Member Message — January 21, 2022
Diagnostic & Surgery Task Force
New Study on First Nations Status and ER Triage Scores
COVID Surveillance Update
Since our last update on Tuesday…
Serious Outcome Surveillance:
- Hospitalizations remain high: There are now 664 people in hospitals with COVID-19, up from 620 on Tuesday.
- Daily average hospital admissions down slightly: There were 50 people admitted to hospital yesterday with COVID-19.
- ICU census up: Of the hospitalizations reported above, 50 patients are in ICU, up from 48 on Tuesday. There are a total of 103 patients in ICUs, up one from from Tuesday and still well-over the normal capacity.
- COVID-related ICU admissions have averaged six per day over the last 7 days, up from five per day the previous week.
- 26 more people have died from COVID-19 since Tuesday. This brings the total COVID-19 related deaths to 1,492.
Over the last seven days, an average of 49.4 patients have been admitted daily, which has decreased gradually each day from 53.7 on Sunday. The 664 people in hospital today with COVID-19 is down from 673 the previous day. While encouraging, it’s far too soon to know if this indicates a potential peak in new hospitalizations. It is something many are monitoring closely, with the knowledge that Omicron may have arrived later in rural communities, and that could risk a sustained high level of demand for hospital care. Click here to see a graph of daily hospital admission trends.
According to the COVID-19 Tracker Canada Project, Manitoba has an average of 48 hospitalizations per 100,000, up from 45 on Tuesday and still the highest in the country. Quebec continues to have the second highest rate at 39 per 100,000. Comparing hospitalizations by jurisdictions is becoming challenging as we learn 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*: 2,589 new cases of COVID-19 have been identified since Tuesday, a daily average of 863. This includes 827 cases reported today. The total case count in Manitoba now stands at 114,021.
- Test positivity remains high*: The provincial five-day test positivity rate is 32.4%, down from 34.2% on Tuesday.
- Active cases decrease*: There are 36,575 active COVID-19 cases province-wide, down from $40,805 on Tuesday.
* 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 475 per 100,000, close to the Canadian average of 471 and down from 626 on Tuesday. PEI currently has the highest rate with 1,050 per 100,000. However, comparing jurisdictions is becoming challenging as testing capacity is strained and prioritized in many provinces.
Join the Vax-a-Thon
Can your practice join our Manitoba Vax-a-Thon?
We are looking to plan a single coordinated day with doctors offices across Manitoba offering COVID-19 vaccines. Please read below and let us know if you are interested by emailing covid19@doctorsmanitoba.ca.
Here’s how it would work:
- Participating clinics would set their own time to hold a vaccine clinic on our Vax-a-Thon day (e.g. 8 – 12 noon, 4 – 8PM, etc.). We are looking at either Thursday January 27 or Friday February 4. (Please let us know if either could work for you!)
- Doctors Manitoba will promote the clinics and list them at ManitobaVaccine.ca, with instructions on how to book at each participating clinic. The focus will be on 1st, 2nd or 3rd doses, or even just to book a time to get vaccine advice if individuals are hesitant.
A reminder about remuneration and special additional funding in place to support this work:
- Participating physicians would be guaranteed a minimum hourly rate of $169.35 for weekdays or $184.85 for evening vaccine clinics (plus rural/northern premiums), plus each clinic can claim a $25 per hour administrative stipend.
- Remuneration for each does is $20. Right now, Manitoba Health allows for this to be fully delegated to clinical staff as long as the physician is on-site in case of complications.
- If the patient needs additional vaccine counselling or information beyond the normal informed consent, a visit can be claimed as well.
- If your FFS claims during the scheduled clinic window do not add up to the minimum hourly guaranteed rates noted above, you will be able to claim the difference.
→ If you are interested, please email us at covid19@doctorsmanitoba.ca and indicate if your clinic is able to participate on Thu Jan 27 and/or Fri Feb 4. We will be in touch to confirm the date, and to gather your vaccine clinic hours and booking instructions for the public.
Vaccine Updates
There continues to be progress on vaccinating more Manitobans:
- 85.3% of eligible Manitobans have at least one dose.
- 78.5% have at least two doses.
- 37.4% have three doses.
Booster shots are accounting for the majority of doses administered over the last week, with about 4,800 given per day on average.
