Health Committee on May 11th, 2020

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

Thank you.

My next question is for Dr. Dorian.

I understand your desire to make sure that we have leading indicators in data. What type of organizational barriers are you encountering in getting access to data in order that you can start using data as a leading indicator rather than a lagging indicator, so that we can be more proactive in how we deal with the changes that we're observing?

[Dr. Paul Dorian]

Thank you very much, Mr. Van Bynen. It's a very important question.

The only organization that I'm aware of in Canada that is allowed to receive data that's transported across provincial barriers is CIHI, the Canadian Institute for Health Information. Different provinces have different strategies for collecting data from hospitals and individual practices and aggregating them intraprovincially. CIHI is a very effective organization with some limitations in terms of what it is able to do, particularly in early or just-in-time data provision. They're doing it for COVID, but it would be useful for them to be able to do that with other kinds of data. Some of the limitations are regulatory, such as the challenge of sending data across provincial lines. Within provinces, there are different kinds of challenges, and they're related to the sensitivity around data privacy.

The fact is that the data custodians are the individual agencies that hold the data. For example, for cardiac data in the realm of COVID, we have data that's collected in ambulances, as I mentioned earlier, and housed inside emergency medical systems. These data are not easily interoperable, but the biggest hurdles are not the operability in terms of the IT challenges; they're that the data custodians are not in a position to talk to other data custodians to share data. They just don't feel that they have the regulatory and privacy wherewithal to be able to share data.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Van Bynen.

We go now to Mr. Thériault for two and a half minutes, please.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Dorian, some children are returning to school and will therefore be exposed to potential sources of COVID-19 contamination. The Heart and Stroke website explains that some symptoms associated with Kawasaki Syndrome may be similar to those caused by COVID-19 and that it isn't always easy to distinguish between the two diseases. The standard treatment for Kawasaki Syndrome has been used in Europe for COVID-19, and some doctors believe that this treatment may even be useful for COVID-19. What's your opinion on this?

[Dr. Paul Dorian]

Thank you for your question.

I apologize, but I'm going to answer in English to be more succinct and more accurate. My deep apologies, but I do this for the sake of accuracy and brevity.

Kawasaki disease is a rare disorder. It manifests in the heart as what's called coronary artery aneurysms and sometimes inflammation of the lining of the heart. We see this so rarely in Canada we don't have a good sense of the best therapies, particularly for the COVID version of a similar illness. The standard treatment would be steroid therapy, like a cortisone variance. We have absolutely no idea if this would work in COVID. From some early reports in China where it's been used, there's some limited evidence that this therapy may be harmful to COVID patients.

As a community we're unfortunately flying a little blind. We feel very bad that there are children who are affected, but these individuals are so infrequent that we really don't have any good data to help guide their therapy.

If I may be permitted, I think this is yet another example where to be able to give the best possible advice to our patients, whether it's pediatricians or adult physicians, it is absolutely imperative that we have access to the most comprehensive, accurate and real-time data on all aspects of COVID as we can so we can aggregate this information and not be dependent on our individual minor experience.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Dorian, we've already spoken of deaths because cardiac surgeries weren't performed. Toronto's University Health Network recently estimated that 35 people may have died in Ontario alone because their cardiac surgeries weren't performed. We know that thousands of other surgeries have been postponed or cancelled to ensure enough acute or critical capacity in our hospitals for a possible surge of COVID-19.

Given those estimates, do you feel we have the balance right between providing continuity of essential care for non COVID-19 patients and freeing up the hospital capacity needed to respond to the COVID-19 pandemic?

[Dr. Paul Dorian]

That's a very important question that we talk about a lot, Mr. Davies.

In retrospect, I think it would have been reasonable to have less surge capacity and have continued doing some therapies, but I think I would absolutely not criticize health care planners and public agencies. I think we did the best we could as a community, given the information we had available.

What's really important is that we have accurate planning from today going forward. I think we understand much more now than we did eight weeks ago. It's been a very short period of time since we started this journey.

What's really important on a go-forward basis is that we use whatever information we can get. The more information we get, the better we can predict what the consequences would be of what I think we all agree now must be a ramp-up of cardiac and other needed procedures, cancer surgeries, other kinds of surgeries.

To get the balance right will not necessarily be easy, but it will be made better by having the most accurate and comprehensive data possible. This is not just looking forward for the next two or three months, but I think we have every reason to believe we're going to have to have this careful balancing act for months and possibly years.

