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Yesterday, the government signaled the need to shift from trying to contain COVID-19 to mitigating the risks it poses to Manitobans. No new restrictions were announced, but existing restrictions are remaining. Current restrictions are scheduled to be in place until February 1.

According to Bank of Canada monitoring of restriction stringency, Manitoba’s restrictions are slightly more stringent than the national average, though four other provinces were ranked as having more stringent restrictions than our province.
Schools to resume in-person classes Monday

Public health and education officials announced a shift in approach for monitoring COVID-19 in schools today.

In announcing the changes, Dr. Brent Roussin reviewed the risks to children from COVID-19. Since December 1, there have been 6,700 cases among individuals under the age of 18. Of these, 46 were admitted to hospital, a hospitalization rate of 0.7%, though only 15 of these admissions were due to COVID-19 or because a condition was made worse by COVID-19, which is a hospitalization rate of 0.2%. That hospitalization rate is different across different age groups: for children age 0 to 4 years, the rate was 0.58%. For children age 5 – 11, it was 0.18% and for children age 12 – 18, the rate was 0.11%.

This is similar to the findings released yesterday by the Ontario Science Table, which also reviewed other evidence to inform return-to-school decisions and approach.
Dr. Roussin explained that the nature of the Omicron variant, including its shorter incubation period and increased infectiousness, makes case and contact tracing less effective tools. Because of this, the public health focus in schools is shifting to reflect the current situation.

Schools will report absenteeism and self-reported COVID-19 cases. Confirmed cases will continue to reported on the public online dashboard. Public Health will use this information to monitor for increased transmission above levels expected in the community. Where there is increased absenteeism, case counts or operational concerns, Public Health will investigate and provide guidance to schools. This could include:

• A period of broader asymptomatic rapid testing for teachers, staff and/​or students.
• Other preventive measures such as reducing higher-risk activities.
• A shift to a seven-day period of remote learning for a class, cohort or entire school. 

When asked about parents or teachers who may feel the shift is abrupt or premature, Dr. Roussin stressed Public Health will still be highly involved and closely monitoring schools. ​“We haven’t given up, and neither should you,” he said.

Other preventive measures in place include distributing medical grade masks in schools, making rapid tests available to K‑6 students before their return, enhanced cleaning measures, hand hygiene reminders, and ensuring physical distancing ​“to the greatest extent possible.” Improvements have been made to ventilation, though details were not provided. You can watch today’s press conference here.

Your Views on Restrictions and Return-to-Classes

We want to hear your views on the government’s public health restrictions and return-to-school plan, as well as what your top concerns are right now about the health care system.

→ Take this two-minute survey now to share your views.

We will share a summary with provincial officials.

Dr. Atwal reviewed the latest evidence on Omicron, including the following:

• Omicron is much more infectious than Delta, with Ontario data suggesting each person with Omicron infects 3.5−4 times more people than Delta. The incubation period appears to be shorter, with a 3‑day median. The risk of severe disease and death appears to be lower based on studies from South Africa, England, Scotland and Ontario.
• Because of the increased infectiousness and shorter incubation period, public health resources were shifted from case and contact management to immunization, because case and contact management are less effective in controlling the virus now. 
• Before Omicron, seroprevalence studies suggested testing was identifying about 1 in 5 infections, and with Omicron public health anticipated that would grow by two or threefold. 
• Public Health is monitoring hospital data very closely, but it was acknowledged this is not ​“clean.” With the rapidly increasing community spread of Omicron, it means many more patients admitted to hospital for other issues are being admitted with COVID-19 and these patents are included in the hospital statistics reported each day. Public health is working with clinical hospital leaders and so far, based on chart reviews of pediatric admissions and at one other hospital, they have found about two thirds of COVID-reported hospital admissions were in hospital for other reasons. This is not true right now for patients in ICU with COVID-19, where nearly all (about 95%) appear to be admitted to ICU due to their COVID-19 infection. 

On testing, Omicron also required a shift in strategy to preserve PCR testing for those at increased risks or for whom it can inform their medical treatment. For others, rapid antigen testing has been introduced. All symptomatic Manitobans continue to be eligible for testing, but many are given a kit with two or three take-home rapid tests. The province has been distributing over half a million tests per week over the last few weeks, but continues to be constrained by how much supply they have access to. Physicians and other health care workers continue to have access to PCR testing to confirm a positive rapid test result. PCR turnaround times have improved to under 48 hours. 

→ See full testing eligibility and guidance here. Physicians are asked not to send patients for testing if they do not meet the guidelines. For travel-related PCR tests, individuals should seek a private option. 

→ See current isolation requirements here.

