Health Committee on April 9th, 2020

[Sonia Sidhu, Liberal, Brampton South, ON]

First of all, thank you to all the witnesses for being here. Dr. Mohammad, thank you for your leadership.

My first question is for Dr. Mohammad.

How can the government increase our support to the hospitals, the health care providers, to help mitigate the impact of COVID-19? As you know, we have Brampton Civic Hospital and all the health care professionals are doing an amazing job. I just want your views on that.

[Dr. Naveed Mohammad]

The first thing is that there has been great collaboration between the federal government and provincial governments on some of the things they have put in place right now. The income stability programs for our staff and for all the workers in Canada and things along those lines have been a significant plus and have had a great impact for our community members and the employees we have here at Osler.

As I mentioned in my submission, it's about learning lessons from the past and having plans in place, and specifically having plans in place for personal protective equipment. Suppliers and the supply chain are one of the main things we are challenged with right now.

The other thing is this. I know we spoke about what's happening with international travellers coming to the airport. One of the biggest issues that we face here being so close to the biggest international airport in Canada was that both Canadian and non-Canadian passengers were getting off the plane and telling us that the only people who were asking them questions or screening them were border services agents. I think that was a bit of a weakness in our process, in that smaller countries have public health workers at the gates to check temperatures or ask questions to isolate at-risk patients right at the point of entry.

The last thing I want to talk about is something I mentioned earlier: our drug resource or our supply chain policy for drugs. Right now, because of the number of patients who need to be on ventilators and need to be sedated because they have a large tube down their throat to give them the ability to breathe, I know that across the country and across the province, we're running short on the medications that are utilized to sedate these patients. We're actually quite anxious about that. Therefore, when I talk about the pharmacare policy, not only am I talking about specific drug plans for individual Canadians so that they can have access to medication if we do find one that is working, but I am also talking about a pharmacare policy that creates and opens supply chains for these very important drugs that we may run out of in the very near future in large hospitals.

[Sonia Sidhu, Liberal, Brampton South, ON]

I also want to mention this, if you can answer.

As the member for Brampton South, I represent a highly diverse riding. As you know, many who immigrated to my riding and others are international medical graduates with health care training from international sources. Recently, the federal government has started a recruitment campaign to find those who have medical skills and want to help in the fight against COVID-19.

Dr. Naveed Mohammad, given the recruitment campaign, while credentials recognition is a provincial jurisdiction, how else could the federal government support programs like this, in a pan-Canadian effort to bridge those health care staffing gaps?

Mr. David Dingwall, you can elaborate on this too, please.

[Dr. Naveed Mohammad]

Do you want me to go first?

[Sonia Sidhu, Liberal, Brampton South, ON]

Go ahead.

[Dr. Naveed Mohammad]

I can tell you that we have a large number of international medical graduates who reside in Canada. A lot of them are Canadians who have gone to international medical schools. They are not people coming from other countries with education from there. They are people who have grown up in Canada or are born in Canada and have gone to international medical schools.

I can tell you that we have a plan in place right now to staff our organization in a phased manner, because we have shut down surgeries and we have shut down a lot of elective work. Initially, we are going to be using that staff to fill any gaps we may have. After that, we will reach out to the community, to our community physicians or specialists who are practising in the community. They are not practising in a hospital, but they are volunteering to step up.

To answer your question, the College of Physicians and Surgeons of Ontario has worked with the province to allow international medical graduates to have a renewing one-month licence in Ontario. This means that at Osler, if we get to a point where we run out of local resources for physician staffing, we would hire international medical graduates and give them a job letter. When the graduates present that job letter to the College of Physicians and Surgeons of Ontario as a licensing body, they would have a one-month licence to work with us, and then we could renew that on a monthly basis.

I think it's a great idea to put that in place, because it creates a stopgap measure for us here in this province. I would encourage the federal government to recommend that other provinces go down the same path, because most of these international medical graduates would be willing to travel anywhere in Canada to gain that experience. Not only will it help us now, but it will help these international medical graduates to get residencies in the next couple of years, because they will have local Canadian experience.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Dingwall, what are your views on that?

[David Dingwall]

I think it's a bit of a tragedy, in that we have a number of professionals within our post-secondary institutions across the country who cannot gain access as doctors or nurses or what have you. There are ways to get around that. I think there needs to be a bridging program for physicians and other professionals, so that they can get into the system and provide the necessary services to the citizens.

