November 29, 2021
What you’ll find in today’s message:
- The new Omicron Variant and what we know so far
- Physician Safety a top concern
- Surgery & Diagnostic Backlog — what’s missing?
- COVID-19 Surveillance Update
- Vaccine Update
- Pediatric Vaccine Resources
- Celebrate MB Physicians — Nominate a colleague today!
New Omicron Variant — What we know so far
On Friday, the World Health Organization declared a new variant, first identified by South African scientists, as the fifth COVID-19 variant of concern. The WHO assigned the Greek letter Omicron to identify this variant. On Sunday, Ontario confirmed the first cases in Canada, two travel-related cases in Ottawa.
Here’s what we know so far about this variant, and just as important, what we don’t yet know.
The Omicron variant’s scientific label is B.1.1.529. While it was first identified by South African scientists, the initial sample was collected in Botswana in early November. Last week, South African scientists reported on the variant, which caught rapid global attention because of the large number of mutations and potential risks this could pose. The initial evidence suggested these mutations might impact how easily the virus can spread, the severity of illness it could cause, and the effectiveness of existing vaccines, though these concerns were based on very limited, initial evidence.
By the end of the week, the WHO convened their expert panel to review the evidence and classified this as a variant of concern, rather that a variant of interest. This signals that a variant could cause increased transmissibility, and/or increased virulence, and/or decreased effectiveness of public health measures, vaccines or therapeutics. (See WHO variant definitions and tracking).
The speed at which the variant has been detected and rapidly reviewed is encouraging. However it will take days, or possibly weeks, to understand if Omicron is more transmissible, can cause more severe illness, and/or can evade current vaccines. There will likely be daily news stories focused more on the potential threats from Omicron. While these risks should not be downplayed, as physicians it will be important for you to be armed with scientific evidence to counsel your patients who may be especially anxious during this busy holiday season.
Is Omicron More Transmissible?
Possibly. The Delta variant is about twice as transmissible as the original COVID-19 virus and had been the predominant variant circulating in South Africa. There has been a steep increase in infections in parts of South Africa recently coinciding with the detection of Omicron. Initial evidence is suggesting that Omicron has overtaken Delta as the predominant variant in parts of South Africa. Epidemiological studies are underway to understand if it is because of Omicron or other factors.
Is Omicron More Virulent?
Unknown. There are some reports of increasing hospitalizations in South Africa, but it is not yet clear if this is because of increasing rates of infection, or because the Omicron variant causes more severe outcomes. According to the WHO update, “there is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.” They explain it will take days, or possibly weeks, to determine the level of severity of Omicron.
Are the Vaccines and Previous Infections Effective Against Omicron?
Unknown. Preliminary evidence suggests there may be an increased risk of reinfection with Omicron as compared to other variants of concern, but information is limited. The effectiveness of the current COVID-19 vaccines against this variant is being studied now and vaccine manufacturers are also looking at how to adapt their vaccines, if needed, to offer a booster that targets Omicron.
Testing for Omicron
PCR tests continue to detect COVID-19 infections, including Omicron.
Where has Omicron Been Detected?
No cases of Omicron variant have been detected in Manitoba at this time. Public Health is already sequencing all positive travel-related specimens.
Outside of Canada, cases have been identified in several countries, including some in Southern Africa, several in Europe, as well as Hong Kong and Israel.
What measures are in place to respond to Omicron?
Manitoba Public Health is updating its testing and is already sequencing all positive travel-related specimens. In the meantime, Manitobans are urged to follow the existing public health advice and orders and to get vaccinated.
Canada imposed a travel ban on those arriving from the Southern Africa region — including South Africa, Eswatini, Lesotho, Botswana, Zimbabwe, Mozambique, and Namibia. Foreign nationals who have travelled to any of these countries within the previous 14 days will not be permitted into Canada. Canadians and permanent residents will be subject to enhanced testing and quarantine measures, regardless of vaccination status. Further details are available here.
Several countries introduced travel restrictions similar to Canada, with Israel, Japan and Morocco banning all foreign travellers. Most cases, at least initially, could be expected to be linked to travel but travel bans like this have also been criticized as ineffective and punishing countries that first detect a variant.
