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February 2, 2022

In today’s message you will find:

COVID Update

Since our last update on Friday…
Serious Outcome Surveillance:

  • Hospitalizations high: There are 744 people in hospitals with COVID-19, up from 715 on Friday.
  • Daily average hospital admissions down: There were 32 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 41 admissions per day, down from 53 the previous seven days. 
  • ICU occupancy very high and steady: Of the hospitalizations reported above, 54 patients are in ICU, up from 52 on Friday. Yesterday there was a total of 110 patients in ICUs, unchanged from Friday but still well-over the normal 72-bed capacity. 
  • COVID-related ICU admissions have averaged five to six per day over the last seven days, with 4 admitted yesterday. The daily average is in the same range as the previous week. 
  • 33 more people have died from COVID-19 since Friday with the total now at 1,576.

According to the COVID-19 Tracker Canada Project, Manitoba has an average of 53 hospitalizations per 100,000, up slightly from 51 on Friday. This continues to be the highest rate in Canada, well above the rate of 36 per 100,000 in Alberta.

* 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 but steady*: 2,793 new cases of COVID-19 have been identified since Friday, including 526 cases reported today. This is a daily average 558, down from 697 last week. The total case count in Manitoba now stands at 121,655.
  • Test positivity remains high*: The provincial five-day test positivity rate is 29.2%, down only slightly from 32.1% on Friday.
  • Active cases increase*: There are 32,547 active COVID-19 cases province-wide, up from 29,720 on Friday.

* 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 315 per 100,000, above the Canadian average of 276 but down from 345 on Friday. Several provinces have higher rates. Comparing jurisdictions is challenging as testing capacity is strained and prioritized differently across provinces.

Omicron Sub-variant

A sub-variant of the Omicron strain, known as BA.2, is overtaking the original BA.1 Omicron variant in several countries. An update from the World Health Organization yesterday suggests that BA.2 is no more severe than the original Omicron and that vaccines appear to offer similar protection. Data from Denmark suggests BA.2 is more transmissible than the original, which could be why it is overtaking BA.1 in several countries. 

COVID-19 Treatment

Treatment options for COVID-19, found here, are now available, by referral, for patients who meet the required criteria. COVID positive patients who are symptomatic AND meet specific criteria should seek treatment within 5 – 7 days of the onset of symptoms. 

Travel Restrictions

The federal government recommends that Canadians avoid non-essential travel outside of the country, regardless of vaccination status. Those needing to travel should refer to the guidance for COVID-19 Vaccinated Travellers Entering Canada, and can refer to updated travel and health restrictions for other countries here.

January x COVID — in Review

January was a difficult month on many levels as the Omicron wave swept across Manitoba.

Here’s a summary of the concerning trends we observed:

  • 38,957 people tested positive for COVID-19, or 1,257 per day
  • The estimated number of infections would be 312,000 to 390,000, or up to 12,500 per day.
  • 1,532 people were hospitalized with COVID-19, or 49 per day
  • 173 people died with COVID-19, or 5 – 6 per day. 

Hospitals have been pushed the limit again, with ICUs well over capacity, hundreds more surgeries being cancelled, and patients being transferred to far-away hospitals for care. 

More Manitobans died in January from COVID-19 than any other month since the vaccine became available to the public in Manitoba. 

While these are all trending statistics, there are reasons for hope:

  • Over 238,000 people were vaccinated in January
  • About 38% of the population is now boosted, up from about 24% at the beginning of the month
  • New hospitalizations are decreasing, with a rolling 7‑day average of 43/​day, down from a high of 60/​day mid-month. 
  • There are other signs spread is decreasing too.

Today, Doctors Manitoba recognized how the public has helped to slow the spread of COVID-19, and urged Manitobans to continue helping to protect hospitals and vulnerable citizens. 

Restrictions Easing on Feb 8

Earlier today, the government announced its plans to begin easing restrictions when the current public health orders expire on February 8.

Dr. Brent Roussin offered some context. He reminded us that last week, the modeling they released showed a peak or imminent peak in this wave. While this was encouraging, it was not enough to make a definitive call. That’s why existing restrictions were extended by one week, to February 8. Today, he said those indicators have continued to trend in the right direction, suggesting the Omicron wave has peaked.

“We’ve very likely peaked in cases, very likely peaked in hospital admissions, and are peaking or peaking soon regarding admissions to ICU,” Dr. Roussin explained. ​“We looked at industries and sectors where there is much more frequent testing and look at absenteeism rates and their test (positivity) rates and we see those are all showing us a peak a week or two ago.” He said that based on all of this monitoring, ​“we can move cautiously at this point.”

