In today’s message you fill find:

• COVID Surveillance Update
  
• Vaccine Update
• Precautions in Physician Practices
• School Reopening Plan
• Restrictions summary
• Fantastic Physicians
• Webinar Reminder

Situation Update

Since our update on Friday, July 29:

• Daily cases decrease again: 216 new cases of COVID-19 have been identified since last Friday, a daily average of 31 (down from 32 the previous week). This includes 29 new cases today. The total case count in Manitoba now stands at 57,764.
• Test positivity down: The five-day test positivity rate is 1.9%, down from 2.1%.
• Active cases stable: There are 538 active COVID-19 cases province-wide, up slightly from 526 last Friday.
• Hospitalizations: There are 92 people in Manitoba hospitals due to COVID-19, down from 102. This includes 15 COVID-related patients in Manitoba ICUs, down from 29.
• Seven more people have died from COVID-19, bringing the total COVID-19 related deaths to 1,177.

With low case counts, the province is moving away from reporting publicly seven days per week. News releases will still occur on Mondays and Thursdays, but case counts will be updated five days a week (weekdays) and can be found on the province’s COVID-19 dashboard.

According to Health Canada’s tracking, Manitoba has had 17 cases per 100,000 over the last seven days. Alberta leads the provinces at 37 cases per 100,000. Alberta leads the provinces at 37 cases per 100,000.

South of the border, the Delta variant is fueling a fourth wave. According to the CDC, all but one state are now listed as having substantial or high community transmission. Vermont, the only state listed at moderate, had 43 cases per 100,000 people over the last seven days, much higher than Alberta, the highest province in Canada.

COVID Treatment Study

An international study about treating COVID patients, led by Manitoba physician Dr. Ryan Zarychanski, has been published in the New England Journal of Medicine. Early in the pandemic, physicians found that COVID-19 patients had increased rates of blood clots and inflammmation, affecting multiple organs and leading to complications like lung failure, heart attacks and strokes. The clinical trials tested full-dose anticoagulation with heparin in hospitalized patients with COVID-19 and found the treatment improves survival and reduces the need for vital organ support such as mechanical ventilation in moderately ill patients. However, it does not yield the same positive outcomes among critically ill patients already requiring life support. 

This is another example of an existing medication that is proving to have a therapeutic benefit in the fight against COVID-19. Physicians can cite this example with patients hesitant about vaccines who ask why medications like ivermectin aren’t being used to prevent or treat COVID-19. Regardless of the potential drug, vaccine or treatment, strong evidence is needed about safety and efficacy.

Vaccine Update

Since our last update on July 29:

• 80.3% of Manitobans age 12 and up have received at least one dose, up from 79.3% a week ago. The Labour Day target was 80%.
• 72.4% have received two doses, up from 68.6% a week ago. The Labour Day target is 75%.

Physicians are now encouraged to focus on both first and second doses. Appointments for second doses have slowed down, and there is some concern that the improved COVID-19 situation and changes in restrictions may be perceived by some patients as decreasing the need for a second dose. 

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. 

Doctors Manitoba has launched a vaccine campaign to promote vaccine uptake, leveraging the trust the public has in doctors. The ads will appear on digital outdoor billboards across the province for the month of August. 

One ad stats that over 99% of physicians are already vaccinated against COVID-19 and invites viewers to find out why. At Man​i​to​baVac​cine​.ca, visitors will find several physicians explaining why they got vaccinated, each speaking with a different aspect of vaccine hesitancy. We would welcome more stories for this site. Email us at covid19@​doctorsmanitoba.​ca if you’d like to participate. 

As super sites decrease hours, physicians not offering the vaccine are again reminded to refer patients to doctors’ offices for the shot. Our vaccine finder at Man​i​to​baVac​cine​.ca continues to be updated daily with clinics accepting appointments.

Precautions in Physician Practices

Yesterday Doctors Manitoba asked the public to continue wearing masks in doctors’ clinics.

Specific precautions may vary based on the specific clinic environment, but generally these measures include:

• Requiring patients and visitors to screen and report COVID-19 symptoms before entering
• Requiring patients and visitors to wear masks
• Providing safe physical distance between patients in common areas like waiting rooms (this recommendation has been dropped by Shared Health in the guidance — see below)
• Continuing the use of personal protective equipment by physicians and staff
• Offering virtual visits as an option for some medical issues

We have posters available about masks in clinics, which you can print and use in your practice. Available HERE and HERE.

Shared Health has released an update to its COVID-19 Guidance for Primary Care Clinics and Outpatient Practices for the newest phase of the re-opening. With the new variants and the potential for increased cases in patient populations, they are asking practices to continue measures to ensure the safety and health of all staff and patients, like other health facilities.

