Novel Coronavirus (COVID-19) Information for Health Professionals

Updated September 23, 2021

The City has opened nine COVID-19 immunization clinics. Learn more about how to get vaccinated.

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 Ontario Ministry of Health’s 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 Pfizer-BioNTech, Moderna, AstraZeneca, and Janssen (Johnson & Johnson) COVID-19 vaccines. At this time the Janssen product is not available in Ontario, and the administration of any additional first doses of the AstraZeneca/COVISHIELD COVID-19 vaccines has been paused.

Everyone living in Toronto who is able to get the vaccine should be vaccinated when it is their turn. Vaccines can provide protection from variant strains, and are still recommended to those who have had COVID-19 in the past.

Find more information on eligibility and booking COVID-19 vaccine appointments.

Vaccine Ordering

All Toronto primary care providers and general pediatricians are invited to administer COVID-19 vaccines in their offices. Eligibility criteria are listed on the Eligibility Criteria for Ordering Vaccine from Toronto Public Health website.

To order Pfizer-BioNTech and Moderna COVID-19 vaccines, complete the TPH COVID-19 Vaccine Program Enrollment Request Form   and the onboarding process. Please only complete this form once for each primary care or general pediatric practice. Once complete, access to the ordering portal will be provided.

Email questions about enrolling in the Toronto Primary Care COVID-19 Vaccine Program to COVIDVaccineOrder@toronto.ca.

COVID-19 Vaccine Billings

The Ontario Medical Association  (OMA) has outlined the details of billing for activities related to COVID-19 vaccination. Members should check the OMA portal  regularly for updates.

Physicians with questions pertaining to the submission of these billing codes should email the ministry’s Service Support Contact Centre at SSContactCentre.MOH@ontario.ca

Second Dose Intervals for COVID-19 Vaccines

Everyone born in 2009 and earlier is eligible to book second doses of COVID-19 vaccine per the product monograph intervals:

  • Pfizer-BioNTech: 21-28 days
  • Moderna: 28 days
  • AstraZeneca: 4-12 weeks (Evidence has shown that a 12 week interval provides the best immune response, however, people who received their first dose of AstraZeneca are eligible for their second dose after 8 weeks.)

Referrals for Administration of AstraZeneca COVID-19 Vaccine

AstraZeneca COVID-19 vaccine is available at a City-run immunization clinic for those that are unable to receive mRNA vaccines (Pfizer-BioNTech or Moderna) by referral only.

Those that are eligible to receive AstraZeneca COVID-19 vaccine include:

  • Individuals who have been assessed by an allergist/immunologist and are unable to receive an mRNA vaccine due to severe allergy to the mRNA vaccines or their components.
  • Individuals that have been assessed by a specialist for an adverse event following immunization (AEFI) after a first dose of mRNA vaccine and require access to the AstraZeneca vaccine for their first or second dose.
  • Individuals that received AstraZeneca as their first dose and would like to receive AstraZeneca as their second dose, after consulting with a physician regarding the NACI recommendation that mRNA vaccines are preferred for second doses and weighing the risks and benefits, may also be referred through this process. However, due to extremely limited supply, patients who do not meet either of the above criteria (those who do not have an allergy or have not experienced a qualifying AEFI), will be placed on a standby list and will be contacted subject to vaccine availability.

Refer eligible patients by completing TPH’s AstraZeneca COVID-19 Vaccine Referral Form and providing this form to the patient for presentation at the immunization clinic. Patients must bring this referral form in order to receive their immunization.

Third Dose Intervals for COVID-19 Vaccines

Third doses of COVID-19 mRNA vaccines (Pfizer-BioNTech or Moderna) are recommended in the following special populations:

Residents of long-term care homes, high-risk retirement homes and elder care lodges

  • A third dose can be given at a minimum of five months (20 weeks) after the second dose
  • The Government of Ontario has identified Toronto settings that meet the criteria for high-risk. At this time, only those that have been identified are eligible.
  • Toronto Public Health is actively working with Toronto facilities to plan this roll-out.