He also stressed that a cautious approach was needed because of the continued strain on hospitals. Today, there are 744 people in hospital with COVID-19, accounting for about half of medicine beds in the province. Dr. Roussin again pointed out that not all of these patients are in hospital because of COVID. All hospital patients are screened and tested regardless of the reason for their admission, and through chart reviews officials estimate that about 60% of the patients in hospital with COVID are there for other reasons and thus would have been in hospital regardless of COVID-19. While this adds important context, he noted that all of these patients contribute to strain in the acute care sector because they require additional care and precautions.

In ICUs, where 54 of the 110 patients have COVID-19, chart audits suggest about 70% of the COVID ICU patients are in ICU because of the virus.

Restriction Changes

Based on the ongoing monitoring and modelling, the government announced the several changes to ease pandemic restrictions starting on February 8. Generally speaking, vaccination requirements remain in place along with other precautions in public places like fact masks, with some changes to gathering size limits. These changes will remain in effect for two weeks, expiring on February 22.

The changes include:

  • Allowing larger private gatherings. Indoor private gatherings will be limited to the household plus 25 people if everyone age 12+ is fully vaccinated, up from household plus 10. If anyone age 12+ is not folly vaccinated, the limit is household plus 10 people, up from five.
  • For outdoor private gatherings can include the household plus 50 people if everyone age 12+ is fully vaccinated, up from household plus 20. If anyone age 12+ is not folly vaccinated, the limit is household plus 20 people, up from 10.
  • For restaurants and bars, all patrons age 12+ must continue to be fully vaccinated. Capacity remains limited to 50%, but is not longer limited to a maximum of 250 people. Liquor sales must end at midnight, an extension from the current 10PM cut off.
  • For other businesses and public places, such as gyms, casinos, museums and sports/​arts venues, vaccination requirements and 50% capacity limits remain, but capacity is no longer limited to 250 people. This will allow the Winnipeg Jets, for example, to have up to 50% attendance at games. 
  • Indoor religious services continue to be limited to 25% capacity or 250 people when no proof of vaccination is required. If attendees must be fully vaccinated, capacity continues to be limited to 50% but is no longer limited to 250 people.
  • For retail, the 50% capacity limit in the Southern Health region has been removed. All retail stores and malls in Manitoba must continue to ensure physical distancing and masking.

You can see a summary of all of the current and new restrictions here.

Is the public approaching restriction fatigue?

A constant balancing act for governments is ensuring restrictions are based on public health evidence and advice, while also considering the potential for public adherence to restrictions. A new poll released this week by the Angus Red Institute found that 54% of Canadians believe restrictions should be eased, up from 40% in early January. The support to ease or end restrictions was 51% in Manitoba, up from 44%. While a majority of Manitobans surveyed now support easing or lifting restrictions, it is the lowest level of support outside of Atlantic Canada.

What’s happening elsewhere?

The stringency of current restrictions in Manitoba are middle-of-the-pack according to monitoring by the Bank of Canada. Several provinces have signaled an intent to ease restrictions. 

In Ontario, for example, the first step to easing restrictions took effect on Monday. The restrictions in place in Ontario prior to Monday were more stringent than in 

Manitoba in several ways, and the changes on Monday are somewhat aligned with Manitoba’s restrictions:

  • Social gatherings are limited to 10 people indoors and 25 people outdoors. This is similar to the limits that will come into place in Manitoba on February 8 if unvaccinated individuals are present.
  • Restaurants, bars and many other public places will be able to reopen at 50% capacity, similar to Manitoba. Ontario limits retail settings to 50% capacity, while Manitoba does not. Sporting and cultural events are limited to 50% capacity or 500 people, while Manitoba will only limit capacity to 50%.
  • Indoor religious services are limited to 50% capacity, similar to Manitoba, though no proof of vaccination is required in Ontario.

Meanwhile, several people have fixated on other countries lifting restrictions in major ways. In Denmark, for example, all restrictions were just lifted as public health officials declared COVID-19 was no longer a ​“critical threat.” While the decision is not without controversy, it is important to note that 61% of all Danes have been boosted, while the rate in Manitoba is just below 40%. Indeed, the Danish Prime Minister noted that ​“it is due to the Danes’ goodwill to be vaccinated — also with a third dose — that the restrictions can now be lifted.” 

In England, most restrictions have also been lifted, including capacity limits, mask requirements, and proof of vaccination. Again, the timing of the Omicron wave and booster shot uptake is important to consider. In the UK, 55% of the population has received a third dose.

Vaccine Updates

Join the many clinics that have already registered to participate in this Friday’s Vax-a-Thon! This is a great opportunity to offer more protection to Manitobans, with some unique remuneration opportunities to support your focused work in this area. We chose February 4 because many school divisions have PD days planned that day. We have been promoting the Vax-a-thon over the last week to raise public awareness and demand. All participating clinics with available appointments are listed at Man​i​to​baVac​cine​.ca/feb4.

