Health Committee on June 10th, 2020

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

Thank you, Mr. Chair.

Thank you, all, for your presentations.

Dr. Armstrong, I'm going to start with you. Just so you understand, I was the registrar for the chiropractic profession in Saskatchewan, and then I was the president of the organization. I recognize the difference between the association and the regulatory body. I suspect that, during these times, you have been in close contact with the college of dental surgeons.

If you feel there's an answer that you can throw in there, I would appreciate that.

According to the federal economic response plan, on your CDA website, the financial assistance programs introduced by the government may not be applicable to certain dental practices as each situation depends on the business structure of the individual practice.

Have you experienced a lot of turmoil amongst the many practices?

[Dr. Jim Armstrong]

There are about 18,000 practices in Canada. We probably have 19,000 different ways we're organized. We have found that the federal government has been very good at being able to address and change some of these. For some of them, the wage subsidies have been really important. We hope those continue; it would be nice if they continued past August.

Normally I don't love politicians, but I love all politicians right now because I think by and large we've got more things right in our economic response to COVID. Certainly the federal government seems very flexible at looking at some of these things.

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

In your projections and deliberations, has the CDA relied at all on PHAC and the data that it provides for COVID-19?

[Dr. Jim Armstrong]

I'm going to let Dr. Burry answer this one. He's more knowledgeable on this.

[Dr. Aaron Burry, Associate Director, Professional Affairs, Canadian Dental Association]

Yes, absolutely. We participate in a lot of different conference calls with PHAC around everything that's been going on with respect to COVID.

We, as an organization, have done a national wrap-up virtually every week since this started. We are using data from PHAC and other organizations to make sure that dentists across the country understand what's happening.

The biggest part for dentists is to understand what is going on in their community, as well as the trends, particularly if they look at reopening and reestablishing practices. Many of us have stayed open to provide emergency care throughout. Others are now starting to bring more services online. We need to understand the course of this pandemic, as well as any other information that PHAC provides to us.

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

I realize there is lots of change. First of all, I'd like to thank the whole dental profession because I know they stepped forward with PPE at the onset. A lot of them gave up their own PPE. Your recommendations about getting priority access to PPE are important.

How much discussion are you having with PHAC in order for you to get access to that equipment, such that you can provide oral care to Canadians?

[Dr. Aaron Burry]

In terms of those conversations, I think what the federal government has done in trying to clarify who is actually a legitimate seller and reseller of PPE in this country has been helpful. What is unfortunate is that dental suppliers that have it simply don't have the supplies to give to dentists, and it seems to be a national problem. That's what we hear. It's a growing issue for dentists that the supplies they do have will run out as we start to increase the amount of care that we need to provide and address things that have been put off for several months. In that respect, I think it is a global frustration in not being able to refill supplies as quickly as we would like at this point.

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

Thank you. I appreciate that.

I realize there are a lot of changes interprovincially. In Saskatchewan there are different issues. For example, in Saskatchewan the dentists seem to have the strictest adherence and regulations, whereas Ontario has changed theirs in the last three days from being strict to not, and we have some of the fewest cases here in Saskatchewan.

Does the CDA feel that the jurisdictional approach to reopening is working for their sector, or would some kind of national standard or guidance have been more helpful?

[Dr. Aaron Burry]

I think across the country, everybody would benefit from a more standardized approach and more national leadership around what the guidance should be at the provincial level. I think the variety of guidance that you have in every province and at every level is challenging.

At the same time, you also have to respect and understand that local decisions are based on local capacity. We heard earlier about the capacity of a health care system to be able to respond. I think what you're seeing is that medical officers in certain parts of the country are responding to the fact that they don't have the same level of medical support. They're worried about it, so they're asking the dental community to do more in those particular jurisdictions. It does speak to having a very large, diverse system in Canada in which people who are looking at the same information are coming up with different answers.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kitchen.

We go now to Ms. Jaczek. Please go ahead for five minutes.

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

Thank you, Chair. Thank you to all of our witnesses today for their presentations.

Each of you has alluded to a stronger role for Canada in the areas in which you each work.

I'd like to ask my first question of Dr. Neilipovitz. You alluded to national standards for intensive care units practice. Given that health is, in essence, a provincial jurisdiction, how do you see the development of those national standards?

[Dr. Dave Neilipovitz]

Thank you for the question.

It has always been a challenge of provincial versus federal, and I'm not so naive as to think there's a simple solution. However, a national standard is what most of our societies go by, and I think it's an easy opportunity for the federal government to work with the provincial counterparts to set expectations for critical care units. It would be led by the federal government working with the various provincial counterparts, along with our national society. It could set what we expect a level 3 ICU to provide, and the various other components, and I think provinces and physicians would welcome that.

Maybe I'm naive to think it is easy, but I think a national standard is what we would all look to. We have national standards in the operating room and various other locations, so why would we not have them for our intensive care units?

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

It appears the Ottawa Hospital was well prepared. You planned in advance. Obviously, experiences from before, such as with SARS, seem to have made the Ottawa Hospital very aware of pandemic planning.

How are you preparing for a potential second wave? What is that looking like for the Ottawa Hospital?

