Vaccination Mandate

Additional Restrictions Coming

What Does This Mean for My Practice?

Physician Advocacy Leads to Government Action

New Fourth Wave Projection Model Released

Earlier today, Premier Brian Pallister and Dr. Brent Roussin announced new vaccination requirements, as well as other pandemic restrictions. These new actions are being taken in anticipation of the ​“fourth wave” now spreading rapidly in other jurisdictions. 

Some of the details will be finalized and announced in the days ahead, but we wanted to ensure all physicians have up-to-date information about what we know today. You’ll find below a summary of the new vaccine requirements, other restrictions being planned, and what this means for individual physicians’ practices. We also highlight how physicians’ advocacy has helped to lead to today’s changes. 

Vaccination Mandate

Employees in a variety of public sector workplaces, including health care, will be required to be fully vaccinated by October 31, 2021. This includes both vaccine doses plus the two weeks after the final dose to be considered fully vaccinated, or undergo frequent testing. 

This requirement applies to all health care providers and workers. It includes all physicians, regardless of whether or not you work in an RHA facility or in a private doctors’ office. According to the information released so far, the public health order will apply to:

• Physicians, nurses, allied health professionals, support services and others deemed appropriate for each site/​area/​program
• Public and private health-care settings, such as hospitals, licensed long-term care facilities, community and home care environments. 

Individuals must receive their first dose by September 7, 2021, and their second dose by October 17, 2021. 

Individuals who are not able to be vaccinated, or choose not to be vaccinated, will be required to undergo regular COVID-19 testing, likely three times per week, and provide proof of a recent negative test. It is not yet clear if testing costs will be covered by the province, employer or the unvaccinated individual. A test is considered valid for 48 hours from the time the swab is performed, provided the worker has not developed any symptoms since. 

Other public sector employees affected by the requirement include:

• Educational workers including teachers, school staff and bus drivers.
• Child care workers.
• Justice employees, including in correctional facilities.
• Public servants and funded-agency employees in high risk settings with direct public contact or work with vulnerable populations such as children. This includes group homes and other congregate living settings.

Acceptable proof of vaccination will include the digital or physical Manitoba Immunization Card, or a secure printed provincial immunization record from either public health or the Shared Health online portal that shows immunization dates. 

Private sector employers were also encouraged to adopt similar policies. 

Additional Restrictions Coming

In addition to the vaccination requirements, the province confirmed that other measures will be added to protect against a possible fourth wave of COVID-19. This includes:

• Masks, which will again be required in public indoor spaces.
• Expanding the use of the immunization card to more facilities, events and services to limit attendance to fully vaccinated individuals. 

Precise details, including the timing of these changes, will be available soon. This could happen later this week as public health orders are finalized. 

What Does this Mean for My Practice?

While we await these new orders, it appears certain this new requirement will include all physicians and other health care providers employed directly by the provincial government or by a health care authority.

It also appears these orders will include almost all other practicing physicians and medical learners, as well as those staff employed in private clinics or facilities who may have contact with patients. The government release and a memo issued today by Shared Health both say the orders will include those ​“employed by” or ​“working in” all ​“public or private health care settings”.

The issue of requiring staff in private clinics to be vaccinated was discussed in detail at last week’s webinar, which you can watch on-demand here. At best, the new public health orders will formally confirm that private clinics can require those employees who have contact with patients either to be vaccinated or submit to frequent testing. At the very least, this should minimize the risk of a complaint or claim against any physician or other health care employer requiring employees to be vaccinated or tested.

Doctors Manitoba recommends that all physician practices begin planning now for the eventual implementation of this policy in your office. We will keep you posted as further details are shared, to support your implementation. In
the meantime, here are steps you can start taking:

• Notify your employees that a vaccination requirement is being introduced across the entire health care sector and will include your practice. Strongly recommend all employees be vaccinated, including the need to receive a first dose by September 7 and a second dose by October 17. Invite employees to discuss concerns with you or the appropriate supervisor, and help connect them to a vaccination destination at Man​i​to​baVac​cine​.ca.
• Set up a system to begin documenting your employees vaccination status, including that proof of vaccination has been confirmed. If you foresee any employee declining vaccination, you may need to track and document that a recent negative test result was provided at the start of each shift. 
  
• Review the current information and guidance from Shared Health (see further reading links below). Monitor for updates from Doctors Manitoba.

Allowing employees to submit to regular testing is an accommodation which should take away the various ​“human rights” arguments alleged by those opposed to mandatory vaccination. 

Of note, provincial officials made it clear today that ​“vaccination is not a condition of employment” and remaining unvaccinated, on its own, would not result in termination. However, proof of a recent negative test result would then be required at the start of each shift. Guidance is not yet available, but is expected soon, for employees who refuse both vaccination and regular testing. In the meantime, we strongly recommend that physicians obtain legal advice before taking any disciplinary action against an employee who says they will refuse both vaccination and regular testing.

Further reading:

• Shared Health memo
• Shared Health FAQ
• Doctors Manitoba on-demand webinar (August 17)
• Government news release

Physician Advocacy Leads to Government Action

These new actions closely follow recommendations from Doctors Manitoba, which were made following consultation with members and guidance from our vaccine advisory committee. These actions included:

• Issuing a strong position statement for a vaccination mandate in health care as well as other public and private sector workplaces.
• Recommending for continued mask use in indoor public places.
• Calling for expanded use of the immunization card to create more low-risk opportunities for fully-vaccinated Manitobans to gather.

Thank you to physicians for sharing your views and concerns about the pandemic response. Please continue to send your feedback to covid19@​doctorsmanitoba.​ca.

New Fourth Wave Projection Model Released

On behalf of public health officials, Dr. Jazz Atwal released an updated projection model of the fourth wave, taking into account the more transmissible Delta variant.

The model shows a range of scenarios:

• A controlled scenario, in which vaccine uptake increases and the public complied with public health guidance, could be very minor. 
• A severe scenario, which could rival the third wave in both cases and ICU capacity by December.
  
• An extreme scenario, which would eclipse the second and third waves in both cases by early November and overwhelm ICU capacity by December. 
  

Of particular concern is how the severe and extreme scenarios overlaps with the typical onset of influenza season, which also strains hospital resources on an almost annual basis.

Right now, cases are following a controlled scenario. But yesterday, Dr. Roussin said he is seeing the beginning of what could be concerning trends, especially in the Southern health region.

The impact of a Delta-fueled fourth wave on hospital capacity will likely depend on many factors, including vaccination rates, individual compliance with public health recommendations, and swift introduction of pandemic restrictions. Comparing the fourth wave in the U.S. and the U.K., for example, shows two different experiences. In the U.S., cases are now at 72% of the peak from the third wave, and hospitalizations are at 55% of the earlier peak. In the U.K., on the other hand, cases peaked at a similar level, but hospitalizations have stayed below 25% of the earlier peak.