Health Committee on Feb. 5th, 2020

[The Chair, Liberal, Ron McKinnon]

Welcome everyone. We'll start the meeting now.

Thank you everyone.

I have just a couple of points. The Special Committee on Canada-China Relations has booked this room at 5:30, so we will have a hard cap here at 5:30 so they can start their meeting and be televised.

I suggest for the next meeting that people keep in mind topics of interest so that we can consider where we're going to go in the future.

With that, we'll carry on. I'd like to welcome the Department of National Defence, with Major-General Cadieu, director of staff, strategic joint staff. Merci.

We have Major-General Downes, surgeon general, commander of the Canadian Forces health services group.

We have back again Ms. Namiesniowski, president of the Public Health Agency, and the incomparable Dr. Tam. Thank you for coming back.

We'll start with the Department of National Defence. I believe you have a 10-minute opening statement.

[Major-General T. J. Cadieu, Director of Staff, Strategic Joint Staff, Department of National Defence]

Mr. Chair, committee members, thank you for the invitation to discuss the role of the Canadian Armed Forces in the whole-of-government assisted return of Canadian citizens from China following the outbreak of the 2019 novel coronavirus.

I am Major-General Trevor Cadieu. As the director of the strategic joint staff, my role is to maintain the situational awareness of senior military leaders, to draft directives for the Canadian Armed Forces and to work with other government partners. I'm looking forward to addressing any questions on the operational details of the Canadian Armed Forces' role in the overall effort.

I'm joined today, as you've heard from the chair, by Major-General Andrew Downes, our surgeon general. As the adviser to the Minister of National Defence and the chief of defence staff on all matters related to health, he will naturally be prepared to address any medical-related questions.

I'll speak now about our role in the assisted departure.

On January 31, the Canadian Armed Forces received a request for assistance from Global Affairs Canada, the lead department for the first phase of the assisted return from Wuhan, China to Canadian-Forces Base Trenton.

The military contribution to this part of the operation consists of a medical team comprising six Canadian Forces health services medical professionals. They're tasked to conduct health screening of returnees as part of the aircraft onboarding procedures in Wuhan and to monitor the health of returnees during the return flight to Canada. They will also conduct a final health screening on board the aircraft in order to inform Public Health Agency of Canada officials as to which passengers, if any, require priority attention upon arrival in Canada. Our medical team deployed to this effort will comprise two emergency medicine- and flight medicine-trained physicians, as well as four aeromedical evacuation-qualified nursing officers.

In response to a separate request for assistance received on February 1 from the Minister of Health, the Canadian Armed Forces will also support the reception, staging and onward movement of returnees once they arrive in Trenton. Specifically, as part of the second phase, the arrival and screening phase, Canada's military will support the Canada Border Services Agency and the Public Health Agency of Canada by providing access to the runway and apron areas in Trenton, along with associated aircraft services and aircraft parking.

Additionally, a variety of base infrastructure will be made available to our federal and provincial partners for customs and health screening. Also, as directed by lead departments, the on-board military medical team will assist with disembarkation efforts to include identifying priorities for disembarkation according to the medical needs.

Finally, as part of the third phase, post-screening activities, we will continue to provide logistical and staging support. In essence, the Canadian Armed Forces will provide a logistical framework within which the Public Health Agency of Canada will coordinate public health measures, emergency social services and security services with the Province of Ontario for the period of the quarantine.

Support provided by the Canadian Armed Forces during this phase includes ground transportation for returnees and supporting personnel; accommodations for returnees; infrastructure for use by federal and provincial authorities for the conduct of their tasks related to the quarantine period; food services; and general duties as required.

Of note, Mr. Chair, is that Canadian Armed Forces members, including military police, will not conduct direct security and enforcement activities relating to the quarantine of the returnees. This is being led by the Public Health Agency of Canada. However, Canadian Armed Forces elements in Trenton will coordinate as necessary to enable civilian police and security agencies engaged by the Government of Canada to conduct those tasks.

