Updated May 19, 2021

Note: This situation is continuously evolving; please subscribe to the Communiqué e-newsletter to receive regular updates.

For all symptoms, including atypical symptoms, which should be considered particularly in children, older persons, and people living with a developmental disability, see the COVID-19 Reference Document for Symptoms.

See the Government of Ontario’s Current Case Definition for COVID-19.

Toronto Public Health continues to actively monitor the situation in collaboration with provincial and national health agencies and stakeholders that include local hospitals, airports and community agencies.

Up-to-date information regarding:

Health care settings are being requested to conduct passive and active screening of anyone entering the premises, as detailed by the Ontario Ministry of Health’s COVID-19 Patient Screening Guidance Document.

If this document does not contain information specific to your healthcare setting, please see other documents in the Ontario Ministry of Health’s Health Sector Resources.

For guidance about testing:

If your healthcare setting conducts COVID-19 tests onsite, please review the following guidance to ensure that samples are collected and handled properly:

To get tested for COVID-19 in the City of Toronto, please visit the Toronto COVID-19 Testing website.

To get tested for COVID-19 in another region, please visit the Ontario COVID-19 testing locations website.

The following may be used to obtain COVID-19 test results:

Health Canada has authorized the use of COVID-19 vaccines produced by Pfizer-BioNTech, Moderna, AstraZeneca, and Janssen (Johnson & Johnson). Vaccines can provide protection from variant strains.

NACI continues to preferentially recommend authorized mRNA COVID-19 vaccines due to the excellent protection they provide and the absence of any safety signals of concern. NACI notes that Canada has procured and is expecting enough mRNA vaccines to fully vaccinate the eligible Canadian population before fall 2021. Healthcare providers may help their patients determine which product is best for them based on a discussion of the risk-benefit analysis (see information regarding a risk-benefit analysis under “Vaccine-Induced Immune Thrombotic Thrombocytopenia Health Care Provider Risk-Benefit Analysis” below).

The COVID-19 vaccine is free for everyone in Ontario. For people without a health card, government-issued photo ID (including non-Canadian and expired documents), such as a driver’s license, passport, Status Card, etc., can be used. Those without documentation who are currently eligible may access the pre-registration or appointment booking systems for Hospital Immunization Clinics. They may also book at City-run immunization clinics using any of the phone or in-person booking options listed under What You Need to Know Before Booking Your Appointment

The Ontario Government has planned for the rollout of COVID-19 vaccines in three phases. Sub-prioritization of health care workers has been developed to assist with vaccine delivery to health care workers in parallel with vaccination of other priority populations: COVID-19: Guidance for Prioritizing Health Care Workers for COVID-19 Vaccination.  Healthcare workers are currently eligible for vaccination at hospital or Ontario Health Team clinics. Find more information about eligibility and booking COVID-19 vaccine appointments on our How to Get Vaccinated website.

Health Canada Approved COVID-19 vaccines:

Please see the table below for details about the currently approved vaccines.

Manufacturer Pfizer BioNTech Moderna AstraZeneca Janssen
Authorized for use in Canada December 9, 2020 December 23, 2020 February 26, 2021 March 5, 2021
Vaccine platform Messenger RNA (mRNA) mRNA Non-replicating viral vector Non-replicating viral vector
Indications for use 16 years and older 18 years and older 18 years and older 18 years and older
Efficacy after 1-dose 52-92% 80-92% 50-71% 66%
Efficacy after 2-doses 95% 94% 55-81% Not applicable (only 1 dose required)
Minimal schedule 19 days 21 days 28 days Not applicable (only 1 dose required)
Authorized interval 21 days 28 days 4-12 weeks Not applicable (only 1 dose required)
Extended schedule* 110 days (plus or minus 5 days) 110 days (plus or minus 5 days) 110 days (plus or minus 5 days) Not applicable (only 1 dose required)
Dosage 0.3mL 0.5mL 0.5mL 0.5mL
IM injection Yes Yes Yes Yes
Number of doses
2 2 2 1
Vaccine storage -80° to -60°C -25° to -15°C 2° to 8°C 2° to 8°C
Usage at room temp

2° to 25°C

 Use within 6 hours after dilution Use within 6 hours after vial is punctured Use within 6 hours, or within 48 hours at 2 to 8ºC after vial is punctured Use within 3 hrs at room temp or 6 hours at 2° to 8°C after vial is punctured
Diluent 0.9% sterile No dilution is required No dilution is required No dilution is required
Preservative No No No  No
Multi-dose vial 5 to 6 doses 10 doses 8 dose and 10 dose vial presentations 5 doses
  1. allergies to any COVID-19 vaccine ingredients including PEG
  2. severe reactions to their first dose of COVID-19 vaccine
  1. allergies to any COVID-19 vaccine ingredients including PEG or tromethamine
  2. severe reactions to their first dose of COVID-19 vaccine
  1. allergies to any COVID-19 vaccine ingredients including polysorbate
  2. severe reactions to their first dose of COVID-19 vaccine
  1. allergies to any COVID-19 vaccine ingredients including allergies to polysorbate or severe allergic reaction after a dose of any other ‘adenovirus-based vaccine’

Second Dose Interval Extensions

NACI has released a rapid response document  recommending that based on available clinical trial data, jurisdictions should maximize the number of individuals benefiting from the first dose of vaccine by extending the interval for the second dose of vaccine to 110 days (plus or minus 5 days).

