Thanks.
On the ground, we would benefit from a greater pan-Canadian collaboration and better public health knowledge of existing resources and gaps—for instance, how many ICU beds and ventilators exist in hospitals and regions—and from a stronger, better coordinated structure for clinical research and quality improvement to characterize, to learn and to quickly improve care delivery for an otherwise unknown illness.
These shortcomings are understandably more apparent in the context of COVID-19, but they exist in usual times as well.
The 13 provincial and territorial health care systems have a lot in common but also differ in ways that should enable more constant cross-learning, and we don't always share insights from those natural experiments in health care delivery at the federal, provincial and territorial governments. We've not really created, I would say, an adequate pan-Canadian machinery to support a more systematic innovation and evaluation that would create some more nimble systems that promote higher-quality care in the context of an outbreak like this.
I'm going to speak just a bit about the clinical treatments and knowledge gaps that exist. As of today, there are still, I would say, no proven effective medical treatments against COVID-19. There are a number of pre-existing antiviral medications, anti-inflammatory medications and immune modulating drugs that are under investigation. Treatments with plasma from recovered patients, anticipating a high concentration of antibodies to COVID-19, are being investigated. Monoclonal antibodies manufactured and directed against specific aspects of the virus are under development. I think Canadian-led science in this field has been very impressive in the past, particularly so for other viruses such as Ebola.
Our best treatment options to date remain the best supportive care, including oxygen, mechanical ventilation and organ support as needed. We have knowledge gaps in the ideal ways to do these things, including how to move from oxygen supplementation to nasal prongs to masks to mechanical ventilation, and whether certain forms of our therapies may aerosolize the virus and place health care workers at increased risk. That's been a prominent concern for us in hospitals when treating patients and being part of that risk circle. In addition to medication trials, I would say that we should study the safety and effectiveness of those elements of supportive care.
So far, there have been many clinical trials, frequently examining a single treatment and typically enrolling too few patients to convincingly determine whether a treatment is effective or not, and they have been concluded oftentimes without necessarily helping the next generation of patients. Clinical treatments and research performed in one jurisdiction with one treatment are usually inconclusive. This is another call for mechanisms for collaborative pan-Canadian and international initiatives that draw upon more durable research infrastructure to examine treatments in parallel with one another and to reach a conclusion on one medication and not have to stop a single treatment trial before moving on to the next evaluation, which is typical of many of the ways that we fund and undertake trials.
One of the early and valid concerns of the pandemic, I think, has been the risk of a sustained situation of overwhelmed hospitals and ICUs with too few ventilators and an excess of preventable deaths. This has occurred in many developed health care systems, including most recently throughout many parts of the U.S. We've come very close to this possibility—I think probably really for the first time in our modern history—of explicitly planning on how to deny care to those in need because of a lack of commonly available resources.
While social distancing has flattened the curve of infections, the frail, vulnerable and aged Canadians living in long-term care homes who cannot partake in social distancing have been at continued high risk of contracting the illness and dying once COVID has taken hold. This has been recognized for a long time, and I think it's an important element of this outbreak, which is much more prominent and visible to the population and is one that we should not lose sight of as we go through it.
Similarly, I would say that health care workers in long-term care facilities have not been adequately prepared and supported. This is something that we can do better in the future.
I wanted to comment on other jurisdictions and what we might learn from others' examples. While many highly resourced countries have been pushed beyond their existing capacity by this pandemic, some have shown a much greater ability to respond quickly and to learn from the experience.
I want to highlight a particular example in the United Kingdom, which has a similar burden of infection by population as the U.S. does, but they have done very well with responding with respect to research and a learning health care system, and I think we might draw on some lessons there.
It's underpinned by a couple of decades of political commitment to medical research with a goal of driving value into the system, improving care through innovation, and evaluating that innovation and adopting it when appropriate.
The U.K., at one-fifth the size of the U.S. and about one-twentieth the size of China, has been the first to develop and take a vaccine for COVID into clinical trials, and at the clinical front lines it's leading the world with a longitudinally supported research network in NHS hospitals across lots of specialty areas. This is something that in my own field of critical care we've seen for a number of years, and we are envious of their ability to support longitudinal research in a durable way through funding from their national funder and then to the coalface at NHS hospitals.
