Dear Colleagues,

As our summer winds down, I hope you have had time for a break over the past few months.

The OCFP continues to support you by advocating for the value of the work you do within the health system. We know that there are many competing demands, both personal and professional, including the ongoing strains of COVID-19, the start of the new school year, and much more. There have been many developments over the last little while, so a lot is covered in this message. Grab a coffee/beverage and sit back for this slightly longer read.

Updates and resources below:

• Upcoming OCFP CoP sessions and C/MOH fall plans
• New case and contact management recommendations
• Children’s boosters, new vaccines, and patient resources
• Testing and treatments, including RATs, Paxlovid and Evusheld
• Monkeypox
• OCFP 2022 Annual Meeting of Members
• More updates and opportunities for Primary Care

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• Long COVID will be the focus in our next session of the COVID-19 Community of Practice, hosted with UofT DFCM on Sept. 16, 2022, 7:55 a.m. Also, we will highlight the latest on boosters, new vaccines and more. We’ll be joined by physiotherapist Mr. Adam Brown, Dr. Angela Cheung, Dr. Gerald Evans and Dr. Jennifer Hulme. REGISTER
• In the OCFP’s next Practising Well CoP session with UofT DFCM, a discussion of how “even short appointments can help”, with tips on how to provide care and counselling for substance abuse in the most efficient way, Sept. 28, 7:30 p.m. REGISTER
• The new school year is underway and there are indications flu season may see an early start. We understand that upcoming CMOH recommendations for fall will include having a rescue plan for children with chronic cardiopulmonary disease, especially asthma, and that at-risk children wear masks in indoor public spaces. The MOH is also working on plans to support the catch-up of routine immunizations in the fall. We will keep you updated.

COVID-19 case and contact management

• Changes to Ministry guidance (Aug. 31) include elimination of minimum isolation periods for most cases. Here’s a summary of current guidance:
  • Individuals who have symptoms of ANY respiratory illness should stay home until symptoms have been improving for at least 24 hours (48 hours if nausea, vomiting or diarrhea)
  • If they have a fever, they should stay home until the fever is completely gone.
  • Avoid non-essential visits to vulnerable people for a full 10 days starting the day after symptoms appear.
  • Symptomatic and test-positive individuals should wear a mask when in public spaces for 10 days from the start of symptoms/positive test result
  • For those who are hospitalized, immunocompromised or reside in a highest-risk setting (i.e., acute care, long-term care and retirement homes, group homes, shelters, etc.), 10-day isolation remains and symptoms must be improving as noted above. Note: does not include Primary Care (see points above which apply to Primary Care, and page 7 of Guidance).
• For healthcare workers in highest-risk settings referenced above:
  • close contacts of someone with a positive COVID test or symptoms may work in their highest-risk work setting if asymptomatic.
  • no change to isolation requirements for symptomatic or test positive individuals who work inhighest-risk settings – may return to work 10 days after onset of symptoms or positive test result. Testing for clearance is generally not recommended. See Appendix A of Guidance for more, including options for critical staffing shortages and workplace measures for reducing risk.
• The Ministry has released an addendum to the COVID-19 PPE guidance with information and guidelines for stockpiling, inventory management practices, and accessing needed PPE from the emergency stockpile.

COVID-19 vaccines

• Booster doses for children: As of Sept. 1, children aged 5 to 11 years are eligible for booster doses. For children and youth 5 to 17, MOH is recommending an interval of six months; it may be administered as soon as three months after the previous dose with informed consent. Most boosters will be administered in PHU-led clinics and pharmacies.

We know some of you are vaccinating in office. Here is a list of PHU vaccine contacts for primary care if you have questions, including about vaccinating in your practice.