NACI’s recommendation considered several factors, including:

  • The first two months of real world effectiveness are showing sustained high levels of protection following a single dose of all 2-dose vaccines.
  • Short term sustained protection is consistent with immunological principles and vaccine science where it is not expected to see rapid waning of a highly effective vaccine in adults over a relatively short period of time.

Given NACI’s recommendation and the limited vaccine supply, the Province has decided to extend the interval between doses in order to take advantage of the first dose’s high efficacy and use existing resources to achieve the goal to rapidly vaccinate as many people as possible in order to reduce community spread and achieve herd immunity.

Second Dose Interval Exceptions

The following groups are to receive their second COVID-19 vaccine at the interval outlined in the product monograph:

  • Malignant hematological disorders on immunocompromising therapy (chemotherapy, targeted therapies, immunotherapy)
  • Non-hematological malignant solid tumours on immunocompromising therapy (chemotherapy, targeted therapies, immunotherapy)
  • Transplant recipients (including solid organ transplants and hematopoietic stem cell transplants)

This patient group will require a letter from a hospital clinic/specialist to confirm that they are eligible to get a second dose appointment at the product monograph interval, identifying the reason for the exception. The letter should be presented by the patient at both the first and second appointment.

Second Dose Intervals for COVID-19 Vaccines:

Vaccine Second Dose Interval Second Dose Interval for Exceptions
AstraZeneca 16 weeks 12 weeks
Pfizer 16 weeks 26 days
Moderna 16 weeks 26 days

*Recommended dose intervals are 21-28 days for Pfizer, 28 days for Moderna, and 4-12 weeks for AstraZeneca, as per the product monographs. Based on the evidence, 12 weeks has been shown to provide the best immune response for AstraZeneca. Patients should discuss the timing of their first and second vaccine dose with their health care provider in order to time the vaccine with any immunosuppressive treatments.

Continued diligence in physical protection measures such as the use of masking (for source control), PPE, handwashing, and physical distancing, coupled with the first dose of vaccine will provide multiple means of protection against both infection and severe illness.


Common Side Effects:

  • Pain, redness & swelling at injection site
  • Fatigue, headache, muscle or joint pain
  • Fever, chills, nausea, vomiting
  • Enlarged lymph nodes (less common)
  • Axillary swelling/tenderness (seen with Moderna vaccine only)

Delayed Local Reactions:

Delayed local reactions are reactions that occur at the injection site a few days after vaccination. They may look similar to cellulitis, but will resolve without the use of antibiotics and are not characterized by systemic symptoms. They do not increase the risk of anaphylaxis with future vaccination. They have been reported to occur after immunization with the Moderna COVID-19 vaccine.

  • If an individual has experienced a delayed local reaction in the past, they may still receive vaccines in the future. There is a decreased frequency of delayed local reactions following the second dose of the Moderna COVID-19 vaccine.
  • When providing the Moderna COVID-19 vaccine, counsel patients about delayed local reactions and reassure all individuals that the reaction is benign and self-limited.
  • Delayed local reactions are an Adverse Event Following Immunization (AEFI). Report all AEFI’s to TPH.

Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT, formerly VIPIT)

VITTs is a newly described syndrome of thrombosis and thrombocytopenia that has been associated with AstraZeneca/COVISHIELD and Janssen COVID-19 vaccines, and occurs 4-28 days post-vaccination. It is a rare but serious event with an estimated frequency of approximately one case in 100,000 doses of vaccine. Typical symptoms include:

  • Persistent and severe headaches, focal neurological symptoms, seizures, blurred or double vision
  • Shortness of breath or chest pain
  • Abdominal pain
  • Limb swelling, redness, pallor, or coldness

Health care providers must be prepared to rapidly identify and treat VITT. The Ontario Science Table has developed interim clinical guidance for diagnosis and treatment of VITT, and Interim Guidance for Healthcare Professionals in the Outpatient Setting

Healthcare Provider Risk-Benefit Analysis

As with the provision of any medication, health care providers should thoroughly explain the risk of VITT to their patients, and help patients weigh the risks and benefits of viral vector (i.e., AstraZeneca, Janssen) vaccines and COVID-19 infection. The risk benefit analysis should include the following:

