Situation Update

COVID Surveillance Update

Since our update on Wednesday, the COVID-19 situation has stayed within the same range, though a slight escalation of some indicators has been noted:

• 186 new cases of COVID-19 have been identified since Wednesday, including 104 new cases today. This brings the total case count in Manitoba to 32,607. This is the first day with 100 or more cases identified since February 21.
• Test positivity increased: The five-day test positivity rate is 4.1%, up from 3.8% on Wednesday. While much lower than a few months ago, it has increased slightly from the low of 3.0% on on March 4. It is 3.0% in Winnipeg.
• Active cases decreased: There are 872 active COVID-19 cases province-wide, a drop from 1,185 following a catch up on recovered cases.
• There are 154 people in hospital, down from 162. This includes 22 people in ICU.
• Four more deaths were identified, including one today. The total number of deaths is now 912.

One more case was confirmed to be the B.1.1.7 (UK) variant of concern. The total number of confirmed variant of concern cases of B.1.1.7 is 12 and B.1.351 (South Africa) is 11, for a total number 23 variant of concern cases.

While some indicators have trended up very slightly, something Dr. Brent Roussin said wasn’t a surprise with gradual restriction changes, he noted that the number of severe cases continues to decrease.

Vaccine Situation Update

Manitoba’s immunization rollout is progressing, with the following highlights:

• 99,842 doses have been administered, up from 94,785 on Wednesday. This includes 68,378 first doses and 31,464 second doses.
• 6.4% of Manitoba adults have received their first vaccination, up from 6.0% on Wednesday. 3% have been fully immunized.
• Eligibility was expanded to include people working in congregate living settings, age 40 and older. It was age 60 and over earlier. Also, anyone working in an acute care facility is now eligible to be immunized, including those with no direct patient contact.

Clinics and pharmacies started receiving their first shipments of AstraZeneca/​Covishield yesterday. The province has also released a schedule of pop-up clinics in smaller communities such as Portage la Prairie, Gimli, Teulon, Dauphin, Swan River, The Pas and Flin Flon. The pop-up clinics are scheduled between March 16 and 31 with more dates expected. Review the full list and schedule online.

More data is available at the province’s vaccine data reporting page.

New Info – Medical Clinic Immunization

Last night, Doctors Manitoba hosted a webinar on behalf of government officials for clinics and pharmacies receiving AstraZeneca Covishield vaccine supplies in this first shipment. This was an opportunity for an in-depth Q&A with provincial representatives from the Vaccine Implementation Task Force, including medical lead Dr. Joss Reimer and Mr. Joe Funk.

Here are the key learnings and takeaways from this webinar:

1. Concerns about blood clots: Dr. Reimer reassured participants that the product available in Manitoba was manufactured in a different country that the batch in Europe that has raised some concerns. Manitoba Health has no concerns about the vaccines that are available to Manitobans. Health Canada is currently reviewing the evidence and has not recommended any changes to how this vaccine product is administered. See this article in the BMJ that summarizes the concerns in Europe.
2. Prioritizing eligible patients: Physicians and pharmacies are required to review and offer vaccine first to patients who belong to Priority List 1. When all eligible Priority List 1 patients have been seen, patients with Priority List 2 conditions can be offered a vaccine. Physicians should use their clinical judgement in assessing whether a patient meets the eligibility criteria and document their assessment.
3. Only one consent form: Recently, the two vaccine consent forms were combined into one consent form. This streamlined form will make it easier for physicians to obtain consent from their patients. Physicians can use this form when administering vaccine in their clinics to eligible patients, and may complete it in advance for those patients who are eligible to receive vaccine at Super-site or Pop-up Clinic but who may have questions they would like to discuss with their doctor first. If patients ask why a lengthy consent form is still required, it’s important to reassure them that it’s about ensuring they have the facts about the vaccine, not because there are safety or effectiveness concerns.
4. Patient/​public resources: Manitoba Health has also developed fact sheets and other resources to provide information on the vaccine, common reactions, information for pregnant and breastfeeding individuals and those who may be immunocompromised. Doctors Manitoba has developed a user-friendly public website Man​i​to​baVac​cine​.ca to help Manitobans get information on the vaccine, check when they will be eligible, and sign up for personalized reminders of when they may be eligible to receive the vaccine.
5. Use and Storage: Open vials may be stored at room temperature for 6 hours and up to 48 hours when refrigerated. The COVISHEILD product monograph should be reviewed before administering vaccine. Product monographs of all approved vaccines are available for reference.
6. Avoiding wastage is a top priority: Given the small amount of doses available, and the short expiry date, the province is very focused on minimizing wastage of this precious resource. To avoid wastage, physicians should focus on priority 1 patients first, then priority 2 patients. Beyond this, you can consider seeking referrals from colleagues who may have priority 1 or 2 patients, reaching out to patients on your roster, or immunizing anyone under 65 who would qualify for the Pfizer/​Moderna vaccine, such as healthcare workers or staff working in your immunization clinic. Physicians may use their clinical judgement to vaccinate other individuals as may be needed to avoid wasting even one dose of vaccine.
7. Second Dose Booking: Dr. Reimer indicated that the National Advisory Committee on Immunization has recommended that first and second doses of the vaccine can be extended to four months. AstraZeneca has already been found to be more effective after 12 weeks. To help ensure more Manitobans get the protection from the first dose, clinics should look at extending the second dose to the recommended time-frame. However, given this time-frame, second dose appointments don’t need to be booked during the first dose visit, this can be done later.
8. Oxford-AstraZeneca is safe and effective: Dr. Reimer strongly reinforced that AstraZeneca is safe and effective. It’s not appropriate to compare efficacy between vaccines head-to-head, because each clinical trial were conducted at different times, in different countries, with different levels of virus circulating, and different variants circulating. A recent study, she explained, actually found AstraZeneca to be more effective at preventing hospitalizations. Today, Dr. Brent Roussin said he is looking forward to getting his first dose of AstraZeneca soon.
9. AstraZeneca and Age 65+: Officials anticipate that NACI may change its recommendation around the recommended age range, limiting AstraZeneca to ages 18 – 64, as more and more real-world data emerges. Several countries already administer the vaccine to adults of all ages.

While the webinar has not been posted, it can be access upon request. Please email covid19@​doctorsmanitoba.​ca for access.

If the vaccine rollout here in Manitoba is causing you concern and stress, you are not alone! Yesterday, the CMA released a national survey of physicians that found that the vaccine rollout is among the top contributing factors to increasing levels of fatigue and anxiety.

Mask Changes

Manitoba’s acute care facilities, including hospitals and health centres, as well as licensed personal care homes will soon begin providing all visitors and outpatients with a medical mask at the point of entry or screening. Date of implementation may vary by region and/​or facility but will occur province-wide over the week of March 15.

Visitors and outpatients will be asked to change from their non-medical mask to the provided medical mask, which should be worn for the duration of their visit unless it is required to be removed for the purpose of receiving medical care.

This change does not apply to fee for service clinics, primary care clinics or community health services. Exceptions remain in place for individuals who are unable to wear a mask for medical reasons and for children under the age of five.

More information is available in a recent Shared Health memo. The Green Zone PPE guidelines have also been updated too.

Restriction Updates

The following updates to the existing public health orders will come into effect tomorrow:

• Masks in places of worship will no longer be required, but this only applies to when individuals are seated with their household, and distanced from other households. Masks will still be required otherwise, and will still be required when singing.
• Outdoor patio dining will be permitted at restaurants, with seating of up to six per table, but no household-only requirement. Indoor dining is still restricted to individual households only. Both outdoor and indoor dining is limited to 50% capacity.

Canadian Women Physicians Day

Yesterday was Canadian Women Physicians Day! Doctors Manitoba recognizes and celebrates the contributions that female physicians have made in our province and around the world and will continue to support women physicians in their pursuit of income equity and in their fight against gender discrimination. Thank you to women physicians who have paved the way and who work to make a difference today!

To view previous updates, click here.