In today’s message you will find:
Restrictions to Recommendations
Choosing Wisely — Lab Resource Shortage
Since our update on Thursday March 10, …
- Hospital occupancy continues to decrease: There are 395 people in hospitals with COVID-19, down from 424 on March 10.
- Hospital admissions continue to decline: There were 15 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 16 admissions per day, down from 17 per day the previous seven days.
- ICU occupancy steady: Of the hospitalizations reported above, 17 patients are in ICU, down from 22 on March 10. There are 93 patients total in ICUs right now.
- COVID-related ICU admissions have averaged 1.1 per day over the last seven days. This is down from 2.1 admissions per day on average during the previous seven-day period.
- 15 more people have died from COVID-19 since March 10 with the total now at 1,723.
According to the COVID-19 Tracker Canada Project, Manitoba has an average of 24 hospitalizations per 100,000, down from 31 on March 10. For the first time in a long time, this no longer leads the nation, with Saskatchewan now at 29 hospitalizations 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).
Two Years of COVID-19
Last Friday marked two long years since the World Health Organization declared COVID-19 a global pandemic. The pandemic has greatly affected everyone province-wide. Manitobans’ efforts to slow the spread and protect each other came at a significant cost. We have endured isolation from family and friends, we’ve missed milestones and special occasions, we’ve seen schools close, and students adapt to remote learning, and there have been countless layoffs and lost income to individuals and businesses. Meanwhile, thousands of Manitobans have become seriously ill or died from COVID-19, and we estimate over 100,000 have had tests or surgeries postponed because of the pandemic response.
Over the last two years:
- 133,745 Manitobans have tested positive for COVID, though the real number is much higher. This includes over 5,500 health care workers, with over 200 physicians or physicians-in-training.
- 8,437 have required hospital care, including 1,378 who needed intensive care.
- 1,723 have died.
- An unknown number are struggling with long COVID.
We learned just how vulnerable our hospitals were and continue to be. Surges in COVID admissions and staffing shortages led to surgery & diagnostic tests cancellations, that created a massive backlog of more than 160,000 cases. Manitoba’s ICUs were overwhelmed with patients sent out of province for care.
When it comes to being protected and being ready, things have certainly changed:
- More than 86% of eligible people have received 1+ dose of a COVID-19 vaccine.
- COVID treatments are now available for those at increased risk of severe outcomes, with 212 oral antiviral treatments dispensed and 502 doses of monoclonal antibodies used (as of March 9).
- Most businesses reinforced necessary public health measures to keep staff & patrons safe, with many continuing some precautions even after restrictions are lifted.
Statistics Canada also issued a two-years-in-review update showing how the pandemic has impacted many health, social and economic aspects of our lives across Canada:
- Mental Health and Addictions: Mental health declined and has not fully recovered to pre-pandemic levels. 61% reported good or excellent mental health, down from 67% in 2019. Excess deaths, beyond what would be expected without a pandemic, include COVID deaths, but there appears to have been an increase in unintentional poisonings and overdoses.
- Public Safety and Social Cohesion: reported rates of assault, sexual assault, uttering threats and robbery increased during the pandemic and there was a 37% increase in police-reported hate crimes.
- Population growth fell to levels not seen since WWI, with one in five saying the pandemic made them delay having children or choosing to have fewer. Life expectancy decreased by 0.6 years, the largest single-year drop in a century.
- Economic impacts: Inflation has hit a 30-year high and is outpacing wage growth. Increasing housing costs are having lasting impacts on social and economic mobility. Lockdowns affected many, but disproportionately affected Canadians in racialized communities.
Health Canada today approved Moderna’s Spikevax COVID-19 vaccine for ages six to 11, following similar recent approvals in Australia and the EU. The approved dosing
is a half dose (50 micrograms) for ages six to 11 one month apart. We anticipate Manitoba Public Health will issue local guidance on the use of Moderna for this age group soon.
