Situation Update

COVID-19 Surveillance Update

Since our update on Tuesday:

• Another 183 new cases of COVID-19 have been identified, including 91 today. This brings the total case count in Manitoba to 33,085.
• Test positivity down: The five-day test positivity rate is 4.7%, down from 5.2%. It is 3.6% in Winnipeg, down from 3.7%.
• More variants of concern: 11 new B.1.1.7 (UK) variant cases were identified and 1 new B.1.351 (South Africa) variant case. This brings the total number identified to 76, including 63 B.1.1.7 and 13 B.1.351 cases.
• Active cases up: There are 1,089 active COVID-19 cases province-wide, up from 989.
• There are 146 people in hospital, down from 151 . This includes 23 people in ICU.
• One new death related to COVID-19 was identified. The total number of deaths is 918.

Vaccine Situation Update

• 118,069 doses have been administered, up from 109,875 on Wednesday.
• 7.4% of Manitoba adults have received their first vaccination, up from 6.9% Wednesday.
• Eligibility was expanded today to include those age 71 and older, and First Nations peoples age 51 and older.

Clinics and pharmacies started receiving their first shipments of AstraZeneca/​Covishield last week. The province has also released a schedule of pop-up clinics in smaller communities though many are already fully booked up. The pop-up clinics are scheduled through to March 31 with more dates expected. Review the full list and schedule online.

The government has introduced its online booking option. An alternative to the vaccine call centre, the system requires people to register and enter their health care number. Information on both options has been added to our vaccine finder page at Man​i​to​baVac​cine​.ca.

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

AstraZeneca Updates

While NACI has expanded its recommendations for the Oxford-AstraZeneca vaccine to include adults of all ages, the guidelines in Manitoba have not changed just yet.

Dr. Joss Reimer, the Medical Lead with the provincial Vaccine Implementation Task Force, explained that the existing guidelines will remain in place for this first limited supply of doses, as the pilot project with clinics and pharmacies is already well underway.

“We are actively looking at how to expand the guidelines for the next shipment of AstraZeneca, so that physicians can offer the vaccine to more patients,” Dr. Reimer said. ​“While the federal government has not given us a date yet for that next shipment, it could be just weeks away.”

For now, given the limited supply, clinics should continue to offer the vaccine to those who meet the criteria as follows:

1. Patients who meet the priority 1 criteria (age 50 – 64, or First Nations people age 30 – 64) with priority 1 medical conditions
2. Patients who meet the priority 2 criteria (same age ranges) with priority 2 medical conditions
3. Patients who meet the age criteria (same age ranges) with conditions that physicians consider higher or moderate risk for severe outcomes from COVID-19
4. Health care workers and others, age 18 – 64, who are already eligible to get immunized at a provincial vaccine clinic.

Clinics can reach out proactively to patients who may be at risk. The Manitoba College of Family Physicians has an EMR query guide to help identify patients who meet the provincial criteria, and Doctors Manitoba has sample email templates to help.

If a clinic is having trouble finding enough patients to meet these criteria, they can accept referrals from other physicians. There are many family physicians and specialists not offering the vaccine who would like to support their patients with high risk medical conditions. They can also change their status on the Manitoba government website to indicate to the public that they are accepting appointments

In a boost to physicians eager to offer more vaccine, the U.S. government has agreed to send 1.5 million doses of the AstraZeneca vaccine to Canada. It will likely not be available until April, according to news reports, but this could bring between 45,000 and 50,000 more doses to Manitoba when it is available.

European Regulator Deems Vaccine Safe and Effective

The European Medicines Agency released the findings of their review today following reports of blood clots following a dose of AstraZeneca’s COVID-19 vaccine.

Following its review, the EMA concluded that ​“the vaccine is not associated with an increase in the overall risk of thrombotic events or blood clots.” The Agency has suggested adding a warning about a potential rare side effect to help continue studying the issue. The World Health Organization called on countries to continue using the vaccine.

The vaccine manufacturer received 37 reports of blood clots among the over 17 million people vaccinated in Europe and the UK. The company pointed out that this is much lower than would be expected to occur naturally in a general population of this size and is similar across other licensed Covid-19 vaccines.

If you face questions from patients about the safety of this particular vaccine, you can note:

• Physicians have confidence in the safety of the AstraZeneca vaccine. This includes Dr. Brent Roussin, who has chosen to get the AstraVeneca vaccine himself later this week.
• The scientific evidence, along with the findings of several regulators, reinforces the safety of this vaccine. The blood clot concerns in Europe were investigated by the European regulator, and they deemed the vaccine to be safe and effective.
• Health Canada, the World Health Organization and the European Medicines Agency continue to reinforce the safety and benefits of the vaccine.
• Several countries with rigorous regulatory and safety monitoring are continuing the use of this vaccine, including Canada, the UK and Australia.
• Even if there was a legitimate concern, Canada is using a different batch of the vaccine than the one used in Europe.