In my particular university, last year we had 17 medical doctors from India alone, all willing to participate in the health care, all willing to participate in a bridging program. For whatever reason, the medical societies across the country are not too willing to participate in a meaningful way to make that transition easier.

The federal government can assist by providing some necessary monies for the bridging, but you need the Canadian Medical Association and the provincial associations [Technical difficulty—Editor] to a program that will assist. We're not looking for a diluted way. We're looking for these individuals to bridge in and to become family physicians and various professionals in our health care system. With a little bit of will by some of the stakeholders, that can be accomplished quite quickly and it would serve everyone's interests.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu.

Mr. Thériault, go ahead. You have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Good afternoon, Mr. Chair.

First, I'd like to speak to all the witnesses. Ms. Lapointe, gentlemen, thank you for your valuable contribution.

I will start with you, Ms. Lapointe. First of all, allow me to point out how clear your presentation was. You have almost answered all of my questions. I still have some, but you have given me an update, and I am very happy with that. Allow me also to commend all members of the FIQ and to recognize their courage and goodwill in these difficult times.

The virulence of this pandemic is quite incredible. On March 13, when Quebec issued the emergency protection order, that decision was made when there were 17 cases of infection and no deaths. About 25 days later, last night at 8:38 p.m., there were 10,031 cases and 175 deaths in Quebec. No one saw a virus of such virulence coming. However, you point out that all the relevant SARS recommendations were more or less acted upon.

At what point, Ms. Lapointe, did you realize there was a problem with the stockpile of personal protective equipment?

You said that people have to be able to do their jobs with equipment, but are you aware of anyone in your organization having to work without adequate protection? Could this explain some of the community spread that we're seeing today in some CHSLDs?

[Linda Lapointe]

Thank you for your question.

Yes, the lack of supplies was noticed quite quickly. That is what made us a little angry. In all of his press briefings for two weeks, Mr. Legault was reassuring. He said that there was enough personal protective equipment.

However, in the front lines—we represent 76,000 healthcare professionals across the province—that wasn't at all what we were seeing. Also, we had been told that very restrictive management was in place. We thought there might be enough equipment, but that management was tight in anticipation of a possible shortage. In fact, patients and visitors were stealing masks. We were not sure.

Over time, Mr. Legault had come to recognize that only three to seven days' worth of equipment remained. We had pointed that out. We had been warning the department for two or three weeks. I would send them the names of suppliers who were contacting us at the Fédération. Since we are a union, it's not up to us to provide the equipment, it's up to the employers.

It reached the point that, this week, we had 100,000 masks delivered to the government, and we're expecting another 500,000 next week. We bought them to thumb our noses at the Legault government, even though it has done some good things and implemented some good measures.

How is it that a union could procure over half a million masks in seven to ten days when we had no supply statistics?

If the government knew exactly how much personal protective equipment it had in its possession for three weeks, why weren't those orders made before?

Your second question was whether healthcare professionals had worked without personal protective equipment. The answer is yes, absolutely. We're not surprised that there have been outbreaks of this magnitude in CSHLDs. Our members were crying out to us about this need.

The FIQ website includes a page called “Je dénonce”, where reports on working conditions can be found. Home care and CHSLDs are the two settings where the needs are most pressing and where people did not have equipment. Home care workers would go out to see 12 patients with only one mask. In CHSLDs, there were no masks at all, unless the patient had tested positive for COVID-19. But there may be a period before diagnosis when it is possible to spread the virus. So yes, it has been a problem.

[Luc Thériault, Bloc, Montcalm, QC]

Researchers at Duke University are claiming that, with a sterilization process, N95 masks can be reused.

I understand that it is not your first choice, but do you think that, in the event of a shortage, sterilization in this manner would be worthwhile? Would it be effective?

[Linda Lapointe]

I'm no expert, but it should be understood that the instructions clearly indicate that these masks are disposable and, ideally, single-use. Because of the shortage, they're trying to bring in all kinds of means that have not been proven effective. In Quebec, the Association paritaire pour la santé et la sécurité du travail du secteur affaires sociales, the ASSTSAS, and the Institut de recherche Robert-Sauvé en santé et en sécurité du travail, the IRSST, disagree completely on disinfection in this manner.