Restrictions to Recommendations
On Tuesday, all pandemic restrictions in Manitoba were lifted, including mask mandates in public places and isolation requirements. This is part of the previously announced staged plan to replace restrictions with public health recommendations, similar to other communicable diseases. Public health is continuing to monitor the situation, and may recommend re-introducing restrictions if further waves appear.
- Watch Dr. Brent Roussin’s message to Manitobans as restrictions are replaced with recommendations. This is his last regular scheduled COVID update, though additional public updates will be provided as necessary.
Below we have a summary of what’s changing, including when it comes to testing and isolation guidance.
Public Health Recommendations
As has been communicated for weeks now, public health has provided public recommendations about assessing risks and precautions. Their new public guidance is available here and is consistent with Doctors Manitoba’s NewCOVIDNormal campaign.
Self-administered rapid testing continues to be recommended as the primary method to test and identify COVID-19 infections. PCR testing continues to be limited to eligible individuals. The province confirmed that it is beginning to wind down test sites. On Sunday, March 20, 18 test sites will close across the province, leaving 14 in operation.
Key testing resources:
- PCR testing eligibility
- PCR testing locations, indicating what will be closing March 20 and what will remain open.
- Rapid test kit order form for doctors’ offices, as physicians continue to be encouraged to hand out kits to all patients so they have them at home should they develop symptoms.
While the requirement to isolate has been removed, it is still strongly recommended. The updated isolation guidance confirms that:
- Individuals should isolate if they test positive or have symptoms
- Individuals should isolate for at least 5 days from testing positive, or from symptom onset. Isolation should continue until the individual has no fever and other symptoms are improving.
- Even after the isolation period, caution is needed during the 10-day period following symptom onset or a positive test. Individuals should wear a mask when around others during the 10-day period, and avoid non-essential visits to high-risk settings or with individuals at high risk for severe outcomes.
Household contacts of those who are self-isolating should self-monitor for symptoms for 14 days following exposure.
Vaccination Centres Closing
While vaccination sites in Brandon and Morden have closed and other sites will wind down in the coming weeks. The RBC Super Site will remain open a while longer, but vaccination is now primarily available through doctors’ offices and pharmacies.
COVID Treatment Important
Physicians are reminded to monitor for opportunities to refer patients for COVID-19 treatment. Both antiviral and antibody treatments are available, but must be initiated within five days symptom onset.
Referrals for treatment can be made following a positive COVID test, based on either a PCR test or a rapid test if performed by a health care provider.
- Information for physicians including eligibility and referral instructions.
- Information for the public about treatment.
Across the Country
A scan of all other provinces and territories shows that Manitoba is in the middle of the pack when it comes to the lifting of all restrictions. By Monday, nearly all provinces will have lifted mask requirements in most places. The trend away from restrictions and towards recommendations also appears to be the trend in many other countries as well. Some, however, have seen cases and hospitalizations rise after removing restrictions.
The federal government is removing pre-arrival testing requirements for entry into Canada for fully-vaccinated individuals, starting April 1. Symptomatic travellers will still not be allowed to enter. Random testing upon arrival will continue to help with surveillance. Travellers who are not fully vaccinated will continue to subject to testing requirements, including PCR tests on arrival and on day 8. They will also continue to be required to quarantine for 14 days, regardless of test result.
The federal government continues to require all Canadians aged 12 and up to be fully vaccinated before flying, even domestically and masks are still required in airports and on flights. Federal employees remain barred from employment without proof of vaccination. Canada is an outlier among the G7 countries, with the strictest measures in place.
Mask Up in Health Care & Clinic Settings
Masks continue to be required in all health care settings, including doctors’ offices. You can read about our advocacy to keep masks mandatory in clinics and find guidance and resources on mask requirements in medical practices here. We recommend that doctors’ offices post signage at the entrance of your clinic (download our low-ink mask poster or full colour mask poster). You should also consider posting our respect and safety sign as well.
Health System Recovery Plan
Earlier this week, Shared Health published a Health System Recovery Plan, outlining their efforts to “gradually and carefully” return the system to pre-pandemic operations, plan for the recovery in services disrupted over the last two years, and prepare for potential future surges for COVID care.
