In today’s message you will find:

• COVID Updates
• Restrictions Extended
• Join the Vax-a-thon
• Improved Access to Rapid Tests
• Provincial Budget Input
• Fantastic Physicians
• ICYMI: Recent Updates
• Upcoming Events

COVID Updates

Since our last update on Tuesday…
Serious Outcome Surveillance:

• Hospitalizations high but stabilizing: There are 715 people in hospitals with COVID-19, down from 729 on Tuesday.
• Daily average hospital admissions down slightly: There were 40 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 45 admissions per day, down from 55 the previous seven days. 
• ICU occupancy up slightly and still very high: Of the hospitalizations reported above, 52 patients are in ICU, up from 49 on Tuesday. Yesterday there was a total of 110 patients in ICUs, up from 102 on Tuesday and still well-over the normal 72-bed capacity. 
• COVID-related ICU admissions have averaged five to six per day over the last seven days, though there were nine yesterday alone. The daily average is about the same as the previous week. 
• 23 more people have died from COVID-19 since Tuesday with the total now at 1,543. 140 people have died so far in the month of January. 

According to the COVID-19 Tracker Canada Project, Manitoba has an average of 51 hospitalizations per 100,000, down slightly from 52 on Tuesday and still the highest in the country. Quebec continues to have the second highest rate at 36 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*: 2,092 new cases of COVID-19 have been identified since Tuesday, a daily average of 697.This includes 898 cases reported today. The total case count in Manitoba now stands at 118,862.
• Test positivity remains high*: The provincial five-day test positivity rate is 32.1%, down only slightly from 32.9% on Tuesday.
• Active cases decrease*: There are 29,720 active COVID-19 cases province-wide, down from 39,296 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 345 per 100,000, above the Canadian average of 339 but down from 400 on Tuesday. PEI, which had been successful in largely avoiding previous waves, now has the highest rate with 1,033 per 100,000. Saskatchewan has the second highest, with 756 per 100,000. Comparing jurisdictions is challenging as testing capacity is strained and prioritized differently across provinces.

Close Contact Notification in Child Care Centres

To more closely align schools, the province confirmed today that notification of close contacts by child care centres is no longer required. Attendance of children and staff will be based on symptom screening. Children or staff exposed to COVID-19 in the child care and school settings may continue to attend child care and school if they are asymptomatic. Public health will continue to monitor the overall cases in child care centres and may contact a facility if increased COVID-19 activities is suspected. 

Restrictions Extended

Earlier today, the government announced it is extending the existing pandemic restrictions by one week, from February 1 to February 8.

Health Minister Audrey Gordon said the situation appears to be peaking and stabilizing, but an additional week was required to monitor. She left the impression that current restrictions would not be further extended unless something escalates, and mentioned the Premier would be announcing a reopening plan next week.

Ontario and Quebec have already announced their plans to gradually reopen, though their first steps move their restrictions more in-line with those currently in place in Manitoba. Manitoba’s current restrictions appear to be middle-of-the-pack and slightly more stringent than the Canadian average, according to monitoring by the Bank of Canada. We conducted a survey recently and found that physician views on restrictions are mixed. About half said the government’s restrictions were too loose, while 29% viewed them as appropriate.

Dr. Brent Roussin joined the Minister today, along with the new health system incident commander David Matear, to offer insights into surveillance trends and projections. Highlights include:

• New hospital admissions appear to have peaked and projections show new admissions starting to decrease
• Hospital occupancy by COVID patients also appears to have plateaued, and possibly peaked at 730 on Tuesday.
• ICU occupancy by COVID patients remains high, but has plateaued between 50 and 54 patients for the last couple of weeks
• Staffing sick time in Winnipeg decreased over the last two weeks

While this is encouraging, Dr. Roussin urged caution, noting that ​“While we are seeing some key indicators signal a peak, we need to remain cautious in our approach to the virus.” He also noted that recent data from Winnipeg wastewater testing suggests the viral count may once again be increasing. Test positivity rates are high, but less useful to monitor community spread on its own because it only includes PCR tests.

