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COVID-19: Appearance before the Parliamentary Standing Committee on Health ()—Summary on HESA hearing –

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Committee: Standing Committee on Health (HESA)
Subject: Briefing on the Canadian response to the outbreak of the coronavirus
Location: West Block, room 35-B
Date and Time: , at 3:59 pm to 6:30 pm
Drafted by: Yves Lessard, Senior Parliamentary Advisor, Canada Border Service Agency (CBSA)

Highlights

The committee met to first elect a Chair, Ron McKinnon (Liberal Party of Canada, LPC), and Vice-Chairs, Matt Jeneroux (Conservative Party of Canada, CPC) and Luc Thériault (Bloc Québécois, BQ). The committee continued with procedural votes before ceding the floor to Health Canada and Public Health Agency of Canada officials for opening remarks.

The meeting touched on a variety issues:

The committee felt that this is an emerging situation and that in a week the information provided could change significantly. The Committee will work to bring back PHAC officials, should it be necessary.

Ms. Sidhu (LPC) moved to invite Public Safety, Canada Border Services Agency, Global Affairs Canada, Transport Canada, Immigration, Refugee and Citizenship Canada, and National Defence to appear before HESA on Monday, , and Wednesday, .

Witnesses

Tina Namiesniowski, President, Public Health Agency of Canada
Stephen Lucas, Deputy Minister, Department of Health, opened by stating
Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada, opened by stating

Opening remarks

Tina Namiesniowski, President, Public Health Agency of Canada, opened by stating that PHAC's initial response is to contain and prevent the spread of this disease in Canada. This will be achieved by ensuring the distribution of right information and screening for possible cases. She noted that Canada has learned a lot with past experiences, such as Severe Acute Respiratory Syndrome (SARS). Ms. Namiesniowski gave a background of the evolution of the novel coronavirus from China to Canada. She made note that the CBSA has posted information signage at 3 major airports (Toronto, Montreal, and Vancouver), updated arrival screening questions, and increased personnel in arrival halls. At the Federal-Provincial-Territorial level a new committee has been struck to manage this issue. Canada is also coordinating and aiding in the development of a vaccine at the international level. Further, a hotline has been created to aid Canadians in getting the right information. PHAC has also been in contact with airlines and their obligations under the Quarantine Act.

Questions of concern to the CBSA

Len Webber (CPC)

Question: Are there Canadians still travelling in the Wuhan city and surrounding area?
Answer: PHAC does not have that information.

Question: Who determines if a travel ban should be put in place or what is the threshold that needs to be met? Have other countries put in place any bans?
Answer: The World Health Organization (WHO) will meet and will have recommendations. The WHO does not recommend travel bans at this point. Measures taken must not be out of proportion and should be in line with others. GAC would be better suited to answer this question. This is a security measures question and not a health question. This is very new and we have never experienced something on this scale. Some regions in China are taking precautions.

Question: Are some people at higher risks?
Answer: There is no specific ratio at this point.

Robert Kitchen (CPC)

Question: Asked for the protocols in place be shared in writing with the Committee.
Answer: PHAC agreed to share it with the Committee.

Question: What is the incubation time and how the virus is spreading?
Answer: it is spread through droplets, for example someone coughs on a surface and someone touches said surface. Use common practice such as the ones used to combat the flu. The incubation period in Canada is 14 days.

Question: In airports all visitors come through the same hall. The signs were not too visible when I walked through. Further, we are all touching the same kiosks. What is being done to ensure a surface isn't being touched by an infected traveller? What authority is being given to the CBSA officers to detect ill travellers.
Answer: CBSA BSOs have been trained by PHAC officers. They have authority under the Quarantine Act to detain people should they deem them to be infected.

Question: After SARS a report came forward and stipulated that a certain numbers of quarantine officers should always be at airports, further has the number increased at airport ports of entry.
Answer: PHAC will provide its protocol to the committee. At this time we are training more Quarantine Officers.

Matt Jeneroux (CPC)

Question: Asked how many people had been contacted from those who were on affected flights?
Answer: It remains the duty of those on those flights to come forward should they feel symptomatic and this falls under provincial jurisdiction. The Federal government is aiding provinces by providing information but they have no clear duty to report back PHAC.

Question: The Government is repatriating some 100 Canadians in China. What is the plan once they arrive in Canada? Would they be quarantined and how would they be quarantined, for example, a protocol or standard?
Answer: This is a GAC lead and PHAC will assess them once they are back in the country. PHAC administers the Act and PHAC is talking with GAC in how that would unfold. The Act gives PHAC powers to ensure the disease does not spread.

