I call this meeting to order. Welcome, everyone, to meeting number 21 of the House of Commons Standing Committee on Health. Pursuant to the orders of reference of April 11 and April 20, 2020, the committee is meeting for the purpose of receiving evidence concerning matters related to the government response to the COVID-19 pandemic.
In order to facilitate the work of our interpreters and ensure an orderly meeting, I would like to outline a few words to follow.
First, interpretation in this video conference will work very much as it does in a regular committee meeting. You have the choice at the bottom of your screen of floor, English or French. Please speak slowly and clearly and hold your microphone in front of your mouth as directed during the sound check. If you will be speaking in both official languages, please ensure that the interpretation is listed as the language you will speak before you start. For example, if you're going to speak English, please switch to the English feed and speak. This allows for better sound quality for the interpretation.
Before speaking, please wait until I recognize you by name. When you are ready to speak, click on the microphone icon to activate your mike. Should members need to request the floor outside of their designated time for questions, they should activate their mike and state that they have a point of order. I will remind everyone that all comments by members and witnesses should be addressed through the chair. Should any technical challenges arise, please advise the chair or clerk immediately, and the technical team will work to resolve them. If necessary we will suspend the meeting at those times to rectify the problem.
Before we get started, I'd like to remind you all that if you click—for those operating on a computer—on the upper right-hand corner of your screen you'll see a speaker view versus a gallery view. If you click to gallery view then you should be able to see everyone in the meeting. For those using iPads, it's a little icon in the upper left hand corner.
I'd like now to welcome our witnesses. From the Public Health Agency of Canada, we have Dr. Theresa Tam, chief public health officer, and Ms. Kim Elmslie, vice-president, infection disease prevention and control branch. From the Office of the Chief Science Advisor, we have Dr. Mona Nemer, the chief science advisor. From the Canadian Institutes of Health Research, we have Dr. Michael Strong, president, and from the Canadian Society for Virology, we have Dr. Nathalie Grandvaux, president.
Welcome to all of our witnesses and thank you for being here. The committee and I appreciate your time.
We will start with the Public Health Agency of Canada with, I believe, Dr. Tam.
Please go ahead for 10 minutes.
Thank you, Mr. Chair and committee members, for the opportunity to come back to speak with you again today.
The emergence and rapid spread of SARS-CoV-2, the virus that causes COVID-19, has challenged global capacities in unprecedented ways.
In Canada, there are now around 78,500 cases of COVID-19, including 5,857 deaths. Around 50% of cases have now recovered. Labs across Canada have tested over 1,337,000 people for the novel coronavirus to date, with about 5% of them testing positive overall. Collectively, provinces and territories are testing an average of over 27,000 people daily. As these numbers change quickly, we update them on the Canada.ca/coronavirus web page.
While COVID-19 remains a serious global health threat, our collective efforts to slow down the spread of COVID-19 and bring the epidemic under control have flattened the curve in Canada. The slowed rate of transmission has reduced daily case counts, but there are still localized outbreaks and active transmission in different areas of the country, so we must remain vigilant.
As the initial epidemic wave in Canada comes under control, rapidly detecting and suppressing any new surge in cases is the priority. Simply put, we must keep infection rates low while we accelerate the development of treatments and a safe and effective vaccine for COVID-19.
Given the uncertainties of the path forward, we will need to exercise caution and learn as we go. Canada’s response has and continues to rely on science, our evolving knowledge on how the virus spreads, and the deployment of effective public health measures. We will adjust rapidly, as needed, to effectively reduce the spread of this virus as we reopen Canada’s economic and social life.
Canada’s response to COVID-19 must continue as a collaborative response that supports and includes individuals, communities, different sectors and governments.
Our federal public health role can best be described as leadership through research and science, international collaboration, data and monitoring, and continuous risk assessment; leadership in keeping Canadians informed about what we know, what we don’t know and how we are finding answers to the complex questions that a new infectious disease brings; and leadership by mobilizing capacities to rapidly address gaps wherever they exist and by providing resources that strengthen the public health response wherever it is needed.
A cornerstone of Canada’s overall response to date has been excellent collaboration among federal, provincial and territorial governments.
As we move forward, we will continue to work closely through the federal-provincial-territorial special advisory committee on COVID-19, which includes all the chief medical officers of health, as well as Correctional Service Canada and Indigenous Services Canada officials. At the moment, we are meeting several times per week.
The public health working group on isolated and remote communities, reporting to the special advisory committee, has also been formed to collaborate on addressing the unique needs of remote and isolated communities and those of first nations, Inuit and Métis.
