October 21, 2021
In this week’s message you will find:
- COVID-19 Situation Update
- Vaccine Updates
- Responsible Virtual Care
- Travel testing and vaccine requirements
- Study finds MB docs are overprescribing antibiotics
- Surgery Recovery plan needed
- A new DocTalk series featuring Manitoba Physicians
- Interested in environmental issues?
- Celebrating Manitoba Physicians
- Upcoming Events
- Physician wellness reminder
- Smoking Cessation assistance for patients
Since our last update on Friday, October 15:
- Daily cases down: 482 new cases of COVID-19 have been identified since last Friday, a daily average of 80 (down from 91 last week). This includes 92 new cases today. The total case count in Manitoba now stands at 62,469.
- Test positivity unchanged: The provincial five-day test positivity rate is 3.2%, unchanged from last week. In Winnipeg, it is 1.3%, down from 1.5% last week.
- Active cases down: There are 926 active COVID-19 cases province-wide, down from 963 last week.
- Hospitalizations down: There are 87 people in Manitoba hospitals due to COVID-19, down from 92. This includes 20 COVID-related patients in Manitoba ICUs, up from 16.
- Five more people have died from COVID-19 since last Friday. This brings the total COVID-19 related deaths to 1,235.
Of the current 926 active cases, 38% are located in the Northern health region, 26% in Southern, and 18% in Winnipeg.
The provincial government confirmed the state of emergency will end today. The state of emergency was first declared 19 months ago on March 20, 2020 as the pandemic began. Like many of you, we were initially surprised to hear the state of emergency would end today when the fourth wave is still a looming threat. However, public health orders remain in effect Premier Goertzen offered a caution that “although the state of emergency is expiring, COVID-19 is still here.” The state of emergency was used to take actions that were beyond the scope of The Public Health Act, such as using virtual meetings for corporate meetings, witnessing and commissioning, reporting deadlines and to restrict the movement of staff between PCHs.
According to Health Canada’s tracking, Manitoba had 43 cases per 100,000 over the last seven days, down from 47 last week.
Today, a Manitoba judge ruled that the province’s pandemic restrictions did not violate chart rights, in a court challenge started by a group of rural churches. The court confirmed the province’s authority, and that of the chief provincial public health authority, to introduce restrictions that were justified to address the COVID-19 situation in Manitoba. Earlier this week, a pastor from one of the churches behind the court challenge, was arrested for repeatedly violating public health orders.
Saskatchewan still top COVID hot spot
Saskatchewan continues to lead the provinces, though the situation is starting to improve. There are 182 new cases per 100,000 in Saskatchewan (down from 245 last week).
While new cases of COVID-19 in Saskatchewan may be starting to improve, the demand for critical care is not. Our neighbouring province has started sending patients out-of-province for critical care as their ICU beds are overwhelmed. Unfortunately, Manitoba is still not in a position to help as our ICUs remain over their normal capacity. Earlier this week, the province’s Chief Medical Officer of Health Dr. Saqib Shahab became emotional as he presented the latest new modeling in that province, which shows demand for ICU beds could double or triple the current unsustainable census if the current pandemic course does not change.
In Saskatchewan, 75% of eligible people are fully vaccinated, compared to 83% in Manitoba.
COVID Leading Cause of Death in U.S.
A new analysis in the U.S. found that in COVID-19 was the second leading cause of death in September. Among 35 – 54 year olds that month, it was the number one cause of death, surpassing heart disease and cancer mortality. The analysis of CDC mortality data by the Kaiser Family Foundation. This can help to support vaccination decisions among patients who are younger and don’t feel at personal risk from COVID-19.
Since our update last Friday:
- 86.4% of Manitobans age 12 and up have received at least one dose, up from 86.1% a week ago.
- 82.9% have received two doses, up from 82.4% a week ago.
The last week has seen first and second dose uptake slow over previous weeks.
Eligibility for booster shots has expanded to include all First Nations Peoples living on reserve, age 12 and over. Booster shots for this population should occur at least six months after their second dose. A complete update on booster shot eligibility is maintained by Doctors Manitoba at ManitobaVaccine.ca.
Pfizer vaccine closer to approval for 5 – 11 year olds
Earlier this week, Pfizer confirmed it had submitted its official request to Health Canada for approval of their COVID-19 vaccine, Cominarty, for children aged five to 11. Preliminary data was already submitted to the regulator in early October. The U.S. FDA and CDC will consider the application for emergency use at their respective meetings on October 26 and November 2 and 3, and an American approval could come swiftly from these meetings.
