Health Committee on May 3rd, 2021

[Dr. Marc Ruel]

I couldn't agree more. In fact, that's the big problem with COVID-19, that excess deaths aren't just from COVID-19, but are caused, in large part, by other diseases, such as cardiovascular disease. This is a problem that we have to deal with, and it's called the “double threat”. Since the beginning of the pandemic, there has been an increase in deaths, mostly related to cardiovascular disease. This has been observed in Europe, and very early data were published in The Economist. Other data have recently been published in the United States in the Journal of the American Medical Association.

We're also seeing the same thing. It must be the same for Dr. Perrault, who I know very well, at the Montreal Heart Institute. We're seeing the same thing in Ottawa and in all the centres in Canada because, unfortunately, diagnoses are delayed. Because of COVID-19, we need to protect the nurses and staff who care for patients. All of the impacts on the health care system often slow us down and prevent us from doing surgeries or other cardiovascular procedures at the same rate as before.

[Luc Thériault, Bloc, Montcalm, QC]

According to Dr. Perrault, a patient who hasn't had access to the diagnostic process will show up at a later stage of the disease, which will have worsened, and their chances of recuperation will become more difficult. Their chances of returning to work quickly will also be lessened. A mild heart attack can become much more severe. The patient will lose function, which will affect their quality of life. Sometimes, the patient will suffer from having heart failure and will become a subscriber to the health care system because of the chronic nature of the disease. For this reason, not treating it quickly will lead to an explosion in costs. Is that right?

[Dr. Marc Ruel]

You're right, Mr. Thériault, it's a problem. We must continue to provide cardiac care. The Canadian Cardiology Association and the Ottawa Heart Institute have been repeating this message since the pandemic began, and it's important to keep repeating it.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Perrault said that recurring investments in health care are absolutely necessary. Do you agree with that?

[Dr. Marc Ruel]

We must continue to address both threats simultaneously, the threat of COVID-19 and the threat of other diseases, including cardiovascular disease, which unfortunately cannot be treated in a timely manner because of COVID-19.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We will go now to Mr. Davies.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Dr. Attaran, I would like to explore the federal government's powers a bit more, specifically the Emergencies Act.

Section 3 of the Emergencies Act defines a national emergency as “an urgent and critical situation of a temporary nature that...seriously endangers the lives, health or safety of Canadians and is of such proportions or nature as to exceed the capacity or authority of a province to deal with it” and one that “cannot be effectively dealt with under any other law of Canada.”

Given what you have said about Alberta, and I think some of those comments may apply equally to Ontario, would you say that this definition of national emergency is triggered by the current COVID crisis?

[Dr. Amir Attaran]

Absolutely I would, and to the extent that you can use the Emergencies Act, now is the time to do it. Well, the time to do it was months ago, but it should be used.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks. I'm going to carry on.

Section 5 of that act has a more specific definition. It says:

Public welfare emergency means an emergency that is caused by a real or imminent...disease in human beings, animals or plants...and that results or may result in a danger to life or property, social disruption or a breakdown in the flow of essential goods, services or resources, so serious as to be a national emergency.

In your view, Dr. Attaran, does the present COVID crisis fit the definition of a public welfare emergency?

[Dr. Amir Attaran]

It fits absolutely all of the branches you mentioned, so again, clearly yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Section 8 of the Emergencies Act specifies a range of the numerated powers. One of them—in fact, the first one.... I will just read a bit of the preamble: “While a declaration of a public welfare emergency is in effect, the Governor in Council may make such orders or regulations with respect to the following matters”. It goes on to list, among others, “the regulation or prohibition of travel to, from or within any specified area, where necessary for the protection of the health or safety of individuals”.

I listened carefully to your comments about, as an example, the work camps in Alberta and their potential for being vectors of transmission. Is that a power under this act that could be used by the federal government in order to control interprovincial travel for quarantining and to control the spread of disease?

[Dr. Amir Attaran]

It is, and let me give you some historical context. You can go back centuries to medieval Italy. At that time, the very best public health measure was the cordon sanitaire, the looping off of an area—the cordoning off of an area and not allowing people in or out. It is the surest, safest, best thing when you're dealing with a hot zone, and it's been part of public health practice forever. That is allowed under the Emergencies Act and should be done with hot zones for exactly the reasons you mention, Mr. Davies. That is about as far as the Emergencies Act will carry you, I think, but that's very far, so this part of it should be a no-brainer.

[Don Davies, NDP, Vancouver Kingsway, BC]

Well, there are other powers there. I'd be interested in your views on this one. Paragraph 8(g) would give the Governor in Council the power to establish emergency shelters and hospitals.

We know that hospitals generally fall under provincial jurisdiction. I'm thinking of the overwhelming of the ICUs, say, in Ontario. Would that paragraph (g) not give the federal government the power to move into a province and set up, for instance, mobile ICUs under the power to set up hospitals?

