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COVID Update

Public Health now posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report, which is again showing​“increased activity,” covers the week ending on April 23. Highlights include:

  • Severe outcomes from COVID-19​“decreased compared to previous weeks.” There were 200 hospital admissions, down slightly from 206 last week. This includes 12 ICU admissions, down from 22 last week.
  • There were 13 deaths recorded, about the same as the 12 recorded the previous week. There have now been 1,792 deaths related to COVID-19. 
  • There were 1,436 lab-confirmed cases reported in Manitoba over the week, up from 1,190 the previous week. The test positivity rate was 23.4% , up from 19%

Data from Shared Health also shows hospital occupancy is increasing for patients with COVID-19. There were 579 in hospital with COVID-19 as of today, up from 538 a week ago. This includes 28 patients in ICU with COVID-19, up from 26.

Doctors Manitoba has seen increased number of physicians reporting an isolation or illness due to COVID-19. For the week ending April 26, there were 33 physicians who submitted an isolation notice. While this is down from 55 the prior week, it is still up from the 18 – 21 claims per week for the weeks before. If you miss work due to COVID-19, please review our Physician Isolation Support Benefit and apply if you are eligible. 

As Manitoba is in a 6th wave, it is important to reinforce with patients the need for continued precautions. You can refer patients to our resource, New​COVID​Nor​mal​.ca.

Recent Research of Note

  • Household Spread: In a study published recently in the Canadian Medical Association Journal, Ontario researcher Dr. Marc-André Langlois found that half of those residing in a household in which someone became infected with COVID became infected as well. Adults were more likely to spread infection than children, through both groups did spread. Symptomatic individuals were more likely to spread, but the rate of spread from asymptomatic individuals was still found to be about 35%. The study period predated the more infectious Omicron variant. You can see a summary of the study here, and access the full CMAJ publication here.
  • Unvaccinated increase risk of infection for vaccinated people: A separate CMAJ article published this week found that when vaccinated individuals interact with those who are unvaccinated have a significantly higher chance of being infected than those who only interact with other vaccinated people. For unvaccinated people, their risk of infection decreases when they interact more with vaccinated people. The researchers behind the modeling study concluded that ​“although risk associated with avoiding vaccination during a virulent pandemic accrues chiefly to people who are unvaccinated, their choices affect risk of viral infection among those who are vaccinated in a manner that is disproportionate to the portion of unvaccinated people in the population.” You can access the full article here.

Vaccine Updates

A reminder that Novavax is now available in Manitoba for order by doctors’ offices and pharmacies. Doctors Manitoba, and our Man​i​to​baVac​cine​.ca site, have been contacted by several members of the public asking about availability. These are often individuals who were not comfortable with an mRNA vaccine, and appear to be more open to the Novavax vaccine due to it’s more traditional composition. Currently, there are very few locations offering Novavax. Doctors are encouraged to consider adding this vaccine to their supply by ordering through Manitoba Health. 

Also, this week is National Immunization Awareness Week. Immunize Canada has developed social media and print resources. You can find them here.

Reminder to submit eligible vaccine expense claims

A reminder to physicians and medical clinics to ensure you submit claims for additional vaccine funding, over and above what you can claim through fee-for-service tariffs. Doctors Manitoba negotiated additional funding for outreach to patients and to support holding scheduled vaccine clinics. Don’t leave this funding on the table! The provincial funding covers patient outreach and vaccine clinic activities up to March 31, 2022.

You can access information about the initiative, learn about eligible expenses, and register and submit claims through Doctors Manitoba.

Recent Research and Analyses of Note

  • Vaccines more effective than prior infection: Researchers from the University of Toronto published their study in Med, finding that previous infection alone does not create sufficient levels of neutralizing antibodies to protect against Omicron in vitro. Triple vaccination, however, was associated with greater levels of neutralizing antibodies against several variants of concern, including Omicron. This study included long-term care residents in Ontario. It should be noted that the study focuses on the antibody response, which is only one part of the immune response. Other facets, such as cell-mediated immunity may also contribute to immunity against Omicron and other VOCs. Read more here.
  • Manitoba data confirms vaccine effectiveness against Omicron: Data released earlier this month from Public Health offers compelling new information about how effective the vaccines are against infections leading to severe outcomes. This uses data from February 14 to March 28, 2022. The risk of hospitalization is 7.5 times less likely for fully vaccinated people, but that protection improves to 20 times less likely for those with a booster. The risk of ICU admission is 9.9 times lower for fully vaccinated individuals, and 25 times lower for those with a booster. The risk of death is 32 times lower for fully vaccinated people, and 60 times lower for those with a booster. See the data here.
  • Strong effectiveness against hospitalization and death: A Canadian pre-print, not yet peer reviewed, would confirm the COVID vaccines are highly effective against severe outcomes such as hospitalization and death. The large study, including 2.5 million participants from Ontario, Quebec, BC and Manitoba, found that the effectiveness 98% effective after two doses against both hospitalization and death. The study period looked at Alpha, Gamma and Delta variants, finding ​“very high protection” for people, regardless of whether they received two doses of the same vaccine or mixed doses. Longer intervals between doses generated better protection. Read more here.

