Health Committee on May 7th, 2021

[Dr. Lisa Barrett]

It was a co-signed, fairly large group in the letter.

The nationwide part does refer to something I've alluded to a couple of times, which is that when you're talking about an infectious disease like this, there is science around some of the numbers that can lead to suppression and control. Some of those measures I've already mentioned around how fast the virus moves, how many contacts, the number of cases in a certain area and the ability to spread from person to person.

Therefore, if you have a certain number of cases and a certain type of interaction—distance was one of my pillars—nationwide guidance around areas that have parts of a pandemic that are out of control and suggestions for what to do at that point to limit the distance, increase the awareness or surveillance, and increase the speed of response and engagement, that would make exceptional sense to me.

I guess, in short, what I'm saying is that yes, there are quantitative things that people can fight about till the cows come home in terms of the exact number, but there is very good science around how to contain an epidemic like this. You take those numbers; you go to places that need that guidance and you provide them with the support and the guidelines to be able to do that. I think we need official and national guidance on those items. They don't have to be implemented equally across all regions, but in areas that meet the criteria, those guidelines should be followed or else you are going to see spread of the infection.

This is not a hypothetical; it's a definite, and we know how to fix that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right. I'll come back in a moment to maybe challenge a bit on guidance and suggestions versus measures.

You also wrote in an article on the Al Jazeera website that you noted that Atlantic Canada’s COVID-19 success has been due in part to the guiding principle that “prudence is best” when it comes to restrictions. The article said this contrasts with the approaches taken in other provinces, where people “opened things up before there were good, quantitative, number-based reasons to do so…and when 'lockdowns' were put into place, they were partial.” You were also quoted as saying that “essential activity included things that were not essential, like buying duvet covers.”

Should Canada adopt a nationwide, circuit-breaker shutdown to control this, so that we have a consistent application of that prudence-based model, or should we continue to leave it to the happenstance of provinces who might or might not follow that guiding principle?

[Dr. Lisa Barrett]

Your due diligence in reading the article is appreciated. I didn't write that; I said that. Just to be clear, it was an interview, and that was an interpretation and excerpt from the interview.

On that note, what I'm saying is that the guidance needs to be implemented in areas and regions. There doesn't need to be equal introduction of all restrictions at all points. That may be different for travel and borders. However, the implementation of guidance needs to be done regionally, in areas where there is connection with people.

What I mean by that is not all provinces have to do everything across their entire province at the same time, but the guidance around the numbers when you have a certain number of cases, a certain amount of transmission and a certain amount of unknown transmission should be done nationally. The implementation can be given at a provincial level in a regional way to still provide the same support and answers outside the border part of things.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. That's fair enough.

More directly, in your view, should the Atlantic model of a 14-day quarantine for interprovincial travellers be replicated across Canada?

[Dr. Lisa Barrett]

The 14-day quarantine has been a large part of our success. I can't imagine that people and respiratory tracts are different in different provinces.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings round one to a close. I think we'll have time for an abbreviated round two as well. We'll do as we did for the last panel. We'll have time slots of three minutes and one and a half minutes.

I believe for the Conservatives we have Mr. Maguire next.

Mr. Maguire, please go ahead, for three minutes.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thanks, Mr. Chair. I just want to go back to Dr. Barrett.

Dr. Barrett, I really like your four points. The speed, the distance, the awareness and getting people engaged are key.

I want to know how rapid testing fit into the model of the maritime bubble. Was it used extensively?

We are behind in vaccines compared to many of our G7 country colleagues, and vaccines weren't used as readily as they could have been.

I wonder if rapid tests were used more in the Maritimes. These other issues of distance and awareness are great, but I think the speed of response is one of the key issues. Could you expand on how rapid tests fit into that?

I know the government has made an announcement just today, but my colleague has been calling for this for over 10 months. We still have increasing numbers, so I wonder if rapid tests could be used in the variant areas as well.

