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COVID Vaccine Approved for Younger Children

Health Canada has approved the first COVID-19 Moderna vaccine for Canada’s youngest children. It will be available for children aged 6 months to 5 years. Approximately 1.7 million more children are now eligible for vaccination against COVID-19, including about 80,000 in Manitoba. The vaccine for this age group should arrive in Manitoba shortly, and Doctors Manitoba will keep members posted on this.

Health Canada has determined the benefits of this vaccine for children between 6 months and 5 years of age outweigh the potential risks. The clinical trial showed that the immune response to Moderna’s Spikevax vaccine in children 6 months to 5 years of age was comparable to that seen in people 18 to 25 years of age from a previous study. Full product details from Health Canada are available here.

“This authorization comes at a critical time in the pandemic as we progress through the seventh wave and though children are less likely to experience complications from COVID-19, they can still get very sick,” explained Dr. Supriya Sharma, Health Canada’s chief Medical Adviser. The average monthly rate of young children hospitalized because of COVID-19 increased from 1.4 per 100,000 children under five in the first two years of the pandemic to 15.9 per 100,000 in the first three months of 2022. Children can also be at risk for MIS‑C or long COVID. 

The National Advisory Committee on Immunization also released their advice today, recommending the use of Spikevax in children in this age group. Their guidance includes the following:

  • A two-dose primary series of 25 micrograms each for children in this age group with no contraindications for the vaccine, with the second dose recommended administered eight weeks after the first dose.
  • A three-dose primary series of 25 micrograms each for children in this age group who are moderately to severely immuno-compomised,with four to eight weeks between each dose.
  • Avoid administering Spikevax on the same day as other vaccines for the time being, an approach used when the COVID vaccines were initially introduce for other age groups as well. At least 14 days between Spikevax and other vaccines are recommended to help monitor potential side effects from Spikevax.

More information about this decision can be found here.

The United States approved Moderna and Pfizer’s pediatric COVID-19 vaccines last month, and so far have immunized 267,000 children in that age group as of July 8. Pfizer’s pediatric COVID-19 vaccine for young children between six months and five years old was submitted to Health Canada last month and is still under review.

4th Dose Advice Remains Unchanged

While some provinces are opening up 4th dose eligibility, including to ages 18+ in some provinces, Manitoba’s approach is not changing at this point. As reported by CTV, a provincial update notes that ​“Public Health continues to closely monitor COVID-19 in Manitoba. There are no updates to public health advice at this time and if required, changes will be provided accordingly.” 

Current eligibility in Manitoba: Second boosters are available to Manitobans who live in a personal care home or a congregate living site, no matter their age. Anyone 50 or older living in the community is also eligible as well as First Nations, Inuit or Métis people who are 30 or older. People ages 18 – 49 who are moderately to severely immunocompromised are also eligible and are encouraged to talk with their health care provider about the vaccine dose.

The 4th dose approach in other provinces varies. Some provinces are like Manitoba and still have targeted eligibility. This includes Alberta (70+), Saskatchewan (50+), Newfoundland (70+) and Nova Scotia (50+). Some other provinces have expanded eligibility to younger ages, but continue to only recommend 4th doses for older age groups. In most provinces, there is also targeted eligibility for younger ages including for Indigenous Peoples, residents in congregate settings, and/​or immuno-compromised individuals.

Various infectious disease experts across Canada have added their advice to focus on getting third doses to everyone, while for the fourth dose to focus on those who are at increased risk of severe illness. This video of Dr. Isaac Bogoch from Ontario helps to communicate this.

We have heard from physicians who are hearing concerns from patients about the eligibility for fourth doses. Please continue to share this feedback with us at covid19@​doctorsmanitoba.​ca as we continue to share your perspectives with Public Health.

Last Call: Survey on Representing You Better

You still have a chance to add your voice to the feedback we are getting about whether or not changes are needed to how Doctors Manitoba is governed and how decisions are made on behalf of members. 

“Doctors Manitoba is your medical association,” said Dr. Candace Bradshaw, President of Doctors Manitoba.​“Doctors Manitoba exists to represent the interests of physicians and medical learners and to push for the support and resources you need to do your jobs well. To achieve this, we need to ensure Doctors Manitoba decisions and priorities are responsive to physicians’ and medical learners’ needs and concerns.”

→ Share Your Feedback Here with our five-minute survey!

