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COVID Update

Since our last update on Thursday September 23:

  • Daily cases up: 684 new cases of COVID-19 have been identified since last Thursday, a daily average of 89 (up from 68 last week). This includes 78 new cases today. The total case count in Manitoba now stands at 50,628.
  • Test positivity up: The provincial five-day test positivity rate is 3.0%, up from 2.3%. In Winnipeg, it is 1.3%, up from 1.0%.
  • Active cases up: There are 712 active COVID-19 cases province-wide, up from 498 last week.
  • Hospitalizations increasing: There are 92 people in Manitoba hospitals due to COVID-19, up from 68. This includes 19 COVID-related patients in Manitoba ICUs, up from 14. 
  • Four more people have died from COVID-19 since last Thursday, including two reported today. This brings the total COVID-19 related deaths to 1,211.

According to Health Canada’s tracking, Manitoba had 41 cases per 100,000 over the last seven days, up from 30 last week. Alberta and Saskatchewan continue to lead the provinces with 282 cases per 100,000 in Saskatchewan (up from 277 last week) and 258 in Alberta (up from 254 last week).

COVID in Schools

So far this school year, there have been 181 cases of COVID-19 identified in 83 schools across Manitoba. This includes 155 student cases and 26 staff cases. One outbreak has been declared so far, at Christian Heritage School in Brandon. Information is available using the province’s COVID School Dashboard.

Earlier this week, the COVID-19 Immunity Task Force and CanCOVID held a joint webinar to profile the risks and impacts of the pandemic on Canada’s kids, parents and teachers. The national round table included early results from seven researchers. The key findings include sero-prevalence studies for over 13,700 children, parents and school staff, as well as surveys and other data to understand the issues.

Key findings include: 

  • Infection-acquired immunity remains low among Canadian children, so public health measures and vaccination remain essential. 
  • Preventive measures in schools appear to be working, as few school staff have been found to have caught the virus at school.
  • Most parents and teachers agree vaccination is important, and most parents intend to get their children vaccinated when they are eligible. 
  • The risk of adverse events following vaccination is low among those over 12. The risk of getting myocarditis and pericarditis from a COVID-19 infection is higher for children and youth than it is from the vaccine. 

The researchers also look at the impact the pandemic is having on the mental health and social behaviours of children. Through surveys with children and parents, they found:

  • An increase in non-educational screen time of up to 80%. For children with increased screen time, there was also an increase in irritability and hyperactivity identified. 
  • More than half of children also reported spending less time doing physical activity, and less time with friends (in-person).
  • While parents reported high degrees of pandemic-induced anxiety and stress, they also noted that the pandemic has allowed spending more time with family. 

Family Doctor Finder Backlog

The province’s Family Doctor Finder (FDF) program plays a vital role in helping individuals get matched with a family physician. During the pandemic, however, a backlog has emerged as FDF staff were redeployed to assist with the pandemic response. 

The service received about 2,000 requests per month, and is normally able to match about 70 – 80% with a family physician within 30 days. A story by CTV found that as staff were redeployed, a backlog started to grow. For April to June, 2021, only 32% of requests were matched within 30 days and there is now a backlog of nearly 5,000 individuals waiting to find a family doctor. 

In responding to the issue, Doctors Manitoba President Dr. Kristjan Thompson noted that the issue needs to be addressed ​“before it becomes a crisis of its own.” As an emergency physician, he is already seeing more people coming to the ER with chronic conditions who are waiting to find a family physician. 

Vaccine Update

As of Wednesday, September 29:

  • 85.0% of Manitobans age 12 and up have received at least one dose, up only slightly from 84.5% a week ago. 
  • 80.7% have received two doses, up from 79.8% a week ago. 

Of the 712 active cases in the province, 63% are unvaccinated, 10% have received one dose and 27% are fully vaccinated. Unvaccinated individuals represent 77% of active hospitalizations and 86% of individuals in ICU.

Important Reminder about Dosing Intervals

Manitoba Health has asked us to remind all physicians to adhere to the prescribed minimum dosing interval for COVID-19 vaccines. They have noticed a pattern with multiple patients getting their second dose a day early, and this means they are ineligible for their immunization card.

When determining the minimum number of days between doses, please remember that the day on which dose one was administered should be considered day zero, not day one. The recommended interval for both Pfizer (Comirnaty) and Moderna (Spikevax) is at least 28 days between doses, though the minimum interval acceptable for Pfizer is 21 days. 

