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December 9, 2021

In today’s message you will find:

COVID Surveillance Update

Since our last update on Friday, December 3:

  • Daily cases up: 1,006 new cases of COVID-19 have been identified, a daily average of 166 (up from 139). This includes 203 new cases today. The total case count in Manitoba now stands at 69,314.
  • Test positivity up: The provincial five-day test positivity rate is 6.1%, up from 5.1% on Friday. In Winnipeg, it is 2.7% in Winnipeg, unchanged from last week. The test positivity rate for Southern health is 15%.
  • Active cases up: There are 1,623 active COVID-19 cases province-wide, up significantly from 1,403 last Friday.
  • Hospitalizations up slightly & ICU cases spike: There are 145 people in hospitals due to COVID-19, up from 141 last Friday. This includes 35 COVID-related patients in Manitoba ICUs, up from 23. 
  • Sixteen more people have died from COVID-19. This brings the total COVID-19 related deaths to 1,344.

According to Health Canada’s tracking, Manitoba had 81 cases per 100,000 over the last seven days, up from 64 last Friday and a nearing the high of 84 earlier this month.

Omicron in Manitoba

Public health is reporting a total of 5 confirmed cases of the B.1.1.529 (omicron) variant have been detected in Manitoba.
One individual recently travelled from one of the 10 federally advised countries and the other 4 cases are close contacts and are currently asymptomatic. Public health is conducting aggressive case and contact management. If additional public health risks are assessed and it is deemed necessary to protect the health of others, more information will be released. As of Wednesday, the total number of omicron cases in Manitoba is five.

The new variants spread the same way as the original COVID-19 virus. Manitobans should continue following public health orders, limit contact with others and focus on the fundamentals to limit the spread of COVID-19 (including variants) and protect yourself and those around you.

Omicron has been identified, so far, in 57 countries according to the World Health Organization. As a new variant of concern, the world is rushing to assess if a) it is more transmissible than other variants, b) if it causes more severe disease, and c) if past vaccine or infection immunity are effective against Omicron.

On Wednesday, the WHO emphasized the need for a little more time before answering these questions conclusively. Stories are emerging in the media every day with contradictory information. There are early signs the variant of concern may cause less severe cases of COVID-19 than the Delta variant, but this is not conclusive. If it is more transmissible but less virulent, it could still pose a larger threat to the population. 

As for vaccines, the WHO has said the vaccines should still work against severe Omicron cases. A preliminary study from Pfizer suggests three doses could be just as effective against Omicron as two doses have been against other variants.

The company concedes that this is preliminary and additional data is needed, but Canadian and American health experts have reinforced the value of booster shots as a defense against Omicron. 

Vaccine update

Over 32,000 children between 5 and 11 have received their first dose of the COVID-19 vaccine, a number that is likely higher when doses given in doctors’ offices are added. You can find doctors offering appointments for the COVID vaccine, including the pediatric version, at Man​i​to​baVac​cine​.ca.

The province has adopted NACI recommendations that suggest the Pfizer vaccine is preferred over Moderna for people age 12 to 29, to further minimize the already rare risk of experiencing myocarditis and pericarditis after receiving an mRNA vaccine. Moderna can still be offered, but patients/​parents should make a fully-informed choice about this. 

Yesterday, Dr. Joss Reimer encouraged everyone to get their booster (third) shot of the COVID-19 vaccine as soon as they are eligible. For nearly all adults, that is six months after their second dose. 

Public health officials also provided an update on vaccine effectiveness. The data here is similar to other jurisdictions. Compared to the fully vaccinated, In Manitoba the unvaccinated are 

  • 5.5 times as likely to become infected
  • 8.4 times as likely to be hospitalized
  • 19 times as likely to end up in ICU 
  • 11.8 times as likely to die from a COVID-19 infection compared 

Surgery and Diagnostic Task Force Announced 

Yesterday, the provincial government unveiled its Diagnostic and Surgical Renewal Task Force, a move first recommended by Doctors Manitoba this past June.

In the lead up to the announcement, our President Dr. Kristjan Thompson was very clear that Doctors Manitoba would be watching closely for two things: the task force’s membership and mandate. ​“This backlog is such a massive issue that a task force charged with addressing it must be action-oriented, with a clear mandate, requisite authority, and members that possess the right expertise and experience,” he explained. He also emphasized the need for front line physicians to have a strong voice in shaping the response. (Read this Free Press article for more).

