Health Committee on May 20th, 2020

[Vito Ciciretto]

The ability to transmit results directly from an analyzer onto your laboratory information system and into provincial health repositories is critical from at least two perspectives. One is from a timeliness perspective. As soon as that test result is available you want to make sure that you're able to release it.

The second and perhaps even more important perspective has to do with accuracy. The minute that there's any type of human interaction, of taking a manual result from a machine and then transmitting it onto a computer, there's always that risk of error, and that's not something you want, obviously.

[Sonia Sidhu, Liberal, Brampton South, ON]

Dr. Fisman, as you know the Public Health Agency has its opinion on non-medical masks.

You also mentioned the mask adoption strategy; how is this beneficial to Canadians?

[Dr. David Fisman]

We don't know but we can be highly suspicious that it would help us a lot. Especially if we can get the reproduction number of the disease down to around one. That's a tipping point. At that tipping point, very small changes in infection transmissibility can really make the epidemic fall through the floor and go away.

What you have to remember about masks and disease like this is that masks work in both directions. They reduce the likelihood that you get infectious particles into your nose, mouth and eyes potentially, if you keep your hands off your face. They also prevent you from infecting other people. Probably the more important part with this disease is the reduction of transmission, which happens very efficiently even with cloth masks. The reason that's so important with this particular disease is that what we know of the work of Gabriel Leung and his colleagues in Hong Kong, which was published in Nature about a month ago, is they estimate about 44% of transmissions in Hong Kong occur in presymptomatic individuals. Those are people who are going to feel sick tomorrow, but they feel just fine today. They haven't changed their behaviour.

Masks can be extremely impactful because if I'm wearing a mask and I become infectious but I don't know it yet, I don't infect you. Everybody wants to wear a mask to protect themselves from other people. I'm fine to have folks leverage that to get the masks on. It's pretty clear. There's a reason why surgeons wear masks in the operating room because they block extrusion of respiratory droplets that infect with bacteria the patients they're operating on. This would be the same idea except out in public you're wearing a mask not to protect yourself necessarily—although it might—but to protect other people from you if you're infectious but don't have symptoms.

As I say, we've had reproduction numbers in Ontario and Quebec, which is basically where our epidemic lives now, rumbling along around a reproduction number of one. In Ontario it's been there since early April, we just can't seem to get it down. If anything knocks that reproduction number down to 0.7 or 0.6, we're going to get back to a lot more rapid economic opening up. We're going to be able to open up more. The lower we keep that reproduction number, the more we'll be able to open up the economy while still staying safe.

To me it's a no-brainer. We can argue about class 1A evidence or what have you. We can have a symposium about this in five years and decide what exactly the science shows. But now is the time for action.

As Professor Attaran said, we're burning through $12 billion a week. Getting masks on Canadians and teaching them how to use them is change from between the couch cushions relative to what we're burning through by keeping our society closed. To me it's worth the gamble.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to Mr. Desilets for two minutes and a half, please.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

My thanks to all the witnesses for joining us. The content they have shared with us is very interesting.

My first question is for—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Mr. Desilets, your sound is bad as well.

Could you try and unplug your headset and plug it back in?

I will suspend for a minute.

[The Chair, Liberal, Ron McKinnon]

I declare this meeting resumed.

Please go ahead, Mr. Thériault, on behalf of Mr. Desilets.

[Luc Thériault, Bloc, Montcalm, QC]

Okay.

Earlier, when I asked Dr. Fisman a question, I noticed that Dr. Schabas was reacting. I think he wants to answer the question.

It had to do with the rate of safe reopening that Canada should adopt in order to have herd immunity, given that we don't have a vaccine yet, we don't have antivirals, and we are just beginning serological testing.

My question is for Dr. Schabas.

[Dr. Richard Schabas]

One really profoundly unfortunate thing about what's happened in Canada, where we in fact did the lockdown in advance of our outbreak, unlike many places in western Europe or in the United States, is that in a sense we've had the worst of both worlds. We have achieved very little herd immunity, certainly no more than 5%, at least in the whole country, yet we've had a lot of deaths. We've had a lot of deaths because of the outbreaks in the long-term care homes. The population death rate in the city of Montreal is twice as high as it is in Stockholm, Sweden and is starting to close in on the city of New York. It's not been a very happy experience.

