:
Thank you, Madam Chair.
My name, as mentioned, is Jack McCarthy. I'm both the chair of the Canadian Alliance of Community Health Centre Associations and an executive director of the Somerset West Community Health Centre here in Ottawa. I've just come from meetings on flu assessment centres, so it's within that kind of busy frame that I appear before the committee.
In my opening remarks, I will be drawing a lot on my experience at the community health centre where I am the executive director. I'm here today to present what, in our experience, is a solution to optimally deploy health human resources across the country, and that's the use of salaried health professionals working in inter-professional teams.
I will advance that CHCs are a solution to the problem of not enough family physicians and an opportunity to shift focus to the recognition of the contribution of other health professionals, such as nurse practitioners, in the delivery of comprehensive primary health care. The solution we seek is not about adding more health human resources necessarily, but currently redeploying and using our existing health human resources in a different way.
I will tell you a bit about what community health centres are. They're non-profit organizations governed by boards of directors or advisory boards and use salaried physicians side by side with other salaried health professionals. They focus on access, removing the structural barriers, whether it be cultural, economic, or social, and provide a range of primary health care, social, recreational, non-institutional services with an emphasis on prevention, health promotion, health education and community development. We work in partnership with organizations in other sectors, such as education, justice, recreation, and economic development, to promote the health of the whole community.
The CHC model has eight specific attributes. It's comprehensive, accessible, client-centred, and community-centred, integrated with other health system partners, community governed, inclusive of the social determinants of health, and grounded in a community development approach. My comments this afternoon are going to focus on one of those attributes, and that's inter-professional teams.
Inter-professional teams allow community health centres to provide the right care by the right provider at the right time. Our team at Somerset West CHC in downtown Ottawa includes doctors, nurse practitioners, dieticians, social workers, kinesiologists, acupuncturists, chiropodists, social service workers, nurses, health promoters, and of course, administrative support staff. This inter-professional team is a dynamic process in which two or more health care professionals with complementary skills or backgrounds, sharing a common vision in health goals, work together to plan, assess, evaluate, and deliver client-centred care.
The key to a successful inter-professional team is communication, collaboration, and consultation. These three conditions result in shared leadership and a positive sense of community, balanced with individual autonomy and, of course, a focus on client care. Unlike a multidisciplinary team, inter-professional teams do not function as independent practitioners but rather weave together tools, methods and procedures to deliver care and overcome common problems and concerns. At Somerset West we are participating in a pilot project that includes physician assistants as a part of our primary health care team. In the future, we would love to add a pharmacist as a part of our comprehensive primary health care team.
Unlike a visit to the traditional family physician, our model does not presume that your care needs to be directed or prescribed solely by the physician. Somerset West, located in downtown Ottawa, as I mentioned, operates a non-appointment based walk-in clinic, staffed by nurse practitioners. We see, on average, 31 clients per day, most of whom suffer from at least one chronic illness, such as a major mental illness, heart disease, chronic obstructive pulmonary disease, COPD, or diabetes. This is I think a key point. In this totally nurse practitioner-staffed clinic, a medical doctor is consulted on only 0.5% of all visits. In other words, for every 200 patient visits, only one involves a physician consultation. With a $52,000 differential in starting salaries between a medical physician--$125,000--and a nurse practitioner--$73,000--I think there's an obvious significant cost advantage in using nurse practitioners.
All members of the team have the ability to refer or consult with other members of the team as determined by the needs of the patient. Sixty-four per cent of all our clients see three more different types of providers. Unlike the vast majority of family physicians in Canada, all our doctors are salaried, enabling the inter-professional planning of care based on client need rather than based on a fee schedule. Many of our clients have one or more chronic medical conditions. Having physicians on salary permits our doctors the necessary time to thoroughly assess and treat, and even prevent, further disability.
Unlike other health care organizations, Somerset West enjoys both a high level of staff satisfaction and very limited turnover in our medical, nursing, and other professional staff. I think this can largely be attributed to the organization, culture, and client-centred care created through the adoption of an inter-professional model of care. The versatility of this model of primary care is designed to respond to the unique needs of specific communities and clients. It is also nimble enough to be able to respond in times of crisis, such as the latest H1N1 pandemic where our community health centre and the other health centres of Ottawa stepped up to be flu assessment centres. We coordinated very well with Ottawa Public Health in providing this service.
