A Challenging Start to 2022, More Resources and a Continued Call to Get More Shots in Arms

Dear Members,

2022 has not started off the way we had hoped with the rapid increase in Omicron cases and the shift back to online learning for our kids. As Ontario struggles through what looks to be the most challenging wave of this pandemic, we remain heartened and continually in awe of the dedication of our teams in ensuring you do everything you can do keep your patients and community safe.

When there was a call by the province for an #AllHandsOnDeck pivot during the December holiday season, you didn’t hesitate and did everything you could to support getting as many people vaccinated as possible. In fact, during the week of December 20 to 26 we saw the number of vaccines being given in primary care double – during a time where people should be rightfully getting some much-needed rest and downtime with the family. You can read the Vaccine Implementation Primary Care Update analysis by the Ministry which details the vaccine distribution up to January 3, 2022.

Thank you to everyone who took the time to participate in our quick survey at the end of the year when the call to action was put out – your quick response provided a positive narrative to government officials on just how much primary care has and continues to participate in all efforts of the pandemic response.

For teams who are still struggling with getting vaccines or want to participate in your public health vaccine clinics but do not know where to get assistance, the Ministry has provided a list of the PHU operational contacts who you can connect with. If you’re having any issues, please let us know ASAP so we can work with the Ministry to provide a resolution.

A lot of information was released during the last few weeks so below are some important information you may find helpful – please note that we anticipate an updated Primary Care Guidance Document to be released in the next few weeks.

Ministry of Health guidance documents

• COVID-19 Integrated Testing & Case, Contact and Outbreak Management Interim Guidance: Omicron Surge (December 30, 2021) and Q&As on this guidance for PHUs
  • Testing
    • Molecular testing (PCR or rapid molecular testing) is now limited to high-risk settings (e.g., LTC, hospital) and high-risk populations (e.g., symptomatic patient-facing healthcare workers, patients who are hospitalized, outpatients for whom COVID treatment is being considered, First Nations, Inuit & Metis). See MOH Dec. 30 update on eligibility for PCR testing.
    • Symptomatic people who are patient-facing healthcare workers are also eligible for testing and we have verification from the Ministry that includes primary care providers
  • Isolation
    • Self-isolation period for COVID-positive cases and household contacts, where fully vaccinated and not immunocompromised, is reduced to 5 days (and until symptoms improving for 24 hrs or 48 hrs for GI symptoms).  
    • All household contacts need to self-isolate while a person with symptoms is isolating (regardless of vaccination status).
    • Pulled out of the Guidance Document:
      • One-page guidance if you know or think you have COVID  
      • One-pager guidance if you have been exposed to someone who has tested positive for COVID-19
      • One-pager guidance for testing and isolation of healthcare workers in the highest risk settings (e.g. hospitals, LTC). NOTE: outpatient primary care clinics are not considered “highest risk” settings.   
  • Marathon FHT has developed patient-facing information on self-isolation from and St. Michael’s Hospital AFHT has developed a patient letter which can be adapted and used.  
• COVID-19 Vaccination Recommendations for Special Populations (December 31, 2021)
  • Updated guidance for those with allergies to COVID-19 vaccines, vaccine recommendations for individuals under 30 & includes specific guidance for kids 5-11
• Medical Exemptions to COVID-19 Vaccination (December 31, 2021)
  • Detailed time-limited medical exemption for individuals who are on immunosuppressive therapies that may require alternate timing of their vaccine
  • People who experienced a severe immediate allergic reaction after a first dose of any COVID-19 vaccine may be able to receive future doses of an mRNA COVID-19 vaccine
  • Janssen vaccine contraindications and adverse events following immunization are included
• COVID-19 Reference Document for Symptoms (January 4, 2022)
• COVID-19: Vaccine Storage and Handling Storage (January 5, 2022)
• COVID-19 Pandemic: Home Oxygen Therapy Update – memo from the Delivery Eligibility and Review Branch at the Ministry of Health to implement and reinstate a temporary policy to waive the requirement for applicants who are non-existing ADP clients to meet the Program’s medical eligibility criteria for ADP-funded home oxygen therapy if COVID positive.

Just a reminder that any updates to the Ministry Guidance Documents can be found here.

