Health Committee on May 6th, 2020

[Terry Dean]

We spoke earlier about some of the surveillance that's needed in Canada to help us understand what's happening, and I think this is a great example. Data can inform the decisions we want to make down the road, and I think an investment in that particular area should be something the government considers.

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

You think that if we had the right kind of investigative technology, we'd eventually be able to sort through those questions?

[Terry Dean]

The hope is that the information will help us make better decisions. Right now, I don't think we have a solid enough base to be able to give that confirmation.

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

Thank you.

My last question is for Dr. Wong-Rieger. I really appreciated the information from your survey results, which showed that many non-COVID patients are having a hard time accessing health care right now. I heard of a farmer in Ontario who had a staph infection. He called the hospital to ask if he could come in because he wasn't feeling well, and they told him, no, call Telehealth Ontario. He didn't receive a callback right away and was eventually found dead in his home.

I know that in B.C. here, they'll be studying causes of excess deaths that were not directly blamed on the coronavirus since it appears that we had about 170 deaths in March and April, which would not normally have been expected.

Has your organization seen any evidence of excess deaths due to lack of medical care for anything other than COVID-19 over the past two months?

[Dr. Durhane Wong-Rieger]

I think there is certainly the immediate death that can occur. We definitely have gotten notices around immediate death, where people could not get access to an intervention that would have in fact been life-saving. That definitely has happened.

What we're more concerned about—and we're trying to figure out a system to track this maybe also internationally—is the death that will occur later on because there was a therapy that was not provided. We've had patients who say, “I need to get regular infusions, but I'm afraid to go in for an infusion, so if I skip the infusion, what's going to be the impact?” I think we definitely need to continue to track that. Unfortunately, certainly for rare diseases, we do not have a very good system to do that. That's why we are also pushing very much for data registries and the ability to do that.

Then, yes, there are the cases of immediate deaths and further disabilities as a result of it, but I think down the road we will see much more serious disabilities and progressive diseases that will also be, at the end of the day, caused by COVID and not being able to access.... I don't know exactly how we can track that, but I think we need to because if we have more waves of this, as everybody says, information is king.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to Mr. Fisher, for five minutes.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chair.

Thanks, folks, for being here.

You can't think of COVID-19 without thinking about folks with underlying health conditions. In the age where information is king—well, accurate information is king—we did hear some witnesses today use words like “fear” and “frustration”, and speak about patients' fear of even going to the hospital. We know about blood infusions and MRIs and that people are not being referred to neurologists or oncologists. These things can add to an already sky-high level of stress for some of these patients.

I'm interested in some of these folks with respiratory issues and the cancer patients. What is life like for some of these folks during this time of COVID-19? How are they connecting with health care professionals? I know Dr. Bhutani talked about telehealth. Is it through online sessions? What is life like during COVID-19 for these folks?

I'll start with the Lung Association, and then if there's any time left maybe go to the Cancer Society.

[Terry Dean]

That's a great question. We're hearing—and we talked about it earlier—that telehealth is a great tool. I know a number of physicians who are making themselves available for telephone and video conferences. I mentioned earlier that we have hosted a number of webinars and Q&As on our website, in which we have had respirologists and health care professionals answer the questions of those on the video. For remaining questions, because the webinar was only an hour, we actually had them respond to the questions we received, and then we sent the answers directly to those patients.

We're encouraging them to use the tools, but we're hearing the same thing. There is some stress. There are some mental health issues. We're encouraging them to manage their overall health by making sure they're exercising if they can, getting enough sleep and eating properly. If they are on medications, we encourage them to make sure they're complying with their plans to best manage their health.

[Dr. Mohit Bhutani]

I'll just add to that. I've done a number of telehealth clinics and phone clinics with my patients. The respiratory patient is like any one of us. There's a lot of anxiety about what they should and shouldn't do and how they are going to manage the activities of life like going for groceries, getting their prescriptions and adapting to this.

I think that the stress and anxiety of that is certainly as much as it is for anyone in the country, but I'm going to say that, with the resources the Lung Association and the Canadian Thoracic Society have provided, a lot of them cope as best as they can. There are videos we've developed for at-home exercises and online resources for them to read and maybe become more educated about their lung disease.

We've also promoted lots about how, for people who are considering stopping smoking, this might be a good time. The social circumstances aren't there when you may want to go and have a cigarette. If you're ever contemplating going to consider smoking cessation, maybe this is the right time to do it.

We're trying to work with them on an individual basis, but I would say that, at the end of the day, they're like any one of us. They're nervous. They want life to go back to normal as much as possible, but they've been very compliant with what the Public Health Agency is saying. They're trying to avoid social circumstances that might put them at higher risk. I'm very impressed with some of the responses that I see from my patients.