I have other comments in my document related to international medical graduates, and we'll deal with that in the question and answer period.
In concluding my opening remarks, I want to say it has been my pleasure and experience that health care professionals, whether nurses or doctors, are motivated to provide the best possible care to their patients, and happy workers provide better care. I think the current crop of medical graduates is largely women, and that's a good thing. I think this new breed of family physician places an equal value on non-work aspects of their lives, such as raising a family. That's why most of our physicians are women. Most work part-time. Most have young children.
Without systemic change in how we structure medical practice in this country, these changing expectations of providers will result in reduced access to primary care for Canadians. In the CHC model where doctors are on salary and part of a collaborative team, we see few, if any, examples of doctors suffering from the pressures of time and long hours that result in burnout and sometimes, as a result, poor-quality care. They can focus on providing services to their patients.
I'll leave it at that, and I'd be pleased to answer any questions.
:
Thank you very much, Madam Chair. I'm pleased to address the standing committee today on health human resources, an issue of ongoing concern to family physicians and the College of Family Physicians of Canada.
With over 22,000 members across the country, the CFPC is the professional organization responsible for establishing standards for the training, certification, and life-long learning of family physicians in this country. As the voice of family medicine, we also advocate for specialty family physicians and, very importantly, their patients.
About half of all doctors in Canada are family doctors, which is one of the strengths of our country's health care system, yet we still have roughly four million people in Canada without a family doctor. For many years we have sought ways to increase the number of Canadians with a family doctor, but the CFPC cannot do this alone. Key stakeholders include government and medical schools.
We believe two issues are central to family physician planning: the balance of supply and demand, and changes in patterns of practice. These two are intertwined.
The number of medical students choosing family medicine as a career is a vital issue affecting supply. We need to have 45% of all graduates enter first-year family medicine residency programs if we are to have enough family physicians to meet present and future workforce requirements.
While we strive to train more family doctors and more young family doctors, we also face the realities of an aging workforce, where 13% of the family physician workforce is older than 65 and looking at retirement. Many young family doctors are also seeking better work balance. Changes in work and scope of practice are having an effect on the number of family physicians we need. Over 50% are women who require time away from active practice during their child-bearing years. Governments must be cognizant of shifting patterns in family practice if they are to plan for sufficient family physicians in the future.
A priority for the CFPC is the training, recruitment, and retention of family physicians who provide a broad range of medical services for their patients. However, one-third of today's family physician workforce has a special interest in practice. While this affects the total number providing comprehensive care, these physicians are meeting health care needs within their communities. Family physicians with special interests or focused practices collaborate with their associates, and they are changing the way comprehensive care is delivered. The CFPC recognizes this, and it is supporting these physicians.
With an aging population, we see an increase in patients with chronic diseases and, in turn, complex co-morbidities. These factors are placing more pressure on the demand for family physician services at the same time as demographic factors affect supply. While Canada has begun to address its past mistakes in physician resource policies, it could take another decade to reach the goal that developed nations have already attained in some areas, and that is every person with a family doctor.
Just as population migration from rural to urban communities leaves many towns and villages with scarce human resources, the shortage of family physicians can often be felt more acutely in rural locations. There is thus a disproportionate shortage of family physicians in remote communities and a dire need for medical services for high-risk populations in first nations, Inuit, and Métis communities. These challenges continue to call for a strategic approach.
I'd like to speak briefly about international medical graduates. IMGs are highly valued contributors to our family physician workforce, but we should not rely solely on IMGs to address our physician shortages. We must consider the ethical implications of luring family doctors from countries that need their services.
Further, for those Canadians who are educated at accredited foreign medical schools, we need to ensure there are enough training spaces available to welcome them home to practise in Canada. For its part, the CFPC is pleased to report that we now have reciprocal agreements to certify and welcome board-certified American physicians and Australian-certified family medicine graduates. And we're working on other countries as well.