In closing, I would say that, looking forward, the Canadian Armed Forces will continue to provide support as directed by the government, while delivering on an array of other domestic and expeditionary operations.

Ultimately, our support to Canadians in need will always be our most important mission. We take that role very seriously.

Mr. Chair, ladies and gentlemen, Canada's surgeon general and I look forward to taking your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, General.

We will now go to the Public Health Agency.

I believe you have a statement as well. You have 10 minutes, please.

[Tina Namiesniowski, President, Public Health Agency of Canada]

Thank you, Mr. Chair, for the opportunity to update the committee on the coronavirus. We were here last week, and a few things have transpired since then.

I understand that on Monday this committee also had an opportunity to receive updates from various departments involved in the government's response.

I'd like to take this opportunity to recognize the contribution of all departments and agencies taking part in the response effort to confront the coronavirus and their close cooperation with our agency.

As you're aware, things continue to evolve globally in terms of the spread of the illness and the overall global response. We continue to monitor the situation in China and other countries very closely to inform our own overall risk assessment.

As I'm sure you're aware, there are increasing numbers of cases in China. At this point, approximately 24,000 have been confirmed globally, with the vast majority in mainland China. Of those, the majority are within Hubei province. At this point, there are 27 other countries and regions that are reporting cases, including Canada.

The increase in numbers that we are seeing reported in China is not unexpected. Chinese authorities have undertaken considerable effort to contain the spread of the virus. They've expanded production of medical products. They've been sending additional health workers to support efforts in Hubei province. They've issued technical guidelines regarding the use of personal protective equipment, and they're increasing other venues for receiving and treating patients with mild symptoms or for medical observation of close contacts.

As I said last week, Canada's public health system is well equipped to contain cases coming from abroad and their potential for spreading within Canada. There's a high level of vigilance and coordination by all levels of government, and we have protocols in place to monitor for illnesses and ensure the quick identification and isolation of suspected cases. The system is working as it should to protect Canadians against this novel coronavirus, and the overall risk to Canadians in Canada remains low.

As part of Canada's overall response, on January 28 the federal government and provinces and territories agreed to establish a special advisory committee on novel coronavirus. This is part of our federal-provincial-territorial governance. It allows for a focused, time-limited mechanism for public health collaboration and information-sharing between jurisdictions, related to the overall response to the coronavirus. It continues to meet regularly. As required, it provides advice in terms of the overall government response and how that response should or should not be adjusted relative to what we're observing.

The international response has also evolved in the past week. On January 30, the World Health Organization's director general declared the outbreak of novel coronavirus to be “a public health emergency of international concern”. Canada's response is aligned with the World Health Organization's recommendations.

Last week, I also talked about the different measures that the federal government has put in place in terms of helping to prevent the introduction and spread of the disease within Canada, so I won't repeat what I said. I will just note that in terms of border measures, when I was here last week I made reference to the fact that we have three airports where we have focused efforts—Toronto, Montreal and Vancouver—and I made reference to the fact that in those airports, through the electronic kiosks, we have a question that specifically asks travellers whether or not they've been in Hubei province. That question now exists in seven other airports.

In total, we have 10 Canadian airports that have a questionnaire as part of the electronic kiosk process, whereby travellers are asked to identify whether they've been in Hubei province. As of February 4, 2020, from the point in time when we started collecting that information by way of the kiosks, 855 travellers have identified as having returned from Hubei province, with 43 individuals referred for further assessment by a quarantine officer. Of those, 40 were released with an education handout and three were issued an order for further medical examination.

We also have our National Microbiology Laboratory, which performs confirmatory testing for any positive novel coronavirus laboratory result produced by a provincial or territorial public health laboratory. As of February 4, 2020, our lab has undertaken testing for 149 persons under investigation in Canada.

As you're aware, four have tested positive and 145 have tested negative. To date, there are four confirmed cases of coronavirus in Canada and one presumptive confirmed, which was announced yesterday by British Columbia.

I will now say a few words about bringing the Canadians home. As our colleagues said, we are working closely with our federal colleagues and counterparts. A number of departments are involved in planning the return flight.