More information, remuneration details, posters for your clinic, and social media graphics and a sample message you can send to all of your patients can be found HERE.

Moderna Hesitancy?

While the Moderna Spikevax vaccine has had full regulatory approval in Canada for some time, it finally achieved this stamp of approval in the U.S. on Monday.

However, we continue to hear reports of some patients seeking out Pfizer over Moderna, and refusing Spikevax outright.

In Manitoba, Pfizer is recommended for those under the age of 30 due to a lower risk of myocarditis, which is exceedingly rare and generally mild following mRNA vaccines. Moderna is recommended for those over the age of 30 to help preserve Pfizer doses for those under 30.

If you face concerns like this from patients over the age of 30, it could be worth pointing out that while both vaccines are very effective, emerging evidence is actually suggesting Moderna offers stronger protection:

Vaccine coming for youngest children?

Pfizer has submitted data to the FDA in the U.S. about the safety and efficacy of its COVID-19 vaccine among children 6 months to four years in age. The application will be considered under the emergency use authorization, similar to Health Canada’s interim authorization process. 

Over 1.6 million children under the age of 5 have tested positive for COVID-19 in the U.S. so far. The company is seeking approval for two small doses for this age group in what is planned as a three-dose primary series. Data on the third dose will follow. 

Over 10 billion doses now administered

This week, the world surpassed a staggering milestone: over 10 billion doses of COVID-19 vaccines have been administered with over 61% of the world population receiving at least one dose. However, only 10% of people in low-income countries have received their first dose, raising concerns about vaccine equity and the potential for more variants of concern to emerge as a result.

In Manitoba, over 2.7 million doses have been administered.

Last week, Doctors Manitoba President-Elect Dr. Candace Bradshaw pointed out to Manitobans that this real world experience, combined with rigorous clinical trials, is why physicians are so confident in the safety and effectiveness of the vaccines. She noted that ​“COVID-19 vaccines are not experimental. They are now routine.” Listen to her remarks here.

Long COVID

Long COVID (or post COVID) is affecting many Canadians weeks after COVID-19 infections. Lingering symptoms affect 80% of Canadian adults in the short term (4−12 weeks), 60% of adults in the long term (12+ weeks after infection), and 58% of children (4+ weeks post infection). 

More than 100 symptoms have been reported, but common symptoms can include:

  • fatigue
  • memory problems
  • sleep disturbances
  • shortness of breath
  • anxiety and depression
  • general pain and discomfort
  • difficulty thinking or concentrating
  • post traumatic stress disorder (PTSD)

Find more information on long COVID here or read Understanding the Post COVID-19 Condition (Long COVID) and the Expected Burden for Ontario.

Long COVID Self-Management Group

The Winnipeg Regional Health Authority is offering a 7‑session Long COVID Self-Management Group. The program aims to help those 18+ whose long COVID symptoms have lasted more than 3 months and are negatively impacting their life. The sessions, over 7 Tuesday lunch hours from Feb 15 — Mar 29, will help patients manage fatigue, brain fog, anxiety and guilt and will cover breathing and medication management. If you have a patient who might be right for this program, they can call 204−831−2181 to register. 

Nominate a woman physician today!

Do you know a powerful and influential female colleague? The WXN Top 100 Most Powerful Women Awards are open for nominations. 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! Nominations close May 17, 2022 at 10:55am (CST).

Cannabis/​chronic pain study

Researchers at the Centre de recherché du CHU de Québec-Université Laval, are conducting a research project on therapeutic options for the relief of chronic musculoskeletal pain. Their project aims to gain a better understanding of the motivations and expectations of physicians and patients regarding the prescribing and use of medical cannabis for chronic musculoskeletal pain. The pan-Canadian project needs physicians to make an important contribution to the advancement of knowledge on chronic pain. Participation in this project consists solely in the completion of a 15-minute online questionnaire. The Research Ethics Board of the CHU de Québec-Université Laval Research Center has assessed project MP-20−2020−4962​’s compliance with the principles governing research ethics.

Contact Amy Blanchette, researcher assistant, at amy.​blanchette@​crchudequebec.​ulaval.​caif you have questions. More information about the project can be found here and a promotional poster can be found here.

ICYMI — Recent Key Updates

Here are a few recent updates, in case you missed it:

  • There are two treatment options for COVID in Manitoba. Paxlovid arrived Manitoba last week, and the oral antiviral is being used as an early treatment option for individuals at risk for serious illness. 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. 
  • Missed the COVID Immunity Webinar? It was chock-full of the latest science on immunity and vaccine effectiveness, including against Omicron. We’ve got the key takeaways here, and links to see the full presentation. 
  • We have made some progress when advocating with provincial officials for improved access to rapid tests.

Events & Learning Opportunities

Bookmark our Events Calendar in your browser!

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: jmacdonald@​doctorsmanitoba.​ca.
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

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