2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
Provincial and territorial (PT) governments have primary responsibility for the administration of their health systems, including ensuring physical and workforce capacity. The federal government is responsible for health protection and regulation, consumer safety, and disease surveillance and prevention, and has introduced some measures to increase supply (Health Canada, 2011). On March 13, 2020, the Government of Canada committed a CA$1 billion investment in public health measures (PHAC, 2020c). In particular, CA$500 million was allocated to PTs for health system needs and mitigation efforts (PHAC, 2020c).
The Canadian Institute for Health Information (CIHI), a pan-Canadian agency, provides Canada-wide data on the supply of hospital beds and other physical infrastructure (CIHI, 2020). CIHI reports that there were 3,876 adult intensive care unit (ICU) beds across the country, as of 2017-18 (CIHI, 2020). Hospital occupancy rates have been historically high in Canada (Crawley, 2020); as a result, there have been many concerns about health system capacity during the pandemic (Crowe, 2020a).
Further, the Government of Canada has stated that it is actively monitoring the supply of over-the-counter drugs, natural health products and medical devices in Canada and is aware of the possibility of supply disruptions due to COVID-19 (PHAC, 2020k). Companies that sell prescription drugs in Canada are required to report anticipated or actual drug shortages (ibid). Drug and medical device shortages are also reported at the PT level of government (ibid).
Ahead of the COVID-19 pandemic many First Nations and Inuit communities across Canada had insufficient physical infrastructure and supplies needed to manage an outbreak. They faced challenges with overcrowded housing conditions, lack of potable water, limited access to healthcare equipment, and limited access to healthy foods (Inuit Tapiriit Kanatami, 2020; Pasternak & Houle, 2020).
As noted in Section 1.5, in order to mitigate medical device shortages, the federal government signed an interim order on March 18, 2020 to allow expedited access to COVID-19-related diagnostic kits and medical devices (PHAC, 2020i). This is one of the fastest mechanisms available to the Government of Canada to help make health products available to address large-scale public health emergencies. The order enables faster and more flexible importation of medical devices needed to respond to COVID-19, including test kits (PHAC, 2020i). Under this measure, products that are usually subject to specific regulatory requirements, such as hand sanitizer, masks, gowns, and swabs, will be permitted to be sold in Canada if they are authorized for sale but not fully compliant with Health Canada requirements or if they are not authorized for sale but are authorized in other jurisdictions outside Canada with similar regulations (PHAC, 2020i).
On March 20, 2020, the Government of Canada also called on Canadian manufacturers to help meet the need for medical supplies (Canada, 2020d). The “Call to Action” asks businesses to scale production and re-tool manufacturing lines to develop products, including critical health and safety supplies and equipment, such as personal protective equipment (PPE), sanitization products, diagnostic and testing products disease tracking technology. It also calls upon efforts to enhance and develop disease tracking technology (Canada, 2020d).
On March 31, the federal government announced progress under “Canada’s Plan to Mobilize Industry” to fight COVID-19, including signing new procurement agreements with Canadian companies Thornhill Medical, Medicom, and Spartan Bioscience to purchase and boost capacity to manufacture equipment and supplies, e.g. portable ventilators, surgical masks and rapid testing kits (Canada, 2020g). Through these agreements the government ordered millions of supplies to ease pressure on Canadian health care facilities (Canada, 2020e). Other agreements have also been signed with five other companies to produce additional test kits, hand sanitizer, and PPE (e.g. masks and gowns) (Canada, 2020g). In addition, companies such as Magna, General Motors, Toyota Motor Manufacturing Canada, Ford, Linamar, Shell, Suncor, Alibaba Group, and The Home Depot have donated PPE and safety equipment, as well as sanitizing supplies (Canada, 2020g).
On April 3, the Government of Canada announced that they have partnered with Amazon in an effort to deliver personal protective equipment to front-line health care workers (Canada, 2020h). This partnership will allow the federal government to manage the distribution of PPE and other supplies to support the COVID-19 response. Amazon is providing these services at cost, without profit (Canada, 2020f).
On April 3, Prime Minister Trudeau also issued a warning to the United States’ Trump Administration against their proposed block of trade of essential goods to Canada, particularly against a proposed order to stop exporting N95 respirators, made by the American company 3M, to Canada (Leblanc & Morrow, 2020). On April 7, 3M reached a deal with the United States government to continue exporting N95 respirators to Canada, though it remained unclear whether this deal extended to other PPE (Leo, 2020).
On April 7, the federal government announced that they are teaming up with several Canadian companies to produce up to 30,000 ventilators (Tunney, 2020a). The partnership includes Thornhill Medical, CAE, Ventilators for Canadians, and a group of manufacturers led by StarFish Medical (Tunney, 2020a). According to the federal government, this will increase the ventilator supply six-fold (Tunney, 2020a). With this announcement, the Public Services and Procurement Minister announced that Canada has sourced more than 230 million surgical masks and 113,000 litres of hand sanitizer (Tunney, 2020a).
On May 6, the Government of Canada announced that they would waive tariffs on certain medical goods, including PPE, in an effort to reduce the cost of imported COVID-19 supplies, which typically can face tariffs of up to 18% (Canada, 2020x).
Many provinces are facing shortages of medical supplies, such as PPE (CBC News, 2020c). However, Alberta, appears to be an exception; the government of Alberta announced on April 11 that it would be sending PPE to other provinces including British Columbia (BC), Ontario, and Quebec (Alberta, 2020e). The province has since sent N95 masks, procedural masks, gloves, goggles and ventilators to these provinces (Alberta, 2020e).
First Nations communities without their own source for PPE can request supplies from ISC (Union of British Columbia Indian Chiefs, 2020). On May 29, Chief Wally Burns of the James Smith Cree Nation reported to the CBC that their community was looking to alternative suppliers of PPE after failing to acquire the essential supplies in a timely manner from the ISC (Barrera, 2020). This delay in essential supplies acquisition has also been reported by the Métis Nation Council to Global News (Wright, 2020b).
At the provincial level, efforts have been made to make more hospital beds available to facilitate the anticipated surge in COVID-19 cases. For example, the Ontario and BC governments announced in mid-March (Ontario on March 15, and BC on March 16) that they would be ramping down non-essential surgeries in hospitals to free up hospital resources (Ministry of Health, 2020a; Zussman, 2020). Plans to resume scheduled surgeries and procedures are discussed in Section 3.3. Multiple provinces have also taken supply chain measures to mitigate medical supply shortages. For example, in Ontario, the Ministry of Government and Consumer Services and the Ministry of Health have taken control of the management of all public sector supply chains (Ministry of Government and Consumer Services, 2020); in BC, the provincial government has established a new Provincial Supply Chain Coordination Unit to coordinate the distribution of essential goods and services (British Columbia, 2020d).
Notably, Canada operates a Notional Emergency Strategic Stockpile; however, the focus of this stockpile is for the rapid response to natural disasters, not biological threats (Tumilty, 2020b). While the stockpile changes in response to expected demands, it was not stocked with PPE and was never intended to support PT health care systems (ibid). Such stockpiles would be under the authority of PTs.
Specific provincial and territorial measures are reported by the North American Observatory on Health Systems and Policies on their dedicated COVID-19 page (https://ihpme.utoronto.ca/research/research-centres-initiatives/nao/covid19/).
See full reference list under ‘Key links and articles: Full list of references’.