Health Committee on May 20th, 2020

[Prof. Amir Attaran]

In terms of bending the curve, Dr. Fisman can be more detailed on this, but it's clear that we have not adopted as rigorous a lockdown as some other countries have. We've also had a slow-burning problem in the care homes and this has taken what could have been a sharp peak and broadened it into something of a plateau.

I am very uncomfortable with the fact that we are opening up without the testing at the necessary level, or the tracing. I'm not saying I don't want to open up. I hate being locked up as much as anyone else—you should see my children. There has to be groundwork done, and it is the fact that the governments of this country—some of them, especially the federal government—just haven't done the groundwork.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

That ends round one.

We will start round two.

Mr. Jeneroux, please go ahead. You have five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Thank you to the witnesses for joining us here again today.

I want to address Dr. Khan and some of the comments you made. In particular, I am hoping to get a grasp on when BlueDot—obviously ahead of the curve, early on—provided the first data regarding the coronavirus to the Public Health Agency of Canada.

[Dr. Kamran Khan]

As I mentioned in my opening remarks, our surveillance system had picked this up on December 31. You may also be aware that the Public Health Agency of Canada has a platform called the Global Public Health Intelligence Network, GPHIN. There are some parallels with the platform we're using. I think we may be using a bit more machine learning and artificial intelligence in our system.

I believe, with respect to awareness of the event in Wuhan, this was at a similar time; I believe it was around the end of December or beginning of January. We have had, as I mentioned, a relationship with the Public Health Agency, going past detection of threats and then looking at dispersion, how they might spread and where they might go next. All of the systems that we use internally—software systems, all of the internal data on commercial flights, passenger movements around the planet—are accessible by the Public Health Agency. This is part of our partnership.

I also did share the results of some of our analysis directly with Dr. Tam back in early January—I believe it may have been January 4 or 5, a few days after the new year. I communicated some of our initial findings and then had a follow-up meeting, I think, around the January 9 or 10 to discuss some of this in person.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

What information did you provide exactly? Did you provide that information from December 31 that you had attributed to the beginning of this?

[Dr. Kamran Khan]

Because the Public Health Agency already has a surveillance system and GPHIN had picked up news of the outbreak in Wuhan around the same time as BlueDot, we didn't send them that information because it was something they already had access to. But we have been working with the Public Health Agency around contextualizing this.

Understanding that something is appearing in the world is very different from understanding what risk it presents to Canada and where those risks are greatest at the particular moment. Is it in British Columbia, in Halifax, or somewhere else?

We shared some of our findings on the movements of travellers across the world with Dr. Tam and her office and then met in person to discuss some of the results and, more broadly, really, the need for systems. We had some earlier comments about data internally within Canada. We're clearly not a closed population; we are a microcosm of the world, one of the most connected populations on earth.

It was critical for us to have better systems not only to detect threats but also to quickly assess what risks they present, so that we could be a step ahead and mobilize our resources, heighten our surveillance in the right places at the right time, and to share with you the specifics of the risks associated with the events in Wuhan. That was really just a few days after New Year's in early January.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Did you make any recommendations at that time about shutting down borders and what that would mean to Dr. Tam, and perhaps her team?

[Dr. Kamran Khan]

We discussed obviously what the risks were, but, of course, as you remember, in early January we didn't even know this was the coronavirus. Clearly it caused enough concern from our end just because there were some parallels with the SARS event that had emerged in late 2002 in Guangdong. We had some concerns given the parallels with SARS.

However, as more information became available, as soon as we knew this was a novel coronavirus, we did follow up directly with Dr. Tam and her office. Obviously, they were aware, but our concerns at that point were that we knew the last two novel coronaviruses, MERS and SARS, had killed a third and 10% of their patients, respectively. They have no known vaccines, no known effective antivirals.

A novel coronavirus means that the whole world is susceptible, and that's a lot of fuel for an outbreak, and it's in the middle of wintertime, which is when you have respiratory illnesses. Given the signal-to-noise ratio and the detection of this behind a whole background of febrile illnesses, that certainly caused us quite a bit of concern.

The last point I will make is that I believe it was on January 13 when the first case was reported in Bangkok. By the way, coincidentally, it was the top city that we had identified as being at risk. At that moment we knew this was not a few dozen cases. In order for there for cases to be showing up in a city of 11 million, we had to be dealing with hundreds, maybe even thousands of cases. That was really the moment we became quite concerned, but of course with emerging diseases, unfortunately, you learn as you go. You don't have all the answers and you have to make decisions as new information becomes available.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Mr. Chair, do you mind if I request that Dr. Khan share that early information he provided to the Public Health Agency with the committee?

