Primary Care Open Forum Summary Document (Jun 2)
COVID-19 Support for Primary Care
Discussion Forum – June 2, 2021
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. Join us bi-weekly. Get additional practice support and strengthen East Toronto, by becoming a member of the EasT-FPN.
Key Updates & Summary of June 2/2021 Discussion
MGH will provide those primary care offices who vaccinated first doses in collaboration with MGH with their second doses and they should follow the same schedule as per the provincial guidelines.
Patients who received AstraZeneca for their first dose are able to receive either AstraZeneca or a mRNA for their second dose. There is a supply of AstraZeneca for primary clinics coming in from Toronto Public Health.
We will be administering the second dose for our homebound patients on June 11, 17, and 18.
There are opportunities for primary care clinics in East Toronto to take part in the Moderna vaccine distribution. Please have one representative from your clinic complete the form.
We will be taking a short summer break and the next Primary Care Open Forum will take place on August 25, 2021.
Alpha variant (B117) is very sensitive to the vaccine and is screened on every positive test in Ontario. Variant that doesn’t screen positive- including delta that emerged from India- so that current R not =1 so at the precipice. It is more contagious, and a single dose only provides < 50% against it. Need double vaccination ASAP.
Q: For patients who get two doses of AstraZeneca, apparently the opportune time for the second dose of AstraZeneca is 12 weeks apart. For those who are going to mix vaccines and get the mRNA as a second dose, does this still apply? Should we encourage people to wait till 12 weeks for a second dose if they are getting mRNA?
A: According to the NACI article, it is advised to wait 4 weeks after the first dose. In a setting of community incidence where the individuals are not of high risk, it is suggested to wait.
Q: We are trying to catch our grade 7/8s up on their HPV/Meningitis/Hep B. Currently, NACI is still recommending to wait 28 days post COVID-19 vaccine and 14 days after any other vaccines before getting the COVID-19 vaccine. We are asking our patients to prioritize the COVID-19 vaccine first. Do you think NACI will go the way of the ACIP/ CDC recommendations at some point?
A: Hopefully they do. There are just an extensive amount of COVID-19 vaccines. We are currently still recommended to wait.
Q: I was under the impression pregnant women in their third trimester are at high risk for COVID-19. Do you know why they are not in the provincial list of high risk eligible for shortened duration between doses?
A: They should be on the list because they are at high risk. Hopefully, they will be added soon.
Q: How is, if at all, vaccination rate tied to contact tracing capacity? Do you know how vaccination rate is tied to contact tracing capacity in the phases?
A: The provincial plan is silent on contact tracing capacity interestingly. I think it is because capacity and quality of contact tracing is not universal across the province among Public Health Units.
Q: Based on what we are seeing in pop up clinics, we seem to have saturated the first dose but we are also constrained by this very strict criteria for second doses. We have a larger supply than we are allowed to give. Do you find that the second dose roll out is a bit slow from the province? We could be doing far more shots than we are able based on the limited criteria and not sure how to speed this up?
A: The second dose roll out has been faster than the first dose. There is still a challenge in distribution because it is controlled sequential distribution. There will be a certain time when there will no longer be first doses when we will focus on second doses and use up our supply.
Q: What is Toronto Public Health going to do if we tell patients they should get an mRNA after getting AstraZeneca as their first dose?
A: If primary care providers have the mRNA vaccine then once COVAX allows you to "mix", patients will have the power to do whichever dose they would like for their second dose.
Q: For our AstraZeneca patients awaiting mRNA for their second dose, should we counsel them to wait the 16 weeks or receive it the earliest available, pending logistics? I assume they will need to follow the same second dose roll out algorithm.
A: Things are changing rapidly, currently I would wait for the mRNA given that case counts are low. This will be based on the second dose schedule for the province.
Q: I am still a bit unsure if there is a benefit waiting for a certain number of weeks to get mRNA if they are eligible if their first dose was AstraZeneca?
A: I would wait for myself but that is just my own opinion. I think it would have to do with their risk level and the current rates in their community.
Q: Looking to a new normal, what are your thoughts on masking in public spaces after double vaccination?
A: There will be a formal public health statement that double vaccinated individuals do not need masks in closed spaces. This announcement will likely come when more individuals are fully vaccinated and COVID-19 rates are lower.
Q: Please comment on a possible third booster dose after the standard 2 shots.
A: I think we will require them in about a year-18 months. They will be modified from the original vaccines to help protect from future variants.
Q: Do you have any idea when they will stop the need to quarantine with travel if you are double vaccinated?
A: They will need to figure out how to document vaccination status in a transferable way such as on cell phones or a page on passports before making that change.
Q: Do we still need to clean everything after every patient, as the number of vaccinated individuals increases? I just worry about the impact on the environment, cost, etc.
A: It is still a good idea to clean after each patient. You can possibly stop having environmental services, but just wipe the surfaces and wash hands after each patient.
Q: If a Patient had vomiting and did not feel well a few days after PEG pre colonoscopy but not a true allergy, would you have them see an allergist before their vaccination or just go ahead with caution?
A: If they do have any IGE mediated symptoms such as hives, they can go ahead with their vaccination.
Q: We had a few patients that took a second AstraZeneca as per product monograph at 28 days after the first when we had extras at the end of the day. Should these patients be offered another third dose at some point? Similarly, people who chose to do the second AstraZeneca booster last week, would they be offered mRNA later in the summer or fall if the Delta variant causes a fourth wave?
A: There will likely be a fourth wave in the fall. They will likely be able to receive their vaccination once supply exceeds demands.
Q: Are there plans for COVaxON to allow adding patients who got vaccines in the United States or elsewhere in the world?
A: This will depend on how COVaxON plans to document both doses.