THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
OTTAWA, Friday, June 26, 2020
The Standing Senate Committee on Social Affairs, Science and Technology met by videoconference this day at 11:30 a.m. [ET] to study the government’s response to the COVID-19 pandemic.
Senator Chantal Petitclerc (Chair) in the chair.
The Chair: Honourable senators, before we begin, let me remind you of a few items.
First, senators are asked to leave their microphones muted at all times, and we’ll be responsible for turning their microphones on and off during the meeting. Before speaking, please wait until you are recognized by name. Once you have been recognized, please pause for a few seconds to let the audio signal catch up to you. When speaking, please speak slowly and have the microphone close to your mouth. If you have chosen an interpretation channel, I also ask that members speak only in the language of the channel.
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Good morning. Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
My name is Chantal Petitclerc. I am a senator from Quebec, and it is my pleasure to preside over this virtual meeting.
Before we give the floor to our witnesses, I would like to introduce the senators who are with us today in this virtual meeting. We have with us Senator Munson, Senator Seidman, Senator Bovey, Senator Deacon, Senator McCallum, Senator Griffin, Senator Dasko, Senator Forest-Niesing, Senator Pate, Senator Mégie, Senator Poirier, Senator Moodie and Senator Kutcher.
Welcome. Without further ado, we will introduce the witnesses for today’s meeting.
On April 11, 2020, the Senate adopted a motion to authorize this committee to study the government’s response to the COVID-19 pandemic. Today is our seventh meeting in this study.
For the first part of this meeting, we have the privilege and pleasure to hear from the Honourable Patty Hajdu, Minister of Health. She is joined by two Public Health Agency of Canada representatives, Dr. Theresa Tam, Chief Administrator, and Tina Namiesniowski, President. We are also hearing from Stephen Lucas, Deputy Minister, Health Canada, Dr. Michael Strong, President, Canadian Institutes of Health Research, and Siddika Mithani, President, Canadian Food Inspection Agency.
Minister, I’d like to invite you to make your opening statement.
Hon. Patty Hajdu, P.C., M.P., Minister of Health: Thank you very much, Madam Chair and honourable senators, for inviting me before your committee today. I know you’ve all been working incredibly hard within your own jurisdictions and following the developments of COVID-19 very carefully and Canada’s response with you.
As you’ve mentioned, and I won’t repeat them, I have a number of officials with me from the Department of Health as well as from the Public Health Agency of Canada and the Canadian Institute of Health Research and, of course, the Canadian Food Inspection Agency. I will turn to them occasionally to provide more detail on our government’s work. I’d also like to thank them in front of all of you for the incredibly hard work that they’ve been performing on behalf of Canadians since well before it was on the minds of Canadians, and I know that Canada’s response has been all the stronger for their leadership.
Today, I will talk about our ongoing response to the COVID-19 pandemic. I do have some remarks in French, so you’ll have to have patience as I switch back and forth to the appropriate channel, which I will do right now for a few French remarks.
Our response to this crisis has always been guided by the best and the most recent data available. We have been adapting our approach to the changing circumstances and to the availability of new information.
I think whoever helped me with the translation probably didn’t think about the need to change channels.
The fact is this is a new virus, one we’re still learning about, and it’s presented countries around the world with unique challenges. In Canada, we’ve used the latest science and data to inform our response. As we learned more about COVID-19, we have adapted our response and adjusted our approach to keep Canadians safe.
We know there is still a lot of work ahead, but there is reason for optimism in our country, because in fact transmission has slowed. We’re now at the point where provinces and territories are beginning to cautiously reopen and gradually ease restrictions. But, as we can see from other countries’ experiences around the world, this does not mean that the pandemic is over. As Dr. Tam has said, we will likely see more cases and outbreaks in some areas as public health measures are relaxed. We have to continue to work hard all across the country, together, because we know that this will be with us for some time.
As we move towards reopening, we can expect to see the transmission of the virus continue and likely even increase. At this critical time, it’s important to remind all Canadians that there is no shame in getting sick. The reality is that despite taking every precaution, it is still possible to fall ill. In fact, what we know now is that many of us can carry this virus without ever being aware of it, and that’s why it’s so important that Canadians who need testing or treatment can seek it out without fear or embarrassment. Identifying and isolating new cases will be key in containing future outbreaks. When we are speaking to Canadians, we need to remind them that we are all in this together. We need to be kind to one another and we need to support one another.
As the epidemic has unfolded across the country, it’s become clear that we need more information on certain groups at higher risk for exposure to or severe outcomes of COVID-19. In partnership with various partners and stakeholders, a number of efforts are under way to improve our knowledge of the impact of COVID-19 on different populations and communities, and critical to this is that it’s done in a way that respects privacy laws and individual autonomy. Some of these activities include working with provincial and territorial partners to improve the collection of data on race and ethnicity and other key variables within the national data set for COVID-19, as well as undertaking specialized surveys among key populations, such as health care workers and seniors in long-term care.
During these stressful times, we have also started important conversations about mental health and wellness. COVID-19 is particularly disruptive for those who do not have ready access to their regular support networks. Having to stay home meant that many Canadians weren’t able to see friends and family and, for some, this is increasing the risk of family violence, depression, mental health issues and substance use concerns. No one should have to go through this alone. That’s why we’ve developed digital tools to help Canadians stay healthy and informed. Our Wellness Together Canada portal was created to connect Canadians to mental health and substance use supports. As of June 19, more than 230,000 Canadians have accessed this tool.
We also know that young people and children are suffering. That’s why we’re supporting the Kids Help Phone with a $7.5 million investment to help them continue to offer their critical mental health support to young Canadians during this difficult time.
Canadians have made incredible sacrifices during this pandemic, and Canadians have come together in remarkable ways over the past few months to flatten the curve. There is definitely still more to do, but I believe that Canadians will continue to do their part to fight COVID-19 with compassion, with empathy and with kindness, because, after all, it is who we are and it is how we will keep our communities safe and healthy through the next phase of the pandemic and beyond.
Thank you very much, and I look forward to your questions.
The Chair: Thank you, minister. We are happy to have you among us this morning.
It is now time to proceed with a question period. Just a quick reminder, as it is in our previous practice, to remind you that you have five minutes for your questions, including the answer. If you do wish to have a question, please use the “raise hand” function in Zoom. When asking a question, please identify the person you wish to answer, or if the question is for more than one person.
The first question today will go to our deputy chair, Senator Poirier.
Senator Poirier: Thank you, minister, for being with us. Also, thank you for all the other witnesses that are on standby to answer our questions. I greatly appreciate it and I think it plays an important role of information that you can bring to us as we’re closing this chapter of the first part of our study that we’re doing right now.
My first question is actually for Dr. Tam, if you will allow. We have heard from countless witnesses throughout the committee study that there was a lack of access to personal protective equipment. It was the number one concern through this pandemic. Hospitals and workers have had to ration their supplies while they wait for stock to be replenished, and some have even had to reuse certain equipment. As Dr. Margaret Tromp told this committee, this would be considered a malpractice in a pre-COVID era. Dr. Tam, what was your knowledge about the lack of personal protective equipment in our National Emergency Strategic Stockpile? Can you tell the committee whether you personally ever warned the government that the National Emergency Strategic Stockpile was under-funded or under-stocked?
Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada: Thank you for the question.
In the Canadian context, all levels of government, particularly the provinces and territories, are responsible for the health care system itself. Every provincial-territorial government also maintain their stockpiles, and that’s where the majority of the personal protective equipment is used.
The National Emergency Strategic Stockpile, which is maintained by the Public Health Agency of Canada, actually didn’t have that much personal protective equipment in it prior to the arrival of this particular pandemic. I think that’s fairly transparent, given that the stockpile itself is very much focused on some unusual stockpiles of vaccines and medications that provinces don’t normally stockpile. There was a small amount of personal protective equipment, and that could serve as a backup in the event that the provinces and territories are not able to cope.
Of course, this event taught us that there’s an incredible amount of personal protective equipment required for such a pandemic situation, so the government, very quickly, together with multiple departments, Public Services and Procurement Canada and the Public Health Agency, Health Canada and our ISED colleagues, all got together to use multiple different approaches to acquire personal protective equipment as fast as possible, in a very competitive and unusual supply market, to get PPE to Canadians, and also then to establish domestic supply. So a lot of work was certainly done as fast as possible at the start of this pandemic.
Senator Poirier: Thank you, Dr. Tam.
We’re also seeing lately more and more cases on the world stage, and every day seems to be a new record for the most cases recorded in a day. We have heard time and again that we’re not prepared for the second wave, and we need to prepare for it. It’s not if it comes, it’s when it’s going to come, from what we’re hearing. Dr. Tam, what is your plan to ensure that we’re ready for the second wave? What would you say to health care workers in the wake of a second wave to reassure them that we are ready, that we have the equipment that is needed and that government is prepared?
Dr. Tam: Right now, as everyone appreciates, Canadians, many partners and all levels of government have tried very hard to suppress that initial wave, but always at the back of our mind in constant vigilance is a resurgence scenario. It’s not just a matter of a second wave, but because the virus continues to be in the world and in the Canadian context and we don’t have a vaccine, the population is unlikely to have a high level of immunity so that the risk of a resurgence is very real. What is suppressing it right now is the public health measures everyone has put together, and that has been effective.
But absolutely, while cautiously reopening certain sectors of our society, there is simultaneous rapid planning for any resurgence. Modellers, for example, have worked hard to show us that if we didn’t put the right combination of public health measures in place, including testing, contact tracing, isolation and quarantine measures, a resurgence is very likely to happen.
What we’re trying to do while trying to suppress any outbreaks immediately — that’s the plan — is preparing for a possible return of an even bigger wave in the fall and winter season. It could be anytime, actually, so we need to be constantly prepared and constantly increasing our capacity. What we are concerned with and planning for right now, together with all the chief medical officers of health across Canada, is a simultaneous wave occurring at the same time as an influenza outbreak. That is what we are working very hard to do.
Some of the conditions that the Prime Minister and the premiers have put together are that reopening can only be done under certain conditions. In addition to those public health measures and capacity, such as lab testing and contact tracing, is the absolute requirement for the health care system to have the capacity that it needs to cope with any resurgences.
In the initial wave, in fact, the provinces and territories have been able to keep any sort of overcapacity of the acute care system, so that was actually managed quite well during the first wave, with still vacant capacity that they were able to manage. Some of my colleagues here could elaborate.
There is quite a lot of work in modelling the personal protective equipment requirements under these scenarios and then getting those requirements from the provinces and territories in real time, but also in planning purposes, and then sourcing all of those requirements is a massive amount of work that is ongoing.
All of us believe, of course, that protecting health care workers and anyone who works in the health system is of paramount importance, but, of course, not forgetting our seniors and our long-term care home part of it as well. While the acute care system wasn’t as impacted, the long-term care homes and seniors residences absolutely are, and they need PPE as well.
Senator Poirier: Thank you very much, Dr. Tam.
Senator Griffin: Thank you to the witnesses for being with us here today. It’s great to have you.
I have a question for Dr. Mithani from the CFIA. I am concerned about food security. As you know, there have been backlogs in meat processing plants. Only three plants in our country handle 95% of the beef processing. It’s quite amazing. And of course, there have been COVID-19 outbreaks among the staff in these plants.
What is interesting is that in 1988, there were 119 federally inspected beef processors in our country. Now there are only 20. To add to the problem, interprovincial transport of meat has been an issue, as it is with many other commodities. But because of the pandemic, there has been, fortunately, a temporary exemption by the CFIA for meat to move more freely amongst the provinces.
There are two things I would like you to touch upon: the feasibility of smaller processing plants and the interprovincial transportation of meat. What steps is the CFIA taking to make meat processing less centralized and interprovincial transportation more straightforward? Thank you.
Dr. Siddika Mithani, President, Canadian Food Inspection Agency: Thank you very much for the question.
Since the start of the pandemic, the CFIA has been taking immediate and decisive action around ensuring that, first, the food that we have is safe and reliable; second, that there is no interruption in the food supply chain; and third, and most importantly, that the health and safety of the employees are safeguarded as well.
With respect to your questions on the feasibility of smaller plants, the role of the CFIA is to ensure that, in these meat plants, food safety components have been met according to the requirements. From that perspective, the fact that there might be an appetite for having smaller establishments looking at meat production or processing is feasible and viable. CFIA would be ready to help and aid people and companies if they would so wish to decide to move forward with establishing more meat plants.