We are very much a part of that process, as mentioned, and we're working very closely with all of our federal partners. We are on the ground, as we speak, in terms of finalizing the plans that will enable the efficient processing of the return of individuals on the flight that has been announced by the Minister of Foreign Affairs.

As mentioned, there will be efforts on the flight as well as in pre-flight departure to ensure that we have information on the health status of every individual who is getting on that plane. That will enable us to be ready when people arrive in Canada, so that we're able to respond in an appropriate way.

As I think the committee is aware, we now have an emergency order in place that was made pursuant to the Quarantine Act. That enables us to have the authority to keep all passengers at CFB Trenton for 14 days after the arrival of the flight. This will allow us to undertake full health assessment and the follow-up observation that will be required during that period of time.

We also recognize that individuals who are returning to Canada clearly have undergone a fairly stressful situation. In addition to the type of medical assessment that will deal with their physical health, we are also very much focused on ensuring that we have the right kind of social supports in place to enable all of those individuals to get mental health supports as necessary. In that context, we are working closely with our colleagues in the Government of Ontario, but with other partners as well, such as the Canadian Red Cross.

I will end my comments there. We are ready to answer your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Thanks, all of you. We'll now go to questions.

We'll start with you, Mr. Bezan. You have six minutes.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Thank you, Mr. Chair.

I want to thank our witnesses from the Public Health Agency, and it's always great to see General Downes and General Cadieu, so thanks for being with us today.

I want to thank the Canadian Armed Forces for what it is doing in assisting with getting our Canadians home from China, facilitating their movement and providing the facilities for them to return home safety.

A little bit of information that I think some Canadians would want to know is how we are handling the passengers before they enter the aircraft, whether or not there is any pre-screening before coming on, and whether that's being done by Canada or by China. Also, what protective measures for personnel are being taken with regard to the flight crew and the Canadian Armed Forces medical personnel while they're on board the aircraft? Of course, we know that this is all recycled air, and they're going to be on a direct flight for nine or 10 hours. How is that being dealt with from a biohazard standpoint?

[Tina Namiesniowski]

Mr. Chairman, maybe I can start with the process of how we're taking people through the steps from the point of view of health assessment.

We are working very closely with Chinese authorities, who have been quite clear that they will want to ensure that any individual who is getting on the flight and leaving Hubei province is not symptomatic. They themselves will be having an assessment of every single person, which is not different for Canada relative to other countries that have repatriated their own citizens. There will also be a pre-boarding assessment that will be done by our colleagues in the Canadian Armed Forces.

During the flight itself, we've worked with our partners to ensure there is a comprehensive questionnaire that will be gone through with every single individual on the flight. It will collect information that will enable us to have a good understanding of the individuals themselves: what kind of health considerations might be important for us to know; whom they may have been in contact with during the course of their stay in Hubei province; whether they themselves have been sick; and whether they have been in contact with somebody who was sick. That's so we have a very good understanding of each individual and the type of information that will be necessary for us as we continue the health assessment once they arrive.

If there is somebody who is sick en route, we've worked on protocols that would ensure that those individuals, to the extent possible, are isolated from other passengers on the flight and are given some equipment, such as a mask, to ensure that we're doing what's necessary from the point of view of other individuals who are on that flight. If they are sick enough upon arrival, we do have the right kinds of mechanisms in place whereby we would be transferring that individual to the local public health authority to make sure they get the treatment they would need in response to whatever they may be dealing with from a health perspective.

The same would hold true in terms of people who have subsequently gone through the processing at Trenton. If we were to have an individual who becomes symptomatic, we've already worked out the protocols with our local public health officials in Ontario whereby we would have a seamless transition into the local public health system to make sure that individuals get the kind of support they need.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

And from the standpoint of Canadian Forces protection...?

[Major-General A.M.T. Downes, Surgeon General, Commander, Canadian Forces Health Services Group, Department of National Defence]

Thank you.

Our medical team that deployed last weekend took with them an extensive array of personal protective equipment, including masks, gowns, gloves, face shields, etc. The crew themselves will be wearing protective equipment throughout.

