Dear Colleagues,

We are in it – an increase in cases, return to school, flu season and continuing care for our patients. As we see the surge in cases, we need to tell our patients – social distancing is still necessary.

Your questions continue to come to us as you provide care for your patients with virtual first, and in-person visits as appropriate. You are the best judge of who to see but our considerations for in-person visits remain the same, as does our PPE infographic.

JOIN US for a (CME certified!) practical discussion at the Community of Practice this Friday, September 18 at 8 a.m. with UofT's DFCM. I will be joined by panelists Drs. Jeff Kwong and David Kaplan, along with moderator Dr. Tara Kiran, and we will once again focus on considerations as we plan for the fall.

School clearance

This document lists the symptoms most commonly associated with COVID. BUT – runny nose or nasal congestion is excluded, if there are underlying reasons for these symptoms such as seasonal allergies, post nasal drip, etc.

• COVID positive – public health unit will call and direct return to school
• COVID negative – return 24 hours after symptom resolution
• COVID contact – 14 days from time of exposure

Students should be screening for symptoms every day before going to school.

Notes for return to school – this is taken directly from MOH return to school guidance: “Barriers to return to school, such as requirement of medical notes or proof of negative tests, should be avoided.”

The Centre for Effective Practice (CEP) has a frequently asked questions resource for your patients on school re-opening.

Work accommodation

Our two-pager has been updated with some information about age and mental health-related accommodations.

Asthma remains an evolving clinical issue to monitor. Of note: asthma was not associated with an increased risk of hospitalization for COVID patients. Guidance from the Canadian Thoracic Society is dated April 30 and is due to be revised. 

Febrile patients?

Most will require a swab after you have assessed them virtually, and some communities are exploring having COVID testing centres also assess respiratory illnesses. It has not yet been mandated to be this way, but we are advocating for this.  

Flu shots

Who? Flu vaccines are especially important for those at high risk of influenza-related complications or hospitalization, including:

• 6 – 59 months, ≥65 years
• Pregnancy
• Chronic medical conditions and people who live with them
• Residents in congregate settings
• Indigenous communities
• Healthcare and other essential workers

High-dose flu shots – those ≥65, and consider prioritizing those who also have chronic lung and other health conditions if there are insufficient numbers.

Where? Your offices – see National Advisory Committee on Immunization: “Adaptations to usual immunization procedures”.

What is your community of family docs doing? Some family practices are considering forming a cooperative clinic with other local medical practices, NP clinics or home care providers.

Pharmacies (also giving the high-dose vaccine) – try to encourage your patients to let you know they have received it!

Community – link to your healthline: see CEP local services guide within the CEP COVID tool.

Cancer screening

As noted in my last message, cancer screening is being reintroduced, with FIT testing available for average risk people >60 who have never been screened for CRC, average risk people with previous unsatisfactory FIT results, and eligible average risk people awaiting organ transplant. Prioritize PAPs and mammograms for those who are most “due”. 

Partner activity

Section on General and Family Practice – we continue to value the work that is being done at the SGFP for our shared members. Please read the weekly email briefs from Chair Dr. Aly Abdulla with highlights of their activities, most recently a four-hour CME session on “Building Blocks of Health Policy”. The recording of this excellent session is available for another three weeks. 

The College of Physicians and Surgeons of Ontario is seeking feedback on three updated policies, and is kicking off a review of their telemedicine policy. Share your views by November 16 and help shape these policies: 

• Dedication of controlled acts
• Professional responsibilities in medical education
• Third party medical reports
• Telemedicine

A draft White Paper called PrimaryCare2025, created by a group of family physicians and nurse practitioners, is open for commentary. As an individual family physician, I provided input. As OCFP, we know more voices need to inform this vision to reflect the diversity of providers and patients in primary care.

I encourage you – regardless of how and where you practice – to provide input so that this vision reflects your priorities and reality. As you will see, the paper’s recommendations are based on the principles of the Patient’s Medical Home and Neighbourhood, and reflect some of the lessons learned through COVID.

And OCFP news –

Our Annual Meeting of Members, President’s Installation, and Award Recognition will take place next Friday, September 25, from 8:00 - 9:00 a.m. ET (virtually, of course). Please join us to learn more about our work this past year, and the Board members who will be helping the OCFP to help you in the best way possible in the coming year. 

A special note to family medicine residents – did you know you are also voting members of the OCFP? I encourage you to join this meeting to learn more about the work of your College and how you can get involved.

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As always, it is a privilege to be able to connect with you in this way. I welcome the comments that come in after each of our messages as it sheds light on what we are doing well and what we can do better. 

May you find joy in the work you are doing, as different as it is from your usual, and may the OCFP be part of helping you to do it. 

Jennifer