With respect to the interprovincial trade, prior to COVID-19, I had been working on exploring avenues to look at whether there were any equivalency agreements that we could look at with respect to the movement of food products within provinces. In order to ensure that we would have no food shortage issues, the regulations allow the minister to provide a ministerial exemption, so we have made it possible and facilitated that ministerial exemption to happen in cases where we do have food shortages.
I would say that post-COVID, there will still be conversations around how best to ensure across the country that we do not have any food shortages.
Senator Griffin: Thank you. Those are my questions.
Senator Munson: Thank you to the witnesses and to the minister for doing a wonderful job in protecting Canadians. You also have, minister, probably the best chief of staff on the Hill. Just thought I would throw that in.
Now the combination of the senator/reporter type question on the $600 to the disability community: the Prime Minister announced it and it got caught up in politics, to put it politely. But within the community, a lot of advocates and groups are saying it’s too little too late. What is the status of it right now?
To make sure I get this question in: On the Canada Revenue Agency Disability Tax Credit, there are certain groups that are eligible for that amount of money, but it’s my understanding that those with autism — that’s a community I work closely with — and, perhaps, those with diabetes, are not registered with the Canada Revenue Agency Disability Tax Credit and so therefore will not get the $600.
So two questions, and I do have more, hopefully for Dr. Tam. What is the status? Can you change this? Do you believe in an overhaul so that it can be equitable for the entire disability community?
Ms. Hajdu: Thank you, senator. I don’t know if my chief of staff is in the room at Health Canada, but I will pass on the kind remarks. I agree with you. I’ll pass that on to Sabine Saini.
In terms of the Disability Tax Credit, I know that my colleague, Minister Qualtrough, has worked passionately on trying to increase supports for people living with disabilities. In fact, I was honoured to take part in one of her early round tables with people with disabilities in terms of how the pandemic was affecting them in very tangible ways. There were some extremely heartbreaking stories. She was equally disappointed by the lack of passage of that particular piece of legislation that would have made it possible for the one-time payment. I will remind you, though, that there are other ways that money is getting to people living in lower income settings, such as the enhanced GST, et cetera. There are opportunities that she is working on to enhance the proposed approach to address your issue of certain people that are left out of the delivery mechanism.
Again, this is a little out of my scope as Minister of Health — I have had to pretty much stay in my lane and let my colleagues manage some of the aspects of the economic response — but I will say that some of the challenges that we have had with delivering the economic response is a system that is not designed in a way to get money out as quickly as possible, using legacy systems, such as CRA and the EI system, that are essentially overstretched to begin with in normal times and are really challenged to deliver in new and rapid ways.
I will make sure that she hears your concerns. I know that she has, and I know that she is truly one of Canada’s most committed people in terms of working with the disability community in a true lens of inclusion.
Thank you for your questions, and I wish I could provide you more clarity, but, of course, a lot of it has to depend on how the next steps unfold.
Senator Munson: I will keep pushing on that issue, because I think it’s extremely important for those in the autism community not to be excluded from the Disability Tax Credit. It’s very important.
Dr. Tam, Statistics Canada released a survey a few days ago for Canadians with disabilities to complete, with data collected going to the Public Health Agency of Canada. I’m curious, how will this survey help Canadians with disabilities have better health outcomes during the pandemic? They seem to be the forgotten people in all of this. I know people have concerns and so on and so forth, and I get that part, but what is your work plan for this data, since the survey ends on July 6, for tangible outcomes of helping those with disabilities?
Dr. Tam: Thank you. If I don’t know enough, we will certainly follow up with providing any information that can be provided afterwards.
As we all know, there is some lack of data in the context of this particular pandemic in relation to different populations of Canadians, and I believe that persons with disabilities really should be a focus of effective support throughout the pandemic. As a result, the data is important to inform programs or policies.
On the side of the Public Health Agency, we were privileged to be able to engage with persons with disabilities as we developed some of our guidance related to how we support persons with disabilities during the pandemic itself. There were many different details, such as personal protective equipment, for example, using face shields so that people don’t have to have a mask on that covers their lips, for ease of communication for people with hearing, visual and other impairments. That is important. We don’t have enough information on that front.
I don’t know enough about the specific survey data itself, but the agency also has some funding in existence, for example, for working with persons with disabilities, but also persons with the full range of autism spectrum disorder as well. I hope that the data can also inform all of our existing programming as well. We do have teams in the agency who are linking with Statistics Canada, and we can certainly provide more information as to how the data is being used.
Because the pandemic is evolving all the time, so should our approach and our response. The data is expected to help with any adjustments to the response itself.
Senator Munson: Thank you. I appreciate that, but I can’t help but emphasize, in terms of data, one in five Canadians has a disability. This has to be front and centre, in my view.
Senator Seidman: Thank you, minister, Dr. Tam and members of your department, for the hard work that you are doing every single day to get Canadians through this very difficult time safely. I have three questions: one for Dr. Tam, one for Minister Hajdu and one for Dr. Strong. Perhaps I can start with the first two and see if I ever make it to the third.
The question I have for Dr. Tam has to do with rapid testing and tracing. I would like to get to the nub of this, if I might. Many have suggested that we’ll have outbreaks as opposed to a second wave. I would like to know that we have the means to put the outbreaks out as quickly as possible. That would mean strategic, rapid testing in high-risk regions or workplaces, followed by contact tracing.
There have been a lot of rumours about a rapid, easily administered testing device that can produce results quickly and on the spot for use across the country, say, in a workplace or in a particular region. I would like to know where we’re at with that, because that would be really important going forward. What are the plans to supplement contact tracing with this new app that we seem to be testing?
I’ll just leave that with you for one minute so that the minister will know what I will go to her after Dr. Tam answers. It has to do with national standardized data collection, which I asked you about at the end of March in the Senate Committee of the Whole. I would like to know what the federal government has learned from the COVID pandemic regarding Canada’s public health surveillance system. Specifically, food for thought might be the European Centre for Disease Prevention and Control, which has just replaced 17 independent data collection systems, covering 27 countries and 23 languages, with a single integrated surveillance system for infectious diseases.
If I could start with Dr. Tam on the first question, that would be wonderful. Thank you.
Dr. Tam: With regard to testing individuals for COVID-19, there are different methods and platforms, if you like, for testing. Right now, the most common tests being deployed are what we call molecular testing, which uses PCR and similar technology to detect the presence of the genome of the virus to determine if someone is currently infected with the virus. I’ll also talk a bit about work on serology, which is the testing for antibodies for your immune response to the virus.
Senator Seidman: Excuse me, Dr. Tam, I don’t want to interrupt you and I don’t want to be rude, but if you could just specifically tell us about an on-the-spot test that could be used strategically in outbreaks in a workplace or in a region, because I think that’s the issue. If we’re really to respond to outbreaks, we need on-the-spot, easily administered, almost self-administered, doesn’t go to a lab, produces results in 30 minutes, even before a worker walks into their job. That’s the kind of testing that people are asking about, and I would love to know — [technical difficulties].
Dr. Tam: Yes. In the event that there is a case and there is an outbreak, provinces and territories are geared up to essentially hone in on that hot spot with the necessary testing capabilities, which might be going back to a lab. Where we’re currently focusing on more rapid point-of-care tests is for remote and isolated communities because they actually don’t have easy access to a laboratory. Right now, I think colleagues in Health Canada are working really hard on aggressive procurement strategies, together with the Public Health Agency and others, trying to get innovative lab testing.
There are also interim orders to expedite reviews of any medical devices. Right now, we don’t have a huge number of devices out in the field of this nature. One of them, which is a gene expert device, is not instantaneous, but it can be used in certain communities, as we have seen them used in northern Saskatchewan, for example, for some recent outbreaks in La Loche and those areas, and certainly in the North and others.
The other areas of Canada are currently accessing the existing public health and some private laboratories, but we are acquiring those kind of rapid point-of-care testing as they become available. They do have different performance characteristics, and those have to actually be tested out to see how well they perform.
Senator Seidman: Excuse me again. I’m going to run out of time. Sorry, I hate to keep interrupting you, but I know I’m going to be told any minute that I have no time left.
Could you briefly give me a point in response to the contact tracing app, very briefly? Because I would like to hear from the minister about national surveillance.
Dr. Tam: Deputy Lucas was going to maybe provide an answer on the app, if that’s okay.
Dr. Stephen Lucas, Deputy Minister, Health Canada: Thank you, senator.
The Prime Minister has announced that we will have a national exposure notification app based on use of Bluetooth technology that records close contacts and, in working in partnership with provinces and territories, allow for the notification of people if they have been in close contact with someone who tests positive. It’s slated for launch in Ontario in the week ahead and will be a complement to the work of public health officials for following up on recording close contacts, phoning them and getting them to isolate and be tested. It’s a complement to the existing efforts.
Senator Seidman: Thank you very much. If I could just have a minute or two with Minister Hajdu.
Ms. Hajdu: Thank you very much, senator.
In regard to a national approach to data collection, I am a huge fan of that idea, especially after I have discovered the fractured way that provinces and territories collect data, and more than that, report it up to the federal level.
As you know, we have quite a significant amount of money on the table right now as we negotiate a safe restart with the provinces and territories. I’m sure you’re following closely. One of the areas we are negotiating with the provinces and territories about is actually stronger data standards nationally. We fully support an approach where provinces and territories would have, first of all, a commitment to collecting granular data in a way that would, as I indicated earlier, be able to provide a better sense of the disparities, for example, how particular illnesses impact particular groups in different ways, putting COVID aside for a second, but also the ability for that data to be rapidly shared with the federal government. That has been a weakness for us all along, our ability to actually understand what is happening nationally, and in some cases, even the most basic information in the early days. Dr. Tam and her team have worked incredibly hard through the special advisory committee to improve that process, but some standardization and a national approach is definitely what we’re aiming for.
The Chair: Thank you.
Senator Seidman: Thank you. I might go on the second round, if I could.
The Chair: Absolutely.
Senator Forest-Niesing: I would like to thank all the witnesses for their indefatigable work since the beginning of the pandemic. It is very appreciated.
My questions will be about the lessons learned since this pandemic began and about the possibility of potential successive waves.
I will first address Dr. Tam.
The healthcare professionals who have appeared before the committee said that the public health and emergency preparedness directive perhaps went a bit too far during the first wave of the virus by preventing a sick person’s relatives or even those of a person receiving palliative care to go to their bedside even if those relatives used the protection equipment worn by health workers.
They said that, in fact, that was tantamount to cruel and insensitive treatment of elderly people who were, in many cases, forced to die alone, isolated and very often not understanding what was happening to them. For the upcoming waves, what will be the directives for those types of situations?
My second question is for the minister. Will the federal government pressure the provinces to ensure that the relevant directives are changed?
Dr. Tam: I apologize. We heard both French and English simultaneously, so in fact, we couldn’t actually hear the question here in the room. I don’t know if anybody can fix the technical issue.
Senator Forest-Niesing: I can ask my question in English. I will rephrase it.
My question relates to the very unfortunate realization and the directions with respect to the impossibility for members of the family of those who were in palliative care or those who were on the brink of passing not being able to be by the bedside of their loved one, and that caused an enormous amount of stress for the families, in particular for those who were in that very unfortunate situation of not having a person next to them. Dr. Tam, in anticipation of an upcoming potential resurgence, what will be the direction in regard to those situations? Is there an intention to revise it?
For the minister, I’m interested in knowing what, if any, pressure the federal government will exercise with the provinces in order for there to be a change of direction or restriction in that regard.
Dr. Tam: Thank you for the question. I think it’s absolutely extremely tragic if someone cannot be at the bedside of their family member or loved one when they need to be there the most.
From the perspective of the Public Health Agency, we actually do not provide that type of directive. That is generally, unless I misunderstood your question, for hospitals or long-term-care facilities, which are really in the purview of the provincial and local governments. All to say, though, we can definitely convey this important message to all our partners across the country.
Ms. Hajdu: Thank you very much, senator.
Just to echo Dr. Tam, as you know, the federal government doesn’t have the ability to force provinces and territories to adopt rules or regulations at that level. We do, obviously, negotiate with provinces and territories when we transfer money around increasingly, actually, through our government’s work, for some outcome measurements. But even that work is very difficult, and I’m sure you understand that, given what I’m sure you’ve watched and read in the media.
There is an approach that seems to be working with COVID-19, which is a collaborative approach. It’s not perfect. There are times when provinces and territories diverge from each other and have differences of opinion with the federal government. By and large, I will say that, in the work that I’ve done in politics in the last five years — and I realize I’m still a baby compared to some people — this is one of the most collaborative experiences I’ve had, given that there are so many different political stripes at the table. One of the benefits of Canada or the Canadian approach is that, unlike our dearest neighbours to the south, we have not seen the same kind of political tensions, if you will, around some of the most fundamental aspects of dealing with COVID-19. For that, I’m very grateful. I think it has led to some of the successes we’ve seen, with the full acknowledgement that we’ve had our challenges as well.