Earlier this week, we also released an updated on the backlog, which as grown to over an estimated 152,000 surgeries, diagnostic imaging tests and other procedures. We have added bone density tests and sleep disorder studies to the backlog estimate based on physician feedback, and we are reviewing other suggestions for next month’s update.

→ We are sharing our backlog estimates using an online dashboard, which you can access at Doc​tors​Man​i​to​ba​.ca/​b​a​cklog. We will post updates on provincial progress on this page as well. 

The announcement yesterday is encouraging news, especially after reviewing the membership and mandate of the Task Force. The group is being led by Dr. Peter MacDonald, an orthopedic surgeon at Pan Am Clinic and Professor with the Max Rady College of Medicine. The Committee also includes seven other physicians, two nurses, and four public representatives. In reviewing the mandate, it is clear this Task Force is action-oriented, and not limited to studying the problem and issuing recommendations. You can see the Task Force’s full membership, mandate and approach on its webpage here.

The Task Force is mandated to create a centralized system for health providers to collect wait list information and streamline when and where surgeries and tests can be done as quickly as possible. It will develop human resource solutions, such as hiring LPNs to work in surgery and considering other alternative service providers. It will continue exploring opportunities to increase surgeries outside of existing capacity, building on the requests for supply arrangements (RFSAs) that has led to a few thousand additional surgeries and tests during the pandemic. When needed, the group may consider short-term, out-of-province options for surgeries if waiting in Manitoba jeopardizes patients’ health, though the focus is primarily on solutions in Manitoba.

Overall, we are encouraged by the Task Force’s mandate and the physician and public expertise on the steering committee. Assuming the Task Force has access to the funding and support it needs, we believe it can get the job done.

We also learned yesterday that comprehensive public reporting will start early next year on a monthly basis. This was a second recommendation from Doctors Manitoba, recognizing that transparency about how big the problem is will be essential to developing solutions to tackle it.

Unfortunately, we did not hear the government set a target date to clear the backlog, which was our third recommendation. While we can understand the desire to thoroughly study the problem to understand how big it is before setting a target, we believe a bold commitment from the top is needed for two reasons. First, to give the Task Force and the health system clear direction and firm expectations about the priority to clear the backlog. Second, patients need certainty and hope, and hearing how long their wait may be is a way of helping them cope. We hope this will come early in the new year.

To be clear, the Task Force has an unquestionably monumental task. The backlog is massive and Manitoba has faced more surgery disruptions than other provinces during the pandemic. And, the cancellations continue as nurses are once again redeployed to support overwhelmed and understaffed ICUs. We encourage all doctors to support the Task Force, especially your physician colleagues who have agreed to join it. Doctors Manitoba will be following up to ensure the Task Force will seek out physician views broadly as part of its work. And we will keep you updated, every step of the way.

Here are three resources to learn more:

What Should Physicians Do For Now?

The Task Force was clear that options are limited to add capacity in the next few months while our ICUs are overwhelmed from the fourth wave passes. Dr. Ed Buchel, Provincial Surgery Lead for Shared Health, explained that he hopes hospitals will be back at full OR capacity early in the new year, but until that happens the backlog will continue to get worse.

In the short term, we have the following guidance for physicians.

For family doctors and referring physicians, we suggest the following: 

  • Do not hold back referrals, unless specifically directed to by the receiving specialist. We have heard reports that referrals are down significantly, particularly for endoscopy. It is vital that patients identified as needing a referral for testing or surgery are referred to ensure the health system has an accurate picture of the backlog. 
  • Support patients while they wait, by offering updates when possible. Use an empathetic approach that helps the patient see you as their advocate. As a physician, you are likely almost as frustrated by the backlog as they are, and it is helpful for the patient to know this.
  • Monitor the patient’s status while they wait, and be prepared to increase the urgency of your referral if the patient’s condition deteriorates. Virtual visits can be a useful tool to monitor patients while they wait. 

