Health Committee on March 11th, 2020

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I'll start, then I'll turn to Dr. Tam.

I'll first of all say that we've been using science and evidence to make the decisions around borders. I'll point you to Italy, who had some of the strongest border measures in the G7, who closed their borders in fact to China, and who then, all of a sudden, had an incredible outbreak. That's because.... Of course, the science will settle this as well, but there is some speculation that it's because people came in from a whole bunch of other routes that were not as direct.

Instead, we chose to use World Health Organization recommendations that said it is much better to have targeted measures at the border. That helps you identify the people who are coming from severely affected areas, which can help ensure that you know who is coming in, that they have the information about what to do and that we can monitor them as they self-isolate.

The first location that was added to the screening kiosk was Hubei. When people came from an affected region, they were met by CBSA and public health officials. CBSA would pull them aside and ask them some questions about their health. Public health would work with them, if in fact they were symptomatic, and would transfer them to the local health facility. If they were not symptomatic, then they were asked to self-isolate at home with a mandatory requirement to check in with public health within 24 hours. We have evidence that there was a very high compliance rate. We added Iran as a country of concern as well, because Iran, obviously, had cases that in fact weren't detected until we had identified a case from Iran.

I would also remind you that a virus does not know borders. Over 100 countries now have coronavirus in their country. No country will be left unaffected by the time this is over. We are certain that the right approach is to use our health services appropriately, with the goal of protecting Canadian wellness and health. We have to take decisions that are about protecting the health and safety of Canadians. We can't take them because it feels right. We can't take them despite the evidence. We have to use science and evidence. That is the primary responsibility, I feel, as the Minister of Health—that I will use the evidence that is provided to me from international organizations, from our leadership team, to make the right decision with the goal of ensuring that Canadians stay healthy.

I'll turn to you, Dr. Tam, if you want to say a little more about the science behind borders.

[Dr. Theresa Tam]

I think that in the public health domain we certainly have to remember that our borders are not a solid wall, as was just said. They're but one layer of protection, and it is never a perfect layer. The greater the number of countries affected, you can imagine that trying to screen people at the borders becomes a much more ineffective means of addressing the coronavirus outbreak.

Nonetheless, we do use a very rigorous risk assessment. We've also put several countries on our level three travel health notice, those being China, Iran and, now, all of Italy and some areas of Korea. You have to focus your efforts. Otherwise, you're screening every single traveller.

What we have chosen to do, which I think is really important, is to tell every international traveller that when they come back into Canada or come into Canada they must watch for symptoms, immediately go home if they're sick and then call ahead to their health system. It is not manageable with over a hundred countries having coronavirus. You need to shore up your health system, protect the vulnerable, such as those in long-term care facilities and hospitals, and protect your health workers.

It is a massive societal effort. Every aspect of the public health system is already turned on and fully alert, but you cannot flatten this curve without every member of the public working with you. That's why, while borders are one layer, the other layers are more important if you're going to actually do something about breaking any chains of transmission in Canada.

I do know that we have really stepped up our presence at the border. I think the border is the moment for education and telling people what to do when they come in. Maybe our president of the agency would like to comment on that.

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

Thank you.

I think what is very true is that we've worked very closely with our colleagues at the Canada Border Services Agency. In fact, as I was running in here, I had just gotten off the phone with the president of that agency, just to check in to make sure that we are indeed very focused at our borders, at our airports as well as our land borders. We have to remember that we're focused on all ports of entry into Canada and that we're applying the measures articulated by Dr. Tam at all ports of entry.

We constantly remain in touch and ensure that we're supporting all of our officials who are working on the front line, so that they have access to the information that they need to be successful in the execution of their duties, pursuant to what we're trying to accomplish by way of public health.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Namiesniowski.

Thank you, Mr. Thériault.

Mr. Davies, you have six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I want to start by stating that I think there's a very strong message from Canadians that they understand the COVID-19 public health issue to be one that is completely non-partisan. I think they want to see all politicians working together. In my province of British Columbia, I think Dr. Bonnie Henry and health minister Adrian Dix have done an outstanding job in working across party lines, delivering information to the public and striking exactly the right tone of being calm yet conveying accurate information.

