Health Committee on June 10th, 2020

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. McLeod.

We go now to Mr. Van Bynen.

Mr. Van Bynen, please go ahead for five minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for joining us today.

It's great to be able to welcome a local witness to the committee, so I'll be focusing my questions on Ms. Krystal. It's largely because I've been able to see the challenges that she has needed to deal with in a rapidly growing community. The resources of the hospital for the last nine years that I've seen have been extremely stressed.

When you're facing a growing community like this, how do you create and how do you protect surge capacity?

[Arden Krystal]

That's probably the $1-billion question.

It is very challenging. The only way that we've been able to create surge capacity is by reducing elective and scheduled activity. Of course, that has a very deleterious effect on all of the people on wait-lists for surgeries. In particular, they're not necessarily people who are waiting because of what we would all recognize as life-threatening conditions, such as cancer or cardiac, but, absolutely, those who are waiting for hip and knee replacements and various types of surgeries that are considered “elective”, but which create undue hardship and pain for people while they're on the wait-list. Unfortunately, those have been the ways that all hospitals across Canada have found their surge capacities. That's very challenging.

Remember, as well, that hospitals struggle with something called ALC, alternative level of care, patients. Typically, these are patients who are waiting for admission to long-term care homes and others. With all the long-term care homes having outbreaks, we have a bit of a double whammy going on right now.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

We've also heard from other witnesses that their recommendation is to treat COVID patients away from emergency wards in hospitals. I see that on May 9, CTV's W5 featured a special edition that broadcasted an exclusive look inside Southlake's COVID ICU to showcase the challenges that were faced on the front line.

Could you share with the committee what some of those challenges are and how Southlake was working to overcome them?

[Arden Krystal]

Some of those I addressed in my opening statement, things like personal protective equipment availability in the supply chain, rapidly planning for increased capacity, ramping down surgeries, trying to discharge patients, developing an assessment centre. There were a lot of medical unknowns. This was a novel virus; it had never been seen before. There was a lot of fear among our staff and in the communities, which we had to address, and we had no known treatments.

You test and try on the fly. We used an awful lot of international experience to guide us, and we certainly collaborated a great deal with colleagues.

I think those are the main challenges. Human resource-wise, I think we did quite well.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

I know that COVID-19 has had a significant impact on the mental health of Canadians and that Southlake offers a wide range of mental health services to assist individuals. Has there been a change in the number of individuals seeking assistance from Southlake since the beginning of the pandemic?

[Arden Krystal]

It's interesting. I agree with you that there's no question that living through this pandemic has certainly created an increase in anxiety and depression among not only health care workers and others, but also people dealing with these things in the community. However, interestingly, our mental health ED visits were down 48%, and I think that was because of the fear factor of people not feeling comfortable going to the emergency department. Having said that, we were also providing a great deal of service virtually to get out to people who wouldn't feel comfortable coming in.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

A lot of our questions are aimed at determining how well the government has responded. I believe we're living in a very small universe with a lot of mobility. Therefore, beyond what you've already explained, is there a way that we can build back better, assuming there's likely going to be, if not a resurgence of this pandemic, another pandemic that we're going to need to face, based largely on how globalized we are?

What would your recommendation be beyond what we've seen?

[Arden Krystal]

One of my colleagues mentioned earlier that when she came in through the airport, she received a pamphlet. That was in mid-March. I was hearing those stories well into the end of March. One of the things we could get better at is screening visitors.

We've begun screening absolutely everyone who comes in to the hospital. I'm not convinced that's going to be a short-term phenomenon during the pandemic only. That may well become part of our norm. We can not only use those opportunities to keep patients and staff safe but also use those as teaching opportunities and remind people to do those simple things like washing their hands.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Thank you, Mr. Van Bynen.

We go now to Monsieur Desilets.

Mr. Desilets, you have the floor for two and a half minutes.

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

Thank you, Mr. Chair.

I also thank all of the witnesses. Your insights are very important to us.

My first question is for you, Dr. Liu. You rightly pointed out the importance of best practices. As someone who knows Quebec well, would you be able to tell us, in the context of a second wave, what best practices should be promoted, particularly in the case of CHSLDs?

