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In today’s message you will find:

COVID-19 Vaccine Updates

Yesterday, Dr. Brent Roussin confirmed that a pediatric vaccine for younger children will soon be available in Manitoba.

The Moderna Spikevax vaccine was approved by Health Canada earlier this month for children age 6 months to five years. Children age six and up are already eligible for a Moderna vaccine, and children age five and up are already eligible for a Pfizer vaccine. 

Because the supply is initially limited, the Moderna Spikevax vaccine will be prioritized first for children who:

  • Are First Nation, Métis or Inuit, regardless of where they live
  • Are Moderately to severely immuno-compromised due to a medical condition or treatment
  • Have a serious medical condition, including:
  1. Chronic lung disease (e.g. asthma, cystic fibrosis, chronic obstructive pulmonary disease)
  2. Airway abnormalities (e.g. tracheostomy)
  3. Congenital/​chronic heart or circulatory disease (e.g. valvular heart disease, cardiomyopathy, abnormal heart rhythms, cardiovascular disease)
  4. Neurologic disorders including developmental delay (e.g. cerebral palsy, Down syndrome, muscular dystrophy)
  5. Diabetes (type 1 and 2), or chronic kidney disease (e.g. dialysis, end stage renal disease, nephrotic syndrome)
  6. Any chronic disease of premature birth (e.g. hypertension, chronic lung disease of prematurity)

Eligibility should be opened up to all 76,000 children in this age group as more doses arrive, likely in late July or early August.

The vaccine will be available through vaccine supersites and doctors’ offices. We will maintain a list of physicians offering the vaccine at Man​i​to​baVac​cine​.ca.

Physicians should note a unique tariff has been created for this specific vaccine:

  • Use tariff 8261 for Moderna Spikevax Infant-Pediatric (age 6 months to five years) dose. 

Key links:

Booster Shot Guidance

Meanwhile, Public Health issued guidance today on counselling patients looking for second booster shots. It is midsummer, and planning is underway for a fall immunization campaign. While the BA.4 and BA.5 are circulating and cases may be starting to rise, it is important to help patients weigh the risks and benefits of getting a second booster now:

  • It is ​“unclear how effective a booster with the current vaccine will work against” the Omicron variants now circulating. A bivalent vaccine is currently being reviewed by Health Canada that is likely more effective against these newer variants.
  • NACI has recommended boosters this fall, with a recommended interval of three to six months from the last dose. A mid-summer booster dose could delay being eligible for a new bivalent vaccine this fall. 

Each individual patient’s circumstances should be considered as physicians counsel their patients. 

Public Health has published a patient information sheet, available here, which physicians can use with patients. 

In his update yesterday, Dr. Roussin confirmed that eligibility for fourth doses (second boosters) is not anticipated to change right now. He noted ​“those who have that initial booster are still well protected against severe outcomes, the fourth dose is not showing us a significant benefit outside of those who are high risk, and those who are high risk are already eligible.” He noted that only 55% have received their first booster, and recommended people to get it as soon as possible, especially those who are at increased risk for severe outcomes. 

Moving Forward on Equity, Diversity, Inclusion and Decolonization

The mandate of Doctors Manitoba is to strengthen and support the whole physician, so every physician has the support they need to deliver exceptional care to Manitobans. 

“Over the last few years, guided by feedback from members, our Board has been focusing on how to better support the whole physician,” said Dr. Candace Bradshaw, President of Doctors Manitoba. ​“A recurring theme we hear is about inequities and discrimination within our profession, and how these are barriers for many of our members as they work to provide exceptional care for their patients.” 

Today we are sharing a new step towards this achieving this mandate, which was recently directed by our Board of Directors, specifically around equity, diversity, inclusion and decolonization (EDID).

