Health Committee on April 9th, 2020

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order. I'd like to welcome you all to meeting number 11 of the House of Commons Standing Committee on Health. We are meeting today entirely virtually. Pursuant to the order of reference of Tuesday, March 24, we are meeting for the purpose of receiving evidence concerning matters related to the government's response to the COVID-19 pandemic.

Today's meeting is taking place entirely by video conference and the proceedings will be made available via the House of Commons website. Just so you are aware, the webcast will always show the person speaking rather than the entirety of the committee. I'd also like to note that this is historic. It is the very first entirely virtual meeting of any House of Commons committee. I'd like to thank the House staff, the technicians, and everyone who has worked so hard over this past couple of weeks to bring this together. I know you're on tenterhooks back there and are hoping everything works well. From a long career in IT, with my first computer experience writing Fortran on punch cards, I know that we've come a long way, and I think we'll be fine. I give you all kudos for what you've done in such short order.

I'll carry on with some housekeeping first. To facilitate the work of our interpreters and to ensure an orderly meeting, I would like to outline a few rules to follow. First, interpretation in this video conference will work very much as it does in a regular committee meeting. You have a choice at the bottom of your screen of either floor English or French. Before speaking, please wait until I recognize you by name. When you are ready to speak, you can either click on the microphone icon to activate your mike, or you can hold down the space bar while you are speaking, and when you release the bar your mike will mute itself again just like a walkie-talkie. That may be an old-time reference; I don't know.

All comments by members and witnesses should be addressed to the chair. Should you need to request the floor outside of your designated time for questions, you should activate your mike and state that you have a point of order. If you wish to intervene on a point of order that has been raised by another member, you should use the “raise hand” function. This will signal to the chair your interest in speaking. In order to do so, you should click on the participants at the bottom of the screen, and when the screen pops up, next to your name you can click “raise hand”.

When speaking, speak slowly and clearly, and when not speaking, you should mute your mike. We of course encourage strongly the use of headsets. Should any technical challenges arise, for example, in relation to interpretation, or if you are accidentally disconnected, please advise the chair or the clerk immediately and the technical team will work to resolve these problems. Please note that we may need to suspend at times to ensure that all members are able to participate fully.

Before we get started, can everyone click their screen in the top right-hand corner and ensure they are on gallery view? With this view you should be able to see all of the participants in grid view, and it will ensure that all video participants can see one another. During this meeting we will follow the same rules that usually apply to opening statements and the questioning of witnesses during our regular meetings. Each witness will have 10 minutes for an opening statement followed by the usual rounds of questions from members.

I would now like to welcome our witnesses. We have, as an individual, the honourable David Dingwall, president and vice-chancellor of Cape Breton University; from the Canadian Public Health Association, Ian Culbert, executive director; from the Fédération interprofessionnelle de la santé du Québec, Linda Lapointe, vice-president; and from the William Osler Health System, Dr. Naveed Mohammad, executive vice-president, quality, medical and academic affairs. We will start with Mr. Dingwall.

Mr. Dingwall, please go ahead. You have 10 minutes.

[David Dingwall, President and Vice-Chancellor, Cape Breton University, As an Individual]

Thank you, Mr. Chair, and thank you, members. With your permission, Mr. Chairman, I would like to have my written text attached to the proceedings under written proceedings, and thereafter I'd like to make seven brief comments as part of my opening statement.

[The Chair, Liberal, Ron McKinnon]

Go ahead with your statement. We can get the written text at some point. We don't have it available at the moment, and of course it will have to be translated into both languages before we can distribute it to the committee. If you'd like to go ahead with your other remarks, you have 10 minutes.

[David Dingwall]

Thank you very much, Mr. Chairman.

I did circulate my written text to the committee yesterday, as requested. However, I have just seven fairly quick points.

One is to congratulate members of this particular standing committee for the role you're playing with regard to reviewing some of the aspects of our health care system. As you all know, the issues that relate to Health Canada and the various health-related agencies, particularly the Public Health Agency of Canada, are quite important in view of the situation that we find ourselves in now.

I would hope that when the pandemic comes to a close, or its substantial numbers go down, that the parliamentary committee will continue to review what has transpired to try to ascertain best practices not only in Canada but indeed in other jurisdictions throughout the world so that the appropriate protocols can be put in place and, where necessary, updated from time to time.

The second point I raise is on the issue of governance. I think the Public Health Agency of Canada, as I as a former minister of health understand it, is indeed part of a unique system. It's a federal entity, but it works very closely with provincial entities and with the jurisdiction split between the federal and the provincial governments. It's important for those two entities to share good quality information and to have a frank dialogue among the members.

