January 25, 2022
In today’s message you will find:
- COVID Update
- Has Manitoba peaked yet?
- COVID Immunity Webinar takeaways
- Join the Vax-a-thon!
- Medical note request guidance
- Paxlovid is here
- Trucker Convoy rolls through Winnipeg
- Join our Wordle Challenge
- ICYMI — key info from previous messages
- Upcoming Events & Learning Opportunities
COVID Surveillance Update
Since our last update last Friday…
Serious Outcome Surveillance:
- Hospitalizations remain very high: There are now 729 people in hospitals with COVID-19, up from 664 on Friday.
- Daily average hospital admissions down slightly: There were 39 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 50, down from 54 the previous seven days.
- ICU census steady but high: Of the hospitalizations reported above, 49 patients are in ICU, down from 50 on Friday. Yesterday there were a total of 102 patients in ICUs, down from 103 last Friday and still well-over the normal capacity.
- COVID-related ICU admissions have averaged five to six per day over the last seven days, down slightly from six to seven per day the previous week.
- 29 more people have died from COVID-19 since Friday. Manitoba has surpassed 1,500 COVID-19 related deaths, with the total now at 1,521.
Today marks two years since the first reported case of COVID-19 in Canada and it is the first day in quite some time that most of the severe outcomes in Manitoba are outside of Winnipeg. The province reported five deaths in Southern and one in Winnipeg while hospitalizations are up nine in Prairie Mountain from yesterday
According to the COVID-19 Tracker Canada Project, Manitoba has an average of 52 hospitalizations per 100,000, up from 48 on Friday and still the highest in the country. Quebec continues to have the second highest rate at 38 per 100,000. 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*: 2,749 new cases of COVID-19 have been identified since Friday, a daily average of 687. This includes 637 cases reported today. The total case count in Manitoba now stands at 116,770.
- Test positivity remains high*: The provincial five-day test positivity rate is 32.9%, us slightly from 32.4% on Friday.
- Active cases increase*: There are 39,296 active COVID-19 cases province-wide, up from 36,575 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 400 per 100,000, above the Canadian average of 381 but down from 475 on Friday. PEI, which had been successful in largely avoiding previous waves, now has the highest rate with 1,145 per 100,000. Comparing jurisdictions is challenging as testing capacity is strained and prioritized differently across provinces.
Are We Peaking?
There has been growing commentary over the last few days about whether or not the Omicron wave has peaked.
On Friday, Canada’s Chief Medical Officer of Health Dr. Theresa Tam said there are “early indications that infections may have peaked at the national level.” She was referring to monitoring of case counts, test positivity, the reproduction number and wastewater data. She again commented on the potential peak just yesterday, noting “there are some hopeful signs of reduced disease transmission, nationally. COVID-19 remains widespread and at record high levels, but reported case incidence is presently decreasing across all age groups and the latest seven-day average of lab test positivity is an 11% decrease compared to last week.“
It is important to note, however, that the need to prioritize PCR testing across Canada makes monitoring daily case counts alone a less certain indicator on the trajectory of this wave. Many have suggested the impact on our hospitals is a more meaningful indicator to watch.
In CTV’s coverage of the potential peak, local medical microbiology expert Dr. Jason Kindrachuk noted that hospitalizations lag behind case counts, so the pressure in hospitals isn’t over. He noted that “you may be able to slow down that hospitalization rate over time, but you are still going to have pressure on a health-care system that that has been pushed to its limits.”
Dr. Tam agrees, adding that “the January timeframe, the peak may occur, but the hospitalizations and the ICU admissions may continue to increase for some time. So that’s in February and I really hope that by the end of the next month, we’ll be in a better position.”
Time to Ease Restrictions?
Several provinces have signaled restrictions will start to be lifted as they see evidence that Omicron is peaking.
In Ontario, a three-step gradual reopening plan was announced a few days ago. The first step involves easing restrictions on January 31 for social gatherings and reopening various public places with capacity limits. These first steps would move Ontario closer to where Manitoba’s restrictions are at the present time. Further steps will follow, with 21 days in between for monitoring, with expanded gathering limits and removing capacity limits on public places.
Quebec, which also introduced very stringent restrictions to slow the Omicron wave, announced a slow reopening plan. Restaurants will be allowed to reopen with limited capacity next week and for indoor private gatherings. Again, the initial moves move Quebec more in line with what is currently in place in Manitoba.
In Alberta, the premier signaled he plans to significantly ease public health measures as soon as COVID-related hospitalizations begin to decrease.
In Saskatchewan, the premier ruled out adding any new restrictions as the Omicron wave escalates. Saskatchewan has, by far, the least stringent restrictions, according to monitoring by the Bank of Canada.
What’s happening in Manitoba?
Last Wednesday, Dr. Brent Roussin suggested Manitoba has not yet reached our peak of infections and hospitalizations. “It would be reasonable to expect that peak in the near future if we maintain the same trajectory as other regions, but right now I can’t point to any specifics in our data that suggest that we have reached that.”
