Updated primary care guidance document, revocation of Directive #2 and other supports

Dear Members,

With the announcement on February 14th that the government is moving to the next phase of reopening on February 17th, now more than ever it’s important to keep the pressure on ensuring more Ontarians get vaccinated. Thank you again for all your hard work in supporting your patients and community in all aspects of the pandemic efforts, while also managing the critical work of keeping your doors open for primary care.

In addition to the reopening, as of 8:00 a.m. on Friday, February 18, 2022, Ontario is expanding booster dose eligibility to youth aged 12 to 17. Appointments can be booked through the provincial booking system and the Provincial Vaccine Contact Centre, as well as at primary care clinics and select pharmacies administering the Pfizer vaccine.

Appointments are to be booked approximately six months (168 days) after a second dose and individuals must be 12 years old at the time of appointment. If you would like to administer vaccines in your clinic please connect with your PHU operational lead for information if you haven’t yet done so.

Primary Care Guidance Document
The Ministry has issued the COVID-19 Guidance: Primary Care Providers in a Community Setting (FR) (Version 10.0, Feb. 14, 2022). In this document see:

  • Updated in-person care guidance (page 3)
  • Updated active screening recommendations (page 6)
  • Updated PPE requirements when caring for patients with suspected or confirmed COVID-19 (page 9 and 14)
  • New testing guidance (page 11)
  • Updated case management (page 13)  
  • Updated HCW self-isolation and return to work guidance (page 17)

Also the Ministry has updated COVID-19 Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings (Version 3.0, Feb 11, 2022) which you can find here (FR).

Revocation of Directive #2 and Revised Directive #2.1
On Thursday, February 10th, the CMOH revoked Directive #2 to allow for the resumption of non-urgent and non-emergent surgeries and procedures in hospitals. Until there is a return to normal hospital capacity, Dr. Moore also issued an updated Directive #2.1 to ensure that hospitals resource share across the system. For more details:

To support the cautious and phased resumption of these clinical services, Ontario Health has provided operational guidance to the hospital and health care system in the Operational Direction for Optimizing Care: Wave 5 (FR) document. Of particular note was a specific request for primary care in supporting the response.

Primary Care and Community Support Services:

  • Continue to focus on urgent and emergent care to avoid unnecessary emergency visits
  • Continue to optimize capacity to support flow and provide care at home, as appropriate
  • Resume or continue preventative care (e.g., cancer screening)
  • Undertake early identification and referral of patients who would benefit from covid therapeutics
  • Continue to support vaccinations and remote monitoring of covid patients
  • Ensure community support service organizations continue to participate and collaborate on regional response and recovery efforts

Importance of Vaccinating Children 5-11
As of February 9th, nearly 55% of all Ontarian children aged 5-11 have received their first dose of a COVID-19 vaccine, of which nearly 25% are fully vaccinated with two doses. The government has requested that there be a renewed focused on vaccinating children 5 to 11 years old. To support these efforts, please see:

Update on RATs
The Ontario COVID-19 Science Advisory Table has released a new review on Use of Rapid Antigen Tests during the Omicron Wave. Some key notes:

  • Combined oral-nasal sampling that involves swabbing both cheeks, the back of the tongue or throat, then both nostrils, should be implemented for rapid antigen tests
  • a single negative rapid antigen test result should not be used to rule out a case of COVID-19 at this time
  • a single positive rapid test result can be used to confirm COVID-19
  • there are multiple ways in which serial testing can be applied to assess the likelihood of COVID-19, depending on the case rate, risk tolerance, and setting.  

Just a reminder that the provincial stockpile has received additional RATs and all backlogged orders should have been fulfilled. Additional orders can be made here.

Also a reminder that primary care can refer patients for PCR testing using the PHO developed form when the diagnostic test is required for clinical management, at the discretion of the referring clinician. The form is being embedded in the 3 major EMRs (Telus PSS, Accuro and OSCAR) and updated guidance will soon be available.

Other vaccination resources

  • VaxFacts is partnering with the Black Physicians’ Association of Ontario to provide a dedicated, free telephone service for members of Black communities to receive vaccine information. No OHIP required. Visit shn.ca/VaxFacts or call 416-438-2911 ext. 5738.
  • GO-VAXX Mobile Vaccine Clinics are now accepting walk-in. Check the GO-VAXX schedule for times and locations. If your organization is interested in having the GO-VAXX bus visit your community, please contact GOVAXX@ontario.ca.
  • OCSA’s Accessible Drive-to-Vaccine program has been extended and provides door-to-door rides to vaccination sites for people with disabilities, including seniors with mobility issues.
  • The Rehabilitative Care Alliance has compiled this list of outpatient rehab programs which may be helpful for patients experiencing ongoing symptoms of COVID-19.

Upcoming Events:
Ontario College of Family Physicians/University of Toronto Department of Family & Community Medicine

  • The next CoP session will be Friday, February 18th from 7:55 a.m. to 9:15 a.m. on The Omicron Aftermath: Post-acute COVID and Physician Wellness. Register here.

Choosing Wisely Canada

  • Laboratory medicine is under strain from COVID-19, with critical shortages in blood tubes, devices, and lab staffing. Learn primary care recommendations to conserve - register for the Five Recommendations for Using Labs Wisely During Global Blood Tube and Other Resource Shortages talk on February 24th at 12:00 p.m.

As we start slowly reopening the province again, we want to thank you once again for all you are doing to keep your patients and the community safe. If you need any assistance or have any questions, please do not hesitate to contact us.

 Yours in Good Health,

 The AFHTO Team

(in collaboration with the Primary Care Collaborative)