In today’s message you’ll find:

Situation Update

Covid-19 Surveillance
Since our last update on Tuesday: 

  • Daily cases continue to come down: 502 new cases of COVID-19 have been identified, including 189 today. The total case count in Manitoba now stands at 55,098.
  • Test positivity decreasing: the five-day test positivity rate is 8.3%, down from 10.6% on Tuesday. It is 8.3% in Winnipeg, down from 9.9%.
  • Active cases down: There are 2,436 active COVID-19 cases province-wide, down 536 from 2,972.
  • Hospitalizations remain high: There are 238 people in Manitoba hospitals due to COVID-19, down from 290. This includes 60 COVID-related patients in Manitoba ICUs, down from 63 on Tuesday. There are also 20 Manitoba patients in out-of-province ICUs, down from 24 on Tuesday. 
  • With 4 more deaths reported today, the total is 1,115.

Child Care and Day Camp Update

School-aged children will be allowed to return to child care centres and day camps starting on July 1. The government confirmed the move today, following advice from a number of pediatricians. 

Summer day camps for children aged 11 and under will be permitted to operate effective July 1.

There are no changes to cohort sizes for licensed child-care facilities, currently set at 30, but day camps will be limited to cohorts of 20. You can read the full provincial update here.

Vaccine Updates

With information changing quickly, we have several updates for you on what’s new with COVID-19 vaccines over the last few days.
Eligibility for second doses expanded today to include those who received their first dose on or before May 23.

So far, 70.6% of eligible Manitobans (age 12+) have received one dose, and 22% have received two doses. This is quickly approaching the Canada Day target of 70% first dose (achieved) and 25% second dose (close).

Pfizer Shortages

Pfizer shipments will slow down in early July, resulting in fewer Pfizer appointments in the next few weeks.Manitoba will receive about 50% less doses the first two weeks of July than expected — nearly 90,000 fewer doses. 

Moderna, however, has been arriving in larger-than-expected volumes to more than offset the loss of Pfizer doses, and research findings now support interchanging mRNA vaccines when the same type isn’t readily available for a second dose.

No appointments are being cancelled, but it could happen as provincial officials assess the situation. The temporary supply shortage, however, means the province is pausing second-dose appointments of the Pfizer vaccine for young people aged 12 to 17

Earlier today, Pfizer appointments were only left in Brandon and Thompson. Moderna appointments were available in multiple super site locations, including appointments next week. More doses are expected in medical clinics as well. 

NACI recommendations

Yesterday, the National Advisory Committee on Immunization (NACI) updated its recommendations and now advises that that mRNA vaccines are the preferred” option, both for first doses and for second doses. This includes following a first dose of AstraZeneca.

NACI’s guidance is based on the increased supply of mRNA vaccines, growing evidence that a second dose of an mRNA vaccine produces a stronger protection, and because of the serious but incredibly rare risk of vaccine-induced blood clots associated with AstraZeneca.

In terms of mixing mRNA vaccines, NACI recommends getting the same mRNA vaccine product for a second dose if it is readily available. If not, the Committee supports using a different mRNA vaccine for a second dose interchangeably to complete the full vaccination series.

NACI also recommends mRNA vaccines as the first dose, unless there is a contraindication (e.g. allergy) or access issue that would prevent vaccination.

You can read the NACI update here.

AstraZeneca Hubs

For those patients who received a first dose of AstraZeneca, and cannot or will not access mRNA for their second dose, the province is setting up hubs” to offer AstraZeneca for second doses. A total of 7,500 doses were received recently for this purpose.

A total of 15 medical clinics and pharmacies will act as regional hubs. 

Beginning next week, these will be listed online on the government site. We will also update the Vaccine Finder with medical clinic hubs at Man​i​to​baVac​cine​.ca.

Surgery and Diagnostic Backlog

Yesterday, our President Dr. Kristjan Thompson released a major report on the surgery and diagnostic testing backlog, and called on the government to address the issue without delay. Our comprehensive analysis estimates this pandemic backlog” to include over 110,000 procedures, and counting. 

The pandemic backlog of medical tests and surgeries is staggering, and it’s getting bigger every day,” said Dr. Kristjan Thompson, President of Doctors Manitoba.​“As we move past this third wave, patients need to see immediate and sustained action to address this critical issue.”

The growing backlog, which is leading to lengthy delays in diagnosis and treatment, is estimated to include:

  • Over 39,000 surgeries, including in serious life-saving surgeries
  • Over 44,000 diagnostic imaging procedures, such as MRI, CT and ultrasound scans
  • Over 32,000 other procedures, including endoscopies, mammograms and allergy tests. 

To address the backlog, Doctors Manitoba recommends three broad actions:

  1. A clear provincial commitment to fully address the pandemic backlog by a fixed date.
  2. The creation of a surgery and diagnostic recovery task force, including both health system leaders and front line physicians and health care workers, to lead the immediate and sustained task of addressing the backlog.
  3. Monthly public reporting on the size of the backlog and on actions to improve the situation. 

This has been – and will continue to be – a major focus of our advocacy efforts. The issue has affected all physicians and thousands of your patients. Our push yesterday is another step in this process, and it’s one that got widespread coverage, including in the Free Press and Winnipeg Sun, and on the CTV, CBC, Global and City News broadcasts. 

We recognize the provincial government invested in reducing wait times, but unfortunately all of that progress has been erased by this pandemic,” added Dr. Thompson.​“We now face a backlog and wait lists that are longer than most physicians have ever seen, and this crisis requires an immediate and ongoing coordinated response from provincial leaders.”

