Health Committee on April 15th, 2020

[Margaret Eaton]

I know that some of our services, particularly in metropolitan areas, actually provide services for different language communities. They are translated into key community languages. I believe that's true in Vancouver and also in Toronto, to address those issues.

We also know that one of the big issues for immigrants in particular is stigma around mental health. In addition to having those services, it's also really important that we promote those services to those communities and ensure that they feel welcome there.

[Sonia Sidhu, Liberal, Brampton South, ON]

Especially for our health care heroes who are on the front lines working now, is there any special arrangement for them?

[Margaret Eaton]

We have two programs that I mentioned, OSI-CAN and Resilient Minds, both of which are suitable for front-line workers and could be expanded to serve more clients.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu.

We'll carry on now with Dr. Kitchen.

Dr. Kitchen, please go ahead. You have five minutes.

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

Thank you, Mr. Chair.

Thank you, everybody, for being here. I greatly appreciate your taking the time to come to the meeting and do this video conferencing.

Dr. Liu, I really appreciate your comments. Mr. Davies touched on one of the questions I wanted to ask you.

We've talked about the issue of protecting our dedicated staff as well as dedicated facilities. I can tell you that here in Saskatchewan we have gone to certain hospitals throughout the province that are being designated as specific COVID-based hospitals. Other hospitals are picking up emergent and acute care types of situations, just so you're aware of that.

Your comments lead into my questioning a little bit more about testing and the issue of immunity testing, and whether you see that as something we should be doing at this present time with our present-day health care workers, those people who are on the front lines as they move forward. They want to get there. They want to be out there, whether it is in the hospitals or whether it's in our long-term care facilities, where they want to make certain that they're protected when they go in to assist the clients they care for.

Could I just have your comments on that, please?

[Dr. Joanne Liu]

In terms of testing, it's hard to make a strategy when you have scarce resources, but this should be a priority with regard to who can be tested, and I don't think it is clear yet.

I think this should be a recommendation for workers, because right now to be tested you need to have some symptoms. Now it is much broader than it used to be, but it needs to be much.... Now we have included the GI symptoms and the respiratory symptoms and you need to have only one symptom.

We know there are asymptomatic carriers, so this is why I think that when we are able to afford it, testing our health care workers or front-line workers, which would include those who work in pharmacies as well as other places like elder care homes, should be a priority.

This is something we are doing in some places. I think that in places like first nations areas, where we know we have a vulnerable community, we don't want to import COVID-19, so we should be testing. For example, when we have people from Montreal going back to Nunavut, if we just ask them whether they have symptoms, honestly I think that people who are dying to go back to their community are not going to share exactly what's going on, so I think we should just test people.

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

Thank you very much for that.

Mr. Matthews, I appreciate your earlier comments. I recognize that you're in the process of procurement. How much interaction do you have with PHAC in their simulation models as they simulate a scenario? Does PHAC communicate with you as to what they might anticipate from that, such as where there might be a shortage or how they need access to certain PPE-type equipment? Is that part of the process at all?

[Bill Matthews]

It's part of the outcome. They run their models and then they place orders. As I mentioned earlier, some of those orders are very large. The orders they place with us would be the outcome of their planning. I mentioned that the last one we received was, I believe, for 80 million masks over a long period of time.

That would be the interaction. We wouldn't actually—

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

It's after the fact, then. It's not during the process. They say, “This is our scenario. All of a sudden we're anticipating a need for 100,000 masks and we need them from you”, and they ask you how quickly you can access them.

[Bill Matthews]

We certainly have an ongoing discussion about supply lines and the time it takes. We're very well plugged in to our plans around domestic capacity with ISED and how long it might take for that to come online.

I think it's twofold. One is the long-term orders. Then, as I mentioned earlier, if any kind of immediate, unforecast urgency pops up in a province or territory, they will get on the phone with us urgently to say, “Can you get us something ASAP?” We have that one as well.

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

You mentioned a lot about challenging times and how challenging it is for you to access equipment. In a number of situations that I've seen and that I'm sure my colleagues have seen, someone may be trying to improve a respirator, for example, by coming up with a product that might use one ventilator to create something that's able to deal with two or three types of issues. Those issues obviously have to be recognized and standardized, but it's a challenge for you.

At the finance committee meeting on Friday, April 3, there was a gentleman by the name of Mr. Veso Sobot. He said, “At a time when the government is appealing to the manufacturers to retool and produce needed plastic products for the health care sector”—masks, ventilators, hoses, IV bags, IV tubing, PPEs, like plastic shields—“labelling plastics as toxic is counterproductive”. He said it “disparages and demonizes” the Canadian plastics industry, which has worked very hard to alleviate the effects of the COVID-19 crisis.

Using plastic items such as these is necessary in treating a lot of those suffering from COVID-19. If we anticipate that the crisis is going to carry on for who knows how long, and we deem these plastics basically as schedule 1 toxic substances, does PSPC see this potentially having a negative impact on the procurement of medical devices and PPE with respect to COVID-19?

[Bill Matthews]

I can only speak to my experience in dealing with existing Canadian suppliers, as well as those looking to emerge into the markets. It has not been something that has been raised with me one bit, and that's both through interaction on our website in looking for supply as well as in our interactions with ISED in terms of tooling up the domestic industry. It has not come on my radar at all, although obviously others are hearing about it.

The supply chains for some of these products clearly involve plastic. It's an important component in what's being manufactured. Has the issue been raised with me as a barrier? Not to date.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen.

We go now to Mr. Van Bynen.