We’ll continue to work with provinces and territories through the Special Advisory Committee and through the F/T/P table that I co-chair currently with the Province of Ontario. I also have good relationships bilaterally with all the ministers of health. There is an opportunity through those relationships, and we have used those relationships when there are hot spots or outbreaks of concern. Being able to directly communicate with the minister responsible and to pull in my colleagues as necessary, depending on the sector involved, has been incredibly helpful as well.
Senator Forest-Niesing: Thank you. I certainly understand that the extent of the pressure is limited and that the jurisdiction does rest with the provinces, but I would encourage you, given the very strong testimony that we received from the professionals in regard to the very sad effects of that, to be as clear as possible in your communications with the provinces in that regard. Thank you.
I don’t know whether I can ask my question in French. Are we still having issues with interpretation?
The Chair: We are having some issues, Senator Forest-Niesing, and we don’t have much time left. I suggest that you put your name on the list for the second round. We are trying to resolve the double language issues in the room. Are you okay with that?
Senator Forest-Niesing: That’s unfortunate, but I understand.
The Chair: Thank you very much. I do appreciate it.
Senator Dasko: Thank you to the witnesses.
These are all very important topics. I want to drill down a little bit more on the topics related to data and also to the contact tracing apps. These are questions begun by Senator Seidman.
First of all, we’ve had many witnesses come and talk to us about the data issues and especially the need for three aspects of data collection: data to be timely, to be consistent and to be fulsome. Sometimes those goals are at odds with each other, but those would be the goals of data collection. I want ask the minister or Dr. Tam whether improvements have been made in any of these aspects of data collection. Where have the improvements been made? What is still missing in terms of important data that would fulfill those goals? How do we achieve it? For example, Senator Munson talked about collecting data on people with disabilities. Are we looking for more survey data? Or are we looking for better so-called admin data, that is, administrative data, most of which comes from the provinces? I’m asking what would be the areas of improvement.
Second, on the contact tracing, I would like to ask Dr. Tam or her colleague how much uptake we require for this to be successful. Second, how much uptake do you expect from Canadians after this is introduced? I know the Prime Minister certainly mentioned this a couple of weeks ago. How much is required of uptake, and what is your expectation of uptake from the Canadian public in terms of this app?
Let’s go back to the first one about data collection. Thank you.
Dr. Tam: For us to monitor the evolution and trajectory of this outbreak, we do need very timely information. I’m very happy to say that there’s a lot of collaboration. Local public health was extremely busy. At the beginning, the timeliness and the completeness wasn’t as good as it is now. I’m happy to say that we have bored down to a core minimum data set that we believe was really important to track the trajectory of the epidemiology. We now have essentially 99 to 100% of data being reported with the basic data sets, with the demographics, a little bit less on when someone became ill or was tested to plot these epidemiologic curves.
There are some areas that are not well filled in, however. That does include whether someone has self-identified as First Nations, Inuit or Métis. Because this outbreak data set is aimed for timeliness, it doesn’t actually currently have race or ethnicity data. This is an area that we’re working very hard on.
We’ve tried to get at some of these underlying disaggregated data, if you like. We did look at the actual published literature, a scientific literature review. We’re working very hard with the provinces right now in the short term to get more race and ethnicity and other data. You may have seen that there are some jurisdictions at the local level, including Toronto, that are now collecting this data, which we hope to obtain. We are also engaging with various partners to undertake specialized surveys and enhanced surveillance activities among the key populations of interest, some of which are the racialized communities.
We are partnering with CIHR, the Canadian Institutes of Health Research, as well, to coordinate efforts to facilitate actual research activities, because a lot of this cannot be obtained through surveillance or surveys. We need a multi-pronged approach. We are also working with Statistics Canada. My understanding is that, through our partnership with Statistics Canada, they will be releasing a new ethnocultural data dashboard shortly. We need to tackle data on all fronts, but the key basic data we’re now getting in a very timely manner.
Senator Dasko: Excuse me. Are we getting that from the provinces? Because a lot of that data, I understand, does come from the provinces. This is admin data with respect to intake and other measures. Have the provinces actually improved what they’re giving you to analyze?
Dr. Tam: On the public health data, yes. It comes from local to provincial and then to the federal government. We link with Statistics Canada to make that data available also for researchers. It is published on our website so you can see all of that.
The administrative data, like hospitalization, often, of course, comes from the provinces and territories. They give us basic information about whether someone was hospitalized or in the ICU. However, more comprehensive administrative data then goes through, for example, CIHI, the Canadian Institute for Health Information, and they’re also very much part of our collective data approach.
Senator Dasko: Thank you.
On the question about contact tracing, what are the expectations for take up? What is required and what are the expectations for take up, and also when? Thanks.
Dr. Lucas: On the “when” question, the intent is to launch in Ontario in the coming week and then work with individual provinces and territories to launch it in those jurisdictions, given the importance of plugging in with their health system to enable the case information to be provided.
The uptake and utility are maximized when it’s about 50 to 60% of the population. Certainly, in terms of achieving that, it will take a significant effort in communications awareness. It is going to be a voluntary consent-based approach, but I think it will require significant marketing and support across the country to reach those levels. And against the backdrop, as has been communicated with other public health measures, is the importance of working together to protect Canadians.
Senator Dasko: Do you have any sense of what the uptake will be?
Dr. Lucas: I think the objective will be to use all those methods I noted to maximize uptake but, in terms of a specific prediction, it’s hard to say. The objective is to work to convince Canadians that it’s an important tool, amongst others, to help rapidly arrest the spread when detected through testing.
Senator Dasko: So your goal would be 50%, then? Can I read that into what you’ve just said?
Dr. Lucas: Yes.
Senator Dasko: Thank you, everyone.
Senator Kutcher: Thank you very much, minister and witnesses, for being here today, and also to you and everyone in your departments for the hard work and the effective work that you’ve done to limit the community spread during this pandemic. Thanks for that.
My question probably is best directed to Dr. Lucas and Dr. Strong, though anyone, please, take a stab at it. At the onset of the pandemic, there was and continues to be a tremendous amount of health misinformation and disinformation that was widely and rapidly spread. Also, the response of Canadians in accepting the disinformation has identified a need to significantly improve health literacy in this country. What strategies will be developed going forward to allow for rapid and effective means of addressing false health information, and what will you be doing going forward to improve the health literacy of Canadians?
Ms. Hajdu: Thank you very much, senator, and thanks for your ongoing correspondence with me about mental health and language. I hope that you saw, as you gave me tips and ideas, me reflect that in my conversation with Canadians. It has been very helpful to have that.
I will say that the disinformation to Canadians, not just about health but about everything else, is an ongoing conversation amongst us as politicians, but certainly amongst other officials throughout the Government of Canada. Very early on, we knew that we had to come out of the gates in a strong way to try to provide credible alternatives. The department and the Public Health Agency of Canada standing up the COVID-19 website was a very good thing right away, even though it grew and it has evolved as we’ve had more information and more to share with Canadians.
Being able to direct people to Canada.ca/COVID-19 on a regular basis complemented the other official websites and digital sources of information for Canadians and, as our capacity grew, and as our understanding of the illness and the preventive mechanisms grew, we were able to communicate through a variety of different channels, including social media and print, all kinds of ethnic media. We knew immediately that we were also going to have to provide information in other languages. We used a variety of different methods, including, as I said, reaching into smaller media outlets that sometimes have a concrete group of people they communicate with, but also in our case using members of Parliament who speak different languages to get out there in front of their local media to augment the official communication channels we were using. Again, they are reminding Canadians that the trusted sources of communication were their local public health units and/or provincial and federal government’s official web pages. There’s always more to do.
We are in the age of disinformation. However, I do believe and the data shows that Canadians trust their officials and their government a lot more in this country than in other countries, and that has been an asset for us to remind Canadians that there is a trusted source of information to correct misinformation when it arises, to ensure that people have the most up-to-date information about the virus as it evolves and to use different methods to communicate with different groups.
We have more to do, for sure, in the area of risk communications. It’s something I see as an opportunity to boost both within the Public Health Agency of Canada and with Health Canada. I look forward to that work. In the interim, we are fortunate in this country that we have an ability to somehow rectify some of that misinformation.
Thank you, senator.
Dr. Lucas: To build on what Minister Hajdu said, having that trusted source and accessible information in multiple languages, as Minister Hajdu noted, is critical. We’ve had over 202 million visits to the website, as a single area of focal point for that trusted information, including through the Canada COVID app as a mobile platform that Canadians can access.
Certainly correcting disinformation is another part of the strategy, and engaging media on responsible journalism. Through that, both policy and behavioural and social science work looks to underpin this, and we’ve worked with the Public Policy Forum on this issue of science and health literacy in an era of misinformation and disinformation as a critical area of focus and have worked on direct engagement campaigns with different population groups and segments, including children and youth in areas such as cannabis, vaping and opioids, other public health issues, but critically important in supporting that health literacy and understanding work, similarly with Canada’s Food Guide on nutrition. It’s a multiple-tool strategy that’s very much a focal point now in the context of COVID.
Senator Kutcher: Thank you for that. I do very much appreciate what you have done. It has been first-rate in terms of that receptivity response.
If I could drill down on a couple of things: My understanding of the available research is that two of the things that are most effective when misinformation occurs are rapid and targeted specific response coming from reputable health leaders, such as national physician organizations, national nursing organizations, which are directed to those specific pieces of misinformation, and the other thing is that Canada also has a very robust and vibrant science communicator community, excellent academic locations at Lakehead University and Ryerson University. Are there plans, or have you utilized these kinds of specific strategic actions from rapid responses from reputable health leaders and this robust science communicator community to get your message out?
Ms. Hajdu: Thank you very much, senator.
I would say that one of the most trusted communicators that Canadians see is Dr. Tam, quite frankly. She has been, along with medical officers of health across the provinces, a leader with regards to communicating to Canadians. In particular, Dr. Henry in B.C. is widely admired and has done a lot to correct misinformation.
We have been available to the media every single day, with the exception of a few days or weekends here and there, to be able to answer questions from the media, to be able to correct the record on false information and to make sure people understood how to find credible information. I know that both PHAC and Health Canada use a variety of different experts on a regular basis.
This has been one of the other silver linings of the COVID outbreak — that there is an integration of the academic community in terms of supporting Canada’s response like I’ve never seen before. Many times, these structures are formal and they can be difficult to set up. In our case, we’ve had outreach from a variety of experts across fields to help our response, and we’ve gladly accepted their advice and feedback. Hopefully you can see that in our responses, as I mentioned in my opening remarks to you.
I have found that particularly helpful as the Minister of Health. I do have a background in public health and risk communications, so I’m fortunate in that way. I’ve also been very well supported by a variety of different academics, both formally and informally, who have reached out to me to help clarify things and to give me suggestions about how to manage certain situations, and I gratefully accepted that advice.
Senator Mégie: I thank all of our witnesses. My question is for Minister Hajdu. I will combine two questions in one. We know that more than 80% of deaths related to COVID-19 happened in senior residences. The committee heard from a witness, Dr. Réjean Hébert, who proposed and suggested that the government invest more money into home care. He was working very hard on the issue of home care in Quebec, but the elections came and it all fell through. What do you think about investing more into home care for that senior clientele?
Ms. Hajdu: Thank you very much, senator, for the question.
I think there is no question in any Canadian’s mind that there needs to be some reform of long-term care. More money, of course, is always a solution, but I think it’s a complex conversation. Obviously, until now, the jurisdiction for long-term care has been firmly with the provinces and territories. The federal government has actually had no engagement in terms of long-term care. We don’t have national standards and there are no transfers to provinces and territories for long-term care. It’s been very difficult at this point to have an intersection of what to do next. You’ve heard the Prime Minister say that we’re willing to support the provinces and territories to, first of all, get through this critical phase and protect people from future loss of life and all of the other atrocities we saw through the surge, but I also think that there are some structural changes that need to happen.