For example if a dose was administered on September 1, the second dose should not be administered until at least September 29, and not on September 28.
The patient’s immunization history should be verified before offering their second dose. The minimum interval between second and eligible third doses is also 28 days.

You can access the full advice from Manitoba Health on dosing intervals in Appendix F of the clinical practice guidelines.

Mixing COVID-19 and non-COVID-19 Vaccines

As a precaution NACI previously recommended that COVID-19 vaccines should not be given simultaneously with other routine immunizations. After reviewing the evolving data and evidence, they have stated that the precautionary approach of spacing COVID-19 and non-COVID-19 vaccines is no longer necessary. COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, including live, non-live, adjuvanted, and non-adjuvanted vaccines. This will help facilitate the rollout of the 2021 influenza vaccine program in the fall and winter and will make it easier for individuals to receive other routine vaccines they have missed due to the pandemic. 

To see the full update, please visit NACI’s Recommendations on the use of COVID-19 vaccines.

PCH Boosters

NACI also recommends offering a booster dose of COVID-19 vaccine to LTC residents and seniors living in other congregate settings as a strategy to boost protection and prevent outbreaks among this especially vulnerable population. A booster dose will provide an opportunity raise antibody titres which are likely to result in better protection, and longer duration of protection, including against SARS-CoV‑2 VOC.

Vaccines for 5 – 11 year olds coming soon?

Earlier this week Pfizer submitted data for COVID-19 vaccine use for children aged 5 – 11. They plan to make a formal request to U.S. regulators for emergency use in the coming weeks. The FDA may not make its decision until sometime between Halloween and Thanksgiving. We do not yet know the timeline for when a submission will be made to
Health Canada, but the federal government has said regulatory officials
are ready to review the submission when it is available.

Tightened Pandemic Restrictions Announced

Dr. Brent Roussin announced new public health restrictions today to help slow the spread of COVID-19 as a 4th wave emerges in Manitoba. Cases have been rising in the province, but the increase is being primarily fueled by the Southern Health Region. Hospitalizations due to COVID-19 are also increasing, up 26% in the last week.

The measures target the Southern Health region specifically, and unvaccinated people across the province, recognizing that people who are not fully vaccinated account for 75% of new cases, 79% of hospital admissions and 100% of ICU admissions in Manitoba. 

Under the new province-wide pandemic measures, which largely come into effect on Tuesday October 5, the following changes will take effect:

  • Private indoor gatherings are limited to guests from only one other household if any unvaccinated person who is eligible to be vaccinated is present.
  • Private outdoor gatherings are limited to 10 guests if the gathering includes any unvaccinated person who is eligible to be vaccinated.
  • Reducing indoor public gathering group sizes to 25 people or 25% capacity, whichever is lower, for gatherings that include unvaccinated people who are eligible to be vaccinated. This includes wedding and funerals, though the changes won’t take effect until October 12 for these events. 
  • Setting indoor group sizes for faith-based gatherings to 25 people or 33% capacity, whichever is greater, for gatherings that include unvaccinated people who are eligible to be vaccinated.

For vaccinated individuals, this means little change. Fully immunized Manitobans and those under 12 who are not eligible for the vaccine may gather without capacity limits in each of these areas. Household gatherings, weddings, funerals and faith-based gatherings can occur for fully vaccinated individuals and those under 12 without any restrictions.

Gyms, restaurants, casinos, museums and theatres continue to operate but only fully-vaccinated individuals can attend. 

For everyone, regardless of vaccination status, outdoor public gatherings will be restricted to up to 50 people, down from 500. 

In Southern Health Region, an additional measure is added to restriction retail capacity to 50%. 

The province will move to restricted (orange) on the pandemic response system, though schools will remain at yellow and open to in-person learning.
A detailed overview of the new restrictions is available here.

Join the New COVID-19 Vaccination Initiative 

On Tuesday, we were pleased to unveil details of a new physician-led COVID-19 vaccination initiative during our webinar, including new support for patient outreach, holding vaccine information and immunization clinics, and participating in community outreach initiatives. 

Physicians and medical clinics, including both family medicine and specialties, are strongly encouraged to participate to help increase vaccine uptake among Manitobans. 

The new supports include:

  • Funding to support email and phone outreach to unvaccinated or partially vaccinated patients.
  • A minimum guaranteed hourly rate to hold COVID-19 vaccine information and immunization clinics. This will top up whatever is billed to meet the minimum hourly threshold to help cover basic overhead costs.
  • An hourly administrative stipend to support COVID-19 vaccine information and immunization clinics.
  • Remuneration to participate in community-outreach planning meetings, using a research-based approach supported by the University of Manitoba and the Manitoba College of Family Physicians. 

