Health Committee on Feb. 26th, 2020

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

Why not the rest of China? I mean, clearly there are numerous other provinces with thousands of cases of coronavirus. Why not them? Why not South Korea? Why not people who've specifically come back from Qom in Iran or the Lombardy region of Italy, places where we know there have been outbreaks?

[Dr. Howard Njoo]

To add to what Ms. Evans said, the direction or the advice for self-isolation is for travellers coming back from Hubei province, but for mainland China up to now, there's also been advice given that they should be monitoring for symptoms in the next 14 days—obviously, that's if they've come from mainland China in the past 14 days—and that, should they be coming down with symptoms consistent with COVID-19, they should contact local public health.

We had a discussion, as I mentioned, with our special advisory committee with regard to our travel health advice. We will now go forward and give that same advice to travellers who come back from the other six countries that we're now adding to what we call an “affected region” list—Hong Kong, Singapore, Japan, Italy, Iran and South Korea.

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

There's a second thing. I kind of question your reference to our containment with respect to H1N1 as being the model and as having been effective. Having been an emergency doctor at the times of both SARS and H1N1, I know that the precautions we took in terms of infectious diseases with SARS were totally different from those for H1N1. With SARS we gowned up; we masked and we did everything. With H1N1, I can't recall anything very much.

I would have thought that if we were looking for something to compare it to, it would be what we did with SARS rather than with H1N1. To go along with that, how much are we using the expertise of the people who were involved with SARS to inform the decisions on how to deal with the coronavirus?

[Dr. Howard Njoo]

I am actually also a veteran of SARS, so I guess I'm one of those people who were involved with SARS and H1N1, as were many other physicians and public health experts across the country. I would say that, yes, we are leaning on people who have gone through those, in terms of their experience, and we are using their expertise.

One of the key things we're doing right now, as I mentioned before, is to have a special advisory committee, which consists of the chief medical officers of health from each of the provinces and territories, and they, obviously, have their own experts and their own staff supporting them.

A layer below that, I'm actually the chair of something called the technical advisory committee. Many of the scientific questions, the recommendations, the programs and the policies that need to be developed and then sent to the special advisory committee for their review, consideration and approval are actually worked up at this technical committee. For that, there is representation on this technical advisory committee from the three key provincial health agencies—the British Columbia Centre for Disease Control, Public Health Ontario and the INSPQ from Quebec.

So we are harnessing all of the expertise across the country.

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

The question I'd really like to get in is this: Do you have enough resources, with both the Public Health Agency and the provincial ministries of health?

Given my experience, I don't feel that there is a lot of excess fat in the health care system as it is. Certainly, if there is any substantial outbreak, there is going to be a lot of work for a lot of people in public health in terms of contact tracing and ensuring that people who may have been in contact and have symptoms self-isolate. Certainly, it's going to be a massive burden on the hospitals and hospital resources in terms of the number of beds, negative-pressure rooms, ICU beds, ventilators....

I know we don't know where this is going, but I think you certainly have to be gearing up for the possibility that things are going to get worse. Even at this stage, in terms of gearing up, do you have enough resources in terms of people and money to be doing your job adequately?

[Dr. Howard Njoo]

That's a tough question. For me, personally, I could always use more resources and more money, but that's just me.

As part of the Public Health Agency of Canada and also the Government of Canada, I would say we're doing well. As I said, it's always nice to speculate about what you could do with more resources, but, certainly, as you can see in terms of the whole-of-government approach and what we've been doing to date, I think we've been successful to date. I don't want to predict what might happen in the future if the global situation changes, but so far so good.

As far as the health care system goes, it's difficult for me to comment, because, as we all know, health care is a provincial responsibility in terms of the system, the resources and so on. We are, obviously, discussing that with our chief medical officers of health, and they are also very cognizant. They're in contact with their physicians and front-line workers to see what could or should be done and what can be adjusted.

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

Maybe the bigger question is that this may be the case in the Public Health Agency of Canada, but when it comes to the individual work at the public health level, it's going to be done by what are basically municipal agencies in the hospitals in the provinces. Do they have any added sources of funding to start addressing the possibility that things are going to get worse, let alone to actually put into place some backups so they can respond?