“While we need to learn much more about the barriers to equity and inclusion in our profession,” added Dr. Bradshaw, ​“we already know more than enough to acknowledge these barriers exist and need action.” For example, our recent surveys and analyses found:

  • Overall, half (49%) of our members report being mistreated by patients, colleagues or medical leadership. However, physicians who are BIPOC (Black, Indigenous or People of Colour) are three times more likely to report being mistreated than white physicians, and women are five times more likely than male physicians. 
  • A pay gap of 31% between male and female physicians. On average, women make less than men in nearly every physician bloc, including areas that are dominated by women such as pediatrics, obstetrics and gynecology.
  • 58% of our members see barriers or inequities today in the medical profession, in everything from remuneration and access to hospital resources, to leadership representation, residency and recruitment opportunities. While that number is much lower when it comes to Doctors Manitoba Board and Committee representation – with only 10% of members seeing barriers or inequities – our survey found that women and BIPOC members are two to three times more likely to see these barriers in Doctors Manitoba decision-making structures. 

See further details from our member update on Women Physicians Day. As Dr. Kristjan Thompson, now Past President, said at the time, the medical profession ​“is guided by evidence in all we do, we must follow this data to understand the root causes, and we must act to break the bias. When all physicians can thrive equally, all physicians will benefit exponentially.” 

The Board requested that an EDID strategy be developed for Doctors Manitoba, to help guide our work in this important priority area. To that end, a request for proposals has been issued to find a consult to support Doctors Manitoba in developing an EDID strategy. The development of this strategy will be guided by member feedback. We want to understand if our practices and policies may cause barriers or disadvantages to our members and create an environment where all our members have what they need to provide the best care to Manitobans.

The request for proposals is posted here.

The development of an EDID strategy complements other work and progress being made by Doctors Manitoba on equity and inclusion. This work includes a new strategic plan focus on the whole physician, achieving gender balance on our Board, and reviewing and correcting our benefits and programs to make them more equitable and inclusive. You can read more about the progress being made here, noting of course that much needs to be done within the profession to ensure all physicians can practice to their full potential, free from harassment or bias.

Rural & Northern ER Updates

Another summer week brings more changes to rural and Northern ERs in Manitoba, some positive and some negative.

On the positive side, it appears a few ERs will be increasing their hours. The Pine Falls ER finally reopened on Monday after a closure, though it is open with reduced hours. A physician is now available 8AM to 7PM daily. In Grandview, it appears 24/7 coverage will be available most days starting next week. 

However, the Leaf Rapids ER closure has been extended. Initially the Northern RHA announced a one week closure, with the ER set to reopen earlier this week. The RHA now reports the ER will remain closed until August 31, with primary care available only on weekdays. Due to staffing issues there will be NO emergency department services at the Souris Health Centre on Mondays & Wednesday during the summer months.

We are making weekly updates to Rural​Care​.ca, our new public awareness tool to support Manitobans in accessing care amidst frequent and widespread rural and Northern ER closures.

Among the 68 hospitals in rural and Northern communities:

  • 22 are experiencing full ER closures on a short- or long-term basis, down from 23 last week.
  • 21 are open but reduced hours or periodic closures, up from 20 last week.
  • 25 are open 24/7, the same as last week.

Worth a listen: Dr. Nichelle Desilets, a physician in Neepawa and Doctors Manitoba Board Director, had an extended interview on a national radio show earlier this week to talk about rural and Northern hospital issues in Manitoba. Listen here.

Diagnostic Backlog Opportunity

The provincial government’s Diagnostic and Surgical Renewal Task Force has posted a Request for Supply Arrangements (RFSA) for diagnostic services to help address the massive backlog. Similar to a call last month for surgical services, the diagnostic RFSA is looking for capacity on a short and medium term basis. 

If you or your group is interested in adding more surgical capacity, the RFSA is likely the route to pursue. This applies to both public or private facilities, including hospitals, doctors offices and surgical centres. For public facilities where physicians see an opportunity to increase capacity, contact your medical lead or CMO about the site’s leadership submitting a proposal. 

Submissions are due by August 12.

