Procedure and House Affairs Committee on Dec. 10th, 2020

[The Chair, Liberal, Ruby Sahota]

I call this meeting to order.

Good morning, everyone. Welcome to meeting number 17 of the House of Commons Standing on Procedure and House Affairs.

I'd like to start the meeting by providing you with some information following the motion that was adopted in the House on Wednesday, September 23, 2020. The committee is now sitting in hybrid format, meaning that members can participate either in person or by video conference. Witnesses must appear by video conference only.

All members, regardless of their method of participation, will be counted for the purposes of quorum. The committee's power to sit is, however, limited by the priority use of House resources, which is determined by the whips. All questions must be decided by a recorded vote, unless the committee disposes of them with unanimous consent or on division. Finally, the committee may deliberate in camera, provided it takes into account the potential risks to confidentiality inherent to such deliberations with remote participants. Today's proceeding will be made available via the House of Commons website. I will remind you that the webcast will always show the person speaking rather than the entirety of the committee.

To ensure an orderly meeting, I'd like to outline a few rules to follow. For those participating virtually, members and witnesses may speak in the official language of their choice. Interpretation services are available for this meeting. You have the choice, at the bottom of your screen, of the floor in English or French. Before speaking, click on the microphone icon to activate your own mike. When you are done speaking, please put your mike on mute to minimize any interference. All comments by members and witnesses should be addressed through the chair.

Should members need to request the floor outside their designated time for questions, they should activate their mike and state that they have a point of order. If a member wishes to intervene on a point of order that has been raised by another member, they should use the “raise hand” function. This will signal to the chair your interest to speak and create a speakers list. In order to do so, you should click on the “participants” icon at the bottom of your screen. When the list pops up, you will see next to your name that you can click “raise hand”.

When speaking, please speak slowly and clearly. Unless there are exceptional circumstances, the use of headsets with a boom mike is mandatory for everyone participating remotely. Should any technical challenges arise, please advise the chair. Please note that there may be the need to suspend for a few minutes to ensure that all participants can participate fully.

For those participating in person, proceed as you usually would when the whole committee is meeting in person in the committee room. Should you wish to get my attention, signal me with a hand gesture, or at an appropriate time call out my name. Should you wish to raise a point of order, wait for an appropriate time and indicate to me clearly that you wish to raise a point of order. With regard to the speaking list, the committee clerk and I will do our best to keep a consolidated order of speaking for all members, whether they are participating virtually or physically in person.

That being said, I'd like to welcome Dr. David Williams to our committee.

Thank you, Dr. Williams, for allowing us some time out of what we know is an extremely, extremely busy schedule and very challenging time for all of us, federally and provincially. You have been doing some fantastic work as the the chief medical officer of health for the Ministry of Health in Ontario.

Dr. Williams, you have five minutes for your opening remarks, which will be followed by a few rounds of questions by the members.

[Dr. David Williams, Chief Medical Officer of Health, Ministry of Health, Government of Ontario]

Thank you for inviting me today to present. I thought I'd start off by just giving you a sense of where we are in Ontario at this time. Since we've been at this now since January 2020, it's day 320 since we had the first case reported in Canada. We have now had a total of 134,783 cases of COVID-19 reported.

Over the spring and into the summer we flattened the curve down to a very low fewer than 100 cases a day, even lower than that, and then they started rising again in September, much as in other provinces, and more recently as in some territories.

Today, on December 10, for example, the numbers keep changing and we have a record high of 1,983 new cases of COVID-19 reported in a single day. Our testing volumes remain high. Today again we did just over 62,000 tests for the day. We continue to be averaging between mid-55,000 and 58,000 tests a day at this time, and we're adding more testing with more rapid access testing components in there. We're also doing some of those, in the 3,000 to 4,000 range, and we're going to be adding more in the near future.

Most of our cases tend to be concentrated in our so-called hot zones in the areas of Toronto, York and Peel, which make up 60% of our cases. They are spread out throughout the health units in the province of Ontario, which I will talk about in a moment.

