Primary Care Open Forum Summary Document (Dec 22)
COVID-19 Support for Primary Care
Discussion Forum – December 22, 2021
To support primary care during the COVID-19 pandemic, the East Toronto Family Practice Network (EasT-FPN), in collaboration with Michael Garron Hospital’s Dr. Jeff Powis - Medical Director of Infection Prevention and Control (IPAC), hosts a virtual Primary Care Q+A Open Forum to provide clinical & practice recommendations. Join us monthly. Get additional practice support and strengthen East Toronto, by becoming a member of the EasT-FPN.
Summary of December 22/2021 Discussion
Q: In terms of mask guidance for clinicians, should they be switching to N95 masks in the office and community settings (e.g. grocery stores)?
A: In the hospital we are switching all clinicians in ambulatory settings with unknown COVID status patients to N95 masks. Out in community- need a tight fitting mask. Two masks can be worn to ensure it is tight and secure.
Q: Suggestions from OCFP on how to improve mask fits and N95s made in Canada?
A: Click here for suggestions.
Q: Are the sudden exponential rise in cases due to Delta (due to indoor gatherings) or all due to Omicron? Are the deaths due to Omicron, or still mostly Delta?
A: The rise in cases is 100% due to Omicron - delta has passed. However, all the deaths have been due to the delta variant.
Q: Peter Juni reported last week that available global data shows that so far there is no decoupling of the case count curve and the hospitalization curve with Omicron. What are we seeing at our local level? Is it too soon to tell?
A: Most individuals over 50 will likely be infected without the booster/vaccination. In addition, a high volume and general medical patients will be seen.
Q: What is the period of communicability prior to symptoms on-set/test date, since we will be doing more contact tracing. Is it 48 hours prior to symptom onset or 5 days prior to test date (if case is asymptomatic)
A: It will be 48 hours prior to symptom onset. Public health is no longer doing contact tracing other than larger outbreaks. MGH is trying to contact over 50 and under 12.
Q: With Omicron, what are return to work criteria for primary care providers in the situation of:
1. Household members with confirmed COVID (for the health care provider, is it 10 days self-
isolation or 20?)
2. Primary care provider with confirmed COVID
A: For both- self-isolation is 10 days and asymptomatic.
Q: If a provider cares for an asymptomatic client (who later tests positive) or symptomatic client who didn’t answer screening questions correctly (and later tests positive) using surgical masks and eye protection, is this considered a close contact? If so, is it low risk exposure?
A: No, it is not considered close contact.
Q: If an individual had COVID-19, will the rapid antigen always be positive for them?
A: No, the rapid antigen tests (RAT) are poorly sensitive tests and are not suggested to use to determine if one has COVID.
Q: Could you comment on the best use of the rapid tests now, and also perhaps as PCR testing capacity gets taxed in the coming weeks?
A: PCR tests will not be able to be given to everyone as the number of requests are going to continue to increase. An announcement may come shortly on changes to eligibility for PCR testing.
Q: Can rapid molecular tests(Abbott ID NOW) replace the RATs in screening (e.g. #test-to-stay) for asymptomatic people given the CACs are maxed out and RATs are hard to find?
A: Rapid molecular tests cannot replace PCR or RATs as Abbott is very inefficient.
Q: MGH’s Occupational Health Policy relies on molecular testing (ID NOW). If we do not have access to this type of test, can we substitute with a rapid antigen test?
A:In some circumstances we can substitute with a rapid antigen test, however rapid test access is very hard to get currently.
Q: Will rapid test kits be provided for family physicians associated with MGH?
A: Initially, some rapid test kits were provided to family physicians, however there is now a shortage of RATs.
Q: Is there any access to prioritized COVID-19 testing for community family physicians and their household contacts for symptoms/exposures?
A: The turnaround time will still be 48 hours. However, clinicians can use the oral nasal test kits we have.
Q: Some of our patients report trying to drop off the home PCR tests and getting turned away at MGH "if it is not for a child we don't take it" - what are the current guidelines at MGH for this?
A: May have been today, found people to drop off tests everyday for 10 days and have stopped accepting those now. If you have a pending/positive test, the lab will not run them.
Q: Could you please review the management of COVID in patients we may be following in the community, specifically use of Fluvoxamine/Budesonide/Dexamethasone?
A: The Ontario Science Table is a great source to review as it shows all the information about COVID-19 testing. Fluvoxamine/Budesonide/Dexamethasone is only used for people that would die without this medication - it is all outlined in the science table.
Q: Is there anything in the works for LTC/Retirement/other group settings to receive SOTROVIMAB (recommended for symptomatic with mild illness in these settings)?
A: Not currently, we are looking at a fourth booster dose may be given to some of these group settings.
Q: Are the “check in” times the same for Omicron for unvaccinated (days 4-10)?
A: The same protocol can be used - day 7 is usually when people typically get more sick.
Q: What do you recommend as guidelines for staff lunchrooms?
A: Create a safe space by taking turns eating and keeping distance or eating in your own office.
Q: Is Mask-Fit-Testing available at MGH?
A: Working with ETHP to do the mask fit testing. Schedule your front-line staff and physicians for N-95 Mask-Fit-Testing using this link for individuals and this link for practices (25-35 staff).
Q: If virtual care could be provided remotely, but the client prefers to be seen in person, should in-person options for care be provided?
A: The benefits and risks of patients coming in for visits (whether they are dependent on public transportation) need to be weighed. Waiting rooms would need to be adequately spaced out. Given this, if virtual care is possible, it is recommended to do so.
Q: How effective are second and third doses against Omicron?
A: There is 0%-15% efficacy after the second dose and 55%-70% after the booster (third dose).
Q: Counselling tips for the ages 18-30 if giving Moderna in the office?
A: They cannot get Pfizer at this point as there is a shortage. Risk of myocarditis is less with the Moderna shot than if they get COVID.