Severely immunocompromised individuals

A third dose can be given at a minimum of eight weeks after the second dose for:
  • People undergoing active treatment* for solid tumors and hematologic malignancies
  • Recipients of a solid-organ transplant and taking immunosuppressive therapy
  • Recipients of chimeric antigen receptor (CAR)-T-cell or hematopoietic stem cell transplant (within two years of transplantation or taking immunosuppression therapy)
  • People with moderate or severe primary immunodeficiency (e.g. DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • People who have Stage 3 or advanced untreated HIV infection and people with acquired immunodeficiency syndrome
  • People undergoing active treatment** with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the Immunization of Immunocompromised Persons -Canadian Immunization Guide for suggested definition of high dose steroids), alkylating agents, antimetabolites, tumour-necrosis factor (TNF) inhibitors, and other biologic agents that are significantly immunosuppressive.

*Active treatment includes people who have completed treatment within 3 months. Active treatment is defined as chemotherapy, targeted therapies, immunotherapy, and excludes people receiving therapy that does not suppress the immune system (e.g. solely hormonal therapy or radiation therapy).

**Active treatment for people receiving B-cell depleting therapy including people who have completed treatment within 12 months.

Patients on immunosuppressive treatment should discuss the optimal timing of all vaccine doses with their health care provider. If readily available, the same mRNA vaccine product should be provided for third doses.

Referral Process for Third Doses:

  • If you are providing COVID-19 vaccines at your site, you may provide third doses to individuals listed above as they become eligible and document the dose in COVaxON.
  • If you are not providing COVID-19 vaccines at your site, please complete TPH’s COVID-19 Vaccine Third Dose Patient Referral Form,   a specially developed referral form from an institution (e.g. hospital), or a letter which must include the following:
  • Identifying information:
    • Full Name (matching ID)
    • Ontario Health Card Number
    • Full Address (matching ID)
  • Confirmation that the patient is eligible to receive the third dose
    • 3rd dose vaccinations can be administered no earlier than 8 weeks (or 56 days) after second dose.
    • The Patient meets one or more of the criteria listed above (Any other patients with other health conditions/criteria will not be accepted for 3rd doses at this time.)
    • Patient-specific concerns
      • Treatment considerations and how that may affect vaccine administration

Note: Eligible individuals in need of third doses of COVID-19 vaccines must present a physician referral (TPH form, other institutional form, or physician letter with all of the above information) when they receive their vaccine.

Evaluating and Providing Medical Exemptions for COVID-19 Vaccinations

The Ministry of Health has published guidance to assist health care providers evaluate contraindications or precautions to COVID-19 vaccination that may warrant a medical exemption. Refer to Table 1 for details.

True medical exemptions are expected to be infrequent and should be supported by expert consultation. Referral and specialist consultation support for physicians and nurse practitioners is available through Ontario’s eConsult Service, OTN Hub, and the Special Immunization Clinic (SIC) Network. In many instances, safe administration of subsequent doses of COVID-19 vaccine is possible under the management of an allergist/immunologist.

Providers may be asked to provide a statement of medical exemption for their patients, and if they are eligible, providers may use the Ministry’s Sample Statement of Medical Exemption.

Contraindications

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).

Reporting Adverse Events Following Immunization (AEFI)

An AEFI is an unwanted or unexpected health effect that happens after someone receives a vaccine, which may or may not be caused by the vaccine. Of particular interest are unusual or unexpected events, or serious reactions requiring urgent care.

Toronto health care providers are required to report AEFIs to TPH. Complete the  AEFI Reporting Form and fax it to 416-696-3492 or email it to AEFI@toronto.ca.

Adverse Events and Safety Signals by Vaccine Product

Product(s)
Adverse Event or Safety Signal Description
Follow Up and Counseling
Moderna Delayed Local Reactions

  • Reactions that occur at the injection site a few days after vaccination
  • May look similar to cellulitis
  • Not characterized by systemic symptoms
  • Decreased frequency of delayed local reactions following the second dose of Moderna COVID-19 vaccine
  • Will resolve without the use of antibiotics
  • This reaction does not increase the risk of anaphylaxis with future vaccination. Individuals who have experienced this may still receive vaccines in the future
  • 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.
AstraZeneca / COVISHIELD Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT)