David Matear echoed the need for a cautious because of the continued pressure on hospitals, noting it will be a ​“long road back to normal.” The pressure on hospitals to accommodate and care for COVID-19 positive patients and on PCHs to maintain staffing is affecting other services, namely home care, surgery and outpatient clinics.

To cope, the health system continues to employ exceptional measures to accommodate COVID-19 patients.

In ICUs, there were 110 patients in total today, including 54 related to COVID-19. With 23 nurses who recently completed the 12-week critical care training course, hospitals should have the ability to accommodate up to 123 patients now. Other contingency plans are in place, though they were not described, to accommodate all patients who need critical care. Matear said there are no plans to send patients out of Manitoba for ICU care, which happened in the third wave after ICUs in Winnipeg and Brandon reached 131 patients. Thirty additional nurses have signed up for the next 12-week ICU course, which started in early February.

Hospitals are offering incentives to nurses and other staff to delay vacations, to help improve staffing over the next several weeks.

In medicine, there are about 1,480 beds across the province, and 182 were available last night. However, Matear acknowledged beds are often not available where patients are, requiring transfers to hospitals in different regions. This ​“level loading” was resulted in 253 patients being transferred over the last three months, including 39 over the last week alone.

Doctors Manitoba has raised concerns about these patient transfers, particularly for frail elderly patients. We brought together a group of geriatricians and health system leaders earlier this week for a productive discussion about decreasing the number of these transfers and, when they must happen, improving the quality and safety.

Where transfers do occur, the province will soon offer financial assistance for a designated family member or support person, including meal vouchers, and assistance with transportation and accommodation.

Vax-a-Thon on February 4

Over 20 doctors’ offices have joined our Vax-a-Thon, being held next Friday.

Yesterday, our President Dr. Kristjan Thompson and President-Elect Dr. Candace Bradshaw spoke with media to invite the public to attend, whether they just want to discuss their concerns with a physician or receive their first, second or third dose. Participating clinics have set their own hours and will take their own appointments. They are listed at Man​i​to​baVac​cine​.ca.

Dr. Bradshaw explained that ​“getting vaccinated and boosted is the best defense against COVID-19. With over 2.7 million doses administered in Manitoba, and over 9.9 billion doses worldwide, physicians continue to trust the safety and effectiveness of COVID-19 vaccines and we strongly recommend them. COVID-19 vaccines are not experimental. They are routine.” 

→ Your medical clinic can still join! Check out this page for details on how to sign up, remuneration details and resources to print and share online and with your patients. 

Manitobans who have been reluctant to get their first dose are still seeking information and agreeing to get their shot. It often takes a physician, who can listen to their concerns and offer trusted advice about the vaccines. The Winnipeg Free Press profiled just this approach recently in the Southern Health region, where Dr. Ganesan Abbu visited a Morden-area Hutterite colony to answer questions about the vaccine following the death of a young colony resident.

“I spoke to them about vaccine hesitancy,” Dr. Abbu recalled. ​“We had frank discussions about vaccine safety and how to evaluate claims,” said Abbu, an anesthetist and special care unit doctor at Boundary Trails Health Centre, located between Morden and Winkler. The people who had the most questions were the first ones to roll up their sleeves. They said, ​‘I wish you had come a year earlier and spoken to us.’”

During his visit, 25 people rolled up their sleeves for their first dose.

NACI recommendations updated

On Tuesday, with the surge of the Omicron variant and new real-world data on the safety of the vaccines, the National Advisory Committee on Immunizations (NACI) updated their recommendation, stating children aged five to 11 should get a full regimen of vaccination, and immunocompromised children should get three doses. The latest advice comes after the group consulted with experts and data from other jurisdictions around the world and is a change from previously stating only that children may get a vaccine. This change in wording is as strong a message as NACI can take in regards to safety of the vaccine and speaks to the importance of getting children 5 – 11 fully immunized against COVID-19. 

Today, NACI also provided updated guidance on booster shots for 12 – 17 year-olds. Boosters are not recommended for all 12 – 17 year olds, but rather those at increased risk or vulnerable to COVID-19. This includes those with underlying medical conditions that increase their risk for severe illness, those who live in congregate settings like shelters or jails, and those who are part of racialized or marginalized communities disproportionately affected by the disease.