While not all of the masks come from 3M, the company issued a news release stating that it has been studying disinfection for several years and no method has met their four criteria in terms of the filtration, the elastics and the materials. As a result, they have not approved any method. 3M has been trying to do this for several years.

Some employers in Quebec want to start disinfecting masks, but before we get to that point—again, I'm not an expert—we are advocating extended use of the N95. If a healthcare professional has to go into an intensive care room four or five times, of course, they can't use five different masks. We understand that. If the technique used to remove the mask and put it back on is appropriate, we recommend that the nurse or respiratory therapist use the same mask for a full shift, rather than using masks disinfected with a method that has not been proven effective.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Ms. Lapointe.

Mr. Chair, do I have any time left?

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

You have no time left. We've already gone about a minute over.

We go now to Mr. Davies.

Mr Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Mr. Chair.

Thank you to all the witnesses for being with us today.

My first question is for the Canadian Public Health Association.

In a March 30 article on CBC News, Mr. Culbert, you noted that if people knew more about the COVID-19 outbreak in their particular communities, it would help them to follow advice from public health authorities. However, we're hearing from many health experts across the country that COVID-19 data is of questionable validity due to low testing rates and delays in results. They also note that the data is not gathered, compiled or presented in a consistent manner across the country, and that disaggregated figures are not always provided and inventories of medical equipment and PPE stockpiles are frequently excluded from reporting.

In your view, should the Public Health Agency of Canada mandate that standardized information reporting for all public health authorities across the country be made a reality?

[Ian Culbert]

It would be tremendous if the agency had the authority to mandate that, but unfortunately they do not. That is one of the calls we are making in this request for federal legislation that would give the federal government a greater role in coordinating public health efforts across the country.

The lack of streamlined epidemic data across the country is an ongoing issue. We know alcohol sales the next day, but we don't know the impact of alcohol, for example, for 10 years out. It's the same idea with the COVID-19 outbreak. There's a lack of consistency and we're seeing that as the reason for why the federal government had to wait until today to release its modelling figures.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm not quite clear whom to direct this question to, so I'll open it to whomever on the panel wants to answer it.

We've been hearing from the WHO that we need to test, test, test, and I think there's a pretty consistent consensus in the country that testing, tracing and isolating are key factors in helping us deal with the COVID-19 crisis.

My question is on blood serum test kits. I understand that these kits are manufactured in Canada, and they produce very quick results and can at least confirm positively if someone has been exposed to the virus. I understand that they have been approved by the U.S. and the EU, and are actually in use in many countries, but I understand that Health Canada has yet to approve the use of these test kits in Canada.

Should we be making these serum-based home test kits more widely available so that we can get more accurate figures on who's been exposed to the virus in Canada?

[The Chair, Liberal, Ron McKinnon]

Anyone on the panel who wishes to respond, please go ahead.

[David Dingwall]

I can't respond to the specifics that you're raising, but the World Health Organization is a very reliable and sophisticated partner as it relates to health throughout the world.

It would seem to me that this is probably something the committee would want to take under advisement and to get some specifics from Health Canada as to why they're not, and what conditions would need to exist for them to adopt that. I know from previous experience that our senior officials in Health Canada are a pretty reputable group of men and women who adhere to very high standards. I think we would want to hear an answer from them as to why not, and how they could go to that kind of testing. To me, rapid testing is the most important issue.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Dingwall. That does provide us with a good question to ask Health Canada the next time they appear, because it seems a little incongruous when test kits manufactured in Canada are being used all over the world and we're not able to use that technology in our own country.

Mr. Dingwall, I want to direct my next question to you.

We know that after the SARS outbreak in 2006 there was a very comprehensive inquiry and report issued by Justice Campbell and for 14 years some have called that a playbook for how to deal with a coronavirus-like pandemic. In fact, that report in 2006 said, “there is no longer any excuse for governments and hospitals to be caught off guard and no longer any excuse for health workers not to have available the maximum level of protection through appropriate equipment and training”.

The stories are legion across this country that governments and hospitals have in fact been caught completely off guard and that our front-line health care workers are suffering from a shocking shortage of personal protective equipment. We know that in 2010 a federal audit flagged problems with the management of Canada's emergency stockpile of medical equipment and that in 2018 an assessment of the H1N1 outbreak showed that Canada had a shortage of ventilators.