  • syndrome of thrombosis and thrombocytopenia that occurs 4-28 post-vaccination with AstraZeneca / COVISHIELD with a frequency of approximately 1 case in 55,000 doses of vaccine following the first dose and 1 case in 600,000 doses following the second dose
  • Symptoms:
    • 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
Pfizer-BioNTech and Moderna Myocarditis/Pericarditis

  • Reports of myocarditis and pericarditis following vaccination with COVID-19 mRNA vaccines have emerged, but no clear association has been established. Available information indicates that:
    • Cases were more commonly reported after the second dose
    • Symptom onset was typically within several days after vaccination
    • Cases were mainly adolescents and young adults
    • Case were more often males
    • Case experienced mild illness, responded well to conservative treatment and rest, and symptoms improved quickly
  • The Public Health Agency of Canada recommends  that health care providers:
    • Consider myocarditis and pericarditis in evaluation of acute chest pain or pressure, arrhythmias, shortness of breath or other clinically compatible symptoms after vaccination
    • Consider doing an ECG, troponins, and an echocardiogram, in consultation with a cardiologist
    • Rule out other potential causes in consultation with infectious disease and/or rheumatology, particularly in cases with PCR-confirmed acute COVID-19 infection, prior SARS-CoV-2 infection (e.g., detection of SARS-CoV-2 nucleocapsid antibodies), and other viral etiologies (e.g., enterovirus PCR and comprehensive respiratory viral pathogen testing)

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

The COVID-19 vaccine is the best way to protect your health care setting from the risks of COVID-19. Mangers and clinicians can help encourage vaccination among staff by creating a supportive environment that makes it easier for everyone to get vaccinated.

Develop a Vaccination Policy

  • Establish a vaccination policy for your workplace.
  • Communicate openly about the vaccination policy with staff and third party contractors.
  • Encourage staff to share their vaccination experiences with colleagues.
  • Recruit clinic vaccine champions to address barriers, clarify misinformation, and promote vaccination.
  • Health care settings with on-site COVID-19 vaccines should offer more than one opportunity for vaccination.
  • Support staff with paid sick days if they have vaccine side effects. For workers without paid sick days, refer to Ontario’s COVID-19 Workers Benefits
  • Recognize, support, and celebrate positive steps toward vaccination.
  • Provide general tips to improve the immunization experience.

Key Points

  • Share key messages using their preferred methods of communication.
  • Emphasize the benefits of protecting themselves, their families, peer and clients.
  • Vaccine hesitancy can be complex and may be impacted by historical injustices, racial inequities and misinformation.
  • Small workplace teams can leverage personal connections to help one another with the decision to get vaccinated.
  • Respect personal privacy when discussing vaccine choice in small team settings.
  • Depending on staff size, alternating vaccination dates for staff may be needed to ensure staff with vaccine side effects can stay home and rest while ensuring adequate workplace coverage.
  • Infection prevention and control measures (e.g. handwashing, masks, distancing) are still needed to prevent COVID-19 outbreaks in the workplace.

Please note: the information provided on this webpage does not contain legal advice and should not be relied on or treated as legal advice; those for whom these recommendations are intended may seek their own legal advice for their specific circumstance.

Resources:

COVID-19 Outbreaks

COVID-19 outbreaks in institutional facilities are reportable to their local public health unit. Long-term care homes are also required to report COVID-19 outbreaks to the Ministry of Long-Term Care (MOLTC).

To report a suspected or confirmed COVID-19 outbreak:

Business Hours (weekdays 9 a.m. to 5 p.m.):
  • Communicable Disease Liaison Unit (CDLU) facilities: call your CDLU liaison
  • Long-Term Care and Retirement Homes: complete the Initial Outbreak Notification e-Form  and once completed call your LRCT Liaison.
After hours (weekdays after 5 p.m, weekends and statutory holidays):

Outbreak Forms and Instructions

Testing

Signage

While we aim to provide fully accessible content, there is no text alternative available for some of the content on this site. If you require alternate formats or need assistance understanding our maps, drawings, or any other content, please contact us at LRCT@toronto.ca.

Ministry of Health Resources

Retirement Home Resources

Public Health Ontario Resources

 

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.