Health Committee on May 19th, 2020

[Dr. Theresa Tam]

Well, I think that citizen engagement is very important because of their key role in stopping transmission. We look towards the study in British Columbia with great interest. I think we need to understand more of what the Canadian experience has been.

I'll just also point out—and I'm not sure whether CIHR, Dr. Strong, might wish to comment—that, in line with the biomedical research, there's actually social science and other research as well that is ongoing to look at Canadian perspectives. There's research looking at what Canadians think about contact tracing, for example.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is to Ms. Elmslie. We previously heard from the Canadian Federation of Nurses Unions, which had concerns about PHAC's guidance for PPE in health care settings. Can you explain to us what work you are doing with health care professionals to inform these national guidelines and standards? What kinds of evidence do you and your team use to inform these national guidelines?

[Kim Elmslie, Vice-President, Infection Disease Prevention and Control Branch, Public Health Agency of Canada]

Whenever we are developing guidance, we start with a review of what the scientific evidence tells us. Then we use a very wide network of stakeholders to help us interpret the evidence and identify gaps in that knowledge, and use that to develop guidance.

We also work with groups such as the Canadian Federation of Nurses Unions and other unions, because they bring important perspectives to the table from their knowledge of what's happening on the ground. Whilst there can be debates on the interpretation of science, we always bring those perspectives from workers into the conversation. We take their questions and concerns and refer them back to the experts. It's a bit of an iterative process to arrive, finally, at the set of guidelines that we believe at the Public Health Agency, based on our assessment, are the most important, most reliable and most accurate guidelines at that point in time. The reason they're interim is because we're always looking at evidence and are always analyzing evidence, and that may update or change our guidance.

One of the other things we're doing to stay in contact with the nurses' unions and other important unions across the country is having a weekly meeting where we invite those stakeholders to share their experiences. I use those opportunities to give them an update on the guidance that we're developing and on other things that are happening at the agency. They very generously use that time to indicate where they have concerns and where they would like to see the Public Health Agency of Canada doing more work.

It's a really important dialogue that we are maintaining. People don't always agree, but what's important is that we're listening carefully to each other's perspectives. In fact, the perspectives that the Canadian Federation of Nurses Unions brought to us during this process led us to clarify areas in the guidance that perhaps were confusing, and to adjust areas where we felt, based on their interventions, we could make important changes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Can you explain the guidelines for the home care settings as well?

[Kim Elmslie]

In developing guidelines for home care, we used the same process, in the sense that we're bringing the experts together using the evidence, and then bringing together the communities that work in these areas to ensure that the guidance is highly relevant to them and they can use it in practice. What we've learned is that technical guidance often needs to be used in different formats so that people can apply it easily on the ground. In the context of home care, it's really important that those important workers are well supported as they do their jobs in different contexts. Our guidance is always going to be based on what we've learned, what we know and how we can best adapt it to meet the needs of those workers in as clear and relevant a fashion as possible.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Jeneroux, please go ahead for five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Mr. Chair, before I get to my questions, I would like to go back to the timeline and Dr. Tam. On January 26, the National Microbiology Laboratory received its first case, and a lots of the decisions that were.... Going back to January 26 is when the first case came to Canada. There are questions about the role and the sense of urgency that the Public Health Agency plays in this country, seeing as some of the decisions that we've seen up until this point were not made until late February or March.

That being said, I want to ask some of my questions, particularly when it comes to the PPE supplies. We sent 16 tonnes of PPE to China in February. Has that allotment sent to China been fully replaced by China?

[Dr. Theresa Tam]

I don't know exactly how to answer that question. I know that there are various donations. I have not been particularly involved in the exact logistics. We can get back to you.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Have we been keeping track of that 16 tonnes? It would be great to know if we're even close to that number in getting that 16 tonnes back.

A 2011 report said that the Public Health Agency had 11 NESS warehouses spread out across Canada. That same 2011 report said that there were 1,300 prepositioned sites containing supplies. Sally Thornton, a vice-president under your supervision with the Public Health Agency and in charge of the NESS, said that there were only 1,000 of those sites in 2012. How many of those sites existed at the start of this pandemic?

[Dr. Theresa Tam]

Sally Thornton is the VP closest to the specifics of NESS so I think definitely take her numbers. I know that a lot of those prepositioned sites were cots and blankets, essentially, not actually PPE or any of the medical countermeasures.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Would it be possible to get that number from you or Sally, Dr. Tam, of how many sites that we had remaining from those 1,000 in 2012?

[Dr. Theresa Tam]

Yes, we can get that to you, but again, they were small stashes of sort of post-Cold War kind of equipment, I think, so—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I think it would just be helpful to piece together the whole story here, if that's all right.

Just because I'm short on time, I'm going to move quickly. In documents obtained by this committee and a briefing note dated February 10, it is mentioned that the Public Health Agency is conducting a PPE survey on provinces' and territories' supplies for areas of vulnerability to ensure sufficient supply. What date did that survey begin?

