Dear Colleagues,

It has been a tumultuous few weeks with the surge of COVID cases. I know many of us are dealing with ongoing and exacerbated pandemic stresses – trying to make sense of new guidance, ​managing with short-staffed offices, supporting sick patients, and, not least, our own family responsibilities. I know these challenges make it difficult to continue with business as usual and I'm grateful for what you are doing to be flexible, creative and dig deep to be there for your patients. On our end, these messages reflect our continued efforts at the OCFP to help bring clarity and support you as you continue caring for your patients.

New COVID-19 resources for patients

To help address the most common patient questions about COVID given evolving guidance on testing, how to manage COVID at home, and self-isolation, the OCFP has partnered with UofT DFCM to create a set of six plain language documents that will be available in multiple languages. Find all these guidance documents at ConfusedAboutCOVID.ca and you can also access them individually here:

• I’m not feeling well. How do I know if I have COVID? What should I do?
• I think I have COVID. When should I call my doctor?
• Do I need a COVID PCR test?
• How should I be using a Rapid Antigen Test?
• I’ve been exposed to someone with COVID. What should I do?
• I’m worried about the new variant. How do I keep safe during Omicron?

Supporting COVID patients

Family doctors have a key role to play in supporting patients with COVID symptoms or who are COVID-positive. Please ensure you are continuing to be available to provide advice, care and monitoring (virtually and, where clinically indicated, arranging for in-person care).

• Order N95 respirators via the Provincial Pandemic Stockpile; fit-testing is no longer required before ordering 1870+ N95 masks. Additional details about needed PPE in the ministry’s FAQs on Directive #1.
• Resharing the Hamilton Family Medicine’s guidance for assessing, monitoring and managing COVID in the community.
• Support for caring for mild to moderate COVID patients in the community:
  • order O2 sat monitors
  • key contacts and additional resources
  • OH Toolkit for implementing home monitoring of COVID.
• From the COVID-19 Science Advisory Table, updated guidance (from January 8) on eligibility for outpatient therapeutics and new tips on prescribing fluvoxamine. Note: access to monoclonal antibodies is being regionally managed within specific programs and supply to primary care is currently limited.
• We are expecting more guidance from Ontario Health on the role for community COVID-19 Clinical Assessment Centres (CACs). We understand the CACs are intended for patients with known or suspected COVID-19 who cannot be safely monitored at home; CACs do not offer monoclonal antibody treatment or oral antivirals.

Case and contact management

The ministry updated the guidance for testing as well as case and contact management on Jan. 13, which includes:

• Expansion of PCR testing eligibility to include symptomatic people in these groups: household members of workers in highest risk settings (such as hospitals and LTC); pregnant people; temporary foreign workers in congregate settings; and first responders. Patients who may be eligible for COVID-19 treatment are also eligible for PCR testing.
• Clarification that isolation of household contacts who have not already been cases must continue until the last case's isolation ends OR they become cases. Cases can stop isolating once their isolation period ends, even if others are still isolating.
• Contacts who tested positive within 90 days AND after December 20, 2021, must follow isolation guidance as “fully vaccinated” people if subsequent exposure.
• Isolation period of 20 days for COVID cases who have severe COVID illness (requiring ICU care) or who are severely immunocompromised, such as persons undergoing cancer chemotherapy, with untreated HIV or with combined primary immunodeficiency disorder.

Restating that workers do not need a test or a physician’s note to return to work, and neither do students for return to school, if they have isolated for the full period in the guidelines. We continue to emphasize this with the ministry and with the community and businesses.

More updates

• New MOH recommendations on third doses (January 13) notes that fourth-dose boosters may be administered three months (84 days) after their third dose, to:
  • immunocompromised individuals who are eligible for a three-dose primary series – see pages 8-10 for list of immunosuppressive medications and pages 5-6 for immunocompromised individuals.
  • residents of LTC, retirement homes, Elder Care Lodges and older adults living in other congregate settings providing assisted-living and health services.
• Here is list of the most common COVID-related questions we are hearing now.|For further updates on the guidance, COVID assessment centres and more, be sure to register for our upcoming COVID-19 CoP for Family Physicians with UofT DFCM, January 21, 7:55 a.m.
• Substance use disorders
  • For patients with opioid and other substance use disorders who face special challenges during the pandemic, some resources to help you support them:
    • Upcoming webinar series from the Association of Faculties of Medicine of Canada, including Introduction to Medical Treatment of Opioid Use Disorder, on January 19, 12-1 p.m. ET. with Dr. Jennifer Wyman
    • COVID-19 Opioid Agonist Treatment Guidance from CAMH, OMA, META:PHI (August 2021)
    • OCFP Practising Well Community of Practice: See the resource list and recording focused on Appropriate Opioid Prescribing for Chronic Pain, and check out the upcoming session on January. 26. All CoP sessions are recorded and available

I’ll close with a special invitation to the OCFP’s 2022 Family Medicine Summit – livestreamed days are January 28 and 29, and you can start with on-demand sessions on January 18. Yes, we’ll be talking about COVID, but we’ll also have a chance to gather virtually with colleagues, hear from outstanding speakers like Dr. Glaucomflecken and Dr. Jillian Horton, and learn about clinical topics most relevant to you. The great conference care package is another plus (I've already enjoyed the chocolate and put the socks to use).

As always please continue to send your feedback.

Liz