Provincial incident command system: Manitoba's response to the COVID-19 Omicron wave.

This paper describes how the Government of Manitoba employed the incident command system (ICS) to support its COVID-19 response from March 2020 to March 2022. The paper describes how the system evolved during this period to optimise the efficiency and effectiveness of emergency response and recovery efforts. The paper supports a more comprehensive implementation of the ICS to manage emergency and recovery effectively, with specific reference to the Omicron wave of the pandemic.

Drug utilization patterns before and during COVID-19 pandemic in Manitoba, Canada: A population-based study.

BACKGROUND: The COVID-19 pandemic has led the Canadian provincial governments to take unprecedented measures, including restrictions to healthcare services and pharmacists. Limited evidence exists on changes in prescription trends in Canada during the pandemic period. OBJECTIVES: To examine the trend of prescription medications' utilization before and during COVID-19, among incident and prevalent users in the general population. We examined 18 major classes of medications. METHODS: We used the administrative health databases from the province of Manitoba, Canada, to conduct a province-wide cross-sectional study. Incident and prevalent use was compared between two time periods; pre-COVID-19: July 2016-March 2020 and during COVID-19: April 2020-March 2021. Interrupted time series analysis using autoregressive models was used to quantify the change in level and slope in quarterly medication use among incident and prevalent users. RESULTS: The quarterly study population ranged from 1,353,485 to 1,411,630 Manitobans. The most common comorbidities were asthma (26.67%), hypertension (20.64%), and diabetes (8.31%). On average, the pandemic restrictions resulted in a 45.55% and 12.17% relative decline in the aggregated utilization of all drugs among both incident and prevalent users, respectively. Subclass analysis showed a 46.83%, 23.05%, and 30.98% relative drop among incident users of antibiotics, cardiovascular drugs and opioids use, respectively. We observed a significant slope increase during COVID-19 among the quarterly cardiovascular, antidiabetics, alpha-1 blockers, and statins incident users compared to the pre-COVID-19 period. We noted a significant decrease in level among NSAIDs, opioids, and antibiotic prevalent users, however, no significant changes in slope were observed. CONCLUSION: Our findings show a significant impact of COVID-19 measures on prescription trends in the general population. The observed decline among several medication classes was temporary. Further research is needed to monitor prescription trends and better understand if those changes were associated with increased health services and worsened outcomes.

Analysis of the uptake and associated factors for virtual crisis care during the pandemic at a 24-h mental health crisis centre in Manitoba, Canada.

BACKGROUND: The coronavirus pandemic necessitated the rapid transition to virtual care. At a 24-h walk-in mental health Crisis Response Centre (CRC) in Winnipeg, Canada we adapted crisis mental health assessments to be offered virtually while the crisis centre also remained open to in person visits. Little is known about the sustainability of virtual visits in the presence of comparable in person care, and which visits are more likely to be done virtually, particularly in the crisis setting. METHODS: An analysis of visits to the CRC from the first local lockdown on March 19, 2020 through the third local wave with heightened public health restrictions in June 2021. Analysis of Variance was used to compare the proportion of visits occurring virtually (telephone or videoconference) during the first wave of heightened public health restrictions (lockdown 1) and subsequent lockdowns as well as the in-between periods. A binary logistic regression examined visit, sociodemographic and clinical factors associated with receipt of a virtual visit compared to an in person visit over the first year of the pandemic. RESULTS: Out of 5,357 visits, 993 (18.5%) occurred virtually. There was a significant difference in proportion of virtual visits across the pandemic time periods (F(4, 62) = 8.56, p < .001). The proportion of visits occurring virtually was highest during lockdown 1 (mean 32.6% by week), with no differences between the other time periods. Receipt of a virtual visit was significantly associated with daytime weekday visits, age, non-male gender, living further away from the CRC, no prior year contact with the CRC, and visits that did not feature suicidal behaviour, substance use, psychosis or cognitive impairment. CONCLUSIONS: A large proportion of virtual care occurring at the outset of the pandemic reflects public anxiety and care avoidance paired with health system rapid transformation. The use of virtual visits reduced over subsequent pandemic periods but was sustained at a meaningful level. Specific visit, sociodemographic and clinical characteristics are more likely to be present in visits occurring virtually compared to those in person. These results can help to inform the future planning and delivery of virtual crisis care.

Fit theory: A cancer experience grounded theory emerging from semi-structured interviews with cancer patients and informal caregivers in Manitoba Canada during the COVID-19 pandemic.

