Good afternoon, Mr. Chair, and members of the committee. Thank you for the opportunity to brief you on how COVID-19 has revealed that the system to protect Canadian health workers during a public health emergency is broken, and must be fixed urgently before the expected second pandemic wave.
From the start of the outbreak, the Public Health Agency of Canada has said that droplet precautions, including surgical masks, are sufficient protection for our health care workers, because COVID-19 could not spread through the air, and only spreads through large droplets.
In those early days, Canadian experts who supported the agency's position said that if COVID-19 was airborne we would see outbreaks in places adhering to droplet prevention. One expert said that if this was airborne, all those health care workers would be getting sick.
Here's what's happened since. Nationally, Canadian health care workers comprise nearly one in five of all COVID-19 infections in Canada. That is almost three times the global average as reported by the International Council of Nurses.
It is also approximately four times the rate in China where there was a requirement for the use of airborne precautions, including N95s, in late January. Most health work infections in China occurred before these higher precautions were implemented. This troubling situation is why I have been retained by the Canadian Federation of Nurses Unions to use the lens of the SARS commission to investigate why so many Canadian health care workers are being infected. While the investigation is at an early stage, I would like to share some preliminary findings and recommendations.
The first preliminary finding is regarding the precautionary principle, and the question of airborne transmission. When your committee met on April 7, dedicated Canadian experts, with the best of intentions, said that COVID-19 only spreads through large droplets and contaminated surfaces, and that surgical masks were sufficient protection. N95s, they said, were only needed for high-risk procedures. Since then, the science has evolved. The researchers in Hong Kong, who first identified SARS airborne transmissibility in 2004, have recently published a peer-reviewed article suggesting that large droplets are a negligible transmission route compared to airborne.
The CDC in the U.S. is now suggesting that infected surfaces may only play a minor role in COVID-19 transmission, and most importantly, an open letter published today by 239 scientists from 32 countries, the WHO and public health agencies, states that studies have demonstrated beyond any reasonable doubt that the viruses are released during exhalation, talking, and coughing in microdroplets, small enough to remain in the air, and impose a risk of exposure at distances beyond one to two metres.
Time will tell who is right and who is wrong in this debate though I believe the scales are increasingly tipping toward the growing evidence of airborne transmission. This is precisely the kind of situation where the precautionary principle and the findings of the SARS commission should be invoked. When there's uncertainty about a new pathogen, it calls for erring on the side of safety, and protecting health workers with the higher protections of airborne precautions, including N95s or higher, until the science is clarified. This is what China has done so successfully, and that is why the WHO has concluded that the transmission of COVID-19 among health workers and in health care settings is not a factor in China.
Keep in mind that it was not until a year after SARS that the best evidence of its airborne transmissibility under certain conditions was published. Justice Archie Campbell, who led the SARS commission, found that this was strong validation of the prudence of taking a precautionary approach until the science was settled.
Having regard to growing evidence of airborne transmission and with news that domestic production of N95s is coming on stream, I recommend that the Public Health Agency of Canada invoke the precautionary principle and require airborne precautions, including fit-tested N95s for all health care workers in all health care settings with suspected and confirmed COVID-19 cases. I also recommend that the federal legislation be amended to require the agency to take a precautionary approach to all worker safety guidance.
The second preliminary finding is with regards to our severe shortage of N95 respirators. Even though the SARS commission recommended stockpiling this vital piece of equipment, the federal health minister and the chief medical officer of health have claimed stockpiling was a provincial responsibility. I respectfully disagree. Ottawa destroyed two million N95s last year. It should have replaced them and purchased more, as the Prime Minister now seems to concede. Remember the federal stockpile had only 100,000 N95s entering the pandemic.
But setting this aside, I believe the chief medical officer of health and her immediate predecessor failed in their responsibility under section 12 of the Public Health Agency of Canada Act to warn Parliament and Canadians that we weren't ready, that we didn't have enough personal protective equipment, especially N95s.
When Dr. Tam's office and that of her Ontario counterpart were being established in 2004, Justice Campbell advised both governments to make chief medical officers of health the public guardian by giving them the rights, duties and independence to speak out on public health risks. Both levels of government listened and the wording of section 12 of the federal act and the equivalent section 81 of the Ontario act are virtually identical. Over the past five years Dr. Tam and her immediate predecessor have issued seven reports to Parliament and the public on a variety of important public health issues, including on alcohol and substance abuse. None, however, examined whether we were ready for an existential public health threat like the pandemic, including whether we had enough N95 respirators, despite the explicit intent of the act.
In view of the systemic failure I recommend that Parliament consider amending the Public Health Agency of Canada Act on an urgent basis to require the chief medical officer of health to report in detail each year on the state of Canada's preparedness for the future of public health emergencies and to request that the Auditor General of Canada independently evaluate on a regular basis the Public Health Agency of Canada's ability to monitor and evaluate our public health emergency preparedness.