[The Chair, Liberal, Ron McKinnon]

Sure.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thanks.

[Dr. Kamran Khan]

I'd be happy to do that.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

We go now to Dr. Jaczek.

Dr. Jaczek, please go ahead for five minutes.

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

Thank you very much, Chair.

Thank you to all the witnesses. This session has certainly been fascinating. There has been a real divergence of views, especially from the first three witnesses.

Thank you, all three, for your very considered opinions. We go from one extreme, with Dr. Attaran saying that we haven't gone nearly far enough, to Dr. Schabas saying that perhaps we have gone too far.

Speaking as a member of this committee, of course we're very interested in all of your opinions, but part of what we need to do is to find some commonality, to find where there is agreement. The area where there seems to be agreement, and that we have heard a great deal about from many witnesses, is that there needs to be more of a national data surveillance system as it relates to public health. It's been exemplified by many of you that in fact provinces are collecting data differently. Even in the use of the case definition, there has been a difference from province to province.

Dr. Schabas, given all of your experience, and having known you for so very many years in the trenches, in both urban and rural settings, I will address this question to you. At the end of your remarks, you made a comment in relation to a national surveillance system. I'd like to hear from you on what kind of data you would like to see and where the important areas are that need to be collected. I'm sure you've had to make decisions based on inadequate data, or not as much data as you would like to have had, on many occasions. Could you flesh out for us how you see that national surveillance system?

[Dr. Richard Schabas]

Thank you, Helena, and thank you again for arranging my invitation to this meeting. It's been great. It's been fascinating listening to David and Amir. Maybe at some point I'll have a chance to rebut some of the other things that have been said.

On the notion of having a national agency, we were always very envious of the Americans. They had the Centers for Disease Control, a highly respected agency that led and that took the high ground. It was where everyone turned to for advice and direction and guidelines. We had the old Laboratory Centre for Disease Control at Health Canada. There were some very good people there, but it didn't have the same clout—

[The Chair, Liberal, Ron McKinnon]

Dr. Schabas, could you speak a little bit closer to the mike and maybe a little bit slower for the interpreters?

[Dr. Richard Schabas]

I'm sorry.

The idea emerged almost 20 years ago—I actually wrote an editorial in the Canadian Medical Association Journal on this—of really proposing a national agency that would fulfill some of those roles. I think we had an opportunity 15 years ago after SARS, when there was this surge in interest in public health and improving our national public health capacity, which led to the—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Dr. Schabas.

The interpretation has stopped. We'll suspend for a minute until that resumes.

[The Chair, Liberal, Ron McKinnon]

The meeting has now resumed.

Dr. Schabas, please carry on.

[Dr. Richard Schabas]

As I was saying, 15 years ago, the vision I had hoped we would adopt was not so much one of a federal agency, but a national agency. We had some resources with the federal government, but it was also a time when Ontario was developing Public Health Ontario and British Columbia was augmenting the BCCDC.

There was a real advantage in developing a sense of co-operation between the federal government and the provinces, because the reality is that the provinces collect the data and the provinces make most of the public health decisions. You don't have the federal authority to tell them what to do. They're going to do what they want to do. The only way to get consistency in a truly national approach to a problem like this is to get people to buy in, to get people to be willing to do it because they think it's the right thing to do and because the prestige of the direction they're getting from the national agency is sufficient for them to.... I'm not going to say fall in line, but be consistent with their approach.

We don't ever expect everything to be the same. Here's a great example: Why should British Columbia be doing with COVID what Quebec is doing? They are very different sorts of situations. I think we would all be much happier if we knew there was a common purpose, common objectives and a common directive.

I'm hoping, maybe a little naively, that there will be another surge in interest in public health—I'm sure there will be—after the COVID crisis comes and goes. I hope we rethink how we set things up. That's not a criticism of the Public Health Agency of Canada. I just think it would function better if it was better integrated with the provincial agencies and if the provinces and the federal government were truly partners in this.

[The Chair, Liberal, Ron McKinnon]

Dr. Jaczek, your time is pretty much up but because of the problem in the middle, I'll give you one more question.

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

Thank you, Chair.

Dr. Khan, perhaps I can ask you. Obviously you and BlueDot have been very helpful to the Public Health Agency of Canada. What kinds of interactions have you and BlueDot had with the provincial agencies, such as Public Health Ontario?

[Dr. Kamran Khan]

We have had interactions with the ministry of health in Ontario and have been actively working with the province there. At BlueDot, we're a team of about 50 people. We're also working via Global Affairs Canada—