Health Committee on May 19th, 2020

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

Dr. Tam, you mentioned vulnerable age groups in your report today. As you're aware, PHAC was developed in 2003, after the SARS epidemic. After that, a lot of the studies talked about preparing people for future pandemics. However, as Dr. Nemer said today, we've been playing catch-up. We've heard similar things from many other different presenters at the committee. For example, research was stopped after the SARS pandemic, and there were other issues, such as protocols were being forgotten.

It's been 17 years. PHAC was supposed to come up with the protocols to make certain that we were prepared and our seniors were prepared for this situation. What protocols and steps have been put in place by PHAC in the past 17 years to ensure that our seniors are prepared? You're saying today that we now have to prepare again. Why was that not done after SARS?

[Dr. Theresa Tam]

The Public Health Agency has worked with the provinces quite extensively on pandemic preparedness over many years, and I think that in terms of the international assessments, like the Global Health Security Index, we are one of the top countries in preparedness.

However, this is an absolutely unprecedented global crisis, which I think all of us will have to learn from. One of the key learnings is actually about long-term care facilities and how seniors are or are not being supported in our country. That is a big societal issue, and I think it is something that not just public health care but society writ large must come out of this in having a much better system and approaches to look after our seniors. That would be coming out of the first wave and preventing more tragic consequences for seniors going forward.

I just have to emphasize, as our researchers have said, that this pandemic demonstrates the importance of public health and investment in public health, not just in the Public Health Agency, but in the public health system writ large in Canada, all the way from local to provincial to federal.

We are a relatively small segment of the health system. We are working very hard to prevent the negative impact on the health care system itself and on working with everybody in Canada to flatten that curve so that you didn't get the horrific impacts on the hospitals and health care systems that you did in New York or Italy.

The public health system must not be forgotten. I know that this crisis is massive, but I would like to think that in four or five years' time the investment we're seeing now in public health continues.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen.

Dr. Jaczek, please go ahead. You have six minutes.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you very much, Chair.

First of all, I do want to thank all the witnesses for coming today and sharing their thoughts with us.

In particular, I would like to thank Dr. Tam for all that she has done over the last several months. Really, it's been day in and day out. I can't tell you how impressed I've been with your demeanor, Dr. Tam, throughout this entire situation, so my first question is for you.

Dr. Tam, you and I both know that contact tracing is an essential part of infection control, and this function is formed by local public health units across the country. It's very labour intensive, and it also requires quite a bit of skill in terms of investigative skills and diplomacy, because quite often people don't actually want to disclose where they might have been and who they've been with.

It has been a real struggle here in York Region. I know that our public health staff are working so hard. There has been a real effort to provide the search capacity given the number of positive cases here. Now we're hearing about contact tracing apps and, potentially, their use in a situation such as we're facing at the moment. Could you give us some of your thoughts about whether contact tracing apps could provide some relief to what is currently being done through our public health units?

[Dr. Theresa Tam]

Thank you for the question.

Of course, there are many, many people working really hard on this crisis. I just happen to represent the tip of the iceberg of the public health system.

You're right in that contact tracing is a fundamental public health competency, if you like. Local public health has augmented the capacity, and what we've offered to provinces is that if they don't have enough people to do contact tracing, please let us know. We have developed a roster of people. I know that they've massively increased training, for example, for students, medical students or retired health professionals to supplement their contact tracing capabilities, but we're also here to help, including federal public servants, who may be able to assist. There are different rosters being offered to provinces and territories.

On the application, I actually think, if you look at some of the other countries, that what you have to do as well is have a population that is ready to use contact tracing. You actually have some applications where Canadians have to sign up for them, and you need significant numbers for participation in order for that to work. I do think it is a concept that provinces and territories are interested in, and we've been facilitating some of the discussion on some of the options, so there's definitely more to come on that.

For example, Alberta started using an application. They are trying to get more people to sign up for it, but thus far.... I think in the Canadian context they are still trying to get more people to be recruited. In terms of this conversation, it is something that Canadians need to be engaged in so that they understand what this means. Privacy, of course, is also something of paramount importance as these applications are being used.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you.

What percentage of coverage do you think you would need to make it effective to use an app like that? How many people would have to sign up to use it?

