Health Committee on May 11th, 2020

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Last week we heard from Dr. Wouters from HealthCareCAN who stated that 80% of their staff remain unable to continue essential research into cardiovascular disease, rare diseases, diabetes and many other key diseases that kill the majority of Canadians. Part of it is because the training is all done in hospitals and they aren't able to access the benefits from the programs out there.

Have you heard from any of your researchers on whether there are funding issues when they're working within hospitals?

[Russell Williams]

We're hearing that, and we're talking to them on quite a regular basis. We're trying to figure out the impact throughout the country on that, because I think different people have been affected in different ways. We are pulling together a number of key leaders on that to have a discussion to get a better understanding of it. I could forward some of our data to you following this meeting.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

I have one last question, just quickly.

I've seen issues, for example, where there are shortages in ramipril and metformin, the medications that are used a lot by type 1 and type 2 diabetics. Are you aware of any other drug shortages that are of concern?

[Russell Williams]

In the beginning of this pandemic, we started to hear some concerns. There was some anxiety from people who were thinking about spending time in lockdown and isolation. We monitored that very quickly, very regularly. We have talked to Health Canada, to suppliers, distributors and pharmacists, and people are working through this.

I'll ask Kimberley to add an answer, but our sense is at this point there is not a problem. There have been a few problems at a few pharmacies, but that seems to be working out right now for some of the medications we're dealing with.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Right.

I apologize, Kimberley, but I'm wondering if you could send that comment to the committee. I'm short on time, and I just want to make sure I get some more questions in, if I can.

Mr. Villeneuve, I appreciate you being here. I can tell you that when I first met my wife, she was a pediatric intensive care nurse with the Hospital for Sick Children. She became an intensive care nurse and flew on the air ambulance at Sunnybrook in Ontario. She has extensive experience and spent a lot of time training, as did I. I realize and recognize all the training that goes into our health care workers, in particular when we are looking at long-term care.

The Minister of Employment, Workforce Development and Disability Inclusion stated this:

We may create, working with the Homecare Workers Associations of Canada, some kind of training so that people who aren't in those jobs now—maybe people who are at home and unemployed—can take a shortened version of this training and be able to perform the less complicated tasks that are required at these homes.

I'm wondering what your thoughts are on that and where you see that with health care workers in these long-term care facilities.

[Michael Villeneuve]

Thanks, Dr. Kitchen. I am an old Sunnybrooker too, so I appreciate the reference to your wife's work there.

I think we want to be careful that we are not putting people into positions where they put themselves or residents at risk. The danger in the fast-turnaround course is that they expose the residents to COVID or they themselves get it. If we're talking about simpler functions, for example, what a volunteer might do, such as pushing someone from a bedroom to a common dining room or something, I think that makes some basic sense. However, when it comes to short-cutting the orientation and training time for something as important as very complex continuing care, I think we want to be careful.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen.

We go now to Ms. Sidhu for five minutes, please.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you to all the witnesses for joining us.

I want to recognize that it is National Nursing Week, and I want to thank the thousands of nurses who are working on the front lines to protect all Canadians.

First, turning to Diabetes Canada, it's nice see you, Russell and Kim. I really want to thank you at Diabetes Canada for the work you do for Canadians living with diabetes.

Kim, you will know that a few weeks ago we did a webinar for Canadians living with diabetes. During the webinar we received many questions and comments from patients about an increased risk of diabetes complications due to COVID-19. They are concerned about different provincial and territorial approaches to protecting Canadians living with diabetes, resulting in health inequities.

How can we ensure that efforts to protect Canadians living with diabetes continue, given the difficult circumstances? Do you think leveraging virtual care is helping people? As Russell mentioned, in long-term care he receives calls. What are your thoughts on all of that?

[Kimberley Hanson]

Thank you so much for the question, MP Sidhu. We really appreciate your support for diabetes, always.

As I mentioned in my remarks, we know that diabetes is a disease, as is COVID, that really exploits health inequities. Responding to COVID as well as ensuring the health of people with diabetes will necessitate fundamentally addressing things like food insecurity and job insecurity in a general sense, ensuring that people don't have to choose between taking medication and feeding their children. We know that leveraging things like virtual health, as we have out of necessity the last couple of months, can make care much more accessible to all Canadians, regardless of where they live, and can help reduce wait times significantly. I had an appointment with my specialist over the phone just recently. Instead of taking more than an hour, it took 10 minutes and was very, very helpful. I think that can be a model for us moving forward.