It's essential that those responsible for physician resource planning address all of these issues. Our college would welcome an opportunity to meet with the FPT Advisory Committee on Health Delivery and Human Resources to discuss the changing horizons in family medicine.
Finally, we would be remiss not to highlight the growing importance of inter-professional collaboration in primary care teams as an increasing preference for many family physicians. Overwhelmingly, young family doctors now prefer to work in collaborative health care environments. We are thankful for the support our governments have given to this development.
Taking all our concerns into consideration, the CFPC believes all these challenges call for a pan-Canadian coordinated approach to health human resource planning. Physician resource planning, as with all other health human resource planning, is a national issue that affects all of us.
To conclude, the CFPC respectfully encourages the government's support for a pan-Canadian health human resources plan that assesses the health needs of the population in each and every community and ensures that we have enough doctors, nurses, and all other professionals to meet our population's health needs. This plan must address the right number and appropriate mix of health care providers, including the training, recruitment, and retention of family doctors, as well as other medical graduates.
An adequate supply of physicians, including family physicians, continues to be a top priority for Canadians. It should remain a top priority for governments and health planners. To maintain the number of family doctors required to meet the health needs of people in Canada, we require a commitment from our health system and medical schools to have 45% of graduates enter family medicine.
We must also ensure that IMGs, international medical graduates, have appropriate opportunities to be assessed and to be offered further training, when necessary, so that they can enter the physician workforce alongside Canadian medical graduates.
Family physician teachers and other resources required for family medicine academic and distributive learning sites are currently strained and need to be augmented if we are to assess and train more family physicians.
Comprehensive care must be supported through our health care system to encourage family physicians to provide patients with the broad range of front-line medical services they need from cradle to grave. As advocated in our recently released discussion paper, “Patient-Centred Primary Care in Canada: Bring it on Home”, governments should support new or enhanced primary care models through which patients have access to a family doctor and an inter-professional team of providers.
We must maximize the use of electronic information in pulling teams together. This nation is trailing most developed countries in this area, and it should be addressed with urgency.
In closing, the CFPC and family doctors in Canada are confident that by working together with government, we can improve access to high-quality health care for all Canadians. To achieve this, we need a health human resource plan that ensures that every Canadian has a personal family doctor.
:
Thank you, Madam Chair.
First, let me speak to you today on behalf of the 14 LHINs in Ontario. I represent Lambton County, Chatham-Kent, and Essex County. We refer to it as the gateway to Ontario because of the two major bridges we have as access points.
I'm relatively new to health care. In previous careers I've had the enjoyment of travelling quite a bit around the world. When I travelled, everybody would notice my red Maple Leaf, and they'd come up to me and talk to me about Canada Dry, our ginger ale. But then they'd come up to me and say, “You have good health care.”
If you could look at Canada as a brand, one of our brand attributes is universal health care. It helps to define us as a nation and as a culture. We have plenty to be proud of as Canadians, and I'm especially proud of the health care we deliver across Canada. However, our current health care system was built on fundamentals of the 1950s and 1960s. Since then, our population has aged, chronic diseases are on an increase, and our current cost structure is no longer sustainable.
What I would like to address with you today is what I would call “health care 2020”. Health care 2020 is a call to action to create a vision of transformation for health care in Canada. It is recognition that our current system is antiquated and incapable of meeting 21st century needs. A vision is needed to protect the Canadian brand promise so our children and grandchildren will continue to benefit from our publicly funded system. To do so, I will submit the following three suggestions to the committee: we need to address our human resource issues, both shortages and scopes of practice; we need to transition from episodic care to a comprehensive model of care; and finally, we need to invest in an e-health infrastructure to fully and uniformly transition to the 21st century.
l'II frame this issue with a brief glimpse at our current population health. Our landscape is changing. The prevalence of chronic disease is on a significant increase. This is driving the overutilization of our health care system. This is only compounded by the lack of primary care right across Canada, and especially in Ontario. In Erie St. Clair, we have a shortage of 124 physicians, and that's for a population of 650,000. That leaves approximately 150,000 residents without a family physician. The future doesn't look any better. Over 78% of our physicians are over the age of 50. The bottom line is that our people's health is declining and our system is overburdened.