[Dr. Theresa Tam]

That may depend on the exact set-up of the application or the technology because I think there are different solutions. I would have to get someone who is an expert in this to let you know.

I do know that, depending on the level of infection in the community, the number of contacts that you have to trace in order to suppress the chains of transmission can vary. It can be between 50% to 60% of contacts that you have to trace in order for that transmission chain to be stopped, so you can imagine that it takes a significant number of people to have signed up for this for contacts to even be notified.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you.

We all know that we make decisions based on what we know when we make them. Based on that knowledge, we make our decisions. That leads us to data availability.

We've heard a number of witnesses who have come before the committee suggest that even though you've talked about the great collaboration with provinces and territories, there is a real lack of consistency in public health data that is publicly available and in real time. There have been questions about why the case definition wasn't the same for every province and why every self-assessment tool wasn't the same.

In light of this and some of the comments you've heard this afternoon, would you say there really is a need for the creation of a pan-Canadian public health surveillance system?

[Dr. Theresa Tam]

First of all, the data gap is challenging, I would say. Part of it is a capacity issue, potentially, at different levels of the public health system. We do have a pan-Canadian public health network. We actually have many national or federal-provincial-territorial surveillance systems as it is, but we do need to improve on the....

We actually have national case definitions, but it's up to the provinces and territories to look at that, to report to us according to the case definitions. However, sometimes that does vary, and we do have certain data gaps that we must address. This is a critical aspect going forward, including, I think.... A lot of people have called for disaggregation of data, for example, according to race and indigenous status. I know that some jurisdictions are working on that, but that is still a gap, for sure.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Jaczek.

We'll go now to Mr. Webber.

I have to correct myself. The last two question slots I said were six minutes. That is incorrect. We'll revert now to our proper time slots of five minutes for Mr. Webber and then for Mr. Kelloway.

Mr. Webber, please go ahead for five minutes.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

Thank you to all the presenters today for their opening remarks.

Dr. Tam, I, too, want to begin by saying that I have great respect for the work that you have done, and that we are appreciative of the time and energy that you and your team have put forth in these past few months. I also know that your public availability on a regular basis only adds to your workload, but it certainly is appreciated.

In your opening remarks, Dr. Tam, you mentioned moving forward and that all levels of government are committed to working together toward a shared, evidence-based approach to the cautious lifting of public health measures with the primary objective of protecting the health of Canadians, taking into consideration regional differences.

I want to bring up elective surgeries throughout this country. We know that elective surgeries across Canada were put on hold as we braced for a wave of these COVID-19 cases in hospitals across the country. However, we are sacrificing the health and well-being of many thousands of Canadians with other equally significant health concerns.

Canadians expect the federal government to take a leadership position on this issue as it is its advice that provinces are relying on for guidance during this pandemic. Last week here in committee, Dr. Paul Dorian testified that these cancellations are costing lives. He said that he personally knew of four deaths in just one week in a hospital in the Toronto area, if I understood that correctly.

Dr. Tam, when do you see the cautious lifting of the hold on elective surgeries throughout this country?

[Dr. Theresa Tam]

Given the regional differences, what we did, together with the special advisory committee, was establish the criteria upon which jurisdictions can look at easing the public health measures.

All chief medical officers were very cognizant of the unintended consequences of public health measures. Some of them are definitely negative, although there are some that are positive.

We also provided guidance on some of the initial areas that need to be eased. One of them is non-urgent medical services. This is in the very initial tranche of areas that jurisdictions will be looking at. I think some of them have already begun resuming some of this, but that is within the provincial and territorial mandates.

[Len Webber, Conservative, Calgary Confederation, AB]

Regarding these unintentional consequences, Dr. Tam, can you tell us how many elective surgeries were postponed? Do you hear those numbers at all, by chance, or how many deaths in Canada there have been due to the postponement of these elective surgeries due to COVID? There are two questions in there.

[Dr. Theresa Tam]

This is an area that I've really stressed to Statistics Canada and the Canadian Institute for Health Information. You may have seen that Statistics Canada has released the initial quarter numbers for excess mortality in their reports. Of course, in the first quarter, the epidemic was only just starting in Canada. The data in April from Stats Canada would give us some inkling of the excess mortality statistics.

