February 25, 2022

Dear Colleagues,

It has been another intense period for us and our patients. Yet, although we continue to face uncertainties and negative fallout from the pandemic, we also collectively continue to move forward. It is important we take the time to recognize the impact and the value of the care we provide to our​ patients. Family doctors truly have been the sturdy backbone of the pandemic response – what we do matters. 

At the OCFP, we are working to ensure tangible positive changes – improvements for you in your everyday work and for our profession as whole. As previewed during the 2022 Family Medicine Summit in January, the OCFP will use this critical opportunity of the provincial election campaign to ensure we make the voices of family doctors heard. Stay tuned for our next steps to put family medicine issues front and centre. We also continue to work with and support our partners on this important advocacy effort and here is a video and a toolkit from the OMA Section on General and Family Practice on how to advocate with your local MPP or candidate.  

 CLINICAL CARE

• Backlogs of services stemming from the pandemic are a stressor for both physicians and patients. Abusive behaviour to clinic staff and doctors is unacceptable, no matter what the situation. The OCFP has developed this clinic sign to help remind ​patients of this: colour sign | black and white sign
• Updated MOH guidance for primary care (Feb. 14) reinforces that access to in-person care should be available to all patients regardless of COVID-19 vaccination status. A reminder of the OCFP’s summary of N95 use when seeing patients with suspected or confirmed COVID. We appreciate all your efforts as you pivot back towards more in-office care and continue to address the backlog of care as Omicron wanes.
• Rapid antigen testing: new guidance on RATs from the COVID-19 Science Advisory Table, includes that RATs can more reliably detect infectious cases of Omicron in combined oral-nasal samples. Here is a how-to video for sample collection. See MOH testing guidance (pp 7-8) for the uses of RATs.

LONG COVID (Post-COVID condition)

• We have updated our Long COVID resources, including support, emerging evidence and patient resources, as well as a list of outpatient rehab programs providing Long COVID care.
• eConsult is available for the multiple aspects of Long COVID. Information on all COVID-related specialties and how to sign up and send an eConsult
• In the Feb. 18 COVID-19 Community of Practice, Dr. Ashley Verduyn covered the latest on Long COVID. Access the recording and resources
• Register for the next COVID@Home “connecting call” from Ontario Health, March 9, 8 to 9 a.m., including a demo of an EMR tool based on OH’s post-COVID (i.e., Long COVID) guidance.

OUTPATIENT TREATMENTS | REMOTE MONITORING

• We know there are currently significant barriers to Paxlovid and sotrovimab treatments, including limited supply and access points, and many potential drug interactions. It remains crucial to quickly identify your eligible COVID-positive patients given the short window for starting treatment (within five days of symptom onset for Paxlovid and seven days for sotrovimab). This online form, developed by Dr. Sohal Goyal, is an excellent tool for determining eligibility.
• These 15 sites are distributing Paxlovid (at Jan. 28, 2022); as of earlier this week, 70 doses in total of Paxlovid have been administered in the province.
• Here again is the referral formto the seven sites administering
• Updated guidance on COVID-19 therapeutics (Feb. 23) from the Science Advisory Table (SAT) makes recommendations based on new data and evidence as well as changes in drug supply & demand. A summary of key changes here from SAT member Dr. Andrew Morris: https://twitter.com/ASPphysician/status/1496901383559262213
• The SAT has also published a new brief on Paxlovid for prescribers and pharmacists, including guiding principles for mitigating drug interactions, and here is a great CMAJ summary of Five Things to Know about Paxlovid.
• Repeating this list of Ontario Health’s COVID@Home remote monitoring programs, including referral criteria and contact info for OH regional digital leads, and here are the COVID-19 Clinical Assessment Centres.

VACCINES

• The need remains to encourage vaccination, including among high-risk groups, and we can play an important role as family doctors. Helpful insights on vaccine hesitancy among Black people in this OMA video (gated access). Note that uptake is lagging in children 5-11 with roughly 27 per cent fully vaccinated, and boosters are insufficient in other eligible groups – 60 per cent for ages 50-59 and 76 per cent for ages 60-69.
• We understand that mass vaccination clinics will be winding down and there will be greater focus on mobile clinics in targeted areas. The OCFP will continue to monitor for developments affecting our practices.
• Drive-to-Vaccines program for people with disabilities and seniors with mobility issues is extended to March 31. Patients may call 2-1-1 (toll-free: 1-877-330-3213 / TTY: 855-405-7446) or visit www.ontariocommunitysupport.ca.
• Novavax was approved by Health Canada on Feb. 17 for ages 18+, the first protein-based COVID-19 vaccine authorized for use in Canada. Supply is expected in Ontario in mid-March; no specifics yet.  
• MOH updated third-dose recommendations guidance (Feb. 17), includes boosters for ages 12-17 at six-month interval to second dose. Boosters were previously available to these ages only if underlying condition, at an interval of three months.
• See the handy summary table (on page 3) from NACI on intervals for vaccination for people who have had COVID.
• There is no estimate currently of when COVID-19 vaccines will be available to children under five, as the FDA awaits for data on three-dose series.

OTHER UPDATES

• Patients now have until Sept. 30 to renew their expired health cards, extended from Feb. 28. Also, Ontario Photo Cards are now accepted as ID for online renewals, fixing a previous inequity that required those without a driver’s license to renew in person. We continue to monitor the situation that requires people aged 75-80 to still renew in person, with thanks to our partner AFHTO for leading advocacy in this area.
• The Provincial Council for Maternal and Child Health has new best practice recommendations and an implementation toolkit for Safe Administration of Oxytocin. More in this webinar on March 7, 12-1 p.m. ET and in this short video.
• Labs worldwide are experiencing critical shortages in blood tubes, devices, and lab staffing. Here are primary care recommendations for conserving resources from Choosing Wisely Canada
• Don’t forget to submit your nomination for the OCFP Awards by March 13. Family doctors are amazing, and we know you all know deserving colleagues – whether they work independently, in a team or across a variety of venues; don’t hesitate to put them (or yourself!) forward for this honour.
• The OCFP Family Medicine Summit offers certified on-demand sessions, including recordings of two live-stream days with featured speakers, panel discussions and plenty more. Check out the agenda and register by June 30.
• Register now for the March 4 COVID-19 Community of Practice session from OCFP-UofT DFCM, with Dr. Allison McGeer, Dr. David Kaplan and others, addressing what’s next with COVID. Remember you can also view recordings of all past sessions as Mainpro+® certified self-learning modules.
• The OMA has published guidance for writing clearance notes for travel. (gated access)

*****

We all know the pandemic has changed the way we work in many significant ways including the adoption of virtual care within our practices. I want to draw your attention to a new position statement from the CFPC that highlights the potential pitfalls of paid-access virtual-only care, a category which may be proliferating. The OCFP aligns with our national college on the view that patients are best served when virtual care complements in-person care and is rooted within comprehensive care.

Take care and take time to look after yourselves, 

Liz