Health Committee on April 15th, 2020

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

We'll go now to Dr. Powlowski.

Dr. Powlowski, please go ahead for six minutes.

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

Thank you.

Obviously I think for a lot of people, especially the health care workers, the hottest topic right now is PPE and specifically N95 masks and their availability.

My question is to Mr. Matthews and the procurement people. You've said that you've ordered 130 million N95 masks, but to date there has been delivery of only 609,000, I believe. Can you tell us when we're expecting to get more masks, and specifically N95 masks?

[Bill Matthews]

It's a multi-part answer.

The product is coming in every couple of days. A lot of it comes from China, so we have arranged for fairly regular flights to come from Shanghai into Canada as the product is ready. Now we're seeing a pretty steady flow of products coming out of our orders in China particularly. We've also had some recently come in from 3M. That would all go into the Public Health Agency of Canada distribution system for distribution to provinces and territories.

One of the other things I should flag is that this is in addition to the procurement the provinces and territories are doing on their own, some of which is N95 related. Some of the materials we're bringing back from overseas on the charters we have arranged are specifically for provinces and territories, where we have room. We're adding that into the mix as well, but that would obviously go directly to the province or territory that ordered it.

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

For the N95s, every couple of days there are hopefully more supplies in. How long does it take from the time it arrives in Ottawa or Toronto, or wherever it arrives, to get out to the various places?

[Bill Matthews]

The process would be as follows. There would be an inspection of the goods once they arrive in Canada at the Public Health Agency warehouse. There is actually some specific testing that happens for N95s. There is a quality check there. That process takes a couple of days. It then goes out to the provinces, so we're looking to accelerate that.

Then after that step, frankly, it's up to the provinces to decide where the need is the greatest, so that goes into their distribution system. I really can't give you a good line of sight into how the provinces allocate it.

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

I think The Globe and Mail said something about procurement being a Wild West in China, with a lot of actors all chasing the same thing. What can you do to reassure us that we Canadians aren't being the nice guys too much?

I've lived and worked in a lot of other different countries and I have this picture that must have happened to me of waiting faithfully in line for a bus to come, and as soon as the bus came, everyone crowded around and jammed through the door, and I kind of stood there and waited. By the second time, you obviously figure out that the only way you're going to get on that bus is to fight your way onto it.

I have this notion and worry that as Canadians, we're doing all the right things and we're playing by the rules in China, and we're getting outbid and outfought for what we need. Can you reassure the front-line health care workers that we're in there duking it out with everyone else?

[Bill Matthews]

Thank you, Mr. Chair.

I think we can talk about how the strategy in this area has changed since day one. I did mention in my opening remarks that this notion of putting in longer-term contracts with a variety of suppliers to ensure a steady stream of arrival of goods is important.

On the steps we've taken, I'll talk specifically about what's on the ground in China. Understanding the market is very critical. There were some changes in export rules, and you need to deal with people who understand what those rules are, so we did engage the embassy overseas to help us in vetting suppliers and relationships with suppliers and making sure they understood the rules for exports.

We also adjusted our logistics process to make sure that, basically, when the product comes out of the factory, we have people there to get it, so we are receiving it directly on the factory floor. We are handling the logistics to take it to a warehouse that we rented at the Shanghai airport. We then have some partners on the ground who help us get clearance, and we take care of the cargo arrangements to bring it back home to Canada. That's an example of the adjustments we're making.

The number of manufacturers we're dealing with is significant, so the final check, I would say, is when we bring it back to Canada. As we get more experience with some of these manufacturers, we're getting a better sense of who's producing high-quality goods and who's having some struggles, and we cycle that back to our folks on the ground in China so we can make whatever adjustments we need to make.

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

Thank you.

Another concern is being able to access some important medications, such as propofol, Midazolam and fenantyl, things that you need to sedate people or anaesthetic agents for people who are intubated, and there's a possible shortage of those things. Can you tell us what the government has been doing in order to procure those drugs and if we have any capacity within this country to start making them?

[Bill Matthews]

The government's approach to securing those goods is probably a better question for our colleagues from Health Canada and PHAC.

I can tell you that PSPC, as a purchaser of these kinds of drugs, has historically been a fairly small player. We do have some activity. It's one that we expect will ramp up in the near feature.

I think you've touched on a key question: In addition to procurement, what's the domestic capacity? I think time will tell on that front. I know Health Canada is preoccupied with these things, and I suspect it will be an area for heightened engagement as we go forward.