On public mask use, public health recommends good quality masks that fit well and have multiple layers, such as two layers of fabric with an additional middle filter layer. Medical masks are recommended for anyone who has tested positive or has symptoms or people caring for them, people who are at high risk of severe disease or outcomes, or people at higher risk of exposure due to their living situation.

• Two doses are not prevention Omicron infections very well, with studies showing effectiveness after two doses is down to 12% to 33%. But, two doses are still very effective at preventing hospitalization and ICU admissions (70%-95% depending on the study). Omicron is also less likely to cause severe disease than Delta. 
• Studies are showing that a booster (third) dose is boosting effectiveness against infection, with studies showing effectiveness at 55 – 57% compared to someone with two doses. How long this protection lasts is still being studied.
• In Manitoba, we are still seeing very good protection from the vaccines against hospitalization and ICU admission, and that protection increases with every dose. Compared to unvaccinated individuals:

Those with one dose are three times less likely to be hospitalized or require intensive care

Those with two doses are six times less likely to be hospitalized and 19 times less likely to require intensive care.

Those with three doses are 26 times less likely to be hospitalized and 139 times less likely to require intensive care.

→ Download, print and post Dr. Reimer’s fantastic visuals illustrating the different risk levels for hospitalizations, ICU admission and death. 

On second doses for children age five to 11, public health continues to recommend an eight-week interval even with schools reopening next week. This recommendations is aligned with NACI and the Manitoba Pediatric Vaccine Advisory Committtee’s guidance, which was also reviewed carefully in the context of a return to in-person learning. Parents can request a second dose sooner — as early we three weeks after the first dose — but this should only proceed after a discussion about the risks and benefits. 

Why wait the full eight weeks for children? Dr. Reimer explained that this is about weighing risks and outcomes. Children are at much lower risk of severe outcomes from Omicron and the vaccine is not very effective at preventing infections. Children with one dose already have some protection against severe outcomes, and pushing up the second dose likely will not lead to better outcomes. Spacing it out at eight weeks, as recommended, will maximize the protection for longer against Omicron and hopefully future variants.

On boosters for 12 – 17 year olds, Manitoba is waiting on a recommendation from NACI about this. NACI is reviewing the evidence to determine if a booster can improve outcomes in this age group. 

So far, 186 physicians and physicians-in-training have become infected with COVID-19, with 83 of these being identified since December 5. Occupational Health is not aware of any deaths or hospitalizations among physicians or medical learners.

Generally, isolation guidelines for health care workers who test positive are the same as the public: five days for fully vaccinated individuals with no fever and mild improving symptoms and ten days for unvaccinated. However, for health care workers who are immuno-suppressed, five days of isolation is likely not enough. 

→ Access return-to-work guidance for health care worker here.

On Masks and PPE, Dr. Kraut reviewed the current guidance. For COVID positive or suspect patients, N95 respirators are the default choice. A procedure mask may be used after a point of care assessment. Eye protection, gowns and gloves are also recommended. For non-suspect ​“green” patients, eye protection and medical masks are required. An N95 could be used based on a point of care assessment.

Dr. Kraut reminded physicians of what to consider when deciding between medical masks and N95 respirators during a point of care assessment. You should consider:

• Level of disease in the community
• Level of interaction with the patient
• Patient status
• Physical area of the interaction, including the size of the space and ventilation. 

Right now, Dr. Kraut said, with the level of community spread, providers may want to ​“err on the side of caution and use a higher level of protection than maybe we would in other situations.” He also said that we ​“should be very liberal in the use of N95s these days.

→ Current PPE advice for clinic and outpatient settings is available here. Guidance for reception and admin staff is available here.
→ Current provincial guidance recommends that patients with or without respiratory symptoms should be wearing a procedure mask.

Dr. Francois reinforced the need for primary care to support the broader system right now, recognizing how strained the hospital system is. Patients are being discharged earlier and will need primary care follow up. It is also important to keep a close eye on patients with chronic conditions and monitor for potential deterioration. 

Physicians are encouraged to follow previous primary care guidance on patient and staff screening, infection prevention and control and PPE, erring on the side of more precautions. Ensure symptomatic staff are tested and reduce staff gatherings as a source of transmission. 

On virtual and in-person care, physicians should continue to provide in-person care when needed. As a rough guide, Dr. Francois suggested a third or up to half of visits could be virtual right now. If a patient really needs a physical assessment, it should be done in person. Clinics should continue to see patients with respiratory symptoms if they have the capacity to do so.

→ See this Alberta guide for primary care updated since Omicron arrived. In particular, see their guidance on page 7 for deciding between virtual and in-person visits.
→ The Manitoba pathways for primary care are available to guide decisions on how to offer care for suspect ​“orange” patients and for positive ​“red” patients.