There’s a real intersection as well, as you know, with the value of care work in itself. It’s something I’ve spoken about in both of my previous roles as the Minister of the Status of Women and as the Minister of Employment Work Force Development. The people who are providing the care in these homes — other than the health care professionals who are nurses and doctors — the personal support workers or attendants, are often people from racialized communities, are often women and are often paid in a way that doesn’t actually acknowledge the level of work that they’re performing on behalf of all of us. There is a much stronger conversation to be had about how we value the work of women. No offence to all the gentlemen in that line of work, and I’ve said this before, but I don’t understand why we value taking care of our vehicles in a greater way than we value taking care of our people. I get in trouble all the time when I say that. I always get angry emails from people that tell me how complex the work is to take care of vehicles, and I’m not denying that, but I’m also saying it’s complex to take care of people.
There’s an opportunity to have a conversation with provinces and territories and the federal government about how we can strengthen standards in long-term care and how we shift our value system to value the work of caregiving, whether it’s in the sector of long-term care or child care. These are extremely important roles that we need to actually value. The valuing of that work, as we saw in the outbreak, led to some of the challenges. When people cannot cobble together enough to make a living by working in one home for 40 hours and have to add another 20 hours in another home just to pay rent, that’s appalling.
Sorry, I’m very passionate about this; I’ll add one last thing and then stop. I was at the Ottawa Public Health unit thanking them for their work a couple of weeks ago — physically distanced, of course, and doing it appropriately — and they were talking about one of the clusters in a homeless shelter that they had solved. It started with two Filipina personal support workers who were newcomers to the country and working in the long-term care sector who had become sick and were living in a homeless shelter. If that doesn’t break your heart, I don’t know what does. These are people who are providing care to our loved ones who can’t make enough, even with full-time work, to be able to afford accommodation in a Canadian city.
I think we have a lot of work to do together, and I hope that wasn’t too long.
The Chair: Thank you very much, minister.
Senator Mégie: Do I have time to put a question to Dr. Tam? I would like to know, especially when it comes to long-term care, whether it would be possible to take into account in your plans all the difficulties associated with physical distancing? For example, you know that rooms hold three or four residents. At a dining table, there could be three or four residents and an employee very close to them serving them food. Are there standards or rather advice or a plan to try to avoid further outbreaks in such situations?
Dr. Tam: We have to take into account constantly evolving science, but also the experience of people who are trying to manage the situations on the ground. We have provided guidance — which is published — to assist long-term care facilities, but we’re actually constantly looking for where else we can help. Our guidance is related to infection prevention and control, which does include what we call the hierarchy of controls that involves the physical space, how you adapt those, as well as other factors like engineering and flow. We do have guidance, but of course, it’s one thing writing the guidance and another to actually implement it. I think getting some feedback on how that’s going in order to adapt the guidance would be critical.
Senator Moodie: Thank you, Minister Hajdu, and everyone here today to help shed some light on the COVID response. My questions will focus on what we’ve heard has been a lack of timely response and a failed supply chain around PPE.
Minister, there have been significant challenges in Canada’s personal protective equipment supply chain. Front-line workers have been placed in a position of having to risk their lives because of lack of timely action. We have heard this from multiple witnesses, but we also read in a Globe and Mail article from June 25 that, for some, there was earlier notification or realization. Some provinces, such as Alberta, responded as early as December 2019 to start stockpiling their supplies. They bought in excess, and they actually were able to share and support other provinces later. We learned from wholesalers of safety supplies that, as early as January, private citizens and individual hospitals were lining up at their doors, only to find that the provinces turned up in March when the supply was long gone. We also learned from the CMA survey that was done in April that 75% of physicians in non-hospital settings were very anxious about a lack of PPE, they didn’t know how to access PPE and they got no information on where their requests were at when they did. So it turns out that January had been a crucial window to stock up.
Minister, can you tell us why the intelligence was not relayed to the rest of the country by the federal government in its role as coordinator of a response? Where were government action, communication and coordination? Why was there such a delay in provinces beginning to procure PPE and the federal government working with provinces to ensure this occurred? Three months into this pandemic, do you have a clear understanding of what went wrong here in our procurement of PPE? Also, the flip side of that is to ensure that this has been rectified moving ahead so that when we face the reopening of our economy and prepare for the second wave, we actually are protecting our front-line essential workers with a PPE supply chain that is dependable.
I have a second question for Dr. Tam, if time allows. I would like to be placed on the list for a second question, if possible.
Ms. Hajdu: Thank you very much, senator. I’ll answer in some broad strokes, and then Dr. Tam can talk more about the work of the special advisory committee as well.
There are a few premises in that question that are not quite accurate. We obviously knew this was a public health concern. Dr. Tam struck the special advisory committee very early in January — she will correct me if I get that wrong, but it was very early in January or earlier still when she convened the special advisory committee — to talk about the growing threat of COVID-19 to Canada in order to activate the response network that has been very helpful. All of the public health officers working together across the country — this is one of the lessons that we learned from SARs, and I’m grateful for their work.
In terms of your questions around the PPE, part of the challenge has been that the federal government isn’t really in the business of providing PPE for provinces and territories. In the early days, in fact, we were trying to ascertain from the provinces and territories what was contained in their stockpile, what additional materials they would require for the particular surge we were anticipating or preparing for, and how we could best place a bulk procurement order. The challenge was that, depending upon the jurisdiction, different jurisdictions had different lines of sight in terms of what they held, what they needed and what they would need as they started to use that. That is commonly referred to as the burn rate.
We became aware early on that this was a challenge for the provinces and territories, and decided to procure federally, making some best estimates and assumptions about what we would likely need as a nation. Very quickly, we drew in Health Canada and Public Services and Procurement Canada to assist in a mechanism and measures that would actually facilitate this procurement.
We also knew, by the way, that there was a very tight supply. Don’t forget that the crisis started in China, and incidentally, that is where a lot of the equipment was created. This double whammy of having a crisis in a country where, in many ways, it is the largest provider of PPE for the world, created a really tight supply chain that trickled and rippled through the world.
That is also why we decided very quickly to stand up a domestic response. That domestic response, as you know, has been federally driven and will provide us with the assurance that we can actually manufacture not just PPE but some of the elements of testing components, for example, that will allow us to deal with the future outbreaks.
We have learned a lot over the last three months in terms of the diversification that we need to have to address the PPE challenges, which the world will continue to face, by the way, as the numbers continue to rise.
I’ll turn to Dr. Tam to talk a little bit about the earlier conversations of the special advisory committee. Thank you, senator.
Dr. Tam: I alerted chief medical officers on January 2. We heard about an unusual cluster of respiratory illness on what would have been January 1, I think, and I had already initiated contact with chief medical officers on January 2. We sent out a public health alert through our systems on January 7.
I did not really hear what Minister Hajdu has indicated, but looking forward, there is a massive piece of coordination within the health care system, which the public health part links into. Regarding the complexity of the PPE supply chains, et cetera, we have learned a massive amount. As I said at the beginning to one of the other questions, it took several federal government departments, working with numerous provincial representatives, to try and figure out the actual requirements and the rate of use. Those elements are now planning forward in a world that is still somewhat precarious in terms of ingredients, supply and trying to build a domestic capacity.
There have been a lot of lessons learned all around. I don’t think the system was alerted, but certainly the public health system was. Regarding the health care piece, I can’t really comment on it at this time, but we’re singularly focused right now in trying to do everything we can to prepare for any resurgence.
The Chair: Thank you very much. Senator Moodie, did you want to try and be on the second round?
Senator Moodie: I would like to, yes.
Senator Omidvar: Thank you, witnesses, for being with us and for all the work that you have done. I have a series of questions for the minister. I’ll keep my questions short, and hopefully we can get them all in.
I’m going to focus on vulnerable populations for the first set of questions, and I will focus specifically on senior citizens. We and you know, minister, that the best place for senior citizens is at home. All the science backs that up. Yet, we also know that senior citizens have significant challenges accessing home care. In 2017, your government committed $6 billion over 10 years to provinces and territories to improve home care services. Do you have a good sense of what happened with that money? How is it being used? What are the results, and has that money actually reached seniors on the ground?
Ms. Hajdu: Thank you very much, senator.
I’ll turn to Dr. Lucas, who may be able to answer in more granular detail, but I want to say that you’re absolutely right; I share your perspective that the best place to age is at home. We know there are people with complex health conditions who do require a higher level of care. Ultimately, it’s everybody’s dream to stay at home as long as possible and age in the comfort of their own home. You’re right there. That is why our government committed an additional $6 billion; it was to try and foster increased access to home care across the country.
It is very difficult, I will say, as I’m still a new Minister of Health, but I’m not a new minister. Whenever these large transfer amounts go to provinces and territories, it’s very difficult to get a line of sight in terms of the granular details of how it is used. There are generally commitments by provinces and territories to measure outcomes, and so I’ll turn to Deputy Lucas who may have a better sense of whether or not we had reporting back from the 2017 commitment.
Dr. Lucas: Thanks. The funds under that commitment were anchored on a common statement of principles on the shared health priorities with provinces and agreed-on basket of areas to focus investment, including in home care staffing and training, and then individual bilateral agreements with provinces, which have reporting requirements including through reporting done by the Canadian Institute of Health Information. So we can certainly follow up in terms of specific areas where actions have been taken and the information from the CIHI that has been provided to date.
Senator Omidvar: Thank you. I’m hearing both of you say that we don’t know yet, but you will get me the answer or you’ll get us the answers. Is that correct?
Dr. Lucas: Yes.
Senator Omidvar: I understand jurisdiction is messy, especially in health. Minister, we heard from one of our witnesses about a solution that is not predicated on negotiations with the provinces, and that is the proposal to create a Canadian home care allowance for senior citizens, a direct transfer of money to people to pay for specifically home care. Can I get your response to that proposal?
Ms. Hajdu: Thanks. I think it’s an intriguing idea. Obviously there are challenges as well in an approach like that to make sure that it would be of sufficient amount and that there would be access to those kinds of home care in the jurisdiction which the person lives. There are a number of challenges, but I am looking forward to seeing the proposed idea.
Again, I think about the rural communities that struggle with access. I represent a riding that is partly urban and partly rural, and even with provincially provided home care, it can be a very precarious patchwork for people that are living outside of major centres. I go back to the challenge of home care workers themselves and the precarious wages that they earn. I don’t know, if many people on this call probably have lived this experience, but having had an aging person in my life and working through the home-care system in Ontario, there is nothing more difficult for both the person receiving the care and the family member to get a call that morning that the care worker can’t come to the house to provide the care. Those kinds of things are, as you know, often related to the unstable workforce that is related to conditions of work.
Senator Omidvar: Minister, you’re speaking to a customer of home care, as my aging mother lives with me, and I cannot describe to you in enough detail how challenging that it is to work with the provincial system, so I for one have opted out of the provincial system and just simply do it privately, but that’s not an option that is available to everyone.
Let me move to a question about another vulnerable population, which is migrant workers. We have heard from witness statements that one of the problems is that migrant workers do not have enough access to PPE even when they are infected. I understand that you said just a few minutes ago that it’s not the federal government’s responsibility to distribute PPE provincially, but I’m wondering if it’s not possible for you, for the federal government, to provide every new migrant worker who lands in Canada — and they will continue to land, because picking season goes into November, possibly even December — to provide each one of these migrant workers, who are so essential for our food security, with PPE on arrival. Just as they get their landing permit, their visa, they get their PPE.
Ms. Hajdu: Thank you, senator.
The issue of migrant workers and infection I would say is far vaster than PPE. I mean, all the PPE in the world will not protect you if you’re sleeping in a bunkhouse that is housing 12 to 15 people that may not have any ability for distancing, certainly no private washrooms or kitchens. There are issues of close-quarter working, depending on the type of farm and produce and producer. I’m actively working on the Windsor-Essex outbreak, and I can tell you that the stories that I am learning about the way that migrant workers are treated, both documented and undocumented by the way, in this country, if you’re not aware of it, would curl your hair. It is a national disgrace the way that workers are treated. I will say it’s not all farmers, by the way. There are many excellent farmers and farm corporations that are doing a good job, but there are others that are not protecting the health of their workers and are not taking it seriously.
The federal government, as you know, paid for the quarantine and protection of workers when they came from other countries to have them properly isolated. There was a high degree of worry by Canadians that this would be a vector for the importation of cases. In fact, there were a few ill workers that were able to get treatment appropriately during that quarantine period, but the outbreaks have been coming from Canadians and undocumented workers that are actually working on the farms and linking with the temporary foreign workers. I would say that PPE is a small component of protecting workers on the farm.
Senator Omidvar: I understand that completely, but there is always somewhere to start. I do hear your concern for migrant workers. I’m gratified to hear you pinpoint bunkhouses. Should I read into that response that the federal government will consider national housing standards for migrant workers?
