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Situation Update

Since our last update on Wednesday, 422 new cases of COVID-19 have been identified, including 222 cases today. This brings the total case count in Manitoba to 25,963.

The five-day test positivity rate is at 10.1%, down slightly from 10.4% on Wednesday. In Winnipeg, the test positivity rate is 10.3%, down from 11.5%.

There are currently 4,582 active COVID-19 cases, up from 4,460 on Wednesday.

Twenty-one more COVID-related deaths have been announced since Wednesday, including nine today. So far, 726 Manitobans have died from COVID-19.

You can learn more in today’s public health bulletin.

Dr. Brent Roussin stressed today that ​“we’re not back at normal” and urged Manitobans to follow the fundamentals to stop the spread. He noted that COVID can present in many individuals with very mild symptoms, reminding everyone to take mild symptoms seriously, self-isolate and get tested. 

Code Red Restrictions Extended

The province confirmed today that the existing Code Red restrictions, originally slated to expire later today, will be extended for two weeks to January 22. 

Dr. Brent Roussin noted that officials ​“have been worried about a spike following the holidays” and it’s clear this is what we are seeing now. The increase in new cases this week appears to be driven by holiday gatherings. A more in-depth analysis has so far identified 355 cases linked to holiday gatherings with nearly 1,900 contacts. Some gatherings had well over two dozen individuals in attendance.

With the increase in new cases, along with the high test positivity rate and hospital admissions, there is a need to continue these restrictions. Dr. Roussin emphasized the restrictions were working as Manitoba had improved from a ​“worse case scenario” trajectory, but the holidays has increased the risk and restrictions are needed to stop the spread and ​“to ease hardship in the health care system.”

Doctors Manitoba submitted the advice we received from physicians about the restrictions to provincial officials earlier this week, and shared a summary with media that appeared in the Winnipeg Free Press. Our full statement:

Physicians are highly supportive of Dr. Roussin and public health professionals in carefully considering the situation and what level of are restrictions should be recommended to the government.

We have heard from a lot of physicians and they are largely in favour of extending restrictions, as our COVID numbers are still too high, hospitals are still too vulnerable to a surge in cases, and too many surgeries are being postponed. 

Some physicians also raised concerns about the ongoing impact of restrictions on their patients, particularly their mental health, economic security, and the disruption in health services like surgeries, The hope is that some modest improvements could be made based on public health surveillance that don’t risk increased spread of the virus for lower risk activities or areas of the province.

Dr. Roussin noted that a number of scenarios had been developed, including gradually easing restrictions if our COVID numbers had continued to improve. Instead, the only minor change included in the extended public health orders will allow professional hockey games to resume, a move Dr. Roussin said is possible because of the strict protocols put in place by the NHL.

Next week, the province will launch consultations to get feedback from Manitobans about potential future changes to public health restrictions.

You can view today’s provincial announcement about the restriction extension here.

Hospital Capacity and Surgery Backlog

There are 315 COVID patients in hospital today, down from 329 on Wednesday, including 35 patients in ICU, down from 37. ICUs are still overcapacity.

Provincial officials noted today that elective surgeries are gradually resuming after an 11-week slowdown.

Over 5,900 surgeries were postponed or deferred during the second wave to help free up capacity to support the surge in COVID admissions. There are also apparently still 5,000 surgeries in the backlog from the first wave too.

Starting next week, about 60 extra surgeries will be added weekly across Misericordia, HSC, Pan Am and Concordia. Additional surgery and endoscopy procedures will likely be added in Swan River, Dauphin, Neepawa, Minnedosa and Brandon, with planning underway for Northern and Southern health regions as well. 

Vaccine Update

Appointments are still available for next week at the RBC Convention Centre super site in Winnipeg. Eligibility for the vaccine has not changed and you can find a summary on the provincial government’s eligibility webpage.

First Nations are starting to receive the Moderna vaccine with the first immunizations starting yesterday. Elders in the Pimicikamak Cree Nation were the first to receive the vaccine in a First Nations community. All 63 First Nations are receiving a portion of the initial allotment of 5,300 Moderna doses, with the first shipments going to the four communities with personal care homes.

Priority is being given to people over 60 in remote communities, and over 70 in non-remote areas, as well as people living in personal care homes and front-line health workers. Read more about the First Nations immunization effort.

There have been suggestions that some health care providers, including physicians, are refusing the COVID vaccines. Using feedback from physicians, we provided a response in today’s Winnipeg Free Press noting that physicians are overwhelmingly supportive of the vaccine, with the only hesitation we’ve heard is to allow those perceived to be more in need to get the shot first.

Take our vaccine survey to share your views about the vaccine, including whether you feel comfortable getting the vaccine and recommending it to your patients, as well as providing your views about what physicians need and the role you should play in the immunization rollout. 

Vaccine Webinar – Takeaways

On Wednesday, we held a special webinar on COVID vaccines and the immunization rollout. A big thank you to provincial leads and Medical Officers of Health Dr. Joss Reimer and Dr. Tim Hilderman for taking the time to share a candid update and take many of your questions to provide more insights into the vaccine plans.