BACKGROUND: It is not clear how changes to healthcare delivery related to the COVID-19 pandemic, including virtual care and social distancing restrictions, have impacted the experience of living with cancer. This study aimed to discover a theory capable of describing the cancer experience, how the pandemic impacted it, and for guiding predictions about how to improve it. METHODS: Between October 2020 and July 2021 digitally recorded semi-structured one-on-one interviews were conducted virtually with adult cancer patients and informal caregivers in Manitoba, Canada. Transcriptions and field notes from the interviews were analyzed using classic grounded theory. RESULTS: Interviews with 33 patients and 6 informal caregivers were conducted. Fit emerged as the core concept of the theory and describes the relationship between the healthcare system and the unique combination of characteristics each patient has. Good fit results in a positive experience and poor fit in a negative experience. Virtual care improves fit in clinical situations where non-verbal communication and physical examination are not important. Support from informal caregivers improves fit. Social distancing restrictions reduce the ability of informal caregivers to provide support. CONCLUSIONS: The impact of fit on the cancer experience suggests that care delivery should be tailored to both the individual needs of the patient and the intention of the clinical interaction. Developing evidence-based strategies to inform the integration of virtual care into oncology practice, with aim of promoting good fit between patients and healthcare services, is an important future direction.

Trends of COVID-19 incidence in Manitoba and public health measures: March 2020 to February 2022.

OBJECTIVES: The increasing spread of severe acute respiratory syndrome coronavirus-2 has prompted Canada to take unprecedented measures. The objective of this study was to examine the impact of the implemented public health measures on the incidence of COVID-19 in Manitoba. RESULTS: Using the COVID-19 dataset, we examined the temporal trends of daily reported COVID-19 cases and the coinciding public health measures implemented from March 12, 2020 to February 28, 2022. We calculated the 7-day moving average and crude COVID-19 infection rate/100,000 Manitobans. Due to the restrictions applied, the infection rate decreased from 2.4 (April 1) to 0.07 infections (May 1, 2020). Between May 4 and July 17, 2020, the reported cases stabilized, and some restrictions were lifted. However, in November, the cases peaked with infection rate of 29. Additional restrictions were implemented, and the rate dropped to 3.6 infections on March 31, 2021. As of August 2021, 62.8% of eligible Manitobans received two vaccine doses. The infection rate increased to 128.3 infections on December 31, 2021 and mitigation measures were implemented. This study describes how physical distancing in conjunction with other containment measures can reduce the COVID-19 burden. Future studies into the extent of the implementation of the restrictions are necessary.

Pandemic-related experiences, mental health symptoms, substance use, and relationship conflict among older adolescents and young adults from Manitoba, Canada.

There is growing awareness of the negative impact of the COVID-19 pandemic on young people. The purpose of this study was to examine older adolescents' and young adults' pandemic-related experiences, including financial difficulties, emotional support, social connections, mental health symptoms, substance use, and relationship conflict. Data from the Well-being and Experiences Study (The WE Study) were gathered from November to December 2020 in Manitoba, Canada, among a community sample (n = 664; ages 16-21 years). Over half of the sample self-reported increased stress/anxiety (57.6%) and depression (54.2%) attributed to the pandemic. Increased alcohol consumption was reported by 18.2% of alcohol-users. Among cannabis-users, 35.1% reported increased use. Conflict with parents, siblings, and an intimate partner increased for 19.9%, 15.2%, and 24.0% of respondents, respectively. Females reported greater financial burden, mental health burden, and conflict with parents than males. Young adults reported greater financial and mental health burden than older adolescents. Higher household income was protective of some experiences. The current study adds to growing evidence that young people were adversely impacted by the COVID-19 pandemic. Increased access to virtual support resources is needed and should continue following the pandemic. Evidence-based interventions may need to be tailored to females and young adults.

Manitoba 2020: How centralizing the healthcare supply chain helped with pandemic management.

A case study design was used to understand Manitoba's response to accessing Personal Protective Equipment (PPE) in the first wave of the global coronavirus pandemic. By evolving early on in the pandemic to a provincially led structure dedicated to the healthcare supply chain, Manitoba was able to avoid major shortages in access to PPE. Leadership was focused on the possibilities for action and implementation (ie, dynamic, adaptive, and collaborative) rather than trying to respond within the status quo (ie, a more linear and traditional approach). As a result, few structural items other than the creation of an effective, province-wide digital network to fully visualize the healthcare supply chain are needed going forward. Manitoba's healthcare supply chain had a number of successes during the initial wave of the global pandemic including many new processes like the local production of PPE and the establishment of new supplier relationships.