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

I have a quick question for Dr. Liu.

You've had a lot of experience working in epidemics in other countries. You talked about protecting the front-line health care workers and the anxiety related to not having enough PPE. What do you think about the use of what I understand are called PAPR suits, the kind of haz-mat suits with respirators that were used with Ebola? My understanding is that in places where they used those kinds of things, such as Italy, zero health care workers became sick. I understand that isn't being suggested as necessary by the provinces, the Public Health Agency of Canada or the WHO, but I think people who are working all day with COVID-19 patients would like to have them. What do you think about the possibility and the desirability of using them?

[Dr. Joanne Liu]

Thank you very much for the question.

I think there is a plus and minus. When I was in the Ebola centre, I must say that with my haz-mat suit in west Africa and the DRC, I felt almost safer than being in my ER in Montreal, because I knew I was protected and I knew that if I was doing the right thing, infection would not happen.

The thing is, we're not in this kind of environment. The downside of those kinds of haz-mat suits is that you are dehumanizing health care, and patients don't like it. People don't like to have cosmonauts take care of them. You cut the human factor out of caring, much more than if you only have a shield with an N95 mask and a sort of vest on top.

I think if we were to have a really dedicated structure, where people could work in a room temperature that would be, I would say, bearable for everybody, maybe this is something you could entertain, especially for the ICU, where there's a lot of aerosolized particles and you are much more at risk of being infected. I don't think I would do that for all the front-line workers; I think it would be a bit over the top.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

I'll now give the floor to Mr. Thériault, who has six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I want to thank all the witnesses for shedding light on this issue.

My question is for you, Dr. Liu. You have considerable first-hand experience in dealing with epidemics. I know that we're managing this situation and trying to get through the first wave. Nonetheless, I want to know your assessment of our ability to do our due diligence in this situation.

In other words, how could we have been better prepared to deal with this pandemic, when the largest source of infection in the world is south of our border—

[The Chair, Liberal, Ron McKinnon]

We are having some audio problems with the interpretation for Mr. Davies. Sorry about that.

We will suspend the meeting for a while.

We will resume the meeting.

Mr. Thériault, I will reset your clock. You were about 40 seconds in, but we'll start from scratch so that we have the full context of your remarks.

Go ahead.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

For the benefit of my friend Mr. Davies, I'll start again.

Dr. Liu, you have considerable first-hand experience in dealing with epidemics. Before asking you some more specific questions, I want to express my sincere appreciation for your presentation and your proposals. Public health is probably the most policy-oriented field of medicine. We're talking about public health policy. Since the start of this pandemic, I've suspected that it sometimes stands in the way of what should be done.

I want to know your overall assessment. Only a month ago, the Canadian borders were still open, and Canada considered that its citizens faced a very low level of risk. We now know, a month later, that the United States is the largest source of infection in the world.

Perhaps in public health, we're facing a low level of risk. However, it's a matter of concept and vocabulary. There are still deaths.

What should we have done differently? How would you assess our preparation for the first wave? The second wave could be the deadliest.

[Dr. Joanne Liu]

Thank you for your question.

Yes, I have experience with epidemics and pandemics. However, this is really our first time facing a pandemic of this magnitude on a global scale.

Could Canada have been better prepared? I think that there were some clear signs. I'm not privy to this kind of discussion in Canada. However, I wonder what Canada did to prepare for the global public health emergency announced on January 30, 2020. This issue must be reviewed in due course, once we get through this difficult time.

During a global public health emergency, preparedness mechanisms must be set in motion and a major analysis must be conducted.

I've participated in simulation scenarios before. I know that these scenarios are often created in an abstract way, without taking into account the ecosystem in which the pandemic takes place. I don't think that anyone could have predicted that the entire world would be hunting down N95 masks and personal protective equipment. Everyone was caught off guard. I think that this will be a major lesson.

Regarding borders, I think that the question is excellent. However, you should know that the World Health Organization's recommendations did not include closing borders. We can ask the WHO questions about how it guided our response to the pandemic. I think that there was a certain amount of complacency in some respects. People fell asleep at the switch. How will we respond next time?

I won't point the finger at Mr. Matthews, the third witness. I'm sure that he doesn't sleep at night in order to find protective equipment for all staff in Canada. I think that it will take a much quicker push to get things moving, to respond in a clear manner, and to use the authorities that have experience.