Passengers will be offered protective equipment as well, but should one of the passengers manifest symptoms consistent with coronavirus during the flight, they will be isolated as much as possible in the aircraft and will be required to wear full protective equipment. If we're not able to properly isolate them or isolate them sufficiently, other passengers would be offered the same level of protection.

You could imagine this as being very similar to the level of protection that would be seen in a hospital should a patient come in with these types of symptoms.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

I appreciate that.

I only have one minute left. I guess the question revolves around the physical facilities and how you're doing isolation on CFB Trenton. What types of risk factors are you going to be mitigating in terms of keeping proper distances from people in quarantine versus the day-to-day operations of the base? I just want to get a bit of an idea about that and how people in the community potentially might be expressing some concern.

[MGen T. J. Cadieu]

Mr. Chair, I'll comment on the mitigation measures we are taking at Trenton to mitigate the risk to the returnees, the Canadian Armed Forces members and, subsequently, of course, our missions as well.

On arrival, in support of CBSA, those individuals will receive an initial screening, after which we will transport them by bus to accommodations at CFB Trenton. On the accommodations that returnees will be staying in, they are going to be in single rooms, except families; in support of the Public Health Agency of Canada, we are making arrangements for family units, for their integrity, for them to remain together. Each of those rooms has bathroom facilities as well, so they do not require shared use by the returnees.

During the period of quarantine, the returnees will stay in the Yukon Lodge; those are the accommodations that have been set aside only for the returnees for the duration of their stay. They'll have an opportunity to move about in that very local area, but they will not be mingling with Canadian Armed Forces.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Bezan.

We'll go now to Dr. Powlowski.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thanks very much to all of you for coming out today, and thank you for your work on behalf of all Canadians. I think you're doing a great job.

We had customs and border services come and speak to us earlier in the week. It seems that if you come from Wuhan or Hubei province, that initiates a process of screening and dealing with people who have potentially been exposed to the virus, people who have symptoms. Is this being done only with people coming from Hubei province and not from the rest of China?

[Tina Namiesniowski]

Yes, Mr. Chair.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Johns Hopkins University has a dashboard showing the number of cases from other provinces. My understanding is that there are two other provinces with almost 900 cases. There are a number of other provinces with over 500 cases. That's gone up pretty dramatically over the last couple of days, from when it was almost half that number.

As we remember, there's a quarantine period of up to two weeks, so these numbers are going to go up even higher. Have you considered possibly implementing the same provisions regarding all passengers coming from China, with the idea that perhaps China has done a good job of barring the door but the horse may have bolted?

[Tina Namiesniowski]

Mr. Chair, what's very clear in the context of the Quarantine Act is that every single air carrier that flies into Canada has an obligation to ensure that if they have a sick passenger on board that flight, they make the Government of Canada aware of that prior to their arrival. This ensures that, irrespective of where they're coming from, we are quick to respond as a plane arrives in Canada, to deal with anybody who requires some level of medical treatment. That applies across the board.

In the three airports where we have the vast majority of flights that come from China, as I said, we have put in place additional measures, including, at the kiosk, a question related to whether or not you've been in Hubei province. However, in the customs halls themselves, there are screens that are advising all passengers, irrespective of whether they've come from Hubei province, to make sure that if they're feeling sick, they identify that to a border services officer.

In addition, all passengers have access to the information available to the individuals who are coming off those flights. That provides them with advice on what they should be looking for in terms of symptoms, as well as what they should do in the event that they feel they should contact local public health. Those handouts provide information across all jurisdictions as to whom they should contact and, if they are feeling symptomatic and are concerned about whether or not they actually are symptomatic in relation to the coronavirus, what they should do, including calling ahead and following the types of protocols that we believe are necessary to ensure that people are ready to receive them. To date, that's exactly what has happened.

As I mentioned, very few people have actually been referred for any kind of medical assessment. What we've seen to date is that the measures we've put in place in the airport have done what we expected them to do. As Dr. Tam will probably speak to, the border measures are not a be-all and end-all, and we know that. They are but one level of effort relative to other things that are happening in relation to system readiness and response here in Canada.

