Health Committee on July 6th, 2020

[Paramvir Nagpal]

First of all, technically the entire population can have access to this technology. One of the main cases is that you need to have a smart phone to enable the use of this technology. Theoretically, you can deploy this using Google Play store or App Store, and you can give everybody the capability to use this technology.

That said, if a person doesn't have a smart phone, they can also use certain features of this technology by going through a website, where they can see how the spread is happening in their own locality. If they're seeing some symptoms, they can easily go to that website, enter that information, and then do contact tracing. There are various ways we can securely provide that access to Canadians.

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

Could you be more specific please, Mr. Nagpal?

I get the impression that not the entire population has a cell phone and would be able to install this app.

Honestly, I don't know what percentage of the population could install this app. Are we talking 70%, 80%?

[Paramvir Nagpal]

The percentage would depend on how we want to deploy the technology. If 70% of people have a smart phone, they can easily install the smart phone application, and the rest can go on a website and access similar features on a web browser. The compatibility depends on how we are deploying the technology. You can deploy it on a smart phone, a website, or a web browser.

Of course, there will be some situations where we won't be able to hit the prospects, where they're not able to access the Internet or a laptop or a computer. We will not be able to cover those kinds of populations, but the majority of the population will be able to do that using this technology. This is exactly how countries like Singapore or some European member states have done this very successfully.

We have some customers in Taiwan, and they were saying to us that they didn't face that type of challenge as it was faced by the rest of the world, and it's because of how countries are using specific technologies for the well-being of their citizens.

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

Okay, good.

What I fear is that this app won't be available to the part of the population that is underprivileged and who, perhaps at the same time, is simply more at risk.

Thank you for your answer, Mr. Nagpal.

I have a question for Mr. Possamai.

After more than three months of the COVID-19 pandemic, do you feel that the current measures are adequate and sufficient?

[Mario Possamai]

I presume you're asking about the personal protective measures for health care workers. Is that correct?

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

Yes.

[Mario Possamai]

They're not, and I believe the data showing that one in five of the COVID-19 cases in Canada involves health care workers demonstrates that point. I think we urgently need to take a precautionary approach and protect our health care workers across the country to the highest level using airborne precautions.

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

Right. I understand very well.

Should there be a potential second wave, is there enough time to turn things around to better protect these people and hope for lower infection rates?

[Mario Possamai]

We have enough time if we act urgently.

One of the really disappointing things thus far from the federal government and PHAC is that we have not acted urgently to ensure we had enough PPE. For example, in late December, Alberta bought a huge quantity of N95 respirators. PHAC and Ottawa sat on their hands. Federally, we didn't begin to buy in large scale until March, and by that time, as you have heard, it was like the wild west in trying to buy N95s. We lost that opportunity. We have to move urgently. We have to create a domestic supply and we also have to look at alternatives, because N95s are not the only way to protect health care workers. There are P100s and other types of equipment that should be looked at on an urgent basis so that we have enough equipment.

For example, we were talking about technology. There have been some efforts to begin creating new types of equipment, and we have to move quickly.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Desilets.

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

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

We go now to Mr. Davies for six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Mr. Nagpal, you mentioned that Singapore was one of the earliest adopters of contact tracing and you commented on the European Union being in the process of developing a model for contact tracing. We have had many experts tell this committee that testing and contact tracing are vital parts of getting a good grip on COVID-19. Where is Canada today in our implementation of contact tracing?

[Paramvir Nagpal]

I believe Canada hasn't been the front-runner in adopting contact tracing. In the past week we had an announcement from the PMO that BlackBerry and Shopify would be collaborating to build a contact tracing app that would be available for Canadians to download anonymously and voluntarily. We haven't used the technology the way we should have.

Other countries have adopted it very quickly at very early stages. Right now we don't have the available app. We don't have any available data to see how it can be used. If you can't analyze it, you can't improve it. Let's say somebody has COVID and he or she goes to the hospital. How can you find with 100% accuracy where that person went in the last week or the last 14 days? It's very difficult. I believe we are doing some good through the announcements that we will be launching it, but we haven't done that at this time.

[Don Davies, NDP, Vancouver Kingsway, BC]

Experts estimate that voluntary contact tracing apps usually need approximately 60% participation among the public to be effective. In your view, is that level of voluntary uptake realistic, or should we be looking at mandatory use of contact tracing? What's your advice to the committee on that aspect?