From what I can see, Mr. Chairman, I think that is taking place as we now speak. The federal agency is regularly meeting with provincial agencies—virtually, that is. They share information, different analyses, and different models. I think this is good for our country and it's good for our health care system.

In my small province, Nova Scotia, I think the system is working well. Chief Medical Officer Dr. Strang issued a health order on or about March 13, followed thereafter by a state of emergency being declared by the province. But they meet regularly with their federal counterparts to exchange information, analysis and best practices.

From a university perspective, the Council of Nova Scotia University Presidents has a working group that meets every day. We are in constant communication with the chief medical officer and his professional staff to share information and to try to address some challenges, particularly for post-secondary, and that has worked well.

The politicians and the political leaders of the three political parties have been very professional, very non-partisan, and very helpful, and I believe the premier, the leader of the opposition and the leader of the NDP are deserving of public praise for the way in which they have handled themselves.

Also, at the senior level in terms of the governance model, or the bureaucracy, we have the deputy minister of health, and of course we have the deputy minister of labour and advanced education, Duff Montgomerie, who has played a particularly helpful role for post-secondary institutions, for universities, in our province.

The third point, which may be perceived by some as provincial in focus, does have a national aspect and that is the need for the governments of Canada and Nova Scotia to address the fact that a lot of international students across the country do not have access to our provincial health care systems. Many international students have to pay a private sector provider to assist them with their health care needs. These can range anywhere between $1,300 and $1,700, and they get limited access to our health care system.

University presidents, student union leaders and many others have called for provincial governments with the assistance—moral persuasion if you will—of the Government of Canada to ensure that all of our international students have ready access to health care in our respective provinces.

The fourth point is that, as I now speak, there is real anxiety and fear among students, family members and friends. There is actually grief, and of course there are mental health challenges. We see those in a variety of ways. They're manifested in such questions as, “What am I going to do to pay my rent?”; “What am I going to do for my food?”; “What can I do about my tuition?”; “I don't have any summer job to go to now”; and if there are summer jobs, they will be limited to those in a few sectors. So there's real anxiety and fear about their future, and universities, I am sure, across the country are attempting as well as they can to co-operate and to address those. I don't want to miss this opportunity to note that the concerns they have are real, and I think Universities Canada has made a submission to the Government of Canada for what it calls “a better future” education investment grants, which would provide, across the country, about $500 million to assist these Canadian and international students in their time of need, in their time of anxiety. I would hope that the committee, in its wisdom, would do this.

Point number five is support for remote Internet access. Some may say that this is a health care committee, not an IT committee. But you need to know that there are real challenges to our health care system to not having good-quality remote Internet access.

If I may, I'll give you a small example. All of our Cape Breton University Bachelor of Science in Nursing students have continued their studies remotely since face-to-face courses were suspended on March 16. As students returned to their homes across Nova Scotia and began remote online learning, many have experienced Internet connectivity difficulties since they live in rural areas across the province. For instance, 77 students had started their nursing-practice placements with the Nova Scotia Health Authority in Cape Breton, and they had completed only two days of their placement when the health authority suspended all student health learners from practice settings across Nova Scotia.

Thinking innovatively, we at the university, and in the nursing program in particular, sought an alternative learning model for students who had to leave their hospital placements. We purchased a virtual sim. A VS uses online learning modules that are interactive and require the students to apply their knowledge and prioritize the care of the patient. There are multiple case scenarios, and the student is provided with feedback on their decisions at the end of the scenario. The student can repeat the scenario multiple times, receiving feedback and a mark each time. The problem is that the virtual sim modules require a strong Internet connection to access and work through each patient scenario. These young nurses are now being asked to join the health care system as new providers in order to support our existing cohort. But a lack of good-quality Internet access is making it very difficult, if not next to impossible, for them to take part and to make a contribution at this difficult time.

The sixth point I would like to raise with committee members is strategic infrastructure investments. A program that could be modelled on the post-secondary institutions strategic investment fund would stimulate the economy and add to our health care science.

Each university is different, but we here at Cape Breton University in rural Nova Scotia want facilities for a collaborative research laboratory, public health applied learning clusters and community engagement hubs, which provide real benefits for the community and the students. Universities Canada, after extensive consultations with all post-secondary institutions across the country, had made that submission to the Government of Canada as well.

Finally, my seventh point is the following. Canada needs a rapid testing module that can be scaled accordingly. Let me be a bit parochial since I represent a university. There are currently 634 students studying in our bachelor of health sciences program in public health, which is one of six programs in Canada accredited by the Canadian Institute of Public Health Inspectors. Students who graduate from this program are eligible to pursue practicum and certification to be environmental or public health officers in Canada, providing a talent pool that is trained and ready to meet workforce demand for rapid testing.

