February 10, 2022
In today’s message you will find:
- COVID Update
- Vaccine Updates
- Restrictions & Mandate Protests Update
- Meet this year’s Resident of the Year
- Prescribe the outdoors with PaRx Pass
- Public Health Success — Addressing COVID & Vaccine Inequities
- Rapid Tests and Isolation Requirements for Physicians
- Fantastic Physicians
- Upcoming Events and Learning Opportunities
Since our last update last Wednesday…
Serious Outcome Surveillance:
- Hospitalizations decreasing but still high: There are 661 people in hospitals with COVID-19, down from 744 last Wednesday.
- Hospital admissions continue to decline: There were 28 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 34 admissions per day, down from 42 the previous seven days.
- ICU occupancy very high and steady: Of the hospitalizations reported above, 42 patients are in ICU, down from 54 last Wednesday. the total number in ICU continues to cover around 109 to 110 patients, well-over the normal 72-bed capacity.
- COVID-related ICU admissions have averaged three to four per day over the last seven days, with seven admitted yesterday. The daily average has improved from five to six admissions per day the previous week.
- 40 more people have died from COVID-19 since last Wednesday with the total now at 1,616.
According to the COVID-19 Tracker Canada Project, Manitoba has an average of 49 hospitalizations per 100,000, down slightly from 53 last Wednesday but still the highest rate in Canada and well above the rate of 36 per 100,000 in Alberta, the next highest province.
*Comparing hospitalizations by jurisdictions continues to be challenging as some provinces may use slightly different standards (e.g. only reporting patients with active COVID-19 infections and not recovered, or only reporting patients admitted because of COVID-19 and not with — Manitoba still reports both using a broader strategy).
While the hospital situation is improving, the strain on hospitals continues to disrupt surgeries and diagnostic testing and it continues to result in patients being transferred to other health regions for care. During the 10-week period of November 22, 2021 to January 30, 2022, Shared Health found surgery volumes in Winnipeg hospitals were down 32%, with 3,101 fewer surgeries performed. Doctors Manitoba is incorporating this into our surgery backlog estimates, which also non-acute facilities in Winnipeg such as Pan-Am and private clinics, as well as rural hospitals. Meanwhile, the ORs at Carmen’s hospital remain closed causing major disruptions to surgical and endoscopy activity at that site.
Surveillance indicators (interpret with caution due to PCR testing prioritization):
- Daily cases high but declining*: 3,525 new cases of COVID-19 have been identified since last Wednesday, including 570 cases reported today. This is a daily average 439, down from 558 last week. The total case count in Manitoba now stands at 125,180.
- Test positivity high but declining*: The provincial five-day test positivity rate is 23.2%, down from 29.2% last Wednesday.
- Active cases decrease*: There are 13,119 active COVID-19 cases province-wide, down significantly from 32,547 last Wednesday.
* A reminder that daily cases are likely significantly under-estimated and test positivity may be over-estimated as rapid test results are not counted in the provincial statistics.
According to Health Canada’s tracking, Manitoba’s seven day rate of COVID-19 is 214 per 100,000, above the Canadian average of 204 but down significantly from 315 last Wednesday. Most other provinces have higher rates but comparing jurisdictions is challenging as testing capacity is strained and prioritized differently across provinces.
Shared Health has produced an updated guide on COVID-19 treatment recommendations, based on advice from the scientific committee on COVID-19 therapeutics.
So far, we are hearing many people potentially eligible for Paxlovid or monoclonal antibodies are not being identified early enough for those treatment options to be effective. Early identification of these patients is critical.
Below are several important updates related to COVID-19 vaccines for the past week.
Vaccine Expense Claim Forms Now Available!
We have launched expense claim forms for physician-led vaccine initiatives. This includes eligible expenses for patient outreach initiatives as well as scheduled vaccine clinics.
Please note we have three claim forms available:
- Patient Outreach Expenses Form can be used to claim email outreach (onetime flat fee of $700), phone outreach ($3 per patient contacted), and immPACC Committee attendance.
- Individual Vaccine Clinic Expense Form can be used to claim expenses for a single vaccine clinic, including the administrative stipend ($25/hour) and/or a top up to meet the minimum guaranteed hourly rate.