We need a national health human resource plan that will seek to make the best use of available resources. If we continue as is, we will not have the professionals we need to meet our community needs. We need to redesign the system to work smarter, not harder. To do so, a national plan needs to look at how to maximize the scope of practice of all allied health professionals, such as our nurse practitioners and pharmacists. We also need to look at the barriers we impose across the provinces. A national plan needs to look at a system of redesign to promote the recruitment and retention of our health professionals.
In Erie St. Clair, over 90% of our emergency department visits are for non-life-threatening issues. Most relate to the provision of primary care. However, emergency departments were not designed for that. Collaborative or team-based care is the future of the health care system. It relies on a team of professionals that can look at the individual as a whole and is ideally suited to the provision of chronic disease management. It makes the best use of all allied health care professionals.
As a consumer entering a collaborative family practice, be it a CHC or a family health team, you will not see the sign on the wall saying “One issue only per visit”. They say it takes a village to raise a child. Think of a community health centre or a family health team as a village of care supporting a community. It's all under one roof. The alternative to this system will be an individual going to their family doctor, only to have to go back for another referral, only to have to visit another specialist.
For rural communities, this one-stop shopping experience is a great opportunity to introduce a new level of equality and accessibility in health care, avoiding costly and prohibitive trips to town for these services. In Erie St. Clair we've been working very hard with the local government to expand our community health centres and our family health teams. We've also extended this concept to developing teams for the provision of home care and end-of-life services.
New family practice collaborative models such as family health and community health centres are attractive to new graduates and have been widely successful. We must continue with this success. Collaborative care will depend on access to information technology to unlock its true potential. Health care has been lagging on this front, and so we have not yet seen the benefits of a uniform and functional e-health infrastructure.
We need to align our systems to ensure interoperability. I'm not talking about a system that's Canada-wide or province-wide; I'm talking about a system within our community. Eight-five per cent of the care our residents receive is in our community. We know our referral patterns, which will take us to 98% of our community.That's where we need interoperability.
Secondly, every Canadian needs an electronic patient record. Until this happens, our system will remain in the dark ages. Physicians should not have to work without access to somebody's medical history. They shouldn't have to order redundant tests and they shouldn't have to worry about reactions to prescriptions.
To change this is like working on a moving train. However, in the 21st century nothing less will suffice. Information technology is at the core of everything we do, and it should be at the core of our health care system.
To summarize, what I've discussed today is the challenges we have in preparing for our resources for 2020 and the need to have a national plan to address these challenges, and secondly, the need to change to a comprehensive model of care. And finally, we must learn to leverage our technology.
The federal government can provide assistance, just as it has shown with the wait-time strategies. Make it a national priority to maximize every health care professional skill for practice. Invest with the provinces to assist in the transformation to collaborative care. Help us build villages of care in all communities, both urban and rural, and provide the incentives that would allow the provinces to make courageous decisions to align our backrooms and our clinical platforms.
In all the places I've visited, health care is a common denominator. Our health care system does indeed help define us, and as a nation we must ensure that our system will live up to the health care brand we are so famous for. Let's continue our promise to Canadians and make the necessary steps to safeguard our universal health care.
Thank you.
:
Nearly 25% of Canadians in the rural areas are without a family doctor, compared to 8% in the urban areas. Have you noticed whether there has been an increase in stress leave among the health care professionals?
Second, I come from an area that has a high rate in terms of an aging population, and we're seeing that across Canada as a whole. In Elliot Lake, for example, their main focus is to attract seniors to the area, but when the seniors get there, they're being told, oh, they'll get a doctor eventually. I know that from province to province your ability to obtain a doctor varies, depending on which province you live in and where you're moving to. I had a call from a lady in Elliot Lake last week. She's been there for two years, and she is still not able to get a doctor. In order for her to obtain another family physician, she needs to get off the Ontario plan with her doctor, the authorization that she signed with that doctor. And she's not guaranteed that she's going to get a family physician.
