I call this meeting to order. Welcome, everyone, to meeting number 35 of the House of Commons Standing Committee on Health.
The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic, and specifically, examining Canada's national emergency response landscape.
I'd like to welcome the witnesses. As individuals, we have Dr. Lorian Hardcastle, associate professor, Faculty of Law and Cumming School of Medicine at the University of Calgary; and Dr. Wesley Wark. From the Ontario COVID-19 Science Advisory Table, we have Dr. Brian Schwartz, co-chair.
With that, I will invite the witnesses to make their statements.
By the way, I will display these cards. The yellow one is to indicate your time is almost up, typically a minute before, although sometimes I lose track. The red one is when your time is fully up. If you see the red card, you don't have to stop instantly, but please try to wrap up.
Thank you very much.
We'll start with Dr. Hardcastle, for six minutes.
Before I start, I want to thank you all for the opportunity to speak with the committee today.
I'll begin by first discussing the specific legal avenues open to the federal government before turning to some more general comments on the role of the federal government in the pandemic.
There's often a perception that health, including public health, is a matter of provincial jurisdiction, subject to narrow exceptions such as the Quarantine Act. This misguided perception and the hands-off approach that the federal government often takes with health is likely the result of the provinces being the ones who deliver most health care services, along with some political issues stemming from the funding of health care services and some politics around the Canada Health Act.
In fact, the federal government plays an important role in public health. The Supreme Court of Canada has repeatedly acknowledged that health is an area of overlapping jurisdictions. Furthermore, at this point, COVID-19 is not solely a health issue. What perhaps started as a health issue has also now become the largest social and economic issue of most of our lives. It has affected all facets of the lives of Canadians.
With regard to the specific legal avenues open to the federal government, the first and the one that's received the most attention is the Emergencies Act, which empowers the federal government to act in response to a public welfare emergency. This is defined to include a disease that results, or may result, in a danger to life or property, social disruption or a breakdown in the flow of goods or services. All of these things we've seen, to some extent, with COVID.
When a public welfare emergency is declared, the Governor in Council can issue orders and regulations on a number of matters, including restricting travel, directing persons to render aid, regulating essential goods and establishing hospitals. These powers may have been used, for example, to deal with the spread of COVID over provincial borders when the variants emerged, or to set up hospitals to serve as testing sites when many provinces were struggling in that regard. Although there is a consultation requirement under this legislation, the federal government does not need provincial approval to act.
The second option would be to draft COVID-specific legislation. Unlike the COVID-specific legislation that's already been drafted, which is primarily financial in nature, it would be open for the federal government to draft COVID-specific legislation that focuses more on the public health aspects of this issue.
This could be done by relying on their powers to legislate with respect to peace, order and good government, pursuant to section 91 of the Constitution. This power enables the federal government to act in response to emergencies or national concerns. We've heard from the Supreme Court of Canada that a pestilence would no doubt qualify under POGG. Although it is outdated terminology, of course, COVID certainly constitutes a pestilence.
Third, and finally, the federal government might have considered using its powers under section 11.1 of the Department of Health Act to issue interim orders on public health matters. Although this avenue hasn't received nearly the amount of scholarly commentary as the Emergencies Act or POGG, I understand that the committee heard about the Department of Health Act at its last meeting.
Turning now to some more general comments on the role of the federal government in a pandemic, I would first note that it's surprising to me that, in arguably the largest emergency this country has seen since World War II, we haven't seen the federal government turn to the exceptional powers granted under the Emergencies Act or pass COVID-specific legislation grounded in the POGG power. If the Emergencies Act was not used here, I am not sure when it would ever be used.
Not only have these powers not been used by the federal government, but they seem to have received very little vigorous consideration. Typically, what I've heard from the and others on this issue are rather vague comments as to the Emergencies Act remaining on the table or to the effect that they're considering all options, with very little transparency for the public in terms of why these powers aren't being used. I would want more transparency around that.
Does the federal government view the problem as a legal one, such that the Emergencies Act is inadequate to address these issues? If so, then I would wonder why the Emergencies Act wasn't fixed in the last year so that it was ready for the arrival of the variants and the third wave.
I'm concerned that the real reason we haven't seen greater federal action is political. We have heard from the premiers that they didn't want the federal government to invoke the Emergencies Act, saying that they could handle it on their own. Premier Moe said they could “effectively manage” it. This has clearly not been the case. Saskatchewan has not effectively managed this, but nor have provinces like Quebec, with the long-term care issues, or Alberta, which is experiencing the worst numbers in North America.
The provinces have relied on the federal government for financial support and preparing supplies, but the federal government's role in actually limiting the spread of COVID beyond that has been quite limited, with their focus being on financial fallout. I know there's a political cost to enacting public health restrictions, but I think trying to walk a political middle ground to try to keep the provinces happy and keep everyone else happy has the effect of undermining those rules. I would want to see the federal government transparently consider the use of the emergencies power and make decisions based on what's in the interest of Canadians rather than the politics of federal-provincial relations.
Mr. Chair and members of the committee, thank you for this invitation to appear before the committee in its study of the current health emergency.
Many things have gone badly with our preparedness and response to the COVID-19 pandemic. The crucial first thing that went wrong was our early warning and risk assessment system. This, I think, must be understood and fixed. Early warning and accurate risk assessments are vital to preparedness and response. They buy precious time for informed decision-making and public communications. They save lives and treasure.
Canada had ample opportunity for proper, early appreciation of the threat posed by COVID-19. Because of what I call an epic failure of systems and imagination, we missed many significant signals as COVID began its relentless march across China, and then globally.