Reserve Your Spot at Our Annual Gala! 

Please join us on Thursday, May 19 for our Annual Awards Gala. We’re excited to confirm that CMA President Dr. Katharine Smart will be traveling to Winnipeg attend!

At the Gala, you’ll hear from incoming Doctors Manitoba President Dr. Candace Bradshaw about the year ahead, as well as from Dr. Smart from the CMA. We will also celebrate each of our eight extraordinary 2022 award winners.

→ Click here to learn more about the gala and buy tickets today.

If you cannot attend, consider buying a ticket and donating it for a medical student or resident physician so they can attend.

The Gala is the signature annual event for physicians, offering a great opportunity to reconnect with colleagues, meet new ones, and celebrate the very best of the medical profession, including our eight extraordinary 2022 physician award winners.

MD Financial and Scotiabank are our presenting sponsors, and you can enter to win a fabulous door prize from them when you purchase your tickets. 

The Gala will be held at the RBC Convention Centre and starts at 6PM with a cocktail reception, followed by a gourmet dinner and program beginning at 7PM. 

Our 114th Annual General Meeting will happen right before the Gala, starting at 5PM. We encourage you to attend to learn more about your Association and offer feedback about the priorities for the year ahead.
You can see the official AGM notice and registration instructions here.

Leadership Through Connection

Join us for a panel discussion series on Leadership Through Connection. This interactive webinar is an opportunity for members to hear perspectives on leadership from their colleagues.

  • Our May 2 panel discussion, which will share perspectives from student, resident and early career physicians will include our President Dr. Kristjan Thompson, along with Dr. Calvin Howard and Allison Balasko. It will be co-facilitated with a medical student representative and Dr. Ming-Ka Chan, Office of Leadership Education, Rady Faculty of Health.
  • Our May 9 panel discussion, which will share perspectives from student, resident and mid-career physicians
  • Our May 30 panel discussion, which will share perspectives from student, resident and late career physicians

Hospital Capacity Still Strained

While hospital admissions due to COVID-19 may have plateaued or be in decline, hospitals are still very much under pressure. This strain is continuing to disrupt or delay care for patients. Doctors Manitoba continues to raise awareness about these concerns as part of our advocacy for action to improve the situation. 

ER Wait Times

The last couple of weeks have been filled with media coverage about ER wait times in Winnipeg, with physicians including our President Dr. Kristjan Thompson raising concerns about lengthy wait times faced by patients.

The WRHA sent out a memo to staff about the situation, in response to ​“concern expressed by various ED doctors in recent weeks in the media.” CEO Mike Nader acknowledged that the current situation and that they ​“could be doing a better job of sharing information” with physicians and staff. ​“It is so important for you to have a better sense of what’s going on,” he explained,” ​“so you can be a more direct part of helping to find solutions.” Mr. Nader has been visiting sites to hear from ER staff and physicians, and in his memo he invited his ​“call for your insight, criticism, and ideas.” 

We see this as a shift in the tone from health leaders. We applaud it and hope is a sign of more open dialogue, more transparency, and more collaboration with doctors and others on improving care. While the actions that follow this dialogue will mean the most, communicating with physicians and inviting their feedback is an important first step towards tackling this serious patient care issue. 

Mr. Nader acknowledged that increased COVID-19 spread is a contributing factor to the current situation, as well as patients who have delayed seeking care, high staff sick time including due to COVID infection, and nursing vacancies.

Watch Dr. Thompson respond to the issue on CityNews.

Testing and Surgery Backlog

Tomorrow, we will release a monthly update to our estimate of the surgery and diagnostic backlog. The updates cover February for surgery and diagnostic imaging, and March for other diagnostic procedures. 

The total estimated pandemic backlog is now 169,198 cases, an increase of 1,311 from last month. It appears the backlog is still growing, though at a slower rate, which reflects several hospitals getting back to regular pre-pandemic baseline volumes. 

The current estimated backlog includes:

  • 55,571 surgeries (as of February 2022), up 751 cases over the last month’s estimate.
  • 46,189 diagnostic imaging procedures (as of February 2022), up 938 cases over last month’s estimate.
  • 67,438 other diagnostic testing procedures (as of March 2022), including allergy tests, endoscopies, mammograms, sleep disorder studies, and lung function tests, an improvement of 378 cases over last month’s estimate. 

The full breakdown will be available on Friday at Doc​tors​Man​i​to​ba​.ca/​b​a​cklog.

Residency Programs Accreditation at Risk

Many physicians and medical learners were concerned today after seeing the front page of the Winnipeg Free Press. The headline today is ​“Hospital crisis puts U of M medical-school programs in danger.” The story reveals that three residency programs — neurology, core internal medicine, and obstetrics and gynecology — have received a notice of intent to withdraw from the national accrediting body the Royal College of Physicians and Surgeons. After their visit to assess the programs last month, the accreditation team cited concerns over whether residents are appropriately supervised in a safe learning environment. The other 43 programs assessed passed.

