to prove to people that this is serious. That's where public health is often challenged, because when we're successful, nothing bad happens, but if we're unsuccessful—if we don't change people's behaviour, if we don't change our systems for the future—bad things do happen. It is a process.

I'll leave it at that for now.

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

You talked about a national framework that you think would be desirable in terms of public health practice across the country. We've heard a little bit about the authority for the federal government to actually require data collection coordination, and that rather than it being more on a voluntary basis, the federal government would have the authority to collect data nationwide.

What else in that national framework would you like to see in terms of perhaps better coordination of activities among the federal government, the provinces and the territories?

[Ian Culbert]

Well, certainly the establishment of national public health standards across the country would be a wonderful development out of something like that. In the case of immunization, we have different immunization schedules in different jurisdictions, and so you would have the ability to bring all of the parties together to come up with a harmonized immunization schedule and also the funding envelope to be able to support the provinces and territories in adopting those schedules. It really is about creating a rising tide so that we can raise the level of health and well-being for all Canadians equally and fill in the gaps where necessary across the country.

Data is a consistent problem in terms of the ability of provincial and territorial governments to collect what the federal government would like to have, but then there is that sense of not always wanting to share information about problems because, unfortunately, it is politicians who make those final decisions as to what information gets shared, and so there are challenges there. If we had that national framework, I think it could improve things dramatically.

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

Perhaps I could ask this to the Honourable David Dingwall, in terms of his experience as a former minister of health.

Hearing Mr. Culbert, what is your opinion of having more of a national framework when it comes to public health?

[David Dingwall]

I think timing is of immense importance in the process going forward. I think if you would call upon all of the various stakeholders, they would probably agree that some clear national standards that we all buy into would be very helpful for those who are on the front lines.

I also believe it requires some statutory obligations, as I said in responding to one of the earlier questions. I don't think we can just have a framework; I think we need a framework that has statutory teeth, such that people are going to have to report on a regular basis in terms of what is transpiring and what is not transpiring. It's all well and good to have the framework, but someone has to exercise it to see that the stockpiles are renewed, that we don't have antiquated equipment, that people are trained, that we're looking for the best practices worldwide and that we're taking into consideration the practices of the World Health Organization in terms of all of their abilities. From that perspective, I say yes to the national framework, but it needs to have some teeth, and I think the teeth are the statutory obligations of the parties going forward.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Jaczek.

We go now to Monsieur Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

My question is for Mr. Culbert.

You said earlier that everything was going according to plan and that, to that extent, the measures had to be proportional to the threat, because there might be a low level of buy-in and support for the measures being taken.

However, when Quebec declared a health state of emergency, there were only 17 cases of infection and no deaths. In Canada, there were 176 cases and only one death. Right now, Quebec is considered one of the champions of lockdown measures and adherence to lockdown and social distancing. Nevertheless, we are the leader in terms of the number of infections and cases, and deaths are concentrated in living environments such as CHSLDs.

Especially with regard to the rationing of personal protective equipment, how do you explain the fact that after the SARS crisis we were unable to cope with the pandemic, with our national stockpile depleted? What role did your association play, from the SARS episode to the present day, to put us in such a situation?

[Ian Culbert]

Certainly many of the lessons of SARS have been learned, and I think we would be in a much worse situation if we had not followed those recommendations as closely as we did. We have the Public Health Agency of Canada, which is really doing a tremendous amount of work, and the coordination work that they're doing is incredible.

Have those lessons been learned—

[Luc Thériault, Bloc, Montcalm, QC]

Is everything really going according to plan with respect to the shortage and the availability of equipment in the national emergency strategic stockpile?

[Ian Culbert]

Absolutely not. I would say that the national emergency stockpile is probably the largest failure in our response to date. As I mentioned, it is one of those things that require much greater collaboration between the federal government and the provincial and territorial governments.

[Luc Thériault, Bloc, Montcalm, QC]

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

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr Davies.

Mr. Davies, you have two and a half minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr, Chair.

I am sorry, but I'm going to ask Ms. Lapointe my question in English.

Madame Lapointe, Quebec's COVID-19 cases far exceed those in any other province. The numbers that came out today show a rate of 110 positive cases per 100,000 and no other province is above 50 cases per 100,000.

I'm wondering if you could tell us why that is.

[Linda Lapointe]

We believe this is largely due to the number of tests that have been done. In Quebec, we have been at the forefront of testing people. That is probably the main reason why we have so many positive cases.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

One of the other profound observations of the Campbell SARS report said:

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

Now many people are expressing that they think the reaction of the Public Health Agency of Canada may have been too slow and too cautious—too slow to close borders and impose travel restrictions, too slow to acknowledge community transmission, too slow to acknowledge asymptomatic transmissions, too slow to recommend the potential that masks may have in helping to reduce transmission. You identified as well that perhaps the agency was too slow in identifying potential airborne transmission.

What is your sense, Madame Lapointe? Are we fully displaying the precautionary principle, or do you think we are being too slow in getting ahead with measures that may help in slowing the spread of the virus?

[Linda Lapointe]

I will speak for the healthcare professionals we represent. We have been slow to protect them. It's something we have noticed in the field for several weeks now.

With regard to contamination in CHSLDs, once family visits were stopped, it's possible that healthcare professionals may have infected patients, but we will never know. There were also healthcare professionals visiting several healthcare establishments. We're in the process of correcting that. If an asymptomatic infected person visits two or three establishments, there's no question that this can lead to further contamination.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That ends our second round. We go now to our third round. We begin with Ms. Jansen.

Ms. Jansen, you have five minutes. Go ahead.

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

Thank you so much, everybody, for joining us as we try to understand what's working and what's not working.

I wonder if I could address my first question to Mr. Ian Culbert. You mentioned that Dr. Tam was taking an incremental approach to the restrictions because Canadians wouldn't be willing to comply and it had to be done slowly.

For me, I'm about an hour outside of Vancouver. On January 21, I hosted a Chinese New Year event, and the Langley Chinese Arts and Cultural Association did a beautiful presentation for us. It was fantastic. Then by January 25, it cancelled its much larger presentation that was going to happen in Langley due to the COVID crisis. They were begging me to get the government to be more proactive. They themselves as a community began to pick people up from the airport who were returning from China to ensure they didn't take cabs. They were buying them groceries so that they wouldn't go to grocery stores. This was all done on a completely voluntary basis.

I'm just wondering—is it possible that it was because of a misjudgment of the willingness of Canadians to self-isolate that this didn't go quicker?

[Ian Culbert]

I would say that you're talking about a highly sensitized community in that situation. They had a direct connection to what was happening in China and were very much aware. I think many Canadians were not that connected and were thinking of it as a problem on the other side of the country.

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

Thank you. I appreciate that.

I have a question now for Linda Lapointe.

You mentioned that there was a stockpile failure. You mentioned it in your presentation in regard to PPE and said that reuse was a real disaster. I know Linda Silas mentioned it was “sick, sick, sick”. That was what she said at our last meeting. Then you mentioned at the end of your presentation that the government was really pulling out all the stops, so that's fantastic to hear.

Does that mean that you have been able to stop the reuse of PPE? I have not heard that here on the western side of Canada.