For surgeons and other specialists with a backlog:

  • Get your wait list organized. We anticipate the Task Force will be connecting with your group to assess the magnitude of the backlog. Thus far, Doctors Manitoba has estimated the backlog based on reduced volumes during the pandemic. Your wait lists are the source of truth, and ensuring they are complete and current will help.
  • Support patients while they wait, by offering updates when possible. Use an empathetic approach that helps the patient see you as their advocate. As a physician, you are likely almost as frustrated by the backlog as they are, and it is helpful for the patient to know this. See our suggested messaging here. 
  • Monitor the patient’s status while they wait. Watch for updates from referring physicians. Longer wait lists mean more attention is required to catch issues early. Virtual visits can be a useful tool to monitor patients while they wait. 

ICU Situation

While a plan was unveiled to address the surgical and diagnostic backlog this week, there is far less transparency and clarity about how our ICUs will cope increasing admissions during this fourth wave. 

ICU’s have been at or over their baseline capacity for weeks, and has COVID admissions increase, hospitals are struggling to open more beds to accommodate admissions. 

Over the weekend, we learned that cardiac surgeries were again being postponed to free up ICU space for rising COVID-19 related admissions. Our monitoring has found that 208 fewer cardiac surgeries have been performed during the pandemic than baseline volumes, and a concerning number of patients are beyond their medically-recommended benchmark wait time. 

On Tuesday, Dr. Kristjan Thompson responded publicly, raising concerns about the cardiac surgery cancellations and ICU capacity. He explained that cardiac surgery cancellations is concerning and a sign the health system has implemented crisis standards of care to cope. You can watch his response as part of this Global News story here. 

The situation is becoming so concerning, that even Shared Health issued a public statement about how the increase in hospital admissions, primarily among unvaccinated Manitobans, is putting everyone at risk. 

As of yesterday, there were 98 patients in ICUs, 34 of which are related to COVID-19. The baseline ICU capacity is 72 beds. 

We have been connecting regularly with critical care specialists to seek their advice and offer our support. Doctors, nurses and others working in many areas, including critical care, have been working shorthanded for far too long and this is causing burnout. However, the lack of transparency about the ICU contingency plan is needlessly adding to their stress, causing confusion and uncertainty. We are continuing to press for health system leaders to be more open about how our ICUs will cope, especially to share these details with critical care physicians who are wasting time each day searching for open beds for new admissions. 

Pharmacists’ Scope of Practice Expanded 

Last week, the Manitoba government announced the expansion of the scope of practice for pharmacists to ​“assess and prescribe treatment for recurrent, uncomplicated cystitis for non-pregnant women”.

Patients can access up to three assessments with a pharmacist per year at no cost, with the province paying pharmacists directly for this service. Participating pharmacists will be required to complete additional training with their College.

Doctors Manitoba was not consulted by the government before this announcement. We have a number of unanswered questions, including how patients and pharmacists can identify uncomplicated from complicated bladder infections or other similar symptoms, how pharmacists will record patient interactions, whether or not pharmacists will notify a patient’s family doctor, and how pharmacists will be able to monitor if a patient has exceeded three assessments per year. We are also interested in learning more about the requirements for the patient assessment, and the obligation of pharmacists to handle follow up care needs and complications. While this is a fairly limited expansion of pharmacists scope of practice, there are important questions about continuity of care and follow-up care that should be addressed before further changes are considered. If you have questions or concerns about this expanded scope of practice please contact us, in confidence, at practiceadvice@​doctorsmanitoba.​ca.

Study to Understand & Improve Physician-Patient Dialogue

Researchers at the University of Manitoba are currently inviting practicing physicians in Manitoba to participate as interviewees for a study that is examining potentially difficult conversations physicians have with their patients. The Province has dedicated $14 million towards physician outreach to improve COVID-19 vaccine uptake among unvaccinated Manitobans by inviting them to discuss their hesitancy with their doctor. This study aims to collect interview data from physicians who have had such discussions with their unvaccinated (for COVID-19) patients. By sharing your experiences, you will be valuably assisting study researchers in identifying associated challenges that you have encountered in such discussion along with strategies for building relevant trust and reaching satisfactory outcomes for both physician and patient. Outcomes of this study will assist in helping physicians optimally navigate similar discussion in the future (e.g. whether being the current and/​or future pandemics, or childhood/​seasonal vaccinations). Your involvement will entail filling out a brief survey and a 20 – 30 telephone interview and you will receive a $50 honorarium or gift card for your time.