Mr. Van Bynen, please go ahead for five minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

Last month the town of Newmarket launched a #StandApartTogether campaign, announcing a group of 10 community positivity ambassadors to spread stories about people doing good things and to spread positivity during these difficult times.

Also, both the Newmarket Chamber of Commerce and the Aurora Chamber of Commerce are providing their members with regular opportunities to check in on one another and stay connected, and to share best practices through virtual coffee conversations and virtual networking events.

My question is for the Canadian Mental Health Association. I'm wondering if you've seen many of these local activities surface to keep people connected, and what your thoughts are on their role in preserving mental health in our communities.

[Margaret Eaton]

We've been so pleased with responses across the country and the Canadian idea of caremongering, and there are wonderful Facebook groups across the country doing that.

One of our branches, the Quebec division in Quebec City, has set up a secure group chat for eight people at a time to talk about their issues, and we're seeing similar movements across the country. I think it's invaluable. I love walking around my neighbourhood and seeing signs that say, “We're in this together.” I think a lot of people expect there to be social decay when a pandemic happens, but in fact the opposite is true. We see social cohesion, and that is incredibly important for all of our mental health.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Are there any of these types of efforts in particular that stand out to you? If so, could you briefly share them with the committee?

[Margaret Eaton]

I mentioned our one Quebec group. There have certainly been these Facebook groups with people who are providing care and going out and shopping for people.

What we've seen from CMHAs is that some of them are actually keeping their doors open. Even though the general advice here in Ontario, for example, is to shut your doors, some of them have said, no, they have to be open for walk-in clients. They take precautions, but they are still aware and keeping the doors open because they feel that mental health should have a front-line response and they are front-line responders for people with mental health challenges.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

I'm curious about the precautions you mentioned. We've seen so much misinformation on the Internet about COVID-19. What are your recommendations for people seeking out some of these chat groups or even virtual counselling? How can they be satisfied they're getting the types of credentials they're looking for?

[Margaret Eaton]

I think of programs that the CMHA runs, for example. The CMHA is often the first stop for people searching for mental health resources in their community.

As to looking for certifications, we offer a peer support certification. There are also other certifications. Certainly the Canadian Psychological Association and other registered professions have the credentials to provide you with the supports you need.

There is a lot of online information as well. I would turn to the new government application. That actually has evidenced-based tools and resources that can be used.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Great. Thank you.

Dr. Liu, since you started with Doctors Without Borders, the world has lived through a number of pandemics. To name a few, there was SARS, MERS, Ebola, H1N1 and Zika. Can you elaborate on how Doctors Without Borders contributes to the international response in a pandemic?

[Dr. Joanne Liu]

Doctors Without Borders is an organization with an operational budget of 1.6 billion euros. It works in 72 countries, and 55% of our countries of intervention are in conflict zones. We have about 68,000 people working for the organization.

In terms of the response to a pandemic, we answer epidemics all year long. The smallest one is the measles, which nobody hears about, or polio or cholera. We do it over and over again.

When it comes to the big pandemics, most of the time we have much more of a focus on low- and middle-income countries or those in protective crises, because that is where there are more needs. The reality now with COVID-19 is that we are deployed in high-income countries. For example, in Italy we are running four hospitals. In France, we are doing all the home care with the government in Île-de-France. We work in Germany. We work in Spain. We work in Greece. We will probably increase our budget in high-income countries by easily tenfold from what we have had in the past.

This is something very different, and it's probably linked to the fact that there are travel bans. It's probably also linked to the fact that we have an expertise to offer in terms of pandemic response, because most of our staff have worked at tackling epidemics in different countries. We work almost everywhere that we have an office.

Right now in Canada, MSF Canada will be working on infection prevention control in elder homes and first nations communities.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Van Bynen.

Mr. Thériault, you have the floor. You have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Liu, you rightly pointed out earlier, at the end of your presentation, that patients who don't have COVID-19 and who are waiting for health care shouldn't be neglected.

We know that the authorities, when faced with a weakened health care system lacking all kinds of resources, decided to free up beds to ensure that intensive care units had room to handle the peak of the first wave. There may be a second wave, which could require even more intensive care should the mortality rate increase.

How long will it take to adapt to the situation? In all likelihood, some operations are being delayed.

How long will it take to restore balance so that we don't hit a wall in the medium term?

[Dr. Joanne Liu]

Thank you for your question.

Certainly patients who don't have COVID-19 are becoming second-class patients. This effect has been demonstrated in almost all epidemics. There are many examples of this effect in West Africa. The people who experienced a decline in health or who died from a disease other than Ebola likely outnumbered the people who had Ebola.

Therefore, we must resume medical activities for patients who don't have COVID-19, including outpatient and inpatient services. This is where the idea of having hospitals for patients who test positive for COVID-19 and other hospitals for patients who test negative makes all the difference.

Patients who go to the hospital to receive treatment for cystic fibrosis wouldn't be exposed to COVID-19. They wouldn't be putting themselves at risk. For me, this is important. I'm telling everyone that we must start planning for the recovery period now and that we must learn to live with COVID-19.

We must consider the research capacity when the second wave will hit. We'll need to be innovative. We'll need to reorganize the tasks of the different medical communities. We'll probably need to ask residents and our medical students to work at a higher level.

We really must consider this. I suspect that not many plans are being made in this area today. We can't keep a health care system on hold forever. There would be collateral damage and avoidable situations that could have been prevented, such as the fact that patients' health would decline.

If you must emphasize one thing, that would be it.

[Luc Thériault, Bloc, Montcalm, QC]

So if we allocated—