Health Committee on April 15th, 2020

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Excuse me, am I subbing in for someone?

[The Clerk]

I don't have you as a substitute today, Ms. Block, just as a member attending.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Okay. Thank you.

[The Chair, Liberal, Ron McKinnon]

Carrying on from where we left off, I would like to now welcome the witnesses. As an individual, we have Dr. Joanne Liu, who is a physician and former international president of Doctors Without Borders. We have, on behalf of the Canadian Mental Health Association, Margaret Eaton, national chief executive officer.

From the Department of Public Works and Government Services we have Bill Matthews, deputy minister; Michael Vandergrift, associate deputy minister; and Arianne Reza, assistant deputy minister for procurement.

We will start with Dr. Liu. You have 10 minutes for your statement if you wish.

[Dr. Joanne Liu, Physician and Former International President of Doctors Without Borders, As an Individual]

Thank you very much, Mr. Chair.

Good afternoon. I would like to echo some of what I have written already in The Globe and Mail about my obsession about avoiding the worst-case scenario for Canada in tackling the COVID-19 pandemic.

I think all of us right now are holding our breath and are hoping that our physical distancing strategy will do the job to flatten the curve. The reality right now is we have put our health care system on pause in order to gear up and prepare for a surge of COVID-19 patients. Another reality is the managing of a pandemic with a shortage of medical resources.

My key message for you today—and I will bring forward a few examples—is to really prepare for the worst-case scenario but also very much to prevent what is preventable.

In terms of the health care system and the health care facilities, I am very adamant about pushing for dedicated medical facilities or dedicated parts of facilities with dedicated staff only for COVID-19 patients. It has been proven again and again that swapping staff from COVID-positive to COVID-negative patients may contribute to more infected patients. It is very evident that people working in a close circle of patients become much better at caring for patients. In this closed environment if there is a COVID-positive patient, they are going to go through the part that only COVID-positive patients would go through. There should be dedicated places, for example, to get an X-ray. A COVID-negative patient should not cross paths with a COVID-positive patient. That's a way to make sure our health care system doesn't become a vector for COVID-19. Additionally, a secondary gain is it might reduce the amount of personal protective equipment we might need.

I would like to draw your attention to a few special circumstances. It's about the vulnerable communities. It has made the headlines now about the homes for the elderly, but there are the shelters and the first nations as well. For me, it is mandatory to think about implementing radical shielding strategies. This means that we shield those vulnerable populations. It's what we call reverse isolation.

We isolate the sick, but we also isolate the vulnerable. We shouldn't do what has been done in Quebec, which is the double failure of isolating our elders and not giving them the right and adequate care. We need to make sure we avoid that.

There is another thing we need to bring in as quickly as possible. We need to test regularly the caregivers who care for those vulnerable communities. We know there is an increasing number of asymptomatic people, and they become what we call “super-spreaders” who are infecting others. The bottom line is we don't want to import COVID-19 into vulnerable communities. We don't want to bring it into our first nations. We don't want to bring it into homes for the elderly. We don't want to bring it into the shelters.

I also want to make a point about the health care staff, and I'm pretty sure that people from the mental health community will say something about this as well. For me it's mandatory. I have seen it with Ebola. I have seen it with cholera. I have seen it now with COVID-19 in my hospital. We need to protect our health care workers, first-line workers, physically and mentally. That's our last line of defence for this pandemic.

I'm bringing that to your attention, MPs, because I would say it's very uncivilized when my boss in the ER is telling me to please use PPE wisely. This is nerve-racking. I do understand that we have to use our PPE carefully, but if you want us to care for patients, I'm begging you to care for us and protect us.

It is important that you do everything to protect us physically and mentally as well. We should have hotlines to discuss what is going on, hotlines for the ethics committee that's going to help us make difficult decisions on patients who are on ventilators. They might want to remove the ventilator or stop care. We need to have psychological counselling and support all the time. Nobody should be blackmailed for not feeling comfortable to work in a COVID-positive environment.

Again, knowing the growing community transmission that's going on, I still think that as soon as we have enough tests, we should try to test our first-line workers regularly because of the asymptomatic carriers.