Canada's early warning system was not able to function effectively. The first GPHIN special report regarding a viral pneumonia outbreak in Wuhan, China, was issued on January 1, 2020, but no GPHIN alerts meant for a wider global clientele were authorized. Thereafter, GPHIN issued a series of daily and increasingly voluminous global media scan reports that were not geared for value for Canadian decision-makers.
In the period between January 7 and March 16, 2020, PHAC produced six risk assessments on COVID-19. I analyzed these reports in detail while serving as an expert consultant to the Auditor General. Until the final PHAC risk assessment on March 16, the agency delivered a consistently reassuring message that COVID-19 posed a low risk to Canada and Canadians. As the Auditor General found in her damning report, the methodology employed by PHAC in preparing these risk assessments was deeply flawed and untested. The risk assessments failed to consider forward-looking pandemic risk, and risk assessments were not discussed or integrated into decision-making.
Now, PHAC has accepted the Auditor General's report, as you know, and has promised a lessons-learned review, but it has also punted this review to December 2022 at the earliest.
To understand how we set ourselves up for such an abysmal failure, we have, I think, to look back to the period after the SARS crisis. In April 2004, with the SARS crisis still fresh on its mind, the government published Canada's first-ever national security policy called “Securing an Open Society”. That policy stated:
Going forward, the Government intends to take all necessary measures to fully integrate its approach to public health emergencies with the national security agenda. ...the public health dimension will figure prominently in the Government's integrated threat assessments....
Now, regretfully, none of this happened in the years after 2004.
What Canada must now build is a system for health intelligence that understands and utilizes the model of the classic intelligence cycle to achieve the following: timely, all-source collection; rigorous, high-quality assessment; reporting for impact on decision-making. When COVID-19 struck, not a single element of this system was in place within the federal government. We must also reinforce an international dimension, including full and timely sharing of health intelligence with the WHO as per the International Health Regulations.
A future system of the kind I'm advocating cannot operate within a PHAC silo. To escape from a siloed approach, we need to do a number of things. We need to produce a guiding national security strategy. We need, I think, to create a national security council structure at the centre of government to consider security threats, including health security, holistically. We need to build a health intelligence fusion or watch centre, and we need to ensure contestability by reaching out to experts and stakeholders. These are all concepts being explored in a path-breaking research project on reimagining a Canadian national security strategy for the 21st century, which is being led by the Centre for International Governance Innovation, CIGI, in Waterloo.
Our closest allies understand the need to do things differently. Britain has established, as of May 2020, a Joint Biosecurity Centre to better manage and use information and assessments to inform decision-making. President Biden issued a national security memorandum in January 2021, which calls for the establishment of an inter-agency national centre for epidemic forecasting and outbreak analytics to modernize global early warning.
Canada, alongside its allies, could be a world leader in global epidemic intelligence, but this will take innovative thinking, commitment to meaningful change—including organizational change—and urgency. I hope the committee will share my concern about these matters and lend its weight to this vital reform agenda.
Thank you for your invitation to speak with the committee today. I'm appearing here as a co-chair of the Ontario COVID-19 Science Advisory Table, a mostly volunteer group of 54 scientists drawn from across medical, scientific and mathematics disciplines.
We are not part of the provincial government. We operate entirely independently. While some of our members, including me, are public health professionals who may also work for government agencies, we do not operate as part of the public health apparatus of Ontario. We don't issue public health orders or recommendations. We don't advise communities on public health practices.
Our sole job is to seek out and analyze the scientific evidence that will help the government, public health and health professionals, and Ontarians fight the battle against COVID-19. We regularly brief different parts of the Government of Ontario. We make all of our work available to the public.
Today I am happy to share our thinking about what the scientific evidence tells us about the situation in Ontario, but I would ask the committee to bear a few things in mind as we have this discussion.
The first is that as an independent science table, it is not appropriate for us to comment on government policy. We can tell you what the numbers are and what they mean. We can say what the evidence tells us about measures that give us the best chance against COVID. We can tell you whether we see those things happening. However, it's not appropriate for us to review, criticize or assess any government's performance.
Second, our focus is firmly forward. I am a physician, and while many of the scientists on the table are not physicians, we think of our service to the population in the way a doctor might think of service to a patient. Arguments about the past don't belong at the bedside. Only the forward view helps the patient.
Finally, science is a process. Evidence evolves as the facts on the ground change. We're learning something new every day. There's a great deal more we don't know. In science, uncertainty isn't a failure. Uncertainty is part of the process.
With that, I will summarize a document we prepared last month, entitled “Fighting COVID-19 in Ontario: The Way Forward”. It represents our clearest thinking on what the current evidence says Ontario needs to do right now.
Since its formation in July, the Ontario science advisory table has operated according to three principles. One, we are guided by the most current scientific evidence. Two, we are transparent. All of our science briefs and presentations are publicly posted. Three, we are independent. While we generally advise the provincial government of what we say publicly, no government body or office vets or controls our scientific content or communications in any way.
More than one year into the COVID-19 pandemic, we know that the following six things will reduce transmission, protect our health care system and allow us to reopen safely as soon as possible.
The first thing is essential workplaces only. Some indoor workplaces have to remain open, but the list of what stays open must be truly essential while strictly enforcing COVID-19 safety measures. For example, essential workers must wear masks at all times while working indoors or when close to others outdoors, and must be supported.
The second is paying essential workers to stay home when they are sick or exposed or need time to get vaccinated. SARS-CoV-2 spreads when people go to work sick or after they've been exposed to the virus. Workers often do this because they have no choice. They must feed their families and pay their rent. An emergency benefit will help limit the spread if it offers appropriate income, is easily accessible and immediately paid, and for the duration of the pandemic is available to these essential workers when they are sick, exposed or need time off to get tested or vaccinated.