I will take a few minutes to provide an update on some of the key areas where the Public Health Agency of Canada is supporting the Government of Canada and our provincial and territorial partners in the response.
Testing is a critical aspect of our COVID-19 response. Canada’s testing strategy will continue to be adapted as science on the virus evolves, as more test options become available and as the pandemic progresses. It is based on the three central public health priorities of testing all suspected cases, aggressively tracing their contacts, and isolating infected people and quarantining contacts.
Testing and contact tracing are critical to setting up a ring fence around every case and breaking the chains of transmission. Canada’s National Microbiology Laboratory, NML, has played a critical role in this area.
Within five days of the novel virus' genetic sequence becoming available, scientists at the NML developed a molecular diagnostic test, and now more than 30 labs across Canada can perform confirmatory tests. As commercial tests became available, the NML’s validation and quality assessment programs rapidly ramped up to ensure that these tests deliver accurate results.
The special advisory committee on COVID-19 recently updated the national laboratory testing guidance with a focus on broadening testing to anyone with symptoms, even those with mild symptoms. Considerations for testing asymptomatic individuals were also provided.
The Government of Canada also recently announced the COVID-19 immunity task force to coordinate population-based serology or antibody studies to determine the extent of COVID-19 infection in Canada. This will help determine the fraction of the population who have some immunity to the virus to inform effective public health responses going forward, including any vaccination programs.
A robust testing approach is a key component of the reopening phases, and Canada is looking to implement a multi-pronged testing approach that encompasses a combination of lab-based PCR testing, point of care and serology testing.
A priority for all countries is the development of a vaccine for COVID-19. The National Microbiology Lab is part of a national network using genome sequencing to understand how the virus works, how it is evolving and why people experience such differences in the severity of illness. The NML's work on vaccine development builds on a track record that includes the successful development of an Ebola vaccine. We are pursuing seven vaccine development technologies and collaborating with industry and academia to contribute to vaccine discovery.
Another important area of focus for the Government of Canada has been securing critical personal protective equipment and medical equipment for front-line health care workers. We are doing this through collaborative bulk procurement with provinces and territories, building domestic production capacity and identifying potential alternatives and ways to extend product life.
The Public Health Agency also continues to work closely with provinces and territories to update infection prevention and control guidance based on the best available evidence for a variety of health care settings, including long-term care.
Another important area of focus is keeping Canadians informed. The Public Health Agency of Canada has been providing Canadians with timely information about how they can protect their health and our broader health care systems. This includes the Canada.ca\coronavirus web page, a toll-free COVID-19 information line and the Canada COVID-19 app that has been downloaded more than 540,000 times to date.
Nationally we have witnessed the impact of Canadians working together to slow COVID-19 epidemic growth through collective adherence to recommended public health measures, including physical distancing and hygiene measures. In moving forward, all levels of government are committed to working together towards a shared evidence-based approach to the cautious lifting of public health measures with the primary objective of protecting the health of Canadians while taking into consideration regional differences.
There is a need to strike a critical balance between public health control measures that minimize health impacts and the social and economic consequences. For instance, border measures under the Quarantine Act to strengthen and restrict entry into Canada from abroad, including from the U.S., remain in place. These measures will be continually reassessed as new information becomes available.
The special advisory committee on COVID-19 recently provided recommendations and national public health guidance with shared objectives, principles, criteria and indicators that serve as the foundation for lifting restrictive measures.
We must also continue to strengthen public health capacity across the country in anticipation of potential future waves of COVID-19, which includes capacity for enhanced testing to rapidly detect cases, investigate outbreaks and find and manage contacts. The Government of Canada is also working closely with provinces and territories to expand testing capacity beyond the existing laboratories and strategies to mobilize human resources to support contact tracing.
The impact of COVID-19 on the overall physical and mental health of Canadians has been significant. The direct health impacts have been devastating, with the most severe outcomes being suffered by seniors residing in long-term care and assisted living facilities. Our approach going forward must ensure that vulnerable or high-risk groups are better protected. These include those who are vulnerable because of age, underlying health conditions, remote location, close living spaces and temporary or unstable living spaces.
We must also consider the unintended consequences of restrictions in place, including increased domestic violence and social isolation, delayed care for acute and chronic health conditions and problematic substance use.
As public health restrictions are lifted, the aim is to be able to rapidly respond to any new cases or clusters to keep the epidemic suppressed. However, we must prepare for the possibility that public health restrictions may need to be reinstated if cases spike again.