Ms. Hajdu: Thank you very much, senator. My colleague Minister Qualtrough and I are working right now on her ideas around how to reform the Temporary Foreign Worker program. In the interim, as the Minister of Health, I’m actively engaged with the other levels of government to protect the health of workers first and foremost.
Senator Omidvar: Thank you, minister.
Senator Petitclerc, I don’t have any time?
The Chair: No, you do not. Thank you, senator.
Before we move, we have some non-members here and I do want to allow them to ask a few questions, but I would turn to Senator Forest-Niesing.
Senator Forest-Niesing, we had to interrupt you earlier because of technical difficulties. It seems that the issues have now been resolved and everything is working. You had enough time left for a quick question. If you want to use that time, I will let you take the floor right before we continue with senators who are not committee members.
Senator Forest-Niesing: Thank you very much and thank you for giving me this opportunity. The theme of my questions was the lessons learned. Perhaps I could ask my question in a more general way. Our committee’s mandate is to assess the government’s response to the pandemic crisis. So I will put the question directly to you, minister.
How ready do you think the government was and has it reacted well? What lessons have we learned and what corrections should we make, as a second wave is expected?
Ms. Hajdu: Thank you very much.
That’s a really difficult question to answer, because although it feels like we have somehow reached a milestone, we’re still in the middle of a pandemic and an outbreak in Canada. I will say that we have learned a lot about some of the gaps that made things very difficult in the beginning. Data has been frequently discussed in this meeting and many others, a better sense of what is happening at a granular level and being able to report back up to the federal government.
We have learned the need for collaboration and quick action when there are outbreaks. We have learned of some of the particular aspects — actually it’s not a new learning, but it’s certainly a reminder of how if we don’t invest in vulnerable people and vulnerable settings, that disease and infectious disease can take a foothold and then threaten the health of everyone. This is something that actually has driven me into politics as a former public health official myself, was the understanding that investment in vulnerable people is actually beneficial to the entire society. Good social policy is good fiscal policy.
I think we have learned a lot about the need to invest in public health. The Public Health Agency of Canada is a very small agency. Successive rounds of government have not made substantial investments in the Public Health Agency of Canada to be able to take a robust approach, not just to the protection of health in the case of an outbreak but certainly to the promotion and the prevention of illness in Canada. I think there are important reflections on how we support public health at a national and provincial level.
Are we ready for the next stage of what this pandemic brings to Canada? I would say that we are dramatically more ready than we were during the outbreak because we have developed much stronger relationships with provinces, territories and local governments to make sure that we can act quickly when there is an outbreak. We certainly have a better sense of how to procure at a national and international level. We definitely have a much higher capacity to test and to contact trace when we do have outbreaks. That is, as you know, a critical component of being able to address outbreaks, to be able to quickly and rapidly test people and then have an isolation strategy that includes isolating close contacts.
I think we have political commitment at all levels of government to continue these efforts. I think there is no politician in Canada who does not understand that the economy of Canada is actually critically connected to being able to protect the health of Canadians. We have learned a lot. There will be future lessons to learn, I am certain, but I will again thank the Public Health Agency of Canada and Health Canada for their incredibly hard work over the last several months to get us to where we are.
The Chair: We have our witnesses with us for another 10 minutes, and we appreciate that. I have three non-member senators on the committee who wish to ask questions. If we go to one question directed to one witness and try to focus, I believe we can make it happen.
Senator McCallum: This question is for Minister Hajdu. It concerns equity and ensuring that appropriate resources surrounding research are committed to Indigenous peoples of Canada. Whether these resources are human, financial, research or ethics-related, they must be equally available so that First Nations, Métis and Inuit peoples do not continue to be marginalized. It is through this continued marginalization that Indigenous people will continue to be victims of morbidity and mortality with a second wave.
Will your office ensure the following: That Indigenous researchers, who are experts in Indigenous and scientific knowledge and already have a working relationship with Indigenous people, be meaningfully and concretely involved in the research regarding COVID-19; that indigenous peoples, as per the Tri-Council Policy Statement, and the Tri-Council Policy Statement be respected and practised by the reps of the federal government responsible for looking at the proposals surrounding COVID-19; that the data surrounding Indigenous peoples, as proposed by the Indigenous Advisory Circle, be supported so that there is consistency across the country and compatibility with other like systems, allowing data to be shared across other electronic databases; that proper and formal ethical and rigorous guidelines are followed, as this research involves the human lives of Indigenous peoples; and finally, that the real or perceived personal conflict of interest is noted by the individuals who are reviewing and making decisions on the proposals. Thank you.
Ms. Hajdu: Thank you very much, Senator McCallum.
I will just tell you that we have had the inclusion of Indigenous people and the leadership of Indigenous people at the heart of our research agenda. In fact, we have Indigenous advisory for the COVID-19 Immunity Task Force.
I will quickly turn to Dr. Strong, though, because I know he is heavily immersed in this particular aspect of our response. Dr. Strong?
Dr. Michael Strong, President, Canadian Institutes of Health Research: Thank you, minister.
Thank you for the terrific question. We have, in fact, been incredibly focused on ensuring that we do meet the needs of our Indigenous colleagues from a research point of view. As an example, I can point to the most recent rapid response phase two component where we, in fact, made sure that funding was available to meet our obligations and actually exceed them with regard to the funding of Indigenous researchers. That is a primary focus for us and will remain as such.
The same thing with regard to conflict of interest. It’s a very important issue that you raise there. It is something that we are at all times attuned to, particularly our Institute of Indigenous Peoples’ Health. Research has been watching that very carefully and ensuring that there is no conflict with respect to the reviewing process as funds come forward.
Your question is well-founded, but we are working very hard, and on this last cycle, we in fact were able to meet and indeed exceed our goal.
Senator Pate: Thank you, minister, for the work of you and your colleagues.
My question is for Dr. Tam. Despite UN and World Health Organization recommendations for depopulation strategies for prisoners, as well as such a call from more than [Technical difficulties] 150 health professionals [Technical difficulties] not to mention the direction from Minister Blair himself at the end of March to reduce the risk to prisoners, staff and the general public, CSC did not engage in such a strategy. Instead, contrary to international and Canadian law, as well as doctors’ recommendations, prisoners were isolated and have been kept in conditions of confinement for months that medical and legal professionals have described as physically, psychologically and neurologically damaging, and indeed, that can amount to torture.
Dr. Tam, from our correspondence and the previous evidence of the public health authorities before this committee, it was indicated that recommending depopulation of prisons in order to permit humane and appropriate physical distancing, as well as public health and hygiene measures, falls outside of your mandate. This means the decision that has significant import on the health of prisoners, staff and members of surrounding communities was left to CSC, Correctional Service Canada.
As a result of urgent calls to us by prison-based health professionals as well as staff members who were concerned that internal public health advice and standards, including regarding depopulation, were not being implemented by CSC, as you know, I wrote to you a couple of times, as well as other provincial and territorial health authorities, requesting that you intervene to inspect and audit the conditions in prisons.
I’m curious and would like to know, please, did you provide any information regarding the vital public health dimensions of depopulation? Did CSC benefit from any other independent public health advice in reaching its decision not to engage in the depopulation exercise and instead to utilize the segregation measures?
Dr. Tam: I cannot comment on the decision regarding depopulation, but I can say that the Public Health Agency and Health Canada were both engaged to provide expertise in infection prevention control of environmental health and also of occupational health, most notably in British Columbia, at the Mission Institution. As a result of the lessons learned and the linkage with particularly local public health but also provinces, we essentially provided advice.
But we do know, at least based on what we were provided, that of Correctional Service Canada’s 43 institutes, I think all of them — we can double-check — would have had an inspection and an audit of their practices now. I think they were trying to translate the knowledge across all of the institutions. Also, we provided tools, training, webinars, training on PPE, as well as guidance on how to do rapid detection and an outbreak response with the local public health departments. I know that probably more needs to be done, but I do know that those elements were completed.
Senator Pate: Thank you.
Senator Bovey: I would like to thank the minister and Dr. Tam for being with us.
My question will be quick and has to do with the Arctic. We were fortunate, I believe, that the first wave did not have outbreaks in the Arctic, but there were serious consequential issues such as food security, cost of security, interruption of video medicine and concerns for mental health. Can you illuminate us further on the preparedness for a second wave that may come to the Arctic, given the distances and the irregularities of the internet? I’m concerned particularly about PPE and testing in the North.
Ms. Hajdu: Thank you very much, senator.
I think Dr. Tam has said so many times that the best prevention is preventing it from getting into vulnerable populations in the first place. First of all, I want to thank Inuit, Indigenous and Métis leaders for their incredible work, and Minister Miller, quite frankly, who made a strong appeal to essentially self-governance by saying we will provide funds but that in fact it’s the Indigenous leaders who will know best how to manage and prepare their own communities. I’ve heard from 12 communities in my own riding that that was a pivotal component to their response. To have the flexibility of the funds without attachments for how they would be spent was, I think, critical in what we’ve seen as largely successful responses of Indigenous communities to prevent the exposure.
We have been equally focused on trying to ensure the operationality of the North, as you point out. We know it has unique challenges in terms of transportation and food security. It has been a whole-of-government response. The Minister of Transport, for example, and the Minister of Northern Affairs are ministers that have been actively engaged and bringing to the table every step of the way various components of life in the North that were precarious or threatened by the extreme measures of isolation that had to be put into place to protect these communities.
We will continue to work with Indigenous and Inuit leadership to make sure we understand an effective response that also allows for that connectivity in a number of ways that you mentioned. We have also been working on improving access to broadband and high-speed internet because we know that is a partial solution for some of these things that you spoke about — access to remote health care, digital health care, but also digital learning and all of the other things that, in a way, Canadians are all waking up to how hard life is in the North because they’re also having to use digital ways to connect with all kinds of care and services.
It’s important work that we do with Indigenous, Inuit and Métis communities to make sure they truly are leading the response, and we’ll continue to have that approach. So far, it seems to be working. Again, I want to thank all Canadians, including Inuit, Métis and Indigenous communities and members, for their incredible self-sacrifices that have led to Canada’s ability to flatten the curve.
The Chair: Thank you. We did begin the meeting with some delay, and I’m happy to hear that our witnesses, the minister and her team, are agreeing to stay with us for another five or ten minutes. We absolutely appreciate your time. Thank you. This does provide for a few more questions on a second round. Let us try to stay with one question to one witness in order to maximize the time. Again, thank you, minister, for this time.
Senator Poirier: Again, thank you, minister, for allowing this.
My question is for you, minister. Earlier in my questions, Dr. Tam talked about the stockpile that was possibly under-funded and under-stocked in the National Emergency Strategic Stockpile. Minister, at what point were you or was the government made aware that there was a shortage in the stockpile and that it was underfunded?
We’ve also heard from many of the witnesses the fear of the second wave and not being ready for that second wave, and a lot of them feel that we’re not ready. Could you please confirm to us the condition of the stockpile at this point in the National Emergency Strategic Stockpile? Are we funded? Are we ready for the second wave going forward?
Ms. Hajdu: Thank you very much for the question.
I think Dr. Tam’s remarks reflect the fact that the National Emergency Strategic Stockpile was not meant to stockpile huge volumes of personal protective equipment. Furthermore, it’s challenging for the National Emergency Strategic Stockpile to do that because, in fact, different infections would require different kinds of PPE and different kinds of equipment.
Having said that, we know what’s required with COVID-19, and, in fact, Procurement Canada has a dashboard available publicly that can give you a direct line of sight in terms of what we’ve ordered and what we’ve procured.
We have an agreement with the provinces and territories that 20% of what we acquire we hold back in the National Emergency Strategic Stockpile so that we can augment their needs should there be a particular surge in any particular region of the country. I have to thank my provincial-territorial partners for working so hard on that. This allows them to also build up their stockpiles with the equipment they may need for any particular surges, second wave or whatever does appear, while allowing the federal government the ability to build up again what we need to support that.
Frequently, provinces and territories will ask for equipment and/or personal protective equipment from the National Emergency Strategic Stockpile. I think we’ve had over 45 of these requests, and we’ve managed to fulfill all these requests for provinces and territories, so I think we’re on the right track.
In terms of when did I know, I was appointed about a month and a half before the pandemic outbreak. We were preparing budget letters, requests around flu vaccine, et cetera. Those conversations happened very early in terms of what we did and didn’t have and what we were going to need to procure.
Finally, in terms of the federal government’s commitment to procuring enough PPE, I can tell you that no expense is spared to make sure Canadians are ready for whatever the next wave looks like.
Senator Poirier: Thank you, minister.
The Chair: Senator Seidman, did you want to ask a question?
