Thank a Resident This Week!

It’s Resident Doctor Appreciation Week! Doctors Manitoba joins physicians from across the province in recognizing the dedication and hard work of resident doctors. The pandemic has had a major impact on all physicians, and resident doctors are no exception. We have all been inspired by how resident physicians have handled the disruptions and uncertainty during COVID-19, and have assisted with the pandemic response in a variety of capacities.

We encourage all members to take a moment this week and thank the resident physicians you work with. Doctors Manitoba has created a Resident Appreciation e‑card, so you can send messages of gratitude to residents throughout the province.
Recognizing the impact the pandemic is having on residents, our team has planned a few special activities this week to help demonstrate the appreciation physicians have for residents:

• We are holding a draw this week with prizes for resident physicians focused on improving their well-being in a self-defined way
• We have engaged 16 residency sites throughout the province to provide some refreshments during breaks and to encourage residents to connect with each other (schedule sent to residents directly)
• We are partnering with PARIM to provide treats at their lounge this Thursday for residents

Residents have a tremendous impact on patient care, and they are an invaluable partner to other physicians. During this week, you can also consider learning more about residents from the following sources:

• Watch our video about Dr. Heather Watson, the 2021 Resident of the Year. Stay tuned later this week, when we will unveil the 2022 Resident of the Year!
• Read our profile of Dr. Lerly Luo, which appeared in Rounds last year. Dr. Luo reflects on what COVID-19 has meant for her medical residency and her fellow residents.
• Check out these profiles of current and past Manitoba residents from Resident Doctors of Canada.

COVID Vaccine Eligibility Update

Manitoba announced changes today to its recommendations for eligibility for COVID-19 booster doses. The changes to eligibility were announced today by Dr. Joss Reimer and focus on booster shots for youth aged 12 – 17. These recommendations align closely with those from the National Advisory Committee on Immunizations (NACI).

Booster shots for all youth are still not recommended based on the currently evidence on risks and benefits. However, booster shots should now be considered for youth (age 12 – 17) at increased risk of severe outcomes from COVID-19 because of medical or social considerations. This includes:

• Youth with underlying or chronic medical conditions. This includes cancer, cystic fibrosis, diabetes, down syndrome, neurodevelopmental and other chronic neurologic conditions, obesity, substance use disorder, pregnancy, sickle-cell disease as well as chronic diseases of the kidneys, lungs, liver or heart. A complete list is available on Man​i​to​baVac​cine​.ca.
• Youth residing in a congregate living setting (age 12 – 17): Individuals, including youth, living in large group settings may be at higher risk of serious illness or outcomes from COVID-19. These settings could include shelters, group homes, quarters for migrant workers and correction.
• Youth who belong to racialized and/​or marginalized communities disproportionately affected by COVID-19 (Age 12 – 17). Dr. Marcia Anderson presented today the disproportionate impact of COVID-19 on BIPOC communities and the impact vaccination has had on reducing these disparities. 

Booster doses are recommended a minimum of six months after a second dose for these individuals. Parents and/​or youth are not required to provide proof or documentation of eligibility to receive a booster, but they should be advised of the risks and benefits before providing informed consent.

Physicians are expected to help parents and youth understand the risks and benefits of proceeding with a booster dose. You can view the Public Health memo to health care providers from Public Health here about the new recommendations, which summarizes the evidence considered in adopting NACI’s recommendations in Manitoba. This includes the risk of getting sick from COVID-19, the evolving evidence on both safety and effectiveness of booster doses, and what is known and unknown at this time.

The NACI documentation is available here, outlining the evidence to support their recommendation for booster doses in adolescents.
Booster doses continue to be recommended for immuno-compromised individuals, age 5 and up. For these individuals, booster doses should be given 6 months after their primary immunization series, which will often be three doses, not two.

Immunization after Infection

The current guidance in Manitoba is to wait about four weeks after a COVID-19 infection before proceeding with the next vaccine dose. On Friday, NACI issued a new guidance on the timing of vaccination for individuals previously infected with COVID-19.

Dr. Reimer confirmed today that Public Health is reviewing this new guidance and will provide an update in the next few days about whether or not Manitoba will adopt or adapt this guidance.

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 limited available evidence, immunological principles and expert opinion to provide updated guidance. They also note it is subject to change.

The highlights of 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 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.