While we do not know what will happen with COVID-19 in a few months, public health has to prepare for the possibility of another wave coinciding with the annual influenza season. This and more challenges lie ahead of this unprecedented global health crisis. Public health authorities are aware, engaged and fully committed to tackling these challenges head on with the full weight of Canadian ingenuity, collaboration and innovation.
Thank you for your attention.
I will be pleased to answer any questions.
Good afternoon, Mr. Chair and members of the committee.
Thank you for the opportunity to appear before you today. I'd also like to thank my fellow witnesses for their statements and for all their efforts during this pandemic.
As you know, I was appointed as Canada's chief science adviser on September 26, 2017, to provide science advice to the Prime Minister and cabinet. My office is responsible for ensuring scientific analyses are considered in government decisions and coordinating expert advice to cabinet. I also provide recommendations on how government can better support quality scientific research. Furthermore, my office helps to ensure that government science is fully available to the public. Lastly, I have a mandate to promote collaboration between federal scientists and academia, both in Canada and abroad, and to raise public awareness of scientific issues.
Since the beginning of the COVID-19 pandemic, I have had the opportunity to make contributions in all these areas. If I may, I will summarize them for you.
Starting in February 2020, I set up a number of expert groups and task forces. These experts are keeping us abreast of ongoing clinical and scientific challenges, and best practices for pandemic response in Canada. I have also been involved in science coordination efforts within the federal government with respect to medical countermeasures. I have worked with the broader science and research community in Canada to enhance coordination efforts.
For example, working with a few other people, I helped set up CanCOVID-19, a pan-Canadian research platform to optimize collaboration during the COVID-19 crisis. More than 2,000 researchers are registered on the platform—barely a month old—which attests to the determination and extraordinary engagement of the Canadian scientific community in the response to the pandemic.
Additionally, I'm engaged in the international science advice response to COVID-19. Chief science advisers, or the equivalent, from a dozen countries have been meeting weekly for the past two months. We discuss the dynamic developments and challenges of the pandemic and its evolving characteristics in different countries at different times. We share data and information on social and medical measures. These interactions provide important opportunities for coordinating research and science advice.
An example of this international effort was the group's call to global publishers to make COVID-19 scientific publications openly accessible to all, which the publishers quickly agreed to. This has meant that research results are now quickly disseminated and used to help manage the pandemic everywhere. This is an unprecedented development that is supporting scientific data-sharing at a rate never witnessed before.
Over the past few months, our knowledge of the new SARS-CoV-2 virus that causes COVID-19 has rapidly progressed, including efforts by our own Canadian researchers. However, there are still many unknowns that affect disease prevention and management. I'll highlight a few of those, with your permission.
The first area is in terms of disease susceptibility. Not everyone in the population appears to have a similar risk of infection, but how exposure to different levels of the virus leads to different individual responses is unclear. As you can imagine, this has an impact on prevention measures in different settings.
The issue of infectivity still needs to be clarified. Infected individuals seem to be contagious for two or three days prior to symptom onset until around seven days thereafter, and possibly longer. This implies that significant transmission comes from asymptomatic individuals, which creates an added challenge for early detection and the control of disease spread.
With respect to disease outcome, we've all seen that older age and chronic preconditions, such as cardiovascular disease, diabetes or obesity, have been associated with a higher risk of a poor COVID-19 outcome. However, the reasons remain unexplained. Our experts have pointed out the need for harmonized, quality data collection and sharing, which is important for sorting out the confounding variables and, more precisely, guiding disease management in the Canadian context.
With respect to prevention and treatment, Dr. Tam has already alluded to the importance of a vaccine. In the absence of acquired immunity or an effective vaccine, avoiding or minimizing exposure to the virus is the best prevention. We know what this means.
Vaccine development is under way, including in Canada, using a wide range of classical and novel approaches.
With respect to treatments, several clinical trials are ongoing, including in Canada, to test the efficacy of existing drugs. However, the results so far are disappointing. It should be noted that currently there are very few broad-acting antiviral medicines, which is why the development of new antiviral drugs is being pursued in parallel to vaccine production efforts.
Let's remember the successful management of hepatitis C and HIV with antiviral therapies, not vaccines. I think that we have hope on both fronts.
With respect to diagnostics, Dr. Tam has already mentioned the use of qPCR, which is the gold standard for testing for the presence of the virus. However, this multi-step test is not very well suited for remote areas and for other situations that require faster or repeated screening, such as borders and primary care, which is why the development of complementary detection methods is ongoing.
