Dear Colleagues,

The arrival of 2022 brings a mix of emotions. On the one hand, I hope you have had time to connect with the people and activities that bring you joy. At the same time, with COVID cases rising exponentially, there are significant implications for our professional and personal lives. We are shouldering a heavy load right now. Our patients are looking to us for advice and support, we are worried about how to keep ourselves and our clinics safe, and we may be juggling the care of our school-aged children and vulnerable family members. In addition, information and guidance is evolving and at times incomplete. Let’s be clear – this is an incredibly challenging time.

I want to assure you that we at the OCFP will continue to do our very best to keep you informed and supported. We are engaging with all our health-system partners to ensure we stay focused on working together as a system through this urgent time, and advocating for the supports and information we need to do our essential work as family doctors.

Here is a compilation of the key recent changes to help in your practice – we anticipate further guidance from the Ministry of Health (MOH) in the days ahead.

Updated guidance on testing and isolation from MOH on January 1, 2022

• Testing
  • PCR testing is now limited to high-risk settings (e.g., LTC, hospital) and high-risk populations (e.g., symptomatic patient-facing healthcare workers, patients who are hospitalized, or outpatients for whom COVID treatment is being considered, First Nations, Inuit & Metis). See MOH Dec. 30 update on eligibility for PCR testing.
  • A positive rapid antigen testing (RAT) does not need to be confirmed with a PCR test; a negative RAT does not rule out COVID. NOTE: Accessing RATs is currently a challenge given global supply issues; we understand more will be coming.  

• Isolation
  • Self-isolation period for COVID-positive cases and household contacts, where fully vaccinated and not immunocompromised, is reduced to 5 days (and until symptoms improving for 24 hrs or 48 hrs for GI symptoms). 
  • One-page guidance if you know or think you have COVID or if you have been exposed to someone who has tested positive for COVID-19.
  • All household contacts need to self-isolate while a person with symptoms is isolating (regardless of vaccination status). NOTE: PHO has advised us that the first symptomatic person in the household does not need to extend their self-isolation beyond their initial 5 days if another household member becomes symptomatic within that first 5-day isolation period.
  • Summary guidance for testing and isolation of healthcare workers in the highest risk settings (e.g. hospitals, LTC). Isolation remains 10 days though may be less in situations where there are Critical Staffing Shortages in highest risk settings, pages 16-17)  NOTE: outpatient primary care clinics are not considered “highest risk” settings.  
  • Good patient-facing information on self-isolation from Marathon FHT (Facebook post) and see this patient letter shared by Unity Health/St. Michael’s Hospital AFHT, which you can adapt and use.

COVID treatments for patients in the community 

• Budesonide, fluvoxamine and the monoclonal antibody sotrovimab are recommended for certain high-risk patients. Here is an updated Ontario COVID Science Advisory Table brief on Recommended Drugs and Biologics in Adult Patients with COVID-19 and an outpatient therapeutics summary from a group pharmacists at St. Michael’s Hospital. NOTE: monoclonal antibodies/treatment are in very limited supply so priority will be for those at highest risk.
• Oral antivirals (paxlovid and molnupiravir) are not yet authorized for use in Canada but should be in upcoming weeks; again, we understand supply will likely be limited.

COVID and PPE

• Keeping yourself and your clinic team safe is key. CMOH Directive #1, updated Dec. 21, requires N95 respirators for direct care of any patient with suspected/confirmed COVID. If you are unable to access fit-tested N95s, consider a non-fit tested, but well-fitting, equivalent (i.e., KN95s which are designed for use without fit-testing). Please see my previous message for more on PPE guidance.
  • Family doctors may order N95s for themselves and their practice via the Provincial Pandemic Stockpile – from dropdown menu, select “N95 Mask for Regular Supply”. The requirement for fit testing has been removed for ordering the 1870+ N95 masks for primary care but not for other models.
  • Question 15 in this MOH Q&A on Directive #1for a list of organizations that provide fit-testing. Expectation is for the 1870+ mask fit testing to be done when possible. Direct questions to [email protected].
• Take steps to preserve and re-use your N95 mask by wearing a surgical mask over it and by hanging it for 3 to 4 days before re-using. Note that a mask that is wet or crumpled should be discarded. See Health Canada’s COVID-19 medical masks and respirators: Information for health professionals

COVID in the community, in-person, virtual and assessment centres

• Continue to maintain your essential role in patient care; your patients want and need to connect with you. Provide in-person and virtual care as clinically appropriate. The CPSO has affirmed that, in this unprecedented context, physicians should be continuing in-person and virtual visits based on clinical need. NOTE: Currently, the cessation of non-essential care (i.e., non-emergent and non-urgent surgeries and procedures) under Directive #2 applies only to hospitals and IHFs, not to primary care.
• We understand that community COVID assessment centres are to remain open to support the care of symptomatic patients, including access to COVID treatments. More details from Ontario Health as these emerge.

• We have an important role to play in the support of COVID-positive patients with mild and moderate symptoms. OH’s toolkit for COVID@home monitoring and you can request O₂ saturation monitors. Great information here from Hamilton Family Medicine on assessment, monitoring and triaging of patients.
• Be aware that COVID symptoms with Omicron may look different to what we were seeing until now and may include runny nose, headache, fatigue and sore throat, in addition to symptoms with earlier variants. Here is the MOH’s just-updated COVID-19 Reference Document for Symptoms.
• Continue to encourage vaccination with boosters particularly for those at greatest risk (such as >70, immunocompromised, pregnant women, and others, as well as vaccination for those aged 5-11). Note: Our current understanding is children must be 5 years old on the day they receive their vaccine and similarly 18 years old to receive a booster.
• Published by Ontario Health in December, here is guidance on long COVID for primary care.

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I know the waters are rough and hard to read right now but we will pull through this together. The OCFP will continue to keep you updated with regular email messages as information and guidance evolves. We are also providing regular updates through the OCFP/DFCM COVID-19 Community of Practice sessions and I invite you to join the next one, this Friday, January 7, 8 to 9 a.m. REGISTER

As always, I welcome your feedback.

Liz