- Multiple Vaccine Clinic Expense Form can be used to claim admin stipends and remuneration top ups for multiple clinics on one form.
The claim forms are available here. You can also access a brief guide to tariffs and vaccine funding initiatives here.
You can determine if you are eligible to claim a top up under the minimum remuneration guarantee using this one-page guide. If your total fee-for-service billing during the scheduled vaccine clinic is below the minimum hourly guaranteed rate, you can claim the difference as a top up to bring up up to the minimum hourly rate. The minimum hourly rate is $169.35/hour for clinics held weekdays in Winnipeg, with evening/weekend rates and rural/northern differentials as well. Please note, you must include ALL fee-for-service claimed during the scheduled vaccine clinic, not just vaccine-related claims.
By default, expenses will be paid to physicians for committee attendance and the hourly top-up. Expenses for the administrative stipend, email and phone outreach will be paid to the clinic. Expenses will only be paid via direct deposit.
After you’ve tried submitting an expense, please let us know how it went and if there is anything we can improve.
Please note: there is no longer a need to submit scheduled vaccine clinics in advance. You can simply submit these as you claim expenses after the clinics have occurred.
Immunization after infection
Dr. Joss Reimer confirmed this week that Manitoba is adopting guidance released last Friday from the National Advisory Committee on Immunizations (NACI) about the timing of COVID-19 vaccination for individuals previously infected, though this is being adopted as guidance and not a rule.
The NACI guidance notes there is little evidence about the optimal interval between infection and vaccination, but given the spread of Omicron they are using the limited available evidence along with general immunological principles and expert opinion to provide updated guidance. They also note it is subject to change as more evidence emerges.
The key highlights from NACI’s guidance includes:
- Individuals who were previously infected with COVID-19 should continue to be offered vaccination
- For infection before a first or second dose, the next dose should be provided eight weeks after symptom onset or positive test. However, if individuals are moderately to severely immuno-compromised, the next dose in the primary series should be received four to eight weeks after symptom onset/positive test. Note that the primary series for immuno-compromised individuals is three doses. If the individual has a history of MIS‑C, the next dose should be offered after clinical recovery or at least 90 days since the onset of MIS‑C, whichever is longer.
- For booster doses for individuals age 12 and older, it should be administered three months after symptom onset / positive test, assuming it has also been at least six months from their last dose.
The full NACI document is available here with the supporting rationale for this guidance on the interval between infection and vaccination. Doctors Manitoba will monitor for updates from Manitoba Public Health and provide updates to physicians as this becomes available.
Restrictions & Mandate Protests Update
A reminder that Manitoba’s pandemic restrictions were eased slightly on Tuesday. The changes ease some limits on gathering sizes, but vaccination and face mask requirements were left in place. See a full summary of the changes in last week’s update.
Since this time, an anti-mandate protest has emerged in Winnipeg, similar to the one in Ottawa. A group has maintained a protest since last week by the Manitoba Legislature, with trucks and other vehicles. Memorial Blvd is being used as a staging area by the protesters, who at times disrupt traffic on Broadway to the South and York Ave to the North. On the weekend, a hit-and-run incident injured four of the protesters.
The disruptions have spread, a group of protesters today moving to block the Emerson border crossing, similar to a blockage at the crossing in Windsor, Ontario and a major crossing in Alberta. An anti-mandate protest at Steinbach Regional Secondary School resulted in a school lock down. The school has about 1,700 students. Early reports suggest a group of parents and supporters began protesting shortly after school started today, about between 100 and 150 students walked out to join them around 9AM. This follows reports of other protestors targeting a Winnipeg elementary school.
The protests come at a time that the Omicron wave is gradually receding, and restrictions begin to ease as well. The easing of restrictions has been controversial, with some worried it is moving too fast as hospitals are still under tremendous pressure, and others pushing for restrictions to be eased much more quickly.
In Saskatchewan, the Premier announced on Tuesday that proof of vaccination policies will end on February 14, with other restrictions set to be lifted by the end of February. This includes removing the requirement for masks in public places and mandatory self-isolation.