I have the privilege of sitting on the immunity task force with Dr. Tam. This ongoing work is going to be important to determine the actual prevalence of exposure in Canada and to inform vaccine development.
As countries reopen their economies in the weeks and months ahead, the scientific community will continue to gather more data to better understand both the virus and the disease it causes. These efforts are instrumental for our ongoing preparedness to live with and overcome the virus.
Around the globe, countries are also stepping up their efforts in key areas, including deploying robust and agile systems for virus testing and contact tracing, as well as understanding the level of the population that has been exposed to the virus.
Another area is the standardization of data collection, constantly improving the quality and developing protocols for sharing and mining the data, including using AI-supported tools. This is again an effort that Canada is part of.
Of course, everyone around the world is stocking up on medical equipment and therapeutics, or at least trying to, and putting in place national strategies for local manufacturing of personal protective equipment as well as COVID-19 diagnostics and medical countermeasures. More broadly, countries are expanding research and development efforts and considering approaches to national health security across the entire medical supply chain.
Last but not least, strengthening health emergency preparedness is on everyone's mind, including at the level of the multidisciplinary science advisory function.
In conclusion, this pandemic is highlighting the critical value of research and the importance of science coordination across disciplines and sectors. It's also underscoring the need for national production capacity for health security. Right now, we're playing catch up, but we hope that current investments and efforts will result in a sustainable ecosystem for infectious disease research and development. The war against COVID-19 will be won through science. Let's ensure that Canada's excellence in science continues to be mobilized for the benefit of all Canadians.
I look forward to our exchange.
Mr. Chair, thank you for having me before the committee once again to speak about the continued importance of research and the ongoing role of the Canadian Institutes of Health Research in Canada's response to COVID-19.
Before we begin, I want to reiterate my sincere appreciation and gratitude to all of the health care professionals—the front-line and essential workers who are working tirelessly to support the health, safety and well-being of Canadians.
I would also like to extend my sincere condolences to the members of the Canadian Snowbirds for the tragedy of this past weekend. My wife, Wendy, and I had the opportunity to see the Snowbirds in London on Mother's Day. It was a real treat. They are, and always will be, a symbol of the pride that we as Canadians have in this great country. Our thoughts are with them at this time.
As I am sure many of my colleagues here today will echo, I also wish to commend the incredible and continued efforts of the Canadian research community. Our researchers are among the very best in the world, and they continue to play a critical role in the global and domestic research response on COVID-19.
I am pleased to be with you today to provide an update on the research initiatives that CIHR has recently implemented as part of Canada's efforts to address the pandemic. Before doing so, I wish to emphasize that CIHR's efforts to address the COVID-19 outbreak continue to be undertaken in very close collaboration with federal partners—including my colleagues who are appearing with me today—at Health Canada; Innovation, Science and Economic Development Canada; the National Research Council, and many others.
I also wish to highlight the recently established COVID-19 immunity task force that Dr. Nemer referred to. I am pleased to say that two of CIHR's scientific directors, Dr. Charu Kaushic and Dr. Carrie Bourassa, are lending their expertise on immunity and infection and indigenous health respectively to this important initiative. CIHR also continues to work hard hand in hand with such international partners as the WHO and the Global Research Collaboration for Infectious Disease Preparedness, otherwise known as GloPID-R, to enable Canadian researchers to help in the global research efforts.
Additionally, CIHR supports the calls made by the chief scientific advisers around the world, as noted by Dr. Nemer, to ensure that such research outputs as data and publications are publicly available to support the ongoing global emergency response efforts.
As I shared with you at my previous committee appearance, CIHR moved quickly in February to efficiently mobilize the research community through the launch of a rapid research response to COVID-19. In just a few weeks, CIHR was able to select, through a rigorous peer review process, 99 COVID-19 research projects focused on developing and testing medical, social and policy countermeasures to address this public health crisis.
Given the uncertain nature of vaccine development and therapeutics and the need for additional preventive measures, Canada's response to the COVID-19 pandemic also requires sustained research investment to ensure a rich pipeline of innovations. That is why on April 23 the announced an additional $1.1 billion in support of a national medical research strategy for COVID-19, including close to $115 million in funding for CIHR.
This new investment builds on CIHR's initial rapid research response and will enable us to support researchers working on projects related to the development of vaccines, therapeutics, new diagnostics and public health interventions to move to the next critical stage in their research. It will also help to secure Canadian participation in domestic and international clinical trials responsive to WHO priorities that will increase the understanding of the efficacy and effectiveness of vaccines, therapeutics, mental health supports and clinical management approaches to COVID-19.
