December 15, 2021
In today’s message you will find:
- COVID surveillance update
- Omicron Update
- Vaccine Update
- ICU & hospital situation
- Backlog Task Force news
- New CPSM Direction
- Urban and Rural Locum programs need you!
- Practice Opportunities
- New CancerTalk Issue
- Events & Learning Opportunities
Since our last update on Thursday, December 9:
- Daily cases up: 1,026 new cases of COVID-19 have been identified, a daily average of 171 (up from 166). This includes 206 new cases today. The total case count in Manitoba now stands at 70,340.
- Test positivity up: The provincial five-day test positivity rate is 6.2%, from 6.1% last Thursday. In Winnipeg, it is 4.4% in Winnipeg, up significantly from 2.7% last week. The test positivity rate for Southern health is 12.9%, down from 15% last week.
- Active cases up: There are 1,779 active COVID-19 cases province-wide, up from 1,623 last Thursday.
- Hospitalizations down: There are 139 people in hospitals due to COVID-19, down from 145 last Thursday. This includes 34 COVID-related patients in Manitoba ICUs, down from 35.
- Thirteen more people have died from COVID-19, including two today. This brings the total COVID-19 related deaths to 1,357.
According to Health Canada’s tracking, Manitoba had 87 cases per 100,000 over the last seven days, up from 81 last Friday and a high for the fourth wave. Quebec (143÷100,000) and New Brunswick (111÷100,000) are the only two provinces with higher averages than Manitoba.
Non-essential travel outside of Canada discouraged
The federal government is changing its travel guidance today to officially advise Canadians to avoid non-essential travel outside the country for the time being. Omicron is taking over in several countries, including in Europe. The government called this a “drastic” move just 10 days before Christmas.
The Omicron situation is changing rapidly, which could put travellers at risk of infection and at risk of changing travel and quarantine rules. Canadians could find themselves stranded, the government warned.
You can read more about travel recommendations and restrictions here.
Omicron Variant Update
Dr. Brent Roussin and Dr. Joss Reimer offered important updates today about the Omicron variant of concern and COVID-19 vaccinations.
Regarding Omicron, there are still a lot of questions outstanding, including how virulent the variant is. However, Dr. Roussin confirmed emerging evidence from other jurisdictions that Omicron is more transmissible. There is not enough data yet to understand if the variant causes less severe illness.
“We know definitely it is more transmissible than the Delta Variant,” explained Dr. Roussin. “We are still learning about the severity and impacts of vaccine and prior infection. With the amount of increase in transmissibility, it would have to be very very less severe to not be a threat to us. It is very unlikely we rely on that.”
Omicron appears to have a significant growth advantage over the Delta variant, which was already twice as transmissible as the original COVID-19 strain. Other jurisdictions are finding Omicron is taking over from Delta, and they are finding it is spreading faster than any other previous variant. In the U.K., initial analysis suggests a doubling rate of 2.5 days for Omicron, with new cases growing 35% per day. In Ontario, the COVID-19 Science Table has found that the doubling time for Omicron is 3 days, compared to 34 days for Delta. On Monday, they estimated Omicron was accounting for 21% of new cases, and as of today the Science Table estimates Omicron accounts for 53% of cases.
A less virulent variant can still be a bigger risk to the population if it is much more transmissible, as it could still result in more serious cases than a less transmissible but more virulent virus.
It also appears there is a reduction in immune protection against infection, though more data is needed about immunity protection against severe disease.
Dr. Roussin stressed that “we need to rethink our plans over the holidays of large gatherings, especially if you are at increased risk of severe outcomes from COVID.” He urged Manitobans to reduce their contacts and to get vaccinated, including a booster shot as soon as eligible.
Dr. Reimer said she hopes this modeling “will result in immediate action on the part of Manitobans who need to get their first, second or third doses.” She acknowledged that with increasing case counts and waning immunity, the time to get your next dose is now and that the booster should be received before you begin gathering with family and friends. She emphasized that booster shot eligibility has been shortened for some groups, and encouraged others to get their first and second shots as soon as possible.
Dr. Reimer explained that previous infection may not provide the same protection against Omicron as with previous variants.
See the Vaccine Update below for updated booster eligibility and recommendations.
What does this mean for Manitoba?
There are only six cases identified so far in Manitoba: two travel related and four close contacts of known cases. Two of the cases were fully immunized and both were asymptomatic. Four cases were unvaccinated, with one symptomatic and the other three asymptomatic.
With so few Omicron cases today, it makes it difficult to project when and how Omicron will impact Manitoba with certainty. As of right now, Public Health advises that “Delta is still the predominant strain in Manitoba – but based on what has been observed in other jurisdictions, we expect to see a rapid increase in Omicron.” However, Dr. Roussin released a preliminary model today using the 35% growth rate observed in the UK and Ontario. This model projects:
- 223 cases per day by December 25, which is a gradual rise from the 171 average daily cases observed over the last week.
