In today’s message you will find:

• COVID Update
• Updated Return to work Guidance for HCWs
• COVID Treatment Options Expanding
• Return to School
• New Law Protecting Doctors and Allied HCWs
• Practice Opportunities
• Events & Learning Opportunities

COVID Surveillance Update

Since our last update last Thursday:

Serious Outcome Surveillance:

• Hospitalizations up: There are now 620 people in hospitals with COVID-19, up from 499 last Thursday.
• Daily average hospital admissions up: There were 34 people admitted to hospital yesterday with COVID-19. Over the last seven days, an average of 47 patients have been admitted daily, up from 42 per day the week before.
• ICU census up: Of the hospitalizations reported above, 48 patients are in ICU, up from 47 on Thursday. There are a total of 102 patients in ICUs, unchanged from Thursday and still well-over the normal capacity. 
  
• COVID-related ICU admissions have averaged six per day over the last 7 days, up from four per day the previous week. 
• 28 more people have died from COVID-19 since Thursday. This brings the total COVID-19 related deaths to 1,466.

According to the COVID-19 Tracker Canada Project, Manitoba has an average of 44.8 hospitalizations per 100,000, the highest in the country. Quebec continues to have the second highest rate at 39.7 per 100,000.
Pressure on hospital capacity continues to be a major issue, with demand for medicine beds now a key stressor. 

Last week, we discovered only 160 of the 1,460 medicine beds across the province were available. Over the last week, 38 patients have been moved from Winnipeg hospitals to other regions to free up space for incoming patients. Doctors Manitoba and geriatric specialists have raised concerns about this practice, as we continue to hear reports of frail, elderly patients being transported in the middle of the night, with incomplete documentation, and sometimes arriving dehydrated. 

Surveillance indicators (interpret with caution due to PCR testing prioritization):

• Daily cases high but steady*: 4,805 new cases of COVID-19 have been identified since Thursday, a daily average of 961. This includes 847 cases reported today. The total case count in Manitoba now stands at 111,432.
• Test positivity remains high*: The provincial five-day test positivity rate is 34.2%, down from 44.9% on Thursday.
• Active cases increase*: There are 40,805 active COVID-19 cases province-wide, up from 36,087 on Thursday.

*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 626 per 100,000, down from last week and the 5^th highest rate of all the provinces. Alberta currently has the highest rate with 890 per 100,000. However, comparing jurisdictions is becoming challenging as testing capacity is strained and prioritized in many provinces. 

Updated PHAC Omicron Projections

The Public Health Agency of Canada released updated epidemiology and modelling on the pandemic a few days ago. They key findings include:

• Omicron has eclipsed all previous waves and even though it is less severe than Delta, it is driving up severe illness trends because it is more transmissible. 
• Hospitalization rates are increasing across all age groups, but the highest rates are among older adults, particularly age 80+.
• Two doses have low effectiveness against infection/​symptomatic disease. A booster dose improves protection against infection, but not as good as with Delta.
• Two doses continue to provide good protection against hospitalization, which improves with a booster dose.
• Manitoba appears to be tracking at or better than the improved scenario, which reflects current public health measures strongly reducing transmission
• Manitoba could see hospital admissions with COVID-19 approach nearly 200 per day.

Updated Return-to-Work Guidance for Health Care Workers

Shared Health has updated its return to work guidance for health care workers, specifically those who have a close contact with a positive COVID-19 case. 

Under the new guidance, fully-vaccinated asymptomatic health care workers who live with someone who tests positive for COVID-19 can continue to work, but must participate in a regular rapid testing program. A supply of at least 5 rapid tests will be provided to be used over 10 days. The tests can be acquired at provincial testing sites and they are being made available in some hospitals and health facilities, though we don’t yet have a list. 

At provincial testing sites, health care workers are instructed to show their work ID or pay stub to get the larger rapid test kit supply, as the public will only receive two or three tests, not five. We have asked what identification community-based physicians and their staff must present and will provide an update when we hear back. 

Other return-to-work guidance remains in place, including allowing fully-vaccinated HCWs who test positive to return to work after five days of isolation assuming they have no fever and lingering symptoms are mild and improving. Workers who are symptomatic but test negative (one on PCR or twice on rapid test) who have no fever and mild and improving symptoms are also able to return to work.

This one-pager from Shared Health provides an overview of the various isolation and return-to-work scenarios. Health care workers are not expected to return to work if they are still ill and not able to perform their duties.
Additional information is available in this memo.

Doctors Manitoba has written the Minister about improving access to rapid tests for physicians, including in rural and Northern communities that do not have a provincial test site nearby. 

