In today’s message you will find:

• Situation Update
  
• Vaccine Updates
  
• Vaccine / Testing Mandate + Rapid Test Kits Available
  
• Physician Safety During the Pandemic
  
• CMA Health Summit
  
• CMA Wellness Toolkit
  
• Nurses Reach Tentative Deal
  
• CMA Awards
  
• Upcoming Events

COVID Situation Update

Since our last update on Friday, October 1:

• Daily cases up: 629 new cases of COVID-19 have been identified since last Friday, a daily average of 104 (up from 89 last week). This includes 132 new cases today. The total case count in Manitoba now stands at 61,257.
• Test positivity up: The provincial five-day test positivity rate is 3.4%, up from 3.0%. In Winnipeg, it is 1.5%, up from 1.3%.
• Active cases up: There are 868 active COVID-19 cases province-wide, up from 712 last week.
• Hospitalizations stable: There are 85 people in Manitoba hospitals due to COVID-19, down from 92. This includes 15 COVID-related patients in Manitoba ICUs, down from 19. 
• Four more people have died from COVID-19 since last Thursday, including one reported today. This brings the total COVID-19 related deaths to 1,215.

According to Health Canada’s tracking, Manitoba had 50 cases per 100,000 over the last seven days, up from 41 last week. Alberta and Saskatchewan continue to lead the provinces, though it appears the situation is starting to improve in both provinces. There are 261 new cases per 100,000 in Saskatchewan (down from 281 last week) and 210 in Alberta (down from 258 last week).

Manitoba on Severe Trajectory, ICU Capacity to Be Tested

Earlier this week, Dr. Brent Roussin noted that Manitoba is on the ​“severe trajectory” based on the fourth wave projection model released by public health officials in August. This is not as bad as the ​“extreme scenario” projected, which would eclipse the second and third waves in both cases and ICU capacity, but the severe scenario trajectory could rival the third wave in both cases and ICU capacity.

Dr. Roussin noted that Manitoba’s ​“fourth wave was more delayed than what early projections had shown, but we’re certainly on the trajectory of the severe outcome, severe trajectory right now.” 

He warned that the province is on ​“a trajectory right now that could take us to a place where we’ll see quite a significant amount of strain on our health-care system, unless we change it. 

This severe scenario trajectory was identified and prompted the introduction of new public health restrictions, designed to largely reduce spread among unvaccinated and partially vaccinated Manitobans. These new restrictions took effect on Tuesday this week.

→ See a summary of the changes here.

We are closely monitoring Manitoba’s ICU capacity, especially as the incidence of new COVID-19 cases is increasing. ICUs are still at or over their normal capacity in Manitoba, and their ability to expand and open more beds continues to be limited by the health human resources. Tonight, we are convening a meeting with critical care specialists to hear their concerns and suggestions, so we can continue to advocate for a better level of preparedness for the weeks and months ahead. 

Vaccine Updates

Since our last update on Friday:

• 85.4% of Manitobans age 12 and up have received at least one dose, up only slightly from 85.0% a week ago. 
• 81.4% have received two doses, up from 80.7% a week ago. 

As of yesterday, more than two million doses of COVID-19 vaccines have been administered so far in Manitoba. This is a significant milestone, and we want to thank physicians for their role in contributing to this progress.

Booster Shot Update

In case you missed it, earlier this week we sent an update that the province is expanding eligibility for third doses, or booster shots, to include designated health care workers as well as individuals who received only viral vector vaccines. The booster shots should be administered at least six months after a second dose.
Booster shots are recommended, but they are not required to maintain status as fully immunized. 

You can see the full eligibility for booster shots and third doses at Man​i​to​baVac​cine​.ca.

Medical Exemption Requests

The province has published details on physicians should handle requests for a medical exemption from COVID-19 vaccination.

The exemptions will be considered for people who have had specific adverse reactions to a COVID-19 vaccine, have a serious allergy to a vaccine ingredient or component, or are undergoing a treatment or therapy that compromises their immune system.