The third thing is accelerating the vaccination of essential workers and those who live in hot spots. Vaccines are essential in slowing the pandemic. We need to allocate as many doses as possible to hot-spot neighbourhoods, vulnerable populations, and essential workers; accelerate the distribution; and make it easier for at-risk groups to get vaccinated.
The fourth is limiting mobility. This means restricting movement between and within provinces. COVID-19 is not a single pandemic, because different regions of Ontario and Canada face distinct problems. Moving around the country may create new hot spots, because the variants of concern are so transmissible. People need to stay as much as possible in their local communities.
The fifth thing is focusing on public health guidance that really works. This means not gathering indoors with people from outside one’s household. It means people can spend time with each other outdoors, distancing two metres, wearing masks and keeping hands clean.
The final one is keeping people safely connected. Maintaining social connection and outdoor activity is important to our overall physical and mental health. This means allowing small groups of people from different households to meet outside with masking and two-metre distancing. It means keeping playgrounds open and encouraging safe outdoor activities.
What won't work are policies that harm or neglect racialized, marginalized and other vulnerable populations. They will not be effective against a disease that already affects these groups disproportionately. For these reasons, pandemic policies should be examined through an equity lens.
In conclusion, there's no trade-off between economic, social and health priorities in the midst of a pandemic when it’s at its peak, as it has been recently in Ontario and some of the other provinces. The fastest way to get this disease under control, as quickly as we can, is to do it together.
My questions will be for you, Dr. Wark. I share your concern. You know, there's going to be a lot of time for inquiry, but we have to be getting things right now. Looking to change only in December 2022 is too late. I note that one of the significant variants of concern from India was identified in October of last year, yet Canada.... We're just so reactionary on emerging threats, even in the middle of a pandemic.
However, I digress. I wanted to get to recommendations on what we could do to fix some of these gaps right now and then going forward, so that we can include them in our report. The Auditor General's report talking about the risk to Canada being low and not looking at the forward-looking risk was very damning, as you said. What could we do differently right now?
I'm wondering if there's some sort of.... First of all, there's no centralized way of collecting intelligence. You talked about that. I think we need to remedy that, number one. Second, we need to somehow put that information into a very clear risk assessment system that can be used to assess a wide variety of pathogenic risks—almost like a Defcon-level system—so that it can be clearly communicated to the public. Third, associated with each of those risk levels would be measures that the government would undertake, be it flight bans or travel advisories or quarantine measures or whatnot.
That's roughly what's been in my head, reading the Auditor General's report, and I'm wondering if there's anything we could do right now, if it is reorganizing that way or not, to make sure we're not vulnerable, particularly to variants.
Ms. Rempel Garner, thank you for your question.
I suppose I should address the chair, but that's always seemed to me a strange formality. My apologies.
I think you make an excellent point, but I would say two things in response to the question of what we can do now. One is that there are a lot of, if you like, ad hoc possibilities for immediate application of the kinds of capabilities and talent that exist in the federal government.
The security intelligence community is extremely well versed in collecting all-source information and doing professional risk assessments. The problem was that, as I said, PHAC was siloed from that activity and that expertise. In an ad hoc fashion, the thing we need to see being done—perhaps it is being done behind the walls of the security intelligence community—is simply ensuring that the expertise and set of capabilities from the variety of agencies in the Canadian security intelligence system are available to PHAC for an ongoing risk assessment process.
I'm not even aware of the extent to which risk assessments may continue to be done. They were essentially stopped in March 2020 after it was realized that the pandemic had arrived. Now, perhaps they've been restarted. I don't know; I've not seen anything in the public domain on that.
There should certainly be an ongoing risk assessment capability. If we'd had one, it might have helped us prepare for second and third waves and variants and all the things we know of.
The last thing I would say is we just have to be careful to make sure that whatever ad hoc measures we take in our scramble to deal with an emergency don't get baked in as permanent measures. We have to keep our minds on what we ultimately want to achieve.
That's why I think there are some very important structural and strategic things that we need to undertake. A national security strategy.... We need a national security council structure, finally, at the heart of government. We need to have a whole-of-government intelligence collection and assessment capability to deal with not just health emergencies, but a range of non-traditional threats that we're now confronting in Canada.
My questions are for Dr. Schwartz.
First, let me say thank you to you and your colleagues. I'm sure that at times this feels like a thankless job, but we certainly appreciate your expertise in coming together during this difficult time.
I appreciate your outlining very clearly the six priority areas you're talking about in terms of moving forward. I took note of them.
In that vein, my question is around the biggest risks you're seeing in Ontario right now. We have data that suggests more than 60% of outbreaks are from workplaces and education—43% are from workplaces and 21% from educational settings. In that vein, and with the six priority areas you mentioned, where do you see the biggest threat of spread in cases that are putting the strain on our health care right now in Ontario?
First of all, thank you for your kind words, Ms. O'Connell.
I think the biggest threat moving forward is, in fact, related to crowded workplaces and crowded workplaces in hot spots. In particular, certainly less in education and more in workplaces involved with distribution and transportation, we have workers in those workplaces who live in hot spots, in crowded conditions and with other workers in multi-generational households, particularly in northwest Toronto and Peel.
Because of that, we have recommended, and the province is rolling out, very targeted vaccines to those areas. We're very gratified that those recommendations, which are based on some of the modelling we did, will—we hope—start being effective in reducing the transmission in those settings.
