Health Committee on June 10th, 2020

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

With the big wait-lists that have been created, are there any creative ways that we can clear those up? Are there procedures we could deal with outside of the regular health care system that could perhaps take off the pressure, like, I don't know, private mobile radiology services or something like that? Is there a way to do this creatively? I mean, a seven-year wait-list for a hip replacement sounds like a bad idea.

[Dr. Dave Neilipovitz]

There are always creative ways to do it. Any time there is a change in the system, there's actually an opportunity to make it better.

We certainly have found a lot of efficiencies during COVID. Telemedicine certainly helped a lot of aspects. All patients don't need to come to a hospital to be seen by a physician, so I think that is an opportunity. If we invest in our telemedicine, we'd be able to unload some of the burden that's going on with that.

In terms of your ideas of going private and outside of the traditional setting, there is a downside to that, but there is also an opportunity. Certainly, I think we should explore it, but recognizing that our ultimate goal should be to ensure that care is provided to all Canadians in an equal fashion.

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

Yes.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Jansen.

We'll go now to Mr. Kelloway.

Mr. Kelloway, go ahead for five minutes please.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thanks, Mr. Chair, and hello to my colleagues and to the witnesses today.

I've said this before. I forget the number of meetings we've had. I should know that offhand, but there's been plenty during this COVID pandemic. However, each of the witnesses has provided so much information and knowledge to us, to me and to the Canadian public, and I just want to thank you folks for this today.

I'm going to start my questioning with the Canadian Dental Association.

You have aha moments when you're asking questions or, more importantly, listening to the answers. Dr. Armstrong, you talked about looking at dentistry as many outpatients, and I found that to be an incredible aha moment for me in terms of reframing perceptions versus realities in health care. You made a really interesting comment, and I want to drill a little deep into it. You talked about the $3 billion that could be invested, or should be invested, into the province from the feds. I think you've alluded a little bit to it, but I want to give you this opportunity to maybe do a little deeper dive on what those specific elements, those areas of investment, would be.

A second question, and I'll stay with the Canadian Dental Association, is that dental services are beginning to resume across the country as are a lot of other health care services. Can you tell us what dentistry is going to look like in the next day, 24 hours or next couple of weeks, as opposed to pre-COVID?

Thank you very much.

[Dr. Jim Armstrong]

Thank you for both questions. I'm going to start with the second one first because it's easier.

I can't tell you how it's going to look because it's evolving daily. We had 3,000 new papers published last week on COVID. There are too many things: how long does this last, when will we get a vaccine, how long are we going to have change our processes.

I want to go back to Dr. Neilipovitz's comment about telemedicine. We're starting to use teledentistry. I think that has great potential for being able to make care more equitable.

We at the Canadian Dental Association certainly want to make care more equitable, and we also want to drive costs out, and we want to increase quality.

Coming to your first question, the $3 billion, Canada underfunds compared to many countries, the public health aspects and the public support. As one of your colleagues, the honourable Don Davies, has pointed out, somewhere between 30% and 35% of Canadians lack funding or have inadequate funding. What we're really concerned about is the number of Canadians who are going to lose it because the recession that follows this pandemic may be very deep and long.

If there was a tranche of financing that was specific to oral health care, that would help, because what happens in dentistry right now is often our funding comes through social services, not actually through health. We're the last dollar in, and we're the first dollar that gets clawed back. We have really good private facilities, but we also have really good hospital dental facilities that are just underfunded. If we could get that funding.... I think all of us have said that we would be open to any suggestions. We'd be open to looking at all ways in which to target this, but the issue is equitable access for all Canadians.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

A bit of a running theme in today's discussions has been around equitable access for sure.

I'm really interested in learning more about teledentistry as well. What we're seeing on the telemedicine side in Nova Scotia is that there's been obviously an increased uptake because of COVID, and people are getting a little bit more familiar with that concept. I'd be interested in learning more about teledentistry. Thank you for that.

My next question is for the witness from the Ottawa Hospital.

I'm hoping you can walk through what it's like for a person to be hospitalized with COVID at your hospital. I'm interested in the treatment but I'm also interested in the aftercare as well. I wonder if you could, for the panel here, for my colleagues, and for Canadians, walk through that for us if you could.

[Dr. Dave Neilipovitz]

It's a big question.

As for patients who present with it, there are several different types of presentations. What is one person's experience isn't necessarily the experience of everyone.

The patients I see unfortunately are the sickest of the sick. When they come in, many of them are struggling to breathe. There's also the fear and anxiety just with the syndrome itself, and all the hype that's been around it. Certainly, the caring that the nurses have demonstrated has been fantastic.

