Evidence of meeting #30 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was countries.
A recording is available from Parliament.
12:10 p.m.
Liberal
The Chair Liberal Ron McKinnon
Mrs. Jansen, you no longer have the floor. Mr. Webber has the floor.
Mr. Webber, please carry on.
12:10 p.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
Okay, well I'm going to pass my questions back to MP Jansen then.
12:10 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you.
Mrs. Jansen, your time is up.
We go now to Dr. Jaczek. Please go ahead.
12:10 p.m.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you very much.
The analysis that both of the witnesses have given has been very insightful for all of us who have been following this pandemic for a number of months. I assure you that I'll give you plenty of time to answer my questions.
I was in public health practice as a local medical officer of health for nearly two decades. Certainly the communication of risk and people's perception of risk do vary tremendously, and it's very difficult to communicate that.
Professor Gostin, you started by talking about trusting the experts, making sure that people understand that a lot is unknown, that you are trying to communicate honestly and so on. Going forward, what do you see as the role of the WHO in communicating risk and making sure that people voluntarily adopt physical distancing and the public health measures that are recommended? Can you give us what you would see as an ideal way forward?
12:15 p.m.
O'Neill Professor of Global Health Law, Georgetown University, and Director, WHO Collaborating Center on National and Global Health Law, As an Individual
The WHO is in a more difficult position in terms of risk communication and health advice than the national government would be, because its advice goes to every country.
I think Jeremy was right that the mask issue occurred because of evolving science, and some of it.... We just didn't realize that it was such a risk mitigation measure, particularly because there was asymptomatic transmission going on. On the other hand, there are some countries where mask use is not as easy and effective as it would be in other countries. The WHO is in a difficult position.
My advice to the WHO—and I'll state it publicly, and they know it—is exactly what I said before: to actually state honestly what we know and what we don't know, and to express that uncertainty.
If anybody tells you that we are sure of something in this COVID-19 pandemic, you need to take it with a grain of salt. I've said to myself, “Larry, we have to approach this virus with some humility.” That doesn't mean we ignore science. We have to double down on science to try to find the answers, but we do have to have humility, and we don't want to be preachy. We want to explain what the levels of uncertainty are, understanding that people have different risk tolerances and different risk perceptions. They absolutely do. All the science tells us that.
12:15 p.m.
Liberal
12:15 p.m.
Senior Policy Fellow, Centre for Global Development
Yes, I agree with Larry.
I think partly what we're seeing here is the process of science playing out. We start with a lot of uncertainty and we make a best guess based on the closest parallels we have. There is a real challenge in public health communication in providing that information in a way that is authoritative without being overconfident or without being misleading. I don't think, frankly, that much of the world has done a good enough job of communicating that uncertainty.
As we understand more about the science of the disease, the recommendations evolve and change. I think that's what you're seeing. We are finding that to control COVID, we need to do things that are different from what we needed to do to control SARS, because SARS did not have the kind of asymptomatic transmission we're seeing here, and it is different from what we needed to control flu, but at the beginning, we had no way of knowing that. Recommendations were based on the closest known parallels we had. As we gather more data and more information, those recommendations have evolved.
I think that is a difficult thing. If you're a member of the public and paying only partial attention to this, and you see those changing recommendations without really understanding the rationale behind them, it is confusing and it does undermine trust.
12:15 p.m.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
In Canada we have another complication, in that we have a very vast country with different geography and different demographics. One of the issues on which I think public trust was somewhat eroded was that there was a lack of consistency in public health guidelines in terms of allowable behaviours, and even now as we're opening up the economy.
There has been some suggestion that we would be best served with some national standard. In a way, Mr. Konyndyk, I think you alluded a little bit to gradations within public health emergency standards so that it's fairly clear that different jurisdictions might have different responses depending on where they are within the emergency gradation, so to speak.
Do you have some comment, Mr. Konyndyk, on how a vast country like Canada might ensure some more consistency?
12:15 p.m.
Senior Policy Fellow, Centre for Global Development
Absolutely, and we are struggling with the exact same problem here.
