Health Committee on April 12th, 2021

[Luc Thériault, Bloc, Montcalm, QC]

I'd like to stay on the same topic and carry on the discussion with Mr. Stanford about what other jurisdictions did. In Canada, the inclination has been to open borders and relax the rules at the first opportunity.

You told us that Australia instituted much more stringent lockdowns in terms of movement between regions, which may be due to its continental situation. You recommend a cautious approach, saying we should be very careful because opening things up at the first opportunity can ultimately do more to hurt the economy than to keep it going. Can you elaborate on that?

You also spoke about rethinking workplaces. Can you give us some specific examples?

[Dr. Jim Stanford]

The Australian case shows that the faster and more comprehensively you shut down interactions, the better your chances of stopping the contagion from taking hold and spreading. I mentioned the severe lockdown in Melbourne's case, but the rest of the country learned from that.

Every time they get an outbreak now—and it does happen from time to time—they very quickly put the whole city down under another lockdown order for three, four or five days. Yes, we get the usual complaints from business groups that they're going to suffer from lost business, but they're being done a favour, because by stopping the contagion that quickly, you're allowing those businesses to reopen. This is where you need government to take a forceful, long-term view and do what's right for the whole community.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Stanford.

Thank you, Mr. Thériault.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Stanford, your long-time work in championing the Canadian auto industry is well known. I'm curious about what you see in a macro, post-COVID economic perspective in terms of national self-sufficiency. We saw earlier on that Canada didn't have self-sufficiency in PPE and essential medical supplies. I'm wondering if you have any suggestions to give the federal government on how we can position the Canadian economy for greater national economic security in the future.

[Dr. Jim Stanford]

This is certainly a moment when we have to think about our role in the global economy after the pandemic. There's no doubt that some industries are going to change forever because of this pandemic. New industries are going to grow and some industries are going to face challenges for years, obviously. As we heard, the aerospace and air transportation sectors are going to take years to recover. I'm an advocate of a very forceful, engaged sector development strategy from both the federal and provincial governments engaging other stakeholders, private businesses, educational institutions, unions, and so on, and there are lots of opportunities for Canada to leverage its technological know-how, skilled workers and strong social inclusion in Canada into successful industries of the future.

Examples of that obviously would be around renewable energy and all the inputs and downstream benefits that come from that. Health technology is obviously going to be a huge one. We know we can't do vaccines all by ourselves—no country can do that—but we can certainly have a much better foothold in the global supply chain of modern medicine and modern medical equipment than we have now. That requires planning, public investment, co-investment and active policy rather than just sitting back and thinking that the markets will take care of it.

I think there is an opportunity after the pandemic to think more about public sector leadership in all areas of the economy, including industrial and sector development.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

That brings us to a close on our round of questions. I would like to thank all the witnesses for sharing their time with us this morning, and for their expertise. Your testimony is most helpful to us. With that, we will suspend to bring in our next panel.

[The Chair, Liberal, Ron McKinnon]

We are now resuming meeting number 28 of the House of Commons Standing Committee on Health. We are meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic and, most specifically at this point, the collateral effects of the pandemic.

On this panel we have Ms. Linda McQuaig, journalist and author, as as individual. From the Canadian Association of Radiologists, we have Dr. Michael Barry, president; and later we may have Dr. Gilles Soulez, vice-president. From the Fitness Industry Council of Canada, we have Mr. Scott Wildeman, president; and from the Tri-City Transitions Society, we have Ms. Carol Metz, executive director, consultant and leadership coach.

Thank you all for being here today.

We will start witness statements with Ms. McQuaig. You have six minutes, please.

[Linda McQuaig, Journalist and Author, As an Individual]

Thank you very much, Mr. Chairman. I appreciate this opportunity to address the committee today.

I would like to talk about Canada's lack of domestic vaccine production facilities, which I think has been one of the key problems in Canada's slow vaccine rollout.

Last month the Trudeau government attempted to correct this problem by investing $415 million in the French pharmaceutical giant Sanofi. The idea was to help Sanofi expand its vaccine production facilities in Canada.

