Health Committee on May 3rd, 2021

[Dr. Marc Ruel]

I think there should be an exception made for health care workers, for the reasons we highlighted. Health care workers should receive their second dose within the usual therapeutic window that has been mandated by Moderna, Pfizer, you name them.

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

Are you aware of any other country that has extended the dosing intervals to four months?

[Dr. Marc Ruel]

I'm not aware of another country, because I focus on Canadian data. That being said, there could very well be some.

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

Okay. I haven't seen any.

In terms of the potential impact, are there any studies that you could point the committee to, or research that's being undertaken, into how immunity is waning beyond the manufacturer's window? Is there any research that we should be looking at or examining?

[Dr. Marc Ruel]

That's an excellent question. So far the data appear to be encouraging. There doesn't seem to be an indication that if the second dose is delayed you will be more likely to need a third dose. It may very well be that we'll all need a third dose in the future.

That being said, really the point here that is most urgent is that health care workers need to be fully protected as soon as possible, because the incidence rates are high; they are providing frontline care to patients with COVID-19, and they do not have the option to refrain from direct contact with those patients.

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

Thank you, Chair.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rempel Garner.

We'll go now to Mr. Kelloway.

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

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Chair, and hello to my colleagues. To the witnesses, thank you so much.

My questions are going to be for Dr. Patterson.

I spent some time in Nunavut when I was with the Nova Scotia Community College and working with the Nunavut Arctic College. I often felt very much at home, given that there were quite a few Cape Bretoners and Newfoundlanders there, so it's great to connect with you.

Dr. Patterson, early on in the pandemic there was great cause for concern about how the territories would fare with limited health resources. The federal government, in partnership with the Government of Nunavut, took quick, early action to focus on outbreak prevention, ensuring that the territories had the resources they needed.

From your perspective as a chief public health officer of Nunavut, why do all levels of government need to work together to combat COVID-19?

I have a secondary question. It's based on your testimony. You talked about Nunavut having a unique set of challenges in talking about being involved in decision-making processes and informing policy on health.

I'm wondering how we can we do this better between the government you represent in your area and those provincially and federally.

[Dr. Michael Patterson]

Having a structure in place that supports preparations and the ability to respond to the next outbreak in a more efficient manner would be extremely helpful; one that provides, for example, remote communities with greater access to public health labs and other diagnostic supports. That work is extremely specialized and is typically located only in larger centres.

Nunavut is not alone in not having access to trained medical microbiologists and certified public health labs that can roll out and ramp up diagnostic capacity in a hurry. An organized approach to supporting remote and isolated jurisdictions or areas that lack those services is needed for the next pandemic.

I'm sorry, Mr. Kelloway, can you restate the second part of the question?

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Sure. It actually emanates from your testimony when you talked about the unique challenges you just spoke to.

This may be something you do a deeper dive on from your previous question, but I'm curious as to how we create better relationships, better systems between unique communities such as Nunavut and the south, as you described, in terms of playing a much deeper role in informing policy up front—community intelligence, health care intelligence on the ground—and translating it into collaboration with provincial or federal counterparts.

[Dr. Michael Patterson]

I would say it's by providing support and expertise in terms of surveillance and diagnostic capacity and physical resources, but being careful not to mandate activities in a very strict way and automatically tie them to funding.

There have been examples in research in the U.S. In 2001-02, there were mandates to prepare for anthrax or white powder events. U.S. federal funding was tied to those preparations, and it led to declines in preparation for other emergencies that would be much more common than bioterrorism, such as hurricanes and other events.

Hospitals in New Orleans, for example, were more prepared for bioterrorism than they were for Hurricane Katrina, with disastrous results.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Doctor. I want to pivot to focusing on vaccines.

Dr. Patterson, as soon as vaccines were available in Canada, those living in the territories were prioritized. Since then, there has been a considerable uptake, with thousands of those living in Nunavut vaccinated earlier in the year.

Can you tell us and Canadians why it was important for those living in Nunavut and the territories to be prioritized? Can you tell us the impacts of vaccination in your community so far?

[Dr. Michael Patterson]

It was recognized early on that there was a much higher burden of risk in Nunavut and in other remote indigenous communities. With the absence of other supports or reduced supports and services in other areas, increased access to vaccination is one way to offset that increased burden of risk. It appears to have helped.

By this time in the Arviat outbreak, three weeks into it, almost 5% of the community had been diagnosed with COVID-19. We're two and a half weeks into the outbreak in Iqaluit, and the numbers are still rising, but not as fast, so it has made a difference already when we compare the two communities.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We'll go now to Mr. Thériault.

Mr. Thériault, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

My questions are for Dr. Ruel, and I hope my colleagues will be able to benefit from the English interpretation.

Dr. Ruel, how many hospitals in Quebec do you think are currently dealing with an outbreak?

[Dr. Marc Ruel]

Mr. Thériault, thank you for your question.

I don't necessarily have that information on hand.

[Luc Thériault, Bloc, Montcalm, QC]

If you have it, perhaps you could send it to the committee later.

In the first wave, hot and cold zones had to be organized, and there was no vaccination. We're now in the third wave, and I imagine the outbreak rate in hospitals must have gone down a lot. Is that the case?

[Dr. Marc Ruel]

That's not necessarily the case. As you know, with the new variants, the mutations, the transmissibility of infections is significantly enhanced and not at all favourable. So there is much more potential for transmission from person to person.

[Luc Thériault, Bloc, Montcalm, QC]

There's a difference between the potential for transmission and a definite outbreak, isn't there?

[Dr. Marc Ruel]

There isn't a huge difference because an outbreak usually occurs on most floors between two patients where transmission has occurred in a hospital setting.

The definition is still quite strict.

[Luc Thériault, Bloc, Montcalm, QC]

In your testimony, you said that at least 25% of health care workers were reluctant to get vaccinated.

How do you explain that?

[Dr. Marc Ruel]

The data changes every week. I can tell you that, in my speciality, it isn't 25%. All health care workers want to get their vaccine, and the second dose, as soon as possible. Later, it may be the third dose.

There may be regional variations, but that's not what we're seeing here.

[Luc Thériault, Bloc, Montcalm, QC]

When you mention variations, are you talking about areas of specialty? You said that the percentage is different in cardiology.

[Dr. Marc Ruel]

Actually, I think it's really not that percentage.

We have the pandemic in our face every day. We have patients on artificial hearts and lungs because of COVID-19. Right now, there are a lot of patients who are between life and death, and the situation tips more often in the wrong direction.

[Luc Thériault, Bloc, Montcalm, QC]

You talked about patients who don't have COVID-19 earlier. On April 26, we heard from Dr. Perrault, president of the Association des chirurgiens cardiovasculaires et thoraciques du Québec. He told us that before the pandemic, despite chronic underfunding in the health care system, these surgeons were trying to keep the percentage of patients on a waiting list at less than 10% above acceptable wait times for the situation to be manageable. We know that cardiac procedures have to be early, just as they have to be in cancer.

Very quickly, in the first wave, this percentage on the waiting list rose to 20%. It's now reported to be between 40% and 45%. Dr. Perrault said something quite powerful. He said that at these rates, we're playing Russian roulette, because the important thing is to be able to counteract sudden death. If patients end up getting care, they're obviously going to experience much greater consequences.

Do you agree with those comments?