• Answers to questions about kids' vaccines: SickKids has compiled FAQs to support parents who may have vaccine questions, including specific focus on children under 5 years old and those aged 5 to 11 years. Parents can also use SickKids COVID-19 Vaccine Consult Service for medically complex/specific questions.
• Bivalent vaccines: Moderna’s vaccine which targets the original COVID-19 virus and the BA.1 Omicron strain was authorized by Health Canada on Sept. 1 (see NACI recommendations), as a booster dose for adults age 18+. Delivery is expected in Ontario this week and the priority initially will be those at high risk for severe outcomes from COVID-19. Pfizer’s BA.1 bivalent vaccine is expected to be approved soon.
• VaxFacts Plus: The VaxFacts Clinic has expanded to include a specialized consultation stream for members of Black communities to have one-on-one conversations with Black physicians and get answers to questions. Additional topics and services for all available through ‘VaxFacts Plus’ include monkeypox and other infectious diseases, and information about childhood vaccines, flu vaccines and preventative health. Book appointments online.

COVID-19 treatments and testing

• Evusheld: We understand an announcement of wider eligibility for Evusheld is imminent. This is a preventive treatment for high-risk individuals who are immunocompromised and are unlikely to mount an adequate immune response to vaccination or for whom COVID-19 vaccination is not recommended. Currently eligible groups include solid organ and stem cell transplant recipients, CAR-T therapy recipients, and patients being treated for other haematological cancers who meet certain criteria. It is administered primarily at cancer and transplant centres. From Ontario Health: Evusheld information for healthcare providers and patient handout.
• Combined or oral-nasal samples can better detect infectious cases of Omicron – refer patients to this guide, available in 26 languages, on how to collect a sample using a rapid antigen test (RAT).
• PAXLOVID: Ontario Health is highlighting the lower sensitivity of RATs as a potential barrier to high-risk patients who are eligible to receive Paxlovid. Important reminder that high-risk outpatients who are eligible for COVID-19 treatments are also eligible for PCR testing and should get a PCR test if they have symptoms and test negative by RAT. OH’s patient handout is also available in multiple languages.

Monkeypox

• Ontario has expanded eligibility for the pre-exposure monkeypox vaccine (Aug. 29) to include people who are two-spirited, non-binary, trans- or cis-gender individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual and other men who have sex with men (gbMSM) community, and anyone who engages in sex work or plans to do so. See page 2 of Ministry guidance (Aug. 29) for details and criteria.
• A reminder that you can test for monkeypox in your practice. Doing so would be beneficial to your patients (who you know best) and could help alleviate strains on sexual health clinics and hospital emergency departments, where most testing is being done currently. Note that transport of specimens is the same as for other suspected infections in an outpatient setting. Resources to support our important role: OCFP’s monkeypox webpage, Ontario Health’s answers to common questions and Primary Care guidance for monkeypox testing and management (Aug. 4).

Annual Meeting of Members

• Join us at the OCFP Annual Meeting of Members (AMM), via Zoom Meeting on Wednesday Sept. 28, 2022, at 8:00 a.m., for a fulsome discussion of advocacy issues, OCFP Board of Directors appointments, reports on governance and finance, and more. AMM MATERIALS and REGISTRATION | PROXY

More opportunities and updates

• For physicians interested in joining or starting a FHO, the OMA has a new online resource that can help connect members and support the process. Log in to access the Primary Care Practice Finder Tool on the 2021 PSA implementation webpage.
• With supply issues for children's over-the-counter fever and pain medicine, remind parents that a prescription is not required for these medications and advise them to speak with a pharmacist about appropriate alternatives. Pharmacists can dispense liquid acetaminophen from stock bottles without a prescription, and parents could use chewable tablets, or crush/cut an adult tablet for kids as appropriate. (See Ontario College of Pharmacists.)
• We are aware of the additional burden and the effects on uptake that result when FIT test orders are rejected by labs because of expired Health Card version codes and similar details. We are pleased to report that the issue is being addressed by at least one major testing lab. Thanks to all partners for this collaborative work.
• Ontario Health is seeking feedback on a new quality standard and patient guide for sickle cell disease. Review and provide your input by Sept. 23, 2022.
• Health Canada wants input on the Prescription Drug List, including whether existing exemptions should be added. Provide your input by Nov. 29, 2022.

I have said it before and will say it again: signing off with gratitude to you all for your hard work, and fierce pride in our incredible profession that continues to make such a profound difference in our patients' lives.

Liz