It needs to be said that the same thing could be said about you, Dr. Tam, and you, Minister Hajdu. Maybe we don't say this in politics enough, but I want to thank you for the leadership you've shown. I know that this has been a very trying time, and I think all Canadians are very proud of the way that our health care system has responded.

You may not have been as quick to pick up on the sage advice of the New Democrats as we would like, but we're going to continue to offer you the best information that we can. I want to say thank you. We appreciate your work.

Minister, what are your projections for mild, moderate and severe outbreak in Canada?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I actually think this is a better question for Dr. Tam as it's a medical one, but as you know, research is evolving as we understand the experiences of other countries that have gone through their wave earlier than ours.

I will turn to Dr. Tam because it is a more medical question. Thank you.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have a quick answer to that, Dr. Tam?

[Dr. Theresa Tam]

I think this virus is a very interesting virus. It's a bit unusual in that it can spread better than SARS and the MERS coronavirus. It is the first coronavirus to cause a pandemic. It is probably a virus that has hit the sweet spot. It is not completely lethal, so there are people with mild illnesses and a range of clinical symptoms who can transmit the virus, for instance. The severe end of the spectrum is with people who are older in age and have underlying medical conditions, but there's a bulk of the illness in working-age adults. We're not seeing it much in kids.

If you looked at the full range of mild, moderate and severe and were looking at the likelihood of exposure versus the severity of the disease, this is hitting at about a moderate or medium scenario. However, viruses always have surprises, which is why we have to keep monitoring it. It may change the trajectory.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll tell you the reason I asked, Dr. Tam. Today, in fact an hour ago, I think, the Danish Prime Minister announced that a widespread COVID-19 outbreak could overwhelm Denmark's health system. I think we're seeing that in Italy. The are reports coming out of their ICU system being severely overloaded.

There have been alarms raised by the hospital system and by doctors about whether we have enough masks, whether we have enough ventilators, whether we have enough negative pressure rooms, whether we have the diagnostic capacity and whether we have enough critical care beds. I'm just wondering how you can properly plan for that, for the resources necessary, if you don't have an accurate assessment of the kinds of numbers, or at least the range of numbers, you're expecting.

Are we looking at 5,000 cases, 10,000, 20,000 or 100,000? Do you have that kind of assessment you can share with us?

[Dr. Theresa Tam]

We plan for a range of scenarios. Planning for a worse case than you might see is probably a prudent measure. Some of the scenarios look at the facts as we know them, which is the proportion of people who are mildly ill, which is 80%, followed by a 14% or 15% group who's going to be ill enough to go into the hospital, followed by a smaller group, like 6%, who demand ICU care.

Right now it's very difficult to determine the proportion of people who may die from this illness, unfortunately, because the global numbers will change day by day, and we don't know for certain. I think we can assume that this is an outbreak that's very serious.

If you looked at influenza mortalities, it is at a 0.1% case fatality. Right now the best estimate is that it could be just under 1%, depending on which country you're in, whereas a pandemic influenza, the worst one, is going to be 1% to 2%. If this is close enough to a 1% case fatality, it is a very serious situation.

Having said that, we can change the course. We are changing the course by doing all these massive pieces of work that the public health system is—

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Tam, I have to interrupt because that's really not my question, and I have other questions I want answered. I'm still not getting an answer, really, from this government. I want to know numbers. I want to know, are we talking...?

You have to plan for this. Surely you have numbers that you're expecting. A mild outbreak is 1,000 to 5,000 infections. I think we're at about 80 or something today, ballpark. Can we expect 1,000 or 5,000? Do you have those numbers or not? I've asked this question repeatedly, and for some reason, I'm never getting an answer from the government. Why is that and how can we plan our resources if we don't have a general idea of what the transmission or infection rate is going to be?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you for the question.

Through the chair, I think what Dr. Tam is trying to say is that we have no certainty of what the numbers are, but we are planning, as she indicated, for the worst-case scenario. I think it's irresponsible to give you a number because we don't know, because the science is not clear and because there are a range of numbers that have happened in various countries. There are a range of estimates, but I would say that it's safe to assume that it could be between 30% of the population that acquires COVID-19 and 70% of the population. That seems to be an acceptable range.

I realize it's a large range, but that is our best guess from a science and evidence perspective.