Senator Seidman: I did. Thank you very much. Actually, it’s a question that I think the whole committee was perplexed over, and maybe the health minister can help us.
We heard from Réjean Hébert and Roger Wong, who were both members of your Task Force on Long-Term Care, convened by the Office of the Chief Science Advisor. Both of them indicated the force had had five meetings but there were no meetings planned. The task force seemed to be finished its work, but there were reports being prepared. The first report was going to be focused on immediate actions and the second on more medium term. I’m wondering if these reports are going to be made public, and if, in fact, that task force has finished its work or if its mandate is over. If so, is it not going to be around to monitor or advise on implementation recommendations?
Ms. Hajdu: Thanks, senator. I’ll try to give some general comments and maybe my officials will know more. The chief scientist has her own task force. They don’t report to me, so I’m not aware of what their future plans are. I will turn to deputy minister Stephen Lucas to provide additional information.
Dr. Lucas: Thank you, minister and senator.
The task force was to look at short-term recommendations and longer term. The reports were prepared, and my understanding is that they will be posted.
Certainly now with those reports, a multiplicity of other studies, the report from the Canadian Forces, at present there is a significant body of information to help inform actions to be taken, as the minister has noted, including conversation about national standards and the infection prevention and control that needs to be in place to help protect these vulnerable people.
Should the need arise, we would work with the Chief Science Advisor in terms of convening the group to look further, but the emphasis now is with the body of work, including from the task force, to look at taking action across the country through provinces and territories to ensure that our seniors are protected in long-term care and other assisted living facilities.
Senator Seidman: Thank you.
Senator Munson: I’ll ask this question to Dr. Tam, although the minister might want to answer it.
We’ve seen what’s happening in the United States today, so close by. Dr. Tam, there have been some scientists today, in one of the major newspapers, really warning that there is going to be a second wave and that it will be ten times bigger than the first one. It’s difficult to say “if,” but it’s always lingering there. What would you do if that took place in this country again? Are you, and minister, ready to isolate the country again, in even a more severe way? Now that we’ve had the opportunity to wake up and breathe, it may be a very difficult thing to do.
Dr. Tam: Right now, the border restrictions that have been put in place with the United States and with other countries still remain, except for a certain exempt group of essential service workers or people who transport our food, for example. There is still a 14-day mandatory quarantine for those coming into Canada. Those are some of our key public health measures. Those are still in place.
We will not be moving fast except very close discussions with the provinces and territories as to where things are domestically. Totally conscious of what’s going on to the south of us, the epidemiology of what’s going on in the United States forms a key part of input into the advice. Carefully, slowly, has been the mantra or the principle of the reopening to date, and I believe that will continue.
We are preparing for surges, and those might come in the fall. We hope they won’t come earlier. We do have to prepare for the worst-case scenario, or what we call the reasonable worst-case scenario, while at the same time doubling down on the effort to put down any little sparks of introduction or a resurgence. That is the strategy, putting out those fires or sparks at the same time as still preparing for a potential bigger wave.
The Chair: Minister, did you want to add something to that before we let you go?
Ms. Hajdu: Yes. I’ll just agree with Dr. Tam that slow and steady has been our focus.
I think your question was less about the border and more about watching what’s happening to the south of us and whether or not that would be a possibility here. Anything is a possibility. We don’t know the virus. We don’t know how it will change, and we don’t know so much about it. What we have learned over the last six months are things that we can do to better protect Canadians.
I will also say there’s a big difference between the U.S. and Canada in terms of how we’ve dealt with the virus and the communications around the virus from the very beginning. We don’t have the level of political animosity that we see in our southern neighbours around whether or not the virus was real, if you’ll recall, in the early days. No politician in Canada questioned whether or not this virus was real, which helped Canadians take it seriously.
We have a public health care system here, so there are no barriers to testing or treatment. People are not constrained by financial resources to come forward and get a test. That’s not even a concept for Canadians, that they would have to pay to find out whether or not they have COVID-19. Most of us have grown up with the benefit of a public health care system that provides access.
I’m very proud of my colleagues who understand that our economy is critically linked to the health of Canadians. There is not a dichotomy, as we see in some other jurisdictions, where it’s health or the economy. In fact, in Canada, with my colleagues around the cabinet table, we are very aware, and I would say provincially as well, that the economy is actually dependent on the health of Canadians. Raise your hand if you want to go to Texas today. Not me. The United States added 34,000 cases — and that’s just the cases they know about — yesterday. This, obviously, has a very detrimental effect on their economy.
We believe that in order to continue the reopening of the Canadian economy, we have to do so with Canadians’ health at the centre. All of the work we’re doing to increase our capacity, to test, to trace, and to make sure Canadians understand the need to continue to physically distance and protect themselves, to wear masks when they can’t be physically distant, all of that work has to continue while we also slowly and cautiously reopen our economy.
As Dr. Tam says, I have no doubt that we will experience outbreaks, but I am increasingly comforted by the fact that we are learning rapidly what to do when we see those outbreaks. I’m also comforted by the level of collaboration I’m seeing across the country, no matter what the political party of the leadership at that level is, that there is a willingness to come together and solve these very difficult challenges. Thank you.
The Chair: Thank you all for your time, your availability and your testimony. This has been very helpful as we conclude the first part of our study and get ready to write a preliminary report today and Monday. This is very timely and much appreciated.
I thank everyone.
We are continuing our study on the government’s response to the COVID-19 pandemic, and we are now hearing from our witnesses for the next hour.
We are welcoming, from the Department of National Defence and the Canadian Armed Forces, Major-General Marc Bilodeau, Deputy Surgeon General/Director General of Clinical Services, Canadian Forces Health Services Group, and Brigadier-General Lise Bourgon, Director General, Operations, Canadian Joint Operations Command.
We will begin by asking Brigadier-General Bourgon to make her opening statement.
BGen. Lise Bourgon, Director General, Operations, Canadian Joint Operations Command, Department of National Defence and the Canadian Armed Forces: Thank you very much, Madam Chair.
Madam Chair, distinguished members of the Standing Senate Committee on Social Affairs, Science and Technology and COVID-19, thank you very much for the invitation to discuss the role the Canadian Armed Forces has played and the whole of government response to the pandemic. I’m accompanied by MGen. Marc Bilodeau, the CAF Deputy Surgeon General. We have both been closely involved with the planning and execution of the CAF response to the COVID-19 pandemic.
The Canadian Armed Forces involvement and response to the initial stage of the pandemic began under Operation GLOBE, our military support to Global Affairs Canada in the repatriation of Canadians outside of the country. While Global Affairs Canada was responsible for coordinating the logistics of returning flights during Operation GLOBE, the Canadian Forces Health Services medical personnel on board the aircraft ensured that pre-boarding, in-flight and post-flight screening protocols, developed in close collaboration with the Public Health Agency of Canada, or PHAC, were followed to make the flights as safe as possible for repatriated Canadians.
Upon arrival in Canada, the Canadian Armed Forces, in coordination with PHAC and the Red Cross, facilitated the quarantine period of over 870 Canadians at CFB Trenton.
As COVID-19 evolved to take on global pandemic proportions, the CAF initiated Operation LASER, an operation designed to protect its own members and to be able to respond effectively to Government of Canada objectives and requests for assistance. Task forces were made ready in each of our six Joint Task Force regions, with ships and crews available on each coast, an Air Task Force LASER with dispersed supporting detachments, and additional RCAF assets on reduced notice to move, all to support Canadians.
At its peak, 24,000 service personnel were mobilized, ready to respond to government requests to assist Canadians across the country. This included not only 7,000 Reservists but also 1,180 Canadian Rangers specifically on standby to support the unique needs of our northern and Indigenous communities.
In April, the Government of Canada received requests for assistance in managing the deteriorating situation in long-term care homes in the provinces of Quebec and Ontario. The CAF was tasked to provide medical and non-medical support to COVID-afflicted long-term care facilities, or LTCFs. CAF members received specialized training and personal protective equipment, PPE, to ensure that they were prepared to carry out this non-standard military task, in order to safely and effectively support a uniquely vulnerable population.
We recognize that COVID-19 poses unique hazards for CAF members operating in these environments. To date, we have had 55 members, 41 in Quebec and 14 in Ontario, working in LTCFs who have tested positive for COVID-19. Of those, 49 have recovered. None have required hospital care.
Recently, we acquired additional testing capability that allows us to strengthen our screening processes. CAF members are now tested prior to deployment in a long-term care facility, as well as at the end of their post-deployment isolation. This approach ensures that we reduce the risk of spread of the illness within the CAF, the LTCF or within the civilian population.
Additionally, we have developed new tactics, techniques and procedures regarding force health protection that will improve CAF responses in a COVID environment. We are also acquiring more personal protective equipment in order to ensure that we are ready to react to any future requirements, be they pandemics, fires or floods.
As of today, June 26, CAF support to the LTCFs in Ontario and Quebec is drawing down. CAF continues to support one facility in Ontario — Woodbridge — until July 3. In Quebec, CAF teams will remain available and on call to support five LTCFs until all the conditions have returned to green.
So far, we have provided CAF Augmented Civilian Care teams to a total of 54 LTCFs, 47 in Quebec and 7 in Ontario, which has helped stabilize the situations in those homes so that the provinces have been able to resume control. We are proud of the work that our members have done under trying conditions, at risk to themselves. Should the government call upon us again in this capacity, we have a contingency care task force comprised of 10 trained, properly equipped and ready teams with associated support troop elements, able to respond on 24-hour notice and for as long as needed. They are currently positioned in Montreal, and I am very confident that they can and will respond once again, quickly, effectively and compassionately, as they have done in the past four months.
I would like to conclude by saying that the safety, health and well-being of our CAF members, whether on operations at home or overseas, are always of paramount concern. To ensure the mental well-being of our members working in the demanding environment of Operation LASER, we have a tailored reintegration package to bridge the gap between their LTCF employment and home.
Thank you very much. Major-General Bilodeau and I are looking forward to answering your questions.
The Chair: Thank you both very much and thank you for joining us. I also want to thank you on behalf of all the senators. I am thinking of all the members of the Canadian Armed Forces and can tell you that we all have so much appreciation for the work you do on the ground. We appreciate you being here today to answer our questions and help us in this study.
We will proceed with questions from the senators. I will remind you, as usual, you have five minutes for your questions and answers. I will remind you even more strongly, knowing that we have our witnesses for only the next hour, so please be mindful of that and the time that you take in asking questions in order to get the answers that we want.
We will begin with the deputy chair of the committee, Senator Poirier.
Senator Poirier: Thank you both for being here today, and a big thank you and appreciation to all the Canadian Armed Forces members who answered the call and are, unfortunately, putting themselves at risk of harm also.
The report that came out in May showed that the long-term care system in Ontario is broken, and unfortunately we don’t have the time to fix it before the second wave will probably come upon us. Could you please advise us if you feel that you have the human, financial and material resources you need to answer to a second wave in the long-term care homes like the army has done during the first wave?
BGen. Bourgon: Thank you for the question.
I think when you look at the Canadian Armed Forces, we are the force of last resort. We have our members ready to assist as we are asked by the Government of Canada. So indeed, we have the personnel, we have the resources, and when we are asked to go back to the LTCF because there is a demand, we will do it.
Senator Poirier: Okay. What was the biggest challenge that you experienced so far with the Armed Forces in the long-term care homes?
BGen. Bourgon: I think I’m going to talk first and then I’ll give the floor to General Bilodeau. I think for us, the CAF, this was quite a different task than we have ever done before. From the get-go, the training that we had to do, the logistics and the coordination with the long-term care homes, so that we would know our roles and what the requirements were, I think for us was probably the biggest challenge because this is something new. We are used to helping Canadians in flood and fire situations, but that was the first time in the long-term care homes. That was the big lesson learned for us. Marc?
Major-General Marc Bilodeau, Deputy Surgeon General / Director General of Clinical Services, Canadian Forces Health Services Group, Department of National Defence and the Canadian Armed Forces: If I may add, the biggest challenge from my perspective as a physician is that this environment we were putting our members in was highly infectious. It’s a very high-risk environment from that perspective, which required a lot of preparation in order to make sure that our members were as protected as possible in order to protect their health, but also the health of the civilian co-workers who were already in these homes, and most importantly the health of the residents of those long-term care facilities.
The fact is that this type of medical task is new for us, because obviously we have never been engaged as armed forces in long-term care facilities before, and it required a lot of preparation too. That was part of the training, to understand what those health care environments were and how we could support despite the fact that we are not experts in the field.
