In today’s message you will find:

• COVID-19 Situation Update (surveillance and vaccine updates)
• AstraZeneca Second Dose Plans
• MB Hospital Situation Update
• Information about a new tool to address vaccine hesitancy
• News on the new labels for VOCs
• Residential School News
  

Situation Update

COVID Surveillance Update

Since our last update on Friday:

• Daily cases remain high: 946 new cases of COVID-19 have been identified. This includes 303 cases today, though Dr. Brent Roussin noted this is likely an under-count due to a technical delay, which means tomorrow’s count could be an over-count to catch up. The total case count in Manitoba now stands at 51,090.
• Test positivity down slightly: the five-day test positivity rate is 12.1%, down from 12.5%. It is 13.7% in Winnipeg, down from 14.0%.
• Active cases down slightly: There are 4,504 active COVID-19 cases province-wide, down from 4,676. This number is likely overstated as contact tracers focus on new cases and not updating patients’ status from active to recovered.
• Hospitalizations remain high: There are 308 people in Manitoba hospitals due to COVID-19, down from 312. This includes 71 people in Manitoba ICUs, up from 69. There are also least 36 in ICUs in Ontario and Saskatchewan, for a total of 107 Manitoban COVID-19 patients in ICUs.
• Nine new deaths were identified yesterday related to COVID-19, including one death reported today. The total number of deaths is now 1,053.

Contact tracing update: 50 contact tracers from the federal government should arrive this week for orientation. As of last week, there was a total of 847 additional contact tracers from outside of public health, including 143 from the provincial recruitment/​redeployment, 466 from 24/7 Intouch call centre, 175 from Statistics Canada and 63 from Red Cross. As of last week, tracers were able to reach 74% of contacts of a COVID case within 24 hours. The goal is 80%.

Vaccine Update

Eligibility for second doses expanded today to include individuals who received their first dose on or before April 8. Tomorrow at 11:45AM, eligibility will expand again to include those who received their first dose on or before April 13. 

Manitoba has now administered over 852,094 doses. 61.4% of those aged 12 and over have received at least one dose.
We continue to update Man​i​to​baVac​cine​.ca with public information about eligibility, as well as new Q&As.

AstraZeneca Second Doses

Today, the Manitoba approach for second doses was unveiled for those who received AstraZeneca for their first dose.

The new guidelines were developed by provincial medical leads based on emerging research and recognizing the current limited supply of AstraZeneca. The new guidelines are:

• Individuals who received a first dose of AstraZeneca can now receive an mRNA vaccine for their second dose. 
• AstraZeneca can be offered as a second dose to anyone who would not otherwise receive a second dose, as long as they meet the age and health condition eligibility for AstraZeneca. 
• Second doses, regardless of vaccine time, are recommended 8 – 12 weeks after the first AstraZeneca dose for optimal protection, but second doses can be given earlier as long as it is at least 28 days (4 weeks) after the first dose if needed.

The guidelines will be updated as new evidence is available. 

Individuals who received first doses of AstraZeneca start to reach the 12-week mark later this week. Public health had held off releasing guidance for second doses in hopes that new evidence would be available from a study on mixed-dosing in the UK, but the results are now delayed until late June. Instead, Dr. Reimer and public health medical leads relied on animal models for heterologous dosing of COVID vaccines, on data from other multi-dose vaccines (non-COVID vaccines), and from the Spanish CombivacS study. The CombivacS study demonstrated a strong immune response when Pfizer was given 8 – 12 weeks after AstraZeneca. You can learn more about studies into heterologous dosing here.

What do clinics do with first dose patients?

After a successful pilot of using mRNA vaccines in clinics, we understand Manitoba Health will start to make mRNA vaccines available to more clinics in the days and weeks ahead, beginning the week of June 7^th. The number of doses will be finalized this week but ​“may not immediately be sufficient to cover the number of Manitobans who received AstraZeneca and are eligible for second doses.” The provincial update stated locations that received a shipment from the first 18,000 AstraZeneca doses will receive an allotment according to what they are able to administer. 

You can get ready by preparing a list of patients who received a first dose of AstraZeneca and sort it by date. For those approaching the 12-week mark after their first dose, you may consider reaching out and letting them know your clinic’s plans for second doses. This could involve contacting them for appointments, once you receive details of how many doses you will receive and when. 

Patients can also access their second dose at other locations, including provincially-run super sites or pop-up clinics. 

We will monitor this situation closely, and we will continue to press for more mRNA vaccine supplies for medical clinics to offer both first and second doses.

AstraZeneca Expiry Date Extended

There are about 3,700 unused doses of AstraZeneca still in clinics and pharmacies, and these were scheduled to expire on May 31. Health Canada has approved a one-month extension of the expiration date based on data from the manufacturer. This includes lots MT0055 and MT0056. These doses now expire on July 1, 2021. 