Dean Dr. Brian Postl responded by identifying how strained and stretched hospitals have contributed to the concerns, and that this situation is not entirely related to just the pandemic. ​“COVID arrived into a system that was not prepared for it, and was already stretched remarkably thin (and) had been living with budgets of austerity for several years,” Dr. Postl said to the Free Press. ​“And superimposed on that was a significant restructuring that was changing the way things worked.” 

The University and Shared Health offered reassuring statements that work is underway to secure additional resources to address the issues and get all three programs back to full accreditation. 

Part of the concerns stem from the balance for resident physicians between providing patient care while receiving the training and feedback they need during their residency. PARIM President Dr. Josh Aquin responded and pointed out that residents ​“work incredibly hard to provide frontline medical care to Manitobans around-the-clock in all corners of the province, all the while completing their advanced clinical training.” He called for ​“a working and learning environment that is safe, respectful, and inclusive.”

Read more in the Winnipeg Free Press article.

Stay in touch about what you are seeing

Please continue to stay in touch with Doctors Manitoba about your work environment and any strain you are observing. We have also heard concerns about rural health care, critical care and ongoing inter-regional patient transfers, particularly for elderly patients. 

Get in touch by emailing us at covid19@​doctorsmanitoba.​ca.

Get Ready to Claim 2021 CME Expenses 

Watch your email this week for a message about applying for your 2021 Continuing Medical Education (CME) Rebate. Eligible physicians will be able to claim up to $3,800 in expenses for last year, plus any unused amount carried over from 2020. We’ve expanded the type of expenses eligible under the rebate and increased limits in some areas as well. You’ll be able to apply online for an expedited rebate.
The 2021 CME Rebate is separate from the $2,000 pandemic education rebates we have offered. 

Supporting Ukrainians Arriving in Manitoba

The province announced this week it is setting up a Reception Centre for Ukrainian evacuees arriving in Manitoba. The reception centre is located at the Best Western Plus Winnipeg Airport Hotel for Ukrainian refugees when they arrive in Winnipeg. Public health nurses will be on site to help triage and refer people to appropriate programs which might include mental health services, prescription refills, managing a chronic condition, or vaccinations (including COVID-19 vaccines.) 

Ukrainians arriving in Manitoba will be eligible for Manitoba Health coverage the date they arrive in Manitoba. The reception centre staff will help them apply, and Manitoba Health cards will be expedited with, we are told, 48-hour turnaround time. In the event you encounter a Ukrainian patient without a health card, you should provide care and direct them to register for a health care. Hold submitting claims until they can provide you with their Manitoba Health registration information. 

How can you help?

As we prepare to welcome people displaced by the war in Ukraine, Doctors Manitoba is working with partners at Shared Health and Manitoba’s health service delivery organizations to compile a list of providers and clinics interested and able to provide health services for this population. It is anticipated there will be a need in both urban and rural communities.

While there is no immediate request for services at this point, we are compiling a list of physicians who can help to be ready.

→ If you may be able to help should the need arise, please submit your name using this online form.

Shared Health has created a resource page about health services for Ukrainians arriving in Manitoba. You will find information about interpreter support, as well as fact sheets about basic health service available in English, Ukrainian, Russian and French. 

The provincial government has also created a general information page for Manitobans with information about how to help, immigration resources and information for new arrivals.

Avian Influenza Detected in Manitoba

Recently, highly pathogenic avian influenza (HPAI), subtype H5N1, has been detected in wild birds and a domestic poultry farm in Manitoba. Multiple outbreaks of HPAI H5N1 have been occurring in North America and Europe this year. At this time, transmission to humans has been rare, with one asymptomatic case report in the UK. The risk of transmission to humans is currently thought to be low. 

Public Health has provided a bulletin for physicians, including signs and symptoms and how to respond as a physician. 

Physician Views Sought

There are three separate groups seeking physician feedback on the topics of aging, concussions and women’s heart health:

  • Concussions: The Ottawa Hospital Research Institute is seeking clinicians to participate in a voluntary survey-based research study with the aim of developing a standardized virtual physical assessment for concussion patients. The study involves completion of two rounds of surveys. The aim of round 1 of the survey is to identify what concussion assessment measures are typically used by clinicians in the clinic setting. If you would like to participate, click here to access the Consent Form and Survey. Click here to provide your email address to receive the second survey.
  • Women’s Heart Health: The Canadian Women’s Heart Health Alliance (CWHHA) is currently conducting a national environmental scan to develop an understanding of the current landscape of women’s heart health programs and services available and to identify system-level barriers in access to women’s specific cardiac care across Canada to inform care and policy changes. Survey data will help inform future projects by the CWHHA with the ultimate goal of improving women’s cardiovascular health across the lifespan. The survey takes less than 15 minutes to complete and your insights will help inform future projects by the CWHHA with the ultimate goal of improving women’s cardiovascular health across the lifespan. 
  • Aging: The Manitoba Centre on Aging is seeking feedback about continuing education and professional development in aging, to gain a picture of the training/​education needs of those working with older adults. You can learn more the initiative and get a link to the survey through this invitation letter

ICYMI

Here are some important and popular recent updates, in case you missed them:

Upcoming Events

Check out our events calendar for upcoming events for physicians. Here are a few highlights to consider over the next few weeks:

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