January 3, 2022
In today’s message you will find:
- COVID-19 Surveillance Update
- Testing for COVID-19 Shifts
- Changes to Self-Isolation Requirements
- Restrictions Update
- Hospital Pressure Grows
- HCW Return to Work Changes
- Vaccine updates
- COVID Treatment updates
- Fantastic Physicians
- Upcoming Events & Webinars
COVID Surveillance Update
As Omicron causes COVID-19 to spread so quickly and with testing capacity stretched and being prioritized, we anticipate that daily cases and active cases are being under reported. At the same time, reported test positivity rates may be higher than in the past as PCR testing is prioritized.
Therefore, we are now emphasizing indicators of serious illness, including hospitalizations, ICU admissions and deaths. We will continue to report the other surveillance indicators as well.
Since our last update two weeks ago on Monday, December 20:
- Hospitalizations up: There are 228 people in hospitals due to COVID-19. This is up 50% from 152 two weeks ago, and up 32% over the last week alone.
- Daily hospital admissions up: There were 20 people admitted to hospital yesterday with COVID-19. Over the last week, this has averaged 18 admissions per day, up from 10 per day two weeks ago
- ICU census up: Of the hospitalizations reported above, 32 patients with COVID are in ICU. This is up 19% from 27 patients two weeks ago. There have been two to three ICU admissions per day over the last week, up from about one per day two weeks ago.
- 32 more people have died from COVID-19. This brings the total COVID-19 related deaths to 1,398. Over the last seven days, Manitoba has led the nation with 1.3 deaths per 100,000 people, more than three times the national rate of 0.4.
According to the COVID-19 Tracker Canada Project, Manitoba leads the nation with 16.5 people hospitalized with COVID-19 per 100,000, followed closely by Quebec at 16.2 cases / 100,000. Alberta has 8.4 cases / 100,000 and Ontario has 8.3 cases / 100,000.
Surveillance indicators (interpret with caution):
- Daily cases up significantly: 3,917 new cases of COVID-19 have been identified since our last update two weeks ago. Over the last seven days, there has been a daily average of 1,399 new cases identified (up from 250 two weeks ago). This includes 1,721 new cases today. The total case count in Manitoba now stands at 75,507.
- Test positivity jumps: The provincial five-day test positivity rate is 37.9%, from 8.6% two weeks ago and 21.9% a week ago.
- Active cases jump: There are 15,318 active COVID-19 cases province-wide, up from 2,183 two weeks ago.
According to Health Canada’s tracking (last updated Dec 30), Manitoba had 417 cases per 100,000 over the last seven days, up from 92 two weeks ago. The average across Canada was 514, driven primarily by Quebec (878 cases/100,000) and Ontario (488 cases/100,000). Comparing jurisdictions is becoming challenging as testing capacity is strained and prioritized in many provinces.
COVID Testing Approach Shifts
Manitoba’s COVID-19 testing capacity has been overwhelmed, as we are seeing in other jurisdictions. With the rise of Omicron, there have been reports of both long waits at testing sites, as well as long turnaround times to get results. Over the holidays, there was still a backlog of over 10,000 tests that labs were working to process.
Based on this, PCR testing is being prioritized to ensure those at higher risk can get a test. The following approach has been introduced:
- Fully-vaccinated symptomatic individuals may receive take-home, self-administered rapid tests (a random number will be selected for a PCR test as a “control measure”). We understand the kit includes three tests with instructions to conduct a self-test daily for three days. If a rapid test comes back positive, individuals should return for a PCR test to confirm the result. Currently, four testing sites are offering the take-home rapid test kits: Drive-thru testing sites at 1066 Nairn Ave and 125 King Edward Street in Winnipeg, the walk-in testing site at 1 Research Road in Winnipeg, and the testing site at 100 Easton Drive in Selkirk.
- Individuals with symptoms who are under 40 and otherwise healthy have been encouraged to assume they have COVID and self-isolate, rather than seek a test.
- Individuals should continue to get a PCR test if they are unvaccinated with symptoms. If they are deemed high risk, they may also receive a take-home rapid test and may be referred for monoclonal antibody treatment.
While testing is important from a surveillance perspective, Omicron has changed the focus given it is highly transmissible with a shorter incubation period. This makes case and contact management challenging, but it also means the daily case counts, active cases and test positivity rate are likely distorted and less useful to understand and compare these indicators over time or with other jurisdictions. However, testing continues to be an important tool from a treatment perspective and to help limit spread.
