Dear Colleagues,
As you know rapidly rising cases of Omicron will have both individual and system-wide implications over these next 4-8 weeks. Many of you are supporting local COVID vaccination, testing and assessment efforts while also maintaining your day-to-day work and at the same time planning for what lies ahead – there is a lot being asked of us at this unprecedented time.
Our patients and system partners need us to optimize the care we can provide to help keep Ontarians out of hospital and the emergency department, and prevent potential strain on other parts of the system. In this effort it is critical that we keep ourselves and our staff and teams safe and healthy so we can continue to do what we do every day to keep our patients well – it is important that we “secure our ship” as we head into this storm.
Based on the best available evidence and guidance at this time, we have laid out the following priorities to help guide your approach over the coming weeks, recognizing that each of you will be making decisions based on your individual and practice contexts. Also given the rapidly changing environment, we know there is a need to remain flexible and nimble to adapt to the situation.
STEP 1: Keep yourself and your staff/team safe and healthy
- Continue to use a layered approach to IPAC/PPE in your offices, applying all available measures for maximum protection in clinic and in the community. There is no single IPAC/PPE measure that is best on its own – they work best together.
- Continue to adhere ourselves to all the PHU guidance – what we do outside the office may matter as much as what we do in the office, particularly given community transmission risk right now.
- Maintain an adequate supply of well-fitting masks including N95 (or equivalent), based on the updated guidance. See below for more on masks.
- Continue to screen patients and require mask wearing, handwashing and physical distancing for in-person visits. Here is a printable sign to remind patients to keep their masks on during visits.
- Ensure all team members and their households have received all COVID-19 vaccines for which they’re eligible, including boosters.
- Consider screening all staff regularly (2-3x weekly if possible) using rapid antigen testing (RAT) as an additional tool to reduce in-office transmission. RATs can be ordered via the Provincial Pandemic Stockpile; however, we understand availability is limited currently. We are monitoring the situation and will update you as we get new information.
- Tighten staff policies around gathering. Limiting the number of people in break rooms at the same time and holding all non-essential meetings virtually can reduce the risk of in-office transmission.
- Pay attention to proper ventilation, including by using HEPA filters, keeping doors/windows open where possible, and properly placed fans. See tips from PHO for an air quality check of your office and a ventilation/filtration guide and tip sheet from Masks4Canada.
- Ensure workplace policies reflect the latest guidance for case and contact management: Bottom line – fully vaccinated HCWs in primary care who have a household contact with a confirmed COVID case must isolate; non-household contacts don’t need to isolate if fully vaccinated and asymptomatic. Be aware and prepare for the potential strain this may place on your human resources.
- Reach out to your regional testing leadership/primary care leads/OHTs to understand processes for access to PCR testing for HCWs.
- Protect your mental health and support your colleagues’ mental wellbeing. Be intentional about supporting yourself and each other. If needed here is a list of professional mental wellness resources for physicians.
MASK TIPS
We are providing the following interpretation of recommendations/requirements on masks but acknowledge the fluidity of the situation and the changing guidance and evidence. We will provide updated information as it becomes available.
PHO recently updated its PPE recommendations to state that the recommended PPE for direct care of patients with suspected or confirmed COVID-19 includes:
- Fit-tested, seal-checked N95 respirator (or equivalent, or greater protection), eye protection, gown and gloves.
- Other appropriate PPE (based on individual point of care risk assessment) includes a well-fitted medical mask or non-fit tested N95 respirator (or equivalent), eye protection, gown and gloves for direct care of patients with suspect or confirmed COVID-19.
Use a point-of-care risk assessment (PCRA) for each direct patient encounter to guide your choice of PPE.
Good fit is the most important criteria for all masks, including medical masks. Private fit-testing services for N95 (or equivalent) are available in most communities and some hospitals may also offer fit testing for community physicians.
More information on respirators from Masks4Canada and from PHAC specifically for health professionals.
Family physicians may order N95s from the Provincial Pandemic Stockpile for PPE, however we are aware there may be limited supplies currently.
