In today’s message you will find:

• COVID Surveillance Update
• Vaccine Updates
• Don’t miss our webinar next Tuesday!
• Masks, vaccine cards and restrictions
• Mandatory vaccination in health care?
• Who is lagging behind in vaccine uptake?
• Climate change and health
• Heart & Stroke Anti-Vaping Campaign
• Medical Cannabis for Chronic Pain
• Medication Safety Workshop

COVID Situation Update

Since our last update on Friday, August 6:

• Daily cases decrease again: 187 new cases of COVID-19 have been identified since last Friday, a daily average of 31 (unchanged from the previous week). This includes 34 new cases today. The total case count in Manitoba now stands at 57,951.
• Test positivity up: The five-day test positivity rate is 2.6%, up from 1.9%.
• Active cases stable: There are 586 active COVID-19 cases province-wide, up slightly from 538 last Friday.
• Hospitalizations: There are 75 people in Manitoba hospitals due to COVID-19, down from 92. This includes 11 COVID-related patients in Manitoba ICUs, down from 15.
• Seven more people have died from COVID-19, bringing the total COVID-19 related deaths to 1,184.

According to Health Canada’s tracking, Manitoba has had 16 cases per 100,000 over the last seven days, a decrease from 17 the week before. Manitoba and Ontario are tied with the lowest cases outside of the Atlantic provinces. Alberta continues to lead the provinces at 58 cases per 100,000, a significant increase from 37 last week. Alberta, along with BC (56 cases/100,000) and Saskatchewan (50 cases/100,000) have all seen cases increase in recent days, and they are now all in a range defined by the CDC as substantial transmission. When transmission reaches the substantial or high levels, the CDC recommends indoor mask use. All three of these provinces discontinued mandatory mask mandates along with other restrictions in July. 

COVID Testing Location Updates

The COVID testing location at Thunderbird House in Winnipeg will close tomorrow, August 13. This site was set up to offer a low barrier testing option for individuals in Winnipeg’s Downtown and Point Douglas areas. Doctors Manitoba 2021 Medal of Excellence recipient Dr. Kerrie Wyant played an instrumental role in establishing and overseeing this location. Testing will still be available in the community at the Aboriginal Health and Wellness Centre at 215 – 181 Higgins Avenue and at the Ma Mawi Wi Chi Itata Centre testing site at 445 King Street. 

A full listing of testing locations across Manitoba can be found here. There are still two medical clinics in Winnipeg offering regular after hours and weekend testing, at Dakota Medical Centre and a drive-through location at Red River College run by the Minor Illness and Injury Clinic.

Vaccine Update

Since our last update on August 6:

• 80.7% of Manitobans age 12 and up have received at least one dose, up from 80.3% a week ago. The Labour Day target was 80%.
• 73.5% have received two doses, up from 72.4% a week ago. The Labour Day target is 75%.

Breakthrough Infections

COVID-19 infections among fully vaccinated Manitobans continue to be extremely rare, as they are in other jurisdictions. When they do occur, symptoms are much more mild. This further validates that the vaccines are extraordinarily effective, especially at preventing severe illness, hospitalizations and death.

As of last weekend:

• 435 infections have been identified among 852,485 fully vaccinated individuals, a rate of 0.05%.
• Only 46 of these individuals were hospitalized. There were 12 deaths, all over the age of 60.
• The majority (72%) of infections among fully vaccinated were among individuals age 20 – 69.
• Just over half (52%) of infections were variants of concern.

Individuals are considered fully vaccinated 14 days after their second dose. While infections are higher among partially vaccinated individuals, they are still quite low. There were 2,055 infections among partially vaccinated individuals, or a rate of 0.2%.

Reminders to Physicians Administering Vaccines

Physicians are now encouraged to focus on both first and second doses. Physicians are also encouraged to vaccinate patients who are willing, even if that means not using a full vial of vaccine. The province will now tolerate vaccine wastage as the supply situation has improved dramatically. If a single patient is in the office and willing to be vaccinated, you should proceed.

Vaccine Card, Apps, and Out-of-Province Immunizations

Several physicians have asked recently about how to help patients who received one or both doses of COVID-19 vaccine out-of-province. Patients should complete a government online form to update their immunization information. This e‑form can also be used to request other updates or corrections to a COVID-19 immunization. 

The immunization card can be requested online, and a hard copy can also be ordered for free during the sign up process.

The government now has an immunization card app, which will allow access to the card even when a device does not have a cellular or Wi-Fi connection. The app is available in the App Store for Apple devices, and the Google Play store for Android devices.

The immunization verifier app is also available for download. Used primarily by businesses, this app allows the user to scan the Manitoba immunization card QR code to confirm COVID-19 vaccination status. This app is also available in the App Store for Apple devices, and the Google Play store for Android devices.