In addition, we did discuss at the special advisory committee some of the key data that we would like to seek from some of these organizations in order for us to look at some of the key unintended consequences. That work is under way.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you.

Just on another line here, as you may be aware, this health committee has been meeting twice a week during this pandemic, and the Minister of Health has said that our work in committee here is important now.

Because this is the first time, Dr. Tam, that you have appeared before the health committee since the pandemic was declared, I'd like to know if you are paying attention to the testimony here, as it is often at odds with the government actions and priorities.

Can you, Dr. Tam, just let us know specifically what testimony you've heard at our committee here, and what impact that has had on your decisions?

[Dr. Theresa Tam]

A lot of things have happened, and I just want to maybe look back at the records of when I last appeared. I think some of them were estimates, but I think March 11 was the last time and much has happened.

We do have a team at the agency that keeps us apprised of the outcomes and activities of this committee, and it is a really important committee, because the crisis is extremely complex and you actually have to look at many different dimensions of this, fundamentally the perspectives of many different sectors and Canadians as well.

I think it's absolutely critical that these kinds of discussions occur and that we learn from some of the deliberations. Of course, many of them are from health care workers from the front line, in terms of the kinds of support they need.

From the Public Health Agency perspective, a lot of what we do is more guidance, but also the huge amount of work done by many departments in getting personal protective equipment, for example, is coming out of some of your deliberations on how we better protect the front line, and that is from only some of the deliberations.

As we've already said, regarding the significant impact on the long-term care homes and seniors, it's extremely important for Canadian society to have a good discussion on how we can do that better moving forward.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Webber.

Mr. Kelloway, we now go over to you for five minutes, please.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Mr. Chair.

Before beginning my line of questioning, I just want to thank each of the witnesses for their tireless research efforts and dedication to the fight against COVID-19. Hearing you speak today only confirms to me that team Canada has the right folks on the job and that we'll get through this together.

I have three questions, and we'll see if we can get through the three.

My first question is for Dr. Nemer.

Dr. Nemer, I understand that the COVID-19 immunity task force intends to oversee and support serological testing in Canada over the next two years to track the extent of the virus in the general population and in specific groups at greater risk of being infected.

Can you describe the task force's role in overseeing and supporting this testing in Canada, and what role the provinces, the research institutions and others would play in the work of this task force?

[Dr. Mona Nemer]

This is a very important task force. The work will be done in collaboration with the provinces, the academic hospitals and a number of existing networks in Canada, such as the network for the study of aging and so on. The idea of having the task force is really to coordinate the collection of data—I'm very impressed that we're talking a lot about the data—and to make sure that all the right data is collected. Basically, it's harmonizing the approaches and making sure that everyone is using the right tools and the right tests. A lot of tests will give more positives than negatives or have less sensitivity and so on.

It's a coordinating function, but the work will be carried out evidently locally in the research hospitals as well as in collaboration with the Public Health Agency's local representation on the task force.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Dr. Nemer, will vulnerable population groups and those in rural Canada be tested as well?

[Dr. Mona Nemer]

Yes, absolutely. I'm happy to share, perhaps, the development that there will be an indigenous circle to work with indigenous communities. There are efforts already to look at what's happening in children, and longitudinal studies of health care workers to see when they developed immunity, until when, and so on.

A number of these are ongoing. I can't remember them all, but we've already started.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you very much.

Dr. Strong, while a number of groups in Canada are conducting research around a vaccine for COVID-19, Dalhousie University in my province of Nova Scotia has been the first to be approved for clinical trials. Can you tell me how CIHR will support Dalhousie University researchers through their development?

[Dr. Michael Strong]

There are two aspects to that. First, through the original initiative of the rapid response, we do provide funding through to researchers at Dalhousie who are participating in this. Second, we've been very involved, working with our colleagues at ISED, NRC, Health Canada and PHAC, in helping with the design of the studies that will be needed to know about the effectiveness of this.

We know that those studies will first be driven through Dalhousie for that, but at the current moment, we're in the process of really adjudicating a massive number of grants in which we expect we will see that roll-up coming into play.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Great.

How much time left do I have, Mr. Chair?

[The Chair, Liberal, Ron McKinnon]

You have two minutes.