June 26th 2020 - Study on the government’s response to the COVID-19 pandemic
Senator Poirier: Thank you, minister, for being with us. Also, thank you for all the other witnesses that are on standby to answer our questions. I greatly appreciate it and I think it plays an important role of information that you can bring to us as we’re closing this chapter of the first part of our study that we’re doing right now.
My first question is actually for Dr. Tam, if you will allow. We have heard from countless witnesses throughout the committee study that there was a lack of access to personal protective equipment. It was the number one concern through this pandemic. Hospitals and workers have had to ration their supplies while they wait for stock to be replenished, and some have even had to reuse certain equipment. As Dr. Margaret Tromp told this committee, this would be considered a malpractice in a pre-COVID era. Dr. Tam, what was your knowledge about the lack of personal protective equipment in our National Emergency Strategic Stockpile? Can you tell the committee whether you personally ever warned the government that the National Emergency Strategic Stockpile was under-funded or under-stocked?
Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada: Thank you for the question.
In the Canadian context, all levels of government, particularly the provinces and territories, are responsible for the health care system itself. Every provincial-territorial government also maintain their stockpiles, and that’s where the majority of the personal protective equipment is used.
The National Emergency Strategic Stockpile, which is maintained by the Public Health Agency of Canada, actually didn’t have that much personal protective equipment in it prior to the arrival of this particular pandemic. I think that’s fairly transparent, given that the stockpile itself is very much focused on some unusual stockpiles of vaccines and medications that provinces don’t normally stockpile. There was a small amount of personal protective equipment, and that could serve as a backup in the event that the provinces and territories are not able to cope.
Of course, this event taught us that there’s an incredible amount of personal protective equipment required for such a pandemic situation, so the government, very quickly, together with multiple departments, Public Services and Procurement Canada and the Public Health Agency, Health Canada and our ISED colleagues, all got together to use multiple different approaches to acquire personal protective equipment as fast as possible, in a very competitive and unusual supply market, to get PPE to Canadians, and also then to establish domestic supply. So a lot of work was certainly done as fast as possible at the start of this pandemic.
Senator Poirier: Thank you, Dr. Tam.
We’re also seeing lately more and more cases on the world stage, and every day seems to be a new record for the most cases recorded in a day. We have heard time and again that we’re not prepared for the second wave, and we need to prepare for it. It’s not if it comes, it’s when it’s going to come, from what we’re hearing. Dr. Tam, what is your plan to ensure that we’re ready for the second wave? What would you say to health care workers in the wake of a second wave to reassure them that we are ready, that we have the equipment that is needed and that government is prepared?
Dr. Tam: Right now, as everyone appreciates, Canadians, many partners and all levels of government have tried very hard to suppress that initial wave, but always at the back of our mind in constant vigilance is a resurgence scenario. It’s not just a matter of a second wave, but because the virus continues to be in the world and in the Canadian context and we don’t have a vaccine, the population is unlikely to have a high level of immunity so that the risk of a resurgence is very real. What is suppressing it right now is the public health measures everyone has put together, and that has been effective.
But absolutely, while cautiously reopening certain sectors of our society, there is simultaneous rapid planning for any resurgence. Modellers, for example, have worked hard to show us that if we didn’t put the right combination of public health measures in place, including testing, contact tracing, isolation and quarantine measures, a resurgence is very likely to happen.
What we’re trying to do while trying to suppress any outbreaks immediately — that’s the plan — is preparing for a possible return of an even bigger wave in the fall and winter season. It could be anytime, actually, so we need to be constantly prepared and constantly increasing our capacity. What we are concerned with and planning for right now, together with all the chief medical officers of health across Canada, is a simultaneous wave occurring at the same time as an influenza outbreak. That is what we are working very hard to do.
Some of the conditions that the Prime Minister and the premiers have put together are that reopening can only be done under certain conditions. In addition to those public health measures and capacity, such as lab testing and contact tracing, is the absolute requirement for the health care system to have the capacity that it needs to cope with any resurgences.
In the initial wave, in fact, the provinces and territories have been able to keep any sort of overcapacity of the acute care system, so that was actually managed quite well during the first wave, with still vacant capacity that they were able to manage. Some of my colleagues here could elaborate.
There is quite a lot of work in modelling the personal protective equipment requirements under these scenarios and then getting those requirements from the provinces and territories in real time, but also in planning purposes, and then sourcing all of those requirements is a massive amount of work that is ongoing.
All of us believe, of course, that protecting health care workers and anyone who works in the health system is of paramount importance, but, of course, not forgetting our seniors and our long-term care home part of it as well. While the acute care system wasn’t as impacted, the long-term care homes and seniors residences absolutely are, and they need PPE as well.
Senator Poirier: Thank you very much, Dr. Tam.
Senator Poirier: Again, thank you, minister, for allowing this.
My question is for you, minister. Earlier in my questions, Dr. Tam talked about the stockpile that was possibly under-funded and under-stocked in the National Emergency Strategic Stockpile. Minister, at what point were you or was the government made aware that there was a shortage in the stockpile and that it was underfunded?
We’ve also heard from many of the witnesses the fear of the second wave and not being ready for that second wave, and a lot of them feel that we’re not ready. Could you please confirm to us the condition of the stockpile at this point in the National Emergency Strategic Stockpile? Are we funded? Are we ready for the second wave going forward?
Ms. Hajdu: Thank you very much for the question.
I think Dr. Tam’s remarks reflect the fact that the National Emergency Strategic Stockpile was not meant to stockpile huge volumes of personal protective equipment. Furthermore, it’s challenging for the National Emergency Strategic Stockpile to do that because, in fact, different infections would require different kinds of PPE and different kinds of equipment.