In my previous life, I was also in politics, but at the municipal and regional levels in Ontario. We had some areas of responsibility over health through our local health agencies. Part of that responsibility is communication and educating residents on how they can help prevent the spread in this instance and, really, education on risks.
If we're looking at workplaces right now as the number one concern, I noticed your six priority areas don't cover borders. The kind of political.... I fully recognize your comments off the top. I'm not asking you to criticize a political decision, but if these are the areas of concern, and workplaces are the biggest threat, when it comes to the resources and the efforts to communicate with Ontarians in this case, would it not serve the broader public health measures to invest in resources that focus on the hot-spot areas or focus on the areas of concern to also arm and educate the public in those areas that are most affected right now? In putting communication priority on things like the borders, which account in Ontario for less than 2% of transmission, aren't we missing an opportunity to educate and help Canadians in stopping the spread? Is that a missed opportunity to educate our communities?
Thank you very much, Mr. Chair.
I'm very pleased to be with you today replacing my hon. colleague Mr. Thériault.
The two messages we heard gave me pause. Now that we have experienced this pandemic, others will follow. That is what I understand.
I also wondered about the role of the provinces and Quebec. While you were speaking, I looked up the word “confederation”, and it means an alliance of independent states. During a pandemic, the independent states forming a confederation must be consulted. Section 25 of the Emergencies Act actually stipulates that the lieutenant governors must be consulted before a state of emergency is declared.
I would like the witnesses to explain what consultations were held and what the outcome was. Logically, a health transfer should have resulted from the consultations, to address the critical needs during the pandemic.
A situation like this must not occur again. Obviously, we need to respect each other's powers, but each state must have the necessary tools and means, depending on factors like culture, language or territory. As I have heard so clearly, things vary greatly.
First, I invite Professor Hardcastle to comment on what can be imposed on all provinces.
Dr. Hardcastle, picking up on Dr. Schwartz's last comment, I think it's fairly common knowledge now that jurisdictions around the world, as Dr. Wark has pointed out, that were able to contain travel with hard stops had the greatest success in reducing transmission. We saw that in Canada with the early closures in Atlantic Canada.
I'm looking at the Emergencies Act, section 8. The very first power given to the federal government, were it to invoke the Emergencies Act, is “the regulation or prohibition of travel to, from or within any specified area, where necessary for the protection of the health or safety of individuals”.
My question is, is it only the federal government that has the constitutional power to regulate travel interprovincially and between provinces and territories? If they didn't do it, would any province have the ability to do it?
The provinces can regulate travel within their provinces. Many have that in their public health act as an emergency power that can be done in a public health emergency. Many have it in their emergencies act provincially, but there does seem to be this reticence among some to use it.
For example, B.C. really was concerned about using it to keep Albertans out, so there seems to be.... Once that Albertan is in B.C., then they have the power, potentially, to exclude them, but there seems to be some concern about the legality of that, whereas with the federal government, I think there wouldn't be that same concern, because there's no question that they could do it federally.
I think there are problems with the variants moving from one province to the other. We had a situation in Alberta where one traveller came from B.C. to Alberta. There were 35 cases, at least one death and two ICU admissions, so these provincial borders pose real threats.
I very much feel for the Brampton community. It has been very severely impacted.
The science table watched with concern what was going on in Great Britain over the course of December and January. We were looking at the B.1.1.7 variant and how it affected Britain and western Europe.
Looking forward and in trying to prevent a fourth wave, the idea of keeping restrictions as restrictive as possible for as long as possible is a very important principle. As we said, reducing the number of essential workplaces and reducing mobility.... It's very hard to look back. I certainly feel for decision-makers who have a number of factors to take into account beyond the science of public health, like the economy and so on. I wouldn't want to second-guess the decisions that were made.
Looking forward, it's very important for us at this point to continue the lockdown as long as possible, to allow the vaccine to take effect.
I thank my colleague for giving me the opportunity to ask a question. Actually, the question goes to all the witnesses.
As you know, Quebec was hit harder at the beginning of the pandemic last year. This was due to the fact that we had spring break earlier than other provinces, but also because we were close to the North American epicentre of the pandemic, New York State.
In light of that, do you think it would have been a good idea for the government to immediately stop all air and land border crossings, including those by the passenger buses that frequently travel between the two countries? Should the government have acted quickly to do that?
I'm referring to one of the witnesses who said earlier that the government was not prepared for the pandemic, unlike other countries such as Australia or New Zealand. After all, we should have learned from the SARS outbreak we had previously experienced.
So should we have acted sooner?
Very quickly, in response to the question, the answer is yes, absolutely. I think a variety of measures, including earlier border closure measures, would have been of assistance.
Quebec's timing with regard to its March break and the return of snowbirds and so on, was very unfortunate. Ontario had a similar experience.
If we had taken more seriously all the evidence in front of our eyes about the spread of COVID-19 globally and had been willing to act on that, Canada could have been in a much better position to protect itself nationally and provincially by, at the very latest, the end of February, if not earlier than that, and certainly not having to wait to go into mid-March before we took real action.
This is a great mystery that we have to get to the heart of, and I hope, as Ms. Rempel suggested, that there will really be a serious, across-the-board, lessons-learned exercise. I haven't seen any sign that it's going to take place yet. We've had ad hoc efforts to learn some lessons.
At the heart of it, I think there was a systemic failure. We didn't have the structures in place to deal with the information that was coming to us.
Secondly, there was a failure of imagination. Those of you who are familiar with the 9-11 commission report out of the United States will recognize that term. It is that we knew, and should have known, that pandemics could hit us and could hit us hard. We knew that, but we didn't believe it.
