Health Committee on June 10th, 2020

[Dr. Joanne Liu]

On the masks, Mr. Chair, I think this is something that I have a bias for. When you look at the experiences of other countries, especially in Asia, you can see that this is something that has been imposed and perhaps is part of the culture to a certain extent. The reality is that with our incoherent message on masks it has been hard to foster compliance, and now we want to be stronger on the message and it's difficult to implement.

Yes, my personal view, which is not based on more than my personal view, is that in public transport or closed public spaces the mandatory use of masks might be helpful. Nothing is perfect. In this kind of scenario, with an unprecedented pandemic, we're always going to deal with imperfect solutions to implement. That's normal, and we need to accept that. Masks are not a magic wand, but they will contribute. They might decrease this by only 10% or 15%, but they will decrease it, and that would be helpful.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

We'll go now to Mr. Thériault.

Mr. Thériault, go ahead for six minutes, please.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for their testimony, which will help us in the search for solutions.

Mr. Powlowski asked a short question that I wanted to ask, since Dr. Quach-Thanh and Dr. Tremblay, when they came here, told us that they found the decision of the Montreal authorities not to impose the wearing of masks in public places and on public transportation unjustified. So you have answered that question. I'm going to ask a slightly longer question.

As you said earlier, we don't know much about this virus yet. It was discussed at our meeting on April 15 as well. We still don't have a vaccine or antiviral drugs. Our country is still not self-sufficient. Screening strategies are variable and traceability is relative. So, as you said, we are condemned to managing time and space through the use of mitigation measures.

On your last visit, you expressed concern about misguided deconfinement and the effects it could have on a second wave. You stressed the urgency of restarting the health care system in the quieter interim period, to care for patients who do not have COVID-19. The radiologists talked about this earlier. You also insisted that we prepare for a second wave by creating a better seal between hot and cold zones.

Do we have a plan or a strategy? Where are we now? Are we ready for the fall? Is there a strategy or action plan that would allow us to be proactive rather than reactive? That seems to me to be key going forward.

[Dr. Joanne Liu]

Are we ready for a second wave? That's the question of the hour, and it's extremely difficult to answer.

Indeed, we see that the recommendations are still hesitant. I think it's extremely difficult, because we're always trying to be very careful with what we do. We're putting containment versus economic stimulus, which creates a general confusion in people's minds.

So, personally, what I see—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Dr. Liu. Could you hold the mike a bit closer? Thank you.

[Dr. Joanne Liu]

All right, I'm sorry.

I think it's hard to be ready, because people are in the deconfinement and economic recovery state of mind. Right now, I don't know if the authorities in the country are working very hard on a plan to deal with the micro outbreaks that I think are going to happen over the summer, or a possible second wave.

I'm not involved in the planning and I don't know how we're preparing, but I get the impression that we're focusing more on deconfinement and economic recovery than on preparing a response to micro-spikes or a second wave. That's what I see as a citizen.

[Luc Thériault, Bloc, Montcalm, QC]

Two months minus five days ago, on April 15, you appeared before the committee. Two months minus five days is an eternity in a pandemic, because things happen. Thank you for being with us this afternoon. Indeed, it is important to have follow-ups, and your vast experience can enlighten us.

On April 15, you said that hot zones should be better sealed off than cold zones. Is there any hope that this is going to happen? We have time in the interim to prepare for the worst of a second wave. Do you have the impression that this is being put in place more proactively? We were reactive, and it was the cross-contamination that led to some of the disasters.

[Dr. Joanne Liu]

Sealing off hot and cold areas is difficult. What is unfortunate about all this is that strategies change as community transmission evolves. In a situation like the one discussed today, where community transmission is very high, it becomes increasingly difficult to get “cold” patients. All patients will be more likely to have COVID-19 and become “warm”. As a result, it becomes extremely difficult to have separate areas because there is a lack of space.

From the beginning, it would have been nice to have a hospital for positive patients and a hospital for negative patients to ensure continuity of care. We decided to cut it in the middle and that has its limits.

I hope that at least in rural areas that have not been affected but may have cases of COVID-19 eventually, there will still be time to follow these hot and cold zone procedures. This was done for the intensive care unit in Montreal, but we have realized that it is extremely difficult to comply with all of this. That's why there have been eight micro outbreaks in eight teaching hospitals in the greater Montreal area.

[Luc Thériault, Bloc, Montcalm, QC]

Have you—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We will go now to Mr. Davies for six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses.

Dr. Liu, it's good to see you back. I'll begin with you.

Last week, in an interview, you stated, “We need a testing strategy—we need to establish our testing priorities.” It seems that every expert and researcher who comes to our committee tells us that having a rigorous testing and contact-tracing program is essential to our ability to control COVID-19, yet we can't seem to ramp up testing beyond about 30,000 a day, far below our capacity.

Can you tell us whether you think we're testing enough, and if we're not, where the barriers are and what your suggestions for a good testing strategy would be?

