Health Committee on June 13th, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 26 of the House of the Commons Standing Committee on Health.

We are meeting for two hours today with witnesses for our study on the emergency situation facing Canadians in light of the COVID-19 pandemic. Today's meeting's themes are long COVID and COVID therapeutics.

Today's meeting is taking place in a hybrid format, pursuant to the House order of November 25, 2021.

Per the directive of the Board of Internal Economy on March 10, 2022, all those attending the meeting in person must wear a mask, except for members who are at their place during the proceedings.

I have a couple of comments for the benefit of witnesses. Interpretation is available. You have the choice at the bottom of your screen of floor, English or French. When you're not speaking, please ensure that your mike is muted. Please don't take screenshots or pictures of your screen. All of the proceedings will be made available on the House of Commons website.

We are now ready to proceed with opening remarks.

I understand that one of our witnesses is not yet with us, but is working through some technical difficulties and will join shortly. That is Dr. Eric Arts, a professor at the department of microbiology and immunology at the University of Western Ontario. We have back with us today, Dr. Emilia Liana Falcone, director, post-COVID-19 research clinic, Montreal Clinical Research Institute, and attending physician, infectious diseases, Centre Hospitalier de I'Université de Montréal. Also with us is Dr. Kelly O'Brien, associate professor, department of physical therapy, University of Toronto, and co-director of the rehabilitation science research network for COVID at the U of T. Representing the COVID Long-Haulers Support Group Canada, we have Susie Goulding, the founder.

Thank you all for being here today. The length of your opening statement should be five minutes or less.

We're going to start with Dr. Falcone.

Welcome back. You have the floor.

[Dr. Emilia Liana Falcone, Director, Post-COVID-19 Research Clinic, Montreal Clinical Research Institute, Attending Physician, Infectious Diseases, Centre hospitalier de l'Université de Montréal, As an Individual]

Thank you, Mr. Chair.

I would like to start by thanking the members of the Standing Committee on Health for giving me the opportunity to appear before them today and share my thoughts with them.

My name is Emilia Liana Falcone, and I am an infectious disease physician at the Centre Hospitalier de l'Université de Montréal, or CHUM. I also work at the Montreal Clinical Research Institute, or IRCM, where I am the director of the microbiome research unit and the founder of the Post‑COVID‑19 Research Clinic. We do a comprehensive evaluation of long‑term COVID‑19 patients and work with colleagues from other institutions to improve the management of these patients.

The COVID‑19 pandemic has weakened our health care system. More than 3.9 million Canadians have contracted COVID‑19. As we estimate that between 10% and 30% of Canadians could have long‑term effects, more than 1 million Canadians could potentially experience long COVID‑19. and probably 200,000 to 300,000 of them will be sick for months or years, often unable to return to work. The burden on our health care system will be major, and the socio‑economic impact will be significant. It is in this context that I would like to share with you the challenges and major issues we are currently facing.

The first challenge is diagnosing long COVID‑19, which is complex. It is a heterogeneous disease with many associated symptoms. These symptoms can fluctuate or even occur after recovery. In addition, many symptoms, such as fatigue and shortness of breath, are the same as those of other illnesses. We therefore need to find biomarkers that would facilitate the diagnosis of long COVID‑19.

The second challenge is to better understand the causes of long COVID‑19 from a mechanistic perspective. This will allow us to have more accurate diagnostic tests, to better understand the course of the disease and, above all, to develop new and better targeted therapies.

At the same time, we need to study the impact of new variants and vaccination on the incidence of long COVID‑19. We know that individuals can be reinfected and have post‑vaccination infections. In our experience, even if an individual did not develop COVID‑19 after a first infection, this doesn't mean that they aren't at risk of long‑term sequelae after re‑infection.

We also need to better understand the role of antiviral drugs, not only to treat acute COVID‑19, but also to prevent or even treat long COVID‑19, especially considering that there may be virus particles hiding in some tissues.

The pandemic has taught us that we need to be agile in our ability to adapt to evolving clinical situations as new information emerges. An effective way to do this is through the systematic integration of a research infrastructure into clinical care pathways.

As I have mentioned in my previous participation in a meeting of this committee, my eight-year experience at the National Institutes of Health in the United States led me to suspect early on in the pandemic that there would be long-term sequelae from COVID. This is why I created the IRCM Post-COVID Research Clinic thanks to the support from our governments. My objective was to integrate our clinical evaluation with a research platform and biobank that would lead to a better understanding of long COVID in an effort to identify diagnostic biomarkers and develop novel therapeutic strategies.

Our research clinic model could be extended to specialized centres across Canada. This model would be even more effective if it were integrated into a network that would use standardized protocols and have an established infrastructure for real-time data sharing and integration. With this coordinated and rapid approach, we would further distinguish ourselves as a country, not only in the context of long COVID but also in the management of other complex and chronic diseases, and in preparedness for the next pandemic.

Finally, such an infrastructure that systematically integrates research with clinical evaluation would foster national and international collaborations between governments, industry and academic institutions.

There are several other thoughts I'd like to share with you, and I'd be happy to continue the conversation during the question period.

Thank you for your attention.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Falcone.

Next we're going to hear from Dr. Arts, professor in the department of microbiology and immunology at the University of Western Ontario.

Thank you for being with us, Dr. Arts. You have the floor for the next five minutes.

[Dr. Eric Arts, Professor, Department of Microbiology and Immunology, University of Western Ontario, As an Individual]

Thanks for having me here today. I'll just give a brief introduction of myself.

I'm a Canada research chair in viral pathogenesis and control. I just moved back to Canada—it seems like I just moved back eight years ago—after being at Case Western Reserve University in Cleveland, Ohio, for 20 years. I'm a virologist. I hold a number of patents and I have an expertise in viral pathogenesis, diagnostics and drug and vaccine development. Also, during the pandemic, we opened a new facility, a level-three facility. It's called the Imaging Pathogens for Knowledge Translation centre. It is a level-three facility that was opened just a few months before the pandemic in January. We had one of the most modern facilities that was open. Lesson to be learned: never be a virologist and open a new biosafety level-three facility just before a pandemic if you want a real life. Maybe it's the same in government.

Just to give you background on that, the ImPaKT facility has been working with about 30 different companies during the pandemic, several multinational companies, and we do global testing for antivirals, interventions, therapeutics, materials and vaccines. To date, about 30,000 retail outlets, government offices, schools, etc., house products to prevent transmission for which we tested as service contracts for companies.

We also provide waste-water analysis for about one fifth of the Ontario population through MECP in Ontario. Then we have contracts with Health Canada. We provide the detection of the sort of the frequency of the variants of concern across all ports of entry in Canada. That's through a contract with Health Canada. We report twice a week to the Public Health Agency of Canada and Public Health Ontario.

I just want to shift in the remaining few minutes to talk about the shift in the pandemic.

One of the things we realized early on is that this will eventually end, but the consequences of this pandemic will become much more severe, as the last speaker indicated. After the 1918 pandemic of flu and the 1957 and 1964 pandemics of flu, within a few years of those pandemics we saw a major rise in the increase of cognitive impairment and neurological decline and neurodegenerative diseases.

There's just been a study out by Harvard and the University of Pennsylvania that talked about people post ventilation in regard to COVID. Approximately 40% of those patients who survived the ventilation and COVID are now experiencing cognitive impairments.

In addition to this, the disease itself, the severity of the initial COVID disease, doesn't seem to be linked to the development of potential cognitive impairments in future, which then could be linked to these neurodegenerative diseases like ALS, Alzheimer's, or early onset dementia and Parkinson's.

The one thing that's an interesting observation, though, is that unlike those diseases that I just described, we don't know the triggers of those diseases and we can't identify when they occur. One benefit—if you will, which is an unfortunate benefit—is now that we have over three million people in Canada for whom we've defined when they got COVID, we can start working towards implementing potential therapeutics that are already available to us. The models that can be set up is through various animal testing models that are well-defined for cognitive decline. We can determine which therapeutics can prevent that in animal models post a COVID infection in those animal models, and then rapidly parlay that to off-label therapeutic trials of these immunomodulatory drugs, anti-inflammatory drugs and even antivirals, which we never could do before because we didn't know what the triggers were for those diseases that can manifest themselves sometimes 10 years, for even 15 years, in the future.

However, in all predictions, if we even have a low percentage of the population that goes down what we would call a “long, long-term COVID role” in neurodegenerative diseases, we are looking at a second wave of this epidemic that will inevitably be much more costly for the health care system.

The one good point is that we have a level of expertise in Canada that's really not replicated anywhere in the world. There have been good investments already in brain scans in a number of different facilities and research institutes across Canada. At Western, in particular, we have leading experts in cognitive impairment who were originally Canadians and were recruited back to Canada from Cambridge just a few years ago. They've set up testing platforms. We've brought in the expertise in therapeutics and antivirals to get engaged with that. There are many places around Canada that can also contribute to this, and be the leaders in the world in trying to combat this particularly devastating long-term consequence of neurodegenerative diseases, which we will likely see.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Arts.

Next, we have Dr. Kelly O'Brien, associate professor, department of physical therapy at the University of Toronto and the co-director of the rehabilitation science research network for COVID at U of T.

Dr. O'Brien, welcome to the committee. You have the floor, for the next five minutes.

[Dr. Kelly O'Brien, Associate Professor, Department of Physical Therapy, and Co-Director, Rehabilitation Science Research Network for COVID, University of Toronto, As an Individual]

Thank you very much for the invitation and the opportunity to speak at the meeting of the House of Commons Standing Committee on Health today.

My name is Kelly O'Brien. I'm a physiotherapist and associate professor in the department of physical therapy at the University of Toronto. I am a co-director of this newly established rehabilitation science research network for COVID with the Temerty Faculty of Medicine at the U of T and co-director with Long COVID Physio, wan international patient-led association of physiotherapists living with long COVID and their allies.

As a Canada research chair in episodic disability and rehabilitation, my research has primarily been grounded within the foundational context of HIV. My colleagues and I are now applying these lessons learned from the context of HIV to the context of long COVID.

We know that a growing number of individuals are living with persistent signs and symptoms following infection with COVID-19. Defined by the World Health Organization, post-COVID condition, or long COVID, occurs in individuals with a history of probable or confirmed SARS-CoV-2, infection usually three months from the onset of COVID-19, with symptoms that last for at least two months.

An estimated 144 million individuals are living with long COVID globally. A recent systematic review involving 50 studies, of which 41 were included in a meta-analysis, concluded a pooled global prevalence of long COVID at 43%. This expands to non-hospitalized as well as hospitalized patients living with COVID.

The long-term trajectory of long COVID remains unknown. Therefore, conceptualizing the context of disability in long COVID is essential for better understanding the health-related challenges experienced by this community. There is an opportunity to apply the lessons learned in other chronic and episodic conditions such as HIV to understand and conceptualize disability experienced among this community.

Lesson one is to anticipate multi-dimensional disability and recognize its potentially episodic nature. Long COVID has a mass disabling effect, and the episodic disability framework was derived from the perspectives of adults living with HIV to characterize the multi-dimensional and episodic nature of health-related challenges.

This framework includes six dimensions of disability, all of which may apply to the context of long COVID. For example, there are physical health challenges such as fatigue, post-exertional symptom exacerbation, malaise or shortness of breath seen among individuals living with long COVID. As was mentioned earlier, there are cognitive health challenges, such as difficulty thinking or concentrating, resulting in mental and emotional health challenges in some cases, such as anxiety and depression. There are difficulties carrying out day-to-day activities, such as showering or meal preparation. This all accumulates in having an impact on one's challenges to social inclusion, such as engaging in meaningful life roles like employment. This framework also acknowledges the disability dimensions that can be triggered by factors such as physical activity or exercise, prolonged cognitive activities, such as engaging in intense or online meetings or other health conditions.

Currently I have the opportunity to collaborate with a group of individuals in a CIHR-funded study to adapt this framework as a way to conceptualize the relapsing and remitting nature of some of the health-related challenges seen among people living with long COVID. Given the importance of terminology in providing clarity and understanding among community and health providers, we recommend the use of the term “episodic disability” to characterize these experiences.

Lesson number two is that uncertainty and worry about the future is a key feature of disability experienced among people living with long COVID. This is a disability, and there is uncertainty of when an episode might arise, the severity and duration of that episode and the impact it might have on one's health, finances and emotional health.

We're now dealing with the new uncertainty of what occurs in the case of a reinfection among someone living with long COVID. There is diagnostic uncertainty, where it can be difficult for an individual who did not have a positive PCR antigen test to access employment or income benefits or rehabilitation services. There's financial uncertainty about if, such as if, when and how individuals may be able to return to the workforce. Uncertainty is also [Inaudible--Editor] with health and rehabilitation providers in terms of how to safely approach, assess and treat individuals with long COVID. Lastly, there is uncertainty among employers and human resource professionals as to how best to accommodate and facilitate return to work.

Lesson three is that there are similarities among those living with HIV and long COVID relating to health inequities, stigma, and discrimination. We know that long COVID disproportionally affects females, individuals in their prime career-building years, those working in social care and education, and those with other existing activity limitations, conditions, or disabilities, which will have an impact and further compound the complexities of long COVID.

Lesson four is that the role and access to rehabilitation is critical to help prevent, address and mitigate disability, and to enhance health outcomes for individuals living with long COVID. Rehabilitation, such as physiotherapy and occupational therapy, can have a role in being goal-oriented, person-centred, and focused on function and tailored to an individual's goals and abilities.

Lesson five is the importance of ensuring there is a patient and community engaged rehabilitation response. In combination with this, there is the need to have greater meaningful involvement of people living with long COVID, who are people living with and affected by the pandemic. Building on existing research and clinical networks in rehabilitation can provide foundations for long COVID. Taking a strength-in-numbers approach and partnering with other chronic and episodic conditions, such as myalgic encephalomyelitis or chronic fatigue syndrome, will help to inform future rehabilitation approaches and policy.

In summary, a safe, effective, and coordinated response to rehabilitation is critical in the context of long COVID. While evidence continues to emerge, rehabilitation professionals are positioned to help address episodic disability. Opportunities exist to build on some of the successful disability and rehabilitation models from other chronic and episodic illnesses that may apply to the context of long COVID.

Thank you very much for your attention.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. O'Brien.

Next, we're pleased to welcome Susie Goulding, founder of COVID Long-Haulers Support roup Group Canada.

Welcome to the committee, Ms. Goulding. You have the floor.

[Susie Goulding, Founder, COVID Long-Haulers Support Group Canada]

Thank you for the opportunity to address this committee.

Long COVID needs to be acknowledged. It is a mass disabling event on a scale that has not been seen by most Canadians living today. All Canadians, public health care systems and policy-makers need to be aware of the complex issues of long COVID, how it negatively affects the health and livelihood of Canadians, and the impact it has on the workforce and the economy.

Canadian long-haulers urgently need funding for research, treatment and lost income for the many who are too disabled to work.

Long COVID, as mentioned, is a debilitating episodic illness with symptoms such as cognitive dysfunction like a brain injury, crippling fatigue and post-exertional symptom exacerbation. From toes to testicles to the temporal lobes, nothing is spared. People are unable to stand, walk or even sit up in bed due to POTS-like symptoms and dysautonomia. They are bed-bound, housebound and need mobility aids to move. Basic tasks like showering and getting dressed can cause heart rates to soar for hours.

Few qualify for financial supports. Savings are burned through quickly and people are left in desperate situations. Health care coverage is desperately needed among long-haulers, as many Canadians don't qualify for long-term disability insurance. Because of a lack of PCR testing and not having a positive result, people are denied claims. EI benefits cover only 15 weeks of illness when long COVID is a minimum of 12 weeks just to get a diagnosis.

The impact of financial hardship is extreme. Small businesses close. Jobs are lost. Relationships end. The stress of these great losses makes symptoms worse. It's a vicious cycle. Some long-haulers face eviction and homelessness. They talk of suicide.

We're fired from our jobs for underperforming or not showing up when we are sick. We want to get better. We want to contribute. We want to earn a living. We want to be healthy. We are trying, but we need your help.

Too many long-haulers are not believed. We are gaslit by doctors. We're told that it's all in our head. We're treated like pariahs. We need long COVID to be defined as a disability, so that we can access existing programs and supports. We need emergency benefits that are similar to the CERB, regardless of whether we were employed, in between work, self-employed or an unpaid caregiver at the time of sickness.

Resting and pacing is suggested, but it's not achievable for people who have to pay bills or children to look after. Recovery should not be a lottery for only those who can afford to not work and have significant outside support. While Canada has treatment clinics, there aren't enough to deal with the sheer volume of long-haulers and most of these are capped off at max capacities.

Knowledge of what does and what doesn't work is beginning to develop. It needs to be disseminated. Federal, provincial and territorial governments need to coordinate efforts. A national strategy needs to be committed to by all. Information and knowledge needs to be robust and distributed so that all health care and allied professionals know how to recognize long COVID, treat symptoms and avoid doing harm.

COVID Long-Haulers Support Group Canada has participated in countless studies nationally, internationally and provincially. We have partnered with Viral Neuro Exploration and brain health charities to survey over 2,000 people. We are patient partners. We are advisers. We are in many research projects in this country. We suggest that this be expedited. Robust funding for coordinated longitudinal research needs to be strategized, prioritized and funded. The $20 million that was given and allocated towards research for long COVID is a great start, but so much more is needed. There needs to be vast funding.

There's a burning need for research and treatment for kids with long COVID. They are under-represented and the least understood. Parents and pediatricians need to be educated to recognize and treat symptoms. Kids are missing out on their childhoods and peer relationships in school through absenteeism. They need special accommodations in school to help them succeed. These needs are urgent and need to be prioritized.

Excellent work is being done. What is lacking coordination of efforts and funding to match the scale of the problem.

Internationally, Canada lags behind its G8 neighbours in commitments to long COVID solutions, but with proportionate funding and a national strategy, we could be the global leader.

The vaccine rollout has proven it is realistic to create partnerships that will address the needs of all long-haulers. On behalf of our nearly 17,000 members and the 400,000 to 1.15 million people suffering with long COVID today, I thank the committee and beseech you to take swift action on these matters.

People do not pretend to be sick. With long COVID, long-haulers are pretending to be well.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Goulding.

We're now going to begin our rounds of questions, starting with the Conservatives.

Dr. Ellis, please, you have six minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair, and thank you to all of the witnesses who came today.

It's certainly a very interesting topic and timely, of course. As we move forward, we'll have to spend more and more time on this topic.

I'd be interested, simply as a comment to Dr. Arts and Dr. Falcone, if you would provide any papers you've authored or co-authored to the committee. I think they would be fascinating for some background reading.

That being said, Dr. Arts, through the chair, you spoke briefly about the interest you have with respect to COVID in the future at some point becoming a nidus for neurodegenerative disorders. I'm wondering if you might enlighten us a bit more on that. Also, you talked a bit about perhaps brain scan changes and some of the agents that may be useful to fight this potential onslaught of neurodegenerative disorders. If you could provide some context with respect to this, that would be great.

[Dr. Eric Arts]

Of course, we all hope that the surge is not coming in anywhere between five and 10 years. We suspect that with early diagnosis of cognitive impairments already observed.... There are a number of clinical studies that have looked at neurological consequences, particularly through neuroimaging. Some of these things can be diagnosed early.

One of the interesting concepts that's emerged in this process is.... It's always been thought that there's a linkage between infectious diseases and, in many cases, viruses. One of the witnesses described HIV. HIV is very unfortunate and leads to a lot of neurodegenerative diseases. We saw that very early on in the absence of treatment. When treatments were available, these different complications that led to many neurodegenerative diseases and cognitive impairments reduced dramatically. Now, in HIV, this is a very uncommon secondary infection and secondary disease.

One of the points with this is to try to identify therapeutics early on with things that we never had in the early days, for example, with HIV infections. There has been an explosion in pharma with anti-inflammatories and immunomodulatory drugs, and even antivirals. You can envision, even though the antivirals that exist today don't necessarily have a great impact in shortening the duration of disease—the COVID infection, that is—they could be instrumental in reducing the inflammatory responses that are likely the triggers for long-term COVID in general, but, in particular, in reducing early-onset dementia and the diseases I described earlier.

We have the opportunity now to screen for these drugs using very sophisticated animal models that have never been available before, specifically in cognitive early-onset...early diagnoses of cognitive decline and impairment. As a consequence, we can start looking at the drugs that are already available to us and try to identify ones that will be effective. Those particular drugs that are most often Health Canada-approved could then be parlayed into clinic trials pretty rapidly, because we are all developing these cohorts of long-term COVID to try to stave off what we see as the coming pandemic.

It's the way we envision this approach. As we screen for these current drugs that we have available to us, we try to identify the pathways leading there and develop much more targeted therapies that can be applied later with, maybe, reduced side effects, for example.

That's the way the academic community that studies this area is envisioning it. Fortunately, we have the tools and investments that were made early on. This is a pretty long-term, heavy financial commitment, but it is one that could save us billions in the future and preserve our health care system.