For COVID treatment, physicians should review the guidance about assessing and referring patients for monoclonal antibody treatment. 

Don’t miss: Mentorship and sponsorship models that promote equity in our educational & healthcare systems with Dr. Jamiu Busari — January 17 at 6pm CST.
ICYMI: Watch the on-demand video of the Psychological Safety talk with Dr. Ming-ka Chan and Dr. Anne Matlow here.

Physician Leadership in Challenging Times: Building Capacity Through Connection is a four-part speaker series to give physicians an opportunity to build their leadership skills and knowledge and create opportunities for growth. The series was created in partnership with Doctors Manitoba and the University of Manitoba, Office of Leadership Education for Rady Faculty of Health Sciences is offered with generous support from Canadian Medical Association. It is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Learn more about Dr. Busari’s presentation here.

Webinar on Women and Girls with Bleeding Disorders — January 19^th at 7pm

In this presentation, important to physicians managing adolescent or pre-adolescent girls to help identify heavy periods. Dr. Vicky Price and Dr. Meghan Pike will be introducing the Adolescent Menstrual Bleeding Questionnaire (aMBQ), designed to measure the impact of heavy menstrual bleeding on adolescent quality-of-life, and the app, called WeThrive, can identify adolescents who have heavy menstrual bleeding. Register HERE, read more details here or email info@​hemophiliamb.​ca for more information.

Immigrant and Refugee Mental Health Course

Funded by Immigration, Refugees and Citizenship Canada (IRCC), the course offers evidence-based information, tools and resources for service providers to provide mental health care and support to both immigrants and refugees arriving in Canada. The online course offers an overview on the social determinants of health and its impact on mental health, the role of migration trajectories and highlights the specific needs of sub populations.

The course is designed to provide a uniquely interactive learning experience where service providers can consult with experts in the field, share ideas and experiences with hundreds of peers from all over Canada, and learn strategies to use on-the-job.For full details and registration information click here.

Autism and Neurodiversity in Primary Care — Part 1: ASD Diagnosis: Recognize & Refer

UBC CPD has partnered with the UBC Centre for Interdisciplinary Research and Collaboration in Autism (CIRCA) to create a two-part program on autism and neurodiversity filled with useful activities and videos. Part 1 is available now and is designed to assist primary care providers to better understand autism, recognize indicators of autism, and learn how to better support patients of all ages as they navigate the diagnostic process in BC. Part 2 will be available in late 2022 and will focus on the ongoing management of autism in primary care.

Primary care is often the first point of contact with the healthcare system for individuals with autism. It is critical that you can recognize, refer, and manage autism in your practice.The course is on-demand through elearning and eligible for up to 2.0 Mainpro+ credits. You can learn more and register HERE.

Physician Leadership: Engaging Others — 2 day Virtual Course February 4 & 5, 2022 | 9:00am – 4:30pm (CT) — Register now.

In this PLI course, facilitated by Paul Mohapel, PhD and Monica Olsen, BScN, BA, MHRD, you will focus on the core skills and practical tools you need to nurture an engaged organizational culture. Please note that there is pre-course work that is due on January 12^th. It is estimated to take 2.25 hours to complete the assessments and review the results.

This program has been accredited by the College of Family Physicians of Canada for a minimum of 14.25 Mainpro-M1 credits. This event is a accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada and approved for a minimum of 14.25 credits. Participants should only claim credit for the actual number of hours attended.

Physician Leadership: Leading Change — 2 day Virtual Course March 10 & 11, 2022 | 9:00 am – 3:30 pm (CT) — Register now.

In this PLI course, facilitated by Brian Golden, MS, PhD, FCAHS and Joshua Tepper, MD, FCFP, MPH, MBA, you will learn the strategies you need to motivate, implement and sustain change in the complex system in which you practice. Although the course structure is guided by key readings and insight from your instructors, it is primarily conversation and experience based. Anticipate participating in discussions as you work through the challenges you are facing in real time. Please note that there is pre-course work for this event.

This program has been accredited by the College of Family Physicians of Canada for a minimum of 11.5 Mainpro-M1 credits. This event is a accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada and approved for a minimum of 11.5 credits. Participants should only claim credit for the actual number of hours attended.

Allyship Webinar

Equity in Medicine and Sanokondu have made available for on demand viewing the recent workshop Effective Allyship: Advancing Women in Healthcare Leadership. With expertise and experience, panelists shared practical tips on how to be a good ally to advance women in healthcare leadership. You can view the webinar here.