Updated Directive #1 and PPE
On December 15, Public Health Ontario issued an Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID 19 which provides a summary of PPE recommendations.

Given the high transmissibility of the Omicron variant, the Chief Medical Officer of Health (CMOH) has issued a revised Directive #1 for Health Care Providers and Health Care Entities (December 21, 2021) instructing the move to wear a well-fitted surgical/procedure mask, or a KN95 respirator, or a non fit-tested N95 respirator (or equivalent) if not yet fit-tested. For questions you may have around Directive #1 read this Q&A document (December 24, 2021) which goes into more details.

Primary care teams can order N95s via the Ontario Health Critical Personal Protective Equipment portal – from the dropdown menu, select “N95 Mask for Regular Supply”. The requirement for fit testing has been removed for ordering the 1870+ N95 masks for primary care but not for other models. If you have any questions about the provincial stockpile, please direct questions to COVID19SupplyChain@ontariohealth.ca.

Prioritizing Pregnant Individuals for Booster Shots
On January 4, 2022, the CMOH issued a memo prioritizing of booster vaccines in pregnant individuals. With the recent hospitalizations of infants with COVID, it’s important now more than ever to ensure that pregnant individuals get their booster doses to prevent risk of severe outcomes with Omicron. If you’re looking for information around pregnancy and COVID vaccination, please visit:

• BORN Ontario
• The Provincial Council for Maternal and Child Health (PCMCH)
• Society of Obstetricians and Gynecologists of Canada (SOGC)
• Pandemic Pregnancy Guide (also includes webinars with Dr. Tali Bolger)

Other Important Information

• On Monday, the Ontario government announced a return to a “modified step 2” of its reopening framework, effective January 5 to 26.
  • See Summary of Measures: Modified Step Two of the Roadmap to Reopen briefing deck
  • See New Public Health Measures Questions and Answers (January 3, 2022)
• From the Ontario Science Table:
  • Ontario Dashboard – Tracking Omicron
  • Ask Ontario’s Science Table: Omicron Edition (December 23, 2021) Slide Deck
  • Recommended Drugs and Biologics in Adult Patients with COVID-19 (December 22, 2021) (this will be updated shortly)
    • Outpatient COVID-19 treatment algorithm for adults symptomatic for less than 1 week and not currently requiring oxygen from Drs Noah Ivers and Andrea Chittle (and Medical office assistant triage related to COVID-19)
    • Outpatient therapeutics summary from St. Michael’s Hospital
• Post COVID-19 Condition: Guidance for Primary Care (December 2021) from Ontario Health
• COVID@Home Ontario Health Toolkit and ordering of 02 saturation monitors (additional monitors now available) – you can also find assessment, monitoring and triaging of patients flowsheets on the Hamilton Family Medicine website.  
• Ontario Medical Association Pathways to COVID-19 Vaccination for Patients with Allergies tool co-designed with the OMA section on Allergy, to support primary care in managing allergies in the context of COVID vaccination.
• OCFP COVID-19 Community of Practice for Family Physicians: Managing COVID-19 in the Community, January 7, 2022 - video and resource list from this morning’s session now available

Events

• OCFP COVID-19 Community of Practice for Family Physicians: Managing COVID-19 in the Community- Friday, January 21, 2022, 8:00-9:00am EST. Details to be announced soon here.
• Ontario Health Primary Care and COVID-19 Quality Improvement Support CoP: January 12 meeting registration here.
• Vax for the Future: Equity, Community and Trust – Building Vaccine Confidence with Marginalized Populations – Wednesday, January 26 from 12:00 to 1:30 p.m. Join the Alliance for Healthier Communities for a webinar on innovative, equitable approaches to overcoming vaccine hesitancy in marginalized populations. They will be showcasing best practices and lessons learned for improving vaccine confidence.  Learn more including registration here.
• Children's Healthcare Canada Immunizing Children With Confidence Vaccination Conversation on January 27 – registration here.

As always, we thank you so much for all that you do and continue to do, especially during these tough times. Please stay safe and if you have any questions or need additional support that we can provide, please email us at info@afhto.ca.

Yours in good health,
The AFHTO Team