Having said that, we know what’s required with COVID-19, and, in fact, Procurement Canada has a dashboard available publicly that can give you a direct line of sight in terms of what we’ve ordered and what we’ve procured.
We have an agreement with the provinces and territories that 20% of what we acquire we hold back in the National Emergency Strategic Stockpile so that we can augment their needs should there be a particular surge in any particular region of the country. I have to thank my provincial-territorial partners for working so hard on that. This allows them to also build up their stockpiles with the equipment they may need for any particular surges, second wave or whatever does appear, while allowing the federal government the ability to build up again what we need to support that.
Frequently, provinces and territories will ask for equipment and/or personal protective equipment from the National Emergency Strategic Stockpile. I think we’ve had over 45 of these requests, and we’ve managed to fulfill all these requests for provinces and territories, so I think we’re on the right track.
In terms of when did I know, I was appointed about a month and a half before the pandemic outbreak. We were preparing budget letters, requests around flu vaccine, et cetera. Those conversations happened very early in terms of what we did and didn’t have and what we were going to need to procure.
Finally, in terms of the federal government’s commitment to procuring enough PPE, I can tell you that no expense is spared to make sure Canadians are ready for whatever the next wave looks like.
Senator Poirier: Thank you, minister.
Senator Poirier: Thank you both for being here today, and a big thank you and appreciation to all the Canadian Armed Forces members who answered the call and are, unfortunately, putting themselves at risk of harm also.
The report that came out in May showed that the long-term care system in Ontario is broken, and unfortunately we don’t have the time to fix it before the second wave will probably come upon us. Could you please advise us if you feel that you have the human, financial and material resources you need to answer to a second wave in the long-term care homes like the army has done during the first wave?
BGen. Bourgon: Thank you for the question.
I think when you look at the Canadian Armed Forces, we are the force of last resort. We have our members ready to assist as we are asked by the Government of Canada. So indeed, we have the personnel, we have the resources, and when we are asked to go back to the LTCF because there is a demand, we will do it.
Senator Poirier: Okay. What was the biggest challenge that you experienced so far with the Armed Forces in the long-term care homes?
BGen. Bourgon: I think I’m going to talk first and then I’ll give the floor to General Bilodeau. I think for us, the CAF, this was quite a different task than we have ever done before. From the get-go, the training that we had to do, the logistics and the coordination with the long-term care homes, so that we would know our roles and what the requirements were, I think for us was probably the biggest challenge because this is something new. We are used to helping Canadians in flood and fire situations, but that was the first time in the long-term care homes. That was the big lesson learned for us. Marc?
Major-General Marc Bilodeau, Deputy Surgeon General / Director General of Clinical Services, Canadian Forces Health Services Group, Department of National Defence and the Canadian Armed Forces: If I may add, the biggest challenge from my perspective as a physician is that this environment we were putting our members in was highly infectious. It’s a very high-risk environment from that perspective, which required a lot of preparation in order to make sure that our members were as protected as possible in order to protect their health, but also the health of the civilian co-workers who were already in these homes, and most importantly the health of the residents of those long-term care facilities.
The fact is that this type of medical task is new for us, because obviously we have never been engaged as armed forces in long-term care facilities before, and it required a lot of preparation too. That was part of the training, to understand what those health care environments were and how we could support despite the fact that we are not experts in the field.
Senator Poirier: Thank you. I have two more short questions so I will wrap them both together so I hope I can get them in.
First off, we had heard a lot of places where they are saying there is a shortage of PPE equipment. I was wondering if that was the same issue for you when you went into the Armed Forces. Was there enough access to the PPE?
Also, during the first wave, there were just two provinces you had to come in and help. I’m just wondering, with the second wave, if the need is to go to other provinces across the country, are you equipped and ready for that? Do you have the manpower for that?
BGen. Bourgon: I’ll start the question on the PPE. From the PPE perspective, there are always two kinds — the medical PPE and the non-medical PPE. Initially, before this crisis started, the PPE was left at the discretion of the regional, so each of our bases and wings were responsible for the procurement of their equipment. With the COVID-19 crisis, we quickly realized as a whole of government that there was not enough PPE available. So PHAC and PSPC took control of the procurement process for all the federal agencies, and they are coordinating a major buy, which they have already done. The equipment is starting to come in slowly.
For us on a non-medical piece, what is super important for us is the gloves and the masks. The big procurement, as I said, that was done, of course, is coming from China. It has been delayed a bit, but we are strongly confident that it will arrive in the summer, so that in the event that there is, indeed, a second wave, we will have the right equipment so that we can do the job.
I’ll give the floor to Marc on the medical stuff, and then I’ll come back with what we can do for the provinces in the future.
MGen. Bilodeau: In addition to the gloves and non-surgical masks for health care professionals, what we need are N95 masks. I’m sure you have heard about that. This is a resource that is hard to procure now as we speak. But also, the gowns as well as some face shields. This is additional equipment that we initially had challenges in procuring, but now we’re in a better position and are starting to build up our stockpile that will allow us to be prepared for potential additional requests. Back to you, Lise.
BGen. Bourgon: For the helping of the other provinces, we have a finite amount of medical personnel. The Canadian Armed Forces only have the medical personnel that we need to take care of ourselves and also for our deployed operations, so we don’t have a lot of medical people. Of course, if another crisis comes and we need to support more provinces, we’ll have to prioritize. If all our people are going to be again as a force of last resort, we will get all our personnel and we’ll put our teams together, but then there will have to be, at the federal level, kind of a prioritization so that we can ensure that the critical facilities in the provinces are supported as best we can with the resources that we have.
Senator Poirier: Thank you very much. Again, thank you for all that you do for us and the country. Greatly appreciate you guys. Thank you.