It puts quite a bit of pressure on public health planners, epidemiologists, so we need now more than ever to have a community-based, fact-based, evidence-based response to health care planning.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I have a quick question for Mr. Villeneuve.

Approximately how many Canadian nurses have been infected with COVID-19 to date?

[Michael Villeneuve]

I don't know the number today, but I can get that information for you.

Certainly, we've been concerned by any infected, and it seems to us, here in Ontario, that it has been in the long-term sector that the support workers have been unduly affected. However, we're working with the CMA, as I think I mentioned earlier, and CIHI to try to gather that data and report it in a reliable way.

One of our problems, as you can well imagine, is this: Did the worker get it at work? Did they get it from a child outside? How are we going to distinguish those sorts of outcomes?

I will look for that information for you when we put our brief in this week.

[The Chair, Liberal, Ron McKinnon]

Thank you.

That ends round two. We start round three at this point with Mrs. Jansen.

Mrs. Jansen, please go ahead for five minutes.

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

Thank you so much.

I would like to direct my first question to Dr. Dorian.

As you mentioned, all of this data is already being collected, and yet we don't have access to that information. In this day and age when everyone is concerned about making science-based decisions, it does seem surprising that we do not have access to that information. It's even more surprising, of course, since the 2006 SARS report was clear that we needed a real-time, information-sharing system in place to help with tracking cases in a situation like this. Even here in B.C., we're looking at excess deaths that can't be attributed to COVID-19. That sort of data would help us better understand if our COVID-19 response was appropriate.

Do you think that some regions are afraid to share that data for fear of liability issues perhaps?

[Dr. Paul Dorian]

I don't think it's necessarily a fear of sharing the data because of liability, but there are certainly lots of appropriate questions about data privacy.

I think individual data custodians, the individuals who hold the data, whether it's within hospitals, regions, provinces or agencies like emergency medical care systems, for example, are understandably and appropriately concerned with exporting their data without being assured that the data, which involves individual patient information, will be kept private. One of the concerns is privacy. Another concern is data interoperability.

A third concern, and not a concern but a limitation, is that data tends to be siloed within jurisdictions and we just don't have, today, the structures. It really needs to be an overarching structure, provincial or federal, in my opinion, that brings together all of these individual custodians and has them work together so that they trust each other with their data and the data can be federated in one location.

We know it's technically possible. The hurdles are jurisdictional and informatics-based.

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

Wonderful. Thank you very much.

I have a question for Ms. Benard.

You suggested that public long-term care facilities provide better care than private. Amanda Vyce from CUPE made a similar bold statement a few meetings ago, which I also challenged.

I'm wondering what science-based information you're using to make that suggestion, especially since we just heard from Dr. Dorian that there is no pan-Canadian data collection system to support that kind of an assertion. Is this just one of those cases where if you say it long enough and hard enough it becomes true? Here in B.C. we've had a private long-term care facility ban public health nurses from entering due to the fact that they were only given two masks and two gloves to ration for the month by our regional health care authority.

Clearly, the challenge that long-term care facilities have is far more complicated than just being either public or private. Access to PPE has been one of the biggest fiascos our public health authority has had to deal with. Our national emergency stockpile system was severely mismanaged, making it very difficult for all nurses, including long-term caregivers, to be able to protect themselves and their patients from infection.

Protecting our seniors should be our top priority. Do you think that the Toronto Star article you cited has been sufficiently peer reviewed to be able to extrapolate such a bold assertion?

[Melanie Benard]

Respectfully, I mentioned that the private, for-profit or public, not-for-profit is a factor in terms of providing higher quality care, and that is not simply based on the Toronto Star article that Mr. Davies cited earlier. It's based on decades of academic research. The office of the seniors advocate in B.C. also published a report, I think, a month before the COVID crisis began, and it looks—

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

So it's not just private versus public. I appreciate that. That's what I was hoping to hear. That's awesome.

I have a question for Mr. Villeneuve.

In regard to telehealth, I've tried before to call in to get test results and I always have to go in to the doctor's office to get my results because of billing. Also, when I had kids and I was going to the emergency and called to see if I should go in or shouldn't go in, they would often say, “Well if you don't know, you should come in.”

I'm wondering if there might be a certain situation that we have in front of us that will hold us back from using telehealth more in the future.