The last general point I would like to make is about the non-COVID patient. Life goes on even if we have COVID-19. It would be a disaster, a tragedy, if highly treatable and preventable medical conditions became lethal. We know that now, a patient with a heart attack is dying at home or with cerebrovascular accident is staying alone at home with their disease and illness. It is important right now that we make sure we're not creating a second-rate status for non-COVID-19 patients, because life goes on. We need to have a plan to relaunch the health care system in an incremental way. It is really, really important. You cannot put a whole health care system on hold forever; otherwise, we will start to die of very preventable diseases.

As a humanitarian aid worker, I cannot not talk about the more global message of where Canada stands on the global response in the world. I know we're tackling what we have here, but we know as well that the only way to win against COVID-19 is to win in every single country. My plea as well for Canada is to find out how we are going to support the low- and middle-income countries to respond to COVID-19, knowing that we are so interconnected and knowing that making all of us healthier depends on making each of us healthier.

So knowing that the Canadian government has invested $300 million, or at least pledged $300 million, for research and development, I beg you to make sure that there are all the safeguards—that the vaccine, the treatment or the tests that will be developed will be a public good; that Canadians as much as other people will have access to those new discoveries; and that it will be affordable and accessible to all.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Liu.

We will go now to the Canadian Mental Health Association and Margaret Eaton, national chief executive officer.

Please go ahead, Ms. Eaton. You have 10 minutes.

[Margaret Eaton, National Chief Executive Officer, Canadian Mental Health Association]

Thank you very much for this opportunity. I really appreciate being here.

As the national CEO of the Canadian Mental Health Association, I'm honoured to be representing the 86 divisions and branches that provide direct services and programs to people with mental health problems and illnesses. Our broad network of over 5,000 staff and 10,000 volunteers provides mental health services and programs to over one million Canadians annually. We are present in over 330 communities in each province and the Yukon territory. Right now the phones are ringing off the hook at those CMHAs all across the country, so today I want to talk about the impact of the COVID-19 pandemic on mental health and offer you some solutions.

We applaud the federal government for its swift whole-of-government response to this rapidly accelerating pandemic. We also commend the commitment to provide mental health support to Canadians during these unprecedented times, including the newly announced portal for mental health and substance abuse that has been named Wellness Together Canada. I'm very excited to see that announced today.

Now more than ever we need to ensure our mental health care system is empowered to meet Canadians’ needs. We are already seeing signs of a potential “echo pandemic” of mental health issues as a result of COVID-19. Just last week the CBC reported on the surge in demand at CMHA Nova Scotia. It typically receives 25 calls per day, but is now fielding 700 daily requests for mental health support. These requests come mostly from people without a history of mental illness.

Canadians are very worried. They’re worried about contracting the disease. They’re worried about their family and friends. They’re worried about losing their jobs and ability to make ends meet. People with serious mental illness and addiction are particularly vulnerable. Many of CMHA’s clients are facing housing instability and live in situations where practising physical distancing and infection control is very challenging. In many communities, the programs, services and treatments they rely on have been suspended. They're at serious risk of infection, loneliness, increased symptoms and relapse.

Indigenous peoples are perhaps the most vulnerable of any population in Canada. Many community members live with serious mental health issues as a result of colonization and experience the highest youth suicide rates in the country. Older adults have small social networks and limited access to technology, which weakens their opportunities for connection. We're concerned that these issues will only be exacerbated by pandemic conditions.

Our health care and front-line workers are also at risk for mental health issues, as Dr. Liu so poignantly explained. As you've been hearing, the challenges and pressing needs they are facing on the job every day are triggering fear, anger and anxiety. The grave consequences of the substantial burden these workers are carrying is already emerging in China, Italy and the United States. A recent study found that health care workers who treated COVID-19 patients in China reported symptoms of depression, anxiety, insomnia and distress. In Italy, at least two nurses on the front lines have died by suicide. Health care workers in the U.S. are using the term “moral injury” to describe their experience of physical and mental exhaustion, fear of infection, inadequate supply of personal protective equipment, and the heartbreak of making very difficult decisions.

