February 14, 2022
In today’s message you will find:
- COVID-19 Surveillance Update
- Vaccine Updates
- Restrictions Roadmap
- Join us for the Task Force Town Hall
- Lab Supply Shortage
- Fantastic Physicians
- ICYMI — recent updates
- Events & Learning Opportunities
Since our last update last Thursday…
Serious Outcome Surveillance:
- Hospitalizations decreasing but still high: There are 633 people in hospitals with COVID-19, down from 661 last Thursday
- Hospital admissions continue to decline: There were 20 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 31 admissions per day, down from 39 the previous seven days.
- ICU occupancy very high and steady: Of the hospitalizations reported above, 40 patients are in ICU, down from 42 last Thursday.
- COVID-related ICU admissions have averaged three to four per day over the last seven days, with two admitted yesterday. This is similar to the previous seven day period.
- 21 more people have died from COVID-19 since last Wednesday with the total now at 1,637.
According to the COVID-19 Tracker Canada Project, Manitoba has an average of 46 hospitalizations per 100,000, down slightly from 49 last Thursday 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).
Surveillance indicators (interpret with caution due to PCR testing prioritization):
- Daily cases high remain high*: 1,830 new cases of COVID-19 have been identified since last Thursday, including 188 cases reported today. This is a daily average 458, up from 439 last week. The total case count in Manitoba now stands at 127,010.
- Test positivity high but declining*: The provincial five-day test positivity rate is 22.3%, down from 23.2% last Thursday.
- Active cases increase*: There are 14,938 active COVID-19 cases province-wide, up slightly from 13,119 last Thursday but down significantly from the week before.
* 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 171 per 100,000, above the Canadian average of 157 but down from 214 last Wednesday. Most other provinces have higher rates but comparing jurisdictions is challenging as testing capacity is strained and prioritized differently across provinces.
Vaccine & Treatment Updates
Physicians are reminded of the following recent vaccine updates:
- Boosters for Youth: Vaccine booster eligibility was expanded to include youth age 12 – 17 at increased risk of serious outcomes because of health or social considerations, including those with underlying medical conditions, youth residing in congregate settings, and BIPOC youth or those living in racialized or marginalized communities. See the full update here.
- Immunization after infection: Manitoba has adopted NACI’s guidance on the timing of COVID-19 immunizations after an infection. For first and second doses, it should be eight weeks after an infection’s symptom onset or positive test, and for a booster shot it should be three months after infection assuming it has been at least six months from the last dose. See the full NACI document is available here. This is a guideline, however, and patients and their physicians can consider an earlier dose after infection.
- Vaccine Expense Forms Now Available: You can now claim eligible expenses for physician-led COVID-19 vaccine initiatives, including for patient outreach and scheduled vaccine clinics. Find out more here. Every doctors’ office that has offered COVID-19 vaccines since September could qualify.
So far, 86% of Manitobans age 5 and over have received at least one dose and 81.1% have received two doses. Just over 40% have received their third dose. 58.4% of children age five to 11 have received their first dose.
Uptake of COVID-19 treatments has not been as high as some expected, and in some cases it is because individuals who would qualify and benefit from treatments aren’t seeking testing early enough. Treatments must start within 5 – 7 days of symptom onset.
So far, about 450 doses of monoclonal antibodies have been administered, with more than 1,000 doses still available. Nearly 100 doses of Paxlovid (oral antiviral) have been administered, with about 1,000 doses still available.
The criteria targets individuals at increased risk of serious illness from COVID-19, including those who are:
- Unvaccinated or partially vaccinated with no prior COVID infection if they are either over age 40, or age 40 and under with a serious health condition.
- Immuno-compromised adults (age 18+) regardless of vaccination status or previous infectious.
- Fully vaccinated with a serious health condition, if they are not boosted and it has been 4+ months since their last dose, and they are age 50+, or age 40+ if they are Indigenous.
Key resources on COVID treatments:
- Provider resources on COVID Treatments, including referral information.
- Patient resource on COVID Treatments
- Shared Health guide on various COVID-19 treatment recommendations, based on advice from the scientific committee on COVID-19 therapeutics.
Easing of Restrictions Roadmap
On Friday, the Premier announced that the government is accelerating its plan to reduce public health restrictions based on the improving COVID-19 situation in Manitoba.
This three-step plan involves removing several restriction starting tomorrow, February 15, with additional steps to follow on March 1 and 15. We have a summary of these changes, along with Doctors Manitoba’s public response, guidance for physicians and a message from Dr. Brent Roussin to all health care workers below.
Effective tomorrow (February 15), Manitoba’s pandemic response alert level will be downgraded from Orange to Yellow (caution). Capacity limits will be lifted or increased in many areas:
- Indoor and outdoor private residential gatherings will no longer have any capacity limits, regardless of vaccination status.
- Indoor public gatherings will not longer have a limit if everyone age 12+ is fully vaccinated. If anyone age 12+ is not fully vaccinated, capacity is limited to 50 people, up from 25 people. This rule also applies to weddings and funerals.