[Michael Villeneuve]

I think that if we cling to old patterns, that will be an issue.

We've certainly seen here that the public seems willing to do this and seems satisfied with it. We've heard in many regions across the country—not just from our polling but from regional health authorities—that they've also moved to 70% virtual, and more than half of that by phone. I think that if we can get the billing right, because I do believe physicians need to be paid just as nurses and others are paid, and if they're adequately compensated, I think we can make that shift.

I have to say that I'm an aging baby boomer now. I'm at the bottom end of the trail, and we want those kinds of services. We want those sorts of changes, so I believe we can make them.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Jansen.

Mr. Fisher, please go ahead for five minutes.

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

Thank you, Mr. Chair.

Thank you to all the witnesses who are here sharing their expertise as usual.

Dr. Dorian, you gave incredibly thoughtful remarks, and your responses to the questions were equally thoughtful, and I want to thank you for that. I've changed my direction and I'm going with you because of some of the thoughtful things you've had to say.

I think we've been very fortunate in Canada. I think the Canadian public has generally bought into the public health message and done a pretty good job.

You talked about refining the public message, and your organization has offered to help or would offer to help develop and spread the public health message. I'm putting words in your mouth here, but I think you said we need to find a way to balance medical needs with coronavirus needs. You've acknowledged that the coronavirus patients are appropriately prioritized. Again, I'll repeat my belief that we've been very fortunate in Canada that Canadians have bought into public health.

Again, because of your thoughtful comments, I'm fascinated and I would rather we could sit down and have a cup of coffee or a beer and talk for an hour and a half on this, but we have five minutes, and I know you're only going to be able to touch on this.

If you were developing and spreading the public health message, what would it look like? Would it be similar or would it be vastly different? I would feel confident if you were in that role based on the things you've said today, but maybe you could just touch on some of the things you might have done if you had been crafting that public health message for Canadians.

[Dr. Paul Dorian]

Thank you very much for your kind remarks, first of all.

I think we have a task to do as a community, and this includes physicians, nurses, all the health care workers and representatives of government, and that is to help patients figure out whether the symptoms they have warrant emergency care or not. That is true for COVID-like symptoms and that is true for cardiac-like symptoms.

The major challenge we have, for which there is no easy answer, is to make sure that we educate all members of the public that, if they have severe symptoms—this could be shortness of breath, a cough or a high fever in the case of COVID, or it could be chest pain or it could be paralysis in the case of strokes—they seek emergency care immediately.

We have the extraordinary good fortune in Canada of having a very well-functioning emergency health care system. It would be an extreme shame—which is why it's so frustrating for those of us on the front lines—that patients who could benefit from immediate care in the fortunately infrequent situations where immediate care is necessary were forgoing that care.

What that message should sound like exactly, I'm not exactly sure. The Heart and Stroke Foundation has come up with some specific instructions to patients, but the requirement, I think, would be to come up with something simple, straightforward and available in all the languages that all our Canadian citizens speak. It would be messaging that would be widely spread to reassure individuals that emergency care is available if they just want to seek it.

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

Thank you, Doctor.

Mr. Villeneuve, telehealth fascinates me. I know we had some pioneers in Nova Scotia who were pushing for this for a long time and see it maybe as one of the only good things to come out of the coronavirus thing, which is that we are now talking about telehealth and doing telehealth.

Is it here to stay? Is telehealth going to expand? Are we going to utilize our medical health care professionals in a bigger way through telehealth in the future after coronavirus says goodbye?

[Michael Villeneuve]

Mr. Fisher, I can't imagine us going back. I can't imagine the public would be satisfied going back.

Ms. Jansen mentioned it a few minutes ago. I think we're going to have to learn to manage how much risk we're willing to take on. When nurse Mike is on the phone talking to someone in the public, what is the balance of “I can't see you, so I can't tell,” but now we can see you? We're doing it right now.

The public has learned to work like this. Offices are closed and the country has sort of shut down, but society has gone on with great communication. When we ran the national expert commission almost 10 years ago, I can remember one of our business leaders saying, “Why do you people spend so much time trying to describe a wound when we all have a camera that we could show the doctor and click it?”

We've made that leap and I can't imagine now that the public, or even doctors and nurses, will want to go back.

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

Mr. Chair, do I have any time remaining?

[The Chair, Liberal, Ron McKinnon]

You have 10 seconds.