Additionally, Cape Breton University welcomes students from well over 50 countries to study at our institution. Many of these students arrive in Canada with international credentials, particularly in the health professions. A bridging program would assist the country, let alone the small communities, in meeting its health care staffing shortages, a challenge that is significant in Canada, but particularly in Atlantic Canada. At present, there are more than 150 internationally trained health care professionals studying at Cape Breton University—doctors, nurses, pharmacists, physiotherapists, and the list goes on—but a model needs to be set in motion for rapid testing. If we have the vaccine, whatever it takes in terms of years, I think testing will be here with us for quite some time, and we need to develop that capacity in order to give comfort to the country at large, to the health care professionals and to our first responders in terms of what we may do to address those kinds of things.

That is my submission, Mr. Chairman.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Dingwall.

We'll now go to our next witness, the Canadian Public Health Association.

Mr. Culbert, please go ahead for 10 minutes.

[Ian Culbert, Executive Director, Canadian Public Health Association]

Good morning, Mr. Chair and committee members. Thank you for the invitation to present to you today.

First, I want to acknowledge that I am joining today's meeting from the ancestral and unceded territory of the Algonquin Anishinabe peoples. The Canadian Public Health Association is committed to working with first nations, Inuit and Métis people and their governments in realizing meaningful truth and reconciliation.

I will begin by expressing our support and gratitude for the efforts of everyone involved in the Canadian response to COVID-19. Throughout this extraordinary situation, people from all walks of life in this country are showing their true grit.

With my time today, I will tell you about how our system has learned from previous responses and how we need to continue to adjust and improve.

This country needs a public health system that can provide a national perspective while supporting the provinces, territories and indigenous peoples with the skills, tools and equipment necessary to meet the demands of this and future disaster or pandemic responses while reducing the burden on the acute care system.

Public health is defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society”. The core functions of public health systems in Canada include health protection, health surveillance, disease and injury prevention, population health assessment, health promotion and, of course, emergency preparedness and response.

I remind you of that today, because this pandemic has been a classic case study of that definition. From the start of this year, the Public Health Agency of Canada has been monitoring this outbreak, following the evidence and the growing body of knowledge about this novel coronavirus. The agency and public health officials across the country have been following, and contributing to, the science.

As COVID-19 continued to spread around the world, pandemic preparedness plans developed after SARS and H1N1 were refreshed, and the Canadian response began to be formulated. That response is guided by a set of principles embodied in existing pandemic preparedness plans and includes a number of commitments. First, all levels of government and stakeholders are collaborating to produce an effective and coordinated response. Second, decisions are based on the best available evidence. Third, the response to the pandemic is proportionate to the level of the threat at any given point in time. Finally, plans and actions are flexible and tailored to the situation, and evolve as new information becomes available.

Where the “art” of public health comes into play is in the decision-making process for interventions. While it may be tempting to look back and suggest that Canada should have closed its borders and implemented physical distancing measures as soon as the first travel-acquired case was identified in our country, the reality is that there would have been very little public support for those moves at that time. Low public support would have resulted in minimal adherence and a diminishment of support for any future interventions.

For the past few weeks, the message I have been repeating from the Canadian Public Health Association is that how we respond as individuals may be the single most important factor in how well we fare as a country. For both better and worse, this is playing out as we expected. Those who are heeding the advice of public health officials are helping to flatten the curve, while those who do not appreciate the seriousness of this situation continue to endanger others through their behaviour.

The intersection of public health guidance, civil liberties and human behaviour is always a tricky one to navigate. While there has been criticism of the incremental or proportionate approach adopted by public health officials and governments across this country, we believe that this was the most prudent way to navigate this intersection.

Public health officials and politicians alike began with requests for behaviour modification. These requests became appeals, which later became requirements and eventually enforceable requirements with penalties for non-compliance. At each juncture, the request for behaviour modification, be it frequent handwashing or physical distancing, was accompanied by the evidence that predicated that request. This process was and continues to be a perfect example of health promotion in action or the process of enabling people to increase control over and improve their health.

Public health officials across the country understand that if we want our population to change their behaviours, we cannot simply tell them to change. We have to empower them to make the decision for themselves. In times of a public health crisis, health promotion efforts can be hampered by the lack of resources or the time to get people on board and change their behaviours. It is in this situation that enforcement and penalties are reluctantly put into place to safeguard well-being.

