Dear Colleagues, 

It's encouraging to see vaccination rates increasing and COVID rates continuing to decline, and with this an ability to increase in-person visits and start to exhale a bit to consider what will be our "new normal". See below for resources, and other updates and information to help you in your work.  

As President of the OCFP and along with our Board, we welcomed the recent CFPC statement that included an apology for a recent CFP editorial article and a commitment to “meet with the CFP’s Editorial Advisory Board to debrief, review its terms of reference and develop a clear statement with respect to editorial independence while ensuring that the values of the CFPC are met".  

As many of you expressed, the tone of the article was disheartening to our profession. We know that family physicians across the country, including in Ontario, continue to stand up and do what is needed for their patients through this pandemic. We are encouraged that the CFPC and the CFP will find a constructive path forward and look forward to ongoing discussions about continuing to elevate the profession. 

COVID-19 News  

• We have updated two OCFP documents to support you in seeing patients in your clinics:
  • Top IPAC/PPE questions, including information on ventilation.
  • Balancing in-person and virtual care, with tips to help guide your decision making.
  • Note: we understand that screening tools will soon be updated to align with vaccine status – we’ll keep you updated.

• The OCFP continues to advocate for a strong family physician role in COVID-19 vaccination as well as a clear plan for the post pandemic recovery as it relates to family medicine and primary care. 
  • We've been clear that family physicians who are able to and wish to vaccinate should have access to vaccines. The Ministry of Health (MOH) has advised that family physicians interested in vaccinating should continue to reach out to their PHUs.
  • On the recovery plan, we have advocated for guidance on the prioritization of key clinical activities, with a manageable phase-in and the necessary supports to our sector.
  • As it relates to supports more broadly, the shortage of health human resources, especially urgent in rural and Northern areas, has prompted temporary expansion of the locum program (July 1 to Sept. 7, 2021) to include greater eligibility and a new incentive structure for emergency department physicians in the highest-need hospitals in these regions. More info is on the OMA COVID-19 Billing and Compensation webpage (gated), and check out current rural opportunities in HealthForceOntario’s listings.

COVID-19 Information/Resources 

• Myocarditis/Pericarditis: On June 30th, Health Canada updated the product monographs for the Pfizer-BioNTech and Moderna vaccines to describe myocarditis and pericarditis following vaccination. NACI followed with updated guidance on July 2nd, andS. health officials and medical organizations issued a statement based on data on myocarditis/pericarditis from the CDC’s Advisory Committee on Immunization Practices (ACIP) meeting on June 23rd. 
  • Bottom line is: the overall rate is low (12.6 per million for second doses of any mRNA vaccine in the 21 days following vaccination per CDC data), events appear higher in males vs. females, tend to happen within a few days of vaccination and most cases were mild and could be treated conservatively. This graphic from Unambiguous Science and Science Whiz Liz summarizes the evidence so far.
  • Here are healthcare provider FAQs from SickKids and the MOH information sheet for youth. Also re-sharing info for parents and youth on vaccination from the Children’s COVID-19 Vaccine Table.
• Vaccination reports: For those working in patient-enrolled models (PEMs), this memo from Ontario Health outlines how to download a new report (expected to be available in mid-July) to help identify patients in your panel who have received a COVID-19 vaccine; a ONE ID account is required. Recognizing that we do not yet have integration between COVaxON and our EMRs on vaccination data, we know this process will take some administrative time. However, this is an important step in our ability to identify non-vaccinated patients and support them towards full vaccination. We hope to see this support extended to non-PEM models as well.
• OMD has compiled useful tips for recording COVaxON vaccination data in your EMR among other resources. For additional support, contact: [email protected].
• If your patient is seeking their vaccination receipts, they can access and download via the provincial portal.

Mixing and Matching Vaccines | Delta Variant

• Updated guidance from NACI states preference for an mRNA vaccine as second dose after AstraZeneca (AZ), based on data from two studies: ComCOV (U.K.) and CombivacS (Spain). Early data on vaccine side effects with mixing and matching and immune response are reassuring; outcome data is not yet available.
• NACI has stated that Moderna and Pfizer vaccines may be used interchangeably. These FAQs from the University of Waterloo and partners address common patient concerns. 
• Real world data from the U.K. looking at protection from the Delta variant demonstrates the importance of second doses. For preventing hospitalization: for AZ, 71% with one dose and 91% after two doses; for Pfizer, 94% with one dose and 96% with two doses.

Other COVID-19 Supports

• Update to AZ product monograph: Heath Canada updated the AZ and COVISHIELD Product Monograph (page 8) on June 29th with new information about a very rare capillary leak syndrome and further guidance for healthcare professionals and vaccine recipients.
• The Provincial Antigen Screening Program (PASP) is providing free rapid antigen test kits to any organization that is open and requires staff and others to be on-site – including family practices. Learn more about accessing the kits.
• Vaccines and allergies: Great FAQ from the Canadian Society of Allergy and Clinical Immunology on many key questions.
• Guidance for fully vaccinated: Public Health Ontario’s PIDAC-IPC has issued interim guidance for vaccinated healthcare providers (HCP) and patients in hospitals and LTC. We are awaiting guidance for primary care but the bottom line is likely to apply to our sector as well. Two key takeaways: guidance for routine IPAC practices and PPE is unchanged and testing is no longer recommended for fully vaccinated patients or HCPs who are asymptomatic and do not have a known exposure to COVID-19 (ie: routine or pre-procedure testing). See Section 8 for recommendations.
• Our next COVID-19 CoP with UofT DFCM is Friday, July 9, 8-9 a.m. (ET). Get vaccine updates and tips for safely ramping up in-person visits, with panelists Dr. Allison McGeer and Dr. Abhishek Raut. REGISTER and see past sessions here.   

CPD/Clinical Care Updates 

• The Mainpro+^®cycle ended June 30th, but you have until August 13, 2021 to report your credits. Report your credits here.
• The upcoming Practising Well CoP with UofT DFCM will take place Wednesday, July 28, 8-9 a.m. (ET), with panelists Drs. Rupa Patel, Ashley White and Jennifer Wyman, addressing the issue of appropriate opioid prescribing for chronic pain. REGISTER
• Temporary prenatal genetic screening measures implemented last year have now been extended to March 31, 2022. More information about these measures, including frequently asked questions, are available from Prenatal Screening Ontario.

 *****

Please enjoy your summer. Mark off time in your calendars to really get away from your work and look after yourself; you have given so much to so many during this pandemic. I am grateful to each of you for all that you continue to do to ensure your patients are safe and healthy. 

In the spirit of staying well and being inspired, I enjoyed getting on my bike recently to cycle around the city to visit a few of the practices where family doctors were giving vaccines. 

Liz