In my opinion, this is not the answer. This is not the solution to the problem of our limited vaccine capacity. On the contrary, I would go so far as to say it's a reckless use of hundreds of millions of dollars of public money.

In announcing the investment, the federal industry minister said that Ottawa was currently in negotiations with Sanofi over a contract that would give Canadians priority access to Sanofi's vaccines during a future pandemic, but hold on—surely it would have been better to postpone that $415-million announcement until after Sanofi had agreed to the government's terms to give Canadians priority access. Without that key term being nailed down, we really are just keeping our fingers crossed that Sanofi will deliver for us. I think in some ways this reveals just how vulnerable Canada is now that we no longer have a domestic vaccine capacity that we control.

Of course, we once did have that capacity. We had Connaught Labs, a Canadian publicly owned enterprise that was one of the world's leading vaccine producers. For seven decades, Connaught developed and produced a range of vaccines. It provided those vaccines to Canadians at cost. It provided them to other countries at affordable prices. Connaught operated without government financial support, yet it even made profits, which it reinvested in medical research. Connaught's research scientists were among the best in the world. They contributed to some of the key medical breakthroughs of the 20th century, including insulin, penicillin and a polio vaccine. Connaught even played a vital role in the World Health Organization's global vaccination campaign to rid the world of smallpox, yet despite this remarkable record, Connaught was privatized by the Mulroney government in the 1980s.

The Connaught facilities still operate today in Toronto, but they are now owned by Sanofi. In fact, Ottawa's $415-million investment in Sanofi is going to expand the old Connaught facilities, but Canada no longer has control over what happens there.

There is, of course, much to lament about the sell-off of this spectacular Canadian company and Canadian enterprise, Connaught Labs, but that is history. That is history. The key point now is that it's not too late to create a new version of Connaught. That would be a publicly owned biotech company that could produce vaccines and other medications and could be counted on to put Canada and Canadian needs first, which was what Connaught always did. Rather than investing $415 million in a private company that we don't control, we could invest that money in a company that we do control.

Next week's budget would be a perfect opportunity to announce the launch of a new publicly owned biotech enterprise. I realize that may sound ambitious, but it wasn't too ambitious for the visionary Canadians who created Connaught in the early 20th century. Let's see if we can't own that podium again.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. McQuaig.

We go now to The Canadian Association of Radiologists. Dr. Barry, please go ahead for six minutes.

[Dr. Michael Barry, President, Canadian Association of Radiologists]

Thanks, Mr. McKinnon, and thank you very much to the committee.

I'll be as quick as I can to work through the statement.

I want to thank you all for all this work that you're doing in this difficult time, and it is a difficult time. Although we're not through COVID-19 yet, we will be soon, we hope, and it's because of work like yours and the people in the front trenches that we'll get there. However, now is a time to plan our reopening and what Canada's health care system and our country will look like after COVID-19.

As many of you know, imaging, radiology and high technology are the centrepiece of a medical system in the 21st century. Every branch of medical care in Canada and worldwide is reliant on a comprehensive radiology imaging program to look after our preventive care and our active care. We are the single most important infrastructure investment in the health care system. Much like roads, bridges, seaports and airports are to our transportation networks, we are an investment and not a cost centre.

I'd like to share some observations from COVID-19 and some of the effects.

Initially, imaging wait times because of COVID-19 left hundreds of thousands of people in the long wait-list that was already quite long. We have found there's probably been about a 50% reduction in medical imaging and screening services, non-urgent ones in particular, that we've neglected because of COVID-19, through no fault of anybody. It's just a fact of the matter. Cancer doesn't wait for COVID. It's created a real sense of urgency and caused an overwhelming backlog in medical imaging services from coast to coast.

Before the pandemic, patients in Canada were waiting an average of 50 to 82 days for CAT scanning and 89 days for MRI. These are between 20 and 52 days longer than recommended from the OECD wait-lists, and because of the COVID-19 impact, the wait-lists are even longer. This is especially concerning for cancer patients, for breast screening and colorectal screening, and just diagnostic screening for people who are waiting at home and afraid to go to the hospital because of the first wave, second wave, and now the third wave.

