Member Message — July 23 2021
In today’s message you will find:
- COVID-19 Situation Update
- Vaccine Update
- The Danger of Misinformation
- Building Vaccine Confidence Panel Discussion
- Feedback on Clinic Practice Precautions
- Travel Rules Slowly Changing
- Fantastic Physicians
- Mentors Needed!
- Medical Cannabis Survey
- Bug Day — 25th Anniversary
Since our last update on on July 15:
- Daily cases continue to decrease: 331 new cases of COVID-19 have been identified since last Wednesday, a daily average of 41 (down from 52 the previous week). This includes 41 new cases today. The total case count in Manitoba now stands at 57,359.
- Test positivity down: the five-day test positivity rate is 3.0%, down from 3.4%. It is 2.1% in Winnipeg, down from 3.1%.
- Active cases continue on a downward trend: There are 537 active COVID-19 cases province-wide, down from 973 last Thursday. This is the lowest number of active cases since October 5.
- Hospitalizations are coming down: There are 106 people in Manitoba hospitals due to COVID-19, down from 126. This includes 24 COVID-related patients in Manitoba ICUs, down from 29.
- Six more people have died from COVID-19, including three today. The total of COVID-19 related deaths to 1,170. This includes the death of a 30-year old male from Southern health region identified earlier this week.
Earlier this week, news emerged that ICU nursing vacancies were at a critical level during the third wave of the pandemic, a factor that likely contributed to needing to transport patients to other provinces to receive critical care. A total of 57 patients were sent to ICUs in other provinces. The ICU nursing vacancy rate was 25% in May.
This validates the concerns Doctors Manitoba raised with Shared Health about nursing capacity in ICUs and ERs, reflecting the feedback we heard from specialists working in these areas. We’ve also identified the nursing shortage as the top barrier to addressing the growing surgery backlog too.
Since our last update on July 15:
- 78.2% of Manitobans age 12 and up have received at least one dose, up from 76.9% a week ago
- 64.3% have received two doses, up from 59.3% a week ago
- 2nd doses continue to account for about 80% of doses administered
Super Sites to Start Winding Down
The provincial vaccine task force has signaled that the super site mass immunization clinics, located in communities in all five health regions, will begin winding down their operations in August. The task force has described the super sites as the most efficient way to quickly immunize people, conceding it is likely being used by those keen to get vaccinated and less appropriate for those who are hesitant about the vaccines or face access barriers. Hours will start to be shortened and some sites may start to close.
As this happens, more and more supply is being made available to doctors’ offices, pharmacies and community groups. You can find an updated list of medical clinics offering the shot at ManitobaVaccine.ca.
Youth Vaccination Reminder
For youth to be considered fully vaccinated by the start of school, they should receive their first dose of the vaccine by Tuesday, July 27. This will allow 28 days between doses as well as two weeks following the second dose to optimize their protection.
Pfizer is still the only option for youth, currently approved for ages 12 and up. Several clinics are now offering Pfizer, and you can find a list at You can find a list at ManitobaVaccine.ca.
Mixing Doses No Longer Needed Dr. Joss Reimer advised Manitobans this week that mixing doses is no longer needed as Manitoba now has an ample supply of both Moderna and Pfizer to support the same product for both doses. Mixing vaccines was recommended when supply was constrained to avoid delays in getting a second shot. This approach is no longer needed.
Are Booster Shots Coming?
At this point, it is not known if booster shots for COIVD-19 vaccination will be needed in the future. While not currently recommended, earlier this week, Dr. Reimer outlined three scenarios in which booster shots could play a role:
- To address waning immunity over time
- To add immunity against possible future variants for which the current vaccines are less effective, similar to annual flu shots
- To boost immunity for those who are immunocompromised
She emphasized that it still too early to know if any of these scenarios will become reality. The potential of needing to boost immunity for the immunocompromised is emerging as the most pressing scenario to consider, especially as the Delta variant is leading to another wave of infections and hospitalizations in other countries. The issue is being considered in several countries, with the CDC considering boosters for Americans with weakened immune systems just yesterday. The CDC’s preliminary data on the issue finds that:
- Vaccine effectiveness appears to be lower among immunocompromised (71% vs 90% overall for infections, and 59% vs 91% for hospitalizations)
- Immunocompromised individuals account for 44% of hospitalizations among those fully vaccinated, while accounting for just 2.7% of the U.S. population.
This is similar to findings in Israel, where some immunocompromised individuals are now eligible for a third dose. Pfizer is beginning to seek regulatory approval for third doses in multiple jurisdictions. France is offering a third dose to “severely immunocompromised” groups, and the UK is considering a proposal for third doses that could start in September.
