Member Update-August 27, 2021
Equity, Diversity and Inclusion in Medical Associations
4th Wave Projections, Vaccine Mandate and Restrictions
Situation Update
Since our last update on Thursday, August 19:
- Daily cases increase again: 372 new cases of COVID-19 have been identified since last Thursday, a daily average of 53 (up from 26 last week). This includes 31 new cases today, and 105 new cases on Wednesday — the first time there has been more than 100 cases since June. The total case count in Manitoba now stands at 58,506.
- Test positivity up: The five-day test positivity rate is 2.8%, up from 1.9%. It is 1.5% in Winnipeg, up from 1.4%.
- Active cases up: There are 430 active COVID-19 cases province-wide, up from 297 last week.
- Hospitalizations: There are 65 people in Manitoba hospitals due to COVID-19, down from 69. This includes 21 COVID-related patients in Manitoba ICUs, up from 14.
- One more person, a male in his 20s, has died from COVID-19, bringing the total COVID-19 related deaths to 1,189.
According to Health Canada’s tracking, Manitoba has had 25 cases per 100,000 over the last seven days, up from from 14 a week ago. While increasing, Manitoba has the lowest case rate outside of the Atlantic provinces. Alberta and Saskatchewan continue to lead the provinces with 100 cases per 100,000 in SK and 125 in AB, up from last week. The NWT have had 261 per 100,000. When transmission reaches the substantial (50−99 cases/100K) or high levels (100+/100K), the CDC recommends indoor mask use.
All three of these provinces discontinued mandatory mask mandates along with nearly all other restrictions in early July. BC, however, is reintroducing its mask mandate, and they will also become the third province to introduce a vaccine card and limit access in some public places to fully vaccinated individuals.
Vaccine Update
Since our last update on August 19:
- 81.7% of Manitobans age 12 and up have received at least one dose, up only slightly from 81.0% a week ago. The Labour Day target was 80%.
- 76.2% have received two doses, up from 74.6% a week ago, surpassing the Labour Day target of 75%, later than initially thought but still ahead of schedule.
Vaccine effectiveness continues to be very strong. Breakthrough infections in fully vaccinated Manitobans are still very rare. Provincial data released for the week of August 16 to 22 suggest that infection rates among unvaccinated individuals are 9.6 times higher than among fully vaccinated people. This is consistent with a BC analysis that found case rates per 100,000 in that province are 10 times higher among unvaccinated individuals, and hospitalizations are 17 times higher.
FDA Approval
Earlier this week, the U.S. Federal Drug Administration (FDA) provided a full approval of Pfizer’s vaccine.
This isn’t a Canadian regulator, so why is it significant? This is the first COVID-19 vaccine to receive a full approval from a major national regulator. The lack of a full approval has caused hesitation among some individuals, concerned the vaccines were not fully tested or were rushed to market. In the U.S., vaccines were authorized under an “emergency use authorization.” In Canada, they were authorized for use by Health Canada under an “interim order.” A description, for patients, of the fast yet rigorous review and authorization process is posted at ManitobaVaccine.ca.
Physicians should note that the FDA has approved Pfizer’s vaccine under its new official brand name, “Comirnaty.” What does this name mean? Find out here. What will Moderna name its vaccine? Apparently it will be called SpikeVax.
Moderna for 12+
Health Canada announced today that Moderna is approved for 12 – 17 year olds in Canada. The vaccine has proven to be safe and effective in preventing COVID-19. The health agency advises that children should be given two doses of the mRNA vaccine scheduled one month apart for maximum protection. According to clinical trials, the Moderna vaccine was 100 per cent effective in participants aged 12 to 17 years old two weeks after their second dose.
Share with your Patients — Back-to-School Town Hall
More and more physicians are reporting they are getting questions from concerned patients and parents about the return to in-school classes next month. Many are concerned about what precautions should be taken to reduce the spread of COVID-19 in schools. Others are concerned that masks and other precautions could have negative impacts on their children, and others are worried about the mental health impacts the pandemic isolation has already caused and how these might affect a return to school.
Doctors Manitoba has organized a back-to-school town hall this Tuesday, August 31 at 7PM to discuss all of these issues. We request all physicians to invite their patients to this virtual town hall.
Manitobans can send in questions in advance or register for an event reminder email at DoctorsManitoba.ca/school. Questions can also be submitted live live during the event. The town hall will be broadcast live on YouTube.“The return to in-school learning is concerning to some parents, students and teachers, especially with the threat of a fourth wave,” explained Dr. Kristjan Thompson, President of Doctors Manitoba. “Doctors are here to help, and our town hall will look at the level of risk in schools, and how the right precautions help to maintain a lower risk and to keep schools open this fall.”
