October 152021

In today’s message you will find:

COVID Situation Update

Since our last update on Thursday, October 7:

  • Daily cases down: 730 new cases of COVID-19 have been identified since last Friday, a daily average of 91 (down from 104 last week). This includes 92 new cases today. The total case count in Manitoba now stands at 61,987.
  • Test positivity down: The provincial five-day test positivity rate is 3.2%, down from 3.4%. In Winnipeg, it is 1.5%, unchanged from last week.
  • Active cases up: There are 963 active COVID-19 cases province-wide, up from 868 last week.
  • Hospitalizations up: There are 92 people in Manitoba hospitals due to COVID-19, up from 85. This includes 16 COVID-related patients in Manitoba ICUs, up from 15
  • Fifteen more people have died from COVID-19 since last Thursday. This brings the total COVID-19 related deaths to 1,230.

According to Health Canada’s tracking, Manitoba had 47 cases per 100,000 over the last seven days, down from 50 last week. Alberta and Saskatchewan continue to lead the provinces, though it appears the situation is starting to improve in both provinces. There are 245 new cases per 100,000 in Saskatchewan (down from 261 last week) and 140 in Alberta (down from 210 last week).

Within Manitoba, Northern Health region accounts for 38% of active cases, followed by Southern Health accounting for 22%. Patients from Southern Health account for more than a third of all current COVID-related hospitalizations.

Dr. Jazz Atwal announced on Tuesday new more targeted self-isolation rules for the Southern Health region. If a symptomatic person living in Southern Health-Santé Sud is awaiting test results and self-isolating, the rest of the household has to self-isolate unless otherwise exempt. Those exempt include people who are fully vaccinated, those who were infected with COVID-19 within six months, and asymptomatic designated workers who are not fully vaccinated but do regular rapid testing. If an otherwise exempt designated worker or close contact in a household has symptoms, then they are required to self-isolate. 

The updated isolation rules are effective immediately, and will be stay place until community transmission in the region decreases or the strain on the health care system capacity is reduced. 

U.S. Land Border to Reopen

Starting November 8, the U.S. land border will reopen to non-essential travel for the first time since March 2020. Travellers must be fully-vaccinated. The Canadian border reopened to American fully-vaccinated travellers on August 9

The U.S. policy will recognize COVID-19 vaccines approved by the World Health Organization, including AstraZeneca. It is not yet clear, however, whether travellers with mixed dosed will be recognized as fully-vaccinated. 

Anyone travelling outside of Manitoba should bring a printed copy of the COVID-19 immunization record, as the Manitoba immunization card is not recognized outside of the province, or by Canadian customs officials. Travellers will still need a valid PCR test to get back into Canada.
The Public Health Agency of Canada still advises against non-essential international travel. 

MERCK COVID-19 treatment pill

On Monday, Merck applied to the U.S. FDA for emergency use authorization for a tablet to treat mild to moderate COVID-19. It would be the first antiviral pill to treat COVID. In a trial of mild to moderately ill COVID patients, the pill, called Molnupiravir, cut the rate of hospitalization and death by 50%.

Merck has a U.S. government contract to supply 1.7 million courses and expects to produce 10 million courses of the treatment by the end of 2021. It has also agreed to license the drug to several India-based generic drug-makers, which are expected to supply the treatment to more than 100 low- and middle-income countries.

Vaccine Updates

Since our update last Thursday:

  • 86.1% of Manitobans age 12 and up have received at least one dose, up from 85.4% a week ago. 
  • 82.4% have received two doses, up from 81.4% a week ago. 

Last week we provided details on the booster shot eligibility and medical exemption requests. You can find that information here.

More Evidence of Vaccine Effectiveness

For the first time. the U.S. CDC is publishing national data on infections, hospitalization and death by vaccination status. 

The new reporting helps to understand the relative risk, or likelihood, of testing positive for COVID-19, being hospitalized, or dying.

For the month of August, when cases were surging across the U.S., unvaccinated individuals were 6.1 times more likely to test positive for COVID compared to fully vaccinated individuals. At the peak that month, there was an incidence of 737 cases of COVID-19 per 100,000 unvaccinated people, compared to just 121 among vaccinated people. 

