Health Committee on April 19th, 2021

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We now move to Mr. Thériault.

The floor is yours for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I would like to thank all the witnesses for joining us. I will turn to Dr. Bélanger first.

We have gone through the first and second waves, and we are starting the third. The pandemic has forced our networks to organize care into two categories of patients: those who have COVID-19 and those who do not.

We seem to be forgetting that the real effects of the pandemic will really emerge when we have a complete handle on the situation of patients who do not have COVID-19. It would be wrong to think that we will have overcome the pandemic when everyone is immunized because the pandemic will still have collateral effects, perhaps for more than one year, perhaps more than two.

The figures are horrifying. You told us just now that 110,000 people are waiting for a colonoscopy and that 63% of the colonoscopies are late. You also told us that colon cancer is the third most frequent and the second most deadly.

So what are the consequences of those delays? What are your fears?

[Dr. Mélanie Bélanger]

The biggest impact is not seeing asymptomatic patients for colon cancer screening now and only seeing them later. This will inevitably result in a demonstrable increase in the number of colon cancer cases in the coming months and years.

As a clear illustration, with no pandemic, a monthly average of about 55,000 fecal blood tests in Quebec are positive. An average positivity rate of 5% means that we get 2,750 positive tests. As it is said that 35% of the patients testing positive are in the latency period, we can conclude that, each month, in Quebec, about 1,000 patients are seen endoscopically and therefore avoid developing colon cancer.

Consequently, for every month when those patients are not seen, their lesions progress. The science proves that, for a patient in that trajectory, when you push back a colonoscopy for eight months, you double the risk of cancer and of cancer at an advanced stage.

Not seeing those asymptomatic patients now, through no fault of their own, involves much more than one problem. At the outset, we are dealing with an illness, a cancer, that is completely preventable under normal circumstances. Months later, we end up with confirmed cancer, advanced cancer, and terminal cancer.

[Luc Thériault, Bloc, Montcalm, QC]

According to the Quebec Association of Gastro-Enterologists, with patients receiving a cancer diagnosis, the real effects will only be known in a number of years and could lead to death. We are not going to see those effects in a month, but often only in several years.

We know that, before the first wave, the network was already fragile. Chronic underfunding was already a problem. Everyone came to tell us that.

You told us just now that, in your practice, there was a delay after the first wave. If we continue the current trend, do you feel that will clear the backlog? If so, how long will that take?

[Dr. Mélanie Bélanger]

In Quebec, as of today, there has been no single month when we have been able to perform the same number of colonoscopies as in the corresponding month last year. The current resources do not even let us stop the backlog from increasing. Let me give you an example to give you an idea of the situation. During the pandemic, we performed 63,323 fewer colonoscopies than by the same date last year. The monthly average of colonoscopies done in endoscopy units in Quebec was 22,000. Compared to last year, the accumulated backlog represents three months of full-time work in all those units in Quebec. That is what we need just to handle the backlog and it excludes any additional patient load.

Our current resources will certainly not allow us to respond to the influx of patients that we know we are going to face. Because of factors like physical distancing and the fact that, in some cases, patients cannot present for their appointments because they have to be in isolation, our current resources will not allow us to conduct the same number of colonoscopies per month. Continuing along these lines will only increase the backlog. Eventually, therefore, we are going to be dealing with patients who are more seriously ill.

Just talk to doctors working on the front lines. We see tragedies every day. In some cases, illnesses are diagnosed too late. I exclude colon cancer here. We see more advanced illnesses, surgical procedures, hospitalizations and deaths that could have been avoided. Avoidable deaths are an everyday occurrence for front-line doctors.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Soulez, from the Canadian Association of radiologists, told us that these delays are going to increase mortality rates. So you have the same fears. Does it make sense to you to say that, after the pandemic, investments must be sustainable and federal health transfers must be increased?

[Dr. Mélanie Bélanger]

For colon cancer, we need funding specifically for endoscopy. For things to work, we will have to have more rooms and more staff. Yes, more investment is needed. Because of the size of the backlog that we are currently experiencing, the situation cannot be resolved by reorganizing work or services. We really need financial support. Gastroenterologists are available as needed to work more. We can do the work. What we need is access to secure and well organized facilities and additional payments for our specialized staff, whom we wish to keep.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

Mr. Davies, please go ahead, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to the witnesses for being here.

On this committee we all agree that the opioid death crisis in this country is sobering. Since 2016, we have had over 20,000 Canadians die from overdose deaths. Last year, in B.C. alone, we had 1,700. That's the deadliest year on record. The last quarter of opioid deaths is the highest that Canada has ever recorded since we started surveilling numbers.

Ms. McBain, what if any is the connection between the federal policy of criminalization of drug use and the harms that come from drug use, including deaths?