A group of physicians with medical expertise in a variety of relevant areas will take part in the event, including pediatric medical leaders and those with expertise in infectious diseases, mental health and immunology. The full panel includes:
- Dr. Marni Hanna, President of the Manitoba Pediatric Society
- Dr. Ruth Grimes, President of the Canadian Pediatric Society
- Dr. Jared Bullard, pediatric infection disease specialist
- Dr. Ashley Chopek, pediatric oncology and bone marrow transplant specialist
- Dr. Andrew Hall, child and adolescent psychiatrist
- Dr. Melanie Morris, pediatric general surgeon and Indigenous health lead at Children’s Hospital
“We invite all Manitobans concerned about the safety of schools this fall to join us as we answer your questions and respond to your concerns.” said Dr. Marni Hanna, President of the Manitoba Pediatric Society. “With the right COVID-19 precautions in place, schools can be a low risk environment for children and youth, including those under 12 who are not yet eligible to be vaccinated.”
Equity, Diversity and Inclusion in Medical Associations
Last Sunday, the Canadian Medical Association held their Annual General Meeting and General Council, which considered a proposal to adopt significant changes to their governance model focused on improving the equity, diversity and inclusiveness of the CMA’s governance. It also proposed changes to how their Presidents are elected. Over 300 members attended, and the changes did not receive the two thirds support needed to move ahead. You can read more about what was proposed in this summary from CMAJ.
Many CMA members supported the proposed changes and were left feeling concerned about how inclusive and equitable the medical profession wants to be. A smaller group opposed the changes, largely because they argued the CMA was moving too quickly, and some of the reforms might be a barrier to democracy.
Doctors Manitoba’s Focus on Improving Equity, Diversity and Inclusion
Here in Manitoba, your Association is taking action to ensure our governing members and operations are reflective of, and inclusive to underrepresented groups.
These actions include:
- Outreach to and support for women and BIPOC members interested in serving on the Board of Directors or Committees that guide our organization.
- Asking all members, if they so choose, to indicate their ethnicity, race or Indigenous identity, as well as including a broader listing of gender identity options as part of the membership renewal process this year. This will help us to better understand who our members are, which groups are underrepresented, and to identify potential disparities in economic, mental and professional well-being.
- The Board of Directors will focus on learning more about equity, diversity and inclusion at a scheduled Board event later this fall.
Our Board has commissioned a special committee to review our governance structure. The existing District Medical Societies are based on a structure that pre-dates regionalization in 1998 and no longer represents accurately the diverse types of practice of Manitoban physicians. At the same time, some Provincial Medical Associations have adopted a more skills-based Board, and others have focused on modernizing governance systems to ensure a more inclusive governance structure that better reflects the diversity of its membership.
Right now, the Committee is conducting research and reviewing how other provincial medical associations are governed. In the coming months, every member will have an opportunity to share their views about our governance structure through a broad consultation process. Our by-laws ensure that members will have the final say on any proposed changes. The Committee is led by former Doctors Manitoba President, Dr. Aaron Chiu, and the Terms of Reference for this Committee are available here.
The ultimate purpose of this committee and the governance review is to recommend to the Board how it can provide the best representation to and for you, the members of Doctors Manitoba.
CMA — New President and President-Elect
Dr. Katherine Smart, a pediatrician from the Yukon, is now the President of the Canadian Medical Association. Dr. Smart is a past President of the Yukon Medical Association. Before moving to the Yukon, Dr. Smart was a pediatric emergency medicine physician at the Alberta Children’s Hospital in Calgary.
Dr. Alika Lafontaine was also confirmed as the CMA’s first Indigenous president-elect for 2022 – 2023. Born and raised in Treaty 4 Territory, Dr. Lafontaine has Anishinaabe, Cree, Métis and Pacific Islander ancestry and is an award-winning anesthesiologist in Grande Prairie, Alberta. He will start his mandate as CMA president in August 2022.
Doctors Manitoba welcomes both Dr. Smart and Dr. Lafountaine to their new roles. We also extend our sincere gratitude to Dr. Ann Collins, who has finished her presidency with the CMA. Dr. Collins has become a familiar face to Canadians during the pandemic, and has been a strong supporter of supporting provincial medical associations and their members, including here in Manitoba.
