In today’s message you will find:

Situation Update

Since our last update on Monday:

  • Daily cases up: Another 735 new cases of COVID-19 have been identified over the last two days, including 402 today. The total case count in Manitoba now stands at 44,189.
  • Test positivity increasing: The five-day test positivity rate is 13.5%, up from 12.7%. It is 15.1% in Winnipeg, up from 14.3%.
  • Active cases steady: There are 4,550 active COVID-19 cases province-wide, down slightly from our last report of 4,568.
  • Hospitalizations increasing: There are 293 people in hospital due to COVID-19, up from 265. This includes 80 people in ICU, up from 73.
  • Five new deaths related to COVID-19 were identified, including four reported today. The total number of deaths is now 1,016.

ICUs Pushed Beyond Limits

Hospitals are facing a surge in COVID-19 admissions, and ICUs are well beyond their limits. Today, there are 80 people in ICU linked to COVID-19, which is well above the normal bed base of 72 beds. This does not include patients in ICU for other reasons. The peak during the second wave for COVID-related patients was 55.
Provincial officials now say ICUs are at significant risk.” From May 13 to 17, there were 34 COVID-related ICU admissions.

Today, we learned two stable COVID patients were transferred to Thunder Bay, the first time patients have been transferred out of province for care. Shared Health explained this occurred because of continued high admissions, no ICU patients that were sufficiently recovered for a move to a medicine ward, and an increase in the number of very sick patients in our medical wards at risk of needing to be transferred into ICU.” 

We’ve also heard reports of more critically ill patients being held in ERs for longer waiting for an ICU bed. We are seeking feedback directly from critical care and emergency physicians to help inform our continued advocacy. 

In the meantime, we reflected today on the recommendations we submitted to Shared Health last November, when hospitals were under siege from a surge of admissions during the second wave. Based on advice then from hundreds of physicians, we submitted 27 recommendations to rapidly improve hospital capacity. While there has been progress in some areas, including access to PPE and efforts to minimize the disruptions to surgery, sadly many of the issues we escalated then are issues again today during this third wave:

  • Physicians continue to be distressed by a lack of information about contingency plans. 
  • Concerns remain about a triage protocol to guide decisions if critical care resources are overwhelmed. Earlier this week, Shared Health CNO Lanette Siragusa revealed that no such protocol has yet been developed, though she pledged if it is needed critical care physicians and ethicists would be involved in its drafting. 
  • The contingency plan for ERs, also facing pressures from the surge in cases, remains unclear.

Please continue to stay in touch about this situation and how it is impacting you, your practice and your patients. 

Second Dose Bookings Start Friday

Today, the province confirmed second dose appointments can be booked beginning this Friday (May 21), starting with those who have high risk medical conditions, such as those on dialysis, those with serious conditions like liver cirrhosis, serious heart failure, some cancers, Down syndrome and HIV. You can see the full list here.

Next week, appointment bookings will open up to those who got their first dose in March. Every few days, eligibility for second doses will expand based on when first doses were received. 

Individuals will need to know the type of vaccine they received, and the date they received it. This can be accessed online through Shared Health or by calling their local public health office.

This approach applies to those who received Pfizer or Moderna vaccines. 

What about AstraZeneca second doses?

Dr. Joss Reimer explained today that public health recommends individuals who received AstraZeneca for their first dose wait at least 12 weeks for their second dose to get optimal effectiveness, even if that second dose ends up being a different vaccine product. More details are expected by Friday on the approach for AstraZeneca second doses. The first individuals in Manitoba who received AstraZeneca will reach the 12-week mark the first week of June. 

Medical clinics who have AstraZeneca vials left will not be penalized if doses expire without being used. That said, Manitoba Health will allow physicians to complete a case-by-case clinical assessment to determine if a patient would benefit” from their second dose before the recommended 12 weeks, as long as it is at least 28 days after the first dose. This can be considered for patients that have health conditions that may decrease the effectiveness of dose one.”

If a physician proceeds with offering a second dose prior to the 12 – 16 week recommended timeframe, Manitoba Health recommends the following points be communicated with the patient as part of their informed consent:

  • Clinical trial data showed that the vaccine efficacy was greatest when the second dose was administered ≥12 weeks after the first; and
  • It is possible that the client may be offered a second dose with an mRNA vaccine if they choose to wait, depending on potential changes to guidance on interchangeability of products
  • The risks surrounding VITT when receiving an AZ/COVISHIELD COVID-19 vaccine. According to the most recent NACI statement, the rate of VITT in Canada as of April 28, 2021 is closer to 1 per 100,000 persons vaccinated with the AZ/COVISHIELD COVID-19 vaccine. The data and rates will be updated as more information becomes available. Cases of VITT have been reported after dose 2 though there is little information or data on the frequency of VITT for second doses of AZ COVID-19 vaccine. 

So far, just under 80,000 doses of AstraZeneca have been administered in Manitoba. Right now, there are approximately 6,500 doses of AstraZeneca left in various clinics and pharmacies, with a delivery of another 23,800 doses expected this week. It’s not yet clear when additional doses will arrive. 

A national poll released earlier this week found that among those who received AstraZeneca, very few regret it. Despite this, however, some patients may want to pursue a different vaccine for their second dose. Results are expected soon from studies underway to confirm the effectiveness of mixed dose immunization. A Spanish study this week showed promising results for those who received Pfizer for a second dose following their first dose of AstraZeneca. 

We will keep you posted as public health officials finalize their recommendations for second doses, and we will continue pressing for more mRNA vaccines to be allocated to doctors’ offices.

Reminder to Monitor for VITT (Blood Clots)

It appears Manitoba has one case of vaccine-induced immune thrombotic thrombocytopenia (VITT). Monitoring and assessing for VITT is critical to support timely treatment. Thrombosis Canada has a short decision tree for diagnosing and ruling out VITT, and Hematology has developed an overview that provides guidance on the presentation, diagnosis and management of VITT. We will continue to keep you updated as we learn more from the province about whether or not the suspected case is confirmed to be VITT and how that may impact AstraZeneca use in Manitoba going forward.

World Family Doctor Day

From birth to end-of-life care, Family physicians accompany and support patients on their health and wellness journey all the way through. Today, on Family Doctors day we want to recognize the dedication and vast knowledge and expertise it takes to be a family physician. You know your patients’ histories and the care and attention you provide are paramount in detecting disease and poor health. You are first line of defense in our health care system and you have truly risen to the challenge this past year. It has not gone unnoticed. Thank you family doctors, for the work you do keeping Manitobans healthy.

Wellness Hub for Medical Educators

The CMA has added a new suite of wellness resources aimed at helping medical educators to their Physician Wellness Hub. With topics like Creating a psychologically safe learning environment, Establishing a wellness mindset, Health & wellness during medical career transitions, and Mentorship in health care, Medical educators can use the tools to help medical students combat stigma, cope with the extreme demands of their studies, and practice self-care for lifelong success and positive patient outcomes.

Anyone taking part in the teaching process of medicine is encouraged to take advantage of these resources.

Urban Locum Pilot — Learn more! 

Join us tomorrow (Thursday) at 6:30PM to learn more about the new Urban Locum pilot project.
Research has shown that not taking time away from practice contributes significantly to physician stress and burnout. Now, there’s one more option to help physicians get time away while ensuring coverage for their patients. Learn more about the new Urban Locum initiative and how you can register to become a locum provider or access the services of a locum. Participants will also learn more about the Rural and Northern Locum Program too.