We’re only just beginning to grasp the mental health impacts of COVID-19. As our experience supporting Albertans following the Fort McMurray fires revealed, recovery takes time, sometimes up to two years. Research conducted one year after the SARS epidemic found increases in psychological distress and post-traumatic stress disorder among patients and clinicians. We won’t know the full picture of the impact, but our experience tells us the mental health impacts will be significant.

Simply put, Canadians need an immediate and substantial investment in mental health to prevent that “echo pandemic” of mental health problems. That’s why we’re supporting Canadians now and we’re already planning for the recovery period ahead. As a pioneer and leader in community mental health since 1918, we’re focused on mental health promotion and prevention.

We aim to keep people out of the hospital, shoring up the mental health of Canadians before their issues escalate, while supporting those with severe and persistent mental illness to help them live better during and after treatment. Our vast network includes mental health and addiction counsellors, therapists, nurse practitioners, peer supporters and recovery coaches. They're on the ground in the neighbourhoods where Canadians live, work and play. We stand ready to mobilize this network to bring more mental health supports to Canadians who need them most in this time of crisis.

We can quickly scale up proven programs in English and French to reach thousands of people. Our cost-effective, evidence-based solutions are designed for children and youth, older adults, indigenous people and first responders. For all Canadians, we offer a program called BounceBack. This is a skill-building program based on cognitive behavioural therapy. In B.C. alone, more than 11,000 people have participated, and 85% said that the program helped them make lasting, positive change to reduce anxiety and depression.

For front-line workers, we offer peer support through a program called OSI-CAN, and mental health awareness training through Resilient Minds. These two programs are based on professionals helping each other and have provided health and healing to hundreds of front-line workers since their inception. With rapid government investment, we can immediately scale and ensure that these proven programs have nationwide reach, including to rural and remote communities.

While getting resources to Canadians experiencing mental health problems and illness now, in the midst of the pandemic, remains our priority, it is also crucial to plan for the future. We are already looking ahead to the national recovery and ways to support people as they transition back to normal life. Our recovery colleges are mental health learning centres that provide education and peer support through courses on well-being. There are recovery colleges in 11 communities in Canada already, with many CMHAs eager to develop their own.

The Canadian Mental Health Association’s mandate is one of mental health for all. We know that meeting this goal requires meaningful government investment in mental health. Canadians deserve access to publicly funded, evidence-based therapies, and to a complement of mental health and social supports. As the mental health impacts of COVID-19 will differ based on each person’s economic and social circumstances, we know that good mental health starts with having the basics, such as meaningful employment and adequate housing.

In addition to helping people now, we must also ensure that we are prepared for the inevitable demands that are going to be made on the mental health system as a result of the increases in depression, psychological distress, substance abuse, PTSD and domestic violence that almost always accompany large-scale disasters. As the COVID-19 pandemic has revealed, our economy is completely dependent on the well-being of our population. To restart our economy and secure its lasting recovery, we must ensure that Canadians are healthy enough, both physically and mentally, to return to work and to their daily activities.

Canadians know that mental health is just as important as physical health. As we will underscore during Mental Health Week—which is May 4 to 10 this year, led by CMHA for nearly 70 years—while one in five Canadians experiences mental illness in a typical year, five in five Canadians need to protect their mental health.

We’re truly at a crossroads. While motivation to seek help has never been higher, the mental health sector lacked capacity to meet demand before the pandemic began. We must act now to ensure we are prepared for a surge in mental health problems as a result of COVID-19.

Now more than ever, Canada must demonstrate true vision and leadership on mental health. We know Canadians will reach out for help. They're reaching out right now. We’re simply asking you to please empower us to reach back.

Thank you again for the invitation to speak to you today. I look forward to answering your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Eaton.

We go now to the Department of Public Works and Government Services.

Mr. Matthews, I believe you will commence. You have 10 minutes, please.

[Bill Matthews, Deputy Minister, Department of Public Works and Government Services]

Thank you, Mr. Chair. Good afternoon and thank you for having me and my officials here with you today to talk about the role of Public Services and Procurement Canada in the government's response to COVID-19.