Long-term care and overall mortality continue to increase. As we see our cases, we have a lag of three weeks and then we start to see hospitalizations and start to see deaths rising. We continue to note that. Now we're thinking we could exceed 25 deaths a day. While this is lower than in the first wave, it is nevertheless an ongoing concern and most unfortunate.

The reproduction effect, or the “RE”, that we talk about, is fluctuating just around 1. We're hoping to get that down below 1, to see it start diminishing again to see if we can come down off the peak of the second wave. We're sort of on a high plateau in a precarious state waiting to see if we're going to go back up or come down again.

Our ICU capacity and our hospital capacity continue to be challenged. We have over 200 beds now occupied in intensive care with COVID patients out of our approximately 1,700 to 1,800 beds. The challenge there of course is that, unlike in the first wave, during which we had stopped all elective surgery, we have all our hospitals up and functioning full tilt. That means these beds are pushing in with other cases, including those with elective surgery who are in there for a day or two post-op and are requiring the beds. That is putting stress on our system, a lot of which is at over 90% occupancy. We remain in this precarious position, to which there are a number of aspects.

In order to deal with this in the uniqueness of Ontario—and it probably affects the elections process—we, unlike other provinces, have 34 autonomous municipally incorporated public health units in Ontario. They range in size, with Toronto being the biggest at about 3.4 million, down to small ones of about 38,000 in the north. They cover all the geography in Ontario, including places where there are first nations communities. Each of the medical officers there, 34 of them and their staff, have the authority under boards of health to be responsible for the public health in their respective jurisdictions.

In order to assist with the overall impact of COVID, we moved, after our initial phase of closing and opening up, to putting in Ontario's “COVID-19 response framework: keeping Ontario safe and open”, which we initiated in September-October. It has indicators for each of the levels, with colour zones and names for them.

Green, the lowest, is in prevent mode and most of the things are on an ongoing prevention basis. Those remain low numbers, usually at less than 1%. Yellow is the protect level and has its own percentage parameters and cases per 100,000. Orange is the restrict level. Then we have red, the control level, which is anything above 40 per 100,000 or above 2.5% positivity in the lab tests coming in. This means we have 34 different areas in different colour zones, and they can move. We review the data weekly and then recommend if health units in those areas are moving up to these new zones or moving down. We also have grey, or lockdown, zones. Those are in effect at the moment in Toronto and in Peel.

That is when there are a number of metrics met that indicate that we have to put them into a lockdown mode, knowing that, unlike our first wave, they're not totally the same. Our long-term care is still allowing essential visitors. Our schools are still open, even at this date, up until Christmas. We have a large student body with 2.5 million students and most of our 1,400 schools are open. At the moment, we only have 10 closures in the province. Some of those are not due to outbreaks, but due to administrative reasons where, with staffing situations, they have had to close. There are child care centres as well.

Another difference from wave one is that we haven't stopped elective surgery. We are trying to catch up on that to make sure people are not having increased morbidity or mortality due to the delay in essential investigative and operative procedures. That's how we're structured and that's how we're dealing with it right now.

Also, we're doing some modelling and projecting to see how we will fare as we go through. Then, of course—as you've heard in the news—we are starting into the early stages of vaccination and that process is carrying forward. We're hoping to keep ramping that up into the new year.

In terms of the opportunities or issues related to conducting elections in Ontario, my office has been involved with the discussions with Elections Ontario. We are advising. There's an opportunity to learn from experience. It will be important to document and share these at the federal, provincial and territorial levels.

Ontario supports the committee's acknowledgement that the administration of an election should be executed without creating further barriers to voting, especially in consideration of providing every individual who is legally able to vote with the opportunity to vote, regardless of accessibility needs. That means using assistive voting technology and other types of assistance at the voting location—depending on zones within Ontario and COVID-19 status—and place of residence, such as correctional facilities, long-term care, group homes and other congregate settings.

There is a need to ensure that the election administration plans include contingencies and can be readily adapted to be sufficiently nimble in processes to respond to the changing situation in each jurisdiction. Because this is an ongoing COVID outbreak, it is changing by the day and week. With vaccinations coming in, we'll have further impacts that we're going to have to take into consideration as we continue on this journey. We have to be nimble and deal with the issues as they arise and be responsive.

