Health Committee on April 9th, 2020

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I have a quick question for Dr. Mohammad. Woody says hello, by the way.

You mentioned the lack of medications for sedation and anaesthesia. I would think you were talking about maybe propofol and Midazolam. I'm not sure of the jurisdiction in terms of procuring medications. I would think, as with most things in curative medicine, that it's the Government of Ontario. I would also think that our federal government, as with all kinds of procurement, has pulled out all the stops and tried to do its best to get these things.

Do you know specifically what's being done to try to expedite access to propofol or Midazolam? I know Ventolin is another one.

[Dr. Naveed Mohammad]

You're right that the medications that I'm referring to are propofol and Midazolam. There's also fentanyl. What's happening is that people who are presenting with COVID-19 and have significant respiratory distress, when we've had to sedate them and put them on ventilators, many of them have had to be on ventilators for much longer periods of time than we usually have people on ventilators, so that has increased not only the length of time we use the medications but also the volume of patients that we now have in our ICUs.

Ventolin is also in short supply. That's more of a community issue right now. In hospitals, we're okay with Ventolin.

We're basically working through our usual partners. The Ministry of Health and its sources is one of the partners, but we have significant relationships with our supply chain, with our drug companies, because of the large amounts of purchasing that we do, as many hospitals do throughout Ontario. Right now, just as with PPE, since the issue is not localized to Canada and China, or to Ontario and China as in the case of SARS, but is a worldwide issue, the suppliers are probably not able to create it as fast as they need to.

Once again, this goes back to what we can do to prepare and have these things on hand. I know that unlike PPE, drugs will expire, so that is something that we'll have to go back and look in a more innovative way at how we can cycle these through our warehouses so that if an event like this occurs again, or if and when an event like this occurs again, we can be much better prepared.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you very much. We'll do whatever we can at the national level to push this same issue and access those medications.

I want to quickly change gears and ask a bit of an academic question to Mr. Culbert. He mentioned that our approach from a public health perspective with respect to this crisis was first to try to suggest things to people, to educate the public. We were left coercive actions only as a last resort. I think the Public Health Agency of Canada and the Ministry of Health have been criticized as being maybe too slow in doing this.

However—and I would throw this back at the public health community and public health academia—I would suggest that this approach only reflects the prevailing attitudes of public health and public health academia. Having myself gone through a bit of public health university and also having been involved in writing public health legislation, I think there's been a tremendous swing in the pendulum, away from what used to be a heavy emphasis on coercive action to control the spread of infectious disease while giving scant attention to impeding individual liberties. Over the years, because of a lack of infectious disease, we've become a lot more concerned about doing everything possible not to infringe on individual liberties, and we've been very reluctant to use any sort of coercive action to control the spread of infectious disease. This is public health academia. Although our government was criticized for it, it is the prevailing attitude in public health academia and public health circles in the western world.

I'm throwing it out to you that this was perhaps a mistake on the part of the public health community.

[Ian Culbert]

Thank you for your question. I would suggest that we have some evidence to show that coercive actions can only be used as a last resort. For example, forcing people living with TB into sanatoriums earlier in the 20th century resulted in their avoiding public health authorities, going underground and actually continuing the spread of TB.

We have had a massive cultural change as well over the last 100 years in the public's attitude towards science and authority. We only have to look at the growth of vaccine hesitancy and vaccine denial to see that just telling people the right thing to do does not work anymore. We have to convince people and bring them along that path. It takes time, unfortunately, and we don't always have time to do it, but it is actually what works.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

We go now to Mr. Thériault.

You have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair. I'm going to go to Ms. Lapointe.

In conclusion, I would like to summarize your message to us today. If we want to counter such a virulent pandemic by applying the precautionary principle in terms of public health and workplace health and safety, that means we cannot continue to make health networks weak and precarious by underfunding them. Adequate funding would be particularly useful for front-line services, as well as for applying the precautionary principle, which is so important in public health.