What we're fundamentally learning here is that the more we can act in coordination, one province to the other—learn from each other's best practices, leverage data, analyze it and use it to make decisions about health care—the better that health care will be and the better the health outcomes will be for Canadians. Those are, as you know, all behind our diabetes 360º nationwide strategy.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for the Canadian Nurses Association.

As we know, there are outbreaks in long-term care centres. In Brampton South, one example we have is Holland Christian Homes' long-term care Grace Manor. Due to the labour shortage this year, Canadian Armed Forces are helping now during the COVID-19 situation.

I heard from the Canadian Nurses Association that we need fundamental changes in long-term care. I want to know how the federal government can work with the provinces and territories and with organizations such as yours and others to ensure that more nurses are able to help in our health care facilities, because our seniors deserve a high standard of care.

[Michael Villeneuve]

Thanks very much, Ms. Sidhu, for the really great question.

It's very complicated, so it's hard to answer in a short couple of minutes, but there are a couple of things. First of all, Canadians, and certainly nurses and CNA, do look to the federal government for strong leadership, and one of things that federal government has traditionally done well is convene. I think there's a convening function to bring people together. We're a bit leery of five more years of talk, because we've identified many of these problems for years. Some of them are as simple as four-bed rooms or single-bed rooms with a Jack and Jill bathroom. It spreads like a brush fire through those kinds of places.

Some of it's old, outdated infrastructure, so if we had a modernization of the idea of what long-term care looks like.... In places like Sick Kids and many other hospitals, now they're going to basically all single rooms because of this very problem. The infrastructure of long-term care looks like 1955. It just has not kept up, and it might have been fine when people were walking around in their clothes and driving to do their shopping from those facilities, but it's not now.

I think we turn to the federal government for the convening functions, the strong sense of levelling the playing field and the standards across the country. As a Canadian, what can I expect in Saskatchewan that I should also expect in New Brunswick? It's a bringing together, development of standards function to set the expectations.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu.

Mr. Webber, go ahead for five minutes, please.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair, and happy National Nursing Week to all of you, in recognition of all our heroes out there: all our nurses and health care workers.

Dr. Dorian, you mentioned in your presentation that procedures for heart valve replacements, defibrillators and such have been delayed significantly, if not even cancelled. Are people actually dying because of their inability to access heart surgeries and procedures due to the prioritization of COVID-19?

[Dr. Paul Dorian]

The short answer is yes. We don't have the exact numbers, but we have a number of cases. I just talked to a colleague from Sunnybrook hospital yesterday, who is in charge of data for the province of Ontario, and they've had four deaths on their waiting list in the last month, so the answer is yes.

Unfortunately, these are quite ill patients, and we use the term “elective procedure” very carefully. These are individuals who need a procedure not immediately, for example, an acute heart attack or somebody who's at death's door. These are individuals who normally would be expected to have a procedure within somewhere between four and eight weeks and are now potentially facing a wait-list of months and perhaps even longer.

[Len Webber, Conservative, Calgary Confederation, AB]

We hear that quite often. Even with an area that I'm quite involved in, which is organ and tissue donation, the fact that those have been delayed as well is causing people to die, and that's just a shame.

You mentioned research briefly in your presentation and how COVID-19 has affected heart patients. Can you talk a little about the research that has been going on, if any, that you've heard of regarding the long-term effects on the heart due to COVID?

[Dr. Paul Dorian]

Those are superb questions. Absolutely, we would like to be able to help our patients understand, both in the short term and the longer term, what the consequences are to the heart of having COVID. We know that if you already have heart disease, then your chances of getting sicker, or sadly, not surviving COVID are higher. This is, of course, no news to anybody.

We also know that a substantial proportion, probably a minority, but a large number of patients who have the COVID illness not only have respiratory illness—they have troubles breathing and they have lung problems—but they also develop acute heart damage. We call that myocarditis. There are at least five or six different kinds of heart problems that can happen with COVID.

What we don't yet know is, in addition to what the best way is to treat the heart during COVID, what the long-term consequence is, what we should be looking out for, and how we should treat these patients to prevent worsening of their heart problems after they're discharged from hospital. There are some active research programs going on in Canada, sponsored by the Canadian Cardiovascular Society, and indeed worldwide, to answer those questions.