Hospital Situation

We continue to monitor the hospital capacity situation closely. As of this morning, there were 122 patients in Manitoba ICUs, and this included 71 patients linked to COVID-19. There are also 36 Manitoba COVID-19 patients in ICUs in Ontario and Saskatchewan, for a total of 106 COVID-related ICU patients today.

There were 30 COVID-related ICU admissions over the weekend, including a record 17 on Saturday. 

A total of 40 COVID patients have been transferred out of Manitoba for critical care so far during this third wave. One was transferred to Saskatchewan, and the remaining 39 were transferred to hospitals across Ontario. Four have since returned to Manitoba. One military crew and aircraft are assisting with patient transfers. 

Two military teams are also in Manitoba helping out at isolation centres. 

The call for out-of-province help, following a Doctors Manitoba report urging for that action, has also yielded 6 military medical lab technicians and six Red Cross nurses. Shared Health has also arranged for 13 respiratory therapy students to graduate early to assist with the response. 

Shared Health also issued guidance to critical care physicians on Friday about out-of-province transfers, clarifying that such transfers may happen without patient/​family consent at times. Shared Health CEO Adam Topp confirmed that the decision to transfer patients is the decision of Shared Health, not treating physicians. Clinical expertise of the treating physician assists ​“in determining which patients can be considered for transfer” but for the decision to transfer, ​“Shared Health will remain accountable.” You can read Shared Health’s update here.

A New Tool to Address Vaccine Hesitancy

Physicians connected to Primary Care Home Clinics will soon have access to a new tool to support their patients in getting vaccinated. Starting later this week, home clinics will have access to weekly reports listing patients who have not yet received or scheduled their first COVID-19 immunization. This new tool is the result a collaborative initiative among Doctors Manitoba, The University of Manitoba, Department of Family Medicine (Office of Research and Quality Improvement), Manitoba College of Family Physicians, Shared Health and Manitoba Health. 

Doctors and clinic staff can use this list to follow up with patients in several ways, such as: 

• Contacting patients as a group to let them know you recommend the vaccine and invite patients to contact you to discuss any concerns or hesitations they have about the vaccines; 
• Reaching out to patients individually by phone (virtual and in-person visits responding to vaccine hesitancy are billable)
• Cross-referencing the list with your upcoming appointments to ensure you raise vaccination with patients who have not yet been immunized. 

For clinics offering COVID-19 vaccines, this will also allow you to offer a vaccine to your unvaccinated patients. 

The report cross references enrollment data for patients in the Home Clinic Portal, with vaccination data from PHIMS and the central vaccine appointment system. Doctors Manitoba wants to recognize the innovative work of Dr. Alex Singer and Dr. Alan Katz, from the University of Manitoba, and the provincial officials producing the reports, for making this new tool a reality. 

You can read the full update to Primary Care Home Clinics here, and you can learn more about Home Clinics here.

New Labels for Variants of Concern

The World Health Organization released a new ​“easy-to-say” naming convention for variants of concern and variants on interest today. You’ll likely start to hear these new labels in the weeks ahead, so we wanted to provide you with an update and summary. 

WHO will adopt the Greek alphabet to label the variants, to reinforce moving away from attaching the name of countries where they were first identified. Concerns about stigmatizing those countries have been raised, and WHO wants to avoid the potential of a country not reporting a new variant.

For the four variants of concern identified so far, the labels are as follows:

A complete list of variants of concern and variants of interest can be found on the WHO website.

The ​“alpha” variant is the primary variant of concern circulating in Manitoba. 

Residential School Situation

Our hearts are heavy today, as we stand with Indigenous communities & mourn the loss of the 215 sons & daughters whose remains were found in Kamloops. We honour & recognize the countless other Indigenous children whose lives were taken & whose communities were irreversibly altered by Canada’s residential schools.

The board and staff at Doctors Manitoba are committed to our role in reconciliation and recognize how important the role of non-Indigenous Canadians is on the path to reconciliation. Non-Indigenous Canadians must work to better understand Indigenous Canadians’ lived experiences, their long history of oppression and the generational trauma that continues to affect their communities today.

The news this past weekend will be traumatizing or re-traumatizing for some of your patients who have been affected by residential schools, and we encourage you to assist them in finding the resources and tools they need to help them. We also encourage our members whose lives are directly affected to seek assistance when needed. A National Indian Residential School Crisis Line has been made available 24/7 to provide support to former residential school students and those affected. You can access emotional and crisis referral services by calling the 24-Hour National Crisis Line at 1−866−925−4419.