Primary Care Open Forum Summary Document (Feb 23)

COVID-19 Support for Primary Care
Discussion Forum – February 23, 2022

To support primary care during the COVID-19 pandemic, East Toronto Family Practice Network (EasT-FPN), in collaboration with Michael Garron Hospital’s Dr. Jeff Powis - Medical Director, IPAC, hosts a virtual Primary Care Q+A Open Forum to provide clinical & practice recommendations. Get additional practice support and strengthen East Toronto, by becoming a member of the EasT-FPN. 

Key Updates & Summary of February 23 Discussion 

  • Wednesday March 2, 6pm - 8pm: Virtual mix and mingle event for all East Toronto family doctors and specialists. Sign up here.

  • EasT-FPN is looking for primary care physicians interested in joining a new FHO at Taylor-Massey

    • Taylor-Massey is one of the five City of Toronto Neighborhood Improvement Areas served by ETHP, with a high need for increased primary and integrated care services

    • EasT-FPN is working with SETFHT and other community partners to help increase access to primary care in this neighborhood 

    • Physicians who are interested can contact us via contact@eastfpn.org

COVID-19 Updates

  • The number of hospitalizations in Ontario is currently on track with Ontario Science Table’s projections; we are currently at a low point in the number of hospitalizations

  • Expecting to see a rise again in the number of hospitalizations in Ontario in the next couple weeks hopefully peaking by march break before going down again

  • Hard to interpret data on community positivity as testing availability is not very high; therefore using staff positivity rates as surrogate for population rates

  • Staff and community positivity rates are both decreasing; this aligns with the watershed testing of fecal COVID-19 load in the sewer system, which is a good marker for population level COVID-19

  • New published study on Paxlovid indicates good results for unvaccinated patients treated in the first 5 days of illness 

  • We are building capacity at CACs to distribute therapeutics; looking to redesign CAC to have point of care PCR testing to reduce time to treatment; expecting low volume of treatment to start 

Q: What are your recommendations on returning staff to work in the office?
A: For triple vaccinated healthcare providers in the community with household exposure,  recommend to wait at least 5 days from last exposure, then do PCR. If PCR is negative, then able to return to work. For double vaccinated healthcare providers, you would get COVID with certainty with household exposure. 
People are still communicable on day 5; if staff is needed due to staffing crisis then need to assess risk. For the hospital, staff are able to return to work on day 7 if symptom free with negative RATs on day 6 and 7. 

Q: What are your recommendations on returning to the office for those who were asked to work virtually due to Omicron? 
A: Could bring people back to work in the office now. The risk of COVID is low. Continue to wear masks in the office and maintain good ventilation. 

Q: What precautions do you recommend for persons sharing an office or larger reception space?
A: Wear masks when interacting with people outside of the household, until we clearly see a decrease in the number of cases. 

Q: Is MGH considering any changes to its mandatory vaccination policy?
A: Taking into consideration the vulnerability of the patients we work with, there are no plans to reevaluate the mandatory vaccination policy. No plans to bring back previously terminated unvaccinated staff even if the government changes the mandatory vaccination policy. 

Q: Is MGH considering any changes to its visitor policy?
A: Not currently but may change in the future as the incidence rate continues to decrease, starting with increasing the number of visitors, then stopping RAT, and finally removing vaccination checks for visitors upon entry. 

Q: Are you making any changes to occupational health requirements related to travel?
A: We are aligned with the current travel restrictions set by the government.

Q: Is MGH planning to continue active screening?
A: Yes. Current recommendation from the provincial government is to continue with screening.

Q: What about screening patients?
A: Yes, we are continuing to screen patients, albeit more passively. Everyone admitted to MGH will get a COVID-19 test, and outpatients are asked to read and acknowledge the screening questions. 

Q: With all the COVID restrictions lifting in such a sudden fashion around the world, do you have concerns about more waves (variants) since so much of the world is not vaccinated?
A: COVID has shown to be able to mutate and become more communicable and/or more resistant to vaccines. Likely to mutate again, and the next waves will likely be able to infect those who had Omicron. Just a matter of when it will happen. 

Q: How optimistic can we be at this point and should we as primary care still have screeners/limits on capacity for the foreseeable future?
A: More optimistic due to getting better at dealing with COVID waves. Recommend primary care to continue being flexible in terms of adjusting capacity for in-person and virtual services as infection rate fluctuates, until we arrive at a stage where infections are milder/rates are more predictable.

Q: What are your thoughts on 3rd doses for teens 12-17?
A: Incidence rates are decreasing, therefore motivation to get 3rd dose now is low because it will be gone by the time the next variant emerges. Recommend to assess the teen’s risk of exposure and the incidence rate. 

Q: Thoughts on N95 vs surgical masks in our office?
A: Not sure how much benefit one can gain from N-95 over a well-fitted surgical mask in primary care settings. Can wear ear loop mask in a clinic setting when seeing patients and wear N-95 when rounding in hospital in higher risk areas. 

Q: How have flu rates been this winter?
A: Very low due to masks. 

East Toronto Family Practice Network