[Dr. Joanne Liu]

Mr. Chair, thank you very much for the question on testing.

Everybody sees the necessity to have a testing strategy. This was especially true a few weeks ago, when we were in the reality of not having enough tests. We have ramped up, though not to the extent we wanted to. The thing is, if we are still limited by the number of tests we can do—and I think we still are, to a certain extent—then we need a strategy, and we need to prioritize.

Whom should we prioritize? We should prioritize the people who we think can be vectors of COVID-19. For me, what has been missing since the beginning is that we never had the priority of testing the front-line workers. I still do not understand that. This is something that, in all the epidemics I've worked on in the past, we always made readily available, especially when we knew that there were some asymptomatic cases, whereas for Ebola it's not exactly the same.

We know there's asymptomatic transmission; we know there's pre-symptomatic transmission. Therefore, I would advise front-line workers to be tested regularly, to make sure they are not going around...so we don't have a case like in Campbellton, where a doctor who was positive ended up exposing more than 150 people, and then there were at least 16 people who were part of that chain of transmission.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

You also mentioned that you thought it would be prudent if we got ahead of a potential vaccine and started thinking now about how we would approach vaccinating Canadians. Do you have any suggestions at this early stage about how we would prioritize access to a vaccine, if and when we develop one?

[Dr. Joanne Liu]

Mr. Chair, about the strategy on vaccination, I think I alluded to it in my short intervention. In all the experience I have from other pandemics and regional epidemics, we always prioritize the front-line workers. The reason is that if they fall ill, we have no one else to care for the patients. For me, that would be a must.

After that, if it's feasible, advisable and safe, I think we should prioritize the vulnerable community, because we know that the elders have been very vulnerable to COVID-19. If they could sustain vaccination, I think we should think about them, but probably any sub-population of people who live in a vulnerable situation should be prioritized to be vaccinated.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I can drill into that, there's been some talk recently about our not keeping data on racialized communities, indigenous populations or other populations that, it's been postulated, may be more vulnerable to COVID-19. Do you think we should be gathering data on these sorts of subgroups for the purpose of developing an idea of where the vulnerabilities are, say, for purposes of determining access to vaccination priority?

[Dr. Joanne Liu]

Mr. Chair, about getting data on people in sub-communities, this is a question that is about personal, private information. I think that possibly would be feasible if we were to ask people if they were willing to give their information and be part of a supra-repository of data.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

I'll ask you a final question, Dr. Liu. You mentioned the importance of Canada having a seat at the table, but I was unclear which table you were referring to.

[Dr. Joanne Liu]

Mr. Chair, about Canada having a seat at the table, right now there are different high-governance platforms in terms of R and D, for example the WHO R&D Blueprint. On different boards of big NGOs, Canada is there on Gavi, but not on CEPI, the Coalition for Epidemic Preparedness Innovations, where Canada has pledged $2 million and is adding another $2 million, I think. Since this is a consortium developing a vaccine, it could be advisable to make sure that we influence.... Right now there are more than 10 candidates, and probably one of them is going to go to the finish line.

When we know that there are those sorts of opportunities for deliverables, and Canada is already investing, it should wave and say, “I'm present” and invest more in terms of presence to be able to influence the outcome.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Krystal—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

This ends round one. We'll start round two with Dr. Kitchen.

Dr. Kitchen, please go ahead for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you, everybody, for being here.

Dr. Barry, I suspect that when most people listening to this conversation hear the word “radiologist”, they are going to think maybe X-rays or MRIs or they might throw in ultrasound, but they don't realize the many other aspects of health care the radiologist provides to Canadians, such as CT scans, echocardiography, PET scans, tomographies, radioisotope scans, SPECT scans, all these things, such huge amounts of which are involved in looking after Canadians' health.

I appreciate and I thank you for your recommendations. You may or may not be aware that last year during the election, part of the Conservative platform was to propose a $1.5-billion investment for purchasing MRI and CT scan machines to replace the aging equipment. I'm glad to see that this is part of your recommendation. That number is familiar and very helpful.

I'm interested to know, though, what data the Canadian Association of Radiology is using to determine how best to alter its practices to ensure the safety of both employees and patients.

[Dr. Michael Barry]

This is a real-time story, really. The data we have is empirical. We've done 12 publications since the beginning of COVID-19 over 12 weeks. The most recent article, and probably the most comprehensive one we've done, is on the re-entry task force that was chaired by Dr. Anderson—and Dr. Soulez was on it. It's a national committee looking at the impact of the reduction of services down to 20% or 30% and the slow reintroduction.

A lot of it is empirical, on the fly. It's hard-to-get data at the best of times, let alone in real time, but we do have a pretty strong network, through the office and nationally, to know where most provinces are and where most major metropolitan areas are when it comes to their ability to ramp up the system.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Would you be using PHAC data? If so, do you feel you're getting that in a timely manner?

[Dr. Michael Barry]

What is PHAC data?

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

It's from the Public Health Agency of Canada.