COVID-19 Update – October 30

Due to the acute increase in cases and spread in Winnipeg, the metropolitan area will be elevated to critical (red) on the pandemic response system, effective Monday. We have a summary of the restrictions for you – including major changes to health services – along with a situation update. We also have important updates on physician wellness, advocacy and the public medical dialogue about COVID-19. 

Situation Update

Since our last update on Monday, there have been 1,025 new cases of COVID-19 identified, including 480 new cases today. This large daily count includes catching up on cases from previous days, leaving 237 identified in the last 24 hours. The total number of cases identified so far in Manitoba now sits at 5,374.

The five-day test positivity rate in Manitoba is 8.6%, up from 7.1 % on Monday. In Winnipeg, the test positive rate is 9.7, up from 8.3% on Monday. 

There are currently 2,737 active cases, up from 2,117 on Monday. This includes 104 people in hospital — a record high — up from 80 on Monday, with 19 in ICU. Over 78% of active cases (2,134) are in Winnipeg, but cases are increasing in all health regions. 

Ten more COVID-related deaths have occurred since Monday, including eight individuals in their 80s and 90s, an individual in their 60s and one in their 40s. Four of these deaths were residents of Parkview Place PCH, bringing the total number of COVID-19 deaths there to 19.

You can learn more about the current situation in today’s public health bulletin.

There are 27 facility-based outbreaks including 18 PCHs, four hospitals and other facilities, including correctional centres, a school, gym and retirement home. A listing of current outbreaks can be found here

Due to the current situation, public health is elevating the Winnipeg metropolitan area to red (critical) on the pandemic response system. More information on this can be found below. Also, the Prairie Mountain, Interlake-Eastern and Southern health regions are elevated to orange (restricted), with the same precautions in place as in the Northern RHA, and previously in Winnipeg. 

A new testing site will open tomorrow in Winnipeg’s Polo Park area in the MPI building at 125 King Edward Street. A list of current testing locations is maintained online

Meanwhile, the pilot test of rapid testing for hospital staff has been expanded from HSC to St. Boniface Hospital. Information is shared internally about these services. Doctors Manitoba continues to advocate for broader rapid, dedicated testing for health care workers, including physicians. 

What Does CODE RED Mean?

Effective Monday, November 2, at 12:01AM, the following new restrictions will be in place in the Winnipeg metropolitan area:

  • All restaurants and bars will be closed except for take-out and delivery.
  • Sports and recreation programming will be suspended.
  • Retail businesses will be restricted to 25% capacity.
  • Gyms and fitness centres will be limited to 25% capacity and masks will now be required at all times.
  • Movie theatres and concert halls will close.
  • Faith-based gatherings are reduced to 15% occupancy or 100 people, whichever is lower.

Grocery stores will remain open at 50% capacity. Schools and child care centres will also remain open.  Dr. Brent Roussin explained that spread within schools has been rare. Where cases are reported associated with schools, most are contracted outside of school and thus far have limited school contacts. He emphasized schools are a relatively safe place to be with all the precautions already in place.

Dr. Roussin also recommended everyone limit their contacts. “I am encouraging all Manitobans to stay home as much as possible”, he urged, including those who can to work from home. 

What about restrictions on health services?

Like the spring, health services are also facing increased restrictions to help limit contacts and free up capacity for a surge in admissions. These restrictions include:

  • Non-urgent and elective surgeries and diagnostics will be suspended. Essential and time-sensitive surgeries will continue, including for cancer, cardiac and trauma.
  • Outpatient and ambulatory care will be suspended, with as many appointments as possible shifted to virtual care. Those that can’t be converted to a virtual visit will be postponed if not urgent.
  • PCH visitation will be restricted only to designated family members directly involved in the care needs of the residents. General visitors are now prohibited, with exceptions for end-of-life compassionate situations.
  • Hospital visitation will be suspended, with case-by-case exceptions for end-of-life care, obstetrics and pediatrics. 

How is the health system coping?

With 104 people now in hospital with COVID-19 and ICUs nearly full, hospital capacity is being stretched. While a full pandemic contingency plan has not been shared – despite our repeated requests – Shared Health did offer limited information in today’s public briefing.

First, the response is much like any annual overcapacity protocol to support the response to influenza season. The system will utilize overcapacity beds and off-service into surgery and other areas to accommodate a surge in admissions.

Next, within two to three weeks, they can activate new contingency space. Shared Health assured the public that beds, equipment and supplies have been ordered and are in storage for contingency hospital beds. Additional space has been designated through an RFP over the summer. While Lanette Siragusa, the Shared Health lead, acknowledged that staffing will be their “biggest vulnerability”, HR plans were also being drawn up for nurses. 

There was no mention, however, of plans to recruit additional physicians to cover this contingency space or shortages due to isolation or illness. Doctors Manitoba has offered our help with this, and we are advising physicians asked to help with the response to ensure they have clarity about what they are being asked to do and what safety precautions and supports will be in place. Over 200 doctors have volunteered to help, but over 200 days into this pandemic, we still do not know how many physicians may be needed, in what capacity, and where. 

You can learn more about the code red restrictions in a provincial bulletin issued this afternoon

Please contact us with your questions or concerns at covid19@doctorsmanitoba.ca

Support Yourself and Your Colleagues

The second wave is here. Your patients are worried. Your family is concerned. And physicians are under pressure, facing uncertainty and risks they haven’t faced before.

Taking care of yourself and your physician colleagues couldn’t be more important.

Our President, Dr. Cory Baillie, has an important message for you: take this seriously.

“My patients are more concerned about the pandemic than ever before, and frankly, so am I,” admits Dr. Baillie. “Physicians feel like they are expected to have all the answers, but the truth is, when it comes to COVID-19, we don’t.”