Any diagnostic service for which there is a pandemic backlog could be considered. The Task Force is specifically seeking submissions for the following procedures:

  • Allergy testing
  • Bone density scans
  • CT scans
  • Echocardiograms
  • Mammograms
  • MRI
  • Myocardial perfusion
  • Pulmonary function
  • Sleep disorder
  • Ultrasound
  • Surgical pathology including cytology

The call for proposals has some requirements outlined. It appears preference will be given to facilities with capacity to quickly begin delivering the service and sustain it over the duration of the contract, which could run until March 31, 2024. The proposal must have a human resource plan that will not​“impair” existing capacity in the public system. 

While physician tariffs are already set by the Master Agreement, the RFSA allows public and private facilities to outline other costs required to deliver the service. Presumably, the government will review the responses and select bidders with competitive costs in their proposal. 

The RFSA is posted on the public tender site MERX. To access it you will need to sign up here, and then access the RFSA documents here. While Doctors Manitoba cannot assist physicians with their individual submissions, we can answer questions or provide any background information we have. Contact us at practiceadvice@​doctorsmanitoba.​ca.

Doctors Manitoba’s latest estimate last month suggests the backlog in surgical and diagnostic procedures is improving but is still between 102,000 and 128,000 cases. 

COVID Surveillance Update

Public Health posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report covers the week ending July 16, and is showing​“decreased activity” after ​“increased activity” was reported last week for the first time in quite a while. Highlights include:

  • Severe outcomes from COVID-19 increased compared to the previous week. There were 52 hospital admissions, down from 59 the week before. This includes 2 ICU admissions, down from 7 the previous week. Hospital admissions last peaked at 264 the week ending April 16.
  • There were 2 deaths recorded, the same as the previous week. There have now been 2,056 deaths related to COVID-19.
  • There were 171 lab-confirmed cases reported in Manitoba over the week, down from from 229 the previous week. The test positivity rate was 13.9%, down from 14.8%.

The updated wastewater surveillance dashboard for the city of Winnipeg includes data up to July 14. It is continuing to showing low levels of COVID-19 circulating, and an increase detected last week seems to have tapered off.

Other Health System Updates

West Nile Virus: Public Health issued a bulletin this week confirming mosquitoes have been identified in Manitoba carrying the West Nile Virus (WNV). The first mosquitoes were found in Headingley, just west of Winnipeg. The risk of exposure is currently low, with no human cases yet this year, but likely to increase in coming weeks. Over the last five years, nine WNV patients were hospitalized and four required intensive care. See the bulletin here for more information, including precautions you can recommend to patients. 

Hand Foot Mouth Disease: Children’s Hospital physician Dr. Elisabeth Doyle was on the news this week to bring attention to a spike in hand, foot and mouth disease cases among children. 76 cases were identified in the first half of July, which is much higher than the 20 per month normally seen during the summer. Watch or read the story here, including advice from Dr. Doyle about symptoms and treatment. 

Private Healthcare Court Decision: Last week the British Columbia Court of Appeal dismissed an appeal by the private Cambie Surgical Clinic to strike down the BC law preventing extra billing and private care. The Court found Canada’s Medicare system is constitutional, as although patient’s rights to life and security of the person can be violated by waiting for surgery, this is permitted under the principles of fundamental justice. The Court relied on the value of ensuring the equitable provision of health care, and preventing the creation of a two-tier system where access to potentially life-saving treatment depends on wealth. A further appeal to the Supreme Court of Canada is expected. You can read more here.

ICYMI

Here are some of our most read and notable recent updates, in case you missed them:

Upcoming Events

Upcoming events are always listed on our events calendar.

Your Life After Retirement — We’ve added another date to this popular workshop. Space is limited and first workshop filled up in a few days! September 22 from 8:30am — 12pm. 

Free, On-Demand (self-led) Modules (for all physicians)

*Click on links below to register. You do not need to be a CMA member, you just need to have a complimentary cma​.ca account. Click here to create an account and contact pli@​cma.​ca to set up your CMA ID*

Transition to Practice Summer Virtual Sessions (designed for residents and early career physicians but for anyone who wants this information, sessions are led by physicians)

*click on embedded links below to register with email via zoom*

Additional practice management resources (e.g. checklists, interview questions, staffing, evaluating practice opportunities, etc.) are also available online (scroll to the bottom).n with Confidence.

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