Hastings Prince Edward Public Health
Online Bulletin for Health Care Providers

February 9, 2022

From:
Dr. Ethan Toumishey
Acting Medical Officer of Health
Hastings Prince Edward Public Health

In this Issue:

  1. Dr. Ethan Toumishey appointed as Medical Officer of Health and Chief Executive Officer for HPEPH
  2. Ontario is gradually easing public health measures
  3. COVID-19 vaccine fourth dose eligibility
  4. NACI’s updated recommendation on the use of COVID-19 vaccines in children 5 to 11 years of age
  5. Updated guidance on COVID-19 vaccination for individuals experiencing myocarditis and/or pericarditis
  6. Gradual resumption of selected clinical activities as outlined in the revised Directive #2
  7. Access to outpatient therapies for COVID-19 (Sotrovimab and Paxlovid)
  8. New and updated COVID-19 resources

News & updates

Dr. Ethan Toumishey appointed as Medical Officer of Health and Chief Executive Officer for HPEPH

Dr. Toumishey has been in the role of Acting Medical Officer of Health at HPEPH since the fall of 2021. He holds a Bachelor of Science in Biomedical Sciences from the University of Ottawa, graduated with a Bachelor of Medicine from Dalhousie University, completed a Masters in Public Health at Queen’s University and met the requirements for fellowship with the Royal College of Physicians and Surgeons of Canada in June 2021. He has worked as an independent family physician and is also a guest lecturer at Queen’s University. Dr. Toumishey recognizes that local health care professionals are key partners in achieving public health objectives, and is looking forward continuing to work together to help local communities be as healthy as they can be.

COVID-19 vaccine news & updates

Ontario is gradually easing public health measures

On January 31, 2022 Ontario returned to a modified step 3 of the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020. Ontario plans follow a cautious and phased approach to lifting public health measures, with 21 days between each step. Some of the updated public health measures include:

  • Social gathering limits of 10 people indoors and 25 people outdoors
  • Organized public events limited to 25 people indoors
  • 50 percent capacity limits at most indoor public settings (e.g. restaurants, recreational facilities, etc.)

COVID-19 vaccine fourth dose eligibility

A fourth dose of an mRNA vaccine is recommended for residents of long-term care homes (LTCH), retirement homes (RH), Elder Care Lodges, older adults living in other congregate settings providing assisted-living and health services and individuals who are severely to moderately immunocomprised (18 years of age and older) who received their third dose at least three months (84 days) prior.

Although an HCP referral form for the fourth dose is preferred, presentation of a prescription / medication bottle for immunosuppressant medication listed in COVID-19 Vaccine Third Dose Recommendations is sufficient evidence to prove eligibility for a fourth dose; if the dose is not listed, confirmation of the dosage by the presenting client is sufficient. The same HCP referral form used for a 3rd dose will be accepted for a 4th dose so advise patients they may use the 3rd dose referral form twice. Individuals residing in a congregate living setting should bring proof of address.

An updated summary chart on eligibility for COVID-19 mRNA vaccine boosters is available on our website.

NACI’s updated recommendation on the use of COVID-19 vaccines in children 5 to 11 years of age

NACI has strengthened their recommendation on the use of COVID-19 vaccines in children 5 to 11 years of age in a statement released on January 25, 2022. NACI now recommends:

"A complete series with the Pfizer-BioNTech Comirnaty vaccine (10 mcg) should be offered to children 5 to 11 years of age who do not have contraindications to the vaccine, with a dosing interval of at least 8 weeks between the first and second doses."

"Canada is currently facing a fifth wave of the pandemic, largely driven by the highly transmissible Omicron variant. Children 5 to 11 years of age continue to remain at low risk of severe COVID-19 outcomes, including from the Omicron variant; however, the number of children experiencing severe disease or requiring hospitalization is increasing due to large number of children becoming infected with SARS-CoV-2 during this wave of the pandemic."

Updated guidance on COVID-19 vaccination for individuals experiencing myocarditis and/or pericarditis

NACI has issued updated guidance on vaccination with COVID-19 vaccines following myocarditis and/or pericarditis.

NACI continues to recommend that:

In most circumstances and as a precautionary measure, further doses of mRNA COVID-19 vaccines should be deferred for people who have experienced myocarditis (with or without pericarditis) within six weeks of receiving a previous dose of an mRNA COVID-19 vaccine. This includes any person who had an abnormal cardiac investigation including electrocardiogram (ECG), elevated troponins, echocardiogram or cardiac MRI after a dose of an mRNA vaccine.

NACI now recommends that:

  • Those with a history of symptoms compatible with pericarditis, and who either had no cardiac workup or had normal cardiac investigations, can receive the next dose once they are symptom-free and at least 90 days has passed since vaccination.
  • Some people with confirmed myocarditis (with or without pericarditis) after receiving a dose of an mRNA COVID-19 vaccine may choose to receive another dose of vaccine after discussing the risks/benefits with their healthcare provider.
  • If another dose of vaccine is offered, they should be offered the Pfizer-BioNTech 30 mcg vaccine due to the lower reported rate of myocarditis and/or pericarditis following the Pfizer-BioNTech 30 mcg vaccine compared to the Moderna 100 mcg vaccine.

Gradual resumption of selected clinical activities as outlined in the revised Directive #2

As per a memo from the CMOH issued February 1, 2022, the revised Directive #2 allows cautious and gradual resumption of services such as diagnostic imaging, cancer screening and scheduled ambulatory clinics. Resumption should take place as operationally feasible in public hospitals, with consideration of local contexts.

Further, pediatric speciality hospitals, private hospitals, and other independent health facilities will resume non-urgent and non- emergent surgeries and procedures to address and alleviate pressures from deferred care. Pediatric specialty hospitals will continue to work with their regional partners to accept patient transfers in alignment with Directive #2.1. Cautious and gradual resumption of activities in these targeted areas will help ensure we do not adversely impact inpatient capacity or health human resources in hospitals.

Access to outpatient therapies for COVID-19 (Sotrovimab and Paxlovid)

A guidance document and memo for primary care providers outlining how primary care providers can access outpatient therapies for people at higher risk of severe disease, specifically Sotrovimab (a monoclonal antibody) and Paxlovid (an oral antiviral) was distributed earlier this week by Ontario Health.

As supply of Sotrovimab and Paxlovid is currently limited, Ontario is distributing these therapeutics through a limited number of sites across the province and prioritizing individuals who are at higher risk of severe outcomes from COVID-19 infection. The sites distributing Sotrovimab and Paxlovid may differ by location.

The Ontario COVID-19 Science Advisory Table has released updated guidance that incorporates Paxlovid and Sotrovimab in their recommendations for therapeutic management of adult patients with COVID-19.
CADTH also released drug implementation advice for Nirmatrelvir and Ritonavir (Paxlovid).

New and updated COVID-19 resources

Vaccine information

COVID-19 guidance

Current information on COVID-19 specifically for health care providers can be found at hpePublicHealth.ca, Ontario Ministry of Health and at publichealthontario.ca.

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Contact Information: 

To give us your comments: hart.sara@hpeph.ca

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To report AEFI or DOPHS: Online / Fax: 613-966-1813 or CDCFAX1@hpeph.ca

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