Evidence of meeting #18 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
President and Chief Executive Officer, HealthCareCAN
One was funding and one was better coordination between the provincial governments and the federal government. Those are the only two I have at this moment, but I could get back to you with the list and say which ones we thought could be done better.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you. That would be helpful.
Mr. Dean, this is a good segue, because you spoke of the need for information.
Previous witnesses have called for federal legislation establishing mandatory standardized information sharing between provinces, territories and the federal government in cases of national health crises. Is that something you would support?
President and Chief Executive Officer, Canadian Lung Association
Absolutely, and beyond crises, there is obviously ongoing care and management of chronic disease.
This said, we want to make data-informed decisions. That's the best use of our allocation of resources. I think we need to start by building the database.
Liberal
The Chair Liberal Ron McKinnon
Thank you.
That brings round two to a close.
We'll start round three with Ms. McLeod.
Ms. McLeod, please go ahead, for five minutes.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Thank you, Chair.
This is the first time I have subbed in to this committee or any virtual committee, and of course my first disappointment is that it doesn't have all the power we would normally have. Certainly if we did, I'd be making a motion right now and supporting Dr. Kitchen's thoughts around the issue of the CEWS and the CERB.
You're paying money for one versus the other, and you get so much value out of the other. I would have loved to be able to make a recommendation to the government that they need to perhaps broaden that criteria.
I really appreciate that testimony, because you spelled out the case very clearly. It can't be a motion of committee, but certainly I think that as independent MPs, if we feel strongly about it, we should all take the opportunity to move that forward.
My first question would be perhaps to Ms. Seale of the Canadian Cancer Society.
It's very tragic. There's a young woman who is dying of cancer and receiving care at home, but of course no one is visiting her because of COVID. Is there any mechanism or is a system in place—and do you have access to PPE, proper equipment—whereby people in palliative care, in their home environments or others, can have visitors? What a terrible thing to be dying alone at home without people coming to visit.
Is there a system in place? Is there adequate protective equipment so that we can have those sorts of visits?
Chief Executive Officer, Canadian Cancer Society
Yes, it's very tragic. We've heard the same kinds of stories of people having to be isolated from each other at times when they want to connect and, of course, we've all seen the situation in long-term care homes.
The patients we speak to and the families we speak with are very respectful of the instructions from Public Health to self-isolate and protect our health and protect each other. They haven't been looking to access PPE that would otherwise be needed in the health care system. Even in spite of how tragic and difficult it is, I think that for the most part we've seen a great deal of support for wanting to ensure that the health care system has what it needs to care for the most numbers of people.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
If we had had adequate PPE, if we'd had the storerooms that should have been filled with updated equipment across the country and if we had had adequate protective equipment in place for the health care workers, including in our long-term care facilities, is this something that as an organization you might have wanted to support?
Chief Executive Officer, Canadian Cancer Society
I think any kind of support we can give to allow people to connect with each other right now is vital. It's what we're trying to do when it comes to our online and telephone support, where people are able to connect that way. We've really augmented the kinds of offerings we're making right now in terms of our website resources and our phone support, and people are certainly accessing them.
I think that in the absence of being able to connect in person, this is.... People are accepting it and turning to those more virtual ways, but of course it's not the same as being able to be there in person with the people you care about.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Again, had Canada been well prepared, then it might have been a little easier.
For my next question, you talked about everything being on hold in terms of chemo, radiation and surgery, and diagnoses all being delayed, which of course is very difficult. Have you been able to do any quantification of that yet? Or is it going to take time?
Chief Executive Officer, Canadian Cancer Society
Yes, it's definitely going to take time. As we have talked about in a couple of circumstances here, the data is not there. It's hard to get a picture of the experience. It's also very much varied across the country. Different jurisdictions are providing different levels of care right now.
There was a study from the Quebec Cancer Coalition. They surveyed patients and found that 61% reported that their treatment or their care has been interrupted to some degree. It's certainly something that we've heard on a fairly widespread basis, but we also know that some of the most urgent surgeries have been going forward as they need to, and that depending on the resilience of the local health system, they're starting to reopen and treatments are starting up again in some places. That's very good to see.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I won't say anything more. Thank you, Chair.
Representative, Canadian Lung Association and Professor of Medicine, Division of Pulmonary Medicine, University of Alberta
Mr. Chair, may I make one comment?
Liberal
The Chair Liberal Ron McKinnon
Sure. Please go ahead with a quick answer to Ms. McLeod's last question.
Representative, Canadian Lung Association and Professor of Medicine, Division of Pulmonary Medicine, University of Alberta
It's actually more toward her PPE question. I think COVID-19 has created a lot of complexity in health care and the situation you described is very tragic, obviously. The one thing to keep in mind is that with PPE is that there's donning of it, putting it on, and doffing it, and understanding these processes takes a skill set. You have to be very careful about who has access to these things, and how they have access them, because it's actually in the doffing, in the taking off of the PPE, that most of the errors happen, resulting in the transmission of infection. To make it available to the general public is an idea, but it has to be done with careful thought.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We go now to Dr. Jaczek.
Dr. Jaczek, please go ahead. You have five minutes.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you very much, Chair.
Monsieur Cloutier, I'm not sure if you remember, but we were supposed to meet on Friday, March 13, when essentially all hell broke loose, and obviously we were not able to hold that meeting.