- Outdoor public gatherings will no longer have any capacity limits, regardless of vaccination status.
- Restaurants, gyms, museums, casinos, movie theatres, and professional sports or performing arts events will no longer have any capacity limits, but proof of vaccination will be required.
- Indoor religious services will have no capacity limit if proof of vaccination is in place. If there is no proof of vaccination required, capacity is limited to 500 people or 50% capacity, whichever is lower.
- Recreational sports and arts: No capacity limits for spectators, but proof of vaccination remains. Tournaments are again permitted. For youth age 12 – 17, proof of vaccination or testing is no longer required.
Schools will also move to Yellow (caution) on the pandemic response system, which requires cohorts in K‑6. Masks will continue to be required indoors, but medical masks will now be recommended rather than required for staff. No masks will be required during physical education. Schools will continue to send out community notification letters if public health officials have identified increased transmission or recommended remote learning for a class, cohort or entire school.
Effective March 1, the province plans to remove proof of vaccination requirements. Masks and other restrictions will be lifted March 15.
Several other jurisdictions are making similar moves to ease restrictions:
- Alberta ended proof of vaccination last week, with masks no longer required in schools today. Most restrictions will be lifted by March 1, including capacity limits and mask requirements.
- Saskatchewan is ending proof of vaccination today, with other restrictions set to be lifted by the end of February.
- Ontario will lift capacity limits and proof of vaccination on March 1, with a date for the removal of mask requirements coming soon after.
- Quebec plans to lift most restrictions by mid-March.
What is the Rationale?
While no data or projections were presented at the press conference Friday morning, a slide deck was made available later in the day. The update notes that:
- New cases and test positivity are improving
- Wastewater surveillance indicates transmission is dropping
- New hospitalizations are declining from a peak the week of January 9
- New deaths are decreasing, from a peak the week of January 16
- Projections for hospitalizations suggest the rate could return to pre-Omicron levels this month.
Dr. Roussin has pointed out that restriction are a blunt instrument that have many difficult unintended consequences on people’s health and well-being, and thus must only be in place when absolutely required. While restrictions are changing, public health recommendations will remain to help Manitobans reduce the risks, like other communicable diseases. He has also stressed that should the situation escalate, he will not hesitate to recommend a return of restrictions to the government.
The two-week period between each of the three steps is about four incubation periods, he noted, which provides time for continued surveillance and monitoring.
The projections here in Manitoba look very different than those produced by the Ontario Science Table. This group predicts hospitalizations and ICU occupancy in Ontario to “rebound” after reopening moves, except under the most favourable of assumptions about recent infection rates and booster uptake. Regardless, they say to expect prolonged pressure on ICUs and hospitals.
Doctors Manitoba’s Response
On Friday, we provided a statement urging Manitobans to be cautious to help protect overwhelmed hospitals and help prevent a back-slide on COVID that could prolong the Omicron wave. Our statement was widely circulated both on social media and in the news.
While all of us are ready for the pandemic to be over, it is important for Manitobans to be cautious a little longer to protect our hospitals, and to ensure we don’t slide backwards and end up making this Omicron wave last even longer.
Doctors strongly recommend for all Manitobans to continue following public health COVID-19 guidance even if it is no longer reflected in a government restriction. We also strongly recommend all eligible Manitobans to get vaccinated including a booster shot. Only about 40% of all Manitobans have received their third dose, which is much lower than countries like Denmark and the UK that are lifting restrictions.
We have been through so much together over the past two years, and doctors remain here for you to listen and to help. We want the very best for our patients in terms of their physical and mental health. We want to protect our precious resources in terms of hospital capacity today, and into the future. We want those waiting for surgery and diagnostic procedures to get the help they need as soon as possible. We will get through this pandemic, and we will get there faster by being cautious and by supporting and protecting each other.
Guidance for Physicians
We understand many physicians and patients may be anxious about these changes. Based on where we are at today, we have put together the following guidance during this transitional period:
- Reinforce the importance of being cautious with patients, including promoting vaccination and booster shots, continued use of masks in public places and the need to stay home when sick to avoid infecting others.
- Doctors’ offices can and should continue to require patients to wear masks for the time being, even after the provincial mask requirements are lifted on March 15.
- Continue to practice precautions in your office, such as patient screening and appropriate PPE. Remember that physicians must provide or arrange for in-person care for patients who request this over a virtual visit.
We have a number of posters you can use in your clinic to advise patients of the need to wear a mask, about the precautions you are taking in your clinic, and the need to be respectful of clinic staff and physicians.
In fact, just last week we were reminded that these signs can be helpful from Dr. Michael Loudon from the Teulon Medical Clinic. “Last week we had two incidents where patients were abusive toward me and my clinic staff,” he explained. “I reached out to Doctors Manitoba about signage for the clinic. They were quick to respond with the resources I could print and put up around the clinic. The signs they provided were very effective in setting expectations for anyone entering the clinic and provided our staff with a visible shield to deter any future outbursts. Doctors Manitoba staff also encouraged me to report the incident using the Physician Practice Incident Report Form.”