  • On-going exposures to situations where COVID-19 may be contracted (such as not being able to work from home),
  • Risk of severe illness if COVID-19 is contracted, and
  • Estimate of how long it may take to receive an mRNA vaccine. Currently, in Ontario’s Phase 2 prioritization, all Ontarians who are not in a priority group should be eligible for vaccination by July 2021. The predominant vaccine supply that will be available will be mRNA vaccines. If additional vaccine supply becomes available by the federal government, timelines may be moved up.
More information:

Reporting Adverse Events Following Immunization (AEFI)

Toronto health care providers are required to report AEFIs, including delayed local reactions and VITT, to TPH. An AEFI is any event or reaction that occurs after receiving a vaccine. Of particular interest are unusual or unexpected events, or serious reactions requiring urgent care.

Complete the new AEFI Reporting Form  and fax it to 416-696-3492 or email it to AEFI@toronto.ca.

Vaccine Ingredients

Pfizer BioNTech Moderna AstraZeneca Janssen
  • active ingredient:  mRNA
  • active ingredient: mRNA
  • active ingredient: adenovirus vector (ChAdOx1-S recombinant)
  • active ingredient: adenovirus vector (Ad26.COV2.S recombinant)
  • lipids, cholesterol
  • polyethylene glycol [PEG]
  • lipids, cholesterol
  • polyethylene glycol [PEG]
  • amino acid: L-Histidine, L-Histidine hydrochloride monohydrate
  • emulsifier: polysorbate 80
  • emulsifier: 2-hydroxypropyl-β-cyclodextrin, polysorbate-80
  • salts: potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dehydrate
  • sugars: sucrose
  • salts: acetic acid, sodium acetate,
  • sugars: sucrose
  • buffers: tromethamin, tromethamin hydrocholoride
  • salts: sodium chloride, disodium edetate dihydrate (EDTA), magnesium chloride hexahydrate
  • sugars: sucrose
  • alcohol: ethanol
  • buffers: citric acid monohydrate, hydrochloric acid, sodium hydroxide, trisodium citrate dehydrate
  • salts: sodium chloride
  • alcohol: ethanol

Who Should Be Vaccinated?

Everyone living in Toronto who is able to get the vaccine should be vaccinated when it is their turn, and everyone who wishes to be vaccinated will have access. All available vaccines are safe and effective. Building immunity across communities is the best way to stop the spread of COVID-19.

People with stable health conditions such as diabetes, high blood pressure, HIV, and hepatitis B or C may still receive COVID-19 vaccines. Some conditions require informed consent with the health care provider on the benefits and risks of vaccinating based on the underlying condition or medical therapy including if they are:

  •  are pregnant, could be pregnant or breastfeeding
  •  have an autoimmune disorder
  •  are immunocompromised due to illness or treatments

Vaccines are inactivated and still safe in those who have an autoimmune condition or are immunocompromised. Their efficacy has not been studied in these groups.

Vaccines are still recommended for those that may have had COVID-19 and recovered, however those with current COVID-19 symptoms should delay vaccination until symptoms resolve.


Do not administer vaccine to clients without an allergist consult if they have a history of:

  • severe allergic reaction to the first dose of the COVID-19 vaccine
  • severe allergies to any COVID-19 vaccine ingredients, including polyethylene glycol (PEG) (Pfizer-BioNTech and Moderna vaccines only)
  • severe allergies to tromethamine (component of Moderna vaccine only)
  • severe allergies to polysorbate (AstraZeneca vaccine only)
  • mild to moderate localized allergic reaction , within four hours after receiving a COVID-19 vaccine (seek allergist referral prior to re-immunization).

How to Get Vaccinated

TPH has opened 9 mass immunization clinics that are operating as vaccine supply permits.

Please see TPH’s COVID-19 How to Get Vaccinated website for details on who may book an appointment at different clinic sites, and updates on newly eligible groups.

Vaccine Ordering

Pfizer BioNTech, Moderna, and Janssen COVID-19 vaccines are not currently available for ordering by primary care providers. Please follow TPH updates and connect with your local OHT for more information on this topic as it becomes available.

Learnings from pilot programs are now being used to expand the availability of COVID-19 vaccines in primary care practices, according to eligibility criteria determined by the Province. We are currently in the process of expanding the AstraZeneca COVID-19 Vaccine Program in Primary Care. If your clinic site would like to provide the AstraZeneca COVID-19 vaccine, please contact healthprofessionals@toronto.ca for information about the onboarding process.