For instance, through this investment, we were able to provide Dr. Srinivas Murthy and his team from UBC with an additional $3.5 million to support the Canadian treatments for COVID-19 trial, otherwise known as CATCO, the Canadian arm of the WHO “solidarity” trial. This will enable Dr. Murthy and his team to expand the trial to include additional hospital sites and more study of participants across Canada to study the effectiveness of different drug treatments for COVID-19. We are confident that this type of research will greatly contribute to our efforts to rapidly find effective treatments for the benefit of all Canadians.
A portion of the investment will also be dedicated to working with Health Canada to improve ethics research review processes and structures. This will help accelerate the launch of promising multi-site, multi-jurisdictional research, including clinical trials across Canada. Further, these funds will also allow the Government of Canada, under the leadership of CIHR, to set up a centre for pandemic preparedness and health emergencies research that will lay the groundwork towards more nimble domestic and global pandemic research coordination.
Finally, we have heard loud and clear from Canadians and health care providers that more support is needed to help understand and mitigate the mental health and substance use impacts of the COVID-19 crisis. As such, CIHR, in partnership with the Public Health Agency of Canada and Health Canada, has established an expert advisory panel on mental health and substance use and will support research to facilitate the rapid synthesis and translation of evidence on effective virtual service delivery models for the benefit of all Canadians.
We are pleased to share that the second phase of CIHR's rapid research response is currently under way, and we have received a staggering number of applications. This underscores the incredible and widespread mobilization of the Canadian research community in response to COVID-19. Applications for the second phase are currently under review, and funds will be provided to successful applicants in a few weeks.
In the meantime, CIHR continues to coordinate and support the sharing and translation of ideas, data and innovative solutions across all levels of government to enhance timely and effective responses to the COVID-19 crisis. Since we last met, CIHR has rolled out a number of virtual knowledge mobilization meetings to strengthen connections between researchers funded through the COVID-19 rapid response competition and Government of Canada departments and agencies in order to accelerate research and knowledge translation.
I want to reiterate that these investments in research provide the crucial high-level evidence needed to inform policies and clinical and public health responses to mitigate the rapid spread of COVID-19 and save the lives of Canadians.
The critical importance of the work generated by CIHR's research community brings me to my last point. As you may well be aware, CIHR has postponed this year's spring project grant competition. Given the growing interest in this decision, expressed both publicly and within the scope of this very committee, I would like to take a moment to explain the reasons for this decision, which was made in close consultation with our trusted partners.
As a result of the COVID-19 outbreak and the redirection of government priorities to address the pandemic, CIHR placed a moratorium on all existing and any new strategic funding opportunities, with the exception of those related to COVID-19. At the time, CIHR could not be certain about the reliability of critical infrastructure required to deliver the project grant competition, which requires the review of thousands of applications in a short period of time, just after all CIHR employees had been directed to work from home.
We made the very difficult decision to ensure that these funds would be saved for the fall of 2020 project grant competition, but at the same time, we also began exploring options to support both the researchers and the trainees impacted by this decision, as well as those impacted by the shutdown stemming from COVID-19 of the broader research programs.
For instance, to support lead applicants whose work was impacted by the postponement of the spring competition, CIHR will provide prolonged financial support for existing grant holders for some and extend bridge grants for others. To support trainees, including students and post-doctoral fellows, the government recently announced new funding of $291 million to maintain income support for these individuals while the majority of academic research programs are closed.
On May 15, the announced an additional $450 million in funding to help Canada's academic research community during the COVID-19 pandemic. This funding will support universities and health research institutions to maintain essential research-related activities during the crisis and then ramp back up to full research operations once physical distancing measures are lifted. Further details on these supports can be found in the written brief we provided the committee in advance of this meeting.
To conclude, I would like to re-emphasize that CIHR recognizes the dual importance of supporting both Canada's response to COVID-19 and the broader research community that has been adversely impacted by this pandemic. Investments such as those recently announced are critical to sustaining Canada's research excellence, talent and knowledge.
To ensure that we are doing our utmost to support our researchers through the COVID-19 response and the post-pandemic economic recovery, CIHR continues to work closely with our federal partners, the research community and health charities to explore additional ways to support our researchers in these difficult times.
Again, thank you for inviting me to provide an update on CIHR's continuing efforts to support COVID-19 research. I am happy to answer any questions you may have.
Good afternoon, members of the committee and fellow witnesses.