4th Wave Projections, Vaccine Mandate and Restrictions
Earlier this week, public health officials released modeling that projects different scenarios for a fourth wave of COVID-19 in Manitoba. The magnitude of a fourth wave could be worse than any before it, but this depends largely on several factors:
- Vaccine uptake by eligible Manitobans, which must be higher than the current 65% of the whole population
- Public compliance with public health recommendations, including those that go over and above the government’s pandemic restrictions
- Government action to tighten restrictions to slow the spread at the first sign of increasing rates.
Also earlier this week, Premier Brian Pallister and Dr. Brent Roussin announced new actions in anticipation of a fourth wave, including requiring vaccination or regular testing in health care, schools and other public sector operations. They also committed to re-introducing mask requirements in public places and expanding the use of the vaccine card to more places.
→ See our full summary of these changes, and what they mean for physicians’ practices from earlier this week.
What’s New Since Tuesday?
Today Dr. Brent Roussin and Health Minister Audrey Gordon announced new restrictions.
Masks will be required in all indoor public spaces immediately.
The province has developed new requirements for people to be fully immunized to participate in certain events and activities. These requirements will come into effect by public health order on September 3 for all health regions and will include:
- indoor and outdoor ticketed sporting events and concerts;
- indoor theatre/dance/symphony events;
- restaurants (indoor and patio dining);
- nightclubs and all other licensed premises;
- casinos, bingo halls and VLT lounges;
- movie theatres;
- fitness centres, gyms and indoor sporting and recreational facilities (excluding youth recreational sport); and
- organized indoor group recreational classes and activities, and indoor recreational businesses.
Children 11 and under who are not eligible to be immunized will be able to attend events and activities with a fully immunized adult.
Private businesses and organizations are being encouraged to mandate vaccines for employees.
You can read more about the restrictions here.
Exemptions
We’ve heard that some physicians are getting requests for vaccination and/or mask exemptions.
For mask exemptions, we believe the same advice from earlier in the pandemic still applies. You can find guidance on that here.
Vaccine exemption requests, however, are likely more complicated and could be dependent on an employer. Guidelines are not yet available for employees in the provincial public sector, such as health care, education or justice, but the initial details confirm that those who object to vaccination or who cannot be immunized due to a medical reason will have to show recent negative test results. With this provision in place, exemptions from a physician likely are not needed at this stage.
We will monitor the situation and continue to provide updated guidance as needed.
Please continue to send your questions about the implementation of the vaccination or testing requirement to covid19@doctorsmanitoba.ca.
Rural Health Infrastructure
Earlier this week, Premier Brian Pallister announced investments in rural health care infrastructure, as part of an over in $800 capital spending in health care. Upgrades at Brandon Regional Health Centre will see 30 additional medicine beds added, a new adult ICU and a renovation and expansion to the neonatal ICU. The Western Manitoba Cancer Centre will also be expanded and outfitted with a new linear accelerator. Meanwhile, Portage la Prairie will get a brand new, expanded hospital.
The investments, the government says, are part of the provincial Clinical and Preventive Services Plan. However, other details in the plan have yet to be unveiled, including if and when rural hospitals will see changes to their services, which includes speculation of emergency departments closures.
New Issue of Cancer Talk
In the August Issue of Cancer Talk learn from expert, Dr. Belynda Salter-Oliver as she outlines treatment for a patient with metastatic melanoma on ICPIs, read Dr. Pierre Plourde’s Untangling Tuberculosis and Latent TB Infection (LTBI), and learn what considerations are being made for the COVID-19 Vaccination of cancer patients.
Read the August issue of Cancer Talk.
Trauma — The next pandemic?
The Homewood Research Institute is hosting an upcoming webinar Trauma: The Next Pandemic? on September 14 at 6:00 PM.
In this live virtual conversation, they will explore the mental health impacts of COVID-19 on individuals, families, healthcare workers, and first responders. In particular, they will discuss two growing concerns affecting people across the country: post-traumatic stress and moral injury. Register here.
Travel
We have heard about frustrating experiences because of conflicting or difficult to find information regarding travel.
The government of Canada continues to recommend no non-essential travel outside Canada. For those needing to travel, monitor government websites to stay up-to-date on travel requirements such as steps for the fully vaccinated traveller exemption. Manitoba’s immunization card is not accepted at the US border.
If you or your patients are traveling by plane, international travellers require a specific test (available at some private clinics) in order to board the plane. Domestic travelers usually do not need a test prior to boarding but should check with their airline and with the province they are flying to for their entry requirements. Ensure you print and keep your full COVID-19 immunization record for out-of-province travel. Though a national standardized proof of vaccine is in development, if travelling prior to that ensure you have your immunization record with you.
There has also been isolation requirement confusion while waiting for test results. Info can be found here and patients can also be encouraged to call Health Links for clarity due to the rapidly changing information.