The Danger of Misinformation
As uptake for first doses continues to slow down, efforts are increasing to reach those hesitant or complacent about COVID-19 vaccination. With 78.2% of Manitobans having received their first dose and 5 – 8% extremely unlikely to get the vaccine at all, how do we reach that final 10 – 15% of people who are not yet convinced?
Vaccine hesitancy is largely fueled by misinformation about the vaccines or COVID-19 itself. Some people believe the vaccines affect fertility, that if you’ve had COVID you don’t need to be vaccinated, that the vaccines are not safe, or that the mRNA vaccines change our DNA. These instances of misinformation, largely circulated over social media, have proven to be the greatest hurdle in battling vaccine hesitancy across the globe.
For instance, ivermectin as a preventative or post-diagnosis treatment is one of the most popular misguided theories circulating right now. Most studies looking at the efficacy of ivermectin in the fight against COVID-19 show that there’s not enough evidence to prove that it is useful in the treatment or prevention of COVID-19. The most robust summary of evidence for the drug proves it does not work and a recent major clinical trial was withdrawn. Still though, information touting it as a miracle cure for COVID-19 continues to circulate online.
One piece of misinformation can snowball into a more widespread belief among large groups of the population. National Public Radio in the U.S. outlined The Life Cycle Of A COVID-19 Vaccine Lie, explaining how false information is amplified when someone who finds a small kernel of truth gets the ball rolling, finding traction with anti-vaxx influencers. This week in the U.S., the government took aim at Facebook for its role in the dissemination of misinformation, while the Centre for Countering Digital Hate reported that just 12 people, dubbed the “disinformation dozen”, are responsible for 65% of the misinformation about vaccines circulating online.
While the misinformation is rampant and difficult to curtail, we have tools that can reach the final 10 – 15%. Our research report released in April, showed that doctors are the key to helping vaccine hesitant Manitobans with information and guidance that is needed to gain vaccine confidence. Give your unvaccinated patients an opportunity to have their questions answered.
What can doctors do?
We encourage physicians to use the Home Clinic Portal that lists all enrolled patients who have not yet received or scheduled their first COVID-19 immunization and reach out to those patients. With the new Vaccine Hesitancy Tariff announced last week, you can discuss vaccines with unvaccinated patients while they are in for another reason. Grants are available to physicians to support initiatives outside of regular clinic operations. Contact email@example.com for more information and support on applying for grants.
When caring for vaccine hesitant patients, refer to our Guide to Responding to Vaccine Hesitancy or use any of the great resources on the Immunize Canada website. You can also hear from a panel of experts discussing vaccine confidence next week (read more below).
Some of the tips we are hearing from physicians include:
- Focusing on the risk of “long COVID” with patients who may not perceive the disease as a threat personally, or with patients hesitant about long term risks from the vaccine
- Helping patients understand the benefits and risks in relatable ways. The CDC published a good summary yesterday that helps to understand the benefits (avoiding hospitalization and death) and risks (developing myocarditis, often in a mild and treatable form) after mRNA vaccination. For example, among a million men age 30 – 49, vaccination avoids 700 hospitalizations and 25 deaths, with the incredibly rare risk of 5 – 6 people developing myocarditis (see CDC’s age/sex benefits and risks chart here).
- Approaching patients in a non-judgmental way, and inviting their questions and concerns regardless of how misinformed they may be.
- Providing a clear recommendation, as a trusted medical professional.
If you have tips for overcoming vaccine hesitancy, let us know by emailing firstname.lastname@example.org.
Building Vaccine Confidence Panel Discussion
The University of Manitoba and The Conversation Canada is hosting a live video panel discussion to explore vaccine hesitancy and what can be done to promote vaccine confidence. The event, with panelists Dr. Marcia Anderson, Dr. Esyllt Jones, Dr. Jason Kindrachuk and Dr. Lori Wilkinson, will take place on Wednesday, July 28 from 7 – 8:30 p.m. No pre-registration is required and you can view the event here.
Feedback on Clinic Practice Precautions
A reminder to send us your questions and feedback by Monday about how pandemic guidance for primary care and outpatient practices should be updated. As restrictions are eased for businesses and services, many physicians are asking what this means for their practice.
Shared Health is currently reviewing their guidance on precautions for the primary care and outpatient setting for the re-opening period and beyond. Dr. Jose Francois, provincial lead for primary care, has asked for physician feedback during their review. What should waiting room capacity look like? Should distancing be required? What are the PPE recommendations for providers? Should patients wear masks in clinics, even if they aren’t required in the future in retail settings? When should virtual care be recommended?
