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.
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 |
| Contraindications: |
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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:
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.
The following groups are to receive their second COVID-19 vaccine at the interval outlined in the product monograph:
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.
| 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.
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.
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:
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
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:
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.
| Pfizer BioNTech | Moderna | AstraZeneca | Janssen |
|---|---|---|---|
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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:
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:
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.
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:
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
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.
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.
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.
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.:
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).
There are no specific treatments for coronaviruses. Most people with common human coronavirus illness will recover on their own.
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.
Complete the new AEFI Reporting Form and fax it to 416-696-3492 or email it to AEFI@toronto.ca.