[Dr. Amir Attaran]

In a physical sense, yes, but this is where the law clashes a bit with practical reality. You can set up the hospitals federally using paragraph (g), but how are you going to staff them and integrate them into the health system so that, for instance, you have somewhere to discharge those patients as they get better? This is not a power that could be exercised without some co-operation from the province.

On the other hand, Mr. Davies, you mentioned the cordon sanitaire. That's something that can be done by the federal government instantly, and ought to be.

For some of these other powers in the Emergencies Act, yes, you could use them, but they will take greater integration with the province.

[Don Davies, NDP, Vancouver Kingsway, BC]

Well, I want to go to that too, because the act is very clear on when provincial agreement is needed, and my reading of the act is that if an emergency is restricted to one province, then you must have the consent of the province. However, where the emergency is in multiple provinces, then consultation is required, but the agreement of the provinces is not required. Is that a correct understanding of the Emergencies Act?

[Dr. Amir Attaran]

Definitely.

[Don Davies, NDP, Vancouver Kingsway, BC]

Finally, I'm going to read to you from the working paper for Bill C-77, as it was called, from 1987, which I dug up. It is the document that surrounded the act that became the Emergencies Act in 1988. It starts off by saying this:

The constitutional responsibility for dealing with emergencies is divided between the federal government and the provinces. The Constitution Act, 1867 does not delineate in specific terms the authority of each level of government over emergencies, but...the federal government has primary and ultimate responsibility to provide for the safety and security of Canadians during national emergencies. Its constitutional jurisdiction over such national emergencies stems from the power of Parliament to legislate for the “Peace, Order and Good Government of Canada” and the emergency doctrine which has evolved from it.

That doctrine invests the Parliament of Canada, during times of national crisis, with temporary plenary jurisdiction to legislate on all matters, including those normally reserved exclusively to the provinces. It operates, as Mr. Justice Beetz of the Supreme Court of Canada stated in the Anti-Inflation Reference, as a “partial and temporary alteration of the division of powers between Parliament and the provincial legislatures”...which gives to the Parliament of Canada in times of national crisis, “concurrent and paramount jurisdiction over matters which would normally fall within exclusive provincial jurisdiction”. And, as he also observed, “the power of Parliament to make laws in a great crisis knows no limits other than those which are dictated by the nature of the crisis”.

Those are the opening words of the instruction of parliamentarians prior to the introduction of the Emergencies Act. Does that jibe with your constitutional understanding of the way the Emergencies Act flows?

[Dr. Amir Attaran]

Yes, it's all correct. Interestingly, a case around the peace, order and good government power comes to the Supreme Court about once every 30 years, and we just had one decided a few weeks ago. The carbon tax case was a peace, order and good government case. I litigated it—full disclosure—and the Supreme Court just weeks ago reaffirmed that the federal government can do precisely what you've read out, so yes, whatever needs to be undertaken in an emergency, should Parliament choose to take it up, it can do. Essentially, it is unlimited power, as long as it's time-limited in nature. That was true in the summary you read, and it was true according to the Supreme Court just weeks ago. That this has not been used so far in the pandemic is Canada's cardinal blind spot, marked only by thousands of dead. It's tragic.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

We will have a very short time for a quick snapper round. I propose 30 seconds per party, and I hope we're agreed on that.

With that, we will go to Mr. d'Entremont, please, for 30 seconds.

[Chris d'Entremont, Conservative, West Nova, NS]

I have a quick question for Dr. Patterson in Nunavut.

Did you roll out rapid testing, to try to get into some of those really remote communities without having to get the test back to labs and do all that? I see you've already done 12,500 tests. How many of those might have been rapid testing?

[Dr. Michael Patterson]

We have rapid testing in a number of communities and plan to roll it out to all of our communities, but it is still required to get confirmatory testing, which is available only in Iqaluit and Rankin Inlet.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. d'Entremont.

We go now to Ms. O'Connell. Please go ahead for 30 seconds.

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

Thank you, Mr. Chair.

Dr. Ruel, I just wanted to follow up on your suggestion, and I support [Technical difficulty—Editor] frontline health care workers right away. I guess my question is around the fact that the decision about dosing intervals is actually made provincially, as is the decision about prioritization of vaccines.

I am thinking that there are some provinces that provide those intervals sooner for health care workers. Do you have any statistics on which provinces and territories those might be?

I'm sorry, Mr. Chair. That took a little longer.

[Dr. Marc Ruel]

I don't want to get into province specifics. This is obviously a national panel. I hear your thoughts around the greater good, but we think that not delaying the second dose for health care workers brings greater good and allows for health care workers to take care of people with COVID and non-COVID-related illnesses.