Now, why is that? That gap, that failure of imagination, is a profound issue that somehow needs to be addressed going forward.
I'm a little confused by the order here.
There's an embarrassment of riches on this panel. There are so many people I'd like to ask questions of.
Lorian, sorry. I can't get to you.
Dr. Wark, too, that was great testimony.
Dr. Schwartz, I'm going to put you on the spot a little because I have a bit of a bone to pick with the science council, and that's over the issue of the use of monoclonal antibodies by infectious disease people in Ontario who certainly want to use them.
There have been a couple of randomized controlled trials with the use of bamlanivimab—which our government bought 40 million dollars' worth of—published in pretty good journals, such as JAMA and the New England Journal of Medicine, showing a benefit when used early in high-risk people.
Another recent case-control study in Clinical Infectious Diseases showed that you needed to treat eight people to prevent one person being admitted to the hospital.
With bamlanivimab, I know the FDA changed its approval, but for the variants we have in Ontario, it still works on 90% to 92% of people.
With the whole bunch of new monoclonal antibody combinations, they're still waiting for approval by Health Canada, but there have been a number of studies, not yet published, in which manufacturers have shown pretty good evidence for a 70% to 80% reduction in hospitalization, again when used early in high-risk individuals.
In fact, a recent GlaxoSmithKline study of their monoclonal antibody had to be stopped early because it was considered unethical to continue the study because of the decrease in hospitalization.
Despite this, infectious disease people in Ontario, 12 of whom I recently wrote an op-ed with, who want to use monoclonal antibodies, can't get hold of it. Why is that?
It would seem that there are a few influential people who aren't elected, some of whom sit on the science table, who feel that there's not enough evidence for the use. What I would question is that these are non-elected people—these are a few infectious disease people—yet why should they have the power to control what other infectious disease people use as therapeutics? Therefore, I'm kind of questioning whether the science table is really serving the public in giving some advice.
We are trying to find out what happened between January 7 and March 7. I will tell you: we were distracted by parliamentary sparring. Since my party is the only one that doesn't want to take power, I can say these things. When parliamentary sparring predominates, it takes time to act when crises like the one we experienced arise.
Earlier, I heard my colleague say that, with respect to COVID-19 transmission, the border was involved in only 2% of cases.
Mr. Wark, I don't understand how you can say, all at once, that the government didn't act swiftly enough, that a variant came in from another country, and that managing the border is not that important.
I'd like to hear your opinion on that.
We are resuming meeting 35 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic. Specifically, today we are examining Canada's national emergency response landscape.
I would like to welcome the witnesses. We have appearing today, as an individual, Dr. Lisa Barrett, assistant professor. Also as an individual, we have Reverend Michael Garner, Anglican priest.
I will invite the witnesses to go forth with their statements. I will start with Dr. Barrett.
I also advise the witnesses that I will be using these cards to indicate when your time is almost up. I will display this when there's roughly a minute remaining—but that's approximate—and this when your time is officially up. If you see the red card, you don't have to stop instantly, but try to wrap up.
With that, we'll go to Dr. Barrett.
Go ahead for six minutes, please.
The invitation to bear witness here this afternoon is very much appreciated. Thank you to the committee for inviting me.
I'm an infectious disease physician and clinician, scientist and researcher at Dalhousie University, and I speak from that perspective today. Although I work with and collaboratively around both the Nova Scotia Health Authority and the public health department at the government of Nova Scotia, I speak as an individual here today.
I want to provide a bit of context perhaps of somewhat of a microcosm of the pandemic response from Atlantic Canada, specifically in terms of Nova Scotia and our response. As an infectious disease person, I think the things that have made our response arguably very successful.... We have, even with our current wave, 346 per 100,000 people who have had COVID-19 infections. To put that into context, other provinces include Ontario at 3,200 per 100,000 and Saskatchewan at 3,800 per 100,000. Again, as I said, there were 346 per 100,000 here in Nova Scotia.
We have arguably had a successful response and, as an infectious disease person, I would say there are several components to the response that are rather important.
Number one, we understood speed of response fairly quickly, as in infectious disease, speed is always important. Number two, that speed has added distance between human beings which, with a respiratory infection, is an incredibly important thing to do. Number three, in addition, there has been awareness of the infection and where it is through the use, primarily, of an exceptional amount of testing, both in people who are symptomatic and those who are asymptomatic, throughout the pandemic. The fourth, less quantitative and I think exceptionably important thing that we have managed to do as part of our pandemic response is to engage the community, not just as passive members of the pandemic response but as active members in being tested, getting tested, being the testers and being actively engaged throughout. I'll speak briefly to each of those components.
On the first part, speed, I'll use our most recent wave as an example. We went from zero to six cases per day from about last June until November, when we had a small number of increased cases up into the low double digits. Until then, we had gone back down to zero to six cases, again per day, with almost zero unlinked epidemiologic cases. For those who don't spend their lives looking at microbes and infectious diseases, that would imply that community spread was limited, which is very important. We knew where the cases were coming from and how. That changed in April. Between April 15 and April 21, we started to go into double digits of new cases per day, and there was the beginning of a signal by April 27 that we had community spread when we hit 97 cases per day. At that point, our restrictions went from being fairly open to being very closed.
In the intercurrent period between our waves, the Atlantic bubble still existed, and I'll speak to that in the distance part of things, when people coming into the region were required to quarantine. Anyone coming in from outside the Atlantic bubble.... In fact, our bubble burst a couple of months ago when our cases started to go up a little, and even people coming from within the Atlantic provinces were required to quarantine for 14 days.
