Today’s message features:
- COVID Updates
- Long COVID Resource Site
- Indigenous Peoples Day — June 21
- LGBTQ2S+ Sexual Health & Gender Affirming Care
- Bridging Lung Cancer Treatment During COVID
- Health Systems Update
- Fantastic Physicians
- ICYMI — Recent Updates
- Upcoming Events
Public Health now posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report, which is again showing“decreased activity,” covers the week ending June 15. Highlights include:
- Severe outcomes from COVID-19again “decreased compared to the previous week”. There were 80 hospital admissions, down from 100 the week before. This includes 14 ICU admissions, twice as many as last week (7). Hospital admissions have peaked most recently at 264 the week ending April 16.
- There were 3 deaths recorded, down from 7 recorded the previous week. There have now been 2,015 deaths related to COVID-19.
- There were 228 lab-confirmed cases reported in Manitoba over the week, down from 337 the previous week. The test positivity rate was 9.6%, down from 10.8%.
The updated wastewater surveillance dashboard shows ongoing activity at much lower levels than earlier this year and decreasing in early June.
National monitoring is finding some concerning Omicron sub-variants gaining ground in Canada. PHAC reports that by late May, it appears BA.4 and BA.5 account for nearly 10% of cases that were sequenced, up from previous weeks. BA.2 sub-variants sill account for most (90%+) of the COVID cases circulating in Canada.
Vaccine approved in US for young children
The U.S. FDA yesterday recommended authorizing pediatric doses of Pfizer and Moderna’s COVID vaccines for young children between the six months and five years of age. If the CDC approves, the special pediatric doses could be available in the U.S. next week. Based on the research, both vaccines appear to be safe and effective for children in this age group. Side effects were generally minor and less common than among adults.
The recommended dosing for this age group will be:
- Moderna’s vaccine will be one quarter the adult dose with two doses required in the primary series.
- Pfizer’s vaccine will be one tenth the adult dose and require three doses in the primary series.
FDA’s advisory group meetings are live streamed and their meeting materials including research to support vaccine recommendations are made public.
Dr. Joss Reimer, former vaccine medical lead and Doctors Manitoba Humanitarian for 2022, tweeted about the news yesterday, saying this is “step 1 in getting covid vaccines for kids under 5! Hopefully Health Canada approves shortly.”
Health Canada is reviewing Moderna’s application, but had yet to receive an application from Pfizer. Yesterday, Health Canada was not able to predict when a regulatory decision would be made.
Severe acute hepatitis in children linked to COVID
A recent study on Long COVID-19 Liver Manifestation in Children found that severe acute hepatitis in children is linked to COVID. Previous reports were unclear, suggesting severe acute hepatitis cases might have been triggered by adenovirus. The new Israeli study analyzed the cases of five patients who were hospitalized in Schneider Children’s Medical Center last year due to liver injury. All five patients had tested positive for SARS-CoV‑2 before presentation of symptoms. Researchers reported two distinct patterns of potentially long COVID-19 liver manifestations in children with common clinical, radiological, and histopathological characteristics after a thorough workup excluded other known etiologies. The average delay was 74 days after a COVID infection, which could explain why PCR tests at the time of the hepatitis investigations were negative.
As of early June, 12 cases were identified in Canada including two in Manitoba. Globally, over 600 cases have been identified. See our message from last month with further information.
Canada to lift most vaccine requirements for flights
Beginning June 20, vaccination will no longer be required to board a plane or train in Canada. Masks will still be required throughout the journey. Travelers must continue to follow all entry requirements such as vaccination and testing, including for cruise ships.
CITF Monthly Research Report
The COVID-19 Immunity Task Force released its monthly research report, which is full of useful updates from Canadian researchers on COVID. This month’s issue includes:
- A research synthesis on hybrid immunity, which underscores that even those who have been infected by SARS-CoV‑2 need to have all their recommended COVID-19 vaccinations, found on pages 12 – 13.
- How the Omicron tsunami swept across Canada and its impacts, found on pages 2 – 3, 4, and 16.
- CITF-funded research revealing that a significant proportion of those who have been infected do not produce antibodies, found on page 5.
- Results from CITF-affiliated experts on severe COVID in children and the effectiveness of a fourth vaccine dose among long-term care facility residents, found on pages 14 – 15.
