December 20, 2021
In today’s message you will find:
- COVID surveillance update
- Monoclonal Antibody Treatment for COVID-19 – Information for Providers
- We are encouraging Manitobans to #CelebrateSafe this holiday season
- Joint press conference with CMA on alarming rise of Physician Mistreatment & Abuse
- Extra Funding to Expand Physician-Led Vaccination
- Events & Learning Opportunities
COVID-19 Surveillance Update
Since our last update on Wednesday, December 15:
- Daily cases up significantly: 1,250 new cases of COVID-19 have been identified, a daily average of 250 (up from 171). This includes 200 new cases today, and 333 new cases on Sunday, which is a high since the third wave six months ago. The total case count in Manitoba now stands at 71,590.
- Test positivity jumps: The provincial five-day test positivity rate is 8.0%, from 6.2% last Wednesday. In Winnipeg, 8.1% which is a big increase from 4.4% last week. The test positivity rate in Winnipeg is now slightly higher than the provincial rate.
- Active cases jump: There are 2.183 active COVID-19 cases province-wide, up from 1,779 last Wednesday.
- Hospitalizations down: There are 137 people in hospitals due to COVID-19, down from 139 last Wednesday. This includes 27 COVID-related patients in Manitoba ICUs, down from 34.
- Nine more people have died from COVID-19. This brings the total COVID-19 related deaths to 1,366.
According to Health Canada’s tracking, Manitoba had 92 cases per 100,000 over the last seven days, up from 87 last Wednesday and a high for the fourth wave. The average across Canada is 103, being driven by 186 cases per 100,000 in Quebec and 120 per 100,000 in New Brunswick.
A total of 17 cases of the Omicron variant have been identified in Manitoba so far, up 9 from last count. There are likely more cases in Manitoba than have been identified by labs so far.
In Ontario, it’s now estimated Omicron accounts for 88% of new cases, up significantly from 20% one week ago. The Ontario Science Table estimates cases are doubling every 2.7 days. As Omicron cases take over in Ontario, the Science Table is also seeing effectiveness of two doses of vaccine dropping significantly, though protection against hospital and ICU admission appear to be holding in these very early days (see powerful visual).
The World Health Organization emphasized the threat of Omicron today too. “There is now consistent evidence that Omicron is spreading significantly faster than the Delta variant,” WHO director-general Tedros Adhanom Ghebreyesus told a news briefing in Geneva. “And it is more likely people vaccinated or recovered from COVID-19 could be infected or re-infected.”
Meanwhile, Moderna issued new data today suggesting their booster shot should offer protection against Omicron, similar to an earlier report from Pfizer. Both companies stressed these findings are preliminary.
So far, over 190,000 people, or 14.5% of eligible Manitobans, have received their third dose. 84.4% have received their first dose and 78.2% have received their second dose.
CLOSE CONTACT NOTIFICATION CHANGE
Public Health is shifting resources from contact notification to vaccination. The update today noted that “with the introduction of the omicron variant of concern, Manitoba is anticipating a surge in COVID-19 cases similar to that seen in other countries and provinces. Manitoba is shifting public health resources to increase vaccination rates and support treatment.”
This will mean that cases will be required to notify close contacts themselves. Public Health will still do contact tracing in a targeted way, including school outbreaks, PCHs, child care, shelters and health facilities.
Additional information is available here.
HOSPITAL CAPACITY SITUATION
Hospital capacity continues to be extremely limited, leading to care being prioritized.
While ICU occupancy decreased over last week, physicians are bracing for a surge in admissions that could follow rapid spread fueled by Omicron. Last week, the provincial government requested federal assistance for 15 – 30 ICU nurses for 6 weeks as ICU capacity was so vulnerable. Over the weekend, we learned that the Canadian Red Cross is sending 8 nurses, due to arrive today. This is a very limited number given the potential for the situation to escalate so quickly.
Meanwhile, we also learned that more scheduled elective surgeries are being postponed this week, to free up resources to continue cancer and emergency surgeries. The changes will affect surgeries at HSC, St. Boniface and Grace Hospitals, and could impact 10 – 15 patients per day. Shared Health stressed that the changes won’t further reduce the overall surgical capacity in place right now, but is redirecting resources to support high priority procedures. Later today, we also learned that procedures from Carman will move to Boundary Trails to maintain beds there, and some surgeries may be cancelled or postponed in Brandon to maintain ICU capacity.
Doctors Manitoba estimates the surgical backlog has grown to over 56,000 cases in October, and we plan to update this estimate in early January. This is part of the total backlog, which we estimate has grown to over 152,000 surgeries and diagnostic tests.
→ Read this story that caught national attention today about how the backlog delayed one individual’s kidney transplant.
NEW RESTRICTIONS START TONIGHT
New restrictions, intended to slow the spread of COVID-19 and protect hospital capacity, start tonight at midnight. The public health orders were announced late Friday afternoon by Dr. Brent Roussin, and we forwarded a news flash to members shortly after.