I would like to pursue the line of questioning that a number of my colleagues have been pursuing. It's essentially this. You have recommended a pandemic preparedness council and a greater role for the federal government. You've referenced the fact there was a minister of state for public health; in fact it was the Hon. Carolyn Bennett, from 2003 to 2006, post-SARS. I was the medical officer of health for York region at the time, so I remember that vividly.
In an ideal world, how would you see our going forward, given all of your experience in government, in organizing this pandemic preparedness council? What sort of authority would it have? It's all very well to talk about coordination and collaboration with provinces, but what compels provinces to comply? Could you describe what, in an ideal world, you would like to see take place?
President and Chief Executive Officer, HealthCareCAN
Good question, and I'm sorry we missed our meeting on the 13th.
First, you have to start by saying to yourself that at this moment the Public Health Agency of Canada is often considered the poor cousin of Health Canada. It has very little money; it has very little influence. If it has a major issue during a crisis like this, it has to report to two or three people before actually getting to report to cabinet. My proposal for a council is that it should not be reporting only to one or two people, but also reporting to a body of people who can actually make decisions very quickly about the country, not just about a province or a problem. It would be reporting to the Prime Minister or even reporting to cabinet. That would give it the authority and the visibility and allow it to have access to decision-makers across the country.
The other thing, too, is I think there has to be a review of the relationship of the Public Health Agency of Canada with the various provinces and how they work. I have to admit, very politely, that I think the communications and the coordination exchanged this time was much better than during the time of SARS. When the government wanted to really act, it did very well by trying to get all the people around the table to discuss issues such as ventilators and PPE.
However, I would like it to be given more power and some visibility and access to decision-makers, and also the authority to be able to speak to the person who has to make the decisions, and not have to go through a number of levels before reaching the top individual in government.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
In a post-COVID-19 world, assuming all has gone well with the enhancement to PHAC, as you suggest, what federal role do you see in health care more broadly? You've talked about hospitals across the country being at capacity already and that wait times for procedures are lengthy in many provinces. How would you see the federal government perhaps wanting to ensure, should there be another pandemic, that we at least have the ability to have some sort of surge capacity locally within hospitals, within public health units?
President and Chief Executive Officer, HealthCareCAN
They would have to look at the picture at this moment in terms of surge capacity, because we are lacking. We had problems in the area of surge capacity even before COVID-19. The federal government, with the provincial government, would have to look at that carefully and say, what is the normal world that we have and our needs in terms of surge capacity?
In addition to that, as I said earlier, there's going to be another surge capacity for all those patients who have not received care or have not received their surgery. That is going to be an added surge capacity, so you may see hospitals having the same problem or the same challenges that they have had with COVID-19, but maybe double, because COVID-19 patients will continue in any case. It won't stop tomorrow morning. It will only stop if there's a vaccine, and that won't happen for 18 months.
My concern would be for the governments to come together and discuss how we address surge capacity in each of the provinces, because it does vary from one province to another. Surge capacity is the biggest problem that a hospital faces every day when they're trying to treat patients.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Jaczek. We'll go now to Dr. Kitchen.
Please, go ahead. You have five minutes.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair. I would like to share my time with Mr. Webber.
Dr. Bhutani, you talked about COPD and asthma, and in particular about inhaler shortages. You mentioned salbutamol, and then you explained a little later why that was the case, because there are actually people storing it in hospitals in preparation for a second or third wave.
We've also heard of shortages of drugs such as hydroxychloroquine, which we know is a malaria drug, but because of its use with RA patients and lupus patients, issues have been brought up about that.
Are you aware or have you heard of any other shortages of drugs? Would they be related to this type of situation where it's being overused, or is it maybe a supply disruption?
Representative, Canadian Lung Association and Professor of Medicine, Division of Pulmonary Medicine, University of Alberta
There are two parts to that question. The first is whether I am aware of any other shortages.
Drug shortages are very common within the country. Health Canada has a website called drugshortagescanada.ca, where all the up-to-date information is applied. These are commonplace. What the pharmaceutical industry has historically done is order or procure a certain number of units of medicines based on historical norms. Things moved very quickly between January and March in regard to the pandemic and a lot of the purchases from the hospitals increased in anticipation of what Mr. Cloutier talked about in regard to the surge planning. I think what ended up happening with the salbutamol MDI, which we use for patients on a ventilator, was that the hospitals stockpiled them. From what we can understand from the information, it wasn't really patients, it was more hospitals stockpiling them, which was the appropriate response from a planning standpoint.
The other complication with salbutamol is that when you're on a ventilator you actually have to use double the dose of the salbutamol, because a lot of the medicine is lost in the tubing of the ventilator. Therefore, for what you need to get down there, you actually have to administer double the amount. That created a perfect storm between requirements from the hospital in terms of what they're planning for and then non-availability for patients.
Working with the pharmaceutical industry, Health Canada and the partners I've identified, we've done a really good job in trying to resolve this, so the concept of the salbutamol shortage is a bit nuanced. Yes, they're only getting one month's supply of it, and I think there was a discussion earlier regarding the dispensing fees resulting from getting only one month's supply. However, in all honesty, if you're ideally managed with your asthma and your COPD as an outpatient, you should theoretically, by current standards, only need one inhaler per year. In reality, if you're using more salbutamol as an outpatient, you should probably talk to your doctor about your chronic management because it probably needs to be improved.