An overview of the additional funding and support is available here.

We have set up a new resource page, which includes a recording of the webinar, the webinar slide deck, as well as registration and scheduling forms. You can also email vaccineteam@​doctorsmanitoba.​ca to learn more. 

About 20% of eligible adults are still not fully vaccinated, and they are not all alike. Vaccine hesitancy researcher Dr. Michelle Driedger (PhD) joined the webinar to explain that while some of the remaining individuals may be ​“refusers”, most are likely to consider advice and recommendation from a physician. Some may be misinformed, some may be seeking answers to very specific questions, and some may be complacent or not concerned that COVID-19 is a threat to them or those around them. 

Shared Health will make lists available for physicians and clinics of unvaccinated or partially vaccinated individuals. Doctors Manitoba has created a sample script to help clinic staff make the initial calls to try to set up a visit with the physician. 

Physicians and clinics can still enroll with Manitoba Health to start receiving COVID-19 vaccine, so participation is not limited to only those physicians who have been immunizing so far. 

Physicians are trusted, but tone matters.

The webinar panel echoed sentiments shared by Premier Kelvin Goertzen last week: physicians are in the best position to reach anyone who has held out on getting fully vaccinated. You have built trust with your patients, and you have collectively built that trust with the public. 

That said, people who have not yet been fully vaccinated may have strong concerns, higher levels of suspicion, and could be hostile because of vaccine mandates and vaccine passports introduced by the government. 

Because of this, tone matters.

Physicians and clinic staff should use a non-judgmental and inviting approach. Make it clear that physicians want to support a fully-informed decision to get vaccinated, with a personal conversation to assess risks and benefits. Vaccination is a personal decision — and in the short term those decisions have consequences — so physicians want to ensure all of their patients can make a fully-informed choice.

To avoid the perception that you are pushing the vaccine, consider calling immunization clinics ​“vaccine information clinics” with a focus on supporting informed consent. Of course, ensure you have vaccine doses on-hand should patients be willing to accept a vaccine dose. 

Avoid terms like ​“anti-vaxxer” or ​“vaccine hesitant” as these are becoming divisive terms that do not invite unvaccinated individuals to feel welcome and open to new advice.

A firm and direct recommendation from a physician is important. However, it is not worth ​“burning the bridge” over this single issue and risk losing the trust of patients who may need care for cancer, heart issues or other acute and chronic health issues. 

It may be discouraging to get a series of patients declining the vaccine in a row, but this is to be expected at this point and it is important to remember that a no today is not a no tomorrow. And that every yes counts. 

Vaccination and Testing Requirements — New Details

Last week, the government of Manitoba posted new Public Health Orders and further details on the COVID-19 vaccination and testing requirement for the health care system. We have summarized the new details below, to assist physicians working across the health system with preparing for the implementation. 

The new order clarifies that the government requirement for COVID-19 vaccination or regular testing will take effect on October 18, 2021. This is earlier than the originally planned effective date of October 31, 2021. 

Who does the vaccination/​testing requirement apply to?

The requirement apples to physicians and health care workers with ​“direct contact with patients, residents, and clients” in the following settings:

  • Hospitals, PCHs and supportive housing facilities.
  • Northern nursing stations operated by the Government of Manitoba.
  • Facilities operated by Shared Health, an RHA, AFM, or an agency with a funding agreement with Shared Health or an RHA.
  • A residential mental health or addictions treatment facility that is operated by or has a funding agreement with the Government of Manitoba.

What about doctors’ offices and private practices?

The public health order does not include doctors’ offices, despite an earlier FAQ issued by Shared Health that suggests the requirement would apply to both public and private care settings. 

CPSM’s current guidance suggests that:

  • CPSM members ​“should be fully immunized against COVID-19 (unless rare medical reasons preclude vaccination) as part of evidence-informed practice of medicine” and goes on to state that non-vaccinated CPSM members must comply with the public health order to submit to testing up to three times per week and provide proof of a negative test before they can resume working. 
  • For members who own or operate a medical clinic, CPSM notes that ​“you are required to provide a safe workplace for all staff and the public that attend your clinic. As a CPSM member, you are required to engage only in medical care that is safe. This extends to your medical clinic. Employees or staff who interact directly with the public should be fully immunized or submit to testing and wear the appropriate PPE.”