What should physicians do for now?
For now, not much changes. Physicians should continue to:
- Screen patients and recommend testing to any that meet the criteria, including with relevant international travel history (see Manitoba screening tool for Public Health and Health Links).
- Reinforce pandemic precautions, such as distancing, mask-use and staying home if symptomatic.
- Recommend vaccination to patients. While the effectiveness of vaccines against this new variant are being studied, experts like Dr. Anthony Fauci are already saying the vaccines should offer at least some protection against the new variant, particularly severe illness. Manitoba Public Health today noted that “vaccine still provides one of the best defences against COVID-19.”
Doctors Manitoba will continue to monitor the situation closely, and provide updates as more is learned about the Omicron variant.
Physician Safety a Growing Concern
Over the last few weeks, a Doctors Manitoba survey has found a very concerning increase in unsafe incidents, including abuse, threats and harassment towards physicians. Six in 10 physicians have experienced at least one unsafe incident within the previous month, and over half of incidents appear to be related to the pandemic response or COVID-19 vaccine.
Our survey was adapted from one used by the British Medical Association (BMA), and launched after several concerning incidents were reported to our office over the few months. With over 400 responses, 57% of Manitoba physician respondents have faced at least one incident of verbal abuse, threats, harassment or physical assault over the last month. This includes:
- 50% experienced at least one incident of verbal abuse within the last month, much higher than 37% in the BMA survey.
- 37% experienced incidents of bullying or harassment, and 36% experienced threats or intimidation
- 6% experienced some form of physical assault, more than three times higher than in the BMA survey.
Younger physicians were more likely to report unsafe incidents. These incidents were more common among family physicians (66% vs 50% among specialists), female physicians (63% vs 52% male physicians), BIPOC physicians (62% vs 56% white physicians). Doctors working in Northern, Southern and Interlake-Eastern health regions were also more likely to experience unsafe incidents.
Nearly all of these incidents occurred at work, though 15% of physicians reported incidents that occurred online and, notably, 3% at physicians’ homes. 59% of physicians indicated these types of incidents have increased over the last year.
New Federal Legislation Offers Protection
Doctors Manitoba has been working with other medical associations, including the CMA, to monitor this situation closely and advocate for action to protect physicians, health care workers and patients. Last week, the federal government introduced legislation that would make it a criminal offense to threaten, harass or intimidate a health care professional or patients, as well as to obstruct or interfere with a patient’s access to a health care facility or clinic.
We thank the CMA for its advocacy on the national stage for physician safety and join them in applauding the federal government’s proposed law. “Rapid action on this urgent issue is a welcomed relief as physicians and health workers are working within an overwhelmed health system while facing threats to their personal safety,” explained CMA President Dr. Katharine Smart. While the legislation must still be passed by the House of Commons and Senate, it appears to have enough support to become law. Doctors Manitoba will be following this very closely.
Other Safety Information
Our survey also found that only 4 in 10 physicians (37%) feel “very safe” at work, with 43% feeling only somewhat safe and 17% feeling somewhat or very unsafe.
There are steps physicians can take to improve safety in their practice setting. The following resources can assist you with considering safety risks and actions to take to decrease those risks:
- Doctors Manitoba has published a Guide to Physician Safety During the Pandemic. This includes tips and resources for your practice and your professional obligations.
- Post signage about maintaining a safe and respectful care environment. Doctors Manitoba created this sign you can print and use.
- Report unsafe incidents to Doctors Manitoba to help us track and monitor this issue. You can use our confidential safety incident report form.
- CMPA also has a resource guide on physician bullying and threats.
Responding to unsafe incidents is important, to ensure the situation deescalates. In 40% of cases, the individual was warned or asked to leave and in 20% of cases facility management were notified. In 16% of cases, security was called to assist with the response and in 5% of cases the police were called. However, nearly a quarter of physicians reported no actions were taken following unsafe incidents.