You can download the latest issue for free, including a desktop version and mobile-friendly version.
Webinar: The Omicron Tsunami — June 23 | 10am
CITF-affiliated experts will discuss how the Omicron variant changed the course of the pandemic by rapidly infecting hundreds of millions of healthy people around the globe, spurring the distribution of additional vaccine doses to boost immunity. Omicron has brought a new set of challenges, including reinfections and immune evasion. Learn more and register here.
COVID Protest at CPSM
A protest against pandemic restrictions is planned for Friday, June 24 between 10 and noon outside of the CPSM building on Portage Avenue. We suggest avoiding the area.
While this protest appears to target CPSM, similar protest groups have changed locations at the last minute. There were protests at HSC and other health facilities a few months ago. Doctors Manitoba created a Guide to Physician Safety During the Pandemic, and it continues to be available for your reference.
Long COVID Resource Site
Earlier this week, Shared Health launched a new online resource on Long COVID, including resources for patients and for providers. The resources were designed by a committee, including several physicians, and its promotion could generate some calls to doctors’ offices.
Long COVID, or post COVID-19 condition, is the presence of COVID-19 symptoms three months after becoming ill that cannot be attributed to any other medical condition. These symptoms usually impact daily activities and may change over time. A positive polymerase chain reaction (PCR) test or rapid antigen test (RAT) is not required for a diagnosis of Long COVID or referral for interdisciplinary care. Common symptoms of Long COVID include fatigue, shortness of breath and brain fog. There are other symptoms that can impact a person’s ability to function in day to day activities. A full list of symptoms is available in the resources listed below.
The public resource page is found here. It helps the public to understand that it can be normal to have some symptoms linger for four to 12 weeks, but if symptoms continue for more than 12 weeks, it could be a sign of long COVID. Patients are encouraged to review self-management resources and to talk to their health provider about recovery plans. In particular, patients are encouraged to contact a health provider if they have:
- Concerns about their recovery,
- Shortness of breath, including during activities that usually easy or that does not improve after resting,
- Brain fog, attention span, memory or energy levels are not getting better,
- Feelings of depression, anxiety or stress that aren’t getting better, or
- Symptoms that make regular daily activities very hard to do or stop you completely (e.g., caring for yourself or going back to work or school)
A short video is also promoted from the Long COVID Physio resource site.
A resource page for providers is also available, with more content apparently coming soon. So far, it includes:
- Symptom referral pathways for Winnipeg (pathways for outside Winnipeg coming soon).
- Services available without a prescriber referral.
- COVID-19 Yorkshire Rehab Screen (C19-YRS)-Manitoba – a straightforward tool that assesses the impact of multiple post COVID-19 condition symptoms on a person’s daily function and life.
- Long COVID poster in English and in French
We understand from Shared Health that the provider section will soon include pathways for regions outside of Winnipeg along with many other resources such as guidelines and literature, resources related to children and teens, and more.
Indigenous Peoples Day on Tuesday
June 21 is National Indigenous Peoples Day, an important part of Indigenous History Month. Doctors Manitoba will be marking the occasion, including online recognition of Indigenous physicians and drawing attention to Indigenous health inequities and issues.
Here are a few ways you can take part:
- Participate in events or activities, or read resources, which we are maintaining in our events calendar. We welcome and invite your submissions or suggestions to firstname.lastname@example.org.
- Learn about the health-related Calls to Action from the Truth and Reconciliation Commission. Reflect on what they mean for your practice and what you can do to contribute. Read this article outlining the eight health-related Calls to Action from 2016, which offers a good overview with important contributions from Dr. Alika Lafontaine from Alberta, who is now CMA’s President-Elect.
- Register for this CHI Grand Rounds on June 28, Introduction to the Manitoba Indigenous Healthcare Quality Framework. You’ll hear from Dr. Marcia Anderson, Doctors Manitoba Physician of the Year, and others about this important new tool. Register here.
It’s also important to remember the effect recurring news about the discovery of graves at former residential schools has on Indigenous patients. The provincial government just committed $2.5 million for Indigenous organizations to fund investigations into burial sites, and Sioux Valley Dakota Nation is working on identifying children buried at a former Brandon residential school site.