So she has to remove herself from the list of the Toronto physician in order to try to obtain one.
These are problematic areas. I don't know if the LHIN is dealing with that, but Mr. Maxted, you'd probably be able to answer with regard to the stress on the family physicians. I'm just wondering how we are dealing with the aging workforce, because we also have doctors who are retiring. What do we need to do? How short are we going to be in the next 10 years?
:
I understand that it's much easier for Dr. Butler-Jones to come here at 4:30. As long as we have an agreement in the committee that with votes or whatever we'll make sure there is adequate time for us to do our work as a committee....
I have sent to the clerk a number of names of witnesses who I think would be prepared to make some commentary or enlighten us in terms of how things are going on the ground.
[Translation]
In the province of Québec, in particular, there are Drs Massé, Lessard and Poirier.
[English]
There's also Dr. Isaac Sobol in Nunavut, who has his already done.
Also, there are some of the local medical officers of health.
In B.C., there's Dr. Perry Kendall, who gave excellent testimony in the summer. We'd like to see how things are going there.
Obviously there's Dr. Daly from Vancouver, who is worrying desperately about the effect on the upcoming Olympics. We don't know whether--
[Translation]
I am very pleased to be providing you with a brief update on the situation regarding the influenza A (H1N1) virus.
[English]
We're now well into the second wave of this pandemic, seeing increases on all fronts. As of yesterday, a total of 198 deaths were reported. In the week ending November 7, the number of reported hospitalizations in one week is close to what we saw in the whole of the first wave. There was a large number of admissions to intensive care units, 136 in one week, compared with a total of 289 over the 18 weeks of the first wave.
These are sharp increases, but fortunately--or unfortunately--they're what we might expect at this point during the pandemic. It's important to recognize that if not for the efforts at all levels to ensure effective prevention and appropriate treatment, the number would be much higher.
Provinces and territories are also well into their vaccination campaigns and are reporting steady progress. For example, Nunavut announced today that they have now immunized about 60% of their population.
[Translation]
There have been several new and important elements from the viewpoint of the federal government since my last update to the Committee.
[English]
These include approval of unadjuvanted vaccine, freeing up 1.8 million doses; distribution of additional unadjuvanted vaccine ordered from CSL, our Australian supplier; and continuing distribution of adjuvanted vaccine to provinces and territories.
Since our last update, we have also seen that the vaccine is providing remarkably high immune response in those receiving it. The response is in the range of mid- to high 90%. Normally seasonal flu vaccines provide effective antibody levels in the range of 60% to 80%.
Further, since clinics opened, the Public Health Agency of Canada and Health Canada, with the collaboration of provinces and territories, the Canadian Paediatric Society, and a network of researchers, have been actively monitoring serious adverse events following immunization with the vaccine. This surveillance began once the campaign began.
The most frequent reported events are minor and include nausea, dizziness, headache, fever, and soreness at the injection site.
There were several reports of allergic reactions. These have onset mostly within minutes of the immunization and have been treated promptly by medical personnel.
Serious adverse events are reactions that could cause life-threatening illness, hospitalization, disability, or death, such as a severe allergic reaction. Amongst the first 6.6 million doses that were distributed, there have been only 36 serious adverse events reported. These included reports of febrile seizures, a seizure brought on by high fever, and anaphylaxis. Anaphylaxis is a severe allergic reaction.
[Translation]
We take seriously all of the serious adverse event reports, which all trigger an investigation.
[English]
It should be noted that these are rare. The rate of serious adverse events following immunization in any campaign is about one for every 100,000 doses distributed. It's important to remember that even though a medical event follows vaccination, it may not have been caused by the vaccine itself. It may have been caused by other factors, such as a pre-existing medical condition.
By the end of this week, 10.4 million doses will have been distributed across the country. As we stated at yesterday's news conference, this is enough to immunize close to one-third of Canada's population. To put it in perspective, this is close to the volume we deliver in a whole regular flu year, and we're only a few weeks in. Our supplier is continuing to ensure that there is much more vaccine coming every week.