The restrictions include limits on household gatherings, including for fully-vaccinated Manitobans, as well as capacity limits on a number of public places.
You can review our summary here. You can also see a summary of all of the restrictions here.
It’s important to also remember that the federal government is discouraging non-essential U.S. and international travel again. Physicians should carefully review their travel plans and everyone should be prepared for disruptions and changes to isolation requirements.
Monoclonal Antibody Treatment for COVID-19 – Information for Providers
Full memo is available here.
Manitoba is launching a by-referral monoclonal antibody treatment program at a number of locations across the province. The following information should be shared broadly with providers.
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.
Health-care providers are encouraged to use the referral form for patients who meet the eligibility requirements. Clients whose eligibility is not related to a health condition may be referred to Health Links-Info Sante. Clients whose eligibility is related to a health condition, must receive a referral from a health-care provider.
The treatment is available to eligible patients across the province. Select sites are administering this treatment beginning Monday December 20, 2021. Other sites will begin offering this service in the coming days.
Please Note: To be eligible, patients must meet all criteria and must receive the treatment within seven (7) days of symptom onset.
To qualify for this treatment, patients must meet the following criteria:
Confirmed SARS-CoV‑2 infection by COVID-19 test
AND COVID-19 symptoms less than 7 days
AND one of the following:
|Unvaccinated or partially vaccinated, AND; Have no history of COVID-19 infection, AND; 40 years or older
|Unvaccinated or partially vaccinated, AND; Have no history of COVID-19 infection, AND; 40 years or older; Conditions/risk factors such as diabetes, smoking, obesity, heart disease, kidney disease, lung disease, or cancer
|18 years or older (regardless of vaccination status or previous COVID-19 infection) AND; Immunocompromised*
*Examples including but not limited to one of the following: active treatment for solid tumor or hematological malignancies; solid organ transplant recipient receiving immunosuppressive drug therapy; receiving CAR‑T cell therapy or hematopoietic stem cell transplant within the last 2 years; moderate to severe primary immunodeficiency; advanced untreated HIV or AIDS; active receipt of anti‑B cell therapies (e.g. rituximab, ocrelizumab, obinutuzumab); high-dose systemic steroids (> 20mg prednisone equivalent daily for at least 14 days); Alkylating agents (e.g. cyclophosphamide, cisplatin), antimetabolites (e.g. methotrexate, 5‑flucytosine); Anti-TNF agents (e.g. infliximab, adalimumab)
Additional information for providers is available here:
#CelebrateSafe for the Holidays
Last week, Doctors Manitoba launched our #CelebrateSafe campaign to urge Manitobans to gather wisely this holiday season.
Dr. Kristjan Thompson, President of Doctors Manitoba, asked everyone to be cautious, as he recognized the triple threat facing Manitoba right now: “Our hospitals are already full, there is a substantial level of COVID-19 spreading in our communities, and Omicron has barely arrived in Manitoba. Please be cautious and reduce the number of households you are gathering with this holiday season. If you are hosting or attending a gathering, please follow our tips to reduce the risks to you and others around you.”
The #CelebrateSafe campaign urges Manitobans to reduce their contacts by going beyond public health orders, by not only keeping gatherings small but also by reducing the number of gatherings they attend this year. Concrete and practical tips for both hosts and guests are offered at the campaign site, DoctorsManitoba.ca/celebratesafe.
Rise in Physician Abuse and Mistreatment
Earlier today, our President Dr. Kristjan Thompson was joined by CMA President Dr. Katharine Smart and rural physician Dr. Don Klassen to discuss the disheartening results of our latest survey, which has revealed an alarming rate of physician abuse and mistreatment in Manitoba. Doctors Manitoba issued a call for respect and kindness, even in the most difficult situations.
Our research found:
- 57% of physicians experienced incidents of mistreatment over the last month.
- More than half of incidents (52%) appear to be linked to the pandemic in some way.
- Incidents are happening more frequently than a year ago, with 59% of physicians reporting increased frequency.
- Most incidents occurred in doctors’ offices or hospitals, though there were some incidents that occurred on social media, in public places and at physicians’ homes.
Incidents of mistreatment appear to occur more frequently among physicians who are women, BIPOC, or working in family medicine. Physicians located in rural communities experienced mistreatment more frequently too.
“I’ve worked in the Southern health region for decades and I’ve never seen anything like this,” explained Dr. Klassen, who works in Winkler and at Boundary Trails Health Centre.“I’ve heard from several physicians who are considering early retirement or relocation at least in part because of the threats and verbal abuse they’ve faced.”
In addition to a public appeal for kindness and respect, physicians are very encouraged by the passage of Bill C‑3 in Ottawa last week, legislation that will protect health workers and patients from threats, violence and harassment. Doctors Manitoba joined the Canadian Medical Association in pressing for legislative action, following a growing number of incidents and protests earlier this year.
“The survey results from Manitoba echo the stories of harassment, intimidation and abuse we have heard from physicians across Canada,” said Dr. Katharine Smart, President of the Canadian Medical Association.“This kind of hateful behaviour is unacceptable in our health system. The legislation passed by the federal government last week was unfortunately required to ensure the safety of health workers. We greatly appreciate the support and kindness of the great majority of Canadians who understand how hard we are working to provide care to our patients.”