As described by Dr. Lisa Richards and Dr. Andrew Boozary in an article in The Lancet last year, the neglect and abuse have lasting impacts on the health of survivors, with intergenerational trauma continuing to undermine the well-being of children, families and communities of survivors.
LGBTQ2S+ Sexual Health & Gender Affirming Care
Doctors Manitoba wants to develop a comprehensive list of clinics and practices that provide sexual health and gender affirming care for Manitobans from the LGBTQ2S+ community. We would also like to get an idea of what the wait times are for this type of healthcare.
Please email email@example.com if you know of or belong to a clinic that provides this very important care. Provide the name of the clinic, its address, the type of care offered, and the estimated wait times for care.
Bridging Lung Cancer Treatment During COVID-19
Read a recent article from Rounds Magazine about how thoracic surgeon Dr. Biniam Kidane worked with radiation oncologists Dr. Julian Kim and Dr. Bashir Bashir on a protocol to continue lung cancer treatment during COVID surgical disruptions. Read Bridging Lung Cancer Treatment During COVID-19 now.
Health System Updates
- The most recent issue of CancerTalk Newsletter is out with information on self-screening for cervical cancer, FIT for colorectal cancer, the importance of lung cancer screening, and guidelines for advanced hepatocellular carcinoma. Read the summer issue here of CancerTalk here.
- The WRHA is asking for feedback to help develop its new strategic plan. A lot has changed since the current plan was developed, including the creation of Shared Health. Physicians are encouraged to submit your views using the WRHA survey before June 24.
- The province will now cover cochlear implant sound processors for adults, building on existing coverage in place for children.
- The province is now reimbursing Ukrainian newcomers for the cost of Immigration Medical Exams.
Congratulations to Dr. Markus Ziesmann on receiving the UM General Surgery Residency Program Teaching Excellence award for the second year in a row.
Dr. Peter Nickerson received the Dr. John M. Bowman Memorial Winnipeg Rh Institute Foundation Award, in recognition of his life altering and life-giving research contributions to the field of transplant immunology medicine. Dr. Nickerson and his team significantly enhanced patients’ access to transplants, reduced their risk of rejection, and improved their quality of life for patients all around the world. Congratulations Dr. Nickerson!
Dr. Carly McLellan was named a 2022 UM Distinguished Alumni. She was the recipient of both the College of Family Physicians of Canada Indigenous Medical Student Scholarship and the UM Indigenous Award of Excellence in the Trailblazer category. She has demonstrated incredible leadership in both Indigenous health and rural medicine, and currently practices in Dauphin, Manitoba. This summer, she will begin work for Ongomiizwin Health Services in Garden Hill and Wasagamack First Nations. Congratulations, Dr. McLellan!
Dr. Arnold Naimark also received at 2022 Distinguished Alumni Award from UM. Dr. Arnold Naimark’s name is synonymous with public service and he is unquestionably deserving of this honour. He established the department of family medicine and heavily promoted health research funding while he was the dean of medicine from 1971 to 1981. He served as UM president and vice-chancellor from 1981 to 1996. Additionally, he has held influential leadership roles at CancerCare Manitoba, the Health Canada Science Advisory Board, and as president of the Association of Universities and Colleges of Canada. Congratulations Dr. Naimark!
Here are some important and popular recent updates, in case you missed them:
- Read about DRMB at PRIDE and ways you can create an inclusive space for patients and colleagues
- Can your help to clear the surgery backlog? The province is accepting proposals right now!
- Physicians are now responsible for prescribing Paxlovid
- Public Health requires reports of blood lead levels of 50 μg/L (5 μg/dL) or greater
- June is Stroke Month and we’ve got a toolkit for you.
Yesterday, June 15, was World Elder Abuse Awareness Day. An estimated 7.5% of Canadians 55+ experience abuse and in 2021 woman 55+ represented 28% of all victims of femicide. Elder abuse is a global social issue affecting the health & human rights of millions of older persons in both developing & developed countries. Primary health care providers can help to identify & deal with the problem. You can learn more about WEAAD here and the Mayo Clinic has guidance on Identifying and addressing geriatric abuse.
Check out our events calendar for upcoming events for physicians. Here are a few highlights to consider over the next few weeks: