Health Committee on June 13th, 2022

[Dr. Eric Arts]

It's always confusing. When we talk about seasonal flu, we kind of lump them together because it happens so frequently. If you go back into a person's lifetime and see that they developed early-onset dementia or Parkinson's, they may have had several episodes of flu, so you don't definitively know. The difference with what happened in 1918 or 1957 or 1964 was that those were more large antigenic shifts, so our immune systems don't recognize them as well. There's a greater chance that we have a higher level of inflammatory responses with the infection and that respiratory infection with inflammatory responses often trigger neuroinflammation responses that can lead to this type of progression.

What I was referring to is that we've been studying—and I'm new to the neurosciences field to a certain extent, and I've gotten a rude lesson, if you will—neurodegenerative diseases for 30 years, and in that period of time we've never developed a treatment that dealt with early-onset aspects of diseases. Now we have something that occurs a little bit earlier, that is not approved in this country, but when you look at it, our drug development pipeline for Alzheimer's and Parkinson's is very, very poor as compared to that for other diseases, and that's because we can't define when the triggers have occurred.

We know what's happened in the past and know what potentially happens now and even the signs and symptoms that we're discussing today in the near term for long-term COVID, which are already causing pretty significant cognitive impairments and which are possibly also associated with the advancement of even cardiovascular diseases, clots, etc. What we're looking at is the ability to define the disease and the triggers and then to make some inroads in treatment, especially now that, again—and this is hard to share—we have these amazing animal models in which we can induce the same diseases. We then apply touchscreen cognitive tests in those animals the same way we do in humans, with the same types of tests, and then look at the treatments that might be available already—and how they might impact mouse studies, for example—and then apply them to humans, especially with approved drugs. These are types of things we can never study unless we know the trigger and, of course, establish what those biomarkers are.

One of the things I fear is that a lot of biomarkers can be very hard to assess, as Dr. Falcone indicated, and the other thing Ms. Goulding indicated as well was the availability of those diagnostic and disease-monitoring tools. I think we'll have to be relying on neurological imaging quite a bit in diagnosis, disease progression and the effects of treatment.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Arts and Mr. Hanley.

Go ahead, Mr. Garon. You have two and a half minutes.

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

Thank you, Mr. Chair.

Ms. Goulding, I found your testimony very moving.

The Bloc Québécois has been working very hard for several years now to extend the period of EI benefits to 50 weeks for certain serious illnesses. The House of Commons also passed a motion to that effect. The House of Commons is currently considering Bill C‑215, which seeks to extend EI benefits to 52 weeks.

Do you think this measure could help people suffering from, for example, the most severe form of long COVID‑19 to care for themselves with more dignity?

[Susie Goulding]

Thank you for asking me this question, because I really dropped the ball on the other question that was asked of me.

Benefits are needed, yesterday. People are suffering. They're losing their homes. They can't provide medicines for themselves. They can't eat properly. They're eating Kraft dinner. It's catastrophic. Benefits, benefits, benefits, definitely, and 55 weeks would really help.

It almost seems as if the people who are able to rest in the acute stages of catching COVID may be the ones who recover better. Pacing is recovery. The more you can rest, the more you can pace yourself. By pacing, I mean, doing only what your body tells you that you can do. It's like looking at your day with a battery that's half full, and being able to do only what that allots you to do, with only half the energy that you would normally have. That's how you have to go about your day, and get everything done. You have to prioritize.

Definitely, 55 weeks would be a great help, because if we were to provide aid to people who were trying to recover, they would not have to worry. They could take the time they need. They wouldn't have the stressors that were making things worse. They could relax, and take the time they need. Maybe this could be the difference; it could be the difference.

Thank you so much for asking this question. Yes, absolutely.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Next, we have Mr. Davies, for two and a half minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. O'Brien, my information is that women appear to be disproportionately affected by long COVID by as much as a 4:1 ratio. Is that correct? If it is, are there any theories about what might explain that disproportionate impact?

[Dr. Kelly O'Brien]

Yes, sex is a predictive factor, when it comes to experiencing long COVID. There are hypotheses on that. There is some evidence to suggest what might be a predisposing factor, placing someone at a higher risk of establishing long COVID. One of those is an autoimmune condition. Women have a higher rate of autoimmunity, so there is that linkage there.

I see Dr. Falcone nodding her head.

The other hypothesis is that women tend to be in employment situations that placed them at higher risk, so personal care workers, education workers, other health care workers who didn't have the ability to take the time off, as Ms. Goulding mentioned, to have purposeful rest and recover during the acute phase of COVID, and didn't have the opportunity for sick leave or benefits, for example. There is that hypothesis as well.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is there any linkage between the prevalence of long COVID and vaccination status?