It is important to note that there are many in our country who are not in a position to take control of their health or change their behaviours. They may live in crowded housing conditions, are homeless or living in shelters, or they do not have access to clean water. The negative impact of these pervasive social determinants of health are intensified during a public health emergency.

Of course, the Canadian response to COVID-19 to date has amplified some of the perpetual challenges of our federated model and the delegation of authority for health to the provinces and territories. This delegation of authority is a double-edged sword in that it allows provincial and territorial officials to develop responses that are honed to the specific circumstances of their jurisdictions. But in the case of a national public health emergency, it can create the perception that different jurisdictions are taking dissimilar approaches to the outbreak and the perception that there is a lack of coordination. Any differences in public health messaging can be seized upon by the public or the media as signs of disharmony, or worse, incompetence among public health officials.

COVID-19 has once again revealed the lack of surge capacity within our public health systems, mental health support systems, acute care systems and especially in the services available to many if not all indigenous communities. The requirements for testing and contact tracing have pushed public health personnel to the limit, even though all available resources have been redirected toward the COVID-19 response. This redirection of resources will inevitably have repercussions as other core public health functions will be set aside during this crisis.

The lack of surge capacity is directly linked to the chronic underfunding of public health services in Canada. While this issue is not currently within the purview of the federal government to rectify, we are encouraging the development of a legal, regulatory and financial framework in consultation with provincial, territorial and indigenous governments that would provide the Government of Canada with a mechanism to protect and promote the physical and mental well-being of people in Canada through population-based approaches. Such a mechanism will help facilitate the establishment of public health standards and the reasonable provision of public health programs and services. The purpose of this legal and regulatory package would be to provide a national framework of public health functions and activities to inform provincial and territorial activities, accompanied by a resource envelope to support their implementation.

COVID-19 has brought tremendous disruption, hardship and tragedy to the lives of many in our country. It has also resulted in an unprecedented level of scientific progress, non-partisan collaboration and a resolve to triumph over this deadly virus. While we continue to face significant challenges, we inevitably start planning for recovery. As we do so, we have an opportunity to take a longer view of pandemic preparedness with the understanding that COVID-19 will not be the last novel pathogen to disrupt our world and it will most likely not be the worst.

It has too often been the case that a year or two after a public health emergency, public health and political interest in public health wanes. Budgets that were temporarily enhanced are cut back to provide for the immediate needs of the acute care system.

I would ask that you keep one fact in mind as this committee considers recommendations for the future. Public health systems and services in this country are the front line of the health system. If you want to have sustainable acute care systems across the country, you need to have much more robust public health systems to prevent disease, prolong life and promote health both in times of crisis and during normal times.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Culbert.

We now go to the Fédération interprofessionnelle de la santé du Québec.

Madame Lapointe, go ahead.

[Linda Lapointe, Vice-President, Fédération interprofessionnelle de la santé du Québec]

Mr. Chair, committee members, good morning.

My name is Linda Lapointe. I am a respiratory therapist and vice-president of the Fédération interprofessionnelle de la santé du Québec, commonly known as the FIQ. I am responsible for the workplace health and safety of our healthcare professionals. We represent close to 76,000 nurses, nursing assistants, respiratory therapists and clinical perfusionists working in all healthcare settings in Quebec.

We would like to thank you for inviting us to this study on the Canadian response to the pandemic...

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, if I may interrupt. I'm not getting any translation.

[The Chair, Liberal, Ron McKinnon]

Mr. Davies, could you check at the bottom of your screen and make sure where it says “interpretation” that you've chosen English?

There's an icon bar at the bottom of the screen on the Zoom window.

[Don Davies, NDP, Vancouver Kingsway, BC]

I see it now.

If I press “English”, it says “language interpretation”.

Should I press “English”?

[The Chair, Liberal, Ron McKinnon]

Yes. Go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Thank you, Mr. Chair. Sorry, to the witness.

[The Chair, Liberal, Ron McKinnon]

Sorry, Ms. Lapointe. Please go ahead.

[Linda Lapointe]

Do you want me to repeat?

[The Chair, Liberal, Ron McKinnon]

Yes, please.

[Linda Lapointe]

All right.

Mr. Chair, committee members, good morning.

My name is Linda Lapointe. I am vice-president of the executive committee for the FIQ, the Fédération interprofessionnelle de la santé du Québec. I am responsible for the workplace health and safety of our healthcare professionals. We represent close to 76,000 nurses, nursing assistants, respiratory therapists and perfusionists working in all healthcare settings in Quebec. We thank you for inviting us to this study.

Over the next 10 minutes, we will briefly discuss federal healthcare funding, and then delve into the issue of safety for healthcare professionals in these difficult times.