I've spoken to the committee about an initial case that came through our hospital here in Saint John, New Brunswick, where I have practised for 30 years. I can remember when a young man in his 30s came in about six or eight weeks after his initial symptoms and found out he had a high-grade glioblastoma. He was too afraid to come in because of COVID, so he waited for his treatment. By the time he came in, he had a high-grade glioblastoma. It was a late intervention, and he did not do well, needless to say. That was concerning.

We have a lot of patients who present at the emergency room with obstructions of their bowel, colon obstruction. They have rectal bleeding, but they're afraid to go to the hospital. We see that, unfortunately, every day.

The Maritimes hasn't been as impacted as the rest of Canada, but I can assure you that nationally we're hearing stories on a daily basis from our colleagues from coast to coast. We had a recent report from the CMA about clearing the backlog and the cost to return to wait times at pre-pandemic levels.

Wait-time delays do cause an additional economic cost to the system. Waiting 52 days for an MRI scan costs our health care and economic system approximately $377 million a year. CT scans, waiting 33 days, cost us approximately $377 million on a yearly basis. According to Deloitte, the procedures that have the highest funding requirements are MRI and CT scans. They make up about 75% of all procedures across Canada.

That gets to our point and is close to our ask. I've spoken to a number of you before in person and on Zoom about The Conference Board of Canada report published in 2019, which talks about how far behind Canada is in capital equipment. We're by far the worst off, with 75% of our capital equipment being almost at end of life. We've had the request on the table to all parties for an immediate commitment of $1.5 billion over the next five years. That was a pre-COVID ask. That was an attempt to bring our national wait-list to a more acceptable standard. There are still many patients waiting for months and unable to work. We have estimates from The Conference Board that the cost to the economy was upwards of $5 billion in 2020.

Our response to COVID-19 has been fast and rapid, based on our being able to pivot and change our health care. We're already very virtual in radiology, as many of you know, but it's imperative that the diagnosis of injury, chronic illness in particular, and acute illnesses not wait. We have actually pivoted very quickly in of our ability to work at home when the time came, as well as in the hospital, to get our wait-list in order, but we still continue to fall behind.

There are many technical requests that go into this ask, which include artificial intelligence and new updated equipment to make our turnaround times faster and enable us to address this tremendous backlog.

In closing this part of it, the CAR is asking for $1.5 billion over the next five years to support Canadians, ensure capacity and integrate technology such as AI to help run the system more efficiently. This is an investment, not a cost. It will get people back to work, look after our sick people and chronically ill people, and get our cancer screening back to what it should be and beyond.

It is not unprecedented for the federal government to take charge in this. As many of you know, there was a targeted investment in 2005 and 2006 by the Paul Martin government. It put $2 billion into equipment targeted for imaging and reduced our wait times significantly. I think a number of you have seen our radiology report from The Conference Board showing the impact of that investment, which really has tapered off since 2013. Now we're back to where we were in 2004 and 2005.

Our second ask is to strike a federal task force to look at the health human resources and infrastructure components, such as waiting rooms, workspace, air ventilation and consulting areas to support new equipment, because we'll have to be much better prepared in the way we practise medicine in 2021 in a post-COVID world with a possible further pandemic .

That's it, Mr. Chair. I could go on forever, but I'm available for questions. I'll stand by for questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We'll go now to the Fitness Industry Council of Canada and Mr. Wildeman, president.

Please go ahead for six minutes, Mr. Wildeman.

[Scott Wildeman, President, Fitness Industry Council of Canada]

Thank you for the opportunity to speak to you all today.

The Fitness Industry Council of Canada represents over 6,000 fitness facilities, ranging from single boutiques to large regional and national chains. We employ over 150,000 Canadians coast to coast to coast, and we serve over six million members.

We've been decimated by the closures and the restrictions arising from COVID-19. To give some context, if a facility is able to be open, they are operating at around 50% of pre-COVID levels. If they're forced to close, they're operating at 0% to 10%, depending on their online presence.

