Evidence of meeting #21 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.
A recording is available from Parliament.
Conservative
Chief Public Health Officer, Public Health Agency of Canada
I think, like all other countries, we learned the specific infection prevention control measures that are fundamental to public health and that we all know work: staying home when you're sick, washing your hands, covering your cough, all of those things.
I think we're learning a lot more about how we apply border measures and travel health advice. We'll continue to look at what other countries are doing and what happens, particularly during this time, as economies or societies open up in other countries. We need to look at what happens to them and learn from them as well.
Liberal
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Tam, I know hindsight is 20/20, but let's look to the future and base decisions on science and evidence.
What about the possibility of some sort of mandated use of masks in Canada? There is plenty of evidence out there that masks are a benefit, mostly in preventing transmission from somebody who has the disease—perhaps people who are still asymptomatic and don't know they have the disease—to other people.
There's a whole bunch of studies. Let me quickly run over some of them.
Howard et al, in a study that hasn't yet been published, but that looks as if it'll be published in Proceedings of the National Academy of Science, looked at the evidence and concluded, “The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts”.
In the Annals of Internal Medicine a recent meta-analysis of 64 studies showed that transmission was decreased by 50% to 80% in health care settings. A Leung study on other forms of coronavirus showed decreased transmission when people who are infected have masks. There was a well-publicized, light-scattering study in the New England Journal of Medicine showing what happens when you have a mask and when you don't have a mask. A number of papers have been written on modelling, looking at what happens when you add masks—even if they're not a solution, but do have incremental benefit—combined with other public health measures, indicating that these can significantly reduce the transmission of disease and the progression of the pandemic.
Many countries in Southeast Asia that have done very well in their response to the pandemic by requiring masks in public settings. Places like Taiwan, Singapore, Thailand and 90 countries globally have some kind of mandated use of masks.
To top it off, there's a recent open letter in the United States, signed by 100 prominent medical people, to governors across the United States. A lot of people who wrote this letter were from Harvard; there were two Nobel laureates, and people from Cambridge, Oxford, Berkeley—all the big schools—and their conclusion was that requiring the use of fabric masks in public places could be among the most powerful tools to stop the community spread of COVID-19. They too are calling for mandated use of masks.
We're spending billions and billions of dollars in dealing with this. It's really important that we don't screw up as we come out of our initial social isolation. How about some form of mandated use of masks?
Chief Public Health Officer, Public Health Agency of Canada
As I've just said, the federal-provincial-territorial special advisory committee, which includes the chief medical officers of health, has been reviewing the evidence, much of which you have just cited.
The committee really wanted to ensure that there is flexibility according to local context and epidemiology. In provinces and territories where there hasn't been any community transmission, that's a bit different than in certain provinces where that has already occurred.
As we're exiting and beginning to cautiously and slowly relax some of the public measures, we have updated our recommendation on the use of non-medical masks. The way it is positioned right now—based on the evidence, but also on Canadian epidemiology—is that when the local epidemiology and rate of community transmission warrant it, the wearing of non-medical masks or cloth facial coverings is recommended for when you can't physically distance from others, particularly, as you can imagine, on public transport, in grocery stores and in retail places. It is a matter of your protecting others, so “I protect you and you protect me” is part of that.
As to what exactly happens in the individual jurisdictions like Toronto or Montreal, they need to have the flexibility to do that. It is, as you said, an added layer of protection, as long as everybody remembers that it doesn't necessarily negate the need for physical distancing and hygienic measures. It is certainly an added layer when you can't be assured that you can get that two-metre physical distance from others.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Tam, I'm sure you would agree that it would be wonderful if everybody in society did the right things, but that isn't the case.
Would you be willing to consider the possibility of mandating the use of masks in places where there are still significant numbers of COVID-19 cases, such as Montreal and Toronto?
Chief Public Health Officer, Public Health Agency of Canada
Again, that's a jurisdictional flexibility. As you will see, Montreal is increasing that kind of recommendation. Also, you have to support people to be able to meet those recommendations, so ensuring that those, for example, who can't.... We need to make sure that it is available to all segments of society as well.
Canadians played a very, very big role in controlling this epidemic, and we must bring them together and their collective actions. The wearing of a mask is a massive social behavioural change, and I do believe that momentum is now there, so engaging Canadians and maintaining their trust is very important. Whether you're mandating it, I think, then depends on what happens in your local jurisdiction as to whether it is warranted.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Tam.
We'll go now to Mr. Thériault.
Mr. Thériault, please go ahead. You have six minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
My first question is for Dr. Tam.
Dr. Tam, as you will recall, the first few times you appeared before the committee, mainland China was the world epicentre of the outbreak. We talked about the very definite threat for our neighbours to the south given their health system, which leaves the equivalent of Canada's population out in the cold. They don't have access to health care, so screening them is a challenge.