The hospitalization rate was 12 times higher among unvaccinated individuals, and that gap is even higher for individuals younger than age 65. The CDC also found that unvaccinated persons were 11.3 times more likely to die from COVID-19 than fully vaccinated persons.

You can view the CDC data and analysis here.

Vaccine or Testing Requirement Starts Monday

A reminder to all physicians that as of Monday, October 18, all direct care physicians and health care workers are required to be fully vaccinated against COVID-19, or to be regularly tested. We have a few reminders and developments to assist physicians with implementing this requirement in their practices.

The requirement was announced under a Public Health Order and applies to all physicians and health care workers providing direct patient care. This includes hospitals, personal care homes and any other facility or service run by, or funded by, Shared Health or an RHA. The College of Physicians and Surgeons also requires all physicians to be fully vaccinated or tested prior to treating patients. 

For physicians and staff who work in a Shared Health or RHA facility, you must follow their guidance on vaccination and testing.

Shared Health has issued guidance that any staff person who is unvaccinated and refuses regular rapid testing will be placed on an unpaid leave and face disciplinary action. Shared Health’s advice and resources on rapid testing may be useful to independent physician practices too.

For physicians who work in an independent medical practice, you should be taking steps to implement this requirement in your practice. The CPSM states that employees or staff [of medical clinics] who interact directly with the public should be fully immunized or submit to testing and wear the appropriate PPE.” See our earlier advice about setting up a process to collect and document vaccination status and regular testing for unvaccinated staff. 

Need Rapid Test Kits? If there are unvaccinated physicians or staff in your practice, Doctors Manitoba has worked with the Province to obtain rapid test kits. Clinics pay the shipping costs, but there is no cost for the kits. To request rapid test kits for unvaccinated staff, please complete this form. Our staff will contact you to confirm your order and obtain a credit card for shipping costs. 

Join New COVID-19 Vaccination Initiative 

A few weeks ago we announced the creation of a new physician-led COVID-19 vaccination initiative which includes new financial opportunities to support patient outreach, hold vaccine information and immunization clinics, and participate 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.

→ Learn more about the program’s supports, get advice and find other resources here.

Updated Vaccine Billing Advice

Based on your advice, we have successfully advocated for a change to the billing requirements for COVID-19 injections. For clinics offering first and second COVID-19 shots, physicians do not need to personally see the patient to bill Manitoba Health for the injection. The informed consent, injection and monitoring can be delegated to qualified staff, such as a clinic nurse. However, the billing physician must be on-site to provide supervision, advice or assistance, as needed. 

This is limited to the COVID-19 vaccination campaign, and is not applicable to other vaccines such as the flu shot.

Booster / Third Dose Reminder

A reminder that booster shots and third doses are now available to a variety of groups, including physicians. We are maintaining up-to-date eligibility at Man​i​to​baVac​cine​.ca.

We’ve received a few messages from physicians feeling uncomfortable or guilty about receiving a booster dose, when only 2.7% of people in low-income have received their first dose. While these sentiments are commendable, refusing or delaying a third dose likely won’t result in any more doses arriving in low-income countries. 

A recent STAT news article by an American physician explains that once vaccines are received and distributed, it is not easy or feasible to recollect them, repackage them, and ship them overseas. 

From a local perspective, there is also an abundant supply in Manitoba. So, healthy physicians or health care workers should not be concerned that their booster is impacting on the ability of others to get a first, second or third dose at this stage. 

You can help by contacting your MP to advocate for Canada to do more to contribute vaccines to lower-income countries. You can also consider contributing to the UNICEF Canada #GiveAVax campaign to deliver more COVID-19 vaccines to lower-income countries. 

Preparing for Vaccine Approval for 5 – 11 year olds

Pfizer has submitted data to regulators including the U.S. FDA and Health Canada to authorize its COVID-19 vaccine for children between the ages of 5 – 11. A decision could come in a matter of weeks. The FDA is expected to review the request the first week of November, and it’s possible Health Canada could do the same. 

We understand the vaccine for this age groups will have a different dose, dilution requirements and storage conditions, and may come in a unique vial. 