The one aspect that patients are experiencing that unfortunately makes them unique compared to any other disease and disorder is there are no friends or family that are around them. I think that is a tragedy of this situation that we'll be talking about for years from now. We have done our best, at least in the Ottawa Hospital, to provide means, such as videos, to permit them to see the people they really want to see. Someone touching them and holding them who's not their family is certainly better than no one, but I don't think it's the same.

In answer to how they experience...they feel short of breath. Some of them are struggling to breathe, and others, surprisingly enough, aren't struggling, albeit that the oxygen levels in their blood that we measure are quite low.

As for the recovery, certainly I know my rehab colleagues are doing their best to accommodate this. There certainly are a lot of unknowns that have been alluded to, such as whether or not people are actually infectious. They are doing their best to rehab these individuals. Some of them are staying on ventilators for almost a month, so you can imagine how much muscle...and the changes they have experienced.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you very much, folks.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We'll go now to Monsieur Desilets.

Mr. Desilets, you have two and a half minutes.

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

Thank you, Mr. Chair.

Good evening everyone. Thank you for being here.

My question is for you, Dr. Neilipovitz. You talked about national standards, but you also said that there should be significant collaboration with the provinces. In this context, what do you say about health transfers, which are often requested, obviously, by the provinces?

[Dr. Dave Neilipovitz]

What would I think of the health transfers? Should they be increased? Should they be adjusted?

Certainly, with regard to the idea of increasing funding, there's not going to be any physician who says that we shouldn't fund more, although I think we need to fund smarter. I think that is something that we all share.

In terms of the transfers, certainly we would like to see that increased. However, I would also put back that I think we all need to be smarter with what we're doing. There's no bottomless pit of money that can come. There is an opportunity for us all to work together. I do work with my colleagues across the river in Gatineau. When this was coming about, we offered our services to them, and I worked with my counterpart there. There is collaboration between provinces. We can do this together, and funding can certainly follow where collaboration is leading the way.

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

In your second recommendation, I believe, you want the government to support the development of telemedicine in the ICU.

Can you explain to me how telemedicine can be experienced in the ICU?

[Dr. Dave Neilipovitz]

Thank you.

The opportunity needs to build on what's actually being done around the world so that a centre like mine would be able to get a video feed, as well as information from the investigations and monitors, to be able to assist the teams that are there providing care, providing opinions and guiding treatments. That way, experts, even in various other centres, could be brought in to help improve the care that's going on in our more remote facilities. It's an opportunity, both by video and also by better linkage, to be able to see and know what's going on.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Desilets.

We go now to Mr. Davies.

Mr. Davies, you have two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Dr. Nickerson, in the previous Parliament, the health committee prepared and produced a report on open science, which recommended developing global access licensing requirements for medicines and vaccines with CIHR funding. To your knowledge, does CIHR have a global access policy for COVID-19 medicines and vaccines developed with public research funding, or does it require institutions receiving CIHR funds to have a global access policy?

[Dr. Jason Nickerson]

I'm not a recipient of CIHR funding at the moment, but to the best of my knowledge, no, I'm not aware of there being such a requirement.

[Don Davies, NDP, Vancouver Kingsway, BC]

I take it you would recommend that we implement such a requirement.

[Dr. Jason Nickerson]

Absolutely. This is one of the things that we recommended to the committee in the previous Parliament during this exact study: that funding provided for the development of drugs, vaccines, diagnostic tests and other health technologies should be conditional on recipients of public funds having a policy in place which stipulates that if they are going to license it to someone else, it be done in a way that includes provisions that ensure that it will be affordable, accessible and priced fairly when it eventually comes to market. I think that enacting these provisions early upstream gives a degree of control to be able to negotiate some of these provisions fairly effectively.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Armstrong and Dr. Burry, I know that you co-chaired the CDA's return to practice task force. I have a couple of questions.

In your view, are all regions of the country in a position to begin safely reopening dental offices, at least for non-emergency services?

[Dr. Aaron Burry]

In terms of the areas of the country, for example, on the east coast where they haven't had any COVID infections for several weeks, I think they're in a very good position to resume services safely. I think we are still struggling in places like Quebec and Ontario, where we have outbreaks and we're still monitoring that.

Going forward, it would be good to have some national standards and some sliding ability to look at, when there's a pandemic, what should happen in practice versus “we're trying to do this”. All guidance coming out has largely been interim. We have to remember that it's interim guidance for a new experience. This is unprecedented; we haven't seen this before.

I think most practices are in a good position to be opening, while there are questions, like in the Northwest Territories, where the medical officers are very worried about the fragile nature of their health system and so on.

[The Chair, Liberal, Ron McKinnon]

Thank you.

That brings round two to a close.

Panel, I'd like to thank you for all of your time, your expertise and for sharing your knowledge with us. I'd also like to thank the members of the committee.

The meeting is adjourned.