[Dr. Lisa Barrett]

We have used all forms of the rapid point-of-care tests that have been disseminated from the federal government as part of the pandemic response. That includes two tests that have a machine and are not quite as easy to scale up or as portable, as well as a large number, over 100,000, of point-of-care tests that are almost like pregnancy tests. We've used them extensively and across the province, both in waves and between waves, for asymptomatic diagnosis.

The point of that testing in between waves is to provide us with a feeling. It's an early detection system in the community for an asymptomatic virus, because this is an asymptomatic virus that spreads easily. That was useful in helping us get an early fix on where the virus was and wasn't.

During the waves, it has off-loaded pressure from our medical systems because it is not being run in labs, of course, and it's also being done by volunteers. During this wave, we've managed to maintain asymptomatic testing of up to 5,000 tests a day to promote early detection and diagnosis.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you.

I have just one quick question as well on the directness and decisiveness of the decisions that you made in the Maritimes to keep the numbers down as you did. As I mentioned in my previous question, I can see that early responses really help make that happen.

Did you use clear emergency information that you already had in the Atlantic bubble to be able to make those decisions as quickly and as decisively as you did, or did they just happen to be the right decisions that you used from common practice you've had in the past?

[Dr. Lisa Barrett]

I didn't make the decisions; our government did. I will say that the government took great advice; there was almost sole input from public health and they took advice from the science and the numbers. There was very little wiggle on other reasons to not shut things down or put restrictions in place very quickly. I would say there was rapid, decisive science used with a minimum number of distracting other factors. That seems to be, at least as an outsider, part of the decisiveness that was maintained through the first, second and third waves.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Maguire.

We go to Ms. O'Connell now, please.

You have three minutes; please go ahead.

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

Thank you, Mr. Chair.

Dr. Barrett, first, thank you for being here. I'm sure you're incredibly busy, and your testimony is quite helpful .

Quickly, as I only have three minutes, your point about strong restrictions—and I think you said real, not half measures—is one that I want to speak about.

Obviously, any sort of lockdown or restrictive measures are difficult for everybody. I don't think anyone would not acknowledge that's the case; however, I would assume death and severe illness would be far worse.

This past week, we had an emergency debate on the situation in Alberta, and some of the testimony by our Conservative health critic, our colleague here, referred to lockdowns. She said, “Lockdowns are a very bourgeois concept for a lot of legislators.” She said, “It is a luxury.” She referred to it as being “classist”.

The suggestion that was made was to just use vaccines, and then we don't have to get into this luxury lockdown situation. My community doesn't find that lockdowns are easy, but we do it to make sure we keep our communities safe and our loved ones safe. In terms of that context, is there any jurisdiction that was able to get through the pandemic with vaccines alone, given the fact that we know it takes time for the effectiveness to take hold, even when the person gets a vaccine. What is the importance of strong lockdowns in conjunction with vaccines, and why is this a public health measure and not a bourgeois concept, as has been suggested?

[Dr. Lisa Barrett]

Okay, I'm not quite sure how to respond to the concept. A lockdown is about distance, right? Distance is a key part of preventing and maintaining control of a respiratory illness transmitted by air. Distance is an important part of that; lockdown generates distance, so that's a fact, not an opinion.

It is a luxury if we don't support people who are homeless, under-housed and can't stay at home, and that is a key, core part of this. A lockdown requires a heck of a lot of support, and that should be provided and shouldn't be a luxury. Otherwise, vaccines are an adjunctive measure. You don't vaccinate your way entirely out of a lockdown situation or a high-spread situation. Everyone touts the U.K.; they used the lockdown with a massive vaccine rollout.

Then, to be clear, that's a combination measure. Vaccines are your long-term plan, not an acute plan. I'm happy to do an infectious disease management lesson on that, but that's the actual part of it. There's no such thing as one or the other.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. O'Connell.

We go now to Mr. Barlow.

Please go ahead, Mr. Barlow, for three minutes.