Certainly I don't think Canada has the capacity to build a thousand-bed hospital in a week, as China did. For ventilators, you can't just go buy—

[The Chair, Liberal, Ron McKinnon]

Dr. Powlowski, can you wrap it up?

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

Do they have the resources?

[Dr. Howard Njoo]

It's difficult for me to comment, because it's a provincial responsibility. I would say that at the Government of Canada and the Public Health Agency of Canada, we do have what we call surge capacity support, so, should a province require additional support, maybe for some of the equipment we have in our national emergency stockpile system, we're certainly able to meet that request. However, in terms of speaking to the resource requirements, etc., in individual or provincial health care systems, I can't comment.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

We'll go now to Mr. Beaulieu.

You have six minutes.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Thank you, Mr. Chair.

Dr. Njoo, you said numerous times that you had good communication with health authorities in Quebec, the other provinces and the territories. However, Karl Weiss, a well-known virologist at Montreal's Jewish General Hospital, told Radio-Canada on Monday that he had not seen any effective coordination by the federal government.

How do you explain that? What tangible steps have you taken to ensure coordination? Can you give us the details of your plan?

[Dr. Howard Njoo]

It's difficult for me to comment on what someone else said on Radio-Canada, but I can tell you that we are working closely with our provincial and territorial counterparts.

I co-chair a national technical committee with representatives from every province and territory. My co-chair is Dr. Horacio Arruda, Quebec's chief medical officer of health. We work very well together. He and his colleagues contribute to some excellent discussions within the technical committee, which provides advice and recommendations to the special advisory committee. I would say that's part of the plan.

That is the FPT response plan for biological events.

It's part of the governance mechanism to manage the COVID-19 situation in Canada. I would say it's well-established. The level of co-operation is high.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

The same virologist from the Jewish General Hospital, Dr. Weiss, didn't rule out the possibility of putting entire Canadian cities in quarantine, if necessary. In fact, that's being done in certain cities in northern Italy right now.

Where do you stand on that?

[Dr. Howard Njoo]

It's difficult for me to comment. I respect Dr. Weiss as a physician and specialist. For my part, I work closely with public health specialists. That's my area of expertise. Other specialists may have other opinions. I'm okay with that.

In Canada, we're not at that point. It's tough to predict the future should the outbreak become more widespread in Canadian communities. Thus far, the measures in place have been effective. Other than the cases imported to Canada, the virus hasn't spread further.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Should it become necessary, do you have a plan?

[Dr. Howard Njoo]

Yes, that's something the special advisory committee discusses. If a situation arises anywhere in Canada, we are always ready to respond as the circumstances warrant.

For the time being, however, it's hard for me to say what exactly would need to be done should this or that happen. Facts, circumstances, information, evidence and scientific data will guide our decision-making, just as they do now.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

My next question is for the Canada Border Services Agency official.

A few days ago, a woman on a flight from Iran flew through the Montréal-Trudeau International Airport on her way to British Columbia. She was diagnosed by authorities in British Columbia as having COVID-19.

That makes people wonder just how effective the measures in place are when it comes to screening travellers with connecting flights in airports. She wasn't diagnosed at the Montreal airport, even though that's where she arrived first.

Can you tell us why she eluded the detection of border authorities given the measures in place? How will you make sure there aren't other cases?

[Calvin Christiansen]

The traveller arrived in Montreal from Iran. The information we have is that she arrived on February 14.

Around that time, we had no prior indication of what was going on in Iran, and we weren't paying any special attention, other than what we had in our primary inspection kiosk questioning for Hubei province.

We did go back and look at the situation of when she came through and the type of contact she had with our officers before she then moved on for her flight onward to Vancouver. It was a very brief interaction she had, as it is with many travellers who come through Canada.

She wasn't asked specifically if she had been to Hubei, obviously. She wasn't observed as having any outward illness of any sort at that time, and she progressed through the border clearance processes, as many travellers would on a daily basis. There was nothing abnormal about her when she arrived. Then she became symptomatic, I believe. I'm not sure whether she was symptomatic at the time she crossed or whether she became symptomatic later.