I hope that answers the question.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Arts.

I think I have one minute left.

Dr. Falcone, you talked about some biomarkers, which I assume will fold nicely into Dr. Art's work as well. Are these new biomarkers things like CRP and D-dimer or ESR, which we already know about?

[Dr. Emilia Liana Falcone]

One of the things we were able to do was systematically evaluate those biomarkers that you mentioned, because they're clinically available and widely used. In our experience, those are not the biomarkers that will aid in diagnosis, so we have to dig a little deeper.

Some of the candidates that we are investigating go into the realm of autoantibodies, but on broad scale levels. We're doing this through collaborations at the international level. There are also elements that have proteomic markers, as well as immunological signatures.

One of the specialties of my research group is to look at the microbiota and some of the metabolites. The microbiota is the community of bacteria that lives in any given area of the body, but we're particularly interested in the community that lives in the the guts. This has a profound effect on interactions with the immune system, inflammation and immune dysregulation.

The microbiota is another example of a potential biomarker or elements of what the microbiota produces, such as its metabolites.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Falcone and Dr. Ellis.

Next, we'll go to Mr. Jowhari for six minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to all our witnesses for coming today.

Welcome back, Dr. Falcone. I'm going to start with you.

In your opening remarks, you talked about agility. You said that's one way we can deal with the aftermath of COVID-19. You specifically talked about the integration of research into what I wrote down as “clinical evaluation”. You also said that, if you had time during the questions, you have a number of other ideas you'd like to share.

Here's the platform for you to share those other points of views.

[Dr. Emilia Liana Falcone]

Thank you very much for that question.

What I would like to share are more concrete examples of how we can implement a setting where we integrate research platforms into clinical care.

Based on my experience at the National Institutes of Health, this was something I lived on a day-to-day basis. Concretely speaking, it means that, when a patient is admitted into clinical care—be it an out-patient or in-patient setting—they consent to being part of research protocols from the get-go. These research protocols can be granular, comprehensive and detailed—or not—depending on the infrastructure and resources available. Having the ability to collect clinical information with informed consent, in a way that can be harmonized among different research groups locally, nationally and potentially even beyond, would already be one major step that would, for instance, increase our agility. We would be able to collect and analyze these data in real time and have this information inform our next steps insofar as the pertinence of certain clinical evaluations and how comprehensive they need to be.

We know that patients with long COVID, when they're not in a long COVID referral centre where there is an awareness and acknowledgement of the disease, are often bounced around among different specialists, leading to lots and lots of tests. Some are helpful and some are not. This is a huge waste of resources and time, and of patient energy, as we heard from Ms. Goulding. Small efforts can translate into big functional setbacks for these individuals.

That's one example.

If we add another layer to that and collect biospecimens, there's a lot we can do with just one tube of blood: genomic evaluation, gene expression data, or looking for biomarkers—a lot of these are easily found in a substrate of a blood sample, such as the plasma or serum. It's in small amounts with our current technology. All of this can be harnessed into improved clinical care and possibly more rapid identification of new therapeutic targets.

We speak a lot, at least in Quebec—and I'm sure in other areas, as well—of analyzing big data, artificial intelligence and harnessing this kind of ability for us to learn better. One thing you need for these kinds of scenarios is a lot of data. You need to have access to those data in a way the patient is aware of and has consented to. The only way to do that is to start collecting it from the beginning.

[Majid Jowhari, Liberal, Richmond Hill, ON]

For collection of those data.... One can talk about regulation, but I think patient consent and educating the patient at the outset are key determinants, wouldn't you say?

[Dr. Emilia Liana Falcone]

Absolutely. The more individuals are informed and understand the implications, with all the right security measures and protections of confidentiality, of course, which are absolutely key.... In my experience, I find that—and perhaps Ms. Goulding can speak to this from other experiences—when we involve patient partners, there's a keen interest in participating in the improvement of care. We often find that patients are really enthusiastic and want to see change.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

I have about a minute. I want to go to Dr. Arts.

Dr. Arts, I'm not a medical doctor, and I don't have any medical background. I come from a management consulting background, and I always ask some fundamental questions. Does being vaccinated or not vaccinated have an impact on an individual's ability to develop long COVID and, even when they develop long COVID, an impact on whether it could be treated with different therapeutics?

[Dr. Eric Arts]

That's another good question. I also am not a medical doctor, but I can give you my opinion based on my knowledge.

