December 3, 2021
COVID Surveillance Update
Since our last update on Monday, November 29:
- Daily cases up: 556 new cases of COVID-19 have been identified, a daily average of 139 (up from 120). This includes 147 new cases today. The total case count in Manitoba now stands at 68,308.
- Test positivity steady: The provincial five-day test positivity rate is 5.1%, unchanged from Monday. In Winnipeg, it is 2.7% in Winnipeg, up slightly from 2.5% earlier this week.
- Active cases down: There are 1,403 active COVID-19 cases province-wide, down from 1,493 on Thursday.
- Hospitalizations steady: There are 141 people in hospitals due to COVID-19, down from 142 on Monday. This includes 23 COVID-related patients in Manitoba ICUs, down from 25.
- Thirteen more people have died from COVID-19. This brings the total COVID-19 related deaths to 1,328.
According to Health Canada’s tracking, Manitoba had 64 cases per 100,000 over the last seven days, down from 70 on Monday and a high of 84 earlier this month.
Omicron Variant Update
As of today, no cases of the Omicron variant of concern have been detected yet in Manitoba. So far, 11 cases have been identified in Canada, including in Ontario, Quebec, Alberta and BC. Globally, cases have been identified in over two dozen countries, now including the U.S.
Not a lot of new information has emerged since our Q&A about the Omicron variant we sent on Monday, which you can view here. Physicians are reminded that there will likely be daily stories with “new” evidence about whether the new variant is more transmissible, more virulent, and can evade immune protection through vaccination or past infection. It will, however, likely take a few weeks to understand these questions. It’s important to be cautious, but not panic, for now, while we all wait for more definitive evidence in the weeks ahead.
Both the World Health Organization and Health Canada leaders reinforced the importance of getting vaccinated. The Delta variant still dominates here and around the world, the vaccines are highly effective against it.
The National Advisory Committee on Immunization updated its recommendations today on booster shots, but this advice is largely already reflected in Manitoba’s eligibility. NACI’s advice on boosters now includes:
- A recommendation for a booster dose for adults age 18 and over, six months after their second dose.
- A “strong recommendation” for groups at increased risk, including people age 50+, residents of long-term care homes and seniors in congregate living settings, recipients of viral vector vaccine series, adults from First Nations, Inuit or Métis communities, and all front-line health care workers with direct patient contact.
In Manitoba, all adults are already eligible for booster shots, provided it has been six months from their second dose, with few exceptions. Manitoba’s recommendations include other at-risk groups, including individuals with specific chronic health conditions, pregnant individuals, residents of Northern Manitoba, and home care recipients. The full eligibility is posted on the government’s website here. Manitoba Public Health officials will be reviewing NACI’s statement and expects to make any adjustments to Manitoba’s eligibility and recommendations next week.
Physicians can check the date of second doses in patients’ EMRs, and patients can check their own dates on the Shared Health portal.
A reminder that third doses of Pfizer are the same dosage as first and second doses, but boosters for Moderna are half doses for some groups. Read the dosage instructions in the provincial clinical practice guidelines.
Pediatric and Young Adult Doses
Over 15,000 children, age 5 – 11, have already received their first dose of the COVID-19 vaccine, with thousands more appointments booked. These numbers do not yet include all of the immunizations being done in pediatricians’ offices. This is a strong start to the vaccine rollout for younger children.
We have added doctors’ offices offering the pediatric COVID vaccine to our vaccine finder at ManitobaVaccine.ca. You can now filter based on vaccine type.
See our update from Monday with key information about how to order pediatric COVID-19 vaccine, and important billing advice and additional funding opportunities. We also have a Q&A for physicians and pain management tips too.
NACI issued updated advice today on the use of COVID-19 vaccines for individuals age 12 to 29, based on the ongoing review of myocarditis and pericarditis reported following vaccination. These heart and heart-lining inflamation cases have been observed in extremely rare case following immunization with an mRNA vaccine in teenagers and young adults. Symptoms are generally mild and generally occur in males age 12 to 29, and more often following the second dose of the Moderna Spikevax vaccine than the Pfizer Comirnaty vaccine.