First of all, let me thank you for the opportunity to appear before you today to speak as the president of the Canadian Society for Virology. I am very proud to lead this young not-for-profit society that I co-founded in 2016 with Dr. Craig McCormick, a professor at Dalhousie University.
CSV was originally founded to help Canadian virologists who were spread across the country, including world-renowned experts in basic, clinical and epidemiological research, to come together to exchange ideas and discover new opportunities for collaboration to meet the challenge of existing and emerging viral infections and realize their potential to lead in this research area. CSV now counts 220 members, who study viruses that infect human, animals, plants and bacteria. CSV members represent universities, hospitals and research institutes across the country. The society provides unique opportunities to bring the community together and foster exchanges, thus promoting collaborations to accelerate discoveries and the translation of research findings into positive health outcomes for Canadians. Canadian virologists have made important contributions to the fundamental understanding of many viruses, which has led to the development of new strategies for monitoring, preventing and solving global health challenges related to viral infections, such as, for example, the Ebola virus vaccine and anti-HIV drugs.
As you can imagine, our community quickly plunged into the heart of the current global pandemic and is at the forefront of research to contribute to the understanding of SARS-CoV-2, the virus responsible for COVID-19, from a biological and epidemiological point of view and its diagnosis and treatment through antivirals or vaccines.
The outbreak of SARS-CoV-2 was under the radar of members of CSV, including members of the executive, as soon as it appeared in China in December 2019. The immediate action of CSV was to contribute to the organization of support for health care workers, medical microbiologists and virologists in China to help contain the outbreak, treat patients and protect front-line workers who were facing shortages of protection equipment and supplies.
With the leadership of CSV executive members, together with Dalhousie University and members of the Canadian medical community, about $48,000 was raised through donations and used to purchase and ship Tyvek suits to hospitals in Wuhan.
Members of our community, including clinicians and microbiologists, were part of the team managing the first COVID-19 case in Toronto. Through collaboration with other CSV members, they quickly achieved laboratory culture of the virus. Other collaborative teams took alternative routes to culture the virus and very quickly test animal models, which are key to antivirals and vaccine development. These tools are now spread through our community, which is responding in an exceptional way by quickly redirecting the research to respond to the urgent need to better understand SARS-CoV-2, improve diagnosis, identify therapeutic strategies and develop vaccines.
The community effort is immense, and we want to acknowledge that this was only made possible thanks to the very quick response of the federal government and agencies. The major investment in COVID-19 research, made through the CIHR, NSERC, SSHRC, CRCC, new frontiers in research fund, the International Development Research Centre and Genome Canada, has strongly supported the effort made by our community. It would not have been possible without this investment.
This must, of course, be underlined, but it should not make us forget the reasons that have contributed to the lack of preparedness in facing the current pandemic. Indeed, the lack of funding for investigator-initiated fundamental research over the years has strongly limited the diversity of research that could have given us an advantage over the virus. In fact, over the past decade, scientists have raised awareness against the class of viruses to which SARS-CoV-2 belongs. It was clearly established that the most probable naturally occurring threat that humans face is from a respiratory-borne RNA virus.
This class of microbes should have been a preparedness priority. I personally raised awareness about it to the CIHR's infection and immunity institute advisory board last year. The SARS epidemic in 2003, which had already affected Canada, should also have sent the signal for the necessity of preparedness. Scientists are in the best position to keep watch on the emerging fields. In order for them to translate their observations into knowledge and tools to face emerging infectious diseases, they need continuous and sustained funding for investigator-initiated research.
Major investments were made at the time of the SARS epidemic, but once it ended research funding in this area was limited, and advances that had been made were stopped. If global research had continued, we could have had antivirals and/or hints for quick development of vaccine candidates against SARS-CoV-2, a closely related virus.
Accumulation of knowledge, including biology, interaction with the host, epidemiology and ecology, of diverse viruses would give us an advantage in the anticipated fight against emerging pathogens. As such, let’s not repeat history and cut funding when this pandemic comes to an end. Let’s also not make the mistake of focusing only on coronaviruses, but rather on a wide variety of viruses, as we do not know what the next threat will be.
Importantly, SARS-CoV-2, like SARS, is a zoonotic virus, meaning it spread to humans from an animal. This pandemic is showcasing how viruses jumping from other species can be a threat to humans, and further underscores the necessity of funding research on viruses of diverse origins, not only human.
Expertise in the manipulation and study of human-threatening viruses, and the development of antivirals and vaccines, requires years of training. CSV members are currently training the next generation of virologists, and CSV is dedicated to providing support through career workshops and opportunities to network during sponsored symposia, awards and lab exchange programs.