There were two kinds of outbreaks. There was the long-term care outbreak, which drives mortality, and then there's the community outbreak, where there has been very little mortality.

The fundamental question is: Is it safe to reopen in the presence of active disease? No, not in the sense that we're not going to see more COVID disease. We will. When we start to open up, we are going to see more COVID disease.

The whole thrust of my presentation is to look at it the other way. Is it safe not to open up? We talked, and one of the earlier questions was: When are we going to open the schools? Why are we opening the schools? There's going to be more COVID spread. Well, the reason you open schools is that children have to go to school. It's a fundamental right of children to have an education. If we deprive a whole generation of children of six months or a year of education, we're going to be paying the public health price for that for years to come.

There is no nice solution. Dr. Fisman and Dr. Attaran talk about doing more testing and contact tracing, something which, by the way, has never been done to control a respiratory virus. It may work well on a spreadsheet; the real world is more complicated. I hope they're right. I hope they're right and that works, but the real world is a rather more complicated place.

I was just going to say what I'm really worried about is that when they try the strategy and the disease resurges in the fall and the strategy fails, as I believe it almost certainly will, we can't go back into this kind of lockdown because we will do more long-term damage to our public health than COVID-19 could ever do.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Schabas, you wanted a chance to explain, so I'm going to put a few things to you. After SARS, you wrote, “In the unlikely event of another SARS outbreak in Canada, public health officials should quarantine no one.” Now, our current pandemic is a SARS outbreak. The virus is SARS-CoV-2. We fought it mainly with lockdown and quarantine. My first question is, are you standing by your extraordinary statement that we should quarantine no one?

Before I get to that, I want to contrast that. In 1990, when you were Ontario's chief medical officer, you classified HIV as a virulent disease, which is the worst category of characterization, and you recommended that we forcibly confine people with HIV who may have had sex with someone else, even if they used a condom and even if they disclosed that to their partner.

My final piece, before I let you answer, is that you said that we should treat this more like the 1957 flu, but the fatality rate in the 1957 flu was about 0.1%, which is about one-twelfth that of COVID-19.

Throwing all those together, can you help me understand your point of view?

[Dr. Richard Schabas]

I'll try to remember all of them.

First of all, let me start with the SARS 1 and the quarantine. I was talking about SARS 1. SARS 1 was a disease that was not transmissible asymptomatically and was not even transmissible in its early symptomatic stage, so quarantine made zero sense with SARS 1, and my hope was that it wouldn't happen again.

Yes, we've used it widely in SARS 2. Whether it's really been very effective, or whether it's a useful tactic, because as I've said before, you can maybe flatten the curve.... In fact, I'm quite impressed by our ability to implement quarantine, and I think it probably has to some degree flattened the curve, but the question is ultimately to what end? The virus isn't going anywhere, and unless the measures you're using to flatten the curve are somehow sustainable in the long term, I'm not sure they really get us anywhere.

On the third question, as related to HIV, yes, I had recommended it. I didn't do it. It wasn't up to me. I had recommended to the minister that it be classified in the same category as diseases like tuberculosis, syphilis, gonorrhea and hepatitis B. It was a classification that would give a judge the authority to incarcerate someone who was deliberately spreading the disease. That was the context of it. It actually never happened, and that's not quarantine. Please understand that quarantine is when you lock someone up who you think is incubating the disease.

Case isolation, which is a totally different thing, is that when you know somebody has the disease, you take steps to isolate them. I'm not recommending that we do this for HIV. That's a different context. That's what we do, in fact, when people have COVID or we have good reason to believe they have COVID. We isolate them. That's not quarantine. Quarantine is when you lock them up when you think you're incubating them.... The term “quarantine” itself derives from the 40 days of Lent. That's a medieval strategy and, by and large, I think it belongs back in the Middle Ages.

[The Chair, Liberal, Ron McKinnon]

Thank you.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have a point of privilege to raise before we adjourn, Mr. Chair.

