Health Committee on May 20th, 2020

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I am going to address Professor Attaran first. These days, we can say that science is being tossed around a lot. All decisions are supposedly made in the name of science. One might even think that it is being used more to justify some political dithering.

Mr. Attaran, on page 3 of your brief, you say the following:

...the Prime Minister hesitated, perhaps because of the scientifically inaccurate advice from his Minister of Health, that closing the borders to slow the disease down is “very ineffective.”

Some people argue that border closures have no significant effect in stopping the spread of the disease. I understand you disagree. Should the borders—especially the U.S. border—have been closed much sooner?

Did we have all the information we needed to make that decision? If not, what would have been required to make that decision as quickly as possible? What is the reason for the conflicting scientific advice?

[Prof. Amir Attaran]

You are right that scientific issues are often politicized, and that was the case with the border closure.

In my view, the purpose of closing the border is to protect us, especially in the case of the U.S. border. However, as you already know, the WHO says that it is almost useless, and the minister said that it is useless, but I disagree.

I know that, after the disaster we are now experiencing, we will rethink these issues. In Africa, for example, the borders between countries were quickly closed. They learned that lesson from the Ebola crisis. Now we see that nations are more protected. The infection rate in Kenya and Rwanda, for example, is lower than it would normally be. So it works.

[Luc Thériault, Bloc, Montcalm, QC]

Some witnesses have told us that we cannot fall behind in the case of this virus. The fact that the incubation period is often 14 days means that, since the beginning of the pandemic, we have constantly been feeling that we are playing catch-up. So I imagine that things should have been done differently and that decisions should have been made much more quickly.

You were talking about structural and systemic difficulties related to the Confederation and the inability of the scientific community and public health authorities to work in a coordinated manner and in real time with respect to sharing data.

What is the point of not working together? What justifies it? You gave the example of Ontario during the SARS episode. What is the point of those provinces or Quebec not working together? I have trouble understanding that.

[Prof. Amir Attaran]

I don't understand it either. It's almost dangerous to think of our Confederation as 10 provinces that are not connected through their biomedical resources, especially considering the virus that's connecting us right now. You are right.

[Luc Thériault, Bloc, Montcalm, QC]

How could legislating or establishing regulations be more effective? I'm trying to understand the motivation behind this inefficiency.

[Prof. Amir Attaran]

To answer more effectively, I have to speak in English. May I?

[Luc Thériault, Bloc, Montcalm, QC]

Yes, of course.

[Prof. Amir Attaran]

I'm sorry, but some of the legal words I don't know in French. I try.

The order in council that would be necessary to make data exchange mandatory between the federal government and the provinces is not a controversial thing. It is something that Parliament put into the law in, I believe, 2004 or 2005. Simply put, it should be used. We should not let our preconceptions about the appropriateness of what the province may do, or what the federal government may do, stand in the way of the clear reading of the law. You, as parliamentarians, created that law on sharing, and I'm grateful to you for doing so. It's a very useful tool, but it does need to be used.

I think Dr. Fisman would probably be able to add something to this.

[Dr. David Fisman]

I'm not sure, though I could add my perspective as a researcher based in Toronto since 2006.

What I've always found astounding is the failure to make accessible data that are paid for, assembled and cleaned on the public dime available to Canadians in a manner that doesn't threaten anyone's privacy or well-being. I've found that astounding for a long time.

A lot of my work, since I've come to Toronto, uses the national hospital discharge survey from the United States, which is pretty similar to the stuff you get from CIHI, except that if you ask for the data online from the CDC, they will FedEx it to you and pay for the FedEx, whereas if you ask for the same stuff from CIHI, you pay them. I don't understand it.

There's a much deeper issue here than COVID, and I thank my colleague for flagging it. We have a culture of what I call data hugging in Canada, and it does need to change. It harms us all.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We will now go to Mr. Davies.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Fisman, last week you were interviewed on TVO and you said, “I think there are a lot of folks who are itching to declare victory and open things up again, which is a bit of a problem because the reason that infections are subsiding is because we have distancing in place.” Are you concerned that some provinces and territories may be moving too rapidly to open?

[Dr. David Fisman]

I think my own province is, and I appreciate tremendously the pressure our premier is under. I think he's done a marvellous job given the cards he's been dealt, but I'm also aware there are a lot of folks who want to get back to business.