One of the things we need to ascertain and understand more clearly is whether, if you get infected with different variants...because specifically with omicron it's quite a different type of viral infection, and we don't yet know how that's going to impact the development of what we call “short-term long COVID disease” and potentially “long-term long COVID disease”. That's one aspect we have to understand.

The other thing is how vaccination mitigates the development of long COVID when you do get infected. We know that if you have been vaccinated the severity of disease is reduced when you get infected—and now more so with omicron, which tends to be a wimpier virus in terms of pathogenesis. But we still don't understand fully how that's going to impact specific cues that establish what would be cardiovascular complications, which further link to cognitive impairments and any other neurological diseases that a lot of people are suffering from.

Those studies still need to happen, but I don't think we should wait in our development of therapeutics to try to define all the characteristics. We should be embarking on therapeutic development and testing as soon as possible. Because it's a longer manifestation of disease, we need to be looking at ways to cut it off at the knees, if you will.

That's my interpretation. I do agree with Dr. Falcone that cohort development at the same time you're dealing with drug testing, specifically those drugs that are already available, is going to be essential, because you need to be able to parlay that immediately into a phase two off-label clinical trial. Then you can see pretty rapid use of that in the clinic to potentially negate these long-term effects.

For all of what we're talking about there has to be a somewhat coordinated response, and a lot of countries in the world are grappling with how to deal with it. I'm surprised at how much progress we've already made in that development, and I think we stand a good chance of leading the world in that regard.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Arts and Mr. Jowhari.

Mr. Garon, you now have the floor for six minutes. I'm happy to see you again, and I hope you're doing well.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you, Mr. Chair.

The COVID‑19 symptoms were short‑lived, perhaps because of the vaccination. So I encourage Quebeckers and Canadians to get vaccinated. But you already know that, Mr. Chair.

I'm going to do something I rarely do, which is to continue along the same lines as the last question. Obviously, I am also interested in the link between vaccination and the likelihood of contracting long COVID‑19 and of experiencing symptoms of varying severity. I thought I noticed some non‑verbal signs from Dr. Falcone that she might want to add a comment to Dr. Arts's analysis of this.

I'll give you the floor, Dr. Falcone.

[Dr. Emilia Liana Falcone]

Actually, this issue is of great interest to us, first of all, because it could give us a renewed optimism. It would also give us a better understanding of the pathogenesis of long COVID‑19.

As far as the numbers are concerned, studies in the United Kingdom suggested that vaccination reduced the risk of long COVID‑19 by 50%. It was very optimistic indeed. Then another study from the United States suggested that the risk was just under 50%, so 15%.

Of course, studies have their limitations, and each is based on data that differs from study to study. That being said, what we are finding is that vaccination could be beneficial. We know that, first, people who don't get COVID‑19 are less likely to get long COVID‑19. Second, people who don't have serious illnesses that could lead them to intensive care or hospital admission on a regular basis have a better chance of avoiding the very distinct complications that affect the group of people with serious illnesses.

For the remaining 90% of those with COVID‑19 who were not hospitalized, there may be a decrease in the number of long COVID‑19 cases, but it doesn't go away. So there is certainly a need for other approaches and treatments.

Another important question to ask is what would be the effect of the treatments used in the acute phase of COVID‑19 in terms of possibly decreasing the chances of the person having long‑term complications.

[Jean-Denis Garon, Bloc, Mirabel, QC]

I'm thinking of the famous drug PAXLOVID, which pharmacists in Quebec are allowed to prescribe in certain circumstances.

Are there any studies showing that more frequent use of this drug could reduce the incidence of long COVID‑19?

Could this be one of the treatments you mentioned that doctors are already using in the acute phase of the disease?

[Dr. Emilia Liana Falcone]

It's possible, but we don't have any data on that. We have data on the decrease in the risk of developing a severe form COVID‑19 or dying, but the consequences for less severe cases in the acute phase have yet to be determined. Consideration should also be given to the prophylactic effect this could have after exposure to COVID‑19. It is a very interesting hypothesis that should be studied.

Another question is whether PAXLOVID could treat long COVID‑19. That's another issue that certainly needs more study. For the moment, what we are seeing are anecdotal situations that seem to indicate, in some cases, that there might be an improvement in the symptoms, but we don't know how long that improvement will last.