COVID Treatment Options Expanding

Yesterday, Health Canada approved Pfizer’s COVID-19 antiviral treatment, called Paxlovid. The pill, which is the first approved at-home COVID-19 treatment, is already approved in the U.K. and the U.S.

Manitoba has been allocated 1,100 doses from the initial supply available through the federal government, and has requested more. There are no details yet on when the first shipment will arrive in Manitoba or how it will be distributed. 

What is Paxlovid?

Paxlovid is actually a combination of two antiviral drugs: nirmatrelvir and ritonavir. Patients take one of each drug orally twice per day for five days. The clinical trial found that for high-risk individuals, Paxlovid reduced hospitalization or death by 89%. Additional details are available through Health Canada.

Health Canada approved the drug for use in Canada for adults with mild to moderate COVID-19 who are at high risk of serious disease, including hospitalization or death. It should be used within five days of the start of symptoms.

Health Canada noted in its announcement that ​“No drug, including Paxlovid, is a substitute for vaccination. Vaccination remains the most important tool in preventing serious illness from COVID-19 infection. Both the Public Health Agency of Canada and Health Canada continue to strongly recommend vaccination for all eligible Canadians, including those who are pregnant, may become pregnant or are breast-feeding.” 

Monoclonal Antibody Treatment

Another treatment option is already available in Manitoba, targeted to individuals at higher risk for hospitalization. Physicians can refer patients for monoclonal antibody treatment, or MAB, if they meet specific criteria:

• Individuals age 40 and older who are not fully vaccinated, with no prior COVID-19 infection; or
• Individuals age 18 – 40 who are not fully vaccinated, no prior COVID-19 infection, and have conditions or risk/​factors such as diabetes, smoking, obesity, heart, kidney or lung disease, or cancer; or
• Individuals age 18 and older who are immunocompromised, regardless of their vaccination status or previous COVID-19 infection history.

All patients must have a positive COVID-19 test and initial symptom onset within the previous 7 days.
Key information for physicians:

• Shared Health information for providers, including the eligibility and referral process
• Patient information

Return to School

Yesterday, most students returned to in-person classes in Manitoba, a highly anticipated day by both those who have championed a safe-return to school as well as those concerned it could accelerate community spread and should be delayed.

The Canadian Paediatric Society issued a fact sheet for families as students in Ontario, Quebec, Nova Scotia and Manitoba returned to in-person learning yesterday. Students in Saskatchewan, Alberta and BC resumed in-person classes last week. Students in PEI, Newfoundland and New Brunswick are still in remote learning.

→ What do you think about the return to school and other restrictions? Add your voice in our 2‑minute survey.

So far, about 18% of physicians have suggested the return to in-person classes should have been delayed.

Key messages that physicians can focus on with parents and patients include:

• Focus on reinforcing how to properly don and doff a mask, and ensure students and school staff wear good quality masks. 
• Strongly recommend that anyone with symptoms should stay home, even if symptoms are mild. 
• Offer reminders about distancing when possible and regular hand hygiene. 
• Reassure parents that the risk of severe illness for most children is very low. Households with immuno-compromised children or family members should discuss the risks with their physician. 
• Encourage everyone to reduce their contacts to help protect essential services like hospitals and schools

Doctors Manitoba will continue to monitor this issue closely, and share your feedback with provincial officials. 

Federal Intimidation Law

On Sunday, the federal government’s new law making it illegal to intimidate doctors, nurses and patients, and to obstruct care or treatment from being provided came into effect. Thank you to the CMA and its President, Dr. Katharine Smart, who worked hard to advocate for the legislation to prevent bullying, attacks against its members and other allied health care workers. 

Doctors Manitoba has been raising concerns about physician mistreatment. We conducted a survey of physicians in November and December and found:

• 57% experienced incidents of mistreatment over the previous month.
• More than half of incidents (52%) appear to be linked to the pandemic in some way.
• Incidents are happening more often than a year ago, with 59% of physicians reporting increased frequency.
• Most incidents occurred in doctors’ offices or hospitals, though there were some incidents that occurred on social media, in public places and at physicians’ homes. 

Practice Opportunities

Looking for a change in your career? You can always find practice opportunities HERE and locum opportunities HERE.

You or a colleague might be the right fit for the Regional Lead, Medical Services & CMO position for the Interlake-Eastern Regaional Health Authority. 

Upcoming Events & Learning Opportunities

Keep up with our upcoming events and learning opportunities by bookmarking our events calendar in your browser. You’ll find interesting webinars like ​‘How long does immunity to COVID-19 last?’ or courses to hone your leadership skills like ​‘Leading Change — a Physician Leadership Course’.