Below, you’ll find the top 10 takeaways from the webinar, with links to key resources. As always, please contact us at covid19@​doctorsmanitoba.​ca with any questions or concerns related to the pandemic or the vaccine.

1. Pregnant and breastfeeding women and individuals with autoimmune conditions are being screened out for the vaccine right now as a safety precaution, which is consistent with most trials and new treatments. This is recognized as an issue and Manitoba has raised these concerns with NACI for review. Public Health anticipates this will change soon and they are planning to launch an enhanced consent process within 10 – 14 days. This could occur at the immunization sites or in a physician’s office. The tools to support enhanced consent will be made available soon. 
2. These are safe and effective vaccines. Manitoba’s public health medical leads are satisfied with the trial and approval process. The Pfizer and Moderna vaccines were approved under an interim order based on two pivotal clinical trials showing very high degrees of efficacy (94 – 95%). This is highly effective and stronger than typical influenza vaccines. Reactogenicity appears to be a little higher than standard flu shots, but lower than some other vaccines. This includes short lived reactions like pain at the site of infections, fatigue or head aches. There are reports of anaphylactic reactions which are being closely monitored, but it’s early and this could be a result of more rigorous monitoring. Learn more in the Manitoba Public Health Fact Sheet and the Health Canada COVID vaccine page.
3. Health care provider eligibility. Because the initial supply of the vaccine is so limited there is a need to prioritize within the prioritized at-risk populations. Health care providers eligibility has been based on a number of factors, including risk of exposure, vulnerability of providers’ patients, specialized workforce that is difficult to replace and demonstrated risk of outbreaks. You can see the current eligibility on the provincial website. Provincial officials also provided the following additional information: 
   • Physicians of any age working on designated COVID-19 wards are now eligible. The designated wards were identified by RHA and can be found here. If you work on a ward that you feel should be designated, escalate this to your CMO or medical director.
   • Physicians who had COVID-19 are asked to consider waiting three months before getting immunized while supplies are constrained. However, this should be based on a personal assessment of your risk of exposure to COVID and your personal health risks.
   • Officials have carefully used the term ​“work in” for areas like critical care and acute care. For example, a physician who routinely consults in an ICU might be considered to work in critical care, but someone who consults very rarely might not.
   • Physicians were encouraged to carefully review the eligibility guidelines and to consider their own personal risk factors including work setting and health status to make a decision about getting immunized now while supplies are still limited. The call centre staff are not medical experts. 
4. Community-based doctors are a priority group, but they will likely not be eligible for the vaccine for at least a few weeks. With such a limited supply of vaccine right now, officials have to weight the risk for infection and severe symptoms among different at-risk populations, such as community-based health care providers vs. older elderly Manitobans (90+ years).
5. Work is underway to improve the appointment-booking system, including adding more staff to the call centre and developing an online scheduling system.
6. Clinic-based immunizations are not part of the short term plan given the limited supply as well as the logistical and storage challenges. These are the first mRNA vaccines and they are very fragile – something as simple as shaking the vial in the wrong way can change the effectiveness of the vaccine. As more is learned through the vaccine super centres, officials anticipate shifting to a more traditional immunization approach in the future.Doctors Manitoba continues to advocate for physicians in the immunization rollout, including offering the vaccine in physicians’ offices when supplies allow. 
7. Working as an immunizer. We heard that there are enough immunizers in Winnipeg for the volumes they are expecting this month, but more will be needed in a month or two. Immunizers are still needed in Brandon. You can submit an offer to help through Doctors Manitoba.
8. Immunization volumes will ramp up. About 10,000 immunizations per week are planned for January and February based on the supply allocated to Manitoba. Officials are expecting this to ramp up rapidly as supply shipments increase.
9. The role of physicians was recognized as critical to the success of the immunization rollout. Provincial officials stated that doctors are the ​“trusted” and ​“powerful” voice with patients. Public health is preparing more resources for physicians, particularly to support enhanced consent for at-risk and priority populations.
10. Report adverse events following immunization: While many adverse events will show up before individuals leave the immunization clinic, physicians may identify potential adverse events in follow-up visits. You are asked to report potential adverse events following immunization, or AEFIs, to Manitoba Public Health using their AEFI reporting form. More information is available in the provincial user guide on AEFIs.

Physicians may be interested in the following key resources:

• Manitoba COVID-19 Vaccine site
• Manitoba COVID-19 vaccine forms and resources
• Recommendations on use of COVID-19 vaccine from the National Advisory Council on Immunizations
• Manitoba Public Health Fact Sheet
• Health Canada COVID vaccine page

Please let us know if there’s a topic you’d like to suggest for a webinar. Based on your feedback, we are already looking at webinars on dealing with vaccine hesitancy. 

PPE Recommendations Change

Provincial recommendations on personal protective equipment (PPE) were updated this week, expanding the recommendation for when N95 respirators can be accessed.