Before I begin I would like to thank the people behind the scenes who are making this meeting possible, including our language interpreters who continue to do an exceptional job in ensuring that Canadians have the most recent information.

With me today, Mr. Chair, as you mentioned, is Michael Vandergrift, the associate deputy minister at PSPC; as well as Arianne Reza, the assistant deputy minister of the procurement branch.

PSPC is the central purchaser for the Government of Canada and is responsible for procuring goods that will help see us through the COVID-19 pandemic. Specifically we are helping to equip Canada with personal protective equipment and medical supplies for now and for the months ahead. It is no secret that we are operating in a highly competitive global environment, and this comes with challenges. The entire world is scrambling to get the same materials from a finite number of suppliers, many of whom are located in China. This is resulting in a complex and unpredictable supply chain. Add to this order restrictions and you end up with a highly unstable marketplace where orders don't always materialize into immediate deliveries.

I think I should spend a few minutes, Mr. Chair, talking to you about our procurement strategy. Then I will drift into some updates on specific goods that we are acquiring.

I can tell you that our procurement experts are working day and night aggressively buying from all available suppliers and distributors here at home and abroad. In support of Canada's front-line health workers, we buy supplies on behalf of the Public Health Agency of Canada, which consolidates requests from provinces and territories and also maintains our national stockpile. This procurement activity is over and above what provinces and territories are doing on their own.

I should stress that the strategy we're pursuing, which I mentioned I would share with committee, continues to evolve and be fine-tuned as circumstances change as we are dealing with global marketplaces such as we have never seen. I am sure that members are aware of the importance of PPE, personal protective equipment, given the global scale of this crisis and the importance of China from a PPE production standpoint. We're dealing with a situation in which many jurisdictions are competing for scarce supplies. At the same time, industry is trying to scale up to meet the global demand, which means that new players are emerging rapidly. Normally we would look to procure these types of goods through a Canadian distribution channel, but given the rapidly changing market conditions, a different approach was and is necessary.

Our procurement strategy is three-pronged. The first part involved buying existing inventory where we could, inventory that was already on the shelves. As you can imagine, given the pandemic, these goods were in short supply but they were important to obtain while we put in place the second part of our strategy.

Part two of the strategy, which is ongoing, was to place large orders to receive a steady stream of goods over a number of months. One of the benefits here is that big orders are more commercially attractive in a competitive marketplace. Ordering collaboratively with the provincial and territorial partners allows us to increase the size of our orders and get the attention of industry. We've also made the deliberate decision to order aggressively, or stated another way, to consciously over-order. This was and is a deliberate attempt to acquire goods given the uncertainty around the timeliness of receipts and delivery.

As you can imagine, close collaboration with provincial and territorial governments is imperative to our success. To that end, the minister of PSPC has established a federal-provincial-territorial ministerial table on procurement, which is helping to bring even greater coordination in identifying and meeting supply needs.

The third prong is domestic. Under the leadership of the Department of Innovation, Science and Economic Development Canada, discussions have been launched with domestic industry in Canada to help fill the gap on a medium- and longer-term basis. Many companies from across Canada have answered that call with some manufacturers completely shifting their production lines to meet the urgent need. My department's role in this case is to establish contracts with these companies. We've already begun to do so, and I will get into that in a moment.

There are some challenges and I would be misleading the committee members if I left anyone with the impression that procuring in this environment is easy or risk-free. There are many risks. We are buying products at a high volume from unfamiliar suppliers, and that situation can present challenges both in terms of delivery and in terms of quality. Limited availability of many of these products is resulting in buyers overbidding—I mentioned competition earlier—and established orders are often redirected to those who are willing to pay the most. On top of this, we are seeing export controls change in China and rules around requirements for medical supplies changing as well. I mentioned China already. That situation has changed a couple of times and it's worth keeping an eye on as rules change there.