- A rapid increase to over 1,000 new cases per day early in the new year.
Because the rate of hospitalization from Omicron is still unclear, it is difficult to project the impact on hospitalizations and ICUs. Needless to say, ICUs are already well over capacity and in a very vulnerable position (see ICU Update below).
Physicians are encouraged to review the update today, including the slide deck here, and a video (about 20 minutes) of Dr. Roussin and Dr. Reimer here.
Public Health revised its recommendations and eligibility for booster shots (third doses) of the COVID-19 vaccine on Friday.
The changes include strongly recommending an earlier booster shot for some groups during the holiday season:
- Individuals age 60 and over who received their second dose on or before July 10, 2021.
- Individuals age 18 and over living in a First Nation community who received their second dose on or before July 10, 2021.
Public health also recommends a booster dose for individuals age 50 and over six months after their second dose. While all adults are eligible and able to get their booster after six months too, public health recommends the booster for individuals age 50+ (previously age 70+).
For individuals age 12 and older who are moderately to severely immuno-compromised, they should continue to get their third dose 28 days after their second dose. A booster shot (fourth dose) is recommended 6 months after their third dose.
You can view the Public Health memo here.
Ordering More Vaccine for Your Practice
As booster shots are more strongly encouraged, physicians should expect more calls for booster shots. Manitoba Health had not planned to send additional vaccine supplies until the new year, but they will do a run of shipments next week. You can email COVID@gov.mb.ca to request more vaccine supply, if needed, before the new year.
Recently, Dr. Joss Reimer included an important message in a ProtectMB update about vaccine effectiveness. Compared to fully-vaccinated Manitobans, unvaccinated individuals are:
- 5.5 times more likely to become infected with COVID-19
- 8.4 times more likely to be hospitalized
- 19 times more likely to require ICU care
- 11.8 times more likely to die from a COVID-19 infection.
These relative risks are an important way to describe comparative risk and vaccine effectiveness. Right now, the province’s dashboard shows the new number of new cases per day, broken down by vaccination status. Most days, there are more cases among unvaccinated people than fully vaccinated, but some days the opposite is reported. This is, of course, not a surprise, but it can be misleading or misinterpreted in a way that casts serious doubt about vaccine effectiveness. In fact, some anti-vaccine proponents share the stats on these days to back up their position.
You can read more about the importance of how this data is presented publicly in an article in today’s Free Press, with support from Doctors Manitoba to share the more complete picture.
Court Direction on Parental Consent
Yesterday, the Chief Justice of the Court of Queen’s Bench issued a very clear direction to clarify parent consent when it comes to child vaccination. Unless additional evidence is provided, the recommended COVID-19 vaccinations will be considered in the best interests of the child. The “evidence” needed to overcome this presumption would likely include a medical reason why vaccination is not recommended. This advice is particularly relevant to shared custody situations where parents have disagreed about vaccination. Should a parent request a letter to oppose a child’s vaccination, a physician should follow the existing guidance on the extremely limited number of medical conditions which would warrant this opinion.
ICU and Hospital Capacity
As of yesterday, there were 103 people in ICU beds, including 34 related to COVID-19. Normal ICU capacity across the province is 82 beds. While the current census is lower than the high point in earlier waves, the staffing situation (primarily nursing) appears to have deteriorated and this is limiting the ability of hospitals to open more beds.
Doctors Manitoba joined calls to bring in federal assistance to shore up ICUs, and on Monday the province requested 15 to 30 nurses to help. Doctors Manitoba responded that this is a good start, but that 15 – 30 nurses are only enough to open 5 – 10 more ICU beds, perhaps a few more if normal staffing standards are stretched. We encouraged the provincial government to ask for more help to be on stand by.
We have also urged the government to make rapid test kits more widely available at no cost, as we’ve seen in other provinces such as Saskatchewan, Nova Scotia and New Brunswick. If the supply situation requires it, a strategic and targeted approach may be needed. Rapid test kits are not a panacea, but they are another layer that helps to reduce the risks.
We will also be sharing holiday gathering advice with Manitobans to be cautious over the holidays, recognizing the substantial level of community transmission, the risks coming with Omicron, and hospitals that are already overwhelmed. A key focus will be on urging Manitobans to reduce the number of contacts they have over the holidays and making holiday gatherings safer.
Our advocacy on ICU capacity has been building for many months. We continue to press health system leaders to share a plan with critical care specialists. The lack of transparency is causing unnecessary distress and workload among this already-busy group. We first called for more transparency a year ago, and we repeated this request last month in a letter to newly-appointed Premier Heather Stefanson. In August, we raised concerns about the provincial response as a fourth wave was approaching, urging the government to consider additional measures to protect Manitobans and to protect hospital capacity which was, even then, still fragile and close to the edge.