Vaccine Campaign Update

Our vaccine campaign, Man​i​to​baVac​cine​.ca, continues to engage Manitobans about the vaccine, supporting both the vaccine confident and vaccine hesitant with reliable advice from the profession they trust the most.

By the numbers:

• Over 1.3 million views
• Over 114K eligibility checks
• Over 12K have already received same-day notifications when they became eligible.

Public feedback has also been very positive, with lots of comments and emails like this one:
​“Thank you for creating this helpful website. A real indication our doctors care about their patients.”

As a physician, you can help let Manitobans know about the vaccine and support their access. Many clinics have sent out an email to all patients about the vaccine, and encouraging them to visit Man​i​to​baVac​cine​.ca to learn more and find out when they’ll be eligible. We’ve created materials for you, like posters, sample patient emails, voicemail messages, and more. Check out our vaccine campaign resources.

Once there is enough vaccine for doctors to offer a shot to more people, we will make it easier for Manitobans to find clinics offering the vaccine on our site.

The government also launched a vaccine campaign just yesterday called ProtectMB. More communication about the vaccine is a good thing, so we welcome this site. The government site also has vaccine information and the ability to sign up for notifications, though it appears only weekly notifications will be offered.

Is it Time to Move to Code Orange?

The government and public health officials are considering decreasing Manitoba’s status on the pandemic alert system from Red to Orange.

Changes to public health restrictions are also on the table. While there are no proposed changes to indoor private gatherings, the changes being considered include:

• Increasing outdoor gatherings to 25 people or less, up from the 10-person maximum today;
• Expanding capacity for weddings and funerals to 25 people;
• Increasing capacity at places of worship to 25% or 250 people, whichever is lower;
• Increasing retail stores to 50% or 500 people, whichever is lower;
• Restaurants would remain at current capacity, but indoor dining would allow households to sit with their designated visitors or household;
• Casinos, movie theatres, concert halls could reopen with up to 25% capacity or 250 people;
• Allowing indoor organized team sporting games, and allowing youth not to wear masks while playing; and
• Travel restrictions would be altered to remove self-isolation requirements for inter-provincial travel only for work-related trips.

The public survey is now open on the government’s engageMB website. In addition to seeking feedback about the changes above, it also asks about the public’s comfort on the timing of implementing changes.

The timing of these changes has not been set, and Dr. Brent Roussin recognized that Easter and Passover are approaching. However, he cautioned that ​“we all saw what happened after Thanksgiving last fall – case numbers rose dramatically and we ended up in lock down for Christmas. We don’t want to see a repeat of that happening again, just before summer.”

Physician Billing Audit Letters

We know… no one wants to be audited. Not because you’ve done something wrong, but because the process is time consuming, stressful and, at times, feels unfair.

If it happens to you, Doctors Manitoba will be with you every step of the way.

Earlier, we reported that billing audit letters will now come from the Comptrollership and Compliance Unit (CCU) in the Department of Finance. We expect the new Unit will enforce time limits, and you may need to take steps to protect your right to question any findings.

We want to help you, and your colleagues, in dealing with the new Unit. If you receive an audit letter, you should call Doctors Manitoba before you respond to or speak with an auditor.

Contact Allison Crolly at acrolly@​doctorsmanitoba.​ca or 204−985−5856 or Andrew Swan at aswan@​doctorsmanitoba.​ca or 204−985−5860 for advice.

Last Chance – Virtual Care Webinar

This is our last reminder to register for an upcoming webinar on the future of virtual care. The deadline to register is Monday, March 22 and the session will be held on March 24.

The way we care for patients is changing, and we hope virtual Care is here to stay. In fact #VirtualisVital, and we need to make the most of this new way of meeting with patients. To help share leading information on implementing virtual care, The Manitoba Institute for Patient safety and Doctors Manitoba have collaborated to offer this upcoming webinar, ​“Virtual Healthcare in Manitoba: Past, Present, Future” with Dr. Gigi Osler, and moderated by Doctors Manitoba CEO, Theresa Oswald.

The session has been approved for CPD credit.

• At the conclusion of the webinar, participants will be able to:
• Recognize the current state of virtual care in Canada
• Identify barriers and enablers of delivering virtual care
• Analyze ways to improve the quality and safety of virtual care delivery

Register today, or by the Monday deadline, to participate!

MAiD Law Changes

Yesterday, the Senate of Canada passed changes to the Criminal Code which will increase the access to Medical Assistance in Dying (MAiD) for some Canadians. The changes now allow for those intolerably suffering to pursue MAiD, even if their natural deaths are not reasonably foreseeable. Eventually, the change will include people suffering solely from mental illness.

The protection of personal conscience of physicians in Manitoba is not affected by these changes.

Issues surrounding MAiD are difficult and emotional for many Canadians, including for physicians who provide care to people nearing the end of their lives.

We will provide you with more details on these changes in the days to come. We anticipate that CPSM will be updating its Standards of Practice to reflect these changes soon.

To view previous updates, click here.