Successfully navigating this environment requires significant support on the ground. This is an area where we have had to adjust our strategy to better align with reality. Given the emergence of new players and the shortage of supply, we can no longer rely solely on Canadian distributors to obtain products. Our officials are working closely with partners in other countries, including embassies, to ensure our supply chain. This on-the-ground support and expertise is proving invaluable, as diplomatic staff and external partners assist in vetting companies in advance to ensure better quality. This is in addition to the on-the-ground support to ensure product delivery, logistics and warehousing expertise to help secure our shipments and bring them to Canada.

This support includes receiving product as it comes off production lines, quickly inspecting it for quality, arranging for shipment to a warehouse we have secured at an airport and actively securing customs clearance.

Through all of this, we have had to significantly accelerate our procurement processes by making quick decisions and streamlining contracting steps. Contracts that would usually take several months to finalize are being put into place in days, if not hours. Traditional competitive approaches would mean that the product would be sold to another buyer before we made a decision, in an environment where prices are increasing rapidly and rules and regulations are changing overnight.

Even after our shipments arrive in Canada, the Public Health Agency must first inspect purchased supplies and then get them to where they're needed across the country. The same is true for any supplies we produce in various regions across the country. To help us with this logistics effort and to help our colleagues at the Public Health Agency of Canada, we have reached an arrangement with Amazon Canada to do delivery and warehousing inside Canada. Canada Post and Purolator are also playing a role in this effort and that is really to help the Public Health Agency of Canada make sure that the PPE gets to the locations where it is needed most. This is all about moving supplies from where they're manufactured into the eventual hands of our doctors, nurses and health care professionals as fast as possible. PSPC has a role in doing that.

Let me turn now to the latest numbers in terms of orders and deliveries. These numbers are as of April 13 and they change rapidly. We have managed to order more than 293 million surgical masks and more than 130 million N95 respirators, a key piece of protection for health care workers. To date, we have received deliveries of more than 17 million surgical masks, and just over 609,000 N95 respirators. To meet longer-term supply needs, we are working to establish a domestic manufacturing contract in Canada with Medicom of Pointe-Claire, Quebec for these masks. Like all of the equipment that countries are seeking, ventilators are in short supply. In this tight market, we have managed to secure orders for 32,000 ventilators from a variety of companies, including Canadian companies Thornhill Medical, CAE, StarFish and FTI professional grade.

In addition, we have ordered more than 20 million litres of hand sanitizer. Delivery has already started and will continue over the coming months. This is supported domestically in part by an agreement with Fluid Energy, a Calgary-based company.

We have ordered over 900 million pairs of gloves, and to date we have already received nearly five million. We have ordered 17 million face shields. This includes an agreement with Bauer, which has shifted its hockey skate production lines to make face shields that are so important for front-line medical staff.

Test kits are an area of frequent discussion. When it comes to test kits, supplies are being delivered, including hundreds of thousands of swabs and we continue to work to procure more. I would note that there's a global shortage of reagent, which is an important chemical used in testing. It's something we are aggressively seeking out and ordering. We continue to monitor the situation with Health Canada on the availability of global supplies.

I would also like to mention that Health Canada and the Public Health Agency of Canada are accelerating regulatory reviews of new tests and other products, so that more products are available to support our response.

Here at home we have recently awarded a contract to Spartan, an Ottawa-based company that will provide rapid test kits to test more than a million Canadians for the virus. This is on top of the testing that is already being done by provinces and territories.

These are just some of the things we've procured and a handful of the Canadian companies that are rising to the challenge and involved in the response. We are constantly adding to our orders and identifying our needs.

Just before I wrap up, there are a couple of things I should highlight to the committee because the department is offering support in other ways besides procurements. I've already mentioned our interpreters here today. The translation bureau is supporting the communication of COVID-19 related information to Canadians. This includes sign languages, official language and indigenous language interpretation for government officials, ministers and the Prime Minister.

As we manage one of the largest portfolios of real estate across the country we are currently inventorying our holdings to explore how to best provide communities with the support for secure accommodations that they may need in the future. This obviously involves working with local governments and provincial partners as well.

In closing, Mr. Chair, the most important role we're playing is the purchase of vital supplies. These are unprecedented times, and the government is taking unprecedented measures to get equipment to the front lines. While we are making significant progress, we are operating in a hyper-competitive market, and we must continue to be vigilant. We know that we may be dealing with spikes in COVID-19 infections in Canada for months to come, and we need to be prepared for all scenarios.

