Thank you very much, Mr. Chair.
Good afternoon, standing committee members.
My intervention will be limited to my area of expertise, which is, basically, tackling regional epidemic-pandemic responses at the micro and macro levels as a humanitarian aid worker and then through my training as a master in education and health management. We're nearly going to hit the 100-day mark of the pandemic, and very sadly, in Quebec, we have reached 5,000 deaths of patients with COVID-19.
I want to remind everyone that we still don't have a vaccine, that we still don't have a specific treatment, and that we still don't know much about the immunity that we have once we have the infection. Therefore, our best friend and best way of tackling it is mitigating measures for the response, so my speech will be about preventing the preventable.
We have a duty to absolutely learn the lessons to be learned after these 100 days. I think that we have to understand, as well, that there's a cost for response, but that despite the cost, because of the pattern of recurrences of pandemics over the last 15 years—SARS in 2003, swine flu in 2009, MERS in 2012, Ebola in 2014 and 2015, Zika in 2015, and now COVID—whatever we're doing right now is a rehearsal for next time around, and it's an investment. We've learned a lot, and we've managed throughout the pandemic to manage a shortage of inventory. Some variables have been impacted and I think I will not go there because my first statement a few months ago highlighted that. The procurements, the patient beneficiaries, the personnel and the hospital were some of them.
The lesson that we learned over the last few months is about the brutality of the disease and the loneliness of patients dying alone. We learned about the different vulnerable communities: elders, people in prison and homeless people. We learned about how to isolate people in their communities. We learned the hard way how to personalize IPC, infection prevention control, in a meaningful way. We learned as well, hopefully, that we have to protect, mentally and physically, all our staff and front-line workers. We learned that we should manage the mobility of people. We learned that outbreaks happen in hospitals, even university hospitals, more than we want. We learned that communication needs the correct message, otherwise people will get confused. We learned that public health needs the basics to be implemented: tests, contact tracing, isolation and treatment. We learned that internal surge capacity was stretched and that access to care has been an issue for non-COVID patients.
What is the role at the governmental level, at the federal level, now that we have finally passed the peak and flattened the curve to a certain extent? We have breathing space, and we can probably switch from a mode of being reactive to something that is much more anticipatory. What I'm looking for and what I'm begging for are—knowing that the federal level is the only place where we have an overview of the whole country—some sort of norms and guidance for the best practices to be implemented.
I have five points that I'm going to share with you.
The first point is the second peak versus rebounds. There are a lot of people who talk with assertiveness about the possibility of a second peak. The reality is that we don't know what the seasonal behaviour is, if there's going to be a dormant phase for the coronavirus, so we don't know if it's going to become strong in the fall. We need to prepare ourselves for the worst-case scenario. Keeping that in mind, I think we should develop a specific strategy on vaccination for influenza, knowing that influenza is going to be back, because we don't want to overload our hospitals in the fall. We need to do everything to prevent the second wave, if ever it happens.
Meanwhile, my biggest fear is repeated rebounds, repeated micro outbreaks away from the epicentre. That's what we've seen with many other outbreaks, with Ebola, with cholera, and then with yellow fever. I know it's different, but nevertheless, I think there is repeat pattern. While we ease the lockdown and we increase mobility of Canadians, especially during the summer vacation period, we might be facing micro outbreaks in different places in rural areas.
Why is it a concern? It is a concern because in many places in rural areas, they haven't been exposed and they haven't had many cases, meaning they don't have much immunity. That's one thing. The other thing is that hospitals in rural areas are often staffed by what we call “depanneur doctors”. From 20% to 80% of the ER shifts are basically covered by locum doctors. How do we frame the visits of those doctors? We probably won't quarantine them for 14 days. Are we going to make sure that they don't become vectors of COVID-19? Are we going to test them, test them before they go, or test them while they're there? That's one thing.
The other thing about rural areas is that I would strongly advise implementing rapid response teams or SWAT teams, as I like to call them, to go in and stabilize when there's a micro outbreak, and make sure that we optimize IPC and we support the response.