Just as a follow-up, when we did receive information regarding this particular traveller, we went back into our systems to see exactly when she arrived and how she was processed through the airport. We contacted our officers who encountered her to just advise them that they had been in brief contact with the person and to advise them to take appropriate precautions, to call a local health authority if they started to notice any change in their physical condition.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Beaulieu.

Ms. Kwan, you have six minutes.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much, Chair.

Just to follow up on that, since [Technical difficulty—Editor] the B.C. medical health officer has just made this public. Notices have gone out to schools in Coquitlam, Port Coquitlam and Port Moody, which is the tri-city in British Columbia, as well as other Fraser health areas in British Columbia. This is to do with the case of the woman from Iran, and I think they warn folks about potential concerns for anyone who has been in close contact with this woman in British Columbia.

Given that this is the case, there are now notices in schools in British Columbia about this, precisely to the point.... Their screenings could be missed. A person could be asymptomatic or have mild symptoms and be missed because they are not travelling back from Hubei province, and now that person is in an area in British Columbia potentially wider than what we anticipated to begin with.

In light of that, what measures should Canada be undertaking to address these kinds of concerns? We now hear the issue may well be a pandemic. The Minister of Health just today is encouraging Canadians to stockpile food and medications in their homes in case they or a loved one falls ill with the novel coronavirus.

I have a question about that too. If the minister is encouraging people to stockpile food and medications, how much food should they be stockpiling? How much medication should they be stockpiling? Should they be stockpiling surgical masks as well? In Hong Kong, in China and elsewhere, the shelves have become empty, and people are desperate to get these items.

I'm trying to get a sense of what statements like this mean for Canada.

This is for anybody on the panel, please.

[Dr. Howard Njoo]

There are several elements to your question, so maybe I will start with the last one about the pandemic. If there is a pandemic, it has yet to be declared by the World Health Organization at the global level. As I mentioned earlier, Dr. Tedros Adhanom Ghebreyesus, the director general, is indicating that the window of opportunity for containment is closing, but at the present time, it is not, in his opinion, a worldwide pandemic.

Having said that, we recognize that there is certainly a widespread outbreak in several parts of the world but not yet in Canada. With our twelve cases in Canada, we're still in containment mode.

Obviously, I can't speak for the minister, but certainly my sense is that part of her job, along with that of Dr. Tam, myself and other officials, is to sensitize the public to the fact that while we are still in a containment phase, we have to start preparing. We have to look at all potential outcomes. If that includes making sure that you have your medications up to date and that you have an adequate supply at home, that's all part of it; so that's one thing.

To your other point, about about what the B.C. health officer did with school notices, I can't speak for Dr. Henry, the B.C. health officer. My sense is that, if anything, it might be in terms of education and awareness for parents, in terms of trying to dispel any sort of fear, stigma or discrimination. From what we know, as soon as this case was identified and diagnosed, this person was put into isolation. Then, contact tracing was undertaken by B.C. officials, doing a close investigation of people who were in close contact. That resulted in another case.

Other than that, my understanding is that everything else is being followed up appropriately by B.C. officials. There is no evidence at the present time that it's widespread in British Columbia.

[Jenny Kwan, NDP, Vancouver East, BC]

On the question of stockpiling, from your medical expertise point of view, how much should people be stockpiling? Is it one week's amount of food, two weeks? Should they be loading up on surgical masks as a preventative measure? I'm just trying to understand what exactly that means from a medical point of view.

[Dr. Howard Njoo]

At this point, I would say that those kinds of questions about what kinds of measures individual Canadians can take would probably be a good topic, as I said, in terms of our ongoing discussions with our counterparts, the provincial and territorial authorities. In terms of what kind of recommendations we would make, both at a government and organization level but also for individual Canadians, I'm not in a position to comment.

[Jenny Kwan, NDP, Vancouver East, BC]

Okay, thank you. All right, so we don't have an answer for that, despite what the minister said.

My other question is this: In terms of preparing for the potential spread of the virus, what measures are undertaken to prepare communities that might have insufficient resources to deal with a potential outbreak? For example, in indigenous communities or lower-income communities, what measures are being undertaken to ensure that they are preparing for a potential outbreak?