At today's press conference, you pointed out that the massive reduction in international travellers has allowed Canada to manage the first wave of this pandemic. In hindsight, would you have recommended closing the border with the U.S. sooner?
Chief Public Health Officer, Public Health Agency of Canada
I think the virus itself travelled across the world very fast and so, while the initial epicentre was China, we also picked up cases very soon. The Canadian surveillance system was able to pick up cases from Iran, but it was really the cases from Europe and the United States that had the greatest impact on the introduction to Canada.
As I said, at that time, because of a very few cases we were taking incremental measures. Shutting down the longest land border in the world is a massive decision and is one for decision-makers. In retrospect—and maybe looking forward—the world might be a very different place in terms of whether this kind of measure is enacted. We will learn from these lessons but as you can imagine, you have to look back and also think about whether this is how we manage every epidemic.
For sure, this is something that is unprecedented. Practically every single country enacting travel bans is a huge—
Bloc
Luc Thériault Bloc Montcalm, QC
Pardon me, Dr. Tam. With all due respect, my question was very straightforward.
Our neighbours to the south have 1,500,000 cases and 91,500 deaths. In hindsight, would you have recommended closing the border with the U.S. sooner? When did you recommend to the government that the border be closed?
Chief Public Health Officer, Public Health Agency of Canada
I think, again, with hindsight, at that time there weren't a lot of cases. If you had asked policy-makers at the time whether they would have closed the border— I'm not going to second-guess what they may think now—with all the lessons learned and knowing that some instantaneous travel restrictions are an option with, of course, the society willing to take all the different consequences of that—
Chief Public Health Officer, Public Health Agency of Canada
—going into the future, you may want to consider it faster.
Bloc
Luc Thériault Bloc Montcalm, QC
Dr. Tam, you're giving me the same answer. I'm not sure whether you don't want to answer the question, even though it's quite straightforward.
In light of the case you're making now, would you recommend closing the border with the U.S. sooner? When did you make that recommendation? On June 21, are you going to recommend reopening the border?
The Prime Minister said that his actions were science-based, and you are the voice of science. I'm asking you a straightforward question, and I'd like a straightforward answer.
Chief Public Health Officer, Public Health Agency of Canada
What happens in June depends on the epidemiologic situation in the United States at the time. We'll continue to evaluate it but, right now, I think the recommendation, together with the chief medical officers, is we need to keep that border restricted as it is now.
Looking back, could you have done it faster? Possibly. I think that is definitely something that could have happened faster, but this virus was travelling in invisible ways. A lot of things happened very quickly around March 13th, the 18th and, I think, it was the 21st when, successively, travel restrictions were placed very rapidly as soon as we got the sense that this virus was actually in every country. We didn't just start with Europe and the United States. We went with travel advice as well as the travel restrictions essentially for the world, because you couldn't really tell where the virus was going to come from.
In hindsight I think that, yes, people could have acted faster and maybe in the future we would take different positions. That remains to be looked at in lessons learned.
Bloc
Luc Thériault Bloc Montcalm, QC
That matters because the Prime Minister consistently reminds us that all of his decisions are science-based.
The committee is gathered here today, and with all due respect, I would say that the voice of science is struggling right now. I think it's important to be clear in response to clear questions. I don't want to hear why it was slow in coming. I think it was done too late, but beyond that, we need solutions for the future. What I take away from your answer is that we should have closed the border sooner.
Chief Public Health Officer, Public Health Agency of Canada
Well, again, we're learning about this situation as we go. It's an absolutely unprecedented move. I think going into the future, having learned what we've just learned, actions may have been faster. Right now, though, I think some of the really key measures we've put in weren't necessarily just closing the border and reducing the numbers. It's also been asking people to take the 14-day quarantine measures. I think that is essentially the cornerstone of what we need to do going forward as well.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Thériault.
We go now to Mr. Davies.
Mr. Davies, please go ahead. You have six minutes.
Mr. Davies, you're muted.
Let's suspend the meeting for a couple of minutes and get Mr. Davies sorted out.
Liberal
The Chair Liberal Ron McKinnon
We'll now resume the meeting.
Go ahead, Mr. Davies. You have six minutes.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Dr. Tam, you spoke of the importance of data and keeping Canadians informed. I share that commitment with you 100%. You said that you altered your advice on masks because of your review of the emerging evidence.
Will you share the emerging evidence you reviewed that caused you to change your recommendation on masks to this committee—not right now, I mean, but afterwards? Will you send us that evidence you relied on?
Chief Public Health Officer, Public Health Agency of Canada
Yes, absolutely.