Dr. Roussin also took the time on Wednesday to explain the shift in approach by public health, to match the changes Omicron has brought with a much shorter incubation time and much higher rate of transmission. He acknowledged this might have seemed like a “sudden shift” in approach to some, but was necessary given how significantly the virus has changed. “The virus has changed dramatically, so we need to change,” he explained, noting that now-familiar approaches like contact tracing are less effective now and PCR testing must be prioritized.
What does the data say in Manitoba?
- Looking at the seven-day average of daily new cases, the current number is 748, which is down significantly from a high of 2384 on January 9. Test positivity is down to 32.9%, from a high of 48%. Dr. Roussin has cautioned, however, that these declines likely reflect the need to prioritize PCR testing.
- For hospitalizations, the number in hospital with COVID-19 continues to climb, reaching a new all-time high today of 729, up 47% over the last two weeks. However, the number of new hospitalizations has been trending down the last few days, with an average of 50.1 admitted per day over the last week, down from 53.9 the previous week.
Manitoba’s current restrictions — which are “middle of the pack” according to the Brandon Sun and slightly more stringent than the Canadian average according to the Bank of Canada — are set to expire on February 1. Doctors Manitoba has joined many physicians, including public health leaders, in urging Manitobans to go beyond the government’s current pandemic restrictions to slow the spread of COVID-19.
We heard from over 320 physicians in our survey over the last two weeks about the current pandemic situation, and feedback has been mixed:
- 53% see the current government’s restrictions as too loose, while 29% view them as appropriate. Among those who think restrictions should be tightened, the most effective changes cited would be further limiting private gatherings and further reducing capacity at places of worship, restaurants and bars, and introducing capacity restrictions at retail stores.
- When it comes to schools, 51% of physicians agreed the return to in-person learning was appropriate while 23% thought additional precautions should have been added. Another 22% felt remote learning should have been continued.
- Physicians’ top concerns right now include the surgery and diagnostic backlog, stress and burnout among health care workers and hospital capacity to handle the COVID-19 admission surge.
We have shared your views with provincial leaders. We will be monitoring the situation closely over the next few weeks, keeping you updated every step of the way.
COVID Immunity Webinar Key Takeaways
Yesterday, the COVID-19 Immunity Task Force featured a number of experts on how long immunity to COVID-19 lasts, with over 600 participants from across Canada. We watched and we have key findings that can help to inform your practice below.
Vaccines work, though protection wanes
- 83% of all hospitalizations and deaths in Canada were among unvaccinated patents since the vaccines were introduced in December 2020. Only 11% were among the fully vaccinated (two doses).
- Overall vaccine effectiveness against infection declines over time, from 90% in the first two months to 73% after eight months. Effectiveness against symptomatic infection declined too, but not as much, reaching 80% eight months after second dose.
- Effectiveness against hospitalization and death was sustained above 90%, even eight months following a second dose.
Vaccine effectiveness against variants
- Delta variant: Eight months after a second dose, effectiveness against symptomatic infection was 80%, but improved to 93% after a booster. Effectiveness against severe outcomes (hospitalization/death) was between 95% eight months after second doses, improving to 99% after a booster shot.
- Omicron variant: Initial data suggests effectiveness against symptomatic infection was very low after a second dose, but improved to 61% after a booster. Effectiveness against severe outcomes was between 82 – 86% after second doses, improving to 95% after a booster shot.
Other highlights from the webinar include:
- The interval between first and second dose impacts waning immunity. In a study of healthcare workers who received Pfizer, those who received their second shot 8 – 16 weeks after their first had 3.2 times higher levels of anti-RBD antibodies than the group who received their second dose 3 – 6 weeks after their first.
- Among long-term care residents, researchers found that Moderna/Spikevax resulted in a higher quality and quantity of antibodies than those who received Pfizer, and generated more CD4+ T cells as well. A third dose of Moderna elicited a stronger antibody response than Pfizer. Another research team found that a third dose of an mRNA vaccine was effective in this population at preventing breakthrough infections, but that antibody concentrations started to decline again just like after a second dose, suggesting further doses may be required.
Join the Vax-a-Thon on Feb 4
Join the many clinics that have already registered to participate in the February 4 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.
These types of vaccine events have been successful in creating excitement, improving access, and providing the “nudge” needed to help some people get immunized in other provinces across the county. We are planning a public announcement in the next few days and we will promote the Vax-a-thon over the next two weeks to raise public awareness and demand. All participating clinics with available appointments will be listed at ManitobaVaccine.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.
Medical Note Requests
Are you getting more requests for medical notes? Please let us know at firstname.lastname@example.org.
We have heard from a few physicians that they are getting more requests for sick notes from patients, suggesting employers may again be requesting notes from physicians to explain medical absences. At the beginning of the pandemic, we worked with the province and Dr. Roussin to issue an advisory to employers to stop asking for medical notes for patients with respiratory or COVID symptoms. We would like to hear if you think it’s time for a public reminder about this.