Pediatric primary care in Ontario and Manitoba after the onset of the COVID-19 pandemic: a population-based study.

BACKGROUND: There were large disruptions to health care services after the onset of the COVID-19 pandemic. We sought to describe the extent to which pandemic-related changes in service delivery and access affected use of primary care for children overall and by equity strata in the 9 months after pandemic onset in Manitoba and Ontario. METHODS: We performed a population-based study of children aged 17 years or less with provincial health insurance in Ontario or Manitoba before and during the COVID-19 pandemic (Jan. 1, 2017-Nov. 28, 2020). We calculated the weekly rates of in-person and virtual primary care well-child and sick visits, overall and by age group, neighbourhood material deprivation level, rurality and immigrant status, and assessed changes in visit rates after COVID-19 restrictions were imposed compared to expected baseline rates calculated for the 3 years before pandemic onset. RESULTS: Among almost 3 million children in Ontario and more than 300 000 children in Manitoba, primary care visit rates declined to 0.80 (95% confidence interval [CI] 0.77-0.82) of expected in Ontario and 0.82 (95% CI 0.79-0.84) of expected in Manitoba in the 9 months after the onset of the pandemic. Virtual visits accounted for 53% and 29% of visits in Ontario and Manitoba, respectively. The largest monthly decreases in visits occurred in April 2020. Although visit rates increased slowly after April 2020, they had not returned to prerestriction levels by November 2020 in either province. Children aged more than 1 year to 12 years experienced the greatest decrease in visits, especially for well-child care. Compared to prepandemic levels, visit rates were lowest among rural Manitobans, urban Ontarians and Ontarians in low-income neighbourhoods. INTERPRETATION: During the study period, the pandemic contributed to rapid, immediate and inequitable decreases in primary care use, with some recovery and a substantial shift to virtual care. Postpandemic planning must consider the need for catch-up visits, and the long-term impacts warrant further study.

Conversations in Times of Isolation: Exploring Rural-Dwelling Older Adults' Experiences of Isolation and Loneliness during the COVID-19 Pandemic in Manitoba, Canada.

Older adults have been described as a vulnerable group in the current context of the COVID-19 pandemic. In Canada, where this study took place, older adults have been encouraged to self-isolate while the rest of the population has been cautioned against in-person contact with them. Prior to COVID-19, social isolation and loneliness among older adults was considered a serious public health concern. Using a series of semi-structured interviews with 26 community-dwelling older adults (65+) living in rural Manitoba, we explore older adults' experiences of isolation and loneliness in the initial stages of the pandemic between the months of May and July 2020. Participants identified a loss of autonomy, loss of activities and social spaces (e.g., having coffee or eating out, volunteering, and going to church), and lack of meaningful connection at home as factors influencing their sense of isolation and loneliness. Although these loses initially influenced participants' self-reported isolation and loneliness, the majority developed strategies to mitigate isolation and loneliness, such as drawing on past experiences of isolation, engaging in physically distanced visits, connecting remotely, and "keeping busy." Our findings call attention to the role of different environments and resources in supporting older adults social and emotional wellbeing, particularly as they adapt to changes in social contact over time.

Relaxation of social distancing restrictions: Model estimated impact on COVID-19 epidemic in Manitoba, Canada.

OBJECTIVES: The unprecedented worldwide social distancing response to COVID-19 resulted in a quick reversal of escalating case numbers. Recently, local governments globally have begun to relax social distancing regulations. Using the situation in Manitoba, Canada as an example, we estimated the impact that social distancing relaxation may have on the pandemic. METHODS: We fit a mathematical model to empirically estimated numbers of people infected, recovered, and died from COVID-19 in Manitoba. We then explored the impact of social distancing relaxation on: (a) time until near elimination of COVID-19 (< one case per million), (b) time until peak prevalence, (c) proportion of the population infected within one year, (d) peak prevalence, and (e) deaths within one year. RESULTS: Assuming a closed population, near elimination of COVID-19 in Manitoba could have been achieved in 4-6 months (by July or August) if there were no relaxation of social distancing. Relaxing to 15% of pre-COVID effective contacts may extend the local epidemic for more than two years (median 2.1). Relaxation to 50% of pre-COVID effective contacts may result in a peak prevalence of 31-38% of the population, within 3-4 months of initial relaxation. CONCLUSION: Slight relaxation of social distancing may immensely impact the pandemic duration and expected peak prevalence. Only holding the course with respect to social distancing may have resulted in near elimination before Fall of 2020; relaxing social distancing to 15% of pre-COVID-19 contacts will flatten the epidemic curve but greatly extend the duration of the pandemic.