Some of the overarching challenges include harnessing up front the opportunities for minimizing travel and gatherings, especially in consideration of using mail-in or virtual voting, actual day of voting on weekends or work weeks, and variations in public health measures that are in place in our communities, such as access to large community centres. Settings in lockdown are limited, so how might we have to modify those to allow people to come into buildings at certain times and allow proper space in the lines as well as proper precautions in each of the locations for the administration staff, volunteers, scrutineers and candidates? We need to establish linkages with regional local authorities to support the election process, such as linking in with our health and education sectors primarily.

We want to establish consistent and tailored processes for voting locations. Are they in schools? Remember that our schools are in a certain status situation. We don't allow people into the schools at the moment because of our policies and directions there. The community centres are mostly closed. They could be open, but they have to be established in that line. Also, there are specific processes for long-term care and other types of congregate facilities.

Other considerations might be the processes in place to screen those who are entering a polling station and separating electors who are unmasked or screened positive. How do we do that? If someone is positive and they're in their quarantine period, can they vote or not vote? How would we handle that type of process? Capacity limits and traffic flow need to be established. Of course, there's the ongoing cleaning and disinfecting protocols for all surfaces and equipment.

We would also like to recommend that a comprehensive training program include dry runs through the various scenarios and establishing worker screening processes that take into account the locations of their work the day of the elections, including any movement between locations and mobile voting processes. We don't want people moving from our high lockdown zones into red zones or others. We'd like them to be in that type of setting and to stay in those locations. They're planning ahead where their movements might be and minimizing them, so if there were outbreaks, they would not be attributed to the workers.

That would ensure consistent worker protection across all the voting locations, whether in the different settings we've talked about already, or our varying levels of interactions of electors. Overall these are the general parameters. As I've noted, Ontario is a big province. We have many remote first nations communities and challenges with accessing them. We have a large geography as well as the largest population to work through. We have to work that into our various settings and locations. We hope we can assist and work, if and when that is necessary, in response to the changing COVID situation we continue to experience.

Thank you, Madam Chair.

[The Chair, Liberal, Ruby Sahota]

Thank you, Dr. Williams. You've given some great recommendations to our committee.

I know there are so many questions we would probably like to ask Dr. Williams, given he's from the largest province, but we're going to keep our focus on the study at hand of a federal election during a COVID-19 pandemic. We will start with the first questioner for six minutes, please.

That's Ms. Vecchio.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Thank you very much, Chair.

To begin I would like to thank you, Dr. Williams. As a resident of Ontario I imagine during the last 320 days you have probably had no sleep. I would like to commend you for your work. I know I am fortunate to have both Dr. Mackie and Dr. Lock in southwestern Ontario in the London Middlesex area. I recognize what an effort you're putting forward and I greatly appreciate it.

We've had two federal by-elections in Ontario, one in York and then one in Toronto. Has anything come out of those centres that could be linked to the election? Are there any concerns about holding those by-elections in November?

[Dr. David Williams]

We asked our local health unit to document that. We have not seen any impacts related to that. We were pleasantly surprised it went very smoothly and we could not identify any exacerbation of cases related to those events that have been attributed to the locations of the various scrutineers, etc. It was a well-run process.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

That's fantastic to hear. Thank you for that good news.

What were some of the restrictions? I assume that Elections Canada was speaking to you or to the people in the Toronto area frequently on this. What were some of the suggestions that were made to ensure that voters, the candidates and their teams, as well of course, all the staff who were going to be there were safe? What were some of the guidelines you provided?

[Dr. David Williams]

A lot of the guidelines were stipulated by the local medical officer of health from Toronto public health, Dr. Eileen de Villa and her team, to make sure they were following the standards and protocols that were in effect during their time. I think they were in the modified stage two before they moved into the red zone, and now subsequently into the lockdown zone. Even now their standards have shifted a bit, but they were asked to do the proper minimizing of gatherings indoor and outdoor, as well as proper distancing and masking and limiting the access points, and as I noted in my comments already, ongoing cleaning of surfaces and keeping people moving through so there wasn't a congregation of larger numbers in any setting. They would have taken them from their medical officer who was specific to the zone they found themselves in.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

That's excellent.

