May 20th 2020 - Study on the government’s response to the COVID-19 pandemic
Senator Poirier: Thank you to the witnesses for being here today and for your presentations. It’s greatly appreciated.
My first question is for the Canadian Medical Association representative. In your latest memory survey, a third of the physicians in community practice said they had less than two days’ worth of the key PPE. Yet on May 3, almost two months after the self-isolation measures began, the government created a new COVID-19 supply council to do, among other things, “ordering ahead in bulk on behalf of provinces and territories.”
It is difficult to order ahead when you’re already in a crisis. So I’m asking your opinion on how the COVID-19 supply council will help Canadian physicians get the PPE they needed two days ago, and how can they help other physicians and nurses when they’re not given a seat on the council?
Dr. Buchman: Thank you very much for the question. I think that the best way the council will be able to help secure PPE and help health care professionals is by coordinating the actual procurement of the PPE, creating a domestic supply, including the standard or the quality of the PPE that is imported meets Canadian standards, and providing consistent, coordinated information to health care providers, to regional health administrators, et cetera, who are then able to deploy the equipment in a coordinated and socially just manner to the places in the country where it’s needed the most at this time. I think they will have an important role in advocating for and coordinating the supply of the PPE.
It’s late. The government has been working very hard during the whole crisis in trying to obtain PPE, procure it and retool our current manufacturing facilities to provide a domestic supply. It’s a challenge. We shouldn’t be in this position of scrambling for PPE at this time. That speaks to an earlier question about pandemic response, and I am hopeful that what the council may be able to do is help us prepare later on, more long-term, once we’re through the major part of this crisis.
Senator Poirier: Again to the medical association, a past experience with influenza pandemic suggests that recurrent waves of COVID-19 are a strong possibility. Right now we seem to be nearing the end of the first wave, but in your opinion has the government put in place what is needed for a medical professional to be ready for a second or third wave, and if not what should the government do differently?
Dr. Buchman: In my opinion, we’re not fully prepared for a second wave. We don’t have adequate diagnostic testing, so original testing — disease testing for people who have the disease, and we are doing insufficient contact tracing. When we do adequate testing of cases, as well as contact tracing, we can better prepare to see if the health care system would be overwhelmed. We would get a much better picture of what we should do. In addition, we haven’t undertaken serological testing. That actually assesses the immunity within the population.
We have insufficient information as to what’s out there and we can’t make really good, evidence-informed decisions about opening up the health care system, for example, the number of elective surgeries, getting primary care back up, all the things we do ordinarily, and we are unable to reopen the economy and schools, et cetera, in an evidence-informed way, so we’re gambling by reopening.
We understand the challenges of having an economy and a business and a society where people have these restrictions. There are huge health consequences to maintaining the restrictions. There is intimate-partner violence, of course, there are ongoing mental health problems, there’s poverty, there are people not getting primary care, they’re not looking after their hypertension and cardiovascular diseases, they’re not doing cancer screening. All this is really important, but we need the contact testing, we need the tracing and we need the serological testing in order to make decisions about what to do next.
Senator Poirier: Thank you very much.
Senator Poirier: My question is a follow-up to Dr. Buchman’s answer earlier. As you answered earlier, we’re not ready for the second or third wave that could possibly be coming, due to lack of testing and contact tracing. I saw an article earlier saying we are behind in testing compared to other nations. My question is: Why are we falling behind in testing at a time when the government should be expanding that testing?
Dr. Buchman: I do not know the answer to that. What is it, we lack supply for adequate testing? Is it lack of trained workers who can go out and do the contact tracing? Being just manual does put us behind. We could be hiring many more contact tracers and train them easily to do this. This question needs investigation. Right now, I do not have an answer as to why we’re so behind compared to other nations. I wish I did.
Senator Poirier: Thank you. Maybe we could follow up.
Senator Poirier: My first question is for the Society of Rural Physicians of Canada.
We have heard of multiple reports about the lack of PPE across the country. For rural and remote communities, could you elaborate on what the current situation is for personal supply and for testing? Do you have easy access to testing kits and contact tracing for the rural and remote communities?
Dr. Tromp: What happened with the PPE is it was a bit of a moving target. Pre-COVID, in an emergency department, I would use an average of zero masks per day, maybe one or two a week. Then you get into a situation where you would use a fresh mask for every single patient encounter. That is how we are supposed to ideally do it, because if you encounter one patient and they breathe on you, they could put the virus on your mask, and then, when you talk to the next patient, the virus from your mask could be transmitted to the other patient. So in an ideal world you would change your mask for every patient encounter.
In my emergency department, we see between 60 and 100 patients per day. So that means, in the ideal world, we would need 60 to 100 masks per day. That increases your need for a mask to approximately 1,000 times what you used to previously need.
How do we decide when we have enough? Now, instead of changing your mask for every patient, you get one mask at the beginning of every shift and you are encouraged to use that mask for the entire shift. If it gets soiled, you get a second mask. As I said, we have not had a lot of COVID-19 in our community, so I think generally as people work in the emergency department they are not high-anxiety about this. But if you’re in a community like La Loche, where you’re told to use the same mask all day, that would be a whole different anxiety level.
One of the issues that people have expressed to me is this real emotional turmoil about having to do things that, pre-COVID, would have been considered malpractice, or poor nursing or medical care. You would never wear the same mask from one patient to another patient. If you did, you would be reprimanded for bad practice. Now you’re instructed to do this, and this causes the emotional turmoil to people.
For example, I had a woman in my office who works for a home care company, and it is her job to schedule — she wasn’t in my office, but we talked on the phone — PSWs to go into people’s homes. She said, “I know this is not right. They have to use the same mask for the entire day going from home to home to home.” She was in tears telling me about this. She said, “I can’t do it. It is so wrong. We’ve been told that this is not what you do, and this is what we have to do.”
With us all using the same PPE, the same mask for the day, we’re not short. There has been no day that I have gone to work and someone has said to me, “We don’t have a mask for you today.” There is always one for me every day, but at the hospital and in my private office I provide my own. At the hospital they always have them, but that’s because we are using them at a level that, in pre-COVID-19 times, would have been considered to be against public health recommendations.
So it is similar in all the rural communities like that.
Senator Poirier: From your perspective, is the government doing enough to address the mental health issues that have developed as a result of the pandemic and the subsequent social distancing measures for rural communities? What more can be done?
Dr. Tromp: The mental health issues come out a bit later. Initially you have social isolation. You’ve probably seen the curves that people show about the initial wave that goes up, and then you have the post-wave when some people went home and then got sick again. Then you have the chronic care wave where people who should have care, but aren’t getting care, get sick. Then you have the mental health wave that is more gradual and comes later. So the major mental health effects appear after weeks to months.
For the first week or two, people aren’t doing too badly, but then they get more and more stressed as they become more isolated. How do we address these issues? For many of us, we’re not even yet aware of what the mental health effects are, because these patients are not presenting to us because they have this message — not given by me, because I’ve written my patients messages and said you phone and do this and this — but there are many patients who are reluctant to call or come unless they think they are literally dying. So they don’t come with stress and mental health concerns at this point, but I think they will be coming down the road.
Right now, I don’t have that many people making phone appointments with me to discuss mental health concerns. Most of the people I’ve seen with this problem have had pre-existing stressors in their life and maybe it is coming to a head, but they are not people that I would have been totally surprised if they would have come to me with mental health concerns outside the pandemic.