[Paramvir Nagpal]

First of all, I think it's true that it needs to have 60% uptake. I don't feel we would get a 60% uptake on a contact tracing app in Canada. I don't believe we should make it mandatory. We are not a country that would take away that right from its citizens. I feel we should complement that with other location-based technology or another traditional method. When you combine the new technology with the traditional methods and also use some other kind of location-based applications, you are able to get the result you are looking for, and I feel that's the unifying mixture we need to look for to get the maximum result out of such technology.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Possamai, on January 31 you wrote to the federal health minister, Patty Hajdu, urging her to adopt precautionary protections for health care workers. In that letter you wrote, “I am profoundly disappointed that the Public Health Agency of Canada is risking health worker safety by recommending lower protections against the novel coronavirus." You also wrote that failing to act with tougher policies “would be to do a grave injustice to the victims of SARS and their families. Half of SARS victims in Ontario were health workers.”

What was her response to your concerns?

[Mario Possamai]

She never replied to my letter.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Possamai, staying with you, we know that the final report of the independent SARS Commission in 2006 recommended very clear prescriptions for how to deal with a future pandemic. One of them, as you've pointed out several times, is that in any future infectious disease crisis, the precautionary principle should guide the development, implementation and monitoring of procedures, guidelines, processes and systems.

We've already pointed out that when it came to masks, droplet versus airborne transmission, asymptomatic transmission, community transmission, travel restrictions, border closures and emergency stockpiles, I think it's a fair comment to say that in all of those areas, if we did anything, it was that we ignored the precautionary principle and instead waited until there was actual evidence of something before we acted.

Would that be a fair characterization of Canada's response from January to date?

[Mario Possamai]

It is.

We had opportunities over and over, especially in the beginning and late December, when we had the first inkling that something very serious was happening in Wuhan. We had the opportunity to act boldly and quickly to protect our health care workers and, by extension, to protect the country, because protecting health care workers goes hand in hand with pandemic containment. The countries that have low levels of health care worker infections also have the best record of containing the pandemic.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you help us understand why that's the case? We had an unprecedented focus after SARS. As you mentioned, we had the Archie Campbell commission, and I think we had one at the federal level as well. We have very clear prescriptions about what to do, yet in the last 14 years, from 2006 to 2020, we have not only fallen down in that period, but also, from the beginning of COVID-19, we have failed to implement the very prescriptions in the independent SARS Commission report.

Can you give us your view on why that is? How could that happen?

[Mario Possamai]

I'll tell you personally that I'm gutted that it has happened, that things have gone the way they have here. This has gone far worse than my worst nightmare, and one of the reasons is that PHAC does not understand the role of unions and workers in worker safety. In any workplace, the responsibility for worker safety is a joint one between workers and their employer, which means, especially in the health care sectors, that nurses, doctors and other health care workers have a direct role in ensuring the safety of the workplace.

In the interactions that I know of and that I have heard of between PHAC and the unions, there's not been a positive dialogue, a collaborative dialogue, between workers, unions and PHAC. Instead, it's done cursory consultations with workers and unions, just ticking the box. In fact, there should be an ongoing dialogue, because front-line workers know first-hand what the risks are and how things are evolving. They can make real-time recommendations on how to ensure that everyone is protected. By “everyone”, I mean workers, patients, visitors and the rest of us, because, as I said earlier, pandemic containment and worker safety go hand in hand.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

We'll go now to the second round. We'll start our second round with Ms. Jansen.

Ms. Jansen, please go ahead for five minutes.

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

Thank you very much. I would like to ask my first questions of Mr. Possamai.

I really appreciated your explanation of the lack of urgency. I can tell you that having been on this committee from the very beginning, I felt that very same lack of urgency coming from PHAC and from the government on a number of these things.

We had very serious concerns about the messaging from Dr. Tam regarding the danger that mask use would pose to Canadians and her insistence on ignoring the precautionary principle. This messaging, obviously, was subsequently repeated by Minister Hajdu at many of the COVID-19 briefings, and now, since then, there is new science that made them change their recommendation. Unfortunately, this meant that we lost a very important window of opportunity to get Canadians on board and comfortable with mask use.

From the various presentations we've had at this committee, it appears that Canadians were possibly being told not to wear a mask at the beginning because PHAC knew our national stockpile had not been maintained and there were not enough masks in Canada to protect even just our health care workers.

Would you say that the politicization at the highest level of PHAC has affected the decisions being made, to the detriment of Canadians?

[Mario Possamai]

I think PHAC has been slow to the game, and public masking is a great example. Early on I wrote a letter to Dr. Tam saying that concerns about self-contamination are warranted, but if that's the case, you should have an urgent, wide public health campaign—as they do in Singapore, as they do in Hong Kong, as they do in Taiwan—on how to wear a mask. That still hasn't happened. As I walk in Toronto, I see well-meaning Canadians wearing homemade masks, but they're wearing them with their nose exposed. I see Canadians with beards wearing masks, when we all know that beards prevent the safe wearing of masks.

There is a real failure there to really act urgently to protect Canadians and also to make sure they get the best information.