One of the challenges is that for reasons we don't yet fully understand, it hits different places at different times. It's easy for the areas in the United States that locked down earlier, that locked down before they had a raging crisis, to then look at that and, rather than think they dodged a bullet, think they were bulletproof.
Some of the states that have now reopened, in my view too early and too recklessly, are paying a real penalty for that. Arizona is about to have its hospitals overwhelmed, as are parts of Texas, and I think Florida is not far behind. The reason was that they assumed there was some difference inherent in their states that meant they were not going to face the same sort of situation that New York faced eventually, or that this problem was unique to New York.
I think there are absolutely differences and there are gradations, but the fundamental thing we know is that if you give this virus oxygen, it will burn you down. If you do not have some way of controlling it....
You can't sustain a lockdown forever, and you shouldn't need to. I think what we see from South Korea, Hong Kong, Taiwan and some of the better performers in East Asia is that if you have good testing, tracing and strong public health measures and you're following science, you don't need these long-term, very crushing lockdowns, but you have to pass the baton to something if you're not going to keep the social distancing measures in place. If you lift social distancing without having the other measures in place, as much of the U.S. is doing, that's disaster.
12:20 p.m.
O'Neill Professor of Global Health Law, Georgetown University, and Director, WHO Collaborating Center on National and Global Health Law, As an Individual
I might just add two dimensions to this discussion as well.
Canada, the United States, and other countries, such as Russia, are federalist countries. How do you deal with a pandemic in a country that divides its powers and its influence among various jurisdictions?
Often federalism has strengths, because you can have local innovation and local experimentation, but you also need, as you said, consistent national guidance and a consistent national response, because if there is a fire in one place, it will spread to other places, so you do need that federal leadership.
The other thing we're seeing in Canada, the United States, Brazil and many other places is a political and cultural divide. A virus should make us all think that it doesn't matter what political party we are or what ideology we have, whether we're rural or urban, or what our culture is. We all need to respect that virus in the same way, but somehow this has become a political cultural symbol. It's very unhelpful when we start to do that.
12:20 p.m.
Liberal
12:20 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Over nine million people were reported infected and over 472,000 people were reported dead. In the United States, over 2,300,000 people were reported infected, which amounts to a quarter of the population of Quebec. We have no vaccines or antivirals. Our strategy has only just been implemented. We have no serological test. In short, we know very little about the virus.
Right now, there's a lull, an in-between period. What worries me is the lifting of the lockdown. From a public health perspective, there's little reason to lift the lockdown quickly. The basis for lifting the lockdown isn't public health, but economic pressure.
Mr. Konyndyk, if we don't want to see a second and even more deadly wave on the planet, at what rate should the lockdown be lifted right now, given what you said about rich countries and poor countries?
12:20 p.m.
Senior Policy Fellow, Centre for Global Development
That is the biggest question that I think every country is facing right now.
I would say a few things.
First, the lifting of confinement or stay-at-home orders needs to be very cautious, very gradual and driven by data. If some measures are lifted and this does not provoke a spike in the virus, then go to the next phase, wait, make sure it does not cause another spike in the virus. I've worked with other colleagues here in the U.S. in laying out a series of recommended steps for local areas to determine whether they are ready to safely reopen. That is based on a range of things. You need to understand what the virus is doing locally. What is the status of the local outbreak? Have incidents come down to a low absolute level? Is testing positively down to a low absolute level?
Second, is there enough testing and contact-tracing capacity in place to then manage the spread of the virus so that if you see a rise in cases, you can use testing and contact tracing to begin containing that? Is there readiness in the hospital system for a future wave? These are all the measures that need to be in place in order to safely reopen. Then, by all means, have a conditions-based reopening with safety measures in place to contain the virus through other means. What's dangerous is a reopening that is not based on clear conditions and that does not have the tools to contain the virus through other means once the social distancing measures are relaxed.
