Health Committee on May 7th, 2021

[Michael Garner]

In the movement in the 2014 revision to the Public Health Agency of Canada Act, where you had a bureaucrat put in charge of this organization, that's the key. The bureaucrat needs to support the CPHO, but ultimately a trained medical professional—a public health doctor or a public health nurse—needs to be responsible for the resources.

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

This is the last question.

I notice there's a lack of frontline clinicians involved in any area. There are just not a lot of people who actually practise. Do you think that's something that needs to be rectified as well?

[Michael Garner]

Do you mean in the federal government or on the ground?

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

I just mean, where are the frontline doctors advising the government right now?

[Michael Garner]

Yes, we need more public health expertise: doctors, nurses, epidemiologists who are not subordinate but are actually the ones with the decision-making power, who are supported by the bureaucracy. That's where we've gone wrong.

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

Thank you so much.

[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.

My questions will be for Dr. Barrett.

Dr. Barrett, I want to thank you so much for taking the time to be here today. You are an expert, and you've been such a leader in Nova Scotia and in our response to COVID-19. I can speak on behalf of my constituents when I say I'm so proud—so proud—to have people like you representing our province.

We've demonstrated, I think clearly, that provinces can control the spread of this virus if they take a committed stance and follow provincial public health advice, so I have a couple of questions for you.

From day one of this pandemic, Dr. Strang and his public health team, and of course former premier McNeil and now Premier Rankin, have taken COVID-19 seriously by implementing very strict public health measures.

This is a chance, Dr. Barrett, to unpack the measures you spoke to in your opening statement. I'd like to hear a bit more and maybe do a deeper dive on that in respect to the first wave, but given the severity of our third wave, do you think we could be doing more?

I have one more question I'm going to put in there, because I want to take this time we have for you to answer these questions. With the record-high cases—I think it's 227 today, and I think that's a total of a little over 1,400 cases—can you tell us what you think the next couple of weeks look like for Nova Scotians? What advice would you give to those watching at home?

Thank you, and over to you.

[Dr. Lisa Barrett]

Maybe I'll start with the end first.

I think we have a bit of a rough go yet. We still have a large number of cases that are unconnected, and we're about day 10 or 11 into a lockdown. That's the real lockdown, not the kind of lockdown you see in some places. I think we're going to need a few more restrictions that are going to hopefully come into play right now. It's tough, because a lot of this is engagement, and I truly believe that Nova Scotians and Atlantic Canadians, and people, Canadians.... You can have the best bureaucrat in the world or the best doctor in the world leading something and suggesting to people they do something, and unless people are engaged at a real level and a granular level—at an individual level in places and provinces—you're not going to get a response, because people just won't do whatever is suggested. I think we have a rough few weeks ahead, but I think we'll get there, because there is an incredible amount of engagement.

Do we need to do more? Probably a little more. People need to get their heads back into last April's mode of a state of emergency, not current mode. I think that's probably something that heralds into the bigger picture here and what other places have done.

Nobody in Nova Scotia, because our numbers.... I mentioned to you that there are quantitative numbers that have been followed. To come back to the federal approach, I'm shocked and appalled that we haven't, as a federal agency, prescribed some quantitative measures of what would be useful guidelines for people in terms of regions and when they might loosen restrictions at different points. We've stayed pretty close to our quantitative measures of community spread, reproductive number of virus and number of cases on a daily, rolling seven-day average. This is not rocket science; this is called epidemic/pandemic management 101.

I'm surprised that we haven't federally required people in eight regions to do that at the provincial level before restrictions are reduced. I see headlines today about places that are thinking about reducing restrictions when the number of cases and unlinked cases is still exceptionally high. I know we won't do that, and I think that's a key, core part of what has kept us safe. That comes back to the four things, which are distance, speed, awareness through testing, and engagement. Testing has been a huge part of the way we're going to make it through this, but that's also because we have an engaged population. You can suggest anything. If people aren't doing it, then you're not going to get anywhere.

I think, one, yes, there's a bit more we need to do; two, it requires a little more engagement; and, three, I'm saddened and disappointed that we haven't done that with a prescriptive set of guidelines for provinces. I think it's a bit unconscionable that, just because you live in a different part of Canada, your public health advice may be a little different around things that can be helpfully quantitative and are able to be implemented.

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

Thank you so much, Doctor.

I particularly like.... I think there are four pillars: awareness, speed, distance and.... What was the fourth one?

[Dr. Lisa Barrett]

It's the most important one: engagement.

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

Engagement. Of course. That wasn't an artificial pause on my part; I just drew a blank.

It's an ongoing thing, obviously. The pandemic evolves, and our response to it evolves. Do you see those four pillars changing, or any additional pillars being added to those four measures or four pillars? For example, we're in a third wave now. Do you see us deviating from that or adding to that in terms of a repertoire to better engage people and better react to COVID?

[Dr. Lisa Barrett]

I think the pillars are core to the management of any infection that spreads with a respiratory mechanism. By that, I mean the way we implement those and the tools that are used, at times after vaccination, etc., are going to be different.