The new legislation amends the Criminal Code of Canada to make it illegal for people to intimidate health care workers, impede access to medical facilities, or intimidate people accessing health services, including COVID-19 vaccinations. The new offences carry a maximum penalty of 10 years in prison.
“We are also calling on the provincial government and health system leaders to reinforce the need for respect and safety in medical facilities,” added Dr. Thompson. Doctors Manitoba published a safety guide earlier this year for physicians and health care organizations.
We invite members to use our Guide to Physician Safety During the Pandemic and we continue to urge our members to report any incidents of mistreatment, threats, verbal or physical abuse and bullying HERE. You can also download a poster to print and put up in your practice to help remind patients to treat you and your staff with the respect you deserve.
Extra Funding to Expand Physician-Led Vaccination
With a substantial level of community transmission and the threat of the COVID situation escalating from the Omicron variant, the provincial government is looking to doctors’ offices and pharmacies to support rapid immunization efforts. Many Manitobans are trying to book through super sites, but the province is hoping to rely much more on the physician/pharmacist model for this stage of the campaign.
To support a rapid scale up and to support physicians in immunization capacity, the government has agreed to extend additional funding support and relaxed tariff rules to include pediatric doses and booster shots effective today until January 16, 2021. These initiatives include:
- Full delegation of all COVID-19 immunizations to qualified clinic staff, including both informed consent and the injection. The physician must be on-site in case of complications or complex questions, but you can claim the $20 tariff without seeing the patient personally.
- Email Communication: A one-time fee of $700 to support a mass email to patients about vaccine availability.
- Patient Phone Calls: To support contacting your patients individually, you can claim $3 per patient (or parent) reached on the phone by your staff, regardless if they come in for immunization. Your staff should maintain a call log, and only patients actually reached (not voicemail) can be claimed.
- Vaccine Clinic Support: For doctors’ offices that hold scheduled vaccine clinics, there is a $25/hour administrative stipend available to support additional staff time. There is also guaranteed minimum hourly rate, which means you can claim a “top up” if your total fee-for-service claims during a scheduled vaccine clinic do not reach the minimum hourly rate.
If physicians participate in the immPACC initiative led by the MCFP and University of Manitoba, you can claim attendance at planning meetings. This initiative brings together physicians and other community organizations to plan immunization outreach efforts.
These initiatives, introduced in September, were originally intended to support increase first and second doses among long-eligible groups who may be hesitant or complacent about vaccination. Physician practice groups must register with Doctors Manitoba, and schedule vaccine clinics in advance, to be eligible for the special funding initiatives. A process to claim additional funding support will be available soon through Doctors Manitoba. In the meantime, fee-for-service claims should be submitted promptly to the province, as per normal practice.
Many clinics have already signed up to participate in the original initiative. The online form to submit claims under the new funding should open in early January.
Need More Vaccine Supply?The province is taking emergency orders early this week. If you need more vaccine supply to make it until the first week of January, please email COVID@gov.mb.ca ASAP.
Can You Scale Up Quickly and Offer Public Appointments?
We are exploring options with the province to help connect the public trying to book through the province’s vaccine call centre or online booking portal with physicians’ offices. The concept we are exploring is essentially holding a scheduled pop-up vaccine clinic in doctors’ offices, and allowing a portion of your appointments to be allocated to the provincial booking system. They would offer the appointments to the public based on the availability you share with the province, and send you an appointment list.
If you are open to accepting walk-in patients on set dates, please let us know. We can promote this online, and we can let the province know to promote through their call centre and online booking system. We do not yet have the green light from the province on this concept, but if you are interested please email us ASAP at firstname.lastname@example.org. This is not a commitment, just an expression of interest with details to follow.
If you have other ideas about how to get the public connected to your clinic’s excess immunization capacity, let us know.
Upcoming Events & Educational Opportunities
Physician Leadership Speaker Series — One Talk Left!
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 the series here. Download and print a poster to share with colleagues.
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.
The impact of COVID-19 disease & vaccination on pregnancy and newborns — December 20! — Register NOW!
Given the limited data on COVID-19 illness and vaccination during pregnancy, we are eager to share the latest research from three CITF-supported studies looking at the impact of SARS-CoV 2 infection and COVID-19 vaccination on pregnant people and newborns. The results of these studies are already being communicated regularly to public health officials to help inform COVID-19 vaccine administration programs in Canada. Join CITF-funded experts Dr. Deshayne Fell of the University of Ottawa and the Children’s Hospital of Eastern Ontario Research Institute; Dr. Deborah Money of the University of British Columbia and BC Women’s Hospital; and Dr. Deborah O’Connor of the University of Toronto as they present their latest findings and discuss the policy implications, followed by a lively panel discussion and question and answer session. Mark Monday, December 20, 2021 11:30 am – 1:00 pm EST in your calendars! 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.