Alberta’s Premier followed later on Tuesday, announcing proof of vaccination requirements would end that night and capacity limits were increased. Students will no longer be required to wear a mask at school starting on Monday. By March 1, most restrictions will be lifted including all school requirements, capacity limits, mask mandates and working from home. Mandatory self-isolation will become a recommendation at a later date.
Some see the Alberta and Saskatchewan moves as a response to the protesters’ demands as they focus first on removing vaccination requirements.
Other provinces have also followed. Quebec plans to lift most restrictions by mid-March, Newfoundland and Labrador are starting to lift restrictions, and PEI is also making similar moves. Other provinces are expected to announce their plans soon. South of the border, several Democratic-run states are lifting statewide mask mandates as well.
What’s next in Manitoba?
At a briefing these week, Deputy Chief Provincial Public Health Officer Dr. Jazz Atwal said Manitoba continues to rely on its monitoring of data to guide its decision about easing restrictions.
“Just because one province is doing something doesn’t mean we’re necessarily going to do that,” Dr. Atwal noted. “A handful of individuals who protest have no bearing on what public health recommends. It’s as simple as that. We have to look at what we have from a capacity standpoint, to look at what we recommend from a public health perspective, and we’re going to continue to do that.”
Dr. Atwal said while surveillance data is encouraging, showing Manitoba on an improving trajectory, there are no immediate plans to remove mask mandates or proof of vaccination requirements yet. Those restrictions will be removed like all others eventually, but doing so too soon would have an effect on transmission rates.
We understand the provincial government will provide an update on Manitoba’s longer term plans for easing restrictions tomorrow.
Meet the 2022 Resident of the Year
What better time to announce this year’s Doctors Manitoba Resident of the Year than Resident Doctors Appreciation Week!
A natural leader who consistently exceeds the expectations of colleagues and patients, she could not be more deserving of this award. Meet Dr. Dorothy Yu, our 2022 Resident of the Year!
We will be unveiling the winners for our other annual awards soon — stay tuned.
In the meantime, it is still Resident Doctors Appreciation Week. Our team has been connecting with residents at 16 sites across the province, including in the PARIM lounge today.
Don’t forget to send a personalized thank you note to a hard working resident doctor this week. You can do that using our Resident Appreciation e‑card here.
Park Prescriptions (PaRx)
Physicians in Manitoba can now help improve patient health by prescribing access to nature with the Parks Canada Discovery Pass through PaRx, Canada’s national nature prescription program. Medical research has shown a direct correlation between wellness and time spent in nature, with nature prescriptions being named one of the top eight global wellness trends in 2019. Nature prescription programs have been implemented around the world to address mental and physical health problems. At this critical time for health and wellness, with COVID-19 continuing to take its toll on Canadians, physicians can promote the mental and physical health benefits of getting outdoors.
Doctors Manitoba has joined as a partner, and you can participate as a Manitoba physician. Here are they key facts:
- Physicians prescribe one Adult Parks Canada Discovery Pass per month while supplies last. These passes provide 12 full months of access. The Discovery Pass covers admission to one of Manitoba’s most popular nature destinations: Riding Mountain National Park.
- Please prioritize passes for those who live close to national parks, national historic sites, or national marine conservation areas, those who could benefit from it the most and for those whom cost could be a barrier to access, as supplies are limited.
- Physicians have to register first with the PaRX program to be able to prescribe park passes. To register, complete this form.
- Once registered, you will receive further instructions on how to prescribe a National Park pass to your patients
The program has already seen over 1,000 prescribers registered in British Columbia, Ontario, Saskatchewan and Manitoba, with an aim to expand in all provinces and territories. You can learn more here about this unique collaboration between Park Prescriptions (PaRx) and Parks Canada, which was originally started by the BC Parks Foundation in 2020.
Physicians registered with the PaRx program can independently prescribe passes to patients during the course of regular visits. While the program launched in Manitoba in October of 2021, there will be another press release about the program next week.
Addressing COVID and Vaccine Inequities
Earlier this week, Dr. Marcia Anderson provided an update on the disparities in COVID-19 and vaccine access in Manitoba. As a Medical Officer of Health, Dr. Anderson has been a regular voice on this issue during the pandemic in her role as public health lead for the First Nations Pandemic Response Team.