[Anne Simard]

I think the other piece, if I may jump in—

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Okay. I know we were going to go to Ms. Seale, but if you have something quick you want to say, go for it.

[Anne Simard]

I just also think the way that they're getting care is very different, even when you show up at the hospital. Today, for example, when you're talking about stroke, we talk about door-to-needle time. If you are a candidate for the clot-busting intervention, what we would aim to do in 45 minutes, to save as many brain cells as possible when you have a major stroke, now can take twice or three times as long with a number of serious consequences.

To the questions earlier about never minding the impact of COVID, but with the way that hospitals are managing—very beautifully with precautions—there are still other consequences that may have knock-on effects of more disability, more death and more complexity.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

I'll go to the Cancer Society.

[Andrea Seale]

Yes, thank you. I would echo everything that's been said.

There's such a feeling of powerlessness when you are diagnosed with cancer that you need support in the best of times. What we've been hearing through our helpline—we have a community called cancerconnection.ca where patients and caregivers go to support each other and share their experiences—is a frustration that they can't get answers about what's going to be next for them, which is very understandable, because the health care system right now is trying to determine how it's going to reopen, resume services and get back up to the levels of care that people need.

The anxiety is very high. For us it's meant that we're more relevant than ever to people. We're not part of the health care system; we're not funded as part of the health care system. We're funded purely by donations that people from across the country contribute to help each other. I think that's really pointed out the importance of that second part of the health care system that keeps a lot of things going, that takes the pressure off government-funded health care, but that is really a lifeline for people when they have nowhere else to turn and they have to deal with the inadequacies of our system.

The anxiety is there, and I think it's going to be there until we start to see the backlog being dealt with.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you.

[The Chair, Liberal, Ron McKinnon]

We go now to Mr. Thériault.

Mr. Thériault, please go ahead for two minutes and a half.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Ms. Seale, on December 9, two cancer survivors, Ms. Dubé and Ms. Sansfaçon, joined us in challenging the government. We organized a meeting with the Prime Minister regarding employment insurance sickness benefits. This seems to me to be fundamental for anyone who wants the least financially stressful treatment possible. At the beginning of the discussions, we were talking about at least 26 weeks, but we were proposing 50 weeks because, after all, these people have paid into employment insurance.

I'd like to hear your perspective on that. I imagine that you would agree to increase the benefit period to 50 weeks?

[Andrea Seale]

We've been advocating for an increase to the employment insurance sickness benefit for a number of years now. It currently provides 15 weeks of coverage, so when someone needs to take time off work, 15 weeks are covered.

From a cancer point of view—and this, of course, is different for different diseases—we know that's not adequate for the average length of time that a person needs to be off work to receive cancer treatment. We have asked for at least 26 weeks of sickness benefits and would see that as being very helpful to those with cancer. Of course, more time would provide for people who are not the average and have much longer experiences and need support.

The extension of employment insurance sickness benefits would be very meaningful to people with cancer and other diseases and would help address what I described earlier, that incredible financial strain people feel when they're ill, and the strain that then puts on families and caregivers and their extended support network around them.

So, yes, we would absolutely be very supportive of an extension to the sickness benefit.

[The Chair, Liberal, Ron McKinnon]

You have 15 seconds.

[Luc Thériault, Bloc, Montcalm, QC]

This can also be useful in the event of relapse. Of course, when you're undergoing treatment and you're under stress, the results aren't necessarily always there.

[Andrea Seale]

Yes, you're right. It's very often complex. It's not just a matter of one course of treatment; this is sometimes many years of impact on a person's life.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Davies, please go ahead. You have two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Cloutier, two weeks ago, you wrote in Policy Magazine the following:

The Naylor report charted a clear course forward, but we only followed the roadmap partway. We created PHAC but failed to maintain the necessary resources and processes to deal with an outbreak of the scale and scope of COVID-19.

In your view, in what ways did we fail to implement the recommendations of the Naylor report and what can we do going forward to remedy those?

[Paul-Émile Cloutier]

I made reference in my article that there was a report in 2006 that outlined a number of recommendations. If you look at the list of recommendations that were made and how many of them were implemented, you'll see that many of them have not been implemented.

That's why I said that if SARS was not the wake-up call, I would hope COVID-19 will be that clarion call where you are going to address not only the failures and the gaps that existed during SARS, but also the same gaps that might still exist during COVID-19.

I'm particularly pleased that a task force has been put together, again with Dr. Naylor, who is well versed and well capable of analyzing this situation. I hope this time that the governments—not just the federal government—will take this report seriously and try to implement all of the recommendations from this report.

[Don Davies, NDP, Vancouver Kingsway, BC]

Of that itemized list of suggestions that were not moved forward with, do any stand out to you that you could advise this committee would be priorities for us to address this time?