Once we have confirmed that your clinic is able to meet provincial readiness and planning requirements, and that your refrigerator has passed a cold chain inspection in the past year:

  • TPH will collect your clinic’s information and share it with the Ontario Ministry of Health and Home and Community Care Support Services (formerly the LHIN),
  • Home and Community Care Support Services (formerly the LHIN) will work with local Ontario Health Teams (OHTs) to allocate and distribute vaccines to your site. OHTs will then connect with sites for shipments.
  • OntarioMD will provide training, and support for the proper use of COVAX, and arrangements will be made for you to receive a COVaxON ID

Billing for the Provision of a COVID-19 Vaccine

All physicians who are scheduled by a hospital or public health unit to administer COVID-19 vaccines in Ministry designated COVID-19 Mass Vaccination Sites or primary care offices where a hospital or Public Health Unit is responsible for operations/vaccine delivery at the site, are eligible to be compensated under the H409/H410 billing codes.

In settings that are not designated by the Ministry (non-mass vaccination settings such as primary care offices), physicians may use billing codes G593/Q593.

For detailed instructions on how to use these billing codes, please see the ministry INFObulletin  on this topic. Physicians with questions pertaining to the submission of these billing codes should contact the ministry’s Service Support Contact Centre by email at SSContactCentre.MOH@ontario.ca

More information about COVID-19 vaccines can be found at:

The Ontario Ministry of Health has issued Orders, Directives, Memorandums, and Other Resources for long-term care homes (LTCH), hospitals, and retirement homes for COVID-19 operations.

Hospitals and Acute Care

Long-term Care Homes & Retirement Homes

Long-term care homes can access the Ontario Ministry of Health’s COVID-19 Long- Term Care Communications website for updates on directions specifically for LTCHs.

Retirement home operators can look to trusted sources, such as the Retirement Homes Regulation Authority’s COVID-19 Updates and Resources website for information specific to their operations.

Role of TPH in Long-Term Care & Retirement Homes During COVID-19

Public Health Ontario and the Ontario Ministry of Health have also published the following COVID-19 resources pertaining to both LTCHs and retirement homes:

Long-term care homes and retirement homes are required to screen anyone that may enter the facility, and may use the Ministry of Health’s COVID-19 Screening Tool for Long-Term Care Homes and Retirement Homes.

Long-term care homes and retirement homes can order COVID-19 swab tests from  the Ontario Ministry of Health using the following form:

COVID-19 Swab Test Order Form for Long-Term care and retirement homes

Specimen pick-up by TPH must be requested in advance by LTCHs and retirement homes with suspected or confirmed outbreaks using the TPH COVID-19 Specimen Pick-up e-Form. 

Tests can also be conducted at a City of Toronto Assessment Centre.

COVID-19 Outbreaks

It is mandatory for institutional facilities such as LTCHs, RHs, and hospitals  to report COVID-19 outbreaks to their local public health unit (i.e. Toronto Public Health). Long-term care homes  are also required to report COVID-19 outbreaks to the Ministry of Long-Term Care (MOLTC).

All COVID-19 cases in staff, residents and patients linked to a COVID-19 outbreak in Toronto-based LTCHs, RHs, and hospitals. are managed by TPH. The Ontario Ministry of Health has published Case and Contact Management Resources on the Guidance for the Health Sector website.

To report a suspected or confirmed COVID-19 outbreak weekdays 9 a.m. to 5 p.m.:

  • Hospitals and Communicable Disease Liaison Unit (CDLU) facilities: call your CDLU liaison
  • Long-Term Care and Retirement Homes: complete the Initial Outbreak Notification e-Form or on weekdays call your LRCT Liaison and on weekends/statutory holidays send an email to LRCT@toronto.ca.

After hours (seven days a week after 5 p.m.), hospitals, LTCHs and retirement homes are to call 3-1-1 or 416-392-CITY (2489).

Low-level positive results among staff or residents must also be reported and treated as infectious (unless otherwise directed by Toronto Public Health).

Outbreak Forms and Instructions


There are no specific treatments for coronaviruses. Most people with common human coronavirus illness will recover on their own.

Reporting Probable and Confirmed Cases

Probable and confirmed cases of COVID-19 must be immediately reported to Toronto Public Health by telephone at 416-392-7411 (after hours: 311), or by faxing TPH’s COVID-19 Reporting Form to 416-696-3477.

Note: Hospitals and Assessment Centres

  • Hospitals and COVID-19 assessment centres must continue to report laboratory-confirmed cases of COVID-19 to TPH by fax only: 416-696-3477.
  • Please ensure an appropriate specimen was collected for COVID-19 testing and the patient is advised to self-isolate until their results are available.

Reporting Adverse Events Following Immunization (AEFI)

Complete the new AEFI Reporting Form   and fax it to 416-696-3492 or email it to AEFI@toronto.ca.