With increased vaccination rates, the development of effective treatments and the introduction of at-home rapid tests, the approach to managing COVID-19 cases has evolved. Doctors Manitoba has created this article to assist physicians to support patients who may need COVID-19 testing, diagnosis, and treatment.

COVID-19 Testing

Effective April 15, all provincial COVID-19 testing sites are closing. While most COVID-19 testing is now happening at home using self-administered rapid antigen tests (RATs), some patients will continue to require a test administered by a physician or health care professional, often in primary care settings. For further background on the transition to primary care-based testing, see this memo from Public Health and this memo from Shared Health.

Physicians are encouraged to review the following resources, including clinical guidance, test supply ordering, and remuneration guidance.

To get your clinic is set up, you should use the resources below to ensure:

• Reception staff can effectively screen and direct patients appropriately
• You have sufficient rapid tests and PCR test supplies on site (available at no charge)
• Appropriate PPE is available for physicians/​staff
• A protocol is in place to notify patients of positive test results, especially when time-sensitive COVID-19 treatments may be necessary

Watch our webinar on changes to COVID-19 testing and treatment in primary care.

Clinical Guidance Resources

With the transfer of testing to primary care Shared Health has issued new clinical guidance in relation to screening, testing and treatment of COVID-19 we recommend you review that guidance.

Most patients should be able to use a self-administered RAT at home to test for COVID-19, with physicians offering guidance on isolation and symptom monitoring. Generally, the only patients who need a COVID-19 test from a physician or other health care provider are those who have symptoms and for whom knowing the test result would inform the medical management or treatment decisions, or if they have serious symptoms or live in a higher risk setting. At times, Public Health may also direct individuals to be tested. It may also include children, individuals with developmental or medical issues that make conducting a test difficult.

Key resources for physicians include:

• Clinical Guidance and Algorithm for screening, testing and treating COVID-19/Influence-Like Illness in Primary Care (Shared Health) 
• PCR testing eligibility (Manitoba Health)
• Standard Operating Procedure for Swabbing for PCR tests (Shared Health)
• PPE requirements (Shared Health)
• General Guidance for Primary Care and Outpatient Clinic In-Person Care (Shared Health)
• Physicians should report positive RAT results if administered in your office. Use this Public Health case report form. Note, PCR positive tests are automatically reported by the lab.

For PCR test results, patients should be advised to check on their own through the Shared Health Online Portal or by calling Health Links-Info Santé. Patients who test positive should be contacted by the physician’s office in a timely way to ensure they understand isolation guidance, symptom monitoring, and to ensure they are referred for time-sensitive treatment, if eligible (see treatment and remuneration guidance section below).

Patient Resources

• Rapid Tests: For pick-up locations and instructions, patients can visit this government website (Provincial Government) 
• COVID-19 Public Health Factsheet including isolation guidance for patients (Manitoba Public Health)
• Handout Shared Health COVID Results Portal info English & French (Shared Health)
• Eligibility for COVID-19 Treatment information for patients (Manitoba Health)

Test Supply Ordering

Ensure your clinic has sufficient testing supplies on site.
Rapid Tests:

• For fee-for-service clinics: use Doctors Manitoba | Rapid Test Kit Orders for Doctors’ Offices
  
• For RHA-operated sites: use established supply chain ordering process

PCR supplies

• Use existing ordering process for specimen collection supplies Forms and Requisitions — Cadham Provincial Laboratory | Health | Province of Manitoba (gov​.mb​.ca)

Remuneration Guidance

Doctors Manitoba has been successful in negotiating new tariffs for the administration of the Rapid Tests and PCR tests by physicians. 

NOTE: tariff numbers have not yet been issued for these new tariff. Doctors Manitoba will be sure to communicate once a number has been assigned. 

COVID-19 Treatment

There are effective treatment options available for COVID-19 that can help to reduce the risk of severe outcomes, such as hospitalization and death. However, treatments are very time-sensitive, and should be started by day three to five after symptom onset. 

Treatment options include monoclonal antibodies (Sotrovimab) and antivirals (Paxlovid), and patients in designated higher-risk groups are eligible. Patients must be diagnosed by a provider with COVID-19 using either a rapid test or PCR.
Key resources include:

• Treatment Resources for Providers, including eligibility/​treatment algorithm and infographic, referral forms, and information & education resources (Shared Health)
• Treatment Recommendations for outpatients and inpatients (Shared Health)
• Treatment Information for Patients (Manitoba Health)

Please note: This therapy is available via referral only, with central referral intake and review in each health region. Designated prescribers have similarly been established in each region to support this program, and ensure that the therapy is prescribed within established criteria given an extremely limited supply of Paxlovid initially.

At this time, supplies are limited for COVID-19 treatments, which means they are being centrally managed within each health region and accessible via referral only. 

If you have further questions, contact COVID therapeutics referral intake as follows:

• Winnipeg: Fax 204−940−1978; for phone inquiries please call 204−926−7071
• Interlake Eastern: Fax 204−482−9386
• Northern: Fax 204−944−2414
• Prairie Mountain Health: Fax 204−578−4952; for phone inquiries, please call 204−578−4235 and ask to speak to the COVID treatment pharmacist
• Southern/​Sante Sud: Fax: 204−379−2769 (Mon-Fri only)