Because of this, NACI is now recommending the Pfizer Comirnaty vaccine is preferred for individuals in this age group to further minimize the rare risk of experiencing myocarditis and pericarditis after receiving an mRNA vaccine. Manitoba Public Health officials are reviewing the new recommendations and expects to update Manitoba’s recommendations next week.
New Canadian Immunity Task Force Resources
The National COVID-19 Immunity Task Force and CanCOVID will hold a webinar on December 20 focused on the impact of COVID and vaccination on pregnancy and newborns. This continues to be a recurring concern, and this webinar will offer physicians important information to help counsel your patients. You can learn more and register here.
The Task Force has also launched a new monthly online magazine focused on the latest results and conclusions from studies and modelling. This month’s issue features a commentary on the benefits of pediatric vaccination. There is both a desktop version and mobile version available.
Travel Changes and Considerations
Physicians with international travel plans over the next several weeks should be aware that they may face additional restrictions or requirements when they return to Canada. This could include the need to isolate, even if fully vaccinated. With the emergence of the Omicron variant of concern, travel rules are changing rapidly and are very unpredictable. It could take a few weeks before authorities understand the level of risk posed by this variant, and incorporate that evidence into travel rules.
Shared Health issued a memo on Wednesday with updated travel considerations for health care workers. The advice suggests that “all non-essential travel outside of Canada continues to be discouraged” and should be prepared for restrictions following international travel to change “in the coming days.” Anyone returning from the list of African countries designated by the federal government must isolate for 14 days, regardless of vaccination status.
New Federal Restrictions
In response to the Omicron variant, the federal government is expanding travel restrictions. While full details have not been revealed, the changes announced on Tuesday include:
- Expanding the ban on entry to include foreign travellers who have been to Nigeria, Malawi and Egypt in the last two weeks, adding to the list of African countries already facing travel bans: South Africa, Mozambique, Namibia, Zimbabwe, Botswana, Lesotho and Eswatini.
- Allowing Canadians and permanent residents who have travelled in any of these countries in the past two weeks to return, but with “enhanced pre-entry and arrival testing, screening, and quarantine measures” regardless of their vaccination status.
- Arrival testing for all fully vaccinated air travellers arriving from all destinations outside of Canada and the U.S. starting “in the coming days,” and the requirement to quarantine while awaiting results. Unvaccinated travellers will continue to be tested on arrival and day 8, and must continue to quarantine for 14 days.
The federal government’s announcement has caused some confusion, with key questions still unanswered about when the requirements will start, what type of arrival test can be used, and where it can be taken.
Federal travel restrictions are maintained on this government web page.
The U.S. announced Thursday that all air travellers entering the U.S. — including those from Canada — will required a COVID-19 test within 24 hours of boarding their flight, regardless of their vaccination status. Previously, people who were fully vaccinated would have been able to present a negative test taken with 72 hours of boarding a flight to the U.S. No changes yet to land travel across the U.S. border were announced.
Vaccine Town Hall Success
On Tuesday evening we hosted our Pediatric COVID-19 Vaccine Town Hall with a panel of medical experts who covered topics that included COVID-19 risks to children, vaccine safety and effectiveness, and how to access the vaccine. The panel answered questions about needle anxiety, side effects, variant resistance, compromised immunity, dosage, and long term impacts.
The event had nearly a thousand views, both live and on-demand, since Tuesday evening. You can stream it anytime at ManitobaVaccine.ca/townhall. We encourage you to share the page with patients and on social media channels to help parents and caregivers who may have questions or concerns about the vaccines for children.
We have already received positive feedback from several parents who said the panel answered their questions and they are booking appointments for their children’s immunizations.
