Health Committee on May 3rd, 2021

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order.

Welcome to meeting number 34 of the House of Commons Standing Committee on Health. The committee is meeting to study the emergency situation facing Canadians in light of the COVID-19 pandemic. Specifically, today we are examining Canada's national emergency response landscape.

I would like to welcome the witnesses.

As an individual, we have Dr. Amir Attaran, professor in the Faculty of Law and the School of Epidemiology and Public Health at the University of Ottawa. From the Canadian Cardiovascular Society we have Dr. Marc Ruel, president. With the Nunavut Department of Health we have Dr. Michael Patterson, chief public health officer.

Thank you for joining us today.

I will invite the witnesses to make up to a six-minute presentation. When your time is nearly up I will give you a yellow card, and when your time is up I will show you the red card. When you see the red card, please do try to wrap up.

With that, we will start with Dr. Attaran.

Doctor, would you present your statement for six minutes, please?

[Dr. Amir Attaran, Professor, Faculty of Law and School of Epidemiology and Public Health, University of Ottawa, As an Individual]

Good morning, Chair.

I'm Amir Attaran, a lawyer, a scientist and a professor of both. Thank you for inviting me again.

This morning I've been asked to discuss federal emergency powers and COVID.

Let's start with the obvious: This country has learned nothing. We are in a third wave larger than the first two. How did Ontario, Saskatchewan, Quebec and other large provinces get a year and two practice runs into this pandemic, only to fail worse the third time? It's humiliating.

Look at Alberta. Yesterday, it became the most dangerous place in North America, literally. Alberta's incidence of COVID cases is higher than those of all nine provinces and of 50 American states, higher even than India's. Jason Kenney's inability to lead brought us this, and now, unfortunately, Alberta has become a threat to the rest of Canada.

Take the work camps in the oil sands. Many are fly-in, fly-out. The camps have about 700 active cases currently, including the most dangerous variants. What is going to happen if you take all those workers and fly them all over, including to Atlantic Canada, which has licked COVID? If you were a mad scientist, it would be the perfect plan: contrive camps with abundant disease and deliver the victims to an airport to seed death widely.

Now if we had a serious federal government in Canada, that simply would not be allowed. Rather than using its spending power liberally to cure the damage of COVID, which is a salve costing hundreds of billions of dollars, Ottawa would be more concerned to use its constitutional power over emergencies to prevent the damage in the first place. Ottawa would use the Emergencies Act, or even better, the Department of Health Act, to make emergency rules that both crush the cases and restrict travel out of hot spots. You'd make emergency rules to contain fires such as the kind burning in Alberta right now.

However, as we speak today, Ottawa still has no emergency rules. An emergency has never been declared federally. Frankly, it's because the Prime Minister is too scared to lead.

Pierre Trudeau, I often remember, used the Constitution's emergency power to combat inflation and rising prices, but his son is callow and won't do likewise, a year into a pandemic that is Canada's worst catastrophe in a century. He does not consider COVID-19 an emergency and has never declared so. That abdication is bottomless.

I believe it is time for the Prime Minister to pull up his photogenic socks and use his emergency powers. Since I think he won't, my next comments really can't be addressed to him. They have to be addressed to tomorrow's historians instead, who one day will wonder about this.

At the moment, there are three legal options. Number one, Canada can trigger a public health emergency under the Emergencies Act, but that, I feel, is a poor option because the Emergencies Act does not let Ottawa order shutdowns of non-essential activities in the provinces. It is, to be frank, an inferior and nearly useless law that Parliament simply has to get rid of and start over. That is how useless the Emergencies Act is.

The better option for now is, number two, for Parliament to pass bespoke COVID emergency legislation under the general residual power of section 91 of the Constitution. That law could set minimum national standards of disease control as Parliament considers necessary.

However, there's a third option, and it's my favourite. Number three: Patty Hajdu can unilaterally issue an interim order under section 11.1 of the Department of Health Act.

You may not have heard of that act, but it gives Ottawa the power to impose “immediate action...required to deal with a significant risk, direct or indirect, to health or safety.”

That fits COVID perfectly. We need immediate action to deal with a threat to health, and an interim order can happen instantly. I even published a draft of one in Maclean's last year, which you might find interesting to read.