Doctors Manitoba was established over 100 years ago to bring together and represent the medical community. Periodically, our Association has made changes to ensure it is representing the broader membership in the best possible way to deliver the best possible results for physicians. Recognizing a lot has changed in the profession over the last two decades, the Board of Directors created a Special Committee on Board Modernization to consider whether or not changes are needed once again to improve our governance structure and how we engage members in decision-making. You can see the full terms of reference for the Special Committee here.

The Special Committee is chaired by former Doctors Manitoba President Dr. Aaron Chiu, who is joined by a group that reflects a cross section of members. Their role is advisory, to review the latest in governance best practices, how other medical associations are governed, and to seek the views of members on the issue. This will be used to make a recommendation to the Board about pursuing governance changes or maintaining the status quo. Ultimately, any significant changes to the governance structure or how decisions are made would be subject to members’ approval.

“This is the time to have your say about how Doctors Manitoba should represent the profession for the next decade and beyond,” explained Dr. Chiu. ​“Could our governance structure be improved to make better decisions on behalf of our members? Should we review and update our Medical Districts? What’s the best way to engage members on important issues? Please take five minutes to share your views.”

Dr. Chiu and Dr. Bradshaw noted there are several reasons the Board has tasked the Special Committee with reviewing how Doctors Manitoba is governed and how members are engaged in important decisions:

  • Some of Doctors Manitoba’s governance structures haven’t changed in years and might be considered outdated (e.g. medical district boundaries).
  • The medical profession is growing and changing, and it’s important to ensure Doctors Manitoba is able to understand and represent its members.
  • Doctors Manitoba needs to be positioned for what is coming. There are many challenges on the horizon coming out of the pandemic, including a health care system that is struggling, record levels of burnout in the profession, and the potential for economic instabiity and fiscal restraint.
  • Corporate boards are striving to ensure they have access to technical skills and expertise to make the best possible decisions.
  • Many Boards are prioritizing equity, diversity and inclusion because of growing evidence about the value of diversity in decision making.

Rural ER Updates

We are making weekly updates to Rural​Care​.ca, our new public awareness tool to support Manitobans in accessing care amidst frequent and widespread rural and Northern ER closures.

The biggest update this week is the temporary closure of the ER in Leaf Rapids in Northern Manitoba. The Northern RHA announced a short-term closure running from July 13 to July 19. Primary care services are available weekdays during the closure.

Among the 68 hospitals in rural and Northern communities:

  • 23 are experiencing full ER closures on a short- or long-term basis, up from 22 last week.
  • 20 are open but reduced hours or periodic closures
  • 25 are open 24/7, down from 26 last week.

CBTm for Physicians and Medical Learners

Updated Advice — Providing Abortion Services to U.S. Citizens

In our member newsletter on June 24, 2022, we compiled some information for members in light of the U.S. Supreme Court overturning the 50-year old decision in Roe v. Wade. Some Manitoba physicians anticipate being approached by U.S. citizens seeking a surgical or medical abortion.

CMPA, which protects most Manitoba physicians from professional liability claims, has since raised concerns about some U.S. states considering laws which may attempt to limit their citizens’ ability to seek health care elsewhere. These laws could attempt to empower courts in those states to impose criminal or civil (financial) sanctions on Manitoba physicians providing abortion care in Manitoba to residents of their state.

In our earlier newsletter, we recommended that any physician treating a U.S. patient, for any reason, should obtain the patient’s agreement to have Manitoba law and courts apply to the medical services, and directed members to this form. While this remains prudent advice, CMPA has advised that they may not be in a position to provide legal assistance for physicians facing legal action in the U.S. We do note, however, that CMPA advises that physicians may be eligible for assistance if ​“care is not reasonably available in [the] country of origin.”

CMPA has written to the federal Minister of Health with its concerns, and has asked the federal government to work with the provinces and territories to protect physicians. You can see the letter here. The initial federal response is that the protection of physicians is a provincial and territorial responsibility.

We strongly recommend any physician being asked to provide care to a U.S. citizen review CMPA’s advice.

As always, please contact us with questions or concerns at practiceadvice@​doctorsmanitoba.​ca.

Health System Updates

COVID-19 Surveillance Update

Public Health posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report covers the week ending July 9, and is showing ​“increased activity” for the first time in several weeks. Highlights include:

  • Severe outcomes from COVID-19​increased compared to the previous week. There were 59 hospital admissions, up from 46 the week before. This includes 7 ICU admissions, the same as the previous week. Hospital admissions last peaked at 264 the week ending April 16.
  • There were 2 deaths recorded, up from 1 the previous week. There have now been 2,053 deaths related to COVID-19.
  • There were 269 lab-confirmed cases reported in Manitoba over the week, more than double from the 125 the previous week. The test positivity rate was 14.8%, up from 11.5%.