For access to the study invitation and contact information, please click here.

Elder Dave Courchene Dies at 71

Earlier this week, we learned of the death of Elder Dave Courchene Jr., an Indigenous leader from Sagkeeng First Nation. Elder Courchene was also known by his spirit names Nitamabit and Nii Gaani Aki Inini.

Elder Courchene founded the Turtle Lodge Centre in 2002 as a gathering place to exchange intergenerational knowledge, revitalize language, train youth leaders and find environmental solutions to climate change. It has become internationally recognized as a centre of excellence for Indigenous education and wellness.

Last year, Dr. Sabina Ijaz who works closely with Turtle Lodge was honoured with the Doctors Manitoba Distinguished Service Award for her unique contributions with and for Indigenous communities, as well as her contributions to a culturally safe and holistic practice of medicine. Her nomination was strongly supported by Elder Courchene.

→ Watch Elder Courchene’s thoughtful comments about Dr. Ijaz here.

You can learn more about Elder Courchene’s life and contributions to Manitoba here.

We also encourage you to watch a short animated web series written by Elder Courchene and directed by Indigenous filmmaker Erica Daniels from Peguis First Nation. The Seven Sacred Laws follows a young boy on a vision quest, an Indigenous rite of passage. On his journey, he meets seven sacred animals that teach him how we should each live our lives on Mother Earth. Each animal offers a lesson, including about respect, love, courage, honesty, wisdom, humility and truth, topics that align so closely with the values that guide physicians in their work every day.

→ Watch The Seven Sacred Laws here. 

Conversion Therapy Banned

Bill C‑4, the proposed law banning conversion therapy, was supported by all political parties and fast tracked in the House of Commons and has become law. The law makes providing, promoting or advertising conversion therapy a criminal offence. Conversion therapy is defined as the ​“practice, treatment or service designed to change a person’s sexual orientation to heterosexual, or to change a person’s gender identity to cisgender” and has been discredited by both the American and Canadian Psychological Associations. 

The new law creates four new Criminal Code offences: causing a person to undergo conversion therapy, subjecting a minor to conversion therapy abroad, profiting from the provision of conversion therapy and advertising or promoting the practice, with penalties of two to five years in prison and will allow courts to authorize the seizure or removal of online content advertising the practice.

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. 

What’s involved?

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 rsawyer@​doctorsmanitoba.​ca. The committee’s next meeting is February 24, 2022.

Fantastic Physicians

Dr. Marina Reinecke, who developed and executes the Opioid Agonist Therapy program in Manitoba, is this year’s recipient of the CPD Educator of the Year Award, which is given to educators who have demonstrated excellence, innovation, and commitment to lifelong learning. Dr. Reinecke ” teaches passionately, mentors new speakers, promotes interprofessional collaboration, and ensures these two-day workshops are organized and effective.”

The OAT Workshop is a comprehensive and accredited course that has reached many physicians and other health professionals since 2016. The program has seen methadone and Suboxone prescribers grow exponentially. From just 9 physicians in 2015, to 150 prescribers today, patients have access to effective and life-saving treatment. Read more about Dr. Reinecke’s award here. 

DRMB Award Nominations Close in 6 days!

Nominations for the 2022 Doctors Manitoba Awards close on 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 kjohnson@​doctorsmanitoba.​ca.

→ Learn more and nominate a colleague today.

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.

Upcoming Events & Educational Opportunities

Physician Leadership Speaker Series Continues Tonight at 6:30!

There’s still time to register for tonight’s keynote presentation: Syndemic Systems: Thinking for leaders before, during and after the COVID-19 crisis with Dr. Johny Van Aerde and Dr. Victor Do.

Don’t miss:
Civility with Dr. Sara Hosseini — December 14 at 6pm
Mentorship and sponsorship models that promote equity in our educational & healthcare systems with Dr. Jamiu Busari — January 17 at 6pm. 

ICYMI:

Watch the on-demand video of the Psychological Safety talk with Dr. Ming-ka Chan and Dr. Anne Matlow here.

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.

WCB Workshop

The Workers Compensation Board of Manitoba invites physicians to a free online workshop: Supporting Return to Health and Work after an Injury. On 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.

You can find more information here and register here.

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.

Allyship Webinar

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.

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