You can read the full update here. We note that this recent change may not yet be reflected on the government’s website or in guidance documents for clinicians.
Manitoba is not the only province forced to prioritize PCR tests. In fact, access is even more restricted in BC, Ontario, Alberta, and Nova Scotia, for example. In most of these cases, testing is being limited to those at high risk for severe illness, health care workers and emergency responders.
Changes to Self-Isolation
On Friday, the province made significant changes to self-isolation requirements.
The move expands self-isolation requirements to include individuals who test positive on a rapid antigen test, given the wider use of these testing options. Previously only individuals with PCR positive tests were required to self-isolate under public health orders.
The changes also decrease the isolation period for fully-vaccinated individuals from 10 days to five, either from the date of the test or the date symptoms first appeared, whichever is later. Individuals who are not fully-vaccinated must continue to isolate for 10 days. In both cases, individuals can end isolation if their symptoms are improving and they do not have a fever, otherwise they must continue to self-isolate.
Public health officials also advised people leaving isolation to avoid any non-essential visits to high-risk settings or non-essential contact with individuals at high risk for severe disease for an additional five days.
Close contacts of cases must continue to isolate for 10 days, unless they are fully-vaccinated or exempt from isolation.
You can read the full update here. We note that the public health orders and guidance documents are still being updated, so the government website and guidance on managing cases and contacts may not reflect these changes for a few days.
Manitoba’s changes appear aligned with several other provinces, including BC, Alberta, Saskatchewan, Ontario and New Brunswick. They all follow a similar change made by the U.S. Centers for Disease Control and Prevention (CDC) last month, though some have criticized those changes as being more about minimizing economic disruption. Dr. Anthony Fauci said today officials are considering adding a testing requirement to end the 5‑day isolation period.
Last month, Manitoba introduced a series of pandemic restrictions to slow the spread of COVID-19, which is now rapidly increasing due to the Omicron variant. These restrictions include limits on private gatherings and reduced capacity at public places, such as restaurants, public events, museums, theatres and places of worship (see current restrictions here). Manitoba also announced it was delaying the resumption of school from January 6 to January 10.
Some have called for further restrictions as cases soar and our hospitals are already being pushed past their limits.
How does Manitoba compare? Going into this Omicron wave (Dec 15), Manitoba did have the tightest restrictions in Canada according to a stringency index maintained by the Bank of Canada. However, a lot has changed since mid-December. Manitoba tightened its restrictions, as did most other provinces using a variety of approaches to reduce contacts. In the last few days, the two largest provinces in Canada – which also have the highest rates of new infections – have gone even further:
- Quebec went further on December 30, imposing an overnight curfew, closing restaurants completely to dine-in, closing non-essential businesses on Sundays, and delaying the return-to-school until January 17.
- Ontario announced tougher restrictions today, including closing gyms, prohibiting indoor dining at restaurants, limiting retail and personal services capacity to 50%, moving to work-from-home if possible, further reducing private gathering sizes, and shifting schools to remote learning until January 17. The province is also pausing non-urgent surgeries as COVID-related hospital admissions are projected to rise.
Meanwhile, Manitoba has faced a great deal of criticism for not making rapid test kits available widely and for free like in other provinces. Instead, rapid tests are being distributed here at test sites, through schools for students K‑6, and in other targeted sectors. While all provinces received proportional supplies from the federal government, they have been used differently. Manitoba’s option to allow unvaccinated public sector employees to use rapid tests to stay on the job has taken a chunk out of our stockpile, as has the partnership the government created with the Chambers of Commerce to encourage the vaccinate-or-test mandate in the private sector. That program is now under review, and this is disrupting the availability of rapid tests for doctors’ offices as well, which we are following up on.
We will continue to monitor the situation closely, and we will continue to share your feedback about restrictions with public health officials.
Hospital Pressure Grows
While hospitalizations have risen by 50% over the last two weeks to 228 COVID-19 patients in hospital today, this is still much lower than peak of 400+ hospitalizations during the second wave in fall winter 2020/21. In the ICUs, meanwhile, there are 32 COVID-19 patients today, about half of the peak seen during earlier waves.
So, why are we hearing so much concern about hospital and heath system capacity? There are several reasons:
- Since earlier waves, we have seen health care worker attrition, adding to staffing shortages that were already an issue earlier in the pandemic.
- Now, like other provinces, we are seeing infection rates and sick time among health care workers rise.