Doctors Manitoba is monitoring the situation very closely, and will help physicians prepare for the possible approval. Please watch your email for regular updates. 

If your practice has not yet registered to receive COVID-19 vaccines, you should consider doing this now to be ready. Learn more about how to register with Manitoba Health here.

Fighting for Surgery and Diagnostic Recovery

Yesterday, we released a major progress report on the massive backlog of surgery, diagnostic and other procedures as part of our continued advocacy for a concrete recovery plan. 

Our analysis found that the estimated backlog is nearly 130,000 cases, up from our original estimate of 110,000 in June. This includes:

  • Over 52,000 surgeries, up from 39,000 in June, accounting for most of the increase.
  • Over 41,000 diagnostic imaging procedures, such as MRI, CT and ultrasound scans, down from over 44,000 in June.
  • Over 35,000 other procedures, including endoscopies, mammograms and allergy tests, nearly the same as in June.

The reduction in the diagnostic imaging backlog was driven by the elimination of the backlog for CT scans, though the wait time for this medical test is now 18 weeks, three times higher than it was before the pandemic. The backlog for other diagnostic imaging procedures has increased. 

See our progress report here!

We had hoped to see the backlog start to shrink after the third wave as COVID case numbers decreased,” added Dr. Kristjan Thompson, President of Doctors Manitoba.​“Instead, that opportunity was missed, and the backlog has actually gotten worse. We’re now anticipating further delays and disruptions as Manitoba enters the fourth wave.” 

The new report also measures progress on the three recommendations Doctors Manitoba made in June. Overall progress has been slow, with no government commitment to fully address the backlog by a set date and no additional public reporting on the backlog. There were preliminary steps taken to form an advisory group, but the group has not yet met and it is not clear whether a task force will be established with the authority to oversee the immediate and sustained action needed to fully address the backlog. 

The growing backlog is a top concern for physicians, and our advocacy received widespread media coverage, including from CBC, CTV, Global, the Winnipeg Free Press, Winnipeg Sun and several rural local news outlets. 

Government Response

In response to our report, the provincial government signaled that a task force to oversee the issue is being established, and a deadline to tackle the backlog will follow — both actions recommended by Doctors Manitoba.

The government announced $50 million earlier this year to address the backlog, but earlier this week it was revealed they have only spent $2.5 million so far.
The pandemic has not only affected surgeries and diagnostic imaging procedures, but also lab resources. A Free Press story earlier this week revealed that hospital labs had rejected more than 5,300 testing requests last fall. Shared Health reports that lab testing restrictions were in place, but ended on August 172021

Report Threatening Incidents!

Have you faced threats, intimidation, bullying, vandalism, abuse, or violence from patients or the public? Please report any recent or past incidents to us today, so we can monitor this issue and advocate for physician safety. 

Last week we provided some advice on how to handle patients who may be using threats and intimidation in the face of feeling pressured to get the vaccine. Patients who are feeling forced or coerced to get a COVID-19 vaccine and have fears or concerns about vaccination may act out toward their physicians. Because we are very concerned about this trend, Doctors Manitoba has created a new Guide to Physician Safety During the Pandemic. that offers advice about what to consider and what to do in your practice to maintain a safe environment for you, your staff and your patients and visitors. 

We strongly encourage all members to report any current or recent incidents to us involving bullying, harassment, threats, vandalism, abuse, violence or intimidation. 

Resident Needed — Insurance Committee

Doctors Manitoba is recruiting a resident physician to join our Insurance Committee! 

All residents participate in our insurance program with term life, disability and accident coverage. Some residents also subscribe to additional optional insurance. Because of this, it is vital to have a resident voice on the Committee.

Doctors Manitoba’s 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 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, including residents, 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, please contact Rick Sawyer at rsawyer@​doctorsmanitoba.​ca.

Practice Reminders

All physicians are reminded of the following pandemic-related considerations in their practices:

Reminder to See Patients In Person

In Ontario, the College of Physicians and Surgeons, chief public health officer and government teamed up with a message to all physicians: resume in-person patient visits. The reminder was issued following a series of complaints from patients about physicians refusing in-person visits and only offering virtual appointments. 