The updated wastewater surveillance dashboard for the city of Winnipeg includes data up to July 7. It is showing low but increases levels of COVID-19.

Doctors Manitoba supplements this monitoring and we are hearing of increased COVID-19 presentations in the ER. We have not yet seen an increase in physicians reporting infections or isolation. We are interested to hear if you are seeing increased COVID-19 activity in your practice — let us know at covid19@​doctorsmanitoba.​ca.

Reminder about Physician Isolation Benefit

With COVID cases rising again in Manitoba, we are sending a reminder to physicians about our Physician Isolation Benefit.

Recently, Dr. Leslea Walters shared her experience with isolation during a recent COVID-19 infection. ​“I’d like to give a shout out to @DoctorsManitoba. When I had Covid in May, I was able to take time off to properly recover, and actually received sick pay. That’s never happened since I became a doc.”

If you miss work due to COVID-19, please review our Physician Isolation Support Benefit and apply if you are eligible. Please review Shared Health’s guidance on isolation and return-to-work for health care workers here.

Random Testing for Air Travel Resumes in Canada

The federal government is bringing back mandatory random COVID-19 testing for air travellers coming into Canada, starting July 19. Those travelers who are randomly selected with be tested outside of the airport and at no cost to the traveler.

PCH Standards

The Manitoba government is inviting Manitobans to provide feedback on personal care home standards to better understand their perspectives on this important topic. Click here to take part in the engagement. The deadline for feedback is July 29.

Expert Advisory Panel – Colorectal Cancer Canada

Colorectal Cancer Canada is looking for interested family physicians to join the My Symptoms Matter’s Expert Advisory Panel (EAP). As a member of the EAP, you will be contacted to provide feedback on certain deliverables including educational materials, pamphlets, toolkits, and infographics as well as participation in future webinars. If you are interested in joining contact patilm@​colorectalcancercanada.​com. Learn more.

Premiers Demand More Federal Funding

Earlier this week, Premiers from all thirteen provinces and territories met in B.C. and health care was the top of their agenda. The premiers were united in their call for the federal government to increase its share of health care funding from 22% today to 35%, which is still a far distance from the original 50 – 50 split when medicare was created. They also requested a meeting with the Prime Minister to discuss health care funding. 

This is not a new call, and it’s one that has been sent and received by provincial and federal governments of different political stripes. Manitoba Premier Heather Stefanson is the latest provincial leader to take up the cause, noting that ​“the prime minister promised to address this structural funding gap after the pandemic and now is the time for action.”

Meanwhile, CMA President Dr. Katharine Smart pointed out that sustainable funding is only part of the issue.

“This is years of lack of political will to recognize we have a health system that was designed in the 1960s and has been failing for years, with no one wanting to take action,” she said. ​“Let’s stop with the finger pointing and winning the political points. Even just a willingness to move away from the politics and more to the action-oriented, and solution-oriented, would go a long way.”

The Premiers, represented this year by B.C. Premier John Horgan, acknowledged that the health system also needs to be rebuilt, saying that ​“we need to re-imagine public health care in Canada” and that ​“the whole continuum of care needs to be revisited.” 

Manitoba is experiencing many of the same issues as other provinces, including high levels of burnout among health care workers, long wait times and backlogs in care, rural ER closures, and a shortage of health care workers. In fact, Manitoba already had the lowest number of family physicians per capita in Canada before the pandemic.

ICYMI

Here are some of our most read and notable recent updates, in case you missed them:

Upcoming Events

Check out our events calendar for upcoming events for physicians. 

Your Life After Retirement — We’ve added another date to this popular workshop. Space is limited and first workshop filled up in a few days! September 22 from 8:30am — 12pm. 

CANCOVID-Preg: Canadian Surveillance of COVID-19 in Pregnancy Fri. July 15, 2022, 8am — 9am PDT / 11am — 12pm EDT

Hosted by Women’s Health Research Institute, UBC, and BC Women’s Hospital with speakers Dr. Elisabeth McClymont, (University of British Columbia) and Isabelle Korchinski (University of British Columbia). Email whri_​cwbc@​cw.​bc.​ca for more information or to register.

From Practice to Policy-Keeping What Worked: Lessons learned from COVID-19 pediatric immunizations Tues. Sept. 13, 2022, Day-Long Mini Conference 

Children’s Healthcare Canada: Immunizing Children with Confidence.

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