[Dr. Theresa Tam]

I'll have to get back to you. I know that the survey continues in a very diligent way, but we'll have to get back to you on the specific date.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Was it before or after February 4? Would you know?

[Dr. Theresa Tam]

I do not know. We'll have to get back to you.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I'd previously requested a copy of that survey from Sally Thornton. Hopefully, between the two of you, we'll be able to get a copy of that survey. She had agreed to provide this survey and we're looking to see the results of that survey.

Do you think Dr. Bruce Aylward's attending our committee would benefit the committee's ability to review the government's response to COVID-19?

[Dr. Theresa Tam]

I think the committee should feel free to invite your witnesses. Dr. Aylward obviously works for the WHO and he was a critical component of the WHO response. He's not part of the agency. He doesn't work in Canada so I think.... I'm sure the WHO gets invited to committees such as this, so I think please invite the witnesses you think would be helpful to you.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Just a point of clarification for the witness, Mr. Chair, Dr. Aylward has been invited to this committee. He has turned down the invitation a number of times. We actually had to put forward an official summons to have him appear.

That would lead me to assume that there hasn't been a sense of seriousness undertaken by the WHO to actually come to this committee. Any sort of pressure that Dr. Tam or Minister Hajdu could put on Dr. Aylward or members from the WHO to take this committee seriously would certainly be appreciated, I think, by all members of this committee, because we did vote unanimously in favour of having him come. We also voted unanimously in favour of the summons. I would hope that in the next conversations, in any conversations, Dr. Aylward would be encouraged to come forward to this committee.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

Mr. Van Bynen, go ahead, please. You have five minutes.

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

Thank you, Mr. Chair.

Thank you, Dr. Tam, for joining us today, and thank you so much for your incredible dedication to Canadians through this pandemic, particularly when you tend to get barraged in second-guessing some decisions that were made on the basis of the knowledge that was in our hands at the time.

I appreciate your coming back to the committee to update us. You've provided a number of updates on modelling. Do you have a new update that you could share and provide to the committee today? I promise you that I will listen to your answer, because I genuinely want to hear an answer.

[Dr. Theresa Tam]

I think the most important updates decision-makers or Canadians want to hear is where we are at and whether things are getting better. I think all of our indications are that the epidemic is definitely slowing down.

One of the things that we looked at was the rate of drop in cases. The case counts over the last seven days compared to the previous seven days have dropped by about 13%. When we looked at what we call the doubling time, the epidemic showed exponential growth at the beginning, so the doubling time was about three days, which is very fast. Now it is almost an irrelevant indicator because it's now over 30 to 60 days, so that tells you that the rate of increase or doubling is definitely slowing down.

There is one indicator that everybody is interested in, which is what we call the effective reproduction number. This looks at whether one Canadian transmits to fewer than one Canadian, in which case the chain of transmission will break.

This number at the national level is less meaningful than perhaps looking at a regional level, because we have regional epidemics, but right now it is below one. Below one is where we want it to be. We want to see it really below one, and that is sustained in terms of that trajectory, but it is very different in different provinces.

Many jurisdictions have no community transmission or have the epidemic under control, but, we are keeping an eye on Ontario and Quebec, because the two provinces account for about 85% of cases and 94% of the deaths. Looking at their rate of the slowing down of the cases and their hospitalizations and deaths is extremely important as we look at this.

Basically, with the regional epidemic in mind, which is different, all provinces are showing a decline, basically, in their projections. Again, my message is that we are optimistic, but we must be very, very cautious, because in this next phase, if we ease the measures.... Again, modelling will show different scenarios as to how much of a release in these public health measures one can afford to do. You've seen some of that from British Columbia as well. The modellers are very much all working really hard at this. Really, it's the final epidemiology where, if we do see cases reignite, we will have to leap on them really, really fast. That is the premise of the testing and contact tracing.

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

In spite of what we heard was or wasn't done, can you confirm to me that Canada is flattening the curve?

[Dr. Theresa Tam]

Yes. The collective actions of everybody in Canada, including every citizen who heeded public health advice, have brought the initial epidemic wave to begin to be under control, but one mustn't forget that there are still outbreaks in Ontario and Quebec, in particular in certain hot spots, so we haven't quite finished that yet, and we have to be very cautious.

Really, it's the collective action of the whole population. That's how complex this disease is. No one single layer of government can do this, but the whole society has to continue to help.

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

Dr. Tam, over the weekend you shared the great news that 50% of the COVID-19 patients in Canada have recovered from the virus. While that's great news, we aren't quite through this outbreak yet, and I think you share my concern that, as the weather gets nicer and the numbers get lower, more people will be tempted to return to their regular activities.

What is your advice to Canadians on how to find a balance between maintaining an effective, safe practice and also finding ways to take advantage of the nicer weather?