You can download posters and notices for your practice here:
- Respect Poster
- Mask Required Poster
- Mask Required Poster — low ink version
- Safety Measures
- Vaccine Questions / Doctors Have Answers
If you have a suggestion for a resource you need in your clinic or practice, we’d like to hear from you. Email email@example.com.
Message from Dr. Brent Roussin
The following message is being distributed from Dr. Brent Roussin and David Matear, co-leaders of the Incident Command team, to health care workers across Manitoba.
On Friday, a phased loosening of public health orders over the coming weeks was announced. We anticipate there will be questions about what these changes will mean for the health system, where response to COVID-19 remains a significant area of focus and operational priority. We want to provide the following reassurance.
Over the coming weeks, while Manitobans begin to return to more normal activities permitted by these changing public health requirements, our health system will continue to support both COVID and non-COVID care. Together with Public Health, Manitoba’s Health Incident Command will continue to closely monitor key metrics, including occupancy, capacity and staffing, as well as epidemiological modelling. All indications at present, hospitalizations and staff sick time included, point to an improving situation ahead.
We can expect to see some increase in transmission of the virus as restrictions ease and the Provincial COVID-19 Incident Command structure remains in place with plans to increase capacity, should it be required.
We know that many staff remain redeployed from their usual duties, home facility or program, and we will be working with all service delivery organizations for an orderly return of our workforce as soon as operationally possible.
A transition from COVID response to regular operations, however, will take some time and will include consideration of both the need to ensure the safety of our patients, residents and clients and the desire that we all have to return staff and reunite teams. This work will also include planning for the orderly recovery of services that have been impacted over the past two years and we will work closely with the Diagnostic and Surgical Recovery Task Force to ensure that a return to more regular operations includes prioritization of the services and procedures that must be restored most quickly.
We remain grateful for the efforts of health-care workers across Manitoba and acknowledge that within the health system, the demands of the pandemic are not yet over, though they are lessening. Thank you for your work in the days and weeks ahead.
Join Town Hall with Backlog Task Force
Join us on March 2 for a special virtual Town Hall with the Diagnostic and Surgical Recovery Task Force, organized by Doctors Manitoba for the medical community.
The Task Force was appointed by the government in December to address the growing backlog of surgeries and diagnostic procedures caused by pandemic disruptions. This was one of three recommendations Doctors Manitoba made in June last year in our first report on the backlog.
The Town Hall will feature a presentation from the Task Force leads followed by an extended Q&A to take questions and suggestions from physicians.The panel will include:
- Dr. Peter MacDonald, Chair of the Task Force and an orthopedic surgeon in Winnipeg
- Dr. Ed Buchel, Provincial Specialty Lead for Surgery
- Dr. Marco Essig, Provincial Specialty Lead for Diagnostic Imaging
- Mr. Matthew Lister, Task Force Director
Please join us for this important event. Registration in advance is required
- Date: Wednesday, March 2
- Time: 6:30PM
- Where: Registration for Zoom Town Hall is required: Click here.
When you register, you will have the opportunity to submit a question or suggestion for the Task Force. You will also be able to submit questions live during the Town Hall. We will do our best to get to as many questions as possible during the event. For background, you can learn more about the Task Force here:
- Task Force Website, including links to its mandate, membership, and progress updates.
- Message to Physicians from Task Force Chair
Choosing Wisely During Lab Supply Shortage
As with nearly all other parts of Canada’s health care system, our laboratory testing capacities have been strained as a result of COVID and because of supply shortages. The Canadian Society of Clinical Chemists and the Canadian Association of Medical Biochemists, through the Choosing Wisely Campaign, have developed recommendations about the critical shortage of laboratory supplies.
Choosing Wisely is hosting a special webinar on blood tube shortages on Thursday February 24 at 11am. Register here.
Celebrating Fantastic Physicians!
Congratulations to Dr. Barry Lavalee who received the Canadian Association for Medical Education 2022 Certificate of Merit! The award promotes, recognizes and rewards faculty committed to medical education in Canadian medical schools. Dr. Lavallee has been recognized many times over in the last few years for his leadership and advocacy.
We want to share physician accomplishments with our members! Do you know of a colleague who has received an award or recognition for the work they do? We’d like to hear about it. If you know of a physician or medical learner who has been recognized with an award or honour, please let us know by emailing firstname.lastname@example.org!
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.
ICYMI — Recent Updates
Here are a few recent updates, in case you missed it
- Meet the 2022 Doctors Manitoba Resident of the Year, Dr. Dorothy Yu.
- Manitoba physicians can now prescribe the outdoors to their patients through the new PaRx program. Learn more here.
- We’ve advocated for RATs for Rural & Norther Doctors’ offices & an extension for Isolation Benefits
- 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.
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: email@example.com.
Leading with Emotional Intelligence — March 3 & 10 — 9am‑3:30pm11.5 accredited CPD hoursLearn more and register here before February 1 (limited spots available)
Cost: $200 each course (subsidized) Costs may be eligible for reimbursement through the DRMB CME Rebate