The dates for Health Canada’s reviews are not known, but it is anticipated this could occur in November. After Health Canada approves the vaccine, the National Advisory Committee on Immunization (NACI) will review the vaccine to ensure the benefits outweigh potential risks for young children.
The Canadian government has confirmed it will receive enough of the pediatric dose of the Pfizer vaccine — which is different from the existing dose — for all Canadian children age 5 – 11. The government has not stated what the delivery date is, but promised it would come as “soon as possible” after approval is granted.
Gear up for vaccine boosters and doses younger children!
We are encouraging physicians to support the ongoing COVID-19 vaccination campaign in the weeks ahead. This opportunity is still open to all physicians.
We are anticipating demand for COVID-19 vaccination to increase substantially in November and December, as first doses will likely be rolled out to younger children, and eligibility for booster shots will likely expand to more and more groups. There is now ample supply in the province, and we understand from the province that physicians should not experience delivery delays or disruptions this fall.
And we now have a new COVID-19 vaccine initiative we negotiated with government, with 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.
Your clinic can still sign up to start receiving COVID-19 vaccine, if you haven’t already. Manitoba Health is encouraging all practitioners with pediatric patients including pediatricians to participate in the COVID-19 Immunization Program. Physicians (or their delegates) can review the program requirements and complete the online registration form to have their medical clinic approved to offer the COVID-19 vaccine. This information is available here. Please be advised that the program requirements are under review, to streamline the registration process as much as possible.
Generally, the following additional requirements set administration of the COVID-19 vaccine apart from the other routine vaccines (e.g., Tdap-IPV-Hib, pneumococcal, meningococcal, etc.): (1) requirement to bill for doses within two (2) business days of administration; and, (2) reporting inventory/wastage once per week via the online secure web link. The mRNA vaccines (Pfizer and Moderna’s COVID-19 vaccines) have specific storage requirements which are included in the educational materials that are available to practitioners to ensure competency. All other program requirements remain the same as for administration of the routine vaccines (e.g., reporting AEFIs, awareness of evolving provincial public health guidance/recommendations, etc.). We will send direct communications to medical clinics that are registered as COVID vaccine administrators as we learn more about Pfizer’s pediatric COVID-19 vaccine (and any differences that set it apart from the adult formulation).
Update — COVID Vaccine & Testing Requirement
On Monday, the provincial mandate came into effect requiring health care workers to be fully vaccinated or undergo regular rapid testing for COVID-19. In the days leading up to the deadline, there were news stories of 10,000 health care workers who had not disclosed their status. Many of them, it turns out, submitted their response on paper, or were are casual employees. By Wednesday, Shared Health confirmed only 158 health-care workers were put on unpaid leave for refusing to disclose their vaccination status or comply with regular testing. Just over half — 83 — of these workers are from Southern Health, and only 17 are from Winnipeg.
Of the 42,000 or so staff impacted by the requirement, about 1,800 (or less than 5%) have been identified as unvaccinated and needing to submit to regular testing.
We are not aware of any physicians who have refused to comply with the vaccination or testing mandate, something the CPSM requires of all physicians. Over 99% of physicians are vaccinated against COVID-19.
→ Need Rapid Test Kits? If there are unvaccinated 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 themselves. 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.
Physicians Using Virtual Care Responsibly
Virtual care is still a relatively new tool for physicians and their patients, introduced in the early days of the pandemic a Manitobans were told to stay home and limit their contacts. Phone and video visits have been a life saver in the health care system, allowing patients and doctors to stay connected for chronic and ongoing health issues, as well as new medical concerns.
Physicians were directed by provincial health officials to use virtual care to reduce patient traffic into their practices and, eventually, Shared Health issued guidance for primary care and outpatient settings suggesting two thirds or more of visits should be done virtually when the pandemic situation in the province was most serious.
New data from Doctors Manitoba confirms family physicians have embraced this new tool, and pivoted between virtual and in-person visits through the first three waves of the COVID-19 pandemic. In the middle of the first and second waves, virtual visits accounted for as much as 70% to 80% of visits, but in between these waves in-person visits increased significantly.
Last month saw the lowest use of virtual care yet since the pandemic began, with nearly two thirds of visits conducted in-person. This is aligning with the new Shared Health direction released in August, that states that “practices are encouraged to continue to offer virtual visits when appropriate — in primary care it is estimated that 25 – 30% of visits are appropriate to be done virtually.”