Our goals have not changed--namely, to reduce the overall impact of a pandemic--and we remain on track to have enough vaccine available for every Canadian who wants it by the end of December. This puts us in one of the best positions in the world. However, we cannot be complacent. Pandemics are unpredictable. Like any flu season, changes to our approach are necessary as we receive new evidence about the virus and its behaviour. Thanks to our experiences in dealing with outbreaks and our years of comprehensive pandemic planning, we are better able to adapt to these new challenges as they arise.
[Translation]
And if Canadians continue to get vaccinated as they are doing now, as a country, we will avoid a lot of infections.
[English]
We have a great deal of work ahead of us still on all fronts. Paramount in our efforts is the push for vaccination.
I look forward to providing further updates as we move forward.
Thank you.
:
Thank you, Madam Chair.
As Dr. Butler-Jones has said, we're still seeing widespread influenza activity across Canada. And the experience among first nations, as we know it, is a reflection of that. This means that we will see some severe illness, hospitalizations, and deaths in first nations and among other aboriginal people. We will continue to monitor activity in the community nursing stations to watch for issues on which we have to provide extra advice.
On immunization, we're finding that the rollout of H1N1 vaccine on reserves has been well planned, well managed, and well received by the communities. During the first three weeks of immunization, approximately 93% of first nations communities held immunization clinics. In fact, probably all those communities that have a significant number of individuals have been covered. There are some very small communities and also some communities that are seasonal. It's important to note, though, that 100% of remote and isolated first nations communities have in fact launched immunization.
Over 162,000 doses of H1N1 vaccine have been administered on-reserve. To this point, approximately 40% of on-reserve first nations populations have been immunized. However, that does not take into account the fact that we do not have the most up-to-date information from two large provinces. Therefore, that is an underestimate. For those regions for which we have up-to-date information and are confident about it, the coverage rate ranges from 55% to 85%.
There have been some challenges, as one might expect. As per other communities across the country, there has been some slowing down of the vaccine rollout. But as Dr. Butler-Jones said, that will continue to be dealt with. Health Canada is helping the affected communities readjust their plans accordingly by rescheduling clinics, adjusting volunteer schedules, and in fact, in some cases, reallocating supplies of vaccine among communities.
Health Canada continues to monitor the vaccine rollout, and the regional offices are monitoring any communities where there are significant challenges with clinics. We expect that the immunization of first nations on reserve will be completed at the same time as, if not before, the rest of Canada.
I'd like to update you now on the virtual summit, which was held November 10. It was shown live over the Internet and was co-hosted by the and the national chief of the Assembly of First Nations. This was a live webcast provided to first nations and other partners across the country. It provided a comprehensive overview of first nations pandemic preparedness and response.
There was a panel that led the discussion that included Dr. Kim Barker, from the Assembly of First Nations; Dr. David Butler-Jones; Gina Wilson, who is the senior assistant deputy minister for INAC; and me. Initial feedback indicates that it was a success and certainly achieved the goal of delivering important information on H1N1 to first nations communities.
There were over 1,000 unique log-ins during the roughly two-hour webcast, but it is difficult to estimate the total number of individuals it reached, as quite likely there were a number of individuals at each site. The recording of the webcast will be up on the AFN website until the end of December for anyone who wishes to consult it.
The virtual summit fulfills a key commitment under the joint communications protocol of the AFN, INAC, and Health Canada and was an excellent example of collaboration among the parties. In particular, the use of modern communication tools ensured that the summit was relevant to first nations youth. Members of the AFN National Youth Council were involved in the summit through pre-recorded video segments. They expressed their thoughts and concerns and posed youth-focused questions that were put to and responded to by the expert panel.
Thank you very much.
:
Thank you, Madam Chair.
Thank you to our witnesses.
I have four questions; I hope I will have enough time to put all of them to you. I will be very brief, in order for you to have the opportunity to answer them.
At the present time, we have 1.8 million doses of non-adjuvanted vaccine intended for pregnant women. Dr. Grondin was telling us last week that there was too much vaccine for this population group and therefore that other people would be able to receive the non-adjuvanted vaccine doses not needed for pregnant women.