[Dr. Dave Neilipovitz]

I can speak to the Ottawa Hospital but also Ontario. I think Ontario, as you pointed out, with our experience with SARS, was perhaps better prepared than some of our counterparts in that we've been planning this for about 15 years. We've had practice runs, be it with H1N1.

What we're doing for the second wave, which may or may not come, is that we continue with our preparation in ensuring that there's an adequate amount of PPE, personal protective equipment, for us. There are additional ventilators coming in almost weekly, so we have that.

I'm working with counterparts in other areas to see how we can work together with it. It has actually been a very positive experience, seeing the co-operation between all the sites. I think that's something Canadians should take some solace in knowing. We're working on that.

We're revising our protocols and practices with it, and we're sharing along the lines of what's going on internationally, which was being advocated by Dr. Nickerson. We are certainly doing that in Ontario and working with that.

We're also trying to develop ways to identify when perhaps a second wave is beginning. We're looking for measures and signals such that we would be able to prepare quickly but not impact other health care, as seemed to happen in the first wave.

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

What about the issue of burnout in front-line workers, intensive care unit workers? It's obviously extremely stressful for those working in those units. How have you been dealing with the mental health aspects that inevitably occur under such stress?

[Dr. Dave Neilipovitz]

I think it's through talking and sharing experiences. I've actually been quite impressed with what has been provided by some of our societies as well as by government, at least my own government in Ontario, to allow us mental health and mindfulness types of strategies.

I'll be honest. It's not just critical care that has been stressed. I think we should recognize that in other areas of our hospitals, health care professionals have gone out and helped in environments that they're not familiar with. I know that a lot of the operating room staff—I'm also an anesthesiologist—have volunteered, given up their time and cared for patients in the long-term care facilities.

I do worry, the longer this goes on, about how protracted it will be, including the restart. It certainly will be taxing our nurses, our respiratory therapists, our other specialists and our physicians. I do think the assistance that has been provided for corporations has been helpful for physicians. The added pay for our health professionals was certainly welcome.

I do think that a long-term strategy on the mental illness effects secondary to COVID on health professionals as well as on Canadians in general should be a major consideration for our government.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Jaczek.

We go now to Ms. Jansen for five minutes.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Thank you.

Dr. Neilipovitz, I was wondering what percentage of ICU beds Ottawa used at the peak of the pandemic. I think you mentioned it.

[Dr. Dave Neilipovitz]

We were at 57 beds with the two campuses. Fortunately, believe it or not, critical care wasn't stressed in most centres across Canada, so we were roughly at about 80% in use. We never had to go into our pandemic areas.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Okay.

We heard the Prime Minister right at the very beginning say that our health care system has plenty of surge capacity. My first thought was that every Canadian knows there's no surge capacity in our system once they've sat in emergency for a few hours.

Do you feel that shutting down important medical services like cardiac surgeries and so forth constitutes actual surge capacity, or is it just that we rob Peter to pay Paul, in a manner of speaking?

[Dr. Dave Neilipovitz]

By the nature of your question, you know the answer, in that we were affecting other people's care. I think that is the reality. It's one thing to take away emergency surgery, which really did not happen; most of it was elective surgery that was impacted. There was some surge capacity that isn't inherent in our system. I think there are ways to improve it.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

What are your thoughts on that? Is it field hospitals? I don't think we really utilized that at all, keeping COVID away from other processes perhaps with field hospitals. Has that been thought about at all?

[Dr. Dave Neilipovitz]

Field hospitals were explored. I was part of groups that explored and discussed them, but that's easier said than done. If we open a bunch of surge hospitals, we could open them, but how do we staff them? How do we supply them with equipment and things, and such?

I think there are other more effective strategies. I believe most Canadians are now aware that acute care hospitals have a lot of patients who would be better cared for in a long-term care facility, which is certainly, unfortunately, in short supply. That is a huge issue going forward. Now, with changes in long-term care, it has stressed our acute care even more. I think a comprehensive long-term care strategy is long overdue for all of Canada.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Right.

Hearing all the needs that the health care system has following this pandemic—I mean, this panel obviously has a tremendous amount of needs—it seems almost too big of a problem to solve. You know, if every hospital needs to be updated, it feels like it's a little bit like trying to eat an elephant. Where do you even start?

Is there a way to prioritize things? What would you say would be the most critical change that needs to be made to our infrastructure or whatever? What would be the low-hanging fruit? Is there something specific you could point to that would make a lot of difference and that you could get done right away without doing everything?

[Dr. Dave Neilipovitz]

It's a good question.

Trying to boil the ocean is impossible for all of us, but I would really start with looking at long-term care. How do we get patients out of an acute care hospital who don't need to be there?

I did allude to some of the challenges with end of life, and it certainly is a difficult topic to address. I believe, however, it is important that we look at all aspects of end of life and not simply the main component that was addressed several years ago. There are other aspects.

Long-term care, I really do believe, would go a long way to addressing some of the challenges that hospitals are experiencing. By far and away, our biggest issue and challenge is space. If we were able to get what's roughly about 20% to 30% of all hospital beds empty of patients who, unfortunately, have nowhere else to go, I think that would go a long way to improving our health care system.