[John Barlow, Conservative, Foothills, AB]

Thank you very much, Mr. Chair.

My question is for Mr. Garner.

Thank you very much for your very frank and open testimony. That's certainly much appreciated in the situation we find ourselves in.

We were talking earlier with previous witnesses about some of the missteps along the way, and I know you can't give that inside information, but I found it interesting that PHAC was going to do a national pandemic simulation in 2019 but put it off. This would have been in partnership with the provinces and territories and in conjunction with the federal government, which is the focus of our study here.

What kind of a difference would that have made, from your expertise, in terms of identifying the capacity of provinces and territories to handle a pandemic and maybe identifying as well some of the obstacles or shortfalls that we may have had in that provincial-territorial-federal relationship?

[Michael Garner]

I think best practice for emergency preparedness, universally, is that you exercise. You practice and practice, and then, when the earthquake happens, you are basically running on muscle memory. In general, we can say that exercising those pandemic plans, and practising, would have identified issues in our response at that time, during the practice.

The challenge becomes how to respond to that. Do you have the willpower and the budget to make the changes to the plans that you then implement in response to the deficiencies that you have found, and then have to practice again? It is an iterative process, which, in the absence of a pandemic, can seem like a waste of money because you're spending all this money and not preventing anything, just preparing.

Again, it's that challenge of people who aren't emergency experts or public health experts being the decision-makers. They don't keep their eye on the prize; and the prize, at this point, was being prepared to respond to a coronavirus pandemic.

[John Barlow, Conservative, Foothills, AB]

Thank you very much.

I have only a couple of seconds left. You bring up a really good point, which I don't know if any of us really asked about. It came out a bit during the debate the other night. We've seen the dismantling of the early warning system and that PHAC didn't go ahead with the simulation. During your time with the Public Health Agency of Canada, I'm assuming you felt confident, after H1N1 and SARS, that a global pandemic wasn't about “if” but “when”.

Wouldn't you agree that we knew this was coming and that we should have been prepared?

[Michael Garner]

Yes. We knew it was coming.

The challenge with public health is that it has a massive scope, from opioids to pandemics. It's really tough to focus on things that don't have an immediate payoff, and we're seeing the consequence now.

[John Barlow, Conservative, Foothills, AB]

Thank you very much. I appreciate your time.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Barlow.

We'll go to Dr. Powlowski again. Please go ahead, sir, for three minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

That's an interesting comment and, I would suggest, Reverend Garner, that yes, public health has changed its focus in recent years away from infectious disease and towards non-communicable diseases. That was perhaps part of the problem.

I was also very interested in your allegations about the bureaucratization of PHAC, in terms of the doctors and scientists being replaced by bureaucrats. I want to perhaps engage you in a bit of an academic conversation. Isn't this something that has happened broadly across other departments, and not only here in Canada but globally?

I was speaking to a friend, a scientist who worked high up in the British government, and he was talking about the same trend of replacing content experts with bureaucrats. I know that in the hospital, it's basically the same thing. A lot of administrators are people who don't actually practice medicine. I think this is part of a broader movement. Why is that? Why don't we have people who are more content experts in positions of authority?

[Michael Garner]

I can't speak to the worldwide situation. I can say that most public health institutes worldwide have public health doctors or public health professionals in charge.

I agree that there is a move to more bureaucratic...or non-experts. I think, in part, it's because the advice of a doctor is hopefully going to be driven by health, whereas the advice of a bureaucrat can be balanced with politics. We have the example in Canada. There was a change made in 2014 that demoted the CPHO and promoted a bureaucrat to the head of that organization, and we've seen the impact throughout the Public Health Agency of Canada, where science is devalued and there is an inability to brief with complexity because the people you are trying to brief don't have any training in public health.

There are lots of examples worldwide. We could have an academic conversation, but we could also have a specific conversation about the impact of the decisions that both the Harper and the Trudeau governments made around the Public Health Agency of Canada Act, and say, “This is why we're in this situation.”