Dear Colleagues,

With vaccination of children aged 5 to 11 starting, I feel we are taking a hopeful step toward a return to a more normal life. Along with the optimism brought by this good news, I have deep concern over incidences of doctors being harassed, even threatened, for speaking about the benefits of vaccination.

Harassment is never okay. The OCFP stands behind the advocacy of our members and efforts to share evidence-based information that support patients to make informed decisions. We support the CMA’s call for follow-through by the federal government on its pledge to protect health workers. If you are feeling bullied or threatened, you can reach out to us at the OCFP; please also see these strategies for responding from the CMPA.

In other positive updates, last week we welcomed Kimberly Moran to the OCFP as CEO. Kim is a well-respected leader with a strong record of sparking change in the health system and we are very much looking forward to the benefits of her work. Read more about Kim and her words of introduction.

Children and COVID-19 Vaccination

With rising COVID-19 pediatric cases and hospitalizations in unvaccinated children, there is greater risk for severe and long-lasting health challenges in this population. The benefits of vaccination for children 5-11 outweigh the risks; addressing the concerns and hesitancy of our patients who are parents of young children will be crucial to a successful vaccination rollout.

We understand there are enough vaccines to immunize all children aged 5-11 in Ontario and doses are being delivered to public health units based on population. Vaccine appointments for this group will be a combination of strategies, including mass vaccination, pharmacy, in-office in primary care and school based. Contact your public health unit for ways to support vaccination clinics in your region including vaccinating in-office.

Common patient questions about vaccinating children 5-11 years

• Vaccine efficacy is high (90.7%) against symptomatic COVID in the preliminary clinical trial data and there were no serious safety concerns and no cases of myocarditis or pericarditis.
• The risk for myocarditis is expected to be significantly lower in 5-11 year cohort given the lower dosage (10ug), longer interval between doses (8 weeks) and what we understand about a lower predisposition of myocarditis in younger children. More information on myocarditis post-vaccination in this UWaterloo two-pager (pdf).
• A 14-day interval between the COVID vaccine and other vaccines is recommended by NACI (pdf) as a precaution to better monitor for adverse events; however, it is recognized that this may not always be feasible.
• Children who are turning 12 this year (2021) are recommended to get the adult dose (30ug). A child who is 11 should get the pediatric dose rather than wait weeks or months to become eligible for the adult dose. If they receive the first (pediatric) dose and turn 12 ahead of their second dose, they may then receive the adult dose, although a pediatric second dose can also complete the series.
• Dosing for the vaccine is based on age, not weight, and antibody response of the 10ug in children five to 11 years old was equivalent to the 30ug dose in older children.
• A reminder that short-term menstrual cycle changes have been reported but fertility and hormone levels are not affected by vaccines. See vaccine myths and facts from the SOGC (pdf).

RESOURCES

For physicians

• COVID-19 Community of Practice for Family Physicians with UofT DFCM: Our two most recent sessions (Nov. 5 and Nov. 17) focused on questions about the vaccine for children, safety and efficacy, boosters, Ontario’s rollout, and more – access recordings, resources and registration
• New modules for Family Physicians on vaccination in children 5-11 in the UofT DFCM/OCFP “COVID-19 Vaccination in Canada” educational series. Register for free series access
• CEP’s COVID resources have been updated with info on COVID-19 vaccines for children, including ways to support confidence in the vaccine
• The ministry has updated the COVID-19 Vaccine Administration guide to include the pediatric Pfizer vaccine.
• Two letter templates – one developed by the OMA section on Pediatrics (gated) and another from Dr. Tara Kiran and Dr. Noah Ivers – which you can adapt and use to help encourage patients to vaccinate their children who are eligible.

To share with patients

• Factsheet on Youth and Children Vaccination (pdf) from the MOH.
• COVID-19 Vaccine Consult Service (VSC) from SickKids and VaxFacts – for patients who might benefit from a dedicated, confidential phone appointment to answer their vaccine questions.
• Max the Vax, a compilation of credible information and resources about vaccines and vaccination for kids.
• Series of user-friendly information pieces from UWaterloo school of pharmacy Focused Covid Communication team, including FAQs on the mRNA vaccine for children (pdf) and decision tool on whether to vaccinate a child now or wait (pdf).