It has been just over eight weeks since Manitoba started offering first doses to children age 5 – 11, which means some children are now ready for the second shot.
Diagnostic & Surgery Task Force
Earlier this week, the government’s Diagnostic and Surgical Recovery Task Force provided their first monthly update, after being appointed just last month.
Despite the pervasive disruptions to hospital care right now due to the Omicron surge, the Task Force revealed four early actions they are pursuing to alleviate the massive backlog in surgical and diagnostic procedures.
First, the Task Force identified a backlog of approximately 3,000 gynecology surgeries, with about two thirds of these that can be done as day procedures. The government will be partnering with Maples Surgical Centre and other local providers to offer up to 1,000 gynecology surgeries starting in early February. We have learned the plan is for Maples to use local Manitoba physicians for this work.
Second, the province is introducing fecal immunochemical test screening (FIT screening) to help identify potential colon cancers while reducing the demand for endoscopic procedures. Many other provinces have already adopted this practice, and the Task Force reports the test will “provide more timely diagnosis and support better outcomes for individual clients” while decreasing the demand for endoscopies by approximately 10 to 15 percent once fully implemented. We anticipate that additional information will follow, including guidance for referring physicians.
The province is also preparing to train and hire up to 13 more anesthesia clinical assistants (ACA) over the next three years to extend the capacity of anesthesiologists as a third initiative. This will double the number of ACAs working in Manitoba, we understand. With surgical capacity expected to increase significantly to tackle the backlog as hospital capacity allows, the demand for anesthesiologist support will increase as well.
Finally, the Task Force confirmed that the province is pursuing an agreement to send patients in need of spine surgeries to Sanford Health in Fargo as part of Manitoba’s Out of Province Medical Referrals Program. Eligible individuals will be referred by their care provider, typically for conditions such as spinal stenosis and chronic degenerative disc disease. The wait list for spine surgery was very long even before the pandemic, and it has only grown since. The Task Force described this as a temporary measure while the province builds its own capacity. Services will be offered “later this year” as capacity and the pandemic situation allows. Again, we anticipate further information to follow soon, including for referring physicians.
Doctors Manitoba’s latest estimates from earlier this month indicate the diagnostic and surgical backlog could be as high as 153,320 cases, including over 57,000 surgical cases. The Task Force was one of three recommendations we made last June, and we are eager to see progress soon on the other two: comprehensive monthly reporting on size of the backlog, and a target date to clear the pandemic backlog, a goal we hope to see the government make soon.
You can see updates from the Task Force on their website.
Message from Task Force Chair
Last month, I was appointed by the government to chair a Task Force to tackle to the massive backlog of diagnostic and surgical procedures that has accumulated during the pandemic.
I want to connect with you, my physician colleagues, to share an update about our work and to invite your feedback in the weeks ahead. As a surgeon, I have been frustrated by how COVID-19 has disrupted our hospitals and my ability to treat the patients who need my help. I am eager to see the disruptions to diagnostics and surgery end, and to introduce solutions that will add additional capacity to address the backlog.
The Diagnostic and Surgical Recovery Task Force is led by a team of 15 individuals, including eight physicians. Our mandate includes several actions to address the backlog, including introducing a centralized wait list system, optimizing scope of practice for nurses and allied health providers, negotiating agreements to increase the number of procedures being performed. We are also tasked with providing monthly updates and improving transparency to all Manitobans. You see our mandate and full membership here.
The Task Force was appointed just as the Omicron variant was taking hold in Manitoba. Unfortunately, this has resulted in a new round of disruptions to procedures as hospitals create capacity to accommodate a surge in admissions. It has also meant that our options as a Task Force to add capacity are limited right now.
However, earlier this week we provided our first monthly update including four actions we can take now. This includes a partnership with Maples Surgical Centre and other providers to increase gynecology day surgeries. To take pressure off of the growing endoscopy wait list, Manitoba will introduce Fecal Immunochemical Testing (FIT) as a proven alternative to identifying colon cancers. We are preparing to train and hire 13 new anesthesia clinical assistants to extend the capacity of anesthesiologists to better support expanded surgical capacity. And, we have made a difficult decision to send some patients to the U.S. for spine surgery. You can see further details here.