Only certain medical specialists can approve an exemption, including cardiologists, hematologists, oncologists, neurologists, medical officers of health, allergists or specialists supervising a transplant. Once approved, it will be submitted to public health and after a week or two the exempted individual will be able to request a COVID-19 immunization card. 

Requests to family physicians or specialists not identified above should prompt an initial assessment and screening and then, if appropriate, a referral to the designated medical specialist.

→ Billing advice: Please note that all physicians should bill the appropriate visit tariff for any medical exemption requests, and use the K indicator in the special circumstances field. 

You can see the full public health memo here, which provides a detailed list of conditions and which provides a detailed list of conditions and referral process overview.

Participate in the COVID Vaccine Initiative! We’ve had several clinics already sign up to join the new COVID-19 vaccination initiative, to help reach Manitobans who have held off getting fully vaccinated. This initiative is critical as Manitoba enters a fourth wave, and every immunization counts. 

The initiative has new funding and support for doctors’ offices to reach out to patients, and to hold vaccine information and immunization clinics. There is also an evidence-based community-outreach initiative to support physicians and local communities, being coordinated by the MCFP and the Department of Family Medicine.
→ Learn more, and sign up today!

Vaccine / Testing Mandate — Test Kits Available

Last week we provided an overview of the new provincial mandate for health care workers to be vaccinated against COVID-19 or regularly tested, including considerations for implementing this requirement in independent physician practices.

There are two important developments since last week.

CPSM Requires Physician Vaccination or Testing

First, the CPSM updated its direction to make it clear that all physicians are ​“to be fully vaccinated or tested for COVID-19 prior to treating patients, commencing October 18, 2021.” This applies to all physicians, ​“regardless of your practice environment.” Physicians who are not fully vaccinated for any reason must notify the Registrar by tomorrow (October 8, 2021). The CPSM states that information will be kept secure and confidential. Notifications should be sent to TheRegistrar@​cpsm.​mb.​ca and must include a plan to ensure either full vaccination or testing are in place by October 18, 2021. 

The CPSM guidance also 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.”

Order Rapid Test Kits Through Doctors Manitoba

We have established a process with the Province to assist medical clinics with obtaining rapid COVID-19 test kits.
Rapid tests are available specifically to support implementing a vaccination and testing requirement in physician practices outside of an RHA or Shared Health facility. 

If you have unvaccinated individuals in your practice and will require routine testing, we have worked with the provincial government to ensure you have access to rapid test kits for this purpose. 

For now, rapid test kits will be provided at no charge though this may change in the future. Clinics ordering the kits will be responsible for paying the shipping costs. Special shipping containers are required to maintain an appropriate temperature and avoid damaging the sensitive kits.

Physicians can order test kits through Doctors Manitoba. We will charge the shipping fees up front on behalf of the province, and submit your orders to be shipped. Physicians should anticipate delivery one to two weeks after ordering. 

To determine how many tests to order, consider the following:

• Plan to order a supply that will last for one to two months
• Calculate the test kits required based on how many unvaccinated staff you have and how often they work. Staff should have a negative test within 48 hours of the start of each shift, so full time staff will require three tests per week. 
• Each package includes 25 rapid tests, so round up after you determine the number you need for one to two months. 

A link for order will be provided in next week’s member message, but if you would like to order kits ahead of this, please email covid19@​doctorsmanitoba.​ca.

See our advice from last week about setting up a process to collect and document vaccination status and regular testing for unvaccinated staff. 

Your Safety During the Pandemic

As the COVID-19 pandemic and vaccination campaign draws on, we have observed an escalating trend of intimidation and disrespect towards physicians stemming from frustration with pandemic restrictions and COVID-19 vaccination. Most recently, this appears to be driven by patients who are feeling forced or coerced to get a COVID-19 vaccine, but have fears or concerns about vaccination. 

Doctors Manitoba is very concerned about this trend, and we anticipate it may continue to escalate in the short-term as physicians continue to care for COVID-19 patients, apply pandemic precautions in their practice, and contact patients about vaccination. We want all physicians and medical learners to know that we are here to support you, every step of the way.