The main change removes the requirement for health care providers to perform a point-of-care assessment to determine the risks before accessing an N95 mask. N95 masks continue to be required for aerosol-generating medical procedures in most situations, but employers must now provide them without any assessment in the following care situations:

• Providing direct patient care to confirmed or suspect COVID-19 patients (red or orange zones)
• In labour and delivery, ERs and urgent care, except for areas designated as green zones or with patients with a negative test result
• Providing care to undifferentiated patients, where a possible or confirmed case could exist
• Providing nasopharyngeal swabs in COVID-19 testing sites. 

Providers can wear a procedure mask in these situations if they prefer.

You can learn more from the summary on our PPE resource page, or by reviewing Shared Health’s in-depth PPE resources.

Doctors Manitoba has a limited supply of N95 masks and other PPE to assist physicians who cannot obtain needed PPE from their usual supplier. Please use our PPE request form or contact us at PPEconcerns@​doctorsmanitoba.​ca for more information.

Reminder: Isolation Support Application

If you have tested positive or if you’ve had to isolate due to COVID-19 symptoms or a workplace exposure, be sure to apply for our Isolation Support benefit.

We know over 60 physicians have been diagnosed with COVID-19, and dozens more have had to isolate as a precaution. Eligible physicians can claim up to $1,000 per missed work day for up to 10 days per isolation. The support benefit will help to maintain your practice and overhead during your isolation. 

Learn more about the benefit and apply online. Applications received and finalized by Monday will be processed for payment later next week.

Top 10 Resources of 2020

Last year was unprecedented in many ways, including the number of new resources we created to support you.

We’ve compiled a top 10 list of the most viewed resources for 2020 to help you ensure you’re up to date.

1. COVID-19 Resource Centre: This hub for everything COVID rapidly became the most visited part of our site. You’ll find regular updates to physicians here along with key resources on a variety of pandemic-related topics. We are doing our best to stay on top of the rapidly-changing information about the pandemic to help you stay up to date. We’re in the process of making it better and we’d love your feedback on what you need!
2. Call your Doctor: Based on your feedback, Doctors Manitoba ran its first public awareness campaign in decades to help remind patients not to put their health on hold during the pandemic. Our public web site, Cal​lY​our​Doc​tor​.ca, along with our TV and social media advertising brought this message to Manitobans when they needed it most. As code red continues, this concern has reemerged and our resources for physicians are still available to help you with your patients. 
3. Special Pandemic Education Rebate: In November, Doctors Manitoba created a Special Pandemic Education Rebate to recognize the unparalleled level of learning physicians have had to undertake to stay up-to-date with the emerging and changing knowledge about COVID-19, as an extension of our annual CME rebate. If you haven’t already applied, contact Barry Hallman at bhallman@​doctorsmanitoba.​ca to get your access code.
4. Virtual Care: While Manitoba was quick to introduce a few limited tariffs, we fought to get virtual care expanded as the pandemic endured. Our virtual care resource centre has information on the tariffs as well as resources and tips to help you introduce phone and video visits in your practice.
5. Staying Protected – While the supply chain for personal protective equipment (PPE) seems to have caught up with pandemic demand, our PPE page provides updated summaries about PPE requirements. Back in the spring, when supplies were hard to find, Doctors Manitoba stepped in to help physicians who couldn’t find PPE, a service we still provide! You can always contact us for help at PPEconcerns@​doctorsmanitoba.​ca.
6. Staying Well During Pandemic: COVID-19 has created levels of pressure and stress unlike anything the profession has seen. We’ve sent out frequent reminders encouraging physicians to focus on their own well-being. See our Guide to Stay Well During the Pandemic, information about counselling and other services to support you, and our Guide about Protecting Your Family During the Pandemic.
7. Red Alert / Stop the Spread: Responding to concerns from physicians about hospital capacity amid a surge in COVID cases, we ran a public campaign urging Manitobans to stay home, stop the spread and save our hospital resources. Our Red Alert news release was the most viewed tweet of the year!
8. Hospital Capacity Recommendations: As admissions surged, physicians’ questions about hospital contingency plans went unanswered. Our survey found 85% of physicians were not confident the health system was ready for the second wave of the pandemic. We compiled your advice and concerns into a series of recommendations for provincial officials to rapidly improve the preparedness of Manitoba’s hospitals, which were being pushed beyond their limits. These recommendations are still important as hospitals remain overcapacity and vulnerable to a surge in admissions.
9. Anti-Masker Response: We provided a summary of medical advice about responding to concerns about mask-wearing and other COVID-skeptic issues. Check out the advice. We also had to issue a public statement this year about an anti-mask rally in Steinbach as organizers had advertised a ​“doctor” as a speaker. We clarified this was not a medical doctor, and that physicians supported the need for precautions to stop the spread of COVID-19.
10. Thank Your Physicians: Our most viewed video of the year was a thank you message from Manitobans to all doctors on National Physician Day. Watch it again!