Her presentation is worth a watch (find the link at the end of this story), and we have the highlights for you below.
The analysis looked at COVID-19 infections, serious outcomes and vaccination uptake among white Manitobans and those who identify as Black, Indigenous or People of Colour (BIPOC). BIPOC individuals make up about 36% of our population according to census results.
Earlier in the pandemic, BIPOC people were disproportionately affected by COVID-19, accounting for about two thirds of positive cases and hospitalizations despite only making up about a third of our population. Vaccine access was prioritized for BIPOC communities, including earlier eligibility and targeted access initiatives. These initiatives included prioritizing vaccine eligibility earlier for younger Indigenous people and racialized neighbourhoods, as well as opening Urban Indigenous Clinics, offering language interpreter services, offer paid leave to get immunized and offering community outreach grants.
These policies helped, with BIPOC individuals now accounting for about 41% of those who are vaccinated. This suggests vaccine uptake is slightly higher among BIPOC communities than among white Manitobans.
More importantly, the impact of these policies is reflected in more recent COVID-19 data. In December, a hospital review found BIPOC patients accounted for only 22% of COVID-19 ICU patients and 25% of non-ICU hospitalizations. This is a dramatic change from earlier in the pandemic.
Dr. Anderson called this “a remarkable public health success that occurred in collaboration with members, leaders in BIPOC communities.” She went on to explain that “it’s important to understand that nothing else has changed. There is still systemic racism, there is still overcrowded housing, there is still higher rates of being in low income or higher-risk occupations and yet we see a dramatic difference in the proportion of cases occurring in these communities.”
While the outcome is remarkable, there are reasons for concern once again because of the Omicron variant. Uptake of booster shots is lagging among BIPOC communities, with only 28% of those boosted identifying as BIPOC. Recent breakthrough infections are more common among BIPOC communities, and hospitalizations appear to be disproportionately growing again as well. “This reinforces the need for us to apply the same accessibility lenses to third doses as well as new treatments,” Dr. Anderson added. On Monday, Manitoba formally adopted guidance from NACI that includes offering booster doses to BIPOC youth between 12 – 17 years of age, six months after their second dose.
All physicians can help by focusing on eligibility and access in their practice. Encourage BIPOC patients to get their booster dose, and consider outreach efforts to connect with BIPOC patients and communities to invite them to get their third dose. Consider working with a BIPOC community or organization to support outreach. Remember that Doctors Manitoba has negotiated special funding in addition to the $20/dose tariff to support physician-led vaccine initiatives, and that funding can support this important work.
And when you are meeting with patients, here are some quick stats on vaccine effectiveness from Dr. Anderson’s presentation:
- BIPOC individuals with two doses are nearly two times less likely to be hospitalized or require intensive care after two doses, and about three times less likely after a three doses.
- They are two times less likely to die from COVID after two doses, and over 32 times less likely to die after three doses.
Rapid Tests & Isolation Benefit for Physicians
We have two important COVID-related updates for physicians today.
First about access to rapid antigen tests (RATs) for doctors’ offices. As previously communicated, the province has agreed to send RATs to rural and Northern doctors’ offices that are located 45 minutes or more from a provincial testing site for physician and clinic staff use. We advocated for this based on recent changes to return-to-work guidance from Shared Health that requires vaccinated health care workers to use RATs for 10 days after a close household contact. Physicians and clinic staff can also pick up RATs at provincial testing sites for this purpose, but will require a work ID, pay stub, business card or other proof of your status as a physician or health care worker.
We continue to advocate for improved rapid tests access for your patients as well, and we hope to see success in this area as the supply of RATs improves in Manitoba.
Second, we have pressed for an enhancement to the physician COVID-19 Isolation Benefit. The benefit has provided up to 20 days of financial support to physicians who have to isolate due to COVID-19. With the Omicron variant, some physicians have met the 20-day limit, even with more flexible return-to-work guidelines following an exposure or infection. Starting this week, physicians can request up to five additional days of support in the case of a positive test result or if you are immuno-compromised.
Rapid test results are satisfactory to claim the isolation benefit. We recommend taking a photo of your positive rapid test with the date it was taken for documentation purposes.