[Leslie McBain]

Criminalization of people who use drugs tends to push them into the corners. It is incredibly stigmatizing. What is more stigmatizing than being arrested, and thrown into the criminal justice system, when, in fact, you have a substance use disorder, and you need to have drugs you can only find on the street in a dangerous and illicit way?

If possession of illicit substances was decriminalized and people were able to feel safe, in normal times there would be more congregating in communities, and so on, but during COVID times, it just exacerbates the idea of using alone.

Decriminalization is essential for people to actually come out of the closet as it were, to seek services if they are available and to start on a path of possible recovery. We find that as a very big step in solving this tragic problem.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Moms Stop the Harm has called on all levels of government to work together to change current drug policy to an evidence-based approach that, according to your website, “respects and supports the human rights of people who use substances”, and that specifically ensures “access to a safe supply of pharmaceutical-grade substances”, in addition to decriminalization.

Why is it important to address the supply side of the equation in addition to decriminalizing the possession?

[Leslie McBain]

Using the substances that are available to people, which are the illicit toxic substances on the market today, is the reason, the one single reason, that people are dying or suffering permanent brain injury. It just follows that if a safe supply of pharmaceutical alternatives were available to people, and they were able to access those in a low-barrier way, they wouldn't die. That's the hope. We know that it won't completely end the problem, but if the federal government and the provinces could work together to remove the barriers to actually implementing a safe supply of opioids—in particular, a safe supply of fentanyl and heroin, which sounds crazy—and they were safely distributed and used, people would not die.

Really, our primary goal here is to keep people alive. Once people are stabilized on a safe supply, the evidence shows that their lives stabilize. They are more inclined to seek treatment. They can even get jobs and hold good jobs if they don't have that everyday search and everyday danger of accessing illicit drugs.

[Don Davies, NDP, Vancouver Kingsway, BC]

You touched on treatment. I think all of us in this committee are aware of the pressing need for people to get just-in-time treatment when they want to seek help and the fact that we just don't have the public capacity. I think we're aware that the delivery of treatment services in this country is essentially privatized.

I'm just wondering if you have any suggestions for what the federal government could or should do to ensure that Canadians can get access to treatment on demand through our public health care system. As I think you pointed out, that clearly isn't the case right now.

[Leslie McBain]

I think it's a matter of funding recovery and treatment facilities. As well, having good surveillance, good oversight and good policies in place for those facilities is critical. Substance use disorder is the only health issue in this country wherein people have to go to the street to get their medicine. The treatment for them is inaccessible, mostly for their families, because of the cost, or there are way too few subsidized beds in the facilities.

There are a lot of problems that could be solved, that we know how to solve, but it seems to be a matter of political will, for one thing. It's definitely about funding. We don't send people with heart disease or diabetes to unsupervised facilities that are without oversight. We need to treat substance use disorder like any other disorder, any other health issue.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have a few seconds left. Prime Minister Trudeau has explicitly ruled out the decriminalization of drugs. He says it isn't a silver bullet. Do you accept that logic? If not, why not?

[Leslie McBain]

I absolutely do not accept that logic. I would say that we need about six silver bullets. It is not a silver bullet; it is one step towards treating people with substance use disorder as human beings, with everything that we all have. To shut it off like that is to me unconscionable. I wish very much that he would reconsider that statement.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings our rounds of questions to a close. We will thank the witnesses at this point so that we can bring in our next panel.

Thank you, all, for your time today. Thank you for your preparation and for sharing with us your knowledge and experience.

With that, we are now suspended.

[The Chair, Liberal, Ron McKinnon]

We are resuming meeting number 30 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic.

I'd like to welcome the witnesses for this panel. As an individual we have Amedeo D'Angiulli, professor, Carleton University; from the Association des médecins hématologues et oncologues du Québec, Dr. Martin Champagne, president and hemato-oncologist; from CHATS, Community & Home Assistance to Seniors, Christina Bisanz, chief executive officer; and from Don't Forget Students, Brandon Rhéal Amyot, co-organizer.

Thank you to all for being here.

We will start by inviting witnesses to make statements.

Mr. D'Angiulli, please go ahead for six minutes.

[Amedeo D'Angiulli, Professor, Carleton University, As an Individual]

Thank you for inviting me, Mr. Chair.

I want to contribute to the committee some of the results from a development study on the effects of COVID on children and families. It's an ongoing study of research syntheses, in which we have basically collected all of the available peer reviewed, high-quality research. Today, I want to give you a snapshot, a summary of some of the progress we have been making on the results.

The impact of COVID can be categorized in three broad categories: family dynamics and stress on parents; children's mental health; nutrition, physical activity and media, simply to give you an idea. These categories are a little artificial. They overlap sometimes, but the important thing is that they capture the essential ingredients of the impact.