We need that as a country—and we need it now—to set minimum national standards of disease control so that places, one province after the next, do not spin out of control and endanger the whole federation. If we're a serious country, we will not allow that to happen.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We go now to the Canadian Cardiovascular Society and Dr. Marc Ruel.

Go ahead please, Doctor, for six minutes.

[Dr. Marc Ruel, President, Canadian Cardiovascular Society]

Thank you very much, Mr. Chair.

Good morning, everyone.

I would like to begin by thanking all the members of the committee for giving me the opportunity to represent the Canadian Cardiovascular Society.

My name is Marc Ruel. I'm the chief of cardiac surgery and a cardiac surgeon at the Heart Institute in Ottawa. I'm also, incidentally, the president of the Canadian Cardiovascular Society, which is the national professional association that represents 2,500 cardiologists, cardiac surgeons and scientists across Canada.

I'm pleased today to have this opportunity to describe to you the realities that my colleagues and I are facing as we treat heart patients throughout the COVID-19 pandemic. As you know, this is a time that is very challenging for our resourcefulness. Among our concerns have been the priority sequencing for COVID-19 immunization and our country's ability to deliver essential cardiac care as the pandemic continues.

My colleagues and I oversee medical and procedural aspects of hospital cardiac care across the country. We have direct contact with COVID patients and their contacts every day as we serve as Canada's front line of defence in the pandemic. Our patients are the most severely ill: some who have pre-existing heart disease and then contract COVID-19, and some who develop cardiac complications as a result of COVID infection.

Along with the physicians and the health care and support workers who have direct contact with COVID patients are also the nurses, technologists, care aides and cleaners, and they need full protection from the virus. This has been recognized by the National Advisory Committee on Immunization, which identified health care workers as a priority population for immunization, given their essential role and their high potential for transition to those at high risk of severe COVID illness.

We applaud the recent acceleration of vaccination of vulnerable populations and the continued emphasis on preventive public health measures to reduce the spread of COVID-19. However, we have expressed our strong and persistent concern about the policy shift to a four-month delay in providing the second dose of vaccines—which is off-label for the Pfizer and Moderna messenger RNA vaccines—for frontline health care workers.

Incomplete vaccination of health care workers has translated into vaccination rates of essential health care workers of as low as 50%, depending on the region, as of today. There's recent data from The New England Journal of Medicine that demonstrates the profound effect of the timely administration of the second dose of the vaccine. One dose dropped rates of infection by about 30%, whereas the second dose dropped COVID infection rates by 98%. Let's remember that frontline health care workers do not have the option of not providing direct care in close contact with COVID-19 patients.

Other emerging data suggest that the delays for off-label use of mRNA vaccines lead to inadequate immunization and a paradoxical increase in the risk of variant spread. They also may exacerbate vaccine hesitancy due to infections after one dose, leading to lack of confidence in effectiveness among the population.

Outbreaks have already occurred in hospitals across Canada in this third wave. Most patient-facing health care workers and key support staff in many provinces are not fully vaccinated, and some of those with incomplete vaccination have become infected with the virus. We have seen examples of these in every centre. These outbreak situations and the general intensity of COVID-19 in hospitals not only puts patients and health care workers at risk for COVID, but also puts patients at risk from cardiac and other non-COVID disease conditions—indeed a dual threat. This has placed extreme strains on hospitals that were already heavily strained to deliver care prior to the pandemic.

Therefore, we fear that our public health organizations and governments have underestimated the negative impact of incomplete vaccination on health care workers and on the workforce as a whole, which has a direct negative effect on the health of Canadians from both COVID and non-COVID-related illnesses.

A related concern is an increase in vaccine hesitancy when infection occurs as a result of delayed dosing. Strict measures are needed to ensure the highest possible adherence to the vaccine with limited medically documented exemptions.

We all agree that vulnerable populations should be vaccinated as soon as possible, and that public health preventive measures are key even with vaccination, but again, protecting health care workers has the compounded benefit of protecting the public from both COVID and non-COVID illnesses and keeping hospitals less vulnerable to outbreaks. In a reality where we're now overwhelmed with COVID patients and what feels like an insurmountable backlog of critical non-COVID cardiac patients, every policy and practice improvement matters.

