Health Committee on March 30th, 2022

[Dr. Emilia Liana Falcone]

Thank you very much for these very interesting questions. In fact, we have some preliminary answers to these questions.

First of all, in terms of risk factors, there is certainly a link with the severity of the acute illness. So if it's more severe, you're more likely to have long-term complications. That said, even patients with less severe disease or even an asymptomatic infection can develop long COVID.

With regard to other risk factors, we certainly see more women. We also see an association with type 2 diabetes, as well as [Technical difficulty—Editor]. One study showed an association with a history of asthma, a history of mental health problems, as well as several comorbidities prior to infection.

In more recent papers, which are more basic in nature, we see associations with certain autoantibodies— we're getting into the research area—with viremia, that is, the presence of an elevated SARS‑CoV‑2 viral load in the blood, as well as with reactivation of EBV, the Epstein‑Barr virus. These are examples.

There is a team, in Germany, that has developed a tool to calculate risk that involves using some clinical data, which I've already told you about, combined with total blood immunoglobulin measurements.

That's the state of the art on risk factors.

[Luc Thériault, Bloc, Montcalm, QC]

I see.

We know that the Omicron and BA.2 variants are less virulent and more contagious. Could this have an effect on the prevalence of long COVID?

Can we assume that there will be an increase? Have you seen an increase in relation to these variants that are more contagious but less virulent, or is it more the virulence, at the beginning, that determines whether one will develop long COVID?

[Dr. Emilia Liana Falcone]

That's an excellent question.

Here you have to consider two factors: the virulence and contagiousness, of course, of the variant, but also the vaccination status of the host, since vaccination also decreases the risk of having long COVID. The majority of studies on this subject are not peer-reviewed. However, the data seem to suggest that there is about a 50% reduction in the risk of getting long COVID in this context. So you have to consider that part of the equation when you're assessing this. There are many more cases, so theoretically there should be more cases of long COVID. However, in a context where the disease is less severe and the hosts are vaccinated, I would expect that there would be a lower percentage of long COVID cases. That's what we're hoping for, at least.

That said, we are already seeing patients in our clinic who have symptoms of long COVID after being infected with the Omicron variant.

[Luc Thériault, Bloc, Montcalm, QC]

In short, may we conclude that being vaccinated provides additional protection against contracting the most severe form of the disease?

[Dr. Emilia Liana Falcone]

Yes.

[Luc Thériault, Bloc, Montcalm, QC]

I see.

Do you think that in the long term, a fourth dose of the vaccine would be necessary to protect people from long COVID?

[Dr. Emilia Liana Falcone]

At the moment, the data is still incomplete. The preliminary data I've already seen about the fourth dose seems to show a very moderate benefit in this context. I think you would have to have vaccines tailored to the emerging variants to have an effect on long COVID. I say that with considerable reservations, because we still need a lot of data.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

There are many people with long COVID who report that they continue to suffer from brain fog.

[The Chair, Liberal, Sean Casey]

Mr. Thériault—

[Luc Thériault, Bloc, Montcalm, QC]

Can you explain what “brain fog” means?

[The Chair, Liberal, Sean Casey]

Did you hear the question, Dr. Falcone?

[Dr. Emilia Liana Falcone]

Yes, I heard it.

[The Chair, Liberal, Sean Casey]

Very well.

Please answer briefly. I tried to interrupt the member, but was not successful.

[Dr. Emilia Liana Falcone]

It's a fairly subjective term. Literally, patients feel that their ability to process new data is slowed down. They find that their cognitive abilities are diminished. This is associated with a perception that things are fuzzy, so to speak.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Theriault and Dr. Falcone.

We'll go next to Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for your patience and your excellent testimony.

Dr. Bogoch, two days ago on Global News, you said the following:

I think we should be wearing masks, I really do. We are seeing a rise in cases throughout the province. There's the wastewater surveillance signals that are up in most jurisdictions, not just in Ontario, but in many parts of Canada. There's probably more COVID in the community now than there was a week and two weeks ago.

My question for you, Doctor, is, do you believe it's premature to lift mask mandates in Ontario or across the country?

[Dr. Isaac Bogoch]

Thank you for that question.

Yes, my personal bias and my personal opinion is that it is too soon. Just because mask mandates are lifted doesn't mean that you can't wear a mask. We can all still choose to wear a mask.

I hope that many people are choosing to wear a mask given that we are seeing more COVID now than we did a few weeks ago and that we are in the midst of a wave. Just depending on where we are, the size of the wave might be a little bit different. I think we should be wearing masks now, and I'm continuing to wear a mask in indoor settings.

[Don Davies, NDP, Vancouver Kingsway, BC]

Would I be right, though, Doctor, in assuming that if there were a mask mandate, that would probably result in more people wearing masks than if it were purely voluntary?

[Dr. Isaac Bogoch]

Yes, I certainly agree with that. We do see that mandates indeed do work.

I truly don't know what proportion of people are wearing masks now that the mandate has been lifted, but [Technical difficulty—Editor] than if there was a mandate. We would still see more people wearing masks if there was a mandate than if there was not.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm looking for a yes or no response to this. Would I be correct in my thesis that wearing a mask has salutary effects to some degree against the spread the prevalence of aerosolized or droplet-based illnesses?

[Dr. Isaac Bogoch]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Also, the subvariant of omicron known as BA.2 appears to be more transmissible than the original strain, BA.1, and is currently fuelling outbreaks in Europe and Asia, and in fact in other places around the world.

In your view, Doctor, have we reached the endemic phase of COVID-19?

[Dr. Isaac Bogoch]

No, I don't think we have. Endemic means different things to different people. I don't think we're at an endemic phase. We're probably on our way, but I don't think we're there just yet.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Now, Mr. Hunt, in a December 2021 article from CBC News, you noted that Canada's PPE industry was feeling “betrayed” by the Canadian government because the government is not buying from small home-grown companies, after encouraging them to step up to deliver the critical supplies. You were quoted as saying, “What we've seen is the exact opposite: buying only from multinationals, buying only commodity products, locking health care workers out of new and innovative products, and essentially, decimating the new PPE industry.

Can you expand on that, Mr. Hunt?

[Barry Hunt]

Initially the government, in March 2020, made a plea to Canadian industry to stand up a new PPE industry and made a promise to the Canadian public that they would be partnering with Canadian industry to deliver solutions for COVID. I have a quote here: “With a view to longer-term support, the Government of Canada will ensure procurement flexibility to support innovation and build domestic manufacturing capacity to supply critical health supplies to Canadians.”

That has not happened. The number of federal contracts given to the Canadian PPE industry, the members of CAPPEM, the Canadian Association of PPE Manufacturers, are zero. The contracts that have been given to the two multinational companies amount to about $600 million. That amounts to essentially an active measure against the Canadian PPE industry, in that $600 million in potential market is taken away and there are essentially crumbs that are left.