This analysis follows concerns raised in the Free Press earlier this week, with a strong reminder from the CPSM that doctors should see a patient in-person when it is medically appropriate or requested by the patient. While there may be isolated situations in which the transition back to in-person care has taken longer, our new data suggests that overall virtual care is being used appropriately and with patient medical needs and preferences in mind.
Physicians should note that CPSM has cautioned that in-person care should not be refused when medically required or when patients request it, including unvaccinated patients, unless there is a risk of spread to others in the practice. Patients should observe precautions in your clinic that predate the availability of the vaccine, including wearing masks, screening for symptoms, hand hygiene and physical distancing.
In August, the Canadian Institute for Health Information found that about 87% of physicians in Manitoba had offered virtual visits during the pandemic, and as many as 68% of patients had received at least one virtual visit.
Travel Testing and Vaccination Requirements
Over the last week, there have been several developments that impact your patients who are planning travel out of the country.
- The U.S. confirmed its land borders will reopen November 8 to non-essential travel, but only for fully-vaccinated travellers. Air travellers will need to show proof of vaccination, plus they will need to show a negative COVID test taken within three days of boarding their flight. Canadians returning to Canada by land or air will still require a negative test either way.
- The U.S. confirmed it will recognize patients vaccinated with AstraZeneca, as well as mix-and-match vaccinations, such as AstraZeneca followed by Moderna.
- The Prime Minister confirmed today that provincial or territorial proof of vaccination should be acceptable for international travel, following work to create a pan-Canadian format. This new format will follow a national standard with the government of Canada logo, but will be administered by each province as health records are maintained at a provincial level. The documentation will include the individual’s name, date of birth, number of doses received, type of vaccine, lot numbers, dates of vaccination, and a QR code.
Earlier this week, the provincial government confirmed that pharmacists could administer and interpret rapid COVID-19 tests for travellers, to broaden access to necessary travel documentation. Pharmacies are each responsible for sourcing their own kits from their suppliers, setting their own price for this uninsured service, and any other aspects required to deliver this service. We found that rapid antigen testing is available for as low as $69 at one pharmacy in Winnipeg, though prices vary wildly between pharmacies.
Physicians already have the scope of practice to administer and interpret rapid tests. Any clinic could source their own rapid tests and charge patients directly as an uninsured service. It would be important for clinics offering COVID-19 testing for travel purposes to ensure they provide documentation that meets requirements for the destination country and airline. This U.S. document, as an example, identifies the information required in travel documentation. Note that Canadians may still need to take a molecular test, like the expensive PCR test, in order to return to Canada from the United States after the land border reopens to fully vaccinated travellers in November, and potentially other countries.
Study Suggests Overprescribing of Antibiotics
Earlier this week, the Manitoba Centre for Health Policy released a new study, led by a two physicians Dr. Chelsea Ruth and Dr. Sergio Fanella. The report looks at potentially inappropriate outpatient prescribing of antibiotics, and includes some concerning results, which are consistent with those identified in other countries including in the U.S. and across Europe.
This study looked at antibiotics dispensed in the community from 2011 to 2016, and how they linked to physician visits and diagnoses. The study found that antibiotic use increased from 2011 to 2016, with highest use in adults aged 65+ and in children under age 5, rates of inappropriate antibiotic use was high and increasing. For conditions that may need antibiotics, the antibiotics being given were often not the ones recommended by guidelines. Physicians and other providers varied widely in how often they prescribed antibiotics for a given condition.
Notably, the study found:
- 73% of people who have bronchitis were prescribed antibiotics, even though this condition generally does not need antibiotics,
- 52% of antibiotics prescribed to children with pneumonia were the wrong type, and
- The most used antibiotic for bladder infections is not recommended as it kills bacteria that do not cause the illness.
The researchers acknowledge their methods of using physician billing codes to identify the reason for antibiotic use has some limitations, but that it is widely used as a way of identifying potential issues to provide feedback to prescribers. Nevertheless, the study findings suggest the need for antibiotic stewardship programs to improve antibiotic use, along with several other recommendations.Doctors Manitoba responded to the report by noting that doctors appreciate new studies like this that identify potential issues in the delivery of care, as this is an important part of the continuous learning and improvement that all physicians embrace as part of their practice. We recognize that antibiotic use is a concern in countries around the world, and this study suggests Manitoba’s experience is similar to other countries and, perhaps, better than many European nations.
Surgery Recovery Plan Needed
In case you missed it, last week we released our progress report on the surgery and diagnostic backlog, finding that the backlog grew over the summer and a window of opportunity between the third and fourth waves was missed. This has generated a continued interest in the issue, with a strong opinion article about the need for urgent action and a distressing patient story about a retired firefighter waiting for spinal surgery after repeated cancelations.