On behalf of the health officials that we support, my department will continue to seek out supplies and secure them and the necessary products our health care professionals need to keep Canadians and themselves safe.

Thank you for your time. We look forward to your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Matthews.

We go now to our questioning rounds. As noted before, we have agreed amongst all parties that we will do three full rounds.

Mr. Jeneroux, please go ahead for six minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Thanks to the witnesses for coming.

The intent of this is to better support and advise the government on pandemics current and potentially in the future. I appreciate you taking the time out of your very busy schedules to show up today.

Ms. Eaton, I have a couple of questions with regard to seniors. You highlighted them in particular as part of your opening comments. We're seeing right now that we're immersed in technology here with Zoom and others like FaceTime. I know that not all seniors are immersed in those technologies. Facilities have closed their doors to outsiders to protect seniors, but the stories of neglect are on the rise in the country.

Do you think that allowing family members or a designated family member to occasionally visit, using all appropriate health protocols, would be beneficial for a senior's mental health during this time? If not now, do you think it's an area the government should prioritize when it starts executing plans to get back to the new normal?

[Margaret Eaton]

I'm not an expert in the management of long-term care homes, so it would be difficult for me to comment on that. I can say generally that isolation is something that drives anxiety and depression in everyone, but particularly in the older population.

One good thing that I believe is happening with CMHAs across the country is that they've turned their walk-in services to virtual and telephone services. The telephone is a much-maligned piece of technology that has suddenly a lot of relevance right now during COVID-19. I believe that by reaching out to seniors' homes through the telephone and providing telephone support to residents could make a real difference in decreasing that isolation.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you. I certainly don't need for you to be an expert on long-term care facilities. I'm mostly just looking for your advice on the mental health aspect of these questions.

What tools and measures need to be available to support Canadians' mental health once isolation starts being lifted and Canadians start adapting to a new normal?

[Margaret Eaton]

I think it's very important that community resources be available.

I mentioned the BounceBack program. I think that has tremendous relevance. It's a program that is delivered online and on the telephone. You get a coach who helps you work through a cognitive behavioural therapy program. That program is being scaled in Ontario and scaled in British Columbia, but unfortunately, smaller provinces do not have access to those tools and resources. We see a strong role for the federal government to play to help create parity of access to those kinds of programs that would give people in rural, remote and isolated communities an opportunity to have training that would make a long-term difference in their mental health.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Great, thank you.

You're in Alberta. Text4Hope is a very popular service that's been used.

At the beginning, you also mentioned the anxieties that some of the front-line workers you've heard from have experienced. Would you agree, again from the mental health perspective, that a lack of PPE for our front-line workers has led to mental health struggles?

[Margaret Eaton]

I believe that not having the equipment they need to protect themselves is one of their larger areas of anxiety, as Dr. Liu mentioned as well. That does create more anxiety. Yes, I believe that protective equipment is important.

Certainly, once again, we want to be there to support front-line responders, especially with peer-based programs created by professionals who have walked that walk, the same walk as the front-line responders, and have created the programs and supports to address their needs.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Great.

Is the government working directly with the Canadian Mental Health Association to address some of this during the pandemic, from mid-January to the current date?

[Margaret Eaton]

We're very pleased that a partnership we have with CAMH and with Crisis Services Canada is going to be funded by the federal government. It hasn't been announced yet, but we're really delighted to have that support.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Do you know when that's planned to be announced?

[Margaret Eaton]

I don't know at this point.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

It will be sometime during the current pandemic, I guess. Is that...?

[Margaret Eaton]

Yes, I think it's imminent.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Okay. I hope you'll keep the committee up to speed on when that is put in place.

On the resources put in place in December and January, prior to the pandemic, to support our front-line workers, what types of resources did we see from the government?

[Margaret Eaton]

I am not familiar with those resources to front-line workers.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I was under the assumption that there weren't any, so I think you've cleared that up for me. Thank you very much for that.

Thanks, Mr. Chair.