Thank you to our panel of pediatric, infectious disease and vaccine medical experts, including Dr. Marni Hanna, Dr. Ruth Grimes, Dr. Jared Bullard, Dr. Joss Reimer and Dr. Ashley Chopek, along with our co-host Dr. Alexis Botkin.
Surgery and Diagnostic Backlog
After the government promised to announce the task force to address the surgery and diagnostic backlog this week — something we first called for last June — we learned today that the announcement is delayed until Wednesday next week to enable surgeons and front line providers to participate. While we can understand the delay, we know physicians and patients are anxious to see action.
When the announcement comes, Doctors Manitoba will be looking for two things: membership and mandate. There are really two kinds of task forces: those that study an issue and provide recommendations, such as the Wait Time Reduction Task Force from a few years ago, and those that are action-oriented with the membership and authority to solve major problems, like the Vaccine Implementation Task Force. This is something our President, Dr. Kristjan Thompson, reinforced this week in a letter to Health Minister Audrey Gordon, explaining that “the surgical and diagnostic backlog is such a massive issue, in need of urgent action, that this task force must be action-oriented with a clear mandate, requisite authority, and a membership that possess the right expertise and experience.” He also reinforced the need to for front-line physician involvement at every step, to identify barriers and solutions.
Doctors Manitoba will continue to monitor this situation closely, and push for urgent action to address the massive backlog. Our current estimate pegs the backlog at over 136,000, including a range of surgical and diagnostic procedures.
We will be updating our estimate next week, and we welcome your input on any surgical or diagnostic procedures our estimates may be missing. Last month we added sleep disorder studies based on physician and patient feedback. You can view the current backlog estimate, and all of the procedures it includes, at DoctorsManitoba.ca/backlog. We’ve already heard that other procedures, such as bone density scans, should be added. Email us at email@example.com with your suggestions.
New Endoscopy Study Focuses on Wait and Clinical Opportunities
The Manitoba Centre for Health Policy released a major report today looking at gastrointestinal endoscopy procedures. The study found that over 25% of Manitobans had at least one endoscopic procedure over the last 10 years, facing a median wait before the pandemic of two to three months.
Doctors Manitoba’s backlog monitoring has found the over 10,000 endoscopies were canceled or never scheduled during the pandemic, part of the massive overall backlog of over 136,000 surgical and diagnostic procedures.
The MCHP research team, which includes Dr. Harminder Singh, also found that:
- The use of endoscopies is increasing, from about 1% of the population receiving on in 1984/85 to over 4.4% in 2016/17.
- Rural residents are more likely to get an endoscopy than Winnipeggers.
- The use of anesthesiology varies across Manitoba and should be further reviewed.
Finally, the study investigated post-colonoscopy colorectal cancer (CRC) diagnosis rates, a key performance measure of colonoscopy quality. Most post-colonoscopy CRC are regarded as preventable. The post-colonoscopy CRC rate in Manitoba over the study period was 10.5%, a number higher than that reported in recent times from other jurisdictions. Unfortunately, Manitoba’s post-colonoscopy CRC rate is not decreasing. Patients with a diagnosis of diverticulosis, previous colonoscopy, and previous CRC and IBD diagnoses were more likely to have post-colonoscopy CRC. This is an opportunity to improve the quality of care, and the research team recommended further investigation and action.
Nominations Due December 15
Nominations are open for the annual Doctors Manitoba Awards, and must be submitted by December 15, 2021.
Let us know if you are working on a nomination. We can connect physicians who may be working on nominations for the same nominee to help you collaborate. Doctors Manitoba staff are also available to support the nominations process. Reach out by contacting Keir Johnson at firstname.lastname@example.org.
As the pandemic continues to disrupt medical care and so many other things in our lives, we don’t want to lose sight of recognizing excellence in the medical profession. The Doctors Manitoba Awards are the highest honour in the province for physicians. There is no shortage of physicians who have been demonstrating excellence this year. For some, this has meant contributing to the pandemic response and vaccination campaign in some way. For others, it has meant persevering during the pandemic to continue their work on patient care, research and other priorities.
There are five different awards including:
- Distinguished Service Award to recognize a long career that embodies the highest standards and ideals of the medical profession
- Physician of the Year to recognize an exceptional achievement or contribution to the practice of medicine and/or to the community, including a recent significant achievement or advancement in the practice or study of medicine.
- Medal of Excellence to recognize those who demonstrate excellence in the medical profession and whose actions are a source of inspiration for other physicians (up to three awarded each year).
- Resident of the Year awarded for excellence in academic and clinical training and noteworthy contributions to the resident’s home program/specialty or residency program.
- Dr. Jack Armstrong Humanitarian Award, to celebrate outstanding contributions in the service of humanity either within Canada or abroad.
Practicing Physician Needed — Insurance Committee
Doctors Manitoba is recruiting a practicing physician to join our Insurance Committee! Our insurance programs are designed by physicians for physicians and operate on a non-profit basis. Surpluses are returned to those who participate, rather than going to insurance company shareholders. The Committee helps to review and update insurance coverage available to physicians to ensure insurance products meet member needs.
The Committee meets about four times per year. Meetings generally last to two hours and occur during evenings. Committee members are compensated for their time. Generally, members are appointed for a two-year term, which can be renewed for up to two additional terms.
As a Committee member, you will have a chance to help improve insurance products while meeting and working with physician peers. Committee memberships are also an excellent way to build leadership experience, which can be an asset in future roles.
To learn more or apply before December 20, please contact Rick Sawyer at email@example.com. The committee’s next meeting is February 24, 2022.
World AIDS Day
Tuesday was World AIDS day and we encourage physicians to commit to helping Manitobans living with HIV/AIDS reach the health care they need. Manitoba Health & Seniors Care has announced expanded coverage for HIV PrEP medications. To help support their partners and clients respond to this important advancement, the Manitoba HIV Program and Nine Circles Community Health Centre invite you to a free webinar.
“Introducing Manitoba’s New HIV Testing and Prevention Guidelines”
December 8th, 2021 12:00pm – 1pm CST
Moderator: Dr. Kelby Treloar
Speakers: Dr. Laurie Ireland & Dr. Bria Sharkey
Learn who needs to be tested for HIV, about the important new HIV prevention protocols in Manitoba, as well as how to become a PrEP prescriber. This Group Learning program has been certified by the College of Family Physicians of Canada and the Manitoba Chapter for up to (1) Mainpro+ certified credits.
Be sure to review the Manitoba HIV Program’s new HIV Testing and Prevention Guidelines.
Learn more and register for the December 8 webinar HERE.
Doctors Manitoba would like to remind members that we still have NIOSH certified Dasheng DTC3Z N95 masks. These masks require fit testing and typically fit medium.
We will require a credit card for shipping costs if shipping is requested.
To order, please email PPEconcerns@doctorsmanitoba.ca
Physician Leadership Speaker Series Continues!
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.
The Workers Compensation Board of Manitoba invites physicians to a free online workshop: Supporting Return to Health and Work after an InjuryOn Wednesday, December 15, 2021; 6 p.m. to 8 p.m. join Dr. Mitch Cosman, Chief Medical Officer, and Dr. Cam Stacey, Medical Consultant to the WCB, for a two-hour online session covering best practice for fitness for work determination and use case studies applicable for you in your day-to-day practice. At the end of the workshop, the WCB will conduct a brief focus group to gather information for the development of future workshops.
The impact of COVID-19 disease & vaccination on pregnancy and newborns
SAVE THE DATE! December 20!
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! Registration link to come!
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.
- Dr. Javeed Sukhera
- Dr. Marcia Anderson
- Dr. Matthew Chow
- Dr. Pauline Alakija
- Dr. Dennis Kendel
- Dr. Kim Kelly
You can view the webinar here.