The reason that's important is that we were able to keep track of where the cases were and how they were. At 97 cases, our government closed down public places where you would be unmasked and indoors, both retail and restaurants, etc., which had been open in between waves. Gyms were closed down very quickly, and people were asked to be at home. Then the cases went up even higher, into the hundred range, and the whole province was shut down. That's the speed part of things.
Seeing cases go up and community spread go up met the criteria that we have in place here that are quantitative: high numbers of unlinked cases, high reproductive numbers of the virus and case numbers going up in the community per hundred thousand. That was done very quickly, and distance was added. Inside, and in places where people can't mask, they were asked to do so quite a bit.
Then there was awareness. We always maintained asymptomatic testing between waves, so we knew when there was asymptomatic virus in the community. We also ramped that testing up to between 1.5% of the population per day when we went into this wave of the last week and a half ago and 5% of the population per day in our hot spots. In addition to that, awareness through our symptomatic testing was maintained.
On the engagement part, which I will be happy to give testimony on later, is the fact that we ran much of this testing outside our labs. Community-based volunteers were doing this work. There were taught to test, swab and provide an exceptional resource to people at the time, so we had a warning detection system for virus in the community.
I think, together, this has been an example of how we may be able to do things better in Canada and in different parts of the world as we go forward in this pandemic. The effects of speed of response, distance of people, awareness through diagnosis, and engagement of the community cannot be underestimated. I'd love to take questions on that afterwards.
Thank you for allowing me to speak.
Good afternoon, Mr. Chair and honourable members of the committee. Thank you for inviting me here today to speak with you.
My name is Michael Garner. I am an Anglican priest and an infectious disease epidemiologist. I worked at the Public Health Agency of Canada from 2006 to 2019. I was invited here today to expand on my comments in the July 25 edition of The Globe and Mail.
When the Public Health Agency of Canada was created in the aftermath of SARS in 2004, the government of the time decided that the chief public health officer should be the deputy head of the agency because then the authority and responsibility for public health in Canada would reside in one person who would be an expert responsible for the public health resources of the federal government. This leadership structure echoed most other national public health institutes around the world.
I trust you have all read the recent Auditor General's report on the performance of PHAC in the pandemic. The Auditor General's conclusion confirmed the reality of what all Canadians have been living. It said, “The agency was not adequately prepared to respond to the pandemic, and it underestimated the potential impact of the virus at the onset of the pandemic.”
Despite identifying a myriad of issues at PHAC, the Auditor General failed to identify the root of the problem. At no point did she ask why the systems were allowed to go untested. Why didn't the risk assessments from January to March of 2020 look adequately at the potential for COVID-19 to become a global pandemic?
Plainly, we have a national public health institute that is run by non-experts.
Six and a half years ago, the Harper government moved the leadership of PHAC from the CPHO, who is a public health doctor, to a president who is a career bureaucrat. This decision set PHAC on a course that has gravely influenced its ability to put into place the foundational elements required to proactively prepare for and effectively respond to the coronavirus pandemic. It also created a cascade where public health experts are no longer present at the senior levels of the agency. They have been largely forced out and replaced over time by generic bureaucrats with no experience in or understanding of the very basic principles of public health science.
Perhaps even more troubling was that in the midst of the pandemic, when faced with the need to install a new deputy head of PHAC in September of 2020 and with the failures of responding to the crisis evident to all Canadians, the , rather than installing a doctor with expertise and experience in public health and pandemic response, picked another career bureaucrat with no credentials in public health, who would have to learn on the job in the midst of the biggest health crisis of the last century.
Interestingly, the United States' CDC faced a similar situation of needing a new director. It replaced the outgoing director—a physician and virologist—with a physician and public health expert.
In the midst of the catastrophe of the federal response to the pandemic, the government has continued its long practice of devaluing expertise and subject matter competency in favour of bureaucrats. However, I would suggest to you that the failures in the PHAC response to the pandemic should not be pinned solely on the bureaucratic leadership of PHAC. If I was put into a cockpit of an airplane and the lights began to flash, I wouldn't understand what to do because I wasn't trained to be a pilot. It is unfair to expect Mr. Stewart or any of the other non-experts running PHAC to adequately manage the Canadian response to the pandemic. They don't have the training or experience required.
As we emerge from the pandemic—as we surely will—I hope this committee and others will initiate a re-examination of where public health experts are needed in the federal government. I hope the Public Health Agency of Canada Act will be restored to its original form, with the position of president of the Public Health Agency removed and that power restored to the CPHO role.
Ideally, this will initiate a new cascade, where public health training and expertise is valued over the ability to work the bureaucracy for personal gain. It is the decisions of the Harper and Trudeau governments over almost a decade that have led us to the depths of this crisis. The decisions of Mr. Harper and Mr. Trudeau have had a cost—a cost that has been paid for with the lives of Canadians who have needlessly died from COVID-19.
Thank you. I look forward to our discussion.
My questions will be for Dr. Barrett.
Dr. Barrett, I want to thank you so much for taking the time to be here today. You are an expert, and you've been such a leader in Nova Scotia and in our response to COVID-19. I can speak on behalf of my constituents when I say I'm so proud—so proud—to have people like you representing our province.
We've demonstrated, I think clearly, that provinces can control the spread of this virus if they take a committed stance and follow provincial public health advice, so I have a couple of questions for you.
From day one of this pandemic, Dr. Strang and his public health team, and of course former premier McNeil and now Premier Rankin, have taken COVID-19 seriously by implementing very strict public health measures.