The last thing I would say is that what we're coming to learn about the virus is that super-spreading events—these events where large numbers of people in an enclosed space become exposed at a single event—are probably the most dangerous and aggressive way the virus spreads. Those are the sorts of things that should be among the last things to reopen only once the virus is almost totally suppressed.
12:25 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Thériault.
Mr. Davies, please go ahead for two and a half minutes.
12:25 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
I really appreciate the refreshing and frank advice. I can tell you that it really resonates with me that one of the lessons I think we ought to learn out of this is our need for public health officials to express uncertainty. I think almost every country is guilty of that to some degree. I know President Trump talked about opening by Easter. China, of course, famously didn't report it [Technical difficulty—Editor].
12:25 p.m.
Liberal
The Chair Liberal Ron McKinnon
Mr. Davies, are you there? It looks like your line or your session is frozen.
We will suspend the meeting for a brief time while we get Mr. Davies sorted out.
The meeting is now suspended.
12:25 p.m.
Liberal
12:25 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Bringing a whole bunch of threads together, I think it's very accurate to say this was a novel virus we were feeling our way through. Of course the essence of [Technical difficulty—Editor] predict and replicate results in a predictable fashion, which is difficult to do. I take the example of masks. We were strongly advised not only not to use them, but that they would be harmful. This is a lesson from the WHO.
Where does the precautionary principle intersect with science? If the WHO were to say they were not quite sure about the efficacy of masks, but they have been helpful in reducing the transmission of droplets [Technical difficulty—Editor] so they would recommend that we use them if we want to as opposed to a hard no, is that one of the lessons that comes out of this? Perhaps we need to adjust the public health advice we give when we're not sure.
12:30 p.m.
Senior Policy Fellow, Centre for Global Development
I think that's a fantastic question.
One of the challenges with the masking was early on we knew that medical-grade masks were needed for health facilities to keep health care workers safe. We knew there were not enough of them, and we knew that masking guidance was being interpreted by the general public to buy an N95 mask from the hardware store. These are very common masks, and many people would normally have them.
There was an overreaction early on to try to deter people from buying masks because they were competing with critical health care supplies. I think this is a takeaway lesson. A better job should have been done of distinguishing between medical and non-medical grade masks, saying not to buy medical grade. Some of this was done but it was not forthright enough.
The science on the value of masking in the general population was uncertain. The science on the value of masking in the medical situation was certain, and that was what we were going on initially as the understanding of the virus evolved. I agree I don't think that was well-enough explained, and I think there are lessons there for the future about how that uncertainty and the state of the evidence, the state of understanding, is communicated with the public going forward.
12:30 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies.
That wraps up round two, our first panel. I thank the witnesses; you've been enormously helpful. We certainly appreciate your time and expertise.
With that we will suspend as we bring in our next panel. We are changing interpretation so it will probably be a 20-minute suspension. We will start as soon as we can. We are running a little short of time.
12:50 p.m.
Liberal
The Chair Liberal Ron McKinnon
The meeting is now resumed.
I'd like to welcome the members back.
I welcome the witnesses to meeting number 30 of the House of Commons Standing Committee on Health.
Pursuant to the order of reference of May 26, 2020, the committee is resuming its briefing on the Canadian response to the outbreak of the coronavirus.
I would like to make a few comments for the benefit of the new witnesses. Before speaking, please wait until you are recognized by name. During questioning, the questioner will signal to whom the question is addressed. When you are ready to speak, you can click on the microphone icon to activate your mike.
I remind everyone 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. 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.
When you are not speaking, your mike should be on mute.
I'd like now to welcome our second panel of witnesses.
From Statistics Korea, we have Asaph Young Chun. Mr. Chun is the director general of the Statistics Research Institute.
[Chair spoke in Korean]
[English]
We have, from the Taipei Economic and Cultural Office in Canada, Mr. Winston Wen-Yi Chen.
[Chair spoke in Mandarin]
[English]
Thank you to both of you for being here. You each will have time for a 10-minute statement.
We will start with Statistics Korea.
Mr. Chun, please go ahead for 10 minutes.