Health Committee on May 6th, 2020

[Dr. Bradly Wouters]

Access to the wage subsidy program for our 700 people would allow us to keep them employed and bridge through this suspension so they can participate in COVID-related research and can be there and ready for us to come back when research gets turned on and we can compete for those dollars again.

It's a very competitive environment. Health hospitals all over the world compete for those funds for those clinical trials. We want Canadians to have access to those trials but it means we need very strong clinical research and clinical scientists here who are able and ready to carry out those trials.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

That brings round one to a close. We'll start round two at this point with Mr. Webber.

Mr. Webber, please go ahead for five minutes.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

I will continue with Dr. Wouters on that specific topic of the suspension of research.

Have other countries suspended their research as well in these areas?

[Dr. Bradly Wouters]

Yes, they largely have. Every academic health science centre, like those in Canada, has largely been suspended whether this is Harvard or Stanford or Johns Hopkins in the United States, anywhere in Europe; they're all very much in that same situation.

How they all respond is a little different because they are in different jurisdictions.

[Len Webber, Conservative, Calgary Confederation, AB]

Okay, thank you.

Dr. Bhutani, have we seen any evidence of permanent or long-term lung damage in those who have contracted COVID-19?

[Dr. Mohit Bhutani]

Currently, the evidence is building in regards to what the long-term effects are going to be. There's going to be a multi-tiered response or an expectation of that. If they have had mild symptoms, probably at the end of the day, probably not a lot of damage. But there's a potential for the patients who get admitted to hospital and ultimately go to intensive care units and are put on ventilators to develop some long-term consequences.

Currently in Canada and around the world we are trying to carefully follow these patients in clinics after their discharge from hospital, seeing what the natural history or the progression of this disease is going to be. Once they get discharged from hospital, at least in our institutions, a lung specialist will follow up on them longitudinally, taking a look at their lung function over time.

The question is uncertain at this point. I think the length of stay in the ICU, the type of care they get in the ICU for complications they develop in the ICU will all impact the expectations we have.

[Len Webber, Conservative, Calgary Confederation, AB]

Is that potential damage because of the actual COVID disease or is the ventilator the issue there?

[Dr. Mohit Bhutani]

That's a great question. I give a lecture to medical students on this every year. If you have an hour, I can take you through all of it.

The reality is that there is the acute problem and a chronic problem. The infection itself results in massive inflammation within the lungs, and the lungs harbour a lot of inflammatory cells. That inflammation, in the short term, becomes very severe and can lead to permanent damage to the lungs. The infection can lead to that problem.

It can be complicated with what we call ventilator-associated complications. When the lungs get inflamed like that, they become very stiff. Lungs are normally very pliable. They're like a balloon: They inflate and deflate very easily. When the inflammation sets in, they become very stiff. When you're trying to drive air into this stiff bag, there's a chance of developing complications like a collapsed lung or a punctured lung. Those are ventilator-associated complications. Those are very well studied, and there are strategies within the ICU to prevent the frequency or occurrence of them, but at the end of the day, there's still a potential risk of ventilator-associated complications.

[Len Webber, Conservative, Calgary Confederation, AB]

That's interesting.

Dr. Bhutani, you talked a bit about some medicines that should not be prescribed during this pandemic. Are you aware of patients who are being denied prescriptions because of COVID, prescriptions for conditions other than COVID? Am I making sense?

[Dr. Mohit Bhutani]

Yes, one hundred percent.

In the pulmonary-lung world, the two primary conditions are asthma and chronic obstructive pulmonary disease, COPD. For both of those diseases we use a medicine called, as a broad term, an inhaled corticosteroid. It is a very minute dose of steroid introduced into the lungs to help deal with the conditions.

The concern that patients and other practitioners have had is that steroids suppress your immune system. If you have asthma or COPD, does taking this inhaled steroid put you at any higher risk of potentially acquiring the infection? There's no evidence to suggest that is the case. In fact, it's the opposite. We really want patients with those two conditions to optimally manage their lung condition to prevent them from developing some of the more serious complications of the infection, if they were to acquire it. In fact, we tell them to be more compliant with it.

The only issue we've run into relates to dispensation. Because of the pandemic and the preparation for a potential hospital surge, Health Canada recognized, through a report from the pharmaceutical industry, a need for salbutamol, a rescue inhaler also known as Ventolin. You might recognize it as the blue inhaler, as it's the one most commonly seen around. It's meant to be used in a rescue circumstance. There's going to be a potential shortage of it because hospitals have acquired a large quantity of it in anticipation of a hospital surge.

Health Canada and the partners we identified in our notes got together and developed a strategy. The comment earlier about dispensing one month at a time, really, from our world, has come from that standpoint. We weren't sure what was going to end up being needed and required as the industry tries to replenish its supplies.

