Evidence of meeting #14 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pharmacies.
A recording is available from Parliament.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you, Mr. Chair.
Once again, thanks to all the witnesses.
I will quickly go back to Ms. Shields.
Welcome back and thank you for agreeing to stay back. I would like to focus on one of the innovative initiatives that are currently under way in your branch in York Region, which is the mental health crisis hub.
Can you give us a little bit of a background about this project, specifically with the youth services and integrated cures lens you talked about in your opening remarks, please?
Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association
Thank you.
Our branch is leading the development of a first-in-Canada and, certainly, a first-in- Ontario, 20-bed mental health and addiction crisis hub.
For those familiar with the Centre for Addiction and Mental Health, CAMH, it's similar to the CAMH emergency model, except this is for those 12 years old and up and is integrated with community supports. It wiIl be staffed by physicians, psychiatrists and nurses so that they will able to offload from ambulances and from police.
The difference is that, instead of simply treating it like a hospital, we are embedding community support so that each person who comes in and their families will get the services they need to stabilize the crisis, help them withdraw from any substances they need to withdraw from, and also, in the hub, to get connected to ongoing community care, because, as we know, people who are in crisis who leave hospital may not get connected to the services they need, causing them to return to the ED or worse, have mortality.
This model has been supported by the Centre for Addition and Mental Health, all three local hospitals, the police, the paramedics and primary care, because that's really important. All of them, the health and addiction partners and social services partners, have come together to design a model that not only thinks about how we take people in to de-escalate but also how we can ensure that people who leave get the services they require.
This model is something that we are sharing as we build it, because many communities are interested in it. We know that one of the main reasons that people end up returning to mental health services is that they're not connected to the right ongoing supports, particularly post-24 hours and seven days after care.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you. Can you shed some light as to the timeline of this project and where you are with the implementation and rollout of it?
Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association
That's a great question.
Right now we are working with provincial capital funding to try to establish the capital planning requirements so that we are seen to have completed our functional plan and are waiting for final sign-off. We are hopeful that it will happen before the provincial government drops the writ, so that we get our next tranche of funding.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
What can the federal government do? I understand you're working closely with the provincial government. What can we do on the federal side to support you?
Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association
I really believe that this is a multi-government approach. We have a lot of municipal support as well, and the federal government can also step up with supporting access and how this can support our newcomer and refugee population.
I talked about an integrated model as well. This can't be siloed. We are trying to leverage all of the people who support mental health into this hub, because people are getting services from different communities, including the federal government. They have to be at the table helping the design of this and then support the funding of it so that services are connected by having the staff necessary to do that, because it's not just about the team and the hub, but also about the team of people who are going into the hub who connect people afterwards. This hub will only be another bottleneck if we don't have the services for people after they are in crisis.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Can you briefly talk about how this concept will reduce the burden on the health care services at the primary sources that we are accustomed to?
Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association
Right now, as we know, there are many busy emergency departments receiving intake from the police, who are taking people to hospitals for care often as a first source, or people don't know where to go for care. With this 24-7 design for people to be welcomed to get the services and connected to the services they need, it supports access, supports navigation and de-escalates crisis. All three things are the major cause of people escalating or their symptoms escalating.
We know for sure that people who are connected to care are less likely to return to emergency departments. We know that people with serious and persistent mental illness need welcoming spaces to go where they are welcomed and not treated as if they are “frequent flyers”, but seen as welcomed into the care they need and where they can go somewhere, even it it's just to have that socialization so that they can get the support. It will reduce the burden on hospitals in dealing with patients who would be more appropriately serviced in community, as well as supporting clients and families as young as 12 years old to get connected to care easily, quickly and in an integrated manner.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Shields and Mr. Jowhari.
Mr. Theriault, you have two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Doctor Falcone, earlier you touched on the fact that women seem to be much more affected than men by long COVID. According to some studies, it could be as high as 80% of cases.
Can you provide some sort of preliminary explanation for this?
Director, Post-COVID-19 Research Clinic, Montreal Clinical Research Institute, Attending Physician, Infectious Diseases, Centre Hospitalier de l'Université de Montréal, As an Individual
There are two aspects to consider, the biological and the socio-psychological one.
On the biological side, it is generally thought that there is an autoimmune aspect to long COVID, that is, the infection may trigger a process where the immune system attacks proteins or molecules that are innate, that are part of our bodies; this generates a widespread dysregulation of the inflammatory response and the immune system in general. We know that women are predisposed to this kind of attack. That's a tentative explanation regarding the biological aspect.
The other aspect, which is more related to a societal role, is that women are more likely to go to outpatient clinics. We saw this in the population of patients who had COVID‑19 and were not hospitalized in the acute phase; there were many more women. There is also the aspect that women may have been exposed to a higher viral load given their work and professional or personal role. This too may be an issue in developing long COVID.