We still have fixed cost bases. We applaud the federal government for the CEWS program and the CERS program. They have been very well received and appreciated. However, there are still other costs that we incur.

Little consideration has been given to new start-up businesses that opened in January or February of 2020. With regard to regional chains with multiple locations, the fact that their CERS is capped means they're still on the hook for the balance of their rent. At the end of the day, after government supports, facilities are still losing between $15,000 and $30,000 per month. We have asked the provincial governments for industry-specific support.

I'm here today to talk about how we, as an industry, can be part of the collective health and wellness of Canadians and do our part to help with the national recovery. We're not here to ask for a bailout; we're here to be part of the solution.

We know that exercise has a multitude of benefits. It reduces hypertension by 33% to 60%. It reduces diabetes and cardiovascular disease. It reduces risks of stroke and colon cancer, of breast cancer and Alzheimer's, and it reduces the impacts of anxiety and depression. We also know that COVID-19, unfortunately, has significant impacts for those who have one or more of these chronic conditions.

How can we be part of a solution? Post-COVID, we're looking to ask the federal government and PHAC to expand the Prescription to Get Active program across Canada. For those who don't know about the program, it's based out of Alberta, and it links primary care—your physician—with the fitness and recreation options in your community. We have no-cost and low-cost options. We have fitness facilities. We have remote options for those who are in rural or rural remote areas or are simply not interested in joining a facility.

We want to expand this program. It is turnkey, but it is also flexible to accommodate various geographical regions of Canada. For example, northern Ontario is much different from downtown Vancouver.

We are also asking the federal government to have fitness expenses—fitness memberships and services—considered a medical expense. On your federal tax return, you could include fitness as a medical expense. We have the ability to provide attendance reports for auditability. We have professionals from coast to coast to coast who are ready, willing and able to serve Canadians, to help build sustainable behaviour change to ensure that we create healthy and active lifestyles.

The infrastructure already exists. This truly is a stroke-of-the-pen change that we're asking for. We believe that with this change, we can provide the government with a significant return on investment, over 500%, in terms of reducing the overall burden on the health care system. We can move somebody with a chronic condition from sedentary to physically active, inspiring Canadians to take proactive steps toward their own health and wellness.

We will get many of our young people back to work. Our industry employs many young people. We have college and university programs across the country that do a fabulous job of creating fitness professionals. They will have a viable industry to enter, and we'll get many of our folks we've had to lay off back to work. We will rebuild our industry.

As I mentioned earlier, we have incurred significant amounts of debt. Many operators are now well over $200,000 to $250,000 in debt. By adding fitness as a tax deduction, we believe we can get more people into our industry to help us pay back those debt amounts.

In summary, we're here today to be part of the solution. We'd like to partner with government, and we look forward to answering any questions you may have.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Wildeman.

We go now to Tri-City Transitions Society and Ms. Metz Murray, the executive director. Please go ahead for six minutes.

[Carol Metz, Executive Director, Consultant and Leadership Coach, Tri-City Transitions Society]

Thank you, Mr. Chair.

Honourable members, I'm delighted to be here today with you to talk to you about the impacts of COVID-19 in the world of domestic violence, intimate partner violence or violence in relationships, whatever title you wish to give it.

I appreciate being invited to the committee.

Tri-City Transitions is a 46-year-old organization serving women, children, youth and men. We began as a women-serving organization. In the early 2000s, we saw that we could help women, children and youth all we wanted, but band-aids were running out, so in 2006 we began to provide services to men because domestic violence is not just a community and women's issue but also a men's issue. There are generally two parties to domestic violence.

In the world of COVID-19, our services changed somewhat from what we were offering earlier. Our services include a transition house for women and children fleeing domestic violence. We also offer counselling services for women. We offer counselling services for children, ages three to 18, and their caregivers, whether they are parents, grandparents, foster parents or whatever the caregiver definition includes. We also offer a victims service program for women, children, youth and men who are impacted by domestic violence, as well as when domestic violence becomes a criminal matter. We are also offering a mentor relationship program for men. All of these services have been impacted as a result of COVID-19.