These actions are just the beginning. I look forward to providing further updates next month.
I have no doubt that every physician in Manitoba has patients who are caught in the backlog and have seen their tests or surgeries delayed. I know that many of you have concerns to share and advice to offer to support our work in addressing the backlog. We want to hear it. In the next few weeks, we will be working with Doctors Manitoba to arrange a virtual town hall for physicians, so we can provide you with a more in-depth update of work and so we can hear from you. In the meantime, please continue to pass your feedback on to Doctors Manitoba.
Dr. Peter MacDonald
Chair, Diagnostic and Surgical Recovery Task Force
Latest on COVID Treatments
With news earlier this week that Paxlovid has been approved for use in Canada, there is a renewed interest in COVID-19 treatment options.
For now, we know Canada has a very limited supply of Paxlovid, the Pfizer antiviral treatment, and Manitoba will receive an initial allotment of just 1,100. The delivery date is still not known. In the meantime, monoclonal antibodies remain available for early treatment for individuals at high risk for severe outcomes.
There are other treatments available, including some existing and repurposed drugs, and others for which there is not enough evidence to use. The Ontario Science Table released a new brief this week with clinical practice guidelines on COVID-19 drugs and biologics. The clinical summary offers guidance on treatment options for mildly, moderately and critically ill patients. It also notes that there is insufficient evidence to support the use of colchicine, interferon and vitamin D as a treatment option outside of clinical trials. It also recommends against the following therapies due to a lack of benefit, potential harm or system implications of overuse: antibiotics, hydroxychloroquine, ivermectin, lopinavir/ritonavir and casirivimab-imdevimab (due to a lack of neutralizing activity against Omicron).
You can view the Ontario clinical practice guidelines for therapeutic management of adult COVID-19 patients here.
New Study on First Nations Status and ER Triage Scores
A new study released this month in the Canadian Medical Association Journal found that First Nations patients’ visits to emergency departments are prioritized as less urgent than comparable non-First Nations visits in Alberta.
The retrospective cohort study was conducted to understand the relationship between First Nations status and triage scores, building on other research that has found that race is associated with ER triage scores and the potential for health care inequity. Earlier research has also documented First Nations patients’ experiences with racism while seeking emergency care.
Using data from 2012 to 2017, the team found that First Nations status was associated with lower odds of receiving higher acuity triage scores, including when comparing triage scores in common disease categories and diagnoses, including for long bone fractures, respiratory infections and anxiety disorder.
The researchers note this “may reflect systemic racism, stereotyping and potentially other factors that affected triage assessments.” They note that First Nations patients made up 4.8% of patients but 9.4% of ER visits in Alberta.
You can view the study published in the CMAJ here.
New IPAC Mentorship Program
The Indigenous Physicians Association of Canada has also just launched their Mentorship Program. To participate you must be a member of IPAC. To learn more about their program, and requirements for membership, head to their website.
Mentorship Opportunities!: Doctors Manitoba relaunched their mentorship program in the Fall. Recruitment for participants is ongoing. Students, Residents and Attending Physicians are all invited to participate. Learn more about the program and register to participate.
ICYMI: Recent Updates
Here are a few recent updates, in case you missed it:
- Return-to-work guidelines were updated for health care workers, including physicians. The new guidance from Shared Health covers close contact with household members who test positive, and includes earlier guidance about return after testing positive, and for symptomatic health care workers who test negative. See our summary here.
- We are still interested in hearing about your views on public health restrictions in Manitoba, the return to in-person learning, and the biggest issues in the health care system right now. Take our two-minute survey here.
- A new federal law is now in effect making it illegal to intimidate doctors, nurses or patients as well as to obstruct care or treatment. Learn more here.
- Last week we held a Town Hall for physicians with exerts from public health, occupational medicine and primary care. You can see our summary of the key takeaways here, and you can still view the full Town Hall on demand.
- Vaccine hesitancy researchers at the U of M are looking for physicians to participate in interviews to share your experience in having difficult vaccine conversations with patients. Find out more about the study and how to participate.
Upcoming Events
Check out our upcoming events page for a list of webinars and events for physicians. You will see a webinar on January 24 about how long COVID-19 immunity lasts, on January 25 a webinar about physician retirement, and series of physician leadership courses in February and March.