These unsafe incidents, or even the risk of such incidents, can have a harmful impact on the well-being of physicians, colleagues and your families. Remember that physicians and those in your household have access to special supports, including a 24/7 Physician and Family Support Program. Don’t hesitate to access any of these resources. Find out how.
Surgery and Diagnostic Backlog — What Are We Missing?
Last week, we updated our diagnostic and surgery backlog estimate to a staggering 136,000 cases. We also added sleep disorder studies to our backlog estimates based on advice from physicians. It turns out, the wait list has doubled and patients are waiting two years for tests.
→ See CBC article today “Thousands ‘suffering in silence’ as sleep disorder clinic backlog balloons: Doctors Manitoba”
We want to know if there are any other surgery or diagnostic procedures that have been disrupted during the pandemic and have accumulated a large backlog. So far, our estimates include:
- All surgeries. While we are able to get more specific with cardiac, cataract and hip/knee replacements, we would welcome your insights on other surgical procedures that have been significantly disrupted. The pandemic backlog for all surgeries is estimated at 53,805 cases.
- Diagnostic endoscopies. The pandemic backlog is estimated at 10,672.
- Diagnostic imaging, including CT, MRI, ultrasound and myocardial perfusion studies. The pandemic backlog is estimates at 39,701.
- Allergy tests, with estimated backlog of 2,054.
- Diagnostic mammograms, with an estimated backlog of 25,079.
- Sleep disorder studies, with an estimated backlog of 4,791.
These pandemic backlog estimates only reflect the backlog accumulated during the pandemic. They do not include wait lists that existed prior to March 2020.
Let us know if you are are seeing concerning backlogs for procedures we haven’t identified above. Email us at firstname.lastname@example.org.
COVID-19 Surveillance Update
Since our last update on Thursday, November 25:
- Daily cases down: 478 new cases of COVID-19 have been identified, a daily average of 120 (down from 181). This includes 86 new cases today. The total case count in Manitoba now stands at 67,753.
- Test positivity down: The provincial five-day test positivity rate is 5.1%, down from 5.5%. In Winnipeg, it is 2.5% in Winnipeg, down from 2.9% last week.
- Active cases up: There are 1,493 active COVID-19 cases province-wide, unchanged from Thursday.
- Hospitalizations up: There are 142 people in Manitoba hospitals due to COVID-19, up from 136 on Thursday. This includes 25 COVID-related patients in Manitoba ICUs, up from 24.
- Eleven more people have died from COVID-19. This brings the total COVID-19 related deaths to 1,315.
No cases of the Omicron variant of concern have been detected yet in Manitoba.
According to Health Canada’s tracking, Manitoba had 75 cases per 100,000 over the last seven days, down from 80 on Thursday. Quebec has surpassed Manitoba and now leads all provinces 82 cases per 100,000 people over the last seven days. The overall national average has risen to 52 per 100,000, up from 47, driven primarily by increased in Ontario, Quebec and New Brunswick.
Doctors Manitoba is holding an online public town hall tomorrow (Tuesday) at 7PM to answer questions on the pediatric COVID-19 vaccine for children age 5 to 11. A panel of pediatric and vaccine experts will take questions from parents to help address concerns and battle misinformation. You can learn more about the town hall at ManitobaVaccine.ca/townhall. We encourage you to share the town hall with patients and on social media channels using the graphics here.
Funding & Remuneration Support
As you may know, we negotiated targeted funding for physicians to support outreach and immunization for unvaccinated Manitobans age 12+, such as administrative stipends and guaranteed hourly rates.
As flu shots, COVID-19 booster shots and pediatric doses roll out, we have some clarity to offer about how this funding applies to these other vaccine campaigns.
- Ensure your clinic claims the appropriate tariff for COVID-19 vaccines, payable at $20 per dose. There are unique codes for different vaccine types and doses.
- If additional patient counselling or advise is required beyond standard informed consent, you may also be able to claim for a visit.
→ See our Vaccine Billing Advice here for further details and a list of COVID-19 vaccine tariffs.
Additional Funding Opportunities
The COVID-19 vaccine initiative announced in September was originally designed to support reaching long-eligible, but hesitant unvaccinated Manitobans. Specifically, it this initiative is to be used to support physicians in reaching unvaccinated individuals age 12+, who are presumably hesitant, cautious or complacent.