The plan offers encouraging information about ICU capacity, with Shared Health committing to maintaining a larger bed-base in critical care going forward. The province will maintain 87 adult ICU beds going forward, up from 72 as a pre-pandemic baseline. They are also increasing the size of the cardiac ICU from 20 to 23 beds. To address staffing shortages in this area, the critical care nurse orientation program will now be run four times per year, allowing up to 120 nurses to complete the training annually.
The medicine bed map is being reviewed and will likely be expanded, with better plans in place for overcapacity/flex beds to offer more timely admission to medicine. The goal is to better accommodate both COVID and non-COVID patients while also helping to reduce ED congestion, support more timely transfers out of ICU and support physical distancing requirements.
Avoiding hospitalization or reducing length of stay for COVID-19 patients remains a priority for the health system. This requires the ongoing support of all physicians through the following activities:
- Promoting the importance of vaccination, including booster doses.
- Ensuring timely antiviral or antibody treatment for eligible patients.
- Using the Virtual COVID Outpatient Program (VCOP) to support patients with treatment in their homes.
In other areas, the plan focuses on efforts to support recovering after two years of massive disruptions:
- For outpatient clinics, the plan reinforces increasing in-person care: “Practices may continue to offer virtual visits where appropriate, anticipated to be approximately 20 – 25 per cent of visits, with variation according to the specific practice.” We are aware that some outpatient clinics may not be able to increase in-person care as nursing staff are still reassigned. Please let us know if your outpatient clinic is limited by a lack of hospital resources by emailing firstname.lastname@example.org.
- For surgery, redeployed staff are being returned in a four-phase process over the next few weeks, which is returning many areas to pre-pandemic capacity. Details by site are included in Shared Health’s plan. While this return to pre-pandemic volumes will help stop the backlog from growing, new capacity will be needed to clear the backlog. That is the responsibility of the Diagnostic and Surgical Recovery Task Force.
- For PCH and long term care, a separate detailed plan was posted that speaks to planning for and management of future outbreaks.
- Visitor guidelines for hospitals and PCHs are cautiously loosened.
A Long-COVID Working Group has been created to compile and facilitate access to resources and services for those living with long-term effects of COVID-19. To support workforce health and wellness, a Psychological Safety Steering Committee has been established and is currently gathering information to understand the current issues and needs among health care workers.
Shared Health’s plan explains that as restrictions are eased, they are planning for a potential increase in COVID activity. “While Manitoba moves into the next phase of pandemic management, with recommendations replacing requirements and public health restrictions, it is anticipated that COVID-19 activity will increase and hospital admissions and ICU admissions may also rise.”
It’s hoped that pressure on hospitals will be avoided or minimized due to measures such as high levels of vaccine uptake and timely COVID treatments. However, Should there be another surge in hospitalizations, Shared Health’s plan to manage this includes:
- Expanding ICU capacity in 10-bed increments.
- Redeploying staff from other areas, now with a standardized provincial approach in place to prioritize which services are disrupted first.
- Flexing up the use of the VCOP for outpatient COVID care.
The plan also notes that inter-regional hospital transfers will continue to be used to manage medicine capacity, a policy that has been called “level loading” by health system administrators. The plan notes that these transfers “will continue and may increase in the coming weeks as weather can be expected to play less of a limiting factor.” These transfers of “clinically appropriate, stable patients,” Shared Health explains, are necessary at times to maintain medicine capacity for both COVID and non-COVID patients. However, we have heard serious concerns from geriatricians that a large number of these transfers have included frail elderly patients for whom transfers can negatively impact their care. They’ve also raised concerns about the safety and quality of these transfers, with some elderly patients reportedly arriving in the middle of the night, dehydrated and with incomplete documentation. Doctors Manitoba has raised these concerns with senior health system leaders. We will continue to closely monitor this situation and support the escalation of any new or recurring concerns about this issue.