[Don Davies, NDP, Vancouver Kingsway, BC]

You've anticipated where I was going, because that's exactly what the U of T researchers have just predicted their modelling would show. We know that Canada has 4,982 mechanical ventilators. If we hit infection rates like that and there's a 5% requirement for ventilators, then that means we don't have enough ventilators in Canada.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

If I can just answer this, I think it's an important clarification. That might mean that we don't have enough ventilators in Canada at that range, if we didn't acquire any more, and if everyone were to get sick all at once. That's why part two of Dr. Tam's answer is so important. The intent of flattening the curve is so that everyone doesn't get sick all at once, so that we don't see a severe peak and we can support our health care system to manage severe illness at that higher level in a way that's much more predictable, and we'll have the time and the ability to ensure we can procure the additional materials we would need as that illness continues.

Part two of her answer is very important. We all have a role to play in reducing the curve. The curve, the extreme peak of illness, all at once, is what puts your health care system into crisis, and the goal that we have had all along is to ensure that, as we deal with the coronavirus, we reduce and flatten that peak so that not everyone gets sick at once and we don't end up in a surge capacity in hospitals—

[Don Davies, NDP, Vancouver Kingsway, BC]

Let's hope not.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Obviously, let's hope not. I think all of us around this table would agree that this is a national emergency and crisis, and we need to make every effort as Canadians and as leaders to be informing the people who are listening to us.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

Mr. Webber, you have five minutes.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

Thank you, Honourable Minister, as well as the panel, for being here today, and Minister, thank you for being here for two hours. I've been on this health committee for four and a half years, and to have a minister here for two hours is unprecedented. Kudos to you for being here for the whole time.

I have some questions on blood donation. Canada relies on voluntary blood donation for critical surgeries and life-saving transfusions, and many of the donors are seniors. In fact, 37% of Canada's active blood donors are seniors. What impact from COVID-19 do we foresee or are we experiencing now regarding blood donation rates?

As of today, our national blood inventory has only two days of O negative blood in supply, so it is a concern. How will the government ensure Canada has its needed blood supply?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I'm glad you've identified that as an issue that could be affected by a large number of people who are ill. We continue to work on ensuring that we have an adequate supply of blood.

I'll turn it over to Deputy Lucas to give you some more details.

[Dr. Stephen Lucas, Deputy Minister, Department of Health]

This is an area Health Canada is actively monitoring through our regulatory function to ensure the safety of the blood supply through work with Canadian Blood Services and Héma-Québec. If we need to turn to other donors to increase that, those efforts will be taken, but it is an area of active monitoring to ensure that Canadians have access to the blood they need for—

[Len Webber, Conservative, Calgary Confederation, AB]

Would it not be something you'd want to take an active role in right now, increasing the blood supply right now before a possible pandemic occurs here?

[Dr. Stephen Lucas]

Again, we rely on the operators of the blood system. We are in communication with them in terms of their monitoring, and they will take the actions and will ensure the safety of the blood supply.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you. I appreciate that.

I'm looking through the supplementary estimates. I know that this particular number is under the Canada Revenue Agency. There is close to $5 million on funding for the advisory committee on the charitable sector, the Canada workers benefit, and the organ and tissue donor registry. I find that interesting, the $5 million there.

I see under the Department of Health in the supplementary estimates that there is $500,000 for creating a pan-Canadian database for organ donation and transplantation.

Can you, Minister, let us know if the federal government has now reached an agreement with the provinces and territories to create a national organ donor registry? If not, what is this money for, and what is a pan-Canadian database if it is not a national registry?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Clearly, you are well immersed in this area. Thank you for being so. It's a really important part of our medical system that we have organ and tissue donations and that we have an adequate blood supply, and I'm glad someone has their attention turned to that.

It's why we're developing a pan-Canadian system that will help more Canadians get transplants, supported by over $36 million from budget 2019. We are working right now with all levels of government and stakeholders to ensure we have a pan-Canadian system that meets the needs of Canadians, and it's building on these significant investments—$70 million to support the Canadian Blood Services donation and transplantation efforts and an additional $100 million towards research.

Have we arrived there? Not yet, but that work is ongoing, and I share your passion for it. Thank you.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you. It's not at that base, it's—