As far as federal government funding is concerned, Quebec's health network has been under severe strain since the outbreak of this pandemic. Were it not for the will and know-how of those working on a daily basis, it would have been impossible to provide the high-quality care the public needs in these difficult times. Each day for several weeks now, they have brilliantly met this challenge, despite the many constraints with which they have to cope.

Apart from the magnitude of the pandemic and the speed at which it is spreading, the weaknesses in our network are largely due to the lack of funding, both provincially and federally, in recent years. For several years now, the FIQ has been asking its federally elected representatives from all parties to increase the health transfer to help finance healthcare and services to at least 25% of provincial spending. Unfortunately, this very legitimate request has fallen on deaf ears. Given the severity of the COVID-19 outbreak, adequate funding would undoubtedly have helped facilitate the day-to-day work of the healthcare professionals we represent, and helped provide the public with the care they have a right to expect.

Last week, the Minister of Health, Ms. Patty Hajdu, noted that, over the past decades, various federal governments have underfunded preparedness for public health emergencies. As a result, Ms. Hajdu said, the national emergency strategic stockpile does not have all the equipment needed to deal with a pandemic of this magnitude. We regret that this reserve has not been regularly reviewed and that the amounts invested are still not adequate. A well-provisioned national stockpile would have been useful, especially since Canada depends largely on foreign industry for the supply of personal protective equipment.

Nevertheless, we applaud the federal government's willingness to address this dependency by encouraging Canadian industry to produce this equipment that is essential to the work of our healthcare professionals in the future.

I will now talk about the safety of our healthcare professionals. As we eagerly await Canada's self-sufficient supply of personal protective equipment, we feel it is appropriate to recall the words of Justice Campbell, commissioner of the SARS Commission, which we echo here today. Until the precautionary principle is recognized as a basic principle of workplace health and safety in Canada, our healthcare professionals will be at risk.

Given the timidity of certain recommendations on personal protective equipment by the Public Health Agency of Canada, or PHAC, particularly its refusal to apply the precautionary principle to the risk of airborne spread of COVID-19, the FIQ took the opportunity to express its dissatisfaction on February 7 in a letter to Dr. Tam, the PHAC's chief official. As we emphasize in that letter, we continue to believe that PHAC leadership would have been helpful in the current context.

In Quebec, from the very beginning of this crisis, the FIQ was concerned about the recommendations and the language used in some recommendations issued by the Institut national de la santé publique du Québec, the INSPQ. They did not factor in airborne transmission, as the PHAC did, and the Quebec recommendations expressed concern for a potential shortage of personal protective equipment.

What is even more alarming, however, is that airborne transmission of the virus remains concealed today, even though current research shows that this form of transmission is happening. Moreover, a panel of U.S. experts has just released its opinion on the subject. The INSPQ's recommendations must quickly be adjusted to reflect this scientific evidence. Otherwise, the workers' rights to safety will be violated.

For the past few weeks, the scenarios by the Institut national de la santé publique du Québec have rapidly turned into improvised, last-resort solutions, particularly when it comes to respiratory protection devices. I'm thinking specifically of the prolonged use, or reuse, of single-use disposable masks.

The INSPQ also recommends the use of expired masks and suggests that disposable masks be disinfected, all of which is endorsed by the public health department.

We question these public health directives, which seem to separate public health from the protection of healthcare professionals, or even set them in opposition. We now understand that they are the result of an obvious lack of preparation and that this puts our healthcare professionals at risk and in peril.

We are very concerned that, in emergency situations, the precautionary principle, which must always guide good practices for infection protection and workplace health and safety, is being set aside. No pandemic, no supply issues can justify putting our healthcare professionals at risk of infection.

The picture we want to share with you today is not a happy one; it is raising a great deal of concern among our members. In 2003, during the SARS epidemic, the sheer uncertainty of what we knew about the virus was a source of considerable stress and anxiety for healthcare workers. Today, that same uncertainty is combined with a real global shortage of essential personal protective equipment.

Healthcare professionals were already overworked at the beginning of the pandemic, and they are now facing significant overloads. While many people are seeking care, healthcare professionals themselves or their loved ones may become ill.

Our members are under a lot of stress. They feel unprotected in the face of the virus. Right now, they feel that, if they are not well protected, they may become infected and they may infect other patients, colleagues or family members. Even more worrisome is that this feeling is not unfounded: employers deny them access to protective measures when they could provide better safety.

This equipment is sorely lacking most particularly in residential and long-term care centres, or CHSLDs. Our healthcare professionals are already coping with a staff shortage in these settings, and they must now provide care to very vulnerable clients with minimal protective equipment. These shortcomings largely explain just how fast the virus is spreading in those settings and, correspondingly, they are putting more stress on healthcare workers.