Bloc
Director, Post-COVID-19 Research Clinic, Montreal Clinical Research Institute, Attending Physician, Infectious Diseases, Centre Hospitalier de l'Université de Montréal, As an Individual
There is a relatively high proportion, yes.
There is evidence that the health status of a fairly large proportion of people will improve. Indeed, you can see an improvement in their health between four and twelve weeks after infection.
By some definitions, [Technical difficulty—Editor] about 20% will get better between three and six months later.
Personally, I estimate that between 15% and 20% of patients might have complications that last longer than a year. It's difficult to pinpoint exactly. Today, there are patients who still have complications who were affected by the virus more than two years ago.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Falcone and Mr. Theriault.
Next is Mr. Davies, please, for two and a half minutes.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Mr. Hunt, your association stated the following in a press release:
Federal and provincial procurement still relies on outdated tendering criteria that gives advantage to offshore producers who, in some cases, are dumping product below cost into the Canadian market.
You yourself are quoted as saying this:
By not recognizing Canadian content or high product standards, our procurement systems are also allowing products of inferior quality into our hospitals and homes, and, far too often, those products are coming from jurisdictions with poor labor and environmental practices.
That's as you've testified today.
Mr. Hunt, how prevalent is this, and what do you suggest be done about it?
President, Canadian Association of PPE Manufacturers
The first thing we need to do, really, is to eliminate the tariff exemption that was put in place in the early days of COVID. Some $19 billion worth of product, including PPE, has been purchased under that tariff exemption. That amounts to about a $3-billion subsidy for foreign goods, or lack of protection of domestic industry.
It's very prevalent still, the amount of defective or counterfeit or contaminated product that comes into this country; 99% of Health Canada's safety alerts and recalls on their website related to PPE are for products from offshore. We see this continually. We would like to see the standards updated to include the new CSA standard that just came out for Canadian N95 respirators. We would certainly like to see better standards for medical masks in procurement.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Bogoch, we know that vaccine effectiveness wanes over time. Efficacy is substantially reduced, it seems, about three or four months post-jab. How long after the third booster is efficacy substantially reduced? What do you think is a good long-term plan, if that's the case, given that the European Medicines Agency has stated that they don't think we can boost ad infinitum?
Associate Professor of Medicine, University of Toronto, Staff Physician in Infectious Diseases, Toronto General Hospital, As an Individual
Yes, this is clearly an issue. One of the key points here, though, is that with two and, of course, three doses of a vaccine, while the efficacy wanes more significantly for protection against infection, you still see very significant protection with three doses against severe outcomes like hospitalization and death. Having said that, it also starts to wane a little bit, but not as significantly versus getting the infection in the first place.
This is speculation here—we'll let the data drive the policy—but I think we'll see two things. One, we'll probably see annual vaccines similar to what we see with influenza, and not vaccinations every four or five months. On top of that, we'll probably have more updated vaccines reflective of the circulating variant du jour. Currently, we're still using vaccines for the original virus that emerged from Wuhan, but we'll probably see some updated vaccines for omicron or other variants shortly.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Bogoch and Mr. Davies.
Next we'll go back to Dr. Ellis, please, for five minutes.
Conservative
Conservative
Mike Lake Conservative Edmonton—Wetaskiwin, AB
My questions are going to be focused on Dr. Bogoch.
There's so much noise out there right now and I'm convinced, over and over again, that despite that noise, everyone wants to be healthy. No one wants to screw up their lives. We all want to thrive. It's increasingly difficult to make the best decision you can with all the noise that's out there.
I'm going to put you on the spot. What do a number of people believe that just isn't correct about COVID?
Associate Professor of Medicine, University of Toronto, Staff Physician in Infectious Diseases, Toronto General Hospital, As an Individual
I think there's still some skepticism toward the utility of vaccination in some proportion of the community—not a large proportion, but some proportion of the community. There may be some thoughts on therapeutics that might be as effective, such as ivermectin or hydroxycloroquine.
However, I think your point is significant in that it raises a much larger point that we do have significant issues even in Canada—more in other places, but still here in Canada—with misinformation and disinformation amplified online that drives behaviours that aren't really associated with healthy outcomes. This is obviously a much bigger discussion than why we're here, but there has to be a coordinated effort to combat misinformation and disinformation, because it is impeding healthy outcomes.
Conservative
Mike Lake Conservative Edmonton—Wetaskiwin, AB
For sure. I'd love to follow up on the conversation. Please reach out to me after this, because I want to have a longer conversation with you.
Complementary to that question, where is the most common agreement amongst medical experts, even medical experts who might have differences of opinion with you on some things? Where is the most common agreement on COVID science?