[Dr. Kelly O'Brien]

That's a very good question, and the evidence is still emerging, as Dr. Falcone mentioned. Initially, there was some promising evidence to suggest that vaccination does have a protective effect against long COVID, but most recently there was an article that came out in Nature at the end of May suggesting that vaccination was only partially protective against long COVID. The evidence is still emerging, and time will tell as the evidence further emerges.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. O'Brien.

Next is Ms. Goodridge, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair.

For those of you who follow along at home, one thing you perhaps don't see that happens at the health committee is that we receive a large number of briefs from individuals from all across the country, who share their perspective on a variety of things we study. I think it would be fair to say that this particular study has received a very large number of briefs. It seems that just about every day, or at least every Monday, we have a pile full of briefs. I want to let everyone who is following at home know this, especially those who have written and sent in those briefs. At least, my colleagues from the Conservatives—I see some heads nodding—and, I believe, just about everyone takes into consideration all of those written briefs we've been receiving.

There was one today that hit me probably a bit more than others, because it's so similar to so many of the emails I've received at my constituency office. It was one that talked about someone who was unable to fly due to ongoing travel restrictions and, as a result, she was going to miss a family funeral. Funerals are such emotionally charged moments in people's lives. To me, it's really sad that these travel restrictions are having such a huge impact on so many people's lives.

As a result of some of these briefs, I would like to move:

That the committee is of the opinion that travel mandates in relation to COVID-19 be lifted immediately; and that the chair report this motion to the House at the next available opportunity.

[The Chair, Liberal, Sean Casey]

There has been no notice provided for the motion, so we can take this as a notice of motion and bring it forward at a later date.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Mr. Chair, I am of the understanding that as long as a motion is related to what we are currently studying, it is in order.

[The Chair, Liberal, Sean Casey]

I take your point. The motion is in order. We are now obligated to debate the motion, unless you want to defer it so that we can hear from the witnesses. It's properly before the committee, so unless there's a motion to table it, the debate is now on the motion. The floor is open.

Go ahead, Dr. Ellis.

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

Thank you, Mr. Chair.

This is perhaps somewhat unexpected. That being said, I think it's important that this committee understand the nature of the multitude of illnesses that exist with respect to COVID-19. Today we've heard some witnesses and experts with respect to long COVID and the devastating impacts that creates for Canadians.

We know from some of the papers that Dr. O'Brien has sent out that using multidisciplinary committees to begin to understand long COVID and the vast array of symptoms that can come along with it are very important. I would certainly suggest that another illness coming along with COVID is the desperation, depression and anxiety that exists with the inability to be reunited with loved ones, whether it be related to a funeral, as my colleague mentioned, or to the inability visit those who are near and dear to us. We realize there are a multitude of Canadian out there who are, of course, choosing for their own bodily autonomy to not be immunize and are unable to access air, rail and sea.

Although, we do know from recent comments in the House that there are folks who are not immunized who are able to access air, rail, and sea, which creates this distinct disadvantage for some within Canada. That, of course, is not the style of society that we are attempting to create here.

The other point that's very important for people to begin to understand is that for folks out there who have significantly waning immunity after perhaps six months after their third dose, we know the likelihood of them being protected against infection is small. In fact, those out there who are not immunized, but who had a rapid antigen test or even a PCR test before travel would indeed be safer to travel than with someone such as myself, who has a multitude of COVID shots and is not required to have any type of testing before I access any type of public transportation.

This inequity, I believe, is worth addressing. What better place to address it, sadly, than here in the Standing Committee on Health? This is an important issue that has been brought up in the House, but we've certainly not been able to sufficiently and adequately address it amongst members in a cohesive fashion to really point out the inequities of Canadians who are unable to access public transportation. In country the size of ours, the expectation that they should drive around this country is really rather unfair.

The other thing that's important to consider, Mr. Chair, is that these individuals would also be unable to even leave this country, if they have such a desire. That creates a significant issue for them if they were not immunized. They couldn't access the United States and they couldn't access transportation. I suppose if they bought their own boat they could go somewhere else. This creates an inability not just to travel inside their own country, but to actually leave a country where they may disagree with many of its policies, especially this particular one on public health. It effectively traps them inside their own country, which is really something we've never seen or heard of before for folks who are not incarcerated.

The other thing to point out would be to say that this would probably affect about 15% of Canadians, given that 80% of folks would have had two doses of vaccine. I would suggest to the committee members that 15% of Canadians is not an insignificant number of people who have chosen not to be fully immunized, by the current definition.