Senator Poirier: Thank you. I have two more short questions so I will wrap them both together so I hope I can get them in.
First off, we had heard a lot of places where they are saying there is a shortage of PPE equipment. I was wondering if that was the same issue for you when you went into the Armed Forces. Was there enough access to the PPE?
Also, during the first wave, there were just two provinces you had to come in and help. I’m just wondering, with the second wave, if the need is to go to other provinces across the country, are you equipped and ready for that? Do you have the manpower for that?
BGen. Bourgon: I’ll start the question on the PPE. From the PPE perspective, there are always two kinds — the medical PPE and the non-medical PPE. Initially, before this crisis started, the PPE was left at the discretion of the regional, so each of our bases and wings were responsible for the procurement of their equipment. With the COVID-19 crisis, we quickly realized as a whole of government that there was not enough PPE available. So PHAC and PSPC took control of the procurement process for all the federal agencies, and they are coordinating a major buy, which they have already done. The equipment is starting to come in slowly.
For us on a non-medical piece, what is super important for us is the gloves and the masks. The big procurement, as I said, that was done, of course, is coming from China. It has been delayed a bit, but we are strongly confident that it will arrive in the summer, so that in the event that there is, indeed, a second wave, we will have the right equipment so that we can do the job.
I’ll give the floor to Marc on the medical stuff, and then I’ll come back with what we can do for the provinces in the future.
MGen. Bilodeau: In addition to the gloves and non-surgical masks for health care professionals, what we need are N95 masks. I’m sure you have heard about that. This is a resource that is hard to procure now as we speak. But also, the gowns as well as some face shields. This is additional equipment that we initially had challenges in procuring, but now we’re in a better position and are starting to build up our stockpile that will allow us to be prepared for potential additional requests. Back to you, Lise.
BGen. Bourgon: For the helping of the other provinces, we have a finite amount of medical personnel. The Canadian Armed Forces only have the medical personnel that we need to take care of ourselves and also for our deployed operations, so we don’t have a lot of medical people. Of course, if another crisis comes and we need to support more provinces, we’ll have to prioritize. If all our people are going to be again as a force of last resort, we will get all our personnel and we’ll put our teams together, but then there will have to be, at the federal level, kind of a prioritization so that we can ensure that the critical facilities in the provinces are supported as best we can with the resources that we have.
Senator Poirier: Thank you very much. Again, thank you for all that you do for us and the country. Greatly appreciate you guys. Thank you.
Senator Griffin: I had a couple of brilliant questions to ask, but the material has already been covered, so I will pass, with thanks.
Senator Moodie: Thank you to the witnesses today.
My questions are focused around your experience and a little bit around the supports you needed while you were in the role of supporting the long-term care homes. In terms of the exposure that your members had, can you give us a sense of how many were infected themselves by COVID-19? Was there transmission to any member of staff in the military?
Secondly, what did you do and how did you approach testing? Was that something that was done by you as a separate organization, or were you tested within the context of the homes in which you worked?
I think the third question has to do with how you operated and what you saw as the supports that were present. Did you carry your own medical staff into each home, or were you reliant on the medical staff that existed within the homes? And to what extent did you feel there was a deficiency of support from medical staff within the homes? Thank you.
MGen. Bilodeau: As we mentioned during the opening remarks, we had 55 of our members who became infected while working in long-term care facilities. All of those members, except five, have fully recovered. The others are recovering now, and none of them required hospital care. So overall, that was a benign disease for them.
We are not tracking any secondary infection from those members, which means that after we identified that they were positive or that they were sick, they were quickly put in isolation. Obviously, they recovered and are isolating from others to avoid others becoming infected.
Of note, 40% of those were asymptomatic, which means that they were tested, because there was a testing regime within the long-term care facilities trying to screen out people and identify those asymptomatic carriers that could be the source of an uncontrollable outbreak. That’s one of the ways that some of our members were tested.
The other mechanism we have in place is we had a clinic supporting each of those missions, one in Toronto and another in Saint-Jean, Quebec. If our members had any symptoms, they were by themselves, away from that long-term care facility, and they would seek medical care at our clinics, where we were able to get a sample from them and send the sample to a civilian lab in order to get a diagnosis. That’s how we were able to diagnose the different members who were positive initially.
Now we have a more proactive testing system. Initially we didn’t have access to other tests except the ones from the civilian health care system. Now we have a contract with a private lab that is allowing us to be more proactive. Before a member goes into a new facility, we’re able to test them in order to make sure they were not an asymptomatic carrier who could bring the disease into the facility.
We also have a process to test them at the end of the mission, once they have done their 14 days of isolation, before bringing them back home. This way, we can make sure they’re not making anybody sick in their home or their workplace.
Regarding your question on the support to the medical staff in the facility, we brought nurses and medical technicians who were carrying out the role of the personal support workers in the long-term care facilities. We felt this was the biggest contribution, which was requested by the provinces we supported. There was no requirement for physicians in the nursing homes.
In addition, there was some non-medical staff who were there to support more logistical tasks and cleaning tasks and other similar types of tasks.
BGen. Bourgon: As soon as our CAF members deployed, they deployed with a reconnaissance team. They would meet with the facilities and establish the needs. The CAF contribution depended on the requirements on the ground. As Marc said, there were nursing personal support workers and also the traditional soldiers who carried out other duties as there was a requirement on the ground. Each facility had the same structure, but it depended on the demand on the ground, and we targeted specific requests and requirements.
Senator Moodie: To be clear, I’m hearing from you that at no point did you feel there was a deficiency in medical support you encountered within the settings and in fact what you provided was needed?
MGen. Bilodeau: We need to define “medical support.”
Senator Moodie: I mean a physician available to ask a question or provide support on standards, or isolation standards or anything like that.
MGen. Bilodeau: There was some mention in the Ontario report that there were some challenges in reaching out to some physicians in some of the long-term care homes. This hasn’t been a systemic issue from our perspective. These were anecdotal findings that were part of our report and were communicated to the province. I’m not tracking that this was a systemic issue, though, in most of the long-term care homes.
Senator Moodie: Thank you.
Senator Munson: Thank you for your service to our great country.
Was it voluntary or mandatory for the military services to go into these homes?
BGen. Bourgon: Senator, we are soldiers, so we take orders very well. It’s not a volunteer basis. This is part of our duties and assignment. The soldiers were chosen. They were available and they were deployed because that’s what Canadians needed. That’s our job.
Senator Munson: It’s good to hear that.
The committee did not hear from the owners of the privately regulated nursing home sector. With military intervention to assist nursing homes in the state of crisis, you have your first-hand experience. To what extent did the private sector differ from the public one? Which one was worse?
MGen. Bilodeau: It’s hard for us to comment on that because we have only been exposed to a sample of all the long-term care homes in Quebec and Ontario. There is really no way for us to make a conclusive statement regarding the status of private and public long-term care homes.
The homes we attended were all initially in very bad shape when we arrived, and we were able to provide some support. There were private and public long-term care homes on that list.
BGen. Bourgon: The soldiers were given orders to support, but what I really wanted to point out in my previous answer is they were so proud of doing the job and helping the residents. All of them, after and even as they were still doing the job, are extremely proud. Their experience was extremely valuable, and they have all loved their time in residence. So yes, they did it because they were ordered to do it, but they are feeling good about it.
Senator Munson: I appreciate that very much. When I was a reporter some time ago, I was asked to go to Chernobyl and I wasn’t forced to, but I had said no. Covering other stories when you can actually see something in war zones, you go and you cover them and you have to do them. Sometimes when you can’t see what the disease may be, for some individuals there could be a bit of fear when walking into that environment. I asked it and I expected your answer, but I think it’s just good to know that our soldiers are on the front line in that regard.
We have heard in these discussions with Dr. Theresa Tam and others about amending the Canada Health Act to cover regulation and the needs of long-term care homes. From what you saw in your interventions into 30 of these long-term care homes in Ontario and Quebec — I know you’re public servants, but you’ve seen everything — do you support an amendment to the Canada Health Act to cover regulations in these homes? From the perspective of many, the lack of regulation has left us where we are today, with 80% of the infections inside these nursing homes.
MGen. Bilodeau: It is obviously outside of my role to comment on that. All I can say is we were called to do a mission. We brought all of our energy into that mission, and we delivered on that mission.
Senator Munson: I know you have a uniform on and I respect that, but from what you saw, do you think there needs to be improvement, through regulation or whatever, in nursing homes across this country so that soldiers don’t have to be called into this kind of environment? Soldiers are made to defend our country and, of course, engage in other activities.
MGen. Bilodeau: We all agree there is room for improvement, of course, because the fact that the CAF has been called to support shows that there were issues.
I’m confident, though, through our engagement with the two provinces, that they are fully tracking the requirement to improve what they had and that they have a good plan to move forward with that.
Senator Munson: Thank you.
The Chair: Thank you very much for those answers to questions that are not easy.
It’s very helpful for us, but it’s not always easy for the witnesses and we appreciate it.
Senator Forest-Niesing: I thank the witnesses for joining us. I will continue along the same lines as Senator Munson. I would like to put a question to you about the issues you mentioned in the reports produced for Quebec and Ontario.
If it was determined that there were also issues in the territories and in other provinces, what do you think the federal government’s role should be toward what would [Technical difficulties] in terms of long-term care across the country?
MGen. Bilodeau: This question goes well beyond the role of the Canadian Armed Forces. It is difficult for us to comment on it more specifically. It is clear that the issues we have identified must be used as lessons for other provinces, and we hope they will be communicated to the institutions in order to better protect them against a potential second wave.
Senator Forest-Niesing: Thank you, I do realize that my question was fairly broad and that it is difficult to answer it.
I have a question about issuing a call for innovation to find solutions to the main challenges Canada must face alongside an upfront financial commitment of $15 million.
Can you describe to us the initiative to seek out innovative ideas to address the challenges Canada is facing during the pandemic? What departments and organizations are collaborating on that initiative?
MGen. Bilodeau: I cannot tell you exactly what departments and organizations are collaborating on it.
We have heard of various investment opportunities stemming from those programs, and that enabled us to create a list of medical priorities in terms of research areas that could benefit us.
Anything to do with infection control, including personal protection equipment, is an important area of research. There are many things we still don’t know about this virus, and I think that the more we learn about how to protect people — be they health professionals, patients or the general public — the better of a position we will be in to reduce the morbidity of this disease over the next few years. Vaccine development and developing specific therapies against the virus are worthwhile areas of research.
As for National Defence, our mandate is unique and different. What we must study more is how we can continue to operate as a military organization in a highly infectious environment, such as the COVID-19 environment, and how we can continue to carry out international operations and domestic training on our various bases in a safe environment.
I think that will be our research objective: to determine how we can protect our troops while continuing our missions.
BGen. Bourgon: During the pandemic, we have learned many good lessons when it comes to residences, but also when it comes to operations. We are now working with Zoom; that is something we would have never thought about before Christmas. So we have not had any choice but to adapt because of the pandemic. I think that has opened a Pandora’s box and that the way we operate in everyday life will change a lot.
This situation makes us think differently, and we will continue to move ahead by thinking differently.
Senator Forest-Niesing: Thank you.
Senator Kutcher: Thank you for your service and also for being with us here today. Thank you for the tremendous work that you did by stepping into the breach when it was so desperately needed.
I understand that the Forces were deployed to both public and private facilities. That’s correct? My understanding is correct? Thank you. With deployment to the private facilities, are you recovering all your costs for assisting in private health care?
BGen. Bourgon: When we do requests for assistance, the cost recovery is at the Minister of National Defence and at our DM perspective. So at this point right now, we are tallying the costs of the spending and the manpower and the equipment, but this is way above our pay grade. That is a discussion that will have to be at the Minister of National Defence and our DM for cost recovery and federal help and all that stuff. We’re not going to go there.
Senator Kutcher: Can we ask, then, that we get that question answered for this committee so we will see if we have cost recovery for taxpayer dollars used for private health care?
The Chair: Yes, we can.
Senator Kutcher: Thank you.
What has been the impact of providing health care services to long-term care facilities on the health care needs of the armed forces personnel? Was there a loss of capacity to provide for health care for the forces?
MGen. Bilodeau: This has been a challenge for us because we obviously have a limited amount of health care professionals working in the Armed Forces. This has required basically an all-hands-on-deck, if you will, approach in order to support that many long-term care facilities.
It took place at a time, though, when most of the society was shut down, as you know — I’m sure you’ve all been a victim of that — where there was a decrease in not necessarily the needs but a decrease in the demand for health care. This hasn’t been unique to the Armed Forces. This has been seen in all of society. There has been a decrease in demand for ambulatory type of care, for family medicine type of care. Many physicians in the country were available but not busy because people were not showing up, either because they were not comfortable with the virtual approach or because the clinics were just not accessible to them because of the lockdown.