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

Just to add to what the president said, obviously the front line of all the health facilities is a very critical point for assessment. Based on what all the provinces and territories are doing, they have a very low threshold at the moment for looking for anyone, not just from Hubei province, but from all over China, and they have the flexibility and physicians to test anyone they suspect might have the coronavirus. It's through that specific history, like “Have you been in a hospital?” or “Have you contacted someone with pneumonia?”, and they have a very low threshold right now for testing.

So far, though, all the positive cases have a link back to Wuhan.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

My understanding is that the United States is asking all people returning from China to voluntarily self-isolate for two weeks. We're trying to figure out whether the United Kingdom is doing the same or not; it wasn't clear. I don't know if you have more information. Has Canada contemplated doing the same thing, asking all people returning from China to self-isolate for two weeks?

[Dr. Theresa Tam]

The situation is continuing to evolve in terms of what's happening in China. I just want to underline that the risk in Canada is low. We have very few cases. The chains of interaction have been contained. It's not spreading in Canada.

Really, out of an abundance of caution, while the risk is low, we're actually in quite a special period globally of containment. If anything is going to be done to limit spread, it will be now. I think Canada should be contributing to that containment effort, so together with the chief medical officers and the special advisory committee, we're adapting our advice. As of essentially now, we're recommending that if you've travelled to Hubei province in the last 14 days you limit your contact with others. That is essentially what the United States and others think of as self-isolation, and you should monitor your health and report to local public health if you have any concerns.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

We'll go now to Mr. Thériault.

You have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Ladies, gentlemen, welcome. Thank you for being here to provide us with further information on a situation that is constantly evolving, and quite spectacularly, at least in China. Statistically speaking, the situation has now surpassed the SARS crisis. I have been reading everywhere that, when they come home, people who are symptomatic during the flight will be directed to the first refuelling stop, in Vancouver.

Does that mean they cannot be treated on the military base? Do they absolutely need to be sent to a hospital if they are having health issues? I would like to understand that. A quarantine zone has been set up, so I thought that everyone affected would be sent there and that they would have everything needed on site to treat all cases in isolation.

[MGen A.M.T. Downes]

Thank you for your question.

First, I would like to say that we in the military do not have everything needed to treat passengers presenting coronavirus symptoms. The provinces are responsible for providing care.

[Luc Thériault, Bloc, Montcalm, QC]

Let's say that those who live in the Vancouver area will get treated in a Vancouver hospital. The people arrive in Trenton and, all of a sudden, there are people from Toronto and from Quebec. Will they be taken off the base as soon as they become ill and sent to a hospital, because the military base is only an incubation zone? That is unclear.

[Tina Namiesniowski]

I will try to answer the question.

We are now finalizing protocols with the province of Ontario. Right now, based on our approach, the province is responding in a highly reactive manner, with help from EMAT, the Emergency Medical Assistance Team, an Ontario government resource.

It's a resource of the Ontario government whereby they will be on the base, and should there be somebody who is sick, they will be able to take that person, using their mobile capacity. They have a negative pressure room that will be available for people. They will be able to use that negative pressure room and assess the individual in situ. If the person presenting is symptomatic, they would be able to draw samples from that person, and through our own mobile lab from the National Microbiology Laboratory, we would be able to test that sample there.

If that sample were positive, there would have to be a determination as to whether it is a mild case, because you know that some individuals within Canada who had a positive test for the coronavirus have actually not spent time in hospital. It would depend on the severity of the situation whether that individual would need to be transferred to the local hospital.

Clearly, the objective would be to ensure that the right type of support is put in place to help manage that particular situation.

[Dr. Theresa Tam]

I just want to add that, on the question of Vancouver, the idea is that no passengers get off in Vancouver, unless there's an emergency—if someone had a heart attack or there were other issues.

The British Columbian teams are already rehearsing, if there's an emergency, to safely transport to the health facility. However, this is just a plan. It is expected that we get everyone to Trenton as quickly as possible.