We understand regulators in other provinces have already moved to impose vaccination and testing as a professional standard, whether or not it is required by public health authorities. We are seeking further clarity about whether or not the vaccination/​testing requirement will apply to physician practices that are owned and operated outside of the Shared Health/​RHA system. Regardless, we continue to recommend adopting this policy in your practice.

Impact on Physicians Working in Hospitals and RHA Facilities

If you work in a hospital, PCH or other Shared Health or RHA-run facility, you must comply with the public health order to be vaccinated or be tested for COVID-19. 

According to Shared Health, physicians working in these settings should submit their vaccination status to their facility by today, October 1, 2021. Information was sent directly to physicians from their chief medical officer or site medical lead. Declarations of vaccination status can be submitted online to Shared Health.

If physicians and health care workers are not fully vaccinated by October 18, 2021, regular testing for COVID-19 will be required. Rapid testing is being rolled out across the province for these workers using the Abbott PanBio or BD Veritor antigen tests. These can be self-administered. Workers must maintain a testing log and must produce this log for review upon request. Observed testing may be required in some situations. 

Individuals who receive a negative test result are considered presumptive negative for a period of 48 hours and allowed to work. 

Individuals who test positive will be responsible for notifying their supervisor immediately and seek confirmatory testing at a provincial testing site. 

This memo from Shared Health contains additional information. 

Impact on Community Physicians and Medical Clinics

As noted above, the public health order as currently written does not include physicians’ practices outside of a facility or service run by Shared Health or an RHA. However, based on earlier guidance from Shared Health and the CPSM, Doctors Manitoba continues to recommend all physicians adopt the COVID-19 vaccination or testing requirement. 

There are several considerations for medical clinics that implement a vaccination or testing requirement, which we will try to address below. 

  1. Requesting and documenting physician and staff vaccination status. You can request vaccination status. This can be verified by reviewing a provincial immunization card or record. We suggest your practice establish a system to request, verify and document each physician and employee’s status. 
  2. Clinics should seek legal advice about their requirement to accommodate unvaccinated employees. As a private employer, you may be able to make vaccination a requirement, and consider actions for unvaccinated employees including reassignment of work duties that do not involve direct patient contact, unpaid leaves of absence, or termination. You should seek legal advice first and consider any contracts or collective agreements in place to inform your decision. 
  3. For clinics seeking to implement a testing requirement for unvaccinated employees, Doctors Manitoba has pressed for answers about access to rapid testing. Our position is that clinics should have the same access to rapid testing as other health care settings. We will report back on this as soon as we get direction from provincial authorities, including whether the province will make rapid tests available to clinics and who will bear the cost. 
  4. If a testing option is adopted in your clinic, you will need to consider adopting a system to document and track test results. We recommend adopting a system similar to Shared Health, which puts the onus on employees to maintain a log, and for the employer to spot check the log and consider observing testing at its discretion. You can see an overview of the process in this memo to physicians who work in a Shared Health or RHA facility.

Please continue to monitor updates from CPSM and Doctors Manitoba about how vaccination and testing requirements will apply to community-based, independent physician practices. 

Flu Shot Share is Back

Doctors Manitoba is once again coordinating Flu Shot Share. The initiative helps medical clinics avoid the delays in receiving their influenza vaccine supply due to Manitoba Health’s rotating delivery schedule.

We know a major source of frustration for physicians and their patients every year is the timing and availability of the flu shot. Manitoba Health rotates which clinics and pharmacies get flu vaccines first on a three-year delivery cycle, which means two years out of three your clinic and your patients face delays of two to four weeks in receiving the flu vaccine.

Have you ever wondered why pharmacies don’t seem to face the same delays? The answer is pretty simple. Retail pharmacy chains have been sharing vaccine supplies among multiple locations for years. This has meant every pharmacy seems to have doses available earlier than most medical clinics.

Because medical clinics are largely independently-run with single locations, Doctors Manitoba created the Flu Shot Share Initiative to help clinics get vaccine supplies earlier so you can immunize your most vulnerable patients sooner. The initiative helps put medical clinics on an even footing with retail pharmacy chains. We piloted this initiative last year and it was very successful, with over 60 clinics participating. 

Our initiative matches medical clinics into cohorts to facilitate sharing doses. Clinics that are scheduled to receive the vaccine first this year will share a portion with those clinics in second and third spots on the rotating delivery cycle. When the receiving clinics get their shipment from Manitoba Health a few weeks later, they will return their portion to the sharing clinic in their cohort to ​“make them whole.”