Surveillance, understanding where the virus is and how it's moving, and understanding the geolocation of different variants and what they look like all require the ability to test people frequently over time and to monitor borders, but not necessarily keep them closed. The tools we use in the toolbox are going to change, but I think the pillars remain the same and the goals remain the same.

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

Thank you, Doctor.

How much time do I have, Chair?

[The Chair, Liberal, Ron McKinnon]

You're out of time already. You're right on the money.

Thank you, Mr. Kelloway.

Ms. Gaudreau, you have the floor for six minutes.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Thank you, Mr. Chair. Your French is excellent. It's very nice to hear you.

My thanks to the witnesses. I must admit that it's great to hear about good practices. I commend the work that's been done at all stages, particularly in your case, Ms. Barrett. As you explained so well, we in Quebec saw a lot of enthusiasm for volunteering. People came together to support the community. They even created a website called jebenevole.ca. People were so supportive that it was hard to manage all the volunteers willing to help the community.

With respect to how quickly action was taken, I confess that I was also outraged at the two-month delay that we had to deal with. I'm thinking of the lives that could have been saved.

We are now in the third wave. I hear a lot of people saying that government actions are grossly inadequate. Mr. Garner's comments are very specific, and I thank him for that.

Ms. Barrett, I would also like to hear your comments about how quickly governments took action. I would also like to hear what you have to say about rules and communications, that is, the whole issue of government public relations in all the provinces and in Quebec.

[Dr. Lisa Barrett]

I'm certainly not a communications expert, that's for sure. I will comment from the perspective of the science and the infectious disease point of view.

The engagement part is important. I think it was interesting.... We didn't try to manage the volunteers. Once there was that wave of engagement that was partially generated, there was an opportunity. We generated opportunities for people to be engaged, particularly through testing. Not just around testing, but also as part of the testing events, as it was the actual people doing swabs and doing the point of care tests. However, we didn't try to manage that.

It's important that there is sometimes a great deal of oversight—paternalism, maternalism or they-ism—that comes into our public health responses, in that we try to control it. It's a notifiable disease. We let go of that a bit. We let go of medical professionalism and protectionism of fields to include people in a very real way that was very much generated by them as well.

I think if we're going to be successful as we go forward in any province, we have to give people a bit of autonomy at the same time as we're telling them to restrict. I'm not a human behaviour specialist, but I think that was an important part of the combination of responses here in Nova Scotia. I hope that's going to continue.

To your point about speed, we can't do this if governments aren't definitive and quick. The speed at which you take away the restrictions should be as slow and guided by quantitative measures as the implementation should be swift. Taking things away too fast, before the numbers go down, is a catastrophe.

In terms of speed and communication to people, we just provided a whole lot of information to folks in a real way and said that this is the way it is.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Congratulations, Ms. Barrett. You are a great role model. It made me realize that in Quebec, we're also very fortunate with respect to public health.

Mr. Garner, you talked about inertia in decision-making and the relationship between public health authorities and government. In my view, in Quebec, but certainly elsewhere as well, public health authorities made all the recommendations and codified everything that had to happen, such as restrictions or physical distancing, and the government made decisions. It all had to be done extremely quickly.

I'd like to get more clarity on the process: listen to the science, take responsibility, and put partisanship aside, because we're talking about human lives. We have a few seconds left, so I would like to hear from you on that, Mr. Garner.

[Michael Garner]

The challenge of public health is that our political benefit is to respond to something rather than to prevent, and I think that's the question of inertia. If we had prevented all the cases of COVID, people would ask why we were making such a big deal about it. Before things get bad, you need people in places of decision-making who can understand the potential for really significant outcomes and significant events. It think that's part of what I'm proposing—this reordering of the public health experts actually being in the places to make those decisions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Gaudreau.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Thank you, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

We'll go now to Mr. Davies, once again, for six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Reverend Garner, the Vatican recently threw its support behind the request of India, South Africa and I think almost a hundred countries that have proposed that the WTO waive the intellectual property restrictions that are preventing countries from getting access to technology to produce their own vaccines. Does the Anglican Church of Canada have an official position on this proposal?

[Michael Garner]

I'm here speaking as an individual and not as a representative of the Anglican Church of Canada.

As an individual, I think anything we can do to ensure that vaccines are distributed with equity and with rapidity is in line with the moral teachings of the church, so I think we want to see..., but that also goes for Canada. We want to ensure that, for people who have the least access, those barriers are removed. I think that is something we need to continue, both at the level of the federal government and all the way down to the local level, to ensure that the most needy of Canadians have equitable access to these vaccines and perhaps even preferential access.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Barrett, you recently co-signed an open letter in Maclean's, along with a group of leading Canadian physicians and researchers, calling for strict nationwide restrictions to control COVID-19. The letter said, among other things, the following:

It did not have to be this way. A maximum infection suppression strategy implemented early in the epidemic to reduce COVID cases to as low a level as possible, and then stamp out outbreaks as they arise, would have saved tens of thousands of Canadian lives. This approach, with some modifications, remains the best strategy right now.

Dr. Barrett, you mentioned the word “nationwide”. Should the federal government use its powers under various pieces of federal legislation to bring in nationwide restrictions?