- Other jurisdictions are seeing Omicron cases surge. Even if Omicron causes severe illness in fewer people, its high degree of transmissibility looks like it could result in more hospitalizations overall than previous waves.
The concern is not only about what is coming. Even before Omicron arrived, Manitoba had the highest rate of COVID-19 hospitalization in Canada. This has resulted in:
- More surgery cancellations.
- About 150 patients, many frail and elderly, have been transferred to other facilities hundreds of kilometres away for care.
- Rural hospital service disruptions, including ERs.
- Outpatient clinic nurses being reassigned to inpatient units.
When you consider where Manitoba was at as Omicron arrived and overlay that with the projected hospital pressures coming based on jurisdictions with a few weeks more experience than us with Omicron surges, it’s easy to understand why many physicians are more concerned than ever about hospital capacity.
Last week, our President Dr. Kristjan Thompson urged all Manitobans to go further than public health orders to help slow the spread of COVID-19 to help spread out the impact on hospitals and health services. This built on our #CelebrateSafe campaign over the holidays, asking Manitobans to reduce their contacts and to reduce risks if they did gather with other households.
Health Care Return to Work Changes
As the isolation requirements have changed for all Manitobans (see above), the return-to-work guidance for health care workers has also been updated to also reflect the change from 10 to five days.
The current isolation and return-to-work guidance for health care workers includes:
- Health care workers who test positive and are fully vaccinated are no longer required to notify Occupational Health (OESH) of their positive result.
- Health care workers who test positive and are fully vaccinated may return to work on day six, after the five-day isolation period, provided they have been afebrile for 24 hours without fever-reducing medication. Any lingering symptoms must be mild and improving, and health care workers “must feel well enough to complete their duties.” No notification to OESH is required for a return to work.
- Workers who are not fully vaccinated and test positive must continue to isolate for the full 10-day period. They must notify OESH of their positive test result and they must also seek clearance from OESH or a designate before returning to work.
- Health care workers who test negative and have mild and improving symptoms with no fever may be allowed to return to work if they are able to resume their duties, without any prescribed isolation period.
Please see this memo from Shared Health for further details on workers who positive, as well as this Q&A to understand the rationale behind the changes. This Shared Health memo explains the changes and procedure for workers who test negative.
Over the week before Christmas (Dec 19 – 25), 418 health care workers tested positive for COVID-19 according to Shared Health. These health care worker infections could have been acquired at work or in the community on personal time. This is nearly a seven-fold increase over infections from the previous week. Shared Health said while the increase is significant, it is proportional to the jump in cases Manitoba is seeing overall. Nearly 80% of infected health care workers (330) had not yet received their booster shot.
The infections reported for this week include 49 physicians or physicians-in-training.
Reminder about Doctors Manitoba Isolation Benefit
If you have have to isolate due to a COVID-19 positive test result, symptoms OR a work-related exposure, you may be eligible to claim our COVID-19 Isolation Benefit. We’ve seen an increase in claims over the last week, and we will continue to process these claims as they arrive. This benefit is funded by the province, and was created after Doctors Manitoba advocated for isolation support for physicians.
Click here to review the full eligibility criteria and benefits, which were set by the government after advocacy from Doctors Manitoba.
Acute and PCH Visitor Restrictions Re-Introduced
All social/general visits to a PCH and social leaves from a PCH have been suspended as of December 31. Relevant exceptions remain in effect. Designated Family Caregivers will continue to have access to facilities provided they pass all screening requirements. The full memo from Shared Health is available here. There are currently 10 outbreaks in PCHs in Manitoba.
Hospital visitations are also being limited to essential care partners. Shared Health’s current guidance can be accessed here.
As of December 31:
- A total of 2.47 million doses of COVID-19 vaccines have been administered in Manitoba
- 78.5% of eligible Manitobans have received two doses and 23.5% have received three doses.
- People who are not fully-vaccinated are three times more like to test positive for COVID-19, nine times more likely to be hospitalized, 26 times more likely to be admitted to ICU, and 17 times more likely to die with COVID-19.
Age-Based mRNA Vaccine Recommendations
Last week, the province announced that it is recommending individuals age 30 and older receive the Moderna mRNA vaccine (Spikevax), even if their previous dose was Pfizer (Comirnaty).
Several weeks ago, Manitoba adopted NACI’s guidance that Pfizer is preferentially recommended for all doses for those age 12 to 29 to minimize the risk of myocarditis/pericarditis among adolescents and young adults. While extremely rare, the conditions have been observed more often following Moderna immunizations than Pfizer for younger people.
