Situation Update

COVID-19 Surveillance Update

Since our update on Thursday:

• Another 426 new cases of COVID-19 have been identified, including 98 today. This brings the total case count in Manitoba to 33,551.
• Test positivity up: The five-day test positivity rate is 5.3%, up from 4.7%. It is 3.9% in Winnipeg, up from 3.6%.
• One more variant of concern: One more case of the B.1.351 variant (South Africa) was identified. This brings the total number identified to 77, including 63 B.1.1.7 (UK) and 14 B.1.351 cases.
• Active cases up: There are 1,247 active COVID-19 cases province-wide, up from 1,089.
• There are 142 people in hospital, down from 146. This includes 25 people in ICU.
• Eleven new deaths related to COVID-19 were identified, including one today. The total number of deaths is 929.

Vaccine Situation Update

• 139,591 doses have been administered, up from 118,069 on Thursday.
• 8.7% of Manitoba adults have received their first vaccination, up from 7.4% Thursday.
• Eligibility now includes individuals 65 and older, or 45 and older among First Nations people.

The Morden mass immunization clinic opened yesterday, the fifth ​“super site” clinic in the province. The government has updated its schedule of pop-up clinics in smaller communities.

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

Over the weekend, Canada’s Chief Public Health Officer, Dr. Theresa Tam, noted a drop in new infections among people over the age of 80 and fewer outbreaks in long term care homes. Dr. Tam explained that this trend should ​“reassure us that vaccines will bring more (and) greater benefits in the weeks to come.”

We continue to maintain two important vaccine resources:

• Our Vaccine Resource Centre for physicians includes resources and information, including sample patient messaging, a billing guide, a vaccine hesitancy guide and more.
• Our public vaccine hub, Man​i​to​baVac​cine​.ca, continues to offer your patients answers to common vaccine questions, including when individuals will become eligible.

Manitoba to Stay at Code Red

This morning, the province confirmed that Manitoba will stay at code red and only a modest change to public health orders will be implemented at this time.

Last week, the government had considered moving to code orange and proposed a wider, broader list of changes to ease public health restrictions.

The more cautious approach, Dr. Brent Roussin explained today, responds to growing concern about new variants appearing across Canada, the need to protect hospital capacity, and public concern about moving too fast.

As of this Friday, public health orders will allow:

• Outdoor gatherings at public places to include 25 people, up from 10
• Weddings and funerals to include 25 people, up from 10
• Retail stores will stay at 50% capacity, but the maximum number of people increases from 250 to 500
• Drive-in events can allow attendees to leave their vehicles, as long as they follow other public health measures

Other changes are not moving forward right now, such as relaxed rules for indoor dining at restaurants, increased capacity for places of worship, reopening casinos and theatres, and loosening travel restrictions for business travellers.

The more modest approach follows a week of relatively stable COVID surveillance juxtaposed with increasing concern about the spread of more transmissible variants. Manitoba’s rate of new COVID-19 cases per 100,000 residents over the last two weeks is 82.2, which is much lower than the western provinces, Ontario and Quebec which range from 114.8 to 172.8. Variants of concern are becoming a larger issue in other provinces that are seeing ​“exponential growth” with Ontario experts signaling that province is now entering its third wave.

AstraZeneca Vaccine Update

To some, the AstraZeneca vaccine updates have felt like a roller coaster, with lots of ups and downs. Here is a summary of the last 36 hours:

• Yesterday morning, the company shared the early results from their U.S. clinical trial, which had very strong results with 79% efficacy against symptomatic COVID-19, and 100% efficacy against severe illness and hospitalization.
• Late last night, the National Institute of Allergy and Infectious Disease issued a statement cautioning that this data may have been incomplete or outdated
• This morning, AstraZeneca explains their news release was based on data to mid-February, and promises to update the results within 48 hours.
• Also this morning, Dr. Anthony Fauci says the vaccine is ​“very likely a very good vaccine.” Documents obtained by media suggest the actual efficacy from the US trial might be in the 69% to 74% range for symptomatic cases, still considered very strong by vaccine standards

The public, and physicians, are not used to seeing science unfold in the news in real-time like this. Normally, the rigorous review and debate about the research and development is not public. These are new vaccines for a new disease, and it’s important for physicians to reassure patients who may be discouraged by seeing these updates.

Bottom line: the vaccine continues to be viewed as safe and effective by experts and regulators. Patients who have concerns should be responded to with respect, which allows you to build trust and present the facts. Most importantly, it allows you to emphasize that the best vaccine is the first one available to you.

Did you get the AstraZeneca vaccine? Email us at covid19@​doctorsmanitoba.​ca.

Post-COVID Resources for Doctors

Post-COVID symptoms can persist for many weeks. The severity of initial illness does not always predict the presence of post-COVID symptoms. Individuals who are not hospitalized may still develop significant persistent symptoms.

Primary care physicians are in most cases the first point of contact for individuals post-COVID, whether or not they were hospitalized.

A group of WRHA providers developed the following resources to assist primary care providers in assessing individuals and identifying appropriate services if needed:

• C19-YRS-Covid-Rehab-screening-tool-Manitoba provides a systematic assessment of common complications post-COVID, it can be administered in-person or by virtual visit. It may help providers identify specific symptoms and assess the severity of those symptoms.
• post COVID-19 referral pathways March2021 identifies specialized services that could be used if specific symptoms are identified. It does not need to take the place of good local resources such as rehab professionals attached to provider clinics or EAP services if those are available, but it will provide a framework for what services to consider. At present the resources are generally WRHA-specific.

The World Health Organization has also published a very comprehensive WHO rehab self-management after COVID. Some COVID hospital units are already providing this to patients but this is not universal practice yet.

Changes to MAiD

Last week, we reported Bill C‑7 had been passed into law by the Parliament of Canada. This new law, which took effect immediately, expands the criteria and changes the process for Medical Assistance in Death (MAiD) in Canada. These changes were made in response to a court decision which found certain MAiD restrictions violated the Charter of Rights and Freedoms.

The main changes to the MAiD régime include:

• Canadians no longer must have a ​“reasonably foreseeable” death in order to be eligible for medical assistance in dying.
• There are now two sets of safeguards in place: one for those whose death is reasonably foreseeable, and a more stringent one for those who death is not reasonably foreseeable.
• Canadians who have been assessed and approved for MAiD, but risk losing capacity to consent prior to the MAiD procedure, can now sign a waiver of final consent.

There continues to be an exclusion for those whose sole underlying medical condition is a mental illness, but only for two years. During the next two years, the Government of Canada will hear from experts and develop safeguards and protocols for people who seek access to MAiD due to mental illness.

You can find more details at the Justice Canada website.

We can expect the debate over MAiD will continue. In addition to the government’s obligation to consult on access to MAiD by those with a mental illness, the government is now required to conduct a full review of the MAiD régime. Future court decisions may require other changes to the law.

The protection of individual physician’s personal conscience has not changed. Nothing in the federal law compels any physician to participate in MAiD. In Manitoba, physicians are also specifically protected from disciplinary or employment repercussions for their choice not to participate in MAiD.

The College of Physicians and Surgeons issued Standards of Practice respecting MAiD, which were last updated on January 1, 2019. We anticipate the CPSM will now be reviewing its Standards in light of the changes to the law. You can find the existing Standards here.

Manitoba’s MAiD team will be reviewing its policies following these changes. You can find more information about the MAiD team from Shared Health.

Please contact us at practiceadvice@​doctorsmanitoba.​ca should you have any questions about your responsibilities under Canada’s MAiD law.

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