I might just emphasize that the only way to do that type of work is to have rapid access to all of the data that we require to answer these questions; otherwise, we're extremely inefficient in going patient by patient.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you for that, Doctor.

Ms. Kimberley Hanson of Diabetes Canada, you also mentioned research and how the diabetes patients are three times more likely to die of COVID.

You mentioned early research. Can you elaborate on that, on what you've heard about early research on diabetes and the effects that COVID-19 has had on diabetic patients?

[Kimberley Hanson]

Mr. Webber, the data we have are quite early on. We have data that unfortunately doesn't distinguish between whether patients had type 1 diabetes or type 2 diabetes. The research doesn't give us well-segmented data in terms of how many complications the patients had and perhaps what their ages were, and so on.

However, what we see from countries that had the pandemic earlier than we did and therefore are farther along in their journey is that when somebody who already has diabetes catches COVID, they're more likely to experience that cytokine storm that can result in the type of COVID that needs hospitalization; they are much more likely to end up in the ICU than somebody without diabetes and consequently, they're more likely to experience a death as a result of it. We need to learn a lot more about that in order to fully understand what that means.

We're trying to send Canadians with diabetes a clear message, that they don't necessarily need to be afraid right off the bat, that they just need to take precautions, as do all Canadians, in order to reduce the risk that they'll catch COVID-19. However, it's important to recognize that diabetes does predispose people to a greater likelihood of a poor outcome if they do catch it.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Webber.

Mr. Van Bynen, you're up next, please. You have five minutes.

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

My first question is for Ms. Benard of the Canadian Health Coalition.

We've seen the need for a radical change in long-term health care, because of the devastating effect we've seen with COVID-19. I understand that your organization has been looking at national standards for long-term care facilities. How would you propose implementing and regulating these measures, recognizing that there are a number of layers of jurisdiction involved in providing health care and long-term health care?

[Melanie Benard]

Thank you for the question. It is a bit of a complex question because of this overlapping jurisdiction.

As we have seen in other areas of health care, there is a really critical role for the federal government to play. In the Canada Health Act, we have some criteria that the provinces must meet in order to access federal funding. There's no reason we couldn't do something similar for long-term care, having dedicated funding for that specifically and then including these national standards that the provinces have to meet to access that funding.

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

I understand, and we've heard a lot about funding.

My concern is that we seem to be pointing at organizational change, structural change, in order to improve the lines of communication for things like providing PPE on a national basis. Is there a need for a different type of organization or for structural change in the delivery of health care to make it more efficient and more effective, particularly in relation to these national emergencies, these pandemics? How would we go about implementing that?

[Melanie Benard]

That's a big question. The kinds of standards for long-term care and home care that we're calling for would be really broad principles that, as I mentioned, the provinces would be expected to meet. When it comes down to operationalizing those principles, that would most likely be done at the provincial or municipal levels. We would be looking for things like staffing levels and the number of hours of direct care that each resident should be getting per day. It would be really those kinds of broad principles and criteria that could be implemented at the federal level.

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

My next question is for Mr. Villeneuve.

Many nurses have been helping on the front lines of provincial telehealth programs, for example. I'm interested in hearing your thoughts on the Prime Minister's recent announcement to expand virtual care during this pandemic, and how initiatives like this can help nurses and other health care professionals during this time.

[Michael Villeneuve]

Thank you very much, Mr. Van Bynen.

It's been amazing to watch—just as an observer, let alone being an RN in the job I'm in—how quickly we were able to make that transition. When we surveyed nurses, polled some of our members, 70% had moved to virtual care options in their practices. We've known in nursing for quite some time that nurse lines, nurse-led care and nurse-led models of care, for example, are very satisfying to the public and have great outcomes. They are the same as or better than traditional models, have the same or less cost and are as satisfying to the public. We would absolutely strongly encourage more virtual care.

There are not enough of us to do it all, so it does extend our reach. The visits are shorter. We would absolutely strongly support it. One of the issues, though, that's been brought to us by our own members is that you need a reasonable amount of bandwidth to do some of that, and that's become a problem across the country.

One of our nurse leaders in Nunavut, for example, told us that just to do a Zoom meeting they use up their entire month's worth of bandwidth, and then they are paying by the minute, and so on. The other pieces have to be put in place, but we would strongly advocate for more virtual care.