We have a great deal of knowledge in Canada. Several international organizations established in Canada have taken action during epidemics and pandemics in other parts of the world. They can share their knowledge. I don't think that we've used these organizations very effectively.

Yes, I think that we're behind. However, there are some mitigating facts. The WHO didn't send the right messages to make people understand that the situation was dangerous and that they should be properly prepared. The WHO recommended that the borders be left open, and this can be called into question. During the Ebola epidemic, we were told not to close the borders and not to quarantine people. At this time, we've done a 180-degree turn by closing the borders. The key strategy to avoid a peak of cases, which would completely overwhelm our health care systems, is physical distancing.

I think that we could have been better prepared. However, I also think that we're on a very steep learning curve.

[Luc Thériault, Bloc, Montcalm, QC]

We're bound to face a second wave. We may get the economy moving again quickly. The economy will come under pressure. As long as there are no health measures, vaccines or personal protective equipment manufactured here in sufficient quantities to handle all this, I imagine that we should keep up the fight.

[Dr. Joanne Liu]

Absolutely. That's a very important point. The upcoming second wave is certainly keeping me up at night. Everyone's patting themselves on the back today because things could have been much worse. We're glad that we didn't experience a scenario like the one in Italy or New York. However, we mustn't rest on our laurels, because a second wave is quite possible. We don't know the level of immunity that people will have following the infection. You can look at the medical literature on this issue.

A few Chinese studies that have already been published show that some people didn't develop a significant increase in immunity following the infection. This raises some significant questions. Will part of the population really be immune? Are we counting on this to handle the second wave?

To answer Mr. Matthews' question, yes, we need tests, including serological tests. Having answers from a serological perspective will probably help us determine who we can put at the forefront. If a person had COVID-19 and developed an immune response, that person will be able to work and will be less anxious. We can use this staff to carry out the front-line work on a broader basis. This isn't the case today. These issues are significant. We must get back to normal and get things moving again. However, we must do so gradually, one step at a time.

If West Africa could live with Ebola for two years, I think that Canada can live with COVID-19. We just need to get organized and to continue to maintain people's trust in our government institutions.

That's your role. When we ask people to make sacrifices economically, emotionally, physically and socially, as we're doing today, we must maintain this relationship of trust. This has been very difficult in West Africa, the Democratic Republic of the Congo and Yemen. I hope that Canada will succeed.

[Luc Thériault, Bloc, Montcalm, QC]

I have something to say to Mr. Matthews—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies. You have six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

My first question is to Public Works Canada. This week Health Canada announced that it has approved a new rapid COVID-19 test kit to be used in remote and indigenous communities. Chief public health officer Dr. Theresa Tam has indicated that the federal government is looking to secure a supply of 40,000 of these devices per month in the coming months and then see how that progresses in the supply rate.

Could you confirm when these testing kits will be made available to remote and indigenous communities, and let us know if you're confident that 40,000 units per month will be a sufficient supply to meet the testing needs in remote and indigenous communities?

[Bill Matthews]

The test the member referenced, which was also referenced earlier this week, is one that I referenced in my remarks about Spartan, an Ottawa-based company that has recently been awarded a contract. This is new technology. I have no comments or opinion on the volume of testing required, but this company is scaling up a new business line.

What is interesting about this test is that in a traditional test, a sample needs to be taken from the potential client and then sent to a lab for testing. That obviously takes time. If you're in a remote community, that takes more time, and that's time that people are not comfortable with.

This test that we're talking about specifically here comes with a unit that's almost.... We can think of it as a laboratory in a box. The unit would go with it, so you can do the test on site. It's not just the number of tests; you also need the unit to go with it. Obviously, because of that type of technology, it would be particularly attractive for remote and isolated communities.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I might, sir, I understand what the test is. My question asked when the test kits will be delivered.

[Bill Matthews]

Again, we're starting up here. We're hoping to hit full production in July. There's a gradual ramp-up. Again, it's new technology, so we're working with them to get that up and running. We're all anxious to get that going. The delivery details are being worked out, but we're hoping they hit full production scale by July.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Liu, reports are emerging that COVID-19 is disproportionately impacting racialized communities in the United States. In Chicago, for example, more than half of all confirmed cases and 72% of recorded deaths have been among African Americans, who make up just 32% of the population of that city. Are we seeing similar disparities in Canada? You spoke of vulnerable communities. Do we even have the data to make that determination?