Manitoba physicians should take note of this advice. Doctors Manitoba has received some calls from concerned patients who were refused in-person visits. In each case, we worked with the patient and individual physician to resolve the issue. Some patient visits are still, and will always, be suitable for a virtual visit, but some require in-person care and should not be delayed. 

Virtual care is not yet permanent in Manitoba. As we continue our work to negotiate permanent virtual care tariffs, the continued responsible and appropriate use of virtual visits as a care option is critically important. 

Sick Note / Exemption Note Reminder

Many employers in both the public and private sectors are implementing vaccination and testing mandates. Some private employers are not offering a testing alternative. Some employees continue to have concerns about their safety in the workplace where they are likely to have contact with unvaccinated individuals (particularly health care employees, teachers, and early childhood educators), and some parents continue to be concerned about their unvaccinated children in school.

Some of our members are reporting an increase in patient requests for physician letters or notes to try to avoid or defer the consequences of failing to comply with employer rules, a physical return to the workplace or school, or working conditions which may pose a greater threat to their health.

We remind you that the CPSM, Manitoba Health, and Shared Health have all given direction on appropriate practice, including the limited circumstances under which medical exemptions are appropriate. Earlier this week, the CPSM issued a reminder to physicians about providing sick notes. We are including their message below, as there has been an increase in medical note requests related to COVID-19 and vaccines. 

As more organizations across the province require their employees to be fully vaccinated or undergo testing for COIVD-19, you may have an increase in patients seeking medical/​sick notes. 

Writing a medical note is deemed the provision of medical care and must adhere to the requirements of good medical care in the practice of medicine as defined in the regulations and Standards of Practice. 

Members are expected to provide continued treatment for any medical condition that precludes that person from attending to work, school, training, or other organized activity for a prolonged period. Members must abstain from providing anyone for any reason a medical/​sick note in the absence of a justified medical condition or based upon information that is known to be inaccurate. Holding a strong opinion against COVID-19 and/​or COVID-19 testing and/​or COVID-19 vaccines is not a medical condition. Members are not obliged to provide a medical/​sick note if they deem it is not medically indicated or appropriate for the individual circumstances.

We offer the following general guidance on handling requests during the pandemic:

  • You should NOT provide a note justifying a failure to be vaccinated: there is now a formal process for approval of a vaccination exemption by a specialist only.
  • You MAY provide a note exempting a patient from mask rules, although there are very limited conditions which warrant an exemption.
  • You MAY provide a note respecting a patient’s medical condition which indicates a greater risk for the patient in certain employment or educational situations. Patients who are health care employees will seek the advice of their Occupational and Environmental Health officer; other employees should follow their own employers’ processes.
  • The province has not changed its position from the very outset of the pandemic that sick notes should not be required by employers: employees should stay home when ill, without facing barriers such as the requirement for sick notes.

→ See our message from last week with advice on responding to requests for a COVID-19 vaccination exemption. A special process is in place for this, including special billing advice for referrals. 

We know that some patients have unreasonable expectations of your ability to exempt them from public health or employment rules. Please contact us at covid19@​doctorsmanitoba.​ca if you have any questions, and of course report any incidents should any patient cross the line into inappropriate behaviour directed at you or your staff. 

New Advice on Aspirin for Heart Health?

The U.S. Preventive Services Task Force has amended its draft guidance on the use of aspirin in 60+ adults not at risk of heart disease. The risks of bleeding outweigh any potential benefit from a low-dose of aspirin. The task force says there may be a small benefit for adults in their 40s who have no bleeding risks, and for people in their 50s they say evidence of benefit is less clear. While the task force previously said certain people in their 50s and 60s may want to consider a daily aspirin to prevent a first heart attack and stroke, and protect against colorectal cancer, the new guidance says more evidence of any benefit for colorectal cancer is needed.
Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice.

Doctors Manitoba Office Reopens

Our Doctors Manitoba staff are proud of the advocacy and leadership of our members in promoting the importance of the COVID-19 vaccine. We agree, and that’s why all of us are fully vaccinated.
With appropriate precautions in place, our office has reopened to members who prefer to attend in-person. Visitors to our office must be fully-vaccinated, and you should be ready to show proof of vaccination when you visit. We are using the same Manitoba Health app as restaurants, sports teams, and concert venues. Since we won’t save any of your personal information, we will check your proof of vaccination each time you visit us.
We look forward to seeing many of you, as we cautiously resume in-person meetings and events at our office.