While CSV members are now focusing on COVID-19-related research, their research program on other viruses is on pause. It is essential to expand research capacity in order to ensure a broader scope of research on a variety of human and animal viruses.
Importantly, to fight viruses, virologists cannot work in silos. They need training in, or collaboration with, researchers with expertise in immunology, vaccine and drug development, epidemiology and ecology. Canada should support careers and build capacity in various areas of virus-related research such as fundamental research, epidemiology and drug and vaccine development by raising the profile of those career opportunities and creating supportive environments for training.
The study and development of therapeutics and vaccines against emerging pathogens causing threats to humans, such as SARS-CoV-2, requires experiments that must be done in high-level containment level 3 facilities. It is key that this infrastructure across Canada meets all the government laboratory biosafety guidelines at all times. This is essential for researchers to perform the required experimental work to build knowledge on viruses and respond quickly to a situation of threat.
This was not the case in this current time, as several facilities were not certified and could not have been updated over time because of lack of funding. It is important that the federal government commit to secure funding for building capacity and maintenance of containment level 3 laboratories and animal facilities, which are essential for a response to any emerging pathogen. The development of these laboratories should not only be in the form of infrastructure funding, but also in the form of operating funds.
In closing, I want to leave you with the following take-home message. The spillovers of emerging infectious diseases are continuing to increase and the current pandemic will, unfortunately, certainly not be the last. Increased preparedness through funding investigator-initiated research and infrastructure will cost far less than the public health and economic toll of another virus that we may have been able to identify and contain earlier.
It is essential for the CSV community that the required increase in basic virus research is not done at the expense of funding for other fields, threats or diseases. Virus-related research is part of an ecosystem that overall urgently needs more investment for fundamental, investigator-initiated research.
Lastly, I'd like to stress the fact that CSV members mobilized in an exceptional way in response to the current COVID-19 pandemic. They were able to quickly redirect their research, something that would not have been possible without the federal government's major investment in COVID-19 research, made through the CIHR, the Natural Sciences and Engineering Research Council of Canada, or NSERC, the Social Sciences and Humanities Research Council, or SSHRC, the Canada Research Coordinating Committee, or CRCC, through the new frontiers in research fund, the International Development Research Centre, or IDRC, and Genome Canada.
Unfortunately, we are experiencing the insidious effects of years of underfunding for non-targeted basic research. Adequate investment would have meant that we were better prepared to deal with emerging infectious diseases. Scientists are in the best position to keep watch on these emerging fields, but they need the resources to translate their observations into cutting-edge research.
Their message is this: the repercussions of emerging infectious diseases continue to increase and the current pandemic will unfortunately not be the last. Increased preparedness through funding of research and infrastructure will decrease the public health and economic toll of another virus that we may have been able to identify and contain earlier.
Lastly, it is essential that the required increase in basic virus research is not done at the expense of funding for other fields, threats or diseases. Virus-related research is part of an ecosystem that overall urgently needs more investment for fundamental, investigator-initiated research.
Thank you, and I would be happy to answer your questions.
Dr. Tam, I know hindsight is 20/20, but let's look to the future and base decisions on science and evidence.
What about the possibility of some sort of mandated use of masks in Canada? There is plenty of evidence out there that masks are a benefit, mostly in preventing transmission from somebody who has the disease—perhaps people who are still asymptomatic and don't know they have the disease—to other people.
There's a whole bunch of studies. Let me quickly run over some of them.
Howard et al, in a study that hasn't yet been published, but that looks as if it'll be published in Proceedings of the National Academy of Science, looked at the evidence and concluded, “The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts”.
In the Annals of Internal Medicine a recent meta-analysis of 64 studies showed that transmission was decreased by 50% to 80% in health care settings. A Leung study on other forms of coronavirus showed decreased transmission when people who are infected have masks. There was a well-publicized, light-scattering study in the New England Journal of Medicine showing what happens when you have a mask and when you don't have a mask. A number of papers have been written on modelling, looking at what happens when you add masks—even if they're not a solution, but do have incremental benefit—combined with other public health measures, indicating that these can significantly reduce the transmission of disease and the progression of the pandemic.
Many countries in Southeast Asia that have done very well in their response to the pandemic by requiring masks in public settings. Places like Taiwan, Singapore, Thailand and 90 countries globally have some kind of mandated use of masks.