Unfortunately, overcapacity ICUs are not the only sign our hospitals have been pushed beyond their limits. Surgeries continue to be cancelled — including cardiac surgeries — to allow nurses to be redeployed to support critical care. We estimate the backlog of surgeries has grown by over 56,181 so far during the pandemic.
Further, elderly patients are being transferred to hospitals, often hundreds of kilometres away. We are hearing reports of frail elderly patients being transferred in the middle of the night and arriving dehydrated with incomplete transfer information, another issue we will be raising with provincial health system leaders.
All of these issues point to a lack of capacity in our hospitals to cope with the increasing rate of COVID-19 hospitalizations.
We are continuing to monitor the situation closely, and we invite you to share your views by emailing firstname.lastname@example.org.
Backlog Task Force
As you likely know, the provincial government announced its Diagnostic and Surgery Recovery Task Force last week, after months of pressure from Doctors Manitoba. You can see a summary of the backlog situation and our analysis of the Task Force announcement here.
We’ve heard from a number of physicians encouraged by the Task Force’s mandate and physician membership, while others have raised some concerns about groups that aren’t included in the Task Force’s Steering Committee. We are looking forward to meeting with the Task Force to share physician perspectives, concerns and ideas to address the massive backlog. We must ensure the Task Force hears from all physician groups, and acts on the advice from different specialty groups and family physicians, as well as the rural perspective.
In the meantime, we are continuing to monitor the pandemic backlog closely, and we plan to provide our next monthly estimate in early January. We are interested in your views about what procedures may be missing from our backlog estimates, to ensure they are included in the government’s commitment to clear the backlog. You can email them to us at email@example.com.
New CPSM Direction Coming on Complaints and Investigations
We understand that a new Practice Direction respecting Complaints and Investigation Procedures was passed by the College of Physicians and Surgeons at its Council meeting earlier this month. This replaces the current Practice Direction in effect since 2019.
Although we saw a draft, we have not seen the final text of the Practice Direction. We understand this will be shared with members by the CPSM in the near future. We are told the CPSM’s intent is to align the Complaints and Investigation Procedures with The Regulated Health Professions Act and Regulations. We understand the Practice Direction will include new rules to clarify when repetitive or meritless complaints can be dismissed at an early stage, and will expand the informal resolution of complaints where an explanation or apology might be sufficient. We welcome these changes if they will allow a more timely resolution of certain complaints.
However, we are concerned that the new Practice Direction could be effective immediately. Before the Council meeting, we asked the CPSM to give some time to allow members to familiarize themselves with these new procedures before they come into force. We also raised concerns about certain provisions of the draft Practice Direction. We hope these concerns were taken into account by the CPSM Council.
We will provide more details once we see the text of the new Practice Direction.
Urban and Rural Locum Program Needs You!
New-to-practice physicians, those wanting to work fewer hours nearing the end of their career and physicians looking for more hours can apply to be a Locum Physician in the new urban pilot or the existing rural and northern program. This is a great opportunity to practice in a variety of sites, and work with a different of teams of care providers.
The new Urban Locum Pilot Project, a joint initiative between Shared Health, Manitoba Locum Tenens Program and Doctors Manitoba, as well as the Rural Locum Program currently have openings to be filled. Current urban openings include Tuxedo Family Medical Centre, Enhanced Care Clinic and Pritchard Farm Medical Clinic. Rural postings include Open Health Niverville and Elizabeth M. Crowe Memorial Hospital among others.
Interested in being a Locum Physician anywhere in Manitoba? Click here.
Research has shown that not taking time away from practice contributes significantly to physician stress and burnout. There are options to help physicians get time away while ensuring coverage for their patients. To have your practice covered while you are away, click here.
As always, you can find practice opportunities on our website HERE.
Chief Provincial Psychiatrist
Manitoba’s Department of Mental Health, Wellness and Recovery is seeking a Chief Provincial Psychiatrist (CPP) to join our senior leadership team. In addition to the primary responsibility of the overall management of the CPP Office, this position will be a key member of the leadership team offering clinical and system level expertise and consultation to the department in order to drive system level service enhancements within the provincial mental health and addictions system. The CPP will also play a key consultative role in the implementation of an integrated, whole of government 5 year roadmap that will provide enhanced access to mental health and addictions services and aims to improve life outcomes for Manitobans. Closing date is January 14, 2022. For full details about this posting, click here.