Tamara Jansen (CPC)

Question: Who will be able to board the plane that will be coming back to Canada?
Answer: That is better suited to GAC.

Question: How are specific individuals such as minors, permanent residents, etc. allowed to be on the plane?
Answer: It is a GAC issue but reach out to consular services.

Luc Thériault (BQ)

Question: Are there any cases in Canada or outside of China that occurred from second-hand transmission?
Answer: As of now, there are 3 cases of transmission that were due to close contact. All countries are monitoring close contact cases to ensure the virus does note spread. The risk to Canadians of becoming infected is low.

Question: If I understood correctly, you are not recommending those coming back from China be quarantined?
Answer: China is not letting anyone out of the country, unless it is a dire case. They are containing the spread. Our protocol is to keep those that may be affected under close watch.

Question: How long does it take to track down those that could be affected on these flights? How long do we follow-up after the incubation period? Are these people quarantined or isolated?
Answer: We monitor them for 14 days, the longest incubation period we have noted. Public Health officials are in contact with them everyday. There are different cases, such as spouses and close proximity traveller who would be isolated to protect from any further transmission. For other contacts, they will be monitored by local Public Health Officials.

Question: In Quebec there were only 6, negative, self-declaration. But how long is the time between the case being identified to being brought forward?
Answer: Across Canada it is the same protocol. Anyone who fits a case definition will not have to wait for a test, they are immediately isolated and treated medically. The whole testing time will take a matter of hours. The provinces and territories alert PHAC almost instantly.

Question: What is the timeframe in the US?
Answer: PHAC has daily calls with the US Centers for Disease Control and Prevention (CDC) to share information.

Tony Van Bynen (LPC)

Question: If this becomes an international emergency, how will Canada react?
Answer: The WHO would ask that we contain and monitor people. Canada is already doing that. Hospitals are on alert. PHAC does not expect more to happen as we have been preparing for over a month now.

Question: Can PHAC contrast the readiness with SARS and this virus?
Answer: International collaboration is key.

Marcus Powlowski (LPC)

Question: Would the Government ask for self-quarantine as some other countries are asking for?
Answer: There is a balancing act that needs to be done once people arrive back in the country.

Question: Should Canada consider self-quarantine on Canadians like Britain is doing?
Answer: China is looking at evidence about the virus and its transmission. And Canada needs a measured response that addresses psychological and health impacts.

Question: Why has the NCoV-2019 not yet been declared an international emergency?
Answer: That is up to the WHO to declare.

Sonia Sidhu (LPC)

Question: How is PHAC ensuring that the travellers potentially affected are receiving the right information at the airport and at home?
Answer: The signs and handouts are in 3 languages (French, English, Simplified Chinese) and the kiosks have 13 languages. The handouts provide the steps to take should they feel or become ill.

Question: If a traveller shows symptoms of the virus at the airport. Where does the quarantine begin, at the airport or at the hospital?
Answer: The traveller would be separated from the general population in the airport. PHAC would be tested in an emergency facility and proper precautions are taken. Once they have passed the border, they become the responsibility of the local public health.

Question: How do you prevent the spread of misinformation?
Answer: That is a challenge of the day. We provide regular updates and disseminate information on various platforms. Although challenging, PHAC is trying to improve Canadian health literacy and messaging. When misinformation presents itself, it needs to be addressed and rectified.

Mike Kelloway (LPC)

Question: What are the testing capability?
Answer: Ontario has developed a test that is effective but it is always sent to Winnipeg at the National Microbiology Lab to ensure it is the virus. Everyone confirmed case will be brought to the PHAC.

Question: What would travellers see at the border when they arrive?
Answer: Arrivals screens will ask travellers to identify themselves if they are sick. BSOs will be alerted by either the kiosks or by method of questioning. Affected travellers will be brought to a safe space. BSOs will call PHAC Officers to continue the process. The traveller will be safely transported to designated hospitals and assessed by emergency room doctors.

Question: What is the thresholds for officers to determine if they are sick?
Answer: If they have a cough, fever, and difficulty breathing, BSOs will take them aside to be tested.

Question: What is the definition of a low risk to Canadians?
Answer: In China it is high. But in Canada we look for the likelihood of importation of the virus from one country to another. We examine to see if we have measures in place, etc.

