Canadian Medical Association

Thank you, Mr. Chair.
I am honoured to have the opportunity to appear before you today. That we are gathered here virtually rather than physically simply serves to further underscore the gravity of the situation we all face as Canadians.
In light of exploring Canada’s response to the COVID-19 pandemic, I am pleased to represent the unique perspective of the front-line workers who are entrenched in the daily battle to defeat it.
My name is Dr. Sandy Buchman. I have over twenty years of experience practising comprehensive family medicine, with special interests in primary care, cancer care, palliative care, HIV/AIDS, global health and social accountability. I have spent the last 15+ years practising home-based palliative care, including providing palliative care to the homeless in Toronto. Today I appear before the committee as President of the Canadian Medical Association.
I wasn’t around for the Spanish Flu in 1918. But the CMA was. And I wasn’t the president when SARS hit in 2003. Or when H1N1 came in 2009.
But the CMA was. 
The organization that represents Canada’s physicians has witnessed significant outbreaks during its 153-year history. The Canadian Medical Association represents the interests and well-being of the very physicians who care for our nation’s health. I have the humble honour today to speak for our members - the frontline physicians.
As we are all aware, the COVID-19 pandemic is evolving rapidly.
We did not get to control if it came to us. We did not get to control when it came to us. But - to the degree to which we are equipped - we can control how we respond to COVID-19.
Messages of the health of Canadians and the health of the economy mean nothing without an equal pillar: the health and safety of our front-line workers.
At this point, it is of incredible urgency that we support our care providers. And, we understand how important it is to be armed with information to make the decisions to make it happen.
We have heard through our members that the inadequate supply of personal protective equipment is even starker than has been reported.
We launched a rapid survey, to collect real on-the-ground stories from physicians. On March 30th and 31st, we heard from close to 5000 physicians. They represented an almost equal split between both community-based physicians and hospital-based physicians. This poll was essential to accurately inform us of the situation at the frontlines. We now have a clear snapshot of physicians’ observations and experiences around the personal protective equipment – or PPE - available to them. These include surgical masks, N95 respirators, face shields, gowns and gloves.
The feedback received shows a dark reality. The results don’t just reveal the issues with supply and distribution of personal protective equipment. The results unveil the enormous lack of information available about the status of supplies and how health providers can get supplies.
The toll that is paid for this uncertainty weighs heavily on health care workers across the country.
They are scared. They are anxious. They feel betrayed. They don’t know what supplies are available.
More than a third of physicians in community care - that’s doctors’ offices, walk-in clinics and health hubs - said they believe they would run out of masks, respirators, eye/face shields and goggles/glasses within two days or less. Or they’d already run out.
That was seven days ago.
71% of physicians in community care have tried to order supplies in the past month, but fewer than 15% received confirmation that supplies were en route or had been received. In Nova Scotia, only 2% of physicians indicated that their recent order had been received or was being shipped. That’s fewer than 50 doctors.
When it comes to alternate supply sources, 1 in 10 physicians waiting on supplies was aware of a government source of supply. The rate is highest in Alberta at 26% and lowest in both Nova Scotia at 5% and New Brunswick at zero.
Physicians who work primarily in hospitals, where COVID-19 cases are being directed, were largely unaware of how long their current supply will last. A great many respondents are being asked to ration supplies.
Physicians are saying there is lack of information and transparency. They are facing unclear and inconsistent messaging about PPE supply and use. This has become a major concern and source of anxiety.
94% of those who work in the community responded that they are able to provide patient care virtually over the phone to some degree. Over a third are able to do videoconferencing and a quarter can provide patient care via email or text. But physicians noted that there are many situations where patients must be examined in person.
Canada is known for its health care. But the holes in our system have been evident to those of us working in it for far too long. The delay of measures to ensure greater safety are now even more evident — to more people.
The pressing needs of today – all of them – are those that our nation has thirsted for in times of general health. Too often, and for too long, they have all been pushed to the back burner.
Even at the best of times, hospitals across the country are at overcapacity. Millions of Canadians do not have access to a regular family doctor. Countless communities grapple with health care shortages. There are populations that are especially vulnerable in this pandemic, such as our homeless and those on limited income, our elderly – especially those in long-term care, our Indigenous peoples, those residing in prisons, people of all ages with complex medical conditions and disabilities to name but a few. They have challenges in accessing care and their increased susceptibility to the disease is of grave concern. Virtual care is in mere infancy. National licensure is only in discussion.
We appreciate that the federal government is working to make this a priority. We applaud the innovative efforts of our very own industries who are pivoting production to supply PPE. And we understand the global competition to supply this protective gear for our care providers. Still, asking health care workers to be on the frontlines of this pandemic without the proper equipment is unacceptable. Shortages must be addressed immediately and information about supplies must be disseminated. People’s lives are on the line. 

Would we expect a firefighter to enter a burning building, risking his or her life, without adequate protective equipment to keep them from harm? Physicians and other frontline health care workers have a call to duty. They are willing to place themselves in harm’s way. But they have rights too – and that is their right to be protected when they put themselves at risk of harm. And it is not only themselves that they put at risk – it is also their family and loved ones.  Society and government have a reciprocal moral responsibility to protect them from harm – hence the critical necessity of adequate PPE at the front lines. 
We cannot win this COVID-19 war without it. 

These are very exceptional times and I appreciate you recognizing the urgency being felt at the frontlines.
History has repeatedly demonstrated that times of crisis can define the path forward. We can implore this crisis to guide us towards a healthy future.
Despite being in crisis now, we cannot, in the future, forget these lessons in preparedness.
We need to ensure that health workers are kept safe. If we are to do this together, we need the physicians and all health care workers to be kept top of mind.
In conclusion, Mr. Chair, allow me to thank the committee once again for the invitation to participate in today’s proceedings and to share with you the experiences of Canada’s physicians. We must supply armour to those who are defending us. Without it they are defenceless. Without them, Canadians are defenceless.

Thank you. Merci. Miigwetch. 

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