Helping people in need can be rewarding, but it can also be difficult. Healthcare professionals may experience fear, sadness, frustration, guilt and burnout. These are reactions that can be expected in situations of this magnitude and uncertainty.

In conclusion, it must be said that the recommendations arising from the various reports on the SARS epidemic in 2003 do not seem to have been well assimilated. We hope that those that will emerge from the current pandemic will be implemented so that we can be better prepared to deal with other pandemics. It is essential that our healthcare professionals be able to provide quality care to the public in a safe work environment where all the necessary equipment is available.

On a more positive note, we would like to recognize that the federal government moved swiftly to take measures to support workers during this lockdown period. Some of the measures have undoubtedly helped partially reduce the stress of a loss of income for some of our professionals' spouses and enabled them to continue providing quality care to the public.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Lapointe. We'll go now to Dr. Naveed Mohammad from the William Osler Health System.

Dr. Mohammad, go ahead, please, for 10 minutes.

[Dr. Naveed Mohammad, Executive Vice-President, Quality, Medical and Academic Affairs, William Osler Health System]

Good morning, everyone. Thank you very much for the invitation to address the House of Commons Standing Committee on Health today.

My name is Dr. Naveed Mohammad, and I'm the executive vice-president of quality, medical and academic affairs at William Osler Health System, or “Osler”, as we commonly refer to our hospital. I have had the privilege of working on the front lines of health care in emergency medicine for the majority of my career, much of the time at Osler, beginning in 1997. This coming Tuesday, April 14, I will assume the role of president and CEO of our hospital corporation.

Osler is one of the largest community hospitals in Canada, serving our regional population of more than 1.3 million people. We have three sites in northwest Toronto and Brampton: Etobicoke General Hospital, Brampton Civic Hospital and Peel Memorial Centre for Integrated Health and Wellness.

The population we serve continues to grow rapidly, which presents unique capacity pressures for both community health programs and the provision of acute care services. Osler also serves a very diverse population, including a large South Asian community as well as a significant number of new Canadians and international patients. With our close proximity to Canada's largest airport, we are designated as first responder for Toronto Pearson International Airport. This means that while Osler has a primary relationship with the Government of Ontario as a public hospital under provincial jurisdiction, we also serve as an important stakeholder impacted by the policies and legislative directions of the federal government.

In my address today, I would like to provide the committee with a brief overview of how Osler has responded to COVID-19 and give you a sense of what has been happening for health care teams working on the ground. I will also share my perspectives on how the federal government's COVID-19 response has been effective in supporting hospitals and our health care workforce, as well as my suggestions on how Canada and our health care system can be better prepared for future pandemics that we now know are inevitable.

The emergence of COVID-19 in Canada came at a difficult time in hospitals and health care. We were in the middle of a flu surge season, a time each year when most hospitals struggle with higher patient volumes and greater capacity challenges. In fact, when Osler identified its first COVID-19-positive patient, the organization had been in what we call “code gridlock” for some time. As news emerged about a new virus outbreak in China and later elsewhere, it became apparent that our health care system needed to quickly plan, as we feared a similar trajectory in Canada.

Like many physicians, nurses and allied health professionals of my generation, I was in the front lines during SARS, H1N1 and Ebola, as were many members of Osler's senior leadership team. We knew we needed to be proactive.

Also, over the last number of weeks, hospitals, regional partners and provincial authorities, including Ontario's Ministry of Health and the Ontario health agency, have been working together in unprecedented ways to develop and implement a planned and phased approach to critical care and emergency capacity planning. As an acute care hospital, Osler quickly mobilized our focus around COVID-19 strategies and measures. We adjusted our clinical operations and infrastructure to ensure capacity for COVID and non-COVID patients needing hospital care. A core principle throughout has been to protect and ensure the safety of all patients, staff, physicians, volunteers and the community.

Osler's strategies for COVID-19 capacity have included cancelling all elective and non-urgent services, procedures and surgeries and repurposing these spaces within the hospital; where possible, moving or discharging rehabilitation patients or patients requiring an alternative level of care with appropriate home or community care supports; and taking advantage of the natural decline in volume to consolidate our patient activity in new spaces.

To further reduce the number and flow of patients coming in and out of the hospital, Osler has enhanced our virtual care through teleconferencing and video conferencing, and more services are being provided remotely. With this, virtual care has contributed to an overall decrease in patient volumes for non-COVID emergency department visits, and this has allowed Osler to safely take on further COVID-19 capacity. Our virtual strategies also include using iPads and other devices to support virtual visitation between patients and families, as we have needed to make the very difficult decision to implement a no visitors policy.