All clinics receiving influenza vaccine doses this year are encouraged to participate. Please email practiceadvice@​doctorsmanitoba.​ca by October 5 to be considered for a match. We will do our best to match as many clinics as possible, however we cannot guarantee all clinics will be matched. 

Truth and Reconciliation

Yesterday marked the first National Day for Truth and Reconciliation. The commemorative day aims to honour the children, survivors, families and communities affected by the abuse and inter-generational trauma inflicted by the Canadian government and residential schools on Indigenous Peoples.

We invite all physicians to share with us how they marked the Day, and what actions they are considering over the weeks and months ahead to support the path towards reconciliation. This could include learning, supporting colleagues and staff to learn the truth, and making changes like focusing on recruiting more Indigenous staff and finding new ways to better support Indigenous patients. Please take a few minutes to email us at covid19@​doctorsmanitoba.​ca, and if you have any photos to share, please include those as well. 

In case you missed it, we put together a list of advice and resources of ways physicians and no-physicians alike can work to make meaningful change, along with perspectives from Indigenous physicians. 

Monday, October 4, is a Provincial Day of Awareness for Missing and Murdered Indigenous Women and Girls and Two-Spirited Peoples. This is another reminder about the inequity experienced by Indigenous Peoples and the legacy of our colonial history. Please monitor your local media and health system news for updates on ways to mark this occasion and show your support.

Mentorship Event Success

Earlier this week, we held our first in-person event since before the pandemic. We gathered 150 fully-vaccinated Mentors and Mentees as part of our re-launched medical learner mentorship program, for a team building night to help foster these important professional connections. It was very exciting for participants to connect in person, and this was a reminder of what is and will be increasingly possible as more people get vaccinated and we emerge from the pandemic. There are a lot of exciting things coming up for the program, including skills building sessions through CMA-Joule.

If you are interested in participating as a mentor or mentee, but haven’t yet registered, learn more here and consider registering today!

Award Opportunities

CMA Awards

The CMA is seeking nominations for its annual awards. The CMA recognize the dedication, successes and talents of individuals who are making significant contributions to health, health care and the medical profession. Call for nominations is now open until Nov. 30. Nominate a worthy friend or colleague today.

Joan and Dean Sandham Scholarship in Indigenous Health Professional Leadership

An endowment fund which has been matched by the President’s Fund at the University of Manitoba, will be used to offer scholarships to Indigenous students who are passionate about medicine or nursing and who are pursuing further degree studies that will specifically serve to enhance and develop leadership skills, in order to advance their professional career in delivering high-quality health care. Candidates must meet specific criteria and the application deadline is October 31, 2021. Learn more here.

Upcoming Events

Kids and COVID: Back to School Webinar - October 4, 2021 1pm — Register here.
The Royal Society of Canada and the COVID-19 Immunity Task Force is holding a webinar for Canadians who may have questions about school safety, the plans for vaccines, and the cumulative impacts of the pandemic on the mental and social well-being of our children. 

We welcome you to also watch the on-demand Doctors Manitoba COVID-19 Back-to-School Town Hall where six pediatric experts answered questions surrounding risks, precautions, impact and vaccines. You can find shareable graphics of tips we’ve compiled in partnership with Shared Health here.

Pediatric COVID-19: Children are not just little adults Webinar- Tuesday, October 5, 2021 3pm — Watch here (Passcode: 284416).
Join Pediatric expert Dr. Stephen Freedman as he presents on what multicentre pediatric studies have been teaching us about COVID-19 infection in children.

New to Practice Webinar — Tuesday, October 12, 2021 6pm — Register here.
Starting your practice is a major milestone for young physicians, and this milestone has only become more complex during COVID-19. We’re here to help you navigate this transition in your journey as a physician. This popular annual session will provide an overview of what Doctors Manitoba offers you, exclusive benefits and insurance available to physicians, billing tips, virtual care and more. 

2021 Doctors Manitoba Annual Awards Celebration — Saturday, November 20, 2021 — Details will be updated here.
SAVE THE DATE — Join us for our annual celebration, where we will recognize our 2021 Doctors Manitoba award winners. This is an opportunity to connect with colleagues, celebrate our profession, and support each other through the next stages of the pandemic and vaccination campaign. We are hopeful an in-person celebration will be possible. This will follow public health guidance to ensure the safety of all attendees. If the pandemic situation requires it, we will change this event to a virtual format. Further details will be released soon and ticket sales will open in early October.

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