Regarding the stress on parents, one of the things we see reported in the peer reviewed literature is the effect of home schooling and the fact that the parents have to juggle careers and to take cuts or make a financial decision to lessen their income to stay with children. There aren't a lot of external supports to make up for these losses. But at the same time, the surprising thing is that there are protective factors and positive influences on family dynamics due to the fact that the children are closer to their parents.

One of the essential things that has been very much talked about is what is now called the “she-cession”, the fact that women are hard hit by this economic collateral damage of COVID. One of the surprising things is that there is a perception that men have taken up more of families' domestic work. Even so, women continue to be at a disadvantage because they are likely to have jobs that cannot be performed at home. They work 15 more hours at home on unpaid domestic labour, and they are the ones who are suffering more from the economic situation, with an increased risk of gender gap, increased poverty and divorce. You should look at the Stats Canada report that was released in 2020.

For young, middle and adolescent children, we have an array of factors at play. Disability is one major factor, which also plays into stress and the family's hardship. Domestic violence is not necessarily addressed by the fact that there is isolation and home orders. Lack of socialization especially hits young children in periods when socialization is very important for communication and learning.

Virtual learning is also not a positive experience for some of the students, and it is not necessarily leading to very good outcomes. You have poverty in youth. There are also the added effects of media exposure, especially the fact that we are constantly immersed in a media war disaster climate that unconsciously plays on the mental health of young children.

Many of these changes are due to school closures, or the flip-flop of closure and opening and changes. The main outcomes are documented as being increased anxiety and depression.

To conclude, other aspects that are intimately correlated and have an affect on children and youth are their sedentary behaviour and decreased physical activity, which is correlated with a higher use of social media and mobile devices, and a decrease in the quality of nutrition, especially take-home fast food and other things that are not appropriate nutrition for development.

We are working on a general framework to make more sense of this. I have provided the document. Maybe you could look at the framework that we are creating to interpret and organize this data and make it more accessible and contribute to the ongoing study.

Thank you so much.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We'll go now to Dr. Champagne, president and hemato-oncologist.

Doctor, please go ahead for six minutes.

[Dr. Martin Champagne, President and Hemato-Oncologist , Association des médecins hématologues et oncologues du Québec]

Good morning, Mr. Chair. I thank you and the members of the committee for your invitation.

I am going to discuss the impact of COVID-19 on cancer, a chronic disease with acute episodes of care over a long period of time. It is very different from single episodes of care such as orthopedic surgery for hip or knee replacement, or cataract surgery.

The postponement of medical activities has caused diagnostic delays that have major consequences. Indeed, a longer diagnostic delay allows cancer to progress, leading to an increased risk of relapse and a decreased chance of cure. For patients, the consequences are important since it will result in increased morbidity. As patients are sicker and are sick longer, the intensity of treatment required will have to be increased because the disease will be more advanced. The more advanced stage of the disease will also result in higher mortality. Because cancers are diagnosed too late, the impact of the pandemic will be felt for many years, both on patients and on the human and financial resources required by health care systems.

Three things need to be tracked: waiting lists, patients on those lists whose care has been delayed, and diagnostic delays, which are very telling of the real impact.

Let's talk about screening programs first. Patients with symptomatic illnesses come to the emergency room, are seen, and for the most part, are managed. That hasn't changed much. Screening programs, on the other hand, diagnose patients at early stages who do not have symptoms. It is estimated that screening programs can reduce mortality from detected asymptomatic cancers by 20% to 40%. This is because diseases discovered at early stages require much less intensive, easier care. They can be limited sometimes to simple surgery rather than requiring a combination of surgery and chemotherapy.

In Quebec, colon and breast cancer screening programs were shut down in the first wave of the epidemic in March 2020. It has not been possible to catch up diagnostically for these patient cohorts. I will provide data in a few moments.

During the previous sessions, Dr. Bélanger explained the strategy for screening for blood in the stool, occult blood, for colon cancer. Patients who test positive for blood in the stool will undergo colonoscopy, which sometimes reveals polyps, a lesion considered precancerous, or even colon cancer.

Presumably, we are seeing a significant reduction of about 28% in tests performed compared with the previous year. The cumulative backlog, despite the lull in the COVID-19 pandemic over the summer and early fall, has not been cleared. What is known is that the less screening that is done, the fewer diagnoses are made. There are not fewer cancers, it's just that they haven't been screened.

In care-delayed patients, there is less occult blood screening and the number of patients who are found to have blood and to whom we want to offer colonoscopy has increased. So the care-delayed patients represent significant numbers, on the order of about 152% if you look at the entire cohort.

In Quebec, about 800 fewer colon cancer surgeries were performed this year than at the same time last year. Dr. Bélanger noted that this cancer is the third leading cause of cancer death in Canada. So this is something that has important consequences. Indeed, as the cancer progresses, surgery may become pointless and one must then turn to chemotherapy or radiation therapy.