Darren Fisher (LPC)

Question: What is Canada doing differently or additionally compared to other countries to protect Canadians?
Answer: We are in line with other comparable countries. The WHO is more focused on countries that do not have the capacity to handle these types of situations. A containment strategy works only if all countries are working actively to contain it.

Question: Is PHAC happy with China's response?
Answer: We deal with the WHO but we are impressed with their reaction.

Don Davies (NDP)

Question: What percentage of patients have severe symptoms? Is the current death toll high in this short period of time?
Answwer: So far data out of China suggest that it is about 20%. At this point in time, there is no way to gather data yet as it is still too early. In comparison to SARS it is low.

Question: What is the incubation period?
Answer: 1 to 14 days. That number changes everyday and today it is 5 to 6 days. Canada shows the longest incubation period, which is 14 days.

Question: There are about 160 Canadians who wish to leave China. What measures will be taken before they come back to Canada? What tests will be done?
Answer: The details are still being worked out. Chinese officials will be examining people and those showing symptoms will not be able to leave. A diagnostics test will be administered.

Question: Do you know when the plane will touchdown in China?
Answer: The Government is working out the details with Chinese officials. PHAC is conscious of the concerns that Canadians have of these people coming back to Canada.

Question: What treatment options are available to those available and if there are no treatment how long until one becomes available.
Answer: At this time, there is simple care such as providing oxygen, fluids, as one would receive for other respiratory illnesses that do not have vaccines. The WHO is coordinating an international effort and at home academics, medical officers, and others are coming together to contribute to the global effort. PHAC does not anticipate a vaccine becoming available until next year.

Question: Are other countries quarantining their citizens?
Answer: PHAC is unsure.

Question: In a study for SARS in 2003 by Dr. Theresa Tam, noted that tests were almost ineffective at the border.
Answer: Noted that this is a multilayered response and viruses can easily cross borders. In that paper, Dr. Tam noted that there are various approaches that need to be taken. Thermo-monitor didn't pick up any cases.

Question: Are any models being made to see case projections in Canada?
Answer: Numbers are being calculated. The risk is low but we are expecting cases and preparing the country to ensure we are ready.

Pierre Paul-Hus (CPC)

Question: Australia and other countries are taking measures but Canada is falling behind even though we have protocols in place.
Answer: PHAC is working with CBSA to implement the Quarantine Act at all ports of entry to ensure the health and safety of all Canadians.

Question: Why are tests not conducted directly on airplanes or separating people coming back from China and other international flights?
Answer: Our response is in line with other countries across the world.

Question: In your opening remarks you mentioned that people on the initial flights were contacted, was that everyone?
Answer: The protocol states it is for those people that are seated near the infected person.

Question: Does the Government of Canada not have tighter control over provinces to ensure this does not spread further?
Answer: We work very collaboratively with the provinces and has been for a number of weeks. We are ensure a consistent approach and that cases are dealt with properly.

Jenny Kwan (NDP)

Question: There are reports that an individual could be asymptomatic but still be contagious. When will we know is this is truly the case?
Answer: It depends on the individual and their background. For this virus it is spread through droplets, therefore the individual would be symptomatic to spread the disease.

Question: What is the process of individuals who may have been in contact with people from Wuhan and surrounding area? Or those travelling from China but coming from other countries such as Japan and Korea?
Answer: That question is better directed to GAC officials. As for those coming from other areas would be subject to the same protocols as any other traveller and are subject to the Quarantine Act.

Summary of comments

MP Jeneroux (CPC) asked about the process for following up with the passengers from the first flights from China following the outbreak. He also asked about the repatriation of Canadians from China and whether they would be quarantined upon arrival. The President explained that contact tracing was a provincial and territorial responsibility, but that the Agency was supporting the Ontario's efforts. She stated that Global Affairs Canada (GAC) was leading the repatriation initiative and that details were still being worked out.

MP Powlowski (LPC) asked if Canada was considering asking people returning from China to voluntarily self-isolate and about the fact that Chinese disease experts have said that the virus can be communicated even when asymptomatic. He also confirmed that the World Health Organization (WHO) had not yet declared a Public Health Emergency of International Concern (PHEIC). The Chief Public Health Officer (CPHO) reiterated that protocols were in place to isolate cases and for rigorous contact tracing. She stated that the WHO was looking at evidence of past coronavirus and had determined at this time that communication when asymptomatic was possible, but rare.