We are now identifying decanted spaces in our sites to create incremental capacity for more patient beds. Tented spaces are being put up adjacent to the hospital and, if necessary, we will use these and other unconventional spaces for patient care, including our auditoriums, outpatient areas and patient dining rooms.

To facilitate COVID-19 assessment and testing for the public as well as for our staff, physicians, volunteers and their families, Osler quickly brought online three COVID-19 assessment centres, including one of the first to open in Ontario. Operating both within the hospital walls and through an innovative and accessible drive-through model, Osler has now swabbed 5,260 patients. We are currently looking at ways to expedite assessment and testing for community providers and first responders, who experience a greater risk of COVID-19 exposure.

We continue to work with the provincial and regional partners to source and procure personal protective equipment, or PPE. Osler has been blessed with tremendous support from corporate partners, local businesses and donors to source and procure additional PPE. A robust stewardship and conservation strategy has been necessary to ensure a sustainable supply, and this remains a critical priority for the hospital.

It has been an unprecedented time and there have been many hospital policies and procedures we’ve had to create or evolve in real time as information about the characteristics of the virus and its associated clinical implications has evolved. Some policies have meant very difficult conversations for our teams. Decisions such as having a no visitors policy have been informed by ethical decision-making tools; however, the discussions have been difficult and sometimes emotional. We know these changes have been tremendously hard on our patients and their families.

Osler’s people are our most valuable asset. Many hospital staff have been working long hours seven days a week. The health and well-being of our teams has been very much top of mind, and we’ve developed incremental healthy workplace and resilience strategy resources and practical supports along with spaces for respite, reflection and self-care for our staff.

Teams at Osler as well as those at other hospitals and other health care organizations have been genuinely moved by the outpouring of public support for our health care heroes. These gestures have taken many shapes, including sincere and meaningful words of recognition by elected officials, including Prime Minister Trudeau, Premier Doug Ford, local mayors and our municipal and regional councillors. Gifts of financial donations to hospital foundations, words of encouragement on social media and simple gestures of kindness and support amongst neighbours and friends have inspired us and are helping our people through this challenging time. Those of us in health care are sincerely thankful to Canadians for this support.

Having spoken to my colleagues, front-line nurses, physicians and other allied professionals, I can say that the collective sense is that the federal and provincial governments have been working well together to support this crisis on the front lines. Daily updates by the Prime Minister , the premier, as well as municipal leaders have been well executed and have kept people apprised of new decisions and directions. We have been pleased to see the non-partisan way in which governments have come together to expedite high-priority needs, particularly the work on PPE and N95 mask procurement, as significant achievements.

However, as I reflect on what has happened to date and how best to ensure we continue to collectively manage this situation, I ask that you consider the following.

While the government response has been significant and relatively well coordinated, we have collectively been put in a situation, along with the rest of the world, of reactivity. Seventeen years ago when we experienced SARS, and through more recent experiences with MERS and H1N1, we have learned how likely it is that pandemics will continue to occur. The federal government has tremendous expertise in emergency response planning and mobilization, meaning that it is uniquely positioned to ensure that we learn from this experience and do the following:

One, enhance our pandemic stockpiles of PPE and other equipment, as well as diversify the supplier network. Not knowing whether there's going to be enough PPE, ventilators or other life-saving equipment has created significant fear on the front lines.

Two, develop strategies to ensure that we can do more pervasive community testing. Quite simply, we need the ability to do more testing. This will allow us to have a more targeted approach to quarantining staff and physicians, and make it easier to ensure surge planning that better segregates patients with and without a specific virus or communicative disease.

Three, move forward on the national pharmacare strategy to ensure we can mitigate challenges of drug supply shortages and stockpiling.

Four, ensure a coordinated, multi-level and all-party approach to pandemic planning and implementation. This will best leverage federal expertise, ensure resources are best allocated, harmonize policies across jurisdictions, promote the greatest levels of transparency and trust, and ensure that the focus remains on the important work of implementing the plan down to the front lines.

Finally, we hope our levels of government continue to work in the non-partisan way they have been to support all Canadians in putting COVID-19 behind us.

I want to thank all of you for the opportunity to come before the standing committee. I look forward to the discussion and your questions.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Mohammad.

We'll go now to our questions. We'll start our first round of questions with Dr. Kitchen.

Dr. Kitchen, you have six minutes.

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

Thank you, Mr. Chair.

Thank you, everybody, for your presentations. It's greatly appreciated.