The youth immunization catch-up program is now taking appointments for immunizations such as HPV, hepatitis B, meningococcal disease and tetanus, diphtheria and pertussis. Young people who have missed these routine school-based immunizations due to the pandemic can make an appointment at many provincial vaccine sites online or by contacting the vaccine call centre at 1 – 844-MAN-VACC (1−844−626−8222)Information is being mailed out to parents and caregivers soon and is posted at https://​pro​tectmb​.ca/​s​c​h​o​o​l​-​i​m​m​u​n​i​z​a​t​ions/. Catch-up appointments will be available beginning the week of Aug. 23. 

Don’t Miss Our Webinar on Tuesday

We are excited to add another expert panelist to our webinar next week on Practice Issues in the ​“New Normal.” Dr. Denise Koh is Manitoba’s Chief Occupational Medical Officer and Medical Officer of Health for Emergency Preparedness and Disaster Management. She will add a new focus to our webinar, exploring control measures and advice to workplaces across all industries. 

Over 100 physicians have already signed up for our webinar on Practice Issues in the​“New Normal.” Join them on Tuesday, August 17, along with a panel of medical and legal experts. The panel will discuss precautions in medical facilities as other sectors ease restrictions, along with other issues you may encounter in the weeks and months ahead, such as vaccination status with employees in your practice.

Join our expert panel as we consider these issues and offer guidance for the pandemic recovery period. The panel includes:

• Dr. Jose Francois, Provincial Specialty Lead for Family Medicine and head, Department of Family Medicine with Max Rady College of Medicine
• Dr. Allen Kraut, Medical Director, WRHA Occupational Health and Associate Professor with Max Rady College of Medicine
• Ms. Kristin Kersey, a lawyer with expertise in labour, employment and human rights law from Thompson Dorfman and Sweatman (TDS) LLP.
• Dr. Denise Koh, Chief Occupational Medical Officer and Medical Officer of Health for Emergency Preparedness and Disaster Management 

Registration Details
When: Tuesday, August 17 at 6:30 pm
Register: Register in advance online

Masks, Vaccine Passports and Restrictions

Doctors Manitoba has issued public advisories over the last week urging Manitobans to continue wearing masks in public indoor spaces, especially when the vaccination status of others is unknown. We have also advised that medical clinics and other medical facilities will continue to require masks and take other precautions to maintain a safe environment for patients. 

It’s not common for our Association to issue public advisories like this, but we took these unusual steps based on concerns from physicians about changes to the pandemic restrictions, announced last week. Nearly 80% of doctors are worried about the changes to remove too many restrictions too quickly, most notably the requiring masks in public settings and the elimination of the use of the immunization card in some public settings. 

Earlier this week, the Manitoba Dental Association joined us in advising the public that masks will continue to be required in dentists’ offices too.
Manitoba had been the only province to introduce a ​“vaccine passport” and require its use in many public settings to limit access to fully vaccinated individuals. Last week, the changes to pandemic restrictions removed restaurants and several other public places from this requirement.

Meanwhile, Quebec announced this week that it will introduce its own passport on September 1 to combat an ​“inevitable” fourth wave. The documentation will be required in places with high capacity and a high rate of contact, such as festivals, bars, restaurants, gyms and training facilities, to avoid the widespread closures. 

Mandatory Vaccination in Health Care?

An issue gaining more and more attention is whether or not COVID-19 vaccination should be required for health care workers.

In a survey we conducted last week among physicians, over 86% agreed that Manitoba should adopt a requirement for health care workers to be vaccinated, to protect the patients they care for. About 5% of physicians were unsure about this policy, while 9% disagreed with mandating vaccination. 

So far, neither the provincial government nor Shared Health have announced plans to mandate vaccination among staff in health facilities. Our President, Dr. Kristjan Thompson, has written to provincial officials to offer support in developing and introducing such a requirement, while also raising questions about how to accommodate staff who can’t or won’t be immunized. An existing Shared Health policy already requires vaccination for Rubella, Measles, Hepatitis B and Varicella, with immunization recommended for diphtheria/​tetanus, mumps, polio and influenza. 

Today, the Long Term and Continuing Care Association of Manitoba called for requiring COVID-19 immunizations for health care workers. Revera has already announced that staff working in its personal care homes must prove they are vaccinated, or provide a documented medical reason why they can’t be. Staff who refuse must take mandatory education sessions, wear PPE and undergo daily testing.

In BC, it was announced today that all staff and volunteers working in long term care and assisted living will be required to be fully vaccinated against COVID-19 by October 12.

True North Sports and Entertainment has made vaccination a requirement for its staff at both the arena and Burton Cummings Theatre for concerts and Winnipeg Jets games. Fans attending these events must also be vaccinated.

Many American health providers have started requiring vaccination, but they operate under different laws than in Canada.

