Dear Colleagues,

We are providing this update given the recent changes in Phase 2 Ministry guidance, in particular moving pregnancy from “at risk” to “highest priority” health condition, which means pregnant women are eligible for vaccination now. More details on this and other updates below.

We continue to see family doctors’ successful in-office vaccinations across the province – including this community event in Ottawa, efforts focused on vaccinating Black communities and impressive adaptation of flu drive-through clinic experience at an indoor soccer facility. experience at an indoor soccer facility. Such great examples of family doctors stepping up and creating innovative ways to vaccinate.

We are concerned with the booking challenges facing many Ontarians and are asking the government for more transparency and ease in this process. We firmly believe and will keep advocating that Ontario’s rollout would be more equitable and simply better if family doctors and the primary care sector generally were empowered to get more involved.

Many of you have expressed your wish to vaccinate. Others have noted capacity limits to do so. To help us better understand your views on this and other aspects of the rollout so that we can amplify you needs accordingly, please fill out this 2-minute survey by Monday May 3rd.

Pregnancy

• Pregnant women can use Ontario's vaccine booking system to find out how to schedule an appointment, call the Provincial Vaccine Booking Line number at 1-833-943-3900, or contact their Public Health Unit (PHU). In most cases, extra documentation is not required. The extended dose interval of 16 weeks remains in place.
• The Society of Obstetricians and Gynaecologists of Canada (SOGC) notes that vaccine-induced thrombotic thrombocytopenia (VITT) is not more likely to happen in pregnancy and VITT does not develop through the same process as usual types of bleeding or clotting problems (including in pregnancy).
• SOGC also "supports the use of all available COVID-19 vaccines approved in Canada in any trimester of pregnancy and during breastfeeding in accordance with regional eligibility."
• Considerations in the decision of whether to wait for an mRNA vaccine include the risks to the individual of not being vaccinated. For those at high risk of exposure because of living or working in a “hotspot” area of high prevalence, for example, the best vaccine remains the first vaccine they can get. See NACI’s recommendations on use of COVID-19 vaccines.
• The Provincial Council for Maternal and Child Health has updated its vaccine decision tool for pregnant individuals and is hosting a webinar series (first session May 3rd, 7–8:30 p.m. ET) to support providers of maternal-neonatal care during the third wave of COVID-19. Register here.
• Access a recording of a Facebook Live Q&A on COVID-19 vaccines in pregnancy, hosted by CTV News and including family physician Dr. Tali Bogler as a guest. For regular updates on Instagram for you and your patients, check out the @PandemicPregnancyGuide.
• BORN Ontario/Prenatal Screening Ontario has compiled COVID-19 Resources for Pregnant People in Ontario, and developed this suite of multi-lingual videos on COVID-19 Vaccine and Pregnancy.

 AstraZeneca Vaccine

• While NACI updated its guidance on April 23 to recommend offering the AZ vaccine to people 30 and older, Ontario has maintained the eligible age to 40+ for now due to supply issues. 
• Ontarians aged 40 and older with no contraindications will continue to be offered the AZ vaccine given certain conditions (page 26), including if the “advantages of earlier vaccination outweigh the limitations of vaccinating with a less efficacious vaccine.” 
• The European Medicines Agency has developed a set of visuals to put the risks of VITT in the context of benefits for different age groups and different rates of infection.
• We have updated our vaccines FAQs to help answer emerging COVID-19 questions, including about variants of concern and the safety of the AstraZeneca vaccine.
• Thrombosis Canada is hosting a free webinar, Thrombosis and COVID-19 Update - Expert Perspectives, May 4 | 7 to 8:30 p.m. ET: Register

Phase 2 Prioritization – Notable Updates 

• Individuals awaiting organ transplant moved up to the "highest risk" health conditions.
• Primary essential caregivers are defined as those who provide care to someone in the “highest risk conditions” group who require regular and sustained assistance with personal care and/or activities of daily living (page 17).
• Reminder of the specified medical conditions (e.g. transplant recipients, certain cancers) that are excepted from the extended dose interval.

Updates | Resources

• Dr. Allison McGeer (infectious disease specialist) and Dr. Menaka Pai (hematologist) will be the panelists at our next COVID-19 Community of Practice on Friday, May 7, held with University of Toronto DFCM, to address latest questions about the vaccines, variants and VITT. 
• Following its orders to ramp down non-urgent and non-emergent procedures, the Ministry has published a Q&A on Directive #2 to help define the requirements and explain expectations.
• For your patients, Health Canada and the Public Health Agency of Canada have multilingual COVID-19 educational resources available in 14 languages, including vaccine information (e.g., “How do I know COVID-19 vaccines are safe without long-term data?”) and advice for caregivers (e.g., “How to care for a child with COVID-19 at home”).
• The OCFP is pleased to partner in promoting This is Our Shot, a national movement to help end COVID-19 by encouraging people to get the vaccine when it’s available. Events, vaccine information for your patients (in English and 27 other languages), and more are available on the website.

*****

At our Community of Practice last Friday, where close to 900 of us gathered, I spoke about hope and how important it is as a foundation for action. Not naïve hope but, in the words of Thomas Homer-Dixon, “commanding hope” that is grounded in the honest facts and is a powerful force to guide us through this time of uncertainty and keep us from despair and cynicism.

We heard from Dr. Rosemarie Lall about the work of her practice getting vaccines into the arms of patients in Scarborough, one of the hardest hit regions in the province. Dr. Allison McGeer shared how, in the midst of the chaos of this pandemic, the facts show us that family doctors and primary care have been “a miracle” in how we have stepped up and cared for our patients.

And finally, we were reminded how fortunate we are that science has produced vaccines with such efficacy (and safety). So, in spite of the challenges facing us today in our communities and pressured hospitals, I firmly believe there is reason for hope, powerful and commanding hope.

Liz