Physicians cited a shortage of nurses and technologists as top barriers to addressing the backlog, a problem that started long before the pandemic. This left Manitoba’s hospitals especially vulnerable during the pandemic, perhaps more so than any other province, because there was little capacity to absorb even a moderate increase in COVID-19 admissions without significant disruptions to other hospital services.

The diagnostic and surgery backlog is one of the top concerns for physicians in Manitoba, who are worried about their patients. Delays and repeated cancellations are leading to:

  • Patients waiting in pain and discomfort;
  • Minor health issues becoming more complicated, requiring more complex surgeries and longer hospital stays; and
  • Patient harm, including delayed diagnosis, permanent disability and death.

The full report, Addressing the Surgery and Diagnostic Backlog: A Path to Recovery, is available here.

Help Spread the Invite — Vaccine Town Halls

Please help us spread the invitation (not the virus!) for our public vaccine town halls next week. We are hosting four town halls next week. Our aim is to answer community members’ questions in an effort to help Manitobans better understand the vaccines.

These are non-judgmental events and all questions are invited. So far, the question we have received have been respectful. Some of the questions are clearly influenced by misinformation, but they genuinely seem to be seeking factual information from physicians as a trusted source. 

How can you help?

Help us get the word out. You could:

  • Post on social media! We have social media graphics you can use. Try a supportive and inviting post, such as: 
  • Send a message to all of your patients inviting them to attend. You can use the images on our site and invite patients with questions to attend the town halls or to contact your office if they have questions or concerns. 

The following town halls are planned next week:

New PCH and Hospital Visitor Guidelines

Starting on Monday, June 21, fully vaccinated individuals will have increased social visitation” to PCHs. Shared Health has published guidelines on the change. Proof of vaccination will be requested for general visitors” though it won’t be required for the designated family visitors. 

This expanded social visitation for fully immunized residents and their fully immunized visitors will include the ability for general visitors to visit residents, indoors, including in some instances in the resident’s room. There is no change to the requirements or access of designated family caregivers. 

Further information on acute care visitation will be available soon. 

Webinar on Vaccines and Variants

PHAC is hosting a Variants and Vaccines webinar for health care providers. The one hour webinar will highlight national surveillance systems, key findings on the efficacy of vaccines on VOCs and how predictive epidemiological models can inform forecasts and response. They will present the webinar in both French and English.

CPSM Consultation on Virtual Care and Other Standards

CPSM is now consulting with members, stakeholders, and the public on four draft Standards of Practice: Virtual Medicine, Documentation in Patient Records, Maintenance of Patient Records in All Settings, and Performing Office Based Procedures.

Virtual medicine is here to stay, as long as Manitoba Health accepts its value and continues to support its maintenance and expansion as we look towards the post-pandemic era. Doctors Manitoba has been engaged with Manitoba Health respecting virtual medicine – since before the beginning of the pandemic – and will continue to advocate for appropriate tariffs wherever virtual medicine is appropriate. CPSM’s attention to the difficult issues raised by virtual medicine is appreciated.

We note the Standard respecting Office Based Procedures may have a substantial impact on certain areas of practice, including plastic surgery and dermatology, particularly where some tasks are delegated to non-physicians. We encourage all members who may be affected to review the draft Standard carefully.

Doctors Manitoba will be reviewing all of these draft Standards and may provide submissions respecting some or all of them to the CPSM. You can view the proposed standards here:

  1. Standard of Practice for Virtual Medicine
  2. Standard of Practice for Documentation in Patient Records and Standard of Practice for Maintenance of Patient Records
  3. Standard of Practice for Office-Based Procedures

We welcome your input. If you wish to make your own submission directly to the CPSM, please consider also sending us a copy at general@​doctorsmanitoba.​ca.

The deadline for submissions on all consultations is Friday, July 162021.

Medical Leadership Opportunity

The WRHA is looking for a site medical lead for family medicine at ACCESS Winnipeg West, located on the Grace Hospital campus. The key functions of the position are to assist the WRHA Regional Medical Specialty Lead in the planning and coordination of a system wide program and to provide leadership to the primary care physicians and team members on site.

For full details, click here.

Fantastic Physician Fridays

We love sharing the accomplishments of physicians and medical learners in Manitoba! See below for three colleagues we learned this week have received honours. If you know of a colleague with a significant accomplishment, let us know by emailing jsie@​doctorsmanitoba.​ca.

Dr. Barry Lavallee, Dr. Paul Komenda and their team were the top winner of the Univants of Healthcare Excellence Award. The team won the award for their program Kidney Check: The Next Generation of Surveillance for Hypertension, Diabetes and Chronic Kidney Disease. The program, which has reached over 5,500 Indigenous Manitobans, across 11 communities, with nearly 1,700 participants opting-in for screen, has expanded to four other provinces.

The prestigious award is an earned honour, assessed by world-renowned organizations, societies, and leaders from across health care. As a result of this award, Dr. Komenda, Dr. Lavallee and their team will get global amplification of their best practice. 

Dr. Ginette Poulin, Medical Director of AFM received the Canadian Certified Physician Executive (CCPE) title this year. Dr. Poulin is well known for her work in the area of addictions and harm reduction and has been the driving force behind many initiatives to help treat Manitoba’s most vulnerable patients. She developed RAAM clinics throughout the province, staying closely involved with each site (including rural and Northern), and mentoring physicians and other health care professionals. Congratulations on receiving one of the most coveted physician leaders title in Canada. She is also part of the Doctors Manitoba Board of Directors as the Representative for the Misericordia District.