When we were going through that, were there any rapid test processes, or anything like that, that Elections Canada established with you to make sure people were safe? Were any available at the time, and if so, would you have been able to use them?

[Dr. David Williams]

We didn't use any rapid testing at that time. We still had lots of capacity in our daily testing through our assessment centres in each of those locations, mostly because we were putting our confidence in the PCR test. We've been doing a lot, working through the various models of rapid testing. We're trying to use them in areas where we can't move the test through quickly enough to have adequate turnaround time.

Those locations are very central so we didn't have to worry about that. As well, we wanted to make sure we had the proper quality checks in those testing methods. If you're in high zones of positivity, to use some of those tests that have less sensitivity you may have a certain rate of false negatives, which would not be what we desire. You have to put in testing protocols that would overcome them. You want to use them in the right areas with the right group at the right time, administered by the proper experts, because some are changing from the nasopharyngeal swab to anterior nasal, buccal and oral. Then we were also testing some saliva mouthwash-type methods. A lot of new technology is coming, but we didn't use it for those by-elections.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Excellent, thank you.

You were talking about long-term care homes. All of the members on this committee are very concerned about long-term care homes and those who are most vulnerable and disabled. We want to make sure they are safe.

You indicated that we should screen those coming to the long-term care homes. What would that screening look like? Would it be those types of tests that you were just referring to, buccal, and those different things or just a swab of the inside of your cheek, perhaps? Would those be easy to administer?

Let's start with the long-term care homes, but do you feel that we must ensure that all Elections Canada people are tested or have that type of screening done, and how can we do that in the larger picture as well?

[Dr. David Williams]

The tests in our long-term care facilities are of major concern to us. We are continuing to increase the security around the long-term care facilities where we have high levels of transmission in some communities. There are more and more cases coming in, usually through the staff, volunteers and essential visitors.

We're putting in strident measures to make sure that, first of all with the security guard in some of the lockdown zones, people are asked about a history of signs and symptoms. They have to show proof of having had a test done. It's not just attestation anymore; they have to show that they've had a test in the last week. We're going to weekly testing, and we're talking about whether we would have to go up to even twice weekly tests with some of the rapid tests in there. We have not yet implemented that.

Regardless of the steps we put in, there still seem to be infections coming into these locations, and once it gets in there, it spreads quite quickly, so we have to put as many barriers around them as we can.

If people coming in from the outside—who are not staff members or essential visitors who are registered and noted in the log—don't have proof of testing, they will not be allowed to enter the facility.

In green and yellow zones, it is less stringent. There's a variation across the province, but we're trying to put these measures in. We're going to implement a rapid-test methodology. We're going to have to make sure that it's done with the proper sequential timing to ensure that we rule out any misgivings of the test as in false negatives. Right now you have to get those other tests done.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Thank you so much, Dr. Williams. I appreciate your time.

[The Chair, Liberal, Ruby Sahota]

Next up we have Dr. Duncan for six minutes, please.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

We thank Dr. Williams for being here. We appreciate your time and effort, especially during the pandemic.

My focus is on protecting the health and safety of Canadians should there be an election and particularly on protecting the most vulnerable.

I have limited time, so I will be largely asking for yes or no answers or one-word answers.

In Ontario, does the impact of the pandemic vary across public health units? Yes or no, please.

[Dr. David Williams]

Yes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

In Ontario, does the impact of the pandemic vary within public health units? Yes or no.

[Dr. David Williams]

Yes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Could you tell me how many long-term care homes in Toronto are in outbreak today, please?

[Dr. David Williams]

I'd have to look at my sheets. I can't do a yes or no to that.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Roughly...?

[Dr. David Williams]

I will just looked at my data for today. I didn't know you were going into that detail.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Maybe I can come back to that, because time is limited.

[Dr. David Williams]

Right now we have seven long-term care homes in outbreak in Toronto.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

How many in all of Ontario, please?

[Dr. David Williams]

In all of Ontario there are 21 long-term care.... When you say outbreak, there can be just one staff member positive, so it's not in full-blown outbreak. We have a very open definition for early warning.