Screening practices for patients through telephone, with signage, and upon check-in and self-screening prior to shifts for staff should continue. Infection prevention remains important and sanitizing and required masks are prevention strategies that should be followed in clinics. Patients should be masked as well.
The same PPE requirements remain in place for staff, as does the requirement for 6‑foot physical distance between individuals in waiting rooms.

You can read more about approaches for management of Orange-Zone or COVID-risk patients, appropriate use of PPE for providers and staff, cleaning protocols and the continued use of virtual modalities HERE.

We are also hosting a webinar on August 17 to discuss precautions in doctors’ offices and physician practices, along with other issues.

School Reopening Plan

Yesterday, the Manitoba government announced its plan and guidance for reopening schools this September. The plan has evoked a range of views, with physicians already hearing questions and concerns from parents. We have a summary of what is in the plan below, how it compares to other provinces and what advice physicians can offer parents and children in the days and weeks ahead. 

Manitoba’s School Plan The plan unveiled yesterday will see schools reopen at the yellow (cautious) level of the pandemic response system. The plan includes a mix of requirements and recommendations, similar to approach used earlier in the week when pandemic restrictions were eased for other sectors. 

Students will return to in-class learning this September, with activities resuming and libraries reopening.

• Kindergarten to Grade 6 students will continue to be grouped in cohorts to reduce potential exposure for children not yet eligible for vaccination. 
• Students and staff will continue to screen for symptoms, stay home if ill, and seek testing in accordance with public health recommendations. 
• Physical distancing should be used to the greatest extent possible, and the flow of people in common areas (e.g. halls) must be managed to avoid crowding. Entry and exit times will be staggered.
• Water bottles and non-touch water drinking practices continue to be required
• Good hand hygiene must be promoted and monitored
• Assigned seating will continue on school transportation
• Schools will focus on maintaining ventilation and follow provincial ventilation guidance. 

Case and contact management will continue, but may change over time. Provincial exams will not proceed for the 2021/22 school year. 

Masks are ​“strongly recommended” for students, staff and visitors, but the province has not mandated their use at this point. As occurred earlier in the pandemic when the risk of spread was lower, the province issued guidance to school divisions which then created their own plans. Some divisions have already indicated they will be asking everyone to wear masks in schools.

Similarly, vaccination among eligible children and staff is not required, but it is strongly encouraged. We have also heard that school-based vaccination will be planned to help improve access and increase uptake among eligible students. 

You can read the full Manitoba plan for schools here, a short version for parents and students here, and the government’s news release here.

What are other provinces doing?Most provinces have issued guidance for the return to school this fall. While Atlantic provinces have not yet announced their plans, all other provinces have plans in place that include a return to in-class learning. Here is a summary, by province, of what has been announced. 

• BC: Schools will continue to require screening for symptoms. The BC plan does not appear to require masks or physical distancing, and cohorts are no longer required. Hand hygiene will continue to be emphasized, and student activities will resume. 
• Alberta: Consistent with Alberta’s other moves, schools will reopen without any restrictions in place. Provincial exams will be mandated this year. The plan notes restrictions could be reintroduced if outbreaks occur. 
• Saskatchewan: Like Alberta, Saskatchewan has lifted all restrictions and this also applies to schools. Screening is only encouraged and there are no requirements for masks, cohorting or other precautions. Provincial exams will be optional. 
• Ontario: The approach in Ontario is more cautious. Screening and masks are required, through ​“reasonable exceptions” can be made at a school-level. Cohorts will be used in elementary grades. Activities will resume and hand hygiene will be reinforced. 
• Quebec: Enhanced cleaning is still required, but otherwise there are no requirements for masks or cohorting. 

Our review found that no province has made vaccination mandatory for students. 

Physician Guidance

Dr. Marni Hanna, President of the Manitoba Pediatrics Society, and Dr. Ruth Grimes, President of the Canadian Paediatric Society, both welcomed the news that in-class learning and school activities will resume.

“Pediatricians have been very concerned about the impact of the pandemic restrictions, and remote learning in particular, on the well-being of children and youth,” explained Dr. Hanna. ​“A return to in-school classes is the right step, but schools need to be safe for students, teachers and staff.” 

“The approach in Manitoba is certainly not as loose as in Alberta and Saskatchewan, where the lack of restrictions has raised serious concerns among pediatricians across the country,” said Dr. Grimes. ​“We are encouraged that Manitoba is taking a more cautious approach in our schools, but physicians will play a vital role in reinforcing what students and parents should do this September.”