Third Dose Eligibility

Family physicians and all primary care staff are eligible for a third dose if you are six months (168 days) from your second dose. Book now through the provincial portal, participating pharmacies or, if applicable, your local hospital. Note that updated guidance on Nov. 12 shortened the post-vaccination observation period to five minutes for health workers vaccinated in a healthcare setting if there were no issues with previous doses.

• The OCFP has compiled this summary of eligibility for third doses and boosters (pdf) based on the ministry’s Third Dose Recommendations. In general, third doses are indicated for specific populations who may have declining protection over time including [six months (168 days) after last dose], and for immunocompromised individuals [two months (56 days) after last dose]. See Table 1 on page 7 of Guidance for the List of Immunosuppressant Medications for Third Doses.
• Third dose may be either Moderna or Pfizer regardless of previous two doses.
• Moderna dosage: full dose (100 mcg) for age 70+ residents of long-term care homes, retirement homes or seniors in other congregate living settings and eligible immunocompromised individuals; half dose (50 mcg) if younger than 70. If Pfizer: full dose (30 mcg).
• Boosters are not mandatory, i.e., people with two doses are considered fully vaccinated.

We are fortunate to have ample vaccine supply in Ontario and Canada. If you would like to support those who do not, see UNICEF Canada’s donation program for global efforts to vaccinate.

COVID Testing

• Order test kits using the online PPE, Swab Kit and Rapid Test Intake Form. This video – How to order Covid-19 test kits from Ontario Health – walks through the ordering process. If interested in conducting in-office COVID specimen collection and/or testing, or want to support community efforts, contact the Ontario Health Regional Testing Lead for your area.

FLU | ILI

• Just released by Choosing Wisely Canada, an updated The Cold Standard toolkit to address how patients with viral RTIs can be managed appropriately virtually, and recorded session on navigating colds, flus and kids this respiratory season.
• Centre for Effective Practice has flu information for 2021-22 season and here are Ontario Health suggestions for how to navigate patients with ILI.
• It’s important to continue seeing our patients in person when warranted, including where possible, ILI and symptomatic patients. Re-sharing this summary of IPAC/PPE precautions (pdf) and FAQs (pdf) to address top concerns.

From the OCFP

• OCFP Family Medicine Summit 2022 (formerly the ASA), Jan. 28 & 29, 2022. Recorded livestream days and dozens of additional sessions available on demand for six months – see the agenda and register.
• Workshop – Mood Disorders: Comprehensive and Realistic Strategies for Primary Care: Dec. 6 & 10, 2021 Details and registration
• If you're not attending tomorrow's (Nov. 24) Practising Well CoP session on trauma-informed care, you can access recordings and resources from this and other past sessions. The following session, on Dec. 15, will focus on Chronic Pain: Fibromyalgia – Register here.
• The OCFP 2021 Awards Ceremony on Nov. 10 gave us a chance to celebrate family medicine. Check out the recording and read about all the recipients – so proud of these examples of our profession.

Other upcoming opportunities

• Learn how virtual assistants can take on some time-consuming tasks and reduce the burden of administration for clinicians – eHealth Centre of Excellence webinar, on Dec. 2, 12-1 p.m.
• To help address the risks of non-healing wounds, CorHealth has launched Lower-Limb Preservation Strategy. See Information webinars on Nov. 26 and Dec. 2.
• Access messages and resources in multiple languages you can share with patients to help them get caught up on cancer screening.
• Ontario eConsult has launched the Gynecology – Pelvic Mass Imaging provincial BASE™ managed specialty group, to support management of pelvic masses found on imaging, especially pelvic ultrasounds. Sign up and access eConsult via OTNhub.

With the pandemic persisting, our role remains essential for our patients. I know the road has been long and we are weary, but this week I do feel more hopeful about the direction we are headed with the 5-11 vaccination rollout. Please remember to be kind to yourself and to each other. I know I've been leaning on my colleagues lately and finding their support, empathetic ear and (sometimes dark) humour heartening. Know that I remain grateful to each of you and for the work you do.

Liz