MP Thériault (BQ) asked if anyone had been infected outside of China. He also asked for more details about the repatriation of Canadians from China. He asked how people arriving from China were monitored during the incubation period. He asked how long it would take to confirm a case in a province. The CPHO stated that 99% of the cases were in China; the 3 confirmed in Canada were travel-related from close human-to-human contact and connected to Wuhan. There is a case in another country that had not travelled to China but caught the virus from a traveller to China. These cases are rare. The CPHO mentioned that China was not allowing any outside travel and was actively screening anyone leaving the country. The CPHO said people arriving with others who have the virus were actively monitored but not isolated. She stated that getting a confirmation of a case was very fast and that even presumptive cases were dealt with immediately.

MP Davies (NDP) asked how severe was the virus for those infected, how long was the incubation period, what test could be used for people that were asymptomatic arriving from China. He also asked about treatments since there was no anti-viral and no vaccine. He wanted to know if any other countries had quarantined people for 14 days. He also quoted an article where the CPHO spoke about thermal scanners for screening at borders. The CPHO stated that this virus was 20% severe in China, had an average incubation period of 5 to 6 days, but could go up to 14 days. She spoke of the diagnostic testing and that the only treatment was supportive medical care. She stated there was an international and domestic collaborative effort to look at treatment, vaccines and anti-virals, but a vaccine would maybe be ready in one year.

MP Paul-Hus (CPC) was concerned that Canada was slow in responding to the outbreak. He asked about tighter protocols for screening, quarantine and contact tracing. The President said that the Agency was working with its partners, such as Canada Border Services Agency, and provinces and territories to ensure all protocols were in place and aligned with other counties.

MP Sidhu (LPC) asked how people could self-report, what were the protocols if they showed symptoms upon arrival and how the Agency was dealing with misinformation. The CPHO mentioned the 1-800 line for information in English, French and basic Chinese, the information at the kiosks and handouts. If travellers show symptoms, they are isolated, assessed by PHAC staff and sent to designated emergency rooms. The CPHO stated the best way to counter misinformation is to address it.

MP Kitchen (CPC) asked if the protocols for screening and quarantine could be shared with the committee. He mentioned that even though this virus is low risk, it is spread by droplets and that information for travellers upon arrival was not evident. He was concerned of the risk of infection to other travellers at the entry. The CPHO spoke of steps to prevent communication such as hand-washing and coughing in your arm. She spoke of the training for CBSA agents and the protocols in place.

MP Kelloway (LPC) asked for the difference between confirmed and presumptive cases, what steps should someone take upon arriving with the virus, what is the threshold to recognize someone with the virus. He also asked what low risk meant. The CPHO said confirmed meant the cases had been double-checked by the National Microbiology Laboratory (NML). She outlined the process at the border. She stated the risk is high in China, but low elsewhere due to the low number of imported cases and only as a result of close human-to-human contact. The deaths occurred in older people with underlying conditions.

MP Kwan (NDP) asked about the possibility of spreading the illness when asymptomatic and also about the repatriation of Canadians elsewhere in China. The CPHO confirmed that the WHO was looking into this possibility, but that it was rare.

MP Webber (CPC) asked if Canada had considered banning travel to China and if any other countries had done so. He also asked if there were any demographics available at this time. He wondered what was being done domestically to work on a vaccine. The CPHO stated that the WHO was not recommending a ban at this time. She stated three jurisdictions had put in place a ban and that it was too soon for any demographics. The CPHO spoke of talks with other departments and the Canadian Institutes of Health Research as well as international collaborations.

MP Fisher (LPC) asked what Canada was doing differently than other countries and if they were happy with the collaboration from China. He also wondered what other provinces could test for the virus and if it would continue to need the NML for secondary testing. The CPHO stated that the processes in place in Canada were in-line with other countries and that she was impressed by China's rapid and effective response. She stated that the end goal was to have all provincial laboratories able to provide rapid testing.

MP Jenson (CPC) only had very specific questions on the repatriation of Canadians in China which the President said only GAC could answer.

MP Van Bunen (LPC) asked how Canada would respond if the WHO declared a PHEIC, how local areas for vaccinations would be designated and what improvements have been made since SARS. The CPHO said the WHO would have recommendations once that happens. They have already advised countries to prepare and be vigilant. She stated that protocols were already in place, but reiterated that no vaccine was available at this time. She spoke of all the changes and advancements since SARS.

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