These observations are essentially the same for breast cancer, where screening is down 30%, so at 70% of the previous year's level. There are far fewer patients diagnosed with the disease at an early stage. For Quebec as a whole, there is currently a reduction of about 22% in the number of biopsies confirming the diagnosis of cancer, the biopsy being the first step in the confirmation of a cancer. This means that for approximately 60,000 new cancer diagnoses annually in Quebec, there is a cancer diagnosis deficit of approximately 10,000 people.

As a result, there are significant delays and timelines for many oncology surgeries are not being met.

In conclusion, we really need to be concerned about these delays, because patients and society will pay the price. For 13 of the 17 cancers that were studied, a four-week delay in diagnosis increased the risk of mortality by 6% to 8%.

For colon cancer, each four-week delay in diagnosis increases the risk of mortality by about 6%. For breast cancer, the increase is 8%.

British epidemiologists estimate that the mortality rate for cancer patients could be as high as 20% in the next year, but that the price to be paid could extend over 10 years. Indeed, there could be 10% excess mortality per year for the next 10 years.

To solve this problem, we must preserve human resources. As Dr. Belanger mentioned to you, we need significant additional investment to ensure that we have the human and material resources to provide the therapies that patients need.

I have appended several charts that come from the Quebec Ministry of Health and Social Services that give examples of delays in diagnosis and delays related to the various tests that I mentioned.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We go now to CHATS Community & Home Assistance to Seniors.

Ms. Bisanz, go ahead, please, for six minutes.

[Christina Bisanz, Chief Executive Officer, CHATS Community & Home Assistance to Seniors]

Thank you very much, Mr. Chairman and members of the Standing Committee on Health.

My name is Christina Bisanz, CEO of CHATS Community & Home Assistance to Seniors. As an advocate for providing choice for seniors to age at home, CHATS appreciates this opportunity to provide input on the effect of the pandemic on older adults.

CHATS is the largest senior-serving organization in York region in south Simcoe, supporting 8,500 older adults each year through a variety of multicultural programs and services designed to support the health, wellness and independence of seniors and their family caregivers.

Our person-centred programs focus on the social determinants of health in order to enable our clients to live safely and with dignity at home, keeping them out of hospital and long-term care as long as possible. CHATS has been deemed an essential service provider throughout the pandemic, providing support such as transportation to medical appointments, meals on wheels and food security services, caregiver counselling and telephone reassurance calls, just to name a few.

Our personal support workers continue to work on the front line within our assisted living sites, helping seniors with bathing and personal care, meal preparation, medication reminders and other activities of daily living. We've kept our adult day programs open for high needs and dementia clients, which in turn provides their caregivers with greatly needed respite, and when we were no longer able to offer in-person community wellness programs due to public health restrictions, we very quickly designed and delivered virtual wellness and social programs to ensure that our seniors were able to stay connected and engaged with the programs and each other.

In addition, we've worked with our hospital partners to support hospital-to-home transitions for seniors, reducing their risk of readmission.

We're very thankful for the funding that we receive from the seniors new horizons program and other supports, which made it possible for us to be innovative and serve our clients in a virtual world and address emergency needs for food security.

While the ongoing pandemic has illustrated that being in their home and in their community is a safe place for vulnerable seniors to live and receive care, it has also exposed a number of growing risks. I'd like to highlight four of these.

First, the imposed social and physical isolation has led to increased loneliness, depression and a general decline in the physical and mental health of seniors. Many of our clients have not had physical contact with family and friends in a year. Concern with their personal safety by allowing workers into their homes caused a number of our clients to reduce or cancel services, further insulating their social isolation and putting their safety and well-being at risk.

Second has been the impact on family caregivers, who have been experiencing unprecedented and overwhelming levels of stress in keeping their loved ones at home. Frustration and anxiety have led to an increased potential for and incidence of elder and caregiver abuse. The lack of sufficient respite care and support is leading many caregivers to their breaking point.

Third, the pandemic has shown just how dependent we are on the scarce resources of personal support workers in all parts of the health system. The overall shortage of PSWs in Ontario is even more prevalent and more critical in the community sector. Our frontline heroes are also experiencing high levels of stress and anxiety for fear of being exposed to COVID or exposing their clients to risks. Many come from racialized and marginalized communities. With wages generally lower than in the long-term care and hospital settings, the community sector is not in a position to compete for a resource that is crucial to enabling many frail seniors to continue to live at home, where they want to be.

Lastly, when the pandemic was first declared, an incredible spotlight of concern shone upon seniors. New funding, community response, offers of support to make phone calls and send letters and other examples of generosity and caring were unprecedented, but as the pandemic continued, the interest started to wane. Funding support ended with the fiscal year, but the needs and challenges for seniors because of COVID haven't stopped. Let's not leave our seniors behind.

I thank you for your time and attention, and I look forward to your questions.