That being said, I think this is a motion that some may see as inopportune. However, we do continue to study COVID-19 every other meeting in this committee.

Mr. Chair, I thank you for your time and for you indulgence.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Mr. Davies, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

First off, I'm not sure I disagree that this is an issue that the health committee should look at. I would point out for anybody watching this that this is identical to a motion that was tabled in the House of Commons, and we had a full day of debate on whether or not we should remove travel restrictions and mandates. It doesn't mean this can't come before the health committee, but we have had a full day on this with lots of points made on it.

I also empathize very much with a part of the travel mandate aspect, in that I would be happy to examine the science and data on whether or not requiring people to be vaccinated before they travel on federal transportation services is backed up by the data. I think that's a fair question. I certainly have seen data that suggests that the science may not support any rational connection between that anymore.

One of the problems, of course, when we say that we should remove all travel mandates is that we're also including a mask mandate in that, which I think is a very different matter. I personally think that the science behind masks as being somewhat effective in stopping the spread of aerosolized, droplet-based illnesses is very strong.

That's why I generally oppose any kind of attempt to get rid of all mandates on federal transportation, because it fails to make that distinction between a requirement to be vaccinated versus to be masked or even, for instance, requiring foreign travellers to be vaccinated before they come to Canada, which has a different impact. We don't want foreign travellers to get sick in Canada and then necessarily put a burden on our domestic health care system.

Having said all of that, I am a little disappointed that this motion was made with 50 minutes to go. I think it's disrespectful to the witnesses who are here for this whole committee. This committee had an entire discussion about how we would allocate our time, and we agreed that this meeting would be dedicated to long COVID and to COVID treatments, which are two very important issues. I certainly think we can have this discussion on this motion, but I would suggest we do it on a different day when we can all be prepared for it.

For the record, by the way, I don't think the motion should have been in order, because I had no notice of it and had no opportunity to prepare for it. Although it's generally under COVID, we're talking about mandates that are basically made at the transport ministry, not the health ministry. It's a very tangential connection and very weak nexus between that issue and studying COVID, in my view.

I respect the fact that the ruling has made, and I'm going to move that we table this motion so that we can hear from the witnesses here for at least the last bit of the meeting.

I move that we table the motion.

[The Chair, Liberal, Sean Casey]

Okay, so a motion to table is tantamount to a motion to adjourn debate, which is not debatable, so we'll proceed directly to a vote. I presume that we'll need to do it by a standing vote. I doubt there's consensus on this point.

Mr. Clerk, please take the vote.

(Motion agreed to: yeas 7; nays 4)

Thank you very much, Mr. Clerk.

Thank you very much for your patience, witnesses.

We're going to continue now with rounds of questioning, and it is the turn of Ms. Sidhu, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I believe that I have time left.

[The Chair, Liberal, Sean Casey]

No, your time has been well used.

Ms. Sidhu, go ahead, please.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I do believe that I have time left, as my time gets frozen once I move a motion.

[The Chair, Liberal, Sean Casey]

Your time doesn't get frozen when you move a motion. You decided to use your time for the motion. Your time is up. In fact, it's well past the time.

I recognize Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Dr. Arts, you said that biomarkers are hard to assess. However, waste-water surveillance has become a useful tool for detecting variants and informing public health decisions on COVID-19. Can you please expand on how this important tool is being used? Is the data available to the public?

That's for Dr. Arts or Dr. Falcone.

[The Chair, Liberal, Sean Casey]

I think Dr. Arts is trying to answer the question, but nobody can hear him.

Go ahead.

[Dr. Eric Arts]

Oh, geez; you'd think I'd know after a few years of this.

What I was saying that was all of the data on the waste-water surveillance, in particular the viral load assessments, is provided to our regional public health units but also to Public Health Ontario and the Public Health Agency of Canada. It's used in assessments for public health policies across Ontario. Similar systems have been set up in other provinces as well.

In addition to that, we do assessments whenever there is a high level of SARS-CoV-2 in the waste water at ports of entry, and then also in large urban areas where we're assessing this through Health Canada. Three groups—University of Waterloo, University of Guelph and Western University—do that surveillance. That is a more in-depth analysis of what types of variants are circulating in the population and the proportions of those variants.

That information is shared, again, with the Public Health Agency of Canada, the public health units and Public Health Ontario. There is an attempt to provide that information through the Ontario science table. It's a little bit more complicated in terms of its reporting. We hope that the information will be shared.

There is some confidentiality in relation to that information that is assessed. That is more in relation to understanding when something is coming into the country and how it spreads. That is up to the Public Health Agency of Canada to assess and determine when they want to release that information.