Mr. Dingwall, I'm curious as to whether you, as someone with a lot of experience around the cabinet table, can give us any insight into how we can move forward to ensure that 10 or 14 years from now we're not having the same conversation. How can we take the lessons of the current outbreak now and ensure that we follow through with the steps that have been identified? Clearly we didn't do that after 2006.

[David Dingwall]

That's an excellent question, and let me try to respond to it in two parts.

The first part is that I think many governments federally and provincially have followed up on the SARS recommendations. Where I think we may have fallen down as a society has been in our failure to put into statute the obligations of the parties who are involved in the process. For instance, provincially under labour standard codes and federally under the federal labour code, those that deal with our indigenous health, the statutory obligations are quite vague in terms of a pandemic. In some jurisdictions they are literally non-existent. However, we need to amplify those pandemic obligations that the state must provide for, whether for the safety of our workers, for rapid communication, or for a host of other things. I think if we put those into statute, people will then be obligated. I think there should be some sunshine laws, in part so that every three years you would have to review your pandemic plan.

Under the occupational health and safety provisions that many of the provinces have, there is reference to a pandemic, but it is very short and the definition is very inexact as to the obligations on the part of the state to do that. I would look at that to see what they have in order to make it a statutory obligation as opposed to a recommendation that may come from a particular commission.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

We'll start our second round and we'll go to Mr. Webber.

Mr. Webber, you have five minutes.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

I'd like to thank the witnesses for appearing today before our committee. I know that you are likely busier than usual so your time is very much appreciated.

My question is directed to Dr. Naveed Mohammad of Osler.

Dr. Mohammad, I'm currently on the Osler website, and it says:

As part of ongoing preparations to ensure [Osler] is well positioned to provide emergency care for an increased number of patients in the coming weeks, a temporary triage area is being erected at its Brampton Civic Hospital and Etobicoke General Hospital sites. The temporary structures are part of Osler’s escalated preparedness efforts as set out in its Pandemic Plan.

The temporary Emergency Department triage structures, which will remain vacant until they are needed, can be used to provide added capacity for Osler’s Emergency Departments should the need arise. They will provide a dedicated space for triaging patients who may require emergency care and will support the safety of patients who do not have COVID-19.

Dr. Mohammad, I want to share with you also a letter from a doctor in my constituency, a quick letter from Dr. Colum Smith. He states:

...I simply cannot believe that the local hospitals are receiving patients with fever into their emerg departments....

We need “fever only” facilities opened without delay....

Patients with fever or other signs/symptoms of [COVID-19] infection need to be triaged at the main entrance of our hospitals and directed to a separate assessment area....

Dr. Mohammad, because Osler did construct such a temporary facility, should this not become common practice throughout the hospital system in this country?

[Dr. Naveed Mohammad]

I'll answer your question in two ways. One is that everything depends on the configuration of the emergency department and the emergency department's isolation capacity. What that means is that each hospital with an emergency department has different types of rooms. We have rooms called isolation rooms that have negative pressure capabilities, which means it's a room where the airflow is suctioned out of the room. There's a separate bathroom for the patient so the patient never has to leave that room, and there's an anteroom so that you have a place to change before you go in so you can change into PPE.

At Osler, one, because of our experience with SARS—we were one of the SARS designated sites—and the lessons learned from it, and two, because we are close to the airport, we have a flow system in our department so that if a patient comes in who is what we call ILI, or influenza-like illness, which is very similar to COVID, he or she gets triaged separately into that area. We have erected a tent outside for that purpose at each site, so if our COVID-positive patients become such high numbers that we have to utilize the whole ER for COVID-positive patients, then the COVID-negative patients would be seen through our tent.

If a hospital does not have a capacity like ours, then it would behoove them to put structures like this up, sooner rather than later, or work within their community so that certain hospitals see one type of patient and certain hospitals see another type of patient.

We have the luxury of having three facilities. We're a corporation of three hospitals. We have talked about maybe having one facility seeing only COVID patients. We haven't gotten to that point yet, but to answer your question, yes, I agree that people should act sooner. However, it all depends on what their innate capacity is to begin with.