Thank you to each one of you who has stepped forward on the ground, Dr. Mohammad and Ms. Lapointe, on all the efforts that you're putting into making certain that Canadians are protected.

Ms. Lapointe, I appreciate your comments. I would like to start with you.

I speak a little bit of French. I'm learning a new word every day.

That's all I can do. I apologize.

In our last meeting, Linda Silas, who is the president of the Canadian Federation of Nurses Unions, presented. She said, “However, workplace safety has never been PHAC's primary focus, and the agency has unfortunately failed, over and over, to consider and appropriately protect the health and safety of health care workers.”

She went on further to talk about things, but I'll just end here: “In a nutshell, our message to you is this: When faced with this level of uncertainty around the new coronavirus, especially around something as fundamental as how it is spread, we should start with the highest level of protection for health care workers, not the lowest.”

Do you feel from what you've seen that PHAC has actually taken the workplace safety of health care workers seriously, Ms. Lapointe?

[Linda Lapointe]

I would say that is more or less the case. Our observation today, a few weeks into this pandemic, is that we had the distinct impression that public health guidelines were adjusted based on the availability of personal protective equipment, when public health should be ahead of the game and ensure maximum safety for healthcare professionals and all workers in the health sector.

The guidelines were constantly changing. It was becoming apparent that they were lower than what they should have been under normal, non-pandemic conditions. The guidelines were changing all the time and causing safety to be compromised, or at least sending a message to healthcare workers that it might be compromised. As the guidelines changed, people said that the level of protection was being reduced. For example, the situations for the N95 masks were becoming more and more limited. There were only two situations in which the N95 masks could be used, and the method of transmission has not yet been determined. Over the past few weeks, over the past few days, as time goes by, it's become clearer that there could be airborne transmission. The N95 mask is specifically designed for situations where there is airborne transmission. That is what the big debate is about.

Much like the Canadian Federation of Nurses Unions, we at the provincial level have asked that healthcare professionals be given N95 masks as soon as there is a suspected case, not just for confirmed cases. The latest data show that many patients are asymptomatic carriers of the virus, which is why it's important to protect healthcare professionals, so that they do not leave to self-isolate and deprive people of their services.

Yes, we have major criticisms of the Agency with respect to public health, especially in terms of communications. Documents were continually being updated. It was difficult to get a real-time picture of the adjustments, and things were not concise. It wasn't easy to share the information with healthcare professionals in the field...

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

Thank you, and I appreciate that. I apologize for interrupting. I only have a short amount of time.

You mentioned a number of aspects, noting that things are always changing and appearing to change every day. Your comments about the masks are important. The reality is, where are we getting those masks from? We've brought it up with the minister in committee a number of times the question of where these masks are coming from and how quickly can we get them.

Many of you today have talked about the protocols that have been set up. The reality was that after SARS, we developed those protocols. It appears that a lot of times in hospitals, especially in rural hospitals, if you ask a lot of people and where their protocols are from 2005, they don't even know where those are. There is concern as to whether those protocols that were established after SARS are actually being followed.

I'll throw this question to Dr. Mohammad.

Before COVID-19 began to spread across the world, I'm wondering if you or your hospital were aware of the processes and protocols that had been developed previously. I recognize that your hospital is bigger than a lot of ones across Canada, but how often are the health care professionals in your jurisdiction required to review these protocols? How often do you do simulated tests and procedures to make certain that your hospital...? I ask this both from your point of view and also that of smaller hospitals across Canada. How often are those being implemented? Are they done yearly, weekly, monthly?

[Dr. Naveed Mohammad]

I can tell you what we do at Osler.

We are a larger organization with more staff and more bandwidth. We have a pandemic plan that our emergency preparedness committee is in charge of, and it is reviewed on an annual basis. The pandemic plan includes not only the work that needs to be done inside a hospital but also the partnerships that need to be developed outside with EMS, regional governments and the Ministry of Health when such a pandemic strikes. We do it annually and we review it annually.

As I mentioned, we may be at a bit of an advantage because of our proximity to the airport, but we do have simulation exercises with the local fire departments, local police and the Greater Toronto Airports Authority for various types of issues, whether it be an airplane crash, major trauma or an issue like this one, with the risk of an infectious agent.

I have worked in towns of 1,600 and towns of 2,000 in the past, and I think that with smaller hospitals, it all depends on the administrative bandwidth that they have. Being an accreditor for Accreditation Canada, I often accredit hospitals across the country, and I find that in smaller hospitals, just because of the the workload they have, they may not be reviewing the protocols on an annual basis or even every two or three years. They may just be acting when things like this happen.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen. We'll go now to Ms. Sidhu.

Ms. Sidhu, you have six minutes.