We serve between 1,500 and 2,000 families a year. Most of our employees are local, and women make up the majority of our workforce. At the beginning of COVID, we decided to help the broader community. We opened up our phone lines to provide emotional support to whoever might need it. In addition, we very quickly moved to virtual services, whether by phone, Zoom or other technology.

What we discovered, when we originally had staff work from home, was that staff asked to come back to work in our offices. Our services were deemed essential. Our main office is such that we were able to physically distance. We have safety protocols in place. We also realized, for the health and welfare for our staff, that it was important that everybody be in the same building. We have been very successful in remaining COVID-free this whole time period.

Part and parcel of what we saw this past year, and continue to see, is the impact that COVID and the lockdowns have had on families. As I listen to everyone else speak this morning, we speak looking at the environment, but the key in all of this is family, regardless of whatever that dynamic may be.

What we saw here at Tri-City was an increase in sexual assaults. Sexual assaults involved not only adults 19 and older; we saw an increase in youth and children. That's not a surprise, given the fact that families found themselves suddenly at home together and unemployed. Perhaps both partners were unemployed, having to educate children. If there were any issues within a relationship, they would surface very quickly.

What that has also meant for people is that it has stopped women from reaching out for services. Perhaps they will reach out via email, but they won't reach out via phone because their partner is in the home or in the same room. We know that there has been a lot of domestic violence happening where people haven't been reaching out for services.

In that whole process of reaching out, one of the biggest things we saw was the lack of funding for services related to sexual assault, so we moved forward to find ways that we can find funding to help people directly when they are impacted by sexual assaults. As we move forward, we truly want to be part of the solution, because families, whatever that dynamic may be, make up the fabric of Canada.

One of our asks is to remove the barriers when we're looking at domestic violence—to remove those barriers that limit us from funding men's programs. Men, too, need to have services in order to decrease domestic violence.

With that, I conclude my presentation.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Metz Murray.

We will go to our rounds of questions now, starting with Mr. Maguire. Please go ahead for six minutes.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Mr. Chair.

I thank all our witnesses today for their presentations.

First I want to go back for a moment to Dr. Barry from the radiologists association.

It's good to speak with you again. I know the ask of $1.5 billion was something we had put on the table in the last election, but to purchase MRIs and CTs, you're very short. You're making a very good point that many of those—I think you used the number of 75%—are near their end of life as far as that equipment goes. Even though you're still doing a lot of work from home, you're still well behind in the types of scans that you're able to do.

Can you elaborate on that and perhaps tell our committee how long it takes to put that type of equipment in place and whether there are any roadblocks from regulations that we could look at as well?

[Dr. Michael Barry]

Thanks for the question, and again, thanks for the opportunity.

Dr. Soulez has arrived. Thank you, Gilles, for making it.

I'll make a few comments on the wait-lists and whatnot.

The equipment is readily available in the marketplace. The investment turnaround time in the last cycle, 2005-06, was about three years. It ramped up and it made about a seven- to 10-year improvement in the wait-lists on CT and MRI, cardiology, interventional radiology and things of that nature.

In terms of the targeting, a lot of the screening done, particularly mammography, has been reduced. For our mammography screening, it's less than 50%, because of COVID and the intimate location you have when you're screening with mammography. The technologists in particular are very exposed to a patient, so they were reduced to about 10% of their workload at that time. Then, just basically, when a COVID patient comes into our CT scan or our MRI, it takes fully one hour to turn it around. There's a COVID protocol based on ventilation and cleaning with Lysol. Then the room has to sit for an hour afterwards.

I was on call a few weekends ago when we had a COVID patient at the Saint John Regional Hospital emergency area. We fortunately have two scanners. I had to use the older scanner, which was about nine years old. It was routine. You wouldn't really compromise diagnostic capability to keep the trauma scanner open, but once we did that patient, which took 15 minutes, it took 15 minutes to clean it, and then we had downtime of about an hour, as the room had to ventilate. If you're in a smaller centre than ours, you could shut down the whole scanner for the whole day.