You also tell us that we could have been better prepared and that the precautionary principle should not vary according to the amount of equipment we have in reserve to protect the public. You also said that we need to work on this, in order to become less reliant on wheeling and dealing in the global market.

In the end, you want us to not come out of this episode with recommendations put aside as we did after the SARS episode, when we weren't thorough enough.

[Linda Lapointe]

Absolutely. It's not only in Quebec, it's like that everywhere in Canada. Working conditions for healthcare professionals are not easy, and it's not just during a pandemic. They have an enormous workload all the time, not to mention the medical complexity of patients' problem and the staff shortage.

We have long advocated for an adequate nurse-to-patient ratio precisely to provide safe care. In a normal setting, we're always short-staffed. Healthcare professionals work overtime and do not necessarily work in the best conditions. This is particularly the case during a pandemic when the collective agreement is suspended. We send our professionals from one activity centre to another and we don't systematically verify whether they have the required expertise or whether it's the priority of their activity centre. We are all over the map with our healthcare professionals. This does nothing to attract and retain healthcare professionals.

When this crisis is over, people will be tempted. There's a good chance that people will leave the profession. They will change careers. The situation doesn't make professionals want to stay or the public want to study in this field. This must be addressed since it will be an issue over the short and medium term.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'd like to focus on what we can do moving forward to better prepare our country in the future.

It's quite clear now that hospitals are routinely operating above the capacities that they were built for. I note that the Brampton hospital, where Dr. Mohammad works, was built for 90,000 patients per year. It routinely sees 140,000 patients per year. Obviously there is concern about our hospitals' ability to deal with surges. We're having to set up tents and field hospitals.

Mr. Culbert, you spoke of chronic underfunding of our health care system and you said that's primarily outside federal jurisdiction. In 2014, the federal government reduced the health care escalator from 6% to 3%, and that decision was confirmed again with the present government, even though we know that health care costs are rising by about 5.2% per year.

Is this an opportunity for us? Would you advise the federal government to take a look at that escalator and see if we should be increasing it to keep up with inflation?

[Ian Culbert]

My comment was speaking specifically to the federal government's role in public health, which is the prevention and health promotion side of the equation, and it doesn't have a role. I will reassert that the more we keep people healthy, the more likely we'll have a sustainable health care system and keep people out of hospitals except when urgently necessary.

Obviously we need to look at funding across the board, but consistently we don't fund the preventive side of the equation sufficiently. Two to five per cent of the overall health budget is spent on keeping people healthy. That means we put an emphasis on sickness and not on health.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Mohammad, one of your four recommendations was that we move forward on national pharmacare. I wonder if you could expand on that and why you think that's an important policy for the federal government moving forward.

[Dr. Naveed Mohammad]

The first thing is that right now there is talk about certain medications that may or may not work with COVID-19. I know that the evidence is preliminary, but many people who have drug plans or are able to afford it have gone out and stockpiled those medications. Many of those most vulnerable people who may have the highest exposure rate cannot afford these medications. I think that a national pharmacare strategy for all of our citizens, especially those who are most in need, is significantly important, not only for issues like COVID-19 but for any illness.

I know of people who have to pay out of pocket, and when we give them medication that's prescribed for four times a day or twice a day, they only take it once a day or at half the recommended dose to make it last longer, because they can't afford it, and that's under normal circumstances. The vulnerable populations are much more exposed to issues like this. They are sometimes forced to work because they need to work, and they expose themselves to COVID-19. For them, this is of the utmost importance.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That wraps up our questioning. I would like to thank our panel, all of you, for giving us so freely of your time and your valuable perspectives. It has been most helpful.

As we bring this meeting to a close, I'd like to compliment the House of Commons staff and technical personnel for a great job in this very first House of Commons committee meeting by video conference. As far as I'm concerned, it's a great job. Well done. Thank you.

With that, the meeting stands adjourned.