Recognizing that fit-tested N95s may not be widely available at this time, KN95, FFP2/3 (European) and Canadian made CN95/99 respirators are good options that are superior to medical masks. Ensure they are NIOSH certified and Health Canada approved and fit well. (Note that KN95 are designed such that fit-testing is not required.)
For a list of distributors of respirators see Masks4Canada, and for Canadian-specific PPE options Canadian Association of PPE Manufacturers – CAPPEM and Canada Strong.
STEP 2: Prioritize essential work | Balance virtual and in-person care
- Continue to deliver essential care to your patients with attention to urgent, emergent, and new conditions, and after-hours care where applicable. We know our patients need us and want to stay connected to us. The OCFP has issued a public statement to explain the ministry-directed current focus to the public.
- Defer certain preventive and non-urgent care as needed if you are responding to critical system efforts (i.e., vaccination) and taking into account clinical and system demands as well as community prevalence of COVID. The CPSO has recognized that you and your patients are in the best position to determine what care is essential to provide at this time.
- Continue to offer in-person care when indicated and with appropriate IPAC/PPE in place. You may choose to shift to virtual guided by your clinical judgement.
- For management of patients presenting with ILI, see this Primary Care Guidance from Ontario Health with suggestions for clinical support and system navigation.
- For holiday office closures dates and/or times of limited services, ensure also that you have plans in place and have communicated care arrangements to patients.
STEP 3: Support COVID-19 vaccination, especially boosters for the most vulnerable
- All 18+ Ontarians are now eligible for third doses and the interval from the second shot has been shortened to three months. Use all available means to let your patients know about booster-eligibility and availability of vaccines.
- Add messaging to your website and contact patients about where/when they can get their vaccine and how to book. Letter to adapt and use for your practice, and scripts and robo-calling tool to help with contacting patients.
- Priority is for those at highest risk, including those disproportionately unvaccinated due to structural and systemic issues. CEP resources to help address vaccine hesitancy in Black and Indigenous communities.
- Where able, support mass vaccination clinics or mobile vaccination pop-ups through your PHU/OHT/hospital, including deploying publicly funded staff to support vaccination efforts. Please reach out to your Public Health Unit if you have not already been contacted.
- Continue to answer patients’ questions about the vaccine/vaccination, including additional doses and boosters.
- Where possible, vaccinate patients in your office. If you’re not vaccinating in office and want to start, reach out to your public health unit.
STEP 4: Be prepared to support Ontario’s COVID-19 response in other ways in the upcoming weeks.
- Support case and contact management. PHUs will likely shift focus to support the highest-risk individuals and settings (ie: LTC/RH, shelters and other congregate settings). Stay abreast of the most updated guidance so you and your staff can advise your patients on what steps to take..
- COVID Testing – contact the OH testing lead for your region if you would like to participate in testing in the community or your office to help with the system demand.
- Provide COVID care in the community: Primary care resources to help:
- Hamilton Family Medicine primary care pathways for COVID and Women’s College Hospital’s [email protected] program
- From the COVID-19 Science Advisory Table, Evidence-Based Use of Therapeutics for Ambulatory Patients with COVID-19 and Clinical Practice Guideline Summary: Recommended Drugs and Biologics in Adult Patients with COVID-19 (We understand further updates on treatments are coming.) NOTE: Supplies of monoclonal antibodies are limited; we do not yet have guidance on appropriate use and access to these for community family physicians.
In the thick of this public health crisis, our profession continues to stretch above and beyond to keep our patients and communities safe. . Your work is recognized and valued. At the same time, I see and feel the collective and personal exhaustion. Please take time to step away from work – we are all only human and need time for recovery.
At the OCFP we are here for you now in these uncertain times. We will be here for you as we move through this pandemic. Our next update to you will be via the December 29th Community of Practice session which will be recorded.
As we reach the end of this year, I send you deep thanks for the care and dedication that you bring to your work. Please feel free to reach out to me, I always welcome and benefit from your feedback.
Take care,
Liz