As pediatric doses, booster shots and flu shots roll out, we know in practice many clinics will be holding vaccine clinics to offer all of these various vaccines.
We have sought clarity and here is how you can leverage these funding initiatives with these other shots.
The administrative stipend ($25 / hour) and guaranteed hourly minimum for physician remuneration can be used to support vaccine clinics, as long as efforts are made to include first or second doses for individuals age 12 and over. This means that starting today, you can claim $25/hour in administrative support and have the guarantee of an hourly minimum rate if you hold a vaccine clinic that offers flu shots, pediatric COVID-19 shots and/or COVID-19 booster shots, as long as you also intend to offer first and second doses for those age 12 and over.
Just in case you aren’t successful in administering a first or second dose to the target hesitant population during a vaccine clinic, we recommend you document your efforts to include these patients. This could include records of inviting unvaccinated patients to the vaccine clinic, such as direct emails, phone log, or a posting on your website or social media. For example, a clinic might promote the following:
- We are holding a vaccine clinic on Saturday from 12 – 4 PM for COVID-19 and flu shots. If you haven’t had your COVID-19 vaccine yet, please feel free to come and speak to a doctor about your questions and concerns to make a fully-informed choice.
The other funding options under this initiative, including to support email and phone outreach and attend community outreach planning meetings, continue to only apply to outreach work for first and second doses among patients age 12 and older.
→ See our guide to these physician-led COVID-19 vaccine funding opportunities here.
If you have questions about remuneration or these funding initiatives, contact Braden Kalichuk at email@example.com.
Pediatric Vaccine Resources for Physicians
With the support of a group of pediatricians, Doctors Manitoba has produced two documents to support you with your pediatric COVID-19 vaccination efforts:
- Key Messages and Q&A: This document includes key messages to use when discussing the vaccine with patients, and a summary of evidence and information presented in a Q&A format. This is a good resource for physicians to have answers to common questions, with links to studies and other sources for further reading.
- Pain Management During Immunizations: Two out of three children experience needle fears. Physicians play an important role in providing a safe and comfortable environment for children to be immunized. This document reviews the“4 Ps of Pain Management” including tips for vaccine administration procedure techniques, body positioning, psychological strategies, and medication pain supports.
These resources may also be helpful:
- Clinical Practice Guidelines, updated with guidance for the pediatric population beginning on page 34 (Manitoba Health)
- Public Fact Sheet for COVID-19 Vaccine for Children 5 to 11 years old (Manitoba Public Health)
- Summary of Recommendations from National Advisory Committee on Immunization (NACI)
Need to Order COVID-19 Vaccine Doses? If you have not yet signed up to offer COVID vaccines in your practice, you can register with Manitoba Health here. If you are registered, you should be receiving weekly emails to order vaccine supplies.
Celebrate Manitoba Physicians
Nominate a Colleague for a Doctors Manitoba Award!
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 are 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.
Celebrating Our 2021 Winners
Earlier this month, about 400 guests gathered at the RBC Convention Centre for our in-person Awards Celebration Dinner. This was the first in-person awards celebration since May 2019. With pandemic precautions in place, physicians gathered to celebrate our profession, reconnected with colleagues and offer each other support through this difficult period. For those who attended, and for those who were not able to join us, we have photos and videos from the event!
You can also view videos celebrating each of our 2021 award winners:
- Dr. Murray Kesselman, Distinguished Service Award (view video)
- Dr. Brent Roussin, Physician of the Year (view video)
- Dr. Heather Watson, Resident of the Year (view video)
- Cadham Lab Team, including Dr. Paul Van Caeseele, Dr. Jared Bullard and Dr. Kerry Dust (PhD), Medal of Excellence (view video)
- Dr. Demitre Serletis, Medal of Excellence (view video)
- Dr. Chris Burnett and Dr. Mairi Burnett, Medal of Excellence (view video)
- Dr. Kerrie Wyant, Medal of Excellence (view video)
- Dr. Maryanne Crockett, Humanitarian (view video)