Manitoba Public Health is reviewing these guidelines and we anticipate they will be incorporated into Manitoba’s recommendations next week.

Improved Access to Rapid Tests

We have been working with provincial officials to improve access to rapid antigen tests (RATs) for physicians and their staff. We’re pleased to report we have made some progress.

The following steps will ensure community-based physicians and staff have the same access to rapid tests as their hospital- and RHA-based colleagues. It will also improve access in smaller rural and Northern communities.

Earlier this month, Shared Health updated its return-to-work guidelines, allowing some health care workers to return to work using rapid tests. The guidelines, available here, allow the following: 

• Symptomatic HCWs can return to work if they a) test negative on one PCR or two self-administered RATs, b) have mild and improving symptoms, and c) have no fever for 24 hours, and no use of fever reducing medication.
• Fully vaccinated HCWs who live with someone who has tested positive can return to work if they participate in 10 days of rapid testing every 48 hours.

Rapid tests are available for HCWs for these purposes at provincial test sites, but they are required to show Hospital or RHA identification or a pay stub. 

We have confirmed that community-based physicians and their staff can also access tests at provincial test sites. If your clinic does not have a photo ID badge, physicians and clinic staff can show a pay stub or business card or other document confirming they work at a medical clinic. We have been assured that provincial test sites are being notified of this change.

For physicians working in rural communities that do not have a provincial test site within 45 minutes, the province has agreed to send a package of RATs to your clinic for use to meet the Shared Health guidelines noted above. They are identifying these clinics now and we are told they will be in touch over the next week to confirm the number of physicians and staff and to arrange for delivery. At this time, these RATs are for use only for physicians and clinic staff, and not for family members or patients. 

Provincial Budget Input

As part of its annual budget-making process, the provincial government is seeking advice from Manitobans and stakeholder groups about what should be prioritized for the 2022/23 budget.

Doctors Manitoba will be submitting proposals on behalf of the medical profession, and we welcome your input. 

We have adapted the provincial survey tool to gather your views here. Please submit your feedback by February 15. 

This will build on other feedback we’ve already received from physicians lately through other surveys, our bloc working groups and other ways we engage with you. You can also share your views by emailing us at covid19@​doctorsmanitoba.​ca.

Fantastic Physicians

REMINDER: The deadline for submitting a nomination for the 2021 Resident Doctors of Canada (RDoC) Awards is tomorrow, Saturday, January 29. Learn more here.

ICYMI: Recent Updates

Here are a few important recent updates, in case you missed them. 

• Paxlovid arrived Manitoba this week, and the oral antiviral is being used as an early treatment option for individuals at risk for serious illness. Find resources about Paxlovid and monoclonal antibodies on Shared Health’s COVID treatment resource page, including eligibility criteria and referral forms. Both treatments are time sensitive and need to be initiated within a few days of symptom onset. 
• Who doesn’t love a little bit of a distraction these days? We’re hosting a Wordle challenge with a $200 prize for the winning member at a local business of your choice that will improve your joy and wellness. You must complete at least 20 games by February 28 Find out more here.
• Missed the COVID Immunity Webinar? It was chock-full of the latest science on immunity and vaccine effectiveness, including against Omicron. We’ve got the key takeaways here, and links to see the full presentation. 
• The provincial Diagnostic and Surgical Recovery Task Force provided shared its first monthly update two weeks ago. See our summary here, and a message from Task Force Chair Dr. Peter MacDonald here.
• Earlier this month, we held a COVID-19 Town Hall for physicians with experts 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

Events and learning opportunities can always be found on our Events Calendar. We encourage members to bookmark it in your browser.

Here’s a new event we’ve added, which you may want to consider attending. 

“Physician advocates never imagined being the targets of intimidation and death threats for supporting public health measures during the pandemic. But it’s happening.” Join Dr. Caroline Gerin-Lajoie on February 1 at 6pm CST, as she moderates the Podcast Series: Death threats and safety protocols — the troubling new reality for many physicians.
You can register for the event here and you can listen to the podcast here.