Obviously we haven’t seen that increase in demand, which doesn’t mean that there was no increase in distress. We’re expecting that there might be a demand that will increase now that the societal public health measures are relaxed, and we’re ramping up our teams, our health care teams. We have medical professionals working in 37 different locations in the country to provide primary care but also mental health care, and we’re setting them up, having them ready with virtual care settings but also physical setting meeting the public health restrictions —
Senator Kutcher: Excuse me, Major-General. That’s good to hear, but it would have been very hard for you to predict a 40% drop or whatever the percent drop would have been for demand. Yet you deployed Canadian Armed Forces without knowing that you could easily meet the demand for care from the Armed Forces. That’s what I understand.
I have another question. Had there been need for deployment overseas, could you have deployed the necessary health personnel to do that?
BGen. Bourgon: When we were asked to support the LTCF, we looked at the capacity that we had, with what we had to support outside Canada and within Canada. We took everybody that was available to support, and we directed them to the support concept with the LTCF. We took a little bit of risk in our own clinic with the day-to-day routine checks that were not happening. But at the end, it’s a question of the Government of Canada was asking CAF to help citizens and Canadians, and we took all the resources and got the job done.
Senator Kutcher: I’m not criticizing you at all for doing what you did. Thank God that you did what you did. I’m just concerned that you may have inadvertently, by responding to these needs, not met the needs of our own Canadian Armed Forces, and had a deployment necessity occurred, gosh knows we can’t predict that, whether that would have put our own troops at risk.
BGen. Bourgon: You’re right. There was a cost to deploy our medical — because as I said at the beginning, we only have a finite resource of medical facilities, but we prioritized. Canadians in Ontario and the senior citizens in Quebec needed it more than us. Therefore, we supported them. There was a cost to our own services, but that’s life.
Senator Kutcher: Thank you so much for that. It is much appreciated.
Senator Mégie: I thank the witnesses. My first question follows up on the one asked by Senator Kutcher. You have learned lessons from the pandemic. However, if there was a new wave, would your military personnel be better prepared to deal with another crisis and would you have enough personnel?
BGen. Bourgon: We have learned many things medically speaking and in terms of training. As I said in the beginning, we had never worked in extended care facilities. We developed our training very quickly to enable our soldiers and our medical technicians to provide support as quickly as possible. We will knock on wood and hope there will be no next wave, but the training is already done. We have also learned to coordinate with Ontario and Quebec, with various health departments. The Canadian Forces don’t have a lot of experience in that area. We have learned many things. We are starting to work with the Red Cross. That is another organization we are learning to work with and to share with. As for the number of soldiers, that always depends on requests for assistance. We have about 100,000 soldiers. We have medical capabilities, but they are not very high. It is a matter of prioritization. The federal government and the provinces will have to discuss how the Canadian Armed Forces can help to the best of their ability based on the needs on the ground. That is really the question.
Senator Mégie: Given the close proximity of your soldiers on naval vessels, such as ships and submarines, how do you manage to ensure their well-being in that context?
BGen. Bourgon: When it comes to ships, we have been isolating members of our crews for 14 days before we send them out to sea. At the outset, we could know who was clean, if I may put it that way, when they left the shore. So at that point, they could be close to one another because it was known that no one was infected. That is what has enabled us to conduct operations. We had other ships at sea for a long time where there were no cases. After 14 days, we were a bit more certain that no one was sick or contagious. At that point, the proximity is not a problem.
Senator Mégie: Okay. Thank you very much.
Senator Pate: Thank you to both of our witnesses for being here. Thank you to all of the Armed Forces personnel for the work they do. As a service brat some years back, obviously, I’m very appreciative, also as someone who has a mother in a long-term care facility.
I read with interest some of the reports that have been put out, particularly the one by Brigadier-General Milkowski. In it, there are a number of examples of failure to provide adequate care for reasons that appeared to have to do with cost savings, things like required materials such as hand wipes and other hygiene materials being under lock and key, expired medication, those sorts of things. I know you’re not wanting to comment on the difference between private and public, but it strikes me that there are a number of examples there that show it was fundamentally about cost savings.
I’m curious about two things. One, what are the demographics that you observed about patients or residents of the long-term care facilities, as well as the staff, if you had much interaction with the staff? In particular, we’ve heard about the number who are women, racialized and low income. Also, given what you’ve observed and given your experiences, what national standards would you recommend be put in place to improve the care for our elderly and those disabled who are in home care facilities going forward?
MGen. Bilodeau: I don’t have the specific demographics, obviously, of the residents in those long-term care facilities, but I know that most of them were older, not surprisingly, and not only older but with lots of co-morbidities, which made them very vulnerable to COVID, potentially becoming very sick and even dying from the virus. I’m not sure exactly about the status of the staff in those long-term care facilities either, so I can’t comment specifically on that.
With respect to the recommendations, lots of lessons have been learned by those two provinces, for sure, which will apply over the next several months. As I said before, based on the discussions I had with the two provincial governments, I think they are aware of those challenges, and I believe they have a plan to address it.
Senator Pate: Would you have any recommendations for national standards that could be put in place that could prevent some of what you observed and your staff experienced first hand?
MGen. Bilodeau: There are already existing national and international standards in health care, specifically even for long-term care facilities. Most of the provinces have their own standards too, so I think the standards exist.
Senator Pate: Some people have mentioned Australian standards versus what we have in Ontario and Quebec, for instance. If you don’t have any specifics, that’s fine, but if you do, that would be great.
Senator Omidvar: Thank you to all of our witnesses for all that you do for our country, especially in this time of crisis. I believe you have the enormous gratitude and appreciation of all Canadians.
My question is around what we have heard about the future. We know that there will be more pandemics, a second or third COVID, maybe different viruses. For future preparedness, I wonder if you could comment on your own capacity in terms of medical professionals in the Canadian Armed Forces and whether you would recommend that you need to have more medical professionals as members of your Armed Forces to help us deal with the future.
MGen. Bilodeau: The need for more medical professionals in the Canadian Armed Forces has already been identified well before the pandemic. That’s not a new issue. We’ve been in recruiting mode for many years. The challenge is that we’re obviously in competition in some ways with the civilian health care system. We’re drawing from the same pool of people, and there’s as much, if not more, need in the civilian sector — I think the pandemic has shown that very well — than there is in the Armed Forces. It’s a fine balance we need to try to find to bring enough people to the Forces, but at the same time, having enough of those health care professionals. We’re talking here about physicians, nurses, physiotherapists, mental health specialists, as well as radiology, laboratory technicians and everything, as well as, obviously, specialists and nurses in hospitals, all of that. It’s a challenge. We need to find the right balance, but we definitely know that we need to grow, and there is definitely a plan for growing our Armed Forces in order to better equip us for the next missions that the government will ask us to do.
The other thing that we need to grow is obviously our personal protective equipment stockpile. We’ve shown that the current stockpile we had was not sufficient, and we’re now growing it as we speak. We’ve started to grow it in the last several months, and we’re going to keep growing it over the following months. We have several procurement processes in place, with support from the Public Health Agency of Canada, in order to make sure we have enough for an additional wave or for any other virus or bacteria that could impact us moving forward.
Senator Omidvar: While your members were on the ground in long-term care homes, you must have interacted a great deal with semi-professional health care attendants. During our previous witness panels and testimonies, we heard a recommendation that the occupation of personal support workers who provide the daily care to many senior citizens should be regulated. The absence of standards impacts the kind of care that is provided. Would you have a comment on that recommendation?
MGen. Bilodeau: All I can say from a generic perspective is that the reason why so many health care professions are regulated is because we know regulating those professions improves the quality of care that is being delivered in the end. That gives better control on quality and better control on who is allowed to do what and in what circumstances.
Senator Omidvar: I’m curious about the role of reservists and Rangers in this mission and whether — I don’t know; maybe you’ve already stated this and, I’m sorry, I missed it — in fact, reservists and Rangers were also deployed. If so, what were their functions, and what would you observe and recommend for them in future pandemics?
BGen. Bourgon: When we look at the Canadian Armed Forces, we look at a total force concept. From the beginning, preparing for the pandemic, we looked at maximizing how many soldiers, airmen and sailors we could have available to help Canadians. We tried to recruit and get back under contract the majority of the reservists that we have so that we could maximize the CAF personnel available.
We had about 7,000 reservists that were hired for the summer, and lots of them are working to this day in some of the facilities. They received the training, and they’ve been working in the facilities, so they are fully qualified. We provided the training, and now they’re included in everything we do. We don’t make a difference between Regular Forces and reservists. It’s the total force concept.
The Rangers bring such a unique capacity to the North because they are members of the different communities. The same thing applied to them. As much as we could, we put them under contract, and they’ve been supporting those Northern communities. Some of them have been employed in the Northwest Territories. They have been helping communities with COVID-related duties, the distribution of food, taking care of their own, because they are part of this community. The same thing in Quebec, in the region of Basse-Côte-Nord; and Nunavut. We had about 200 Rangers that were providing support to their communities.
Again, based on the requirement from the territories and the provinces, they were requested to help, and they’ve done a fabulous job. They truly understand their communities, and they’re a jewel to have.
Senator Omidvar: Thank you. That was very interesting.
The Chair: Thank you very much. We have a bit of time left with you, and I think that all of our most relevant questions have already been asked.
I have one last question, which is more out of curiosity. I would like to know more about your experience because we have seen so many images of members of our Canadian Armed Forces being there for our seniors. I would like to hear you on the welcome you received and on the way people appreciated your work, keeping in mind that it is not common for Canadians to work with the Canadian Armed Forces. So I would like to hear a bit more if you have anything to share with us on that matter.
MGen. Bilodeau: I could share with you a few little anecdotes we have heard.
From the outset, when our first teams arrived in extended care facilities in Quebec, some were welcomed not only with open arms, but also with tears from the staff on site. That shows how much suffering and distress those individuals were going through. I think that it also illustrates the needs we have filled by going to those residences.
The other remarkable thing, in my opinion, is that, every time we finished a mission in an extended care facility in Quebec or in Ontario, we always held a ceremony. That is part of our traditions; soldiers like to hold ceremonies to mark beginnings and endings. We would invite the civilian staff to each of those ceremonies. The ceremonies were very moving, and a great deal of crying occurred — no hugs, of course, because the public health rules on the issue are clear. We have seen a great deal of recognition from the civilian staff.
Strong connections have been forged between our staff and the civilian staff of those establishments, but also between the residents and our staff. Some of those residents only needed to talk, to be supported or to be guided, and our employees were there for them.
The Chair: Thank you very much for sharing your experience with us. That is all the time we had to hear from you on this issue. We thank you for your answers. I think that you have been the most efficient witnesses, both in terms of quickness and accuracy, and we really appreciate that.
Thank you again for your participation. You have assisted us very much in our study, and it is truly appreciated.
Honourable senators, before I ask to proceed in camera, I would like to take a minute to make the following comments on your behalf because this is the final public meeting before we recess for the summer.
I want to take this opportunity to publicly thank all the technical staff, the interpreters, the stenographers and those from the Committees Directorate for their assistance in taking our meetings online and going virtual. It has been a challenging time for all of us, individually and collectively, and great changes have occurred in a very short period of time. This team really made it possible for us to do our work in this committee. We thank you for your effort.
I also want to thank the members of the Subcommittee on Agenda and Procedure, Senator Poirier and Senator Griffin, for their time and commitment during the last few weeks, again in circumstances that we are not used to, by distance, on the phone, to work together as your steering committee and to plan out those meetings. Thank you very much for this.
Finally, of course, I do want to thank you all, members of the committee, for your time, your engagement, your patience and understanding. It’s been a new adventure going to virtual committees for all of us, and there have been some challenges sometimes with the equipment, but your assistance has been very much appreciated.
I do have a special request from our clerk, Daniel Charbonneau, who thanks you for playing along with the questions of the day before the meetings. That was much appreciated. I want to thank Mr. Charbonneau for his assistance to all of us and myself as your chair. It’s been great, and I’m very proud of what we’ve accomplished under those many challenges.
Is it agreed, honourable senators, that we now proceed in camera to discuss the draft report? All those in favour, please raise your hand in response, and please keep your hand raised for 10 seconds. Please lower your hand. All those opposed? All those who abstain? It is agreed.
I will ask you to wait until the clerk advises that the committee is now in camera. Thank you.