We would be happy to share your advice or questions about this with Shared Health as they update their guidance. Send your feedback to email@example.com by Monday, July 26.
You can access the current provincial guidance for primary care and outpatient settings here.
Travel Rules Slowly Changing
Beginning August 9, Canada will allow American citizens and permanent residents who have been fully vaccinated 14 days prior to enter the country. This will be subject to limited exceptions and all travellers must use the ArriveCan app to submit their travel information. If they meet eligibility, they will not be required to quarantine. Also effective August 9, international flights will be permitted to land at five additional Canadian airports in Winnipeg, Halifax, Quebec City, Ottawa, and Edmonton. Airports in Calgary, Toronto, Montréal and Vancouver will continue to accept international flights.
While Americans can enter Canada after August 9, the U.S. has extended its land border closure to Canadians and Mexicans to August 21 as the country faces a new surge in cases and hospitalizations, particularly in areas with lower vaccination rates. Canadians can still travel to the U.S. by air, provided they test negative for COVID-19 three days prior to departure or provide proof from a licensed health-care provider that they have recovered from COVID-19 in the past 90 days.
On September 7, 2021, provided that the COVID-19 situation remains favourable, the federal government intends to open Canada’s borders to any fully vaccinated travellers who have completed the full course of vaccination with a Government of Canada-accepted vaccine at least 14 days prior to entering Canada and who meet specific entry requirements. You can learn more about the easing of border measures for fully vaccinated travellers here.
Shared health has provided answers to FAQs regarding non-essential travel for Health-care Workers and Guidelines for screen of Manitoba health-care workers who have traveled.
Dr. Gordon Buduhan, a thoracic surgeon-clinical researcher who treats lung cancer patients, has been awarded the 2021 Preparing for Research by Engaging Patient and Public Partners (PREPPP) Award. The award provides financial and advisory support to help engage patients and members of the public as partners in the early stages of their health research. Dr. Buduhan’s work, Relationship Building with Indigenous Patients and Elders through Talking Circles to Inform our Exploration, empowers Indigenous people to identify areas of the health care system that fail to give community members timely and culturally safe lung cancer treatment.
Dr. Deepak Louis, a Neonatologist and pediatric clinical researcher, was also awarded a PREPPP Award for his research Empowering Parents of Premature Babies through Engagement, which will involve parents as an advisory group in project, from the co-design of survey questions and methods to knowledge translation activities.
Call for Nominations:
The Royal College of Physicians and Surgeons in Canada is seeking nominations for the 2022 Royal College Dr. Thomas Dignan Indigenous Health Award. This award acknowledges and celebrates Canadian Indigenous physicians or physicians-in-training, Elders or Knowledge Keepers who epitomize a zeal and devotion to Canadian Indigenous rights and the dogged pursuit of justice for Canada’s Indigenous people. The submission deadline is September 30, 2021. You can submit your nomination here. Any questions about the award can be directed to firstname.lastname@example.org
Past winners include Manitobans Dr. Catherine Cook (2018) and Dr. Marcia Anderson (2021)
Doctors Manitoba, MMSA, PARIM, PGME and UGME Student Affairs are excited to be moving into the next steps of the Medical Learner Mentorship Program. Recruitment for participants is ongoing, no mentoring experience is necessary. The program offers a variety of supports for participant including complimentary training through CMA-Joule! Learn more about the program and register to participate.
Medical Cannabis Survey
Canadians seeking cannabis for therapeutic purposes encounter difficulties in finding a physician that supports their application to access cannabis for medical purposes. A group of investigators from the McGill University Health Centre and The Ottawa Hospital are conducting a survey entitled “Barriers to access for medical cannabis and impact of the COVID-19 pandemic: Canadian healthcare providers perspectives.”
Click HERE to participate in the survey and email Dr. Cecilia Costinuik at email@example.com any questions or concerns regarding the survey and research.
Bug Day — 25th Anniversary
Mark your calendars on October 19 for the 25th Annual Bug Day! The fully accredited event is free to attend, with online streaming options.
The packaged agenda includes consummate host Dr. John Embil with presentations from Dr. Brent Roussin, Dr. Michael Isaac, Dr. Jared Bullard, Dr. Martha Ainsley and Dr. Yoav Keynan as well as several out-of-province speakers. Topics include COVID-19, the future of infection prevention and control, HIV, Lyme Disease, infections among the homeless, tuberculosis, and more!
You can access a poster with the full agenda here, and register here.