Given the shortage that was announced approximately two weeks or more ago, the supplier having had to shift its production from the adjuvanted to the non-adjuvanted vaccine, and given also that we had ordered 200,000 doses of non-adjuvanted vaccine from Australia — which is probably sufficient to vaccinate pregnant women, of whom there are about 200,000 —, I am simply wondering why, when you saw that you had enough vaccine for pregnant women, you did not ask the supplier to concentrate production on the adjuvanted vaccine, with the option of producing non-adjuvanted doses later on if supply was lacking.
:
I'll speak for Canada because of the work that we've done.
Each jurisdiction and every country organizes based on what seems to work best for them. But in terms of having the public health network, having the systems and relationships in place for sharing information, for developing plans jointly to actually be able to implement them, the chances that they will be implemented well and effectively are much greater when people actually are part of their development. So having all jurisdictions involved in this, I think, has proven its worth.
Then on the application of it, I think we've seen, as we're getting more and more experience with this virus.... You have to remember that seven or eight months ago nobody had even heard of this or anticipated that today it would be this bug and this pandemic. So there's a level of learning, and we see that translated into.... When you think, even in clinical medicine, of how quickly best practices are being adopted, how quickly people have picked up on what this is and what we need to do, adapting it; and as I've said, the work around preventing pregnant women from becoming seriously ill, with early treatment, with antivirals; the work at developing and getting systems in place for the whole range of things with this....
Anyway, it's going to be really interesting to look back at how we've applied that. But we are getting the information. Again, they're struggling to deal with what they're facing, and as soon as they can, they are sharing the best lessons and the information that we need. That's really key as we go forward, as we get a clearer and clearer picture of what this disease is and what it potentially could do.
:
There are a couple of things.
One is that the basic character of the virus has not changed. The usual spectrum of illness, plus those, as Dr. Bennett was referring to earlier, who previously, as far as we could tell, were healthy who succumb or get seriously ill with this virus, has not changed. We are seeing larger numbers. As we move in through the second wave, we will see more. Even once we reach the peak, there's still the other half of it. Hopefully what we'll be able to do is truncate or reduce that because of the number of people who are immunized.
In terms of the risk of infection, again, as I said, the very young are at much greater risk of becoming ill with this disease, but their risk of mortality is less. As we're getting more experience, we're starting to see that in, for example, the 40- to 64-year age group, what we saw in the first wave is that for those who were perfectly healthy before, their risk of dying is somewhere between one in 20,000 to one in 100,000 cases, whereas if they have underlying conditions their risk of dying is more in the one per 400 to one in 2,000. Those are not necessarily severe underlying conditions. It could be somebody with well-controlled asthma.
It is something, though, that really does concern us in terms of being able to afford effective treatment and, ultimately, to immunize as many as possible in order to avoid that.
:
Yes. In particular, under the communications policy of the Government of Canada, we have to do evaluations of all of our marketing activities, the major marketing activities, so we do have plans in place to go back into the field and to assess whether or not levels of knowledge and awareness were attained through some of the marketing activities we've undertaken. Of course there may be more to come, and therefore we will be doing this kind of evaluation in the months ahead as well.
Not all of the communication in the entire communications enterprise is formally evaluated. For example, how do you formally evaluate the 46 news conferences that the minister and Dr. Butler-Jones have held, and whether or not their messages were properly captured and disseminated, other than in media analyses or those kinds of evaluation that are not very formal from a methodological perspective?
So we have a mix of means of understanding how the message is being disseminated and how it's being captured. Ultimately, we also do some ongoing assessment of whether or not we're seeing behavioural change as a result of our communications. We do know that we're seeing a greater number of Canadians report a change in their behaviours around handwashing, coughing into their sleeve, and staying home when they're sick. We're seeing progress in that regard. That's in terms of the behaviours and whether or not they noticed our ads and our work.
For example, on the pamphlet you have received today, which was distributed to 10 million households, we know that almost 400,000 Canadians have called Service Canada, 61% as a result of having seen our pamphlet. So we can, through a whole host of means, assess whether or not our messages are being captured, read, understood, and acted upon.