Right now there's no concern. I think we've developed a really nice mitigation strategy to deal with that, should it happen.

[The Chair, Liberal, Ron McKinnon]

Thank you.

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

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

Thank you, Mr. Chair.

I want to thank the witnesses today for bringing a lot of important information forward for us.

My wife volunteers at the cancer centre at Southlake Regional Health Centre, but since the outbreak of COVID-19, she hasn't been able to do so. I know that the work of volunteers is important to patients, their families and the centre.

Mr. Cloutier, I'm wondering if you could share how the centres that rely on helpful volunteers are coping with their absence during COVID-19.

[Paul-Émile Cloutier]

I think they're managing it with a lot of challenges and difficulty. I think they're trying to get help through other health care providers within their own community. I know for a fact that within hospitals, staff who were assigned to a particular floor were reassigned to another position within the COVID-19 area, so there is some flexibility but sometimes it's very difficult. I'll give you an example.

I'm a resident of Ottawa, so I try to offer my help at the Ottawa general hospital because of my work. I believe there are challenges there. You have to be careful with how many people you bring into the system, because if you do this, there's a higher risk that you may get the virus.

A lot has to be done to manage the situation in the system, but I would certainly encourage your wife to continue to offer her services, maybe in an area where there's less risk to her life.

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

Thank you.

The idea of greater pan-Canadian collaboration has been a recurring topic of conversation throughout these committee meetings. I'm wondering if the organizations and the hospitals that HealthCareCAN represents across Canada have been collaborating during the pandemic.

Specifically, what is the process for identifying existing health resources and gaps in health equipment and resources in hospitals? How is this information being communicated at the federal, regional and provincial levels?

In your view, how could communications between hospitals and different levels of government be improved, such that the provincial and federal governments have a better understanding of the needs of the health care provider organizations?

[Paul-Émile Cloutier]

Within each of the provinces, there are a lot of communications and meetings that are happening among these various hospitals to discuss PPE, ventilators and how best to deal with some of the patients who have come through the hospital. That's done at the provincial level, and it's very similar to the other provinces: They do the same and then they usually report their findings to the government, to their ministry of health.

Where I think there was a lack or where there was a gap, it was at the federal and provincial level, where sometimes I felt that the federal government did not have the appropriate information to actually assess and then follow that by making a decision.

I think within the province, within the regions at least, those members of our organization were in constant conversation with their neighbours to discuss issues, practice and lack of ventilators, and see where they could actually get some PPE and ventilators. That conversation was also done on a frequent basis at the provincial level, I know that for a fact. Sometimes even some of our major hospitals would have conversations at the international level only to be able to have access to additional PPE and ventilators. That is done at the provincial level.

I think we need to strengthen the coordination and the information from the provinces to the federal government, and the federal government to the provinces. That's what I would suggest.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Ms. Jansen, please go ahead for five minutes.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

I'd like to direct my first question to HealthCareCAN, to Dr. Wouters. Just for clarification's sake, your organization represents health researchers across Canada, correct?

[Dr. Bradly Wouters]

Well HealthCareCAN represents health researchers across Canada, research hospitals across Canada. We're one of those.

There are more than 40 such organizations.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

You mentioned the fact that all research and clinical trials in Canada that are not related to COVID-19 have been suspended or cancelled, and that, I understand, if trends hold the pandemic will cripple Canada's overall research capacity.

In light of this information, what do the Canadian research members think of the $850 million research grant announcement made by the Prime Minister on Monday, of which $840 million will go to the WHO, according to a tweet by WHO Director-General Tedros.

[Dr. Bradly Wouters]

I think the investment in COVID research is welcome. This is clearly a huge, worldwide pandemic that needs to be solved, and I firmly believe that science and research are going to be our path out of the pandemic.

The investment is good, but it's a piece of it. I think what we're here for today and what we're talking about today is that the larger research infrastructure, what we're hearing from all the charities and the other parts of the research investment, has not been addressed, and is in a very fragile moment.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Yes, so that money could have possibly been better used here in Canada is what I was hoping you would say, but maybe not.

I'm going to now move my questions on to Mr. Terry Dean from the Lung Association. I've been hearing that there is some pressure on doctors to put COVID-19 down as cause of death when comorbidity issues are much more the reason for a patient's death. I'll just give you an example. My grandfather had COPD, but he died of pneumonia. My dad was the same, he had COPD and also died of pneumonia.

Do we have any idea how many deaths currently attributed to COVID-19 should more likely be attributed to comorbidity issues?

[Terry Dean]

At this point I'm not aware of the specific answer, other than to say we know that many of these patients are older, and that they suffer from many different diseases, many different comorbidities. To be able to specify COVID-19, I think it would be very difficult.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Okay.