Fantastic Physicians

Dr. Paul Peters has received the Physician Emeritus Award. A retired family physician who practiced for 38 years in the Steinbach area, Dr. Peters was Chief of Staff at Bethesda Regional Health Centre, a lifetime honorary member of The College of Physicians and Surgeons of Manitoba and a founding partner of the Steinbach Family Medical Centre. He was a medical volunteer on missions around the world in countries like China, Bolivia and Thailand, and received the Blazer Award by Canadian Mennonite University. 

Health Care Heroes

Shared Health and the Winnipeg Jets have teamed up to bring you Scheif’s Healthcare Heroes. You can now nominate a colleague or peer to be featured and celebrated at a Winnipeg Jets home game. Nominees will have stepped up in immeasurable ways, supporting patients, residents and clients navigate the additional stress of accessing health services during a pandemic.” Each home game will celebrate a Manitoban working in healthcare who has made an impact during the pandemic. You can nominate someone here. Nominations are open now, until December 31. A new call for nominees will open in the New Year.

CMA Awards — Call for Nominations

Nominations are now open for the 2022 Canadian Medical Association (CMA) Awards.The CMA Awards recognize the dedication, successes and talents of Canadians who are making significant contributions to our health and health care. For information on how to nominate a colleague click HERE. The submission deadline is November 302021.

Physician Opportunities

Doctors Manitoba maintains a listing of opportunities for physicians across the province. There are two unique roles we are profiling this week.
You can view all practice opportunities on our site.

CPSM Medical Consultant Opportunity

The College of Physicians and Surgeons is seeking a physician for a minimum of 5 years of clinical experience, preferably in family medicine, for the position of Medical Consultant. Experience in hospital-based care is an asset. The main responsibilities of the medical consultant are to assist with the resolution of complaints submitted to CPSM by gathering and examining data, facilitating resolutions, and providing advice and support to the Complaints Committee in their reviews. Assistance with matters before the Investigation Committee may also be required. The position is 0.6 EFT.

View the listing here, with a link to the full job description. Apply by October 29.

Sport Manitoba Seeks Clinic Director

Sport Manitoba Clinic is seeking a clinic director and senior practitioner. The Director will be responsible for mentoring the multidisciplinary team and leading the growth of new and existing services, while also working as a practicing clinician. Viewthe listing here.

Upcoming Events

There are a number of important events planned for the next few months, including both virtual and in-person. Check out our events page for the full list! 

Next Week

Check out the 25th Bug Day on Tuesday. This annual not-to-be-missed event is a great opportunity to learn the latest on infection prevention as well as emerging and existing pathogens. The event is free, online and fully accredited. Learn more here. On Friday, there is an HPV Triage webinar focused on enhancing cervical cancer screening. 

Provincial CancerCare Conference

The 2021 Provincial CancerCare conference will be held virtually from November 4 – 5. The conference is planned for family physicians in oncology, nurses, pharmacists, nurse navigators, psychosocial oncology clinicians from around the province, and primary care providers. The Thursday program will focus on breast cancer and will include topics addressing screening, prevention, surgery, systemic therapy, radiation, survivorship and the psychosocial aspects of breast cancer. The Friday program offers sessions relevant to a variety of disease site groups, including a session addressing the current state of cancer surgery in Manitoba, and sessions on the impact of the COVID-19 in cancer care, virtual care, upcoming new treatments, updates in the treatment of CLL, and an update on liver cancer services in our province. Learn more here.

AGOWIIDIWINAN” (Treaties): Moving Forward Together

There are four free, interactive virtual events planned in November by the Treaty Relations Commission of Manitoba to develop mutual understanding, connection and action as it relates to Treaties in practice. The sessions are planned for Wednesday evenings throughout November.We are ALL Treaty people, and physicians plan an important role in the journey towards reconciliation. Learn more and register now.

Doctors Manitoba Annual Awards Celebration (Nov 20)

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 soon.