Based on the vaccine efficacy and increased risk, the Canadian Cardiovascular Society strongly recommends prioritizing the timely vaccination of our vulnerable populations and, by the same token, reclassifying high-volume patient-facing health care workers and key hospital support staff among those who should receive a second dose no more than two months after the first, also to ensure strict adherence to vaccination. These measures would enable the highest level of protection, so that health care workers can serve the public good to treat COVID and non-COVID-related illnesses, including cardiac disease.

Thank you for your attention.

I look forward to your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We will go now to the Nunavut Department of Health and Dr. Michael Patterson, chief public health officer.

Please go ahead, Doctor. You have six minutes.

[Dr. Michael Patterson, Chief Public Health Officer, Nunavut Department of Health]

Thank you for the opportunity to speak to this committee. I welcome the chance to share Nunavut's experience during the COVID-19 pandemic.

In comparison with the rest of Canada, Nunavut's size, isolation and social determinants of health leave the territory at significantly higher risk of severe impact from infectious disease outbreaks. This is as true for COVID-19 infections as it is for tuberculosis and was for H1N1 influenza. I would like to take this opportunity to illustrate how some of these factors can magnify the impact of outbreaks in Nunavut.

At the onset of the pandemic, testing capacity in Nunavut was identified as a significant challenge, as this territory was entirely reliant on southern public health labs. Combined with decreased airline service, this meant that the turnaround time—the time from collection of a sample to getting results back—could be as long as 17 days. As you can imagine, that lag was not only unacceptable but also dangerous. It put us at risk of having weeks of undetected transmission before a response even started.

Today we can do confirmatory testing in both Iqaluit and Rankin Inlet, and our turnaround time is almost always less than four days. While this is good news, it is not sustainable. We rely on having chartered aircraft on standby, ready to collect swabs from remote communities and transport them to Rankin Inlet or Iqaluit. As of March, the charter aircraft system has cost $2.8 million and is vulnerable to mechanical and weather delays. However, without this charter system, there are limited options for reliable community-level testing that will give Nunavummiut the same kind of surveillance protection as most of the rest of this country.

Isolation was our second major obstacle and one of the areas where we felt the housing burden the most. Nunavut suffers from a shortage of housing, and overcrowding is common in every community. We estimate that less than half of Nunavummiut would have the minimum resources to safely self-isolate at home. We have seen from other jurisdictions and our own experience prior to vaccination that, when COVID-19 arrives in a household, it is common for everyone in the house to become infected.

By the middle of March 2020, it was clear that unchecked spread of COVID-19 infections could easily overwhelm our health care resources. As a result, the decision was made to mandate isolation outside of the territory for most individuals flying to Nunavut. With the exception of exempted workers, most travellers have spent 14 days in an isolation hotel in the south prior to coming here. While this form of isolation is not perfect, experience in Nunavut and around the world shows that it can be part of a successful risk reduction strategy that ensures that the frequency of introduction events is kept to a manageable level.

Out-of-territory isolation is not perfect. While it has been mostly effective, many have struggled with the extra time away from their home and family. For many Nunavummiut, this travel is the only way to meet certain medical needs, even though in doing so they increase their risk of contracting COVID-19 and face two weeks of isolation. This has caused some to delay treatment, and it has increased stress for those who do travel south.

Despite the mandatory isolation system, Nunavut has experienced a few separate introduction events. In November, the community of Arviat, with a population of about 2,700, was one of four communities in the Kivalliq region to have cases of COVID-19. For approximately three months, there were active cases in the community despite aggressive contact tracing supported by public health measures to reduce the spread. This required extra staff and near-daily charter flights to transport samples for testing.

At this time, Iqaluit is also experiencing an outbreak of COVID-19. The first case was identified April 14, with contact tracing showing that there was likely transmission occurring in the city as early as one week prior.

Despite earlier vaccination efforts, there has been a rapid rise in cases. Spread of infection has been driven by household contacts and contact between essential workers, who often work two or more jobs to make ends meet, which is that much harder in a remote northern community.

I hope this short review gives you an idea of some of the unique challenges that Nunavummiut face in their response to this pandemic. I also hope it has reinforced the idea that solutions designed in and for southern Canadian cities may not be appropriate for or applicable to remote northern communities. What is needed is support to develop solutions to local problems, as well as investments to reduce the risk of current health problems and future outbreaks.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We will start our questioning at this point with Ms. Rempel Garner.