I would like to move a motion that this committee inquire into reports that a witness appearing before the health committee, Dr. Amir Attaran, may have been threatened, punished, intimidated or otherwise harmed by the Public Health Agency of Canada, Statistics Canada or the federal government in some other form, because of testimony he has given at the health committee, and to determine if a prima facie issue of privilege has been raised and, if so, report such findings to the Speaker of the House.

Mr. Chair, I'm quoting from Bosc and Gagnon, which says this:

...the intimidation of a committee witness has also been found to be a prima facie breach of privilege. In 1992, a witness who had testified before a subcommittee was advised by a Crown corporation employee that the issue of her testimony was being referred to the corporation's legal department. The witness informed a Member, who raised a question of privilege in the House. The matter was found by Speaker Fraser to be prima facie contempt and was referred by the House to the Standing Committee on House Management for consideration.

In its report, the committee said this:

The protection of witnesses is a fundamental aspect of the privilege that extends to parliamentary proceedings and those persons who participate in them. It is well-established in the Parliament of Canada, as in the British Parliament, that witnesses before committees share the same privileges of freedom of speech as do Members. Witnesses before parliamentary committees are therefore automatically extended the same immunities from civil or criminal proceedings as Members for anything that they say before a committee. The protection of witnesses extends to threats made against them or intimidation with respect to their presentations before any parliamentary committee.

Mr. Chair, I could go on. There are many more. I move that there has been a violation of my privileges as a member of this committee, and I would ask that you act on the motion that I have moved.

[The Chair, Liberal, Ron McKinnon]

Mr. Davies, you're in a point of order. You can't make a motion on a point of order.

As far as the question of privilege goes, as I mentioned earlier, I believe that's out of scope for our authority to conduct these video conference meetings. We are restricted to solely receiving evidence relating to the government's response to COVID-19, and we are also allowed to make motions regarding the invitation of witnesses.

Certainly, as I've mentioned before, I will take the matter under advisement. I will look for a legal opinion from the clerk and from the legal clerk as well, and we can take this up at another time. I'll take that under advisement and—

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Chair, I would like to raise a point of order.

There were comments made in testimony today that I believe break parliamentary language. It was deeply disrespectful to call Canada's public servant untruthful. That comment should be removed from the committee record.

[The Chair, Liberal, Ron McKinnon]

Thank you for that point of order.

Certainly, we are bound by the rules of Parliament in our conduct here. I would certainly urge all participants, going forward, to be prudent in their language.

Thank you, everybody. I'd like to—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Mr. Chair, this is to Mr. Davies' point of order.

[The Chair, Liberal, Ron McKinnon]

Go ahead.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I'm reading the motion adopted by the House of Commons in the sitting on Tuesday, March 24, 2020. Section (i) states the following:

...if committee is not satisfied with how the government is exercising its powers under the Act, it may adopt a motion during a meeting by videoconference or teleconference to report this to the House by depositing a report with the Clerk of the House which shall be deemed to have been duly presented to the House on that day;

I would point to you, Mr. Chair, and also the clerk, to reference that point when coming back and addressing Mr. Davies' question of privilege.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I might, Mr. Chair—

[The Chair, Liberal, Ron McKinnon]

I'm sorry, I—

[Don Davies, NDP, Vancouver Kingsway, BC]

—I want to be very clear that I am not raising a point of order. I am raising an issue of privilege.

I can further quote that it says in the—

[The Chair, Liberal, Ron McKinnon]

Just hold on, Mr. Davies.

Thank you, Mr. Jeneroux, for your contribution.

I believe you did start your remarks, Mr. Davies, on a point of order. You then went into a question of privilege. It's kind of beside the point. I will take under advisement your motion. We will get back to you once I have a ruling from the law clerk.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, with respect, it's very important that you....

You're misunderstanding my point. Earlier I raised a point of order. I am now raising a question of privilege. That's what I did in my second intervention. You clearly have the power, in fact you have the duty, to receive my question of privilege as it's raised in committee, because this is where I have to raise that.

I'm happy for you to go back and reflect on it, but I want to be very clear that I am raising a question of privilege and I am asking for your consideration of the motion that I have moved.