In order to preserve Pfizer doses for those under the age of 30, the new guidance recommends Moderna for those age 30 and older, regardless of which vaccine product was used for previous doses. The guidance allows Pfizer to be used with those age 30+ if there is a contraindication for Moderna, there is no Moderna available, or the individuals insists on Pfizer even after a discussion about safety and efficacy. For this age group, public health says “while we don’t want to turn clients away, it is critical the initial active offer of the Moderna/Spikevax product occurs to help vaccinate as many Manitobans as possible.”
Extension of shelf-life for Moderna (Spikevax) vaccine.
Health Canada has authorized a two-month extension to expiry dates for some Moderna vaccines. The new guidance, adopted by Manitoba, applies retrospectively to all English-only labels with a printed expiry date between Dec 2021 and Aug 2022, and only applies to vials stored in frozen temperatures at the time of the extensions. There is no shelf life extension on thawed product. Any product that has been thawed and in the refrigerator is to still follow the one month time limit for use as per the product specifications (unless the product expiry date occurs within the month from being thawed).
The new expiry date are two months after the listed dates. So an expiry of December 2021 becomes February 2022, and August 2022 becomes October 2022. The following lot numbers have been affected: 3002914, 3003184, 062H21A, 020J21A.
For units without a printed expiry date (i.e. 15-dose or 8mL fill volume vials), the 9‑month shelf life was applied in October and Healthcare Provider’s should continue to refer to the October 29, 2021 HPRC for shelf life information.
COVID Treatment Updates
Individuals who test positive for COVID-19 may be eligible for monoclonal antibody treatment.
Monoclonal antibody treatment for COVID-19 is a one-time intravenous treatment that can be offered to unvaccinated, partially vaccinated or immunocompromised individuals who meet the criteria below. It is expected to reduce the severity of illness and hospitalization rate for some patients by promoting an initial immune response in those with no prior antibodies to COVID-19. This response is also expected to help prevent severe COVID-19 illness in people with weakened immune systems who may not generate a robust response to the COVID-19 vaccines.
While monoclonal antibody treatment is showing some effect in treating COVID-19, a full vaccine regimen remains the best way to prevent COVID-19. This is especially true for the emerging Omicron variant, for which the third dose is showing markedly superior protection. Individuals who have received monoclonal antibody treatment should continue to be encouraged to receive the COVID-19 vaccine, but should wait 90 days post administration of the treatment before being vaccinated. No waiting period is required for non-COVID-19 vaccines.
Individuals are eligible for treatment if it is within seven days of symptom onset and they have a positive COVID-19 test result. They must also meet one of the additional eligibility criteria:
- Unvaccinated or partially vaccinated with no history of past COVID-19 infection and age 41+.
- Unvaccinated or partially vaccinated with no history of past COVID-19 infection, age 18 – 40, with a serious health condition such as diabetes, smoking obesity, heart, kidney or lung disease, or cancer.
- Immunocompromised due to medical condition or treatment, age 18+, regardless of vaccination status.
- Updates for providers about the treatment option are available through Shared Health here
- Referral form is available here.
- Public information is available here.
On December 24th, local radio personality Ace Burpee released his list of Top 100 Most Fascinating Manitobans for 2021. Three of Manitoba’s remarkable doctors made the list. Dr. Marcia Anderson was recognized for her work leading the Manitoba First Nations Pandemic Response Team and for many other impressive accomplishments. Dr. Joss Reimer’s tireless and empathetic work as medical lead and spokesperson of the COVID-19 Vaccine Task force earned her a spot on the list. Dr. Ken Hahlweg was recognized for his heroism and quick-thinking that disrupted a knife attack, that likely saved his nursing colleague’s life in late October. Dr. Heather Watson, our Resident of the Year, was recognized by Ace for her focus on psychosocial obstetrics and gynecology. Dr. Brian Penner was the first person in Manitoba to receive a COVID-19 vaccine. Dr. Melanie Morris is the first Indigenous pediatric surgeon in Canada and has taken on the role of Indigenous Lead for child health, the first such role in Canada. Congratulations to all six of these fantastic physicians!
Upcoming Events & Educational Opportunities
Physician Leadership Speaker Series — One Event Left!
Don’t miss: Mentorship and sponsorship models that promote equity in our educational & healthcare systems with Dr. Jamiu Busari — January 17 at 6pm CST.
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.
Immigrant and Refugee Mental Health CourseFunded 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 12th. 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.
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.