This is a chance, Dr. Barrett, to unpack the measures you spoke to in your opening statement. I'd like to hear a bit more and maybe do a deeper dive on that in respect to the first wave, but given the severity of our third wave, do you think we could be doing more?
I have one more question I'm going to put in there, because I want to take this time we have for you to answer these questions. With the record-high cases—I think it's 227 today, and I think that's a total of a little over 1,400 cases—can you tell us what you think the next couple of weeks look like for Nova Scotians? What advice would you give to those watching at home?
Thank you, and over to you.
Maybe I'll start with the end first.
I think we have a bit of a rough go yet. We still have a large number of cases that are unconnected, and we're about day 10 or 11 into a lockdown. That's the real lockdown, not the kind of lockdown you see in some places. I think we're going to need a few more restrictions that are going to hopefully come into play right now. It's tough, because a lot of this is engagement, and I truly believe that Nova Scotians and Atlantic Canadians, and people, Canadians.... You can have the best bureaucrat in the world or the best doctor in the world leading something and suggesting to people they do something, and unless people are engaged at a real level and a granular level—at an individual level in places and provinces—you're not going to get a response, because people just won't do whatever is suggested. I think we have a rough few weeks ahead, but I think we'll get there, because there is an incredible amount of engagement.
Do we need to do more? Probably a little more. People need to get their heads back into last April's mode of a state of emergency, not current mode. I think that's probably something that heralds into the bigger picture here and what other places have done.
Nobody in Nova Scotia, because our numbers.... I mentioned to you that there are quantitative numbers that have been followed. To come back to the federal approach, I'm shocked and appalled that we haven't, as a federal agency, prescribed some quantitative measures of what would be useful guidelines for people in terms of regions and when they might loosen restrictions at different points. We've stayed pretty close to our quantitative measures of community spread, reproductive number of virus and number of cases on a daily, rolling seven-day average. This is not rocket science; this is called epidemic/pandemic management 101.
I'm surprised that we haven't federally required people in eight regions to do that at the provincial level before restrictions are reduced. I see headlines today about places that are thinking about reducing restrictions when the number of cases and unlinked cases is still exceptionally high. I know we won't do that, and I think that's a key, core part of what has kept us safe. That comes back to the four things, which are distance, speed, awareness through testing, and engagement. Testing has been a huge part of the way we're going to make it through this, but that's also because we have an engaged population. You can suggest anything. If people aren't doing it, then you're not going to get anywhere.
I think, one, yes, there's a bit more we need to do; two, it requires a little more engagement; and, three, I'm saddened and disappointed that we haven't done that with a prescriptive set of guidelines for provinces. I think it's a bit unconscionable that, just because you live in a different part of Canada, your public health advice may be a little different around things that can be helpfully quantitative and are able to be implemented.
Thank you, Mr. Chair. Your French is excellent. It's very nice to hear you.
My thanks to the witnesses. I must admit that it's great to hear about good practices. I commend the work that's been done at all stages, particularly in your case, Ms. Barrett. As you explained so well, we in Quebec saw a lot of enthusiasm for volunteering. People came together to support the community. They even created a website called jebenevole.ca. People were so supportive that it was hard to manage all the volunteers willing to help the community.
With respect to how quickly action was taken, I confess that I was also outraged at the two-month delay that we had to deal with. I'm thinking of the lives that could have been saved.
We are now in the third wave. I hear a lot of people saying that government actions are grossly inadequate. Mr. Garner's comments are very specific, and I thank him for that.
Ms. Barrett, I would also like to hear your comments about how quickly governments took action. I would also like to hear what you have to say about rules and communications, that is, the whole issue of government public relations in all the provinces and in Quebec.
I'm certainly not a communications expert, that's for sure. I will comment from the perspective of the science and the infectious disease point of view.
The engagement part is important. I think it was interesting.... We didn't try to manage the volunteers. Once there was that wave of engagement that was partially generated, there was an opportunity. We generated opportunities for people to be engaged, particularly through testing. Not just around testing, but also as part of the testing events, as it was the actual people doing swabs and doing the point of care tests. However, we didn't try to manage that.
It's important that there is sometimes a great deal of oversight—paternalism, maternalism or they-ism—that comes into our public health responses, in that we try to control it. It's a notifiable disease. We let go of that a bit. We let go of medical professionalism and protectionism of fields to include people in a very real way that was very much generated by them as well.
I think if we're going to be successful as we go forward in any province, we have to give people a bit of autonomy at the same time as we're telling them to restrict. I'm not a human behaviour specialist, but I think that was an important part of the combination of responses here in Nova Scotia. I hope that's going to continue.
To your point about speed, we can't do this if governments aren't definitive and quick. The speed at which you take away the restrictions should be as slow and guided by quantitative measures as the implementation should be swift. Taking things away too fast, before the numbers go down, is a catastrophe.
In terms of speed and communication to people, we just provided a whole lot of information to folks in a real way and said that this is the way it is.
Congratulations, Ms. Barrett. You are a great role model. It made me realize that in Quebec, we're also very fortunate with respect to public health.
Mr. Garner, you talked about inertia in decision-making and the relationship between public health authorities and government. In my view, in Quebec, but certainly elsewhere as well, public health authorities made all the recommendations and codified everything that had to happen, such as restrictions or physical distancing, and the government made decisions. It all had to be done extremely quickly.
I'd like to get more clarity on the process: listen to the science, take responsibility, and put partisanship aside, because we're talking about human lives. We have a few seconds left, so I would like to hear from you on that, Mr. Garner.
It was a co-signed, fairly large group in the letter.