If you're having people coming through the hospital on a daily basis, you could see how the wait-list would get extended just based on the COVID patients, and then the reduction in volumes that could go on—

[Larry Maguire, Conservative, Brandon—Souris, MB]

That relates to the second part of your ask, as well, with regard to the rooms and the types of facilities that you need to work in.

I just want to go back to the cancer issue. You were mentioning that we have a huge backlog here, hundreds of thousands—I think it's 330,000—of situations that need to be dealt with right away, elective surgeries and that sort of thing, but more in the diagnostics area, the extended.... Can you just refer again to the extensions for the cancer patients? Is it a situation of getting the equipment into areas that need it more? Are there areas in Canada that are at greater risk or that have a vacuum of equipment that could be dealt with, or is there technology today to be able to take those scans and move them into another area where a radiologist doesn't have to be there with the person when the imaging is being done?

[Dr. Michael Barry]

There is. It's a complex question, but where there are people, there's cancer, and where there's cancer and people in communities, there are imaging departments in hospitals. Most people are prepared to travel to some degree, 50 or 60 miles or an hour or longer, but not much more than that. In New Brunswick and the Maritimes, most people have a CAT scan or an MRI done within about an hour, but in other communities, not so much.

If people in northern communities need imaging, we do that already, because we have the bandwidth to transfer without too much difficulty. It's basically getting up-to-date equipment in a rapid fashion, getting this backlog of hundreds of thousands of patients scanned, and getting existing.... We're talking about rechecks for cancers of lungs and colons that haven't been done, as well as the patients. The six-month protocol may have been extended to 12 months.

Again, I can go in a million directions, but I don't want to take up all of the committee's time.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you.

I want to ask a last question with regard to whether some provinces have done a better job of adjusting their diagnostic imaging departments to the pandemic and keeping their wait times as short as possible. Are there examples that we could use there and follow up on? What's your best knowledge, just to finalize that? Do you know of any COVID outbreaks happening in diagnostic imaging in Canada? You made a very good case that things are being well controlled, but are there areas of concern?

[Dr. Michael Barry]

I know that Alberta just put put a whack of money into wait-lists for imaging, which we were pleased to see, because they have been hit hard. I'm not as familiar with Quebec and Ontario, which have also been hot spots, but I suspect when the dust settles in this third wave, that.... I talked to people last week in the Hamilton area, and as they head back into the third wave with the variants and lack of vaccinations, their volumes are down 50% already. It's really a moving target.

All I know is that we were quite badly off before this started. We started to stabilize, and then we went into the second wave. Now here we are. It's such a moving target. It's not better—I can assure you of that—and I suspect it'll be a lot worse.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Maguire.

We'll go now to Ms. O'Connell. Ms. O'Connell, please go ahead for six minutes.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you, Mr. Chair.

Thank you, everyone, for being here. I have questions for all of you, but I'm not sure if I'll get through them, so I'll try as quickly as I can.

Dr. Barry, I might as well start where you left off. Certainly I hear your point about the need for equipment pre-COVID and about wait-lists, but you also mentioned in your testimony that Atlantic Canada, for example, isn't hit as hard. Is that because they've had a zero-COVID mentality or a near zero-COVID mentality and that the provinces have put in place restrictions to really limit COVID?

Where I come from in Ontario, we're seeing places like SickKids hospital actually preparing beds to be ICUs and the direct correlation with doctors' warnings back in February that if reopening happened too quickly too soon, we were going to see hospital rooms and ICUs fill up. You mentioned in your testimony Atlantic Canada, the example, and the direct correlation that not getting COVID contained is going to have long-term health impacts outside of just COVID. We're going to see, as you mentioned, issues around screening, prevention and treatments in other areas, so the focus should be around containing COVID to ensure that everybody is able to access health care in the ways that we are seeing in other jurisdictions.

[Dr. Michael Barry]

I couldn't have said it better, Ms. O'Connell. You hit it right on the head.

As a direct correlation, in the Maritimes—New Brunswick, Nova Scotia and Prince Edward Island—we're at about 93% of last year's volumes in radiology, and not so much in Ontario, Quebec, B.C. and Alberta. Not to waste your time and the committee's time, but you nailed it; you're right on. It's a direct correlation.