Doctors Manitoba Response & Your Views
Our initial review of the plan found some positives as well as more questions.
The plan is certainly provides much needed and overdue transparency about the health system’s plan to manage during the pandemic, including contingency plans. The increased ICU capacity is a significant and comforting improvement. These are good steps forward.
Our primary concern, however, is that frontline physicians were not consulted, as far as we know, about this planning. The plan is high level, so it’s natural that many physicians already have questions about the details.
If you have questions or feedback about Shared Health’s plan, please let us know by emailing email@example.com.
Access Full Documents
You can access the original Shared Health documents here:
- Memo from Incident Command to all health care workers (March 15)
- Full Health System Recovery Plan
- Presentation version of the Health System Recovery Plan
Choosing Wisely — Lab Resource Shortage
The following message is being sent on behalf of Choosing Wisely to help manage and avoid lab resource shortages in Manitoba.
COVID-19 has put an extraordinary strain on laboratory medicine in Canada due to critical shortages in blood tubes, devices, and lab staffing. Shared Health Diagnostic Services is managing its resources effectively and is closely monitoring supply. While Manitoba is not experiencing any of the shortages seen at a national level, it is important for providers to continue to use best practices in management of laboratory resources and supplies.
Physicians, nurses, and other providers are key partners with the laboratory in preserving supplies for testing where they are needed most.
Before ordering tests, please consider:
- How and if this test result will change patient management.
- Strategies to minimize blood collections.
- Avoiding test or request duplications, e.g., check EMR or eChart for previous results.
- Talking to your local lab professionals about how you can help conserve tubes.
To address the need to conserve tubes and critical laboratory resources, the Canadian Society of Clinical Chemists and the Canadian Association of Medical Biochemists have assembled two sets of relevant Choosing Wisely Canada recommendations — for hospitals and primary care.How you can get involved:
- Download the recommendations relevant to primary care and hospitals.
- Share these resources through your network to help raise awareness about the urgent need to use lab resources wisely.
WORDLE Challenge Winner!
We are excited to report that the winner of our Doctors Manitoba Wordle Challenge is… Dr. Elliott Wong! Dr. Wong, who works at Pan-Am clinic as a sports medicine family physician, will receive a $200 gift card for a local business of his choice. Congratulations, and thank you to the many physicians who participated.
In case you missed it, we posted a fun Wordle puzzle earlier this week to help promote the benefits of masking during this next phase of the pandemic.
Here’s some of the most popular and most important recent updates, in case you missed them:
- See our recent President’s Letter about how the 1% increase in physician remuneration for 2022/23 is being allocated.
- Physicians can order rapid tests to distribute to patients. Find out how here.
- Our Retention Benefit is being extended to members during maternal/parental leave, and this will be applied retroactively. Learn more.
- Last Friday was Women in Medicine Day, and we shared a report on how far women in medicine have come in Manitoba, and how far they have to go. This includes new survey results, and a new analysis on the potential pay gap between men and women in medicine. Check it out.
- Learn more about Doctors Manitoba’s support for the people of Ukraine.
- Claim your COVID vaccine expenses. Learn more here.
- March is Kidney Health Month. You can help your patients with prevention and care. Read more.
Physician Invite to Shen Yun
To thank health care professionals, the producers of Shen Yun, a Chinese classical dance performance, are offering our members a group ticket price of one complementary ticket for every 14 tickets purchased and with a special code SY2022-M-Winnipeg you will have your $8 ticketing fee waived. Please contact the presenter at 1−855−416−1800 for details. The code will be valid until the end of March 2022.
Bookmark our Events Calendar to be sure you don’t miss any events or learning opportunities that interest you. Some notable upcoming events include:
- Moving Towards Disability-Affirming Healthcare Systems: Let’s Talk Ableism (on March 17),
- The Importance of Pediatric Vaccination (on March 23)
- CMA President Dr. Katharine Smart presenting her Houston Lecture Learning from the Pandemic: Challenges and Opportunities for Canada’s Healthcare System (on March 30).