The winter issue of Cancer Talk is out now. Read about CAR‑T Immunotheraphy from Dr. Kevin Brown, hear from CCMB President and CEO, Dr. Sri Navatatnam, Dr. Eric Bow explains the importance of COVID boosters for cancer patients, meet the new faces at CancerCare Manitoba, read staff highlights and see upcoming events and learning opportunities. Read the newsletter here.
Upcoming Events & Educational Opportunities
Physician Leadership Speaker Series — One Talk Left!
Physician Leadership in Challenging Times: Building Capacity Through Connection is a four-part speaker series to give physicians an opportunity to build their leadership skills and knowledge and create opportunities for growth. The series was created in partnership with Doctors Manitoba and the University of Manitoba, Office of Leadership Education for Rady Faculty of Health Sciences is offered with generous support from Canadian Medical Association. It is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Learn more about the series here. Download and print a poster to share with colleagues.
Autism and Neurodiversity in Primary Care — Part 1: ASD Diagnosis: Recognize & Refer
UBC CPD has partnered with the UBC Centre for Interdisciplinary Research and Collaboration in Autism (CIRCA) to create a two-part program on autism and neurodiversity filled with useful activities and videos. Part 1 is available now and is designed to assist primary care providers to better understand autism, recognize indicators of autism, and learn how to better support patients of all ages as they navigate the diagnostic process in BC. Part 2 will be available in late 2022 and will focus on the ongoing management of autism in primary care.
Primary care is often the first point of contact with the healthcare system for individuals with autism. It is critical that you can recognize, refer, and manage autism in your practice.The course is on-demand through elearning and eligible for up to 2.0 Mainpro+ credits. You can learn more and register HERE.
WCB Workshop TONIGHT!
The Workers Compensation Board of Manitoba invites physicians to a free online workshop: Supporting Return to Health and Work after an Injury. On Wednesday, December 15, 2021; 6 p.m. to 8 p.m. join Dr. Mitch Cosman, Chief Medical Officer, and Dr. Cam Stacey, Medical Consultant to the WCB, for a two-hour online session covering best practice for fitness for work determination and use case studies applicable for you in your day-to-day practice. At the end of the workshop, the WCB will conduct a brief focus group to gather information for the development of future workshops.
The impact of COVID-19 disease & vaccination on pregnancy and newborns — December 20! — Register NOW!
Given the limited data on COVID-19 illness and vaccination during pregnancy, we are eager to share the latest research from three CITF-supported studies looking at the impact of SARS-CoV 2 infection and COVID-19 vaccination on pregnant people and newborns. The results of these studies are already being communicated regularly to public health officials to help inform COVID-19 vaccine administration programs in Canada. Join CITF-funded experts Dr. Deshayne Fell of the University of Ottawa and the Children’s Hospital of Eastern Ontario Research Institute; Dr. Deborah Money of the University of British Columbia and BC Women’s Hospital; and Dr. Deborah O’Connor of the University of Toronto as they present their latest findings and discuss the policy implications, followed by a lively panel discussion and question and answer session. Mark Monday, December 20, 2021 11:30 am – 1:00 pm EST in your calendars! Register here!
Physician Leadership: Engaging Others
2 day Virtual Course February 4 & 5, 2022 | 9:00am – 4:30pm (CT) — Register now.In this PLI course, facilitated by Paul Mohapel, PhD and Monica Olsen, BScN, BA, MHRD, you will focus on the core skills and practical tools you need to nurture an engaged organizational culture. Please note that there is pre-course work that is due on January 12th. It is estimated to take 2.25 hours to complete the assessments and review the results.This program has been accredited by the College of Family Physicians of Canada for a minimum of 14.25 Mainpro-M1 credits. This event is a accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada and approved for a minimum of 14.25 credits. Participants should only claim credit for the actual number of hours attended.
Physician Leadership: Leading Change
2 day Virtual Course March 10 & 11, 2022 | 9:00 am – 3:30 pm (CT) — Register now.In this PLI course, facilitated by Brian Golden, MS, PhD, FCAHS and Joshua Tepper, MD, FCFP, MPH, MBA, you will learn the strategies you need to motivate, implement and sustain change in the complex system in which you practice. Although the course structure is guided by key readings and insight from your instructors, it is primarily conversation and experience based. Anticipate participating in discussions as you work through the challenges you are facing in real time. Please note that there is pre-course work for this event.This program has been accredited by the College of Family Physicians of Canada for a minimum of 11.5 Mainpro-M1 credits. This event is a accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada and approved for a minimum of 11.5 credits. Participants should only claim credit for the actual number of hours attended.
Equity in Medicine and Sanokondu have made available for on demand viewing the recent workshop Effective Allyship: Advancing Women in Healthcare Leadership. With expertise and experience, panelists shared practical tips on how to be a good ally to advance women in healthcare leadership. You can view the webinar here.