ICYMI — Recent Key Updates
Here are a few recent updates, in case you missed it
- Vaccine eligibility has been expanded, specifically boosters for youth aged 12 – 17 here.
- Be sure to thank a Resident Doctor with a personalized ecard for Resident Doctors Appreciation week Feb 7 – 11. You can do that here.
- There are two treatment options for COVID: Paxlovid and monoclonal antibodies. Find resources on Shared Health’s COVID treatment resource page, including eligibility criteria and referral forms. Both treatments are time sensitive and need to be initiated within a 5 – 7 days of symptom onset.
- Who doesn’t love a little bit of a distraction these days? We’re hosting a Wordle challenge with a $200 prize for the winning member to use at a local business of your choice that will improve your joy and wellness. You must complete at least 20 games by February 28 Find out more here.
- We want physician feedback to help inform the Provincial Budget. Share your thoughts with us before February 15.
- There is still more to learn about long COVID but we’ve got some details and information on a self-management group for patients suffering from long COVID.
- January was a difficult month for Manitoba in the fight against COVID-19. We have broken down the stats for you here.
Celebrating Fantastic Physicians!
Congratulations to Dr. Lindsay Nicolle and Dr. Phillipe Lagacé-Wiens on being named to the Highly Cited Researchers 2021 list.
Dr. Nicolle, a professor emeritus of internal medicine at the Max Rady College of Medicine, is no longer active in research, but throughout her career, a major topic she addressed was clinical studies relevant to urinary tract infection. One question studied was the management of asymptomatic bacteriuria, which has become a topic of major interest in the last decade as antimicrobial stewardship initiatives have become essential in the management of infectious diseases.
Dr. Lagacé-Wiens, an assistant professor of medical microbiology/infectious diseases at the Max Rady College of Medicine, works to better understand the resistance to antibiotics in bacteria and evaluate new antibiotics against resistant bacteria to confirm that they might work to treat patients with similar infections in the future. He also conducts research to evaluate new diagnostic tools in the laboratory to help diagnose infectious disease and antibiotic resistance.
Let’s get more Manitoba physicians recognized:
- Nominations are open for the Canadian Medical Hall of Fame, due June 13. Read nomination FAQs about nomination here and tips on creating a compelling nomination package here.
- The WXN Top 100 Most Powerful Women Awards are open for nominations, due May 17. The awards celebrate Canada’s women leaders who lead selflessly with humility and authenticity, lift others up around them and who face adversity with bravery and strength. Nominate a colleague or yourself today!
- Do you know a UM graduate who has achieved outstanding accomplishments in their professional and personal lives? Nominate them for a Distinguished Alumni Award. Find out more here and nominate someone here.
Events & Learning Opportunities
Bookmark our Events Calendar to be sure you don’t miss any events or learning opportunities that interest you.
Early Career Learning Series
CMA Joule recognizes the challenges new physicians face and is offering a Early Career Learning Series to help early career physicians increase awareness and competency in key areas crucial to success. Learn more about the four sessions being offered here.
CanCOVID Speaker Series — Public Health Measures and Child Health During COVID-19 — February 15 2 – 2:30pm
Join researchers from SickKids and ParticipACTION to understand how public health measures have impacted Ontario children’s health behaviours and mental health during the COVID-19 pandemic, and how policy makers, educators, health professionals, and parents/caregivers can act to mitigate the impact.
Learn more about this presentation here.
Physician Leadership Institute Course for Physicians Practicing in PMH, NHR, or IERHA
Your colleagues, Doctors Manitoba, CMA Joule, and IERHA, through the Affinity-funded Physician Health and Wellness Community of Practice, want to reduce physician burnout and increase physician wellness. Since leadership skills have a measurable impact on burnout and satisfaction we are pleased to offer all three participating pilot regions the opportunity to participate in these virtual Physician Leadership Institute (PLI) courses as a small contribution toward this goal. A formal leadership role is not required. The course is aligned with the LEADS in a Caring Environment framework.
Questions? Email: firstname.lastname@example.org.
Cost: $200 each course (subsidized) Costs may be eligible for reimbursement through the DRMB CME Rebate