We will be exploring the potential of mandating vaccination or requiring proof of vaccination status in health care settings next week, during our webinar on Tuesday. Join us!

Who is Lagging Behind in Vaccine Uptake?

A new serosurveillance study has found a gap between the rates of COVID-19 infection and vaccination among racialized and non-racialized Canadians, as well as between lower- and higher-income neighbourhoods.

The study, conducted by Canadian Blood Services and funded through the COVID-19 Immunity Task Force, tested over 17,000 blood donations in April and May. It found blood donors with antibodies acquired through vaccination increased from 24% in April to 60% in May, but the increase was smaller in racialized and lower-income communities. It also found higher levels of antibodies due to infection among these same groups. 

Seroprevalence from infection was two times higher in racialized donors (7.4%) than in white donors (3.3%). It was also 1.5 times higher in donors from neighbourhoods with lower socioeconomic status (5.7%) compared to more affluent neighbourhoods (3.1%).

Vaccine-induced immunity was 1.3 times higher among white blood donors (61.8%) than BIPOC donors (48.9%). It was also higher among donors from higher income neighbourhoods (64.8%) than lower-income neighbourhoods (56.6%). The good news, however, is that the gap between these groups was narrower in May than it was in April.

You can access a full report on the study here.

The report builds on similar findings in Manitoba, released last month by Dr. Marcia Anderson, the public health lead for the Manitoba First Nation Pandemic Response Coordination Team. Within Manitoba, this team found BIPOC groups experienced higher rates of infection, hospitalization and ICU admission.

Climate Change and Health

Earlier this week, the United Nations Intergovernmental Panel on Climate Change released an updated report from scientists about climate change, calling it a ​“code red” for humanity. They warn that greenhouse gas levels are already high enough to guarantee climate disruption for at least decades, but they say there is still time to take action to limit how bad the impact will be. 

World leaders set two targets in the 2015 Paris climate treaty: limit global warming to well below 2, preferably to 1.5 degrees Celsius, compared to pre-industrial levels. The world has already warmed nearly 1.1 degrees since then. 

Under all five scenarios studied, warming will exceed 1.5 degrees. In three scenarios, warming will exceed 2 degrees, leading to far worse heat waves, droughts and floods, unless there are deep cuts to emissions.

The Canadian Medical Association has noted the impact of climate change on human health is accelerating ​“at an alarming pace” and has called for urgent action. They call for a plan that includes:

• A climate preparation and adaptation strategy to respond to current and future challenges posed to health and health systems by climate change
• Further commitments to decrease greenhouse gas emissions to prevent additional impacts
• A detailed pathway to a net-zero economy and health care system
• Measures to prioritize and protect the health of structurally marginalized and vulnerable populations, including those living in rural and remote communities

CMA President, Dr. Ann Collins, noted that ​“tackling the climate crisis is a significant and necessary opportunity to improve the health outcomes of Canadians today and in the future. We must put health considerations at the heart of our climate change responses.”

World leaders are scheduled to meet in three months in Scotland for a climate conference to review progress and consider additional action to address climate change. 

Heart & Stroke Anti-Vaping Campaign

One in five grade 7 – 12 students are vapers and at least 1/3 of teens have tried it. Vaping is harmful to kids’ health and exposes them to high levels of addictive nicotine, increasing their odds of becoming smokers later in life. Unique and enticing flavours are a top reason youth choose to begin vaping and continue with the habit. Heart & Stroke Canada and other partners in tobacco control have developed an e‑advocacy campaign, urging the government to implement strong flavouring restrictions. Find our more about the campaign and send a message to Health Canada voicing your support for these restrictions at Pro​tect​Cana​di​anKids​.ca.

Medical Cannabis for Chronic Pain

Do you treat patients with chronic pain? The Centre d’excellence sur le vieillissement de Québec (CEVQ) is currently conducting a study on chronic pain and the use, or not, of medical cannabis. Help contribute to the advancement of knowledge by participating in their research. Click HERE to fill out a 15 minute online survey.

Participation criteria:

• Be a physician
• Follow patients with chronic pain.

If you have questions please contact the research project’s coordinator: Lise Poisblaud lise.​poisblaud@​crchudequebec.​ulaval.​ca

Medication Safety Workshop

Institute for Safe Medication Practices (ISMP) Canada, a national non-for-profit organization dedicated to improving medication safety, is offering a Multi-Incident Analysis and Medication Safety Culture Assessment Virtual Workshop on Sept 16 – 17 and Nov 20 – 21, 2021! 

This interactive 1.5‑day, facilitated workshop teaches health care professionals how to analyze a group of medication incidents that share a common topic (multi-incident analysis) and how to assess and monitor safety culture within your organization by evaluating incident reports (medication safety culture indicator matrix).