[Dr. Joanne Liu]

Insofar as seniors' homes are concerned, stakeholders protected a vulnerable population and banned visits, but failed to apply the principle of reciprocity. That was the problem. They needed to ensure that people in seniors' homes were well fed and well cared for, whether mentally, physically or socially. That is what was not done well. We failed to apply the principle of reciprocity to a vulnerable population that we were protecting.

In the case of staff and others living in seniors' homes, testing was not done quickly enough, people were not isolated enough, and staff were not protected. In addition, there was a shortage of staff. These are four points that can be dealt with concretely in order to rectify the situation.

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

My second question is also for you, Dr. Liu.

What concerns you most about the prospect of a second wave?

[Dr. Joanne Liu]

What worries me the most about a second wave is not being able to gear up our response strongly enough to meet it.

Maybe the second wave will happen in a few weeks. In my opinion, at that time, we will probably have good habits to minimize the transmission of the virus, such as physical distancing, handwashing and wearing a mask. The challenge for people will probably be to continue to do this in the longer term.

As for our hospitals, despite all their preparation, they've had eight outbreaks. I don't think we need to see that happen again in the second wave. So our infection prevention and control procedures must be ironclad.

All personal protective equipment supply issues must be settled and taken off the agenda. This needs to be addressed. We need to have supplies. Our staff must be assured that they will not run out of equipment.

I work at the Sainte-Justine University Hospital Centre. Even today, the masks are still counted. The head nurse gives them to us; we don't help ourselves. I would like to say that the fear related to the lack of equipment remains.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Go ahead, Mr. Davies. You have two and half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Krystal, on May 25, the Ontario government issued mandatory management orders appointing local hospitals to temporarily manage two of the province's long-term care homes for 90 days. Of course, Southlake Regional Health Centre was appointed to manage River Glen Haven nursing home in Sutton, Ontario. That is a for-profit facility that has seen at least a 102 infections and 32 lives claimed by COVID-19.

We've seen similar things happen in British Columbia, where the government had to take over private care homes.

In your view, why was River Glen Haven unable to control spread of COVID-19?

[Arden Krystal]

I mentioned, I think, in my earlier general comments some of the older homes and some of the challenges they have with four-bed or three-bed rooms. River Glen Haven is an older home. What we found is that some of the rooms there had maybe a foot between beds. That is a very difficult situation in which to contain somebody who maybe has positive COVID status.

We also found that, although they had some PPE, the staff were not wearing the PPE appropriately.

To your question about why there was a difference between profit and non-profit places, my answer would be that I can only assume that there is more of a concentration on the cost of preparation at a for-profit than there would be at a non-profit. I think that some of the homes.... I would say River Glen probably fits into the category of those that are funded for more beds than probably what that older home can realistically house and contain.

[Don Davies, NDP, Vancouver Kingsway, BC]

It would seem to me that, even without COVID-19, warehousing seniors within a foot of distance of each other, a vulnerable population with all manners of infections and comorbidities, was probably not a good idea even before COVID-19.

I was intrigued as well about national standards.

[The Chair, Liberal, Ron McKinnon]

Mr. Davies, you're at 2:38. Could you just be quick?

[Don Davies, NDP, Vancouver Kingsway, BC]

Sure.

Can you elaborate a little bit on what you would like to see in national standards? You mentioned that it's similar to other types of health care delivery. What would you like to see in the long-term care sector with respect to national standards?

[Arden Krystal]

I would like to see specific hours of care per patient day. Each province has some differences in that regard. I've worked in both B.C. and in Ontario, and the integrated model in B.C., I do think, had an advantage in enforcing those types of standards.

[The Chair, Liberal, Ron McKinnon]

Great. Thank you very much.

That brings round two and this panel to a close.

I'd like to thank all of the members of our panel for sharing your time with us today and for all of the great information you have shared with us.

With that, we will suspend for a few minutes while we bring in the next panel.

[The Chair, Liberal, Ron McKinnon]

We now resume the meeting. Welcome back.