Are you getting other requests?
We’ve heard from some physicians asking how to handle requests for notes confirming patients have recovered from COVID-19 before they travel out of country. With the potential to continue testing positive after recovery, some patients see the notes as a way of gaining access to other countries or avoiding quarantine when they return to Canada.
We’re also hearing some patients are asking for rapid test results to be confirmed by physicians or documented in their file. Alberta has introduced a voluntary self-report form that is completed by patients to document their rapid test result, and then could be sent to physicians. We’re curious if his is something Manitoba physicians would find useful.
Share your insights by emailing us at email@example.com.
Paxlovid Treatment Details
Paxlovid arrived in Canada this week and is now available in Manitoba. The anti-viral pill, manufactured by Pfizer, is used to treat adults with early symptoms at high risk for severe illness. It is not approved for severe or critical patients, for prevention of COVID-19, to be used longer than 5 days, or for anyone under the age of 18.
Read more information about the drug HERE.
Eligibility criteria for available treatment options for COVID-19 (and for the monoclonal antibody treatment) have expanded to include some fully vaccinated individuals, with the second dose (or single dose for one dose vaccine) administered more than four months ago. These individuals must also meet other criteria set out related to age and co-morbidity.
Full eligibility and additional information for providers has been developed and are available here. Other resources:
- Memo – Paxlovid Oral Antiviral Treatment
- Paxlovid Information for Health-Care Providers
- Paxlovid Referral Form
- Paxlovid Patient Information Sheet
- French Patient Information Sheet
- Paxlovid Drug Interactions Sheet
For patients who meet the criteria, a referral form must be completed, form available here.
Being largely ignored by the federal government, a groups of truckers calling themselves the Freedom Convoy, is driving across the country to Ottawa to protest vaccine mandates. Convoys have passed through cities across the country, causing traffic jams and attracting throngs of roadside supporters. Over 58,000 people have contributed $4.3 million in support of the Convoy, though GoFundMe has frozen access pending further information from the organizers. The group is demanding all vaccine mandates cease. The protests were triggered following a new federal mandate requiring all Canadian truckers to be fully vaccinated to avoid a 14-day quarantine when returning from the U.S.
Yesterday truckers and supporters in the hundreds drove around the perimeter and parked in front of Manitoba’s legislature.
While the Convoy is attracting some news and social media attention, the views do not appear to be widespread. The Canadian Trucking Alliance, which was previously opposed to vaccine mandates for members, is now advising truckers to comply. The organization reports that the majority of Canadian truckers are vaccinated, and vaccination rate closely mirrors that of the general public. Several public opinion polls since August show a vast majority of Canadians back vaccine mandates for essential workers.
DRMB Wordle Challenge!
A simple daily word puzzle has become the latest pandemic pass time. Based on what we’re seeing on Twitter, physicians and medical learners appear to be enthusiastic adopters, likely because Wordle offers a brief break from the daily pressures of the pandemic.
Doctors Manitoba is organizing a Wordle Challenge, with a prize for the best score!
What is Wordle? Designed by a software engineer for his word-game-loving wife, web-based word puzzle has quickly become popular. You have six attempts to guess the a five-letter word. With each guess, the game uses colour coding to indicate which letter is correct and in the right spot, correct but in the wrong spot, or not in the answer at all that day. A new puzzle is released daily and you can only play it on that day.
Here’s how to play and enter our contest:
- You must complete at least 20 Wordles by February 28, 2022. Past Wordles already completed count.
- You must play on the official site (bookmark this link). No apps or imitators qualify.
- After playing at least 20 rounds, submit a screenshot of your Wordle statistics using this entry form. (See sample here)
To win, you must have the lowest average (mean) after at least 20 plays. In the event of a tie, the winner will be selected from the tied contestants by random draw. The winner must be a Doctors Manitoba member. Doctors Manitoba reserves the right to disqualify submissions that don’t appear genuine it its own judgement.
What do you win? The winner will receive a $200 gift card for a local business of their choice that will improve their joy and well-being.
ICYMI — Highlight of Recent Updates
Here are a few recent updates, in case you missed it:
- Last week, the provincial Diagnostic and Surgical Recovery Task Force provided shared its first monthly update. See our summary here, and a message from Task Force Chair Dr. Peter MacDonald here.
- 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.
- Earlier this month, 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.
You can see upcoming events and learning opportunities here. There are two PLIs being offered to practicing physicians in NHR, IERHA and PMH through the Physician Health and Wellness Community of Practice that are not listed on our events page:
Physician Leadership Institute Courses for Physicians Practicing in PMH, NHR, or IERHA
Your colleagues, Doctors Manitoba, CMA Joule, PMH, 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. Both courses are aligned with the LEADS in a Caring Environment framework.
Questions? Email: firstname.lastname@example.org.
Cost: $200 each course (subsidized)