Dr. Baillie notes he has never seen the levels of stress and signs of burnout among his colleagues that he is seeing this week. “I am feeling it myself,” he says, adding that “while the symptoms across physicians may be similar, the causes of that stress and the solutions to it are very personal and vary doctor-to-doctor.”

“Physicians are facing layers upon layers of pressure. They are worried about continuing to care for their patients. They are facing longer hours. Some are facing stigma at home from family members worried they might bring the virus home from work. And, to top it all off, we still don’t have all the information and support we need from provincial authorities to feel safe and confident about the pandemic response.”

“In times like this, it is important to focus on what we can control, not what we can’t,” Dr. Baillie emphasizes. “Whether you are worried about your own well-being, or that of a colleague, take a moment to add our physician health and wellness contact info to your cell phone now, and review the following resources the team at Doctors Manitoba has prepared for you.”

Physician Health and Wellness Services: All members and others in their household have 24/7 access to the Physician and Family Support Program, offering counseling and referrals. Help is a phone call away at 1-844-436-2762. There are also services available through MDCare and Physicians At Risk. Learn more about these services.

Staying Well During the PandemicOur guide brings together physician-focused advice from a variety of resources. Building resilience and coping with stress and burnout is not one-size-fits-all. Rather, a personal approach is needed. Review our guide for tips and suggestions, and see our pandemic physician wellness page for other resources.

Physician Health Webinar: You can learn more about how to cope — or how to help a colleague cope — by attending our physician health and wellness webinar on November 9 at 5:30PM. We have an expert panel to help you learn more about the various physician health services members can access, as well as share more information about CPSM’s approach to physician health. Learn more here about the panel, and register today!

Advocacy Update

The new code red restrictions announced today have only heightened our advocacy efforts for physicians. Long before today’s code red announcement we were advocating for the answers and supports you’ve needed so you were prepared for this eventuality. Unfortunately the government has not approved our proposals, which are now more important that ever.

With outpatient clinic restrictions, more virtual care is needed. Physicians are being asked to sign up to help with the COVID response, but no contingency plan has been shared by Shared Health. Physicians are facing increased exposure risks, but no isolation and illness support is available. 

We are pressing ahead and making the case for the supports physicians need. We have daily, if not hourly, dialogue with senior provincial officials working on solving these issues. While that dialogue continues, we will continue to use that as our primary means to advocate for what physicians and their patients need to make it through this pandemic.

We have not taken other actions off the table. We have a robust advocacy strategy that includes aggressively increasing our public advocacy. While media coverage and advertising are more visible, other provincial medical associations have recently reminded us that those more provocative actions are not the most effective at delivering results. They are a last resort. 

We will continue to keep you updated, and we urge you to contact us with your concerns and questions by emailing covid19@doctorsmanitoba.ca

As you face the continued uncertainty and growing pressures during this pandemic, there is at least one constant: Doctors Manitoba has your back.

Taking Concerns Public

This morning, many of you picked up the Winnipeg Free Press and were met with a dire warning. The front page headline: “Shut down now, doctors tell premier.”

The article conveys the concerns from group of physicians, documented in an open letter to the Premier urging the government to take immediate steps to slow the spread of the virus. Their hope is these efforts could get ahead of a hospital capacity crunch. The authors warn “we’re in deep trouble based on the numbers we’re seeing now.”  

The level of concern it takes for physicians to go public is significant.

Many doctors contact our office daily with concerns. Right now, we hear from many physicians worried that tougher restrictions are needed. Just a few months ago, though, some physicians went public calling for a more balanced approach to restrictions, recognizing the harm they can cause to society. 

Aside from your views about restrictions, we are hearing concerns daily from you about hospital capacity plans, the importance of isolation support, and virtual care, among others. 

Doctors Manitoba has been acting on your concerns and escalating them to senior provincial officials every day.

We have repeatedly urged Shared Health officials to honour their organizational namesake and share their pandemic contingency plans with doctors. Sharing information builds trust and confidence. Secret plans do the opposite.

Sharing their plans would both reassure physicians there is a plan in place to cope with the looming surge in admissions, as well as allow us to work with them on having a physician HR plan in place to support these contingency services, rather than scramble to find physicians later. With an increase in physician isolations expected, we have also raised the need for a solid back-up coverage plan.

Our President, Dr. Cory Baillie, has also been sharing physicians’ concerns about hospital capacity through the media as well.  Over 200 physicians have signed up to help with the pandemic response, but we still don’t know how many are needed, in what capacity, or where. Training a physician to assist in the hospital could take 10 weeks, but they are clearly needed today with reports that ICUs are at capacity. 

We have two important recommendations to doctors, worried about hospital capacity right now:

  1. Share your concerns with your medical director, to escalate within the provincial incident command structure. Following the process is important for your concerns to be taken seriously.
  2. Copy us when you raise your concerns internally. Or contact our office separately at covid19@doctorsmanitoba.ca to share your concerns confidentially with Doctors Manitoba. We are working hard to raise your concerns daily with provincial officials. While the impact of these discussions is not always highly visible, it has led to changes and progress on a number of issues in recent months, such as expanded testing capacity, getting clarity on offering care for truckers, improving the distribution of flu vaccines, and addressing PPE shortages, and even pressing for a more cautious approach this summer when restrictions were being lifted too quickly.

If you and your colleagues have tried to escalate your concerns using the internal chain of command at your workplace with no success, you may feel inclined to go public. This is a difficult decision that requires careful thought. Contact our office confidentially to discuss your concerns so we can work together. Like any medical intervention, going public can have side effects and unintended consequences, but we can think these through together.