To top it off, there's a recent open letter in the United States, signed by 100 prominent medical people, to governors across the United States. A lot of people who wrote this letter were from Harvard; there were two Nobel laureates, and people from Cambridge, Oxford, Berkeley—all the big schools—and their conclusion was that requiring the use of fabric masks in public places could be among the most powerful tools to stop the community spread of COVID-19. They too are calling for mandated use of masks.
We're spending billions and billions of dollars in dealing with this. It's really important that we don't screw up as we come out of our initial social isolation. How about some form of mandated use of masks?
Thank you for the question.
Of course, there are many, many people working really hard on this crisis. I just happen to represent the tip of the iceberg of the public health system.
You're right in that contact tracing is a fundamental public health competency, if you like. Local public health has augmented the capacity, and what we've offered to provinces is that if they don't have enough people to do contact tracing, please let us know. We have developed a roster of people. I know that they've massively increased training, for example, for students, medical students or retired health professionals to supplement their contact tracing capabilities, but we're also here to help, including federal public servants, who may be able to assist. There are different rosters being offered to provinces and territories.
On the application, I actually think, if you look at some of the other countries, that what you have to do as well is have a population that is ready to use contact tracing. You actually have some applications where Canadians have to sign up for them, and you need significant numbers for participation in order for that to work. I do think it is a concept that provinces and territories are interested in, and we've been facilitating some of the discussion on some of the options, so there's definitely more to come on that.
For example, Alberta started using an application. They are trying to get more people to sign up for it, but thus far.... I think in the Canadian context they are still trying to get more people to be recruited. In terms of this conversation, it is something that Canadians need to be engaged in so that they understand what this means. Privacy, of course, is also something of paramount importance as these applications are being used.
Thank you to all the presenters today for their opening remarks.
Dr. Tam, I, too, want to begin by saying that I have great respect for the work that you have done, and that we are appreciative of the time and energy that you and your team have put forth in these past few months. I also know that your public availability on a regular basis only adds to your workload, but it certainly is appreciated.
In your opening remarks, Dr. Tam, you mentioned moving forward and that all levels of government are committed to working together toward a shared, evidence-based approach to the cautious lifting of public health measures with the primary objective of protecting the health of Canadians, taking into consideration regional differences.
I want to bring up elective surgeries throughout this country. We know that elective surgeries across Canada were put on hold as we braced for a wave of these COVID-19 cases in hospitals across the country. However, we are sacrificing the health and well-being of many thousands of Canadians with other equally significant health concerns.
Canadians expect the federal government to take a leadership position on this issue as it is its advice that provinces are relying on for guidance during this pandemic. Last week here in committee, Dr. Paul Dorian testified that these cancellations are costing lives. He said that he personally knew of four deaths in just one week in a hospital in the Toronto area, if I understood that correctly.
Dr. Tam, when do you see the cautious lifting of the hold on elective surgeries throughout this country?
I think the most important updates decision-makers or Canadians want to hear is where we are at and whether things are getting better. I think all of our indications are that the epidemic is definitely slowing down.
One of the things that we looked at was the rate of drop in cases. The case counts over the last seven days compared to the previous seven days have dropped by about 13%. When we looked at what we call the doubling time, the epidemic showed exponential growth at the beginning, so the doubling time was about three days, which is very fast. Now it is almost an irrelevant indicator because it's now over 30 to 60 days, so that tells you that the rate of increase or doubling is definitely slowing down.
There is one indicator that everybody is interested in, which is what we call the effective reproduction number. This looks at whether one Canadian transmits to fewer than one Canadian, in which case the chain of transmission will break.
This number at the national level is less meaningful than perhaps looking at a regional level, because we have regional epidemics, but right now it is below one. Below one is where we want it to be. We want to see it really below one, and that is sustained in terms of that trajectory, but it is very different in different provinces.
Many jurisdictions have no community transmission or have the epidemic under control, but, we are keeping an eye on Ontario and Quebec, because the two provinces account for about 85% of cases and 94% of the deaths. Looking at their rate of the slowing down of the cases and their hospitalizations and deaths is extremely important as we look at this.
Basically, with the regional epidemic in mind, which is different, all provinces are showing a decline, basically, in their projections. Again, my message is that we are optimistic, but we must be very, very cautious, because in this next phase, if we ease the measures.... Again, modelling will show different scenarios as to how much of a release in these public health measures one can afford to do. You've seen some of that from British Columbia as well. The modellers are very much all working really hard at this. Really, it's the final epidemiology where, if we do see cases reignite, we will have to leap on them really, really fast. That is the premise of the testing and contact tracing.