I'm not sure whether doing a screen share on Zoom is part of parliamentary committees, but we are looking at reproduction numbers here in Ontario. That is the number of new cases per old case. What we see is that the disease has clearly surged over the last week in Toronto, particularly in Peel. Part of that is from the liberalized use of testing, which drives the numbers up. Part of that is probably from the anticipation of greater economic opening. I think we may get a couple of rude bumps along the way, but ultimately distancing will be our parachute. If things start to look too grim, they'll be able to close things back down again, but, yes, I'm concerned that there's tremendous momentum to get folks back to business.

There's a lot of economic activity that could resume safely in the province of Ontario. Ontario is a big place. It's bigger than France, and we have regions.... Dr. Attaran referred to the city of Kingston. It has had one or two cases over the last 10 days but is subject to the same blanket lockdown as Toronto and Peel, which have had a couple of hundred cases a day. I think more—

[Don Davies, NDP, Vancouver Kingsway, BC]

I'd like to direct you to some of the things we should be doing.

You also said in the interview, “Predictably, as we reopen, we’ll see a resurgence of disease.”

[Dr. David Fisman]

Right.

[Don Davies, NDP, Vancouver Kingsway, BC]

That's exactly what we've seen in Korea and in Germany this week, two places that controlled their initial epidemic faster than we did and are moving toward revitalization. They've seen resurgences, just as Singapore did before them and just as Wuhan did last week.

What do you recommend we do, given that you see resurgences? What steps should we be taking to get in front of that, if there are any?

[Dr. David Fisman]

The resurgences will happen. It's just how this works. It's simple math. The reproduction of a disease is number of contacts times the probability of transmission per contact times how long a person is infectious for. We can forget about immunity right now, because immunity is low. Even if it's 5%, it's too low to bring the reproduction number down. Therefore, as contacts go up, the reproduction number predictably goes up.

[The Chair, Liberal, Ron McKinnon]

Doctor, could you please hold the mike?

[Dr. David Fisman]

My apologies.

We're going to go too far. We're going to try to open things up and go too far. That's why we need strong surveillance systems, to see that as it happens.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to move to testing. Maybe you and Dr. Attaran can comment on this.

We hear repeatedly at this committee, from every expert, that we have to test, test, test, and that it's key to getting control of this disease and reopening. However, we've barely done a million tests since January. Wuhan is gearing up to do a million tests per day. We're behind Germany. We're behind South Korea. In fact, we're at barely half of Dr. Tam's target of 60,000 tests a day.

Why are we unable to test at the rate that all experts are telling us we need to? Where is the problem here?

[Dr. David Fisman]

I don't know. Mr. Ciciretto is an expert on how labs work and could probably give you a more meaningful answer than I could.

We do work with local public health units. My concern at the moment is that it's not just the testing. If people are saying we're going to do contact tracing once we open up and we're going to track the contacts of cases as they did in Korea—I think they had a couple of hundred secondary cases associated with a nightclub outbreak—I don't think we could do that.

We have lags all the way along and it gets back to the 1990s technology where it takes time to test, the tests get faxed, it takes a while for them to percolate through the public health system and—

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm sorry to interrupt, but I want to give Dr. Attaran a chance to weigh in on this too.

Other countries are testing at much higher rates. Why can't Canada do it?

[Prof. Amir Attaran]

Again, I am not a testing expert. What I can say is that it's obviously a systemic and administrative problem, because for Ethiopia or Rwanda to be surpassing us in testing.... They're getting the reagents and supplies from somewhere. They are pulling it off.

I did mention the city of Addis Ababa, the capital of Ethiopia. They have actually sent health workers around to every door in the city already to interview people about their travel or exposure history and test them if necessary. If Ethiopia can do that, I refuse to believe Canada can't. We just need to understand better—and I'm not the person to give you the answer—what the administrative holdup is in the testing, but it's clearly administrative not scientific.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Dr. Attaran.

I have one quick question for you.

Your chart spoke for itself. The question I have is why is Canada performing below comparative countries like Australia and other countries you mentioned. Your chart clearly shows we are. What are the reasons for that?

[Prof. Amir Attaran]

In terms of bending the curve, or the testing, specifically?

[Don Davies, NDP, Vancouver Kingsway, BC]

Bending the curve.