The nationwide part does refer to something I've alluded to a couple of times, which is that when you're talking about an infectious disease like this, there is science around some of the numbers that can lead to suppression and control. Some of those measures I've already mentioned around how fast the virus moves, how many contacts, the number of cases in a certain area and the ability to spread from person to person.
Therefore, if you have a certain number of cases and a certain type of interaction—distance was one of my pillars—nationwide guidance around areas that have parts of a pandemic that are out of control and suggestions for what to do at that point to limit the distance, increase the awareness or surveillance, and increase the speed of response and engagement, that would make exceptional sense to me.
I guess, in short, what I'm saying is that yes, there are quantitative things that people can fight about till the cows come home in terms of the exact number, but there is very good science around how to contain an epidemic like this. You take those numbers; you go to places that need that guidance and you provide them with the support and the guidelines to be able to do that. I think we need official and national guidance on those items. They don't have to be implemented equally across all regions, but in areas that meet the criteria, those guidelines should be followed or else you are going to see spread of the infection.
This is not a hypothetical; it's a definite, and we know how to fix that.
Thanks, Mr. Chair. I just want to go back to Dr. Barrett.
Dr. Barrett, I really like your four points. The speed, the distance, the awareness and getting people engaged are key.
I want to know how rapid testing fit into the model of the maritime bubble. Was it used extensively?
We are behind in vaccines compared to many of our G7 country colleagues, and vaccines weren't used as readily as they could have been.
I wonder if rapid tests were used more in the Maritimes. These other issues of distance and awareness are great, but I think the speed of response is one of the key issues. Could you expand on how rapid tests fit into that?
I know the government has made an announcement just today, but my colleague has been calling for this for over 10 months. We still have increasing numbers, so I wonder if rapid tests could be used in the variant areas as well.
Dr. Barrett, first, thank you for being here. I'm sure you're incredibly busy, and your testimony is quite helpful .
Quickly, as I only have three minutes, your point about strong restrictions—and I think you said real, not half measures—is one that I want to speak about.
Obviously, any sort of lockdown or restrictive measures are difficult for everybody. I don't think anyone would not acknowledge that's the case; however, I would assume death and severe illness would be far worse.
This past week, we had an emergency debate on the situation in Alberta, and some of the testimony by our Conservative health critic, our colleague here, referred to lockdowns. She said, “Lockdowns are a very bourgeois concept for a lot of legislators.” She said, “It is a luxury.” She referred to it as being “classist”.
The suggestion that was made was to just use vaccines, and then we don't have to get into this luxury lockdown situation. My community doesn't find that lockdowns are easy, but we do it to make sure we keep our communities safe and our loved ones safe. In terms of that context, is there any jurisdiction that was able to get through the pandemic with vaccines alone, given the fact that we know it takes time for the effectiveness to take hold, even when the person gets a vaccine. What is the importance of strong lockdowns in conjunction with vaccines, and why is this a public health measure and not a bourgeois concept, as has been suggested?
Okay, I'm not quite sure how to respond to the concept. A lockdown is about distance, right? Distance is a key part of preventing and maintaining control of a respiratory illness transmitted by air. Distance is an important part of that; lockdown generates distance, so that's a fact, not an opinion.
It is a luxury if we don't support people who are homeless, under-housed and can't stay at home, and that is a key, core part of this. A lockdown requires a heck of a lot of support, and that should be provided and shouldn't be a luxury. Otherwise, vaccines are an adjunctive measure. You don't vaccinate your way entirely out of a lockdown situation or a high-spread situation. Everyone touts the U.K.; they used the lockdown with a massive vaccine rollout.
Then, to be clear, that's a combination measure. Vaccines are your long-term plan, not an acute plan. I'm happy to do an infectious disease management lesson on that, but that's the actual part of it. There's no such thing as one or the other.
Thank you very much, Mr. Chair.
My question is for Mr. Garner.
Thank you very much for your very frank and open testimony. That's certainly much appreciated in the situation we find ourselves in.
We were talking earlier with previous witnesses about some of the missteps along the way, and I know you can't give that inside information, but I found it interesting that PHAC was going to do a national pandemic simulation in 2019 but put it off. This would have been in partnership with the provinces and territories and in conjunction with the federal government, which is the focus of our study here.
What kind of a difference would that have made, from your expertise, in terms of identifying the capacity of provinces and territories to handle a pandemic and maybe identifying as well some of the obstacles or shortfalls that we may have had in that provincial-territorial-federal relationship?
That's a big one in a couple of minutes, so I'll try to squish it in.
I think we can learn from what's been going on in Atlantic Canada and Q-14. I don't know why we haven't done it in the rest of Canada. That's not another jurisdiction, but it's here.
Do things early. If you have a reproductive level of the virus that's 1.5, or if you have an average of 400 new cases a day in an area, don't leave your gyms and restaurants open for a week and a half to two weeks. These are just very practical things.
Don't not engage people. If you have people volunteering to do things, don't say that a medical expert needs to do a test that you can train a 16-year-old to do, who's one of my best swabbers. Don't turf protect.
In terms of other jurisdictions, New Zealand has always been a leader in this. Australia's always been a leader in this. They engage and they fund public health a lot. They lead by public health—not by having other people on the stage when they're giving direction and advice—and by scientists. I'm a scientist, so I'm biased, but I think that's helpful, and when someone says to do something like that, you do it quickly.
I am recapitulating some of the things I mentioned earlier but also with a few specific examples. Don't go far. We have a fairly successful example here in Canada within the Atlantic. Q-14 is a big part of it. Definitive policy is another part of it, and rapid testing and continued testing are a huge part of it.