While both Dr. Grimes and Dr. Hanna had anticipated a mask mandate to be part of Manitoba’s plan, they are still encouraged by the clear mask recommendation, something that was lacking in Alberta and Saskatchewan.
​“Physicians should recommend students wear masks in school, especially those who are not immunized,” urged Dr. Grimes. ​“Take the time to explain to patients and parents that for now, it’s important to be cautious and these extra steps will help to avoid further disruptions to in-class learning.”

It’s also important to reinforce the need to screen for symptoms daily and keep students home if they are ill, both physicians noted. ​“Parents can be reassured that schools have been safe environments for children and youth,” added Dr. Grimes. ​“They have not been a driver of the pandemic, but merely reflecting within schools what is going on with the pandemic more broadly in our communities.”

“While children are not at as much of a risk as adults for severe outcomes from COVID-19, vaccination is very important to promote and a school-based vaccination program will help,” added Dr. Hanna.

Restrictions Summary

When changes to pandemic restrictions were announced on Tuesday, we sent all physicians a summary. The changes take effect tomorrow, August 7, and lift or loosen restrictions in many sectors, while maintaining them in areas with higher risk of transmission. 

We invited you to share your feedback about the changes. We have heard from many of you already, but we would like to hear from more.

Here is what we have heard so far:

Many of you were concerned about the loosening of restrictions, worried that Manitobans will let their guard down and a Delta-fueled fourth wave will arrive in Manitoba as it has in the U.S. The change in the requirement to wear masks in public places was cited most frequently as the biggest concern. Even though strong recommendations remain from public health officials, and only three provinces have retained a mask mandate, many of you are worried Manitobans won’t act on these recommendations and a surge in COVID-19 cases will follow. 

Some of you were cautiously optimistic, and recognized that Manitobans — especially those who heeded the advice to get vaccinated — deserve a break while the risk of community transmission is low. Public health officials have said restrictions, including the mask mandate, could be reintroduced if cases rise. Some of you again raised concerns about the impact of restrictions on your patients’ mental, physical and economic well-being, while others pointed out that there is a real risk the public will stop taking public health officials and physicians seriously if restrictions remain when the risk is low. 

We are compiling your feedback and concerns to share with provincial officials on behalf of physicians. While we do so, we urge all physicians to be respectful of their colleagues. Physicians should always feel safe to share their views and express their concerns. Please be respectful of your colleagues in sharing your views, and be mindful of how your concerns can be distorted and used in a way that is contrary to your goal. Public comments have benefits and risks, and one risk we have observed is how anti-mask and anti-vax groups use this ​“disagreement among experts” as ​“evidence” to fuel conspiracy theories and sow distrust in public health restrictions and the need for vaccination.

Whatever your view, your passion about this topic reflects the concern you have for the health and well-being of Manitobans, and that is something that connects all physicians. 

Please continue to share your views in our short 2‑minute survey.

Fantastic Physicians

Dr. Ming-Ka Chan is the 2021 recipient of the Donald Richards Wilson Award. This award is given annually to a medical educator or a leader of a team, program or department who has demonstrated excellence in integrating the CanMEDS Roles into a Royal College or other health-related training program. Dr. Chan’s work spans all the CanMEDS Roles but her work as a Pediatrics clinician educator at the University of Manitoba has mainly been in the Leader and Scholar roles. In her work she has championed social justice and leadership education. Dr. Chan led the development of a leadership education library toolkit and helped develop an equity, diversity and inclusion (EDI) toolkit, in collaboration with the Office of Equity, Diversity and Inclusion, for the Rady Faculty of Health Sciences, University of Manitoba. 

2022 Royal College Teasdale-Corti Humanitarian Award - Do you know a Manitoba physician who is making impactful change in people’s health at home or abroad? Nominate him/​her/​them for the 2022 Royal College Teasdale-Corti Humanitarian Award.

The award is named in honour of Dr. Lucille Teasdale and Dr. Piero Corti, a physician couple who devoted their careers to healing, teaching, and improving the condition of people in the poverty stricken Gulu region of Uganda. They worked tirelessly for 35 years, even throughout nearly 25 years civil war and unrest. Eligible physicians can be nominated by fellow colleagues and must meet the following criteria:

• Canadian physicians whose current practice reflects altruism and integrity, courage and perseverance in the alleviation of human suffering; or upon those who have made such a contribution in the past.
• Open to Canadian physicians worldwide.
• Nominators will be asked to describe the nominee’s exceptional contribution, which may have been made in Canada or abroad, as well as to provide curriculum vitae for the nominee and two letters of support from Fellows of the Royal College. (Self nominations will not be accepted). 

To nominate a deserving physician click HERE. Deadline for nominations is September 30, 2021. 

Webinar Reminder

Nearly 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.

Registration Details

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