While the vast majority of Manitobans trust, support and appreciation physicians, a small segment of the population has directed their skepticism and frustration about the pandemic towards doctors and other health care workers. At times, physicians have felt personally threatened and fearful for their physical safety. We have observed a range of incidents, including hospital protests, threatening letters delivered to physicians’ homes, abusive comments, spitting, and online threats and bullying. These types of incidents should not be tolerated, and right now we are concerned about the potential for these to escalate to vandalism or violence. 

We have created a new Guide to Physician Safety During the Pandemic. With examples of incidents here and in other jurisdictions, the guide offers advice about what to consider and what to do in your practice to maintain a safety environment for you, your staff and your patients and visitors. 

We are also inviting you to report any current or recent incidents to us involving bullying, harassment, threats, vandalism, abuse, violence or intimidation. 

→ Report an incident to us now involving bullying, harassment, threats, abuse, violence or intimidation. 

CMA Health Summit

On Tuesday evening, in response to the state of crisis faced by health care workers and the health system, the CMA and the Canadian Nurses Association hosted an emergency summit. In the meeting, which included nearly 40 national and provincial health organizations, and included nurses, physicians, personal support workers, psychologists, educational institutions, and other health organizations, health care leaders identified both short-term and long-term actions to contain the fourth wave, lead an effective COVID-19 response and ensure Canada’s health system remains sustainable. These include: 

1. Taking decisive urgent and long-term actions to address staff shortages across Canada, examining issues including recruitment, retention, workload and safety, and bring immediate relief to workers in COVID-19 hot zones. 
2. Making immediate commitments at all levels of governments — including municipal, provincial, territorial and federal — to avoid the collapse of the health systems at all costs by implementing stronger public health measures and empowering authorities such as school boards to intervene 
3. and protect the people they serve. 
4. Providing urgent and long-term mental health support for health workers who continue to work in dire conditions to care for patients and keep the health system afloat. 

You can read the full press release in English HERE and in French HERE.

CMA Wellness Toolkit

There is little doubt that the pandemic has taken an immeasurable toll on the health and well-being of physicians over these last 20+ months. In order for Manitobans to receive the medical care they need, Doctors must take care of their own health and wellness first.

The CMA has put together a Pandemic Wellness Toolkit with wellness services and resources to support doctors. We encourage you to explore the site and make use of the tools if you are feeling overwhelmed and unable to cope.

In our continued effort to strengthen and support the whole physician, Doctors Manitoba offers health and wellness programs to members. Visit our Physician Health page to find the program that best suits your needs. There is no shame in needing help and reaching out. The more we talk about stress and burnout, the more we work to break the stigma of mental health and create better outcomes for patients.

Nurses Reach Tentative Deal

Yesterday, the Manitoba Nurses Union (MNU) announced it had reached a tentative collective agreement with the provincial government, after being without a contract or pay increase since 2017. 

We know that many physicians, particularly those working in hospitals, have been very concerned about their nursing colleagues. We’ve heard from many members worried more about burnout among nurses than in themselves. A consistent top concern identified by doctors over the last few months is how the nursing shortages are affecting our ICUs, ERs and ORs. 

We hope this new agreement will go a long way to addressing these and other issues in the health care system. 

We also want all members to know that we have been monitoring this and all other public sector negotiations very closely. We have observed a shift in the approach and tone from the provincial government, something we hope will bode well for the medical profession as we continue to work towards renewing our Master Agreement, which expires in 2023. 

Perhaps more significantly, we continuously monitor and evaluate physician remuneration and benefits in other provinces, which provides a benchmark that has proven to be the most important in ensuring physicians here in Manitoba are fairly and competitively remunerated. We continue to do this work to prepare for upcoming negotiations while also addressing pandemic-related concerns for the profession, such as virtual care tariffs, the COVID-19 isolation support benefit, vaccination rollout, and a myriad of other issues. 

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.

Upcoming Events

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.