Ms. Rempel Garner, please go ahead for six minutes.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair. My questions will be for Dr. Ruel.

The letter that the Canadian Cardiovascular Society wrote to some parliamentarians was, I think, a significant warning. I just wanted to expand upon some of the points you made in that letter, as well as in your remarks today, particularly around the dosing intervals that have been approved by [Technical difficulty—Editor].

[Luc Thériault, Bloc, Montcalm, QC]

There's no interpretation. Addressing this issue this morning would be important because the questions are relevant.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

Mr. Clerk, I wonder if you could check with interpretation to see that we are getting—

[The Clerk of the Committee, Mr. Jean-François Pagé]

Mr. Thériault, I think Ms. Garner's screen froze, so the problem isn't with the interpretation.

The technicians are in the processing of verifying that.

[Dr. Marc Ruel]

Mr. Thériault, I can answer in both languages. It will take a little more time, but I'll keep it very brief.

[The Chair, Liberal, Ron McKinnon]

Thanks. I think we'll just suspend for a few minutes, until we get this sorted out.

[The Chair, Liberal, Ron McKinnon]

Thank you all.

We are now resumed. I am told that the interpretation should be good. There was an Internet communications problem.

Ms. Rempel Garner, if you please, you can start over again.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thanks, Chair.

Again, to Dr. Ruel, your letter talked about the delayed dosing interval paradoxically increasing the risk of vaccine-resistant variants, I believe.

I was hoping you could expand upon your concern and perhaps give a recommendation to the committee.

[Dr. Marc Ruel]

Thank you, Madam Rempel Garner.

With regard to vaccine resistance, the data is still unclear. What is important to note is that health care workers do not have the option of staying away and not providing direct care to COVID-19-positive patients. There's no doubt—and the data are clear—that delaying the second dose provides a vulnerability window, if you will, even after the two-week period following the first dose.

Health care workers are at risk. They are providing care. With the high incidence levels we are seeing in most Canadian provinces, we think this is really about vaccinations, focus and money well spent to provide care to Canadians, both with COVID and non-COVID-related illnesses.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

There was a Canadian Press article this morning that talked about the percentage of infections found in persons who have had one dose in Canada. Based on your letter, are you concerned that this percentage could increase as the time between that first dose and the second dose extends across the country?

[Dr. Marc Ruel]

Thanks for mentioning that. Indeed, the Public Health Agency of Canada report that was published in The Globe and Mail this morning is interesting. It notes that 53 infections caused death after receipt of only the first dose, so definitely it's not an impossible occurrence. We have seen at all major institutions patients and health care workers becoming sick after having received only one dose of vaccination.

I can tell you one example specific to the Ottawa Heart Institute. We had an outbreak of COVID-19 about three weeks ago. Very unfortunately, we had more health care workers who were at home with COVID positivity than we had patients themselves who were COVID-positive.

It seems, then, to really be affecting our health care workers primarily, because of the amount of traffic and care provided by health care workers; hence the need for a second dose.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you.

Are you tracking data around how many health care workers in Canada have contracted COVID-19 after receiving only one dose?

[Dr. Marc Ruel]

I think those data are not current at the present time.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Okay. Would you be willing to share whatever data you have with the committee?

[Dr. Marc Ruel]

I would not at this point, because the data are currently not updated, and it's hard to really have a good sense.

I think we have age-specific data. Most of the reinfections after one dose, especially those causing significant morbidity, occur in older people, but it can still happen among health care workers.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

I guess what I'm concerned about is that no other country has extended the dosing interval to four months. What would you advise the committee in terms of direction to the government on how to be monitoring or tracking COVID infections that are happening at different milestones as the delay between doses increases?

It's just that when we have Health Canada in front of us, it's very nebulous, and I'm really concerned about this. What sort of recommendation could you give to committee on how the government could be improving this and sharing data with the provinces?

[Dr. Marc Ruel]

Our recommendation goes along the lines of the message I was providing earlier. We understand that the Canadian population needs to be vaccinated as soon as possible. That may imply a “one vaccine as soon as possible” strategy for the most possible people, and Canada is not the only country to have adopted this path. There are other countries that have done it.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

No other country has extended it for four months, though. Isn't that so?