For the benefit of our panellists on our second panel, we are continuing meeting number 26 of the House of Commons Standing Committee on Health. We are operating pursuant to the order of reference of May 26, 2020. The committee is resuming its briefing on the Canadian response to the COVID-19 pandemic.

I'd like to make a few comments for the benefit of our new witnesses.

As you are speaking, if you plan to alternate from one language to the other, you will need to also switch the interpretation channel so that it aligns with the language you are speaking. You may want to allow for a short pause when switching languages. Before speaking, please wait until I recognize you by name or, during questions, by the member asking questions. When you are ready to speak, you can click on the microphone icon to activate your mike. I remind you that all comments should be addressed through the chair.

Interpretation in this video conference will work very much like in a regular committee meeting. You have the choice, at the bottom of your screen, of floor, English or French. When you're not speaking, your mike should be on mute.

I would like to now welcome you individually.

From the Canadian Dental Association, we have Dr. Jim Armstrong, president, and Dr. Aaron Burry, associate director, professional affairs. From Doctors Without Borders, we have Dr. Jason Nickerson, humanitarian affairs adviser. From the Ottawa Hospital, we have Dr. Dave Neilipovitz, head of the critical care department.

Each group will have 10 minutes to make a statement. We will start with the Canadian Dental Association.

Dr. Armstrong or Dr. Burry, please go ahead for 10 minutes, please.

[Dr. Jim Armstrong, President, Canadian Dental Association]

Thank you very much, Mr. Chair, and good afternoon to the members of committee. It’s my pleasure to present to you today on behalf of the Canadian Dental Association.

I have been serving as president of the CDA since April, but previously I served on the board for the past six years and have volunteered in dental associations across the country for three decades. I am also the managing doctor of a dental co-operative with 10 practices and 150 team members throughout Vancouver. As well, I'm an adjunct professor for the Sauder School of Business at the University of British Columbia. I'm an M.B.A. dentist.

I am pleased to be joined today by Dr. Aaron Burry, who is CDA’s associate director of professional affairs. Dr. Burry is a public health dentist with more than 30 years' experience in navigating issues with both practice and public policy. He's also an M.B.A. dentist. In addition to the work that he has done to lead the CDA’s work in understanding and addressing the challenges of COVID-19 for our profession, Dr. Burry has been serving emergency patients in a public health clinic throughout the past few months and can share with you that unique perspective.

We come today with three essential recommendations to share: first, that greater consideration be given to dentistry as vital front-line health care workers when considering access to PPE; second, that the federal government create a specific oral health envelope of $3 billion as part of the Canada health transfer; and, third, that basic oral health standards be part of any future review of the state of health in long-term care facilities.

I’ll come back to each of these recommendations throughout my remarks, but first I’d like to walk you through the challenges that dentistry has faced as a result of the pandemic, as well as those that are emerging.

In March, by public health orders, dental clinics across Canada ceased providing oral health treatments, with the exception of very restricted emergency care, which was designed to keep patients away from the emergency operations of hospitals. Now, dental clinics are cautiously beginning a staged return to practice in accordance with the guidance set out by their provincial dental regulators, public health authorities and workplace safety regulators.

This guidance has varied from one province to the next and has resulted in great confusion among dentists and patients. Also, within provinces, unfortunately, between those regulators, there sometimes is conflict in regard to regulations that require different protocols or procedures to be used when providing the same type of treatment. This also leads to significant confusion and angst for dentists as they attempt to establish the new normal.

What dentists are finding as they return to practice is a physically demanding and mentally exhausting experience. Dental offices are essentially mini outpatient hospitals and, like any hospital offering outpatient care, we follow strict infection control procedures and practices. That's not new. However, the new guidance and regulations stemming from COVID-19 have made performing outpatient procedures more difficult, physically draining and time-consuming.

Dentists must do considerable additional preparation before seeing each patient, and our early experience in getting back to work suggests that they treat 50% to 67% fewer patients per day. Communication with those patients is also much more difficult. It’s not simply a single aspect of the new approach that is problematic, but rather a cascading effect of changes to how every aspect of care has changed. From the pre-work before coming to the office, to the parking lot, which has now become our reception area—