We are continuing our advocacy for immediate action on this issue, and we continue to engage the government and health system leaders for a solution to this issue.
If you are continuing to see impacts in your practice, or have examples of how the backlog is impacting your patients, we would like to hear from you. Contact us at email@example.com to confidentially share your experience.
Manitoba Physicians Featured in New DocTalk Series
Through the Protect MB Community Outreach and Incentive Grant, and with support from Doctors Manitoba and Alt Hotels, U Multicultural has developed Doc Talk Manitoba. The video series featuring doctors of diverse backgrounds provides statistics, scientific data and facts about COVID-19 and immunization, designed to support Manitobans from diverse backgrounds with accessing credible information from physicians they can trust.
The series features Dr. Denise Koh, Dr. Amila Heendeniya, Dr. Jared Bullard and Dr. Eddsel Martinez.
We encourage you to share these videos with patients, colleagues and on social media in an effort to curb misinformation and reach Manitobans who still have questions and concerns about COVID-19 and the vaccines.
Passionate about Environmental Issues?
CAPE (Canadian Association of Physicians for the Environment) is a national organization which pursues better understanding about how human health is affected by the health of the environment and “takes action to enable health for all by engaging governments, running campaigns, conducting research and drawing media attention to key issues.” They aim to work collaboratively, in an ethical and evidence based manner, to support physicians in being advocates for healthier environments. Resources on many topics are available on their website for health care providers, one example being guidance on how to make your clinic more environmentally friendly.
You are invited to become a supporting member of CAPE and if you are interested in becoming even more involved, join their newly formed Manitoba committee.
Celebrating Manitoba Physicians
Dr. Heather Dean, professor emeritus of pediatrics and child health in the Max Rady College of Medicine, was awarded the 2021 J. Allyn Taylor International Prize in Medicine. Given annually, the award recognizes scientists who have made significant contributions in the institute’s principal areas of research. Dr. Dean, a pediatric endocrinologist, was recognized for her work in the area of discovery and innovation in diabetes. Internationally, she has made significant contributions to the understanding of Type 2 diabetes in children and youth. She founded the Maestro Project, the first formal transition program in Canada to support youth with diabetes in moving from pediatric into adult care.
She was also instrumental in the 30-year story of how First Nations communities teamed with Manitoba health professionals and researchers to address the diabetes, as told in the 2018 book Diagnosing the Legacy: The Discovery, Research, and Treatment of Type 2 Diabetes in Indigenous Youth by Larry Krotz. Dr. Dean has earned many awards and honours for her her work to advance the field of diabetes and endocrinology.
Save the Date — Doctors Manitoba Awards Celebration!
Be sure to save November 20 in your calendar for the Doctors Manitoba Annual Awards Gala. Tickets go on sale in the next few days! Based on member feedback, we are planning for an in-person event at the RBC Convention Centre. This will be an opportunity to connect with colleagues, celebrate our profession, and support each other through the next stages of the pandemic and vaccination campaign. The event will follow public health guidance to ensure the safety of all attendees. If the pandemic situation requires it, we will change to a virtual format and all tickets will be refunded.
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 30, 2021.
On November 26 and December 3, in partnership with CMA Joule and the NHR, Doctors Manitoba is offering a Physician Leadership Institute course through the Physician Health & Wellness Community of Practice. The course — Personal Leadership: Identifying Your Core Values & Vision — is $200 (subsidized), counts as 14 CPD credit hours and may be eligible to claim under the NHR rebate program. It is open to all doctors in the region, not just those in formal leadership roles. If you are interested in registering for this course or want to learn more, please contact Project Manager, Jennifer MacDonald firstname.lastname@example.org.
Check out our upcoming events page for other events, including a webinar tomorrow on HPV triage, a series of interactive webinars next month on First Nations Treaties, and the provincial cancer conference.
Reminder about Physician Health
Alberta physician Dr. Tim Graham wrote a heartfelt and vulnerable article for the CMAJ that got a lot of attention this week and we thought it was a good reminder for members. Dr. Graham’s message is very clear: If you need help, get help. There is no shame in reaching out and making use of the supports offered to you. In these trying times, we want to remind physicians and medical learners of the health and wellness services offered through Doctors Manitoba. If you are finding it difficult to cope, reach out. You can find a list of our programs here.
The Smoker’s Helpline Quit Connection has shared a confidential referral form for patients hoping to kick the habit. We encourage you to have them available to patients in your clinics.