My other concern is about interprovincial mobility and what it can bring in terms of having micro outbreaks. The Campbellton case in New Brunswick is a good example of how someone can move from an epicentre to a province to places where there was low transmission, and there we go, we have an outbreak. I would say that at the federal level there must be guidance about how we are going to control interprovincial mobility.
At the international level, my biggest concern is about, yes, the border. I think we have an agreement that it will be closed until June 21, if I'm not mistaken, but how are we going to follow through knowing that, at the federal level, we control the border, but actually the follow through of people is probably going to be at the provincial level by public health? Are we going to follow up on the visitors? Are we going to hand over the information on visitors? Are we going to ask them to self-monitor? Are we going to trace them? Are we going to request that they isolate?
That was my first point on the second wave of micro outbreaks.
My second point is about personnel burnout.
What I've seen in many other outbreaks is that when we pass the first wave, we are facing burnout of personnel, front-line workers. Are we ready to fill the gap when this happens? What is the buffer in terms of staff? Are we going to have a surge capacity knowing that there is also going to be pullout of military from the places where they've been deployed?
I think that in the mid term and long term, we need to start thinking about a civilian reservist workforce that would be trained and could jump in and be functional. For example, the Red Cross has developed some of those models, but we need to think about that and it should probably be at the federal level.
The third point is that we need absolute guidance on best practices for testing and contact tracing in long-term care facilities. The reason for testing is that we have people who have mobility, and we know there are some people who are asymptomatic or people who are presymptomatic, meaning they don't have symptoms but they will develop the disease in one to seven days. These people can be vectors of the disease. We need to have an overarching strategy about testing. We need swabs and serology and we need to make the system happen, and guidance on that would be quite welcome.
On contact tracing, we need to find out if we are going to have the ability and the capacity to do that if we have a second wave. We know in some provinces it's been a real challenge. What is our surge capacity in that respect?
Last, in terms of guidance, I think we need to be clear on long-term care facilities in making sure that we test the people in long-term care facilities, that we protect them and that we staff them properly. We also need to learn from some of the experiences that have been successful.
The fourth point is about access to care for non-COVID patients. In many other places we still have a health care system that is running at low regime. We need to come up with a priority list for our sector to scale up, because non-COVID-19 patients cannot be the collateral damage of the response to COVID-19. I think that guidance would be helpful.
My last point is about the international level. We've realized how much we are interconnected and interdependent, in a complex way, across the world. We know that making all of us safer depends on making each of us safer. To say it another way, making all of us healthier depends on making each of us healthier. We cannot tackle COVID-19 in isolation from the rest of the world.
Canada has been investing in R and D for a vaccine. There has been a massive investment locally in Canada of $150 million in R and D for a vaccine. We're not sure yet what the scale-up capacity would be for manufacturing it, if it were successful, and we don't know how affordable and accessible it would be. More recently there's been a pledge of more than $600 million for Gavi in the global polio response. I think if we are planning to invest that much in R and D for a vaccine, we absolutely need to get a seat at the table to influence the outcome—the outcome of the public good from the vaccine that comes from the R and D. It's important, because Canada needs to influence how we'll distribute whatever discovery happens. If we don't have a seat at the table, it would probably be really hard to influence the process.
Meanwhile, I really urge that we develop a strategy on how we would vaccinate Canadians if we were to have a vaccine available by the end of 2020 or early 2021. We should do that now, when we have a bit of a lull time. We need to find out who we're going to vaccinate as a priority, such as front-line workers or vulnerable subsets of the population. We shouldn't improvise that at the last minute. We need to think that through.
To summarize, I think it is really, really important that we do everything to do the mitigating measures. We still don't have a treatment. We still don't have a vaccine. We don't know about the immunity. We have to prevent the preventable. It's about preventing people from getting infected, and about preventing people from getting sick, but it's about lives.
Thank you very much.